Combined Modality Therapies for High-Risk Prostate Cancer: Narrative Review of Current Understanding and New Directions.

Despite the many prospective randomized trials that have been available in the past decade regarding the optimization of radiation, hormonal, and surgical therapies for high-risk prostate cancer (PCa), many questions remain. There is currently a lack of level I evidence regarding the relative efficacy of radical prostatectomy (RP) followed by adjuvant radiation compared to radiation therapy (RT) combined with androgen deprivation therapy (ADT) for high-risk PCa. Current retrospective series have also described an improvement in biochemical outcomes and PCa-specific mortality through the use of augmented radiation strategies incorporating brachytherapy. The relative efficacy of modern augmented RT compared to RP is still incompletely understood. We present a narrative review regarding recent advances in understanding regarding comparisons of overall and PCa-specific mortality measures among patients with high-risk PCa treated with either an RP/adjuvant RT or an RT/ADT approach. We give special consideration to recent trends toward the assembly of multi-institutional series targeted at providing high-quality data to minimize the effects of residual confounding. We also provide a narrative review of recent studies examining brachytherapy boost and systemic therapies, as well as an overview of currently planned and ongoing studies that will further elucidate strategies for treatment optimization over the next decade

The Expansion Center and Dynamical Age of the Galactic Supernova Remnant Cassiopeia A

We present proper motions for 21 bright main shell and 17 faint, higher-velocity, outer ejecta knots in the Cas A supernova remnant and use them to derive new estimates for the remnant's expansion center and age. Our study included 1951 - 1976 Palomar 5 m prime focus plates, 1988 - 1999 CCD images from the KPNO 4 m and MDM 2.4 m telescopes, and 1999 HST WFPC2 images. Measurable positions covered a 23 to 41 yr time span for most knots, with a few outer knots followed for almost 48 yr. We derive an expansion center of alpha = 23h 23m 27s.77 +- 0s.05, delta = 58d 48' 49".4 +- 0".4 (ICRS), with little difference between centers derived using outer or main shell knots. This position is 3.0 arcsec due north of that estimated by van den Bergh and Kamper (1983). It also lies 6.6 +- 1.5 arcsec almost due north (PA = 354 deg) of the remnant's recently-detected central X-ray point source, implying a transverse velocity for the X-ray point source of about 330 km/s at a distance of 3.4 kpc. Using the knots which lie out ahead of the remnant's forward blast wave, we estimate a knot convergent date of A.D. 1671.3 +- 0.9, assuming no deceleration. However, a deceleration of just approximately 1.6 km/(s yr) over a 300 yr time span would produce an explosion date A.D. 1680, consistent with the suspected sighting of the Cas A supernova by J. Flamsteed.Comment: Astron. Journal in press, sched. July 2001. AASTex5, 17 pages, 2 jpeg greyscale figures, 3 postscript figure

Public Sector Employees: Risk Averse and Altruistic?

We assess whether public sector employees have a stronger inclination to serve others and are more risk averse than employees in the private sector. A unique feature of our study is that we use revealed rather than stated preferences data. Respondents of a large-scale survey were offered a substantial reward and could choose between a widely redeemable gift certificate, a lottery ticket, or making a donation to a charity. Our analysis shows that public sector employees are significantly less likely to choose the risky option (lottery) and, at the start of their career, significantly more likely to choose the pro-social option (charity). However, when tenure increases, this difference in pro-social inclinations disappears and, later on, even reverses. Our results further suggest that quite a few public sector employees do not contribute to charity because they feel that they already contribute enough to society at work for too little pay.public service motivation, risk aversion, revealed preferences data

SpaceOAR to improve dosimetric outcomes for monotherapy high-dose-rate prostate implantation in a patient with ulcerative colitis.

High-dose-rate (HDR) brachytherapy is an attractive option for patients receiving definitive radiation therapy for prostate cancer with decreased overall dose to the pelvis. However, ulcerative colitis increases rectal toxicity risk and may be a contraindication. A synthetic hydrogel, SpaceOAR (Augmentix Inc., Waltham, MA, USA), can facilitate the use of HDR brachytherapy for patients where rectal toxicity is a limiting factor. SpaceOAR gel (13.19 cc) was utilized in a monotherapy HDR prostate treatment with Ir-192 under transrectal ultrasound guidance, with the intention of decreasing rectal dose. SpaceOAR gel was inserted transperineally into the patient 18 days prior to the procedure. The HDR brachytherapy procedure was tolerated without incident. All planning constraints were met, and the following dosimetry was achieved: Prostate – V100% = 97.3%, V150% = 35%, V200% = 14.5%; Urethra – V118% = 0%; Rectum – D2 cc = 51.6%, V75% = 0 cc. The rectum-catheter spacing was on average between 6-8 mm. Average spacing for our 10 most recent patients without SpaceOAR was 3 mm. SpaceOAR did not hinder or distort ultrasound imaging or increase treatment time. SpaceOAR successfully increases catheter-rectal wall spacing and decreases rectal dose due to improved planning capabilities, while decreasing the likelihood of rectal perforation. One application of this tool is presented to mitigate potential toxicities associated with ulcerative colitis. At five months, one week, and one day follow-up, the patient reported no bowel issues following HDR brachytherapy. © 2018 Termedia Publishing House Ltd. All Rights Reserved

Circular Building Showcase:An Opportunity Map and Blueprint

This research provides a proposal for a real-life experimental house. The proposal is based on both a theoretical state of art of the circular economy (CE) in the built environment through a literature study, as well as a practical state of art through an opportunity map. The opportunity map may also be used as a stand-alone database and includes a variety of examples from practice in the following categories (1) realized buildings, (2) materials, (3) R&amp;D projects (both completed and ongoing), and (4) realized pilots. The observations of the opportunity map and literature study ultimately lead to the proposal for a real-life experimental house and provide certain guidelines and areas of interest. The proposed circular experimental house would address the main barriers hindering the adoption of the CE in the built environment that are identified in this report: (1) lack of awareness, (2) lack of education, (3) lack of knowledge, (4) lack of procedures, and (5) lack of market. It would do so in an interactive way with active involvement of the built environment supply chain.</div