Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness

Introduction Adrenal incidentalomas are lesions that are incidentally identified while scanning for other conditions. While most are benign and hormonally non-functional, around 20% are malignant and/or hormonally active, requiring prompt intervention. Malignant lesions can be aggressive and life-threatening, while hormonally active tumours cause various endocrine disorders, with significant morbidity and mortality. Despite this, management of patients with adrenal incidentalomas is variable, with no robust evidence base. This project aimed to establish more effective and timely management of these patients. Methods We developed a web-based, electronic Adrenal Incidentaloma Management System (eAIMS), which incorporated the evidence-based and National Health Service–aligned 2016 European guidelines. The system captures key clinical, biochemical and radiological information necessary for adrenal incidentaloma patient management and generates a pre-populated outcome letter, saving clinical and administrative time while ensuring timely management plans with enhanced safety. Furthermore, we developed a prioritisation strategy, with members of the multidisciplinary team, which prioritised high-risk individuals for detailed discussion and management. Patient focus groups informed process-mapping and multidisciplinary team process re-design and patient information leaflet development. The project was partnered by University Hospital of South Manchester to maximise generalisability. Results Implementation of eAIMS, along with improvements in the prioritisation strategy, resulted in a 49% reduction in staff hands-on time, as well as a 78% reduction in the time from adrenal incidentaloma identification to multidisciplinary team decision. A health economic analysis identified a 28% reduction in costs. Conclusions The system’s in-built data validation and the automatic generation of the multidisciplinary team outcome letter improved patient safety through a reduction in transcription errors. We are currently developing the next stage of the programme to proactively identify all new adrenal incidentaloma cases

Build Your Own Training Data -- Synthetic Data for Object Detection in Aerial Images

Machine learning has become one of the most widely used techniques in artificial intelligence, especially for image processing. One of the biggest challenges in developing an accurate image processing model is to collect large amounts of data that are sufficiently close to the real-world scenario. Ideally, real-world data is therefore used for model training. Unfortunately, real-world data is often insufficiently available and expensive to generate. Therefore, models are trained using synthetic data. However, there is no standardized method of how training data is generated and which properties determine the data quality. In this paper, we present first steps towards the generation of large amounts of data for human detection based on aerial images. To create labeled aerial images, we are using Unreal Engine and AirSim. We report on first impressions of the generated labeled aerial images and identify future challenges-current simulation tools can be used to create realistic and diverse images including labeling, but native support would be beneficial to ease their usage

DNA metabarcoding as a marine conservation and management tool: A circumpolar examination of fishery discards in the diet of threatened albatrosses

Almost all of the world's fisheries overlap spatially and temporally with foraging seabirds, with impacts that range from food supplementation (through scavenging behind vessels), to resource competition and incidental mortality. The nature and extent of interactions between seabirds and fisheries vary, as does the level and efficacy of management and mitigation. Seabird dietary studies provide information on prey diversity and often identify species that are also caught in fisheries, providing evidence of linkages which can be used to improve ecosystem based management of fisheries. However, species identification of fish can be difficult with conventional dietary techniques. The black-browed albatross (Thalassarche melanophris) has a circumpolar distribution and has suffered major population declines due primarily to incidental mortality in fisheries. We use DNA metabarcoding of black-browed albatross scats to investigate their fish prey during the breeding season at six sites across their range, over two seasons. We identify the spatial and temporal diversity of fish in their diets and overlaps with fisheries operating in adjacent waters. Across all sites, 51 fish species from 33 families were identified, with 23 species contributing >10% of the proportion of samples or sequences at any site. There was extensive geographic variation but little inter-annual variability in fish species consumed. Several fish species that are not easily accessible to albatross, but are commercially harvested or by-caught, were detected in the albatross diet during the breeding season. This was particularly evident at the Falkland Islands and Iles Kerguelen where higher fishery catch amounts (or discard amounts where known) corresponded to higher occurrence of these species in diet samples. This study indicates ongoing interactions with fisheries through consumption of fishery discards, increasing the risk of seabird mortality. Breeding success was higher at sites where fisheries discards were detected in the diet, highlighting the need to minimize discarding to reduce impacts on the ecosystem. DNA metabarcoding provides a valuable non-invasive tool for assessing the fish prey of seabirds across broad geographic ranges. This provides an avenue for fishery resource managers to assess compliance of fisheries with discard policies and the level of interaction with scavenging seabirds

Anti-Nirvana: crime, culture and instrumentalism in the age of insecurity

‘Anti-Nirvana’ explores the relationship between consumer culture, media and criminal motivations. It has appeared consistently on the list of the top-ten most-read articles in this award-winning international journal, and it mounts a serious neo-Freudian challenge to the predominant naturalistic notion of ‘resistance’ at the heart of liberal criminology and media studies. It is also cited in the Oxford Handbook of Criminology and other criminology texts as a persuasive argument in support of the theory that criminality amongst young people is strongly linked to the acquisitive values of consumerism and the images of possessive individualism that dominate mass media

Living for the weekend: youth identities in northeast England

Consumption and consumerism are now accepted as key contexts for the construction of youth identities in de-industrialized Britain. This article uses empirical evidence from interviews with young people to suggest that claims of `new community' are overstated, traditional forms of friendship are receding, and increasingly atomized and instrumental youth identities are now being culturally constituted and reproduced by the pressures and anxieties created by enforced adaptation to consumer capitalism. Analysis of the data opens up the possibility of a critical rather than a celebratory exploration of the wider theoretical implications of this process

Author Correction: A consensus-based transparency checklist.

An amendment to this paper has been published and can be accessed via a link at the top of the paper

A purine metabolic checkpoint that prevents autoimmunity and autoinflammation.

Still's disease, the paradigm of autoinflammation-cum-autoimmunity, predisposes for a cytokine storm with excessive T lymphocyte activation upon viral infection. Loss of function of the purine nucleoside enzyme FAMIN is the sole known cause for monogenic Still's disease. Here we discovered that a FAMIN-enabled purine metabolon in dendritic cells (DCs) restrains CD4+ and CD8+ T cell priming. DCs with absent FAMIN activity prime for enhanced antigen-specific cytotoxicity, IFNγ secretion, and T cell expansion, resulting in excessive influenza A virus-specific responses. Enhanced priming is already manifest with hypomorphic FAMIN-I254V, for which ∼6% of mankind is homozygous. FAMIN controls membrane trafficking and restrains antigen presentation in an NADH/NAD+-dependent manner by balancing flux through adenine-guanine nucleotide interconversion cycles. FAMIN additionally converts hypoxanthine into inosine, which DCs release to dampen T cell activation. Compromised FAMIN consequently enhances immunosurveillance of syngeneic tumors. FAMIN is a biochemical checkpoint that protects against excessive antiviral T cell responses, autoimmunity, and autoinflammation

Functional comparison of blood-stage Plasmodium falciparum malaria vaccine candidate antigens

The malaria genome encodes over 5,000 proteins and many of these have also been proposed to be potential vaccine candidates, although few of these have been tested clinically. RH5 is one of the leading blood-stage Plasmodium falciparum malaria vaccine antigens and Phase I/II clinical trials of vaccines containing this antigen are currently underway. Its likely mechanism of action is to elicit antibodies that can neutralize merozoites by blocking their invasion of red blood cells (RBC). However, many other antigens could also elicit neutralizing antibodies against the merozoite, and most of these have never been compared directly to RH5. The objective of this study was to compare a range of blood-stage antigens to RH5, to identify any antigens that outperform or synergize with anti-RH5 antibodies. We selected 55 gene products, covering 15 candidate antigens that have been described in the literature and 40 genes selected on the basis of bioinformatics functional prediction. We were able to make 20 protein-in-adjuvant vaccines from the original selection. Of these, S-antigen and CyRPA robustly elicited antibodies with neutralizing properties. Anti-CyRPA IgG generally showed additive GIA with anti-RH5 IgG, although high levels of anti-CyRPA-specific rabbit polyclonal IgG were required to achieve 50% GIA. Our data suggest that further vaccine antigen screening efforts are required to identify a second merozoite target with similar antibody-susceptibility to RH5