Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project

Purpose: To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). Methods: A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. Results: Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. Conclusion: Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice

Inverse spin-Hall effect voltage generation by nonlinear spin-wave excitation

We investigate spin currents in microstructured permalloy/platinum bilayers that are excited via magnetic high-frequency fields. Due to this excitation spin pumping occurs at the permalloy/platinum interface and a spin current is injected into the platinum layer. The spin current is detected as a voltage via the inverse spin-Hall effect. We find two regimes reflected by a nonlinear, abrupt voltage surge, which is reproducibly observed at distinct excitation field strengths. Micromagnetic simulations suggest that the surge is caused by excitation of a spin-wave-like mode. The comparatively large voltages reveal a highly efficient spin-current generation method in a mesoscopic spintronic device

Electron Transport in Ferromagnetic Nanostructures

The proposal of logic- and memory devices based on magnetic domain-wall motion in nanostructures created a great demand on the understanding of the dynamics of domain walls. We describe the controlled creation and annihilation of domain walls by Oersted-field pulses as well as their internal dynamics during motion. Electric measurements of the magnetoresistance are utilized to identify permanent- or temporal creation and continuous motion of domain walls initiated by nanosecond short field pulses in external magnetic fields. The injection of domain walls into nanowires with control of their magnetic pattern (transverse or vortex), their type (head-to-head or tail-to-tail magnetization orientation) and their sense of magnetization rotation (clockwise or counter clockwise chirality) is reliably achieved. Influencing the creation process of consecutively created domain walls to obtain multiple walls inside one wire or to mutually annihilate the walls is found to be possible by changes of magnetic field parameters. The time structure of the creation process is analysed by time-resolved transmission X-ray microscopy. After complete formation wall transformations are observed above a critical driving field known as the Walker breakdown. Internal excitations of vortex domain walls are also found in low field motion. A strong interplay between internal dynamics and the macroscopic motion is identified

Focal therapy for small renal masses. Observation, ablation or surgery

The rising incidence of renal cell carcinoma, its more frequent early detection (stage T1a) and the increasing prevalence of chronic renal failure with higher morbidity and shorter life expectancy underscore the need for multimodal focal nephron-sparing therapy. During the past decade, the gold standard shifted from radical to partial nephrectomy. Depending on the surgeon's experience, the patient's constitution and the tumor's location, the intervention can be performed laparoscopically with the corresponding advantages of lower invasiveness. A treatment alternative can be advantageous for selected patients with high morbidity and/or an increased risk of complications associated with anesthesia or surgery. Corresponding risk stratification necessitates previous confirmation of the small renal mass (cT1a) by histological examination of biopsy samples. Active surveillance represents a controlled delay in the initiation of treatment. Percutaneous radiofrequency ablation (RFA) and laparoscopic cryoablation are currently the most common treatment alternatives, although there are limitations particularly for renal tumors located centrally near the hilum. More recent ablation procedures such as high intensity focused ultrasound (HIFU), irreversible electroporation, microwave ablation, percutaneous stereotactic ablative radiotherapy and high-dose brachytherapy have high potential in some cases but are currently regarded as experimental for the treatment of renal cell carcinoma

Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project

Purpose: To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). Methods: A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. Results: Consensus was attained on 23 of 27 topics; TargetedFT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. Conclusion: Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice. © 2016, The Author(s)

Experts and Decision Making: First Steps towards a Unifying Theory of Decision Making in Novices, Intermediates and Experts

Expertise research shows quite ambiguous results on the abilities of experts in judgment and decision making (JDM) classic models cannot account for. This problem becomes even more accentuated if different levels of expertise are considered. We argue that parallel constraint satisfaction models (PCS) might be a useful base to understand the processes underlying expert JDM and the hitherto existing, differentiated results from expertise research. It is outlined how expertise might influence model parameters and mental representations according to PCS. It is discussed how this differential impact of expertise on model parameters relates to empirical results showing quite different courses in the development of expertise; allowing, for example, to predict under which conditions intermediates might outperform experts. Methodological requirements for testing the proposed unifying theory under complex real-world conditions are discussed