Re: A review of continuous vs intermittent androgen deprivation therapy: Redefining the gold standard in the treatment of advanced prostate cancer. Myths, facts and new data on a ?perpetual dispute?

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Analysis of the tilted flat punch in couple-stress elasticity

In the present paper we explore the response of a half-plane indented by a tilted flat punch with sharp corners in the context of couple-stress elasticity theory. Contact conditions arise in a number of modern engineering applications ranging from structural and geotechnical engineering to micro and nanotechnology. As the contact scales reduce progressively the effects of the microstructure upon the macroscopic material response cannot be ignored. The generalized continuum theory of couple-stress elasticity introduces characteristic material lengths in order to describe the pertinent scale effects that emerge from the underlying material microstructure. The problem under investigation is interesting for three reasons: Firstly, the indentor's geometry is simple so that benchmark results may be extracted. Secondly, important deterioration of the macroscopic results may emerge in the case that a tilting moment is applied on the indentor inadvertently or in the case that the flat punch itself is not self-aligning so that asymmetrical contact pressure distributions arise on the contact faces. Thirdly, the voluntary application of a tilting moment on the flat punch during an experiment gives rise to potential capabilities of the flat punch for the determination of the material microstructural characteristic lengths. The solution methodology is based on singular integral equations which have resulted from a treatment of the mixed boundary value problem via integral transforms and generalized functions. The results show significant departure from the predictions of classical elasticity revealing that valuable information may be deducted from the indentation of a tilted punch of a microstructured solid

Late-Onset Anterior Dislocation of a Posterior Chamber Intraocular Lens in a Patient with Pseudoexfoliation Syndrome

Here, we report on a patient with pseudoexfoliation syndrome who developed acute angle-closure glaucoma with a marked myopic shift due to anterior dislocation of the posterior chamber intraocular lens almost 16 months after an uneventful phacoemulsification. Examination with a Scheimpflug camera was extremely useful in confirming the diagnosis. This is the fist case of late-onset angle-closure glaucoma with a significant myopic shift due to anterior dislocation of the posterior chamber intraocular lens, which resulted in a permanent alteration of the postoperative target refraction

Re: A review of continuous vs intermittent androgen deprivation therapy: Redefining the gold standard in the treatment of advanced prostate cancer. Myths, facts and new data on a ?perpetual dispute?

Objectives: To review the literature and present new data of continuous androgen deprivation therapy (ADT) vs intermittent androgen deprivation (IAD) as therapies for prostate cancer in terms of survival and quality of life and clarify practical issues in the use of IAD. Materials and Methods: We conducted a systematic search on Medline and Embase databases using “prostatic neoplasm” and “intermittent androgen deprivation” as search terms. We reviewed meta-analyses, randomised controlled trials, reviews, clinical trials and practise guidelines written in English from 2000 and onwards until 01/04/2013. Ten randomized controlled trials were identified. Seven of them published extensive data and results randomizing 4675 patients to IAD versus CAD. Data from the other three randomized trials were limited. Results: Over the last years studies confirmed that IAD is an effective alternative approach to hormonal deprivation providing simultaneously several potential benefits in terms of quality of life and cost effectiveness. Thus, in patients with non metastatic, advanced prostate cancer IAD could be used as standard treatment, while in metastatic prostate cancer IAD role still remains ambiguous. Conclusions: Nowadays, revaluation of the gold standard of ADT in advanced prostate cancer appears essential. Recent data established that IAD should no longer be considered as investigational, since its effectiveness has been proven, especially in patients suffering from non-metastatic advanced prostate cancer

Multifaceted Simulations Reproducing Experimental Results from the 1.5-MW 140-GHz Preprototype Gyrotron for W7-X

A multifaceted simulation procedure, addressing the electron beam properties, the beam-wave interaction, and the internal losses, has been used for the simulation of the experimental operation of a 1.5-MW 140-GHz short-pulse preprototype gyrotron. The preprototype is related to the development of 1.5-MW gyrotrons for the upgrade of the electron cyclotron resonance heating system at the stellarator W7-X. A very good reproduction of experimental results has been achieved by simulation, without resorting to arbitrary speculations. This validated the numerical tools as well as the design and fabrication of the short-pulse preprototype, which fully reached the target of efficient 1.5-MW operation in millisecond pulses. Special attention has been given to simulating the possibility of parasitic after-cavity interaction in the gyrotron launcher. Also, parasitic backward-wave excitation in the gyrotron cavity has been demonstrated by simulation, at a frequency and voltage range in agreement with experimentally observed parasitic oscillations. This offers an additional possibility with respect to the origin of deleterious parasitic oscillations in high-power gyrotrons, which are usually attributed mainly to the gyrotron beam tunnel

Design of MW-Class Coaxial Gyrotron Cavities With Mode-Converting Corrugation Operating at the Second Cyclotron Harmonic

This article presents investigations on the design of coaxial gyrotron cavities with mode-converting corrugations, operating at the second harmonic of the electron cyclotron frequency with output power of the order of megawatts. The suppression of the competing modes interacting at the fundamental cyclotron frequency is achieved by the combination of a corrugated coaxial insert and mode-converting corrugation on the outer wall. The outer corrugation couples the key competing modes to lower order modes with reduced quality factor. The design steps, which form a generally applicable design procedure, are described in detail. As an illustrative example, the proposed procedure is used for the design of a cavity for a fusion-relevant, second-harmonic MW-class gyrotron, operating at 170 GHz with the TE 37,1837,18 mode. From the simulations, it is found that for the proposed design, this mode is excited with an output power of around/ ∼ 1.5 MW. Two additional paths for cavity optimization toward even higher output power are also presented

Generation of 1.5MW-140GHz pulses with the modular pre-prototype gyrotron for W7-X

In anticipation of an Electron Cyclotron Resonance Heating system upgrade for the stellarator Wendelstein 7-X, a 1.5 MW – 140 GHz continuous-wave gyrotron is under development. In order to provide a first experimental verification of the scientific RF and electron beam optics design of the gyrotron with ms pulses, the Karlsruhe Intitule of Technology has developed a short-pulse pre-prototype gyrotron. In this work, we present details regarding the construction of the pre-prototype as well as measurements from the first experimental campaign delivering up to 1.6 MW in short pulses

Cost-effectiveness of emergency preparedness measures in response to infectious respiratory disease outbreaks: a systematic review and econometric analysis

Objectives Respiratory infectious disease outbreaks pose a threat for loss of life, economic instability and social disruption. We conducted a systematic review of published econometric analyses to assess the direct and indirect costs of infectious respiratory disease outbreaks that occurred between 2003 and 2019.Setting Respiratory infectious disease outbreaks or public health preparedness measures or interventions responding to respiratory outbreaks in OECD countries (excluding South Korea and Japan) so as to assess studies relevant to the European context. The cost-effectiveness of interventions was assessed through a dominance ranking matrix approach. All cost data were adjusted to the 2017 Euro, with interventions compared with the null. We included data from 17 econometric studies.Primary and secondary outcome measures Direct and indirect costs for disease and preparedness and/or response or cost-benefit and cost-utility were measured.Results Overall, the economic burden of infectious respiratory disease outbreaks was found to be significant to healthcare systems and society. Indirect costs were greater than direct costs mainly due to losses of productivity. With regard to non-pharmaceutical strategies, prehospitalisation screening and the use of protective masks were identified as both an effective strategy and cost-saving. Community contact reduction was effective but had ambiguous results for cost saving. School closure was an effective measure, but not cost-saving in the long term. Targeted antiviral prophylaxis was the most cost-saving and effective pharmaceutical intervention.Conclusions Our cost analysis results provide evidence to policymakers on the cost-effectiveness of pharmaceutical and non-pharmaceutical intervention strategies which may be applied to mitigate or respond to infectious respiratory disease outbreaks