Endorectal Digital Prostate Tomosynthesis

Several areas of prostate cancer (PCa) management, such as imaging permanent brachytherapy implants or small, aggressive lesions, benefit from high image resolution. Current PCa imaging methods can have inadequate resolution for imaging these areas. Endorectal digital prostate tomosynthesis (endoDPT), an imaging method that combines an external x-ray source and an endorectal x-ray sensor, can produce three-dimensional images of the prostate region that have high image resolution compared to typical methods. This high resolution may improve PCa management and increase positive outcomes in affected men. This dissertation presents the initial development of endoDPT, including system design, image quality assessment, and examples of possible applications to prostate imaging. Experiments using computational phantoms, physical phantoms, and canine prostate specimens were conducted. Initial system design was performed computationally and three methods of endoDPT image reconstruction were developed: shift and add (SAA), backprojection (BP), and filtered BP (FBP). A physical system was developed using an XDR intraoral x-ray sensor and a GE radiography unit. The resolution and radiation dose of endoDPT were measured and compared to a GE CT scanner. Canine prostate specimens that approximated clinical cases of PCa management were imaged and compared using endoDPT, the above CT scanner, and a GE MRI scanner. This study found that the resolution of endoDPT was significantly higher than CT. The radiation dose of endoDPT was significantly lower than CT in the regions of the phantom that were not in the endoDPT field of view (FoV). Inside the endoDPT FoV, the radiation dose ranged from significantly less than to significantly greater than CT. The endoDPT images of the canine prostate specimens demonstrated qualitative improvements in resolution compared to CT and MRI, but endoDPT had difficulty in visualizing larger structures, such as the prostate border. Overall, this study has demonstrated endoDPT has high image resolution compared to typical methods of PCa imaging. Future work will be focused on development of a prototype system that improves scanning efficiency that can be used to optimize endoDPT and perform pre-clinical studies

Three (Potential) Pillars of Transnational Economic Justice: The Bretton Woods Institutions as Guarantors of Global Equal Treatment and Market Completion

This essay aims to bring two important lines of inquiry and criticism together. It first lays out an institutionally enriched account of what a just world economic order will look like. That account prescribes, via the requisites to that mechanism which most directly instantiate the account, three realms of equal treatment and market completion - the global products, services, and labor markets; the global investment/financial markets; and the global preparticipation opportunity allocation. The essay then suggests how, with minimal if any departure from familiar canons of traditional international legal mandate interpretation, each of the Bretton Woods institutions - particularly the GATT/WTO and the IMF - can be viewed at least in part as charged with the task of fostering equal treatment and ultimate market completion within one of those three realms. The piece then argues that one of the institutions in particular - the World Bank - has, for reasons of at best negligent and at worst willful injustice on the part of influential state actors in the world community, fallen farthest short in pursuit of what should be viewed as its proper mandate. The article accordingly concludes that a fuller empowerment of the Bank to effect its ideal mission will press the Bretton Woods system more nearly into ethical balance, and with it the world into justice; and that full empowerment of the GATT/WTO and IMF should be partly conditioned upon the fuller empowerment of the Bank

Obesity‐induced diabetes and lower urinary tract fibrosis promote urinary voiding dysfunction in a mouse model

BACKGROUND Progressive aging‐ and inflammation‐associated fibrosis effectively remodels the extracellular matrix (ECM) to increase prostate tissue stiffness and reduce urethral flexibility, resulting in urinary flow obstruction and lower urinary tract symptoms (LUTS). In the current study, we sought to test whether senescence‐accelerated mouse prone (SAMP)6 mice, which were reported to develop prostatic fibrosis, would also develop LUTS, and whether these symptoms would be exacerbated by diet‐induced obesity and concurrent Type 2 Diabetes Mellitus (T2DM). METHODS To accomplish this, SAMP6 and AKR/J background strain mice were fed regular mouse chow, low fat diet chow, or high fat diet chow for 8 months, then subjected to glucose tolerance tests, assessed for plasma insulin levels, evaluated for urinary voiding function, and assessed for lower urinary tract fibrosis. RESULTS The results of these studies show that SAMP6 mice and AKR/J background strain mice develop diet‐induced obesity and T2DM concurrent with urinary voiding dysfunction. Moreover, urinary voiding dysfunction was more severe in SAMP6 than AKR/J mice and was associated with pronounced prostatic and urethral tissue fibrosis. CONCLUSIONS Taken together, these studies suggest that obesity, T2DM, lower urinary tract fibrosis, and urinary voiding dysfunction are inextricably and biologically linked. Prostate 73: 1123–1133, 2013. © 2013 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98367/1/22662_ftp.pd

Measuring adherence to antiretroviral treatment in resource-poor settings: The clinical validity of key indicators

<p>Abstract</p> <p>Background</p> <p>Access to antiretroviral therapy has dramatically expanded in Africa in recent years, but there are no validated approaches to measure treatment adherence in these settings.</p> <p>Methods</p> <p>In 16 health facilities, we observed a retrospective cohort of patients initiating antiretroviral therapy. We constructed eight indicators of adherence and visit attendance during the first 18 months of treatment from data in clinic and pharmacy records and attendance logs. We measured the correlation among these measures and assessed how well each predicted changes in weight and CD4 count.</p> <p>Results</p> <p>We followed 488 patients; 63.5% had 100% coverage of medicines during follow-up; 2.7% experienced a 30-day gap in treatment; 72.6% self-reported perfect adherence in all clinic visits; and 19.9% missed multiple clinic visits. After six months of treatment, mean weight gain was 3.9 kg and mean increase in CD4 count was 138.1 cells/mm3.</p> <p>Dispensing-based adherence, self-reported adherence, and consistent visit attendance were highly correlated. The first two types of adherence measure predicted gains in weight and CD4 count; consistent visit attendance was associated only with weight gain.</p> <p>Conclusions</p> <p>This study demonstrates that routine data in African health facilities can be used to monitor antiretroviral adherence at the patient and system level.</p

Evaluating the Clinical Feasibility of an Artificial Intelligence-Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study.

BACKGROUND: Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence-powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows. OBJECTIVE: This study aims to examine the feasibility of an artificial intelligence-powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network-based individualized treatment remission prediction. METHODS: Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews. RESULTS: Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F2,24=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change. CONCLUSIONS: Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT04061642; http://clinicaltrials.gov/ct2/show/NCT04061642

In C. elegans, High Levels of dsRNA Allow RNAi in the Absence of RDE-4

C. elegans Dicer requires an accessory double-stranded RNA binding protein, RDE-4, to enact the first step of RNA interference, the cleavage of dsRNA to produce siRNA. While RDE-4 is typically essential for RNAi, we report that in the presence of high concentrations of trigger dsRNA, rde-4 deficient animals are capable of silencing a transgene. By multiple criteria the silencing occurs by the canonical RNAi pathway. For example, silencing is RDE-1 dependent and exhibits a decrease in the targeted mRNA in response to an increase in siRNA. We also find that high concentrations of dsRNA trigger lead to increased accumulation of primary siRNAs, consistent with the existence of a rate-limiting step during the conversion of primary to secondary siRNAs. Our studies also revealed that transgene silencing occurs at low levels in the soma, even in the presence of ADARs, and that at least some siRNAs accumulate in a temperature-dependent manner. We conclude that an RNAi response varies with different conditions, and this may allow an organism to tailor a response to specific environmental signals

Three Saturn-mass planets transiting F-type stars revealed with TESS and HARPS

While the sample of confirmed exoplanets continues to increase, the population of transiting exoplanets around early-type stars is still limited. These planets allow us to investigate the planet properties and formation pathways over a wide range of stellar masses and study the impact of high irradiation on hot Jupiters orbiting such stars. We report the discovery of TOI-615b, TOI-622b, and TOI-2641b, three Saturn-mass planets transiting main sequence, F-type stars. The planets were identified by the Transiting Exoplanet Survey Satellite (TESS) and confirmed with complementary ground-based and radial velocity observations. TOI-615b is a highly irradiated ($\sim$1277 $F_{\oplus}$) and bloated Saturn-mass planet (1.69$^{+0.05}_{-0.06}$$R_{Jup}$ and 0.43$^{+0.09}_{-0.08}$$M_{Jup}$) in a 4.66 day orbit transiting a 6850 K star. TOI-622b has a radius of 0.82$^{+0.03}_{-0.03}$$R_{Jup}$ and a mass of 0.30$^{+0.07}_{-0.08}$~$M_{Jup}$ in a 6.40 day orbit. Despite its high insolation flux ($\sim$600 $F_{\oplus}$), TOI-622b does not show any evidence of radius inflation. TOI-2641b is a 0.37$^{+0.05}_{-0.04}$$M_{Jup}$ planet in a 4.88 day orbit with a grazing transit (b = 1.04$^{+0.05}_{-0.06 }$) that results in a poorly constrained radius of 1.61$^{+0.46}_{-0.64}$$R_{Jup}$. Additionally, TOI-615b is considered attractive for atmospheric studies via transmission spectroscopy with ground-based spectrographs and $\textit{JWST}$. Future atmospheric and spin-orbit alignment observations are essential since they can provide information on the atmospheric composition, formation and migration of exoplanets across various stellar types.Comment: 16 pages, 17 figures, submitted to A&

Long Range Plan: Dense matter theory for heavy-ion collisions and neutron stars

Since the release of the 2015 Long Range Plan in Nuclear Physics, major events have occurred that reshaped our understanding of quantum chromodynamics (QCD) and nuclear matter at large densities, in and out of equilibrium. The US nuclear community has an opportunity to capitalize on advances in astrophysical observations and nuclear experiments and engage in an interdisciplinary effort in the theory of dense baryonic matter that connects low- and high-energy nuclear physics, astrophysics, gravitational waves physics, and data scienceComment: 70 pages, 3 figures, White Paper for the Long Range Plan for Nuclear Scienc

Common Genetic Polymorphisms Influence Blood Biomarker Measurements in COPD

Implementing precision medicine for complex diseases such as chronic obstructive lung disease (COPD) will require extensive use of biomarkers and an in-depth understanding of how genetic, epigenetic, and environmental variations contribute to phenotypic diversity and disease progression. A meta-analysis from two large cohorts of current and former smokers with and without COPD [SPIROMICS (N = 750); COPDGene (N = 590)] was used to identify single nucleotide polymorphisms (SNPs) associated with measurement of 88 blood proteins (protein quantitative trait loci; pQTLs). PQTLs consistently replicated between the two cohorts. Features of pQTLs were compared to previously reported expression QTLs (eQTLs). Inference of causal relations of pQTL genotypes, biomarker measurements, and four clinical COPD phenotypes (airflow obstruction, emphysema, exacerbation history, and chronic bronchitis) were explored using conditional independence tests. We identified 527 highly significant (p 10% of measured variation in 13 protein biomarkers, with a single SNP (rs7041; p = 10−392) explaining 71%-75% of the measured variation in vitamin D binding protein (gene = GC). Some of these pQTLs [e.g., pQTLs for VDBP, sRAGE (gene = AGER), surfactant protein D (gene = SFTPD), and TNFRSF10C] have been previously associated with COPD phenotypes. Most pQTLs were local (cis), but distant (trans) pQTL SNPs in the ABO blood group locus were the top pQTL SNPs for five proteins. The inclusion of pQTL SNPs improved the clinical predictive value for the established association of sRAGE and emphysema, and the explanation of variance (R2) for emphysema improved from 0.3 to 0.4 when the pQTL SNP was included in the model along with clinical covariates. Causal modeling provided insight into specific pQTL-disease relationships for airflow obstruction and emphysema. In conclusion, given the frequency of highly significant local pQTLs, the large amount of variance potentially explained by pQTL, and the differences observed between pQTLs and eQTLs SNPs, we recommend that protein biomarker-disease association studies take into account the potential effect of common local SNPs and that pQTLs be integrated along with eQTLs to uncover disease mechanisms. Large-scale blood biomarker studies would also benefit from close attention to the ABO blood group