Advances at AIDS 2014. What does the future look like and how can we better use the tools we have now?

During July 2014, the International AIDS Conference, AIDS 2014, was held in Melbourne, Australia. Approximately 13 600 delegates took part, and this brief report from an Australian pharmacist who attended outlines some of the drug-related developments discussed during the 6-day meeting. There is also an AIDS 2014 YouTube channel through which many sessions from the conference can be accessed without charge

Optimizing MRI-guided prostate ultrasound ablation therapy using retrospective analyses and artificial intelligence

Magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) is an emerging therapy that has been used to treat prostate cancer (PCa). TULSA destroys prostate tissue with heat using therapeutic ultrasound. The heating is monitored in real-time using MRI thermometry. Despite TULSA’s promise, there are several challenges that have slowed its widespread adoption. Fortunately, MRI images and heating parameters from all TULSA treatments are stor ed. By conducting detailed retrospective analyses and applying deep learning on existing treatments, we can extract valuable information and then leverage this knowledge to optimize future TULSA treatments. One major challenge occurs for those patients who had PCa radiation therapy failure and are seeking salvage treatment with TULSA. Many of these patients have leftover metal markers in the prostate. These markers can hamper subsequent TULSA therapy because they introduce susceptibility artifacts in the MRI image and may also block the ultrasound, which may compromise treatment safety and efficacy. Through an extensive retrospective analysis, we have determined that gold markers tend not to affect the treatment outcome, except when located simultaneously close to the urethra and far from the target boundary, or when located directly on the target boundary itself. Clinically, gold markers had no apparent effect on treatment safety and efficacy compared to a control cohort without markers at the 12-month follow-up. Conversely, nitinol markers are generally problematic for TULSA. A second major challenge applies to all TULSA treatment indications. Immediately after TULSA therapy, MRI contrast agents are used to visualize the non-perfused volume, an objective measure of the ablation outcome. Unfortunately, even if undertreatment is observed, retreatment is not possible, forcing an additional treatment several months later, and with it the associated risks of a second intervention. By training a deep learning model with existing TULSA treatment-day, contrast-free MRI image sets, we have predicted the non-perfused volume with an accuracy comparable to modern-day deep learning prostate segmentation methods. Overall, this work will help daily clinical practice and increase the odds of a successful TULSA therapy.MRI-ohjatun eturauhasen ultraääniablaatiohoidon optimointi retrospektiivisten analyysien ja tekoälyn avulla Magneettikuvaus(MRI)-ohjattu virtsaputken kautta annettu ultraääniablaatio (TULSA) on uusi primaarin ja sädehoidon jälkeen paikallisesti uusiutuneen eturauhassyövän (PCa) hoitomuoto. Menetelmässä eturauhaskudosta koaguloidaan korkean intensiteetin ultraäänellä reaaliaikaisessa MRI-ohjauksessa, mikä parantaa hoidon tarkkuutta. Lupaavista kliinisistä tuloksista huolimatta MRI-ohjaus altistaa teknisille ja kliinisille haasteille, mitkä ovat hidastaneet TULSA-hoidon laajempaa käyttöönottoa. TULSA-hoidossa jokainen vaihe rekisteröidään MRI-kuvin. Koneoppimista hyödyntämällä voidaan retrospektiivisesti analysoida näitä MRI-kuvia TULSA-hoitotulosten optimoimiseksi. Sädehoidon ohjauksessa käytetyt eturauhaseen asetetut merkkijyvät saattavat vaikuttaa TULSA-hoidon tehoon ja turvallisuuteen uusiutuneessa PCa:ssä, koska ne voivat aiheuttaa artefaktoja MRI-kuvaan ja estää ultraäänen etenemisen. Laajassa retrospektiivisessa analyysissä todettiin, että kultamerkkijyvät eivät yleensä vaikuta hoitotulokseen, elleivät ne sijaitse samanaikaisesti lähellä virtsaputkea ja kaukana hoitokohteesta tai suoraan kohteen edessä. Kultamerkkijyvillä ei ollut ilmeistä vaikutusta hoidon turvallisuuteen ja tehokkuuteen verrattuna kontrolliryhmään ilman merkkijyviä 12 kuukauden seurannassa. Välittömästi TULSA-hoidon jälkeen hoitotulos varmistetaan merkkiainetehosteisilla MRI-kuvilla, joilla visualisoidaan verenkierroton alue, mikä korreloi akuuttiin kudosvaurioon eli onnistuneeseen hoitovasteeseen. Ongelmana on, että vaikka merkkiainetehosteisissa MRI-kuvissa todettaisiin riittämätön hoitovaste, uudelleenhoito ei ole samalla hoitokerralla mahdollista, koska eturauhaseen kerääntynyt merkkiaine estää hoidon. Tällöin tarvitaan uusi hoitokerta kuukausien kuluttua toimenpiteen sisältämineen riskeineen, mikä viivästyttää hoitoa ja kuormittaa potilasta. Tässä tutkimuksessa onnistuttiin tarkasti ennustamaan verenkierroton alue hoidonaikaisista merkkiainetehostamattomista MRI-kuvista hyödyntämällä syväoppimismallia. Näillä havainnoilla on tärkeä kliininen merkitys TULSA-hoitotulosten parantamisessa

A human factors approach to range scheduling for satellite control

Range scheduling for satellite control presents a classical problem: supervisory control of a large-scale dynamic system, with unwieldy amounts of interrelated data used as inputs to the decision process. Increased automation of the task, with the appropriate human-computer interface, is highly desirable. The development and user evaluation of a semi-automated network range scheduling system is described. The system incorporates a synergistic human-computer interface consisting of a large screen color display, voice input/output, a 'sonic pen' pointing device, a touchscreen color CRT, and a standard keyboard. From a human factors standpoint, this development represents the first major improvement in almost 30 years to the satellite control network scheduling task

Extended Resections for Thymic Malignancies

Abstract:Almost all series reporting on the results of resection in thymic tumors indicate that the performance of a complete resection is probably the most important prognostic factor. This issue is not a factor in Masaoka stage I and II tumors that are almost always easily completely resected and have an excellent prognosis. Masaoka stage III tumors that invade the pericardium, lungs, or great vessels have relatively higher incomplete resection rates, significantly higher recurrence rates, and thus a worse prognosis. There are several small reports on the efficacy of resection of the great veins when involved by a thymic malignancy with low morbidity and meaningful long-term survival. Superior vena cava reconstruction is commonly performed by a polytetrafluroethylene, venous, or pericardial graft. These cases can usually be identified preoperatively and, thus, considered for induction therapy. Because these types of cases are almost always of marginal respectability in terms of obtaining a true en bloc resection, there is an increasing enthusiasm for offering induction therapy in an effort to enhance resectability. Preliminary results suggest increased R0 resection rates and improved survival with induction therapy for locally advanced tumors. The optimal induction treatment is unknown. The ultimate extended surgery for advanced thymic tumors is an extrapleural pneumonectomy performed for extensive pleural disease (Masaoka stage IVA). These rarely performed operations are done for IVA disease found at initial presentation and for recurrent disease as a salvage procedure. Again these advanced patients are probably best managed by induction chemotherapy followed by resection

System effectiveness model formulation with application to nuclear safeguards systems

Evaluation of a given system\u27s effectiveness has numerous pitfalls. System objectives may be poorly defined, may shift during the system life, or may be hard to quantify. Further, individual perceptions of the quantifications may differ. Whatever the cause, system effectiveness has been an elusive term to quantitatively define. This research posits a quantitative system effectiveness model and establishes a utilitarian approach for use with an illustrative application to n operating nuclear safeguards system.The Department of Energy (DOE) defines domestic safeguards, which are applied to nuclear material as; an integrated system of physical protection, material accounting, and material control measures designed to deter, prevent, detect, and respond to unauthorized possession, use, or sabotage of nuclear materials. This research includes the investigation of the utility coefficients and simulation of a domestic nuclear safeguards system, as well as simulation of an airport passenger screening system consisting of: an identification screening system; an X-ray system for checking bags and computers; and a walk through metal detector. Expert judgment was used to determine the relative importance (utility) of the individual subsystems through a statistically analyzed web survey. The survey population is nuclear material protection, control, accounting, and plant management experts.The mean utility coefficients determined during the survey were applied to the system components developed assigned randomly generated values of component effectiveness and combined to produce an overall system effectiveness. Simulated Type I and Type II error rates are used for illustration of the probabilistic methodology currently used by DOE (calculating protection effectiveness) and the posited and heuristically based methodology (system effectiveness). Use of the heuristically based system effectiveness methodology illustrates an approach that combines the subsystem components of plant management, physical protection, material accounting, and material control for a domestic safeguards system. The system effectiveness methodology is complimentary to and more robust than the protection effectiveness calculation and can offer opportunities for cost savings during the system lifecycle

Antifungal Antibiotics and Studies on 8-Substituted Homophthalimides

Abstract Not Provided

Exploring behavioural responses of shorebirds to impulsive noise

Despite recent research interest in the consequences of chronic noise for animal populations, the effects of impulsive noise are less well understood. Determining wildlife responses to impulsive sound is pertinent in coastal areas where development of port and power generation industries may result in disturbance from impulsive sounds such as percussive piling, especially around estuaries which may support internationally important numbers of bird species. Discussions between regulators, planning authorities and regional development agencies over precautionary levels of impulsive sound emitting activities are common, yet we're unaware of any study which provides guidance on acceptable noise limits that would keep disturbance to shorebirds to a minimum. This experimental study intentionally disturbed birds at a high tide roost site, an agricultural field adjacent to the sea wall on the south bank of the Humber estuary in northern England, using an impulsive sound, and their behavioural responses were recorded. The researcher sounded an air-horn at ever decreasing distances towards a mixed species flock of shorebirds. While visual disturbance from the experimenter was taken into consideration in the mediods, we cannot statistically separate their effects in this study. An ordinal logistic regression model demonstrated a statistically significant positive relationship between the decibel (dB(A)) level experienced by the birds and the behavioural response observed. In principle, this model can be used to predict the probability of a particular behavioural response at a given dB(A) level. Estimates of sound levels which included calculation of geometric and atmospheric attenuation were superior over more simple measures in predicting behavioural responses. This study has implications for assessing possible disturbance caused by impulsive noise, and adds to growing evidence that the effects of noise may be an important, albeit not straightforward, consideration in management decisions made for shorebirds and other avian species. ©Wildfowl & Wedands Trust