Search

Robustness evaluation is increasingly used in particle therapy planning to assess clinical target volume (CTV) coverage in the setting of setup and range uncertainty. However, no clear standard exists as to an acceptable degree of plan robustness. The aim of this study is to quantify x-ray robustness parameters, as this could inform proton planning when held to a similar standard. Consecutive patients with prostate adenocarcinoma treated with definitive x-irradiation to the prostate alone at a single institution in 2019 were retrospectively reviewed. CTV to planned target volume (PTV) margins of 7 mm in all directions, except 4 mm posteriorly, were used in the main cohort. Plans were normalized to PTV V100% ≥ 95%. Patient setup errors were simulated by shifting the isocenter relative to the patient in each of the cardinal directions. The magnitude of each shift equaled the magnitude of the CTV to PTV expansion in that direction. Range uncertainty was set to 0%. A total of 27 patients were evaluated. The mean (SD) nominal plan CTV V100% was 99.6% (1.1%). The mean (SD) worst-case shift CTV V100% was 97.2% (2.8%). The mean (SD) nominal and worst-case CTV V95% were 100% (0%) and 99.7% (0.5%), respectively. A worst-case CTV V100% > 90% and a worst-case CTV V95% > 99% were achieved in over 95% of plans. The mean (SD) nominal and worst-case rectal V70 Gy were 2.37 cc (1.00 cc) and 11.60 cc (3.16 cc), respectively. The mean (SD) nominal and worst-case bladder V60 Gy were 7.8% (4.8%) and 14.5% (9.3%), respectively. Paired 2-tailed t tests comparing the nominal to worst-case dose-volume histograms were significant for each dosimetric parameter (P <.01). X-ray planning uses PTV margins to inherently provide robustness to patient setup errors. Although the prostate remains well covered in various setup uncertainty scenarios, organs at risk routinely exceeded nominal treatment plan institutional constraints in the worst-case scenarios. Robustness metrics obtained from x-ray plans could serve as a benchmark for proton therapy robust optimization and evaluation. [ABSTRACT FROM AUTHOR]

Stereotactic body radiation therapy (SBRT) is increasingly used as a definitive treatment option for patients with prostate adenocarcinoma. The aim of this study was to assess the late toxicity, patient-reported quality of life outcomes, and biochemical recurrence rates after prostate SBRT with simultaneous integrated boost (SIB) targeting lesions defined by magnetic resonance imaging (MRI). Patients were eligible if they had biopsy-proven low- or intermediate-risk prostate adenocarcinoma, one or more focal lesions on MRI, and an MRI-defined total prostate volume of <120 mL. All patients received SBRT delivered to the entire prostate to a dose of 36.25 Gy in 5 fractions with an SIB to the lesions seen on MRI to 40 Gy in 5 fractions. Late toxicity was defined as any possible treatment-related adverse event occurring after 3 months from the completion of SBRT. Patient-reported quality of life was ascertained using standardized patient surveys. A total of 26 patients were enrolled. Six patients (23.1%) had low-risk disease and 20 patients had intermediate-risk disease (76.9%). Seven patients (26.9%) received androgen deprivation therapy. Median follow-up was 59.5 months. No biochemical failures were observed. Three patients (11.5%) experienced late grade 2 genitourinary (GU) toxicity requiring cystoscopy, and 7 patients (26.9%) had late grade 2 GU toxicity requiring oral medications. Three patients (11.5%) had late grade 2 gastrointestinal toxicity characterized by hematochezia requiring colonoscopy and steroids per rectum. There were no grade 3 or higher toxicity events observed. The patient-reported quality-of-life metrics at the time of last follow-up were not significantly different than the pre-treatment baseline. The results of this study support that SBRT to the entire prostate to a dose of 36.25 Gy in 5 fractions with focal SIB to 40 Gy in 5 fractions has excellent biochemical control and is not associated with undue late gastrointestinal or GU toxicity or long-term quality of life decrement. Focal dose escalation with an SIB planning approach may be an opportunity to improve biochemical control while limiting dose to nearby organs at risk. [ABSTRACT FROM AUTHOR]

While Direct Seeded Rice (DSR) has numerous potential benefits to smallholder farmers in the Eastern Gangetic Plains of South Asia, it's out-scaling has been limited by both a lack of demand by farmers and limited supply of DSR services by machinery owners. This contrasts with the comparatively more rapid scaling of zero tillage wheat in the region. This trend is yet to be fully explored, particularly when focus has been placed almost exclusively on understanding DSR adoption though the lens of farm-level agronomic, economic and environmental performance. Given that limited DSR service provision is likely to be governed outside of these considerations, this study explores with zero tillage drill owners the decision processes they apply in deciding how to use their zero tillage drills. Respondents highlight a complex web of interrelated considerations that highlight the additional complexities of DSR as compared to existing practices. Using a novel 'Decision-making Dartboard' qualitative framework, these complexities are unpacked and a set of potential changes to the assumed theory of change for DSR scaling are identified, including considerations for selection of potential DSR service providers and responsibilities for promotion and extension of DSR to overcome the prevalent negative perceptions of DSR held broadly across the communities explored. The proposed framework and analysis process are also potentially useful for exploration of other farmer decision making processes more broadly. [Display omitted] • Limited service provision is a key constraint to scaling Direct Seeded Rice. • No work explores why Zero Tillage Drill owners don't use it for Rice. • Issues exist with both technology and generically providing services. • Collectivism or service packaging may resolve some of these issues. • Novel framework provides unique qualitative analysis on decision making. [ABSTRACT FROM AUTHOR]

Depression among older adults with cancer is under recognized and under treated. This study characterizes the burden of depression in older adults with gastrointestinal (GI) malignancies prior to chemotherapy and its relationship with geriatric assessment (GA) domains, health-related quality of life (HRQOL), and self-reported healthcare utilization. Patients ≥60 years in GI oncology clinics at UAB were asked to complete a GA entitled the Cancer & Aging Resilience Evaluation (CARE). We examined depression using the Patient-Reported Outcomes Measurement Information System (PROMIS®) Depression four-item short form; moderate/severe depression was defined by a t-score ≥ 60. Multivariate analysis was used to examine associations between those with and without moderate/severe depression. Of 355 included patients, 46 had mild depression (13%) and an additional 46 patients had moderate/severe depression (13%). After adjustment for age, sex, education, cancer type, and cancer stage, those who reported moderate/severe depression had a significantly increased odds of reporting falls (adjusted odds ratio [aOR] 4.01, 95% confidence interval [CI] 1.94–8.26), dependence in IADLs (aOR 7.06,CI 2.91–17.1), dependence in ADLs (aOR 6.23, CI 2.89–13.4), malnutrition (aOR 5.86, CI 2.40–14.3), frailty (aOR 13.7, CI 5.80–32.1), and fatigue (aOR 11.2, CI 3.31–37.6). Moderate/severe depression was also significantly associated with worse physical (aOR 7.58, CI 3.30–17.4) and mental (aOR 26.3, CI 10.1–68.8) HRQOL sub-scores, without significant differences in healthcare utilization. More than one out of eight older adults with a GI malignancy reported moderate/severe depression prior to chemotherapy, which was associated with impairments in several GA domains and HRQOL. [ABSTRACT FROM AUTHOR]

Positron emission tomography using the fluorine-18 (18F) fluciclovine radiotracer has been approved for use in recurrent prostate cancer and is a useful tool for clinical decision making. However, 18F-fluciclovine is not specific for prostate cancer tumor cells, and false-positive results have been reported. In the present study, we have reported our experience with synchronous malignancies identified using 18F-fluciclovine and reviewed other reported cases, with a special emphasis on highlighting the clinical decisions that led to the correct diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: For patients with high risk prostate cancer, conventionally fractionated treatment of the pelvic lymphatics and hypofractionated treatment to the prostate can be delivered simultaneously with dose painting. The purpose of this technical note is to highlight unexpected hot spots within the low dose lymphatic target volume as a clinical problem that we have observed with dose painting, and to describe a simple approach to account for this during treatment planning. Summary: We describe the creation of a control structure that can be incorporated into the optimization objective function. An upper constraint objective can be placed on the control structure such that heterogeneity within the plan is limited to the area near the high dose target volume and better emulates the dosimetry of a conventionally fractionated sequential boost plan. [ABSTRACT FROM AUTHOR]

Patient-reported cognitive complaint (CI) is poorly described in older adults with cancer. The purpose of this study was to quantify the prevalence and examine the associations of patient-reported CI in older adults with gastrointestinal (GI) malignancies at diagnosis. Using participants ≥60 years with GI malignancies from the Cancer & Aging Resilience Evaluation (CARE) Registry that underwent a Geriatric Assessment (GA), we examined CI using the Patient-Reported Outcomes Measurement Information System (PROMIS®) Short Form 4a Cognitive Function. Cognition scores were dichotomized into normal (scores of 15–20) and impaired (4–14), and bivariate and multivariate analyses were used to examine associations. A total of 264 participants with GI malignancy were included, mean age of 70.0 ± 7.1, 55.7% male, pancreatic cancer was the most common cancer (24.2%) and majority were stage III/IV (68.2%). 29.3% of participants endorsed CI. CI was not associated with demographic and clinical domains, but was associated with many GA impairments including instrumental Activities of Daily Living (iADL) impairment (adjusted odds ratio [aOR] 6.0, 95% confidence interval 3.0–11.8), falls (aOR 2.7, 1.4–5.4), anxiety (aOR 10.3, 5.2–20.4), and depression (aOR 10.2, 5.2–20.4). CI was also associated with reduced global mental (aOR 18.7, 8.1–42.2) and physical (aOR 4.7, 2.4–8.9) quality of life, and prior hospitalizations (aOR 2.4, 1.2–4.8). We found a high prevalence of patient-reported CI in older adults with GI malignancies that was associated with increased GA impairments, reduced health-related quality of life, and increased healthcare utilization. [ABSTRACT FROM AUTHOR]

Integrating Geriatric Assessment (GA) in the management of older adults with cancer is recommended, yet rarely practiced in routine oncologic care. Our objective was to assess the feasibility of integrating routine GA in the management of older adults with gastrointestinal (GI) malignancies and characterize impairments in this population. Patients ≥60yo referred for consultation to the GI Oncology clinic were asked to complete the Cancer and Aging Resilience Evaluation (CARE) on their first visit. CARE was adapted from the Cancer and Aging Research Group GA with modifications to create a completely patient-reported version of the GA. Feasibility was defined as completion of CARE by ≥80% of eligible patients during the initial consultation. Of the eligible 354 new patients seen in the GI Oncology Clinic, 323 (91.2%) completed the CARE survey. Most patients (83.1%) felt the length of time to complete was appropriate (median time of 10 min [IQR 10–15.7 min]). GA impairments were prevalent: 54.7% reported dependence in Instrumental Activities of Daily Living, 15.5% reported dependence in Activities of Daily Living, 20.9% reported ≥1 fall, 35.9% reported a performance status ≥2, 55.7% were limited in walking one block, 74.0% reported polypharmacy (≥4 medications), and 36.4% had ≥3 comorbidities. Performing a GA in the routine care of older adults with GI malignancies is feasible, and GA impairments are common among this population. A fully patient-reported GA such as the CARE may facilitate broader incorporation of GA in the routine clinic work flow. [ABSTRACT FROM AUTHOR]

The Calypso Beacon transponder has been modified by the addition of a nitinol anchor feature to allow for positional stability when implanted bronchoscopically into the lung. The purpose of this study was to confirm the feasibility and safety of anchored transponder placement and feasibility of lung target localization and tracking. This study enrolled patients with histologically confirmed cancer in the lung (primary or metastatic) who were scheduled to receive external beam radiation therapy. Three anchored transponders were implanted via flexible bronchoscopy into small (approximately 2- to 2.5-mm diameter) airways. Patient alignment at each radiation fraction was performed with the Calypso system, and anchored transponder position was tracked during radiation delivery. The primary endpoint was defined as the ability to localize at least 85% of the patients during the first week of treatment. Four follow-up visits were specified including a posttreatment assessment and every 3 months up to 1 year. A total of 69 patients underwent anchored transponder placement, and all 207 implanted anchored transponders were visible on the treatment-planning simulation computed tomography scan. Sixty-seven patients underwent radiation therapy, and localization was successful in 66 cases (98.5%). With 1 failure in 67 cases, the P value for rejecting the null hypothesis was <.001 and the primary objective of the study met. Five adverse events in 5 patients were potentially attributed to the study device or implantation procedure, consisting of pneumonia (2 cases), pleural abscess (1 case), and pneumothorax (2 cases). Two serious events (cardiac arrest and acute hypotension) were attributed to anesthesia during the implantation procedure. This study strongly supports that anchored transponders are safe, positionally stable, and useful for lung tumor localization and monitoring. [ABSTRACT FROM AUTHOR]

This report details our institutional workflow and technique for use of the Calypso electromagnetic transponder system with respiratory gating for localization and tracking of lung tumors during stereotactic radiation therapy for early stage thoracic malignancies. Sixteen patients underwent bronchoscopic fiducial placement of 3 transponders in small airways in proximity to the primary tumor. Transponders were placed <19 cm from the most anterior skin location of the patient for appropriate tracking functionality. Patients underwent simulation with 4-dimensional assessment and were treated with transponder based positional gating if tumors moved >5 mm in any direction. Tumor motion <5 mm was not gated and treated using an internal target volume approach. A 5 mm uniform planning target volume was used. Before treatment, fiducial placement and tumor location were verified by daily kilovoltage (kV) and cone beam computed tomography image guidance. Tracking limits were placed based on the movement of the transponders from the centroid of the structures on the maximum intensity projection image. The Calypso treatment system paused treatment automatically if beacons shifted beyond the predefined tracking limits. All 16 patients underwent successful implantation of the electromagnetic transponders. Eight patients exhibited tumor motion sufficient to require respiratory gating, and the other 8 patients were treated using a free breathing internal target volume technique. Difficulty with transponder sensing was experienced in 3 patients as a result of anatomic interference with the placement of the sensing arrays; each of these cases was successfully treated after making setup modifications. Triggered imaging of fiducials during treatment was consistent with real-time positioning determined by the Calypso tracking system. Respiratory gated electromagnetic based transponder guided stereotactic body radiation therapy using the workflow described is feasible and well tolerated in selected patients with early stage lung malignancies. [ABSTRACT FROM AUTHOR]

Patients with lower mediastinal lymphoma (LML) benefit dosimetrically from proton therapy (PT) compared with intensity modulated radiation therapy (IMRT). The added dosimetric benefit of deep-inspiration breath-hold (DIBH) is unknown; therefore, we evaluated IMRT versus PT and free-breathing (FB) versus DIBH among patients with LML. Twenty-one patients with LML underwent 4-dimensional computed tomography and 3 sequential DIBH scans at simulation. Involved-site radiation therapy target volumes and organ-at-risk contours were developed for both DIBH and FB scans. FB-IMRT, DIBH-IMRT, FB-PT, and DIBH-PT plans were generated for each patient for comparison. The median difference in lung volume between the DIBH and FB scans was 1275 mL; the average difference in clinical target volume was 5.7 mL. DIBH-IMRT produced a lower mean lung dose (10.8 vs 11.9 Gy; P <.001) than FB-IMRT, with no difference in mean heart dose (MHD; 16.1 vs 15.0 Gy; P =.992). Both PT plans produced a significantly lower mean dose to the lung, heart, left ventricle, esophagus, and nontarget body than DIBH-IMRT. DIBH-PT reduced the median MHD by 4.2 Gy (P <.0001); left ventricle dose by 5.1 Gy (P <.0001); and lung V5 by 26% (P <.0001) versus DIBH-IMRT. The 2 PT plans were comparable, with DIBH-PT reducing mean lung dose (7.0 vs 7.7 Gy; P =.063) and with no difference in MHD (10.3 vs 9.5 Gy; P =.992). Among patients with LML, DIBH (IMRT or PT) improved lung dosimetry over FB but had little influence on MHD. PT (DIBH and FB) significantly reduced lung, heart, esophagus, and nontarget body dose compared with DIBH IMRT, potentially reducing the risk of late complications. [ABSTRACT FROM AUTHOR]

• Labor shortage due to out-migration adversely affected smallholder farmers in Nepal. • Adoption of scale-appropriate mechanization increased rice productivity by 1110 kg/ha. • Adoption of mechanization by non-adopters would increase rice productivity by 1250 kg/ha. • Very small rice cultivating farms (≤0.25 ha) benefited most from adoption of mechanization. • Rising on-farm rural wage due to labor shortage was the primary driver of mini-tiller adoption. Smallholder farmers in the mid-hills of Nepal are facing an acute labor shortage due to out-migration which, in general, has affected the capacity to achieve timely crop establishment, harvest, and inter-cultural operations. These effects are more visible in the case of labor-intensive crops such as rice and promoting higher levels of rural mechanization has emerged as the primary policy response option. Nevertheless, quantitative evidence for the ability of mechanization to offset the adverse effects of shortages increasing labor prices in these systems is largely absent. This study investigates the impacts associated with adoption of mini-tillers (5 to 9 horsepower) for land preparation on smallholder rice productivity in the mid-hills of Nepal. We use an endogenous switching regression that accounts for both observed and unobserved sources of heterogeneity between mini-tiller adopters and non-adopters. Findings demonstrate that rising on-farm rural wage rates and an emerging decline in draft animal availability are driving adoption of the mini-tiller. Among users, the mini-tiller increased rice productivity by 1,110 kg/ha (27%). Further, regression results suggest that mini-tiller non-adopters would be able to increase their rice productivity by 1,250 kg/ha (26%) if they adopt. Moreover, our analysis revealed that very small farms (≤0.25 ha) that adopt mini-tillers are benefited the most in terms of gains in rice productivity. These findings support policies that favor the expansion of small-scale mechanization in the hill production ecologies of South Asia and highlight the need to foster the emergence of an associated service economy that will permit smallholders access to capital-intensive machinery such as the mini-tiller. [ABSTRACT FROM AUTHOR]

Objective: To determine if magnetic resonance imaging (MRI)/ultrasound fusion-targeted prostate biopsy (TB) would lead to increased recommendations of aggressive radiotherapy treatments for higher risk prostate cancer compared to systematic biopsy (SB) results.Methods: Clinicopathologic data of 533 men who underwent both TB and SB from 2014 to 2017 was analyzed. TB was performed in addition to SB in patients with detection of MRI suspicious lesions. Three patient cohorts were established: (1) biopsy naïve (80/533, 15.0%), (2) active surveillance (185/533, 34.7%), and (3) prior negative biopsy (268/533, 50.3%). Cancer risk categorical criteria were established with recommended radiotherapy treatment for each. Variation of risk classification due to biopsy method for all patients and within each cohort was analyzed using either a chi-squared statistic or Fisher's exact test. McNemar's pairwise analyses were performed for all risk categories between TB and SB to assess the effects of TB on high-risk cancer identification and subsequent radiotherapy recommendations.Results: Number of patients within cancer risk categories (1. "No Cancer or Low-Risk"; 2. "More Favorable Intermediate-Risk"; 3. "Less Favorable Intermediate-Risk"; 4. "High-Risk") varied significantly based on TB and SB pathology among all patients combined (P <.0001), in cohort 2 (P = .0005), and in cohort 3 (P <0.0001). Further, among all patients, TB increased cancer risk classification and correspondingly would result in more aggressive radiotherapy recommendations: "No Cancer or Low-Risk" to "Less Favorable Intermediate-Risk" (30/343, P <0.0001) and "No Cancer or Low-Risk" to "High-Risk" (31/353, P <.0001).Conclusion: Among men with prostate cancer, TB commonly led to reclassification to a higher risk group, which is accompanied by more aggressive radiotherapy treatment recommendations when compared with SB findings alone. [ABSTRACT FROM AUTHOR]

Highlights • Mechanization provided more predictable profit and return on investment of inputs. • Applying inputs by hand disassociated fertilizer from end of season yield. • Chest-mounted spreader can be stop-gap between hand distributed inputs and zero-till. • Labor efficiency was roughly doubled by using chest-mounted spreader. • Chest-mounted spreader increased within and between-field uniformity of yield. Abstract Nepal is at a crossroads of diminishing farm-labor and inadequate investment into farming operations that, among other factors, have stagnated domestic wheat yield. Cultural and economic constraints have hindered the widespread adoption of more expensive precision agriculture technologies like zero-till that have the capacity to improve labor and farm input efficiencies. To capture the benefits from added precision of application but with the ability to fit within the current semi-mechanized seed bed preparation and tillage system, we introduced a low-cost, chest mounted seed and fertilizer. We found that simple mechanization caused yield efficiencies to be positive and significant for nitrogen and phosphate. Seed rates using this method were positively associated with seedling density. This led to both yield and profit being more predictable for farmers. Conversely, hand-applied inputs caused a disassociation between inputs and end of season yield and therefore added a large measure of risk to their farming operations. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the dynamics of the vaginal wall dose for interstitial brachytherapy (ISBT). A patient undergoing ISBT was selected as the patient case. The phantom case was generated to simulate the patient case in all regards with the exception of parallel needle positions. The vaginal wall was contoured as a 0.5-cm expansion around the vaginal surface of the obturator. The prescribed ISBT dose was 20 Gy in 4 fractions. Six treatment plans were generated by modifying relative dwell times and needle positions (DTNP). The volume of the vaginal wall receiving > 150% of prescription dose (V > 150% ) and D 2cc of the vaginal wall were compared among plans. The V > 150% was much larger in the patient case (49.3%) due to unparallel needles compared with the phantom case (14.3%) without modification (plan 1). Among the 6 plans, reduced dwell time (plan 3) and no dwell time (plans 5 and 6) on the vaginal surface needles had the lowest vaginal wall doses with the use of a central obturator needle in both cases. In comparison of patient case plans 1, 3, 5, and 6, V 150% was 49.2%, 19.0%, 21.3%, and 28.7%, respectively, and D 2cc was 41.15 Gy, 33.10 Gy, 36.51 Gy, and 34.37 Gy, respectively, which was limited around each loaded needle. Modification of DTNP is able to reduce the vaginal wall volume exceeding 150% of the prescription dose in the patient case. Understanding these dynamics of the vaginal wall dose will improve dose optimization of ISBT and may reduce vaginal morbidities. [ABSTRACT FROM AUTHOR]

This paper combined experimentally-measured grinding wheel topography data taken around the entire circumference of the grinding wheel with a kinematic simulation of the grinding process. Several new methods were developed in order to create the resulting high-fidelity and computationally-efficient simulation. First a novel peak-removal technique was developed and applied to effectively remove erroneous peaks in the raw wheel topography data. Next a method was found to determine only the active cutting points on the wheel model by considering the kinematics of the grinding process. This new approach was able to reduce the simulation time from over twelve hours to about four seconds without losing any information about the cutting edge–workpiece interaction. The resulting predicted workpiece surface was then experimentally validated by carrying out a grinding experiment using the same grinding wheel used to develop the grinding wheel computer model and then measuring the resulting workpiece surface profile. Good agreement between simulated and experimental workpiece profiles was observed. Finally, the validated simulator was used to develop a kinematically-exact method to calculate the maximum uncut chip thickness and the simulation results were investigated for different depths of cut, wheel speeds and workpiece feeds. [ABSTRACT FROM AUTHOR]

Context: Accurate estimation of life expectancy in patients with brain metastases is critical for counseling and choosing appropriate therapy. Performance status is the single greatest determinant of overall survival in this population. However, current measures of performance status are subjective and often based on brief clinical encounters. Gait speed is an objective, reliable predictor of overall health and survival.Objective: The purpose of this study was to evaluate the relationship between gait speed and survival in patients with brain metastases.Methods: We conducted a retrospective review of all patients with documented gait speed and Karnofsky performance status seen in consultation for newly diagnosed brain metastases from 2014 to 2015. Gait speed was measured during neurological examination over 4 m at normal pace. Graded prognostic assessment scores were calculated from clinical information. The primary outcomes were overall survival and 30-day mortality.Results: Eighty-five of 88 patients (97%) met inclusion criteria. Overall, the median gait speed was 0.7 m/s (range 0-1.0 m/s). Gait speed was associated with increased overall survival in addition to graded prognostic assessment score. Median survival was longer in patients with normal gait speed (>0.6 m/s, 11.9 months) compared to those with slow gait speed (≤0.6 m/s, 4.5 months, P < 0.001) or who were nonambulatory (1.1 months, P < 0.001). Thirty-day mortality for normal, slow, and nonambulatory patients was 0%, 15%, and 42%, respectively. The graded prognostic assessment overestimated actual survival for nonambulatory patients (2.2 vs. 1.1 months) and underestimated for those with normal gait speed (4.4 vs. 11.9 months).Conclusion: Gait speed is associated with overall survival in patients with newly diagnosed brain metastases. Gait speed assessment is simple, objective, and may provide additional prognostic information to improve life expectancy estimation and management decisions. [ABSTRACT FROM AUTHOR]

Changing dietary preferences and population growth in South Asia have resulted in increasing demand for wheat and maize, along side high and sustained demand for rice. In the highly productive northwestern Indo-Gangetic Plains of South Asia, farmers utilize groundwater irrigation to assure that at least two of these crops are sequenced on the same field within the same year. Such double cropping has had a significant and positive influence on regional agricultural productivity. But in the risk-prone and food insecure lower Eastern Indo-Gangetic Plains (EIGP), cropping is less intensive. During the dryer winter months, arable land is frequently fallowed or devoted to lower yielding rainfed legumes. Seeing opportunity to boost cereals production, particularly for rice, donors and land use policy makers have consequently reprioritized agricultural development investments in this impoverished region. Tapping groundwater for irrigation and intensified double cropping, however, is unlikely to be economically viable or environmentally sound in the EIGP. Constraints include saline shallow water tables and the prohibitively high installation and energetic extraction costs from deeper freshwater aquifers. The network of largely underutilized rivers and natural canals in the EIGP could conversely be tapped to provide less energetically and economically costly surface water irrigation (SWI). This approach is now championed by the Government of Bangladesh, which has requested USD 500 million from donors to implement land and water use policies to facilitate SWI and double cropping. Precise geospatial assessment of where freshwater flows are most prominent, or where viable fallow or low production intensity cropland is most common, however remains lacking. In response, we used remotely sensed data to identify agricultural land, detect the temporal availability of freshwater in rivers and canals, and assess crop production intensity over a three-year study period in a 33,750 km 2 case study area in southwestern Bangladesh. We combined these data with georeferenced and temporally explicitly soil and water salinity information, in addition to relative elevation classifications, in order to examine the extent of winter fallows and low productivity rainfed cropland that could be irrigated by small-scale surface water pumps. Applying observations of irrigated crop sowing dates and yields from 510 wheat, 550 maize, and 553 rice farmers, we also modeled crop intensification production scenarios within the case study area. We conservatively estimate that at least 20,800 and 103,000 ha of fallow and rainfed cropland, respectively, could be brought into intensified double cropping using SWI. Scenario analysis indicates that if 25%–75% of the fallow or low-intensity land were converted to irrigated maize, national aggregate production could increase by 10–14% or 29–42%, respectively. Conversion to wheat would conversely boost national production by 9–10% or 26–31%. Irrigated rice is however unlikely to contribute >3%. In aggregate, these actions could generate between USD 36–108 million of revenue annually among farmers. Intensification therefore has important land use policy and food and income security implications, helping to rationalizei SWI investments. Crop choice, water resource allocation, and water governance will however remain crucial considerations for irrigation planners. [ABSTRACT FROM AUTHOR]

Early sowing of wheat has been proposed as an important crop management practice for reducing the threat of terminal heat stress – a threat which is likely to increase under climate change projections for the Indo-Gangetic Basin (IGB) of South Asia, home to more than 400 million people. However, to date there is little empirical evidence for the impacts of early sowing on productivity and profitability outcomes. Using farm survey data collected from the Northern IGB in Nepal and remotely sensed climate data, this study assesses the factors associated with farmers' early sowing decisions and the impact of sowing date on wheat productivity, costs, and returns. We used a quasi-experimental approach to assess the impacts of early sowing on outcome variables. We find that early sowing enhances wheat productivity (236–241 kg/ha; 10–11%) and profitability (US$ 54–55 ha−1). However, we also find that early sowing has heterogenous effects. Large farms (>0.8 ha) and wheat plots receiving higher seasonal precipitation (>90 mm) have the largest expected gains in productivity and profitability. The adoption of early sowing of wheat is associated with farm size, seasonal precipitation, and farmers' crop management practices such as delay in harvesting of the previous season's crop. Our findings suggest that early sowing can enhance wheat productivity and profitability, and reduce risk of terminal stress, which in turn can increase the sustainability of smallholder wheat production in the IGB under forecasted climate change. • ES of wheat has potential to minimize terminal heat stress. • ES enhanced wheat productivity and profitability. • Large farms and plots receiving higher precipitation benefited most. • Delay in harvesting previous season's crop drivers ES decisions. [ABSTRACT FROM AUTHOR]

This paper describes the design and validation of an upgraded grinding wheel scanner system that controls the position of a Nanovea CHR-150 Axial Chromatism sensor along the x - and y -directions of the wheel surface to measure and characterize wheel surface topography. The scanner features a novel homing system that enables the wheel to be removed from the scanner, used on a grinding machine and then re-mounted and re-homed so that the same location on the wheel surface can be repeatedly measured and monitored. The average standard deviation for homing was 27.6 μm and 19.3 μm in the x - and y -directions, respectively, which is more than adequate for typical area scans of 25 mm 2 . After homing, the scanner was able to repeatedly measure features that were similar in size to an abrasive grain (∼200 μm diameter) with an average error of 9.3 μm and 5.9 μm in the x - and y -directions, respectively. The resulting topography measurements were compared with Scanning Electron Microscope images to demonstrate the accuracy of the scanner. A custom particle filter was developed to process the resulting data and a novel analysis technique involving the rate of change of measured area was proposed as a method for establishing the reference wheel surface from which desired wheel topography results can be reported such as the number of cutting edges, cutting edge width and cutting edge area as a function of radial depth. [ABSTRACT FROM AUTHOR]

Glycosylation is a common post-translational protein modification, in which glycans are built onto proteins through the sequential addition of monosaccharide units, in reactions catalysed by glycosyltransferases. Glycosylation influences the physicochemical and biological properties of proteins, with subsequent effects on subcellular and extracellular protein trafficking, cell–cell recognition, and ligand–receptor interactions. Glycan structures can be complex, as is the regulation of their biosynthesis, and it is only recently that the systems biology of metabolic flux control and glycosyltransferase networks has become a study in its own right. We review various models of glycosylation that have been proposed to date, based on current knowledge of Golgi structure and function, and consider how metabolic flux through glycosyltransferase networks regulates glycosylation events in the cell. [ABSTRACT FROM AUTHOR]

To investigate the addition of a computed tomography (CT)-based method of osteoporosis screening to FRAX without bone mineral density (BMD) fracture risk assessment in men undergoing radiotherapy for prostate cancer, we reviewed the records of all patients with localized prostate cancer treated with external beam radiotherapy at our institution between 2001 and 2012. The 10-yr probability of hip fracture was calculated using the FRAX algorithm without BMD. The CT attenuation of the L5 trabecular bone (L5 CT ) was assessed by contouring the trabecular bone on a single CT slice at the level of the midvertebral body and by averaging the Hounsfield units (HU) of all included voxels. L5 CT values of 105 and 130 HU were used as screening thresholds. The clinical characteristics of additional patients identified by each L5 CT screening threshold value were compared to patients whose estimated 10-yr risk of hip fracture was 3% or greater by FRAX without BMD. A total of 609 patients treated between 2001 and 2012 had CT scans available for review and complete clinical information allowing for FRAX without BMD risk calculation. Seventy-four (12.2%) patients had an estimated 10-yr risk of hip fracture of 3% or greater. An additional 22 (3.6%) and 71 (11.6%) patients were identified by CT screening when thresholds L5 CT  = 105 HU and L5 CT  = 130 HU were used, respectively. Compared to the group of patients identified by FRAX without BMD, the additional patients identified by CT screening at each L5 CT threshold level tended to be younger and heavier, and were more likely to be African–American or treated without androgen deprivation therapy. These results suggest that the addition of CT-based screening to FRAX without BMD risk assessment identifies additional men with different underlying clinical characteristics who may be at risk for osteoporosis and may benefit from pharmacological therapy to increase BMD and reduce fracture risk. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to determine whether radiation dose inhomogeneity within the prostate predisposes to late urinary strictures after moderately hypofractionated definitive external beam radiation therapy for prostate cancer. Methods and materials One hundred seventy-three men with clinically localized prostate cancer met the inclusion criteria for this analysis. All patients received 70 Gy to the prostate delivered over 28 fractions, had at least 2 years of clinical follow-up, and had dose-volume histogram information available for review. The endpoint of this study was the development of a urethral stricture that required a procedural intervention such as urethral dilation or suprapubic catheterization. Dosimetric parameters were evaluated for effect on the rate of urethral stricture formation by univariate Cox proportional hazards modeling. Results The median follow-up was 49.5 months (range, 24.6-108 months). At 5 years, the actuarial rate of intervention for urethral strictures across all patients was 4.9%. The maximum point dose within the prostate ( P = .034, hazard ratio = 1.006) and the mean prostate dose ( P = .039, hazard ratio = 1.004) were the only parameters predictive of urethral stricture formation. All patients who developed a urethral stricture were treated by a plan with a maximum prostate dose of > 75 Gy (median, 77.67 Gy). Conclusions For patients receiving moderately hypofractionated prostate radiation therapy over 28 fractions, a maximum point dose of 75 Gy within the prostate was associated with an increased probability of developing a urethral stricture that required procedural intervention. The hypothesis that hypofractionation increases susceptibility to toxicity from heterogeneity within the prostate should be confirmed by analyzing data from randomized trials with a conventionally fractionated control arm for comparison. [ABSTRACT FROM AUTHOR]