SPAWAR awards Leidos $4.3B IDIQ for Defense Healthcare Modernization

Pentagon Awards $9 Billion Deal for Electronic Health Records | DoD Buzz
The contract will modernize how the Pentagon provides care to some 9.5 million military members, families and retirees in part by installing new IT equipment and software to better share patient information with the Veterans Affairs Department and private providers, officials said.
While the military has used electronic health records for years, many troops who deployed to warzones such as Afghanistan and Iraq had trouble accessing their medical history from base to base and resorted to storing the information on portable computer disks such as thumb drives. In other cases, they carried around paper records in manila folders.
“That will be a thing of the past,” Jonathan Woodson, a doctor and assistant secretary of defense for health affairs, pledged during the conference call.
Yet getting the new system up and running across the Pentagon’s 55 military hospitals and 600 clinics will take years. The plan is to begin installing the technology at eight locations in the Pacific Northwest, then expand to the rest of the sites over six or seven years, Kendall said. The names of the initial locations weren’t immediately available.

Defense.gov Contracts for Wednesday, July 29, 2015

No: CR-143-15
July 29, 2015

CONTRACTS

NAVY

Leidos, Inc., Reston, Virginia was awarded a ceiling $4,336,822,777  indefinite-delivery/indefinite-quantity contract, with firm-fixed-price, cost-plus-fixed-fee, cost-plus-incentive fee, and fixed-price incentive pricing arrangements, for the Defense Healthcare Management System Modernization program. As a service provider integrator, the contractor will provide an electronic health record off-the-shelf solution, integration activities and deployment across the Military Health System.
This contract has a two-year initial ordering period, with two 3-year option periods, and a potential two-year award term, which, if awarded, would bring the total ordering period to 10 years. Work will be performed at locations throughout the United States and overseas. If all options are exercised, work is expected to be completed by September 2025. Fiscal 2015 Defense Health Program Research, Development, Test and Evaluation funds in the amount of $35,000,000 will be obligated at the time of award. Additional funds will be obligated as individual delivery orders are issued. This was a competitive acquisition, with six offers received. The Space and Naval Warfare Systems Command, San Diego, California, is the contracting activity (N00039-15-D-0044).


Leidos wins DoD healthcare systems modernization contract 
A team led by Leidos Inc. has won the long-awaited $4.3 billion contract award on July 29 for the Defense Healthcare Management Systems Modernization (DHMSM) system. The team also includes electronic health record vendor Cerner Corporation and Accenture Federal.
The Defense Department issued a request for proposals for a new electronic health records system almost a year ago.
Other competitors that lost out to the Leidos team included parrtnerships led by IBM and Computer Sciences Corp.

The contract award had originally been promised months ago. Federal documents showed a $149 million budget for DHMSM for fiscal 2015, and a contract award was expected in early in the 2015 fiscal year. The program's price tag could reach $11 billion over the course of its life cycle through 2030, Chris Miller, program executive officer for the DHMSM and integrated electronic health records, said last year.

DoD awards Cerner, Leidos, Accenture EHR contract | Healthcare IT News
New estimated cost: $9B. 'Competition has worked for us.'

The US Department of Defense handed down the largest and most-anticipated electronic health record system contract in history late Wednesday.

And the winner is (drumroll, please) … Cerner, Leidos and Accenture. The contract's initial piece, valued at $4.3 billion, calls for the team to provide "an electronic health record off-the-shelf solution, integration activities and deployment across the Military Health System," a DoD spokesperson told Healthcare IT News.

DoD's choice, in the end, came down to three teams: 

1. Epic Systems and IBM; 
2. Cerner, Leidos and Accenture; and 
3. Allscripts aligned with Computer Sciences Corp. and Hewlett-Packard.

Cerner wins DoD electronic health records contract - MedCity NewsMedCity News
A coalition including Cerner has won the coveted Defense Healthcare Management System Modernization contract to replace the electronic health records system for the Military Health System. Kansas City, Mo.-based Cerner joined with with federal contractors Leidos and Accenture Federal on the bid.
Cerner beat out competing bids from the teams of Epic Systems and IBM; and Allscripts, Computer Sciences Corp. and Hewlett-Packard. The award is valued at $4.3 billion, though Defense Department officials said that it could be worth more than $9 billion over the next 10 years — below earlier estimates of $11 billion.

SPAWAR picks 5 small firms for $232M IDIQ FMS C4I Support

Defense.gov Contracts for Wednesday, July 29, 2015

No: CR-143-15
July 29, 2015

CONTRACTS

NAVY

• C4 Planning Solutions, LLC*, Blythe, Georgia (N00039-15-D-0036);
• Cambridge International Systems, Inc.*, Arlington, Virginia (N00039-15-D-0037); 
• Envistacom, LLC*, Atlanta, Georgia (N00039-15-D-0038); 
• Forward Slope, Inc.* San Diego (N00039-15-D-0039); and 
• SOLUTE Consulting*, San Diego (N00039-15-D-0040)

are being awarded a $232,068,059 indefinite-delivery/indefinite-quantity, hybrid, cost-plus-fixed-fee, firm-fixed-price, cost-reimbursable-type, multiple-award contract for command, control,  communications, computers, and intelligence (C4I) systems integration and engineering services in
support of authorized and approved U.S. security assistance and security cooperation programs.


Foreign Military Sale funds in the amount of  $5,000 per contract awardee (for a total of $25,000) will be placed on contract and obligated at the time of award via a delivery order to each awardee. This contract involves utilizing Foreign Military Sales to various security cooperation partners to be identified as individual delivery orders are issued.


Work will be performed in various overseas locations based on the requirement for each individual delivery order placed. The ordering period is three years for the base period up to the contract award amount. The base ordering period expires July 2018. The multiple-award contract was competitively procured with small business proposals solicited and 22 offers received via the Commerce Business
Daily's Federal Business Opportunities and the SPAWAR e-Commerce Central websites. Space and Naval Warfare Systems Command, San Diego, California is the contracting activity.

Related/Background:

• SPAWAR Security Cooperation Overview 20 March ... - DMAG

Smart Meters and Variable Prices Could Cause Chaos and Blackouts

A seemingly obvious way to make the electricity market better may actually make it worse
Smart Meters Can Destabilize Grid, Study Says | EE Times

The simulation shows that in such a competing situation the market behaviour will tend to be wild, erratic and chaotic. An example: If the energy supply is low and therefore the price is high, most users simply will tend to postpone their energy consumption. But they wont be able to do this at infinitum, explains Bornholdt. The more machines are waiting to get started, the higher the potential demand: A bubble forms. This bubble will burst at latest in the moment the price level falls slightly. Because many consumers have postponed their washing schedule, countless washers will start to wash suddenly at the same time. This triggers a collective avalanche mechanism that charges the grids extremely, Bornholdt says. This situation makes black-outs much more probable.


According to the conclusion of the research team, the massive deployment of smart meters is a quick shot that has not been thought through. In our computing model we reproduced with various variables
what real humans would logically do in such situations. In such situations, the individual does not know which consequences arise from his actions if it is multiplied. And unfortunately those who supply the energy do not know either.

Smart Meter Time Varying Pricing Can Lead to “Catastrophic Consequences” for the Grid | Smart Grid Awareness
A new study has been released based upon research at Bremen University that reveals that the use of time varying rates implemented through the mass deployment of smart meters can lead to consumer demand avalanches resulting in smart grid blackouts.

Density of prices for the time series as described in the caption of Fig. 2 (blue solid line). The average price is indicated with a vertical line together with multiples of one standard deviation (dotted lines). The density of highest acceptable prices pi(t) [Eq. (4), black circles] shows a concentration at prices far below the average price. The density of load bought at certain prices [Eq. (5), red squares] shows a maximum at rare price events more than two standard deviations below the average price. Simulation results are shown for N=106 and f=10−3 (as in Fig. 2) and T=107 time steps.

The study of the Bremen scientists has been published in the Physical Review of the American Physical Society.
For more details, see http://journals.aps.org/pre/abstract/10.1103/PhysRevE.92.012815

Abstract

The average economic agent is often used to model the dynamics of simple markets, based on the assumption that the dynamics of a system of many agents can be averaged over in time and space. A popular idea that is based on this seemingly intuitive notion is to dampen electric power fluctuations from fluctuating sources (as, e.g., wind or solar) via a market mechanism, namely by variable power prices that adapt demand to supply. The standard model of an average economic agent predicts that fluctuations are reduced by such an adaptive pricing mechanism. However, the underlying assumption that the actions of all agents average out on the time axis is not always true in a market of many agents. We numerically study an econophysics agent model of an adaptive power market that does not assume averaging a priori. We find that when agents are exposed to source noise via correlated price fluctuations (as adaptive pricing schemes suggest), the market may amplify those fluctuations. In particular, small price changes may translate to large load fluctuations through catastrophic consumer synchronization. As a result, an adaptive power market may cause the opposite effect than intended: Power demand fluctuations are not dampened but amplified instead.

Related/Background:

• Active Adaptive Control Laboratory
• » Smart Meters Navigant Research 
• Modeling and simulation of consumer response to dynamic pricing
• Dynamic Electricity Pricing for Smart Homes - University of ...
• smart meters, real time pricing, and demand response ...
  
  
   

SOC picks 4 firms for $900M IDIQ Support Contract

Defense.gov Contracts for Tuesday, July 28, 2015

SPECIAL OPERATIONS COMMAND

 

• 
  Booz Allen Hamilton Inc. (H92222-15-D-0022) and 
• CACI-WGI Inc.
  (H92222-15-D-0025), Tampa, Florida; 
• Raytheon Blackbird Technologies Inc.(H92222-15-D-0023), Herndon, Virginia; and 
• MacAulay-Brown Inc.
  (H92222-15-D-0024), Dayton, Ohio, 

were awarded an
indefinite-delivery/indefinite-quantity, multiple-award contract with a
combined ceiling value of $900,000,000 for Special Operations Command
Wide Mission Support services. The place of performance is multiple
locations both in the U.S. and overseas. The anticipated period of
performance is not to exceed five years. Each company will be awarded a
$2,500 minimum guarantee, and additional funding will be obligated on
individual task orders. Fiscal 2015 operations and maintenance funds
shall be used to satisfy the minimum of the contract The contracts were
competitively awarded using Federal Acquisition Regulation Part 15
procedures. Seventeen proposals were received. U.S. Special Operations
Command is the contracting activity.

Army Research Laboratory seeks Next Generation Radar (NGR) building blocks

Materials Pave Way To Military Advances
| Analog semiconductors content from Microwaves & RF

C-RAM Home

Advanced RF Technologies | U.S. Army Research Laboratory

U.S. Army Research Laboratory (ARL) Advanced RF Technologies - W911NF12R001103 - Federal Business Opportunities: Opportunities

Title:          U.S. Army Research Laboratory (ARL) Advanced RF Technologies  
Sol. #:         W911NF12R001103
Agency:         Department of the Army
Office:         Army Contracting Command
Location:       ACC-APG - RTP
Posted On:      Jul 27, 2015 1:54 pm
Base Type:      Special Notice
Link:           https://www.fbo.gov/notices/a9244f295a3e871b2af8a7d41c6e7445

U.S. ARMY RESEARCH LABORATORY (ARL), Sensors and Electronic Devices Directorate (SEDD) Advanced RF Technologies

The U.S. Army Research Laboratory (ARL) Electronics and RF Division (E&RF) is announcing a basic research (6.1) opportunity open to all academic, industrial and other government researchers to develop, fabricate and demonstrate a Next Generation Radar's (NGR) modular building blocks. The Division will, via the U.S. Army Contracting Command discussed below, let Cooperative Research Agreements (CRA) that focus on four (4) underpinning research areas, also detailed below, to develop, fabricate and demonstrate these modules. The CRAs let under this action will investigate new approaches to meet these modular expectations for Army's NGR. The research being executed under this action will tap into external high risk, high payoff approaches that will enhance our in-house multimode scalable investigation for Air Defense and Counter Rocket And Mortar (C-RAM) applications. The NGR is a joint Communications Electronics Research Development Engineering Center (CERDEC) , Aviation Missile Research Development Engineering Center (AMRDECO and ARL program with Fires Center of Excellence and Program Management Office (PMO) interest.

Army (and other DoD) Force Protection Radars include handheld, vehicle mounted and airborne configurations to support the following missions: Forward Operation Base (FOB) Protection that includes Dismount Detection, Air Defense, C-RAM. Size, Weight, Power and Cost (SWaP-C) continue to drive technology challenges for significant twenty first century advancements over our adversaries. The main thrust of this action is to address RF devices, components and architectures that are frequency agile across a spectrum along with supporting signal processing techniques that are adaptive to both the congested and contested environment while addressing the variety of potential threats.

Specific BAA Research focus areas:

• 1.2.6.b) Signal processing approaches for handling the adaptive and frequency-agility requirements, while enhancing target detection and tracking capabilities. Power efficient processing along with an open architecture implementation plan.
• 1.2.6.d) Advanced linearization studies - the multiple band and large instantaneous bandwidth requirements will also necessitate higher linearity front end components both integrated and extrinsic.
• 1.2.7) Complex vector modulation for developing spectrally pure intermediate frequency stages. Enhanced wideband receiver sensitivity for dynamic transmitter allocation enabling simultaneous transmit and receive requirements.
• 1.2.9) Highly integrated front end technology that exploits a wide range of power levels at high power added efficiencies. Reconfigurable requirements are needed between a power amplifier mode and a high dynamic range low noise amplifier. Strategies for heat removal will also be considered for amplifier performance enhancements. 

Electro-Magnetic Device Ends Migraine Pain

FDA approves magnetic device to relieve migraine pain - WorldNews

The End of Pain ‹ TERP
TRANSCRANIAL MAGNETIC STIMULATION DEVICE WITH BODY PROXIMITY SENSORS FOR THE TREATMENT OF MIGRAINE HEADACHES - ENEURA, INC.
He helps (and makes) millions | The Beacon Newspapers, Inc. 
The headache device, which received final approval from the Food and Drug Administration last year, is the brainchild of one of the great biomedical inventors of the past century, Robert E. Fischell M.S. ’54, Sc.D. (honorary) ’96.
FLEETING BURSTS OF ELECTROMAGNETISM known as pulses create electrical current in body tissues, blocking pain. That’s the concept behind the headache device, which he patented in 2002 along with his oldest son, David, and Canadian neurologist Dr. Adrian Upton.
UMD researchers helped develop prototypes of the device being brought to market by the Baltimore-based company eNeura. It is now delivering the device, called SpringTMS, to headache clinics around the nation in preparation for broader distribution in the next year.
How do electromagnetic pulses kill pain? Strangely enough, science can’t precisely answer that question because of our limited knowledge of the brain and nervous system. But Fischell’s theory is that the magnetic field scrambles communication between nerve cells. The result, he says, is that the signals received by the brain no longer register as pain.
Magnetic pulses have been used to treat depression, and implantable electrodes that direct electrical currents through the back for spinal pain work on a similar principle—although that requires expensive surgery and carries all of its associated risks, Fischell points out.
David Rosen, CEO of eNeura, predicts SpringTMS will revolutionize migraine treatment, but clinicians may at first be wary.



Fischell is planning a network of U.S. clinics where people suffering from bad backs, nerve pain from chemotherapy, achy arthritic joints and a host of other maladies can seek affordable, drug-free palliative care. Along with business partners—including UMD and the School of Medicine, each with a 3 percent cut—he’s set up a company called Zygood LLC to lay the groundwork for the clinics, which he hopes will operate nationwide and bring comfort to millions.

Previously/Related:

• First Rigorous Test Of Magnetic Stimulation Device Shows Promise For Short-Circuiting Migraines | Albert Einstein College of Medicine
• Migraine With Aura: Magnetic Stimulation Is A Promising Non-Drug Treatment Option - Medical News Today 
• Fischell, R.E., "The invention of the programmable implantable medication system," Engineering in Medicine and Biology Magazine, IEEE , vol.8, no.4, pp.65,66, Dec. 1989
  doi: 10.1109/51.45958
  Abstract: The author describes the genesis of his idea for a programmable implantable medication system and the problems encountered in going from idea to the first prototype. He discusses the funding, development, and marketing of his device. He provides some observations on the process of getting medical inventions into public use.<>
  keywords: {biomedical electronics;medical computing;patient treatment;device development;funding;marketing;medical inventions;programmable implantable medication system;public use;Batteries;Insulin;Laboratories;Manufacturing;Pacemakers;Physics;Prototypes;Pumps;Read only memory;Space technology},
  URL: http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=45958&isnumber=1736
• Fischell, R.E., "The retrospectroscope-the invention of the rechargeable cardiac pacemaker: vignette #9," Engineering in Medicine and Biology Magazine, IEEE , vol.9, no.2, pp.77,78, Jun 1990
  doi: 10.1109/51.57877
  Abstract: The idea for a rechargeable cardiac pacemaker came to the author in the late 1960s after reading an advertisement stating that a company's batteries were so good they would last two years in a heart pacemaker. This meant that pacemaker patients would have to undergo surgery for their replacement frequently. Having worked on the development of hermetically sealed, nickel-cadmium batteries that could function for a decade or longer in an orbiting spacecraft, the author constructed the first prototype of a rechargeable cardiac pacemaker around 1968 to show cardiologists at Johns Hopkins Hospital that a pacemaker of indefinitely long life and much smaller size and weight could be built readily. The subsequent development and marketing of the device, which came on the market in 1973, is recounted
  keywords: {history;pacemakers;prosthetic power supplies;Johns Hopkins Hospital;batteries;heart pacemaker;rechargeable cardiac pacemaker;Batteries;Cities and towns;Hermetic seals;Hospitals;Laboratories;Pacemakers;Physics;Prototypes;Space technology;Space vehicles},
  URL: http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=57877&isnumber=2100
• Saraiva Santos, N.; Sousa, S.C.P.; Crespo, P.; Cavaleiro Miranda, P.; Salvador, R.; Silvestre, J., "Shielding the magnetic field from a transcranial stimulator using aluminium and iron: Simulation and experimental results," Bioengineering (ENBENG), 2015 IEEE 4th Portuguese Meeting on , vol., no., pp.1,2, 26-28 Feb. 2015
  doi: 10.1109/ENBENG.2015.7088824
  Abstract: Repetitive transcranial magnetic stimulation (rTMS) is an up-and-coming, noninvasive technique that holds therapeutic promise in a range of neuropsychiatric and neurological diseases. In rTMS, a time-varying magnetic field induces an electric current in the brain. Since its introduction close to 30 years ago, numerous studies have widely recognised it in the research or treatment of several diseases (e.g. epilepsy, Parkinson's disease, stroke or neuropathic pain). rTMS treatments already occurring in the USA include psychiatric conditions like major depression (approved in 2008), and migraine (approved in 2013). Nevertheless, throughout several years it has been found that the stimulation of subcortical brain structures is inaccessible with standard rTMS equipment. Accessing such deep-brain regions may potentially result in the improvement of a variety of neuropsychiatric and neurological disorders. The design of TMS coils to stimulate deep brain targets is limited by the rapid attenuation of the electric field in depth. This is mainly due to the physical limiting effect arising from the presence of surface discontinuities. To the best of our knowledge the Hesed coil represents the state of the art of clinical deep-brain TMS. Nonetheless, there is no configuration able of producing an effective field at the very center of the brain. We have proposed a TMS system termed orthogonal configuration that is capable of reaching the very center of a spherical brain phantom (at 10-cm depth) with 58% strength in respect to the surface maximum. The high, external magnetic field of this configuration was designed so that it is incapable of inducing heart fibrillation in the patient by four orders of magnitude in respect to its threshold. Nevertheless, Comsol^® AC/DC simulations show that a system operator positioned sideways, 10 cm apart from the orthogonal configuration will experience an induced current density in his heart of 0.7 A/m² (heart fi- rillation threshold is 1 A/m²). Only 3.4 m away from the orthogonal configuration will a heart current density of 0.001 A/m² be achieved. In this work we focus on the shielding aspects necessary to install an orthogonal TMS system providing full safety to patient and any of its operators. For that, we have measured the TMS signal attenuation induced by an iron or aluminium slab of material positioned between a TMS coil and a current density sensor located inside a cylinder container filled with a saline solution (7 S/m, i.e. 5% ^w/v of NaCl in water). Simulations combined with experimental results show that a simple 25-mm-thick slab of aluminium surrounding five walls of the orthogonal TMS system (positioned 40 cm apart from its edges) is enough to achieve a current density in the heart of any operator inferior to 0.001 A/m², i.e. at least three orders of magnitude below fibrillation threshold. This allows us to conclude on the viability of implementing an R&D orthogonal TMS system in the near future.
  URL: http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=7088824&isnumber=7088795
• Kortekaas, R.; van Belkum, S.M.; van Nierop, L.E.; Schoevers, R.A., "Weak field transcerebral pulsed electromagnetic fields in health care," Antennas and Propagation (EuCAP), 2014 8th European Conference on , vol., no., pp.1673,1676, 6-11 April 2014
  doi: 10.1109/EuCAP.2014.6902110
  Abstract: Neuropathic pain and major depressive disorder are two disorders that affect a large proportion of the population and that lead to vast losses of well being, productivity and money. Transcranial magnetic stimulation has been applied in both conditions, with encouraging results. Here we describe experimental treatment of these conditions with weak field transcerebral pulsed electromagnetic fields. Experimentel heat pain could be reduced with our stimulation, but this effect did not generalize to the capsaicin pain model in healthy volunteers. Studies in neuropathic pain patients have just finished data acquisition and studies in depressed patients are ongoing. We conclude that this type of weak field transcerebral pulsed electromagnetic stimulation deserves serious consideration in health care.
  keywords: {electromagnetic fields;health care;transcranial magnetic stimulation;capsaicin pain model;data acquisition;depressive disorder;health care;neuropathic pain;neuropathic pain patients;transcranial magnetic stimulation;weak field transcerebral pulsed electromagnetic fields;weak field transcerebral pulsed electromagnetic stimulation;Antennas;Conferences;Europe;extremely low frequency;measurement;propagation},
  URL: http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=6902110&isnumber=6901672
• Sekino, M.; Suyama, M.; Dongmin Kim; Saitoh, Y., "A magnetic stimulator coil with high robustness to positioning error," General Assembly and Scientific Symposium (URSI GASS), 2014 XXXIth URSI , vol., no., pp.1,3, 16-23 Aug. 2014
  doi: 10.1109/URSIGASS.2014.6930094
  Abstract: Transcranial magnetic stimulation (TMS) is effective for treatment of neurological diseases such as neuropathic pain. We are newly developing magnetic stimulators for use at patient's home for realizing daily treatment. One of the technical challenges is a system for positioning the stimulator coil. In this study, we proposed a coil design which gives a high robustness to positioning error. We numerically evaluated the characteristics of the coil when changing the width, depth, height, and the number of turns of the coil. The results showed that the mostly influencing parameter on the broadening of the eddy current was the width of the coil, and the vertical length was influential on the current density. We found the proposed coil induces eddy currents in a wider range than conventional figure-eight coils.
  URL: http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=6930094&isnumber=6928981 
• Saitoh, Y.; Maruo, T.; Yokoe, M.; Matsuzaki, T.; Sekino, M., "Electrical or repetitive transcranial magnetic stimulation of primary motor cortex for intractable neuropathic pain," Engineering in Medicine and Biology Society (EMBC), 2013 35th Annual International Conference of the IEEE , vol., no., pp.6163,6166, 3-7 July 2013
  doi: 10.1109/EMBC.2013.6610960
  Abstract: Objective: To assess the pain-relieving effects of motor cortex electrical stimulation (MCS) and the predictive factors retrospectively. Methods: Thirty-four patients with intractable neuropathic pain underwent MCS; 19 patients had cerebral lesions, and 15 had non-cerebral lesions. In selected 12 patients, test electrodes were implanted within the central sulcus and on the precentral gyrus. Twelve patients received both MCS and repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex. Results: Pain reduction of >50% was observed in 12 of 32 (36%) patients with >12 months follow-ups (2 patients were excluded because of short follow-up). In 10 of the 12 patients who received test electrodes within the central sulcus and on the precentral gyrus, the optimal stimulation was MCS within the central sulcus. In 4 of these (40%) patients, positive effects were maintained at follow-ups. The pain reduction of rTMS significantly correlated with that of MCS during test stimulation. Conclusions: The test stimulation within the central sulcus was more effective than that of the precentral gyrus. In the selected patients, chronic stimulation within the central sulcus did not significantly improve long-term results. Repeated rTMS seems to be same effective as MCS.
  URL: http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=6610960&isnumber=6609410 
• Yasumuro, Y.; Ebisuwaki, R.; Fuyuki, M.; Matsuzaki, T.; Saitoh, Y., "Coil positioning system for repetitive transcranial magnetic stimulation treatment by ToF camera ego-motion," Engineering in Medicine and Biology Society (EMBC), 2013 35th Annual International Conference of the IEEE , vol., no., pp.3586,3589, 3-7 July 2013
  doi: 10.1109/EMBC.2013.6610318
  Abstract: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive method for treating various neurological and psychiatric disorders. With the growing demands of neuropathic pain patients and their increasing numbers, rTMS treatment tools are becoming more necessary. rTMS uses electromagnetic induction to induce weak electric currents by rapidly changing the magnetic field. Targeting the electric current to a specific part of the brain is one treatment for pain relief. This paper focuses on treatment for neuropathic pain caused by a lesion or disease of the central or peripheral nervous system, including stroke, trauma, or surgery. However, the current style of rTMS treatment is still developing and is so technically specialized that only a limited number of hospitals and only a handful of specialists can provide this therapy. The existing rTMS systems use an optical markerbased 3D sensing technique that positions the stimulation coil to target the small region of interest in the brain through coregistration with pre-scanned MRI data. This system requires the patient to be immobilized on a bed. The optical markers for 3D sensing are placed on the patient's head to maintain accurate positioning. We propose a constraints-free, markerless rTMS system, which employs ego-motion, a computation technique to estimate relative 3D motion of a camera to what the camera sees. We use a ToF sensor as a camera, which is capble of capturing shape information from a single viewpoint instantly. The markerless target spot is based on the shape features of the patient's face. This paper shows the process of a prototype system and its potential for achieving an easy-to-handle system framework.
  URL: http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=6610318&isnumber=6609410
• Yasumuro, Y.; Hosomi, K.; Saitoh, Y.; Matsuzaki, T., "Uncertainty assessment of target localization for rTMS treatment," Complex Medical Engineering (CME), 2012 ICME International Conference on , vol., no., pp.784,787, 1-4 July 2012
  doi: 10.1109/ICCME.2012.6275590
  Abstract: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive method for treating various neurological and psychiatric disorders. This paper focuses on a technical aspect of this treatment method for neuropathic pain that can be caused by a lesion or disease of the central or peripheral nervous system, including stroke, trauma or surgical operation. rTMS uses electromagnetic induction to induce weak electric currents by rapidly changing the magnetic field. Targeting a specific part of the brain to locate the magnetic field works as a treatment for pain relief. This is the reason why the current style of rTMS treatment is still developing and is so technically specialized that only a limited number of hospitals and only a handful of specialists can provide this therapy. The existing systems of rTMS are based on an optical maker-based 3-dimensional (3D) sensing technique for positioning the stimulation coil to target the small spot in the region of interest in the brain, and for referring pre-scanned MRI data to check the target position. Furthermore, the existing systems require the patient to be fixed on a bed in which optical markers for 3D sensing are placed during the treatment to maintain positioning precision. With the growing demands of neuropathic pain patients and their increasing numbers, new approaches and systems to achieve more supportive and easy-to-handle navigation have been proposed lately for rTMS treatment. This paper proposes a quantitative index for localization precision, considering an uncertainty measure. Uncertainty is technically defined as a parameter, associated with the result of a measurement that characterizes the dispersion of the values that could reasonably be attributed to the measurement. This paper shows a detailed example of the uncertainty derivation for rTMS treatment, based on trial tasks for searching the spots on the brain that cause muscle twitch.
  URL: http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=6275590&isnumber=6275588
  
   

USAF Academy use Viking 300 UAV for training

L-3_Viking_300.pdf

VIRIN: 090720-F-0000P-101

U.S. Air Force Academy Cadets 2nd Class Jeffrey Nakayama and Rupert Domingo inspect a Viking 300 unmanned aircraft vehicle before launch from Camp Red Devil on July 20 at Fort Carson, Colorado. The Academy's new UAS training is designed to encourage cadets to serve as UAS leaders after graduation. The Viking 300 weighs between 200 and 300 pounds and has a top speed of 100 knots, with a cruising speed of 55 knots. (U.S. Air Force photo by Ann Patton)/Released

A larger, high-res version can be viewed or downloaded here:
http://media.dma.mil/2009/Aug/11/2000505216/-1/-1/0/090720-F-0000P-101.JPG

Related/Background:

• L3 ISR UAS Flight Operations and Training
• L3 BAI Aerosystems confirms new Viking UAV family in series production for unnamed US military customer - 9/11/2006 - Flight Global 

Very-High-Resolution SAR Image Ontologies

IEEE Xplore Abstract - Very-High-Resolution SAR Images and Linked Open Data Analytics Based on Ontologies

Espinoza-Molina, D.; Nikolaou, C.; Dumitru, C.O.; Bereta, K.; Koubarakis, M.; Schwarz, G.; Datcu, M., "Very-High-Resolution SAR Images and Linked Open Data Analytics Based on Ontologies," Selected Topics in Applied Earth Observations and Remote Sensing, IEEE Journal of , vol.8, no.4, pp.1696,1708, April 2015
doi: 10.1109/JSTARS.2014.2371138

Abstract: In this paper, we deal with the integration of multiple sources of information such as Earth observation (EO) synthetic aperture radar (SAR) images and their metadata, semantic descriptors of the image content, as well as other publicly available geospatial data sources expressed as linked open data for posing complex queries in order to support geospatial data analytics. Our approach lays the foundations for the development of richer tools and applications that focus on EO image analytics using ontologies and linked open data. We introduce a system architecture where a common satellite image product is transformed from its initial format into to actionable intelligence information, which
includes image descriptors, metadata, image tiles, and semantic labels resulting in an EO-data model. We also create a SAR image ontology based on our EO-data model and a two-level taxonomy  classification scheme of the image content. We demonstrate our approach by linking high-resolution TerraSAR-X images with information from CORINE Land Cover (CLC), Urban Atlas (UA),  GeoNames, and OpenStreetMap (OSM), which are represented in the standard triple model of the resource description frameworks (RDFs).
keywords: {Data models;Feature
extraction;Geospatial analysis;Ontologies;Semantics;Synthetic aperture radar; Vectors; Analytics; Strabon; TerraSAR-X images; linked open data;ontologies;queries;resource description framework (RDFs)},
URL: http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=6981927&isnumber=7112230

Dumitru, C.O.; Cui, S.; Schwarz, G.; Datcu, M., "Information Content of Very-High-Resolution SAR Images: Semantics, Geospatial Context, and Ontologies," Selected Topics in Applied Earth Observations and Remote Sensing, IEEE Journal of , vol.8, no.4, pp.1635,1650, April 2015
doi: 10.1109/JSTARS.2014.2363595

Abstract: Currently, the amount of collected Earth Observation (EO) data is increasing considerably with a rate of several Terabytes of data per day. As a consequence of this increasing data volume, new concepts for exploration and information retrieval are urgently needed. To this end, we propose to explore satellite image data via an image information mining (IIM) approach in which the main steps are feature extraction, classification, semantic annotation, and interactive query processing. This leads to a new process chain and a robust taxonomy for the retrieved categories capitalizing on human interaction and judgment. We concentrated on land cover categories that can be retrieved from high-resolution synthetic aperture radar (SAR) images of the spaceborne TerraSAR-X instrument, where we annotated different urban areas all over the world and defined a taxonomy element for each prevailing surface cover category. The annotation resulted from a test dataset comprising more than 100 scenes covering diverse areas of Africa, Asia, Europe, the Middle East, and North and South America. The scenes were grouped into several collections with similar source areas and each collection was processed separately in order to discern regional characteristics. In the first processing step, each scene was tiled into patches. Then the features were extracted from each patch by a Gabor filter bank and a support vector machine with relevance feedback classifying the feature sets into user-oriented land cover categories. Finally, the categories were semantically annotated using Google Earth for ground truthing. The annotation followed a multilevel approach that allowed the fusion of information being visible on different resolution levels. The novelty of this paper lies in the fact that a semantic annotation was performed with a large number of high-resolution radar images that allowed the definition of more than 850 surface cover categories. This opens the way toward an automated identification - nd classification of urban areas, infrastructure (e.g., airports), geographic objects (e.g., mountains), industrial installations, military compounds, vegetation, and agriculture. Applications that may result from this work can be a semantic catalog of urban images to be used in crisis situations or after a disaster. In addition, the proposed taxonomies can become a basis for building a semantic catalog of satellite images. Finally, we defined four powerful types of high-level queries. Querying on such high levels provides new opportunities for users to search an image database for specific parameters or semantic relationships.
keywords: {Earth;Feature extraction;Remote sensing;Satellites;Semantics;Synthetic aperture radar;Taxonomy;Annotation;TerraSAR-X;classification;feature extraction;high-resolution images;indexing;ontologies;querying;semantic catalogs;synthetic aperture radar (SAR);taxonomies},
URL: http://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=6960829&isnumber=7112230 

Big 3 Battle for E-8 Joint-STARS Replacement

USAF Eyes Business Jets As Possible E-8 JSTARS Replacement
| Defense Tech

Boeing Again Pushes P-8 as a JSTARS Replacement
| Defense News: Aviation International News

ANALYSIS: Northrop battling to retain JSTARS as Lockheed, Boeing bid on recap - 7/24/2015 - Flight Global

An effort to recapitalise the Northrop Grumman E-8C Joint Surveillance Target Attack Radar System (JSTARS) with a modern business jet is shaping up to be this summer’s blockbuster defence programme, with three solid industry teams now vying for the $6.5 billion prize and Raytheon working on a curious new airborne radar called “Skynet”.

Northrop (the incumbent prime contractor), Lockheed Martin and Boeing have competing JSTARS proposals and are in a “blackout period” with no communication with the US Air Force as it decides whether to put two or all three teams on contract for an 11-month “pre-development” risk-reduction programme. The decision is expected in late August or early September, the air force says, and the main downselect to a single design will occur in late 2017.

JSTARS Recap, as the programme is known, officially started this year and aims replace the air force’s 16 large and expensive 707-300-based E-8C ground-looking battle management, surveillance and moving target indicator aircraft with 17 militarised business-class aircraft by 2026.

JSTARS Replacement: Competition Opened Wide
June 17/15: Following Northrop Grumman, L-3, General Dynamics and Gulfstream’s lead, a competing team of Lockheed Martin, Raytheon and Bombardier are now positioning to compete for the Air Force’s JSTARS recap program. Raytheon and Lockheed Martin had previously announced their intention to partner for the competition, with Bombardier set to bring their long-range business jet to the team, to complement Raytheon’s sensor portfolio and Lockheed Martin’s system integration expertise. The Air Force has also opened up the competition to European firms.

J-STARS

The entire J-STARS fleet are being progessively upgraded to the Block 20 configuration of the last seven production aircraft in a $40million programme, which has seen new Compaq workstations installed, together with a new General Dynamics radar signall processor and a fibre-optic network. A new open architecture configuration, using two commercial Compaq GS-320 'AlphaServer' processors will allow the aircraft to be upgraded more effectively in the future when new systems are developed. Another development planned for the future is the aircraft’s APY-3 radar benefiting from the $1.3 billion Multi-Platform Radar Technology Insertion Programme (MP-RTIP). Around 2012, the new APY-X two-dimensional electronically scanned active array radar could well replace the current APY-3 radar. In addition, it is also planned to improve the current SAR image resolution with the Enhanced Synthetic Aperture Radar (ESAR) and Inverse Synthetic Aperture Radar (ISAR) upgrades. Another upgrade programme for the J-STARS is the concept of Automatic Target Recognition (ATR) which will provide templating techniques to identify ground-based targets, using the processed ESAR and ISAR data. The MP-RTIP was originally intended to be installed in the E-10 Multi-Mission Command and Control Aircraft and the RQ-4 Global Hawk rather than the E-8, however, considerable doubts are being raised about the programme cost and appropriate E-10 acquision timescale and this could result in the radar being installed on the E-8. If the upgrade is approved, the first five RTIP equipped would be operational until around 2012.
Northrop Grumman E-8 Joint STARS | Project Gutenberg Self-Publishing - eBooks | Read eBooks online

Joint-STARS Radar and systems

The AN/APY-7 radar can operate in the following modes:

• wide area surveillance,
• ground moving target indicator (GMTI),
• fixed target indicator (FTI) target classification, and
• synthetic aperture radar (SAR) modes.

To pick up moving targets, the radar looks at the Doppler frequency shift of the returned signal. It can look from a long range, which the military refers to as a high standoff capability. The antenna can be tilted to either side of the aircraft for a 120-degree field of view covering nearly 50,000 km² (19,305 mile²) and can simultaneously track 600 targets at more than 250 km (152 miles). The GMTI modes cannot pick up objects that are too small, insufficiently dense, or stationary. Data processing allows the APY-7 to differentiate between armored vehicles (tracked tanks) and trucks, allowing targeting personnel to better select the appropriate ordnance for various targets.

The system's SAR modes can produce images of stationary objects. Objects with many angles (for example, the interior of a pick-up bed) will give a much better radar signature, or specular return. In addition to being able to detect, locate and track large numbers of ground vehicles, the radar has a limited capability to detect helicopters, rotating antennas and low, slow-moving fixed-wing aircraft.

Battle management

The radar and computer subsystems on the E-8C can gather and display broad and detailed battlefield information. Data is collected as events occur. This includes position and tracking information on enemy and friendly ground forces. The information is relayed in near-real time to the US Army's common ground stations via the secure jam-resistant surveillance and control data link (SCDL) and to other ground C4I nodes beyond line-of-sight via ultra high frequency satellite communications.
Other major E-8C prime mission equipment are the communications/datalink (COMM/DLX) and operations and control (O&C)subsystems. Eighteen operator workstations display computer-processed data in graphic and tabular format on video screens. Operators and technicians perform battle management, surveillance, weapons, intelligence, communications and maintenance functions.
Northrop Grumman has tested the installation of a MS-177 camera on an E-8C to provide real time visual target confirmation.^[6]

In missions from peacekeeping operations to major theater war, the E-8C can provide targeting data and intelligence for attack aviation, naval surface fire, field artillery and friendly maneuver forces. The information helps air and land commanders to control the battlespace.^[7]
The E-8's ground-moving radar can tell approximate number of vehicles, location, speed, and direction of travel. It cannot identify exactly what type of vehicle a target is, tell what equipment it has, or discern whether it is friendly, hostile, or a bystander, so commanders often crosscheck the JSTARS data against other sources. In the Army, JSTARS data is analyzed in and disseminated from a Ground Station Module (GSM).

Previously:

• spendergast: Joint STARS Re-capitalization effort begins
• Business Jets as Alternative for the E-8C JSTARS | Defense Update:  
• Lockheed teams with Raytheon for JSTARS replacement - 2/19/2015 - Flight Global 
• IEEE Xplore Abstract - Very-High-Resolution SAR Images and Linked Open Data Analytics Based on Ontologies 
• U.S. Navy Hawkeye Crew Evaluated USAF's E-8C JSTARS for Future Maritime Missions 
• Air Force Looking for JSTARS Recapitalization | Air Force Times | airforcetimes.com 
• NATO's New Eyes in the Sky / ISN
  Global Hawk will be a less expensive version of JSTARS, but downlink of data may be a bottleneck.
   

Hertog Summer - Potomac Simulation Hegemon

The Navy's Grade 36 Bureaucrat: Hertog Summer Study: Turn 1

Hegemon is designed as a game to get policy makers to understand the military consequences of a war. Military actions are written at the strategic level, so there is a lot of detail of military action that is auto-generated. The negotiations are done person to person, with different people playing different parts. On Tuesday we got our team assignments, and I was picked to play Indonesia. How about that!
Unfortunately, because there are two different games ongoing, I have to play an Indonesian A and B team. That requires a bit more brainpower to keep everything straight, but I'm up for the challenge

When we finally got our KMZ file
(the game is played on Google Earth),
the world looked like this

So first, my country is pink. Luckily, I'm manly enough to take that. However, I really don't have any units. Because the game designers made the game at the strategic level, I don't have a lot of units.

» Simulations The Potomac Foundation

The Potomac Foundation’s proprietary Hegemon© platform and methodology offer an interactive simulation and modeling experience to teams of analysts and strategists. Based on open-source and de-classified data points for tactical, operational, theater and strategic levels of analysis, Hegemon allows the participants to work through diverse sets of scenarios, test old assumptions and develop new concepts of operations. Our past and current wargaming clients include the U.S. and allied government agencies, military colleges, national security contractors and the private industry.

» The Hertog Summer Study The Potomac Foundation

The Potomac Foundation Hegemon: Rise of China simulation has been featured at the Hertog  Summer Study Program, a program run by Johns Hopkins SAIS to educate field-rank officers being prepared for flag-rank promotion, for the past three years.

The simulation allows officers and academics to take up the challenges currently facing the United States, People’s Republic of China, and various other players in the Asia-Pacific theater (including
but not limited to Japan, Taiwan, the Philippines, Vietnam, Singapore, Australia, and Russia) and compete to achieve their long-term objectives in the theater.

China's own course:

The China Factor--- Managing China’s Global Challenge - CLASS DETAIL - PKU Summer School International 
The rise of China over the last two decades is one of the most significant events that shape global market competition, trade and economic development, and geopolitics. Its implications on worldly issues from global and regional peace and security to the sustainability of the environment are profound. The China factor is an amalgamation of dynamic, complex and interactive forces that appear as problems, puzzles or challenges to different people at different times. This course aims to provide an orientation for students to understand those forces, especially those related to the major stakeholders and their evolving relationships, policies and game rules, and collective behaviors. The orientation is grounded in both Chinese historical and cultural legacies and the contexts of China’s state building, modernization and globalization. The course covers a wide array of topics in primarily three areas: international relations, investment and trade, and market competition.

Another view:

Why the Rise of China Will Not Lead to Global Hegemony
Domestic inadequacies and a loss of international prestige has left a growing number of scholars, analysts, and other experts worried about the imminent decline of the United States of America (U.S.).  This coincides with the assumptions of Hegemonic Stability Theory (HST), which presupposes the cyclical transition of world leadership.  Said differently, the reigning world leader could soon be replaced by a new power.  Over the last few decades military thinkers, journalists, policymakers, and scholars alike, have been watching with a wary eye, the rapid rise of China.  Understandably, some are uneasy about the emergence of the People’s Republic of China (PRC) as a new superpower.  Given the apparent decline of the U.S., many experts even wonder if the PRC is positioning itself to succeed the U.S. as global hegemon.[1] Its impressive economic growth and formidable military buildup could indicate that China is preparing for just such an occasion.

Prostate Cancer News 07-24-2015

Prostate Cancer News 07-24-2015

Study Supports Surgery for High-Risk Prostate Cancer
- Renal and Urology News

Prostate cancer: treatment options | CPD article | Pharmaceutical Journal
Treatment of early stage prostate cancer and locally advanced disease can involve surveillance, radical treatment or androgen deprivation therapy; however, as the disease progresses, these options change. Although patients may require definitive therapy as their disease progresses, active surveillance is an important treatment option.
Radical prostatectomy or radical radiotherapy are recommended for men with intermediate- and high-risk localised prostate cancer, where there is a prospect of long-term disease control. However, both options are associated with complications, including impaired sexual function.
Androgen deprivation therapy has been the mainstay for advanced prostate cancer management; however, recently there has been a move towards initiating hormonal treatment in younger men with early disease or recurrent disease after definitive treatment. Advanced disease, or metastatic castrate resistant prostate cancer, usually occurs 12–18 months after diagnosis and androgen ablation, with a median survival of two to three years. Treatment usually involves chemotherapy with docetaxel, but a number of newer drugs, including cabazitaxel, abiraterone and enzalutamide, are available.

General

Findings suggest improvement in management of localized prostate cancer

After years of overtreatment for patients with low-risk prostate cancer, rates of active surveillance/ watchful waiting increased sharply in 2010 through 2013, and high-risk disease was more often treated appropriately with potentially curative local treatment rather than androgen deprivation alone, according to a study in the July 7 issue of JAMA.  

Among men 75 years or older, the rate of surveillance was 54 percent from 1990 through 1994, declined to 22 percent from 2000 through 2004, and increased to 76 percent from 2010 through 2013. There was an increase in the use of surgery for men 75 years or older with low-risk cancer to 9.5 percent and intermediate-risk cancer to 15 percent; however, there was not an increase in use for those with high-risk cancer, among whom androgen deprivation still accounted for 67 percent of treatment.

Understanding the U.S. News Rankings for Prostate Cancer Care? - Cancer Answers
On Tuesday, U.S. News & World Report released its 2015–16 Best Hospitals rankings. The University of Texas MD Anderson Cancer Center in Houston regained the No. 1 ranking in cancer care. But does that mean it’s where prostate cancer patients should go?
As someone who lives with prostate cancer and heads a prostate cancer nonprofit, I believe the prostate cancer community would benefit from knowing about this top-ranked hospital’s prostate cancer care. But its No. 1 ranking doesn’t answer many questions.
 

What you can do

Preventing Prostate Cancer: Simple Tips For Men - ABC2News.com

UnitedHealthcare steps to help prevent prostate cancer:

• Eat Less Red Meat and Processed Meat. Red meat and processed meats like bacon have been linked to increased risk of prostate cancer.
• Eat more fruits and vegetables.
• Exercise more and maintain a healthy weight

Access : Effects of resistance training frequency on physical functioning and quality of life in prostate cancer survivors: a pilot randomized controlled trial : Prostate Cancer and Prostatic Diseases

This pilot randomized dose–comparison trial provides preliminary data to suggest that RT 3 days per week compared with 2 days per week may improve the strength and physical functioning in prostate cancer survivors, but may also blunt improvements in psychosocial functioning. Larger and more targeted phase II and III trials are needed to confirm the potentially complex effects of RT frequency in prostate cancer survivors.

Mediterranean Diet Decreases DNA Damage in Men with Prostate Cancer  

The results of the study were encouraging. The researchers found that DNA damage decreased as adherence to the modified Mediterranean diet increased and there was an inverse association between olive oil intake and DNA damage. On the other hand, DNA damage was reported to increase with increased consumption of dairy products and red meat.
The authors also found that higher levels of whole blood monounsaturated fatty acids and oleic acid were associated with decreased DNA damage, while high levels of omega-6 polyunsaturated fatty acids were associated with increased DNA damage.
The benefits of the modified Mediterranean diet extended to include weight loss and a feeling of general well-being at the end of the three-month period by some subjects.
Overall results indicate that changing the Western dietary pattern to a modified Mediterranean dietary pattern that includes fish and olive oil can be beneficial in decreasing DNA damage in men with prostate cancer.

Testosterone Replacement Therapy and Prostate Cancer Risk

A review of research on the use of testosterone replacement therapy in men with a history of prostate cancer and in men with elevated prostate cancer risk found no evidence of statistically significant associations between such treatment and cancer progression.

The finding supports the conclusion of several other recent studies that have attempted to evaluate replacement therapy in such populations and failed to find evidence of danger. - See more at: http://www.hcplive.com/medical-news/testosterone-replacement-therapy-and-prostate-cancer-risk#sthash.nr7HYohy.dpuf

A review of research on the use of testosterone replacement therapy in men with a history of prostate cancer and in men with elevated prostate cancer risk found no evidence of statistically significant associations between such treatment and cancer progression.

The finding supports the conclusion of several other recent studies that have attempted to evaluate replacement therapy in such populations and failed to find evidence of danger.

Screening; Diagnosis

Prostate cancer diagnoses drop, but it's not what it seems - NY Daily News

Intermediate and high-risk prostate cancers have seen a major drop in U.S. diagnoses, according to a recent study led by Vanderbilt University Medical Center, published last month in The Journal of Urology. Don’t be deceived: This is anything but good news. This significant drop in the number of diagnoses of intermediate (28%) and high-risk (23%) prostate cancers is most likely an indication that many of these cancers are not being found.

Prostate Cancer Survivor shares his Experiences post-diagnosis | NY City News

John Julius Hungwe (68), a survivor of prostate cancer, said the condition severely impacts the family. Things were quite difficult in Zimbabwe as the cost of cancer treatment is quite costly there. Hungwe said he never wanted to die, as life is so much fun for him.

Sensor chip could lead to more accurate prostate cancer diagnoses - Medical News Today

Sensor technology can improve accuracy of prostate cancer diagnosis, research shows

New research has shown how a smart sensor chip, able to pick up on subtle differences in glycoprotein molecules, can improve the accuracy and efficiency of prostate cancer diagnosis.

Read more at: http://phys.org/news/2015-07-sensor-technology-accuracy-prostate-cancer.html#jCp

New research has shown how a smart sensor chip, able to pick up on subtle differences in glycoprotein molecules, can improve the accuracy and efficiency of prostate cancer diagnosis.

 Initial

Bring Back PSA Prostate Cancer Test: Top Urologist

Bring Back Prostate Screening - NYTimes.com

By DEEPAK A. KAPOOR

July 6, 2015

Rather than use the historical arbitrary cutoff of a 4.0 PSA reading to define abnormal, we now have tools to adjust our interpretation of readings for age (PSA levels normally rise with age); for race (this, too, affects what is considered normal); and for the size of a man’s prostate, which affects how much PSA he produces. We can test for how fast PSA levels rise over time. And we can analyze how PSA circulates in the bloodstream (free or bound to serum proteins), which can predict prostate cancer risk.

When we use these markers together, these varied interpretations of PSA levels give us a clearer picture of who does, or doesn’t, need further testing. And we keep refining our approach. Already, a urine test can find and measure the presence of genes associated with prostate cancer. M.R.I. images can help identify high-risk prostate lesions. And tests for the presence or activity, or both, of genes present in prostate tissue can help distinguish which patients can safely defer therapy from those who cannot.

what frustrates urologists most: Rather than using refined screening techniques to identify those who will benefit most from treatment, we’re just evaluating fewer men. So the task force needs to re-evaluate its recommendation based on the current state of medical knowledge.

But men should not wait for a government agency to tell them what’s best. My own strongest recommendation is that men insist on a baseline PSA test while in their 40s. From this baseline, a personalized screening regimen that considers risk factors and other indicators can be developed.

Men must understand that screening does not commit them to further testing or treatment, even if abnormalities are found. Screening, followed up with today’s sophisticated tools, simply provides information that helps them and their doctors make sound decisions — which could prolong their

lives, or leave them reassured that they have little to fear from an indolent tumor

One man’s OpEd is not the only form of truth | THE "NEW" PROSTATE CANCER INFOLINK

So long as we go on re-fighting the PSA screening wars, we are not going to make any significant progress toward a better way to assess risk for prostate cancer. The PSA test is what it is — an indicator of the potential for any one of several types of prostate/urinary tract problem. And that is all it is. Getting an annual PSA test — and especially getting an annual PSA test while simultaneously refusing to have a digital rectal examination — is not a way to manage risk for prostate cancer.  On the other hand, not getting a PSA test when you need one (for all sort of possible reasons) is about as smart as not getting a vaccination against measles or tetanus or a whole bunch of other deadly disorders. You may well not need that vaccination. And you may well find you did not need the PSA test (just as you may never need certain types of vaccination) … but under the right conditions, any of these actions might help to save your life.

 

Urologist calls attention to implications of flawed prostate specific antigen data in SEER. ecancer - News

The National Cancer Institute (NCI) announced that it had removed all prostate specific antigen (PSA) data from the SEER (Surveillance, Epidemiology and End Results) and SEER-Medicare programmes. The PSA data were removed after quality control checks revealed that a substantial number of PSA values included in the programmes were incorrect.

Prostate cancer diagnosis rates significantly decrease following USPSTF guideline revision

The U.S. Preventive Services Task Force (USPSTF) issued a grade D recommendation that discouraged PSA-based screening for prostate cancer in October 2011, according to study background.

“The results raise concern that if this trend continues, more men may be diagnosed at a point when their disease is advanced,” Barocas said. “Younger, healthier men with intermediate- or high-risk disease would normally be candidates for aggressive local therapy and they may not be receiving a timely diagnosis under this policy.”  

Urine test for prostate cancer? - UPMatters.com Home of Michigan's Upper Peninsula.

Researchers at Sanford-Burnham Medical Research Institute in Orlando are working to more accurately diagnose prostate cancer starting with a set of RNA molecules believed to regulate cell development.

Doctor Ranjan Perera, Associate Professor at Sanford-Burnham Medical Research Institute, said, "We were able to identify some of these RNAs being secreted in the urine of the prostate cancer patients." The team examined the urine and tissue samples of prostate cancer patients with those who did not have cancer and found the RNA levels were higher in those with cancer. Researchers say the RNAs are easily detected in urine.

"Our hope is that we can develop a urine test that would be a better biomarker for diagnosing prostate cancer," said Dr. Patel.

New screening that could be faster, more accurate, and end up saving even more lives. Professor Perera says the next step is to initiate a wide-scale clinical trial. He believes that the clinical study will be completed and a urine test will be developed and ready for use in three to five years. 

 Watching

'Genuine Change' in US Prostate Cancer Management
In the years 2010-2013, the use of active surveillance for low-risk disease "increased sharply" to 40% of all cases, say investigators. The rate had languished at only about 10% in the preceding 20 years.
At the same time, use of androgen deprivation as a monotherapy "decreased sharply," they note, down to only 3.8% of intermediate-risk and 24% of high-risk prostate cancer cases. These percentages represent drops of about one third and one half from earlier periods.
Both trends are desirable because they represent strategies to avoid overtreatment and undertreatment, respectively.

More men with prostate cancer are opting for surveillance | Reuters

There are several possible treatments for prostate cancer, including surgery and radiation. Some men - especially those who are older - may opt for active surveillance.
Men using active surveillance may undergo tests or biopsies to make sure the cancer isn't growing, the ACS says.
The approach helps avoid more aggressive treatments, which can carry the risk for complications such as incontinence and impotence.

Simply observing men with very low-and low-risk prostate cancer very effective and underused, UCLA researchers find - Medical News Today
"Ultimately, the decision-making process surrounding treatment for a man with localized prostate cancer must take an individualized approach. The risks and benefits of expectant management vis-a-vis active treatment should be reviewed with the patient in light of existing knowledge, potentially with the use of decision aids to help enable a truly shared decision-making process," the review states. "Active surveillance is a viable approach for most men with low-risk prostate cancer, and its broader adoption has the potential to stop the overtreatment of men with indolent lesions and redirect resources to men with more serious cancers." 
 

 Prostate cancer: USPSTF recommendations reduce diagnosis of new cases : Nature Reviews Urology : Nature Publishing Group

 Too Few Prostate Cancer Patients Receiving Active Surveillance - MPR

Biopsy/Pathology

Radical prostatectomy may trump radiotherapy in non-metastatic prostate cancer

Access : The biopsy Gleason score 3|[plus]|4 in a single core does not necessarily reflect an unfavourable pathological disease after radical prostatectomy in comparison with biopsy Gleason score 3|[plus]|3: looking for larger selection criteria for active surveillance candidates : Prostate Cancer and Prostatic Diseases
The inclusion of Gs=3+4 in patients suitable to AS does not enhance the risk of unfavourable disease after radical prostatectomy. Additional factors such as number of cores taken and the presence of ASAP should be considered in patients suitable for AS.

Access : Improved detection of anterior fibromuscular stroma and transition zone prostate cancer using biparametric and multiparametric MRI with MRI-targeted biopsy and MRI-US fusion guidance : Prostate Cancer and Prostatic Diseases
MRI-targeted biopsies detected significantly more anteriorly located sPC compared with SBs in the repeat-biopsy setting. The more cost-efficient bpMRI was statistically not inferior to mpMRI in sPC detection in TZ/AFMS.

 Genomics

Structural Organization of the Genome - Theory of Cancer Biology

British Journal of Cancer - The genomic evolution of human prostate cancer
Prostate cancers are highly prevalent in the developed world, with inheritable risk contributing appreciably to tumour development. Genomic heterogeneity within individual prostate glands and between patients derives predominantly from structural variants and copy-number aberrations. Subtypes of prostate cancers are being delineated through the increasing use of next-generation sequencing, but these subtypes are yet to be used to guide the prognosis or therapeutic strategy. Herein, we review our current knowledge of the mutational landscape of human prostate cancer, describing what is known of the common mutations underpinning its development. We evaluate recurrent prostate-specific mutations prior to discussing the mutational events that are shared both in prostate cancer and across multiple cancer types. From these data, we construct a putative overview of the genomic evolution of human prostate cancer.

Study Suggests 90% of Advanced Prostate Cancers May Have Anomaly that May Influence Treatment - Cancer Therapy Advisor
Tt may soon be easier to treat metastatic castration-resistant prostate cancer (mCRPC) based on genetic anomalies. A new international study suggested it may be possible to link specific aberrations to response or resistance to specific treatments in 90% of cases.
Researchers from eight institutions in the United States and in Europe collaborated and sequenced the DNA and RNA of tumor biopsy samples from 150 men with mCRPC. They found that patients with mCRPC harbor genomic alterations in PIK3CA/B, RSPO, RAF, APC, B-catenin, and ZBTB16 and 23% harbor DNA repair pathway aberrations.¹

 New Study Published on Cover of Urology Finds that Decipher® Prostate Cancer... -- SAN DIEGO, July 14, 2015 /PRNewswire/ -- 

The Decipher test used in this study has been previously described in multiple blinded independent validation studies in men at high risk of recurrence at the time of prostatectomy. Researchers found that 60% of the clinically high-risk men would be reclassified as low risk based on the Decipher test and have only a 2.4% risk of metastasis at 5 years after surgery. In addition, the 19% of the patients with the highest risk based on Decipher had a nearly 10-fold higher risk of distant metastases by 5 years. The test provided a more accurate and precise estimate of a patient's risk of recurrence. Use of this test therefore has the potential to assist clinicians to better direct utilization of secondary therapy after surgery.

Researchers Find Potential Achilles’ Heel for Prostate Cancer and B Cell Lymphoma | Memorial Sloan Kettering Cancer Center
MicroRNAs are small molecules that regulate gene function. The laboratory of cancer biologist Andrea Ventura has found that one microRNA, miR-19, plays an important role in tumor cell growth in B cell lymphoma and prostate cancer. Blocking miR-19 seems to make cells resistant to these cancers while having no ill effects. The researchers also clarified the function of related microRNAs, which appear to play essential roles in embryonic development.
 

Access : Which, when and why|[quest]| Rational use of tissue-based molecular testing in localized prostate cancer : Prostate Cancer and Prostatic Diseases
An increased molecular understanding of localized prostate cancer and the improved ability for molecular testing of pathologic tissue has led to the development of multiple clinical assays. Here we review the relevant molecular biology of localized prostate cancer, currently available tissue-based tests and describe which is best supported for use in various clinical scenarios. Literature regarding testing of human prostate cancer tissue with Ki-67, PTEN (by immunohistochemistry (IHC) or fluroescence in situ hybridization (FISH)), ProMark, Prolaris, OncotypeDX Prostate and Decipher was reviewed to allow for generation of expert opinions. At diagnosis, evaluation of PTEN status, use of ProMark or OncotypeDX Prostate in men with Gleason 6 or 3+4=7 disease may help guide the use of active surveillance. For men with Gleason 7 or above disease considering watchful waiting, Ki-67 and Prolaris add independent prognostic information. For those men who have undergone prostatectomy and have adverse pathology, Decipher testing may aid in the decision to undergo adjuvant radiation. Newly available molecular tests bring opportunities to improve decision making for men with localized prostate cancer. A review of the currently available data suggests clinical scenarios for which each of these tests may have the greatest utility.

 Imaging

New Imaging Approach to Map Prostate Cancer | BIRC

Made-in-London software could help diagnose and treat prostate cancer | CTV London News

Dr. Aaron Ward is designing a road map - a computerized, 3D road map - to help better diagnose and treat prostate cancer. And it's getting national attention. A computerized road map uses artificial intelligence to help interpret the nuances in what's shown through an MRI.
Ward explains that the computer takes three different images of the prostate with different information, "and the idea is that this artificially intelligence system is going to automatically integrate and combine all of this information to produce a much simpler to read colour-coded road map for where the threatening areas of potential cancer are."

Inside an MRI, a Non-Metallic Robot Performs Prostate Surgery - IEEE Spectrum

 The typical biopsy that doctors perform to check a man for prostate cancer is far from a precise procedure, says the trial’s principle investigator Clare Tempany, a radiologist and director of the National Center for Image Guided Therapy at Brigham. Typically a physician targets the prostate, which is the size of “a small peach or plum,” she says, by placing a grid guide between the patient’s legs. Then the doctor inserts needles through the skin and into each quadrant to get tissue samples. “This is somewhat disparagingly called ‘the blind biopsy,’ ” says Tempany. “There’s no lesion targeted, it’s just: ‘Let’s push a bunch of needles in and see what we get.’ ”

These biopsies are sometimes aided by ultrasound imaging, which requires inserting a ultrasound wand into the patient’s rectum. Because ultrasound doesn’t provide clear enough images, doctors aren’t able to make precision strikes with their needles, says Tempany. They often end up taking 10 to 50 core samples, she says, and each needle stick carries the risk of infection.

This clinical trial literally shows a better way. Looking at real-time MRI images, the doctor can identify parts of the prostate that look suspicious, and direct the robotic tool to those spots. “In our procedure, a small little robot places the needle on the skin’s surface and says, ‘This is the spot where you need to push, and in five or six centimeters you’ll hit your target,’ ” Tempany explains. In the current trial the doctor takes the actual step of inserting the needle, and typically takes samples in just four locations. “It’s a smarter biopsy,” she says.

Treatment

Case Studies Offer Window Into Evolving Prostate Cancer Paradigm

In the ever-evolving treatment landscape in metastatic prostate cancer, healthcare providers have more options that ever before. Although guideline organizations have now incorporated the results of major clinical trials into treatment paradigms, much controversy remains over how best to sequence therapies, according to experts who participated in a recent OncLive Peer Exchange.

In recognition of this complexity, moderator Raoul S. Concepcion, MD, FACS, and colleagues took a case-based approach to explore the ways in which oncologists and urologists can employ newly acquired evidence to manage patients whom they encounter in their practices. The Peer Exchange session, entitled “Integrating Prostate Cancer Trial Findings Into Practice: A Case-Based Discussion,” incorporated four cases, two of which are presented here.
- See more at: http://www.onclive.com/publications/Oncology-live/2015/July-2015/case-studies-offer-window-into-evolving-prostate-cancer-paradigm#sthash.FozlFACb.dpuf

In the ever-evolving treatment landscape in metastatic prostate cancer, healthcare providers have more options that ever before. Although guideline organizations have now incorporated the results of major clinical trials into treatment paradigms, much controversy remains over how best to sequence therapies, according to experts who participated in a recent OncLive Peer Exchange.
In recognition of this complexity, moderator Raoul S. Concepcion, MD, FACS, and colleagues took a case-based approach to explore the ways in which oncologists and urologists can employ newly acquired evidence to manage patients whom they encounter in their practices. The Peer Exchange session, entitled “Integrating Prostate Cancer Trial Findings Into Practice: A Case-Based Discussion,” incorporated four cases, two of which are presented here.
- See more at: http://www.onclive.com/publications/Oncology-live/2015/July-2015/case-studies-offer-window-into-evolving-prostate-cancer-paradigm#sthash.FozlFACb.dpuf

Radiation

Pioneering treatment for prostate cancer sufferers (From The Northern Echo)
Specialists at Middlesbrough's James Cook University Hospital will be able to use radioactive radium 223 to treat prostate cancer patients for the first time.
The radium is used to treat prostate cancer which has spread to the bones and specifically targets tumours with less pain and fewer side effects.

Radiation therapy may improve survival even when PSA ≥ 75 ml/ml | THE "NEW" PROSTATE CANCER INFOLINK
Sometimes, when patients originally present with very high PSA levels, a negative bone scan, and a negative CT scan, they are put on permanent androgen deprivation  therapy (ADT) because the doctor just assumes it is micrometastatic. A closer look at the data demonstrates that an attempt at curative radiation may improve outcomes.
 

Access : Primary radiotherapy vs conservative management for localized prostate cancer|[mdash]|a population-based study : Prostate Cancer and Prostatic Diseases
Among men >65 years of age, the benefit of primary radiotherapy for localized disease is largely confined to patients with high-risk prostate cancer (Gleason scores 7–10).
 

 Prostate cancer: Radiotherapy is effective in old men with high-risk cancer : Nature Reviews Urology : Nature Publishing Group
In a population-based study of 57,749 patients with prostate cancer, the effectiveness of primary radiotherapy versus conservative management was investigated by comparing patient outcomes in geographical areas with high, versus low radiotherapy use. In older patients (>65 years of age), those in high radiotherapy use areas had small, but significant…
 

Low utilization of immediate and delayed postoperative radiation for prostate cancer with adverse pathologic features - Beyond the Abstract
immediate radiotherapy is still being underutilized after prostatectomy, and this underutilization does not appear to be explained entirely by the use of delayed radiotherapy, which is also low. Urologists should discuss the risks, benefits, and evidence behind immediate vs. delayed radiotherapy with their patients. For those patients who are considering postoperative radiotherapy, referral to a radiation oncologist may be beneficial.
 

Increased radiation offers no survival benefit for patients with low-risk prostate cancer
Increased radiation dose is associated with higher survival rates in men with medium- and high-risk prostate cancer, but not men with low-risk prostate cancer, according to a new study from Penn Medicine published this week in JAMA Oncology. Already-high survival rates for men with low-risk prostate cancer were unaffected by higher radiation dosages compared to lower radiation dosages. 

 Hormone Therapy

Statin Therapy May Help Delay Prostate Cancer Progression in Men Receiving ADT - Cancer Therapy Advisor
Taking a statin while undergoing androgen deprivation therapy (ADT) for prostate cancer appears to pay off when it comes to delaying disease progression, according to researchers at the Dana-Farber Cancer Institute. They analyzed data on 926 men with prostate cancer receiving ADT and found that time to progression (TTP) was significantly delayed if the men were taking a statin.

Androgen deprivation of prostate cancer: Leading to a therapeutic dead end.
In this review, we describe molecular alterations in tumor cells during ADT, which lead to deregulation of different signaling pathways and castration-resistance, and how they might interfere with the clinical outcome of different second-line therapeutics. A recent breakthrough finding that early chemotherapy is associated with a significant survival benefit in metastatic hormone-sensitive disease highlights the fact that there is time for a fundamental paradigm shift in the treatment of advanced prostate cancer. Therapeutic intervention seems to be indicated before a castration-resistant stage is reached to improve therapeutic outcome and to reduce undesirable side effects.

Chemo

Predicting response to chemotherapy for prostate cancer and other stories . . . | The BMJ
A new study shows that the measurement of androgen receptor splice variant 7 (AR-V7) in circulating tumour cells can predict which men with castration resistant prostate cancer are most likely to respond to treatment with chemotherapy rather than enzalutamide or abiraterone (JAMA Oncology 2015, doi:10.1001/jamaoncol.2015.1341).

Detection of AR-V7 in CTCs from men with metastatic CRPC is not associated with primary resistance to taxane chemotherapy. In AR-V7–positive men, taxanes appear to be more efficacious than enzalutamide or abiraterone therapy, whereas in AR-V7–negative men, taxanes and enzalutamide or abiraterone may have comparable efficacy. Circulating tumor cell–based AR-V7 detection may serve as a treatment selection biomarker in CRPC.

Advanced - Recurrent

 A bird's eye view of advanced prostate cancer
An estimated 220,000 American men are diagnosed with prostate cancer each year, with 30,000 expected to die of it this year. While androgen deprivation therapy (ADT) is initially effective against metastatic disease, most men develop tumors that ultimately become resistant to ADT, including the most recent ADT regimen (abiraterone acetate and enzalutamide). This condition is known as metastatic castration-resistant prostate cancer (mCRPC). While many studies have cataloged somatic alterations in primary prostate cancers, genomic studies of mCRPC have been limited to either autopsy samples or preclinical models. To address the gap in our understanding of mCRPC, an international and multi-institutional consortium that included Fred Hutch investigators and benefitted from key contributions from Dr. Pete Nelson’s Laboratory (Human Biology, Clinical Research and Public Health Sciences Divisions), sequenced the DNA and RNA from biopsies of bone or soft tissue metastases prospectively from 150 mCRPC affected individuals. This work was recently published in the journal Cell.
 

Regional hyperthermia and moderately dose-escalated salvage radiotherapy for recurrent prostate cancer. Protocol of a phase II trial
Current studies on salvage radiotherapy (sRT) investigate timing, dose-escalation and anti-hormonal treatment (ADT) for recurrent prostate cancer. These approaches could either be limited by radiation-related susceptibility of the anastomosis or by suspected side-effects of long-term ADT.

A phase II protocol was developed to investigate the benefit and tolerability of regional hyperthermia with moderately dose-escalated radiotherapy.