The One Hour Human Proteome

We describe deep analysis of the human proteome in less than 1 h. We achieve this expedited proteome characterization by leveraging state-of-the-art sample preparation, chromatographic separations, and data analysis tools, and by using the new Orbitrap Astral mass spectrometer equipped with a quadrupole mass filter, a high-field Orbitrap mass analyzer, and an asymmetric track lossless (Astral) mass analyzer. The system offers high tandem mass spectrometry acquisition speed of 200 Hz and detects hundreds of peptide sequences per second within data-independent acquisition or data-dependent acquisition modes of operation. The fast-switching capabilities of the new quadrupole complement the sensitivity and fast ion scanning of the Astral analyzer to enable narrow-bin data-independent analysis methods. Over a 30-min active chromatographic method consuming a total analysis time of 56 min, the Q-Orbitrap-Astral hybrid MS collects an average of 4319 MS1 scans and 438,062 tandem mass spectrometry scans per run, producing 235,916 peptide sequences (1% false discovery rate). On average, each 30-min analysis achieved detection of 10,411 protein groups (1% false discovery rate). We conclude, with these results and alongside other recent reports, that the 1-h human proteome is within reach.

Incorporating artificial intelligence in medical diagnosis: A case for an invisible and (un)disruptive approach

As big data becomes more publicly accessible, artificial intelligence (AI) is increasingly available and applicable to problems around clinical decision-making. Yet the adoption of AI technology in healthcare lags well behind other industries. The gap between what technology could do, and what technology is actually being used for is rapidly widening. While many solutions are proposed to address this gap, clinician resistance to the adoption of AI remains high. To aid with change, we propose facilitating clinician decisions through technology by seamlessly weaving what we call 'invisible AI' into existing clinician workflows, rather than sequencing new steps into clinical processes. We explore evidence from the change management and human factors literature to conceptualize a new approach to AI implementation in health organizations. We discuss challenges and provide recommendations for organizations to employ this strategy.

Challenges and Opportunities for Commercializing Technologies in the Pulmonary Arena: An Official American Thoracic Society Report

"Translational medicine" has been a buzzword for over two decades. The concept was intended to be lofty, to reflect a new "bench-to-bedside" approach to basic and clinical research that would bridge fields, close gaps, accelerate innovation, and shorten the time and effort it takes to bring novel technologies from basic discovery to clinical application. Has this approach been successful and lived up to its promise? Despite incredible scientific advances and innovations developed within academia, successful clinical translation into real-world solutions has been difficult. This has been particularly challenging within the pulmonary field, because there have been fewer U.S. Food and Drug Administration-approved drugs and higher failure rates for pulmonary therapies than with other common disease areas. The American Thoracic Society convened a working group with the goal of identifying major challenges related to the commercialization of technologies within the pulmonary space and opportunities to enhance this process. A survey was developed and administered to 164 participants within the pulmonary arena. This report provides a summary of these survey results. Importantly, this report identifies a number of poorly recognized challenges that exist in pulmonary academic settings, which likely contribute to diminished efficiency of commercialization efforts, ultimately hindering the rate of successful clinical translation. Because many innovations are initially developed in academic settings, this is a global public health issue that impacts the entire American Thoracic Society community. This report also summarizes key resources and opportunities and provides recommendations to enhance successful commercialization of pulmonary technologies.

Care Pathway Analysis to Inform the Earliest Stages of Technology Development: Scoping Oncological Indications in Need of Innovation

OBJECTIVES

Identifying unmet needs for innovative solutions across disease contexts is challenging but important for directing funding and research efforts and informing early-stage decisions during the innovation process. Our aim was to study the merits of care pathway analysis to scope disease contexts and guide the development of innovative devices. We used oncologic surgery as a case study, for which many intraoperative imaging techniques are under development.

METHODS

Care pathway analysis is a mapping process, which produces graphical maps of clinical pathways using important outcomes and subsequent consequences. We performed care pathway analyses for glioblastoma, breast, bladder, prostate, renal, pancreatic, and oral cavity cancer. Differences between a "perfect" care pathway and the current care pathway in terms of percentage of inadequate margins, associated recurrences, quality of life, and 5-year overall survival were calculated to determine unmet needs. Data from The Netherlands Cancer Registry and literature were used.

RESULTS

Care pathway analysis showed that highest percentages of inadequate margins were found in oral cavity cancer (72.5%), glioblastoma (48.7%), and pancreatic cancer (43.9%). Inadequate margins showed the strongest increase in recurrences in cancer of oral cavity, and bladder (absolute increases of 43.5% and 41.2%, respectively). Impact on survival was largest for bladder and oral cavity cancer with positive margins.

CONCLUSIONS

Care pathway analysis provides overviews of current clinical paths in multiple indications. Disease contexts can be compared via effectiveness gaps that show the potential need for innovative solutions. This information can be used as basis for stakeholder involvement processes to prioritize care pathways in need of innovation.

Flexible Ureteroscopy: Global User Experience Using Disposable Devices

INTRODUCTION

Renal stone treatment through flexible ureteroscopy is widely established and successful. Ureteroscopes can broadly be classified into reusable and single-use disposable devices, each with their own advantages. Disposable scopes are cheaper to buy, maintain, and dispose of but may have a greater environmental impact and long-term cost. To establish the collective views of urologists, we conducted a multicentre, global study to demonstrate users' experience with single-use flexible ureteroscopes.  Methods: An online nine-question survey was distributed to urologists globally through email and social media platforms. Questions focused on user grade, experience, location, general opinion, advantages, disadvantages, and estimated cost of a single-use flexible ureteroscope. All responses were collated over a three-day period and analysed using descriptive statistics.

RESULTS

A total of 69 responses were received; the majority of responses were from the UK (75%), and most were consultants (64%). Two-thirds of those surveyed had used a single-use scope on a patient, and 95% of them stated they enjoyed using it, citing excellent vision and reduced need for maintenance. The majority (52%) stated that widespread adoption of disposable scopes was limited due to their prohibitive expense, with an average, sterling-converted responder-estimated cost of £991 (£100-£6000) per reusable scope.

CONCLUSION

Most urologists enjoyed using disposable scopes, finding them comparable or better than reusable devices. However, the initial cost can be prohibitive in certain centres. The potential environmental impact is a further concern as this remains largely unknown for now. In the meantime, it is likely that stone units will continue to use a combination of single-use and reusable scopes, considering their individual needs and budgets as well as local availability and price.

Involving Health Care Professionals in the Development of Electronic Health Records: Scoping Review

BACKGROUND

Electronic health records (EHRs) are a promising approach to document and map (complex) health information gathered in health care worldwide. However, possible unintended consequences during use, which can occur owing to low usability or the lack of adaption to existing workflows (eg, high cognitive load), may pose a challenge. To prevent this, the involvement of users in the development of EHRs is crucial and growing. Overall, involvement is designed to be very multifaceted, for example, in terms of the timing, frequency, or even methods used to capture user preferences.

OBJECTIVE

Setting, users and their needs, and the context and practice of health care must be considered in the design and subsequent implementation of EHRs. Many different approaches to user involvement exist, each requiring a variety of methodological choices. The aim of the study was to provide an overview of the existing forms of user involvement and the circumstances they need and to provide support for the planning of new involvement processes.

METHODS

We conducted a scoping review to provide a database for future projects on which design of inclusion is worthwhile and to show the diversity of reporting. Using a very broad search string, we searched the PubMed, CINAHL, and Scopus databases. In addition, we searched Google Scholar. Hits were screened according to scoping review methodology and then examined, focusing on methods and materials, participants, frequency and design of the development, and competencies of the researchers involved.

RESULTS

In total, 70 articles were included in the final analysis. There was a wide range of methods of involvement. Physicians and nurses were the most frequently included groups and, in most cases, were involved only once in the process. The approach of involvement (eg, co-design) was not specified in most of the studies (44/70, 63%). Further qualitative deficiencies in the reporting were evident in the presentation of the competences of members of the research and development teams. Think-aloud sessions, interviews, and prototypes were frequently used.

CONCLUSIONS

This review provides insights into the diversity of health care professionals' involvement in the development of EHRs. It provides an overview of the different approaches in various fields of health care. However, it also shows the necessity of considering quality standards in the development of EHRs together with future users and the need for reporting this in future studies.

Exploring Stakeholder Requirements to Enable the Research and Development of Artificial Intelligence Algorithms in a Hospital-Based Generic Infrastructure: Protocol for a Multistep Mixed Methods Study

BACKGROUND

In recent years, research and developments in advancing artificial intelligence (AI) in health care and medicine have increased. High expectations surround the use of AI technologies, such as improvements for diagnosis and increases in the quality of care with reductions in health care costs. The successful development and testing of new AI algorithms require large amounts of high-quality data. Academic hospitals could provide the data needed for AI development, but granting legal, controlled, and regulated access to these data for developers and researchers is difficult. Therefore, the German Federal Ministry of Health supports the Protected Artificial Intelligence Innovation Environment for Patient-Oriented Digital Health Solutions for Developing, Testing, and Evidence-Based Evaluation of Clinical Value (pAItient) project, aiming to install the AI Innovation Environment at the Heidelberg University Hospital in Germany. The AI Innovation Environment was designed as a proof-of-concept extension of the already existing Medical Data Integration Center. It will establish a process to support every step of developing and testing AI-based technologies.

OBJECTIVE

The first part of the pAItient project, as presented in this research protocol, aims to explore stakeholders' requirements for developing AI in partnership with an academic hospital and granting AI experts access to anonymized personal health data.

METHODS

We planned a multistep mixed methods approach. In the first step, researchers and employees from stakeholder organizations were invited to participate in semistructured interviews. In the following step, questionnaires were developed based on the participants' answers and distributed among the stakeholders' organizations to quantify qualitative findings and discover important aspects that were not mentioned by the interviewees. The questionnaires will be analyzed descriptively. In addition, patients and physicians were interviewed as well. No survey questionnaires were developed for this second group of participants. The study was approved by the Ethics Committee of the Heidelberg University Hospital (approval number: S-241/2021).

RESULTS

Data collection concluded in summer 2022. Data analysis is planned to start in fall 2022. We plan to publish the results in winter 2022 to 2023.

CONCLUSIONS

The results of our study will help in shaping the AI Innovation Environment at our academic hospital according to stakeholder requirements. With this approach, in turn, we aim to shape an AI environment that is effective and is deemed acceptable by all parties.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/42208.

Cushing's Disease Management: Glimpse Into 2051

Major advancements are expected in medicine and healthcare in the 21st century- "Digital Age", mainly due to the application of data technologies and artificial intelligence into healthcare. In this perspective article we share a short story depicting the future Cushings' Disease patient and the postulated diagnostic and management approaches. In the discussion, we explain the advances in recent times which makes this future state plausible. We postulate that endocrinology care will be completely reinvented in the Digital Age.

Organizational Challenges of Development and Implementation of Virtual Reality Solution for Industrial Operation

This research investigated the organizational challenges related to the development and implementation of virtual reality (VR) technology for operation in a conservative heavy machinery industry. The incorporation of a VR solution for heavy machinery equipment enhanced the safety and convenience of operation under dangerous work conditions. However, the development and implementation processes faced challenges. Furthermore, the adoption of the solution by users was perceived to be slower than anticipated. We aimed to explore the main challenges that the developer organization faced and how it also influenced user organizations. Due to the exploratory nature of the research, qualitative analysis was chosen, interviews were conducted, and thematic analysis was applied. The themes and subthemes were identified and discussed. The results showed the existence of challenges related to technology maturity, managerial challenges regarding communication and support coordination, workload, and multiple stakeholder management. The findings emphasize the importance of attending to the existing and potential organizational challenges before and throughout technological innovation. Theoretical and managerial implications are discussed, and a future research agenda is suggested.

Genome-scale RNAi screens in African trypanosomes

Genome-scale genetic screens allow researchers to rapidly identify the genes and proteins that impact a particular phenotype of interest. In African trypanosomes, RNA interference (RNAi) knockdown screens have revealed mechanisms underpinning drug resistance, drug transport, prodrug metabolism, quorum sensing, genome replication, and gene expression control. RNAi screening has also been remarkably effective at highlighting promising potential antitrypanosomal drug targets. The first ever RNAi library screen was implemented in African trypanosomes, and genome-scale RNAi screens and other related approaches continue to have a major impact on trypanosomatid research. Here, I review those impacts in terms of both discovery and translation.

A User-Driven Approach to Prosthetic Upper Limb Development in Korea

Despite recent significant advances in technology and medicine, the number of patients who undergo amputation of body parts for various reasons continues to increase. Assistive devices such as prosthetic arms can enable limited activities in upper limb amputees and improve their quality of life. This study aims to help in the development of user-centered prosthetics by identifying user requirements and key considerations during selection of prosthetics. This study conducted a questionnaire survey after obtaining prior consent for persons with disabilities with upper limb amputation who visited orthosis companies, rehabilitation centers for the disabled, veteran’s hospitals, and labor welfare corporations. A modified questionnaire was conducted to upper limb prosthetic users and results were analysed using descriptive statistics and t-test. Results of the study showed that the main reasons for discontinuing the use of prosthetics were discomfort (discomfort in wear, weight, and difficulty of detachment) and complaints regarding design and function. Regardless of the prosthesis type, the color and design of the prosthesis were key considerations in prosthesis choices. Respondents indicated that they needed various prostheses designed according to the purpose and situation, such as for sports like golf and cycling as well as everyday use. Most of the respondents answered that buttoning shirts, tying knots, and using chopsticks were challenging or impossible to do on their own. Based on the results of this study, the quality of life of upper limb amputees can be improved if a prosthetic arm with various functions that can satisfy both the user’s needs and wants is developed.

A New Method for Structured Integration of User Needs in Two Health Technology Development Projects: Action Sheets

An early integration of users and stakeholders is needed for a successful innovation process. Nonetheless, the integration of users is often hard to realize - especially when dealing with persons with chronic diseases. In addition, patients or users in general often are not able to formulate the requirements in a technical manner. Therefore, even if user requirements are collected, it is not certain that the developers know or understand 'what is really wanted'. To overcome these 'gaps', we have developed so-called Action Sheets (AS). This article presents the use of AS in two projects: the development of health technologies for people with cancer (INFOPAT) and dementia (QuartrBack). Depending on the project context, group sessions were conducted with different stakeholders to identify the needs of (potential) users. Within the INFOPAT project, ten focus groups were conducted with patients, physicians and other healthcare professionals. In QuartrBack stakeholders like e.g. care professionals, technical assistance organizations and citizens participated in two focus groups and three world cafés. Their requirements were then 'fed' into the technology development by the use of AS. AS appear to be a promising tool to make user needs based on social values more tangible and implementable into technology development processes. In addition, it shows up that four phases seem to be necessary for transferring identified user and stakeholder needs into AS, which can therefore be seen as essential to translate non-technically formulated requirements into technically feasible ones. The case study shows as lessons learned that despite the successful integration of user needs, context-sensitive adjustments are still necessary.

Protecting the privacy of technology users who have cognitive disabilities: Identifying areas for improvement and targets for change

Introduction

Information Technologies (IT) may serve assistive roles that facilitate the interaction of people living with cognitive disabilities (CD) within their environments. However, there are some notable concerns related to privacy threats associated with the use of IT. The purpose of this study was to examine how assistive technology developers may best adapt over time to develop their IT to be resilient against threats to privacy. We therefore focused on the following areas: (1) developers' knowledge and practices related to privacy protection; (2) challenges when applying recommended practices, and; (3) preferred channels to acquire knowledge.

Method

We conducted semi-structured interviews with ten technology developers who are members of the AGE-WELL network undertaking research and development of assistive technologies to be used by people who have cognitive disabilities. We used an inductive-deductive method for the analysis of qualitative data to examine participant responses and generate themes related to the study goals.

Results

Principal themes that emerged from the data include practices specific to populations with CD, challenges to obtaining consent to use of information, and preferred channels to acquire knowledge.

Conclusion

We identify areas of focus for developing a knowledge mobilization strategy to improve relevant policies and practices.

Unmet Medical Need: An Introduction to Definitions and Stakeholder Perceptions

BACKGROUND

Despite increasing informal and formal use of unmet medical need (UMN) in drug development, regulation, and assessment, there is no insight into its definitions in use. This study aims to provide insight into the current definitions in use and to provide a starting point for a multi-stakeholder discussion on alignment.

METHODS

A scoping and a gray literature review were performed to locate definitions of UMN in literature and on stakeholder websites. These definitions were categorized and then discussed among the multi-stakeholder author group via semistructured group discussions and open session workshops with a broader stakeholder audience. Issues with the formation of a common definition and mechanisms for use were discussed.

RESULTS

The reviews yielded 16 definitions. Differences were evident, but all included 1 or more of the following elements: (adequacy of) available treatments (16 of 16: 100%), disease severity or burden (6 of 16: 38%), and patient population size (1 of 16: 6%). The stakeholder discussions led to a suggestion for a definition including the first 2 items and, depending on context, population size. The discussions also showed that quantification of UMN is highly dependent on the scope and the value framework in which it is used based on different stakeholder preferences and responsibilities.

CONCLUSION

We encourage stakeholders that want to promote alignment on the concept of UMN to prospectively discuss the scope in which they want to apply the concept, what elements they find important for consideration in each case, and how they would measure UMN within the broader regulatory or value framework applicable.

Patient Reported Reasons for Surgery Cancellations Do Not Necessarily Correspond with Hospitals' Representation of the Same Problem

Surgery cancellation is a well-recognized quality problem within hospitals. The e-Team Surgery project addressed the problem of elective surgery cancellation at a Norwegian hospital and explored the potential to reduce surgery cancellation by providing a tool for secure online communication between the hospital and the patient. This communication would occur before surgery while the patient was still at home. The causes of elective surgery cancellation are divided into two major categories: hospital- and patient-related reasons. As part of the e-Team Surgery project, this study addressed patient reasons for cancelling surgery through qualitative interviews with 11 patients who fit these criteria. The study found that most patients called the hospital to reschedule, not to cancel, their upcoming surgery. The patient interviews had significant implications for the e-Team Surgery project. They affected the overall understanding of the surgery cancellation problem and made more clear the data and information needed when developing sustainable systems to reduce elective surgery cancellation.

The Importance of Systematically Reporting and Reflecting on eHealth Development: Participatory Development Process of a Virtual Reality Application for Forensic Mental Health Care

Background

The use of electronic health (eHealth) technologies in practice often is lower than expected, mostly because there is no optimal fit among a technology, the characteristics of prospective users, and their context. To improve this fit, a thorough systematic development process is recommended. However, more knowledge about suitable development methods is necessary to create a tool kit that guides researchers in choosing development methods that are appropriate for their context and users. In addition, there is a need for reflection on the existing frameworks for eHealth development to be able to constantly improve them.

Objective

The two main objectives of this case study were to present and reflect on the (1) methods used in the development process of a virtual reality application for forensic mental health care and (2) development model that was used: the CeHRes Roadmap (the Centre for eHealth Research Roadmap).

Methods

In the development process, multiple methods were used to operationalize the first 2 phases of the CeHRes Roadmap: the contextual inquiry and value specification. To summarize the most relevant information for the goals of this study, the following information was extracted per method: (1) research goal, (2) explanation of the method used, (3) main results, (4) main conclusions, and (5) lessons learned about the method.

Results

Information on 10 methods used is presented in a structured manner. These 10 methods were stakeholder identification, project team composition, focus groups, literature study, semistructured interviews, idea generation with scenarios, Web-based questionnaire, value specification, idea generation with prototyping, and a second round of interviews. The lessons learned showed that although each method added new insights to the development process, not every method appeared to be the most appropriate for each research goal.

Conclusions

Reflection on the methods used pointed out that brief methods with concrete examples or scenarios fit the forensic psychiatric patients the best, among other things, because of difficulties with abstract reasoning and low motivation to invest much time in participating in research. Formulating clear research questions based on a model’s underlying principles and composing a multidisciplinary project team with prospective end users appeared to be important in this study. The research questions supported the project team in keeping the complex development processes structured and prevented tunnel vision. With regard to the CeHRes Roadmap, continuous stakeholder involvement and formative evaluations were evaluated as strong points. A suggestion to further improve the Roadmap is to explicitly integrate the use of domain-specific theories and models. To create a tool kit with a broad range of methods for eHealth development and further improve development models, studies that report and reflect on development processes in a consistent and structured manner are needed.

User involvement in digital health: Working together to design smart home health technology

Background

Public involvement adds value to numerous aspects of health research, yet few studies have attempted to evaluate its impact on research. Evidence of such impact is needed to develop recommendations for best practice and ensure adequate resourcing.

Aim

To evaluate public involvement within a large interdisciplinary Science, Technology, Engineering and Mathematics (STEM) research project that focused on digital health.

Methods

The evaluation was conducted with members of the project's Public Advisory Groups (PAG) and with researchers who had participated in involvement activities. Two questionnaires were designed based on a public involvement value systems and clusters framework.

Results

Responses from members of the PAG (n = 10) were mostly positive towards normative values, which include moral, ethical and political aspects of involvement in research, and towards values concerning the conduct of public involvement and best practices. Researchers’ responses (n = 16) indicated they felt that involvement was generally effective and increased the quality, relevance and generalizability of their work. However, their responses about the validity of involvement in research were varied. They also highlighted several challenges including how well public involvement impacted on research, how decisions made in the research might differ from the views generated from public involvement, and barriers to researchers’ participation.

Discussion and conclusion

Our evaluation suggests that members of the public and the researchers value involvement. However, there is a need to consider how to embed public involvement to an even greater extent in STEM contexts and a need to address any barriers for researchers’ own involvement.

Innovations in Wearable and Implantable Artificial Kidneys

More than 2 million people worldwide receive treatment for end-stage renal disease (ESRD). Current modalities of renal replacement therapy include in-center hemodialysis, peritoneal dialysis, home hemodialysis, and kidney transplantation. Patient survival has gradually increased during the past 2 decades and efforts continue to improve mortality and quality of life for patients with ESRD. Developments in sorbent technology, nanotechnology, and cell culture techniques provide promise for new innovations in ESRD management. New modalities currently in testing include wearable (WAKs) and implantable artificial kidneys (IAKs). The automated WAK (AWAK) and WAK are devices that have undergone small trials in humans. Additional study is needed before regulatory approval, coverage decisions, and widespread clinical implementation. The IAK is a biohybrid combining artificial filters and living cells currently in preclinical testing. These portable devices reduce the need for large quantities of water and continuous electrical supply. This could lower some barriers to home dialysis, making self-care renal replacement therapy more accessible and desirable. If widely successful, these devices could reduce the need to build and staff dialysis facilities, thus lowering health care costs associated with dialysis. The potential advantages and shortcomings of the AWAK, WAK, and IAK are described here.

History of Romanian Medical Informatics: Learning from the Past to Reshape the Future

OBJECTIVES

 The paper presents a review of the history of medical informatics in Romania, starting from the pioneering works, relating the present, and foreseeing the future.

METHODS

 Major milestones of the development of this field have not been simply enumerated, but described within the specific socio-political frame, grasping the entire context over the last four decades in Romania. Two main perspectives have been traced: education and training in medical informatics and implementations in healthcare.

RESULTS

 Four distinctive historical periods are identified and the major events of each period are described in a critical manner. The history of the Romanian Society of Medical Informatics is presented in a separate chapter. The last section is dedicated to the present state of the field in Romania.

CONCLUSION

 The history of Romanian Medical Informatics spans many years and is rich in content. The Romanian Society of Medical Informatics is mainly the result of the efforts undertaken by an enthusiastic and sound professional community, trying to continue the tradition, to achieve new goals, and to work as an active member of the international biomedical/health informatics community.

Filopodia Conduct Target Selection in Cortical Neurons Using Differences in Signal Kinetics of a Single Kinase

Dendritic filopodia select synaptic partner axons by interviewing the cell surface of potential targets, but how filopodia decipher the complex pattern of adhesive and repulsive molecular cues to find appropriate contacts is unknown. Here, we demonstrate in cortical neurons that a single cue is sufficient for dendritic filopodia to reject or select specific axonal contacts for elaboration as synaptic sites. Super-resolution and live-cell imaging reveals that EphB2 is located in the tips of filopodia and at nascent synaptic sites. Surprisingly, a genetically encoded indicator of EphB kinase activity, unbiased classification, and a photoactivatable EphB2 reveal that simple differences in the kinetics of EphB kinase signaling at the tips of filopodia mediate the choice between retraction and synaptogenesis. This may enable individual filopodia to choose targets based on differences in the activation rate of a single tyrosine kinase, greatly simplifying the process of partner selection and suggesting a general principle.

Technology gap assessment for a future large-aperture ultraviolet-optical-infrared space telescope

The Advanced Technology Large Aperture Space Telescope (ATLAST) team identified five key technology areas to enable candidate architectures for a future large-aperture ultraviolet/optical/infrared (LUVOIR) space observatory envisioned by the NASA Astrophysics 30-year roadmap, "Enduring Quests, Daring Visions." The science goals of ATLAST address a broad range of astrophysical questions from early galaxy and star formation to the processes that contributed to the formation of life on Earth, combining general astrophysics with direct-imaging and spectroscopy of habitable exoplanets. The key technology areas are internal coronagraphs, starshades (or external occulters), ultra-stable large-aperture telescope systems, detectors, and mirror coatings. For each technology area, we define best estimates of required capabilities, current state-of-the-art performance, and current technology readiness level (TRL), thus identifying the current technology gap. We also report on current, planned, or recommended efforts to develop each technology to TRL 5.

Dendritic-cell-based technology landscape: Insights from patents and citation networks

As the most potent antigen-presenting cells, dendritic cells (DCs) are pivotal players in regulating immune responses. DC-based technologies have generated a series of typical and promising therapeutic options, especially after the first DC-based cancer vaccine was approved by US. Food and Drug Administration (US. FDA). In this context, this paper employs patents and citation networks to conduct a fundamental analysis in order to show overall landscape of DC-based technologies. The results in this research can be used as references for decision-making in developing efficacious DC therapeutic products.

(R)evolution in the Management of Acute Kidney Injury in Newborns

The application of continuous renal replacement therapy (CRRT) in children, before roller pumps and dialysis monitors were available in the intensive care unit, was realized by continuous arteriovenous hemofiltration. Then hemofiltration was coupled with dialysis in order to increase dialytic dose and system efficiency, and the circuit and filters were specifically modified to optimize patency and session life span. After about 30 years, another revolution is ongoing, in that pediatric acute kidney injury (AKI) and fluid accumulation (for which critically ill newborns and children with multiple-organ dysfunction are greatly at risk) are recognized as independently associated with mortality and identified as primary conditions to prevent and aggressively treat. Today, novel technology specifically dedicated for very young patients will allow feasible and straightfoward application of CRRT to infants and children. This article discusses the authors' personal perspectives on how clinical and technical issues of dialysis in children have been addressed and how today, severe pediatric AKI can be managed with accurate and safe CRRT machines that will likely yield outcome improvements in the coming decades.

Indigenous technology development and standardization of the process for obtaining ready to use sterile sodium pertechnetate-Tc-99m solution from Geltech generator

Purpose of the Study:

The indigenous design and technology development for processing large scale zirconium molybdate-Mo-99 (ZrMo-99) Geltech generator was successfully commissioned in Board of Radiation and Isotope Technology (BRIT), India, in 2006. The generator production facility comprises of four shielded plant facilities equipped with tongs and special process gadgets amenable for remote operations for radiochemical processing of ZrMo-99 gel.

Results:

Over 2800 Geltech generators have been processed and supplied to user hospitals during the period 2006-2013. Geltech generator supplied by BRIT was initially not sterile. Simple elution of Tc-99m is performed by a sterile evacuated vial with sterile and pyrogen free 0.9% NaCl solution to obtain sodium (Tc-99m) pertechnetate solution. A special type online 0.22 μm membrane filter has been identified and adapted in Geltech generator.

Conclusions:

The online filtration of Tc-99m from Geltech generator; thus, provided sterile Tc-99m sodium pertechnetate solution. Generators assembled with modified filter assembly were supplied to local hospital in Mumbai Radiation Medicine Centre (RMC) and S.G.S. Medical College and KEM Hospital) and excellent performances were reported by users.