Explainable artificial intelligence (XAI): closing the gap between image analysis and navigation in complex invasive diagnostic procedures.

LITERATURE REVIEW: Cystoscopy is the gold standard for initial macroscopic assessments of the human urinary bladder to rule out (or diagnose) bladder cancer (BCa). Despite having guidelines, cystoscopic findings are diverse and often challenging to classify. The extent of the false negatives and false positives in cystoscopic diagnosis is currently unknown. We suspect that there is a certain degree of under-diagnosis (like the failure to detect malignant tumours) and over-diagnosis (e.g. sending the patient for unnecessary transurethral resection of bladder tumors with anesthesia) that put the patient at risk. CONCLUSIONS: XAI robot-assisted cystoscopes would help to overcome the risks/flaws of conventional cystoscopy. Cystoscopy is considered a less life-threatening starting point for automation than open surgical procedures. Semi-autonomous cystoscopy requires standards and cystoscopy is a good procedure to establish a model that can then be exported/copied to other procedures of endoscopy and surgery. Standards also define the automation levels-an issue for medical product law. These cystoscopy skills do not give full autonomy to the machine, and represent a surgical parallel to 'Autonomous Driving' (where a standard requires a human supervisor to remain in the 'vehicle'). Here in robotic cystoscopy, a human supervisor remains bedside in the 'operating room' as a 'human-in-the-loop' in order to safeguard patients. The urologists will be able to delegate personal- and time-consuming cystoscopy to a specialised nurse. The result of automated diagnostic cystoscopy is a short video (with pre-processed photos from the video), which are then reviewed by the urologists at a more convenient time.

Multi-decadal increase of forest burned area in Australia is linked to climate change.

Fire activity in Australia is strongly affected by high inter-annual climate variability and extremes. Through changes in the climate, anthropogenic climate change has the potential to alter fire dynamics. Here we compile satellite (19 and 32 years) and ground-based (90 years) burned area datasets, climate and weather observations, and simulated fuel loads for Australian forests. Burned area in Australia's forests shows a linear positive annual trend but an exponential increase during autumn and winter. The mean number of years since the last fire has decreased consecutively in each of the past four decades, while the frequency of forest megafire years (>1 Mha burned) has markedly increased since 2000. The increase in forest burned area is consistent with increasingly more dangerous fire weather conditions, increased risk factors associated with pyroconvection, including fire-generated thunderstorms, and increased ignitions from dry lightning, all associated to varying degrees with anthropogenic climate change.

[Positron emission tomography in germ cell tumors in men : Possibilities and limitations]. / Positronenemissionstomographie bei Keimzelltumoren des Mannes : Einsatzmöglichkeiten und Grenzen.

BACKGROUND: Conventional radiographic imaging may fail to safely distinguish clinical stage I from stage IIA germ cell cancer, to localize isolated tumor marker relapses, and to equivocally identify the viability of postchemotherapy residual masses. OBJECTIVES: To provide an overview of the diagnostic value and limitations of functional imaging by positron emission tomography with 2­deoxy-2-[fluorine-18]fluoro-D-glucose with computed tomography (18F-FDG-PET-CT) in male germ cell cancer. MATERIALS AND METHODS: A narrative review based on a literature search of PubMed/MEDLINE for original articles published from 1990-2018 and conference proceedings of ASCO (American Society of Clinical Oncology) and EAU (European Association of Urology) annual meetings 2014-2017 is presented. RESULTS: 18F-FDG-PET-CT does not improve diagnostic accuracy compared to conventional CT imaging clinical stage (CS) I disease. Particularly PET-negativity of postchemotherapy residual masses of seminomas >3 cm in size guide decision-making against further additional treatment. Even PET-positive residues must not result in relapse. For nonseminoma, the value of PET imaging is reduced by potential mature teratoma components, which are commonly PET negative. CONCLUSIONS: Current guidelines recommend 18F-FDG-PET-CT 6-8 weeks postchemotherapy for viability assessment of seminoma residues >3 cm in size. Exceptional circumstances, in which 18F-FDG-PET-CT may be helpful, include: (1) detection of active disease in CS IS, (2) viability assessment of residual masses >1 cm where complete secondary resection is impossible, (3) staging at marker relapse with unconspicuous conventional CT scan, (4) early response assessment during chemotherapy.

A data - Model fusion methodology for mapping bushfire fuels for smoke emissions forecasting in forested landscapes of south-eastern Australia.

The increasing regional and global impact of wildfires on the environment, and particularly on the human population, is becoming a focus of the research community. Both fire behaviour and smoke dispersion models are now underpinning strategic and tactical fire management by many government agencies and therefore model accuracy at regional and local scales is increasingly important. This demands accuracy of all the components of the model systems, biomass fuel loads being among the more significant. Validation of spatial fuels maps at a regional scale is uncommon; in part due to the limited availability of independent observations of fuel loads, and in part due to a focus on the impact of model outputs. In this study we evaluate two approaches for estimating fuel loads at a regional scale and test their accuracy against an extensive set of field observations for the State of Victoria, Australia. The first approach, which assumes that fuel accumulation is an attribute of the vegetation class, was developed for the fire behaviour model Phoenix Rapid-Fire, with apparent success; the second approach applies the Community Atmosphere Biosphere Land Exchange (CABLE) process-based terrestrial biosphere model, implemented at high resolution across the Australian continent. We show that while neither model is accurate over the full range of fine and coarse fuel loads, CABLE biases can be corrected for the full regional domain with a single linear correction, however the classification based Phoenix requires a matrix of factors to correct its bias. We conclude that these examples illustrate that the benefits of simplicity and resolution inherent in classification-based models do not compensate for their lack of accuracy, and that lower resolution but inherently more accurate carbon-cycle models may be preferable for estimating fuel loads for input into smoke dispersion models.

[Work and training conditions of residents in urology in Germany : Results of a 2015 nationwide survey by the German Society of Residents in Urology]. / Weiterbildungs- und Arbeitsbedingungen urologischer Assistenzärzte in Deutschland : Ergebnisse einer GeSRU-Umfrage von 2015.

BACKGROUND: High-quality urologic residency training programs are crucial to secure both the future of our specialty and patient care. However, little is known about the current training and working conditions among German urology residents. OBJECTIVES: To comprehensively assess the training- and working conditions among urologic residents in Germany. MATERIALS AND METHODS: The GeSRU invited all German urologic residents to complete an online survey on training- and work conditions. Furthermore, the model of effort-reward imbalance (ERI) was applied to measure psychosocial strain at work. RESULTS: A total of 476 urologic residents participated in the survey. Workdays are characterized by high pace and workload and economic considerations. This comes at the cost of professional training, research and family time. Due to these circumstances, a relevant part of residents draws or at least considers consequences. Psychosocial strain among participants is high and conveys a risk for physicians' health and patients' quality of care. CONCLUSION: Our findings call for an adjustment of urologic working and training conditions to preserve high-quality medical treatment and to ensure an attractive working environment.

Minimally invasive surgery and its impact on 30-day postoperative complications, unplanned readmissions and mortality.

BACKGROUND: A critical appraisal of the benefits of minimally invasive surgery (MIS) is needed, but is lacking. This study examined the associations between MIS and 30-day postoperative outcomes including complications graded according to the Clavien-Dindo classification, unplanned readmissions, hospital stay and mortality for five common surgical procedures. METHODS: Patients undergoing appendicectomy, colectomy, inguinal hernia repair, hysterectomy and prostatectomy were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Non-parsimonious propensity score methods were used to construct procedure-specific matched-pair cohorts that reduced baseline differences between patients who underwent MIS and those who did not. Bonferroni correction for multiple comparisons was applied and P < 0·006 was considered significant. RESULTS: Of the 532 287 patients identified, 53·8 per cent underwent MIS. Propensity score matching yielded an overall sample of 327 736 patients (appendicectomy 46 688, colectomy 152 114, inguinal hernia repair 59 066, hysterectomy 59 066, prostatectomy 10 802). Within the procedure-specific matched pairs, MIS was associated with significantly lower odds of Clavien-Dindo grade I-II, III and IV complications (P ≤ 0·004), unplanned readmissions (P < 0·001) and reduced hospital stay (P < 0·001) in four of the five procedures studied, with the exception of inguinal hernia repair. The odds of death were lower in patients undergoing MIS colectomy (P < 0·001), hysterectomy (P = 0·002) and appendicectomy (P = 0·002). CONCLUSION: MIS was associated with significantly fewer 30-day postoperative complications, unplanned readmissions and deaths, as well as shorter hospital stay, in patients undergoing colectomy, prostatectomy, hysterectomy or appendicectomy. No benefits were noted for inguinal hernia repair.

Incorrect interpretation of carbon mass balance biases global vegetation fire emission estimates.

Vegetation fires are a complex phenomenon in the Earth system with many global impacts, including influences on global climate. Estimating carbon emissions from vegetation fires relies on a carbon mass balance technique that has evolved with two different interpretations. Databases of global vegetation fire emissions use an approach based on 'consumed biomass', which is an approximation to the biogeochemically correct 'burnt carbon' approach. Here we show that applying the 'consumed biomass' approach to global emissions from vegetation fires leads to annual overestimates of carbon emitted to the atmosphere by 4.0% or 100 Tg compared with the 'burnt carbon' approach. The required correction is significant and represents ∼9% of the net global forest carbon sink estimated annually. Vegetation fire emission studies should use the 'burnt carbon' approach to quantify and understand the role of this burnt carbon, which is not emitted to the atmosphere, as a sink enriched in carbon.

Formation of artefacts while sampling emissions of PCDD/PCDF from open burning of biomass.

Emission factors for PCDD/PCDF determined from open combustion are used to estimate national emission budgets; therefore, it is important to have confidence in their accuracy. It has been suspected that artefacts may form due to the presence of hot metal surfaces of sampling equipment, thus skewing emission factors. In this study, emissions of PCDD/PCDF from open burning of forest biomass over a brick hearth were sampled. Five experiments were carried out using a portable sampler. Experiments were designed where the key variable, sample hood and inlet temperatures were manipulated. Other variables such as fuel origin, type and density were consistent. The measured concentration of PCDD/PCDF in the smoke samples ranged from 0.01 µg TEQ (t fuel)(-1) at the lowest maximum hood temperature (185°C) to 15 µg TEQ (t fuel)(-1) at the highest maximum hood temperature (598°C). when hood inlet temperatures exceeded 400°C emission factors were significantly elevated and this is attributed to the formation of artefacts that can cause the over estimation of emission factors. The increase in hood temperature also resulted in a change in the PCDD/PCDF congener and homologue profile of the emissions. For example at the lowest temperature (Fire 1) the PCDD/PCDF ratio measured was 50:1, whereas at the highest temperature (Fire 5) this ratio was about 0.53:1. When the sampler hood and inlet temperatures were kept in the normal operating range of <200°C, emission factors were comparable to those observed in many previous studies in Australia with emissions dominated by PCDD.

Emission factors for PCDD/PCDF and dl-PCB from open burning of biomass.

The Stockholm Convention on Persistent Organic Pollutants includes in its aims the minimisation of unintentional releases of polychlorinated dibenzo-dioxins and dibenzofurans (PCDD/PCDF) and dioxin like PCB (dl-PCB) to the environment. Development and implementation of policies to achieve this aim require accurate national inventories of releases of PCDD/PCDF/dl-PCB. To support this objective, the Conference of Parties established a process to review and update the UNEP Standardized Toolkit for Identification and Quantification of Dioxin and Furan Releases. An assessment of all emission inventories was that for many countries open burning of biomass and waste was identified as the major source of PCDD/PCDF releases. However, the experimental data underpinning the release estimates used were limited in number and, consequently, confidence in the accuracy of the emissions predictions was low. There has been significant progress in measurement technology since the last edition of the Toolkit in 2005. In this paper we reassess published emission factors for release of PCDD/PCDF and dl-PCB to land and air. In total, four types of biomass and 111 emission factors were assessed. It was found that there are no systematic differences in emission factors apparent between biomass types or fire classes. The data set is best described by a lognormal distribution. The geometric mean emission factors (EFs) for releases of PCDD/PCDF to air for the four biomass classes used in the Toolkit (sugarcane, cereal crops, forest and savannah/grass) are 1.6µg TEQ (t fuel)(-1), 0.49µg TEQ (t fuel)(-1), 1.0µg TEQ (t fuel)(-1) and 0.4µg TEQ (t fuel)(-1), respectively. Corresponding EFs for release of PCDD/PCDF to land are 3.0ng TEQ (kg ash)(-1), 1.1ng TEQ (kg ash)(-1), 1.1ng TEQ (kg ash)(-1) and 0.67ng TEQ (kg ash)(-1). There are now also sufficient published data available to evaluate EFs for dl-PCB release to air for sugarcane, forest and grass/savannah; these are 0.03µg TEQ (t fuel)(-1), 0.09µg TEQ (t fuel)(-1) and 0.01µg TEQ (t fuel)(-1), respectively. The average EF for dl-PCB release to land is 0.19ng TEQ (kg ash)(-1). Application of these EFs to national emissions of PCDD/PCDF for global estimates from open burning will lower previous estimates of PCDD/PCDF releases to air and to land by 85% and 90%, respectively. For some countries, the ranking of their major sources will be changed and open burning of biomass will become less significant than previously concluded.

Emissions of PCDD and PCDF from combustion of forest fuels and sugarcane: a comparison between field measurements and simulations in a laboratory burn facility.

Release of PCDD and PCDF from biomass combustion such as forest and agricultural crop fires has been nominated as an important source for these chemicals despite minimal characterisation. Available emission factors that have been experimentally determined in laboratory and field experiments vary by several orders of magnitude from <0.5 µg TEQ (t fuel consumed)(-1) to >100 µg TEQ (t fuel consumed)(-1). The aim of this study was to evaluate the effect of experimental methods on the emission factor. A portable field sampler was used to measure PCDD/PCDF emissions from forest fires and the same fuel when burnt over a brick hearth to eliminate potential soil effects. A laboratory burn facility was used to sample emissions from the same fuels. There was very good agreement in emission factors to air (EF(Air)) for forest fuel (Duke Forest, NC) of 0.52 (range: 0.40-0.79), 0.59 (range: 0.18-1.2) and 0.75 (range: 0.27-1.2) µg TEQ(WHO2005) (t fuel consumed)(-1) for the in-field, over a brick hearth, and burn facility experiments, respectively. Similarly, experiments with sugarcane showed very good agreement with EF(Air) of 1.1 (range: 0.40-2.2), 1.5 (range: 0.84-2.2) and 1.7 (range: 0.34-4.4) µg TEQ (t fuel consumed)(-1) for in-field, over a brick hearth, open field and burn facility experiments respectively. Field sampling and laboratory simulations were in good agreement, and no significant changes in emissions of PCDD/PCDF could be attributed to fuel storage and transport to laboratory test facilities.

Exposure to bushfire smoke during prescribed burns and wildfires: firefighters' exposure risks and options.

Firefighters are exposed to known health-damaging air pollutants present in bushfire smoke and poorly managed exposure can result in serious health issues. A better understanding of exposure levels and the major factors influencing exposures is crucial for the development of mitigation strategies to minimise exposure risks and adverse health impacts. This study monitored air toxics within the breathing zone of firefighters at prescribed burns and at wildfires in Australia. The results showed that exposure levels were highly variable, with higher exposures (sometimes exceeding occupational exposure standards) associated with particular work tasks (such as patrol and suppression) and with certain burn conditions. The majority of firefighter's exposures were at low and moderate levels (~60%), however considerable attention should be given to the high (~30%) and very high (6%) exposure risk situations for which acute and chronic health risks are very likely and for which control strategies should be developed and implemented to minimise health risks.

Hopping hotspots: global shifts in marine biodiversity.

Hotspots of high species diversity are a prominent feature of modern global biodiversity patterns. Fossil and molecular evidence is starting to reveal the history of these hotspots. There have been at least three marine biodiversity hotspots during the past 50 million years. They have moved across almost half the globe, with their timing and locations coinciding with major tectonic events. The birth and death of successive hotspots highlights the link between environmental change and biodiversity patterns. The antiquity of the taxa in the modern Indo-Australian Archipelago hotspot emphasizes the role of pre-Pleistocene events in shaping modern diversity patterns.

Soil-atmosphere trace gas exchange in semiarid and arid zones.

A review is presented on trace gas exchange of CH4, CO, N2O, and NOx arising from agriculture and natural sources in the world's semiarid and arid zones due to soil processes. These gases are important contributors to the radiative forcing and the chemistry of the atmosphere. Quantitative information is summarized from the available studies. Between 5 and 40% of the global soil-atmosphere exchange for these gases (CH4, CO, N2O, and NOx) may occur in semiarid and arid zones, but for each of these gases there are fewer than a dozen studies to support the individual estimates, and these are from a limited number of locations. Significant differences in the biophysical and chemical processes controlling these trace gas exchanges are identified through the comparison of semiarid and arid zones with the moist temperate or wet/dry savanna land regions. Therefore, there is a poorly quantified understanding of the contribution of these regions to the global trace gas cycles and atmospheric chemistry. More importantly, there is a poor understanding of the feedback between these exchanges, global change, and regional land use and air pollution issues. A set of research issues is presented.

Recent introduction of the dominant tunicate, Pyura praeputialis (Urochordata, Pyuridae) to Antofagasta, Chile.

The large sessile tunicate Pyura stolonifera (Pleurogona: Stolibranchiata: Pyuridae), has been regarded as a complex taxon with disjointed distributions, including Australia (Pyura stolonifera praeputialis), South Africa (Pyura stolonifera stolonifera) and South America (Chile, Antofagasta: Pyura sp., the 'piure de Antofagasta'), and has been cited under at least five taxonomic combinations. The 'piure de Antofagasta' is a competitively dominant species in rocky intertidal habitats and shows a limited geographical range (60-70 km) exclusively inside the Bay of Antofagasta. Using cytochrome oxidase I (COI) mitochondrial sequence data from Pyura specimens of the three taxa we tested whether the Chilean taxon represents: (i) a Gondwana relict; (ii) a more recently divergent species; or (iii) a recently introduced species. The results suggest that the Chilean taxon is a recent introduction to Chile from Australian populations and that Pyura stolonifera praeputialis, from Australia, and the 'piure de Antofagasta' are geographical populations of a single species: Pyura praeputialis; whereas the South African taxon represents a second species: Pyura stolonifera.