Source: http://news.yahoo.com/lightbox/explosion-shakes-prague-slideshow/
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Monday, April 29, 2013
Explosion shakes Prague
Rescue workers and firefighters search the area after an explosion in Prague April 29, 2013. The explosion in central Prague on Monday, probably caused by gas, injured as many as 40 people, officials ... more?Rescue workers and firefighters search the area after an explosion in Prague April 29, 2013. The explosion in central Prague on Monday, probably caused by gas, injured as many as 40 people, officials said, and neighbouring buildings - including the National Theatre - had to be evacuated. REUTERS/Petr Josek (CZECH REPUBLIC - Tags: DISASTER) less?
In 2012, 19 billion chat messages were sent each day across the world?compared to just 17.
In 2012, 19 billion chat messages were sent each day across the world?compared to just 17.6 billion SMS messages.
Source: http://gizmodo.com/in-2012-19-billion-chat-messages-were-sent-each-day-ac-484243111
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How They Filmed Return Of The Jedi's Absurdly Great Speeder Chase
This year marks the 30th anniversary of Return Of The Jedi, the Ewok-filled amazingness that spelled the end of the original Star Wars trilogy. That film contained one of the most amazing high-speed chases ever seen on film. This is how they brought that death-defying chase to life.
One of the highlights of Return Of The Jedi is the speeder chase between the Rebels and the Empire. The Rebels need to distract the Scout Troopers in order to deactivate the shield generator, which would let the Rebel fleet penetrate the Death Star and defeat the Galactic Empire.
But you knew that already.
In the scene, Luke and Leia jump on their speeders and then race through the forest at seriously crazy high speeds. There are tons of narrow misses and there was obviously no way to safely or realistically do this at those high speeds.
That's because it wasn't close to real. The natural assumption is the chase was filmed on a dirtbike and then the footage was sped up, but there's a problem with that: Dirtbikes aren't exactly the smoothest riding vehicles in the world. The speeders float on the air, which means they need to appear smoother than a motorcycle could ever be.
The solution was clever and somewhat old fashioned. Cameras were operated at 3/4 of a frame per second as cameramen walked through Cheatham Grove, CA with steadicams. It sounds like it was back-breaking work:
Just 100 more yards. My left hand is slippery with sweat. Legs tired. Brain hurts most of all. I wonder if really intense concentration produces any lingering harmful effects...look at Bobby Fisher! (At a camera speed of only 3/4 frame per second, a thousand feet of precise walking gets you just 16 feet of VistaVision in the can, and every take you forget a few more important phone numbers, or a family birthday.) Is it worth it? At this rate I will be illiterate in a week and a vegetable in two.
Not only was cameraman Garrett Brown wearing the steadicam, he also had two gyroscopes attached to it for extra stabilization, although a slight amount of wobble was still wanted to make it semi-realistic. He also had to concentrate on the target like a sniper. One misstep would mean a ruined take and another slow trudge through the forest. At 3/4 speed, Brown says that 1,000 feet of walking got him 16 usable feet of footage.
Brown was personally skeptical of the idea when it was presented to him. But instead of saying no, he decided to go for it. What resulted was a cameraman walking slowly through the forest with a ton of equipment, where any slight error would cause him to start over again.
The 3/4 speed footage was sped up 30 times in order to make the film the standard 24 frames per seconds. That also made the speed appear to be a mind-boggling 120 MPH through the forest. Brown had to repeatedly walk through the forest in order to get the right shots. Filming at a slow speed like that also didn't let them calculate for exposure, but it seems that their guesswork was spot on and the corrections done in post production made for a great looking scene.
Was the agony of walking through the forest super slowly and making hundreds of cuts to get a three minute chase worth it? Damn right it was.
Source: http://jalopnik.com/how-they-filmed-return-of-the-jedis-absurdly-great-spe-484407675
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Ask Engadget: best WiFi router for super-fast Fiber?
We know you've got questions, and if you're brave enough to ask the world for answers, then here's the outlet to do so. This week's Ask Engadget inquiry is from Travis from Provo, who is a jammy individual, wants to replace his router. If you're looking to ask one of your own, drop us a line at ask [at] engadget [dawt] com.
"I'm currently living in Provo UT, and my wireless router just died. I want to replace it with something that's going to handle Google Fiber as that's on its way. What do you recommend?"
Given the number of places that are now getting super-speed fiber, we're very interested in the results of this one. We ask a similar question each year, and in 2012 you were all voicing your support for Cisco/Linksys hardware, ASUS' RT-N66U and D-Link's DIR-655. The only question is what'll come out on top in 2013, so get commenting, friends.
Filed under: Wireless, Networking
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Friday, April 26, 2013
Airport Transfers: Why Is It Better Than A Taxi Or Cab?
Tenerife airport transfers bring you safe and secure transport system so that you can make full use of the facility while flying in or flying out of the town. The services would include dropping you to your hotel and also picking you during your return journey. Besides, if you wish for some extra services or custom services, then you can make a request very easily. Many people especially the tourists and backpackers also make use of the service for sightseeing and other travel-related purpose.
There is not much of a difference between a transfer service and a taxi. Taxis need to be booked on spot, unless you have access to prepaid taxi booths. Taxis are unreliable in most cases, and quite often the driver may try to extract more money out of you. You may not feel fully safe with him and he wont bother to listen to your custom requests. On the other hand, airport transfers are dependable and can be banked upon fully. Security, safety and faith are essential features of such services.
These services are run by professional travel operators. So, there is no question or doubt about the quality and safety which such transfers bring with them. All you need to do is to ensure that the company or operator is a genuine and popular one. You can easily figure that out after having a brief chat with the operator. You can also visit the website of these transport providers, take a look at the baggage of services which they offer, and contact them through email or telephone to finalize the matters or to place some special private requests. Most of the reputed professionals would have no problem in listening to your customized requests and tweaking their services accordingly to suit your convenience.
Tenerife airport transfers offer you a huge basket of cars to select from. It is always a wise thing to inspect the entire bouquet of vehicles on disposal and then select one according to your budget and the size of the family. Some cars can have ACs and some can be free from them; some cars can have other luxuries as well. The rates for the transports would obviously vary and would increase with increasing features and amenities. So, select a car after considering all your options.
About the Author:
For gathering more info about airport transfers and mainly about Tenerife airport transfers, please check out these links.
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Source: http://www.articlesnatch.com/Article/Airport-Transfers--Why-Is-It-Better-Than-A-Taxi-Or-Cab-/4568514
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Thursday, April 25, 2013
Facebook Removes Gun Sweepstakes | Fast Company | Business + ...
Facebook has shut down at least five gun sweepstakes pages that used the social network to give away guns. The pages, which sometimes gave away AR-15 rifles alongside smaller weapons, were operated by gun shops and weapon industry news sites. Operators of the five offending sites were giving away free guns in exchange for ?liking? their Facebook page--a violation of internal Facebook advertising restrictions.
The gun-giveaways-on-Facebook story was first reported by Vocativ, a New York City-based news startup. According to Vocativ's Scott Cohen, the story developed from web forum postings by users who primarily used Facebook for gun giveaways.
Facebook's advertising rules remain changing and opaque; many page operators appear to be unaware they were violating Facebook policy. Promotions that do not involve weapons, tobacco, prescription drugs, and gasoline are still allowed on the social network however. Non-weapon sweepstakes have been used to great success by major brands on Facebook and remain an integral part of many online marketing efforts.
Gun giveaways, however, are still widespread on the home pages of many online weapon dealers.
[Image: Flickr user William Wootton | Infographic and Screenshots via Vocativ]
Source: http://www.fastcompany.com/3008793/where-are-they-now/facebook-removes-gun-sweepstakes
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Singapore Law Watch - Nestle sues locally listed Petra Foods
Take-it chocolate wafers look similar to its Kit Kat, says Swiss company
SWISS food giant Nestle has started legal proceedings against a locally listed food company over alleged trademark infringements of its popular Kit Kat chocolate bars.
Nestle claims that a Petra Foods product called Take-it has a shape similar to the famous Kit Kat. It also wants production of the chocolate bar stopped.
The company said the Take-it chocolate wafers look similar to its Kit Kat product, according to Nestle's 76-page document filed with the High Court last December.
Kit Kat bars are usually sold in two forms - two bars of chocolate wafers stuck together or a four-bar version.
Nestle calls these the "two fingers" and the "four fingers" shapes and has trademarked them in Singapore and 20 other countries.
It alleges that Petra Foods has infringed on the trademarked shape of the Kit Kat with its Take-it product, which it produces under the Delfi brand.
It stated that the Take-it bar's "shape, size, weight, finishing, proportions, look and feel were deliberately chosen to mirror the Kit Kat with two fingers" and four fingers.
The Swiss company, which is valued at more than 200 billion Swiss francs (S$265.3 billion), said chocolate bars identical, if not similar, to the Kit Kat's two- and four-finger shapes started being sold as early as 2010 in countries such as the Philippines, Indonesia and Singapore.
Nestle's 21 claims in court documents include demands that Petra Foods halts production of the two- and four-finger chocolate wafers and pays damages and costs.
Petra Foods, in response, said Kit Kat has been promoted and sold for its brand name "Kit Kat" and its slogan "Have a break, have a Kit Kat".
It was not marketed based on the two- and four-finger shapes of the chocolate wafers.
Petra Foods also noted that its chocolate wafers were not sold based on the shapes but its own brand name, Delfi's Take-it.
Petra Foods is counter-suing Nestle over the validity of the two-finger and four-finger trademarks and wants them cancelled.
It has also accused Nestle of "groundless threats" of legal proceedings for trademark infringement.
Petra's latest annual report stated that its branded consumer division, which includes the regional chocolate confectionery business, recorded revenue of US$477.7 million (S$592.4 million).
Sales of the Take-it chocolate wafers in Singapore are estimated to be less than 0.1 per cent of its Asian chocolate sales.
The legal tussle over chocolate wafer trademarks is not unique to Singapore.
Cadbury recently lost a trademark lawsuit to Nestle's Kit Kat over four-bar-shaped chocolate wafers.
That dispute dates back to 2007 when Cadbury challenged Nestle's registered trademark over the shape of Kit Kat chocolate wafers in the European Union. Cadbury appealed and won.
Cadbury's Crispello is a wafer chocolate that is similar to the Kit Kat.
The European Board of Appeal overturned the decision and ruled in favour of Nestle in January.
The Straits Times understands that Cadbury has filed an appeal against that decision.
The case of Nestle and Petra Foods is in the preliminary stage. Both sides are presenting their cases and relevant information and findings to the High Court.
Petra Foods makes cocoa ingredients and distributes chocolate confectionery, among other consumer products.
Its chief executive, Mr John Chuang, was named Businessman of the Year at last year's Singapore Business Awards.
Petra Foods shares closed three cents down at $4.14 yesterday.
rjscully@sph.com.sg
Background Story
Nestle's 21 claims in court documents include demands that Petra Foods halts production of the two- and four-finger chocolate wafers.
Source: Straits Times ? Singapore Press Holdings Ltd. Permission required for reproduction.
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Next Movie's Summer Preview Breaks Down The Next Four Months
FROM NEXT MOVIE With the summer movie season starting earlier every year and the month of May just over a week away, it's time to turn your attention to the blockbuster spectacles of the warmer months. Next Movie just put together the perfect primer for the summer movie season. Their list contains everything you need [...]
Source: http://moviesblog.mtv.com/2013/04/23/next-movie-summer-preview/
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Apple's big day
(adds Hodgson and Charlton quotes, changes slug) DORTMUND, Germany, April 23 (Reuters) - Manchester United's Premier League title triumph and the winning mentality of evergreen manager Alex Ferguson were widely praised across the game on Tuesday, with England boss Roy Hodgson labelling him a "magician". United clinched their 20th league title on Monday after Robin van Persie's hat-trick sealed a 3-0 win over Aston Villa, giving Ferguson the 49th trophy in his long managerial career. ...
Source: http://news.yahoo.com/appl-earnings--a-live-chat-about-the-future-of-apple-173717676.html
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Wednesday, April 24, 2013
Violent carjacking ends in wild chase
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Google Fiber for iPad hits the App Store
Let it never be said that Google doesn't show its iOS-toting fans love. Even when it's not bringing apps to Apple's platform first, it usually makes sure to offer its wares on the competing ecosystem. It may have taken a while, but the Google Fiber remote app is now available outside of Android land. You'll need to have an iPad (sorry, no pocketable version here), but just like its Jelly Bean-bound cousin, you can change channels, schedule recordings and fire up on-demand programming. The free app is available now through iTunes, though, it obviously won't do you much good outside of Google Fiber's limited coverage area.
Filed under: Home Entertainment, Software, HD, Apple, Google
Source: Google Fiber Blog, Google Fiber (iTunes)
Source: http://feeds.engadget.com/~r/weblogsinc/engadget/~3/bygStkJhDsA/
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Tuesday, April 23, 2013
Myanmar leader pardons 93 prisoners
YANGON, Myanmar (AP) ? Myanmar's president pardoned 93 prisoners on Tuesday, including at least 59 political detainees, a day after the European Union lifted sanctions against the Southeast Asian nation.
The pardon was announced on state television and came amid renewed calls for the government to release hundreds more political prisoners still believed to be behind bars.
President Thein Sein's government has routinely denied the existence of political prisoners, saying all people sentenced to jail have been convicted legitimately of breaking the nation's laws. Nevertheless, hundreds of prominent political detainees have been freed since the former general took office two years ago after a long-ruling army junta was dissolved.
In February, Thein Sein appointed a 16-member committee to review the cases of inmates identified by opposition groups as prisoners of conscience. Some cases are complicated because they involve bombings or threats to state security or national stability. Rights groups say many other people were wrongfully convicted and given extreme sentences for actions that would not be considered crimes elsewhere.
Ye Aung, a former prisoner and a member of the government committee, said at least 59 political prisoners were released Tuesday and that at least 300 others remain incarcerated, most of them members of ethnic minorities.
Opposition leaders and rights groups have accused the government of using political prisoners as "bargaining chips" ? releasing some to prove progress, holding others to push the West to ease more sanctions.
The last major prisoner release coincided with a visit to the country by President Barack Obama. Tuesday's pardon came after the European Union dropped all political and economic sanctions against Myanmar to support the country's "remarkable process" in democratic reforms, while warning that it must control recent ethnic violence.
"Amnesties almost always coincide with international events. Today's amnesty coincides with the lifting of EU sanctions," said Ko Ko Gyi, who was released from jail last year and is one of the country's most prominent former political prisoners.
"The government should acknowledge the existence of political prisoners and release them all," he said.
One of those released Tuesday from Yangon's notorious Insein prison, Zaw Moe, said he was among at least five political prisoners freed there. But he said he could not be content because "many of my friends remain" behind bars. "I'm worried about them."
Zaw Moe had been sentenced to an 18-year jail term in 2008 for alleged links to dissident groups fighting against the former military government.
Source: http://news.yahoo.com/myanmar-leader-pardons-93-prisoners-152642296.html
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Highly active antiretroviral therapies may be cardioprotective in HIV-infected children, teens
Apr. 22, 2013 ? Long-term use of highly active antiretroviral therapies (HAART) does not appear to be associated with impaired heart function in children and adolescents in a study that sought to determine the cardiac effects of prolonged exposure to HAART on children infected with the human immunodeficiency virus (HIV), according to a report published Online First by JAMA Pediatrics, a JAMA Network publication.
Prior to contemporary antiretroviral therapies (ARTs), children infected with HIV were more likely to have heart failure.
Steven E. Lipshultz, M.D., of the University of Miami Leonard M. Miller School of Medicine, Florida, and colleagues used statistical models to compare echocardiographic measures in the National Institutes of Health-funded Pediatric HIV/AIDS Cohort Study's Adolescent Master Protocol (AMP).
The study included 14 pediatric HIV clinics in the United States. The participants were 325 perinatally HIV-infected children receiving HAART; 189 HIV-exposed but uninfected children; and 70 HIV-infected (mostly HAART-unexposed) historical pediatric controls patients from the National Institutes of Health-funded Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2-HIV) Study.
"Our results indicate that the current use of combination ART, usually HAART, appears to be cardioprotective in HIV-infected children and adolescents. This finding is even more relevant in the developing world where the prevalence of HIV disease in children is much higher," the study notes.
Scores for left ventricular (LV) fractional shortening (a measure of cardiac function) were significantly lower among HIV-infected children from the P2C2-HIV Study than among the AMP HIV-infected group or the 189 AMP HIV-exposed but uninfected controls, the study results indicate. The results also show that for HIV-infected children, a lower nadir CD4 percentage and a higher current viral load were associated with significantly lower cardiac function.
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The above story is reprinted from materials provided by American Medical Association (AMA).
Note: Materials may be edited for content and length. For further information, please contact the source cited above.
Journal Reference:
- Steven E. Lipshultz et al. This study suggests that highly active ART (HAART) does not appear to impair heart function. JAMA Pediatrics, April 22, 2013 DOI: 10.1001/jamapediatrics.2013.1206
Note: If no author is given, the source is cited instead.
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.
Source: http://feeds.sciencedaily.com/~r/sciencedaily/~3/T_-jEq84p3o/130422175506.htm
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Monday, April 22, 2013
Police: Bombing suspects planned more
BOSTON (AP) ? As churches paused to mourn the dead and console the survivors of the Boston Marathon bombing Sunday, the city's police commissioner said the two suspects had such a large cache of weapons that they were probably planning other attacks. The surviving suspect remained hospitalized and unable to speak with a gunshot wound to the throat.
After the two brothers engaged in a gun battle with police early Friday, authorities found many unexploded homemade bombs at the scene, along with more than 250 rounds of ammunition.
Police Commissioner Ed Davis said the stockpile was "as dangerous as it gets in urban policing."
"We have reason to believe, based upon the evidence that was found at that scene ? the explosions, the explosive ordnance that was unexploded and the firepower that they had ? that they were going to attack other individuals. That's my belief at this point." Davis told CBS's "Face the Nation."
On "Fox News Sunday," he said authorities cannot be positive there are not more explosives somewhere that have not been found. But the people of Boston are safe, he insisted.
The suspects in the twin bombings that killed three people and wounded more than 180 are two ethnic Chechen brothers from southern Russia ? 19-year-old Dzhokhar Tsarnaev and his 26-year-old brother, Tamerlan. Their motive remained unclear.
The older brother was killed during a getaway attempt. The younger brother, Dzhokhar Tsarnaev, was still in serious condition Sunday after his capture Friday from a tarp-covered boat in a suburban Boston backyard. Authorities would not comment on whether he had been questioned.
Sen. Dan Coats of Indiana, a member of the Senate Intelligence Committee, said Tsarnaev's throat wound raised questions about when he will be able to talk again, if ever.
The wound "doesn't mean he can't communicate, but right now I think he's in a condition where we can't get any information from him at all," Coats told ABC's "This Week."
It was not clear whether Tsarnaev was shot by police or inflicted the wound himself.
In the final standoff with police, shots were fired from the boat, but investigators have not determined where the gunfire was aimed, Davis said.
In an interview with The Associated Press, the parents of Tamerlan Tsarnaev insisted Sunday that he came to Dagestan and Chechnya last year to visit relatives and had nothing to do with the militants operating in the volatile part of Russia. His father said he slept much of the time.
The younger Tsarnaev could be charged any day. The most serious charge available to federal prosecutors would be the use of a weapon of mass destruction to kill people, which carries a possible death sentence. Massachusetts does not have the death penalty.
Across the rattled streets of Boston, churches opened their doors to remember the dead and ease the grief of the living.
At the Cathedral of the Holy Cross in South Boston, photographs of the three people killed in the attack and a Massachusetts Institute of Technology police officer slain Thursday were displayed on the altar, each face illuminated by a glowing white pillar candle.
"I hope we can all heal and move forward," said Kelly McKernan, who was crying as she left the service. "And obviously, the Mass today was a first step for us in that direction."
A six-block segment of Boylston Street, where the bombs were detonated, remained closed Sunday. But city officials were mapping out a plan to reopen it.
Mayor Thomas Menino said Sunday that once the scene is released by the FBI, the city will follow a five-step process, including environmental testing and a safety assessment of buildings. The exact timetable was uncertain.
Boston's historic Trinity Church could not host services Sunday because it was within the crime scene, but the congregation was invited to worship at the Temple Israel synagogue instead. The FBI allowed church officials a half-hour Saturday to go inside to gather the priests' robes, the wine and bread for Sunday's service.
Trinity's Rev. Samuel T. Lloyd III offered a prayer for those who were slain "and for those who must rebuild their lives without the legs that they ran and walked on last week."
"So where is God when the terrorists do their work?" Lloyd asked. "God is there, holding us and sustaining us. God is in the pain the victims are suffering, and the healing that will go on. God is with us as we try still to build a just world, a world where there will not be terrorists doing their terrible damage."
Near the crime scene, Dan and Keri Arone were pushing their 11-week-old daughter in a stroller when they stopped along Newbury Street, a block from the bombing site, to watch investigators in white jumpsuits scour the pavement. Wearing his bright blue marathon jacket, Dan Arone said he had crossed the finish line 40 minutes before the explosions.
The Waltham, Mass., couple visited the area to leave behind pairs of their running shoes among the bouquets of flowers, hand-written signs and other gifts at a makeshift memorial on Boylston Street, near the police barriers.
"I thought maybe we'd somehow get some closure," Dan Arone said of leaving behind the sneakers. "But I don't feel any closure yet."
The federal Bureau of Alcohol, Tobacco, Firearms and Explosives was tracing the suspects' weapons to try to determine how they were obtained.
Neither of the brothers had permission to carry a gun. Cambridge Police Commissioner Robert Haas said it was unclear whether either of them ever applied for a gun permit, and the applications are not considered public records.
But the younger brother would have been denied a permit based on his age alone. Only people 21 or older are allowed gun licenses in Massachusetts.
Meanwhile, surgeons at a Cambridge hospital said the Boston transit police officer wounded in a shootout with the suspects had lost nearly all his blood, and his heart had stopped from a single gunshot wound that severed three major blood vessels in his right thigh.
Richard Donohue, 33, was in critical but stable condition. He is sedated and on a breathing machine but opened his eyes, moved his hands and feet and squeezed his wife's hand Sunday.
Massachusetts Gov. Deval Patrick is asking residents to observe a moment of silence Monday at the time the first of two bombs exploded. The one-minute tribute is scheduled for 2:50 p.m., exactly a week after the attacks. It will be followed by the ringing of bells in Boston and elsewhere in Massachusetts.
In New York, thousands of runners donned "I Run for Boston" bibs during a 4-mile run in Central Park, one of a number of races held around the world in support of the victims of the marathon bombings.
Across the Atlantic Ocean, thousands of London Marathon runners offered their own tributes. The race began after a moment of silence, and many competitors wore black armbands as a sign of solidarity.
___
Associated Press writers Meghan Barr and Michael Hill in Boston contributed to this report.
Source: http://news.yahoo.com/police-bombing-suspects-planned-more-attacks-201956630.html
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World shares up, yen slips after G20 accepts Japan stimulus
By Richard Hubbard
LONDON (Reuters) - The Japanese yen weakened toward 100 to the dollar on Monday and shares rose after the G20 accepted Japan's bold stimulus policies, helping to counter the gloom over the global growth outlook.
U.S. stock index futures also pointed to a higher open on Wall Street, where the focus is on quarterly corporate results and whether these suggest further weakness ahead.
In its communique after a two-day meeting, the G20 avoided any direct criticism of Japan's policies and appeared to accept the need to reflate the world's third largest economy as part of efforts to invigorate a shaky global economic recovery.
Major world central banks have been holding interest rates at rock-bottom levels since 2008 while pumping over $6 trillion into their banking systems through loans and asset-purchase operations with only modest success so far.
"The real issue of deflation in Japan has to be tackled before we can have a genuine global recovery," said James Bevan, chief investment Officer at CCLA Investment Management.
The G20's actions removed any remaining obstacles to further yen weakness, setting up a test of the symbolic 100 yen to the dollar level and boosting demand for Japanese stocks.
"Japan not only escaped criticism, but on the contrary won praise as a country that was fulfilling its global obligations," said Marshall Gittler, head of global FX strategy at IronFX.
"That is in effect the green light for the BOJ's easing, which we expect will push USD/JPY through the magic 100 number in the not-too-distant future - perhaps as early as today."
The dollar was at 99.75 yen, off an intraday high of 99.90 and just below a four-year peak of 99.95 hit on April 11.
The euro also rose against the yen, reaching 130.70 from around 129.98 late on Friday, near a three-year peak of 131.10 set earlier this month.
Against the dollar, the euro eased slightly to $1.3040 after touching a session high of $1.3130 on Friday. The euro, which failed to break above $1.32 recently, has been stuck in a $1.30/32 range for the past week.
ITALIAN RESOLUTION
European stock markets were on course for a second straight daily gain, helped up by a jump in Italy's blue-chip index after the country's long-running political crisis moved a step closer to resolution.
Milan's FTSE MIB index gained as much as 2 percent on hopes the re-election of Italy's 87-year old president Giorgio Napolitano would see a new government emerge within days, ending two months of political stalemate.
The broad FTSEurofirst 300 index was up 0.8 percent at 1,162 points at midday, while Paris's CAC-40 and Frankfurt's DAX were about 0.75 percent higher.
MSCI's world equity index gained 0.25 percent, in part due to the better tone seen earlier in Asia when Japan's Nikkei hit its highest level in five years as the yen weakened after the G20 statement.
In the debt market Italian 10-year bond yields dropped to near their lowest levels in two years at 4.08 percent in response to the political resolution, while safe-haven equivalent German bonds were steady at 1.24 percent.
Traders had not expected a big move in German bonds as the market is awaiting key surveys on European purchasing managers' activity in April, due on Tuesday. These are likely to show the euro zone remains mired in recession, increasing the chance of a rate cut by the European Central bank.
COMMODITIES SHAKY
In the commodity markets gold rebounded from its sharp sell-off last week, though sentiment remained shaky after the precious metal posted its biggest-ever daily loss in dollar terms last Monday.
The spot gold price rose more than 2 percent at one point to a high of $1,436.70 an ounce, well above the two-year low of $1,321.35 touched last week.
U.S. gold futures hit a high of 1,434.50 an ounce, up 2.8 percent from the previous close of 1,395.60.
Oil also rebounded, extending its gains into a third day as low prices brought buyers back into the market following sharp drops earlier in the month due to the worries about the growth outlook and its impact on demand.
Brent has lost 10 percent since the start of April as growth in the United States and China - the world's two largest oil consumers - slowed while recession in Europe deepened.
June Brent crude rose $1 a barrel to $100.65, while U.S. crude for June delivery gained 65 cents to $88.65 a barrel after a 3.6 percent loss last week.
"This is more bargain-hunting than anything else. People are getting back in the market, but that may not be sustained depending on the (economic) data this week," said Simon Wardell, an analyst at Global Insight.
(Additional reporting by Anooja Debnath. Editing by Anna Willard and Will Waterman)
Source: http://news.yahoo.com/european-shares-gain-italy-elects-president-092731603--finance.html
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World finance leaders say growth still weak
WASHINGTON (AP) ? While world finance leaders say the global economy has improved slightly this year, they said the outlook for the future was uneven with growth and job creation still too weak.
The policy-setting committee for the 188-nation International Monetary Fund said governments need to act decisively to nurture a lasting recovery and restore the resiliency of the global economy.
But the major economies could not reach a consensus on what policies to follow as they move forward.
"The commodity that is in shortest supply now is confidence," Tharman Shanmugaratnam, the chairman of the IMF panel and Singapore's finance minister told reporters. "We need to regenerate optimism and confidence."
The World Bank announced that its steering committee had approved a proposal to establish the goal of eliminating extreme poverty by 2030. The bank defines this condition as living on less than $1.25 a day. The bank estimates there are 1.2 billion people living in extreme poverty, mainly in sub-Saharan Africa and south Asia.
A spokeswoman for Oxfam , the anti-poverty group, Emma Seery, said while the World Bank target was welcome "we are concerned that it will duck the tough choices needed to reach it."
The weekend began with two days of discussions among finance leaders of the Group of 20 nations, composed of major economies such as the United States, Germany and Japan and fast-growing developing nations like China, Brazil and India. The meetings of the IMF and its sister lending institution, The World Bank, followed.
The finance ministers tried to show they were cooperating even though they did not resolve differences that surfaced after an initially flawed bailout of Cyprus in March. The banking troubles on the Mediterranean island renewed fears that a prolonged European debt crisis still posed risks to the global economy.
The U.S. urged European nations to scale back their austerity programs of spending cuts and tax increases in favor of more stimulus to boost growth and combat high unemployment in countries such as Spain and Greece.
But the push was met with resistance from Germany and Britain, which believe heavily indebted European nations must reduce their debts to give markets confidence and keep government borrowing costs low. In the end, the financial leaders sought to bridge the difference by issuing economic blueprints that left room for both the growth and austerity camps to claim victory.
The G-20 nations did reject proposals to issue hard targets for reducing budget deficits, a victory for the United States and Japan, which had argued for more flexibility.
Source: http://news.yahoo.com/world-finance-leaders-growth-still-weak-115125793--finance.html
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Google fined $190,000 in Germany for illegal WiFi snooping with Street View cars
Google's been taking heat for a number of years since its Street View cars were found to be pulling WiFi data, and the Hamburg Commissioner for Data Protection and Freedom of Information has today hit the search giant with a 145,000 euro fine (almost $190,000) for its indiscretions. You may not remember this specific case in Germany -- it was nearly three years ago that investigations began, after all -- but it has now come a close with this fine and the ruling that El Goog illegally recorded personal data including emails, passwords and pictures, which have all reportedly been deleted. We know the company has enough cash to pay in full, so the ruling will likely make more of a dent to its image than its bank account.
Via: PCWorld
Source: Hamburg's Commissioner for Data Protection and Freedom
Source: http://feeds.engadget.com/~r/weblogsinc/engadget/~3/-ik_ySi5CnQ/
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Kerry pushes Turkey-Israel rapprochement
ISTANBUL (AP) ? U.S. Secretary of State John Kerry on Sunday urged Turkey to speed up and cement an American-brokered rapprochement with Israel, and he explored with Palestinian officials new ways to relaunch Mideast peace efforts.
Kerry tried to advance those second-term foreign policy priorities for President Barack Obama in meetings with Turkey's foreign minister, Ahmet Davutoglu, and the Palestinian Authority president, Mahmoud Abbas.
Kerry also said he had made it clear to the Turks that a planned trip to the Hamas-controlled Gaza Strip by Prime Minister Recep Tayyip Erdogan after his May 16 visit to the White House "would be better delayed and that it shouldn't take place at this point in time.
Both Israel and Abbas, whose Palestinian Authority is based in the West Bank, oppose the Gaza visit.
"We would like to see the parties begin with as little outside distraction as possible. So our sense is that it would be more helpful to wait for the right circumstances," said Kerry, who did not meet with Erdogan on this stop in Turkey.
On a trip to Israel last month, Obama secured a pledge from Turkish and Israeli leaders to normalize ties that broke down after a 2010 Israeli raid on a Gaza-bound aid flotilla that killed eight Turks and a Turkish-American.
But the rapprochement has been slow, fueling concerns that Turkey may be backsliding on its commitment.
Israeli and Turkish negotiators plan to meet this coming week to discuss Turkey's demand for compensation for victims of the flotilla.
U.S. officials hope the discussions will jumpstart the process of restoring full diplomatic relations and exchanging ambassadors between two countries that Washington sees as vital strategic partners in the volatile Middle East.
The raid sparked throughout outrage in Muslim-majority Turkey, making it politically difficult for Erdogan to bend to persistent U.S. appeals to improve relations with Israel.
In March, Obama extracted an apology for the raid from Israeli Prime Minister Benjamin Netanyahu that broke the stalemate.
Kerry said he understood the anger and frustration of those Turks who lost friends and family in the raid. The former Massachusetts senator said last week's Boston Marathon bombings made him acutely aware of the emotions involved.
"It affects the community, it affects the country. But going forward, you know, we have to find the best way to bring people together and undo these tensions and undo these stereotypes and try to make peace," he said.
Kerry said he had a "prolonged and constructive" discussion with Davutoglu, about "the importance of completing the task with respect to the renewal of relations between Turkey and Israel."
Kerry added that he believed Erdogan and Davutoglu "are deeply committed to fulfilling all of the obligations of that understanding."
U.S. officials are keen to see substantive process by the time Erdogan comes to Washington.
"We would like to see us get to a point where we are moving on improving the situation in Gaza, which was part of the agreement ... and where we are also completing the tasks of moving to full diplomatic relations between the countries, which would be very beneficial to everyone," he said.
With Abbas, Kerry discussed ways to improve the Palestinians' living conditions as a confidence-building measure to improve the atmosphere for a resumption of peace talks with Israel.
Kerry has said he fears there is only a two- or three-year window of opportunity to reach a deal on a two-state solution that would end the decades-old Israeli-Palestinian conflict and wants to move as quickly as possible.
Kerry was in Istanbul primarily to attend an international conference on Syria that began on Saturday and stretched into early Sunday as participants debated how best to boost aid to rebels trying to topple Syrian President Bashar Assad's government.
He announced that the Obama administration would double its nonlethal assistance to the Syrian opposition with an additional $123 million in supplies that could include for the first time armored vehicles, body armor, night vision goggles and other defensive military supplies.
"I can't tell you how quickly it will change things on the ground," Kerry said Sunday. "I can promise you that as soon as I return to Washington, I am going to press as hard as I can" to get it to the opposition within a matter of weeks.
"This has to happen quickly, it has to have an impact," he added.
The additional aid, which brings total nonlethal U.S. assistance to the opposition to $250 million since the fighting began more than two years ago, "underscores the United States' firm support for a political solution to the crisis in Syria and for the opposition's advancement of an inclusive, tolerant vision for a post-Assad Syria," Kerry said.
The U.S. pledge was the only tangible, public offer of new international support at the meeting of the foreign ministers of the 11 main countries supporting the opposition and fell well short of what the opposition has been appealing for: weapons and direct military intervention to stop the violence that has killed more than 70,000 people.
The Syrian National Coalition is seeking drone strikes on sites from which the regime has fired missiles, the imposition of no-fly zones and protected humanitarian corridors to ensure the safety of civilians.
With the exception of the United States, none of the participants offered new assistance, although European nations are considering changes to an arms embargo that would allow weapons transfers to the Syrian opposition.
Kerry ended the day in Brussels, where he plans talks with European officials and was to meet Russian Foreign Minister Sergey Lavrov on the sidelines of a NATO-Russia Council meeting. He has said he has not given up on persuading Moscow to reverse its support for Assad.
Source: http://news.yahoo.com/kerry-pushes-turkey-israel-rapprochement-061951724--politics.html
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Sunday, April 21, 2013
Insight: Pakistan cleric tries hand at politics
By Michael Georgy
JHANG, Pakistan (Reuters) - When Maulana Ahmed Ludhianvi greets supporters on the Pakistan election trail, he opens his pitch with the kind of promises to the poor that any other politician might make.
But behind the reassuring rhetoric lies what his opponents believe is a dangerous agenda - to gain a foothold in parliament and further his designs to oppress Pakistan's Shi'ite minority.
Ludhianvi, a radical Sunni cleric, is a hate figure for Shi'ites who accuse him of devoting his decades-long career to fomenting an escalating campaign of gun attacks and suicide bombings targeting their community.
The prospect that he might win a place in the political mainstream at the May 11 vote horrifies Shi'ites who fear his presence in parliament will give him a much stronger platform to strike out at the sect.
And it looks like Ludhianvi may have a better shot than at the last election in 2008 when he came second. His main rival has been barred from the race and a Reuters visit to his constituency of Jhang, in the heart of populous Punjab province, found no shortage of supporters.
"I cannot bring any change if I am sitting as a layman outside parliament," Ludhianvi, flanked by bodyguards, said in an interview. "If I get into parliament, everyone will be listening to what we want."
As he toured Jhang, which served as the cradle of sectarian extremist groups in the 1980s, people in one village after another emerged from their homes to shower him with rose petals.
"If I get into parliament, I will be able to save this entire country from bloodshed," said Ludhianvi, who wears a thick beard and an embroidered skull cap and projects a commanding presence.
The election is seen as a milestone for Pakistan's fragile democracy, marking the first time a civilian government has completed a full term in a country which a long history of military meddling in politics.
Western powers are hoping the polls might deliver a government capable of grappling with huge domestic challenges and helping the United States bring the Afghan Taliban to the negotiating table ahead of a NATO pullout in 2014.
Any triumph by Ludhianvi at the polls could be read as a sign that sectarianism - now seen as a top security threat - has made a troubling new in-road into the political sphere, which could further polarize the nuclear-armed country.
Ludhianvi was a leader of Sipah-e-Sahaba, a sectarian Sunni group which emerged in Jhang in the mid-1980s with the support of Pakistani intelligence and which has since been linked to hundreds of killings of Shi'ites.
The group's offshoot, Lashkar-e-Jhangvi (LeJ), evolved into one of Pakistan's most feared militant groups and has claimed responsibility for many attacks on Shi'ites, including a series of bombings that killed almost 200 people in the southwestern city of Quetta this year.
Police in Karachi, the commercial capital, suspect LeJ or similar groups are behind a wave of gun attacks on Shi'ites.
Pakistan banned Sipah-e-Sahaba in 2001 under pressure from the United States to crack down on militancy but the group changed its name to Ahle Sunnat Wal Jamat (ASWJ), which Ludhianvi heads.
Pakistan's sectarian fringe has long been plagued by divisions which make it hard to determine what role individual leaders play. But security officials see Ludhianvi as a member of a core group of ideologues whose anti-Shi'ite views have served as a source of inspiration for militants, though he denies any role in violence.
SUNNI-SHI'ITE DIVIDE
The military has in the past quietly supported Islamist politicians and parties in the interest of its own political agenda but it is not clear what stand the military-run security agencies that watch domestic politics are taking this time.
The army chief, General Ashfaq Kayani, has avoided the overt meddling in politics of many of his predecessors and repeatedly insisted the election must be free and fair.
The schism between Sunnis and Shi'ites developed after the Prophet Muhammad died in 632 when his followers could not agree on a successor.
Emotions over the issue have boiled in modern times and even pushed some countries to the brink of civil war. Pakistan is nowhere close to that, but security officials say groups like the LeJ and Sipah-e-Sahaba are stepping up their bloody campaign to persecute Shi'ites and are destabilizing the country.
These days, Ludhianvi is careful to portray himself as a man of peace and is waging a populist campaign to capitalize on resentment of Shi'ite landowners. Coming himself from a modest background, he has vowed to build schools, hospitals and roads.
"This is a tribal area which was ruled by a few rich people who used to treat the poor people like slaves," said Ludhianvi.
"There is no education system or schools for girls and boys. Nobody even tries to build schools or colleges."
But other senior members of his ASWJ party are more vocal about their desire to restrict the rights of Shi'ites.
Aurangzeb Farooqi, head of the party in Karachi, told Reuters in January that Shi'ites should be barred from holding important public office and their public religious activities should be restricted. Farooqi is also running for a seat in the national assembly.
In Jhang, Ludhianvi's blend of populism and sectarianism has earned him considerable grassroots appeal. He won 45,000 votes at the 2008 election, placing him second to Sheikh Waqas who won with 52,000 votes.
But Waqas has been barred from this election on the grounds that he had presented a fake education certificate, raising Ludhianvi's chances of victory.
Politicians are taking note. Rather than making alliances with big businessmen or going door-to-door for votes, aspiring office holders like Azad Ansari, who is in the wool industry, are rallying behind Ludhianvi.
Ansari once served in the secular PML-N but now hopes Ludhianvi can help him make a mark in politics.
"I will get more popular if I join him," Ansari said.
Such sentiment has fostered a perception that leaders of the PML-N party, which controls Punjab, have deliberately been soft on sectarian groups for fear of alienating potential voters.
These suspicions were compounded when Rana Sanaullah, Punjab's law minister and a PML-N stalwart, campaigned alongside Ludhianvi at a by-election rally in Jhang in 2010.
The spectacle of Ludhianvi reinventing himself sends chills through the Shi'ite community, which may make up to 20 percent of the population, though some estimates put the number lower.
"What can Ludhianvi do? He will do nothing but spread terrorism," said Raza Hussain, a resident of a Shi'ite neighborhood of Jhang.
Some fear that a victory for Ludhianvi and other hardliners at the polls will provide a veneer of political cover for violent sectarian extremists.
"This could be very dangerous," said Amir Rana, an expert on Pakistani militancy. "This would give all of their activities political legitimacy."
But some security officials argue that bringing leaders like Ludhianvi into conventional politics may be a way to weaken the sectarian threat by isolating the most violent elements.
Conscious of the need to project a respectable image, Ludhianvi is careful to avoid the kind of inflammatory rhetoric favored by many in his party.
But the presence of young men wearing headbands with the symbols of banned anti-Shi'ite groups, who hung on Ludhianvi's every word during his whistle-stop tour, keeps Shi'ites on edge.
"He has done nothing for Jhang except terrorism," said Sheikh Hussain, a businessman. "They should be stopped."
(Editing by Nick Macfie)
Source: http://news.yahoo.com/insight-pakistan-cleric-tries-hand-politics-013733217.html
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2 landmark studies report on success of using image-guided brachytherapy to treat cervical cancer
![[ Back to EurekAlert! ]](http://www.eurekalert.org/images/back2e.gif){kind=small}
Public release date: 20-Apr-2013[ | E-mail |
Share ] Contact: Emma Mason
wordmason@mac.com
European Society for Radiotherapy and Oncology (ESTRO)
Geneva, Switzerland: Two large, landmark radiotherapy studies have shown that it is possible to treat cervical cancer effectively with high doses specifically adapted to each tumour, and with fewer serious side-effects to the surrounding normal organs.
In two presentations today (Saturday) and tomorrow (Sunday) researchers will tell the 2nd Forum of the European Society for Radiotherapy and Oncology (ESTRO) that image-guided brachytherapy is able to deliver very high doses, which prevent the tumour from growing in over 90% of patients, with few serious side-effects.
One of the problems with radiotherapy for cervical cancer is that the vagina receives a high dose of radiotherapy, which can cause symptoms such as vaginal dryness, vaginal narrowing and shortening, with a loss of flexibility (stenosis), vaginal inflammation (mucositis), bleeding, or a hole in the wall of the vagina (vaginal fistula) one of the most serious but rare complications. The bowel and bladder can also be affected by radiotherapy for cervical cancer.
Image-guided brachytherapy involves delivering radiotherapy to the tumour by placing a radioactive source in an applicator, positioned internally in the tumour region. Imaging, either by repeated computer tomography (CT) scans or preferably magnetic resonance imaging (MRI), is used at the time of brachytherapy in order to delineate both the tumour and organs at risk in relation the applicator. This enables radiation oncologists to measure and evaluate the tumour response to the treatment, and adjust the dose accordingly, while sparing surrounding organs. [1]
However, until now, there have been few studies investigating the relationship between the dose of radiotherapy and the effects it has on the vagina during brachytherapy for cervical cancer, according to Ms Kathrin Kirchheiner (MSc), who will be reporting on the international, multi-centre prospective clinical trial EMBRACE (European and international study on MRI-guided brachytherapy in locally advanced cervical cancer) at the meeting today (Saturday).
"To date, the EMBRACE study has followed 523 patients in 19 centres for an average of 14 months to establish a benchmark for clinical outcome with regard to control of the tumour's growth, patient survival, adverse effects of treatment and quality of life," said Ms Kirchheiner, who is a PhD student in the Department of Radiotherapy at the Medical University Vienna (Austria). [1]
Patients with cervical cancer that had started to spread from the original site to nearby tissues and lymph nodes (locally advanced cancer) underwent external beam radiotherapy, chemotherapy and MRI-guided brachytherapy. The vagina and the effects of the treatment on it (morbidity) were assessed at the start of treatment, every three months afterwards for the first year, once every six months in the second and third year, and annually thereafter. MRI was used to assess the amount of dose being delivered to the upper part of the vaginal wall.
"Our results show that severe vaginal side-effects are rare," said Ms Kirchheiner. "The majority of patients are likely to experience mild to moderate (grade 1 or 2) vaginal morbidity in the first two years after the end of treatment. The most frequently reported symptom is vaginal shortening and narrowing in the upper vagina. We performed a dose response analysis to measure the relationship between the amount of dose delivered to the upper vaginal wall and the probability of vaginal morbidity and found that with increasing dose to this region, the probability for moderate vaginal morbidity increases significantly."
This is the first time that the occurrence of mild and moderate side-effects on the vagina have been systematically recorded and related to the amount of radiation dose in this way. "This is important for patients because studies on their quality of life have shown that mild and moderate vaginal symptoms and associated sexual dysfunction can cause long-term distress in cervical cancer survivors, but until now a clear dose response relationship had not been established.
"Brachytherapy is an essential part of the curative treatment of locally advanced cervical cancer, because of the high dose that can be delivered to the tumour while sparing organs at risk of damage from the treatment. With the possibility of dose adaptation and optimisation in image guided adaptive brachytherapy, a highly individualised and tailored treatment has become possible, comparable to the targeted, personalised therapies in medical oncology," concluded Ms Kirchheiner.
The second study is retro-EMBRACE, which collected data on 592 patients in 12 institutions in Europe and Asia. Associate Professor Kari Tanderup, of the Department of Oncology at Aarhus University Hospital, Denmark, will be reporting results from this retrospective study tomorrow (Sunday).
"When using radiotherapy to treat cervical cancer there is a certain distribution of absorbed dose within the body and it is essential to know the dose level needed for local control of the tumour. However, there has been a wide range of brachytherapy schedules throughout the world with application of different dose levels for cervical cancer, and there has been limited evidence for a clearly defined dose response relationship," she will say.
"One of the reasons is that most cervical cancer brachytherapy experience has been based on planning on radiographs and not 3D imaging. With radiographs it is difficult to assess the dose to the tumour precisely, whereas with MRI or CT guided brachytherapy is it now possible to assess the dose to the tumour with much higher precision. With the retroEMBRACE study it has been possible for the first time to assess a dose response relationship in a large number of patients in a multicentre setting. We looked at different dose levels and found a significant increase in local control with higher doses."
Cervical cancer patients were treated with external beam radiotherapy, chemotherapy and image-guided adaptive brachytherapy (IGABT) based on MRI or CT scans. The amount of residual tumour (known as "high risk clinical tumour volume" or HR CTV) was assessed after the external beam radiotherapy in order to plan IGABT, and to target the residual tumour. "By taking the residual tumour into account we are able to tailor the brachytherapy dose to the individual patient and to the individual tumour response. We call this 'adaptive radiotherapy' because we adapt our treatment to changes which occur during radiochemotherapy," explains Prof Tanderup.
"Our study shows very clearly that the higher the dose the better the tumour's response to the brachytherapy for the entire patient population. It is possible to obtain local control in over 90 percent of patients with application of very high doses of over 90Gy. Brachytherapy is a very appropriate technique to obtain highly focused boost doses, and retroEMBRACE shows that it is actually possible to deliver doses greater than 90Gy for a significant fraction of the patients. It would not be possible to achieve doses greater than 90Gy with external beam radiotherapy without significantly increasing dose to critical organs, and therefore brachytherapy is a crucial component of radiotherapy in cervix cancer. Furthermore, the study also enables us to analyse results in patients with different risks of their tumours recurring or continuing to grow."
She will conclude: "The retroEMBRACE study is important for the community because it establishes evidence for a dose response relationship in locally advanced cervical cancer; it shows that local control in over 90 percent of patients can be obtained with the use of MRI-guided brachytherapy; retroEMBRACE makes it possible for institutions to change their dose prescription in order to optimise the balance between local control and adverse side-effects; and it demonstrates that the adaptive target concept which has been developed for MRI-guided brachytherapy is robust in a multicentre setting."
President of ESTRO, Professor Vincenzo Valentini, a radiation oncologist at the Policlinico Universitario A. Gemelli, Rome, Italy, commented: "This is a tangible example of how large series of data, collected by collaborative networks, and high quality treatment that takes advantage of the latest advances in imaging, can help radiation oncologists to adapt treatments to individual patients so as to give them the best chance of a cure with fewer side-effects."
###
[1] Brachytherapy, where the radiation source is placed inside the body, differs from external beam radiotherapy, where the radiation is delivered from outside the body using linear accelerators.
[2] EMBRACE recruited patients from centres in Europe, North America and India. Retro-EMBRACE looked at data from patients from Austria, Denmark, France, The Netherlands, UK, Slovenia, Thailand and Ireland.
[3] EMBRACE was sponsored by the Medical University of Vienna, and funded by Nucletron (an Elekta company) and Varian Medical Systems. Retro-EMBRACE was supported by funding from Nucletron (an Elekta company) and Varian Medical Systems.
[ | E-mail | Share ] ?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Public release date: 20-Apr-2013[ | E-mail |
Share ] Contact: Emma Mason
wordmason@mac.com
European Society for Radiotherapy and Oncology (ESTRO)
Geneva, Switzerland: Two large, landmark radiotherapy studies have shown that it is possible to treat cervical cancer effectively with high doses specifically adapted to each tumour, and with fewer serious side-effects to the surrounding normal organs.
In two presentations today (Saturday) and tomorrow (Sunday) researchers will tell the 2nd Forum of the European Society for Radiotherapy and Oncology (ESTRO) that image-guided brachytherapy is able to deliver very high doses, which prevent the tumour from growing in over 90% of patients, with few serious side-effects.
One of the problems with radiotherapy for cervical cancer is that the vagina receives a high dose of radiotherapy, which can cause symptoms such as vaginal dryness, vaginal narrowing and shortening, with a loss of flexibility (stenosis), vaginal inflammation (mucositis), bleeding, or a hole in the wall of the vagina (vaginal fistula) one of the most serious but rare complications. The bowel and bladder can also be affected by radiotherapy for cervical cancer.
Image-guided brachytherapy involves delivering radiotherapy to the tumour by placing a radioactive source in an applicator, positioned internally in the tumour region. Imaging, either by repeated computer tomography (CT) scans or preferably magnetic resonance imaging (MRI), is used at the time of brachytherapy in order to delineate both the tumour and organs at risk in relation the applicator. This enables radiation oncologists to measure and evaluate the tumour response to the treatment, and adjust the dose accordingly, while sparing surrounding organs. [1]
However, until now, there have been few studies investigating the relationship between the dose of radiotherapy and the effects it has on the vagina during brachytherapy for cervical cancer, according to Ms Kathrin Kirchheiner (MSc), who will be reporting on the international, multi-centre prospective clinical trial EMBRACE (European and international study on MRI-guided brachytherapy in locally advanced cervical cancer) at the meeting today (Saturday).
"To date, the EMBRACE study has followed 523 patients in 19 centres for an average of 14 months to establish a benchmark for clinical outcome with regard to control of the tumour's growth, patient survival, adverse effects of treatment and quality of life," said Ms Kirchheiner, who is a PhD student in the Department of Radiotherapy at the Medical University Vienna (Austria). [1]
Patients with cervical cancer that had started to spread from the original site to nearby tissues and lymph nodes (locally advanced cancer) underwent external beam radiotherapy, chemotherapy and MRI-guided brachytherapy. The vagina and the effects of the treatment on it (morbidity) were assessed at the start of treatment, every three months afterwards for the first year, once every six months in the second and third year, and annually thereafter. MRI was used to assess the amount of dose being delivered to the upper part of the vaginal wall.
"Our results show that severe vaginal side-effects are rare," said Ms Kirchheiner. "The majority of patients are likely to experience mild to moderate (grade 1 or 2) vaginal morbidity in the first two years after the end of treatment. The most frequently reported symptom is vaginal shortening and narrowing in the upper vagina. We performed a dose response analysis to measure the relationship between the amount of dose delivered to the upper vaginal wall and the probability of vaginal morbidity and found that with increasing dose to this region, the probability for moderate vaginal morbidity increases significantly."
This is the first time that the occurrence of mild and moderate side-effects on the vagina have been systematically recorded and related to the amount of radiation dose in this way. "This is important for patients because studies on their quality of life have shown that mild and moderate vaginal symptoms and associated sexual dysfunction can cause long-term distress in cervical cancer survivors, but until now a clear dose response relationship had not been established.
"Brachytherapy is an essential part of the curative treatment of locally advanced cervical cancer, because of the high dose that can be delivered to the tumour while sparing organs at risk of damage from the treatment. With the possibility of dose adaptation and optimisation in image guided adaptive brachytherapy, a highly individualised and tailored treatment has become possible, comparable to the targeted, personalised therapies in medical oncology," concluded Ms Kirchheiner.
The second study is retro-EMBRACE, which collected data on 592 patients in 12 institutions in Europe and Asia. Associate Professor Kari Tanderup, of the Department of Oncology at Aarhus University Hospital, Denmark, will be reporting results from this retrospective study tomorrow (Sunday).
"When using radiotherapy to treat cervical cancer there is a certain distribution of absorbed dose within the body and it is essential to know the dose level needed for local control of the tumour. However, there has been a wide range of brachytherapy schedules throughout the world with application of different dose levels for cervical cancer, and there has been limited evidence for a clearly defined dose response relationship," she will say.
"One of the reasons is that most cervical cancer brachytherapy experience has been based on planning on radiographs and not 3D imaging. With radiographs it is difficult to assess the dose to the tumour precisely, whereas with MRI or CT guided brachytherapy is it now possible to assess the dose to the tumour with much higher precision. With the retroEMBRACE study it has been possible for the first time to assess a dose response relationship in a large number of patients in a multicentre setting. We looked at different dose levels and found a significant increase in local control with higher doses."
Cervical cancer patients were treated with external beam radiotherapy, chemotherapy and image-guided adaptive brachytherapy (IGABT) based on MRI or CT scans. The amount of residual tumour (known as "high risk clinical tumour volume" or HR CTV) was assessed after the external beam radiotherapy in order to plan IGABT, and to target the residual tumour. "By taking the residual tumour into account we are able to tailor the brachytherapy dose to the individual patient and to the individual tumour response. We call this 'adaptive radiotherapy' because we adapt our treatment to changes which occur during radiochemotherapy," explains Prof Tanderup.
"Our study shows very clearly that the higher the dose the better the tumour's response to the brachytherapy for the entire patient population. It is possible to obtain local control in over 90 percent of patients with application of very high doses of over 90Gy. Brachytherapy is a very appropriate technique to obtain highly focused boost doses, and retroEMBRACE shows that it is actually possible to deliver doses greater than 90Gy for a significant fraction of the patients. It would not be possible to achieve doses greater than 90Gy with external beam radiotherapy without significantly increasing dose to critical organs, and therefore brachytherapy is a crucial component of radiotherapy in cervix cancer. Furthermore, the study also enables us to analyse results in patients with different risks of their tumours recurring or continuing to grow."
She will conclude: "The retroEMBRACE study is important for the community because it establishes evidence for a dose response relationship in locally advanced cervical cancer; it shows that local control in over 90 percent of patients can be obtained with the use of MRI-guided brachytherapy; retroEMBRACE makes it possible for institutions to change their dose prescription in order to optimise the balance between local control and adverse side-effects; and it demonstrates that the adaptive target concept which has been developed for MRI-guided brachytherapy is robust in a multicentre setting."
President of ESTRO, Professor Vincenzo Valentini, a radiation oncologist at the Policlinico Universitario A. Gemelli, Rome, Italy, commented: "This is a tangible example of how large series of data, collected by collaborative networks, and high quality treatment that takes advantage of the latest advances in imaging, can help radiation oncologists to adapt treatments to individual patients so as to give them the best chance of a cure with fewer side-effects."
###
[1] Brachytherapy, where the radiation source is placed inside the body, differs from external beam radiotherapy, where the radiation is delivered from outside the body using linear accelerators.
[2] EMBRACE recruited patients from centres in Europe, North America and India. Retro-EMBRACE looked at data from patients from Austria, Denmark, France, The Netherlands, UK, Slovenia, Thailand and Ireland.
[3] EMBRACE was sponsored by the Medical University of Vienna, and funded by Nucletron (an Elekta company) and Varian Medical Systems. Retro-EMBRACE was supported by funding from Nucletron (an Elekta company) and Varian Medical Systems.
[ | E-mail | Share ] ?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Source: http://www.eurekalert.org/pub_releases/2013-04/esfr-tls041813.php
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