Shooting for the Moon or Flying Too Near the Sun? Crossing the Value Rubicon in Precision Cancer Care

In his last two State of the Union addresses, President Barack Obama has focused on the need to deliver innovative solutions to improve human health, through the Precision Medicine Initiative in 2015 and the recently announced Cancer Moonshot in 2016. Precision cancer care has delivered clear patient benefit, but even for high-impact medicines such as imatinib mesylate (Glivec) in chronic myeloid leukaemia, the excitement at the success of this practice-changing clinical intervention has been somewhat tempered by the escalating price of this 'poster child' for precision cancer medicine (PCM). Recent studies on the costs of cancer drugs have revealed significant price differentials, which are a major causative factor behind disparities in the access to new generations of immunological and molecularly targeted agents. In this perspective, we will discuss the benefits of PCM to modern cancer control, but also emphasise how increasing costs are rendering the current approaches to integrating the paradigm of PCM unsustainable. Despite the ever increasing pressure on cancer and health care budgets, innovation will and must continue. Value-based frameworks offer one of the most rational approaches for policymakers committed to improving cancer outcomes through a public health approach.

Complex contests and the influence of aggressiveness in pigs

Animal contests vary greatly in behavioural tactics used and intensity reached, with some encounters resolved without physical contact while others escalate to damaging fighting. However, the reasons for such variation remains to be fully explained. Aggressiveness, in terms of a personality trait, offers a potentially important source of variation that has typically been overlooked. Therefore, we studied how aggressiveness as a personality trait influenced escalation between contestants matched for resource holding potential (RHP), using detailed observations of the contest behaviour, contest dynamics, and escalation levels. We predicted that winner and loser behaviour would differ depending on personality. This was tested by examining 52 dyadic contests between pigs (Sus scrofa). Aggressiveness was assayed in resident-intruder tests prior to the contest. Contests were then staged between pigs matched for RHP in terms of body weight but differing in their aggressiveness. In 27% of the contests a winner emerged without escalated physical fighting, demonstrating that a fight is not a prerequisite between RHP-matched contestants. However, the duration of contests with or without fighting was the same. In contests without a fight, opponents spent more time on mutual investigation and non-contact displays such as parallel walking, which suggests that ritualized display may facilitate assessment and decision making. Winners low in aggressiveness invested more time in opponent investigation and display and showed substantially less aggression towards the loser after its retreat compared to aggressive winners. Aggressiveness influenced contest dynamics but did not predict the level of escalation. Prominent behavioural differences were found for the interaction between personality and outcome and we therefore recommend including this interaction in models where personality is considered. Analyses based on contest duration only would miss many of the subtleties which are shown here and we therefore encourage more detailed analyses of animal contests, irrespective of the level of contest escalation.

A Machine Learning Analysis of Twitter Sentiment to the Sandy Hook Shootings

Gun related violence is a complex issue and accounts for a large proportion of violent incidents. In the research reported in this paper, we set out to investigate the pro-gun and anti-gun sentiments expressed on a social media platform, namely Twitter, in response to the 2012 Sandy Hook Elementary School shooting in Connecticut, USA. Machine learning techniques are applied to classify a data corpus of over 700,000 tweets. The sentiments are captured using a public sentiment score that considers the volume of tweets as well as population. A web-based interactive tool is developed to visualise the sentiments and is available at this http://www.gunsontwitter.com. The key findings from this research are: (i) There are elevated rates of both pro-gun and anti-gun sentiments on the day of the shooting. Surprisingly, the pro-gun sentiment remains high for a number of days following the event but the anti-gun sentiment quickly falls to pre-event levels. (ii) There is a different public response from each state, with the highest pro-gun sentiment not coming from those with highest gun ownership levels but rather from California, Texas and New York.

To breathe or fight? Siamese fighting fish differ when facing a real opponent or mirror image

Displays are a feature of animal contest behaviour and have been interpreted as a means of gathering information on opponent fighting ability, as well as signalling aggressive motivation. In fish, contest displays often include frontal and lateral elements, which in the latter involves contestants showing their flanks to an opponent. Previous work in a range of fish species has demonstrated population-level lateralization of these displays, preferentially showing one side to their opponent. Mirrors are commonly used in place of a real opponent to study aggression in fish, yet they may disrupt the normal pattern of display behaviour. Here, using Siamese fighting fish, Betta splendens, we compare the aggressive behaviour of males to a mirror image and real opponent behind a transparent barrier. As this species is a facultative air-breather, we also quantify surface breathing, providing insights into underlying fight motivation. Consistent with previous work, we found evidence of population-level lateralization, with a bias to present the left side and use the left eye when facing a real opponent. Contrary to expectations, there were no differences in the aggressive displays to a mirror and real opponent, with positive correlations between the behaviour in the two scenarios. However, there were important differences in surface breathing, which was more frequent and of longer duration in the mirror treatment. The reasons for these differences are discussed in relation to the repertoire of contest behaviour and motivation when facing a real opponent.