Building a global consensus approach to chordoma: a position paper from the medical and patient community

Chordomas are very rare bone malignant tumours that have had a shortage of effective treatments for a long time. New treatments are now available for both the local and the metastatic phase of the disease, but the degree of uncertainty in selecting the most appropriate treatment remains high and their adoption remains inconsistent across the world, resulting in suboptimum outcomes for many patients. In December, 2013, the European Society for Medical Oncology (ESMO) convened a consensus meeting to update its clinical practice guidelines on sarcomas. ESMO also hosted a parallel consensus meeting on chordoma that included more than 40 chordoma experts from several disciplines and from both sides of the Atlantic, with the contribution and sponsorship of the Chordoma Foundation, a global patient advocacy group. The consensus reached at that meeting is shown in this position paper.

Local Heat Application for the Treatment of Buruli Ulcer: Results of a Phase II Open Label Single Center Non Comparative Clinical Trial.

BACKGROUND Buruli ulcer (BU) is a necrotizing skin disease most prevalent among West African children. The causative organism, Mycobacterium ulcerans, is sensitive to temperatures above 37°C. We investigated the safety and efficacy of a local heat application device based on phase change material. METHODS In a phase II open label single center noncomparative clinical trial (ISRCTN 72102977) under GCP standards in Cameroon, laboratory confirmed BU patients received up to 8 weeks of heat treatment. We assessed efficacy based on the endpoints 'absence of clinical BU specific features' or 'wound closure' within 6 months ("primary cure"), and 'absence of clinical recurrence within 24 month' ("definite cure"). RESULTS Of 53 patients 51 (96%) had ulcerative disease. 62% were classified as World Health Organization category II, 19% each as category I and III. The average lesion size was 45 cm(2). Within 6 months after completion of heat treatment 92.4% (49 of 53, 95% confidence interval [CI], 81.8% to 98.0%) achieved cure of their primary lesion. At 24 months follow-up 83.7% (41 of 49, 95% CI, 70.3% to 92.7%) of patients with primary cure remained free of recurrence. Heat treatment was well tolerated; adverse effects were occasional mild local skin reactions. CONCLUSIONS Local thermotherapy is a highly effective, simple, cheap and safe treatment for M. ulcerans disease. It has in particular potential as home-based remedy for BU suspicious lesions at community level where laboratory confirmation is not available. CLINICAL TRIALS REGISTRATION ISRCT 72102977.

The impact of associational life on trust in local institutions: a comparison of 57 Swiss municipalities

In this paper, we evaluate the impact of associational life on individual political trust in 57 Swiss municipalities. Our hierarchical regression models show that individual political trust is not only affected by individual associational membership but also by the exchange between associations and local political authorities in a community. In other words, if political authorities and associations are linked at the community level, citizens will place more trust in their local institutions. Furthermore, we find clear evidence for the rainmaker hypothesis: our results show that the positive effect of a vibrant connection between associational life and local politics on political trust is not solely confined to the associational members themselves, but rather indicate that the structure of the local civic culture fosters political trust among members and non-members at the same time. However, the internal democratic processes of associations have no effect on individuals’ trust in local political institutions.

Local Interstellar Medium: Six Years of Direct Sampling by IBEX

The Interstellar Boundary Explorer (IBEX) has been directly observing neutral atoms from the local interstellar medium for the last six years (2009–2014). This paper ties together the 14 studies in this Astrophysical Journal Supplement Series Special Issue, which collectively describe the IBEX interstellar neutral results from this epoch and provide a number of other relevant theoretical and observational results. Interstellar neutrals interact with each other and with the ionized portion of the interstellar population in the “pristine” interstellar medium ahead of the heliosphere. Then, in the heliosphereʼs close vicinity, the interstellar medium begins to interact with escaping heliospheric neutrals. In this study, we compare the results from two major analysis approaches led by IBEX groups in New Hampshire and Warsaw. We also directly address the question of the distance upstream to the pristine interstellar medium and adjust both sets of results to a common distance of ~1000 AU. The two analysis approaches are quite different, but yield fully consistent measurements of the interstellar He flow properties, further validating our findings. While detailed error bars are given for both approaches, we recommend that for most purposes, the community use “working values” of ~25.4 km s⁻¹, ~75°7 ecliptic inflow longitude, ~−5°1 ecliptic inflow latitude, and ~7500 K temperature at ~1000 AU upstream. Finally, we briefly address future opportunities for even better interstellar neutral observations to be provided by the Interstellar Mapping and Acceleration Probe mission, which was recommended as the next major Heliophysics mission by the NRCʼs 2013 Decadal Survey.