ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making

Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis at an earlier stage, the burden of disease and mortality is still high. Improvement of diagnostic and treatment options increased staging accuracy, functional outcome for early stages as well as survival. Although high quality surgery is still the mainstay of curative treatment, the management of CRC must be a multi-modal approach performed by an experienced multi-disciplinary expert team. Optimal choice of the individual treatment modality according to disease localization and extent, tumour biology and patient factors is able to maintain quality of life, enables long-term survival and even cure in selected patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer and the individual clinical situations. This ESMO guideline is recommended to be used as the basis for treatment and management decisions.

Towards a precise test for malaria diagnosis in the Brazilian Amazon: comparison among field microscopy, a rapid diagnostic test, nested PCR, and a computational expert system based on artificial neural networks

Abstract Background Accurate malaria diagnosis is mandatory for the treatment and management of severe cases. Moreover, individuals with asymptomatic malaria are not usually screened by health care facilities, which further complicates disease control efforts. The present study compared the performances of a malaria rapid diagnosis test (RDT), the thick blood smear method and nested PCR for the diagnosis of symptomatic malaria in the Brazilian Amazon. In addition, an innovative computational approach was tested for the diagnosis of asymptomatic malaria. Methods The study was divided in two parts. For the first part, passive case detection was performed in 311 individuals with malaria-related symptoms from a recently urbanized community in the Brazilian Amazon. A cross-sectional investigation compared the diagnostic performance of the RDT Optimal-IT, nested PCR and light microscopy. The second part of the study involved active case detection of asymptomatic malaria in 380 individuals from riverine communities in Rondônia, Brazil. The performances of microscopy, nested PCR and an expert computational system based on artificial neural networks (MalDANN) using epidemiological data were compared. Results Nested PCR was shown to be the gold standard for diagnosis of both symptomatic and asymptomatic malaria because it detected the major number of cases and presented the maximum specificity. Surprisingly, the RDT was superior to microscopy in the diagnosis of cases with low parasitaemia. Nevertheless, RDT could not discriminate the Plasmodium species in 12 cases of mixed infections (Plasmodium vivax + Plasmodium falciparum). Moreover, the microscopy presented low performance in the detection of asymptomatic cases (61.25% of correct diagnoses). The MalDANN system using epidemiological data was worse that the light microscopy (56% of correct diagnoses). However, when information regarding plasma levels of interleukin-10 and interferon-gamma were inputted, the MalDANN performance sensibly increased (80% correct diagnoses). Conclusions An RDT for malaria diagnosis may find a promising use in the Brazilian Amazon integrating a rational diagnostic approach. Despite the low performance of the MalDANN test using solely epidemiological data, an approach based on neural networks may be feasible in cases where simpler methods for discriminating individuals below and above threshold cytokine levels are available.

The need of a weight management control program in judo: a proposal based on the successful case of wrestling

Judo competitions are divided into weight classes. However, most athletes reduce their body weight in a few days before competition in order to obtain a competitive advantage over lighter opponents. To achieve fast weight reduction, athletes use a number of aggressive nutritional strategies so many of them place themselves at a high health-injury risk. In collegiate wrestling, a similar problem has been observed and three wrestlers died in 1997 due to rapid weight loss regimes. After these deaths, the National Collegiate Athletic Association had implemented a successful weight management program which was proven to improve weight management behavior. No similar program has ever been discussed by judo federations even though judo competitors present a comparable inappropriate pattern of weight control. In view of this, the basis for a weight control program is provided in this manuscript, as follows: competition should begin within 1 hour after weigh-in, at the latest; each athlete is allowed to be weighed-in only once; rapid weight loss as well as artificial rehydration (i.e., saline infusion) methods are prohibited during the entire competition day; athletes should pass the hydration test to get their weigh-in validated; an individual minimum competitive weight (male athletes competing at no less than 7% and females at no less than 12% of body fat) should be determined at the beginning of each season; athletes are not allowed to compete in any weight class that requires weight reductions greater than 1.5% of body weight per week. In parallel, educational programs should aim at increasing the athletes', coaches' and parents' awareness about the risks of aggressive nutritional strategies as well as healthier ways to properly manage body weight.

Dry spell mitigation to upgrade semi-arid rainfed agriculture : Water harvesting and soil nutrient management for smallholder maize cultivation in Machakos, Kenya

Improvements in on-farm water and soil fertility management through water harvesting may prove key to up-grade smallholder farming systems in dry sub-humid and semi-arid sub-Sahara Africa (SSA). The currently experienced yield levels are usually less than 1 t ha-1, i.e., 3-5 times lower than potential levels obtained by commercial farmers and researchers for similar agro-hydrological conditions. The low yield levels are ascribed to the poor crop water availability due to variable rainfall, losses in on-farm water balance and inherently low soil nutrient levels. To meet an increased food demand with less use of water and land in the region, requires farming systems that provide more yields per water unit and/or land area in the future. This thesis presents the results of a project on water harvesting system aiming to upgrade currently practised water management for maize (Zea mays, L.) in semi-arid SSA. The objectives were to a) quantify dry spell occurrence and potential impact in currently practised small-holder grain production systems, b) test agro-hydrological viability and compare maize yields in an on-farm experiment using combinations supplemental irrigation (SI) and fertilizers for maize, and c) estimate long-term changes in water balance and grain yields of a system with SI compared to farmers currently practised in-situ water harvesting. Water balance changes and crop growth were simulated in a 20-year perspective with models MAIZE1&2. Dry spell analyses showed that potentially yield-limiting dry spells occur at least 75% of seasons for 2 locations in semi-arid East Africa during a 20-year period. Dry spell occurrence was more frequent for crop cultivated on soil with low water-holding capacity than on high water-holding capacity. The analysis indicated large on-farm water losses as deep percolation and run-off during seasons despite seasonal crop water deficits. An on-farm experiment was set up during 1998-2001 in Machakos district, semi-arid Kenya. Surface run-off was collected and stored in a 300m3 earth dam. Gravity-fed supplemental irrigation was carried out to a maize field downstream of the dam. Combinations of no irrigation (NI), SI and 3 levels of N fertilizers (0, 30, 80 kg N ha-1) were applied. Over 5 seasons with rainfall ranging from 200 to 550 mm, the crop with SI and low nitrogen fertilizer gave 40% higher yields (**) than the farmers’ conventional in-situ water harvesting system. Adding only SI or only low nitrogen did not result in significantly different yields. Accounting for actual ability of a storage system and SI to mitigate dry spells, it was estimated that a farmer would make economic returns (after deduction of household consumption) between year 2-7 after investment in dam construction depending on dam sealant and labour cost used. Simulating maize growth and site water balance in a system of maize with SI increased annual grain yield with 35 % as a result of timely applications of SI. Field water balance changes in actual evapotranspiration (ETa) and deep percolation were insignificant with SI, although the absolute amount of ETa increased with 30 mm y-1 for crop with SI compared to NI. The dam water balance showed 30% productive outtake as SI of harvested water. Large losses due to seepage and spill-flow occurred from the dam. Water productivity (WP, of ETa) for maize with SI was on average 1 796 m3 per ton grain, and for maize without SI 2 254 m3 per ton grain, i.e, a decerase of WP with 25%. The water harvesting system for supplemental irrigation of maize was shown to be both biophysically and economically viable. However, adoption by farmers will depend on other factors, including investment capacity, know-how and legislative possibilities. Viability of increased water harvesting implementation in a catchment scale needs to be assessed so that other down-stream uses of water remains uncompromised.

Il risk management tecnico nel trading di portafoglio

Il problema che si cerca di risolvere attraverso la gestione quantitativa del portafoglio è la riduzione del rischio tramite strategie che non dipendano dalla diversificazione dei titoli che compongono il portafoglio. Nel momento in cui si decide di applicare un trading system su un determinato gruppo di asset, il capitale non viene allocato automaticamente su tutti i titoli e si deve affrontare invece un continuo investimento tramite l’apertura dinamica di posizioni sul mercato.Questo significa che la diversificazione non è più una misura adeguata del rischio sostenuto poiché i rendimenti attesi dell’investimento non dipendono più dalle proprietà stesse degli strumenti scelti, ma dalla profittabilità dei segnali generati dalla logica del trading system su questi. Bisogna testare in questo caso le performance del sistema a livello statistico e prevedere anche, per esempio, che l’algoritmo possa generare dei segnali errati che portano a delle posizioni in perdita. Il portafoglio a livello quantitativo deve essere gestito tramite dei trading system che abbiano la possibilità di valutare aspetti globali, come il profitto totale di tutte le posizioni attualmente aperte, o l’intero rischio sostenuto dal capitale gestito. Le decisioni non vengono prese dall’analisi delle prestazioni individuali che la strategia ottiene operando sui singoli titoli. Per affrontare una possibile soluzione a questa problematica si sono quindi selezionati due trading system le cui prestazioni fossero robuste su un intero portafoglio e non solo su determinati titoli. In un successivo momento vengono analizzate le prestazioni del portafoglio aggiungendo ai test due ulteriori strategie di uscita: lo stoploss di portafoglio e il target di portafoglio. Nonostante esse ricalchino idee ampiamente utilizzate per la gestione delle singole posizioni su un titolo, per i test si è deciso di modificarle implementando la gestione globale del capitale all’interno del trading system di portafoglio.

Modeling systems and vis/NIR device to improve peach and nectarine pre and post-harvest fruit maturity management

During the last decade peach and nectarine fruit have lost considerable market share, due to increased consumer dissatisfaction with quality at retail markets. This is mainly due to harvesting of too immature fruit and high ripening heterogeneity. The main problem is that the traditional used maturity indexes are not able to objectively detect fruit maturity stage, neither the variability present in the field, leading to a difficult post-harvest management of the product and to high fruit losses. To assess more precisely the fruit ripening other techniques and devices can be used. Recently, a new non-destructive maturity index, based on the vis-NIR technology, the Index of Absorbance Difference (IAD), that correlates with fruit degreening and ethylene production, was introduced and the IAD was used to study peach and nectarine fruit ripening from the “field to the fork”. In order to choose the best techniques to improve fruit quality, a detailed description of the tree structure, of fruit distribution and ripening evolution on the tree was faced. More in details, an architectural model (PlantToon®) was used to design the tree structure and the IAD was applied to characterize the maturity stage of each fruit. Their combined use provided an objective and precise evaluation of the fruit ripening variability, related to different training systems, crop load, fruit exposure and internal temperature. Based on simple field assessment of fruit maturity (as IAD) and growth, a model for an early prediction of harvest date and yield, was developed and validated. The relationship between the non-destructive maturity IAD, and the fruit shelf-life, was also confirmed. Finally the obtained results were validated by consumer test: the fruit sorted in different maturity classes obtained a different consumer acceptance. The improved knowledge, leaded to an innovative management of peach and nectarine fruit, from “field to market”.

Formazione e gestione di gruppi in reti veicolari ad-hoc per applicazioni di traffic management

Il presente lavoro di tesi si inserisce nel contesto dei sistemi ITS e intende realizzare un insieme di protocolli in ambito VANET relativamente semplici ma efficaci, in grado di rilevare la presenza di veicoli in avvicinamento a un impianto semaforico e di raccogliere quelle informazioni di stato che consentano all’infrastruttura stradale di ottenere una stima il più possibile veritiera delle attuali condizioni del traffico in ingresso per ciascuna delle direzioni previste in tale punto. Si prevede di raccogliere i veicoli in gruppi durante il loro avvicinamento al centro di un incrocio. Ogni gruppo sarà costituito esclusivamente da quelle vetture che stanno percorrendo uno stesso tratto stradale e promuoverà l’intercomunicazione tra i suoi diversi membri al fine di raccogliere e integrare i dati sulla composizione del traffico locale. Il sistema realizzato cercherà di trasmettere alle singole unità semaforiche un flusso di dati sintetico ma costante contenente le statistiche sull’ambiente circostante, in modo da consentire loro di applicare politiche dinamiche e intelligenti di controllo della viabilità. L’architettura realizzata viene eseguita all’interno di un ambiente urbano simulato nel quale la mobilità dei nodi di rete corrisponde a rilevazioni reali effettuate su alcune porzioni della città di Bologna. Le performance e le caratteristiche del sistema complessivo vengono analizzate e commentate sulla base dei diversi test condotti.

Valutazione della mobilita' di contaminanti inorganici tramite test di cessione su matrici ambientali contaminate

La caratterizzazione di sedimenti contaminati è un problema complesso, in questo lavoro ci si è occupati di individuare una metodologia di caratterizzazione che tenesse conto sia delle caratteristiche della contaminazione, con analisi volte a determinare il contenuto totale di contaminanti, sia della mobilità degli inquinanti stessi. Una adeguata strategia di caratterizzazione può essere applicata per la valutazione di trattamenti di bonifica, a questo scopo si è valutato il trattamento di soil washing, andando ad indagare le caratteristiche dei sedimenti dragati e del materiale in uscita dal processo, sabbie e frazione fine, andando inoltre a confrontare le caratteristiche della sabbia in uscita con quelle delle sabbie comunemente usate per diverse applicazioni. Si è ritenuto necessario indagare la compatibilità dal punto di vista chimico, granulometrico e morfologico. Per indagare la mobilità si è scelto di applicare i test di cessione definiti sia a livello internazionale che italiano (UNI) e quindi si sono sviluppate le tecnologie necessarie alla effettuazione di test di cessione in modo efficace, automatizzando la gestione del test a pHstat UNI CEN 14997. Questo si è reso necessario a causa della difficoltà di gestire il test manualmente, per via delle tempistiche difficilmente attuabili da parte di un operatore. Le condizioni redox influenzano la mobilità degli inquinanti, in particolare l’invecchiamento all’aria di sedimenti anossici provoca variazioni sensibili nello stato d’ossidazione di alcune componenti, incrementandone la mobilità, si tratta quindi di un aspetto da considerare quando si individuano le adeguate condizioni di stoccaggio-smaltimento, si è eseguita a questo scopo una campagna sperimentale.

Data management and data analysis in the large European projects GEHA (GEnetics of Healthy Aging) and NU-AGE (NUtrition and AGEing): a bioinformatic approach

The aging process is characterized by the progressive fitness decline experienced at all the levels of physiological organization, from single molecules up to the whole organism. Studies confirmed inflammaging, a chronic low-level inflammation, as a deeply intertwined partner of the aging process, which may provide the “common soil” upon which age-related diseases develop and flourish. Thus, albeit inflammation per se represents a physiological process, it can rapidly become detrimental if it goes out of control causing an excess of local and systemic inflammatory response, a striking risk factor for the elderly population. Developing interventions to counteract the establishment of this state is thus a top priority. Diet, among other factors, represents a good candidate to regulate inflammation. Building on top of this consideration, the EU project NU-AGE is now trying to assess if a Mediterranean diet, fortified for the elderly population needs, may help in modulating inflammaging. To do so, NU-AGE enrolled a total of 1250 subjects, half of which followed a 1-year long diet, and characterized them by mean of the most advanced –omics and non –omics analyses. The aim of this thesis was the development of a solid data management pipeline able to efficiently cope with the results of these assays, which are now flowing inside a centralized database, ready to be used to test the most disparate scientific hypotheses. At the same time, the work hereby described encompasses the data analysis of the GEHA project, which was focused on identifying the genetic determinants of longevity, with a particular focus on developing and applying a method for detecting epistatic interactions in human mtDNA. Eventually, in an effort to propel the adoption of NGS technologies in everyday pipeline, we developed a NGS variant calling pipeline devoted to solve all the sequencing-related issues of the mtDNA.

Implementazione ed analisi di un framework basato su Cloud per la valutazione di algoritmi di data Distribution Management

Il Data Distribution Management (DDM) è un componente dello standard High Level Architecture. Il suo compito è quello di rilevare le sovrapposizioni tra update e subscription extent in modo efficiente. All'interno di questa tesi si discute la necessità di avere un framework e per quali motivi è stato implementato. Il testing di algoritmi per un confronto equo, librerie per facilitare la realizzazione di algoritmi, automatizzazione della fase di compilazione, sono motivi che sono stati fondamentali per iniziare la realizzazione framework. Il motivo portante è stato che esplorando articoli scientifici sul DDM e sui vari algoritmi si è notato che in ogni articolo si creavano dei dati appositi per fare dei test. L'obiettivo di questo framework è anche quello di riuscire a confrontare gli algoritmi con un insieme di dati coerente. Si è deciso di testare il framework sul Cloud per avere un confronto più affidabile tra esecuzioni di utenti diversi. Si sono presi in considerazione due dei servizi più utilizzati: Amazon AWS EC2 e Google App Engine. Sono stati mostrati i vantaggi e gli svantaggi dell'uno e dell'altro e il motivo per cui si è scelto di utilizzare Google App Engine. Si sono sviluppati quattro algoritmi: Brute Force, Binary Partition, Improved Sort, Interval Tree Matching. Sono stati svolti dei test sul tempo di esecuzione e sulla memoria di picco utilizzata. Dai risultati si evince che l'Interval Tree Matching e l'Improved Sort sono i più efficienti. Tutti i test sono stati svolti sulle versioni sequenziali degli algoritmi e che quindi ci può essere un riduzione nel tempo di esecuzione per l'algoritmo Interval Tree Matching.

Renovascular hypertension: screening and modern management

The diagnosis and management of patients with renovascular disease and hypertension continue to elude healthcare providers. The advent of novel imaging and interventional techniques, and increased understanding of the pathways leading to irreversible renal injury and renovascular hypertension, have ushered in commendable attempts to optimize and finetune strategies to preserve or restore renal function and control blood pressure. Large randomized clinical trials that compare different forms of therapy, and smaller trials that test novel experimental treatments, will hopefully help formulate innovative concepts and tools to manage the patient population with atherosclerotic renovascular disease.

Management of phenylketonuria in Europe: survey results from 19 countries

To gain better insight in the most current diagnosis and treatment practices for phenylketonuria (PKU) from a broad group of experts, a European PKU survey was performed. The questionnaire, consisting of 33 questions, was sent to 243 PKU professionals in 165 PKU centers in 23 European countries. The responses were compiled and descriptive analyses were performed. One hundred and one questionnaires were returned by 93/165 centers (56%) from 19/23 European countries (83%). The majority of respondents (77%) managed patients of all age groups and more than 90% of PKU teams included physicians or dieticians/nutritionists. The greatest variability existed especially in the definition of PKU phenotypes, therapeutic blood phenylalanine (Phe) target concentrations, and follow-up practices for PKU patients. The tetrahydrobiopterin (BH4; sapropterin) loading test was performed by 54% of respondents, of which 61% applied a single dose test (20mg/kg over 24h). BH4 was reported as a treatment option by 34%. This survey documents differences in diagnostic and treatment practices for PKU patients in European centers. In particular, recommendations for the treatment decision varied greatly between different European countries. There is an urgent need to pool long-term data in PKU registries in order to generate an evidence-based international guideline.

Long-term effects of watershed management on surface runoff and sediment loss in the Ethiopian Highlands

Data on rainfall, runoff and sediment loss from different land use types have been collected by the Soil Conservation Research Programme in seven small catchments (73-673 hectares) throughout the Ethiopian Highlands since the early 1980s. Monitoring was carried out on a storm-to-storm basis for extended periods of 10-20 years, and the data are analysed here to assess long-term effects of changes. Soil and water conservation technologies were introduced in the early years in the catchments in view of their capacity to reduce runoff and sediment yield. Results indicate that rainfall did not substantially change over the observation periods. Land use changes and land degradation, however, altered runoff, as shown by the data from small test plots (30 m2), which were not altered by conservation measures during the monitoring periods. Sediment delivery from the catchments may have decreased due to soil and water conservation, while runoff rates did not change significantly. Extrapolation of the results in the highlands, however, showed that expansion of cultivated and grazing land induced by population growth may have increased the overall surface runoff. Watershed management in the catchments, finally, had beneficial effects on ecosystem services by reducing soil erosion, restoring soil fertility, enhancing agricultural production, and maintaining overall runoff to the benefit of lowland areas and neighbouring countries.

Improving prehospital trauma management for skiers and snowboarders - need for on-slope triage?

Background Injuries from skiing and snowboarding became a major challenge for emergency care providers in Switzerland. In the alpine setting, early assessment of injury and health status is essential for the initiation of adequate means of care and transport. Nevertheless, validated standardized protocols for on-slope triage are missing. This article can assist in understanding the characteristics of injured winter sportsmen and exigencies for future on-slope triage protocols. Methods Six-year review of trauma cases in a tertiary trauma centre. Consecutive inclusion of all injured skiers and snowboarders aged >15 (total sample) years with predefined, severe injury to the head, spine, chest, pelvis or abdomen (study sample) presenting at or being transferred to the study hospital. Descriptive analysis of age, gender and injury pattern. Results Amongst 729 subjects (total sample) injured from skiing or snowboarding, 401 (55%, 54% of skiers and 58% of snowboarders) suffered from isolated limb injury. Amongst the remaining 328 subjects (study sample), the majority (78%) presented with monotrauma. In the study sample, injury to the head (52%) and spine (43%) was more frequent than injury to the chest (21%), pelvis (8%), and abdomen (5%). The three most frequent injury combinations were head/spine (10% of study sample), head/thorax (9%), and spine/thorax (6%). Fisher's exact test demonstrated an association for injury combinations of head/thorax (p < 0.001), head/abdomen (p = 0.019), and thorax/abdomen (p < 0.001). Conclusion The data presented and the findings from previous investigations indicate the need for development of dedicated on-slope triage protocols. Future research must address the validity and practicality of diagnostic on-slope tests for rapid decision making by both professional and lay first responders. Thus, large-scale and detailed injury surveillance is the future research priority.

TARWIS - A Testbed Management Architecture for Wireless Sensor Network Testbeds

With research on Wireless Sensor Networks (WSNs) becoming more and more mature in the past five years, researchers from universities all over the world have set up testbeds of wireless sensor networks, in most cases to test and evaluate the real-world behavior of developed WSN protocol mechanisms. Although these testbeds differ heavily in the employed sensor node types and the general architectural set up, they all have similar requirements with respect to management and scheduling functionalities: as every shared resource, a testbed requires a notion of users, resource reservation features, support for reprogramming and reconfiguration of the nodes, provisions to debug and remotely reset sensor nodes in case of node failures, as well as a solution for collecting and storing experimental data. The TARWIS management architecture presented in this paper targets at providing these functionalities independent from node type and node operating system. TARWIS has been designed as a re-usable management solution for research and/or educational oriented research testbeds of wireless sensor networks, relieving researchers intending to deploy a testbed from the burden to implement their own scheduling and testbed management solutions from scratch.