TP53 mutational status and cetuximab benefit in rectal cancer: 5-year results of the EXPERT-C trial.

In this updated analysis of the EXPERT-C trial we show that, in magnetic resonance imaging-defined, high-risk, locally advanced rectal cancer, adding cetuximab to a treatment strategy with neoadjuvant CAPOX followed by chemoradiotherapy, surgery, and adjuvant CAPOX is not associated with a statistically significant improvement in progression-free survival (PFS) and overall survival (OS) in both KRAS/BRAF wild-type and unselected patients. In a retrospective biomarker analysis, TP53 was not prognostic but emerged as an independent predictive biomarker for cetuximab benefit. After a median follow-up of 65.0 months, TP53 wild-type patients (n = 69) who received cetuximab had a statistically significant better PFS (89.3% vs 65.0% at 5 years; hazard ratio [HR] = 0.23; 95% confidence interval [CI] = 0.07 to 0.78; two-sided P = .02 by Cox regression) and OS (92.7% vs 67.5% at 5 years; HR = 0.16; 95% CI = 0.04 to 0.70; two-sided P = .02 by Cox regression) than TP53 wild-type patients who were treated in the control arm. An interaction between TP53 status and cetuximab effect was found (P <.05) and remained statistically significant after adjusting for statistically significant prognostic factors and KRAS.

Bespoke Radiology e-Learning

Introduction: Foundation doctors are expected to assess and interpret plain x-ray studies of the chest/abdomen before a definitive report is issued by senior staff. The Royal College of Radiologists have published guidelines (RCR curriculum) on the scope of plain film findings medical students should be familiar with.1 Studies have shown that the x-ray interpretation without feedback does not significantly improve diagnostic ability. 2 Queen’s University, Belfast Trust Radiology and Experior Medical developed an online system to assess individual student ability to interpret X-ray findings. Over a series of assessments each student’s profile is built up, identifying strengths and weakness. The system can then create bespoke individual assessments re-evaluating previously identified weak areas and quantifying interpretative skill improvement. Aim: To determine how readily an online system is adopted by senior medical students, investigating if increasing exposure to x-ray interpretation combined with cyclical formative feedback enhances performance. Methods: The system was offered to all 270 final year medical students as an online resource. The system comprised a series of 20 weekly 30 minute assessments, containing normal and abnormal x-rays within the RCR curriculum. After each assessment students were given formative feedback, including their own result, annotated answers, peer group comparison and a breakdown of areas of strength and weakness. Focus groups of 4-5 students addressed student perspectives of the system, including ease of use, image resolution, system performance across different operating platforms, perceived value of formative feedback loops, breakdown of performance and the value of bespoke personalised assessments. Research Ethics Approval was granted for the study. Data analysis was via two-sided one-sample t-test; initial minimal recruitment was estimated as 60 students, to detect a mean 10% change in performance, with a standard deviation of 20%. Results and Discussion: Over 80% (n = XXX/270) of the student cohort engaged with the study. Student baseline average was 39%, increasing to 62% by the exit test. The steadily sustained improvement (57% relative performance in interpretative diagnostic accuracy) was despite increasing test difficulty. Student feedback via focus groups was universally positive throughout the examined domains. Conclusion: The online resource proved to be valuable, with high levels of student engagement, improving performance despite increasingly difficulty testing and positive learner experience with the system. References: 1. Undergraduate Radiology Curriculum, The Royal College of Ra, April 2012. Ref No. BFCR(12)4 The Royal College of Radiologists, April 2012 2. I Satia, S Bashagha, A Bibi, R Ahmed, S Mellor, F Zaman. Assessing the accuracy and certainty in interpretating chest x-rays in the medical division. Clin Med August 2013 Vol.13 no. 4 349-352

Activation of STING-Dependent Innate Immune Signaling By S-Phase-Specific DNA Damage in Breast Cancer

BACKGROUND: Previously we identified a DNA damage response-deficient (DDRD) molecular subtype within breast cancer. A 44-gene assay identifying this subtype was validated as predicting benefit from DNA-damaging chemotherapy. This subtype was defined by interferon signaling. In this study, we address the mechanism of this immune response and its possible clinical significance.

METHODS: We used immunohistochemistry (IHC) to characterize immune infiltration in 184 breast cancer samples, of which 65 were within the DDRD subtype. Isogenic cell lines, which represent DDRD-positive and -negative, were used to study the effects of chemokine release on peripheral blood mononuclear cell (PBMC) migration and the mechanism of immune signaling activation. Finally, we studied the association between the DDRD subtype and expression of the immune-checkpoint protein PD-L1 as detected by IHC. All statistical tests were two-sided.

RESULTS: We found that DDRD breast tumors were associated with CD4+ and CD8+ lymphocytic infiltration (Fisher's exact test P < .001) and that DDRD cells expressed the chemokines CXCL10 and CCL5 3.5- to 11.9-fold more than DNA damage response-proficient cells (P < .01). Conditioned medium from DDRD cells statistically significantly attracted PBMCs when compared with medium from DNA damage response-proficient cells (P < .05), and this was dependent on CXCL10 and CCL5. DDRD cells demonstrated increased cytosolic DNA and constitutive activation of the viral response cGAS/STING/TBK1/IRF3 pathway. Importantly, this pathway was activated in a cell cycle-specific manner. Finally, we demonstrated that S-phase DNA damage activated expression of PD-L1 in a STING-dependent manner.

CONCLUSIONS: We propose a novel mechanism of immune infiltration in DDRD tumors, independent of neoantigen production. Activation of this pathway and associated PD-L1 expression may explain the paradoxical lack of T-cell-mediated cytotoxicity observed in DDRD tumors. We provide a rationale for exploration of DDRD in the stratification of patients for immune checkpoint-based therapies.

Mobile Technologies: Expectancy, Usage, and Acceptance of Clinical Staff and Patients at a University Medical Center

BACKGROUND: Despite their increasing popularity, little is known about how users perceive mobile devices such as smartphones and tablet PCs in medical contexts. Available studies are often restricted to evaluating the success of specific interventions and do not adequately cover the users' basic attitudes, for example, their expectations or concerns toward using mobile devices in medical settings. OBJECTIVE: The objective of the study was to obtain a comprehensive picture, both from the perspective of the patients, as well as the doctors, regarding the use and acceptance of mobile devices within medical contexts in general well as the perceived challenges when introducing the technology. METHODS: Doctors working at Hannover Medical School (206/1151, response 17.90%), as well as patients being admitted to this facility (213/279, utilization 76.3%) were surveyed about their acceptance and use of mobile devices in medical settings. Regarding demographics, both samples were representative of the respective study population. GNU R (version 3.1.1) was used for statistical testing. Fisher's exact test, two-sided, alpha=.05 with Monte Carlo approximation, 2000 replicates, was applied to determine dependencies between two variables. RESULTS: The majority of participants already own mobile devices (doctors, 168/206, 81.6%; patients, 110/213, 51.6%). For doctors, use in a professional context does not depend on age (P=.66), professional experience (P=.80), or function (P=.34); gender was a factor (P=.009), and use was more common among male (61/135, 45.2%) than female doctors (17/67, 25%). A correlation between use of mobile devices and age (P=.001) as well as education (P=.002) was seen for patients. Minor differences regarding how mobile devices are perceived in sensitive medical contexts mostly relate to data security, patients are more critical of the devices being used for storing and processing patient data; every fifth patient opposed this, but nevertheless, 4.8% of doctors (10/206) use their devices for this purpose. Both groups voiced only minor concerns about the credibility of the provided content or the technical reliability of the devices. While 8.3% of the doctors (17/206) avoided use during patient contact because they thought patients might be unfamiliar with the devices, (25/213) 11.7% of patients expressed concerns about the technology being too complicated to be used in a health context. CONCLUSIONS: Differences in how patients and doctors perceive the use of mobile devices can be attributed to age and level of education; these factors are often mentioned as contributors of the problems with (mobile) technologies. To fully realize the potential of mobile technologies in a health care context, the needs of both the elderly as well as those who are educationally disadvantaged need to be carefully addressed in all strategies relating to mobile technology in a health context.

Essays on Matching Markets and Their Equilibria

Matching theory and matching markets are a core component of modern economic theory and market design. This dissertation presents three original contributions to this area. The first essay constructs a matching mechanism in an incomplete information matching market in which the positive assortative match is the unique efficient and unique stable match. The mechanism asks each agent in the matching market to reveal her privately known type. Through its novel payment rule, truthful revelation forms an ex post Nash equilibrium in this setting. This mechanism works in one-, two- and many-sided matching markets, thus offering the first mechanism to unify these matching markets under a single mechanism design framework. The second essay confronts a problem of matching in an environment in which no efficient and incentive compatible matching mechanism exists due to matching externalities. I develop a two-stage matching game in which a contracting stage facilitates subsequent conditionally efficient and incentive compatible Vickrey auction stage. Infinite repetition of this two-stage matching game enforces the contract in every period. This mechanism produces inequitably distributed social improvement: parties to the contract receive all of the gains and then some. The final essay demonstrates the existence of prices which stably and efficiently partition a single set of agents into firms and workers, and match those two sets to each other. This pricing system extends Kelso and Crawford's general equilibrium results in a labor market matching model and links one- and two-sided matching markets as well.

Forward - Green Virtual Enterprises and Their Breeding Environments: Sustainable Manufacturing, Logistics and Consumption

Part 9: Innovation Networks

A Phylogenetic Classification of the Video-Game Industry’s Business Model Ecosystem

Part 8: Business Strategies Alignment

Matching theory based travel plan aware charging algorithms in V2G smart grid networks

The frequency, time and places of charging have large impact on the Quality of Experience (QoE) of EV drivers. It is critical to design effective EV charging scheduling system to improve the QoE of EV drivers. In order to improve EV charging QoE and utilization of CSs, we develop an innovative travel plan aware charging scheduling scheme for moving EVs to be charged at Charging Stations (CS). In the design of the proposed charging scheduling scheme for moving EVs, the travel routes of EVs and the utility of CSs are taken into consideration. The assignment of EVs to CSs is modeled as a two-sided many-to-one matching game with the objective of maximizing the system utility which reflects the satisfactory degrees of EVs and the profits of CSs. A Stable Matching Algorithm (SMA) is proposed to seek stable matching between charging EVs and CSs. Furthermore, an improved Learning based On-LiNe scheduling Algorithm (LONA) is proposed to be executed by each CS in a distributed manner. The performance gain of the average system utility by the SMA is up to 38.2% comparing to the Random Charging Scheduling (RCS) algorithm, and 4.67% comparing to Only utility of Electric Vehicle Concerned (OEVC) scheme. The effectiveness of the proposed SMA and LONA is also demonstrated by simulations in terms of the satisfactory ratio of charging EVs and the the convergence speed of iteration.

Efecto del consumo concomitante de inhibidores de bomba protones y levotiroxina : revisión sistemática y metaanálisis

Estudios afirman que la acidez gástrica es importante en la absorción de levotiroxina (LT4) con resultados controversiales sobre la interacción entre inhibidores de bomba de protones (IBP) y LT4. El objetivo del estudio fue establecer el efecto del uso concomitante de LT4 e IBP en los niveles de TSH en pacientes adultos con hipotiroidismo primario. Se realizó una revisión sistemática mediante búsqueda en Medline, Embase, Lilacs, Bireme, Scielo, Cochrane y Universidad de York, Access Pharmacy, Google Scholar, Dialnet y Opengray. La búsqueda no se limito por lenguaje. Se evaluó el efecto en la diferencia de medias de TSH luego del consumo de LT4 y luego del consumo concomitante con IBP. Se hizo un metaanálisis, análisis de subgrupos y análisis de sensibilidad utilizando el programa Review Manager 5.3. Se eligieron 5 artículos para el análisis cualitativo y 3 para el metaanálisis. La calidad de los estudios fue buena y el riesgo de sesgos bajo. La diferencia de medias obtenida fue 0.21 mUI/L (IC95%: 0.02-0.40; p=0.03; I2:0%). En el análisis de subgrupos en pacientes mayores de 55 años la diferencia de medias fue 0.21 mUI/L (IC95%: 0.01-0.40; p=0.27; I2:19%). En el análisis de sensibilidad se excluyo el estudio con mayor muestra y la diferencia de medias fue 0.49 mUI/L (IC95%: -0.12 a 1.11; p=0.12; I2:0%). La diferencia de medias de TSH luego del consumo concomitante no se considera clínicamente significativa pues no representa riesgo para el paciente. Son necesarios estudios clínicos aleatorizados y evaluar el efecto en los niveles de T4 libre.

Essays in nonlinear pricing and rent seeking

This thesis consists of three self-contained essays on nonlinear pricing and rent-seeking. In the first chapter of the thesis, I provide new theoretical insights about non-linear pricing in monopoly and common agency by combining the principal-agent framework with other-regarding preferences. I introduce a new theoretical model that separately characterizes status-seeker and inequity-averse buyers. I show how the buyer’s optimal choice of quality and market inefficiency change when the buyer has other-regarding preferences. In the second chapter, I find the optimal productive rent-seeking and sabotaging efforts when the prize is endogenous. I show that due to the existence of endogeneity, sabotaging the productive rent-seeking efforts causes sabotaging the endogenous part of the prize, which can affect the rent-seeking efforts. Moreover, I introduce social preferences into my model and characterize symmetric productive rent-seeking and sabotaging efforts. In the last chapter, I propose a new theoretical model regarding information disclosure with Bayesian persuasion in rent-seeking contests when the efforts are productive. I show that under one-sided incomplete information, information disclosure decision depends on both the marginal costs of efforts and the marginal benefit of aggregate exerted effort. I find that since the efforts are productive and add a positive surplus on the fixed rent, my model narrows down the conditions for the information disclosure compared to the exogenous model. Under the two-sided incomplete information case, I observe that there is a non-monotone relationship between optimal effort and posterior beliefs. Thus, it might be difficult to conclude whether a contest organizer should disclose any information to contestants.

What is a fractional derivative?

This paper discusses the concepts underlying the formulation of operators capable of being interpreted as fractional derivatives or fractional integrals. Two criteria for required by a fractional operator are formulated. The Grünwald–Letnikov, Riemann–Liouville and Caputo fractional derivatives and the Riesz potential are accessed in the light of the proposed criteria. A Leibniz rule is also obtained for the Riesz potential.

X-ray crystallographic study of DNA duplex cross-linking: simultaneous binding to two d(CGTACG)(2) molecules by a bis(9-aminoacridine-4-carboxamide) derivative

Acridine-4-carboxamides form a class of known DNA mono-intercalating agents that exhibit cytotoxic activity against tumour cell lines due to their ability to inhibit topoisomerases. Previous studies of bis-acridine derivatives have yielded equivocal results regarding the minimum length of linker necessary between the two acridine chromophores to allow bis-intercalation of duplex DNA. We report here the 1.7 angstrom resolution X-ray crystal structure of a six-carbon-linked bis(acridine-4-carboxamide) ligand bound to d(CGTACG)(2) molecules by non-covalent duplex cross-linking. The asymmetric unit consists of one DNA duplex containing an intercalated acridine-4-carboxamide chromophore at each of the two CG steps. The other half of each ligand is bound to another DNA molecule in a symmetry-related manner, with the alkyl linker threading through the minor grooves. The two crystallographically independent ligand molecules adopt distinct side chain interactions, forming hydrogen bonds to either O6 or N7 on the major groove face of guanine, in contrast to the semi-disordered state of mono-intercalators bound to the same DNA molecule. The complex described here provides the first structural evidence for the non-covalent cross-linking of DNA by a small molecule ligand and suggests a possible explanation for the inconsistent behaviour of six-carbon linked bis-acridines in previous assays of DNA bis-intercalation.

Measurement of low-derivative surface lenses by two-laser holography with Bi12TiO20 crystals

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Two-dimensional relaxation-diffusion analysis to study water compartmentalization in cells by a single-sided NMR device

In questo lavoro di tesi è presentato un metodo per lo studio della compartimentalizzazione dell’acqua in cellule biologiche, mediante lo studio dell’autodiffusione delle molecole d’acqua tramite uno strumento NMR single-sided. Le misure sono state eseguite nel laboratorio NMR all’interno del DIFA di Bologna. Sono stati misurati i coefficienti di autodiffusione di tre campioni in condizione bulk, ottenendo risultati consistenti con la letteratura. È stato poi analizzato un sistema cellulare modello, Saccharomyces cerevisiae, allo stato solido, ottimizzando le procedure per l’ottenimento di mappe di correlazione 2D, aventi come assi il coefficiente di autodiffusione D e il tempo di rilassamento trasversale T2. In questo sistema l’acqua è confinata e l’autodiffusione è ristretta dalle pareti cellulari, si parla quindi di coefficiente di autodiffusione apparente, Dapp. Mediante le mappe sono state individuate due famiglie di nuclei 1H. Il campione è stato poi analizzato in diluizione in acqua distillata, confermando la separazione del segnale in due distinte famiglie. L’utilizzo di un composto chelato, il CuEDTA, ha permesso di affermare che la famiglia con il Dapp maggiore corrisponde all’acqua esterna alle cellule. L’analisi dei dati ottenuti sulle due famiglie al variare del tempo lasciato alle molecole d’acqua per la diffusione hanno portato alla stima del raggio dei due compartimenti: r=2.3±0.2µm per l’acqua extracellulare, r=0.9±0.1µm per quella intracellulare, che è probabilmente acqua scambiata tra gli organelli e il citoplasma. L’incertezza associata a tali stime tiene conto soltanto dell’errore nel calcolo dei parametri liberi del fit dei dati, è pertanto una sottostima, dovuta alle approssimazioni connesse all’utilizzo di equazioni valide per un sistema poroso costituito da pori sferici connessi non permeabili. Gli ordini di grandezza dei raggi calcolati sono invece consistenti con quelli osservabili dalle immagini ottenute con il microscopio ottico.