Randomised, multicentre, phase III, open-label study of alectinib vs crizotinib in treatment-naïve anaplastic lymphoma kinase (ALK)-positive advanced NSCLC (ALEX study).

Background: In ∼5% of advanced NSCLC tumours, ALK tyrosine kinase is constitutively activated after translocation of ALK. ALK+ NSCLC was shown to be highly sensitive to the first approved ALK inhibitor, crizotinib. However, all pts eventually relapse on crizotinib mainly due to secondary ALK mutations/amplification or CNS metastases. Alectinib is a highly selective, potent, oral next-generation ALK inhibitor. Clinical phase II alectinib data in 46 crizotinib-naïve pts with ALK+ NSCLC reported an objective response rate (ORR) of 93.5% and a 1-year progression-free rate of 83% (95% CI: 68-92) (Inoue et al. J Thorac Oncol 2013). CNS activity was seen: of 14 pts with baseline brain metastasis, 11 had prior CNS radiation, 9 of these experienced CNS and systemic PFS of >12 months; of the 3 pts without prior CNS radiation, 2 were >15 months progression free. Trial design: Randomised, multicentre, phase III, open-label study in pts with treatment-naïve ALK+ advanced, recurrent, or metastatic NSCLC. All pts must provide pretreatment tumour tissue to confirm ALK rearrangement (by IHC). Pts (∼286 from ∼180 centres, ∼30 countries worldwide) will be randomised to alectinib (600mg oral bid, with food) or crizotinib (250mg oral bid, with/without food) until disease progression (PD), unacceptable toxicity, withdrawal of consent, or death. Stratification factors are: ECOG PS (0/1 vs 2), race (Asian vs non-Asian), baseline CNS metastases (yes vs no). Primary endpoint: PFS by investigators (RECIST v1.1). Secondary endpoints: PFS by Independent Review Committee (IRC); ORR; duration of response; OS; safety; pharmacokinetics; quality of life. Additionally, time to CNS progression will be evaluated (MRI) for the first time in a prospective randomised NSCLC trial as a secondary endpoint. Pts with isolated asymptomatic CNS progression will be allowed to continue treatment beyond documented progression until systemic PD and/or symptomatic CNS progression, according to investigator opinion. Time to CNS progression will be retrospectively assessed by the IRC using two separate criteria, RECIST and RANO. Further details: ClinicalTrials.gov (NCT02075840). Disclosure: T.S.K. Mok: Advisory boards: AZ, Roche, Eli Lilly, Merck Serono, Eisai, BMS, AVEO, Pfizer, Taiho, Boehringer Ingelheim, Novartis, GSK Biologicals, Clovis Oncology, Amgen, Janssen, BioMarin; board of directors: IASLC; corporate sponsored research: AZ; M. Perol: Advisory boards: Roche; S.I. Ou: Consulting: Pfizer, Chugai, Genentech Speaker Bureau: Pfizer, Genentech, Boehringer Ingelheim; I. Bara: Employee: F. Hoffmann-La Roche Ltd; V. Henschel: Employee and stock: F. Hoffmann-La Roche Ltd.; D.R. Camidge: Honoraria: Roche/Genentech. All other authors have declared no conflicts of interest.

Governance mode vs. governance fit: Performance implications of make-or-ally choices for product innovation in the worldwide aircraft industry, 1942-2000

We examine the impact of governance mode and governance fit on performance in make-or-ally decisions. We argue that while horizontal collaboration and autonomous governance have direct and countervailing performance implications, the alignment of make-or-ally choices with the focal firm's resource endowment and the activity's resource requirements leads to better performance. Data on the aircraft industry show that relative to aircraft developed autonomously, collaborative aircraft exhibit greater sales but require longer time-to-market. However, governance fit increases unit sales and reduces time-to-market. We contribute to the alliance and economic organization literatures. (Copyright © 2013 John Wiley & Sons, Ltd.)

Same Performance Changes after Live High-Train Low in Normobaric vs. Hypobaric Hypoxia.

PURPOSE: We investigated the changes in physiological and performance parameters after a Live High-Train Low (LHTL) altitude camp in normobaric (NH) or hypobaric hypoxia (HH) to reproduce the actual training practices of endurance athletes using a crossover-designed study. METHODS: Well-trained triathletes (n = 16) were split into two groups and completed two 18-day LTHL camps during which they trained at 1100-1200 m and lived at 2250 m (P i O2 = 111.9 ± 0.6 vs. 111.6 ± 0.6 mmHg) under NH (hypoxic chamber; FiO2 18.05 ± 0.03%) or HH (real altitude; barometric pressure 580.2 ± 2.9 mmHg) conditions. The subjects completed the NH and HH camps with a 1-year washout period. Measurements and protocol were identical for both phases of the crossover study. Oxygen saturation (S p O2) was constantly recorded nightly. P i O2 and training loads were matched daily. Blood samples and VO2max were measured before (Pre-) and 1 day after (Post-1) LHTL. A 3-km running-test was performed near sea level before and 1, 7, and 21 days after training camps. RESULTS: Total hypoxic exposure was lower for NH than for HH during LHTL (230 vs. 310 h; P < 0.001). Nocturnal S p O2 was higher in NH than in HH (92.4 ± 1.2 vs. 91.3 ± 1.0%, P < 0.001). VO2max increased to the same extent for NH and HH (4.9 ± 5.6 vs. 3.2 ± 5.1%). No difference was found in hematological parameters. The 3-km run time was significantly faster in both conditions 21 days after LHTL (4.5 ± 5.0 vs. 6.2 ± 6.4% for NH and HH), and no difference between conditions was found at any time. CONCLUSION: Increases in VO2max and performance enhancement were similar between NH and HH conditions.

Contaminação por mercúrio no Brasil: fontes industriais vs garimpo de ouro

This paper reviews the history of Hg contamination in Brazil by characterizing and quantifying two major sources of Hg emissions to the environment: industrial sources and gold mining. Industry was responsible for nearly 100% of total Hg emissions from the late 1940's to the early 1970's, when efficient control policies were enforced, leading to a decrease in emissions. Gold mining, on the other hand was nearly insignificant as a Hg source up to the late 1970's, but presently is responsible for over 80% of total emissions. Presently, over 115 tons of Hg are released into the atmosphere in Brazil annually. Nearly 78 tons come from gold mining operations, 12 tons come from chlor-alkali industry and 25 tons come from all other industrial uses. Inputs to soils and waters however, are still unknown, due to lack of detailed data base. However, emissions from diffuse sources rather than well studied classical industrial sources are probably responsible for the major inputs of mercury to these compartments.

Agglomeration vs. dispersion of economic activities in the districts of Paris

The spatial distribution of economic activity has often been analysed for wide geographical areas such as regions or metropolitan areas, but it has rarely been subject to microanalysis, especially outside the U.S. In this paper we focus on what happens within a large European city (Par is), and analyse how the industrial composition of its districts differs and how these districts evolve. We also analyse suburbanization process for both residents and the workforce and provide empirical evidence about the changing roles of the core and intramuros periphery. Keywords: agglomeration, suburbanization, Paris, micropolitan analysis

Regulating Concessions of Toll Motorways, An Empirical Study on Fixed vs. Variable Term Contracts

Recent theoretical developments on concession contracts for long term infrastructure projects under uncertain demand show the benefits of allowing for flexible term contracts rather than fixing a rigid term. This study presents a simulation to compare both alternatives by using real data from the oldest Spanish toll motorway. For this purpose, we analyze how well the flexible term would have performed instead of the fixed length actually established. Our results show a huge reduction of the term of concession that would have dramatically decreased the firm’s benefits and the user’s overpayment due to the internalization of an unexpected traffic increase.

The institutional vs. the academic definition of the quality of work life. What is the focus of the European Commission?

In recent years, we have seen how the quality of work life has been focused and defined by the European Commission (EC). In our study we compare the EC definition with the academic one and try to see how close they are. We also analyse the possibility of applying the institutional definition to the Spanish case through the development of specific indicators. Our main conclusions are that QWL is increasingly important for policy makers. In addition, it is essential to have objective indicators and to conduct surveys in order to reliably measure QWL.

Comparing Methods of Evaluating the Spread of Argentine Ants in Natural Habitats: Pitfall Traps vs. Baiting

Two methods of trapping Argentine ants in natural habitats are compared. both methods are used on the boundaries of an invaded area with the goal of assessing the spread of the invasion front. Pitfall surveys take longer to obtain results than bait surveys, but bait surveys are only a “snapshot” of the moment, with less chance of detecting Argentine ant workers. significant differences are found between the methods in terms of the number of traps occupied by Argentine ants, native ants or a combination of both. Differences in the richness of native ant species are found as well, showing that pitfall surveys are necessary to assess such richness. Despite this, no differences in the assessment of spread are found between the methods. bait surveys are an easier and faster method to assess the spread of Argentine ants, spread being one of the most important characteristics of biological invasions

Numerical Dominance of the Argentine Ant vs Native Ants and Consequences on Soil Resource Searching in Mediterranean Cork-Oak Forests (Hymenoptera: Formicidae)

This study is focused on the dominance exerted by the invasive Argentine ant over native ants in a coastal Mediterranean area. Theimpact of this invasive ant on native ant assemblages and its consequences on total ant biomass and on the intensity of habitat explorationwere evaluated. Foraging ants were observed and their trajectories recorded during 5-minute periods in two study zones, one invaded andthe other non-invaded. Ant species detected, ant worker abundance, ant biomass and the intensity of soil surface searching done by antswere compared between the two zones. The Argentine ant invasion provoked a drastic reduction of the ant species richness. Apparentlyonly one native ant species is able to coexist with the Argentine ant, the cryptic Plagiolepis pygmaea. Ant worker abundance was also modified after the invasion: the number of Argentine ant workers detected, which represented 92% of the invaded zone, was two times higher than the number of native ant workers detected in the non-invaded zone. The total ant biomass was inversely affected, becoming four times lower in the invaded zone highly dominated by Linepithema humile. The higher number of Argentine ant workers and their fast tempo of activity implied an alteration of the intensity of soil surface searching: scanning by the Argentine ants in the invaded zone was higher than that done by the native ants in the non-invaded zone, and the estimated time for a complete soil surface scan was 64 minutes in the invaded zone and 108 minutes in the non-invaded zone. Consequently, resources will be discovered faster by ants in the invaded zone than in the non-invaded zone. The increase of the mean temperature and the decrease of the relative humidity from May to August reduced the ant activity in the two study zones but this reduction was greater in the invaded zone

Tacrolimus vs. Azathioprine in myasthenia gravis treatment: a multicenter, prospective, randomized, double blind, head to head clinical trial

Current evidences show that tacrolimus could be a good therapeutic option in patients non-responsive to first-line treatments and even it could become one of the first-line drugs for treating MG. Our study will try to determine the effectivity and safety of tacrolimus in 190 myasthenia gravis patients with suboptimal response to azathioprine: after 12 months of treatment they will be randomized to continue with azathioprine or they will be switched to tacrolimus. Patients will follow the allocated treatment during 14 months and the response will be assessed as well as adverse effectsPURPOSE: To compare azathioprine vs. tacrolimus effectivity and safety in MG patients with suboptimal response to azathioprine at 12 monthsDESIGN: A 14 months multicenter, prospective, randomized, double blind, head to head clinical trial

Targeted vs. standard treatment against Helicobacter pylori: safety assessment clinical trial

Helicobacter pylori (H. pylori) is a gram negative bacteria that represents a considerable global burden in the world and is related to many gastrointestinal diseases (peptic ulcer, gastric MALT lymphoma or gastric cancer). Currently the triple standard therapy is less used as there is an increase of the clarithromycin resistance. Therefore patients have to receive several lines of treatment with the consequence of adverse events and the possibility to interrupt the treatment. This is why the main objective is to determine if making a culture and antibiogram to do a targeted treatment cause less adverse events with the same eradication than making an empirical treatment to eradicate H. pylori. The secondary objective is to determine the prevalence of resistance to clarithromycin in the province of GironaThis is a multicentre clinical trial without blinding; patients are selected by non-probabilistic sampling, with a total sample of 868 patients randomized in two equal groups of 434 patients in each group. The study will last 2 years. The endpoints will be to evaluate the adverse events and eradication of each group of patients. Also it will be evaluated the resistance to clarithromycin