Multi-institutional validation of the prognostic value of Ki-67 labeling index in patients treated with radical prostatectomy.

OBJECTIVE: Several smaller single-center studies have reported a prognostic role for Ki-67 labeling index in prostate cancer. Our aim was to test whether Ki-67 is an independent prognostic marker of biochemical recurrence (BCR) in a large international cohort of patients treated with radical prostatectomy (RP). METHODS: Ki-67 immunohistochemical staining on prostatectomy specimens from 3,123 patients who underwent RP for prostate cancer was retrospectively performed. Univariable and multivariable Cox regression models were used to assess the association of Ki-67 status with BCR. RESULTS: Ki-67 positive status was observed in 762 (24.4 %) patients and was associated with lymph node involvement (LNI) (p = 0.039). Six hundred and twenty-one (19.9 %) patients experienced BCR. The estimated 3-year biochemical-free survivals were 85 % for patients with negative Ki-67 status and 82.1 % for patients with positive Ki-67 status (log-rank test, p = 0.014). In multivariable analysis that adjusted for the effects of age, preoperative PSA, RP Gleason sum, seminal vesicle invasion, extracapsular extension, positive surgical margins, lymphovascular invasion, and LNI, Ki-67 was significantly associated with BCR (HR = 1.19; p = 0.019). Subgroup analysis revealed that Ki-67 is associated with BCR in patients without LNI (p = 0.004), those with RP Gleason sum 7 (p = 0.015), and those with negative surgical margins (p = 0.047). CONCLUSION: We confirmed Ki-67 as an independent predictor of BCR after RP. Ki-67 could be particularly informative in patients with favorable pathologic characteristics to help in the clinical decision-making regarding adjuvant therapy and optimized follow-up scheduling.

Conservation banking and the economization of nature : an institutional analysis

During the last decade, conservation banking mechanisms have emerged in the environmental discourse as new market instruments to promote biodiversity conservation. Compensation was already provided for in environmental law in many countries, as the last step of the mitigation hierarchy. The institutional arrangements developed in this context have been redefined and reshaped as market-based instruments (MBIs). As such, they are discursively disentangled from the complex legal-economic nexus they are part of. Monetary transactions are given prominence and tend to be presented as stand alone agreements, whereas they take place in the context of prescriptive regulations. The pro-market narrative featuring conservation banking systems as market-like arrangements as well as their denunciation as instances of nature commodification tend to obscure their actual characteristics. The purpose of this paper is to describe the latter, adopting an explicitly analytical stance on these complex institutional arrangements and their performative dimensions. Beyond the discourse supporting them and notwithstanding the diversity of national policies and regulatory frameworks for compensation, the constitutive force of these mechanisms probably lies in their ability to redefine control, power and the distribution of costs and in their impacts in terms of land use rather than in their efficiency.

Non-invasive prenatal testing for aneuploidy and beyond: challenges of responsible innovation in prenatal screening.

This paper contains a joint ESHG/ASHG position document with recommendations regarding responsible innovation in prenatal screening with non-invasive prenatal testing (NIPT). By virtue of its greater accuracy and safety with respect to prenatal screening for common autosomal aneuploidies, NIPT has the potential of helping the practice better achieve its aim of facilitating autonomous reproductive choices, provided that balanced pretest information and non-directive counseling are available as part of the screening offer. Depending on the health-care setting, different scenarios for NIPT-based screening for common autosomal aneuploidies are possible. The trade-offs involved in these scenarios should be assessed in light of the aim of screening, the balance of benefits and burdens for pregnant women and their partners and considerations of cost-effectiveness and justice. With improving screening technologies and decreasing costs of sequencing and analysis, it will become possible in the near future to significantly expand the scope of prenatal screening beyond common autosomal aneuploidies. Commercial providers have already begun expanding their tests to include sex-chromosomal abnormalities and microdeletions. However, multiple false positives may undermine the main achievement of NIPT in the context of prenatal screening: the significant reduction of the invasive testing rate. This document argues for a cautious expansion of the scope of prenatal screening to serious congenital and childhood disorders, only following sound validation studies and a comprehensive evaluation of all relevant aspects. A further core message of this document is that in countries where prenatal screening is offered as a public health programme, governments and public health authorities should adopt an active role to ensure the responsible innovation of prenatal screening on the basis of ethical principles. Crucial elements are the quality of the screening process as a whole (including non-laboratory aspects such as information and counseling), education of professionals, systematic evaluation of all aspects of prenatal screening, development of better evaluation tools in the light of the aim of the practice, accountability to all stakeholders including children born from screened pregnancies and persons living with the conditions targeted in prenatal screening and promotion of equity of access.

Are patients with non-invasive papillary thyroid carcinoma, follicular variant (niFV-PTC) and minimally invasive follicular thyroid carcinoma with capsular invasion only (miFTC-CIO) overtreated?An institutional experience

Background. Recently several meetings and position papers advocate a change in terminology regarding thyroid neoplasms with indolent behavior, proposing the term "tumor" instead of "carcinoma". This change concerns non-invasive papillary thyroid carcinoma, follicular variant (niFV-PTC) and minimally invasive follicular thyroid carcinoma with capsular invasion only (miFTC-CIO). The aim of our study was to evaluate the impact of considering niFV-PTC and miFTC-CIO as lesions of low malignant potential, and to see how this change would influence patient management at our institution. Methods. A 32 months retrospective review of all well differentiated thyroid carcinomas (WDTC) (papillary and follicular carcinomas) diagnosed at our institution was performed, excluding tumors of uncertain malignant potential as well as poorly differentiated and anaplastic carcinomas. We retrieved cases of niFV-PTC and miFTC-CIO, reviewed histological slides to confirm diagnosis and recorded patient treatment. Results. A total of 9 (7.3%) niFV-PTC (4 males and 5 females, aged between 30 and 68 years, mean: 50.8 years old) and 2 (1.6%) cases of miFTC-CIO (2 females, 31 and 51 years old) were identified out of 122 WDTC diagnosed in the study period. The initial treatment consisted in 5 lobectomies and 6 total thyroidectomies (3 because of a compressive goiter, 2 because of a fine-needle aspiration diagnosis of suspicious for papillary thyroid carcinoma and 1 because of a fine-needle aspiration diagnosis of papillary carcinoma). The treatment following the histological diagnosis consisted in 4 thyroidectomy completions among patients who underwent simple lobectomy (4/5, 80%) and 9/11 (82%) radioablations with I131. Conclusions. The incidence of niFV-PTC is low at our institution, probably because we apply strict diagnostic criteria for this lesion. Simple lobectomy with negative margins is the treatment of choice in cases diagnosed as niFV-PTC and miFTC-CIO, due to the indolent course of these neoplasms. All cases with thyroidectomy completions and radioablations could have been avoided. As a consequence, the change of such terminology heavily impacts the malignancy risk evaluated cytologically as well as patients' management.

Innovation process management of complex consumer products and services in new innovation paradigm – case location based business

Innovation is the word of this decade. According to innovation definitions, without positive sales impact and meaningful market share the company’s product or service has not been an innovation. Research problem of this master thesis is to find out what is the innovation process of complex new consumer products and services in new innovation paradigm. The objective is to get answers to two research questions: 1) What are the critical success factors what company should do when it is implementing the paradigm change in mass markets consumer business with complex products and services? 2) What is the process or framework one firm could follow? The research problem is looked from one company’s innovation creation process, networking and organization change management challenges point of views. Special focus is to look the research problem from an existing company perspective which is entering new business area. Innovation process management framework of complex new consumer products and services in new innovation paradigm has been created with support of several existing innovation theories. The new process framework includes the critical innovation process elements companies should take into consideration in their daily activities when they are in their new business innovation implementing process. Case company location based business implementation activities are studied via the new innovation process framework. This case study showed how important it is to manage the process, look how the target market and the competition in it is developing during company’s own innovation process, make decisions at right time and from beginning plan and implement the organization change management as one activity in the innovation process. In the end this master thesis showed that all companies need to create their own innovation process master plan with milestones and activities. One plan does not fit all, but all companies can start their planning from the new innovation process what was introduced in this master thesis.

When supply travels far beyond demand: Institutional and regulatory causes of oversupply in Spain’s transport infrastructure

Spain’s transport infrastructure policy has become a paradigmatic case of oversupply and of mismatch with demand. The massive expansion of the country’s transport infrastructure over the last decade has not been a response to demand bottlenecks or previously identified needs. For this reason, the intensity of use today on all interurban modes of transport in Spain falls well below that of other EU countries. This paper analyzes the institutional and regulatory factors that have permitted this policy, allowing us to draw lessons from the Spanish case that should help other countries avoid the pitfalls and shortcomings of Spanish policy. Based on our analysis, we also discuss policy remedies and suggest reforms in different regulatory areas, which could help improve the performance of Spain’s infrastructure policy.

Webdatanet : Innovation and quality in web-based data collection

The article discusses the development of WEBDATANET established in 2011 which aims to create a multidisciplinary network of web-based data collection experts in Europe. Topics include the presence of 190 experts in 30 European countries and abroad, the establishment of web-based teaching and discussion platforms and working groups and task forces. Also discussed is the scope of the research carried by WEBDATANET. In light of the growing importance of web-based data in the social and behavioral sciences, WEBDATANET was established in 2011 as a COST Action (IS 1004) to create a multidisciplinary network of web-based data collection experts: (web) survey methodologists, psychologists, sociologists, linguists, economists, Internet scientists, media and public opinion researchers. The aim was to accumulate and synthesize knowledge regarding methodological issues of web-based data collection (surveys, experiments, tests, non-reactive data, and mobile Internet research), and foster its scientific usage in a broader community.

Innovation and Regulation in ICT. Keys for Development

The expansion of broadband speed and coverage over IP technology, which extend over transport and terminal access networks, has increased the demand for applications and content which by being provided over it, uniformly give rise to convergence. These shifts in technologies and enterprise business models are giving rise to the necessity for changing the perspective and scope of the Universal Service and of the regulation frameworks, with this last one based in the same principles as always but varying its application. Several aspects require special and renewed attention, such as the definition of relevant markets and dominant operators, the role of packages, interconnection of IP networks, network neutrality, the use of the spectrum with a vision of value for the citizenship, the application of the competition framework, new forms of licensing, treatment of the risk in the networks, changes in the regulatory authorities, amongst others. These matters are treated from the perspective of the actual trends in the world and its conceptual justification.

The Emergence of Regional ICT Regulatory Spaces

This paper examines the role that existing Latin American policy institutions and regulatory coordination mechanisms (otherwise referred to as “regional regulatory spaces”) play in innovation and development of the ICT sector. In doing so, it recognizes that sector regulation does not currently match regional development, thereby limiting its potential progress. In order to shed light on the role that the “regional regulatory space” could potentially play, the author addresses three main questions: · Is there a hierarchy of policies by which it is presumed easy to “coordinate within well-defined technical subjects” but extremely challenging to “agree in matters of public policy?” · What would happen if policy divergence became more important than convergence? Is it reasonable to consider creating “regional regulatory spaces?” or should we focus solely on technological coordination? · Do institutions capable of serving as effective regional regulatory spaces already exist in Latin America or should we consider modifying existing institutions or creating new institutions? After analyzing these three overarching areas of concern, this paper then discusses the need to create a regional space in order to harmonize ICT regulatory frameworks and public policies. Ultimately, this work aims to advance the institutional formulation beyond pre-existing efforts.

Innovation – from individual intuition to collaborative innovation. The role of individual key actor in facilitation of innovation in large organization context

The objective of this research was to study the role of key individuals in facilitation of technology enabled bottom-up innovation in large organization context. The development of innovation was followed from the point of view of individual actor (key individual) in two cases, through three levels: individual, team and organization, by using knowledge creation and innovation models. This study provides theoretical synthesis and framework through which the study is driven. The results of the study indicate, that in bottom-up initiated innovations the role of key individuals is still crucial, but innovation today is collective effort and there acts several entrepreneurial key individuals: innovator, user champion and organizational sponsor, whose collaboration and developing interaction drives innovation further. The team work is functional and fluent, but it meets great problems in interaction with organization. The large organizations should develop its practices and ability to react on emerging bottom-up initiations, in order to embed innovation to organization and gain sustainable innovation. In addition, bottom-up initiated innovations are demonstrations of peoples knowing, tacit knowledge and therefore renewing of an organization.

Productivity and innovation spillovers: Micro evidence from Spain

This article analyses the impact that innovation expenditure and intrasectoral and intersectoral externalities have on productivity in Spanish firms. While there is an extensive literature analysing the relationship between innovation and productivity, in this particular area there are far fewer studies that examine the importance of sectoral externalities, especially with the focus on Spain. One novelty of the study, which covers the industrial and service sectors, is that we also consider jointly the technology level of the sector in which the firm operates and the firm size. The database used is the Technological Innovation Panel, PITEC, which includes 12,813 firms for the year 2008 and has been little used in this type of study. The estimation method used is Iteratively Reweighted Least Squares method, IRLS, which is very useful for obtaining robust estimations in the presence of outliers. The results confirm that innovation has a positive effect on productivity, especially in high-tech and large firms. The impact of externalities is more heterogeneous because, while intrasectoral externalities have a poitive and significant effect, especially in low-tech firms independently of size, intersectoral externalities have a more ambiguous effect, being clearly significant for advanced industries in which size has a positive effect.

A relational approach to the geography of innovation: a typology of regions

The aim of this study was to devise a method for computing a composite indicator that measures the regional degree of exposure to external knowledge sources. On the basis of this indicator, we propose a typology of regions according to their potential capacity to access extra-local items of knowledge, which might help them to recombine complementary elements of such an asset to produce a higher number of new ideas. Building on various research streams that have been relatively independent to date, we summarize a non-exhaustive instrumental list of recent studies that motivates our approach and the construction of our complex indicator, which can be used to appraise the extent to which each region is in an optimal position to access external innovative resources.

Research networks and inventors’ mobility as drivers of innovation evidence from Europe

We investigate the importance of the labour mobility of inventors, as well as the scale, extent and density of their collaborative research networks, for regional innovation outcomes. To do so, we apply a knowledge production function framework at the regional level and include inventors’ networks and their labour mobility as regressors. Our empirical approach takes full account of spatial interactions by estimating a spatial lag model together, where necessary, with a spatial error model. In addition, standard errors are calculated using spatial heteroskedasticity and autocorrelation consistent estimators to ensure their robustness in the presence of spatial error autocorrelation and heteroskedasticity of unknown form. Our results point to the existence of a robust positive correlation between intraregional labour mobility and regional innovation, whilst the relationship with networks is less clear. However, networking across regions positively correlates with a region’s innovation intensity.