Afatinib versus gefitinib as first-line treatment of patients with EGFR mutation-positive non-small-cell lung cancer (LUX-Lung 7): a phase 2B, open-label, randomised controlled trial

Background The irreversible ErbB family blocker afatinib and the reversible EGFR tyrosine kinase inhibitor gefitinib are approved for first-line treatment of EGFR mutation-positive non-small-cell lung cancer (NSCLC). We aimed to compare the efficacy and safety of afatinib and gefitinib in this setting. Methods This multicentre, international, open-label, exploratory, randomised controlled phase 2B trial (LUX-Lung 7) was done at 64 centres in 13 countries. Treatment-naive patients with stage IIIB or IV NSCLC and a common EGFR mutation (exon 19 deletion or Leu858Arg) were randomly assigned (1:1) to receive afatinib (40 mg per day) or gefitinib (250 mg per day) until disease progression, or beyond if deemed beneficial by the investigator. Randomisation, stratified by EGFR mutation type and status of brain metastases, was done centrally using a validated number generating system implemented via an interactive voice or web-based response system with a block size of four. Clinicians and patients were not masked to treatment allocation; independent review of tumour response was done in a blinded manner. Coprimary endpoints were progression-free survival by independent central review, time-to-treatment failure, and overall survival. Efficacy analyses were done in the intention-to-treat population and safety analyses were done in patients who received at least one dose of study drug. This ongoing study is registered with ClinicalTrials.gov, number NCT01466660. Findings Between Dec 13, 2011, and Aug 8, 2013, 319 patients were randomly assigned (160 to afatinib and 159 to gefitinib). Median follow-up was 27·3 months (IQR 15·3–33·9). Progression-free survival (median 11·0 months [95% CI 10·6–12·9] with afatinib vs 10·9 months [9·1–11·5] with gefitinib; hazard ratio [HR] 0·73 [95% CI 0·57–0·95], p=0·017) and time-to-treatment failure (median 13·7 months [95% CI 11·9–15·0] with afatinib vs 11·5 months [10·1–13·1] with gefitinib; HR 0·73 [95% CI 0·58–0·92], p=0·0073) were significantly longer with afatinib than with gefitinib. Overall survival data are not mature. The most common treatment-related grade 3 or 4 adverse events were diarrhoea (20 [13%] of 160 patients given afatinib vs two [1%] of 159 given gefitinib) and rash or acne (15 [9%] patients given afatinib vs five [3%] of those given gefitinib) and liver enzyme elevations (no patients given afatinib vs 14 [9%] of those given gefitinib). Serious treatment-related adverse events occurred in 17 (11%) patients in the afatinib group and seven (4%) in the gefitinib group. Ten (6%) patients in each group discontinued treatment due to drug-related adverse events. 15 (9%) fatal adverse events occurred in the afatinib group and ten (6%) in the gefitinib group. All but one of these deaths were considered unrelated to treatment; one patient in the gefitinib group died from drug-related hepatic and renal failure. Interpretation Afatinib significantly improved outcomes in treatment-naive patients with EGFR-mutated NSCLC compared with gefitinib, with a manageable tolerability profile. These data are potentially important for clinical decision making in this patient population.

Understanding Connectivity between Groundwater Chemistry Data and Geological Stratigraphy via 3D Sub-surface Visualization and Analysis

This paper describes the 3D Water Chemistry Atlas - an open source, Web-based system that enables the three-dimensional (3D) sub-surface visualization of ground water monitoring data, overlaid on the local geological model. Following a review of existing technologies, the system adopts Cesium (an open source Web-based 3D mapping and visualization interface) together with a PostGreSQL/PostGIS database, for the technical architecture. In addition a range of the search, filtering, browse and analysis tools were developed that enable users to interactively explore the groundwater monitoring data and interpret it spatially and temporally relative to the local geological formations and aquifers via the Cesium interface. The result is an integrated 3D visualization system that enables environmental managers and regulators to assess groundwater conditions, identify inconsistencies in the data, manage impacts and risks and make more informed decisions about activities such as coal seam gas extraction, waste water extraction and re-use.

Novel application of a discrete choice experiment to identify preferences for a national healthcare-associated infection surveillance programme: A cross-sectional study

Objective: To identify key stakeholder preferences and priorities when considering a national healthcare-associated infection (HAI) surveillance programme through the use of a discrete choice experiment (DCE). Setting: Australia does not have a national HAI surveillance programme. An online web-based DCE was developed and made available to participants in Australia. Participants: A sample of 184 purposively selected healthcare workers based on their senior leadership role in infection prevention in Australia. Primary and secondary outcomes: A DCE requiring respondents to select 1 HAI surveillance programme over another based on 5 different characteristics (or attributes) in repeated hypothetical scenarios. Data were analysed using a mixed logit model to evaluate preferences and identify the relative importance of each attribute. Results: A total of 122 participants completed the survey (response rate 66%) over a 5-week period. Excluding 22 who mismatched a duplicate choice scenario, analysis was conducted on 100 responses. The key findings included: 72% of stakeholders exhibited a preference for a surveillance programme with continuous mandatory core components (mean coefficient 0.640 (p<0.01)), 65% for a standard surveillance protocol where patient-level data are collected on infected and non-infected patients (mean coefficient 0.641 (p<0.01)), and 92% for hospital-level data that are publicly reported on a website and not associated with financial penalties (mean coefficient 1.663 (p<0.01)). Conclusions: The use of the DCE has provided a unique insight to key stakeholder priorities when considering a national HAI surveillance programme. The application of a DCE offers a meaningful method to explore and quantify preferences in this setting.

How Scientists Retrieve Publications: An Empirical Study of How the Internet Is Overtaking Paper Media

The current mainstream scientific-publication process has so far been only marginally affected by the possibilities offered by the Internet, despite some pioneering attempts with free electronic-only journals and electronic preprint archives. Additional electronic versions of traditional paper journals for which one needs a subscription are not a solution. A clear trend, for young researchers in particular, is to go around subscription barriers (both for paper and electronic material) and rely almost exclusively on what they can find free on the Internet, which often includes working versions posted on the home pages of the authors. A survey of how scientists retrieve publications was conducted in February 2000, aimed at measuring to what extent the opportunities offered by the Internet are already changing the scientific information exchange and how researchers feel about this. This paper presents the results based on 236 replies to an extensive Web-based questionnaire, which was announced to around 3,000 researchers in the domains of construction information technology and construction management. The questions dealt with how researchers find, access, and read different sources; how many and what publications they read; how often and to which conferences they travel; how much they publish, and criteria for where they eventually decide to publish. Some of the questions confronted traditional and electronic publishing, with one final section dedicated to opinions about electronic publishing. According to the survey, researchers already download half of the material that they read digitally from the Web. The most popular method for retrieving an interesting publication is downloading it for free from the author's or publisher's Web site. Researchers are not particularly willing to pay for electronic scientific publications. There is much support for a scenario of electronic journals available freely in their entirety on the Web, where the costs could be covered by, for instance, professional societies or the publishing university.

Where to Submit? Journal Choice by Construction Management Authors

Publishers of academic journals can be seen as service providers to authors, in addition to the traditional role of providers of research results to readers. The purpose of this study was to analyse how author choices of journal in construction management are affected by quality and service perceptions. Seven journals were identified and for each 2006 article, one author e-mail address was extracted. A web based questionnaire was sent to 397 authors and 35% responded. It was found that there were three journals regularly followed by at least half the respondents. Most of the other four journals have scopes broader than construction management and receive lower scores for characteristics such as impact on researchers. No open access journals were included, and authors in the field of construction management rarely post openly accessible copies of their manuscripts or publications on the web. Author ranking of journals for their next submission is found to be related to general criteria such as academic status, circulation figures and ISI indexation.

How do Researchers Find and Retrieve Scientific Publications – A Case study of the Impact of the Internet on the Construction IT and Construction Management Research Communities

The World Wide Web provides the opportunity for a radically changed and much more efficient communication process for scientific results. A survey in the closely related domains of construction information technology and construction management was conducted in February 2000, aimed at measuring to what extent these opportunities are already changing the scientific information exchange and how researchers feel about the changes. The paper presents the results based on 236 replies to an extensive Web based questionnaire. 65% of the respondents stated their primary research interest as IT in A/E/C and 20% as construction management and economics. The questions dealt with how researchers find, access and read different sources; how much and what publications they read; how often and to which conferences they travel; how much they publish, and what are the criteria for where they eventually decide to publish. Some of the questions confronted traditional and electronic publishing with one final section dedicated to opinions about electronic publishing. According to the survey researchers already download half of the material that they read digitally from the Web. The most popular method for retrieving an interesting publication is downloading it for free from the author’s or publisher’s website. Researchers are not particularly willing to pay for electronic scientific publications. There is much support for a scenario of electronic journals available totally freely on the Web, where the costs could be covered by for instance professional societies or the publishing university. The shift that the Web is causing seems to be towards the "just in time" reading of literature. Also, frequent users of the Web rely less on scientific publications and tend to read fewer articles. If available with little effort, papers published in traditional journals are preferred; if not, the papers should be on the Web. In these circumstances, the role of paper-based journals published by established publishers is shifting from the core "information exchange" to the building of authors' prestige. The respondents feel they should build up their reputations by publishing in journals and relevant conferences, but then make their work freely available on the Web.

Organisational Responses to Workplace Harassment: An Exploratory Study

Purpose – The aim of this paper is to explore what kind of measures personnel managers have taken to intervene in workplace harassment and to explore how organisational characteristics and the characteristics of the personnel manager affect the choice of response strategies. Design/methodology/approach – The study was exploratory and used a survey design. A web-based questionnaire was sent to the personnel managers of all Finnish municipalities and data on organisational responses and organisational characteristics were collected. Findings – The study showed that the organisations surveyed relied heavily on reconciliatory measures for responding to workplace harassment and that punitive measures were seldom used. Findings indicated that personnel manager gender, size of municipality, use of “sophisticated” human resource management practices and having provided information and training to increase awareness about harassment all influence the organisational responses chosen. Research limitations/implications – Only the effects of organisational and personnel manager characteristics on organisational responses were analysed. Future studies need to include perpetrator characteristics and harassment severity. Practical implications – The study informs both practitioners and policy makers about the measures that have been taken and that can be taken in order to stop harassment. It also questions the effectiveness of written anti-harassment policies for influencing organisational responses to harassment and draws attention to the role of gendered perceptions of harassment for choice of response strategy. Originality/value – This paper fills a gap in harassment research by reporting on the use of different response strategies and by providing initial insights into factors affecting choice of responses.

Implementing virtual collaborative inquiry practises in a middle-school context

The aim of the present study was to investigate the challenges that relate to the implementation of virtual inquiry practises in middle school. The case was a school course in which a group of Finnish students (N = 14) and teachers (N = 7) completed group inquiries through virtual collaboration, using a web-based learning environment. The task was to accomplish a cross-disciplinary inquiry into cultural issues. The students worked mainly at home and took much responsibility for their course achievements. The investigators analysed the pedagogical design of the course and the content of the participants' interaction patterns in the web-based environment, using qualitative content analysis and social network analysis. The findings suggest that the students succeeded in producing distinctive cultural products, and both the students and the teachers adopted novel roles during the inquiry. The web-based learning environment was used more as a coordination tool for organizing the collaborative work than as a forum for epistemic inquiry. The tension between the school curriculum and the inquiry practises was manifest in the participants' discussions of the assessment criteria of the course.

e-SURAKSHAK: A Cyber-Physical Healthcare System with Service Oriented Architecture

In this paper we present the design of ``e-SURAKSHAK,'' a novel cyber-physical health care management system of Wireless Embedded Internet Devices (WEIDs) that sense vital health parameters. The system is capable of sensing body temperature, heart rate, oxygen saturation level and also allows noninvasive blood pressure (NIBP) measurement. End to end internet connectivity is provided by using 6LoWPAN based wireless network that uses the 802.15.4 radio. A service oriented architecture (SOA) 1] is implemented to extract meaningful information and present it in an easy-to-understand form to the end-user instead of raw data made available by sensors. A central electronic database and health care management software are developed. Vital health parameters are measured and stored periodically in the database. Further, support for real-time measurement of health parameters is provided through a web based GUI. The system has been implemented completely and demonstrated with multiple users and multiple WEIDs.

SYNTHESIS OF CONCEPTUAL DESIGNS FOR SENSORS USING SAPPHIRE-LITE

The demand for variety of products and the shorter time to market is encouraging designers to adopt computer aided concept generation techniques. One such technique is being explored here. The present work makes an attempt towards synthesis of concepts for sensors using physical laws and effects as building blocks. A database of building blocks based upon the SAPPhIRE-lite model of causality is maintained. It uses composition to explore the solution space. The algorithm has been implemented in a web based tool. The tool generates two types of sensor designs: direct sensing designs and feedback sensing designs. According to the literature, synthesis using building blocks often lead to vague solutions principles. The current work tries to avoid uninteresting solutions by using some heuristics. A particularly novel outcome of the work described here is the generation of feedback based solutions, something not generated automatically before. A number of patent violations were observed with the set of generated concepts; thus emphasizing some amount of novelty in the designs.

Wetland Tracker Data Collection Central Coast (Morro Bay Region)

The goal of this project was to gather information on wetland restoration projects in the Moro Bay, California, region. Data provided to the San Francisco Estuary Institute (SFEI) will be used to enhance a web-based, public access database, the Bay Area Wetland Project Tracker. Wetland Tracker provides information on the location, size, sponsors, habitats, contact persons, and status of included projects. Its website provides an interactive map of planned and completed wetland projects (http://www.wetlandtracker.org). (Document contains 4 pages)

Xaverian College: Seeing the long term benefit of personalised learning with bespoke VLE

Xaverian College has created a bespoke web-based solution for the academic, pastoral, managerial and administrative requirements of the College that is accessible to all staff and students. Their VLE/ILP intranet system is cutting edge as it offers a remarkable degree of integration because of its holistic approach and is very ‘student-friendly’.

Chelmsford College: Full circle – using systems integration to enhance observation, appraisal and CPD

Chelmsford College has created an observation, appraisal and continuing professional development (CPD) cycle by successfully integrating a collection of bespoke web-based systems together within its intranet. Students have benefitted from improved teaching and learning because of the rapid, transparent and thorough cycle of staff being observed, appraised and given appropriate CPD. The College has also saved time and money by being able to use single-source data to schedule observations, appraisals and CPD to individuals' needs.

Lancaster and Morecambe College: Uses serious computer games as a teaching tool

John Latham, International Projects Co-ordinator at Lancaster and Morecambe College (LMC), got involved with the project Serious Computer Games as a Teaching Tool (SCOGATT) after using the game EnerCities with his students. The web based platform at www.scogatt.eu serves as a One Stop Toolkit for vocational teachers and trainers who want to use serious computer games (SCG) in their teaching environments but might need a helping hand. There they will be able to find a compendium of serious games, SCOGATT pilot results, teacher reports and the exemplar games, EnerCities.