Cetuximab plus chemotherapy in patients with advanced non-small-cell lung cancer (FLEX) : an open-label randomised phase III trial

Background: Use of cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor (EGFR), has the potential to increase survival in patients with advanced non-small-cell lung cancer. We therefore compared chemotherapy plus cetuximab with chemotherapy alone in patients with advanced EGFR-positive non-small-cell lung cancer. Methods: In a multinational, multicentre, open-label, phase III trial, chemotherapy-naive patients (≥18 years) with advanced EGFR-expressing histologically or cytologically proven stage wet IIIB or stage IV non-small-cell lung cancer were randomly assigned in a 1:1 ratio to chemotherapy plus cetuximab or just chemotherapy. Chemotherapy was cisplatin 80 mg/m 2 intravenous infusion on day 1, and vinorelbine 25 mg/m 2 intravenous infusion on days 1 and 8 of every 3-week cycle) for up to six cycles. Cetuximab-at a starting dose of 400 mg/m 2 intravenous infusion over 2 h on day 1, and from day 8 onwards at 250 mg/m 2 over 1 h per week-was continued after the end of chemotherapy until disease progression or unacceptable toxicity had occurred. The primary endpoint was overall survival. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00148798. Findings: Between October, 2004, and January, 2006, 1125 patients were randomly assigned to chemotherapy plus cetuximab (n=557) or chemotherapy alone (n=568). Patients given chemotherapy plus cetuximab survived longer than those in the chemotherapy-alone group (median 11·3 months vs 10·1 months; hazard ratio for death 0·871 [95% CI 0·762-0·996]; p=0·044). The main cetuximab-related adverse event was acne-like rash (57 [10%] of 548, grade 3). Interpretation: Addition of cetuximab to platinum-based chemotherapy represents a new treatment option for patients with advanced non-small-cell lung cancer. Funding: Merck KGaA. © 2009 Elsevier Ltd. All rights reserved.

Open innovation in small and medium-sized enterprises (SMEs): External knowledge sourcing strategies and internal organizational facilitators

In this paper we explore how small and medium-sized enterprises (SMEs) engage in external knowledge sourcing, a form of inbound open innovation. We draw upon a sample of 1,411 SMEs and empirically conceptualize a typology of strategic types of external knowledge sourcing, namely minimal, supply-chain, technology-oriented, application-oriented, and full-scope sourcing. Each strategy reflects the nature of external interactions and is linked to a distinct mixture of four internal practices for managing innovation. Both full-scope and application-oriented sourcing offer performance benefits and are associated with a stronger focus on managing innovation. However, they differ in their managerial focus on strategic and operational aspects.

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.

Cilengitide combined with cetuximab and platinum-based chemotherapy as first-line treatment in advanced non-small-cell lung cancer (NSCLC) patients: Results of an open-label, randomized, controlled phase II study (CERTO)

Background: This multicentre, open-label, randomized, controlled phase II study evaluated cilengitide in combination with cetuximab and platinum-based chemotherapy, compared with cetuximab and chemotherapy alone, as first-line treatment of patients with advanced non-small-cell lung cancer (NSCLC). Patients and methods: Patients were randomized 1:1:1 to receive cetuximab plus platinum-based chemotherapy alone (control), or combined with cilengitide 2000 mg 1×/week i.v. (CIL-once) or 2×/week i.v. (CIL-twice). A protocol amendment limited enrolment to patients with epidermal growth factor receptor (EGFR) histoscore ≥200 and closed the CIL-twice arm for practical feasibility issues. Primary end point was progression-free survival (PFS; independent read); secondary end points included overall survival (OS), safety, and biomarker analyses. A comparison between the CIL-once and control arms is reported, both for the total cohorts, as well as for patients with EGFR histoscore ≥200. Results: There were 85 patients in the CIL-once group and 84 in the control group. The PFS (independent read) was 6.2 versus 5.0 months for CIL-once versus control [hazard ratio (HR) 0.72; P = 0.085]; for patients with EGFR histoscore ≥200, PFS was 6.8 versus 5.6 months, respectively (HR 0.57; P = 0.0446). Median OS was 13.6 for CIL-once versus 9.7 months for control (HR 0.81; P = 0.265). In patients with EGFR ≥200, OS was 13.2 versus 11.8 months, respectively (HR 0.95; P = 0.855). No major differences in adverse events between CIL-once and control were reported; nausea (59% versus 56%, respectively) and neutropenia (54% versus 46%, respectively) were the most frequent. There was no increased incidence of thromboembolic events or haemorrhage in cilengitide-treated patients. αvβ3 and αvβ5 expression was neither a predictive nor a prognostic indicator. Conclusions: The addition of cilengitide to cetuximab/chemotherapy indicated potential clinical activity, with a trend for PFS difference in the independent-read analysis. However, the observed inconsistencies across end points suggest additional investigations are required to substantiate a potential role of other integrin inhibitors in NSCLC treatment.

Small-Signal Stability Analysis of an Open-loop Induction Motor Drive Including the Effect of Inverter Dead-Time

This paper demonstrates light-load instability in open-loop induction motor drives on account of inverter dead-time. The dynamic equations of an inverter fed induction motor, incorporating the effect of dead-time, are considered. A procedure to derive the small-signal model of the motor, including the effect of inverter dead-time, is presented. Further, stability analysis is carried out on a 100-kW, 415V, 3-phase induction motor considering no-load. For voltage to frequency (i.e. V/f) ratios between 0.5 and 1 pu, the analysis brings out regions of instability on the V-f plane, in the frequency range between 5Hz and 20Hz. Simulation and experimental results show sub-harmonic oscillations in the motor current in this region, confirming instability as predicted by the analysis.

Small-Signal Stability Analysis of an Open-Loop Induction Motor Drive Including the Effect of Inverter Deadtime

This paper demonstrates light-load instability in a 100-kW open-loop induction motor drive on account of inverter deadtime. An improved small-signal model of an inverter-fed induction motor is proposed. This improved model is derived by linearizing the nonlinear dynamic equations of the motor, which include the inverter deadtime effect. Stability analysis is carried out on the 100-kW415-V three-phase induction motor considering no load. The analysis brings out the region of instability of this motor drive on the voltage versus frequency (V-f) plane. This region of light-load instability is found to expand with increase in inverter deadtime. Subharmonic oscillations of significant amplitude are observed in the steady-state simulated and measured current waveforms, at numerous operating points in the unstable region predicted, confirming the validity of the stability analysis. Furthermore, simulation and experimental results demonstrate that the proposed model is more accurate than an existing small-signal model in predicting the region of instability.

READING AND RESPONDING: FINDING AND MAKING MEANING IN THE LIFE WRITING OF DIASPORIC IRANIAN JEWISH WOMEN

This project investigates the English-language life writing of diasporic Iranian Jewish women. It examines how these women have differentially imagined their diasporic lives and travels, and how they have in turn been imagined and accepted or rejected by their audiences. In the first chapter, I use “home” as a lens for understanding three distinct life writing texts, showing how the authors write about what it means to have a home and to be at home in contrasting and even contradictory ways. I show how, despite potential hegemonic readings that perpetuate unequal relationships and a normative definition of the ideal home, the texts are open to multiple contestatory readings that create spaces for new formulations and understandings. In the second chapter, I look more closely at the intersections between trauma stories and the life writing of Iranian Jewish women, and I argue that readers use life writing texts about trauma to support an egocentric reconstruction of American democracy and dominance. I also show how a critical frame for understanding trauma can yield interpretations that highlight, rather than ignore, relationships of power and privilege. In the final chapter of the thesis, I present a case study of two online reading groups, and I show that communal reading environments, though they participate in dominant discourses, are also spaces where resistance and subversion can develop.

Application of Open Innovation Paradigm in Small and Medium Enterprises in Russia

The objective of this study is to explore how the Open Innovation paradigm is applied in by small and medium-size enterprises in Russia. The focus of the study is to understand how the processes of research and development and commercialization proceed in these kind of companies and to which extent they apply open innovation principles. Russian leadership makes certain steps for transition from the export of raw materials to an innovative model of economic growth. The research aims to disclose actual impact of these attempts. The closed innovation model and the erosion factors which lead to the destruction of an old one and emergence of new model are described. Features of open innovation implementation and intellectual property rights protection in small and medium enterprises are presented. To achieve the objective, a qualitative case study approach was chosen. Research includes facts and figures, views and opinions of management of studied companies related to innovation process in the company and in Russia in general. The research depicts the features of Open Innovation implementation by SMEs in Russia. A large number of research centers with necessary equipment and qualified personnel allow case companies to use external R&D effectively. They cooperate actively with research institutes, universities and laboratories. Thus, they apply inbound Open Innovation. On the contrary, lack of venture capital, low demand for technologies within the domestic market and weak protection of intellectual property limit the external paths to new markets. Licensing-out and creation of spin-off are isolated cases. Therefore, outbound Open Innovation is not a regular practice.

Small and Closed vs. Large and Open: Some Lessons from Comparing Cuban to Colombian Agricultural Development

Comparing the experiences of selected Latin America and the Caribbean countries and their trajectories over the past 15 years offers rich insights into the dynamics and causes for not meeting the 2015 MDGs. They also offer clues for post-MDG strategies. Central to achieving sustainable growth are government policies able to support small and medium-sized farms and peasants, as they are crucial for the achievement of several goals, centrally: to achieve food security; to provide a sound and stable rural environment able to resist external (financial) shocks; to secure healthy food; to secure local food; and to protect vibrant and culturally rich local communities. This paper analyses and compares the most successful government policies to the least successful policies carried out over the last 15 years in selected Latin American and Caribbean countries and based on this analysis, offers strategies for more promising post-MDG politics, able to reduce poverty, reduce inequality, fight back informality, and achieve more decent work in poor countries.

Excess open solar magnetic flux from satellite data: 1. Analysis of the third perihelion Ulysses pass

We use the third perihelion pass by the Ulysses spacecraft to illustrate and investigate the “flux excess” effect, whereby open solar flux estimates from spacecraft increase with increasing heliocentric distance. We analyze the potential effects of small-scale structure in the heliospheric field (giving fluctuations in the radial component on timescales smaller than 1 h) and kinematic time-of-flight effects of longitudinal structure in the solar wind flow. We show that the flux excess is explained by neither very small-scale structure (timescales < 1 h) nor by the kinematic “bunching effect” on spacecraft sampling. The observed flux excesses is, however, well explained by the kinematic effect of larger-scale (>1 day) solar wind speed variations on the frozen-in heliospheric field. We show that averaging over an interval T (that is long enough to eliminate structure originating in the heliosphere yet small enough to avoid cancelling opposite polarity radial field that originates from genuine sector structure in the coronal source field) is only an approximately valid way of allowing for these effects and does not adequately explain or account for differences between the streamer belt and the polar coronal holes.

A multispacecraft analysis of a small-scale transient entrained by solar wind streams

The images taken by the Heliospheric Imagers (HIs), part of the SECCHI imaging package onboard the pair of STEREO spacecraft, provide information on the radial and latitudinal evolution of the plasma compressed inside corotating interaction regions (CIRs). A plasma density wave imaged by the HI instrument onboard STEREO-B was found to propagate towards STEREO-A, enabling a comparison between simultaneous remotesensing and in situ observations of its structure to be performed. In situ measurements made by STEREO-A show that the plasma density wave is associated with the passage of a CIR. The magnetic field compressed after the CIR stream interface (SI) is found to have a planar distribution. Minimum variance analysis of the magnetic field vectors shows that the SI is inclined at 54° to the orbital plane of the STEREO-A spacecraft. This inclination of the CIR SI is comparable to the inclination of the associated plasma density wave observed by HI. A small-scale magnetic cloud with a flux rope topology and radial extent of 0.08 AU is also embedded prior to the SI. The pitch-angle distribution of suprathermal electrons measured by the STEREO-A SWEA instrument shows that an open magnetic field topology in the cloud replaced the heliospheric current sheet locally. These observations confirm that HI observes CIRs in difference images when a small-scale transient is caught up in the compression region.