Metastatic melanoma:A regional review and future directions

Aims and background. The incidence of malignant melanoma has risen steadily over recent decades. NCI data from 2005-2007 have suggested that 1.93% of individuals born today in the US will develop melanoma at some stage. Approximately 15% of patients with MM either present with metastatic disease or develop metastases during the course of their illness. Unfortunately, metastatic MM remains a challenge with limited treatment options, and median overall survival is 6-9 months. Methods. We reviewed our data for the treatment of metastatic MM over a period of four years. Data from all patients with metastatic MM treated with systemic therapy without clinical trials from 2006 to 2009 were reviewed. Response rate was determined as per RECIST criteria. Results. Sixty four patients were treated with one or more lines of cytotoxic therapy. Median age was 62 years (range, 23-82) with 53% males. Primary site of the disease was the skin in 75%, mucosal in 12.5%, ocular in 9.4% and nodal with an occult primary in 3.1%. Visceral metastases were present in 75% of patients at the start of treatment, including pulmonary (39.6%) and hepatic (34.4%). All patients were screened for brain metastases, which were present in 26.5% of patients. ECOG performance status was 0 in 7.8%, 1 in 68.7%, 2 in 9.4% and undocumented in the remaining 14%. Patients without brain metastases received single agent DTIC as first line; those with brain metastases received temozolomide. Response rate was 7% for DTIC and 28% for temozolomide, with median progression-free survival of 2.4 and 3.2 months, respectively. Seven patients who received DTIC are alive on follow-up, 2 have ongoing stable disease post-DTIC at 41 months and 18 months. Second line therapy with vinblastine was given to 21 patients (32%), with a response rate of 9.5% and median progression-free survival of 3.4 months. Median overall survival from initiation of therapy was 7.7 months for DTIC and 3.6 months for patients with brain metastases receiving temozolomide. A performance status of 2 was associated with shorter median overall survival (2.0 months). Conclusions. Our results are comparable to published data. Malignant melanoma is a disease with rising incidence and limited treatment options. These patients are best treated in the context of clinical trials as new targeted therapies are promising as future strategies. © Il Pensiero Scientifico Editore.

IEEE C37.118-2 Synchrophasor Communication Framework

Synchrophasors have become an important part of the modern power system and numerous applications have been developed covering wide-area monitoring, protection and control. Most applications demand continuous transmission of synchrophasor data across large geographical areas and require an efficient communication framework. IEEE C37.118-2 evolved as one of the most successful synchrophasor communication standards and is widely adopted. However, it lacks a predefined security mechanism and is highly vulnerable to cyber attacks. This paper analyzes different types of cyber attacks on IEEE C37.118-2 communication system and evaluates their possible impact on any developed synchrophasor application. Further, the paper also recommends an efficent security mechanism that can provide strong protection against cyber attacks. Although, IEEE C37.118-2 has been widely adopted, there is no clear understanding of the requirements and limitations. To this aim, the paper also presents detailed performance evaluation of IEEE C37.118-2 implementations which could help determine required resources and network characteristics before designing any synchrophasor application.

Markers of vitamin D exposure and oesophageal cancer risk: a systematic review and meta-analysis.

Vitamin D has been associated with reduced risk of many cancers, but evidence for oesophageal cancer is mixed. To clarify the role of Vitamin D, we performed a systematic review and meta-analysis to evaluate the association of Vitamin D exposures and oesophageal neoplasia, including adenocarcinoma, squamous cell carcinoma (SCC), Barrett's oesophagus and squamous dysplasia. Ovid MEDLINE, EMBASE and Web of Science were searched from inception to September 2015. Fifteen publications in relation to circulating 25-hydroxyvitamin D (n=3), Vitamin D intake (n=4), UVB exposure (n=1), and genetic factors (n=7) were retrieved. Higher 25-OHD was associated with increased risk of cancer (adenocarcinoma or SCC, OR=1.39;95%CI:1.04-1.74), with the majority of participants coming from China. No association was observed between Vitamin D intake and risk of cancer overall (OR=1.03;0.65-1.42); however, a non-significantly increased risk for adenocarcinoma (OR=1.45;0.65-2.24) and non-significantly decreased risk for SCC (OR=0.80;0.48-1.12) were observed. One study reported a decreased risk of adenocarcinoma with higher UVB exposure. A decreased risk was found for VDR haplotype rs2238135(G)/rs1989969(T) carriers, OR=0.45;0.00-0.91, and a suggestive association was observed for rs2107301. No consistent associations were observed between Vitamin D exposures and occurrence of oesophageal lesions. Further adequately powered, well-designed studies are needed before conclusions can be made.

Saving Energy by Delegating Network Activity to Home Gateways

Today, an ever-increasing number of devices has networking capability. The main implication of this fact is that such devices are often left fully powered yet idle just to maintain their network presence, hence leading to large energy waste. This ultimately results in higher electricity cost for consumers. This paper tackles an effective mechanism to reduce energy waste of consumer electronics, by boosting the usage of lowpower states available in most devices. The main concept is to delegate background networking routines to home gateways, which are today available in most homes and offices. The paper describes the functionality and the software architecture to be implemented by home gateways and consumer electronics, reports performance evaluation on a working prototype, and provides estimation of potential benefits for consumers.

Assessing the Potential for Saving Energy by Impersonating Idle Networked Devices

The idea of proxying network connectivity has been proposed as an efficient mechanism to maintain network presence on behalf of idle devices, so that they can “sleep”. The concept has been around for many years; alternative architectural solutions have been proposed to implement it, which lead to different considerations about capability, effectiveness and energy efficiency. However, there is neither a clear understanding of the potential for energy saving nor a detailed performance comparison among the different proxy architectures. In this paper, we estimate the potential energy saving achievable by different architectural solutions for proxying network connectivity. Our work considers the trade-off between the saving achievable by putting idle devices to sleep and the additional power consumption to run the proxy. Our analysis encompasses a broad range of alternatives, taking into consideration both implementations already available in the market and prototypes built for research purposes. We remark that the main value of our work is the estimation under realistic conditions, taking into consideration power measurements, usage profiles and proxying capabilities.

A Microgrid Testbed for Interdisciplinary Research on Cyber-Secure Industrial Control in Power Systems

This paper describes a smart grid test bed comprising embedded generation, phasor measurement units (PMUs), and supporting ICT components and infrastructure. The test bed enables the development of a use case focused on a synchronous islanding scenario, where the embedded generation becomes islanded from the mains supply. Due to the provisioned control components, control strategy, and best-practice ICT support infrastructure, the islanded portion of the grid is able to continue to operate in a secure and dependable manner.

Continuing the fight in reducing the risk of surgical site infections in the perioperative environment

Assessing risk has become part of the process of supporting patients andmaintaining safety in the healthcare setting. The risk of healthcare associatedinfections (HCAIs) has long been well documented and surgical site infection (SSI)is recognised as one of the most prevalent (Tanner & Khan 2008, Wilson 2013a).

Crafting Modern Design in Italy, from Post-War to Postmodernism

The years between 1945 and the early 1980s are the most celebrated in Italy’s design history. From the rhetoric of reconstruction to the postmodern provocations of the Memphis design collective, Italy’s architects played a vital role in shaping the country’s encounter with post-war modernity. Yet as often as this story has been told, it is incomplete. Craft was vital to the realisation of post-war Italian design, and an area of intense creativity in its own right, and yet has been marginalised and excluded in design historiography.

Between the Bullet and the Hole

Between the Bullet and the Hole is a film centred on the elusive and complex effects of war on women's role in ballistic research and early computing. The film features new and archival high-speed bullet photography, schlieren and electric spark imagery, bullet sound wave imagery, forensic ballistic photography, slide rulers, punch cards, computer diagrams, and a soundtrack by Scanner. Like a frantic animation storyboard, it explores the flickering space between the frames, testing the perceptual mechanics of visual interpolation, the possibility of reading or deciphering the gap between before and after. Interpolation - the main task of the women studying ballistics in WW2 - is the construction or guessing of missing data using only two known data points. The film tries to unpack this gap, open it up to interrogation. It questions how we read, interpolate or construct the gaps between bullet and hole, perpetrator and victim, presence and absence. The project involves exchanges with specialists in this area such as the Cranfield University Forensics department, London-based Forensic Firearms consultancy, the Imperial War Museum, the ENIAC programmers project, the Smithsonian Institute, and Forensic Scientists at Palm Beach County Sheriff's Office (USA). Exhibitions: Solo exhibition at Dallas Contemporary (Texas, Jan-Mar 2016), including newly commissioned lenticular prints and a dual slide projector installation; Group exhibition the Sydney Biennale (Sydney, Mar-June 2016); UK premiere and solo retrospective screening at Whitechapel Gallery (London); forthcoming solo exhibition at Iliya Fridman Gallery (NY, Oct-Dec 2016); Film festivals and screenings: International Film Festival Rotterdam (Jan 2016); Whitechapel Gallery (London Feb 2016); Cornerhouse/Home (Manchester Nov 2016); Public lectures: Whitechapel Gallery with prof. David Alan Grier and Morgan Quaintance; Carriageworks (Sydney) Prof. Douglas Khan; Monash University (Melbourne); Gertrude Space (Melbourne). Reviews and interviews: Artforum, Studio International, Mousse Magazine.

Identification of descendants of an extinct bovine population from the Algarve region of Portugal using numerical taxonomy analysis of morphological traits

The morphology of a sample of four bulls and 43 cows, presumed to be descendants of the extinct cattle breed ‘Algarvia’ (AG), was used to assign their relationship with animals from other Portuguese autochthonous breeds – Arouquesa (AR), Barrosa˜ (BA), Cachena (CA), Marinhoa (MA), Maronesa (MO), Minhota (MN), Mirandesa (MI), (only bulls), Alentejana (AL), Garvonesa (GA), Mertolenga (ME) and Preta (PR). Standard numerical taxonomic methods were applied to a set of 183 (cows) and 170 (bulls) traits, to derive average pairwise taxonomic distances among the sample of 257 cows and 76 bulls. Distance coefficients (morphological index of distance) ranged from 0.22 to 2.62 (cows) and from 0.49 to 2.13 (bulls). Unweighted pair group method using arithmetic averages (UPGMA)-based phenograms and a principal coordinate analysis showed that bulls were highly clustered and cows showed a tendency to cluster according to their geographical and breed origin. The AG population grouped together with GA, AL, ME and MN breeds in the Red Convex group. The average taxonomic distance among breeds was 1.02, the highest being 1.39 (ME versus BA) and the lowest being 0.64 (MA versus AR). The approach allowed for the identification of a phenotypically differentiated set of animals, comprising 19 cows and four bulls representative of the AG breed, and which can be targeted in further studies aiming at the recovery of this extinct breed.

Ecological genetics in the North Atlantic: environmental gradients and adaptation at specific loci

The North Atlantic intertidal community provides a rich set of organismal and environmental material for the study of ecological genetics. Clearly defined environmental gradients exist at multiple spatial scales: there are broad latitudinal trends in temperature, meso-scale changes in salinity along estuaries, and smaller scale gradients in desiccation and temperature spanning the intertidal range. The geology and geography of the American and European coasts provide natural replication of these gradients, allowing for population genetic analyses of parallel adaptation to environmental stress and heterogeneity. Statistical methods have been developed that provide genomic neutrality tests of population differentiation and aid in the process of candidate gene identification. In this paper, we review studies of marine organisms that illustrate associations between an environmental gradient and specific genetic markers. Such highly differentiated markers become candidate genes for adaptation to the environmental factors in question, but the functional significance of genetic variants must be comprehensively evaluated. We present a set of predictions about locus-specific selection across latitudinal, estuarine, and intertidal gradients that are likely to exist in the North Atlantic. We further present new data and analyses that support and contradict these simple selection models. Some taxa show pronounced clinal variation at certain loci against a background of mild clinal variation at many loci. These cases illustrate the procedures necessary for distinguishing selection driven by internal genomic vs. external environmental factors. We suggest that the North Atlantic intertidal community provides a model system for identifying genes that matter in ecology due to the clarity of the environmental stresses and an extensive experimental literature on ecological function. While these organisms are typically poor genetic and genomic models, advances in comparative genomics have provided access to molecular tools that can now be applied to taxa with well-defined ecologies. As many of the organisms we discuss have tight physiological limits driven by climatic factors, this synthesis of molecular population genetics with marine ecology could provide a sensitive means of assessing evolutionary responses to climate change.

Hotel Brand Conversions: What Works and What Doesn’t

As many as one-third of U.S. hotels have been converted from one brand to another in recent years, a process that frequently improves the hotel’s financial performance—although that is not always the case. Using data collected between 1994 and 2012 from PKF Hospitality Research, an analysis of brand conversions by 260 hotels shows that hotels moving downscale generally improved their occupancy, and thus their top-line revenue and profit ratios, compared to a control group of 2,750 hotels that did not change brands. However, hotels that moved upscale did not see notable changes in revenue or profit, nor did hotels that moved across their tier, especially when they stayed within their brand family. Two factors seem to drive the financial results for converted hotels—the relative strength of the brand and the fit between the brand and the property.

Legal, Ethical and Professional Issues

The chapter addresses the professional, legal and ethical issues associated with medicines management and the role of the nurse. To ensure safe practice it is imperative safeguards are recognised and applied; therefore pertinent legislative frameworks, policy and professional regulation are discussed. Safeguarding patients when administering prescribed medicines means the nurse must have up-to-date knowledge and skill and a key aspect of this is to ensure consent to treatment from the service user is secured; for this reason drawing on relevant legislation, the consensual process is reviewed. Not infrequently medicine management provokes ethical and legal challenges for the health care professional; these demand reflection and careful consideration; consequently in this chapter legal and ethical parameters and professional boundaries are appraised.