Identification of Multiple Mechanisms of Resistance to Vemurafenib in a Patient with BRAFV600E-Mutated Cutaneous Melanoma Successfully Rechallenged after Progression.

PURPOSE: To investigate the mechanism(s) of resistance to the RAF-inhibitor vemurafenib, we conducted a comprehensive analysis of the genetic alterations occurring in metastatic lesions from a patient with a BRAF(V600E)-mutant cutaneous melanoma who, after a first response, underwent subsequent rechallenge with this drug. EXPERIMENTAL DESIGN: We obtained blood and tissue samples from a patient diagnosed with a BRAF(V600E)-mutant cutaneous melanoma that was treated with vemurafenib and achieved a near-complete response. At progression, he received additional lines of chemo/immunotherapy and was successfully rechallenged with vemurafenib. Exome and RNA sequencing were conducted on a pretreatment tumor and two subcutaneous resistant metastases, one that was present at baseline and previously responded to vemurafenib (PV1) and one that occurred de novo after reintroduction of the drug (PV2). A culture established from PV1 was also analyzed. RESULTS: We identified two NRAS-activating somatic mutations, Q61R and Q61K, affecting two main subpopulations in the metastasis PV1 and a BRAF alternative splicing, involving exons 4-10, in the metastasis PV2. These alterations, known to confer resistance to RAF inhibitors, were tumor-specific, mutually exclusive, and were not detected in pretreatment tumor samples. In addition, the oncogenic PIK3CA(H1047R) mutation was detected in a subpopulation of PV1, but this mutation did not seem to play a major role in vemurafenib resistance in this metastasis. CONCLUSIONS: This work describes the coexistence within the same patient of different molecular mechanisms of resistance to vemurafenib affecting different metastatic sites. These findings have direct implications for the clinical management of BRAF-mutant melanoma. Clin Cancer Res; 19(20); 5749-57. ©2013 AACR.

Item master management in the engineer-to-order supply chain

Diplomityöntavoitteena on tutkia, kuinka nimiketiedon hallinnalla voidaan parantaa kustannustehokkuutta projektiohjautuvassa toimitusketjussa. Työn kohdeyritys on Konecranes Oyj:n tytäryhtiö Konecranes Heavy Lifting Oy. Nimiketiedon hallinta liittyy läheisesti tuotetiedon hallintaan. Teoriaosassa käsitellään toimitusketjuympäristön tekijöitä, modulaarisuuden ja asiakaskohtaisuuden ongelmallisuutta sekä informaatiovirran vaikutuksia eri toiminnoissa. Yritysosassa vertaillaan konsernitason kahta liiketoiminta-aluetta strategiavalintojen, tuotteiden modulaarisuuden sekä tilaus-toimitusprosessissa liikkuvan nimikeinformaation perusteella. Diplomityön tuloksena annetaan suuntaviivat; nimikemassan eheytykseen, strategisten nimikkeiden tunnistamiseen ja määrittämiseen, nimikkeiden hallintaan sekä master-datan sijoittamiseen tietojärjestelmäympäristöön.

Team Effectiveness in Patient Health Management: An Overview of Reviews

Background: The desire to improve the quality of health care for an aging population with multiple chronic diseases is fostering a rapid growth in inter-professional team care, supported by health professionals, governments, businesses and public institutions. However, the weight of evidence measuring the impact of team care on patient and health system outcomes has not, heretofore, been clear. To address this deficiency, we evaluated published evidence for the clinical effectiveness of team care within a chronic disease management context in a systematic overview. Methods: A search strategy was built for Medline using medical subject headings and other relevant keywords. After testing for perform- ance, the search strategy was adapted to other databases (Cinhal, Cochrane, Embase, PsychInfo) using their specific descriptors. The searches were limited to reviews published between 1996 and 2011, in English and French languages. The results were analyzed by the number of studies favouring team intervention, based on the direction of effect and statistical significance for all reported outcomes. Results: Sixteen systematic and 7 narrative reviews were included. Diseases most frequently targeted were depression, followed by heart failure, diabetes and mental disorders. Effective- ness outcome measures most commonly used were clinical endpoints, resource utilization (e.g., emergency room visits, hospital admissions), costs, quality of life and medication adherence. Briefly, while improved clinical and resource utilization endpoints were commonly reported as positive outcomes, mixed directional results were often found among costs, medication adherence, mortality and patient satisfaction outcomes. Conclusions: We conclude that, although suggestive of some specific benefits, the overall weight of evidence for team care efficacy remains equivocal. Further studies that examine the causal interactions between multidisciplinary team care and clinical and economic outcomes of disease management are needed to more accurately assess its net program efficacy and population effectiveness.

Interoperability of learning objects copyright in the LUISA semantic learning management system

Semantic Web technology is able to provide the required computational semantics for interoperability of learning resources across different Learning Management Systems (LMS) and Learning Object Repositories (LOR). The EU research project LUISA (Learning Content Management System Using Innovative Semantic Web Services Architecture) addresses the development of a reference semantic architecture for the major challenges in the search, interchange and delivery of learning objects in a service-oriented context. One of the key issues, highlighted in this paper, is Digital Rights Management (DRM) interoperability. A Semantic Web approach to copyright management has been followed, which places a Copyright Ontology as the key component for interoperability among existing DRM systems and other licensing schemes like Creative Commons. Moreover, Semantic Web tools like reasoners, rule engines and semantic queries facilitate the implementation of an interoperable copyright management component in the LUISA architecture.

Analysis of vineyard differential management zones and relation to vine development, grape maturity and quality

The objective of research was to analyse the potential of Normalized Difference Vegetation Index (NDVI) maps from satellite images, yield maps and grapevine fertility and load variables to delineate zones with different wine grape properties for selective harvesting. Two vineyard blocks located in NE Spain (Cabernet Sauvignon and Syrah) were analysed. The NDVI was computed from a Quickbird-2 multi-spectral image at veraison (July 2005). Yield data was acquired by means of a yield monitor during September 2005. Other variables, such as the number of buds, number of shoots, number of wine grape clusters and weight of 100 berries were sampled in a 10 rows × 5 vines pattern and used as input variables, in combination with the NDVI, to define the clusters as alternative to yield maps. Two days prior to the harvesting, grape samples were taken. The analysed variables were probable alcoholic degree, pH of the juice, total acidity, total phenolics, colour, anthocyanins and tannins. The input variables, alone or in combination, were clustered (2 and 3 Clusters) by using the ISODATA algorithm, and an analysis of variance and a multiple rang test were performed. The results show that the zones derived from the NDVI maps are more effective to differentiate grape maturity and quality variables than the zones derived from the yield maps. The inclusion of other grapevine fertility and load variables did not improve the results.

Image Resilience after Multiple Crises : The Case of Switzerland in the United States

In der heutigen Welt sind die Reputation und das Image eines Landes als wichtige Faktoren für den wirtschaftlichen und politischen Erfolg angesehen. Jedoch ist die Pflege der Marke eines Landes komplex und führt zu zwei Positionen, die sich potentiell widersprechen: Einerseits kann ein positives Erscheinungsbild eines Landes durch aktive Massnahmen gefördert werden. Andererseits ist es schwierig, das Bild eines Landes abzugrenzen und es ist mit Klischees behaftet. Dieser Beitrag analysiert die Auswirkungen von zwei grösseren Krisen auf das Image der Schweiz in den Vereinigten Staaten: die Krise um die nachrichtenlosen Vermögen aus der Zeit des 2. Weltkriegs im Jahr 2000 sowie die Krise um die UBS und das Bankgeheimnis im Jahr 2009. Die Studie zeigt, dass das Erscheinungsbild der Schweiz unberührt blieb, obwohl ein beachtlicher Teil der Bevölkerung und der Meinungsführer von beiden Krisen wusste. Dies stützt die Hypothese, dass das Image eines Landes eine hohe Beständigkeit aufweist. In today's world, country's reputation and image have become key issues, widely believed to be success factors both economically and politically. Nevertheless, managing a country's brand is complex and leads to two positions that are potentially contradictory: On the one hand, a country's image can be influenced either by promotional activities. On the other hand, a country's image is a construct that is very difficult to delimit and is highly stereotyped. This contribution study the impact of two major crises on the image of Switzerland in the United States: the unclaimed wartime deposits crisis in 2000 and the UBS and banking secrecy crisis in 2009. It shows that despite the fact that a substantial proportion of the public and of opinion leaders was aware of both crises, the image of Switzerland was unaffected, which tends to support the hypothesis of strong stability of a country's image.

Multiple processes regulate long-term population dynamics of sea urchins on Mediterranean rocky reefs

We annually monitored the abundance and size structure of herbivorous sea urchin populations (Paracentrotus lividus and Arbacia lixula) inside and outside a marine reserve in the Northwestern Mediterranean on two distinct habitats (boulders and vertical walls) over a period of 20 years, with the aim of analyzing changes at different temporal scales in relation to biotic and abiotic drivers. P. lividus exhibited significant variability in density over time on boulder bottoms but not on vertical walls, and temporal trends were not significantly different between the protection levels. Differences in densities were caused primarily by variance in recruitment, which was less pronounced inside the MPA and was correlated with adult density, indicating density-dependent recruitment under high predation pressure, as well as some positive feedback mechanisms that may facilitate higher urchin abundances despite higher predator abundance. Populations within the reserve were less variable in abundance and did not exhibit the hyper-abundances observed outside the reserve, suggesting that predation effects maybe more subtle than simply lowering the numbers of urchins in reserves. A. lixula densities were an order of magnitude lower than P. lividus densities and varied within sites and over time on boulder bottoms but did not differ between protection levels. In December 2008, an exceptionally violent storm reduced sea urchin densities drastically (by 50% to 80%) on boulder substrates, resulting in the lowest values observed over the entire study period, which remained at that level for at least two years (up to the present). Our results also showed great variability in the biological and physical processes acting at different temporal scales. This study highlights the need for appropriate temporal scales for studies to fully understand ecosystem functioning, the concepts of which are fundamental to successful conservation and management.

The Key Features of Knowledge and Knowledge Management in Product Development Process

Tutkimusongelmana oli kuinka tiedon johtamisella voidaan edesauttaa tuotekehitysprosessia. Mitkä ovat ne avaintekijät tietoympäristössä kuin myös itse tiedossa, joilla on merkitystä erityisesti tuotekehitysprosessin arvon muodostumiseen ja prosessien kehittämiseen? Tutkimus on laadullinen Case-tutkimus. Tutkimusongelmat on ensin selvitetty kirjallisuuden avulla, jonka jälkeen teoreettinen viitekehys on rakennettu tutkimaan rajattua ongelma-aluetta case-yrityksestä. Empiirisen tutkimuksen materiaali koostuu pääasiallisesti henkilökohtaisten teemahaastattelujen aineistosta. Tulokset merkittävimmistä tiedon hyväksikäytön haittatekijöistä, kuten myös parannusehdotukset on lajiteltu teoreettisessa viitekehyksessä esitettyjen oletustekijöiden mukaan. Haastatteluissa saadut vastaukset tukevat kirjallisuudesta ja alan ammattilaiselta saatua käsitystä tärkeimmistä vaikuttavista tekijöistä. Tärkeimmät toimenpiteet ja aloitteet joilla parannettaisiin tiedon muodostumista, koskivat ennnen kaikkea työnteon ulkoisia olosuhteita, eikä niinkään tiedon muodostumisen prosessia itseään. Merkittävimpiä haittatekijöitä olivat kultturiin, fyysiseen ja henkiseen tilaan ja henkilöstöresursseihin liittyvät ongelmat. Ratkaisuja ongelmiin odotettiin saatavan lähinnä tietotekniikan, henkilöstöresurssien ja itse tiedon muokkaamisen avulla. Tuotekehitysprosessin ydin tietovirtojen ja –pääomien luokittelu ja tulkitseminen tiedon muodostusta kuvaavan Learning Spiralin avulla antoi lähinnä teoreettisia viitteitä siitä millaisia keinoja on olemassa tiedon lisäämiseen ja jakamiseen eri tietotyypeittäin. Tulosten perusteella caseyrityksessä pitäisi kiinnittää erityistä huomiota tiedon dokumentointiin ja jakamiseen erityisesti sen tiedon osalta, joka on organisaatiossa vain harvalla ja/tai luonteeltaan hyvin tacitia.

Quality of Disease Management and Risk of Mortality in English Primary Care Practices

OBJECTIVE: To investigate whether better management of chronic conditions by family practices reduces mortality risk. DATA: Two random samples of 5 million patients registered with over 8,000 English family practices followed up for 4 years (2004/5-2007/8). Measures of the quality of disease management for 10 conditions were constructed for each family practice for each year. The outcome measure was an indicator taking the value 1 if the patient died during a specified year, 0 otherwise. STUDY DESIGN: Cross-section and multilevel panel data multiple logistic regressions were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures. PRINCIPAL FINDINGS: Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression. CONCLUSIONS: The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 782 [95 percent CI: 423, 1140]. A longer study period may be necessary to detect any mortality impact of better management of other conditions.

Centralized Identity Management for Web Applications

Internet-palvelujen määrä kasvaa jatkuvasti. Henkilöllä on yleensä yksi sähköinen identiteetti jokaisessa käyttämässään palvelussa. Autentikointitunnusten turvallinen säilytys käy yhä vaikeammaksi, kun niitä kertyy yhdet jokaisesta uudesta palvelurekisteröitymisestä. Tämä diplomityö tarkastelee ongelmaa ja ratkaisuja sekä palvelulähtöisestä että teknisestä näkökulmasta. Palvelulähtöisen identiteetinhallinnan liiketoimintakonsepti ja toteutustekniikat – kuten single sign-on (SSO) ja Security Assertion Markup Language (SAML) – käydään läpi karkeiden esimerkkien avulla sekä tutustuen Nokia Account -hankkeessa tuotetun ratkaisun konseptiin ja teknisiin yksityiskohtiin. Nokia Account -palvelun ensimmäisen version toteutusta analysoidaan lopuksi identiteetinhallintapalveluiden suunnitteluperiaatteita ja vaatimuksia vasten.

STRATEGIC-1: A multiple-lines, randomized, open-label GERCOR phase III study in patients with unresectable wild-type RAS metastatic colorectal cancer.

BACKGROUND: The management of unresectable metastatic colorectal cancer (mCRC) is a comprehensive treatment strategy involving several lines of therapy, maintenance, salvage surgery, and treatment-free intervals. Besides chemotherapy (fluoropyrimidine, oxaliplatin, irinotecan), molecular-targeted agents such as anti-angiogenic agents (bevacizumab, aflibercept, regorafenib) and anti-epidermal growth factor receptor agents (cetuximab, panitumumab) have become available. Ultimately, given the increasing cost of new active compounds, new strategy trials are needed to define the optimal use and the best sequencing of these agents. Such new clinical trials require alternative endpoints that can capture the effect of several treatment lines and be measured earlier than overall survival to help shorten the duration and reduce the size and cost of trials. METHODS/DESIGN: STRATEGIC-1 is an international, open-label, randomized, multicenter phase III trial designed to determine an optimally personalized treatment sequence of the available treatment modalities in patients with unresectable RAS wild-type mCRC. Two standard treatment strategies are compared: first-line FOLFIRI-cetuximab, followed by oxaliplatin-based second-line chemotherapy with bevacizumab (Arm A) vs. first-line OPTIMOX-bevacizumab, followed by irinotecan-based second-line chemotherapy with bevacizumab, and by an anti-epidermal growth factor receptor monoclonal antibody with or without irinotecan as third-line treatment (Arm B). The primary endpoint is duration of disease control. A total of 500 patients will be randomized in a 1:1 ratio to one of the two treatment strategies. DISCUSSION: The STRATEGIC-1 trial is designed to give global information on the therapeutic sequences in patients with unresectable RAS wild-type mCRC that in turn is likely to have a significant impact on the management of this patient population. The trial is open for inclusion since August 2013. TRIAL REGISTRATION: STRATEGIC-1 is registered at Clinicaltrials.gov: NCT01910610, 23 July, 2013. STRATEGIC-1 is registered at EudraCT-No.: 2013-001928-19, 25 April, 2013.

Is response to fire influenced by dietary specialization and mobility? A comparative study with multiple animal assemblages

Fire is a major agent involved in landscape transformation and an indirect cause of changes in species composition. Responses to fire may vary greatly depending on life histories and functional traits of species. We have examined the taxonomic and functional responses to fire of eight taxonomic animal groups displaying a gradient of dietary and mobility patterns: Gastropoda, Heteroptera, Formicidae, Coleoptera, Araneae, Orthoptera, Reptilia and Aves. The fieldwork was conducted in a Mediterranean protected area on 3 sites (one unburnt and two burnt with different postfire management practices) with five replicates per site. We collected information from 4606 specimens from 274 animal species. Similarity in species composition and abundance between areas was measured by the Bray-Curtis index and ANOSIM, and comparisons between animal and plant responses by Mantel tests. We analyze whether groups with the highest percentage of omnivorous species, these species being more generalist in their dietary habits, show weak responses to fire (i.e. more similarity between burnt and unburnt areas), and independent responses to changes in vegetation. We also explore how mobility, i.e. dispersal ability, influences responses to fire. Our results demonstrate that differences in species composition and abundance between burnt and unburnt areas differed among groups. We found a tendency towards presenting lower differences between areas for groups with higher percentages of omnivorous species. Moreover, taxa with a higher percentage of omnivorous species had significantly more independent responses of changes in vegetation. High- (e.g. Aves) and low-mobility (e.g. Gastropoda) groups had the strongest responses to fire (higher R scores of the ANOSIM); however, we failed to find a significant general pattern with all the groups according to their mobility. Our results partially support the idea that functional traits underlie the response of organisms to environmental changes caused by fire.

Complex patterns of global spread in invasive insects: eco-evolutionary and management consequences

The advent of simple and affordable tools for molecular identification of novel insect invaders and assessment of population diversity has changed the face of invasion biology in recent years. The widespread application of these tools has brought with it an emerging understanding that patterns in biogeography, introduction history and subsequent movement and spread of many invasive alien insects are far more complex than previously thought. We reviewed the literature and found that for a number of invasive insects, there is strong and growing evidence that multiple introductions, complex global movement, and population admixture in the invaded range are commonplace. Additionally, historical paradigms related to species and strain identities and origins of common invaders are in many cases being challenged. This has major consequences for our understanding of basic biology and ecology of invasive insects and impacts quarantine, management and biocontrol programs. In addition, we found that founder effects rarely limit fitness in invasive insects and may benefit populations (by purging harmful alleles or increasing additive genetic variance). Also, while phenotypic plasticity appears important post-establishment, genetic diversity in invasive insects is often higher than expected and increases over time via multiple introductions. Further, connectivity among disjunct regions of global invasive ranges is generally far higher than expected and is often asymmetric, with some populations contributing disproportionately to global spread. We argue that the role of connectivity in driving the ecology and evolution of introduced species with multiple invasive ranges has been historically underestimated and that such species are often best understood in a global context.

Habilitation of a city in case with multiple victims = Habilitación de una ciudad en sucesos con múltiples víctimas

Debido a que en España se han dado diferentes accidentes con múltiples víctimas en diferentes puntos del país, se cree conveniente que cada ciudad tenga un plan de gestión de catástrofes con una serie de espacios habilitados para poder responder en caso de un accidente de estas características. El presente artículo tiene como objetivo presentar la habilitación de espacios aplicable en cualquier capital de provincia de España, tomando como ejemplo la ciudad de Girona. Se ha tomado la ciudad de Girona como modelo por presentar infraestructuras viarias, ferroviarias, portuarias y aeroportuarias cada vez más concurridas