Ariel - Volume 2 Number 3

Editors Delvyn C. Case, Jr. Paul M. Fernhoff News Editors Richard Bonanno Daniel B. Gould Robin A. Edwards Lay-Out Editor Carol Dolinskas Sports Editor James J. Nocon Contributing Editors Michael J. Blecker Lin Sey Edwards Jack Guralnik W. Cherry Light Features Editor Steven A. Ager Donald A. Bergman Stephen P. Flynn Business Manager Nick Greg

Health system resilience: a critical review and reconceptualisation

Sophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Alastair Ager - ORCID: 0000-0002-9474-3563 https://orcid.org/0000-0002-9474-3563This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neglect of equity and of who is bearing the costs of resilience strategies. Resilience depends crucially on relationships between system actors and components, and—as amply shown during the COVID-19 pandemic—relationships with wider systems (eg, economic, political, and global governance structures). Resilience is therefore connected to power imbalances, which need to be addressed to enact the transformative strategies that are important in dealing with more persistent shocks and stressors, such as climate change. We discourage the framing of resilience as an outcome that can be measured; instead, we see it emerge from systemic resources and interactions, which have effects that can be measured. We propose a more complex categorisation of shocks than the common binary one of acute versus chronic, and outline some of the implications of this for resilience strategies. We encourage a shift in thinking from capacities towards capabilities—what actors could do in future with the necessary transformative strategies, which will need to encompass global, national, and local change. Finally, we highlight lessons emerging in relation to preparing for the next crisis, particularly in clarifying roles and avoiding fragmented governance.This Viewpoint has no specific funding, but SW's time was supported by the ReBUILD for Resilience research consortium, funded by the UK Foreign, Commonwealth & Development Office.https://doi.org/10.1016/S2214-109X(23)00279-611pubpub

Papers, posters, and keynote presented at the 26th Polar Libraries Colloquy, hosted by the University of Alaska Fairbanks, Fairbanks, Alaska, USA 10 – 15 July 2016

Published July 2023 by the University of Alaska Anchorage, UAA/APU Consortium Library, and edited by Daria O. Carle. Copyright in individual papers is held by the contributors. A digital copy of this publication can be found at https://polarlibraries.org/colloquy-proceedings/ and in ScholarWorks, the University of Alaska’s Institutional Repository, https://scholarworks.alaska.edu/. A copy of the 2016 Colloquy program is also available at https://polarlibraries.org/colloquy-proceedings/. Further information on the Polar Libraries Colloquy, including details of membership and upcoming conferences, is available at https://polarlibraries.orgHistory of Polar Information Science / Working in Antarctica: Mapping a Changing Experience through the British Antarctic Survey / Géoindex+: A Geospatial Platform for Northern Historical and Research Data / Establishing Criteria for the Development of the “Northern Collection” at Université Laval’s Library: An Exploratory Approach / Introducing Two New Reserach Platforms: seaiceportal.de and expedition.awi.de (abstract only) / Establishing a Digital Library Service for the Inuvialuit Settlement Region / Changing Patterns of Polar Research / Mapping the Rescue of an Archive / Byrd 1933: Films from the Discovery Lecture Series / History of the Elmer E. Rasmuson Library and Its Rare Books Collection / A Roadmap to Navigate the Range of Polar Libraries, Databases, and Archives Now Available Online / Mapping Change with Finna in an Arctic Research Joint Library (paper not listed in program) / Mapping Chang in a Small Library Environment: From Reading Room to Communications Center (abstract only) / The Continued Evolution of the Cold Regions Bibliography Project: Current Status of the Antarctic Bibliography and the Antarctic Journal of the United States and its Predecessors / Connect the North: The Arctic Connect Project / Languages and Dialects in the Digital Library North (abstract only) / Bridging Arctic Indigenous Knowledge with the Digital World: Sharing Indigenous Ways of Knowing in Partnership with Arctic Communities (abstract only) / The Canadian Consortium for Arctic Data Interoperability (abstract and poster

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Pitfalls in HTTP Traffic Measurements and Analysis

Abstract. Being responsible for more than half of the total traffic volume in the Internet, HTTP is a popular subject for traffic analysis. From our experiences with HTTP traffic analysis we identified a number of pitfalls which can render a carefully executed study flawed. Often these pitfalls can be avoided easily. Based on passive traffic measurements of 20.000 European residential broadband customers, we quantify the potential error of three issues: Non-consideration of persistent or pipelined HTTP requests, mismatches between the Content-Type header field and the actual content, and mismatches between the Content-Length header and the actual transmitted volume. We find that 60 % (30 %) of all HTTP requests (bytes) are persistent (i. e., not the first in a TCP connection) and 4 % are pipelined. Moreover, we observe a Content-Type mismatch for 35 % of the total HTTP volume. In terms of Content-Length accuracy our data shows a factor of at least 3.2 more bytes reported in the HTTP header than actually transferred.