Prioritising systemic cancer therapies applying ESMO's tools and other resources to assist in improving cancer care globally:the Kazakh experience

BACKGROUND: In Kazakhstan, cancer is the second leading cause of death with a major public health and economic burden. In the last decade, cancer care and cancer medicine costs have significantly increased. To improve the efficiency and efficacy of cancer care expenditure and planning, the Kazakhstan Ministry of Health requested assistance from the World Health Organization (WHO) and the European Society for Medical Oncology (ESMO) to review its systemic cancer treatment protocols and essential medicines list and identify high-impact, effective regimens. MATERIALS AND METHODS: ESMO developed a four-phase approach to review Kazakhstan cancer treatment protocols: (i) perform a systematic analysis of the country’s cancer medicines and treatment protocols; (ii) cross-reference the country’s cancer protocols with the WHO Model List of Essential Medicines, the ESMO-Magnitude of Clinical Benefit Scale and the European Medicines Agency’s medicine availability and indications database; (iii) extract treatment recommendations from the ESMO Clinical Practice Guidelines; (iv) expert review for all cancer medicines not on the WHO Model List of Essential Medicines and the country treatment protocols. RESULTS: This ESMO four-phase approach led to the update of the Kazakhstan national essential cancer medicines list and the list of cancer treatment protocols. This review has led to the withdrawal of several low-value or non-evidence-based medicines and a budget increase for cancer care to include all essential and highly effective medicines and treatment options. CONCLUSION: When applied effectively, this four-phase approach can improve access to medicines, efficiency of expenditure and sustainability of cancer systems. The WHO–ESMO collaboration illustrated how, by sharing best practices, tools and resources, we can address access to cancer medicines and positively impact patient care

Driving under drugs in Switzerland : a descriptive cross-sectional study

Objectives: Many drugs, both illicit or for medication, are known to influence driving abilities and increase risks of accidents. We explored the prevalence of psychoactive substances in a random sample of drivers in Switzerland. Methods: Saliva samples from 1078 random drivers were collected at 24 different locations in Western Switzerland from October 2006 to April 2008 for complete toxicological analysis using liquid chromatography/tandem mass spectrometry. Results: Provisional results are available for 437 drivers. 6.2% (CI95% 4.1 to 8.9) were under the influence of illicit drugs and 8.7% under psychoactive medication (CI95% 6.2 to 11.7). 37 drivers (8.5%) were under the influence of alcohol of which 14 (3.2%) were above 0.8 mg/L. 21 drivers (4.8%) were under the combined influence of more than one psychoactive substance; however only 4 drivers (0.9%) were under both the influence of medication and alcohol. Looking more specifically at illicit substances, 22 (5.0%) were positive to cocaine, 5 (1.1%) to cannabis, and 2 (0.5%) to amphetamines ; for psychoactive medication, 17 (3.9%) were positive to benzodiazepines, 16 (3.7%) to antidepressors, 7 (1.6%) to opiates, 7 (1.6%) to neuroleptics, and 3 (0.7%) to other substances influencing driving abilities. 17/21 drivers did not self-report their consumption of drugs whereas only 9/35 failed mentioning their medication. Men drivers were 3.2 times (CI95% 1.1 to 9.5) more likely to be under the influence of illicit drugs than women. Full results will be reported when laboratory data will be available in April. Conclusions: Driving under the influence of psychoactive substances is common. In Western Switzerland, prevention messages could focus on men, driving under medication or cocaine

A Comprehensive Overview of the Temperature-Dependent Modeling of the High-Power GaN HEMT Technology Using mm-Wave Scattering Parameter Measurements (Invited Paper)

The gallium-nitride (GaN) high electron-mobility transistor (HEMT) technology has emerged as an attractive candidate for high-frequency, high-power, and high-temperature applications due to the unique physical characteristics of the GaN material. Over the years, much effort has been spent on measurement-based modeling since accurate models are essential for allowing the use of this advanced transistor technology at its best. The present analysis is focused on the modeling of the scattering (S-) parameter measurements for a 0.25 μm GaN HEMT on silicon carbide (SiC) substrate at extreme operating conditions: a large gate width (i.e., the transistor is based on an interdigitated layout consisting of ten fingers, each with a length of 150 μm, resulting in a total gate periphery of 1.5 mm), a high ambient temperature (i.e., from 35 °C up to 200 °C with a step of 55 °C), a high dissipated power (i.e., 5.1 W at 35 °C), and a high frequency in the millimeter-wave range (i.e., from 200 MHz up to 65 GHz with a step of 200 MHz). Three different modeling approaches are investigated: the equivalent-circuit model, artificial neural networks (ANNs), and gated recurrent units (GRUs). As is shown, each modeling approach has its pros and cons that need to be considered, depending on the target performance and their specifications. This implies that an appropriate selection of the transistor modeling approach should be based on discerning and prioritizing the key features that are indeed the most important for a given application

LHC Optics Measurement with Proton Tracks Detected by the Roman Pots of the TOTEM Experiment

Precise knowledge of the beam optics at the LHC is crucial to fulfil the physics goals of the TOTEM experiment, where the kinematics of the scattered protons is reconstructed with the near-beam telescopes -- so-called Roman Pots (RP). Before being detected, the protons' trajectories are influenced by the magnetic fields of the accelerator lattice. Thus precise understanding of the proton transport is of key importance for the experiment. A novel method of optics evaluation is proposed which exploits kinematical distributions of elastically scattered protons observed in the RPs. Theoretical predictions, as well as Monte Carlo studies, show that the residual uncertainty of this optics estimation method is smaller than 0.25 percent.Comment: 20 pages, 11 figures, 5 figures, to be submitted to New J. Phy

Double diffractive cross-section measurement in the forward region at LHC

The first double diffractive cross-section measurement in the very forward region has been carried out by the TOTEM experiment at the LHC with center-of-mass energy of sqrt(s)=7 TeV. By utilizing the very forward TOTEM tracking detectors T1 and T2, which extend up to |eta|=6.5, a clean sample of double diffractive pp events was extracted. From these events, we measured the cross-section sigma_DD =(116 +- 25) mub for events where both diffractive systems have 4.7 <|eta|_min < 6.5 .Comment: 5 pages, 1 figure, submitted for publicatio

Performance of the TOTEM Detectors at the LHC

The TOTEM Experiment is designed to measure the total proton-proton cross-section with the luminosity-independent method and to study elastic and diffractive pp scattering at the LHC. To achieve optimum forward coverage for charged particles emitted by the pp collisions in the interaction point IP5, two tracking telescopes, T1 and T2, are installed on each side of the IP in the pseudorapidity region 3.1 < = |eta | < = 6.5, and special movable beam-pipe insertions - called Roman Pots (RP) - are placed at distances of +- 147 m and +- 220 m from IP5. This article describes in detail the working of the TOTEM detector to produce physics results in the first three years of operation and data taking at the LHC.Comment: 40 pages, 31 figures, submitted to Int. J. Mod. Phys.

Diamond Detectors for the TOTEM Timing Upgrade

This paper describes the design and the performance of the timing detector developed by the TOTEM Collaboration for the Roman Pots (RPs) to measure the Time-Of-Flight (TOF) of the protons produced in central diffractive interactions at the LHC. The measurement of the TOF of the protons allows the determination of the longitudinal position of the proton interaction vertex and its association with one of the vertices reconstructed by the CMS detectors. The TOF detector is based on single crystal Chemical Vapor Deposition (scCVD) diamond plates and is designed to measure the protons TOF with about 50 ps time precision. This upgrade to the TOTEM apparatus will be used in the LHC run 2 and will tag the central diffractive events up to an interaction pileup of about 1. A dedicated fast and low noise electronics for the signal amplification has been developed. The digitization of the diamond signal is performed by sampling the waveform. After introducing the physics studies that will most profit from the addition of these new detectors, we discuss in detail the optimization and the performance of the first TOF detector installed in the LHC in November 2015.Comment: 26 pages, 18 figures, 2 tables, submitted for publication to JINS

First Results from the TOTEM Experiment

The first physics results from the TOTEM experiment are here reported, concerning the measurements of the total, differential elastic, elastic and inelastic pp cross-section at the LHC energy of $\sqrt{s}$ = 7 TeV, obtained using the luminosity measurement from CMS. A preliminary measurement of the forward charged particle $\eta$ distribution is also shown.Comment: Conference Proceeding. MPI@LHC 2010: 2nd International Workshop on Multiple Partonic Interactions at the LHC. Glasgow (UK), 29th of November to the 3rd of December 201

ESMO - Magnitude of Clinical Benefit Scale V.1.0 questions and answers

The ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS) is a standardised, generic, validated tool to stratify the magnitude of clinical benefit that can be anticipated from anticancer therapies. The ESMO-MCBS is intended to both assist oncologists in explaining the likely benefits of a particular treatment to their patients as well as to aid public health decision makers' prioritise therapies for reimbursement. From its inception the ESMO-MCBS Working Group has invited questions and critiques to promote understanding and to address misunderstandings regarding the nuanced use of the scale, and to identify shortcomings in the scale to be addressed in future planned revisions and updates. The ESMO-MCBS V.1.0 has attracted many questions regarding its development, structure and potential applications. These questions, together with responses from the ESMO-MCBS Working Group, have been edited and collated, and are herein presented as a supplementary resource.SCOPUS: re.jinfo:eu-repo/semantics/publishe