Reality Hackers: The Next Wave of Media Revolutionaries

Just as the printing press gave rise to the nation-state, emerging technologies are reshaping collective identities and challenging our understanding of what it means to be human. Should citizens have the right to be truly anonymous on-line? Should we be concerned about the fact that so many people are choosing to migrate to virtual worlds? Are injectible microscopic radio-frequency ID chips a blessing or a curse? Is the use of cognitive enhancing nootropics a human right or an unforgivable transgression? Should genomic data about human beings be hidden away with commercial patents or open-sourced like software? Should hobbyists known as biohackers be allowed to experiment with genetic engineering in their home laboratories? The time-frame for acting on such questions is relatively short, and these decisions are too important to be left up to a small handful of scientists and policymakers. If democracy is to continue as a viable alternative to technocracy, the average citizen must become more involved in these debates. To borrow a line from the computer visionary Ted Nelson, all of us can -- and must -- understand technology now. Challenging the popular stereotype of hackers as ciminal sociopaths, reality hackers uphold the basic tenets of what Steven Levy (1984) terms the hacker ethic. These core principles include a commitment to: sharing, openness, decentralization, public access to information, and the use of new technologies to make the world a better place.https://digitalcommons.trinity.edu/mono/1000/thumbnail.jp

Use of an Arterial Tourniquet to Achieve Complete Radiofrequency Ablation of a Renal Metastasis

Radiofrequency (RF) coagulation of skeletal metastases is usually performed for pain relief. However, patients with solitary skeletal metastasis may benefit from more aggressive attempts to achieve local control. The authors report a case in which an arterial tourniquet was used to enhance the effectiveness of RF treatment of a calcaneal renal cell metastasis, leading to long-lasting local control with preservation of ambulation

Mesenchymal Chondrosarcoma of the Sinonasal Cavity: A Case Report and Brief Review of the Literature

Mesenchymal chondrosarcoma is a rare, highly malignant cartilaginous forming tumor that is rarely encountered in clinical practice. They are unique in their ability to frequently arise in the soft tissues in addition to the common skeletal sites of other bone tumors. Histologically, mesenchymal chondrosarcomas are characterized by a mix of cartilage and undifferentiated stromal tissue. Radiographically, they demonstrate features similar to the more commonly encountered conventional chondrosarcoma, with the tumor location and patient age helping to suggest the correct diagnosis. We present a case of mesenchymal chondrosarcoma presenting as chronic sinusitis, arising in the sinonasal cavity. Additionally, a discussion of the imaging features and a brief review of the literature surrounding this uncommon neoplasm are included

Mesenchymal Chondrosarcoma of the Sinonasal Cavity: A Case Report and Brief Review of the Literature

Mesenchymal chondrosarcoma is a rare, highly malignant cartilaginous forming tumor that is rarely encountered in clinical practice. They are unique in their ability to frequently arise in the soft tissues in addition to the common skeletal sites of other bone tumors. Histologically, mesenchymal chondrosarcomas are characterized by a mix of cartilage and undifferentiated stromal tissue. Radiographically, they demonstrate features similar to the more commonly encountered conventional chondrosarcoma, with the tumor location and patient age helping to suggest the correct diagnosis. We present a case of mesenchymal chondrosarcoma presenting as chronic sinusitis, arising in the sinonasal cavity. Additionally, a discussion of the imaging features and a brief review of the literature surrounding this uncommon neoplasm are included

Treatment sequences for advanced renal cell carcinoma: A health economic assessment.

ObjectiveAdvanced renal cell carcinoma (RCC) is commonly treated with vascular endothelial growth factor or mammalian target of rapamycin inhibitors. As new therapies emerge, interest grows in gaining a deeper understanding of treatment sequences. Recently, we developed a patient-level, discretely integrated condition event (DICE) simulation to estimate survival and lifetime costs for various cancer therapies, using a US payer perspective. Using this model, we explored the impact of treatments such as nivolumab and cabozantinib, and compared the clinical outcomes and cost consequences of commonly used treatment algorithms for patients with advanced RCC.MethodsIncluded treatment sequences were pazopanib or sunitinib as first-line treatment, followed by nivolumab, cabozantinib, axitinib, pazopanib or everolimus. Efficacy inputs were derived from the CheckMate 025 trial and a network meta-analysis based on available literature. Safety and cost data were obtained from publicly available sources or literature.ResultsBased on our analysis, the average cost per life-year (LY) was lowest for sequences including nivolumab (sunitinib → nivolumab, $75,268/LY; pazopanib → nivolumab,$84,459/LY) versus axitinib, pazopanib, everolimus and cabozantinib as second-line treatments. Incremental costs per LY gained were $49,592,$73,927 and $30,534 for nivolumab versus axitinib, pazopanib and everolimus-containing sequences, respectively. The model suggests that nivolumab offers marginally higher life expectancy at a lower cost versus cabozantinib-including sequences.ConclusionTreatment sequences using nivolumab in the second-line setting are less costly compared with sequential use of targeted agents. In addition to efficacy and safety data, cost considerations may be taken into account when considering treatment algorithms for patients with advanced RCC

Application of dynamic modeling for survival estimation in advanced renal cell carcinoma.

OBJECTIVE:In oncology, extrapolation of clinical outcomes beyond trial duration is traditionally achieved by parametric survival analysis using population-level outcomes. This approach may not fully capture the benefit/risk profile of immunotherapies due to their unique mechanisms of action. We evaluated an alternative approach-dynamic modeling-to predict outcomes in patients with advanced renal cell carcinoma. We compared standard parametric fitting and dynamic modeling for survival estimation of nivolumab and everolimus using data from the phase III CheckMate 025 study. METHODS:We developed two statistical approaches to predict longer-term outcomes (progression, treatment discontinuation, and survival) for nivolumab and everolimus, then compared these predictions against follow-up clinical trial data to assess their proximity to observed outcomes. For the parametric survival analyses, we selected a probability distribution based on its fit to observed population-level outcomes at 14-month minimum follow-up and used it to predict longer-term outcomes. For dynamic modeling, we used a multivariate Cox regression based on patient-level data, which included risk scores, and probability and duration of response as predictors of longer-term outcomes. Both sets of predictions were compared against trial data with 26- and 38-month minimum follow-up. RESULTS:Both statistical approaches led to comparable fits to observed trial data for median progression, discontinuation, and survival. However, beyond the trial duration, mean survival predictions differed substantially between methods for nivolumab (30.8 and 51.5 months), but not everolimus (27.2 and 29.8 months). Longer-term follow-up data from CheckMate 025 and phase I/II studies resembled dynamic model predictions for nivolumab. CONCLUSIONS:Dynamic modeling can be a good alternative to parametric survival fitting for immunotherapies because it may help better capture the longer-term benefit/risk profile and support health-economic evaluations of immunotherapies