The entangled geographies of responsibility: Contested policy narratives of migration governance along the Balkan Route

This article examines some of the contested geographical imaginaries of the so-called “Balkan Route” which, although traversing land, is an integral part of the wider Mediterranean migration complex. More specifically, we interrogate how such varied imaginaries of the Route contribute to shaping conflicting geographies of responsibility for migration in the region among a shifting set of international and state actors. We highlight how the attribution of responsibility for the governance of migration is shaped by a variety of geographical and historical entanglements, including on-going processes of post-conflict state-making and the geopolitics of European Union accession, with migrants becoming pawns in the negotiation of preferential relations between the countries of the region and the European Union. Focusing in particular on the framing of migration policy responses along the Croatia Bosnia and Italy–Slovenia sections of the Route, we examine the perspectives of both policy-makers and solidarity networks active in the area, noting how their divergent narratives contribute to the proliferation of conflicting formal and informal practices of border control

Recursive internetwork architecture, investigating RINA as an alternative to TCP/IP (IRATI)

Driven by the requirements of the emerging applications and networks, the Internet has become an architectural patchwork of growing complexity which strains to cope with the changes. Moore’s law prevented us from recognising that the problem does not hide in the high demands of today’s applications but lies in the flaws of the Internet’s original design. The Internet needs to move beyond TCP/IP to prosper in the long term, TCP/IP has outlived its usefulness. The Recursive InterNetwork Architecture (RINA) is a new Internetwork architecture whose fundamental principle is that networking is only interprocess communication (IPC). RINA reconstructs the overall structure of the Internet, forming a model that comprises a single repeating layer, the DIF (Distributed IPC Facility), which is the minimal set of components required to allow distributed IPC between application processes. RINA supports inherently and without the need of extra mechanisms mobility, multi-homing and Quality of Service, provides a secure and configurable environment, motivates for a more competitive marketplace and allows for a seamless adoption. RINA is the best choice for the next generation networks due to its sound theory, simplicity and the features it enables. IRATI’s goal is to achieve further exploration of this new architecture. IRATI will advance the state of the art of RINA towards an architecture reference model and specifcations that are closer to enable implementations deployable in production scenarios. The design and implemention of a RINA prototype on top of Ethernet will permit the experimentation and evaluation of RINA in comparison to TCP/IP. IRATI will use the OFELIA testbed to carry on its experimental activities. Both projects will benefit from the collaboration. IRATI will gain access to a large-scale testbed with a controlled network while OFELIA will get a unique use-case to validate the facility: experimentation of a non-IP based Internet

Experimental evaluation of a recursive internetwork architecture prototype

The Recursive InterNetwork Architecture (RINA) is a recently proposed network architecture based on first principles, which promises to solve a number of issues present in the current Internet such as the lack of inherent security. In this paper, we present the experimental evaluation of the first performance-oriented implementation of RINA, the IRATI stack. Our open source stack is designed for GNU/Linux Operating Systems, with key components developed in kernel space for optimal performance. After briefly introducing the architecture, we present the main features of the stack, give some details about the implementation and discuss some trade-offs that had to be taken into account. We present use case scenarios for the evaluation, which were implemented in a test environment, and present the performance, achieving a goodput close to line rate on a GbE link, even when multiple Distributed Inter Process Communication Facilities (DIFs) are stacked

Right ventricular function in AL amyloidosis: characteristics and prognostic implication

AIM: The importance of right ventricle (RV) dysfunction in AL amyloidosis has been underestimated. This study was designed to comprehensively evaluate RV function and its prognostic role in patients with AL amyloidosis with and without echocardiographic evidence of cardiac involvement. METHOD AND RESULTS: Fifty-two biopsy-proven AL amyloidosis patients underwent a thorough echocardiographic evaluation. Twenty-seven patients (CA) met the international echocardiographic criteria for cardiac involvement [left ventricular (LV) wall thickness >/= 12 mm] and 25 patients had no cardiac amyloidosis features (NCA). Patients were compared with a sex- age-matched control group. Patients and controls underwent traditional, tissue Doppler (TDI), speckle-tracking left and RV echocardiographic evaluation. No difference was observed between groups in RV diastolic diameter, whereas CA patients showed increased RV free wall thickness (P< 0.0001). Compared with controls and NCA patients, traditional echocardiography, TDI, and speckle-tracking evaluation detected significantly (P< 0.0001) depressed RV longitudinal systolic function in CA patients. No difference was observed between groups at Doppler diastolic evaluation, whereas at tricuspidal annulus TDI analysis, CA subject showed significantly lower E' and A' values with increased E/E' ratio (P< 0.0001). Over a 19 months median follow-up period, 18 patients died. Cox multivariate analysis showed that N-terminal pro-Brain natriuretic peptide and RV longitudinal strain were the strongest death predictor. CONCLUSION: Our data show that in patients with AL amyloidosis, RV involvement develops later than LV amyloid deposition but when it occurs, prognosis dramatically worsens. Moreover RV longitudinal strain was the only echocardiographic predictor of prognosis. We suggest that RV function analysis should be performed routinely as a part of echocardiographic evaluation in these patients

Design and implementation of the OFELIA FP7 facility: The European OpenFlow testbed

The growth of the Internet in terms of number of devices, the number of networks associated to each device and the mobility of devices and users makes the operation and management of the Internet network infrastructure a very complex challenge. In order to address this challenge, innovative solutions and ideas must be tested and evaluated in real network environments and not only based on simulations or laboratory setups. OFELIA is an European FP7 project and its main objective is to address the aforementioned challenge by building and operating a multi-layer, multi-technology and geographically distributed Future Internet testbed facility, where the network itself is precisely controlled and programmed by the experimenter using the emerging OpenFlow technology. This paper reports on the work done during the first half of the project, the lessons learned as well as the key advantages of the OFELIA facility for developing and testing new networking ideas. An overview on the challenges that have been faced on the design and implementation of the testbed facility is described, including the OFELIA Control Framework testbed management software. In addition, early operational experience of the facility since it was opened to the general public, providing five different testbeds or islands, is described

Does a 6-point scale approach to post-treatment 18F-FDG PET-CT allow to improve response assessment in head and neck squamous cell carcinoma? A multicenter study

Abstract Purpose Response assessment to definitive non-surgical treatment for head and neck squamous cell carcinoma (HNSCC) is centered on the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET-CT) 12 weeks after treatment. The 5-point Hopkins score is the only qualitative system available for standardized reporting, albeit limited by suboptimal positive predictive value (PPV). The aim of our study was to explore the feasibility and assess the diagnostic accuracy of an experimental 6-point scale ("Cuneo score"). Methods We performed a retrospective, multicenter study on HNSCC patients who received a curatively-intended, radiation-based treatment. A centralized, independent qualitative evaluation of post-treatment FDG-PET/CT scans was undertaken by 3 experienced nuclear medicine physicians who were blinded to patients' information, clinical data, and all other imaging examinations. Response to treatment was evaluated according to Hopkins, Cuneo, and Deauville criteria. The primary endpoint of the study was to evaluate the PPV of Cuneo score in assessing locoregional control (LRC). We also correlated semi-quantitative metabolic factors as included in PERCIST and EORTC criteria with disease outcome. Results Out of a total sample of 350 patients from 11 centers, 119 subjects (oropharynx, 57.1%; HPV negative, 73.1%) had baseline and post-treatment FDG-PET/CT scans fully compliant with EANM 1.0 guidelines and were therefore included in our analysis. At a median follow-up of 42 months (range 5-98), the median locoregional control was 35 months (95% CI, 32-43), with a 74.5% 3-year rate. Cuneo score had the highest diagnostic accuracy (76.5%), with a positive predictive value for primary tumor (Tref), nodal disease (Nref), and composite TNref of 42.9%, 100%, and 50%, respectively. A Cuneo score of 5-6 (indicative of residual disease) was associated with poor overall survival at multivariate analysis (HR 6.0; 95% CI, 1.88-19.18; p = 0.002). In addition, nodal progressive disease according to PERCIST criteria was associated with worse LRC (OR for LR failure, 5.65; 95% CI, 1.26-25.46; p = 0.024) and overall survival (OR for death, 4.81; 1.07-21.53; p = 0.04). Conclusions In the frame of a strictly blinded methodology for response assessment, the feasibility of Cuneo score was preliminarily validated. Prospective investigations are warranted to further evaluate its reproducibility and diagnostic accuracy

EMITTANCE MEASUREMENTS AT THE STRASBOURG TR24 CYCLOTRON FOR THE ADDITION OF A 65 MeV LINAC BOOSTER

Abstract The long term plans of IPHC foresee the installation of a linac that will boost the energy of the protons of the Strasbourg TR24 cyclotron from 24 MeV to 65 MeV. A Cell Coupled Linac, designed by the TERA Foundation, could be used for this purpose. To compute the transverse acceptances of the linac, the horizontal and vertical emittances of the extracted proton beam need to be measured. The secondary emission detector BISE (Beam Imaging with Secondary Electrons) built by TERA and under development at the Bern 18 MeV IBA cyclotron will be used in Strasbourg for the final measurements. The results of the preliminary measurements of the transverse beam profiles are reported together with the development of BISE, the description of the linac structure and the calculation of the expected output current based on the dynamics of the accelerated proton beam

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)