Immunotherapies in Early and Advanced Renal Cell Cancer

The development of new immunomodulatory monoclonal antibodies targeting the CTLA-4 or PD-1 axis has led to a revival of research on immunotherapies in solid tumours including renal cell cancer (RCC). The initial results observed with these monoclonal antibodies in the treatment of advanced melanoma have resulted in considerable interest in this treatment strategy in all tumour types. Preliminary data of these new antibodies in advanced RCC are promising and they have good safety profiles. Response rates are low but durable tumour control has been observed in some patients. However, at the moment there is no evidence that targeting the CTLA-4 or PD-1 axis provides a substantial clinical benefit compared to established treatment with tyrosine kinase or mTOR inhibitors. There are also no reliable predictive markers. At the moment, several randomised trials have been initiated to investigate the new immunomodulatory antibodies either as single agents or in combination with anti-VEGF targeted therapy. Vaccines have continued to be investigated in advanced and adjuvant settings. No trial has so far established vaccines as a standard treatment in either situation. There are still large randomised trials ongoing investigating the potential benefit of a vaccine in combination with standard tyrosine kinase inhibitor therapy. In this chapter we will summarise selected studies on immunotherapy in advanced RCC with a focus on anti-PD-1, anti-PD-L1, and anti-CTLA-4 antibodies. We will also touch briefly on the adjuvant situation and tumour vaccines

e-Mental Health: Providing Quality Mental Health Information to Practitioners and the Public

With the Internet a prominent place for many Americans to turn when seeking health information, the importance of providing authoritative, reliable, quality-filtered resources is a tasl well-suited for professional medical librarians. This article outlines three steps librarians can take to locate, organize, develop and deliver quality e-mental health resources effectively for mental health professionals and their patients, including establishing partnerships, developing and delivering resources, and providing training and outreach

Spatial dilemmas of diffusible public goods

The emergence of cooperation is a central question in evolutionary biology. Microorganisms often cooperate by producing a chemical resource (a public good) that benefits other cells. The sharing of public goods depends on their diffusion through space. Previous theory suggests that spatial structure can promote evolution of cooperation, but the diffusion of public goods introduces new phenomena that must be modeled explicitly. We develop an approach where colony geometry and public good diffusion are described by graphs. We find that the success of cooperation depends on a simple relation between the benefits and costs of the public good, the amount retained by a producer, and the average amount retained by each of the producer’s neighbors. These quantities are derived as analytic functions of the graph topology and diffusion rate. In general, cooperation is favored for small diffusion rates, low colony dimensionality, and small rates of decay of the public good. DOI: http://dx.doi.org/10.7554/eLife.01169.00

e-Mental Health in Central Massachusetts

e-Mental Health in Central Massachusetts (EMH) is a web-based resource designed to improve access to evidence-based mental health information and local resources for mental health professionals and consumers. The Lamar Soutter Library, University of Massachusetts Medical School (UMMS), in collaboration with the UMMS Department of Psychiatry and the Commonwealth of Massachusetts Department of Mental Health, developed EMH to meet the needs of practitioners, patients and caregivers. The project provides an integrative web-based information resource that includes searchable databases of (1) local mental health care services and (2) quality-filtered information about mental health conditions and diseases. Centralized access to professional resources, information literacy training, professional reference services and document delivery to a traditionally underserved population are also provided. After training, participants in the program use the resource regularly and demonstrate heightened awareness of reliable mental health information available to them. The collaborative spirit also continues and will surely benefit future endeavors

mRCC management: past, present and future

Aims and scope Over the last six years, the use of targeted agents has revolutionised the treatment of metastatic renal cell carcinoma (mRCC) and dramatically improved outcomes for patients. Multiple effective first-and second-line agents are now available or are in development, raising key questions and new challenges around the long-term management of mRCC. These topics were the focus of a Pfizer meeting held at the 7 th European International Kidney Cancer Symposium (EIKCS) in Vienna (4–5 May 2012), where leading European oncology experts discussed recent advances and ongoing issues in mRCC clinical practice. 'It is important for clinicians who see large numbers of patients with this rare disease to get together and share their experience and observations, for the benefit of those who only see few patients in their practice', said Professor Manuela Schmidinger, Chair of the meeting. This report offers an overview of the critical evidence and the issues of long-term mRCC management debated at the meeting. It also presents key conclusions from the recently launched report 'Europe 2012: is kidney cancer management at a crossroad?', written by a selected panel of European kidney cancer experts to highlight current barriers to the optimal treatment of mRCC patients and the development of solutions to address these

The Academic Medical Library as Online Publisher

Objectives: To describe the use of an institutional repository system to facilitate the publishing activities of an academic medical library. Methods: The Library launched its institutional repository in 2006 and developed a mature collection of peer-reviewed articles, posters, and conference proceedings. Beginning in 2009, the Library sought to expand the use of the repository and partnered with two academic departments, Neurology and Psychiatry, to publish electronic journals. In spring 2011 the Library began to explore the idea of publishing its own peer-reviewed, open access electronic journal. Planning and implementation considerations included: choosing a unique and appropriate name; infrastructure and hosting options; organizational and governance structure; roles and responsibilities; journal structure and content; aims and scope; editorial, peer review and other policies and procedures; and dissemination. Simultaneously the Library undertook the publishing of its first electronic book, where issues of presentation, page turning, photo placement, and indexing became significant. Results: The inaugural issue of the Journal of eScience Librarianship was published on February 15, 2012 via the journal management platform of the Library’s institutional repository, eScholarship@UMMS. JESLIB has been assigned ISSN 2161-3974. The medical school joined CrossRef so that article metadata could be deposited into their system and each article assigned a DOI (Digital Object Identifier). Additional issues have been published, readership statistics and patterns are positive, and JESLIB is now indexed in the Directory of Open Access Journals. In fall 2012, the Library published its first eBook, “A History of the University of Massachusetts Medical School, which was authored by the medical school’s head of the Office of Medical History and Archives. Conclusions: Academic medical libraries can successfully publish as well as host online journals and books. Utilizing the institutional repository for publishing purposes offers a number of advantages. The repository provides a tested infrastructure for ingesting and sharing of documents. The repository administrator possesses strong in-house expertise, experience with embargoes, metadata, preservation and dissemination, and most importantly, has built strong relationships and trust with faculty and researchers. The open access platform leads to wider dissemination and maximum impact, backed up by reliable usage statistics. Helpful planning guides and other resources are available to assist libraries and academic groups in publishing open access peer-reviewed materials. Lessons learned include: utilize professional copy editing services; locking papers for revisions speeds up workflows

So You Want to Be a Publisher: Planning and Publishing the Journal of eScience Librarianship

Objective: To describe the planning process and activities of the University of Massachusetts Medical School\u27s Lamar Soutter Library around the publication of the new Journal of eScience Librarianship (JESLIB). Methods: The University of Massachusetts Medical School’s Lamar Soutter Library through funding from the National Network of Libraries of Medicine has been a leader in educating librarians about eScience and its impact on librarianship. In spring 2011 the Library began to explore the idea of publishing a peer-reviewed, open access electronic journal about eScience and data management for librarians. Planning and implementation considerations included: choosing a unique and appropriate name; infrastructure and hosting options; organizational and governance structure; roles and responsibilities; journal structure and content; aims and scope; editorial, peer review and other policies and procedures; and dissemination. Results: The inaugural issue of the Journal of eScience Librarianship (http://escholarship.umassmed.edu/jeslib/) was published on February 15, 2012 via the journal management platform of the Library\u27s institutional repository, eScholarship@UMMS. JESLIB has been assigned ISSN 2161-3974. The medical school joined CrossRef so that article metadata could be deposited into their system and each article assigned a DOI (Digital Object Identifier). Conclusion: Libraries can successfully publish as well as host online journals. Helpful planning guides and other resources are available to assist libraries and academic groups in publishing open access peer-reviewed journals. Lessons learned include: consider professional copy editing services to assist the Editorial Board; Editorial Team roles and responsibilities should be clearly defined but allow room for flexibility; and have a clear marketing communication and promotion strategy

Costs of managing adverse events in the treatment of first-line metastatic renal cell carcinoma: Bevacizumab in combination with interferon-α2a compared with sunitinib

Background: Bevacizumab plus interferon-α2a (IFN) prolongs progression-free survival to>10 months, which is comparable with sunitinib as first-line treatment of metastatic renal cell carcinoma (RCC). The two regimens have different tolerability profiles; therefore, costs for managing adverse events may be an important factor in selecting therapy.Methods: Costs of managing adverse events affecting patients with metastatic RCC eligible for treatment with bevacizumab plus IFN or sunitinib were evaluated using a linear decision analytical model. Management costs were calculated from the published incidence of adverse events and health-care costs for treating adverse events in the United Kingdom, Germany, France and Italy.Results: Adverse event management costs were higher for sunitinib than for bevacizumab plus IFN. The average cost per patient for the management of grade 3-4 adverse events was markedly lower with bevacizumab plus IFN compared with sunitinib in the United Kingdom (\[euro]1475 vs \[euro]804), Germany (\[euro]1785 vs \[euro]1367), France (\[euro]2590 vs \[euro]1618) and Italy (\[euro]891 vs \[euro]402). The main cost drivers were lymphopaenia, neutropaenia, thrombocytopaenia, leucopaenia and fatigue/asthaenia for sunitinib; and proteinuria, fatigue/asthaenia, bleeding, anaemia and gastrointestinal perforation for bevacizumab plus IFN.Conclusion: The costs of managing adverse events are lower for bevacizumab plus IFN than for sunitinib. The potential for cost savings should be considered when selecting treatments for RCC