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BackgroundPlanning in behavioral weight loss (BWL) programs helps participants enact changes in eating and exercise, although the direct impact on weight loss is unclear.PurposeTo examine how meal and exercise planning frequencies change in a BWL program and their relations to weight loss outcomes.MethodsParticipants (N = 139) in a 40 week worksite-based BWL program completed a questionnaire regarding meal and exercise planning frequency at Weeks 0, 10, 20, 30, and 40 and were weighed weekly. Growth curve models were used to determine trajectories in meal and exercise planning frequency and to assess the role of an individual’s average meal and exercise planning (between-person effect) and individual variation in planning (within-person effect) on body mass index (BMI).ResultsThe best-fitting model, a linear random effect with a quadratic fixed-effect model, demonstrated that meal and exercise planning frequency increased over the course of the program with slowing growth rates. Between participants, higher average meal planning frequency (B = −0.029, t = −3.60), but not exercise planning frequency, was associated with greater weight loss. Within participants, exercise planning, but not meal planning, predicted a higher than expected BMI (B = 3.17, t = 4.21).ConclusionsFrequent meal planning should be emphasized as a continued, as opposed to intermittent, goal in BWL programs to enhance weight loss. Average exercise planning frequency does not impact weight loss in BWL programs; however, acute increases in exercise planning frequency may be a popular coping strategy during a weight loss setback or, alternatively, may lead to increased calorie consumption and weight gain.

This paper describes the development and characterization of a Δ E-TOF detector composed of a plastic scintillator bar coupled at both ends to silicon photomultipliers. This detector is a prototype of a larger version which will be used in the FOOT (FragmentatiOn Of Target) experiment to identify the fragments produced by ion beams accelerated onto a hydrogen-enriched target. The final Δ E-TOF detector will be composed of two layers of plastic scintillator bars with orthogonal orientation and will measure, for each crossing fragment, the energy deposited in the plastic scintillator ( Δ E), the time of flight (TOF), and the coordinates of the interaction position in the scintillator. To meet the FOOT experimental requirements, the detector should have energy resolution of a few percents and time resolution of 70 ps, and it should allow to discriminate multiple fragments belonging to the same event. To evaluate the achievable performances, the detector prototype was irradiated with protons of kinetic energy in the 70–230 MeV range and interacting at several positions along the bar. The measured energy resolution σ Δ E ∕ Δ E was 6–14%, after subtracting the fluctuations of the deposited energy. A time resolution σ between 120 and 180 ps was obtained with respect to a trigger detector. A spatial resolution σ of 1.9 cm was obtained for protons interacting at the center of the bar.

This article presents emergy evaluation and its application to ecosystems and territorial systems. The emergy approach is an environmental accounting methodology that can be used to assess natural inflows and services within a system. This ecological indicator was inspired by the food chain and the observations that energy quality increases along the chain while energy content decreases. Emergy analysis is able to differentiate between the various units (processes) of an ecosystem. It highlights processes that are sustained by low-quality energy and processes that need high-quality fluxes. The method is an embodied energy analysis that uses solar energy as reference. By evaluating natural resources on a common basis, emergy analysis has proved useful at the interface between human and natural systems and for assessing the impact of human activity on ecosystems. Based on a rigorous algebra, emergy evaluation provides indicators to measure sustainability.

The study of Very Large Complex systems (“VLCS”), of which modern energy conversion systems are an important subset, requires a holistic approach to analyze the system itself and all of its “external” and “internal” interactions. The view taken in this paper is that the VLCS should be considered as an “extended” (in a sense specified below) thermodynamic system. The evaluation of the flows of matter and energy sustaining a VLCS and the knowledge of the transformations therein can be used to describe the rate of exploitation of the available natural resources, to assess the efficiency of the conversion process, and to provide a quantitative estimate of the impact of the system on the environment. This kind of information is an important part of the essential database of any Decision Support System for both the internal and global policy planning and for resources management. Several assessment methods are in use at present, and each one of them provides a different insight in the “performance” of the conversion chain under examination. This paper presents the results of a multi-criteria comparative analysis of both conventional and innovative hydrogen production processes in which H2 is generated from different feedstocks: methane, residual oil and biomass (wood chips).

Presented paper shows the power of emergy analysis and its ability for simultaneous consideration of different industrial resources, goods and services for the purposes of decision-making. Accompanied by the pinch concept, which by now tries to deal separately with each of the resources (energy, water, hydrogen, oxygen, etc.), the combined emergy–pinch analysis provides wide range of benefits boosted with extra inside and design guidelines improving the integration of processes and the ability to consider the ‘past’ and the ‘future’ of the resources (the effort of making them available and the effort of minimising their environmental impact). The paper presents the theoretical background of the emergy and pinch combination into general resources management technique and proves this concept on classical emergy and pinch examples accompanied with a combined resources management industrial problem considering the environmental impact of industrial activities.

Cancer vaccines are intended to promote a long-lasting memory response against tumors. Rationale for cancer vaccines is based on two observations: a) many tumors express antigens (TA), which are recognized by specific cytotoxic T lymphocytes; b) these lymphocytes may protect the host against tumor growth in vivo. So far, cancer vaccines have been developed using soluble TA and, more recently, TA presented by dendritic cells (DC), the most powerful antigen presenting cells (APC). DCs play a key role in the process leading to antigen recognition and lymphocyte activation. Despite a deeper understanding of these processes, clinical efficacy of cancer vaccines is still hampered by the heterogeneity of the studies performed so far, and by the largely unknown mechanisms through which tumors escape immunosurveillance. Current DC-based cancer vaccines require the preparation of DCs from patient blood monocytes, as well as DC-loading with TA. Both whole tumor and TA peptides are used as source of TA. Similar schedules have been implemented in many clinical trials on melanoma, kidney and prostate cancer, with partial responses ranging from 7% to 30%. The study population was made up of non-respondent patients to any other therapy; the DC vaccination showed an extremely low toxicity. 22 patients with metastatic melanoma received a DC vaccine in Forlì (Italy) since August 2001. Good correlation between immunologic response, clinical response and overall survival was found. A clinical trial on pulsed APC administration to patients with recurring prostate cancer is ready to be started in Torino (Italy), pending the Ministerial approval from a local cell factory.

Industrial trials conducted at Sidenor Basauri Works, and numerical modelling at Centro Sviluppo Materiali (CSM), have been combined in order to find a square 185 × 185 mm billet peripheral geometry that improves the quality of cast products by eliminating the occurrence of off corner cracks and depressions, and reducing the percentage of rejection. The idea is to change the square shape of the mould section to a new profile having a larger corner radius and outward bulging faces. Experimental trials using moulds with convex faces and larger corner radii resulted in an interesting decrease in the percentage of rejected bars. The presence of longitudinal defects has not been completely eliminated, but the adoption of moulds with larger corner radii has been demonstrated to be successful. Numerical modelling has been used to verify that the larger corner radius is the most important variable that guarantees the improved result, while it is less sensitive to different deflections of the faces. This e...

Family-based behavioral intervention has been demonstrated to be an effective and safe treatment for childhood obesity and should be considered a first-line treatment option. However, access to such intensive evidence-based treatment is limited and, currently, obesity care is dominated by high intensity behavioral treatment implemented in specialty clinics or less effective low intensity treatments implemented in primary care. However, capitalizing on the established and ongoing relationship between primary care providers and families, primary care providers have an invaluable role in early identification of overweight and obesity, and subsequent referral to an evidence-based treatment. Key aspects of effective treatment include: early intervention, moderate intensity to high intensity intervention of sufficient duration, multicomponent intervention targeting dietary modification, physical activity and behavioral strategies, family involvement and goals targeting family members, and follow-up contact during maintenance. The purpose of this review is to present the current empirically supported treatment options for pediatric obesity including primary care-based interventions and diagnostic tools, multicomponent behavioral intervention with a focus on family-based behavioral intervention, immersion treatment, and pharmacologic and surgical management.

Temozolomide (TMZ) is a new oral alkylating agent which has proven to be as active as dacarbazine (DTIC) in the treatment of melanoma, but with a lower toxicity. A multicentric phase II trial was conducted in an out-patient setting to determine the therapeutic activity and safety of TMZ in combination with interferon-alpha (IFN-alpha). From June 2000 to July 2001, 41 patients were recruited to receive TMZ 200 mg/m orally on days 1-5 every 28 days and with 5 MU IFN-alpha subcutaneously three times a week, continuously for eight cycles or until disease progression occurred. Of the 40 treated patients, two complete responses (5%) and three partial responses (7.5%) were observed, with a median duration of 4 months (range, 1.5-13.5 months). Thirteen patients (32.5%) had stable disease for a median of 2.5 months. Time to progression was 2.6 months and the median overall survival was 11.8 months. Nine patients (22.5%) developed brain metastases. The grade 4 toxicity observed in seven patients was of a transient haematological nature. This combination therapy is well tolerated but does not appear to increase the response rate or overall survival with respect to TMZ alone or to chemotherapeutic regimens. Further and more complex associations of these two drugs could be investigated in specific subsets of patients, in particular to evaluate its real efficacy in preventing brain metastases.

From June 1990 to October 1994, 111 advanced ovarian cancer patients with minimal (less than 2 cm) residual disease after platinum-based front-line chemotherapy and second-look laparotomy entered a cooperative randomized study aimed at evaluating the effectiveness and the toxicity of the addition of interferon-α2 to carboplatin, both intraperitoneally (ip) administered. Patients were randomized to receive either 3 courses of ip Carboplatin 400 mg/m 2 Day 1 q 28 days (54 pts) (CBDCA) or ip interferon-α 25 × 10 6 U Day 1 + ip carboplatin 400 mg/m 2 Day 2 q 28 days (57 pts) (CBDCA + IFN). Patients treated with interferon experienced more severe (WHO grade 3–4) leukopenia (28% vs 17.1%) and anemia (14% vs 4.2%). Fever ( P = 0.000) and flu-like syndrome ( P = 0.02) were significantly more frequent in the combination arm. No difference in gastroenteric, neurologic, or renal toxicity was observed. At a median follow-up time of 13 months (range 1–72) 71 patients showed a disease progression (31 CBDCA, 40 CBDCA + IFN) and 44 patients died (21 CBDCA, 23 CBDCA + IFN). Median progression-free survival was 11 months in the CBDCA group and 10 months in the CBDCA + IFN arm. Median survival was 22 and 29 months in CBDCA and CBDCA + IFN arm, respectively. In conclusion, intraperitoneal interferon-α does not seem to improve the results achievable with intraperitoneal carboplatin in this subset of patients, while the toxicity and the costs of the combination are consistently higher than with chemotherapy alone.

In this paper the authors describe the architecture and the functionalities of the Transport Integrated Platform (TIP), an Intelligent Transport Systems (ITS) application on Dangerous Good Transport on road in Italy. The TIP represents a System of Systems (SoS) application because it aims to manage different kinds of sub systems (each module of the platform) and different kind of entities (electronical devices, DG vehicles, drivers). TIP manages the DG fleet planning routing and the real time vehicles' tours, the customer orders, and other support tools for drivers including training, resource management and advanced data mining. TIP application aims at promoting a safe management of DG freight transport providing timely information to truck drivers and fleet managers about weather, traffic, emergency or other critical situations on the road infrastructures.

Use and production of building materials, such as cement and concrete, is a major cause of global ecological problems with special reference to the overexploitation of non-renewable natural resources due to high temperature production processes, fossil fuels combustion, extraction of raw materials and non-recycling. In this paper, an environmental accounting method was applied to the production of cement and concrete in order to evaluate its dependence on natural resources even non-renewable and heavily relied on external inflows. The main steps of the production process (1) cement production, (2) transport of materials and (3) concrete mixing, were assessed by the emergy analysis (spelled with an “m”). This was performed to measure the amount of environmental resource use in terms of equivalent solar energy, extending the energy hierarchy principle to building materials. The resulting unit emergy values of cement and concrete were compared with previous emergy assessments in order to highlight how emergy analysis is sensitive to local context and reference system's boundaries. An Emergy Investment Ratio (EIR) was assessed and presented as a synthetic indicator of sustainability. Results showed a high dependence of cement and concrete production on external resource flows. Furthermore, the high value of EIR suggested a weak competitive capacity due to a high sensitivity to external instabilities.

In the last decade a great number of studies have been carried out on the possible use of biofuels in order to reduce greenhouse gas emissions. Among biofuels, biodiesel has gained considerable attention as the need to develop alternatives to traditional diesel fuel increases. The Italian parliament adopted directive 2003/30/CE from the European Parliament, in which the guidelines about future production and consumption of biofuels are reported: 1% and 2.5% of biofuels within 2005 and 2010 respectively. The aim of this work is to investigate the reduction in greenhouse gas emission obtained by using biodiesel in agricultural practises, and the role of renewable energy use at a local scale. Comparison between diesel and sunflower methyl ester was made from the point of view of an emission inventory, from production and combustion, by using different scientific tools, such as IPCC methodology and the Danish Life Cycle Assessment (LCA) EDIP Database. Results show that the use of sunflower methyl ester, other than the renewability of CO2 emitted, implies a general reduction of CO2 equivalent emissions of up to 57%.

This paper shows an application of the emergy analysis to the waste management system in the Province of Cagliari, Italy. It aims to consider the importance of waste management within a territorial system by assessing the environmental cost and gain due, directly and indirectly, to waste management processes. It also aims to investigate different steps of this process looking for potential critical points and available strategies for a sustainable waste management in its three phases of waste gathering, waste treatment and waste disposing. A landfill and an incinerator, located within the Province, are studied in order to consider their own environmental efficiency and their role in the waste management process. The emergy method (spelt with an “m”) is based on the assessment of all the inputs that supply the waste management system and its processes (emergy means energy memory). The expected outcomes are in the form of a comprehensive balance that shows the general behaviour of the system and its parts. Through the emergy synthesis, flows of energy and matter that are used within the process of waste management in the Province of Cagliari, are assessed by a common unit, namely the solar energy joule, and compared to each other. This is performed in order to evaluate how an integrated system including incinerator and dumps works in order to make choices and to achieve a sustainable waste management plan.

The SPIn-Eco project has provided very broad and precise data collection regarding the Province of Siena. These data and their elaborations have also been developed as a basis for the environmental certification of this organization. In this way, the Administration of the Province of Siena (the first Province in Italy) has reached its goal of obtaining better knowledge of the state of the system and of constructing its environmental management system (EMS) according to the environmental aspects directly and indirectly arising from the organization's activities. Indirect aspects are mainly related to the territorial monitoring and planning. Indicators based on the classical pressure–state–response approach, as well as more complex ones based on CO2 balance, emergy and ecological footprint analyses, have been used to assess the environmental performance of the EMS. This paper presents how this EMS is constructed, as well as the indicators that are used to analyze the system, paying particular attention to sustainability indicators.

The debate on different waste management practices has become an issue of utmost importance as human activities have overloaded the assimilative capacity of the biosphere. Recent Italian law on solid waste management recommends an increase in material recycling and energy recovery, and only foresees landfill disposal for inert materials and residues from recovery and recycling. A correct waste management policy should be based on the principles of sustainable development, according to which our refuse is not simply regarded as something to eliminate but rather as a potential resource. This requires the creation of an integrated waste management plan that makes full use of all available technologies. In this context, eMergy analysis is applied to evaluate three different forms of waste treatment and construct an approach capable of assessing the whole strategy of waste management. The evaluation included how much investment is needed for each type of waste management and how much "utility" is extracted from wastes, through the use of two indicators: Environmental yield ratio (EYR) and Net eMergy. Our results show that landfill is the worst system in terms of eMergy costs and eMergy benefits. Composting is the most efficient system in recovering eMergy (highest EYR) from municipal solid waste (MSW) while incineration is capable of saving the greatest quantity of eMergy per gram of MSW (highest net eMergy). This analysis has made it possible to assess the sustainability and the efficiency of individual options but could also be used to assess a greater environmental strategy for waste management, considering a system that might include landfills, incineration, composting, etc.

Purpose BMS-936558 is a monoclonal antibody that blocks the PD-1 co-inhibitory receptor expressed by activated T cells. This study describes its activity and safety in pts with previously treated advanced MEL. Methods BMS-936558 was administered IV q2wk to pts with various tumors at 0.1 - 10 mg/kg during dose-escalation and/or cohort expansion. Pts received up to 12 cycles (4 doses/cycle) of treatment or until unacceptable toxicity, confirmed progressive disease, or complete response. Clinical activity was assessed by RECIST v1.0. Results As of Feb 24, 2012, 104 MEL pts had received BMS-936558 at 0.1 (n = 17), 0.3 (n = 19), 1 (n = 31), 3 (n = 17), or 10 mg/kg (n = 20). ECOG performance status was 0/1/2 in 63/38/3 pts, respectively. Most pts (67/104) had received prior immunotherapy (IT); prior anti-CTLA-4, -PD-1, or -PD-L1 was not permitted. The number of prior therapies was 1 (39%), 2 (35%), or ≥3 (26%). Median therapy duration was 20 wks (range 2.0 - 121.7 wks). The incidence of grade 3 - 4 related AEs was 20% and included gastrointestinal (4%), endocrine (2%), and hepatobiliary disorders (1%). There were no drug-related deaths in MEL pts. Clinical activity (responses or prolonged stable disease) was observed at all doses (Table). Of the 26/94 (28%) evaluable responders, 19 (73%) are ongoing ranging from 1.9+ to 24.9+ months. For the 23 responders followed ≥6 months from first dose on study, 16 (70%) are progression free. ORs occurred in pts with visceral or bone metastases. Six pts (6%; 95% CI 2 - 13%) had prolonged SD (≥24 wk); 3 pts had a persistent decrease in target lesion tumor burden in the presence of new lesions and were not categorized as responders. Conclusions BMS-936558 had durable clinical benefit in pts with advanced MEL, including those who had received prior IT. Additional long-term follow-up data will be reported. Dose, (mg/kg) No. ptsa ORR, No. pts (%) [95% CI] PFSR at 24 wk (%) [95% CI] 0.1 14 4 (29) [8 - 58] 40 [13 - 66] 0.3 16 3 (19) [4 - 46] 31 [9 - 54] 1 27 8 (30) [14 - 50] 45 [26 - 65] 3 17 7 (41) [18 - 67] * 55 [30 - 80] 10 20 4 (20) [6 - 44] 30 [9 - 51] * 1 CR aResponse-evaluable pts dosed by 7/01/2011 ORR = objective response rate ([{CR + PR} ÷ n] × 100); PFSR = progression-free survival rate. Disclosure J. Sosman: Research Funding: Bristol-Myers Squibb (myself). M. Sznol: Consultant or Advisory Role: Bristol-Myers Squibb (myself, compensated). Research Funding: Bristol-Myers Squibb (myself, clinical trials funding). D.F. McDermott: Advisory Board Role: Bristol-Myers Squibb (myself). R. Carvajal: Research Funding: Bristol-Myers Squibb (myself). S.L. Topalian: Consultant or Advisory Role: Bristol-Myers Squibb (myself, immediate family member, uncompensated). Research Funding: Bristol-Myers Squibb (myself). J.M. Wigginton: Employment or Leadership Position: Bristol-Myers Squibb (myself, employment, compensated). Stock Ownership: Bristol-Myers Squibb (myself). G. Kollia: Employment or Leadership Role: Bristol-Myers Squibb (employment, myself, compensated). Stock Ownership: Bristol-Myers Squibb/BMY stocks (myself). A. Gupta: Employment or Leadership Role: Bristol-Myers Squibb (employment, myself, compensated). Stock Ownership: Bristol-Myers Squibb (myself). F.S. Hodi: Consultant or Advisory Role: Bristol-Myers Squibb (myself, uncompensated). Research Funding: Bristol-Myers Squibb (myself). All other authors have declared no conflicts of interest.

In this study, the authors report 18 patients with metastatic breast carcinoma affecting the skin, observed since 1988 in Forli, Italy. The results are compared with those already published in the literature.

Uveal melanomas have a significant predilection for metastasis to the liver: up to 50% of patients will develop metastases, the liver is the sole or dominant site in more than 80% of them. Microscopic complete (R0) surgical resection of liver metastases improves survival to 22 months in very high selected patients. Despite aggressive therapy, survival is poor, the 1-year survival rate is 10%. Prognostic factors from the primary include tumor diameter and thickness, anterior location, extraocular extension, epithelioid cell type, monosomy 3 and gene expression profile. Early identification of a high-risk group of patients might allow early detection of metastases, and increase R0 liver surgery. We began in October 2006 an intensive follow-up prospective study to detect early minimal lesions with liver MRI in asymptomatic high risk patients. High-risk was defined by thickness >8mm or diameter >15mm, or extrascleral extension, or monosomy 3. Primary objective was to increase R0 liver resection rate from 10 to 30% (a risk = 0.04 and b risk = 0.05); secondary objectives were overall survival, metastasisfree survival, predictive value of MRI and liver functional tests (LFT’s). After treatment of the primary, patients undergo liver MRI and serum samples/6 months, LFTs/3 months. MRI screening consists in T1, T2, T1 dynamic series with gadolinium injection and LFT’s in total bilirubin, ALAT/ASAT, Alkaline phosphatase, GGT, LDH. MRI suspect abnormalities lead to surgical procedure. Information document is sent to radiologists, MRI central review is conducted by Institut Curie radiologists. From Oct 2006 to March 2009, 85 patients were enrolled, median age 60 (32−83), sex ratio M39/F46. The median uveal tumor diameter was 19mm (11−26), median thickness 11.6mm (2.7−17), with retinal detachment in 65 patients, and extraocular spread in 7. Local primary treatment consisted in proton beam therapy in 9 patients, enucleation in 76. Secondary enucleation was performed in 5 cases (2 for local relapse). The histological cell type was epithelioid in 18 cases, fusiform in 17, mixed in 41. Monosomy 3 (FISH) was present in 41/58 analysed enucleations. With a median follow up of 15 months, the metastasis-free survival is 72%. 2 Patients underwent enucleation for local relapse. 24 patients developed metastasis, 2/11 operated patients had R0 liver surgery (18%). To date, 6 patients died (5 from metastasis, 1 myocardial infarction) and 17 patients are alive with metastasis. MRI and LFT’s screening analysis will be presented with an updated follow up in the 85 available patients.

The study that we present is part of the preparation work for the setup of the FOOT (FragmentatiOn Of Target) experiment whose main goal is the measurement of the double differential cross sections of fragments produced in nuclear interactions of particles with energies relevant for particle therapy. The present work is focused on the characterization of the gas-filled drift chamber detector composed of 36 sensitive cells, distributed over two perpendicular views. Each view consists of six consecutive and staggered layers with three cells per layer. We investigated the detector efficiency and we performed an external calibration of the space–time relations at the level of single cells. This information was then used to evaluate the drift chamber resolution. An external tracking system realized with microstrip silicon detectors was adopted to have a track measurement independent on the drift chamber. The characterization was performed with a proton beam at the energies of 228 and 80 MeV. The overall hit detection efficiency of the drift chamber has been found to be 0 . 929 ± 0 . 008 , independent on the proton beam energy. The spatial resolution in the central part of the cell is about 150 ± 10 μ m and 300 ± 10 μ m and the corresponding detector angular resolution has been measured to be 1 . 62 ± 0 . 16 mrad and 2 . 1 ± 0 . 4 mrad for the higher and lower beam energies, respectively. In addition, the best value on the intrinsic drift chamber resolution has been evaluated to be in the range 60 − 100 μ m. In the framework of the FOOT experiment, the drift chamber will be adopted in the pre-target region, and will be exploited to measure the projectile direction and position, as well as for the identification of pre-target fragmentation events.