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Purpose Comprehensive genomic profiling (CGP) detects several classes of genomic alterations across numerous genes simultaneously and can match more patients with genomically targeted therapies than conventional molecular profiling. The current study estimated the costs of anticancer drugs and overall survival (OS) for patients who were treated with matched and unmatched therapy. Methods Costs were estimated for patients with complete data (188 of 500 patients) from a prospective, nonrandomized study of patients with diverse refractory cancers who underwent CGP and were treated with matched or unmatched therapy. We assessed mean time to treatment failure (TTF) and mean observed OS. Patient-specific drug and administration costs were imputed for the first regimen after CGP on the basis of drug classes, unit costs, and time on treatment. Results Patients on matched (n = 122) versus unmatched (n = 66) therapy had longer mean TTF (+1.5 months) and observed OS (+2.4 months) and higher drug costs (+$38,065; all P < .01). Increased drug costs were largely attributable to the longer duration of therapy associated with extended TTF (66.3%) rather than higher monthly drug costs (33.7%). Incremental increases in TTF (+1.9 months v +1.2 months) and observed OS (+2.5 months v +2.1 months) between matched and unmatched therapies were larger for those who underwent CGP in earlier- versus later-line therapy. Incremental increases in drug costs between matched and unmatched therapies were lower for earlier- compared with later-line therapy (+$27,000 v +$43,000, respectively). Conclusion Matched therapy was associated with longer TTF, increased OS, and manageable incremental cost increases compared with unmatched therapy. Most of these increased costs were a result of the longer duration of therapy rather than higher monthly drug costs. The benefits of matching were numerically greater in earlier versus later lines of therapy, which is consistent with the value of early use of CGP.

PurposeThis study aims to empirically examine the most common appeals recommended for use in nation branding campaigns to attract and retain skilled professionals from abroad to enhance a country’s economic competitiveness. To assess this, the authors examine how the image and reputation of a country as a destination and location for talent compare to its actual performance in terms of attracting and retaining skilled professionals. This comparison provides useful insights into the aspects of a country’s reputation that matter most for attracting the talent it needs to enhance its competitiveness.Design/methodology/approachThis study uses a multivariate analysis to examine a sample of 122 countries using secondary data from the World Economic Forum, the World Bank, the UNDP and other non-governmental sources, such as the Martin Prosperity Institute at the University of Toronto. It then tests the results using a sample of 35 OECD countries to assess whether they apply to all types of countries equally.FindingsThe study finds that the two most important factors for ensuring that a country is maximizing its potential to attract skilled professionals are the availability of employment and the degree of ethnic and cultural diversity within the host country. The most important factor for ensuring that a country is maximizing its potential to retain talent, the study finds, is the availability of employment. This does not mean that other factors do not matter, but employment and diversity are crucial for attracting talent from abroad.Research limitations/implicationsThe study also tests the overall results of the study by using a smaller sample of 35 OECD countries. It finds that the availability of employment and high levels of GDP per capita (i.e. wealth) is important for attracting and retaining skilled professionals in more industrially developed countries.Originality/valueThis paper is one of the few empirical studies to examine nation branding to attract and retain talent from abroad to enhance national competitiveness. Its findings suggest that a multifaceted and holistic framework-based approach to nation branding to attract talent, such as that recommended by Silvanto and Ryan (2014), is less likely to work in the short term than an approach which primarily emphasizes employment and diversity.

The proposed transition to single-pilot operations (SPO) in commercial and military aircraft has motivated the development of advanced autonomy systems. However, a detailed analysis of the impact of advanced autonomy on pilot workload through various phases of flight and contingency scenarios has not been conducted. To this end, this paper presents the development of the Pilot-Autonomy Workload Simulation (PAWS), a discrete event simulation model that allows the investigation of pilot workload under a variety of advanced autonomy capabilities and scenarios. Initial utilization results from PAWS of nominal and off-nominal point-to-point missions demonstrate that the workload for a single pilot assisted by advanced autonomy varies considerably over different phases of flight and various contingencies. These results suggest that advanced autonomy to offset pilot workload is not needed for low-workload phases, but could be critical during periods of high workload.

It is difficult – but increasingly important – to build collaborative systems that can do a range of jobs in a range of ways in a range of conditions. Much of this difficulty stems from the broad scope of contextual and collaborative knowledge required to interact productively with humans amidst uncertainty and change. With respect to physical collaboration, human-robot interaction (HRI) studies have made progress on related problems by constraining uncertainty and dynamism, thus limiting the knowledge required. Our participation in an extreme context prevented us from adopting these approaches: The Defense Advanced Research Projects Agency (DARPA) Aircrew Labor In-Cockpit Automation System (ALIAS) program has a requirement that the prototype robotic copilot system it seeks to develop must be extensible in 30 days to function in a different, unspecified aircraft in a range of flight conditions and missions. To accommodate, we developed a knowledge management-inspired approach and system that allowed a variety of stakeholders to curate and rely on a dynamic body of flight-related knowledge. This had significant positive implications across design, test and use of the system, crucially enabling pilots to compose a robot- and human-legible plan for their interaction with the system using familiar conventions. Our contributions promise to accelerate quality development of extensible collaborative robotic systems for settings such as general medical assistance, disaster response and construction that require collaborative problem solving in highly uncertain, dynamic and variable conditions.

Purpose – The purpose of this paper is to empirically assess the importance for nations of key institutional, economic, and societal factors for attracting skilled professionals from abroad. It examines the existing literature on international talent mobility and empirically tests the validity of nation branding as a strategy for attracting internationally mobile skilled professionals. Design/methodology/approach – The authors use secondary data from the World Economic Forum, the United Nations Development Programme (UNDP) and the Martin Prosperity Institute to test six hypotheses concerning factors that attract internationally mobile skilled professionals to a foreign country to live and work. Findings – The study finds that conditions of employment, quality of life, good governance, and tolerance towards people of diverse backgrounds are key issues that need to be holistically emphasized in successful nation branding campaigns aimed at attracting highly skilled professionals from abroad. Originality/value – The authors use strong secondary data to reduce common method bias in the results which show that “macro” factors sway internationally mobile skilled professionals to favor some countries over others. The authors contribute to the literature on international talent flows by conceptualizing nation branding as a framework through which a variety of push and pull factors can be examined to entice and attract internationally mobile skilled professionals to a particular host-country. The findings will apply to several different types of skilled professionals including self-initiated expatriates, self-initiated corporate expatriates, and third country nationals and local foreign hires.

Aims: To assess the frequency of biopsies and molecular diagnostic testing (human DNA/RNA analysis), anti-cancer drug use (genomically-matched targeted therapy [GMTT], unmatched targeted therapy [UTT], endocrine therapy [ET], and chemotherapy [CT]), and medical service costs among adults with metastatic cancer. Methods: Adults diagnosed with metastatic breast, non-small cell lung (NSCLC), colorectal, head and neck, ovarian, and uterine cancer (2010Q1–2015Q1) were identified in the OptumHealth Care Solutions claims database and followed from first metastatic diagnosis for ≥1 month and until the end of data availability. Utilization was assessed for each cancer cohort (all and patients aged ≥65 years); per-patient-per-month (PPPM) medical service costs were assessed for all patients. Testing frequency estimates were applied to Surveillance, Epidemiology, and End Results Program data to estimate the number of untested patients (2010–2014). Results: Patients with metastatic cancer (n = 8,193; breast [n = 3,414], NSCLC [n = 2,231], colorectal [n = 1,611], head and neck [n = 511], ovarian [n = 275], and uterine [n = 151]) were 63 years old (mean), with 11.1–22.2 months of observation. Biopsy and molecular diagnostic testing frequencies ranged from 7% (uterine) to 73% (ovarian), and from 34% (head and neck) to 52% (breast), respectively. Few were treated with GMTT (breast, 11%; NSCLC, 9%; colorectal, 6%). Treatment with UTT ranged from 0.7% (uterine) to 21% (colorectal). Biopsy, diagnostic testing, and anti-cancer drug therapy were less frequent for those ≥65 years. Medical service costs (PPPM, mean) ranged from $6,618 (head and neck) to $9,940 (ovarian). The estimated number of untested new patients with metastatic cancer was 636,369 (all) and 341,397 (≥65). Limitations: In addition to the limitations of claims analyses, diagnostic testing frequency may be under-estimated if patients underwent testing prior to study inclusion. Conclusions: The low frequency of molecular diagnostic testing suggests there are opportunities to better inform management of patients with advanced cancer, particularly decisions to treat with GMTT.

Stakeholder management and politics have been described as key component of destination branding (Balakrishnan, 2009). This article investigates the impact of political influences on destination branding by examining a sample of 94 United Nations Educational, Scientific and Cultural Organization (UNESCO) World Heritage Sites (WHS) in 54 countries to determine whether democracy and political instability have a significant influence on the decisions of national tourism offices (NTOs) to promote their WHS as tourist destinations. It also examines the relative importance of political instability and democracy on the promotion of WHS by NTOs in comparison to other influences such as stewardship, economic development, and tourism. One of the key contributions of this article is that it applies a multivariate analysis to a field dominated by case study methodologies and suggests the potential complementarities between the two approaches. Democracy, it is hypothesized, facilitates the give and take inher...

This paper discusses the efforts made by Finnish producers to emphasise the country of origin of their products in order to convey an image of innovation, quality and prestige. Finland's efforts in this area are relatively recent, dating mainly from the early 1990s. Traditionally, a producer of resource-intensive commodities—especially wood and wood products—Finland found itself facing growing competition from producers in other countries, especially emerging nations that enjoyed substantial cost advantages over Finnish producers. In response, Finland drew upon its tradition of excellence in design as well as its long-standing policy of investing heavily in education and research. It began to produce more ‘value added’ products and complemented this change in strategy by a conscious effort to make ‘made in Finland’ synonymous with superior design, quality and innovation. To successfully differentiate their wares, Finnish producers not only made intrinsic improvements to their manufactured goods but also made their Finnish provenance an important and attractive extrinsic feature. Finnish companies have been especially successful at creating brands that have a strong Finnish flavour, conveying an image of Nordic life that is progressive, responsible and technologically advanced. In this context, branding is much more than placing a name or a logo on a product. What is important is not only how the customer views the physical product but also the broader notion of how the product was conceived and produced and the values and traditions that it is perceived to embody. This paper cites a number of examples of how Finnish producers and marketers use the country-of-origin effect to differentiate and market their products. The paper, however, is mainly conceptual rather than empirical. It examines a marketing effort—supported and encouraged by the state but carried out by individual firms—but does not seek to provide a systematic overview of the extent or impact of such efforts. These are issues for future research.

Drug-eluting stents have been a major advance in percutaneous coronary revascularization. Widespread use of these stents has been spurred by substantial reductions in restenosis rates when compared with bare metal stents. The use of drugeluting stents during ST-segment elevation myocardial infarction has been a common practice and is associated with lower revascularization rates in various studies. Unfortunately, significant concerns regarding the occurrence of late stent thrombosis with this technology persist. A clinical dilemma exists as to whether the benefits of reduced repeat revascularization with DES outweigh the harm caused by a possible increased occurrence of the infrequent but devastating complication of late stent thrombosis. This review with discuss the theoretical risks and benefits of DES for STEMI, the available data regarding their use, and the areas where future studies are needed.

This article explores the extent to which UNESCOs man and the biosphere (MAB) programme is being used by national tourist organisations (NTOs) to promote tourism and examines the impact of tourism on the central purpose of the MAB programme: developing sites of excellence where new and optimal practices to manage nature and human activities are tested and demonstrated. The article specifically examines how extensively the UNESCO biosphere designation is being used by NTO websites to encourage tourism and whether the biosphere reserves that are being promoted as tourist destinations and attractions are in countries that score favourably on the environmental performance index (EPI), a rating of countries on performance indicators covering environmental public health and ecosystem vitality. The study finds that, on average, countries that promote biosphere reserves as tourist destinations tend to have better environmental records than countries that do not. Further research, especially case studies, is needed to confirm these findings. This study also identifies major trends and issues concerning the use and management of UNESCO biosphere zones as tourist attractions.

Among patients with heart failure, neurohormonal blockade with angiotensin-converting enzyme inhibitors, β-adrenergic receptor blockers (BB), and aldosterone antagonists has been shown to improve mortality and hospitalization rates.1–4 Combination therapy with these drugs can reduce mortality more …

This paper examines and contrasts the human resource policies and practices of US multinational enterprises (MNEs) towards their overseas subsidiaries, taking Japan and Ireland as examples. It demonstrates how economic, social, cultural and other environmental factors mediate the relationship between parent and subsidiary. The analysis draws upon institutional theory and its key concept, isomorphism, to explain the interactions of parents and subsidiaries in different environments. The focus is on three specific HR areas: (a) training, (b) performance assessment and (c) recruitment. The paper examines the countervailing pressures towards corporate integration or local responsiveness encountered in these areas. An examination of these pressures provides valuable insights into the implementation of HR policies and, in doing so, illuminates the environmental constraints under which the MNE operates in different settings. Three sets of issues relating to HR policies and practices are specified and recommended...

Traditional one-variable-at-a-time method was and still is for some researchers, the general procedure to determine the optimal conditions for a chemical, biochemical or biological mechanism. According to this technique, a large number of experiments should be performed to obtain a high precision in effect assessment and also the interaction among the variables cannot be defined. To overcome the limitations of this labor-intensive, time-consuming and expensive technique, the statistical Design of Experiments (DoE) was proposed by. DoE is recently the preferred method for optimization owing to the use of pivotal principles of statistics, randomization and replication. It is a suitable method to analyze the alteration of all factors simultaneously according to a design matrix. Therefore, the effect of each variable and also the combined effect of two or more variables can be estimated with a minimum number of experiments. With the advent of modern computing this method has become a ubiquitous tool in most research labs. While this approach is a versatile method for optimisation, its application can sometimes be haphazard or inappropriate under some conditions. Today, a significant fraction of the submitted manuscripts are influenced by the DoE methodology and the progress in the use of these techniques in the history of biotechnology has been nothing but astonishing. Based on the SCOPUS database, over the last 10 years, the number of manuscripts with ‘Design of experiment’ as a keyword has tripled across the major life and physical science journals. Whilst a vast majority of these manuscripts are published in medical journals and are a standard requirement for drug efficacy testing, within the biotechnology and biochemistry journals there has been a steady increase in the number of manuscripts using DoE methodology. An ever-increasing number of manuscripts that use DoE as a means to demonstrate the optimisation of the production of microbial compounds are being published, with a vast majority reporting incremental changes to the existing literature. However, some of the most highly cited papers have used DoE approaches. DoE software can produce subsequent number of tables/figures and consequently improve the quantity of the paper. However, this technique is only half of the whole story. The novelty of the research, its contribution to the field of study and data collection is the other half. Rejection of a manuscript in a peer-reviewed journal is a not a pleasant experience for the authors. Scientists plan to submit their works to quality journals forgetting the severe acceptance criteria for the journal. Manuscripts depend as much on DoE software tools without any contribution to the scientific community are likely to be rejected at the initial editorial screening. Manuscripts, therefore, should more rely on high quality research that helps in understanding of the role of science and technology in solving the key scientific and societal difficulties for the benefit of mankind and environment.