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We live in a time of deep political and social divisions that permeate our everyday conversations, relationships, and life experiences. As such, it has become increasingly difficult to engage classroom conversations on seemingly open topics without labeling, assuming, or being pulled into positions that stymie openness, curiosity, and critical thinking. This book explores the use of globally informed, culturally rooted approaches to dialogue in the classroom. In this introductory chapter, we describe the genesis of this book;contextualize dialogue within the global impact of the COVID-19 pandemic;provide beginning descriptions of inclusion, intersectionality, and authenticity;distinguish dialogue from other practices;and discuss times in which dialogue may not be possible. Finally, we conclude with an overview of each chapter contribution in this book. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.
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This book explores globally-informed, culturally-rooted approaches to dialogue in the classroom. It seeks to fill gaps in communication and education literature related to decolonizing dialogue and breaking binaries by decentering Eurocentric perspectives and providing space for dialogic practices grounded in cultural wealth of students and teachers. We first describe the book's genesis, contextualize dialogue within the global impact of the COVID-19 pandemic, and share guiding concepts of inclusion, intersectionality, and authenticity in dialogue and pedagogy. We also distinguish dialogue from other practices and times in which dialogue may not be possible. The book brings fresh and urgent perspectives from authors across different disciplines, including ceramics, religious studies, cultural studies, communication, family therapy, and conflict resolution. The chapters distill the idea of dialogue within contexts like a bible circle, university sculpture studio, trauma and peacebuilding program, and connect dialogue to teaching, learning, and emerging ideas of power disruption, in-betweenness, and relationality. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.
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OBJECTIVES: This study aimed to evaluate whether the Families First Coronavirus Response Act (FFCRA) modified the association between pre-existing state paid sick leave (PSL) and weekday workplace mobility between February 15 and July 7, 2020. STUDY DESIGN: This was a longitudinal, observational study. METHODS: The 50 US states and Washington, D.C., were divided into exposure groups based on the presence or absence of pre-existing state PSL policies. Derived from Google COVID-19 Community Mobility Reports, the outcome was measured as the daily percent change in weekday workplace mobility. Mixed-effects, interrupted time series regression was performed to evaluate weekday workplace mobility after the implementation of the FFCRA on April 1, 2020. RESULTS: States with pre-existing PSL policies exhibited a greater drop in mobility following the passage of the FFCRA (ß = -8.86, 95% confidence interval: -11.6, -6.10, P < 001). This remained significant after adjusting for state-level health, economic, and sociodemographic indicators (ß = -3.13, 95% confidence interval: -5.92, -0.34; P = .039). CONCLUSIONS: Pre-existing PSL policies were associated with a significant decline in weekday workplace mobility after the FFCRA, which may have influenced local health outcomes. The presence of pre-existing state policies may differentially influence the impact of federal legislation enacted during emergencies.
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COVID-19 , Humans , COVID-19/epidemiology , Sick Leave , Pandemics , Workplace , Public PolicyABSTRACT
Molnupiravir, a broad-spectrum antiviral is an isopropyl ester prodrug of beta-D-N4-hydroxycytidine. Molnupiravir targets RNA-dependent RNA-polymerase enzyme of the viruses. A new stability-indicating HPLC-method was developed to determine related substances and assay of molnupiravir. Separation was achieved by using Shim-pack GWS C18 column. The method was validated according to current ICH requirements. The calibration plot gave a linear relationship for all known analytes over the concentration range from LOQ to 200%. LOD and LOQ for all known analytes were found in 0.05-0.08 microg mL-1 and 0.12-0.20 microg mL-1, respectively, the mean recovery was found to be 97.79-102.44 %. Study showed that the method, results of robustness, solution stability studies are precise and within the acceptable limits. Molnupiravir was found to degrade in acid, alkali, and oxidative conditions, and was stable in thermal, moisture, and photolytic degradation condition. The method is simple, accurate, precise, and reproducible for routine purity analysis of drug-samples.Copyright © 2022 Indian Drug Manufacturers' Association. All rights reserved.
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This study explores how the transition to online course delivery during the pandemic impacted a professional skills course that incorporates in-class and out of class experiential learning activities. We compare student performance on a resume writing assignment, a LinkedIn profile creation assignment, a mock interview with members of local businesses, and overall class scores during Fall 2019 when the professional skills course was delivered face-to-face with student performance during Fall 2020 when the course was delivered online. We explore whether the effect of delivery mode varied as a function of student sex, race and first-generation college status. Our results indicate students performed better on the resume and LinkedIn assignments when the course was delivered online than when it was offered face-to-face, and there was no difference in mock interview or overall class performance. Despite concerns that women, racial minorities and first-generation students could suffer disproportionately in the online version of the course, the relationship between class delivery mode and student performance did not vary as a function of these student characteristics. This is encouraging for institutions interested in offering these courses, and underscores the importance of future research that expands our understanding of when different delivery modes are appropriate. © 2023
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Indian traditional system of medicine has a definite role in the treatment of Covid-19. This case report presents the outcome of Ayurvedic interventions along with modern medicines in a severe covid-19 infected patient with breathlessness. A patient with a history of cough, breathing difficulty and generalized weakness tested positive for the rapid antigen test and prescribed the standard treatment of care with 14 days of strict home quarantine. During follow-up, there was no clinical improvement and oxygen saturation was fluctuating and required oxygen support. Therefore, the patient sought ayurvedic intervention at the covid-19 healthcare center with supportive oxygen therapy. The patient was managed with ayurvedic intervention along with modern medicines. On the date of admission to the covid-19 care center, the patient's SpO2 72% on room air, HRCT 80-90%, and ESR, CRP, and LDH were 40(mm/hour), 11.47(mg/L), and 306(Units/L) respectively. By adhering to the integrated therapy patient's oxygen saturation and clinical profile were improved with time. On the 11th day of treatment patient, SpO2 was sustained at 95% and HRCT report was 70-80%, and clinical profile improved remarkably. The patient's HRCT after one month was50-60% compared to the previous report suggestive of remarkable improvement. The effect on inflammatory markers and oxygen saturation suggests that integration of modern medicines along with ayurvedic medicine in the patient was significant and deserves further studies. Integrating ayurvedic treatment along with modern medicine might be considered as an effective approach in the management of severe covid-19 patients. Copyright © RJPT All right reserved.
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Background: The SARS-CoV2 pandemic increased the complexity of delivering clinical care and laboratory services for immunosuppressed kidney transplant (KTx) recipients. We evaluated how the pandemic impacted adherence with laboratory draws among patients in the Kidney allograft Outcomes AlloSure Registry (KOAR,NCT03326076). Method(s): 1663 KTx recipients undergoing post-transplant surveillance using donorderived cell-free DNA (dd-cfDNA) were enrolled in KOAR between 2017 and 2021. Participating centers were free to individualize their surveillance strategies. We estimated adherence by using the pre-pandemic distribution of surveillance dd-cfDNA draws across participating sites to establish a baseline regimen, and then compared adherence before the pandemic (P1;through 1/2020) with two subsequent periods in 2020: P2 (2/2020 - 6/2020), coinciding with the first wave of infections, and P3(7/2020 - 12/2020), which captures the bulk of the second and third waves in the US. Result(s): The distribution of surveillance dd-cfDNA draws at participating sites before COVID (P1) identified 7 peaks corresponding to draw points at months 1, 2, 3, 4, 6, 9, and 12 [Figure 1a]. Estimated adherence during P1 based on this regimen was 60.5%. Over the subsequent 5 months (P2), reflecting the early months of the pandemic, adherence declined to 50.5% (p < 0.01). After the expanded availability of mobile phlebotomy services in 7/2020 and despite rising SARS-CoV2 case counts and hospitalizations, adherence during P3 improved to 57.6% (p < 0.01 compared to P2, p = 0.1 compared to P1) [Figure 1b]. Conclusion(s): Our findings demonstrate that adherence to laboratory surveillance among transplant recipients enrolled in the KOAR registry declined in theearly period of the SARS-CoV2 pandemic, however, a variety of adaptations in the latter half of 2020, including the widespread availability of remote phlebotomy for these patients, appears to have led to substantial improvements, with adherence approaching pre-pandemic levels. (Figure Presented).
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Purpose: COVID-19 infection in kidney transplant (KT) recipients is characterized by an unpredictable course and can be life-threatening. Prompt adjustment of immunosuppression and hospitalization when decompensated are potential strategies to increase survival. Our objective is to determine if advanced practice nurse (APN)-driven COVID-19 monitoring would result in better health outcomes for KT recipients. Method(s): We performed a retrospective study on KT patients diagnosed with COVID-19 between 4/1/2020 and 11/30/2021. The patients were stratified into two groups: (1) a control group who initially presented to the emergency department (ED) with COVID-19 symptoms, (2) an intervention group where patients were diagnosed with COVID-19 outside of the ED and followed by the APN team. The APNs monitored this group daily via telephone and/or video call for symptom assessment, immunosuppression adjustment, health counseling, and emotional support. If the patients were distressed, the APNs arranged admission to the nearest hospital or transplant center. Data were analyzed using Pearson Chi-squared for comparisons and linear or logistic regression modeling with adjustment for age, ethnicity, diabetes, and obesity Results: In our cohort, there were 102 KT patients that were infected with the SARS-CoV-2 virus. The majority were Hispanic ethnicity and male gender who presented with fever and flu like symptoms. Fourty-four patients required oxygen therapy. Immunosuppression was adjusted earlier in the intervention group . When the APNs recommended hospitalization, those patients experienced less acute kidney injury (AKI), shorter duration of illness, lower readmission rates, and greater survival than the control group. Conclusion(s): In this single transplant center study, KT recipients diagnosed with COVID-19 had better clinical outcomes when intervention occurred in a timely manner by the APN team. Possible explanations include earlier withdrawal of antimetabolites, prompt triage for hospitalization, and enforcing of nursing practices (dietary educations, blood pressure/glucose management, emotional support). Interpretation and generalization of these findings should be cautious due to a small sample size. As more treatment options for COVID-19 emerge, earlier interventions and close monitoring as demonstrated in our APN-driven model has the potential to achieve better health outcomes.
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Purpose: The SARS-CoV2 pandemic increased the complexity of delivering routine clinical care and laboratory services for immunosuppressed kidney transplant (KTx) recipients. We evaluated how the pandemic impacted adherence with scheduled laboratory draws among patients enrolled in the Kidney allograft Outcomes AlloSure Registry (KOAR, NCT03326076). Method(s): 1663 kidney transplant (KTx) recipients undergoing post-transplant surveillance using donor-derived cell-free DNA (dd-cfDNA, AlloSure, CareDx Inc.) were enrolled in KOAR between 2017 and 2021. Participating centers were free to individualize their surveillance strategies. We estimated adherence by using the pre-pandemic distribution of surveillance dd-cfDNA draws across participating sites to establish a baseline regimen, and then compared adherence before the pandemic (P1;through 1/2020) with two subsequent periods in 2020: P2 (2/2020 - 6/2020), coinciding with the first wave of infections, and P3 (7/2020 - 12/2020), which captures the bulk of the second and third waves in the US. Result(s): The distribution of surveillance dd-cfDNA draws at participating sites before COVID (P1) identified 7 peaks corresponding to draw points at or around months 1, 2, 3, 4, 6, 9, and 12 [Figure 1a]. Estimated adherence during P1 based on this regimen was 60.5%. Over the subsequent 5 months (P2), reflecting the early months of the pandemic, adherence declined to 50.5% (p < 0.01). After the expanded availability of mobile phlebotomy services in 7/2020 and despite rising SARS-CoV2 case counts and hospitalizations, adherence during P3 improved to 57.6% (p < 0.01 compared to P2, p = 0.1 compared to P1) [Figure 1b]. Conclusion(s): Our findings demonstrate that adherence to laboratory surveillance among transplant recipients enrolled in the KOAR registry declined in the early period of the SARS-CoV2 pandemic, however, a variety of adaptations in the latter half of 2020, including the widespread availability of remote phlebotomy for these patients, appears to have led to substantial improvements, with adherence approaching pre-pandemic levels.
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Objective: This paper details a quality improvement project (QIP) spanning a period of 18 months (February 2020 -August 2021), during which we optimized the care delivery system in order to safeguard early pregnancy and emergency gynaecology services during the pandemic. In response to the Covid-19 pandemic, the Royal Wolverhampton Trust (New Cross hospital) in line with government guidance for infection control, relocated early pregnancy and emergency gynaecology wards to distant “non-gynae” areas of the hospital. This was challenging for junior doctors;patient care was compromised as they were seen in new wards where the nursing staff lacked the requisite training to care for them. The new locations lacked items required for clinical reviews;causing prolonged hospital stay and some increase in admissions. This QIP, highlights innovative and cost-effective measures to safeguard quality of care our patients received regardless of the location within the trust. Design: Process mapping exercise was performed to ascertain the issues, team discussions were held, human systems and human factors analysed to come up with an action plan. The action plan involved;specific teaching to members of staff who lacked the skill to care for these patients in the remote areas. We procured trolleys stocked with gynae items and consumables, a gynae bag-pack containing these items was assembled for junior doctors to take along for patient reviews. Methods: Teaching was done by Gynae consultants for staff, procurement processes were followed through to acquire trolleys for items and resources. Necessary adjustments in stages were made to determine the list of items and contents of the Gynae bag-pack. A survey was carried out to assess extent of improvement in the system, we sought support from our trust's continuing quality improvement (CQI) team who help with patient attendance data analysis. Results: Our survey showed 98% Junior doctors were satisfied with ease of access to resources at all remote locations, and felt more confident when carrying the gynae bag pack. The nurse managers and representatives gave feedbacks that they feel more confident in caring for gynae patients after the training they received. Patients received same day emergency care (SDEC) and discharged home, with associated drop in admissions from 48% to 20%. Conclusion This project was successful in utilizing systems optimization approach to safeguarding the quality of care our patients received and also ensured that health care staff safely discharged their duties in a difficult time. The improvement chain is ongoing.
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Background. The COVID-19 pandemic has brought vaccination to the forefront of discourse on public health. The rapid speed of COVID-19 vaccine development, utilization of novel technology, and an atmosphere of politicized misinformation have created a perfect storm for vaccine hesitancy. As early adopters of vaccination, HCWs set an example for the general population;as trusted sources of medical information, they educate and inform. However, comparatively little work has investigated HCWs' attitudes toward vaccination and how those attitudes drive their recommendation behavior. Methods. We surveyed hospital employees about their personal reasons for hesitancy and beliefs about patient hesitancies and randomly assigned them to see one of three messages aimed at increasing vaccine confidence. Message themes included an appeal to return to normal life (Normalcy), a risk comparison between vaccinating or not (SDT), and an explanation of the speed of safe and effective vaccine development (Process). Results. Of the 674 NC hospital employees who completed our survey in February 2021, 98% had been offered the COVID-19 vaccine, and 80% had already accepted. For the 20% who had not received the vaccine, the top reasons for hesitancy involved the speed of development and testing, and concerns of vaccine safety and effectiveness. We also found differences in susceptibility to misinformation and vaccine hesitancy across political affiliation, which was higher in Republicans compared to Democrats. HCWs were generally very comfortable recommending the COVID-19 vaccine to patients and supported the idea of sharing the message they read. Although the risk comparison message was most trusted personally, the process message was rated as both the most helpful to patients and the most likely to be shared with them (see Figure 1). This suggests that what is most appealing on a personal level is not necessarily what a HCW would recommend to their patients. Rating of personal opinions of the passages. On a scale from 1 to 7 with 1 = Strongly Disagree and 7 = Strongly Agree. This chart shows the average message ratings across the board when answering whether they thought the passages were understandable, helpful, correct, believable, and trustworthy. (Error bars are 95% CI) There was no significant difference across the messages. The Process message is seen as most helpful and is most likely to be shared with patient than the other messages On left, the average answer on a scale from 1 to 5 for "Do you think the passage you just read would help your patients feel more comfortable about getting the vaccine?" and on right, the average answer for "Would you share this passage with your patients?" Conclusion. HCWs' high uptake and minimal hesitancy in recommending the COVID-19 vaccine is encouraging and merits further exploration for how to increase confidence in HCW who are hesitant to discuss and recommend vaccines to patients, as several highlighted the importance of respecting patient autonomy.
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Background: As the coronavirus disease 2019 (COVID-19) pandemic continues, the selection of genomic variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated with higher transmission, more severe disease, re-infection, and immune escape are a cause for concern. Such variants have been reported from the UK (B.1.1.7), South Africa (B.1.351) and, Brazil (P.1/B.1.1.28). We performed this study to track the importation, spread, and emergence of variants locally.
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The South China Sea (SCS) has emerged as a theatre of political, economic, and security concerns not only for the countries in the region but also for the world at large. Contrary to conventional wisdom, the SCS issue is not about contestation over territory or control over resources alone. With military facilities including airstrips and artificial islands or structures being built in the area, concerns about freedom of navigation and the right to innocent passage have also become an overwhelming security issue and made the SCS region a flashpoint which, according to many assessments, can lead to confrontations including those involving conventional military means. Disruption of maritime passage could also hamper trade and commerce with very negative impacts on the economic development of the region and other countries. It is now being held that China could also be using the SCS disputes as part of a consorted effort to deflect geo-political pressures on account of the COVID-19 pandemic-related cover-ups and misinformation. This book explores the historical and strategic context of the South China Sea disputes and makes an assessment of the implications of the same for freedom of navigation and other regimes at sea. © 2022 by World Scientific Publishing Europe Ltd. All rights reserved.
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Object detection has application in numerous sectors. It is very crucial in the areas of security and surveillance. The Personal Protective Equipment (PPE) object detection Software can be used to detect people wearing masks in public places. In this paper we used the MobileNet SSD, a TensorFlow model, and Yolo v5, a Pytorch framework, to achieve PPE object identification. Many studies in the Object Detection domain focus only on accuracy. In our study we have also focused on the deployability of the model. We have obtained the 'COVID-19 Personal Protective Equipment (PPE) Detection Dataset' from Kaggle. Furthermore, we have used performance metrics such as mAP, Loss Function and Learning Rate and a comparison between TensorFlow Object Detection API and Yolo v5. These metrics would give us a deeper insight into the models. The classification loss for the Yolo v5 model is significantly lower than that of a TensorFlow model, as can be seen from the observed data. The minimum classification for the Yolo v5 model is 3.719e-3 at 500 epochs, whereas the lowest classification for TensorFlow is 0.0881 at 20250 steps. This indicates that the Yolo v5 model is more effective at categorising data. © 2021 IEEE.
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Research Objective: During the COVID-19 pandemic, novel infrastructure is needed to 1) assess disparities in care delivery 2) address these needs through rapid dissemination of rapidly-evolving, evidenced-based information 3) connecting people to resources and 4) advocating for policy change. Study Design: An interdisciplinary coalition of health care professionals on social media created the organization IMPACT. IMPACT (www.impact4hc.com) leverages social media and novel non-profit/for-profit partnerships to 1) identify and amplify public health needs and disparities in care delivery 2) address needs and gaps by rapidly disseminating evidence-based information, 3) connecting groups to resources, and 4) advocating for science-based policy. IMPACT and Oak Street Health (OSH) [a value based primary care system for low income seniors and medicare enrollees] identified a critical gap in Phase 1a vaccinations in Illinois: limited access to COVID-19 vaccination for health care workers not affiliated with health systems. IMPACT worked with OSH to 1) identify the gap 2) leverage the partnership to vaccinate 3) amplify the messaging to disseminate resources for vaccine sign ups and 4) approach city leadership for policy change. Population Studied: A case study of healthcare workers in Illinois awaiting vaccination in 01/2021. Principal Findings: Disparities in vaccination needs were rapidly identified through multiple sources (twitter, Chicago facebook groups for healthcare workers, emails and messages to IMPACT) for health care workers (HCWs1a) not affiliated with health systems. An IMPACT clearinghouse for vaccine information (registration, interest surveys) was created procuring information rapidly through social media and professional networks. Given high levels of interest (1342 views/10 days, avg 127/daily), IMPACT-OSH partnered to highlight need (twitter, facebook, policy statement), while OSH created a vaccination clinic with web-based vaccine registration for non-system affiliated HCWs. Targeted posts on facebook (2 closed HCW groups [2.2 K members/each], 1 closed general group [15.1 K]) were used to disseminate clearinghouse and OSH vaccine clinic information. Facebook posts alone reached 1650 HCWs, general member group posts reached >3.2 K in 7 days. In the first 7 days of the campaign, 5800 HCWs signed up for the OSH vaccine clinic, with >1800 vaccinated. In the first 48 hours of the social media campaign (over weekend) approx. 2000 HCWs signed up. Of a subgroup of OSH vaccinated HCWs (N = 1500), 50% reported receiving information through social media or web-based link. In response to these concerns, the local health departments encouraged all health care entities to vaccinate non-system affiliated HCWs, and the work was highlighted in the mayor's weekly press conference. Conclusions: By leveraging novel methods of communication and dissemination (social media, partnerships), IMPACT and Oak Street Health were able to assess and address the gap in care delivery of vaccinations to HCWs in a rapid time frame. Implications for Policy or Practice: Novel partnerships and utilization of social media made it possible to identify and then rapidly address a critical gap in HCW vaccination in the short term while laying groundwork for longer-term policy solutions. These findings have future implications for further vaccine rollout.
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Background: SARS-CoV-2 is associated with diverse clinical presentations ranging from asymptomatic infection to lethal complications. Small studies have suggested inferior outcomes in patients (pts) on active cancer treatment. This finding was not independently validated in our prior report on 928 pts, which included treatments administered within 4 weeks of COVID-19 diagnosis. Here, we examine outcomes related to systemic cancer treatment within one year of lab-confirmed SARS-CoV-2 infection in an expanded cohort. Method(s): The COVID-19 and Cancer Consortium (CCC19) registry (NCT04354701) was queried for pts ever receiving systemic treatment. Treatment type, cancer type, stage, and COVID-19 outcomes were examined. Pts were stratified by time from last treatment administration: <2 wk, 2-4 wk, 1-3 mo, or 3-12 mo. Standardized incidence ratios (SIR) of mortality by treatment type and timing were calculated. Result(s): As of 31 July 2020, we analyzed 3920 pts;42% received systemic anti-cancer treatment within 12 mo (Table). 159 distinct medications were administered. The highest rate of COVID-19-associated complications were observed in pts treated within 1-3 months prior to COVID-19;all-cause mortality in this group was 26%. 30-day mortality by most recent treatment type was 20% for chemotherapy, 18% for immunotherapy, 17% for chemoradiotherapy, 29% for chemoimmunotherapy, 20% for targeted therapy, and 11% for endocrine therapy. SIR of mortality was highest for chemoimmunotherapy or chemotherapy <2 wks, and lowest for endocrine treatments. A high SIR was also found for targeted agents within 3-12 mo. Pts untreated in the year prior to COVID-19 diagnosis had a mortality of 14%. [Formula presented] Conclusion(s): 30-day mortality was highest amongst cancer pts treated 1-3 months prior to COVID-19 diagnosis and those treated with chemoimmunotherapy. Except for endocrine therapy, mortality for subgroups was numerically higher than in pts untreated within a year prior to COVID-19 diagnosis. Clinical trial identification: NCT04354701. Legal entity responsible for the study: The COVID-19 and Cancer Consortium (CCC19). Funding(s): National Cancer Institute (P30 CA068485). Disclosure: T.M. Wise-Draper: Research grant/Funding (self), Travel/Accommodation/Expenses: AstraZeneca;Research grant/Funding (self): BMS;Research grant/Funding (self): Tesaro/GSK;Advisory/Consultancy: Shattuck Labs;Leadership role, Travel/Accommodation/Expenses, HNC POA Lead: Caris Life Sciences;Research grant/Funding (self), Travel/Accommodation/Expenses: Merck;Travel/Accommodation/Expenses: Eli Lilly;Travel/Accommodation/Expenses: Bexion. A. Elkrief: Research grant/Funding (self): AstraZeneca. B.I. Rini: Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: Merck;Advisory/Consultancy, Research grant/Funding (self): Roche;Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: Pfizer;Advisory/Consultancy, Research grant/Funding (self): AVEO;Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: BMS;Advisory/Consultancy: arravive;Advisory/Consultancy: 3D medicines;Advisory/Consultancy: Synthorx;Advisory/Consultancy: Surface Oncology;Shareholder/Stockholder/Stock options: PTC Therapeutics;Research grant/Funding (self): AstraZeneca. D.B. Johnson: Advisory/Consultancy: Array Biopharma;Advisory/Consultancy, Research grant/Funding (self): BMS;Advisory/Consultancy: Janssen;Advisory/Consultancy: Merck;Advisory/Consultancy: Novartis;Research grant/Funding (self): Incyte;Leadership role: ASCO melanoma scientific committee chair;Leadership role: NCCN Melanoma committee. G. Lopes: Honoraria (self), Travel/Accommodation/Expenses: Boehringer Ingelheim;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer;Advisory/Consultancy, Research grant/Funding (self), Research grant/Funding (institution): AstraZeneca;Research grant/Funding (institution): Merck;Research grant/Funding (institution): EMD Serono;Research gr