Effect of COVID-19 on the freight forwarding industry in Egypt: An empirical study on agility Egypt

The freight forwarding industry is an important player in the maritime transport industry that facilitates shipping processes by providing various value-added services such as securing bookings, transporting cargo, and preparing shipping documents. However, due to COVID-19 outbreak, the freight forwarding industry faced many challenges like port congestion, container shortages, and blank sailings. Therefore, this study examines COVID-19 effect on the freight forwarding industry and the challenges that the freight forwarders faced especially in Egypt, which is a logistics hub due to its strategic location. The case provides researchers and practitioners with an overview of the challenges that affected both maritime transport and freight forwarding industries in Egypt and investigates the challenges that Agility Egypt encountered due to COVID-19 restrictive safety measures. Also, it presents the solutions undertaken to deal with those challenges. Data were collected through interviews with various operation managers, executives, and specialists in Agility Egypt for shipping and freight. © 2023 by IGI Global. All rights reserved.

[Prioritization of risk situations in neuro-urology: Guidelines based on the Delphi method from Association française d'urologie (AFU), Association francophone internationale des groupes d'animation de la paraplégie (AFIGAP), Groupe de neuro-urologie de langue française (GENULF), Société française de médecine physique et de réadaptation (SOFMER) and Société interdisciplinaire francophone d'urodynamique et de pelvi-périnéologie (SIFUD-PP)]. / Priorisation des situations à risque en neuro-urologie : recommandations par méthode Delphi de l'Association française d'urologie (AFU), l'Association francophone internationale des groupes d'animation de la paraplégie (AFIGAP), le Groupe de neuro-urologie de langue française (GENULF), la Société française de médecine physique et de réadaptation (SOFMER) et la Société interdisciplinaire francophone d'urodynamique et de pelvi-périnéologie (SIFUD-PP).

PURPOSE: During the COVID-19 pandemic, a care reorganization was mandatory, and affected patients in different areas, including management of neurogenic lower urinary tract dysfunction. This work aims to provide validated schedule concerning the assessment and management of patients in neuro-urology. METHODS: Based on a literature review and their own expertise, a steering committee composed of urologists and physical medicine and rehabilitation practitioners generated a comprehensive risk-situation list and built a risk scale. A panel of French-speaking experts in neuro-urology was asked to define the timing for each clinical situation and validated these new recommendations through a Delphi process approach. RESULTS: The 49 experts included in the rating group validated 163 propositions among the 206 initial items. The propositions were divided into four domains - diagnosis and assessment, treatment, follow-up, and complications - and two sub-domains - general (applicable for all neurological conditions) and condition-specific (varying according to the neurological condition (spinal cord injury, multiple sclerosis, brain injury, Parkinsonism, spinal dysraphism, lower motor neuron lesions)). CONCLUSIONS: This multidisciplinary collaborative work generates recommendations based on expert opinion, providing a validated timing for assessment and management of patients in neuro-urology which may help clinicians to reorganize their patients' list with a personalized medicine approach, in a context of health crisis or not.

Impact of auditor characteristics and Covid-19 Pandemic on KAMs reporting

Purpose - This paper aims to investigate how auditors characteristics affect key audit matters (KAMs) in the new audit report. It also provides an understanding of the effect of the COVID-19 pandemic on different audit reporting decisions and audit quality in specific industries. Design/methodology/approach - The paper uses a survey based on actual audit case studies extracted from the management letters of clients in an audit firm with international affiliation to test the proposed hypotheses. Kruslud Wallis and Mann Whitney tests are conducted to analyze variance in responses among different groups of auditors regarding their selection of audit report sections required for each audit matter. The Wilcoxon signed rank test analyses difference in the auditors' responses pre- and post-COVLD-19 implications. Findings - Most of the developed hypotheses were only partially accepted where industry specialization, professional qualifications of the auditors and the effects of COVID-19 had some effects on the ability of auditors to recognize and disclose KAMs. Auditor position is the most factor that significantly influenced the recognition of KAMs in the new audit report resulting in higher audit quality. This was specially the case with auditors specializing in manufacturing and financial institutions. Originality/value - The current research illustrates that during the pandemic, auditors were more effective in recognizing KAMs compared to other audit matters, thus enhancing users' confidence in both the audit and the financial reporting processes. The results are useful to regulators and auditors as they provide a better understanding of the factors that may impact communicating KAMs in the new audit report under COVID-19.

Oncology clinical trial disruption during the COVID-19 pandemic: a COVID-19 and cancer outcomes study.

BACKGROUND: COVID-19 disproportionately impacted patients with cancer as a result of direct infection, and delays in diagnosis and therapy. Oncological clinical trials are resource-intensive endeavors that could be particularly susceptible to disruption by the pandemic, but few studies have evaluated the impact of the pandemic on clinical trial conduct. PATIENTS AND METHODS: This prospective, multicenter study assesses the impact of the pandemic on therapeutic clinical trials at two large academic centers in the Northeastern United States between December 2019 and June 2021. The primary objective was to assess the enrollment on, accrual to, and activation of oncology therapeutic clinical trials during the pandemic using an institution-wide cohort of (i) new patient accruals to oncological trials, (ii) a manually curated cohort of patients with cancer, and (ii) a dataset of new trial activations. RESULTS: The institution-wide cohort included 4756 new patients enrolled to clinical trials from December 2019 to June 2021. A major decrease in the numbers of new patient accruals (-46%) was seen early in the pandemic, followed by a progressive recovery and return to higher-than-normal levels (+2.6%). A similar pattern (from -23.6% to +30.4%) was observed among 467 newly activated trials from June 2019 to June 2021. A more pronounced decline in new accruals was seen among academically sponsored trials (versus industry sponsored trials) (P < 0.05). In the manually curated cohort, which included 2361 patients with cancer, non-white patients tended to be more likely taken off trial in the early pandemic period (adjusted odds ratio: 2.60; 95% confidence interval 1.00-6.63), and substantial pandemic-related deviations were recorded. CONCLUSIONS: Substantial disruptions in clinical trial activities were observed early during the pandemic, with a gradual recovery during ensuing time periods, both from an enrollment and an activation standpoint. The observed decline was more prominent among academically sponsored trials, and racial disparities were seen among people taken off trial.

Disruption to care of patients with thoracic malignancies: A COVID-19 and cancer outcomes study

Introduction: Patients with thoracic malignancies are susceptible to severe outcomes from coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the disruption to care of patients with thoracic malignancies during the COVID-19 pandemic. Methods: The COVID-19 and Cancer Outcomes Study (CCOS) is a multicenter prospective cohort study comprised of adult patients with a current or past history of hematological malignancy or invasive solid tumor who had an outpatient medical oncology visit on the index week between March 2 and March 6, 2020 at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai in New York, NY (MSSM) or the Dana-Farber Cancer Institute in Boston, MA (DFCI). An electronic data capture platform was used to collect patient-, cancer-, and treatment-related variables during the three months prior to the index week (the baseline period) and the following three months (the pandemic period). Two-by-three contingency tables with Fisher's exact tests were computed. All tests were two-tailed and considered statistically significant for p<0.05. All analyses were done in the R statistical environment (v3.6.1). Results: The overall cohort included 2365 patients, of which 313 had thoracic malignancies, 1578 had other solid tumors, and 474 had hematological malignancies. At a median follow-up of 84 days (95% confidence interval, 82-84), 13 patients with thoracic malignancies (4.1%) had developed COVID-19 (vs. other solid: 63 [4.0%] and hematological: 52 [11.0%];p<0.001). When comparing data from the pandemic period to the baseline period, patients with thoracic malignancies had a decrease in the number of in-person outpatient visits (thoracic: 209 [66.8%] vs. other solid: 749 [47.5%] vs. hematological: 260 [54.9%];p<0.001) and an increase in the number of telehealth visits (thoracic: 126 [40.3%] vs. other solid: 465 [29.5%] vs. hematological: 168 [35.4%];p<0.001). During the pandemic period, 33 (10.5%) patients with thoracic malignancies experienced treatment delays due to the pandemic (vs. other solid: 127 [8.0%] and hematological: 79 [16.7%];p<0.001), and 26 (8.3%) patients with thoracic malignancies experienced delays in cancer imaging or diagnostic procedures (vs. other solid: 63 [4.0%] and hematological: 26 [5.5%];p=0.003). Discussion: In this prospective cohort study, patients with thoracic malignancies were not at increased risk of developing COVID-19 compared to patients with other cancers, but experienced significant cancer care disruption during the COVID-19 pandemic with a higher likelihood of decreased in-person visits and increased telehealth visits compared to patients with other malignancies. Focused efforts to ensure continuity of care for this vulnerable patient population are warranted.

SARS CoV-2 seroprevalence and diagnostic accuracy during a COVID-19 outbreak in a major penitentiary complex in Brazil, June to July 2020

Purpose: This study aims to estimate the overall SARS-CoV-2 seroprevalence and evaluate the accuracy of an antibody rapid test compared to a reference serological assay during a COVID-19 outbreak in a prison complex housing over 13,000 prisoners in Brasília. Design/methodology/approach: The authors obtained a randomized, stratified representative sample of each prison unit and conducted a repeated serosurvey among prisoners between June and July 2020, using a lateral-flow immunochromatographic assay (LFIA). Samples were also retested using a chemiluminescence enzyme immunoassay (CLIA) to compare SARS-CoV-2 seroprevalence and 21-days incidence, as well as to estimate the overall infection fatality rate (IFR) and determine the diagnostic accuracy of the LFIA test. Findings: This study identified 485 eligible individuals and enrolled 460 participants. Baseline and 21-days follow-up seroprevalence were estimated at 52.0% (95% CI 44.9–59.0) and 56.7% (95% CI 48.2–65.3) with LFIA;and 80.7% (95% CI 74.1–87.3) and 81.1% (95% CI 74.4–87.8) with CLIA, with an overall IFR of 0.02%. There were 78.2% (95% CI 66.7–89.7) symptomatic individuals among the positive cases. Sensitivity and specificity of LFIA were estimated at 43.4% and 83.3% for IgM;46.5% and 91.5% for IgG;and 59.1% and 77.3% for combined tests. Originality/value: The authors found high seroprevalence of anti-SARS-CoV-2 antibodies within the prison complex. The occurrence of asymptomatic infection highlights the importance of periodic mass testing in addition to case-finding of symptomatic individuals;however, the field performance of LFIA tests should be validated. This study recommends that vaccination strategies consider the inclusion of prisoners and prison staff in priority groups. © 2022, Emerald Publishing Limited.

QUALIFICAÇÃO DO PLASMA CONVALESCENTE SARS-CoV-2 EM DOADORES DE SANGUE

Introducao: A pandemia relacionada ao novo coronavirus (SARS-CoV-2), com sua alta morbi-mortalidade, tem impulsionado um movimento de busca de tratamentos seguros e eficazes. Dentro deste contexto, a utilizacao de imunizacao passiva tem ganhado importancia. O Plasma imune ou "convalescente" (PC), refere-se ao plasma que e coletado de individuos apos a resolucao da infeccao e desenvolvimento de anticorpos. Alem de ja ter sido utilizado nas epidemias de Ebola e H1N1, a administracao de PC para os pacientes enfermos por SARS-CoV-2, tem sido relatado em alguns estudos, com ocorrencia de melhora de parametros clinicos e laboratoriais. A nao padronizacao deste produto e o conhecimento incipiente sobre este agente, traz uma seria de obstaculos que devem ser suplantados. O recrutamento, a elegibilidade do doador e a pesquisa e quantificacao dos anticorpos, sao alguns deles. Nao se sabe ate o momento qual a concentracao de anticorpos necessarias no PC, para que possa ser minimamente efetivo. O Food and Drugs Administration (FDA), preconiza que seja realizada pesquisa de anticorpos contra SARS-CoV-2 e sugere utilizacao de doadores que tenham titulo de anticorpos neutralizantes acima de 1/80. A pesquisa de anticorpos neutralizantes e um teste de pouco acesso na praticas clinica. Estudos tem sido feitos para correlacionar resultados de Elisa e/ou Quimioluminescencia com a presenca e titulos de anticorpos neutralizantes. Neste estudo, descrevemos a experiencia utilizando o teste de pesquisa de anticorpos SARS-CoV-2 (Abbott) com leitura de densidade optica correlacionada com titulos acima de 1/80 de anticorpos neutralizantes. Objetivo: Realizar a qualificacao de doadores quanto a existencia e intensidade de anticorpo SARS-CoV-2 IgG em doadores de sangue, a fim de fornecer terapeutica potencialmente eficaz de PC para o tratamento da COVID-19. Materiais e metodos: Foram realizados 459 testes de titulacao SARS-CoV-2 IgG em doadores de sangue do grupo H.Hemo. Os doadores testados eram homens ou mulheres nuligestas, que atendiam aos criterios para doacao de sangue, com exame confirmatorio da SARS- CoV-2 e no minimo 30 dias de resolucao dos sinais e sintomas da doenca. As amostras foram coletadas em duas situacoes: coleta somente de exames para pesquisa e qualificacao do doador para posterior doacao de plasma convalescente por aferese, ou coleta de doacao de sangue total e amostras para titulacao do plasma fresco congelado. Resultados: Dos 459 testes realizados, 333 (73%) apresentaram resultados positivos para IgG. Destes, 222 (66%) foram considerados qualificados para doacao de plasma convalescente, pois apresentaram leitura de densidade optica maior ou igual a 3,5. Este numero representa somente 47% do total de exames realizados. Conclusao: O desenvolvimento da doenca COVID-19 isoladamente nao representa um criterio seguro para qualificacao de doadores de plasma convalescente, uma vez que foram identificados pacientes com titulos baixos e ate negativos de anticorpo no plasma de doadores em mais de 50% dos candidatos.Copyright © 2020

From sustainable development goals to sustainable cities: A social media analysis for policy-making decision

The United Nations (UN) adopted the seventeen “Sustainable Development Goals” (SDGs) in early September 2015. One of these goals is SDG 11, which refers to the sustainable cities and communities. In this context, local governments face the challenge of aligning with this objective. As a result, they are increasing outreach to their organizational boundaries to involve citizens in policy making and strategy development, continually listening to citizens’ voices. One of the methods citizens use to express themselves is social media. This paper will emphasize social media platforms and specially Twitter to explore the public discourse about cities in the context of SDG 11. We applied descriptive quantitative and qualitative analysis to analyze the tweets that include terms and hashtags referring to the SDG 11. The data analysis process is composed of three major procedures: 1-Engagement analysis, 2-Trends based analysis and 3-Data Insights. Our results show that: 1-the COVID’19 pandemic negatively impacted users engagement towards SDG 11, 2-new technologies such AI and IoT are gaining more importance to help cities reach SDG 11, and 3-the SDGs are related and one SDG can impact other SDGs. © 2021 by the author. Licensee MDPI, Basel, Switzerland.

Teaching During the COVID-19 Pandemic: The Experience of the Faculty of Medicine at the Technion-Israel Institute of Technology

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic forced drastic changes in all layers of life. Social distancing and lockdown drove the educational system to uncharted territories at an accelerated pace, leaving educators little time to adjust. OBJECTIVES: To describe changes in teaching during the first phase of the COVID-19 pandemic. METHODS: We described the steps implemented at the Technion-Israel Institute of Technology Faculty of Medicine during the initial 4 months of the COVID-19 pandemic to preserve teaching and the academic ecosystem. RESULTS: Several established methodologies, such as the flipped classroom and active learning, demonstrated effectiveness. In addition, we used creative methods to teach clinical medicine during the ban on bedside teaching and modified community engagement activities to meet COVID-19 induced community needs. CONCLUSIONS: The challenges and the lessons learned from teaching during the COVID-19 pandemic prompted us to adjust our teaching methods and curriculum using multiple online teaching methods and promoting self-learning. It also provided invaluable insights on our pedagogy and the teaching of medicine in the future with emphasis on students and faculty being part of the changes and adjustments in curriculum and teaching methods. However, personal interactions are essential to medical school education, as are laboratories, group simulations, and bedside teaching.

Shoulder and Trunk Posture Monitoring System Over Time for Seating Persons

The working remotely and online learning has known growth during the last year because of the COVID-19 pandemic spread worldwide. In fact, the remote workers and students remain sitting and slouching on their computers for long hours. Therefore, having a correct sitting posture over time is the greatest way to protect workers from the back pains according to the latest medical researches. In this paper, we present the architecture and design details of the proposed posture monitoring system. The aim of this study is to propose a tracking posture system with complete information about the back posture. The existing posture monitoring systems in literature are limited to trunk flexion monitoring. In this proposal we introduce the shoulder bent monitoring in addition to the trunk flexion monitoring in order to provide complete information about the back posture. The proposed posture monitoring system is a smart belt equipped by inertial sensors to detect the trunk flexion and a shoulder bent to monitor the posture over time. A Smartphone application is developed to notify the person in case of bad posture detection. The proposed system demonstrates encouraging results to monitor the posture over time of seating persons and improves their seating behavior by receiving a real time notification in case of bad posture detection. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

COVID- 19 outbreak: Does confinement have any impact on weight change perception?

Purpose: This study aimed to evaluate the relationship between factors related to COVID-19 confinement (i.e., fear of COVID-19, anxiety, anger, boredom, eating disorders, and duration of confinement) and weight perception in a sample of the Lebanese population. Methods: A cross-sectional web-based survey carried out at a one-time point between April 3 and 18, 2020, enrolled 407 participants. Due to the imposed lockdown, respondents self-reported their weight and height. One dichotomized question (positive/negative) assessed the perception of weight change (yes = change perception, and no = no change perception). The variation in BMI was calculated by subtracting the estimated weight during confinement from the estimated weight before. Results: No significant variation in BMI was detected before and during the confinement (p = 0.40), while a perceived weight change was found in 212 (52.1%) participants. The regression analysis showed that higher fear of COVID-19 score (ORa = 0.96) and higher self-reported weight change (ORa = 0.47) were associated with lower weight change perception. However, longer confinement duration (ORa = 1.07), higher anxiety (ORa = 1.05), and high eating concerns (ORa = 1.81) were associated with higher weight change perception. Conclusion: Our results revealed that both the fear of COVID-19 and self-reported weight change were negatively associated with weight change perception, while higher anxiety and a longer duration of confinement correlated with a higher weight change perception. Further studies are necessary to confirm our findings. © 2021

Disparities in cancer during the COVID-19 pandemic: COVID-19 and cancer outcomes study (CCOS)

Background: The COVID-19 pandemic has rapidly altered cancer care. However, the ways in which it has done so and the associated impact at the individual and societal levels remains poorly defined. Methods: CCOS is a multicenter prospective cohort study designed to define the impact of the pandemic on cancer care delivery and outcomes. The CCOS cohort comprised consecutive outpatients with cancer seen at two US cancer centers from March 2 to March 6, 2020 (index visit). Data was collected at baseline, retrospectively from the preceding 3 months, and prospectively at 3-month follow up. Per patient changes in numbers of visits were compared using Wilcoxon signed rank tests. Correlates of increases in telehealth visits and decreases in in-person visits were evaluated using multivariable logistic regression models. Adjusted Odds ratios [aOR] and 95% confidence intervals (CI) were reported. Results: Of 2365 included patients, 1219 (51.6%) had a decrease in in-person visit frequency during the pandemic period relative to the preceding 3 months. Conversely, 760 (32.2%) had an increased frequency of telehealth visits (decrease in in-person and increase in telehealth visits;both p<0.01). 128 (5.4%) patients developed COVID-19. Compared to White patients, Black and Hispanic patients were less likely to have telehealth visits, had no significant change in frequency of in-person visits, and were more likely to develop COVID-19 (Table). [Formula presented] Conclusions: Significant disruptions to routine cancer care were observed during the pandemic period relative to the prior 3 months. Racial and ethnic barriers to the adoption of telehealth, and related socioeconomic factors, place these vulnerable populations simultaneously at disproportionate risk for decreased cancer-related visits and COVID infection, thereby exacerbating existing racial and ethnic health disparities. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: D. Doroshow: Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Ipsen;Honoraria (self), Advisory/Consultancy: Boehringer Ingelheim;Honoraria (self), Advisory/Consultancy: Athenaeum Partners;Honoraria (self), Advisory/Consultancy: Boston Healthcare Associates. A.L. Schmidt: Travel/Accommodation/Expenses: Pfizer;Travel/Accommodation/Expenses: Astellas. Z. Bakouny: Non-remunerated activity/ies: Bristol Myers Squibb;Research grant/Funding (self): Genentech/ImCore. M.M. Awad: Advisory/Consultancy, Research grant/Funding (self): Bristol Myers Squibb;Advisory/Consultancy, Research grant/Funding (self): Lilly;Advisory/Consultancy, Research grant/Funding (self): AstraZeneca;Advisory/Consultancy, Research grant/Funding (self): Genentech;Advisory/Consultancy: Merck;Advisory/Consultancy: Achilles;Advisory/Consultancy: AbbVie. R. Haddad: Advisory/Consultancy, Research grant/Funding (self): Bristol Myers Squibb;Advisory/Consultancy, Research grant/Funding (self): Merck;Advisory/Consultancy, Research grant/Funding (self): Pfizer;Advisory/Consultancy, Research grant/Funding (self): Genentech;Advisory/Consultancy, Research grant/Funding (self): AstraZeneca;Advisory/Consultancy, Research grant/Funding (self): GlaxoSmithKline. M.D. Galsky: Shareholder/Stockholder/Stock options: Rappta Therapeutics;Honoraria (self): BioMotiv;Honoraria (self): Janssen;Honoraria (self): Dendreon;Honoraria (self): Merck;Honoraria (self): GlaxoSmithKline;Honoraria (self): Lilly;Honoraria (self): Astellas Pharma;Honoraria (self): Genentech;Honoraria (self): Bristol-Myers Squibb;Honoraria (self): Novartis;Honoraria (self): Pfizer;Honoraria (self): EMD Serono;Honoraria (self): AstraZeneca;Honoraria (self): Seattle Genetics;Honoraria (self): Incyte;Honoraria (self): Alleron Therapeutics;Honoraria (self): Dracen;Honoraria (self): Inovio Pharmaceuticals;Honoraria (self): NuMab;Honoraria (self): Dragonfly Therapeutics;Honoraria (institution): Janssen Oncology;Honoraria (institution): Dendreon;Honoraria (institution): Novartis;Honoraria (institu ion): Bristol-Myers Squibb;Honoraria (institution): Merck;Honoraria (institution): AstraZeneca;Honoraria (institution): Genentech/Roche. T.K. Choueiri: Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): AstraZeneca;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Alexion;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Bayer;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): BristolMyersSquibb;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Cerulean;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Eisai;Honoraria (self), Research grant/Funding (self): Foundation Medicine;Honoraria (self), Research grant/Funding (self): Exelixis;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Ipsen;Research grant/Funding (self): 16 Tracon;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Genentech;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Roche;Honoraria (self), Research grant/Funding (self): Roche Products Limited;Honoraria (self), Research grant/Funding (self): Hoffman-LaRoche;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): GlaxoSmithKline;Advisory/Consultancy, Research grant/Funding (self): Lilly;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Merck;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Novartis;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Peloton;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Pfizer;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Prometheus labs;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Corvus;Research grant/Funding (self): Calithera;Research grant/Funding (self): Analysis Group;Honoraria (self), Research grant/Funding (self): Sanofi/Aventis;Research grant/Funding (self): Takeda;Honoraria (self), Advisory/Consultancy: EMD Serono;Honoraria (self), Advisory/Consultancy: UpToDate;Honoraria (self): NCCN;Honoraria (self), Advisory/Consultancy, Dr. Choueiri reports research support from AstraZeneca, Alexion, Bayer, Bristol Myers Squibb/ER Squibb and sons LLC, Cerulean, Eisai, Foundation Medicine Inc., Exelixis, Ipsen, 16 Tracon, Genentech, Roche, Roche Products Limited, F. Hoffmann-La Roche, GlaxoSmithKline, Lilly, Merck, Novartis, Peloton, Pfizer, Prometheus Labs, Corvus, Calithera, Analysis Group, Sanofi/Aventis, Takeda;Honoraria: AstraZeneca, Alexion, Sanofi/Aventis, Bayer, Bristol Myers-Squibb/ER Squibb and sons LLC, Cerulean, Eisai, Foundation Medicine Inc., Exelixis, Genentech, Roche, Roche Products Limited, F. Hoffmann-La Roche, GlaxoSmithKline, Merck, Novartis, Peloton, Pfizer, EMD Serono, Prometheus Labs, Corvus, Ipsen, Up-to-Date, NCCN, Analysis Group, NCCN, Michael J. Hennessy (MJH) Associates, Inc (Healthcare Communications Company with several brands such as OnClive, PeerView and PER), Research to Practice, L-path, Kidney Cancer Journal, Clinical Care Options, Platform Q, Navinata Healthcare, Harborside Press, American Society of Me: Analysis Group. All other authors have declared no conflicts of interest.