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Renegociación de Concesiones en Chile

Este trabajo describe en forma sistemática los montos renegociados en las 50 concesiones cuyos datos han sido publicados por el MOP en su página web. Su principal conclusión es que las renegociaciones son frecuentes y que involucran montos considerables. En promedio, cada concesión ha sido renegociada tres veces, resultando en transferencias a los concesionarios de UF 70,3 millones (unos 2.810 millones de dólares). El presupuesto original de las obras concesionadas era de UF 211,6 millones (unos 8.460 millones de dólares), pero si se consideran los montos adicionales que las empresas recibieron sin mediar un proceso competitivo, el total invertido aumenta en 33%. La ausencia de salvaguardias que aseguren que el interés público está siendo protegido, señalan los autores, hace imperativa una reforma a la Ley de Concesiones que establezca un ente independiente que supervise las renegociacione

An eHealth App (CAPABLE) Providing Symptom Monitoring, Well-Being Interventions, and Educational Material for Patients With Melanoma Treated With Immune Checkpoint Inhibitors: Protocol for an Exploratory Intervention Trial

BackgroundSince treatment with immune checkpoint inhibitors (ICIs) is becoming standard therapy for patients with high-risk and advanced melanoma, an increasing number of patients experience treatment-related adverse events such as fatigue. Until now, studies have demonstrated the benefits of using eHealth tools to provide either symptom monitoring or interventions to reduce treatment-related symptoms such as fatigue. However, an eHealth tool that facilitates the combination of both symptom monitoring and symptom management in patients with melanoma treated with ICIs is still needed. ObjectiveIn this pilot study, we will explore the use of the CAPABLE (Cancer Patients Better Life Experience) app in providing symptom monitoring, education, and well-being interventions on health-related quality of life (HRQoL) outcomes such as fatigue and physical functioning, as well as patients’ acceptance and usability of using CAPABLE. MethodsThis prospective, exploratory pilot study will examine changes in fatigue over time in 36 patients with stage III or IV melanoma during treatment with ICI using CAPABLE (a smartphone app and multisensory smartwatch). This cohort will be compared to a prospectively collected cohort of patients with melanoma treated with standard ICI therapy. CAPABLE will be used for a minimum of 3 and a maximum of 6 months. The primary endpoint in this study is the change in fatigue between baseline and 3 and 6 months after the start of treatment. Secondary end points include HRQoL outcomes, usability, and feasibility parameters. ResultsStudy inclusion started in April 2023 and is currently ongoing. ConclusionsThis pilot study will explore the effect, usability, and feasibility of CAPABLE in patients with melanoma during treatment with ICI. Adding the CAPABLE system to active treatment is hypothesized to decrease fatigue in patients with high-risk and advanced melanoma during treatment with ICIs compared to a control group receiving standard care. The Medical Ethics Committee NedMec (Amsterdam, The Netherlands) granted ethical approval for this study (reference number 22-981/NL81970.000.22). Trial RegistrationClinicalTrials.gov NCT05827289; https://clinicaltrials.gov/study/NCT05827289 International Registered Report Identifier (IRRID)DERR1-10.2196/4925