The lessons learned from the unique characteristics of small technology-based firms.

The aim of this study is to identify how characteristics of small technology-based firms (STBFs), their unique combination of internal capabilities, structure, and processes, influence strategy formulation. Based on qualitative research using multiple case studies supported by semi-structured interviews, the study’s main results indicate the founder’s technical expertise shapes the business, mission, and vision. Lack of resources allows limited activities in strategy formulation with few matching capabilities analyses or benchmarking studies. STBFs favor competitive analysis almost exclusively in developing a market positioning strategy without regard for other methods

Quality of life assessment in elderly patients with aggressive non-Hodgkin's Lymphoma treated with anthracycline-containing regimens. Report of a prospective study by the Intergruppo Italiano Linfomi

Background and Objectives. The aim of this study was to evaluate quality of life (QOL) in a group of elderly patients ( > 65 years) with aggressive non-Hodgkin's lymphoma (NHL) treated with chemotherapy regimens containing anthracyclines. Design and Methods. QOL was evaluated in a population of elderly patients with aggressive NHL enrolled in a phase III clinical trial run by the Intergruppo Italiano Linfomi (11L) from 1996 to 1999 to compare two different anthracycline-containing regimens (mini-CEOP vs P-VEBEC). The EORTC-QLQ-C30 questionnaire, which has already been validated in oncology, was used. The questionnaire was administered at the time of diagnosis, half way through the chemotherapy and at the time of restaging. Results. Ninety-one patients completed pre-therapy and post-therapy questionnaires and they are the subject of this report. Baseline QOL assessment showed a strong correlation of poor values of QOL with anemia and high risk according to the International Prognostic Index (IPI). At the end of treatment no functional scales showed worse values. A significant improvement was observed for pain (p = 0.003), appetite (p = 0.006), sleep (p = 0.015) and global health (p = 0.027). Considering only the 50 patients who achieved a complete remission (CR), an improvement was also recorded for emotional state (p = 0.10), role (P = 0.05), constipation (p = 0.04) and global QOL (p = 0.05). Interpretation and Conclusions. The EORTC-QLQ-C30 is feasible even in a population of elderly patients, in whom it had never been tested before. The improvement of QOL at the end of the treatment demonstrated that the symptoms of the disease have a greater negative influence on the patient's life than do the side effects of the therapy

Direct evidence for a functional role of HLA-DRB1 and -DRB3 gene products in the recognition of Dermatophagoides spp. (house dust mite) by helper T lymphocytes

The contribution of the HLA-DRB1, -B3, and -BS gene products in the recognition of Dermatophagoides spp. (house dust mite) by helper T cells Isolated from an atopic individual (HLA-DRw12, DR7; DRw52b) with perennial rhinitis was investigated. Using a panel of histocompatlble and histoincompatible accessory cells, the restriction specificity obtained for a long term T cell suggested that a component of the dust mite reactive repertoire recognized antigen in association with DRB3 gene products. Ollgonucleotide DNA typing of the presenting cell panel demonstrated a correlation between the DRw52b allele and T cell responsiveness. Murine fibroblasts expressing DRw52b, but not DRw52a or -c molecules, presented antigen to both the T cell line and cloned T cells (DE26) derived from the line, Indicating that the supertypic specificity DRw52b was able to restrict recognition of dust mite antigens. Additional T cell clones (DE9 and DE41) also isolated from the line were restricted by the products of the B1 gene locus (DRw12B1) as determined by murine fibroblasts transfected with the appropriate HLA-DR genes. Clone DE9 was degenerate in Its restriction specificity, also recognizing dust mite presented by accessory cells expressing the DR2 subtypes. Presentation by fibroblasts transfected with DRw12B1, DR2Dw2B5 genes and EBV-transformed B cell lines expressing DR2Dw21B1 and -B5 indicated that the functional site restricting recognition may be associated with residues 70 and 71 of the DR/3 chain helical wall of the antigen combining site. Furthermore, we have recently demonstrated that both T cell clones DE9 and DE26 induce allergen dependent IgE synthesis in vitro. Thus these results demonstrate directly that the DRB1, -B3, and -B5 gene products are functional in the restriction of T cell recognition of dust mite antigen

Acoustic far-field hypersonic surface wave detection with single plasmonic nanoantennas

The optical properties of small metallic particles allow us to bridge the gap between the myriad of subdiffraction local phenomena and macroscopic optical elements. The optomechanical coupling between mechanical vibrations of Au nanoparticles and their optical response due to collective electronic oscillations leads to the emission and the detection of surface acoustic waves (SAWs) by single metallic nanoantennas. We take two Au nanoparticles, one acting as a source and the other as a receptor of SAWs and, even though these antennas are separated by distances orders of magnitude larger than the characteristic subnanometric displacements of vibrations, we probe the frequency content, wave speed, and amplitude decay of SAWs originating from the damping of coherent mechanical modes of the source. Two-color pump-probe experiments and numerical methods reveal the characteristic Rayleigh wave behavior of emitted SAWs, and show that the SAW-induced optical modulation of the receptor antenna allows us to accurately probe the frequency of the source, even when the eigenmodes of source and receptor are detuned

Systematic vs. on-demand early palliative care in gastric cancer patients: a randomized clinical trial assessing patient and healthcare service outcomes

Purpose: Early palliative care (EPC) has shown a positive impact on quality of life (QoL), quality of care, and healthcare costs. We evaluated such effects in patients with advanced gastric cancer. Methods: In this prospective, multicenter study, 186 advanced gastric cancer patients were randomized 1:1 to receive standard cancer care (SCC) plus on-demand EPC (standard arm) or SCC plus systematic EPC (interventional arm). Primary outcome was a change in QoL between randomization (T0) and T1 (12 weeks after T0) in the Trial Outcome Index (TOI) scores evaluated through the Functional Assessment of Cancer Therapy-Gastric questionnaire. Secondary outcomes were patient mood, overall survival, and family satisfaction with healthcare and care aggressiveness. Results: The mean change in TOI scores from T0 to T1 was − 1.30 (standard deviation (SD) 20.01) for standard arm patients and 1.65 (SD 22.38) for the interventional group, with a difference of 2.95 (95% CI − 4.43 to 10.32) (p = 0.430). The change in mean Gastric Cancer Subscale values for the standard arm was 0.91 (SD 14.14) and 3.19 (SD 15.25) for the interventional group, with a difference of 2.29 (95% CI − 2.80 to 7.38) (p = 0.375). Forty-three percent of patients in the standard arm received EPC. Conclusions: Our results indicated a slight, albeit not significant, benefit from EPC. Findings on EPC studies may be underestimated in the event of suboptimally managed issues: type of intervention, shared decision-making process between oncologists and PC physicians, risk of standard arm contamination, study duration, timeliness of assessment of primary outcomes, timeliness of cohort inception, and recruitment of patients with a significant symptom burden. Clinical trial registration: ClinicalTrials.gov (NCT01996540)

Efficient ultrafast all-optical modulation in a nonlinear crystalline gallium phosphide nanodisk at the anapole excitation

High–refractive index nanostructured dielectrics have the ability to locally enhance electromagnetic fields with low losses while presenting high third-order nonlinearities. In this work, we exploit these characteristics to achieve efficient ultrafast all-optical modulation in a crystalline gallium phosphide (GaP) nanoantenna through the optical Kerr effect (OKE) and two-photon absorption (TPA) in the visible/near-infrared range. We show that an individual GaP nanodisk can yield differential reflectivity modulations of up to ~40%, with characteristic modulation times between 14 and 66 fs, when probed at the anapole excitation (AE). Numerical simulations reveal that the AE represents a unique condition where both the OKE and TPA contribute with the same modulation sign, maximizing the response. These findings highly outperform previous reports on sub–100-fs all-optical switching from resonant nanoscale dielectrics, which have demonstrated modulation depths no larger than 0.5%, placing GaP nanoantennas as a promising choice for ultrafast all-optical modulation at the nanometer scale

What is the impact of a national postgraduate medical specialist education reform on the daily clinical training 3.5 years after implementation? A questionnaire survey

<p>Abstract</p> <p>Background</p> <p>Many countries have recently reformed their postgraduate medical education (PGME). New pedagogic initiatives and blueprints have been introduced to improve quality and effectiveness of the education. Yet it is unknown whether these changes improved the daily clinical training. The purpose was to examine the impact of a national PGME reform on the daily clinical training practice.</p> <p>Methods</p> <p>The Danish reform included change of content and format of specialist education in line with outcome-based education using the CanMEDS framework. We performed a questionnaire survey among all hospital doctors in the North Denmark Region. The questionnaire included items on educational appraisal meetings, individual learning plans, incorporating training issues into work routines, supervision and feedback, and interpersonal acquaintance. Data were collected before start and 31/2 years later. Mean score values were compared, and response variables were analysed by multiple regression to explore the relation between the ratings and seniority, type of hospital, type of specialty, and effect of attendance to courses in learning and teaching among respondents.</p> <p>Results</p> <p>Response rates were 2105/2817 (75%) and 1888/3284 (58%), respectively. We found limited impact on clinical training practice and learning environment. Variances in ratings were hardly affected by type of hospital, whereas belonging to the laboratory specialities compared to other specialties was related to higher ratings concerning all aspects.</p> <p>Conclusions</p> <p>The impact on daily clinical training practice of a national PGME reform was limited after 31/2 years. Future initiatives must focus on changing the pedagogical competences of the doctors participating in daily clinical training and on implementation strategies for changing educational culture.</p

Personalizing Cancer Pain Therapy: Insights from the Rational Use of Analgesics (RUA) Group

Introduction: A previous Delphi survey from the Rational Use of Analgesics (RUA) project involving Italian palliative care specialists revealed some discrepancies between current guidelines and clinical practice with a lack of consensus on items regarding the use of strong opioids in treating cancer pain. Those results represented the basis for a new Delphi study addressing a better approach to pain treatment in patients with cancer. Methods: The study consisted of a two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of 17 statements using a 5-point Likert scale (0 = totally disagree and 4 = totally agree). Consensus on a statement was achieved if the median consensus score (MCS) (expressed as value at which at least 50% of participants agreed) was at least 4 and the interquartile range (IQR) was 3–4. Results: This survey included input from 186 palliative care specialists representing all Italian territory. Consensus was reached on seven statements. More than 70% of participants agreed with the use of low dose of strong opioids in moderate pain treatment and valued transdermal route as an effective option when the oral route is not available. There was strong consensus on the importance of knowing opioid pharmacokinetics for therapy personalization and on identifying immediate-release opioids as key for tailoring therapy to patients’ needs. Limited agreement was reached on items regarding breakthrough pain and the management of opioid-induced bowel dysfunction. Conclusion: These findings may assist clinicians in applying clinical evidence to routine care settings and call for a reappraisal of current pain treatment recommendations with the final aim of optimizing the clinical use of strong opioids in patients with cancer

Tailored Hypersound Generation in Single Plasmonic Nanoantennas.

Ultrashort laser pulses impinging on a plasmonic nanostructure trigger a highly dynamic scenario in the interplay of electronic relaxation with lattice vibrations, which can be experimentally probed via the generation of coherent phonons. In this Letter, we present studies of hypersound generation in the range of a few to tens of gigahertz on single gold plasmonic nanoantennas, which have additionally been subjected to predesigned mechanical constraints via silica bridges. Using these hybrid gold/silica nanoantennas, we demonstrate experimentally and via numerical simulations how mechanical constraints allow control over their vibrational mode spectrum. Degenerate pump-probe techniques with double modulation are performed in order to detect the small changes produced in the probe transmission by the mechanical oscillations of these single nanoantennas.Fil: Della Picca, Fabricio Leandro. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Laboratorio de Electrónica Cuántica; ArgentinaFil: Berte, Rodrigo. Ministry Of Education Brazil; . Imperial College London; Reino UnidoFil: Rahmani, Mohsen. Imperial College London; Reino UnidoFil: Albella, Pablo. Imperial College London; Reino UnidoFil: Bujjamer, Juan. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Laboratorio de Electrónica Cuántica; ArgentinaFil: Poblet, Martín. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Laboratorio de Electrónica Cuántica; ArgentinaFil: Cortés, Emiliano. Imperial College London; Reino UnidoFil: Maier, Stefan A.. Imperial College London; Reino UnidoFil: Bragas, Andrea Veronica. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física. Laboratorio de Electrónica Cuántica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Física de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Física de Buenos Aires; Argentin