Factors related to the development of high antibody titres against SARS-CoV-2 in convalescent plasma donors from the ConPlas-19 trial

Background and objectives: The efficacy of COVID-19 convalescent plasma (CP) associates with high titres of antibodies. ConPlas-19 clinical trial showed that CP reduces the risk of progression to severe COVID-19 at 28 days. Here, we aim to study ConPlas-19 donors and characteristics that associate with high anti-SARS-CoV-2 antibody levels. Materials and methods: Four-hundred donors were enrolled in ConPlas-19. The presence and titres of anti-SARS-CoV-2 antibodies were evaluated by EUROIMMUN anti-SARS-CoV-2 S1 IgG ELISA. Results: A majority of 80.3% of ConPlas-19 donor candidates had positive EUROIMMUN test results (ratio ≥1.1), and of these, 51.4% had high antibody titres (ratio ≥3.5). Antibody levels decline over time, but nevertheless, out of 37 donors tested for an intended second CP donation, over 90% were still EUROIMMUN positive, and nearly 75% of those with high titres maintained high titres in the second sample. Donors with a greater probability of developing high titres of anti-SARS-CoV-2 antibodies include those older than 40 years of age (RR 2.06; 95% CI 1.24-3.42), with more than 7 days of COVID-19 symptoms (RR 1.89; 95% CI 1.05-3.43) and collected within 4 months from infection (RR 2.61; 95% CI 1.16-5.90). Male donors had a trend towards higher titres compared with women (RR 1.67; 95% CI 0.91-3.06). Conclusion: SARS-CoV-2 CP candidate donors' age, duration of COVID-19 symptoms and time from infection to donation associate with the collection of CP with high antibody levels. Beyond COVID-19, these data are relevant to inform decisions to optimize the CP donor selection process in potential future outbreaks.European Regional Development Fund (FEDER); Government of Spain, Ministry of Science and Innovation, Instituto de Salud Carlos III, Grant/Award Number: COV20/00072; SCReN (Spanish Clinical Research Network), Instituto de Salud Carlos III, Grant/Award Number: PT17/0017/0009S

Surgical treatment for colorectal cancer: Analysis of the influence of an enhanced recovery programme on long-term oncological outcomes-a study protocol for a prospective, multicentre, observational cohort study

Introduction The evidence currently available from enhanced recovery after surgery (ERAS) programmes concerns their benefits in the immediate postoperative period, but there is still very little evidence as to whether their correct implementation benefits patients in the long term. The working hypothesis here is that, due to the lower response to surgical aggression and lower rates of postoperative complications, ERAS protocols can reduce colorectal cancer-related mortality. The main objective of this study is to analyse the impact of an ERAS programme for colorectal cancer on 5-year survival. As secondary objectives, we propose to analyse the weight of each of the predefined items in the oncological results as well as the quality of life. Methods and analysis A multicentre prospective cohort study was conducted in patients older than 18 years of age who are scheduled to undergo surgery for colorectal cancer. The study involved 12 hospitals with an implemented enhanced recovery protocol according to the guidelines published by the Spanish National Health Service. The intervention group includes patients with a minimum implementation level of 70%, and the control group includes those who fail to reach this level. Compliance will be studied using 18 key performance indicators, and the results will be analysed using cancer survival indicators, including overall survival, cancer-specific survival and relapse-free survival. The time to recurrence, perioperative morbidity and mortality, hospital stay and quality of life will also be studied, the latter using the validated EuroQol Five questionnaire. The propensity index method will be used to create comparable treatment and control groups, and a multivariate regression will be used to study each variable. The Kaplan-Meier estimator will be used to estimate survival and the log-rank test to make comparisons. A p value of less than 0.05 (two-tailed) will be considered to be significant. Ethics and dissemination Ethical approval for this study was obtained from the Aragon Ethical Committee (C.P.-C.I. PI20/086) on 4 March 2020. The findings of this study will be submitted to peer-reviewed journals (BMJ Open, JAMA Surgery, Annals of Surgery, British Journal of Surgery). Abstracts will be submitted to relevant national and international meetings.The present research study was awarded a Ministerio de Ciencia e Innovación health research project grant (PI19/00291) from the Carlos III Institute of the Spanish National Health Service as part of the 2019 call for Strategic Action in Health

The labor market effects of technology shocks

We analyze the effects of neutral and investment-specific technology shocks on hours worked and unemployment. We characterize the response of unemployment in terms of job separation and job finding rates. We find that job separation rates mainly account for the impact response of unemployment while job finding rates for movements along its adjustment path. Neutral shocks increase unemployment and explain a substantial portion of unemployment and output volatilityinvestment-specific shocks expand employment and hours worked and mostly contribute to hours worked volatility. We show that this evidence is consistent with the view that neutral technological progress prompts Schumpeterian creative destruction, while investment specific technological progress has standard neoclassical feature

Gerenciamento de projetos: uma análise a partir da estratégia como prática social

This study adopts the approach of the emerging strategy, regarding it as a social practice, to consider the project management and portfolio of an organization. As organizations become oriented to the implementation of an increasing number of concurrent projects, demands also the alignment of such projects on its strategy. A new approach in the field of strategy, the strategy as social practice, which arose largely because of growing dissatisfaction with traditional research in this area (JARZABKOWSKI; SPEE, 2009) provides a broader interpretation of the strategy as it represents the day to day management involving the actions, interactions and negotiations of multiple actors, as well as practical issues on which they rely for their implementation. Whereas the strategy and project management are interrelated in the management of an organization, and the projects are part of the "make strategy" in organizations, this study sought to understand how selection and project management contributes to "do" strategy in terms of social practice. The methodology applied to achieve the goals, we conducted an applied research, descriptive and qualitative nature in a private organization, the sector of information technology and communication in the city of Uberlândia-MG. The research involved professionals who participate in the design of the company's strategy and project managers. The method of procedure adopted was case study and involved the following sources of evidence: interviews of semi-structured organizational documents, direct observation and physical artifacts. An analysis showed that these practices, while the practical approach of the strategy covers the understanding of organizational routine, involving the perception of people in different hierarchical levels of the company, it is possible that this practice is closely linked to project management. These not only constitute the unfolding of the strategy, but exerts a strong influence on this.Mestre em AdministraçãoEste estudo adota a abordagem emergente da estratégia, que a considera uma prática social, para analisar o gerenciamento de projetos e portfólio de uma organização. À medida que as organizações tornam-se orientadas à execução de um número crescente de projetos simultâneos, demanda também o alinhamento de tais projetos à sua estratégia. Uma nova abordagem no campo da estratégia, a estratégia como prática social, que surgiu em grande parte em função da crescente insatisfação com as investigações tradicionais nesta área (JARZABKOWSKI; SPEE, 2009) proporciona uma interpretação mais ampla da estratégia à medida que representa o dia a dia do gerenciamento envolvendo as ações, interações e negociações dos múltiplos atores, bem como as situações práticas em que se baseiam para a sua realização. Considerando que a estratégia e o gerenciamento dos projetos estão interrelacionados na gestão de uma organização, sendo que os projetos fazem parte do fazer a estratégia nas organizações, este estudo buscou entender como a seleção e o gerenciamento de projetos contribui para o fazer estratégia do ponto de vista da prática social. Como procedimento metodológico para a consecução dos objetivos, foi realizada uma pesquisa aplicada, de caráter descritivo e natureza qualitativa em uma organização privada, do setor de tecnologia da informação e comunicação, localizada na cidade de Uberlândia-MG. A pesquisa envolveu profissionais que participam do delineamento da estratégia da empresa e gerentes de projetos. O método de procedimento adotado foi o estudo de caso e envolveu as seguintes fontes de evidências: entrevistas individuais do tipo semi-estruturadas, documentos organizacionais, observação direta e de artefatos físicos. O desvendar dessas práticas mostrou que, ao passo que a abordagem prática da estratégia abrange a compreensão da rotina organizacional, envolvendo a percepção das pessoas nos diversos níveis hierárquicos da empresa, é possível que esta prática esteja intimamente ligada ao gerenciamento dos projetos, uma vez que estes não apenas constituem o desdobramento da estratégia, mas exerce forte influência sobre esta

Emergência e vigor de sementes de soja em função da disponibilidade hídrica do solo

The soybean crop is an important and growing in several areas in Brazil. To ascertain the influence of water content on seed germination of soybean (Glycine max (L.) Merrill). An experiment was done to see if the water day after sowing would interfere with the germination, applying a layer of 5 mm at different times: 1, 2 or 3 days after sowing. Blades were applied 1, 2, 3, 4, 10, 25, 30 and 35 mm in soil, on the day of sowing, irrigation and a further 5 mm of water on the 4th day after sowing in all treatments. The tests were tested in the Oxisol, medium texture, and it was evaluated the percentage of emergency and normal seedlings (force) in two periods (6th and 11th days after sowing). The cultivar used was NK7074RR obtained harvest 08/09. 300 seeds were sown at 2 cm depth, totaling three replicates of 100 seeds per tray of 0.118 m2, in a randomized design. Irrigation of 5 mm in the first or second day after sowing are sufficient to obtain an emergency around 85.92%, down 31.09% the percentage of emergency where such watering is done on the third day. Regarding the addition of different levels of water depths in the soil at sowing day, the prediction equations showed that the water depth of 9.2 mm makes it possible to obtain higher values of emergence and vigor under the conditions of this experiment.A soja é uma das culturas mais importantes e em expansão nas mais diversas áreas no Brasil. Objetivando verificar a influência do teor de água na germinação de sementes de soja (Glycine max (L.) Merrill), um experimento foi realizado para verificar se o dia de rega após a semeadura poderia interferir na germinação, aplicando-se uma lâmina de 5 mm em diferentes épocas: 1o, 2o ou 3o dia após a semeadura. Foram aplicadas lâminas de 1, 2, 3, 4, 10, 25, 30 e 35 mm no solo, no dia da semeadura, e uma rega suplementar de 5 mm de água no 4o dia após a semeadura em todos os tratamentos. Os ensaios foram testados em latossolo de textura média, no qual avaliou-se as porcentagens de emergência e de plântulas normais (vigor) em dois períodos de avaliação (6o e 11a dias após a semeadura). A cultivar utilizada foi a NK7074RR, obtida da safra 08/09. Foram semeadas 300 sementes, a 2 cm de profundidade, totalizando 3 repetições de 100 sementes por bandeja de 0,118 m2 , em delineamento inteiramente aleatório. A irrigação de 5 mm no primeiro ou segundo dias após a semeadura são suficientes para se obter uma emergência em torno de 85,92%, diminuindo 31,09% a porcentagem de emergência, se essa rega for feita no terceiro dia. Em relação à adição de diferentes níveis de lâmina d ́água no solo no dia da semeadura, as equações de predição mostraram que a lâmina de água de 9,2 mm possibilita a obtenção dos maiores valores de emergência e vigor, nas condições desse experimento

Newly diagnosed versus relapsed idiopathic thrombotic thrombocytopenic purpura: a comparison of presenting clinical characteristics and response to treatment

International audienceThe remission rate with plasma exchange (PE) in thrombotic thrombocytopenic purpura (TTP) exceeds 80%, but the disease relapses in up to 20–30% of the cases. Clinical characteristics and response to treatment of relapsed TTP are not well defined. The objective of the present study was to compare the clinical and biological characteristics at presentation and the response to treatment between de novo and relapsed TTP. For such purpose, a total of 102 episodes of idiopathic TTP (70 de novo and 32 relapses) included in a recent multicentric prospective cohort study were analysed. All patients were homogeneously treated with daily PE and costicosteroids. In comparison with de novo TTP, episodes of relapsed TTP showed a higher Hb level (median, 122 g/l versus 91 g/l,  < 0.001) and lower serum lactate dehydrogenase (2.2- versus 4.5-fold above the upper limit of normality,  < 0.001). Neurological symptoms and fever were less frequently observed in patients with relapsed TTP than in patients with de novo TTP. Patients with relapsed TTP needed fewer PE sessions (five versus ten,  = 0.02) and a smaller volume of plasma (221 ml/kg versus 468 ml/kg,  = 0.004) to achieve remission than those with de novo TTP. There was no significant difference in the rate of recrudescence under treatment, the need of complementary treatments or the frequency of refractoriness to PE therapy. In conclusion, relapsed TTP has a milder clinical profile and responds more easily to PE than de novo TTP

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2)

[Importance] The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery.[Objective] To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).[Design, Setting, and Participants] This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019.[Exposures] Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not.[Main Outcomes and Measures] The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality.[Results] During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR, 0.97; 95% CI, 0.96-0.99; P < .001).[Conclusions and Relevance] An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.This study was supported by institutional and/or departmental sources. The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty (POWER2) study was supported by the Spanish Perioperative Audit and Research Network (REDGERM

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2).

The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery. To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P  An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes