Early Specialty Palliative Care for High Mortality Cancers

Problem: Patients with stage IV cancer have a high mortality rate. Evidence shows that patients have a better quality of life when they receive specialty palliative care (SPC) services. In the microsystem of focus for this project, referrals to SPC are not automatic, and there are no triggers to help the oncologist decide when to refer during a patient’s terminal illness trajectory. Siloes between oncology and SPC exist, which leads to a lack of communication and coordination of care, ultimately affecting patient access to support services from SPC. Context: A multi-disciplinary SPC clinic and a referring oncologist within the same facility partnered to improve early SPC among patients with certain high mortality cancers. Intervention: A weekly oncology/palliative care team huddle was instituted to improve communication and proactively refer, discuss, and plan patient coordination of care. Communication tools were created to enhance patient education and team communication. Measures: Pilot goal was to increase SPC consultation and ongoing follow-up support for stage IV gastrointestinal cancer patients by 20% from a baseline of 37% from February 2021 to 57% by June 31, 2021, for one participating oncologist patient panel. Results: At baseline, 37% (20 out of 54) of patients received SPC consultation and ongoing support. After the huddle interventions, scripted introduction, and direct bookable appointments, 68% (52 out of 76) of patients received SPC consultation and ongoing support. Of the nine patients who died during the project, six died at home with hospice support and three died in the hospital on comfort-only orders. Conclusion: A collaborative and coordinated huddle with oncology resulted in improved consultation and ongoing routine follow up, which benefited the patient and the family by having a peaceful and dignified death concordant with their goals and wishes. The organization benefited by having terminal patients expire with support from hospice or expire without receiving aggressive or ineffective treatment

Strategic orientations, dynamic capabilities and firm performance in knowledge intensive business services: theory and empirical test

In the present study, we try to identify the factors that induce superior performance in companies, analyzing the link between strategic orientations, dynamic capabilities and firm performance. In order to test the theory, we collected primary data through an online questionnaire to SMEs in Knowledge Intensive Business Services. At first, we analyze the interactions between entrepreneurial and market orientation, as well as between market and learning orientation and its effects on firm performance, to examine if the reported conclusions are valid to this particular industry, using a different measure of firm performance. Our main contribution respects the integration of strategic orientations and dynamic capabilities to explain firm performance, where we attempt to understand both direct and indirect effects on firm performance which, to our best knowledge, is the first research study of this kind. We also come up with practical contributions and point some research limitations and directions for future research; RESUMO:No presente estudo, procuramos identificar os fatores que originam um desempenho empresarial superior, através da análise da relação entre as orientações estratégicas, capacidades dinâmicas e desempenho da empresa. No sentido de testar a teoria, recolhemos dados primários através da aplicação de um questionário online às PME dos Serviços Intensivos em Conhecimento. Em primeiro lugar, analisamos as interações entre as orientações empreendedora e para o mercado, assim como entre as orientações para o mercado e para a aprendizagem e os seus efeitos no desempenho, com o objetivo de verificar se as conclusões de outros estudos são válidas para este setor em particular, utilizando uma medida de desempenho inovadora. O nosso principal contributo diz respeito à integração das orientações estratégicas e das capacidades dinâmicas para explicar o desempenho, em que procuramos compreender tanto os efeitos diretos como indiretos no desempenho o que, pelo que nos é dado a conhecer, é o primeiro estudo deste tipo. Finalmente, indicamos algumas considerações práticas, assim como limitações do nosso estudo e rumos para investigações futuras

Characterization of fish scale regeneration: environmental and endocrine control

Fish scales are calcified structures present in skin which have a protective function but which are also implicated in calcium homeostasis. Information about the molecular and cellular organisation of scales and the endocrine factors which regulate their turnover is scarce. In the present study as a first step to studying the influence of hormones on scale metabolism we aimed to characterize elasmoid scales from the sea bream (Sparus auratus), the dynamics of scale regeneration and the possible regulation of this process by calcium availability. Regenerating scales were evident 7 days after their removal in fish maintained in seawater (SW) and brackish water (BW). In BW, the activity of enzymes involved in scale turnover, tartrate resistant acid phosphatase (TRAP) and alkaline phosphatase (ALP), increased indicating active remodelling. The higher activity of TRAP compared to ALP suggests that the reduced calcium availability in BW led to calcium mobilization from the scales. The results suggest that the scales can be used as a regulated reservoir of calcium in this fish.info:eu-repo/semantics/publishedVersio

Temporal changes in cardiac oxidative stress, inflammation and remodeling induced by exercise in hypertension: Role for local angiotensin II reduction

Exercise training reduces renin-angiotensin system (RAS) activation, decreases plasma and tissue oxidative stress and inflammation in hypertension. However, the temporal nature of these phenomena in response to exercise is unknown. We sought to determine in spontaneously hypertensive rats (SHR) and age-matched WKY controls the weekly effects of training on blood pressure (BP), plasma and left ventricle (LV) Ang II and Ang-(1–7) content (HPLC), LV oxidative stress (DHE staining), gene and protein expression (qPCR and WB) of pro-inflammatory cytokines, antioxidant enzymes and their consequence on hypertension-induced cardiac remodeling. SHR and WKY were submitted to aerobic training (T) or maintained sedentary (S) for 8 weeks; measurements were made at weeks 0, 1, 2, 4 and 8. Hypertension-induced cardiac hypertrophy was accompanied by acute plasma Ang II increase with amplified responses during the late phase of LV hypertrophy. Similar pattern was observed for oxidative stress markers, TNF alpha and interleukin-1β, associated with cardiomyocytes’ diameter enlargement and collagen deposition. SHR-T exhibited prompt and marked decrease in LV Ang II content (T1 vs T4 in WKY-T), normalized oxidative stress (T2), augmented antioxidant defense (T4) and reduced both collagen deposition and inflammatory profile (T8), without changing cardiomyocytes’ diameter and LV hypertrophy. These changes were accompanied by decreased plasma Ang II content (T2-T4) and reduced BP (T8). SHR-T and WKY-T showed parallel increases in LV and plasma Ang-(1–7) content. Our data indicate that early training-induced downregulation of LV ACE-AngII-AT1 receptor axis is a crucial mechanism to reduce oxidative/pro-inflammatory profile and improve antioxidant defense in SHR-T, showing in addition this effect precedes plasma RAS deactivation

3D Printable Vascular Networks Generated by Accelerated Constrained Constructive Optimization for Tissue Engineering.

One of the greatest challenges in fabricating artificial tissues and organs is the incorporation of vascular networks to support the biological requirements of the embedded cells, encouraging tissue formation and maturation. With the advent of 3D printing technology, significant progress has been made with respect to generating vascularized artificial tissues. Current algorithms to generate arterial/venous trees are computationally expensive and offer limited freedom to optimize the resulting structures. Furthermore, there is no method for algorithmic generation of vascular networks that can recapitulate the complexity of the native vasculature for more than two trees, and export directly to a 3D printing format. Here, we report such a method, using an accelerated constructive constrained optimization approach, by decomposing the process into construction, optimization, and collision resolution stages. The new approach reduces computation time to minutes at problem sizes where previous implementations have reported days. With the optimality criterion of maximizing the volume of useful tissue which could be grown around such a network, an approach of alternating stages of construction and batch optimization of all node positions is introduced and shown to yield consistently more optimal networks. The approach does not place a limit on the number of interpenetrating networks that can be constructed in a given space; indeed we demonstrate a biomimetic, liver-like tissue model. Methods to account for the limitations of 3D printing are provided, notably the minimum feature size and infill at sharp angles, through padding and angle reduction, respectively.EPSRC Doctoral Training Partner-ship Award (EP/N509620/1) EPSRC (EP/R511675/1 & EP/N509620/1) Isaac Newton Trust Rosetrees Trust (M787). Cambridge Trust CONACyT (Mexico) EPSRC Cambridge & Cranfield Doctoral Training Centre in Ultra Precision (EP/K503241/1

Cadena agroindustrial de la carne porcina la coordinación como puente para el desarrollo de ventajas competitivas

El propósito de este trabajo fue estudiar la performance de la cadena agroindustrial de la carne porcina argentina para identificar el potencial y las limitantes al desarrollo de la actividad en el país y su inserción en el exterior. Para esto se partió delimitando el estudio a partir de un mapa de la cadena. Luego, se realizó un diagnóstico sectorial mediante el desarrollo del Diamante de Porter y, dentro de éste, se abordó la relación entre dos de sus aristas: Las condiciones de los factores y las condiciones de la demanda, a partir del estudio de la relación entre el aumento de la producción y 3 variables explicativas (consumo, exportaciones y % de magro) entre 2009 y 2019. Los resultados mostraron un crecimiento de la actividad en los últimos años en los aspectos técnicos como comerciales (mayor eficiencia de conversión, mejoras en la calidad de las reses, aumento de la demanda interna y de las exportaciones). Sin embargo, se observa que esta mejora en la performance de la cadena agroindustrial, se acota a un reducido número de unidades productivas e industriales, que explican el 84% de la faena, con alto nivel tecnológico y formas innovadoras de coordinación. El modelo de regresión lineal simple mostró una alta correlación entre la producción, y las 3 variables estudiadas. Existe un gran espacio para la construcción de ventajas competitivas cuyo desarrollo requerirá de innovación en los diseños organizacionales de los actores, especialmente, los de menor escala.The purpose of this work was to study the performance of the Argentine pork agroindustrial  chain to identify the potential and the limitations to the development of the activity in the country and its insertion abroad. For this, the study was delimited from a map of the chain. Then, a sectoral diagnosis was made through the development of the Porter Diamond and, within this, the relationship between two of its edges was addressed: The conditions of the  factors and the conditions of the demand, based on the study of the relationship between the  increase in production and 3 explanatory variables (consumption, exports and% of lean) between 2009 and 2019. The results showed a growth in activity in recent years in technical  and commercial aspects (higher conversion efficiency, improvements in the quality of cattle,  increase in domestic demand and exports). However, it is observed that this improvement in  the performance of the agroindustrial chain is limited to a reduced number of productive and industrial units, which account for 84% of the work, with a high technological level and innovative forms of coordination. The simple linear regression model showed a high correlation between production and the 3 variables studied. There is a great space for the construction of  competitive advantages whose development will require innovation in the organizational designs of the actors, especially those of smaller scale. El propósito de este trabajo fue estudiar la performance de la cadena agroindustrial de la carne porcina argentina para identificar el potencial y las limitantes al desarrollo de la actividad en el país y su inserción en el exterior. Para esto se partió delimitando el estudio a partir de un mapa de la cadena. Luego, se realizó un diagnóstico sectorial mediante el desarrollo del Diamante de Porter y, dentro de éste, se abordó la relación entre dos de sus aristas: Las condiciones de los factores y las condiciones de la demanda, a partir del estudio de la relación entre el aumento de la producción y 3 variables explicativas (consumo, exportaciones y % de magro) entre 2009 y 2019. Los resultados mostraron un crecimiento de la actividad en los últimos años en los aspectos técnicos como comerciales (mayor eficiencia de conversión, mejoras en la calidad de las reses, aumento de la demanda interna y de las exportaciones). Sin embargo, se observa que esta mejora en la performance de la cadena agroindustrial, se acota a un reducido número de unidades productivas e industriales, que explican el 84% de la faena, con alto nivel tecnológico y formas innovadoras de coordinación. El modelo de regresión lineal simple mostró una alta correlación entre la producción, y las 3 variables estudiadas. Existe un gran espacio para la construcción de ventajas competitivas cuyo desarrollo requerirá de innovación en los diseños organizacionales de los actores, especialmente, los de menor escala