Ocena wpływu realizacji interwencji współfinansowanych z EFS na podniesienie jakości zasobów ludzkich

Celem badania była analiza i ocena wpływu realizacji interwencji współfinansowanych z Europejskiego Funduszu Społecznego (w ramach Sektorowego Programu Operacyjnego Rozwój Zasobów Ludzkich - SPO RZL, drugiego priorytetu Zintegrowanego Programu Operacyjnego Rozwoju Regionalnego - ZPORR oraz inicjatywy EQUAL) w perspektywie 2004-2006 na podniesienie jakości zasobów ludzkich w Polsc

Identification of CD34+/PGDFRΑ+ valve interstitial cells (vics) in human aortic valves : association of their abundance, morphology and spatial organization with early calcific remodeling

Aortic valve interstitial cells (VICs) constitute a heterogeneous population involved in the maintenance of unique valvular architecture, ensuring proper hemodynamic function but also engaged in valve degeneration. Recently, cells similar to telocytes/interstitial Cajal-like cells described in various organs were found in heart valves. The aim of this study was to examine the density, distribution, and spatial organization of a VIC subset co-expressing CD34 and PDGFRα in normal aortic valves and to investigate if these cells are associated with the occurrence of early signs of valve calcific remodeling. We examined 28 human aortic valves obtained upon autopsy. General valve morphology and the early signs of degeneration were assessed histochemically. The studied VICs were identified by immunofluorescence (CD34, PDGFRα, vimentin), and their number in standardized parts and layers of the valves was evaluated. In order to show the complex three-dimensional structure of CD34+/PDGFRα+ VICs, whole-mount specimens were imaged by confocal microscopy, and subsequently rendered using the Imaris (Bitplane AG, Zürich, Switzerland) software. CD34+/PDGFRα+ VICs were found in all examined valves, showing significant differences in the number, distribution within valve tissue, spatial organization, and morphology (spherical/oval without projections; numerous short projections; long, branching, occasionally moniliform projections). Such a complex morphology was associated with the younger age of the subjects, and these VICs were more frequent in the spongiosa layer of the valve. Both the number and percentage of CD34+/PDGFRα+ VICs were inversely correlated with the age of the subjects. Valves with histochemical signs of early calcification contained a lower number of CD34+/PDGFRα+ cells. They were less numerous in proximal parts of the cusps, i.e., areas prone to calcification. The results suggest that normal aortic valves contain a subpopulation of CD34+/PDGFRα+ VICs, which might be involved in the maintenance of local microenvironment resisting to pathologic remodeling. Their reduced number in older age could limit the self-regenerative properties of the valve stroma

Systematic review and meta-analysis of randomized clinical trials comparing efficacy and safety outcomes of insulin glargine with NPH insulin, premixed insulin preparations or with insulin detemir in type 2 diabetes mellitus

AIMS: A variety of basal insulin preparations are used to treat patients with type 2 diabetes mellitus (T2DM). We aimed to summarize scientific evidence on relative efficacy and safety of insulin glargine (IGlar) and other insulins in T2DM. METHODS: A systematic review was carried out in major medical databases up to December 2012. Relevant studies compared efficacy and safety of IGlar, added to oral drugs (OAD) or/and in combination with bolus insulin, with protamine insulin (NPH) or premixed insulin (MIX) in the same regimen, as well as with insulin detemir (IDet), in T2DM. Target HbA1c level without hypoglycemic events was considered the primary endpoint. RESULTS: Twenty eight RCTs involving 12,669 T2DM patients followed for 12–52 weeks were included in quantitative analysis. IGlar + OAD use was associated with higher probability of reaching target HbA1c level without hypoglycemia as compared to NPH + OAD (RR = 1.32 [1.09, 1.59]) or MIX without OAD (RR = 1.61 [1.22, 2.13]) and similar effect as IDet + OAD (RR = 1.07 [0.87, 1.33]) and MIX + OAD (RR = 1.09 [0.86, 1.38]). IGlar + OAD demonstrated significantly lower risk of symptomatic hypoglycemia as compared to NPH + OAD (RR = 0.89 [0.83, 0.96]), MIX + OAD (RR = 0.75 [0.68, 0.83]) and MIX without OAD(RR = 0.75 [0.68, 0.83]), but not with IDet + OAD (RR = 0.99 [0.90, 1.08]). In basal-bolus regimens, IGlar demonstrated similar proportion of T2DM patients achieving target HbA1c as compared to NPH (RR = 1.14 [0.91, 1.44]) but higher than MIX (RR = 1.26 [1.12, 1.42) or IDet (RR = 1.38 [1.11, 1.72]). The risk of severe hypoglycemia was lower in IGlar than in NPH (RR = 0.77 [0.63, 0.94]), with no differences in comparison with MIX (RR = 0.74 [0.46, 1.20]) and IDet (RR = 1.10 [0.54, 2.25]). IGlar + OAD has comparable safety profile to NPH, with less frequent adverse events leading to treatment discontinuation than MIX + OAD (RR = 0.41 [0.22, 0.76]) and IDet + OAD (RR = 0.40 [0.24, 0.69]). Also severe adverse reactions were less common for IGlar + OAD when compared to MIX + OAD (RR = 0.71 [0.52; 0.98]). CONCLUSION: For the majority of examined efficacy and safety outcomes, IGlar use in T2DM patients was superior or non-inferior to the alternative insulin treatment options. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00592-014-0698-4) contains supplementary material, which is available to authorized users

Public Pension Design and Household Retirement Decisions: A Comparison of the United States and Germany

Social Security provides retirement benefits to age-eligible workers and their spouses. Benefits are permanently increased if initial receipt is delayed. For benefits paid to spouses, these incentives reflect a complex interaction of the worker’s and spouse’s earnings histories, benefit claiming decisions, and age difference. We demonstrate that the benefit increment from delaying initial receipt of spousal and survivor benefits is substantial for some households. Past studies find that workers respond to potential increments in their own benefit by delaying labor force exit. Using a nationally representative panel, we investigate whether an additional dollar in expected lifetime benefits paid to the worker directly is treated the same as an additional dollar paid to the worker’s spouse from spouse and survivor benefits. We find minimal evidence that workers or their spouses change retirement behavior in a way that is theoretically consistent with spouse and survivor benefit claiming incentives. The lack of responsiveness suggests that incentives to delay claiming for benefits other than the worker’s own are not salient in the worker’s decision-making. This may reflect the complexity of benefit rules or different preferences concerning benefits paid to others. A parallel analysis using German data, where rules surrounding survivor benefits are simpler, finds that workers respond in a theoretically consistent way, but small sample sizes prevent conclusive results. Our findings suggest models estimating the policy impact of reducing spousal and survivor benefits on female labor supply are likely overstated, and that a greater understanding of survivor benefits may lead to better claiming decisions for couples.U.S. Social Security Administration, RDR18000002-01, UM19-13http://deepblue.lib.umich.edu/bitstream/2027.42/168229/1/wp417.pdfDescription of wp417.pdf : working paperSEL

Clinical effectiveness of a fixed-dose combination therapy with ramipril plus felodipine ER compared to monotherapy with ramipril or felodipine ER or to a fixed-dose combination therapy with verapamil SR and trandolapril or amlodipine and valsartan in treatment of primary hypertension — systematic review

Wstęp W leczeniu nadciśnienia tętniczego będącego najczęstszą chorobą układu sercowo-naczyniowego w I rzucie terapii stosuje się monoterapię lekami b-adrenolitycznymi, moczopędnymi, antagonistami wapnia, inhibitorami konwertazy angiotensyny czy antagonistami receptora angiotensyny II. Jednak 70–80% pacjentów wymaga podawania preparatów złożonych w celu skutecznej kontroli nadciśnienia. Zalecanym lekiem I rzutu w terapii skojarzonej jest antagonista wapnia (np. felodipina); połączenie tych preparatów z inhibitorami konwertazy angiotensyny może dać bardzo dobry efekt terapeutyczny ze względu na uzupełniające się działanie obu terapeutyków. Celem pracy była ocena efektów klinicznych wyrażonych skutecznością kliniczną i bezpieczeństwem stosowania preparatu złożonego zawierającego ramipril i felodipinę ER w leczeniu nadciśnienia tętniczego w porównaniu z ramiprilem lub felodipiną ER stosowanymi w monoterapii lub z preparatami złożonymi zawierającymi werapamil SR i trandolapril lub amlodipinę i walsartan w leczeniu nadciśnienia tętniczego. Materiał i metody Ocenę efektywności klinicznej analizowanych preparatów przeprowadzono zgodnie z zasadami opracowywania przeglądu systematycznego medycznych baz danych określonych na podstawie Wytycznych Agencji Oceny Technologii Medycznych (AOTM). Analizy i prezentacje wyników badań klinicznych dokonano zgodnie z zasadami medycyny opartej na dowodach naukowych (EBM). W celu odnalezienia najbardziej wiarygodnych doniesień naukowych na temat efektywności klinicznej omawianych preparatów leczniczych przeprowadzono przegląd systematyczny medycznych baz danych. Wyniki W wyniku przeglądu systematycznego medycznych baz danych (Medline, Embase, Cochrane i inne) odnaleziono łącznie 7 publikacji referencyjnych, które zostały wykorzystane w poszczególnych subanalizach. Stwierdzono, że preparat złożony zawierający ramipril i felodipinę ER jest skuteczniejszy niż monoterapia prowadzona z zastosowaniem różnych dawek składników aktywnych leku oraz równie skuteczny jak inne preparaty złożone (zawierające werapamil SR i trandolapril lub amlodipinę i walsartan). Ponadto wykazano, że analizowany preparat złożony cechuje się dobrym profilem bezpieczeństwa zbliżonym do opisanego dla innych analizowanych preparatów złożonych stosowanych w nadciśnieniu tętniczym. Nadciśnienie Tętnicze 2011, tom 15, nr 1, strony 13–20Background Beta-blockers, diuretics, calcium antagonists, angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor antagonists are commonly used as a first-line therapy in arterial hypertension monotherapy. But the majority of patients (70–80%) to sufficiently control their blood pressure require treatment with more than one antihypertensive agent. Calcium channel blockers (e.g. felodipine) are recommended as a first-line antihypertensive treatment. Combined use of ACE-I and calcium channel blocker may result in a good therapeutic effect given a complementary mode of action of the two agents. The aim of the study was to assess clinical effectiveness measured by clinical efficacy and safety of a fixed--dose combination therapy with ramipril plus felodipine ER compared with monotherapy with ramipril or felodipine ER or with a fixed-dose combination therapy with verapamil SR and trandolapril or amlodipine and valsartan as treatment options of primary hypertension. Material and methods Clinical assessment was performed according to PolAHTA Guidelines; analysis and credibility evaluation were based on evidence-based medicine. In order to find the most relevant clinical publications a systematic review of medical databases was performed. Results Systematic review revealed 7 reference publications of clinical trials which were used in specific analyses. It was shown that a fixed-dose combination of ramipril and felodipine ER is more efficient than monotherapy with ramipril or felodipine ER. It was also shown that the fixed- -dose combination of ramipril and felodipine ER was as efficient as other fixed-dose combinations (verapamil SR and trandolapril or amlodipine and valsartan). Apart from that it was demonstrated that the safety profile of the fixed- -dose combination of ramipril and felodipine ER was good and similar to the one of other antihypertensive fixed-dose combinations. Arterial Hypertension 2011, vol. 15, no 1, pages 13–2

Age and productivity. Human capital accumulation and depreciation

This NEUJOBS research report focuses on links between age, productivity and lifelong learning. Various data sources (EU-SILC, LFS, Structure of Earnings Survey, SHARE, ELSA, SHARELIFE) and methodological approaches were used in this report. Our analysis identifies clusters of countries with common characteristics of ageearnings profiles (for certain groups of employees) and allows for an explanation of those differences. Some differences can be attributed to the share of sectors, education types, and occupations in country-specific employment. Others are due to labour market institutions and the (dis)incentives to work at older ages provided by social security systems. Additionally, the dynamics of earnings after age 50 differ less between educational and occupational groups than at earlier ages. We show that the dynamics of average wages are strongly influenced by the timing of entering and leaving labour market. An estimation of the impact of LLL on productivity (measured by earnings) at older ages shows that for employees aged 50+, participation in training increases wages in the short-term

Initial Polish experience of Flexible 19 gauge Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

  INTRODUCTION: EBUS is a well established minimally invasive diagnostic tool for mediastinal and hilar lymphadenopathy. The novel ViziShot Flex 19G needle (Olympus Respiratory America, Redmond, WA, USA) was introduced in 2015 in order to improve loaded scope flexion and to obtain larger tissue samples for analysis. The aims of this study were to assess diagnostic yield of Flex 19G needles and to present endoscopist’s feedback about the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MATERIAL AND METHODS: The Flex 19G needles were used in patients with hilar and/or mediastinal adenopathy in two Polish pulmonology centers. Cytology smears and cell blocks (CB) were prepared. The prospective analysis was performed due to collected data. RESULTS: Twenty two selected patients with confirmed adenopathy on chest-CT (mean age 58 ± 12) underwent EBUS-TBNA with use of Flex 19G needles. All procedures occurred to be diagnostic for smears (yield 100%). The malignancy was found in 15 cases (68.2%), and benign adenopathy in 7 (31.8%). In 12 of 14 cases of lung cancer (yield 85.7%) CB were diagnostic for immunohistochemical and molecular staining. After puncturing nodes, especially in hilar position not extensive bleeding was observed. Comparing to standard 21/22G EBUS-TBNA endoscopists underlined better flexion of loaded scope and sample adequacy and found non-significant differences in another biopsy details. CONCLUSIONS: The first Polish experience with use of Flex 19G EBUS-TBNA needle occurs to be similar in performance with standard technique with use of 22/21G needles and presents high diagnostic yield for lung cancer diagnostics, especially when preparing CB. A safety profile of the biopsy is acceptable.

Initial Polish experience of flexible 19 gauge endobronchial ultrasound-guided transbronchial needle aspiration

Introduction: EBUS is a well established minimally invasive diagnostic tool for mediastinal and hilar lymphadenopathy. The novel ViziShot Flex 19G needle (Olympus Respiratory America, Redmond, WA, USA) was introduced in 2015 in order to improve loaded scope flexion and to obtain larger tissue samples for analysis. The aims of this study were to assess diagnostic yield of Flex 19G needles and to present endoscopist’s feedback about the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Material and methods: The Flex 19G needles were used in patients with hilar and/or mediastinal adenopathy in two Polish pulmonology centers. Cytology smears and cell blocks (CB) were prepared. The prospective analysis was performed due to collected data. Results: Twenty two selected patients with confirmed adenopathy on chest-CT (mean age 58 ± 12) underwent EBUS-TBNA with use of Flex 19G needles. All procedures occurred to be diagnostic for smears (yield 100%). The malignancy was found in 15 cases (68.2%), and benign adenopathy in 7 (31.8%). In 12 of 14 cases of lung cancer (yield 85.7%) CB were diagnostic for immunohistochemical and molecular staining. After puncturing nodes, especially in hilar position not extensive bleeding was observed. Comparing to standard 21/22G EBUS-TBNA endoscopists underlined better flexion of loaded scope and sample adequacy and found non-significant differences in another biopsy details. Conclusions: The first Polish experience with use of Flex 19G EBUS-TBNA needle occurs to be similar in performance with standard technique with use of 22/21G needles and presents high diagnostic yield for lung cancer diagnostics, especially when preparing CB. A safety profile of the biopsy is acceptable