Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Co-design of Sustainability Models: The Process

How can a Triple Bottom Line organization understand and visualize the way in which it creates, appropriates, and delivers value? How can the Sustainability Model Canvas be implemented? This chapter aims to propose a co-design methodology to conceive the main building blocks of the Sustainability Model Canvas. In particular, it offers a way to move from a canvas to a co-design process. First, the design of the process is described, explaining the rationale behind the co-design activities. Second, the Sustainability Model Workshop is presented. Three main phases are described and analyzed, namely the Pre-activity, Onboarding, and Designing phases. Practical guidelines and suggestions are presented for each of the three phases, helping the reader to understand how to apply the methodology

Sustainability Models for Social Innovation Projects: A Theoretical Perspective

How can social innovation projects evolve into organizations with long-term economic sustainability? How can organizations aiming for a triple bottom line become economically sustainable in the long run? Can these organizations use the tools and methods used by for-profit organizations to describe their business model? This chapter starts off with an in-depth analysis of the existing literature on business models of for-profit organizations to understand if there is a need for a sustainability model for the triple bottom line and nonprofit organizations. The most widespread tool to represent the business models for for-profit organizations is described and illustrated in this chapter. The literature review shows that the current tools that aim to describe business models for for-profit organizations focus only on financial and economic objectives, whereas triple bottom line organizations and social innovation projects additionally pursue social and environmental objectives, which need to be considered when designing and defining the activities, resources, and stakeholders of the organization