Valuing qalys at the end of life

There have been changes in the way that NICE evaluates medical treatments for patients who are in the last stages of their lives. If medicines fulfil some criteria to be considered “end of life” NICE considers if QALYs gained under these circumstances should receive an extra weight. In this paper we provide evidence about the social support that this policy may have. We present the result of three surveys conducted in the Spanish general population (n=813). Survey 1 compared increases in life expectancy for patients at the end of their lives with health gains from temporary health problems. Survey 2 compared health gains for temporary health problems with health gains from end of life palliative care. Survey 3 compared increases in life expectancy with palliative care in both cases for end of life patients. Preferences were elicited with Person Trade-Off and Willingness to pay techniques. Our results suggest that QALYs for end of life treatments have a higher social value than for temporary health problems. However, we also find that people discriminate between different ways of health gains within End of Life treatment. People seem to attach a greater weight to palliative care than to life extension.QALY weights, end of life, palliative care, life extension

IGF-1 Regulates the extracellular level of active MMP-2 and promotes Müller glial cell motility

In ischemic proliferative retinopathies, Müller glial cells (MGCs) acquire migratory abilities. However, the mechanisms that regulate this migration remain poorly understood. In addition, proliferative disorders associated with enhanced activities of matrix metalloproteinases (MMPs) also involve insulin-like growth factor (IGF)-1 participation. Therefore, the main interest of this work was to investigate the IGF-1 effect on the extracellular proteolytic activity in MGCs.Methods: Cell culture supernatants and cell lysates of the human MGC line MIO-M1 stimulated with IGF-1 were analyzed for MMP-2 by zymographic and Western blot analysis. The MGCs´ motility was evaluated by scratch wound assay. The MMP-2, β1-integrin, and focal adhesions were detected by confocal microscopy. The localization of active MMPs and actin cytoskeleton were evaluated by in situ zymography.Results: The IGF-1 induced the activation of canonical signaling pathways through the IGF-1R phosphorylation. Culture supernatants showed a relative decrease in the active form of MMP-2, correlating with an increased accumulation of MMP-2 protein in the MGCs´ lysate. The IGF-1 effect on MMP-2 was abolished by an IGF-1R blocking antibody, αIR3, as well as by the PI3-kinase inhibitor, LY294002. The IGF-1 increased the migratory capacity of MGCs, which was blocked by the GM6001 MMP inhibitor, LY294002 and αIR3. Finally, IGF-1 induced the intracellular distribution of MMP-2 toward cellular protrusions and the partial colocalization with β1-integrin and phospo-focal adhesion kinase signals. Gelatinase activity was concentrated along F-actin filaments.Conclusions: Taken together, these data indicate that IGF-1, through its receptor activation, regulates MGCs´ motility by a mechanism that involves the MMP-2 and PI3K signaling pathway.Fil: Lorenc, Valeria Erika. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Jaldín Fincati, Javier Roberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Luna Pinto, Jose Domingo. Departamento de Vítreo-retina, Centro Privado de Ojos R; ArgentinaFil: Chiabrando, Gustavo Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; ArgentinaFil: Sanchez, Maria Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones en Bioquímica Clínica e Inmunología; Argentin

Patent value index: Measuring Brazilian green patents based on family size, grant, and backward citation

Objective. The Patent Value Index is created to identify the most valuable patents based on the evidence yielded by different agents in the patenting chain. Design/Methodology/Approach. The agents and indicators are the following: (a) patent holder (number of countries where the invention is protected); (b) Brazilian IP Office (INPI, the patent-granting agent), and (c) users (number of citations). Brazilian green patents were selected for the application of the index. Data was collected on the Global Patent Index. 478 patents were found, the values of which were calculated by the index. Using the overall score median, the population was divided into two groups: (1) upper-half median (composed of the highest-scoring patents) and (2) lower-half median (lowest-scoring patents). Results/Discussion. The results identified converging behavior among the values demonstrated by the three agents, as the patents in the first 183 positions evidence that 65.5% are from foreign countries, 77.6% belong to companies, 96.2% have a patent family, 86.9% have a Patent Cooperation Treaty request, 78.7% were granted, and 74.9% are cited by other patents. Regarding the 295 patents of the lower median, 94.6% are Brazilian, 44.7% belong to individuals, 22.2% were granted, 4% are cited, and 9.6% have a patent family. Conclusions. The constructed index can be used for those patentometric studies aimed at investigating qualitative aspects of inventions. Originality/Value. A value triad, –with data available in databases–, is created to evaluate patents according to different agents in the inventive chain

Liderazgo y autoeficacia en el comportamiento organizacional positivo

El objetivo que tiene este proyecto es revisar los conceptos básicos acerca de las relaciones que crean los líderes con sus colaboradores dentro de las organizaciones, dichas relaciones y vínculos pueden afectar positiva o negativamente el desempeño de sus actividades diarias dentro de una organización. Para darle inicio a la investigación se estudió como primer paso el concepto de liderazgo transformacional, capital psicológico y que componentes hacían parte de este factor. El desarrollo de la investigación se enfatizó entre el liderazgo transformacional y la autoeficacia ya que son factores claves dentro del desarrollo de las actividades organizacionales debido a que afectan claramente el capital humano de las compañías y están directamente relacionados con el crecimiento de las mismas, lo que nos llevó a preguntarnos ¿qué relación tendrá el liderazgo transformacional y la autoeficacia en la productividad de las empresas? Es aquí donde radica la importancia de esta investigación ya que el cambio de pensamiento de las organizaciones hacia un liderazgo transformacional podría lograr una maximización del desempeño del personal de trabajo en relación al objetivo de la compañía. Como conclusión llegamos a que efectivamente hay un efecto positivo en los individuos que desarrollan un capital psicológico específicamente en el factor de autoeficacia para lograr un desempeño destacable, productivo y eficiente dentro de las organizaciones.The goal of this project is review the basics about creating relationships with partners’ leaders within organizations, such relationships and links can positively or negatively affect the performance of their daily activities within an organization. We began our research studying the concept of transformational leadership, psychological capital and which components were part of this factor. The development of our investigation was emphasized between transformational leadership and self-efficacy as they are key factors in the development of organizational activities because they clearly affect the human capital of companies and are directly related to the growth of the same, which He led us to wonder what relationship will transformational leadership and self-efficacy in productivity of businesses? It is here where the importance of this research since the change of thinking of organizations towards transformational leadership could achieve maximizing staff performance work in relation to the objective of the company. Upon reaching conclusion that there is indeed a positive effect on equity specifically individuals develop a psychological factor in achieving a remarkable self-efficacy, productive and efficient performance within organizations

Clinical and surgical assistance in prostate cancer during the COVID-19 Pandemic: Implementation of assistance protocols

Purpose: Propose an approach of prostate cancer (PCa) patients during COVID-19 pandemic. Material and Methods: We conducted a review of current literature related to surgical and clinical management of patients during COVID-19 crisis paying special attention to oncological ones and especially those suffering from PCa. Based on these publications and current urological guidelines, a manual to manage PCa patients is suggested. Results: Patients suffering from cancer are likely to develop serious complications from COVID-19 disease together with an increased risk of postoperative morbidity and mortality. Therefore, the management of oncological patients should be taken into special consideration and most of the treatments postponed. In case the procedure is not deferrable, it should be adapted to the current situation. While the shortest radiotherapy (RT) regimens should be applied, surgical procedures must undergo the following recommendations proposed by main surgical associations. PCa prognosis is generally favourable and therefore one can safely delay most of the biopsies up to 6 months without interfering with survival outcomes in the vast majority of cases. In the same way, most of the localised PCa patients are suitable for active surveillance (AS) or hormonal therapy until local definitive treatment could be reconsidered. In metastatic as well as castration resistant PCa stages, adding androgen receptor targeted agents (abiraterone, apalutamide, darolutamide or enzalutamide) to androgen-deprivation therapy (ADT) could be considered in high risk patients. On the contrary, chemotherapy, immunotherapy and Radium-223 must be avoided with regard to the consequence of hematologic toxicity and risk of COVID-19 infection because of immunodepression. Conclusions: Most of the biopsies should be delayed while AS is advised in those patients with low risk PCa. ADT allows us to defer definitive local treatment in many cases of intermediate and high risk PCa. In regard to metastatic and castration resistant PCa, combination therapies with abiraterone, apalutamide, darolutamide or enzalutamide could be considered. Chemotherapy, Radium-223 and immunotherapy are discouraged

Principios de integración al entorno paisajista para el diseño de un centro cultural en la ciudad de Tarapoto, 2020

La presente tesis expone el diseño de un centro de integración cultural en el distrito de Tarapoto basado en loso principios de integración al entorno paisajista. En el país los centros culturales se presentan con diseños modernos, la cual hace que se pierda muchas veces la cultura del mismo sitio. Por ello se presenta esta propuesta para dar una solución arquitectónica a los problemas que aquejan a usuarios en los centros culturales, asimismo presentar espacios agradables y sin olvidarse del entorno del lugar. La investigación es de carácter descriptivo, por lo tanto se encuentra validado por la búsqueda de estudios científicos, análisis de casos, tomando como algunos datos para demostrar la necesidad del diseño del objeto arquitectónico presentado y características propuestas. En conclusión la aplicación de los principios de integración al entorno paisajista tendrá una aceptación positiva en los usuarios, ya que se podrá integrar la sociedad y cultura porque en la actualidad se está perdiendo las áreas naturales; a eso se le suma que al diseñar los espacios adecuados, los usuarios se encontraran satisfechos con dichos resultados.This thesis presents the design of a cultural integration center in the Tarapoto district based on the principles of integration to the landscape environment. In the country, cultural centers are presented with modern designs, which often makes the culture of the same place get lost. For this reason, this proposal is presented to provide an architectural solution to the problems that afflict users in cultural centers, also to present pleasant spaces and without forgetting the environment of the place. The research is descriptive in nature, therefore it is validated by the search for scientific studies, case analysis, taking as some data to demonstrate the need for the design of the architectural object presented and the proposed characteristics. In conclusion, the application of the principles of integration to the landscape environment will have a positive acceptance by users, since society and culture can be integrated because natural areas are currently being lost; To this is added that by designing the appropriate spaces, users will be satisfied with these results

Operation Warp Speed: Projects responding to the COVID-19 pandemic

The 2020 COVID-19 pandemic has profound socio-economic consequences. Extraordinary times call for extraordinary measures, so this paper focuses on radical changes to accepted practice in project organizing in response. In particular, we focus on schedule compression to deliver outputs to mitigate the immediate impact of the pandemic on health. In the spirit of engaged scholarship, which is problem-driven rather than theory-driven, we address directly the evidence of what happened in two empirical vignettes and one more substantial case study – the CoronavirusUY app; emergency field hospitals; and vaccine development. We then suggest the implications for project management theory in discussion

Evaluation of the temporary epiphysiodesis procedure using the sherman plate: preliminary results

OBJECTIVE: To evaluate the preliminary results of a technique using temporary epiphysiodesis plates using a Sherman plate in the treatment of disorders and deformities of the lower limbs. METHODS: We retrospectively reviewed 27 patients who underwent temporary epiphysiodesis of the distal femur or proximal tibia with Sherman plates, comprising 28 procedures. The mean age at surgery was 11.2 years (3-15 years). The two-hole plates were made of steel alloy and had a central hole to be used as a guide. The fixation was performed with two 3.5 mm cannulated screws. Indications for treatment were the angular deviations of the lower limbs in valgus (n = 10), varus (n = 2) and mixed (n = 1), limb length discrepancy (n = 9), and the flexion contracture of the knee (n = 5). RESULTS: The mean follow-up period was 11.78 months (± 4.07). We observed only one adverse event (migration of the implant) in a patient who underwent anterior epiphysiodesis of the distal femur for the correction of knee flexion. There were no cases of equipment failure or premature physeal closure. CONCLUSION: The temporary epiphysiodesis procedure using the Sherman plates proved to be easy to execute and was involved with a low rate of complications and lower cost than similar titanium implants. Because it is a procedure with low morbidity, this surgical technique may be indicated for a wide age range and for a variety of disorders of the immature skeleton.OBJETIVO: Avaliar os resultados preliminares da técnica de epifisiodese temporária utilizando-se as placas de Sherman no tratamento de distúrbios e deformidades dos membros inferiores. MÉTODOS: Foram avaliados, retrospectivamente, 27 pacientes submetidos à epifisiodese temporária do fêmur distal ou tíbia proximal com as placas de Sherman, em um total de 28 procedimentos. A idade média no momento da cirurgia foi de 11,2 anos (3-15 anos). Os implantes de dois furos eram confeccionados em liga de aço e apresentavam um orifício central para ser utilizado como guia. A fixação foi feita com dois parafusos canulados de 3,5mm. As indicações para o tratamento foram os desvios angulares dos membros inferiores em valgo (n = 10), varo (n = 2) e mistos (n = 1); discrepância do comprimento dos membros (n = 9); e contratura em flexo do joelho (n = 5). RESULTADOS: O tempo médio de seguimento foi de 11,78 meses (±4,07). Observamos apenas um evento adverso (migração do implante) em um paciente submetido à epifisiodese anterior do fêmur distal para correção de flexo de joelho. Não houve nenhum caso de quebra do material ou fechamento fisário prematuro. CONCLUSÃO: A técnica de epifisiodese temporária com o uso das placas de Sherman mostrou ser de fácil execução e esteve envolvida com um baixo índice de complicações e custo inferior aos implantes similares em titânio. Por ser um procedimento de baixa morbidade, pode ser indicado em uma ampla faixa etária e para uma grande variedade de distúrbios do esqueleto imaturo.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Ortopedia PediátricaUniversidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e TraumatologiaUniversidade Nove de Julho de São Paulo MedicinaUNIFESP, Depto. de Ortopedia e Traumatologia Ortopedia PediátricaUNIFESP, Depto. de Ortopedia e TraumatologiaSciEL

A Utilização do Geogebra na Demonstração Matemática em Sala de Aula: o estudo da reta de Euler

Neste artigo adotamos uma perspetiva de demonstração como forma particular de argumentação matemática. O estudo apresentado envolve uma experiência de ensino no 9.º ano, na qual foram tratadas propriedades do triângulo e seus pontos notáveis. Este estudo segue uma metodologia qualitativa, de carácter interpretativo. Os dados provêm de observação participante, gravações de áudio e vídeo das aulas, produções dos alunos com papel e lápis e no computador e de entrevistas. A partir de figuras construídas no Geogebra, os alunos estruturaram ideias matemáticas e raciocínios e construíram cadeias argumentativas. Os dados analisados mostram que a maioria dos alunos formula e explora conjeturas, procurando caminhos para a sua justificação. Os alunos reconhecem a importância do Geogebra na sua atividade como fator motivador e, acima de tudo, por permitir experimentar e manipular figuras. Os resultados apontam a importância da atividade com o Geogebra, na construção e manipulação como ponto de partida para a demonstração. Palavras-chave: Demonstração. Geometria. Geogebra. Triângulo. Reta de Euler