Meta‐analysis: oral anti‐viral agents in adults with decompensated hepatitis B virus cirrhosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90203/1/apt4990.pd

Procuring sustainably in social housing: The role of social capital

In order to explore its many complexities, scholars have called for a move beyond, descriptions of sustainable procurement. This study responds by seeking insights into sustainable procurement through the lens of social capital theory. Social capital is conceptualized as comprising cognitive, social and relational elements. Sustainable procurement is seen as a means of pursuing environmental, economic and social goals through the purchasing and supply process. The study, proposes and empirically tests the operational measures of social capital and their relationship with, sustainable procurement activity on a sample of 135 procurement professionals in organizations, providing social housing. The results indicate partial support for the study proposition; structural, social capital, rather than structural, social and relational taken together, is found to be the most robust predictor of sustainable procurement. The results highlight the importance of broadening, collaboration models for sustainable procurement beyond an exclusive focus on dyadic relations. It, also demonstrates that this broader engagement with other stakeholders focused on knowledge creation, as well as knowledge sharing, is a significant contributor to sustainable procurement activity. © 2014 Elsevier Ltd

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Surrogate endpoint biomarkers for cervical cancer chemoprevention trials

Cervical intraepithelia neoplasia (CIN) represents a spectrum of epithelial changes that provide an excellent model for developing chemopreventive interventions for cervical cancer. Possible drug effect surrogate endpoint biomarkers are dependent on the agent under investigation. Published and preliminary clinical reports suggest retinoids and carotenoids are effective chemopreventive agents for CIN. Determination of plasma and tissue pharmacology of these agents and their metabolites could serve as drug effect intermediate endpoints. In addition, retinoic acid receptors could serve as both drug and biological effect intermediate endpoints. Possible biological effect surrogate endpoint biomarkers include cytomorphological parameters, proliferation markers, genomic markers, regulatory markers, and differentiation. Given the demonstrated causality of human papillomavirus (HPV) for cervical cancer, establishing the relationship to HPV will be an essential component of any biological intermediate endpoint biomarker. The pathologic effect surrogate endpoint biomarker for cervical cancer is CIN, used clinically for years. The desired effect for chemopreventive trials is complete regression or prevention of progression. In planning chemopreventive trials, investigators need to consider spontaneous regression rates, the subjective nature of detecting CIN, and the impact of biopsy on regression. If intermediate endpoint biomarkers that met the above criteria were available for cervical cancer, then new chemopreventive agents could be rapidly explored. The efficacy of these new agents could be determined with a moderate number of subjects exposed to minimal risk over an acceptable amount of time. The impacts on health care for women would be significant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38459/1/240590915_ftp.pd

Simulating together multiscale and multisectoral adaptations to global change and their impacts: A generic serious game and its implementation in coastal areas in France and South Africa

In this chapter, we propose a new kind of participatory device designed as a serious game suitable for geoprospective workshops and dedicated to help the setting of multiscale and multisectoral long-term adaptation plans to global change. We explain how and why we combined the concepts of the Coupled Infrastructure System with the paradigm of Multi-Agents System to build a generic conceptual model. We present the two games designed with this framework at this date and describe them precisely from their conceptual models up to examples of results obtained during the participatory sessions organized on the field with real stakeholders. The first example is about the George municipality in South Africa and sessions were organized in coordination with South African National park institution (SAN parks). The second example is about the territory of the Scheme Of Territorial Consistency (SCOT) “South of Gard” department in France and sessions were organized with the SCOT “South of Gard” and other institutions

A New Spinel-Layered Li-Rich Microsphere as a High-Rate Cathode Material for Li-Ion Batteries

Li-rich layered materials are considered to be the promising low-cost cathodes for lithium-ion batteries but they suffer from poor rate capability despite of efforts toward surface coating or foreign dopings. Here, spinel-layered Li-rich Li-Mn-Co-O microspheres are reported as a new high-rate cathode material for Li-ion batteries. The synthetic procedure is relatively simple, involving the formation of uniform carbonate precursor under solvothermal conditions and its subsequent transformation to an assembled microsphere that integrates a spinel-like component with a layered component by a heat treatment. When calcined at 700 \ub0C, the amount of transition metal Mn and Co in the Li-Mn-Co-O microspheres maintained is similar to at 800 \ub0C, while the structures of constituent particles partially transform from 2D to 3D channels. As a consequence, when tested as a cathode for lithium-ion batteries, the spinel-layered Li-rich Li-Mn-Co-O microspheres obtained at 700 \ub0C show a maximum discharge capacity of 185.1 mA h g−1 at a very high current density of 1200 mA g−1 between 2.0 and 4.6 V. Such a capacity is among the highest reported to date at high charge-discharge rates. Therefore, the present spinel-layered Li-rich Li-Mn-Co-O microspheres represent an attractive alternative to high-rate electrode materials for lithium-ion batteries