Iniciativas brasileiras de estudos de intervenção em andamento para a COVID-19

Clinical trials investigating COVID-19 treatments have been carried out worldwide, and also in Brazil. Public registration of research protocols promotes transparency and follows the legislation. Objective: To describe the research protocols under development in Brazil for COVID-19 treatment, and to evaluate the publication after registration in Plataforma Brasil/CONEP. Method: A comprehensive search on the databases ClinicalTrials.gov, ReBEC (Brazilian database) and the International Clinical Trials Registry Platform, was performed on April 11, 2020. The CONEP Bulletin was consulted on April 7, 2020 to assess intervention studies elected for public registration. Results: Our study shows that there are sixteen intervention studies in progress about COVID-19 in Brazil (CONEP registry), however, only six are available in the protocol registry databases. Brazilian open access research protocols investigated interventions with: hydroxychloroquine associated with azithromycin or monotherapy; chloroquine; dexamethasone; mesenchymal stem cells. Five studies (83%) are open and include patients with suspected or confirmed COVID-19 diagnosis. Three studies are multicenter and all include clinically relevant outcomes. Conclusion: Brazil has research protocols in progress for COVID-19 treatment, however only 1/3 of these studies has public protocols available.As pesquisas clínicas relacionadas a COVID-19 estão acontecendo em todo o mundo, inclusive no Brasil. Os registros públicos de protocolos de pesquisa promovem transparência e atendem às regulamentações. Objetivo: Descrever os protocolos de pesquisa em desenvolvimento no Brasil para investigações de alternativas terapêuticas para a COVID-19, e avaliar o cumprimento da publicação após registro na Plataforma Brasil/CONEP. Método: Uma revisão foi realizada nas bases de registro de protocolos de pesquisa: ClinicalTrials.gov,  ReBEC (base brasileira) e International Clinical Trials Registry Platform, no dia 11 de abril de 2020. O boletim da CONEP do dia 07 de abril de 2020 foi consultado para avaliar estudos de intervenção passíveis de registro. Resultados: Nosso estudo mostrou que há dezesseis estudos de intervenção sobre a COVID-19 em andamento no Brasil e registrados na CONEP, porém somente seis estão disponíveis nas bases de registro de protocolos. Os protocolos brasileiros de acesso aberto incluíram a investigação de intervenções com: hidroxicloroquina associada a azitromicina ou em monoterapia; cloroquina; dexametasona; células tronco mesenquimais. Cinco estudos (83%) são abertos e incluíram pacientes com suspeita ou diagnóstico confirmado da COVID-19. Três estudos são multicêntricos e todos propõe a avaliação de desfechos clinicamente relevantes. Conclusão: O Brasil tem protocolos de pesquisa em andamento de intervenções terapêuticas na COVID-19, porém apenas 1/3 destes estudos têm protocolos públicos

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia