Guía de orientación en la práctica profesional de la valoración reglamentaria de la situación de dependencia en personas con esclerosis múltiple y otras enfermedades desmielinizantes

La presente guía tiene el objetivo de ser un instrumento útil en la práctica profesional de la valoración oficial de la situación de dependencia en personas con Esclerosis Múltiple (EM) y otras Enfermedades Desmielinizantes (o ED), y servir de apoyo a la formación de los profesionales de los órganos de valoración. Con esta finalidad se ha realizado una revisión de las condiciones de salud de este colectivo que pueden dar lugar a situación de dependencia, en aplicación del Baremo de Valoración de la Dependencia (BVD), aprobado por Real Decreto 174/2011, de 11 de febrero.47 pp

Paradoxical Pulmonary Event Under Tocilizumab Treatment for Systemic Sclerosis-Associated Usual Interstitial Pneumonia

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The Acidity of a Carbon Nucleophile Dictates Enantioselectivity and Reactivity in Michael Additions to Aromatic and Aliphatic Enals via Iminium Activation

The Michael addition of activated methylenes to β-substituted α,β-unsaturated aldehydes (enals) via iminium catalysis takes place following reactivity and enantioselectivity patterns which depend on the electronic nature of the substituent in the β position (β-aryl or β-alkyl). Application of the same reaction conditions to both families of enals may result in erratic levels of asymmetric induction in the reactions of β-aryl enals or low reactivity with β-alkyl enals. A systematic analysis of this behavior using phenylacetic acid derivatives as case studies has led us to find a general trend: the different problems found for β-aryl and β-alkyl enals depend on the acidity of the nucleophile, and the outcome of the reaction for both types of enals can be improved substantially by careful choice of catalyst, solvent, and additive. Furthermore, this study has allowed us to understand subtle aspects of this transformation and has enabled the formulation of a general and reliable protocol to obtain high yields and enantioselectivities consistently, regardless of the acidity of the nucleophile and the nature of the substituent (aromatic or aliphatic) at the β positionWe thank CTQ-2009-12168, CAM (AVANCAT CS2009/PPQ-1634), UAM-CAM (CCG10-UAM/PPQ-5769), CTQ-2012-35957, CTQ2015-63997-C2-1-P, CTQ2016-78779-R and FOTOCARBON-CAM S2013/MIT-2841 for financial support. S.D. thanks the Comunidad Autónoma de Madrid (CAM), and E.R. and S.M. thank MICINN, for predoctoral fellowships. P.M. thanks MICINN for a Ramón y Cajal contract and the EU for a Marie Curie grant (CIG: HYPERCAT-30422

Desenvolvimento de um Repositório de Imagens e Base de Dados Portuguesa de Casos COVID-19: Aprendizagem e Partilha de Conhecimento em Tempo de Pandemia

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Dimensionality reduction and optimization for the inverse design of photonic integrated devices

The widespread use of metamaterials and non-trivial geometries has radically changed the way photonic integrated devices are developed, opening new design possibility and allowing for unprecedented performance. Yet, these devices are often described by a large number of interrelated parameters which cannot be handled manually, requiring innovative design approaches for their effective optimization. In this invited talk, we will discuss the potentiality offered by the combination of machine learning dimensionality reduction and multi-objective optimization for the design of high performance photonic integrated device

Subwavelength metamaterial devices with optimization and machine learning

Subwavelength metamaterials allow to synthesize tailored optical properties which enabled the demonstration of photonic devices with unprecedented performance and scale of integration. Yet, the development of metamaterial-based devices often involves a large number of interrelated parameters and figures of merit whose manual design can be impractical or lead to suboptimal solutions. In this invited talk, we will discuss the potentiality offered by multi-objective optimization and machine learning for the design of high-performance photonic devices based on metamaterials. We will present both integrated devices for on-chip photonic systems as well as recent advances in the development of devices for free-space applications and optical beam control

Sources of Community Health Worker Motivation: A Qualitative Study in Morogoro Region, Tanzania.

There is a renewed interest in community health workers (CHWs) in Tanzania, but also a concern that low motivation of CHWs may decrease the benefits of investments in CHW programs. This study aimed to explore sources of CHW motivation to inform programs in Tanzania and similar contexts. We conducted semi-structured interviews with 20 CHWs in Morogoro Region, Tanzania. Interviews were digitally recorded, transcribed, and coded prior to translation and thematic analysis. The authors then conducted a literature review on CHW motivation and a framework that aligned with our findings was modified to guide the presentation of results. Sources of CHW motivation were identified at the individual, family, community, and organizational levels. At the individual level, CHWs are predisposed to volunteer work and apply knowledge gained to their own problems and those of their families and communities. Families and communities supplement other sources of motivation by providing moral, financial, and material support, including service fees, supplies, money for transportation, and help with farm work and CHW tasks. Resistance to CHW work exhibited by families and community members is limited. The organizational level (the government and its development partners) provides motivation in the form of stipends, potential employment, materials, training, and supervision, but inadequate remuneration and supplies discourage CHWs. Supervision can also be dis-incentivizing if perceived as a sign of poor performance. Tanzanian CHWs who work despite not receiving a salary have an intrinsic desire to volunteer, and their motivation often derives from support received from their families when other sources of motivation are insufficient. Policy-makers and program managers should consider the burden that a lack of remuneration imposes on the families of CHWs. In addition, CHWs' intrinsic desire to volunteer does not preclude a desire for external rewards. Rather, adequate and formal financial incentives and in-kind alternatives would allow already-motivated CHWs to increase their commitment to their work

Practicing governance towards equity in health systems: LMIC perspectives and experience

The unifying theme of the papers in this series is a concern for understanding the everyday practice of governance in low- and middle-income country (LMIC) health systems. Rather than seeing governance as a normative health system goal addressed through the architecture and design of accountability and regulatory frameworks, these papers provide insights into the real-world decision-making of health policy and system actors. Their multiple, routine decisions translate policy intentions into practice – and are filtered through relationships, underpinned by values and norms, influenced by organizational structures and resources, and embedded in historical and socio-political contexts. These decisions are also political acts – in that they influence who accesses benefits and whose voices are heard in decisionmaking, reinforcing or challenging existing institutional exclusion and power inequalities. In other words, the everyday practice of governance has direct impacts on health system equity. The papers in the series address governance through diverse health policy and system issues, consider actors located at multiple levels of the system and draw on multi-disciplinary perspectives. They present detailed examination of experiences in a range of African and Indian settings, led by authors who live and work in these settings. The overall purpose of the papers in thisISIScopu