A geopolítica do COVID-19

A crise sanitária de dimensões mundiais provocada pelo vírus COVID-19 tem resultado em situações semelhantes entre países de economia, cultura e políticas distintas. A acelerada dinâmica de contaminação e indícios que novos arranjos e estágios estão sendo esboçados apontam para possibilidade de mudanças no jogo geopolítico internacional. Um tabuleiro de xadrez onde as peças se movem cuidadosamente. Objetivando analisar seus efeitos socioterritoriais, o texto trata inicialmente da extrema interdependência que a globalização nos levou e dos questionamentos atuais a respeito de um processo inverso – desglobalizar, reterritorializar. Analisa, a seguir, as conjunturas francesa e brasileira e as diferentes medidas adotadas, o efeito territorial do vírus e o aparecimento de ações solidárias por parte de empresas. Um terceiro item explora se o retorno ao uso de produtos e comercio locais poderá significar possibilidades de aceitação e consolidação de novos paradigmas.La crise sanitaire de dimensions mondiales provoquée par le virus COVID-19 crée des situations semblables dans des pays d’économie, de culture et politiques différentes. La dynamique accélérée de la contamination et de ses étapes déjà esquissées indiquent la possibilité de grands changements dans le jeu géopolitique international. Un échiquier où les pièces bougent avec précaution. Avec pour objectif d’analyser ses effets socio-territoriaux, le début de l’article montre l’interdépendance à laquelle la globalisation nous a amenée et les questions actuelles sur un processus inverse – déglobaliser, relocaliser. Il analyse ensuite les conjonctures française et brésilienne et les différentes mesures adoptées, les effets territoriaux du virus et l’apparition d’actions solidaires du côté des entreprises. Un troisième point analyse si le retour à l’usage de produits locaux pourrait signifier des possibilités d’acceptation et de consolidation de nouveaux paradigmes.The global health crisis caused by the COVID-19 virus creates similar situations in countries with different economies, cultures and policies. The accelerated dynamics of contamination and its already outlined stages indicate the possibility of great changes in the international geopolitical game. A chessboard where the pieces move carefully. With the aim of analysing its socio-territorial effects, the beginning of the article shows the interdependence to which globalization has brought us and the current questions on a reverse process - deglobalizing, relocating. So it analyses the French and Brazilian conjunctures and the measures adopted, the territorial effects of the virus and the appearance of solidarity actions by companies. A third point underlines if the return to the use of local products could mean possibilities of acceptance and consolidation of new paradigms.La crisis de salud global causada por el virus COVID-19 ha resultado en situaciones similares entre países con diferentes economías, culturas y políticas. La dinámica acelerada de la contaminación y las indicaciones de que se están esbozando nuevos arreglos y etapas apuntan a la posibilidad de cambios en el juego geopolítico internacional. Un tablero de ajedrez donde las piezas se mueven con cuidado. Con el objetivo de analizar sus efectos socioterritoriales, el texto aborda inicialmente la extrema interdependencia que nos ha traído la globalización y las preguntas actuales sobre un proceso inverso: desglobalizar, reterritorializar. A continuación, analiza las coyunturas francesas y brasileñas y las diferentes medidas adoptadas, el efecto territorial del virus y la aparición de acciones solidarias por parte de las empresas. Un tercer ítem explora si el retorno al uso de productos locales y comercio puede significar posibilidades de aceptación y consolidación de nuevos paradigmas

The Effect of Financial Incentives on Patient Decisions to Undergo Low‐value Head Computed Tomography Scans

BackgroundExcessive diagnostic testing and defensive medicine contribute to billions of dollars in avoidable costs in the United States annually. Our objective was to determine the influence of financial incentives, accompanied with information regarding test risk and benefit, on patient preference for diagnostic testing.MethodsWe conducted a cross‐sectional survey of patients at the University of Michigan emergency department (ED). Each participant was presented with a hypothetical scenario involving an ED visit following minor traumatic brain injury. Participants were given information regarding potential benefit (detecting brain hemorrhage) and risk (developing cancer) of head computed tomography scan, as well as an incentive of $0 or$100 to forego testing. We used 0.1 and 1% for test benefit and risk, and values for risk, benefit, and financial incentive varied across participants. Our primary outcome was patient preference to undergo testing. We also collected demographic and numeracy information. We then used logistic regression to estimate odds ratios (ORs), which were adjusted for multiple potential confounders. Our sample size was designed to find at least 300 events (preference for testing) to allow for inclusion of up to 30 covariates in fully adjusted models. We had 85% to 90% power to detect a 10% absolute difference in testing rate across groups, assuming a 95% significance level.ResultsWe surveyed 913 patients. Increasing test benefit from 0.1% to 1% significantly increased test acceptance (adjusted OR [AOR] = 1.6, 95% confidence interval [CI] = 1.2 to 2.1) and increasing test risk from 0.1% to 1% significantly decreased test acceptance (AOR = 0.70, 95% CI = 0.52 to 0.93). Finally, a $100 incentive to forego low‐value testing significantly reduced test acceptance (AOR = 0.6; 95% CI = 0.4 to 0.8).ConclusionsProviding financial incentives to forego testing significantly decreased patient preference for testing, even when accounting for test benefit and risk. This work is preliminary and hypothetical and requires confirmation in larger patient cohorts facing these actual decisions.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151851/1/acem13823_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151851/2/acem13823-sup-0001-DataSupplementS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151851/3/acem13823.pd

Cetuximab plus platinum-based chemotherapy in head and neck Squamous Cell Carcinoma: a retrospective study in a single Comprehensive European Cancer Institution

Background: The use of cetuximab in combination with platinum (P) plus 5-fluorouracil (F) has previously been demonstrated to be effective in the treatment of metastatic squamous cell cancer of head and neck (SCCHN). We investigated the efficacy and outcome of this protocol as a first-line treatment for patients with recurrent or metastatic disease. We evaluated overall-survival (OS), progression-free-survival (PFS), overall response rate (ORR) and the treatment toxicity profile in a retrospective cohort. Patients and Methods: This study enrolled 121 patients with untreated recurrent or metastatic SCCHN. The patients received PF+ cetuximab every 3 weeks for a maximum of 6 cycles. Patients with stable disease who received PF+ cetuximab continued to receive cetuximab until disease progressed or unacceptable toxic effects were experienced, whichever occurred first. Results: The median patient age was 53 (37-78) years. The patient cohort was 86.8% male. The addition of cetuximab to PF in the recurrent or metastatic setting provided an OS of 11 months (Confidential Interval, CI, 95%, 8.684-13.316) and PFS of 8 months (CI 95%, 6.051-9.949). The disease control rate was 48.9%, and the ORR was 23.91%. The most common grade 3 or 4 adverse events in the PF+ cetuximab regimen were febrile neutropenia (5.7%), skin rash (3.8%) and mucosistis (3.8%). Conclusions: The results of this study suggest that cetuximab plus platinum-fluorouracil chemotherapy is a good option for systemic treatment in advanced SSCHN patients. This regimen has a well-tolerated toxicity profile.info:eu-repo/semantics/publishedVersio

The Songbird Neurogenomics (SoNG) Initiative: Community-based tools and strategies for study of brain gene function and evolution

BACKGROUND: Songbirds hold great promise for biomedical, environmental and evolutionary research. A complete draft sequence of the zebra finch genome is imminent, yet a need remains for application of genomic resources within a research community traditionally focused on ethology and neurobiological methods. In response, we developed a core set of genomic tools and a novel collaborative strategy to probe gene expression in diverse songbird species and natural contexts. RESULTS: We end-sequenced cDNAs from zebra finch brain and incorporated additional sequences from community sources into a database of 86,784 high quality reads. These assembled into 31,658 non-redundant contigs and singletons, which we annotated via BLAST search of chicken and human databases. The results are publicly available in the ESTIMA:Songbird database. We produced a spotted cDNA microarray with 20,160 addresses representing 17,214 non-redundant products of an estimated 11,500–15,000 genes, validating it by analysis of immediate-early gene (zenk) gene activation following song exposure and by demonstrating effective cross hybridization to genomic DNAs of other songbird species in the Passerida Parvorder. Our assembly was also used in the design of the "Lund-zfa" Affymetrix array representing ~22,000 non-redundant sequences. When the two arrays were hybridized to cDNAs from the same set of male and female zebra finch brain samples, both arrays detected a common set of regulated transcripts with a Pearson correlation coefficient of 0.895. To stimulate use of these resources by the songbird research community and to maintain consistent technical standards, we devised a "Community Collaboration" mechanism whereby individual birdsong researchers develop experiments and provide tissues, but a single individual in the community is responsible for all RNA extractions, labelling and microarray hybridizations. CONCLUSION: Immediately, these results set the foundation for a coordinated set of 25 planned experiments by 16 research groups probing fundamental links between genome, brain, evolution and behavior in songbirds. Energetic application of genomic resources to research using songbirds should help illuminate how complex neural and behavioral traits emerge and evolve

Scattering invariant modes of light in complex media

Random scattering of light in disordered media is an intriguing phenomenon of fundamental relevance to various applications. While techniques such as wavefront shaping and transmission matrix measurements have enabled remarkable progress for advanced imaging concepts, the most successful strategy to obtain clear images through a disordered medium remains the filtering of ballistic light. Ballistic photons with a scattering-free propagation are, however, exponentially rare and no method so far can increase their proportion. To address these limitations, we introduce and experimentally implement here a new set of optical states that we term Scattering Invariant Modes (SIMs), whose transmitted field pattern is the same, irrespective of whether they scatter through a disordered sample or propagate ballistically through a homogeneous medium. We observe SIMs that are only weakly attenuated in dense scattering media, and show in simulations that their correlations with the ballistic light can be used to improve imaging inside scattering materials