Available evidence and outcome of off-label use of rituximab in clinical practice

Purpose: To analyze the therapeutic indications for off-label use of rituximab, the available evidence for its use, the outcomes, and the cost. Methods: This was a retrospective analysis of patients treated with rituximab for off-label indications from January 2007 to December 2009 in two tertiary hospitals. Information on patient characteristics, medical conditions, and therapeutic responses was collected from medical records. Available evidence for the efficacy of rituximab in each condition was reviewed, and the cost of treatment was calculated. Results: A total of 101 cases of off-label rituximab use were analyzed. The median age of the patients involved was 53 [interquartile range (IQR) 37.5-68.0] years; 55.4 % were women. The indications for prescribing rituximab were primarily hematological diseases (46 %), systemic connective tissue disorders (27 %), and kidney diseases (20 %). Available evidence supporting rituximab treatment for these indications mainly came from individual cohort studies (53.5 % of cases) and case series (25.7 %). The short-term outcome (median 3 months, IQR 2-4 months) was a complete response in 38 % of cases and partial response in 32.6 %. The highest short-term responses were observed for systemic lupus erythematosus and membranous glomerulonephritis, and the lowest was for neuromyelitis optica, idiopathic thrombocytopenic purpura, and miscellaneous indications. Some response was maintained in long-term follow-up (median 23 months IQR 12-30months) in 69.2%of patients showing a short-term response. Median cost per patient was 5,187.5 (IQR 5,187.5-7,781.3). Conclusions: In our study, off-label rituximab was mainly used for the treatment of hematological, kidney, and systemic connective tissue disorders, and the response among our patient cohort was variable depending on the specific disease. The level of evidence supporting the use of rituximab for these indications was low and the cost was very high. We conclude that more clinical trials on the off-label use of rituximab are needed, although these may be difficult to conduct in some rare diseases. Data from observational studies may provide useful information to assist prescribing in clinical practice.

Psychometric Properties of the Spanish Human System Audit Short-Scale of Transformational Leadership

The aim of this research is to examine the psychometric properties of a Spanish version of the Human System Audit transformational leadership short-scale (HSA-TFL-ES). It is based on the concept of Bass developed in 1985. The HSA-TFL is a part of the wider Human System Audit frame. We analyzed the HSA-TFL-ES in five different samples with a total number of 1,718 workers at five sectors. Exploratory Factor Analysis corroborated a single factor in all samples that accounted for 66% to 73% of variance. The internal consistency in all samples was good (α = .92 - .95). Evidence was found for the convergent validity of the HSA-TFL-ES and the Multifactor Leadership Questionnaire. These results suggested that the HSA-TFL short-scale is a psychometrically sound measure of this construct and can be used for a combined and first overall measurement.

Prevalence of Ischemic Heart Disease and Management of Coronary Risk in Daily Clinical Practice: Results from a Mediterranean Cohort of HIV-Infected Patients

There are conflicting data on the prevalence of coronary events and the quality of the management of modifiable cardiovascular risk factors (CVRF) inHIV-infected patients. Methods.We performed a retrospective descriptive study to determine the prevalence of coronary events and to evaluate the management of CVRF in a Mediterranean cohort of 3760 HIV-1-infected patients from April 1983 through June 2011. Results.We identified 81 patients with a history of a coronary event (prevalence 2.15%); 83% of them suffered an acute myocardial infarction. At the time of the coronary event, CVRF were highly prevalent (60.5% hypertension, 48% dyslipidemia, and 16% diabetes mellitus).OtherCVRF, such as smoking, hypertension, lack of exercise, and body mass index, were not routinely assessed. After the coronary event, a significant decrease in total cholesterol ( � = 0.025) and LDLcholesterol ( � = 0.004) was observed. However, the percentage of patients whomaintained LDL-cholesterol > 100mg/dL remained stable (from 46% to 41%, � = 0.103). Patients using protease inhibitors associated with a favorable lipid profile increased over time ( � = 0.028). Conclusions.The prevalence of coronary events in our cohort is low. CVRF prevalence is high and theirmanagement is far from optimal. More aggressive interventions should be implemented to diminish cardiovascular risk in HIV-infected patients.

Flocking behaviour: Agent-based simulation and hierarchical leadership.

We have studied how leaders emerge in a group as a consequence of interactions among its members. We propose that leaders can emerge as a consequence of a self-organized process based on local rules of dyadic interactions among individuals. Flocks are an example of self-organized behaviour in a group and properties similar to those observed in flocks might also explain some of the dynamics and organization of human groups. We developed an agent-based model that generated flocks in a virtual world and implemented it in a multi-agent simulation computer program that computed indices at each time step of the simulation to quantify the degree to which a group moved in a coordinated way (index of flocking behaviour) and the degree to which specific individuals led the group (index of hierarchical leadership). We ran several series of simulations in order to test our model and determine how these indices behaved under specific agent and world conditions. We identified the agent, world property, and model parameters that made stable, compact flocks emerge, and explored possible environmental properties that predicted the probability of becoming a leader.

Learning analytics in practice: setting up a laboratory for action research at the Universitat Oberta de Catalunya

Since its inception in 1994 as a purely online university, the Universitat Oberta de Catalunya(UOC) has been able to position itself among the main universities of the Catalan and Spanish university systems. Most of the students at the UOC (currently more than 60,000) are adults who have a profile that could hardly fit into the traditional university system, thus finding in the UOC an opportunity to start or continue their higher education grades, in a very innovative environment. The intensive use of ICT for both theteaching/learning processes and management allowsresearchers and practitioners to obtain data aboutwhat takes place in the UOC Virtual Campus, which is continuously being improved according to suchfindings.

Mobility Among Social Education Students at the University of Girona: Taking Stock of a Decade of Fieldwork Practice Abroad

The following article is divided into five sections, each one with a specific objective. The first section briefly presents the student mobility experiences obtained basically through the fieldwork practice course in social education studies at the University of Girona. The second section delves more deeply to explore the value of the exchange and the student mobility experience over one semester of intensive fieldwork practice. The third section presents data about the students who have participated in this experience inall ten of the graduating classes. The fourth part offers an assessment of the experience and reports which aspects are considered essential to a good student mobility experience. Finally, various actions to be taken to improve these educational experiences within the social education studies at the University of Girona are specified

Personal constructs in systemic practice

This paper intends to elaborate the relationship between Kelly's Personal Construct Theory (PCT) and the systemic therapies beyond their notable similarities. Kelly's constructive alternativism is situated in the context of the current constructivist orientation that the family therapy movement seems to be adopting. A model of change is presented based on PCT's experience cycle. From this cycle, the relationship between behaviors and constructions is elaborated incorporating Procter's (52, 53) notions of the Family Construct System (FCS) andposition. This model allows for interventions both at behavioral and construction levels, as well as allowing for a certain technical eclecticism while, at the same time, retaining a strong theoretical coherence. This approach is discussed in the context of the debate about strategizing, power, and control held by authors such as Golann, Hoffman, and Tomm. Finally, some implications for research are outlined.

Early Childhood Mathematics Education: Research, Curriculum and Educational Practice

This article reviews data obtained through research into early childhood mathematics education in Spain. It analyses the current curricular directions in mathematics education with early learners. It also provides an overview of mathematical practices in early childhood education classrooms to analyse the commonalities and differences between research, curriculum and educational practice. A review of the research presented at SEIEM symposia from 1997 until 2012 demonstrates: a) very little research has been done, a trend that is repeated in other areas, such as the JCR-Social Sciences Edition or the PME; b) the first steps have been taken to create a more and more cohesive body of research, although until now there has not been enough data to outline the curricular directions; and c) some discrepancies still exist between the mathematical practices in early childhood education classrooms and the official guidelines