Progress on core outcomes sets for critical care research

Purpose of review: Appropriate selection and definition of outcome measures are essential for clinical trials to be maximally informative. Core outcome sets (an agreed, standardized collection of outcomes measured and reported in all trials for a specific clinical area) were developed due to established inconsistencies in trial outcome selection. This review discusses the rationale for, and methods of, core outcome set development, as well as current initiatives in critical care.

Recent findings: Recent systematic reviews of reported outcomes and measurement instruments relevant to the critically ill highlight inconsistencies in outcome selection, definition, and measurement, thus establishing the need for core outcome sets. Current critical care initiatives include development of core outcome sets for trials aimed at reducing mechanical ventilation duration; rehabilitation following critical illness; long-term outcomes in acute respiratory failure; and epidemic and pandemic studies of severe acute respiratory infection.

Summary: Development and utilization of core outcome sets for studies relevant to the critically ill is in its infancy compared to other specialties. Notwithstanding, core outcome set development frameworks and guidelines are available, several sets are in various stages of development, and there is strong support from international investigator-led collaborations including the International Forum for Acute Care Trialists.

Low luminosity TypeII supernovae-II. Pointing towards moderate mass precursors

We present new data for five underluminous Type II-plateau supernovae (SNe IIP), namely SN 1999gn, SN 2002gd, SN 2003Z, SN 2004eg and SN 2006ov. This new sample of lowluminosity SNe IIP (LL SNe IIP) is analysed together with similar objects studied in the past. All of them show a flat light-curve plateau lasting about 100 d, an underluminous late-time exponential tail, intrinsic colours that are unusually red, and spectra showing prominent and narrow P Cygni lines. A velocity of the ejected material below 10³ km s^-1 is inferred from measurements at the end of the plateau. The 56Ni masses ejected in the explosion are very small (≤10^-2 M⊙). We investigate the correlations among ⁵⁶Ni mass, expansion velocity of the ejecta and absolute magnitude in the middle of the plateau, confirming the main findings of Hamuy, according to which events showing brighter plateau and larger expansion velocities are expected to produce more 56Ni. We propose that these faint objects represent the LL tail of a continuous distribution in parameters space of SNe IIP. The physical properties of the progenitors at the explosion are estimated through the hydrodynamical modelling of the observables for two representative events of this class, namely SN 2005cs and SN 2008in. We find that the majority of LL SNe IIP, and quite possibly all, originate in the core collapse of intermediate-mass stars, in the mass range 10-15 M⊙. 

The nebular spectra of SN 2012aw and constraints on stellar nucleosynthesis from oxygen emission lines

We present nebular-phase optical and near-infrared spectroscopy of the Type IIP supernova SN 2012aw combined with non-local thermodynamic equilibrium radiative transfer calculations applied to ejecta from stellar evolution/explosion models. Our spectral synthesis models generally show good agreement with the ejecta from a M_ZAMS = 15 M_⊙progenitor star. The emission lines of oxygen, sodium, and magnesium are all consistent with the nucleosynthesis in a progenitor in the 14-18 M_⊙ range.We also demonstrate how the evolution of the oxygen cooling lines of [O I] λ5577, [O I] λ6300, and [O I] λ6364 can be used to constrain the mass of oxygen in the non-molecularly cooled ashes to < 1 M_⊙, independent of the mixing in the ejecta. This constraint implies that any progenitor model of initial mass greater than 20 M_⊙ would be difficult to reconcile with the observed line strengths. A stellar progenitor of around M_ZAMS = 15 M_⊙ can consistently explain the directly measured luminosity of the progenitor star, the observed nebular spectra, and the inferred pre-supernova mass-loss rate.We conclude that there is still no convincing example of a Type IIP supernova showing the nucleosynthesis products expected from an M_ZAMS > 20 M_⊙ progenitor. © 2014 The Author. Published by Oxford University Press on behalf of the Royal Astronomical Society.

The Positives of Caregiving: Mothers’ Experiences Caregiving for a Child With Autism

Most research in the field of autism focuses on the medical and psychological characteristics of the disability. Research that focuses on caregiving emphasizes the stresses and pathological features associated with having a child with autism. As such, the more positive aspects of caregiving have been left in abeyance, portraying caregiving and autism as characterized by only negative experiences, prognoses, and outcomes. Based on mothers’ reflections, this article reports on some of the positives of caregiving. The findings provide a glimpse into a seldom studied side of caregiving—events and experiences appraised by mothers in a positive and sometimes joyous light—and the impact they have on mothers’ experiences. Furthermore, practical implications for social service professionals and families are discussed.

Thiol isomerases negatively regulate the cellular shedding activity of ADAM17

ADAM17 (where ADAM is 'a disintegrin and metalloproteinase') can rapidly modulate cell-surface signalling events by the proteolytic release of soluble forms of proligands for cellular receptors. Many regulatory pathways affect the ADAM17 sheddase activity, but the mechanisms for the activation are still not clear. We have utilized a cell-based ADAM17 assay to show that thiol isomerases, specifically PDI (protein disulfide isomerase), could be responsible for maintaining ADAM17 in an inactive form. Down-regulation of thiol isomerases, by changes in the redox environment (for instance as elicited by phorbol ester modulation of mitochondrial reactive oxygen species) markedly enhanced ADAM17 activation. On the basis of ELISA binding studies with novel fragment antibodies against ADAM17 we propose that isomerization of the disulfide bonds in ADAM17, and the subsequent conformational changes, form the basis for the modulation of ADAM17 activity. The shuffling of disulfide bond patterns in ADAMs has been suggested by a number of recent adamalysin crystal structures, with distinct disulfide bond patterns altering the relative orientations of the domains. Such a mechanism is rapid and reversible, and the role of thiol isomerases should be investigated further as a potential factor in the redox regulation of ADAM17.

The prognostic and therapeutic value of EpHA2 in early colorectal cancer (CRC).

Background: EpHA2 is a 130 kD transmembrane glycoprotein belonging to ephrin receptor subfamily and involved in angiogenesis/tumour neovascularisation. High EpHA2 mRNA level has recently been implicated in cetuximab resistance. Previously, we found high EpHA2 levels in a panel of invasive colorectal cancer (CRC) cells, which was associated with high levels of stem-cell marker CD44. Our aim was to investigate the prognostic value of EpHA2 and subsequently correlate expression levels to known clinico-pathological variables in early stage CRC. Methods: Tissue samples from 509 CRC patients were analysed. EpHA2 expression was measured using IHC. Kaplan-Meier graphs were used. Univariate and multivariate analyses employed Cox Proportional Hazards Ratio (HR) method. A backward selection method (Akaike’s information criterion) was used to determine a refined multivariate model. Results: EpHA2 was highly expressed in CRC adenocarcinoma compared to matched normal colon tissue. In support of our preclinical invasive models, strong correlation was found between EpHA2 expression and CD44 and Lgr5 staining (p<0.001). In addition, high EpHA2 expression significantly correlated with vascular invasion (p=0.03).HR for OS for stage II/III patients with high EpHA2 expression was 1.69 (95%CI: 1.164-2.439; p=0.003). When stage II/III was broken down into individual stages, there was significant correlation between high EpHA2 expression and poor 5-years OS in stage II patients (HR: 2.18; 95%CI: 1.28-3.71; p=0.005).HR in the stage III group showed a trend to statistical significance (HR: 1.48; 95%CI=0.87-2.51; p=0.05). In both univariate and multivariate analyses of stage II patients, high EpHA2 expression was the only significant factor and was retained in the final multivariate model. Higher levels of EpHA2 were noted in our RAS and BRAF mutant CRC cells, and silencing EpHA2 resulted in significant decreases in migration/invasion in parental and invasive CRC sublines. Correlation between KRAS/NRAS/BRAFmutational status and EpHA2 expression in clinical samples is ongoing. Conclusions: Taken together, our study is the first to indicate that EpHA2 expression is a predictor of poor clinical outcome and a potential novel target in early stage CRC.

Multiplicity results for some classes of Schrödinger-Poisson systems

In this thesis, we study the existence and multiplicity of solutions of the following class of Schr odinger-Poisson systems: u + u + l(x) u = (x; u) in R3; = l(x)u2 in R3; where l 2 L2(R3) or l 2 L1(R3). And we consider that the nonlinearity satis es the following three kinds of cases: (i) a subcritical exponent with (x; u) = k(x)jujp 2u + h(x)u (4 p < 2 ) under an inde nite case; (ii) a general inde nite nonlinearity with (x; u) = k(x)g(u) + h(x)u; (iii) a critical growth exponent with (x; u) = k(x)juj2 2u + h(x)jujq 2u (2 q < 2 ). It is worth mentioning that the thesis contains three main innovations except overcoming several di culties, which are generated by the systems themselves. First, as an unknown referee said in his report, we are the rst authors concerning the existence of multiple positive solutions for Schr odinger- Poisson systems with an inde nite nonlinearity. Second, we nd an interesting phenomenon in Chapter 2 and Chapter 3 that we do not need the condition R R3 k(x)ep 1dx < 0 with an inde nite noncoercive case, where e1 is the rst eigenfunction of +id in H1(R3) with weight function h. A similar condition has been shown to be a su cient and necessary condition to the existence of positive solutions for semilinear elliptic equations with inde nite nonlinearity for a bounded domain (see e.g. Alama-Tarantello, Calc. Var. PDE 1 (1993), 439{475), or to be a su cient condition to the existence of positive solutions for semilinear elliptic equations with inde nite nonlinearity in RN (see e.g. Costa-Tehrani, Calc. Var. PDE 13 (2001), 159{189). Moreover, the process used in this case can be applied to study other aspects of the Schr odinger-Poisson systems and it gives a way to study the Kirchho system and quasilinear Schr odinger system. Finally, to get sign changing solutions in Chapter 5, we follow the spirit of Hirano-Shioji, Proc. Roy. Soc. Edinburgh Sect. A 137 (2007), 333, but the procedure is simpler than that they have proposed in their paper.

Actas del Consejo Técnico 2004

Sesiones ordinarias y ordinarias

An evaluation of the accuracy of models for the determination of the weighted mean temperature of the atmosphere

The estimates of the zenith wet delay resulting from the analysis of data from space techniques, such as GPS and VLBI, have a strong potential in climate modeling and weather forecast applications. In order to be useful to meteorology, these estimates have to be converted to precipitable water vapor, a process that requires the knowledge of the weighted mean temperature of the atmosphere, which varies both in space and time. In recent years, several models have been proposed to predict this quantity. Using a database of mean temperature values obtained by ray-tracing radiosonde profiles of more than 100 stations covering the globe, and about 2.5 year’s worth of data, we have analyzed several of these models. Based on data from the European region, we have concluded that the models provide identical levels of precision, but different levels of accuracy. Our results indicate that regionally-optimized models do not provide superior performance compared to the global models.

Percepções das famílias e dos profissionais acerca das práticas de apoio precoce no Algarve

Dissertação de mest., Psicologia, Especialização em Psicologia da Saúde, Faculdade de Ciências Humanas e Sociais, Universidade do Algarve, 2008

Élaboration d'une grille d'analyse des conceptions de l'apprentissage sous-jacentes à des sites Internet destinés à l'enseignement des sciences au secondaire

Les progrès récents dans le domaine des technologies de l'information et de la communication (TIC) ouvrent de nouvelles possibilités pour l'enseignement en général et pour celui des sciences en particulier. Les efforts gouvernementaux en cette matière indiquent le caractère pour le moins irréversible de la percée des TIC en éducation et de la nécessite de se pencher sur le matériel qui est offert. Plus particulièrement, nous nous sommes intéressés à la question des conceptions de l'apprentissage qui peuvent sous-tendre l'élaboration d'un site Internet pour l'enseignement des sciences au secondaire. Cette recherche est de type développement. Elle s'intéresse à l'enseignement des sciences au secondaire et au matériel disponible dans Internet. Elle se limite aux premières étapes particulières à ce type de recherche, soit celles de l'exploration de la littérature, de la validation des énoncés par un comité d'experts et de l'élaboration d'une grille d'analyse des conceptions de l'apprentissage sous-jacentes aux sites Internet. Le but de cette recherche est de construire un outil d'analyse des conceptions de l'apprentissage sous-jacentes à des sites Internet pour l'enseignement des sciences au secondaire."--Résumé abrégé par UMI.

Liderança e bem-estar: o caso da hotelaria de cinco estrelas no Algarve

Esta investigação teve como objetivo compreender e descrever o bem-estar na hotelaria de cinco estrelas através da ação das chefias promotoras de bem-estar. Foi analisado o conceito de liderança, entendido como um processo de influência social mútuo entre líder e liderado, considerado como um fenómeno transversal às organizações humanas, construído no seio do grupo numa dinâmica relacional e num diálogo permanente entre génese e estrutura, ação e investigação. Foi igualmente analisado o conceito de bem-estar entendido como um constructo subjetivo multidisciplinar complexo percecionado pelo indivíduo, segundo critérios padronizados e avaliados somente por este, que integra uma componente cognitiva e uma componente afetiva, constituindo um fenómeno social estudado ao nível do indivíduo e da organização. Foram descritas as teorias da liderança e do bem-estar contemporâneas, apresentadas e desenvolvidas numa perspetiva de evolução histórica e de contributo mútuo para o enriquecimento da relevância social dos indivíduos nas organizações, salientando-se as teorias da liderança cujo quadro teórico nos leva à compreensão do objetivo da investigação, bem como as teorias da motivação e espiritualidade no trabalho. Por forma a diferenciar as perceções que os colaboradores apresentam dos chefes que promovem e dos que não promovem o bem-estar, foi utilizada a teoria dos constructos de George Kelly possibilitando a utilização de um questionário administrado a colaboradores de seis hotéis de cinco estrelas no Algarve. Foram validados para análise estatística 439 questionários e realizadas 33 entrevistas a chefias promotoras e não promotoras de bem-estar, tratadas por análise de conteúdo tendo em conta a obtenção da objetividade necessária para a interpretação do discurso das chefias retendo as principais diferenças entre os dois grupos. Os resultados mostraram que a liderança promotora de bem-estar se constrói em torno de duas dimensões – competências relacionais e competências da tarefa. As entrevistas às chefias comprovaram estes resultados na medida em que ficou demonstrado que as chefias promotoras de bem-estar e não promotoras de bem-estar apresentam diferenças significativas quanto à forma como constroem e desempenham o seu papel. Este trabalho contribuiu para a compreensão da liderança e do bem-estar na hotelaria de cinco estrelas, mostrando que a liderança promotora de bem-estar é um processo interpessoal, de transparência relacional e influência organizacional, orientado para o desempenho organizacional focalizado no autodesenvolvimento dos colaboradores.