Outcomes of patients on dual-boosted PI regimens: experience of the Swiss HIV cohort study.

Dual-boosted protease inhibitors (DBPI) are an option for salvage therapy for HIV-1 resistant patients. Patients receiving a DBPI in the Swiss HIV Cohort Study between January1996 and March 2007 were studied. Outcomes of interest were viral suppression at 24 weeks. 295 patients (72.5%) were on DBPI for over 6 months. The median duration was 2.2 years. Of 287 patients who had HIV-RNA >400 copies/ml at the start of the regimen, 184 (64.1%) were ever suppressed while on DBPI and 156 (54.4%) were suppressed within 24 weeks. The median time to suppression was 101 days (95% confidence interval 90-125 days). The median number of past regimens was 6 (IQR, 3-8). The main reasons for discontinuing the regimen were patient's wish (48.3%), treatment failure (22.5%), and toxicity (15.8%). Acquisition of HIV through intravenous drug use and the use of lopinavir in combination with saquinavir or atazanavir were associated with an increased likelihood of suppression within 6 months. Patients on DBPI are heavily treatment experienced. Viral suppression within 6 months was achieved in more than half of the patients. There may be a place for DBPI regimens in settings where more expensive alternates are not available.

The GraftConnector experience. Long-term patency and histological work up in an animal model.

BACKGROUND: A device to perform sutureless end-to-side coronary artery anastomosis has been developed by means of stent technology (GraftConnector). The present study assesses the long-term quality of the GraftConnector anastomosis in a sheep model. METHODS: In 8 adult sheep, 40-55 kg in weight, through left anterior thoracotomy, the right internal mammary artery (RIMA) was prepared and connected to the left anterior descending artery (LAD) by means of GraftConnector, on beating heart, without using any stabilizer. Ticlopidine 250 mg/day for anticoagulation for 4 weeks and Aspirin 100 mg/day for 6 months were given. The animals were sacrificed after 6 months and histological examination of anastomoses was carried out after slicing with the connector in situ for morphological analysis. RESULTS: All animals survived at 6 months. All anastomoses were patent and mean luminal width at histology was 1.8 +/- 0.2 mm; mean myotomia hyperplasia thickness was 0.21 +/- 0.1 mm. CONCLUSIONS: Long-term results demonstrate that OPCABGs performed with GraftConnector had 100% patency rate. The mean anastomotic luminal width corresponds to mean LAD's adult sheep diameter. We may speculate that myotomia hyperplasia occurred as a result of local device oversizing.

Comunicação de Marketing na Formação da Imagem dos Destinos Turísticos: o caso de Cabo Verde

Segundo a Organização Mundial do Turismo (OMT), o turismo é a maior indústria do séc. XXI gerando anualmente milhares de milhões de dólares em divisas para a economia de inúmeros países. Por apresentar um conjunto de características muito específicas, o sucesso desta actividade é fortemente condicionado pela imagem que os turistas e potenciais turistas apresentam relativamente a um determinado destino. Apesar de existirem muitos factores que interferem na formação desta imagem, a comunicação de marketing é apontada, pelos investigadores, como um dos elementos que desempenha um papel crucial neste âmbito. O objecto do presente trabalho de investigação é a comunicação de marketing na formação da imagem dos destinos turísticos particularizando o arquipélago de Cabo Verde. O principal objectivo da pesquisa, é analisar a eficácia da comunicação de marketing de três organizações (Cabo Verde – Investimentos, União Nacional dos Operadores Turísticos e operador Soltropico), na promoção do arquipélago de Cabo Verde, enquanto destino turístico, no mercado português. Para a realização deste estudo empírico, foram definidas três hipóteses. Essas hipóteses foram testadas através do cruzamento da informação proveniente de uma entrevista realizada aos directores de marketing de cada uma das três organizações, com os dados obtidos a partir da análise de conteúdo dos instrumentos de comunicação que têm vindo a ser utilizados pelas respectivas entidades para promover o destino e com as respostas de um conjunto de 115 turistas portugueses, a um questionário cujo assunto se encontra relacionado com os principais atributos de Cabo Verde enquanto destino de férias. A investigação realizada permitiu verificar que, de uma forma geral, existe uma sintonia entre os atributos de Cabo Verde que as organizações têm intenção de divulgar, os atributos deste destino que são transmitidos pelos seus instrumentos comunicação e os principais atributos do arquipélago indicados pelos turistas portugueses. Contudo, os resultados do estudo revelam também a necessidade de se introduzir algumas correcções a nível de conteúdos e imagens que se encontram presentes nos instrumentos de comunicação de algumas das organizações, visando a criação de uma imagem mais atractiva deste destino.

Fathers of girls, fathers of boys: influence of child's gender on fathers' experience of, engagement in, and representations of paternity.

The aim of this study was to examine the influence of child's gender on several dimensions-of paternity: the fathers' personal experience of paternity, their involvement in child rearing, and their representations. A total of 147 Swiss fathers of 18-month-old children (65 girls and 82 boys) relationship to the child or relationship with the child's completed questionnaires. The child's gender had little influence on paternal experience, mother. Globally, the fathers took on few responsibilities which were largely devolved to mothers. Fathers of boys were more involved in child care than fathers of girls. Finally, a discrepancy was found between the fathers representations of paternal roles in rearing girls and boys and the actual level of responsibility that fathers adopted in their relationship with their child.

Recurrent Hepatitis C After Liver Transplantation Experience of the First 21 Patients Treated in Lausanne

BACKGROUND AND AIM: Recurrent hepatitis C is a major cause of morbidity and mortality after liver transplantation (LT), and optimal treatment algorithms have yet to be defined. Here, we present our experience of the first 21 patients with recurrent hepatitis C treated in Lausanne. PATIENTS AND METHODS: Twenty-one patients with histologyproven recurrent hepatitis C after LT were treated since 2003. Treatment was initiated with pegylated interferon-α2a 135 μg per week and ribavirin 400 mg per day in the majority of patients, and subsequent doses were adapted individually based on on-treatment virological responses and clinical and/or biochemical side effects. RESULTS: On an intention-to-treat basis, sustained virological response (SVR) was achieved in 12/21 (57%) patients (5/11 [45%], 2/3 [67%], 4/5 [80%] and 1/2 [50%] of patients infected with genotypes 1, 2, 3 and 4, respectively). Two patients experienced relapse and 6 did not respond to treatment (NR). Treatment duration ranged from 24 to 90 weeks. It was stopped prematurely due to adverse events in 5/21 (24%) patients (with SVR achieved in 2 patients, NR in 2 patients, and death of one patient awaiting re-transplantation). Of note, SVR was achieved in a patient with combined liver and kidney transplantation. Importantly, SVR was achieved in some patients despite the lack of an early virological response or HCV RNA negativity at week 24. Darbepoetin α and filgrastim were used in 33% and 14%, respectively. CONCLUSION: Individually adapted treatment of recurrent hepatitis C can achieve SVR in a substantial proportion of LT patients. Conventional stopping rules do not apply in this setting so that prolonged therapy may be useful in selected patients.

The network social support experience of people involved in home care

Objective: To build a theoretical model to configure the network social support experience of people involved in home care. Method: A quantitative approach research, utilizing the Grounded Theory method. The simultaneous data collection and analysis allowed the interpretation of the phenomenon meaning The network social support of people involved in home care. Results: The population passive posture in building their well-being was highlighted. The need of a shared responsibility between the involved parts, population and State is recognized. Conclusion: It is suggested for nurses to be stimulated to amplify home care to attend the demands of caregivers; and to elaborate new studies with different populations, to validate or complement the proposed theoretical model.


Comunicação de Marketing na Formação da Imagem dos Destinos Turísticos: o caso de Cabo Verde

Segundo a Organização Mundial do Turismo (OMT), o turismo é a maior indústria do séc. XXI gerando anualmente milhares de milhões de dólares em divisas para a economia de inúmeros países. Por apresentar um conjunto de características muito específicas, o sucesso desta actividade é fortemente condicionado pela imagem que os turistas e potenciais turistas apresentam relativamente a um determinado destino. Apesar de existirem muitos factores que interferem na formação desta imagem, a comunicação de marketing é apontada, pelos investigadores, como um dos elementos que desempenha um papel crucial neste âmbito. O objecto do presente trabalho de investigação é a comunicação de marketing na formação da imagem dos destinos turísticos particularizando o arquipélago de Cabo Verde. O principal objectivo da pesquisa, é analisar a eficácia da comunicação de marketing de três organizações (Cabo Verde – Investimentos, União Nacional dos Operadores Turísticos e operador Soltropico), na promoção do arquipélago de Cabo Verde, enquanto destino turístico, no mercado português. Para a realização deste estudo empírico, foram definidas três hipóteses. Essas hipóteses foram testadas através do cruzamento da informação proveniente de uma entrevista realizada aos directores de marketing de cada uma das três organizações, com os dados obtidos a partir da análise de conteúdo dos instrumentos de comunicação que têm vindo a ser utilizados pelas respectivas entidades para promover o destino e com as respostas de um conjunto de 115 turistas portugueses, a um questionário cujo assunto se encontra relacionado com os principais atributos de Cabo Verde enquanto destino de férias. A investigação realizada permitiu verificar que, de uma forma geral, existe uma sintonia entre os atributos de Cabo Verde que as organizações têm intenção de divulgar, os atributos deste destino que são transmitidos pelos seus instrumentos comunicação e os principais atributos do arquipélago indicados pelos turistas portugueses. Contudo, os resultados do estudo revelam também a necessidade de se introduzir algumas correcções a nível de conteúdos e imagens que se encontram presentes nos instrumentos de comunicação de algumas das organizações, visando a criação de uma imagem mais atractiva deste destino.

Experience of spouses of women with breast cancer: an integrative literature review

Objective: To gather, to characterize, to analyze, to synthesize and to integrate primary studies that addressed the experiences of spouses / husbands / partners of women with breast cancer, presenting the current state of knowledge. Method: Integrative literature review carried out in the databases of VHL, PubMed, CINHAL e SciELO. Results: The sample consisted of eight studies published between 2000-2012, which pointed to the experiences of the involvement and the care of the husbands towards their ill wives. Conclusion: This study highlights the need for attention and assistance to those spouses, as well as guidance and education to exercise the care the same way as the health staff has done with women. Furthermore, it emphasizes the importance of further studies in order to deepen the knowledge on this topic, and thus, improve the care with better scientific basis.

Living with pain: the experience of children and adolescents in palliative care

A qualitative study was conducted with semi-structured interviews with the aim of understanding the experience of children and adolescents under palliative care when managing pain daily and how they describe the intensity, quality and location of pain. We used Piaget’s theory of cognitive development as a theoretical framework and oral history as a methodological framework. We found four themes: describing pain; seeking a life closer to normality, despite pain and disease; using a variety of alternatives for pain control; and living with damaged physical appearance. Although pain is a limiting factor in the lives of children and adolescents, we found that they faced their daily pain and still had a life beyond pain and illness. In addition, we highlight the relevance of nurses’ understanding that effective management of pain in children is essential for a normal life and less suffering.

Clinical activity of ipilimumab for metastatic uveal melanoma: a retrospective review of the Dana-Farber Cancer Institute, Massachusetts General Hospital, Memorial Sloan-Kettering Cancer Center, and University Hospital of Lausanne experience.

BACKGROUND: Uveal melanoma exhibits a high incidence of metastases; and, to date, there is no systemic therapy that clearly improves outcomes. The anticytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4) antibody ipilimumab is a standard of care for metastatic melanoma; however, the clinical activity of CTLA-4 inhibition in patients with metastatic uveal melanoma is poorly defined. METHODS: To assess ipilimumab in this setting, the authors performed a multicenter, retrospective analysis of 4 hospitals in the United States and Europe. Clinical characteristics, toxicities, and radiographic disease burden, as determined by central, blinded radiology review, were evaluated. RESULTS: Thirty-nine patients with uveal melanoma were identified, including 34 patients who received 3 mg/kg ipilimumab and 5 who received 10 mg/kg ipilimumab. Immune-related response criteria and modified World Health Organization criteria were used to assess the response rate (RR) and the combined response plus stable disease (SD) rate after 12 weeks, after 23 weeks, and overall (median follow-up, 50.4 weeks [12.6 months]). At week 12, the RR was 2.6%, and the response plus SD rate was 46.%; at week 23, the RR was 2.6%, and the response plus SD rate was 28.2%. There was 1 complete response and 1 late partial response (at 100 weeks after initial SD) for an immune-related RR of 5.1%. Immune-related adverse events were observed in 28 patients (71.8%) and included 7 (17.9%) grade 3 and 4 events. Immune-related adverse events were more frequent in patients who received 10 mg/kg ipilimumab than in those who received 3 mg/kg ipilimumab. The median overall survival from the first dose of ipilimumab was 9.6 months (95% confidence interval, 6.3-13.4 months; range, 1.6-41.6 months). Performance status, lactate dehydrogenase level, and an absolute lymphocyte count ≥ 1000 cells/μL at week 7 were associated significantly with survival. CONCLUSIONS: In this multicenter, retrospective analysis of 4 hospitals in the United States and Europe of patients with uveal melanoma, durable responses to ipilimumab and manageable toxicity were observed.

Análise de Reantabilidade através da Margem de Contribuição

Este trabalho versa sobre a análise de rentabilidade através da margem de contribuição e tem por objectivo evidenciar como a margem de contribuição pode ser utilizada pelos gestores, na rentabilidade dos clientes, dos produtos, dos canais de distribuição e dos segmentos de mercado em que as empresas operam. O estudo está assente num referencial teórico que faz incursões nos principais conceitos conexos ao tema principal nomeadamente: análise custo – volume – resultado, métodos apuramento dos resultados na óptica da absorção e da contribuição, e a curva ABC. Na aplicação prática, procurámos utilizar alguns instrumentos de gestão nomeadamente o ponto de equilíbrio, apuramento dos resultados por segmentos de clientes, negócios e territórios de comercialização e a aplicação da curva de experiência ABC. O caso de estudo incide sobre a empresa nacional de moagem (Moave S.A) e restringe-se ao plano de produção e embalagem através do pequeno ensaque. O processo de colecta de dados foi obtido directamente das informações fornecidas pela Direcção da empresa, nomeadamente os produtos a serem embalados, a estrutura de custos, o plano de produção, a capacidade máxima da máquina e o calendário de trabalho diário e mensal. Os resultados evidenciaram que a utilização da margem de contribuição como ferramenta de gestão, constitui um importante instrumento de análise e avaliação da rentabilidade dos produtos, dos clientes, dos canais de distribuição bem como dos territórios de comercialização. This work focuses on the analysis of profitability through contribution margin and aims to highlight the contribution margin can be used by managers, in the profitability of customers, products, distribution channels and market segments in which companies operate. The study is based on the referential theoretical that makes inroads in key concepts related to the main topic, namely: cost analysis – volume – result, methods of clearance results in optical absorption and contribution, and ABC. In practice, we try to use some management tools in the balance, such as breakeven point, clearance of results by segments of customers, business and marketing territories and the application of experience curve ABC. The case study focuses on the national milling company (Moave s.a), and restricts itself to plan production and packaging through small bagging. The process of collecting data was obtained directly from the information provided by the management of the undertaking, in particular the products to be packed, the cost structure, the production plan, the maximum capacity of the machine and the daily work schedule and monthly. The results showed that the use of the contribution margin as a management tool constitutes an important instrument of analysis and assessment of the profitability of products, customers, distribution channels and marketing territories.

Audit report on the Iowa Turkey Marketing Council for the years ended December 31, 2006 and 2005

Audit report on the Iowa Turkey Marketing Council for the years ended December 31, 2006 and 2005

The Iowa Beach Study Experience, 2007

This monthly report from the Iowa Department of Transportation is about the water quality management of Iowa's rivers, streams and lakes.

Bands width, credibility and exchange risk: Lessons from the EMS experience

This paper presents an analysis of the credibility of the EMScurrencies that covers the period before and after the increase in thebands of fluctuation. Our credibility indicator is based on the inferredprobabilities derived from the estimation of a Markov-switching model(Hamilton (1989)) applied to the expected rate of depreciation. Theresults show that, for most of the currencies, credibility has improved,at least transitorily, after the increase in the bands. However, for allcurrencies, the credibility measured by the indicator proposed in thispaper has been eroded recently even with the widened bands.