986 resultados para Thérapies alternatives


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We construct a model in which the ambiguity of candidates allows them toincrease the number of voters to whom they appeal when voters have intense preferences for one of the alternatives available. An ambiguous candidate may offer voters with different preferences the hope that their most preferred alternative will be implemented. We find conditions under which ambiguous strategies are chosen in equilibrium. These conditions include the case in which there is an outcome that is a majority winner against all other outcomes but is not the most preferred outcome for a majority of voters. It is shown that if the number of candidates or parties increases, ambiguity will not be possible in equilibrium, but a larger set of possible policies increases the chance that at least one candidate will choose to be ambiguous in equilibrium.

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A class of composite estimators of small area quantities that exploit spatial (distancerelated)similarity is derived. It is based on a distribution-free model for the areas, but theestimators are aimed to have optimal design-based properties. Composition is applied alsoto estimate some of the global parameters on which the small area estimators depend.It is shown that the commonly adopted assumption of random effects is not necessaryfor exploiting the similarity of the districts (borrowing strength across the districts). Themethods are applied in the estimation of the mean household sizes and the proportions ofsingle-member households in the counties (comarcas) of Catalonia. The simplest version ofthe estimators is more efficient than the established alternatives, even though the extentof spatial similarity is quite modest.

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A extracção de areia nas praias do mar, nas bacias hidrográficas e nas encostas montanhosas, tem sido prática de muitas famílias cabo-verdianas. A Praia de Calhetona foi uma das que nos últimos anos sofreu degradação significativa, em função da apanha clandestina de areia, sem qualquer plano de extracção, destinada a construção civil. A extracção de areia, para vender ou para a autoconstrução, é efectuada em família por indivíduos, maioritariamente do sexo feminino, de baixa renda ou sem profissão remunerada. O processo de extracção de areia na Praia de Calhetona teve o seu ponto alto nos anos 80, diminuindo consideravelmente com a escassez de areia e implementação do Decreto – Lei nº 69/97, de 3 de Novembro, que visava disciplinar a exploração de inertes nas praias. Em face da pesquisa feita, baseada no estudo de caso, ficou expresso que os inquiridos implicados na actividade de extracção clandestina de areia correm riscos elevados para obterem lucros reduzidos. Quem efectivamente beneficia são os camionistas que compram esse inerte e o vendem pelo dobro do preço. Qualquer actividade de exploração de recursos naturais causa impactes sobre o espaço de actuação. No caso da Praia de Calhetona, observa-se o recuo da linha de costa, a quase ausência de areia e a desertificação de propriedades nas suas proximidades, para além dos impactes negativos sobre o turismo, a função balnear e a desova de tartaruga. Apesar de tudo, constata-se uma consciência generalizada dos impactes ambientais causados pelos inquiridos, os quais, no entanto, alegam que a extracção de areia é uma das alternativas para garantir a sobrevivência individual e das suas famílias.

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It is shown that preferences can be constructed from observed choice behavior in a way that is robust to indifferent selection (i.e., the agent is indifferent between two alternatives but, nevertheless, is only observed selecting one of them). More precisely, a suggestion by Savage (1954) to reveal indifferent selection by considering small monetary perturbations of alternatives is formalized and generalized to a purely topological framework: references over an arbitrary topological space can be uniquely derived from observed behavior under the assumptions that they are continuous and nonsatiated and that a strictly preferred alternative is always chosen, and indifferent selection is then characterized by discontinuity in choice behavior. Two particular cases are then analyzed: monotonic preferences over a partially ordered set, and preferences representable by a continuous pseudo-utility function.

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What are the best voting systems in terms of utilitarianism? Or in terms of maximin, or maximax? We study these questions for the case of three alternatives and a class of structurally equivalent voting rules. We show that plurality, arguably the most widely used voting system, performs very poorly in terms of remarkable ideals of justice, such as utilitarianism or maximin, and yet is optimal in terms of maximax. Utilitarianism is bestapproached by a voting system converging to the Borda count, while the best way to achieve maximin is by means of a voting system converging to negative voting. We study the robustness of our results across different social cultures, measures of performance, and population sizes.

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Digital libraries (DL) are seen as a hope to developing countries in their struggle for accessing bibliographic resources, especially in a context where the traditional distribution mechanisms failed tragically. Several difficulties are however faced by these countries to build and use digital libraries, due mainly to its high development costs and to the poor existing ICT resources in these countries. This paper discusses the importance of digital libraries for developing countries and introduces the main challenges they face in building and using such libraries. The current alternatives and major initiatives for making digital information accessible to developing countries are also addressed.

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Whereas much literature exists on choice overload, little is known about effects of numbers of alternatives in donation decisions. How do these affect both the size and distribution of donations? We hypothesize that donations are affected by the reputation of recipients and increase with their number, albeit at a decreasing rate. Allocations to recipients reflect different concepts of fairness equity and equality. Both may be employed but, since they differ in cognitive and emotional costs, numbers of recipients are important. Using a cognitive (emotional) argument, distributions become more uniform (skewed) as numbers increase. In a survey, respondents indicated how they would donate lottery winnings of 50 Euros. Results indicated that more was donated to NGO s that respondents knew better. Second, total donations increased with the number of recipients albeit at a decreasing rate. Third, distributions of donations became more skewed as numbers increased. We comment on theoretical and practical implications.

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Aware of the importance of developing new alternatives to improve the performance of the companies, our purpose in this paper is to develop a medium term production planning model that deals with the concepts of Partnership and Reverse Logistics. Our model takes advantage of the synergies of integration, developing a model for global production planning that generates the optimal production and purchasing schedule for all the companies integrating a logistic chain. In a second part of the paper we incorporate products returns to the first model proposed, and analyze the implications they have over this model. We use some examples with different configurations of supply chains varying the number of production plants, distribution centers and recovery plants. To solve the model we have combined optimization and simulation procedures.

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Tota anàlisi integral de la violència ha de començar per definir les diverses formes que aquesta adopta amb la finalitat de facilitar-ne el mesurament científic. Hi ha moltes maneres possibles de definir la violència. Tradicionalment, l’adolescència s’ha associat amb un moment de crisi, inestabilitat i immaduresa. L’adolescència comença amb una forma de violència produïda per la naturalesa, que són els canvis físics de la pubertat. Aquest és també un període de profunds canvis psicològics (pèrdues del món infantil, confirmació dels caràcters sexuals distintius del gènere). En definitiva, una etapa d’incertesa a l’espera d’arribar a una identitat on el jo fràgil i insegur tem quedar atrapat en la situació infantil i atribueix a l’entorn les seves dificultats per progressar. Ataca buscant uns límits externs que el continguin i li serveixin per regular-se i trobar-se. Altres vegades per por anticipada al fracàs busca com a identitat una posició on no hi ha exigències, ni perill de fracassar, perquè és la identitat del fracàs mateix (fracàs escolar, addiccions, marginalitat, violència). Així la conducta violenta és una defensa davant amenaces externes i internes a un jo fràgil en perill de ser diluït i aixafat en la seva identitat poc sòlida i definida. La sensació de no ser considerat com a subjecte pot ser objectiva o imaginària, present o ancorada en el passat (JEAMET 2003) però, en qualsevol cas, és una pressió real per l’individu que l’afecta notablement

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Contexte :¦Les affections neuromusculaires sont des maladies rares, le plus souvent d'origine génétique et dont le degré de sévérité est variable. Certaines sont progressives et conduisent à une perte de l'indépendance motrice et à une insuffisance respiratoire, tandis que d'autres permettent une vie proche de la normale.¦Les progrès des connaissances en génétique moléculaire ont permis d'améliorer significativement la connaissance des mécanismes physiopathologiques de ces maladies et ont également ouverts la voie à de nouvelles possibilités thérapeutiques. Concernant les maladies les plus graves, le but premier de ces thérapies sera de tenter de préserver la marche indépendante le plus longtemps possible. Toutefois, les patients ayant déjà perdu la marche et qui dépendent de la fonction de leur membres supérieurs pour garder une certaine indépendance devront également pouvoir être inclus dans des essais thérapeutiques et bénéficier des traitements reconnus efficaces.¦De nouveaux moyens de mesure de la fonction motrice des membres supérieurs doivent être développés non seulement dans la perspective de ces éventuels essais thérapeutiques pour ces patients limités à la chaise roulante, mais également dans le but de pouvoir évaluer plus précisément l'histoire naturelle des maladies même après la perte de la marche indépendante.¦Objectifs:¦Evaluer la fonction motrice des membres supérieurs chez des patients myopathes ayant perdu la marche indépendante par mesure cinématique.¦Méthode :¦Mesure de l'activité des membres supérieurs et le profil de cette activité par mesure cinématique (Physilog) chez:¦-Vingt-cinq patients atteints d'une myopathie en chaise roulante.¦-Vingt-cinq sujets contrôle assis¦Ces mesures seront comparées aux scores obtenus à l'échelle de Mesure de Fonction Motrice (Bérard et al, 2005) et plus précisément à l'axe D3 de cette échelle qui évalue les fonctions distales.¦Les patients seront vus à deux reprises pour une période de deux fois deux heures pendant laquelle ils porteront le Physilog. Il leur sera demandé d'effectuer une série d'exercices afin d'évaluer la fonction motrice des membres supérieurs (manger un yaourt avec une cuillère, verser un verre d'eau et le boire, se toucher selon les possibilités la tête, le front, la bouche, le cou, jouer à la console Wii) Le score de Brooke sera également testé. Chaque exercice sera répété plusieurs fois afin de d'assurer de la qualité des résultats.¦Système portable Physilog :¦Physilog est un système de mesure ambulatoire. La version utilisée dans cette étude est composée de 2 capteurs miniatures et d'une unité numérique portable légère (~215 g), qui filtre, amplifie et sauvegarde les signaux fournis par les capteurs sur une carte mémoire (Physilog-BioAGM, CH).¦Afin de pouvoir enregistrer l'activité des deux membres supérieurs, deux appareils Physilog (4 capteurs) seront utilisés par patient. Deux capteurs seront fixés sur chaque membre supérieur. Les capteurs sont fixés sur la peau à l'aide d'une bande autocollante.¦Les capteurs mis au point par le LMAM (laboratoire de mesure et d'analyse du mouvement) mesurent la rotation angulaire et l'accélération au niveau des membres supérieurs. L'algorithme utilisé dans cette étude a été développé dans le laboratoire LMAM à l'EPFL et a fait l'objet d'une thèse.¦Résultats escomptés :¦Les résultats de l'étude pilote montrent que le Physilog permet de quantifier de manière fiable et reproductible la fonction des membres supérieurs durant des activités courantes de la vie quotidienne et pourrait donc devenir un moyen d'évaluation fiable des nouveaux traitements.

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En aquest article es presenten les diferents mesures que la societat gironina ha anat adoptant al llarg dels anys per fer front al risc d'avingudes, fent especial èmfasi, però, a les mes recents. Aquestes mesures d'adaptació poden classificar-se en dos grans grups, que no son ni moltmenys excloents: les mesures estructurals, integrades bàsicament per les obres hidràuliques, i les mesures no-estructurals, mes dirigides a l'àmbit del comportament individual i col·lectiu enfront el risc. Finalment es realitzarà una valoració de l'estat actual del sistema de defenses de la ciutat i es proposaran un seguit d'alternatives

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Introduction: Tyrosine kinase inhibitors (TKI) have considerably improved outcome of patients with advanced GIST and extended overall survival to more than 5 years. Yet, the median progression-free survival is approximately 2 years with first-line imatinib and 24 weeks with second-line sunitinib, which calls for treatment alternatives. Nilotinib is a second-generation TKI with at least similar inhibitory activity as imatinib. A Phase I study has shown that nilotinib monotherapy has clinical activity in GIST. Methods: After failure of all available therapeutic options patients had access to nilotinib on a compassionate use (CU) programm. Nilotinib was started at a dose of 400 mg bid, with dose reduction to 400mg qd allowed in the case of toxicity. 94 pts were approved for nilotinib CU in 10 European countries. We herein present retrospective data of 42 pts from 5 European countries treated in 11 centers. Results: Median age at nilotinib treatment start was 59 years (median; range 24-79 y). 30 of 42 patients were male. Most pts had metastatic disease of gastric origin at initial diagnosis. KIT exon 11 mutations were most frequent. The median number of surgical resections was 1 (range 0-8). All pts had failed both imatinib and sunitinib before nilotinib, and few had also received additional investigational treatments. Nilotinib was well tolerated, and discontinued due to toxicity in 15% only. Median follow-up is 176 days (range 15-876 d). Nilotinib treatment duration is 75 days (median; range 3-727 d). Partial remission with nilotinib treatment was seen in 11% of pts. Median OS was 263 days (Kaplan-Meier). Conclusion: This is the largest series reported assessing efficacy of nilotinib for imatinib- and sunitinib-refractory GIST reported yet. Nilotinib displays significant clinical activity in this heavily pretreated group of pts. These results warrant further investigation of nilotinib in GIST, including its use in first or second-line treatment. Patient and data collection is ongoing, updated results will be presented.

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The widespread incidence of enterococci resistant to ampicillin, vancomycin and aminoglycosides, the first-line anti-enterococcal antibiotics, has made the treatment of severe enterococcal infections difficult and alternatives should be explored. We investigated the activity of daptomycin combined with linezolid against three Enterococcus faecalis and four Enterococcus faecium strains resistant to standard drugs used for therapy. Minimum inhibitory concentrations (MICs) were determined by the broth dilution method. Drug interactions were assessed by the checkerboard and time-kill methods. Synergy was defined by a fractional inhibitory concentration index (FICI) of ≤0.5 or a ≥2 log10 CFU/mL killing at 24 h with the combination in comparison with killing by the most active single agent. Indifference was defined by a FICI > 0.5-4.0 or a 1-2 log10 CFU/mL killing compared with the most active single agent. MICs of daptomycin were 2-4 μg/mL for E. faecalis and 2-8 μg/mL for E. faecium. MICs of linezolid were 1-2 μg/mL for all bacteria. In the checkerboard assay, five isolates showed synergism (FICI < 0.5) and two showed indifference (FICIs of 0.53 and 2). Killing studies revealed synergy of daptomycin plus linezolid against four isolates (2.2-3.7 log10 CFU/mL kill) and indifference (1.1-1.6 log10 CFU/mL kill) for the other three strains. Antagonism was not observed. In conclusion, the combination of daptomycin and linezolid had a synergistic or indifferent effect against multidrug-resistant enterococci. Additional studies are needed to explore the potential of this combination for severe enterococcal infections when first-line antibiotic combinations cannot be used.

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Taking as an example three study cases in the Costa Brava area, this paper examines through surveys and interviews the perception of floods among residents living in hazardous areas. perception is then related to vulnerability, flood management, and citizens preferences regarding alternatives to curb flood losses in the future. The study concludes that flood awareness and the willingness to take actions regarding this hazard is clearly related to the degree of social involvement with the affairs of the local community

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A extracção clandestina de areia, nas faixas costeiras e nos leitos das ribeiras, tem sido prática de muitos agregados familiares cabo-verdianos. Nas últimas décadas, a praia de Calhetona (Ilha de Santiago) foi um dos muitos locais que sofreram degradação ambiental significativa, devido à realização desta actividade sem quaisquer planos de extracção e de posterior recuperação das áreas degradadas. Este trabalho, através da conjugação de recolha de dados por inquérito, observação directa e pesquisa documental e bibliográfica, teve como objectivos a caracterização da comunidade (que habita no bairro de Ponta Calhetona) que se dedica à extracção de areia na praia de Calhetona, a descrição da dinâmica da actividade extractiva, a avaliação da percepção que a comunidade tem relativamente às consequências da sua actividade e a descrição do impacte ambiental resultante da extracção de areia. Da análise dos inquéritos, efectuados em Fevereiro de 2012, a 25 chefes de agregados familiares que efectuam a extracção de areia na praia de Calhetona, constata-se que estes são maioritariamente mulheres, predominantemente com idade compreendida entre os 40 e os 59 anos, domésticas, com baixa escolaridade, com famílias numerosas e/ou alargadas a seu cargo e dedicando-se à extração de areia à mais de 10 anos. Os inquiridos, face à situação de vulnerabilidade económica, à falta de emprego e à grande procura de areia para a construção civil, vêem nesta actividade uma fonte de rendimento. Contudo, o proveito obtido desta actividade difícil e potencialmente perigosa é reduzido. Quem efectivamente beneficia são os camionistas que compram a areia a quem procede à extracção e a vendem ao consumidor final pelo dobro do preço. Os inquiridos demonstram uma consciência generalizada dos diversos impactes ambientais negativos resultantes da sua actividade, mas alegam que a extracção de areia é uma das poucas alternativas existentes para providenciar o sustento dos seus agregados familiares. Com base na comparação do estado actual da praia de Calhetona com relatos de habitantes locais, relativos às características da mesma no passado, verifica-se que nos últimos 40-50 anos, desde que se iniciou a intensa extracção de areia nesta praia, o seu aspecto físico se degradou claramente. Essa degradação caracteriza-se principalmente pelo recuo da linha de costa, pela quase ausência de areia e pela salinização dos solos localizados nas proximidades da praia, para além dos consequentes impactes negativos sobre a desova das tartarugas e o turismo balnear.