829 resultados para Ivan Turguêniev
Resumo:
Esta pesquisa tem como objetivo realizar uma tradução do original em russo da novela Diário de um homem supérfluo, de Ivan Turguêniev, e analisar o modo como o escritor procurou retratar a primeira personagem da literatura russa a ser denominada homem supérfluo. Procurar-se-á demonstrar que o autor não se limitou a reproduzir no narrador as características clássicas desse tipo literário, mas inovou ao adicionar outras e retirar algumas tidas como essenciais, criando uma figura que viria a dar um novo significado ao termo homem supérfluo.
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Hurricanes are destructive storms with strong winds, intense storm surges, and heavy rainfall. The resulting impact from a hurricane can include structural damage to buildings and infrastructure, flooding, and ultimately loss of human life. This paper seeks to identify the impact of Hurricane Ivan on the aected population of Grenada, one of the Caribbean islands. Hurricane Ivan made landfall on 7th September 2004 and resulted in 80% of the population being adversely aected. The methods that were used to model these impacts involved performing hazard and risk assessments using GIS and remote sensing techniques. Spatial analyses were used to create a hazard and a risk map. Hazards were identied initially as those caused by storm surges, severe winds speeds, and flooding events related to Hurricane Ivan. These estimated hazards were then used to create a risk map. An innovative approach was adopted, including the use of hillshading to assess the damage caused by high wind speeds. This paper explains in detail the methodology used and the results produced.
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Purpose
To compare the efficacy and safety of ranibizumab and bevacizumab intravitreal injections to treat neovascular age-related macular degeneration (nAMD).
Design
Multicenter, noninferiority factorial trial with equal allocation to groups. The noninferiority limit was 3.5 letters. This trial is registered (ISRCTN92166560).
Participants
People >50 years of age with untreated nAMD in the study eye who read =25 letters on the Early Treatment Diabetic Retinopathy Study chart.
Methods
We randomized participants to 4 groups: ranibizumab or bevacizumab, given either every month (continuous) or as needed (discontinuous), with monthly review.
Main Outcome Measures
The primary outcome is at 2 years; this paper reports a prespecified interim analysis at 1 year. The primary efficacy and safety outcome measures are distance visual acuity and arteriothrombotic events or heart failure. Other outcome measures are health-related quality of life, contrast sensitivity, near visual acuity, reading index, lesion morphology, serum vascular endothelial growth factor (VEGF) levels, and costs.
Results
Between March 27, 2008 and October 15, 2010, we randomized and treated 610 participants. One year after randomization, the comparison between bevacizumab and ranibizumab was inconclusive (bevacizumab minus ranibizumab -1.99 letters, 95% confidence interval [CI], -4.04 to 0.06). Discontinuous treatment was equivalent to continuous treatment (discontinuous minus continuous -0.35 letters; 95% CI, -2.40 to 1.70). Foveal total thickness did not differ by drug, but was 9% less with continuous treatment (geometric mean ratio [GMR], 0.91; 95% CI, 0.86 to 0.97; P = 0.005). Fewer participants receiving bevacizumab had an arteriothrombotic event or heart failure (odds ratio [OR], 0.23; 95% CI, 0.05 to 1.07; P = 0.03). There was no difference between drugs in the proportion experiencing a serious systemic adverse event (OR, 1.35; 95% CI, 0.80 to 2.27; P = 0.25). Serum VEGF was lower with bevacizumab (GMR, 0.47; 95% CI, 0.41 to 0.54; P<0.0001) and higher with discontinuous treatment (GMR, 1.23; 95% CI, 1.07 to 1.42; P = 0.004). Continuous and discontinuous treatment costs were £9656 and £6398 per patient per year for ranibizumab and £1654 and £1509 for bevacizumab; bevacizumab was less costly for both treatment regimens (P<0.0001).
Conclusions
The comparison of visual acuity at 1 year between bevacizumab and ranibizumab was inconclusive. Visual acuities with continuous and discontinuous treatment were equivalent. Other outcomes are consistent with the drugs and treatment regimens having similar efficacy and safety.
Financial Disclosure(s)
Proprietary or commercial disclosures may be found after the references.
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Background: Bevacizumab has been suggested to have similar effectiveness to ranibizumab for treatment of neovascular age-related macular degeneration. The Inhibition of VEGF in Age-related choroidal Neovascularisation (IVAN) trial was designed to compare these drugs and different regimens. Here, we report the findings at the prespecified 2-year timepoint. Methods: In a multicentre, 2×2 factorial, non-inferiority randomised trial, we enrolled adults aged at least 50 years with active, previously untreated neovascular age-related macular degeneration and a best corrected distance visual acuity (BCVA) of at least 25 letters from 23 hospitals in the UK. Participants were randomly assigned (1:1:1:1) to intravitreal injections of ranibizumab (0·5 mg) or bevacizumab (1·25 mg) in continuous (every month) or discontinuous (as needed) regimens, with monthly review. Study participants and clinical assessors were masked to drug allocation. Allocation to continuous or discontinuous treatment was masked up to 3 months, at which point investigators and participants were unmasked. The primary outcome was BCVA at 2 years, with a prespecified non-inferiority limit of 3·5 letters. The primary safety outcome was arterial thrombotic event or hospital admission for heart failure. Analyses were by modified intention to treat. This trial is registered, number ISRCTN92166560. Findings: Between March 27, 2008, and Oct 15, 2010, 628 patients underwent randomisation. 18 were withdrawn; 610 received study drugs (314 ranibizumab; 296 bevacizumab) and were included in analyses. 525 participants reached the visit at 2 years: 134 ranibizumab in continuous regimen, 137 ranibizumab in discontinuous regimen, 127 bevacizumab in continuous regimen, and 127 bevacizumab in discontinuous regimen. For BCVA, bevacizumab was neither non-inferior nor inferior to ranibizumab (mean difference -1·37 letters, 95% CI -3·75 to 1·01; p=0·26). Discontinuous treatment was neither non-inferior nor inferior to continuous treatment (-1·63 letters, -4·01 to 0·75; p=0·18). Frequency of arterial thrombotic events or hospital admission for heart failure did not differ between groups given ranibizumab (20 [6%] of 314 participants) and bevacizumab (12 [4%] of 296; odds ratio [OR] 1·69, 95% CI 0·80-3·57; p=0·16), or those given continuous (12 [4%] of 308) and discontinuous treatment (20 [7%] of 302; 0·56, 0·27-1·19; p=0·13). Mortality was lower with continuous than discontinuous treatment (OR 0·47, 95% CI 0·22-1·03; p=0·05), but did not differ by drug group (0·96, 0·46-2·02; p=0·91). Interpretation: Ranibizumab and bevacizumab have similar efficacy. Reduction in the frequency of retreatment resulted in a small loss of efficacy irrespective of drug. Safety was worse when treatment was administered discontinuously. These findings highlight that the choice of anti-VEGF treatment strategy is less straightforward than previously thought.
Fluctuating Levels Of Circulating VEGF In A Subset Of Patients As Part Of The Multicentre IVAN Study
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Collection : Association pour la protection légale des travailleurs, section française ; [1e série], 2
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UANL
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Captar el alcance del pensamiento de Ivan Illich. El trabajo de investigación está estructurado en dos bloques, ambos de carácter teórico. En el primer bloque se ha estudiado en profundidad la teoría de la desescolarización, estudiando la propuesta realizada por Illich (la sociedad desescolarizada) y otras opciones y propuestas alternativas a la institución escolar, como son las realizadas por Goodman, Reimer o Simpfendöfer, que entroncan con la propuesta realizada por Illich. En el segundo bloque de la investigación se ha hecho una revisión crítica de los planteamientos educativos de Illich, realizando una crítica general a dicha propuesta, revisando las críticas realizadas por otros autores y sintetizando las aportaciones de la teoría de la desescolarización. La teoría de la desescolarización supera lo estrictamente pedagógico y la simple crítica a la escuela para insertar su interrogante en un análisis más global, siendo la escuela un ejemplo del sistema, que se impone al individuo y que es criticado por Illich. Las propuestas de Illich destacan por la ambigüedad política al no insertarse en un marco político claro, siendo la voluntad de desescolarización, el deseo de una sociedad convivencial y de una revolución cultural, la única preocupación: devolver al hombre su libertad, su creatividad. La convivencionalidad constituye así una exigencia ética que algunos individuos pueden tener en común, de la misma manera en que la desescolarización puede llegar a ser el objetivo de los que se rebelan contra el absurdo alistamiento escolar. Este carácter ético de la visión del cambio social lleba a considerar la teoría de la desescolarización como un esfuerzo bienpensante sin aplicabilidad alguna.
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