The aim of the present study was to encapsulate vancomycin in different liposomal formulations and compare the
antimicrobial activity against
biofilms.
Large unilamellar vesicles of conventional (LUV ...VAN), fusogenic (LUV
VAN), and cationic (LUV
VAN) liposomes encapsulating VAN were characterized in terms of size, polydispersity index, zeta potential, morphology, encapsulation efficiency (%EE) and
release kinetics. The formulations were tested for their Minimum Inhibitory Concentration (MIC) and inhibitory activity on biofilm formation and viability, using methicillin-susceptible
ATCC 29213 and methicillin-resistant
ATCC 43300 strains.
LUV VAN showed better %EE (32.5%) and sustained release than LUV
VAN, LUV
VAN, and free VAN. The formulations were stable over 180 days at 4°C, except for LUV VAN, which was stable up to 120 days. The MIC values for liposomal formulations and free VAN ranged from 0.78 to 1.56 µg/ml against both tested strains, with no difference in the inhibition of biofilm formation as compared to free VAN. However, when treating mature biofilm, encapsulated LUV
VAN increased the antimicrobial efficacy as compared to the other liposomal formulations and to free VAN, demonstrating a better ability to penetrate the biofilm.
Vancomycin encapsulated in fusogenic liposomes demonstrated enhanced antimicrobial activity against mature
biofilms.
Background: Breast cancer (BC) is largely prevalent worldwide. HER2-positive BC account for roughly 20-25% of all BC cases and has an overall survival lower than other BC. Innovation on BC ...therapeutics is a constant, but novel therapies have higher costs. Therefore, cost-effectiveness research is essential to provide healthcare decision-makers with solid foundations for a resource allocation. This study aims to estimate the average direct medical costs/ patient and cost-effectiveness of adding pertuzumab in neoadjuvant treatment (NeoT) for HER2-positive breast cancer (BC). Methods: Two retrospective real-world consecutive cohorts of ≥18yo female patients diagnosed with HER2- positive BC treated with NeoT at the Breast Clinic of IPO-Porto were studied. The AC-DH regimen (2012-2015) comprised 8 cycles of neoadjuvant therapy (4 cycles of doxorubicin + cyclosphosphamide followed by 4 cycles ofdocetaxel + trastuzumab), while the AC-DHP regimen (2015-2017) included also pertuzumab as NeoT. NeoT was followed by surgery and adjuvant trastuzumab. Micro-costing technique and a bottom-up approach was used comprising all medical direct costs from the hospital perspective. Unit costs were obtained from government official prices or from IPO-Porto costing system. Costs were adjusted to 2017 and are expressed in euros. Multivariable logistic regression models were used for effectiveness assessment, while generalized linear models with gamma distribution were used for costs. ICER was calculated using the pathological complete response (pCR) as the preferential measure of effectiveness. Sensitivity analysis was also performed. Results: AC-DHP (n = 40) and AC-DH (n = 54) cohorts had heterogenous patient profiles (median age 43y/53y; 67.5%/59.3% positive HR; 60.0%/27.8% operable; 25.0%/24.1% inflammatory, respectively). The AC-DHP average total cost/patient was 56,375€, with pertuzumab accounting for 13,978€ (24.79%) and increasing in 15,982€ the average cost/patient (p < 0.001). Clinical staging and hormone receptors (HR) were significantly associated with pCR. ICER was 1.370€ per percentage point of pCR. Conclusions: ICER was more favourable in stage III HR negative BC patients compared to other patient profiles. Innovative treatments access is critical to deliver high-quality healthcare, but sustainability must be considered. These results suggest the importance of establishing a cost-effectiveness profile of Pertuzumab in NeoT for HER2- positive BC.
Abstract Many multinational corporations develop business operations in Europe. The current research attempts to fill the gap on how corporations can increase their political influence in this ...geography by exploring the joint effect of corporate political activity (CPA) and social responsibility (CSR) on political embeddedness and financial performance. Based on institutional theory and on a sample of autochthonous (European Union EU) and allochthonous (non‐EU) firms with declared EU lobbying (from 2008 to 2019) we conducted two studies. Based on a multi‐level model, Study 1 finds strong and robust evidence that boardroom gender diversity and EU lobbyists interactively increase EU political embeddedness. Complementarily, Study 2, which relies on general linear Modeling, suggests that allochthonous corporations are more profitable when they display high‐level political embeddedness and lobbying expenditures, combined with adoption of United Nations (UN) guidelines. Overall, findings show that lobbying in Europe pays off, especially when corporations strive to be aligned with EU ethical values and aspirations. Hiring lobbyists to be based in Brussels and promoting gender equality help establish EU political connections. Subsequently, findings highlight the role that EU political embeddedness, lobbying expenditures, and UN guidelines play in leveraging financial performance, especially across non‐EU corporations. Regarding EU corporations, results show that a firm‐level investment on CPA‐CSR is particularly important. Overall, findings from this research support corporations that are growing businesses in Europe.
This study aims to assess safety and effectiveness of pertuzumab in combination with trastuzumab and docetaxel in the neoadjuvant treatment (NeoT) of HER2-positive breast cancer.
Two consecutive ...retrospective cohorts (
= 94, 2012-2015 and 2015-2017) of adult women with HER2-positive breast cancer, receiving NeoT at the breast clinic in Portugal (IPO-Porto), were followed. All patients had surgery and received trastuzumab as adjuvant therapy. The 2012-2015 cohort received doxorubicin, cyclophosphamide, docetaxel plus trastuzumab, whereas the 2015-2017 cohort was treated with the same protocol plus pertuzumab.
The 2012-2015 cohort was older (median 53 years), with locally advanced tumors (48.1%), mostly hormone receptor positive (59.3%). The 2015-2017 cohort was younger (median 43 years) with 60% operable tumors. Pathologic complete response (pCR) improved in the second cohort, while maintaining a good safety profile and tolerability. Clinical staging (
= 0.001) and hormone receptor (
= 0.003) were significant predictors of pCR, but not treatment regimen (
= 0.304).
Further research with larger samples and longer follow-up is needed to understand the clinical differences. Clinical effectiveness of treatment should also be measured through overall and progression-free survival.
Early reperfusion for patients with ST-segment elevation myocardial infarction (STEMI) is indicated by the European Society of Cardiology, while a timely invasive strategy is recommended for patients ...with high-risk and intermediate-risk non-ST-elevation acute coronary syndromes (NSTE-ACS). This study aims to assess patient and system delays according to diagnosis and risk profile, and to identify predictors of prolonged delay.
We assembled a cohort of patients (n=939) consecutively admitted to the cardiology department of two hospitals, one in the metropolitan area of Porto and one in the north-east region of Portugal, between August 2013 and December 2014.
The proportion of patients with time from symptom onset to first medical contact (FMC) ≥120 min was highest among high-risk NSTE-ACS (57.7%), followed by intermediate-risk NSTE-ACS (52.1%) and STEMI (43.3%). Regardless of diagnosis and risk stratification, use of own transportation and inability to interpret cardiac symptoms correctly were associated with prolonged delays. Regarding system delays, we found that 78.0% of patients with STEMI and 65.8% of patients with high-risk NSTE-ACS were treated in a timeframe exceeding the recommended limits. Admission to a non-percutaneous coronary intervention-capable hospital, admission on weekends and complications at admission were associated with prolonged delays to treatment.
Due to both patient and system delays, a large proportion of STEMI and high-risk NSTE-ACS patients still fail to have access to timely reperfusion.
Atualmente, as normas de orientação clínica da Sociedade Europeia de Cardiologia (SEC) recomendam uma estratégia de reperfusão precoce tanto nos doentes com enfarte agudo do miocárdio com elevação do segmento ST (EAMcST) como nos doentes com síndrome coronária aguda sem elevação do segmento ST (SCAsST) de alto-risco ou risco-intermédio. O objetivo deste estudo foi, considerando o diagnóstico e o perfil de risco dos doentes, avaliar a demora atribuível aos doentes e ao sistema de saúde e identificar preditores de uma demora superior ao recomendado.
Recrutamos uma coorte de doentes com SCA (n=939) admitidos consecutivamente nos serviços de cardiologia de dois hospitais, um na área metropolitana do Porto e um na região de Trás-os-Montes e Alto Douro, entre agosto de 2013 e dezembro de 2014.
A proporção de doentes com tempo ≥120 minutos entre os sintomas e o primeiro contacto com o médico foi de 43,3% nos doentes com EAMcST, 57,7% nos doentes com SCAsST de alto risco e 52,1% nos doentes com SCAsST de risco intermédio. Os doentes que utilizaram transporte próprio e que não reconheceram os sintomas como cardíacos demoraram mais tempo até ao primeiro contacto com o médico. Relativamente aos atrasos atribuíveis ao sistema, 78,0% dos doentes com EAMcST e 65,8% dos doentes com SCAsST de alto-risco demoraram mais tempo do que o recomendado. Ser admitido num hospital sem capacidade de tratamento, ser admitido durante o fim de semana e ter complicações na admissão foram os fatores que contribuíram para os atrasos no tratamento.
Os resultados mostram que uma grande proporção de doentes com SCA é tratada depois do tempo recomendado, limitando o benefício da terapêutica de reperfusão.
Purpose
There are no management decisions deprived of ethical or political consequences. Political corporate social responsibility (CSR) has been highlighting this assertion but research at the ...microlevel on this topic is scarce. This study aims to contribute to the microlevel research by proposing a behavioral framework where leaders’ political skills are determinants of engagement in strategic CSR and perceived CSR leverages their ascribed legitimacy to perform a political role outside the boundaries of the organizations.
Design/methodology/approach
Building upon political CSR and critical realism theories, this study offers a general review on key political CSR microlevel concepts and examines multiple dimensions of CSR to explain the indirect effect between boards' political skills and political legitimacy.
Findings
This research suggests that high politically skilled leaders are associated to more CSR adoption which fosters higher legitimacy to act as political influencers. Among these, CSR activities directed toward community members and employees are seemingly the most successful from a political standpoint.
Originality/value
This study proposes a contemporary form of political influence to business leaders that, in contrast with other strategies such as lobbying or financing political campaigns, does not end up damaging corporate image and reputation. Also, this study proposes that not all CSR activities leverage corporate political legitimacy per se, therefore they do need to be differentiated. This study then offers a comprehensive future research agenda, including detailed suggestions for research designs and measurements.
Abstract
Background and Aims
The demographic characteristics of incident and prevalent hemodialysis (HD) patients have been undergoing significant changes over the last decades, in what has been ...called an “epidemic of aging in renal replacement therapy” 1. The higher proportion of very elderly patients has brought significant challenges to the nephrologists, namely regarding the choice and timing of vascular access (VA) creation. Despite the arteriovenous fistula (AVF) undeniable status has the preferred VA, the applicability of the “Fistula First” initiative in very elderly patients has been questioned.
Method
This single-center observational retrospective cohort study took place at the Coimbra Hospital and University Centre, a Portuguese tertiary referral hospital. Patients were selected from the Nephrology department's database of HD referrals. Inclusion criteria were HD referral between January 2017 and December 2021 and age equal or over 80-years old at time of referral. We collected data regarding demographic characteristics, comorbid conditions, first VA, pre-HD nephrology care and functional status at referral, as well as the time and cause of death during the follow-up period. Functional status was assessed through the Katz index of independence in activities of daily living and the comorbid conditions were assessed through the Charlson comorbidity index. Primary outcome was mortality, and follow-up ended on the 31st of May 2022. Variables associated independently with mortality were included in Cox proportional-hazards regression models.
Results
Our study sample included 288 patients, predominantly male (63.9%), with a median age of 83 and a diabetes prevalence of 42.8%. The VA at first dialysis was a central venous catheter (CVC) in 77.8% and 68.1% had an unplanned HD start. Eighty-four percent had at least 3 months of pre-HD nephrology care. The mean Charlson Index at HD referral was 9.1 and 50.6% presented a Katz index under 5. The mortality incidence rate during follow-up was 32.8/100 patient-year, with 90-days, one-year, and two-year survival rates of 88.2%, 69.1% and 51.4%, respectively. The main known causes of death were infections not related with the VA (29%) and cardiovascular disease (14%). Starting HD through a CVC was associated with worse survival in univariate analysis (Log-rank 15.4, p<0.001). Other mortality-related variables in survival analysis were age at HD referral hazard ratio (HR) 1.082, p<0.001, absence of pre-HD nephrology care (Log-rank 14.6, p<0.001), urgent-start HD (Log-rank 24.3, p<0.001), Katz index (HR 0.67, p<0.001) and Charlson index (HR 1.28, p<0.001). In a Cox Proportional Hazards model, when adjusting for the other mortality predictors, CVC use at first HD and unplanned HD start did not present a statistically significant association with mortality (HR 1.587, p = 0.074; HR 1.508, p = 0.098, respectively).
Conclusion
In our study sample, most patients started HD through a CVC, despite the majority having at least 3 months of pre-HD nephrology care. When adjusting for other covariates in a multivariate model, the first VA did not present a strong association with survival outcomes. The appropriate VA in the very elderly patient is an ongoing debate, and doubts remain regarding the applicability of the “Fistula First, Catheter Last” policy in octogenarian and nonagenarian patients. Our results are in line with recent reports which suggest that initial CVC use with later placement of an AVF, shortly after HD initiation, does not confer worse prognosis than initial AVF use in very elderly patients 2. One of the limitations of our study was not having collected data regarding timings of AVF construction and use, which might have been informative regarding the impact of catheter-dependence time in survival.
Embalagens vazias, quando lançadas no meio ambiente, geridas ou manuseadas incorretamente, tornam-se poluidoras e podem provocar impactos no meio ambiente e aos seres humanos. O estudo que subsidia ...este artigo objetivou a análise do trabalho de uma empresa situada no Estado de Santa Catarina, quanto aos procedimentos de seus colaboradores na coleta, no transporte, na armazenagem temporária e no destino final de embalagens – tambores metálicos vazios contaminados. A metodologia, abordagens qualitativa e quantitativa, centrou-se em visitas técnicas à empresa e aplicação de questionários e entrevistas aos colaboradorestrabalhadores. Analisaram-se os procedimentos adotados, o ambiente de trabalho, as atividades desenvolvidas e o esclarecimento dos trabalhadores no desempenho das suas funções. Os resultados referem falta de escolaridade dos trabalhadores, aliada à pouca atenção aos procedimentos de trabalho e à falta de esclarecimentos quanto ao desempenho de atividades potencialmente poluidoras em relação ao meio ambiente. Diante desses resultados, foram sugeridas práticas de Educação Ambiental (EA).
RESUMO Objetivo Registrar os potenciais evocados auditivos de tronco encefálico nas condições de repouso e movimento, no mesmo indivíduo, utilizando o novo equipamento/sistema Integrity, e verificar ...a concordância das respostas, quando comparadas a um equipamento/sistema convencional, padrão-ouro no mercado. Métodos Trinta adultos com audição normal, de ambos os gêneros, entre 18 e 30 anos, foram submetidos ao Potencial Evocado Auditivo de Tronco Encefálico. Para registro das respostas no mesmo indivíduo, foram usados dois equipamentos, um deles (Integrity) com tecnologia bluetooth, nas condições de repouso e movimento e outro, equipamento/sistema convencional, na condição de repouso. Resultados A comparação entre as latências absolutas e interpicos observada nas condições de repouso e movimento, no equipamento Integrity, foi de equivalência. Os tempos de exame observados nos dois equipamentos, na condição de repouso, foram iguais. O tempo de aquisição do potencial evocado auditivo, na condição de movimento, foi maior que na condição de repouso, no equipamento Integrity. Conclusão Os valores de referência em adultos ouvintes normais no equipamento Integrity foram os mesmos para as condições de repouso e em movimento. As latências obtidas nos dois equipamentos foram equivalentes na condição repouso. Houve concordância entre os valores das latências no equipamento Integrity, nas condições de repouso e de movimento.
This study aims to explore quarantined individuals' emotional well-being over time and how personal response and life activity predict emotional well-being and its change.
Daily data were collected ...from 134 participants with 71 having 14 consecutive days' data. Hierarchical linear modeling (HLM) and General Linear Model (GLM) were used to examine the primary tests.
Overall, positive and negative emotions declined significantly during the surveyed period. Meanwhile, differences were observed in the level of positive, depressed, and negative emotions and/or patterns of change among different population categories. The personal response of worrying about work and life was positively related to depressed and negative emotions at baseline, but was negatively related to the development of both depressed and negative emotions over time. Among life activities, family stressor was a significant predictor for both depressed and negative emotions while social support predicted positive emotions. Moreover, health & hygiene activity was positively related to positive emotions at baseline.
The results provide scientific evidence for public health policymakers on quarantine policies and inform the general public about quarantine life. They highlight the importance of addressing the needs of vulnerable groups (parents with young children, divorcees, clinicians) during the pandemic, and demonstrate the benefits of promoting healthcare and hygiene activity, having a sense of worry and access to social support.
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