Transparency International

Polycarbonate (PC) is widely used in impact-resistant transparent components due to its excellent toughness and optical properties. However, its mechanical behavior under high strain rate loading remains insufficiently understood, particularly from a microstructural perspective. In this study, the macro-micro deformation mechanisms of PC under high strain rate compression were systematically investigated through an integrated approach combining multiscale simulations and microstructural characterization. Two PC grades with different molecular weights were subjected to dynamic compression experiments using a split Hopkinson pressure bar at high strain rates (4500, 5500, and 7000 s–1) and temperatures of 233, 296, and 353 K. The results reveal pronounced strain rate and temperature dependence in yield stress, yield strain, strain hardening, and unloading strain. Two-dimensional wide-angle X-ray diffraction and polarized Fourier-transform infrared analyzes demonstrate that molecular chain orientation is significantly enhanced under high strain rate loading, with lower molecular weight PC exhibiting more pronounced strain hardening due to easier chain alignment. Molecular dynamics simulations further elucidate that higher molecular weight PC possesses greater conformational stability and resistance to compression. Additionally, the DSGZ model parameters of different PC was calibrated, and accurately predicting the high strain rate compressive response in finite element simulations. The findings provide deep insights into the microstructural origins of the macroscopic mechanical behavior of PC under high-strain-rate compression, offering valuable guidance for material design and engineering applications.

Total knee arthroplasty (TKA) restores the mechanical axis of the lower extremity, which is impaired due to gonarthrosis. Foot and ankle pain observed after TKA is not uncommon, and the exact cause has not been determined. This study aims to assess the role of the movement capacity of the subtalar joint and the clinical and radiological risk factors for foot and ankle pain after TKA. This study included 184 patients who underwent TKA due to primary varus gonarthrosis. Patients were evaluated clinically and radiologically before and after surgery. Lower extremity mechanical axis, talar-tilt angle, foot ground-talar dome angle, heel alignment ratio, heel alignment angle, heel alignment distance, and postoperative changes were the radiological angles measured. The Oxford Knee Score, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score, visual analog scale score, and ankle and subtalar joint range of motion examinations were used clinically. Patients were grouped as those whose American Orthopaedic Foot and Ankle Society scores did not worsen after surgery (group 1) and those whose scores worsened (group 2). The group 1 included 142 patients (77.2%) and group 2 included 42 patients (22.8%). The mean preoperative knee varus degree of group 1 was 11.49 ± 3.45, and that of group 2 was 14.26 ± 4.21 ( P < 0.001). The mean body mass index was 26.67 ± 2.31 for group 1 and 29.47 ± 3.14 for group 2 ( P < 0.001). Although no important difference was found between the groups in preoperative ankle motion capacity ( P = 0.086), subtalar joint motion was found to be markedly limited in group 2 ( P < 0.001). High preoperative knee varus degree and body mass index values, especially diminished preoperative subtalar joint motion capacity together with these values, are risk factors for postoperative foot and ankle pain after TKA. Level III, Retrospective comparative study.

Clinical trials are considered to be the largest contributor to pharmaceutical development costs. However, public disclosure of the costs of individual clinical trials is rare. Médecins Sans Frontières (MSF) sponsored a phase 2b-3 randomised controlled trial (TB-PRACTECAL), which identified a new treatment regimen for drug-resistant TB. We aimed to analyse the costs of undertaking a pivotal clinical trial conducted in relatively low-resource health settings and to demonstrate the feasibility of reporting clinical trial costs. TB-PRACTECAL trial costs were analysed using MSF accounting documents. Costs were broken down by cost category, year, and trial site. Total costs for TB-PRACTECAL were €33.9 million and the average cost per patient was €61,460. Twenty-six percent of total costs represented central activities (e.g. trial planning, trial management) and 72% represented trial site activities, with 2% uncategorizable. Within trial site costs, personnel costs were the largest cost (43%) followed by external diagnostic services (11%), medicines (9%), and other medical consumables (7%). Cost variation across trial sites was driven by different varying levels of pre-existing trial infrastructure. A review of previous studies yielded a wide range of cost estimates for clinical trials (ranging US$7-221 million/trial for pharmaceutical phase 2 and 3 trials). Nearly all previous estimates derive from industry reporting that is neither standardized nor auditable; to our knowledge, this is the first published comprehensive analysis of direct expenditures of a specific clinical trial including detailed cost breakdowns. The €34 million cost of TB-PRACTECAL included investments in developing clinical trial infrastructure, the complexity of managing six sites across three health systems, and medical expenditures that are not typical of standard clinical trials. Greater transparency in drug development costs can inform medicine pricing negotiations and is a key element in the design and implementation of more equitable systems of biomedical research and development.

Randomized controlled trials (RCTs) provide evidence of efficacy, while real-world data (RWD) demonstrate effectiveness in real-world practice. We designed a systematic review and meta-analysis of reconstructed time-to-event (RTE) data from propensity score matching studies comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) to compare their effectiveness and evaluate the generalizability of TAVI indications. Systematic review of literature between 2007 and 2023 including propensity score matching studies comparing TAVI or SAVR that reported at least one-year Kaplan-Meier curves of endpoints. Twenty-one studies were included (39538 participants). TAVI shows a higher all-cause mortality (hazard ratio [HR] 1.41; 95% confidence interval [CI] 1.34-1.47, P-value < 0.001), with a significant heterogeneity. The analysis of HR trend over time shows that TAVI superiority is limited to the first month with a steep reversal afterwards, when SAVR becomes clearly superior. All-cause mortality is significantly higher in TAVI in low-risk (HR 1.35; 95% CI 1.08-1.69, P-value < 0.001) as well as in intermediate (HR 1.73; 95% CI 1.35-2.22, P-value < 0.001) and high-risk (HR 1.61; 95% CI 1.38-1.88, P-value < 0.001) patients. The HR trend in the subgroups of risk confirms the data from the whole mixed population. In a real-word setting, TAVI is associated with higher incidence of all-cause death and maintains a survival benefit only in the first month after implantation. These results show that TAVI effectiveness may not reflect the efficacy demonstrated by RCTs and pose a threat to their external validity.

La auditoría de la gestión de recursos humanos en entidades públicas ecuatorianas, centrada en la eficiencia, se posiciona como un proceso estratégico para evaluar y mejorar la administración del capital humano. Enmarcada por la legislación, incluyendo la Constitución de la República del Ecuador, la Ley Orgánica del Servicio Público, y la Ley Orgánica de Transparencia, esta investigación adoptó un enfoque mixto, combinando análisis cualitativos y cuantitativos. Los métodos incluyeron una revisión detallada de documentos normativos y políticas institucionales y de informes de auditorías realizadas por la Contraloría General del Estado, destacando el análisis del artículo 407 de las Normas de Control Interno emitidas por la Contraloría General del Estado. Los resultados revelaron el impacto de las auditorías en diversas instituciones gubernamentales, con el Ministerio de Finanzas revelando eficiencia en los procesos de selección con un 91% y cumplimiento normativo con un 85%. Sin embargo, el Instituto Nacional de Estadística y Censos enfrentó desafíos, especialmente en evaluación del desempeño valorado por un 43%. El Ministerio de Educación mostró un alto nivel de cumplimiento normativo con un 96%, pero identificó desafíos en el reconocimiento del rendimiento en el 25%.

La investigación tuvo como objetivo determinar la propuesta de procesos estratégicos para mejorar la gestión del programa de Vaso de Leche (PVL) de la Municipalidad Provincial de San Martín - 2022. Estudio de alcance descriptivo-propositivo y diseño no experimental. Se evaluaron 103 personas del Programa Vaso de Leche (PVL), incluyendo responsables y miembros de la junta directiva. Se usaron ficha, guía y cuestionario para recopilar información. Los resultados revelaron un nivel regular en los procesos estratégicos del programa de Vaso de Leche en 2022, con discrepancias entre el municipio y el comité de vaso de leche. El 79% de los procesos se ejecutaron, pero el comité consideró eficientes solo el 59%. Ambas fuentes coinciden en la necesidad de mejorar el presupuesto, capacitación del personal, participación comunitaria y procesos de selección y fiscalización. La gestión del programa se evaluó como regular (77% en ficha de recolección) y eficiente (75% según comité), pero se identificaron deficiencias en planificación, logística y ejecución de la distribución de alimentos. La validación del modelo de propuesta de procesos estratégicos por expertos respalda su fundamentación teórica y alineación con recursos disponibles; concluyendo que mejora la gestión del programa, fortaleciendo su efectividad y transparencia.

A regulação da assistência é um importante recurso de gestão pública do Sistema Único de Saúde (SUS) empregado com o objetivo de ordenar o acesso dos usuários aos diferentes componentes da rede de serviços, mediante avaliação de risco e necessidade. No entanto, há estudos que apontam falta de equilíbrio entre a oferta e as necessidades e demandas por serviços da atenção secundária no SUS, bem como transparência nos mecanismos de acesso. Na presente pesquisa, analisou-se o processo de acesso à atenção secundária à saúde com elaboração de seu delineamento na especialidade médica de cirurgia do aparelho digestivo (CAD) de um hospital público e secundário integrante de uma rede regional de saúde e gerido por uma organização social de saúde. Foram realizadas entrevistas com gestores, médicos e demais profissionais envolvidos no processo. A partir das informações coletadas foi construído um mapa dos processos utilizando o software Bizagi e a notação de modelagem de processos de negócios (BPMN). As vagas para consultas no hospital secundário na especialidade de CAD são disponibilizadas para regulação da Direção Regional de Saúde (DRS) que recebe dos municípios as solicitações de agendamentos mediante envio de guias de referência para o Sistema de Apoio à Regulação Assistencial (SARA). O o agendamento é realizado por critério cronológico e de necessidade partir de avaliação compartilhada entre regulação da DRS o próprio hospital. O processo tem incoerências com as diretrizes da regulação e o delineamento o proposto o torna mais transparente e com possibilidade de aperfeiçoamento.

Abstract Payer coverage for Exome Sequencing (ES) is becoming commonplace (albeit in some cases with prior authorization restrictions), coverage for Genome Sequencing (GS) is rare, with most payers considering it as investigational and not medically necessary. Previous studies had identified several concerns and challenges from the payer perspective.The objective of this study is to conduct a targeted literature review of the evidence describing the cost and clinical utility of GS and ES compared to standard of care (SoC) testing in children ≤18 years with suspected genetic disease.We conducted a systematic literature review to identify evidence for cost, diagnostic utility and clinical utility between SoC, ES, and GS in children (0-18 years) with suspected genetic diseases. We also identified list prices for individual tests from Concert Genetics. Descriptive analyses were conducted for cost and comparative effectiveness data.We identified five studies on costs of ES and GS, as well as data from concert genetics, and 62 studies of comparative effectiveness of GS or ES in pediatric patients &lt;18 yrs. with suspected genetic disease. We identified 2 reviews/systematic literature review, one cost savings, one micro-costing, and one cost-effectiveness analysis, in addition to the list prices from Concert Genetics which support the range of costs in the articles. List prices ranged from an average of $2264 (small panel) to $7245 for a rapid ES trio. Nearly half the studies (28/63; 44%) only reported diagnostic yield, and 18 studies with NICU/PICU patients and 18 studies of outpatients that reported a change in management. The change in management was very heterogeneous ranging from 24% to 83% depending on the patients’ suspected disorder and test type (e.g., rapid GS, rapid ES, GS). We were unable to determine if any of the GS test types (ultra-rapid GS or rapid GS or GS, range 24% - 83%) provided a greater change in clinical management rate than the ES test types (rapid ES or ES, range 35% - 83%).There is limited evidence of GS over ES in the ability to effect change in management. Available evidence suggests that rapid over standard GS or ES is of greater benefit in the NICU/PICU setting vs. outpatient setting. Future clinical studies must include both diagnostic yield and clinical management outcomes in order to provide stakeholders with the necessary evidence to support decision-making on implementation and coverage.