Policy Brief: an assessment of the economic and social impacts of climate change on the coastal and marine sector in the Caribbean

Caribbean policymakers are faced with special challenges from climate change and these are related to the uncertainties inherent in future climate projections and the complex linkages among climate change, physical and biological systems and socioeconomic sectors. The impacts of climate change threaten development in the Caribbean and may well erode previous gains in development as evidenced by the increased incidence of climate migrants internationally. This brief which is based on a recent study conducted by the Economic Commission for Latin America and the Caribbean (LC/CAR/L.395)1 provides a synthesis of the assessment of the economic and social impacts of climate change on the coastal and marine sector in the Caribbean which were undertaken. It provides Caribbean policymakers with cutting-edge information on the region’s vulnerability and encourages the development of adaptation strategies informed by both local experience and expert knowledge. It proceeds from an acknowledgement that the unique combination of natural resources, ecosystems, economic activities, and human population settlements of the Caribbean will not be immune to the impacts of climate change, and local communities, countries and the subregion as a whole need to plan for, and adapt to, these effects. Climate and extreme weather hazards related to the coastal and marine sector encompass the distinct but related factors of sea level rise, increasing coastal water temperatures, tropical storms and hurricanes. Potential vulnerabilities for coastal zones include increased shoreline erosion leading to alteration of the coastline, loss of coastal wetlands, and changes in the abundance and diversity of fish and other marine populations. The study examines four key themes in the analysis: climate, vulnerability, economic and social costs associated with climate change impacts, and adaptive measures.

From «Pflantz-Gart» to «Stammregister». On the history of knowledge of fruit cultivation in the canton of Bern

Among the efforts for the improvement of agricultural productivity, the cultivation of useful plants is particularly at the center of the Economic Enlightenment. In contrast to fodder and textile plants, cereals and potatoes, fruit trees are not included among its favoured subjects. This may be considered as astonishing in view of the significance that fruit has acquired in the contemporary diet. Be that as it may, efforts to improve fruit cultivation go back to even before the classical period of the Economic Enlightenment. The example of Bern in particular is suited to such an analysis over the Longue durée that covers the time from Daniel Rhagor’s «Pflantz-Gart» (1639) to the «Register of varieties of excellent species of pome fruits for the canton of Bern» (Stammregister, 1865). From the perspective of the history of knowledge, the connections between scholarly knowledge and local experience on the one hand and the changing actors in these knowledge systems on the other hand are of special interest here

La Geografía en la extensión universitaria : Talleres sobre microemprendimientos productivos en áreas rurales y urbanas del municipio de General Pueyrredón

El objetivo del trabajo es difundir actividades de extensión desarrolladas por alumnos y docentes, con la finalidad de mejorar la calidad de vida de la población del área de estudio, brindar la posibilidad de insertarse al mercado laboral y vincular a integrantes del grupo con diferentes actores sociales en espacios propuestos. Diversos diagnósticos detectaron necesidades sociolaborales en barrios de Mar del Plata. Para mitigarlas, integrantes del Voluntariado Universitario diseñan materiales para dictar talleres sobre Microemprendimientos Productivos. La experiencia tiene resultados positivos porque los encuentros son espacios de debate sobre experiencias locales, que incentivan la asociatividad y generan redes sociales.

La Geografía en la extensión universitaria : Talleres sobre microemprendimientos productivos en áreas rurales y urbanas del municipio de General Pueyrredón

El objetivo del trabajo es difundir actividades de extensión desarrolladas por alumnos y docentes, con la finalidad de mejorar la calidad de vida de la población del área de estudio, brindar la posibilidad de insertarse al mercado laboral y vincular a integrantes del grupo con diferentes actores sociales en espacios propuestos. Diversos diagnósticos detectaron necesidades sociolaborales en barrios de Mar del Plata. Para mitigarlas, integrantes del Voluntariado Universitario diseñan materiales para dictar talleres sobre Microemprendimientos Productivos. La experiencia tiene resultados positivos porque los encuentros son espacios de debate sobre experiencias locales, que incentivan la asociatividad y generan redes sociales.

La Geografía en la extensión universitaria : Talleres sobre microemprendimientos productivos en áreas rurales y urbanas del municipio de General Pueyrredón

El objetivo del trabajo es difundir actividades de extensión desarrolladas por alumnos y docentes, con la finalidad de mejorar la calidad de vida de la población del área de estudio, brindar la posibilidad de insertarse al mercado laboral y vincular a integrantes del grupo con diferentes actores sociales en espacios propuestos. Diversos diagnósticos detectaron necesidades sociolaborales en barrios de Mar del Plata. Para mitigarlas, integrantes del Voluntariado Universitario diseñan materiales para dictar talleres sobre Microemprendimientos Productivos. La experiencia tiene resultados positivos porque los encuentros son espacios de debate sobre experiencias locales, que incentivan la asociatividad y generan redes sociales.

Oxidative stress and its haemodynamic consequences in chronic kidney disease

Chronic kidney disease (CKD) is associated with increased cardiovascular risk in comparison with the general population. This can be observed even in the early stages of CKD, and rises in proportion to the degree of renal impairment. Not only is cardiovascular disease (CVD) more prevalent in CKD, but its nature differs too, with an excess of morbidity and mortality associated with congestive cardiac failure, arrhythmia and sudden death, as well as the accelerated atherosclerosis which is also observed. Conventional cardiovascular risk factors such as hypertension, dyslipidaemia, obesity, glycaemia and smoking, are highly prevalent amongst patients with CKD, although in many of these examples the interaction between risk factor and disease differs from that which exists in normal renal function. Nevertheless, the extent of CVD cannot be fully explained by these conventional risk factors, and non-conventional factors specific to CKD are now recognised to contribute to the burden of CVD. Oxidative stress is a state characterised by excessive production of reactive oxygen species (ROS) and other radical species, a reduction in the capacity of antioxidant systems, and disturbance in normal redox homeostasis with depletion of protective vascular signalling molecules such as nitric oxide (NO). This results in oxidative damage to macromolecules such as lipids, proteins and DNA which can alter their functionality. Moreover, many enzymes are sensitive to redox regulation such that oxidative modification to cysteine thiol groups results in activation of signalling cascades which result in adverse cardiovascular effects such as vascular and endothelial dysfunction. Endothelial dysfunction and oxidative stress are present in association with many conventional cardiovascular risk factors, and can be observed even prior to the development of overt, clinical, vascular pathology, suggesting that these phenomena represent the earliest stages of CVD. In the presence of CKD, there is increased ROS production due to upregulated NADPH oxidase (NOX), increase in a circulating asymmetric dimethylarginine (ADMA), uncoupling of endothelial nitric oxide synthase (eNOS) as well as other mechanisms. There is also depletion in exogenous antioxidants such as ascorbic acid and tocopherol, and a reduction in activity of endogenous antioxidant systems regulated by the master gene regulator Nrf-2. In previous studies, circulating markers of oxidative stress have been shown to be increased in CKD, together with a reduction in endothelial function in a stepwise fashion relating to the severity of renal impairment. Not only is CVD linked to oxidative stress, but the progression of CKD itself is also in part dependent on redox sensitive mechanisms. For example, administration of the ROS scavenger tempol attenuates renal injury and reduces renal fibrosis seen on biopsy in a mouse model of CKD, whilst conversely, supplementation with the NOS inhibitor L-NAME causes proteinuria and renal impairment. Previous human studies examining the effect of antioxidant administration on vascular and renal function have been conflicting however. The work contained in this thesis therefore examines the effect of antioxidant administration on vascular and endothelial function in CKD. Firstly, 30 patients with CKD stages 3 – 5, and 20 matched hypertensive controls were recruited. Participants with CKD had lower ascorbic acid, higher TAP and ADMA, together with higher augmentation index and pulse wave velocity. There was no difference in baseline flow mediated dilatation (FMD) between groups. Intravenous ascorbic acid increased TAP and O2-, and reduced central BP and augmentation index in both groups, and lowered ADMA in the CKD group only. No effect on FMD was observed. The effects of ascorbic acid on kidney function was then investigated, however this was hindered by the inherent drawbacks of existing methods of non-invasively measuring kidney function. Arterial spin labelling MRI is an emerging imaging technique which allows measurement of renal perfusion without administration of an exogenous contrast agent. The technique relies upon application of an inversion pulse to blood within the vasculature proximal to the kidneys, which magnetically labels protons allowing measurement upon transit to the kidney. At the outset of this project local experience using ASL MRI was limited and there ensued a prolonged pre-clinical phase of testing with the aim of optimising imaging strategy. A study was then designed to investigate the repeatability of ASL MRI in a group of 12 healthy volunteers with normal renal function. The measured T1 longitudinal relaxation times and ASL MRI perfusion values were in keeping with those found in the literature; T1 time was 1376 ms in the cortex and 1491 ms in the whole kidney ROI, whilst perfusion was 321 mL/min/100g in the cortex, and 228 mL/min/100g in the whole kidney ROI. There was good reproducibility demonstrated on Bland Altman analysis, with a CVws was 9.2% for cortical perfusion and 7.1% for whole kidney perfusion. Subsequently, in a study of 17 patients with CKD and 24 healthy volunteers, the effects of ascorbic acid on renal perfusion was investigated. Although no change in renal perfusion was found following ascorbic acid, it was found that ASL MRI demonstrated significant differences between those with normal renal function and participants with CKD stages 3 – 5, with increased cortical and whole kidney T1, and reduced cortical and whole kidney perfusion. Interestingly, absolute perfusion showed a weak but significant correlation with progression of kidney disease over the preceding year. Ascorbic acid was therefore shown to have a significant effect on vascular biology both in CKD and in those with normal renal function, and to reduce ADMA only in patients with CKD. ASL MRI has shown promise as a non-invasive investigation of renal function and as a biomarker to identify individuals at high risk of progressive renal impairment.

La construcción de sentido (‘sensemaking’) de un entorno estratégico turbulento por parte de los altos directivos: un estudio en una multinacional automotriz

Este artículo presenta los resultados de una investigación realizada al interior de dos contextos. Por un lado, el teórico, en el marco de uno de los discursos más relevantes en los campos de la estrategia organizacional, de la managerial and organizational cognition (MOC) y, en general, de los estudios organizacionales (organization studies): la construcción de sentido (sensemaking). Por el otro, el empírico, en una de las grandes compañías multinacionales del sector automotriz con presencia global. Esta corporación enfrenta una permanente tensión entre lo que dicta la casa matriz, en relación con el cumplimiento de metas y estándares específicos, considerando el mundo entero, y los retos que, teniendo en cuenta lo regional y lo local, experimentan los altos directivos encargados de hacer prosperar la empresa en estos lugares. La aproximación implementada fue cualitativa. Esto en atención a la naturaleza de la problemática abordada y la tradición del campo. Los resultados permiten ampliar el actual nivel de comprensión acerca de los procesos de sensemaking de los altos directivos al enfrentar un entorno estratégico turbulento.

Predictive factors for local recurrence and incomplete resection of early gastric cancer treated by endoscopic resection: A Western experience

BACKGROUND: Early gastric cancer (EGC) is defined as adenocarcinoma limited to the mucosa or submucosa regardless of lymph node involvement. Local EGC recurrence rates have been described ill Lip to 6% of cases. OBJECTIVES: To evaluate predictive factors for incomplete resection and local recurrence of EGC treated by endoscopic mucosal resection (EMR) that was followed up for at least one year. METHODS: From June 1994 to December 2005, 46 patients with EGC underwent EMR. Possible predictive factors for incomplete endoscopic resection and local recurrence were identified by medical chart analysis. Demographic, endoscopic and histopathological data were retrospectively evaluated. EMR was considered complete or incomplete. Patients from the complete resection group were divided into subgroups (with and without local EGC recurrence). RESULTS: Complete resection was possible in 36 cases (76.6%). Predictive factors for incomplete resection were turnout location (P=0.035), histological type (P=0.021), lesion size (P=0.022) and number of resected fragments (P=0.013). On multivariate analysis, undifferentiated histological type (OR 0.8; 95% Cl 0.036 to 0.897) and number of resected fragments (OR 7.34; 95% Cl 1.266 to 42.629) were independent predictive factors for incomplete resection. In the complete resection group, a larger lesion size was associated with a higher the number of resected fragments (P=0.018). Local recurrence occurred in nine cases (25%). Use of the cap technique was the only predictive factor for local recurrence in five of seven cases (71.4%) (P=0.006). CONCLUSIONS: A larger lesion size was associated with a higher number of resected fragments. Undifferentiated adenocarcinoma and piecemeal resection were predictive factors for incomplete resection. Technique type was a predictive factor for local EGC recurrence.

Preliminary Experience in Treatment of Papillary and Macular Retinoblastoma: Evaluation of Local Control and Local Complications After Treatment with Linear Accelerator-Based Stereotactic Radiotherapy with Micromultileaf Collimator as Second-Line or Salvage Treatment after chemotherapy.

PURPOSE: To determine the local control and complication rates for children with papillary and/or macular retinoblastoma progressing after chemotherapy and undergoing stereotactic radiotherapy (SRT) with a micromultileaf collimator. METHODS AND MATERIALS: Between 2004 and 2008, 11 children (15 eyes) with macular and/or papillary retinoblastoma were treated with SRT. The mean age was 19 months (range, 2-111). Of the 15 eyes, 7, 6, and 2 were classified as International Classification of Intraocular Retinoblastoma Group B, C, and E, respectively. The delivered dose of SRT was 50.4 Gy in 28 fractions using a dedicated micromultileaf collimator linear accelerator. RESULTS: The median follow-up was 20 months (range, 13-39). Local control was achieved in 13 eyes (87%). The actuarial 1- and 2-year local control rates were both 82%. SRT was well tolerated. Late adverse events were reported in 4 patients. Of the 4 patients, 2 had developed focal microangiopathy 20 months after SRT; 1 had developed a transient recurrence of retinal detachment; and 1 had developed bilateral cataracts. No optic neuropathy was observed. CONCLUSIONS: Linear accelerator-based SRT for papillary and/or macular retinoblastoma in children resulted in excellent tumor control rates with acceptable toxicity. Additional research regarding SRT and its intrinsic organ-at-risk sparing capability is justified in the framework of prospective trials.

Report on initial experience with local anaesthesia for carotid artery endarterectomy.

PURPOSE OF THE STUDY: This prospective study reports our preliminary results with local anaesthesia (LA) for carotid endarterectomy (CEA). MATERIAL AND METHODS: Twenty CEA in nineteen patients were performed using a three-stage local infiltration technique. CEA were performed through a short Duplex-assisted skin incision (median length: 55 mm) using a retro-jugular approach and polyurethane patch closure (median length: 35 mm). RESULTS: There were 13 men and 6 women with a mean age of 71.2 years. The indications of CEA were asymptomatic lesions in 11 cases, stroke in 7 cases and transient ischaemic attack in 2 cases. The median degree of internal carotid artery stenosis was 90%. One patient (5%) required an intraluminal shunt. There were no peri-operative deaths, stroke or conversion to general anaesthesia (GA). The median length of stay was 3 days. CONCLUSIONS: LA is a good alternative to GA. It can be used after a feasibility study and a short teaching procedure. In our centre, it is a safe and effective procedure associated with low morbidity, high acceptance by patients and a short hospital stay.

Refashioning local government and inner-city regeneration: The Salford experience

This paper explores the role of local government in urban regeneration in England. The first part describes local-central government relations during recent decades. It concludes that 'actually occurring' regeneration fuses top-down and bottom-up priorities and preferences, as well as path dependencies created by past decisions and local relations. The second part illustrates this contention by examining the regeneration of inner-city Salford over a 25-year period. It describes Salford City Council's approach in achieving the redevelopment of the former Salford Docks and how this created the confidence for the council to embark on further regeneration projects. Yet the top-down decision-making model has failed to satisfy local expectations, creating apathy which threatens the Labour government's desire for active citizens in regeneration projects.

Preliminary Experience in Treatment of Papillary and Macular Retinoblastoma: Evaluation of Local Control and Local Complications After Treatment with Linear Accelerator-Based Stereotactic Radiotherapy with Micromultileaf Collimator as Second-Line or Salvage Treatment after chemotherapy

To determine the local control and complication rates for children with papillary and/or macular retinoblastoma progressing after chemotherapy and undergoing stereotactic radiotherapy (SRT) with a micromultileaf collimator.

Diffusion-weighted magnetic resonance imaging detects local recurrence after radical prostatectomy: initial experience

Current conventional cross-sectional imaging techniques, such as contrast-enhanced computed tomography and magnetic resonance imaging (MRI), are largely inaccurate in detecting local recurrence after radical prostatectomy. We report on five patients with biochemical recurrence after radical retropubic prostatectomy and pelvic lymph node dissection for whom local recurrence could only be detected with diffusion-weighted (DW) MRI. Prior to DW-MRI, all patients had negative digital rectal examinations, negative or equivocal conventional cross-sectional imaging, and negative bone scans. All suspicious lesions on DW-MRI imaging were histologically proved to be local recurrences of prostate cancer after either transrectal ultrasound-guided or transurethral biopsy. These results should encourage other centres to test our findings.