Fernando García Mercadal y el Movimiento Moderno

La tesis plantea el estudio de la figura de Fernando García Mercadal (1896- 1985) y su obra, en el contexto del proyecto moderno perteneciente a la racionalidad teórica colectiva de la segunda generación del Movimiento Moderno en Europa, y explora la vida y circunstancias de un arquitecto que aunque nacido en el XIX, trajo la modernidad a España. El Movimiento Moderno en España, se articula en las décadas de los años 20 y 30 a través del GATEPAC y un grupo de arquitectos racionalistas en Madrid que Carlos Flores denomina Generación del 1925. Fernando García Mercadal, primero de su promoción en 1921 y pensionado en Roma, pertenece a ambos y pronto se convierte junto con Josep Lluis Sert, en una de las figuras más relevantes del panorama moderno español. Único miembro fundador del GATEPAC que había nacido en el siglo XIX, publica habitualmente en la revista AC (1931-1937), y en la revista Arquitectura desde 1920. Organiza en la Residencia de Estudiantes, entre 1928 y 1932, un famoso ciclo de Conferencias que imparten Le Corbusier, Mendelsohn, Van Doesburg, Gropius y Giedion. También asiste a la reunión constituyente de los CIAM en La Sarraz en 1928, al CIAM II en Frankfurt en 1929 y al CIAM III en Bruselas en 1930. Fue profesor en la Escuela de Arquitectura de Madrid y Arquitecto Jefe de la Oficina de Urbanismo y de Parques y Jardines del Ayuntamiento de Madrid, cargo al que accede por oposición en 1932. Tras la guerra fue depurado e inhabilitado profesionalmente, hasta que en 1946 comienza a trabajar en el Departamento de Arquitectura del I.N.P. donde continúa hasta los años 70. En 1979 es nombrado Académico de número de la Real Academia de Bellas Artes de San Fernando y muere en Madrid en 1985. Estos son los datos conocidos y aunque en la tesis se aportan nuevos datos inéditos, es en las premisas para su interpretación donde este trabajo de investigación pone el acento. En la historiografía de nuestra arquitectura moderna, pervive una tendencia a suponer una desconexión entre la vanguardia arquitectónica en los años 20 y 30 y el movimiento moderno internacional. El manto de silencio que cayó sobre la generación anterior a la guerra, una vez terminada esta, contribuye a reforzar la idea, cuyo origen y causas exceden el ámbito de trabajo, aunque se tratarán tangencialmente por ser ineludible hacerlo. La tesis pone en cuestión ese planteamiento desde el convencimiento fundamentado en los datos y en la consulta de fuentes originales, que la arquitectura española anterior a la guerra, aun con las circunstancias particulares del país, estuvo en sintonía con la europea, siendo esta la hipótesis de partida de la investigación. Las aportaciones más significativas que, a mi entender, presenta la tesis doctoral, y tienen mayor originalidad, son las siguientes; 1.Puesta en valor de la arquitectura de FGM, antes y después de la guerra, abandonando la idea de su supuesta renuncia a las ideas modernas a partir de los 30; 2. Puesta en valor, con aportación de datos concretos, de la Intensa relación mantenida por FGM y otros arquitectos españoles del Movimiento Moderno con los arquitectos de igual tendencia en el resto de Europa, a través de contactos recíprocos y continuos; 3. Estudio de la obra de FGM en el marco del Movimiento Moderno como una nueva arquitectura basada no tanto en la epidermis, como en una forma de hacer y encarar los problemas donde el proceso es tan importante como el resultado; con el Urbanismo como una nueva ciencia, y con el desarrollo de nuevos programas funcionales acordes a las necesidades de la sociedad contemporánea como el Rincón de Goya y el Hospital de Zaragoza. Se manejan tres métodos de trabajo. Los dos primeros aportan un nuevo enfoque al análisis crítico de FGM y su obra, situándole en el contexto internacional, además del español. El tercero, de carácter instrumental, permite el manejo y sistematización de la documentación. El primer método, consiste en aplicar el criterio generacional de Pevsner o Giedion entre otros, al Movimiento Moderno en España, situando a Fernando García Mercadal como arquitecto de la segunda generación, para hacer un análisis crítico comparativo de su trayectoria con otros arquitectos europeos de la misma, que permita establecer semejanzas y diferencias. El segundo método, complementario al anterior, consiste en estudiar las relaciones internacionales de FGM con las figuras más próximas a él y sus posibles influencias. Por último, y en relación con la documentación de obras y proyectos, se manejan a su vez dos criterios. Para la obra completa, y debido a la inexistencia de originales del Legado García Mercadal, se utiliza con carácter general el material ya publicado, disperso en libros y revistas. En el caso de las cinco obras seleccionadas, se completa con búsqueda en archivos, toma de datos in situ actualizados cuando es posible, y una recopilación de su repercusión en prensa escrita de su momento. ABSTRACT This research study focuses on Fernando Garcia Mercadal (1896-1985) and his work in the context of the Modern project as part of the collective theoretical rationality of the second generation of European Modern architecture. It explores the life and circumstances of the architect, who even though born in 19th century introduced Modern architecture in Spain. Modern architecture (Modern Movement) in Spain covered two decades between 20's and 30's through GATEPAC and a group of rationalists in Madrid that Carlos Flores named “generation of '25”. Fernando Garcia Mercadal, top of his class in 1921 and granted with the scholarship in Rome, belonged to both groups and early in his career he became, along with Josep Lluis Sert, one of the most relevant figures of Modern Architecture in Spain. He was the only member of GATEPAC who was born in 19th century. He frequently published on the magazine “AC” (1931-1937) and on “Arquitecture” magazine since 1920. He organized a series of famous lectures at “Residencia de Estudiantes” (Madrid) between 1928 and 1932 in which Le Corbusier, Mendelsohn, Van Doesburg, Gropius or Giedion took part. He was a member of the constituent meeting of CIAM in La Sarraz in 1928, CIAM II in Frankfurt in 1929 and CIAM III in Brussels in 1930. Mercadal was a teacher at Escuela de Arquitectura de Madrid and the Chief of the Urban Planning, Parks and Gardens Office of the Council of Madrid. He earned his position by public examination in 1932. After the civil war he was disqualified professionally until 1946, when he started working at the Architecture Department at INP until 70's. In 1979 he was elected as an academic member of “Real Academia de Bellas Artes de San Fernando” and later died in 1985. These are the well-known facts and even though this research study provides unpublished facts, it focuses on the premises to interpret them. Throughout the historiographical discourse of Spanish Modern architecture there is a tendency to assume a disconnection between the Avant-garde architecture movements in 20's and 30's and International Modern architecture (Modern Movement). The generation preceding the war remained silent in regard to this issue and once the war was over, they contributed to support the disconnection. The origin and cause exceed the frame of this work, even though they are incidentally commented due to its importance. This research study questions the approach explained above, based on the facts and the original sources. Its first hypothesis states that Spanish architecture before the civil war was, under its own circumstances, in tune with European architecture. The most important and original contributions of this research study are the following under my point of view: 1. To highlight the architecture of FGM, before and after the war, leaving behind his reputed withdrawal of Modernity after 30's; 2. To highlight the intense relationship between FGM and other Modern Spanish architects and other European architects sharing the same ideas, providing detailed facts; 3. Study of FGM's work in the context of Modern architecture as a new architecture based on its know-how and the way problems are faced. The process is as important as the result, not so much based on the dermis; with urban planning as the new science and with the development of the new functional programs based on the needs of contemporary society as in Rincón de Goya or Hospital de Zaragoza. Three work methods are used. The first two add a new vision of the critical analysis related to FGM and his work, positioning him in the international context in addition to Spain. The third is used as an instrument to manage and systematize the documentation. The first method applies the generational criteria of Pevsner or Giedion (among others) to Modern architecture in Spain, positioning Fernando Garcia Mercadal as a second generation architect. A critical-comparative analysis of his career and contemporary European architects is made to establish similarities and differences. The second method is complementary to the previous one and studies the international relationships of FGM with other recognised architects that were close to him and their possible influences. At last, in relation to his works and projects, two methods are used. For the complete works, due to the lack of originals, published material found on magazines and books is used as the source. In the case of the five selected buildings, it is complemented with archive search, onsite data collection when possible and the impact on the press at that moment.

A Fungal Kinesin Required for Organelle Motility, Hyphal Growth, and Morphogenesis

A gene (NhKIN1) encoding a kinesin was cloned from Nectria haematococca genomic DNA by polymerase chain reaction amplification, using primers corresponding to conserved regions of known kinesin-encoding genes. Sequence analysis showed that NhKIN1 belongs to the subfamily of conventional kinesins and is distinct from any of the currently designated kinesin-related protein subfamilies. Deletion of NhKIN1 by transformation-mediated homologous recombination caused several dramatic phenotypes: a 50% reduction in colony growth rate, helical or wavy hyphae with reduced diameter, and subcellular abnormalities including withdrawal of mitochondria from the growing hyphal apex and reduction in the size of the Spitzenkörper, an apical aggregate of secretory vesicles. The effects on mitochondria and Spitzenkörper were not due to altered microtubule distribution, as microtubules were abundant throughout the length of hyphal tip cells of the mutant. The rate of spindle elongation during anaphase B of mitosis was reduced 11%, but the rate was not significantly different from that of wild type. This lack of a substantial mitotic phenotype is consistent with the primary role of the conventional kinesins in organelle motility rather than mitosis. Our results provide further evidence that the microtubule-based motility mechanism has a direct role in apical transport of secretory vesicles and the first evidence for its role in apical transport of mitochondria in a filamentous fungus. They also include a unique demonstration that a microtubule-based motor protein is essential for normal positioning of the Spitzenkörper, thus providing a new insight into the cellular basis for the aberrant hyphal morphology.

whmD is an essential mycobacterial gene required for proper septation and cell division

A study of potential mycobacterial regulatory genes led to the isolation of the Mycobacterium smegmatis whmD gene, which encodes a homologue of WhiB, a Streptomyces coelicolor protein required for sporulation. Unlike its Streptomyces homologue, WhmD is essential in M. smegmatis. The whmD gene could be disrupted only in the presence of a plasmid supplying whmD in trans. A plasmid that allowed chemically regulated expression of the WhmD protein was used to generate a conditional whmD mutant. On withdrawal of the inducer, the conditional whmD mutant exhibited irreversible, filamentous, branched growth with diminished septum formation and aberrant septal placement, whereas WhmD overexpression resulted in growth retardation and hyperseptation. Nucleic acid synthesis and levels of the essential cell division protein FtsZ were unaltered by WhmD deficiency. Together, these phenotypes indicate a role for WhmD in mycobacterial septum formation and cell division.

A quasi-elastic aquifer deformational behavior: Madrid aquifer case study

The purpose of this paper is to analyze the quasi-elastic deformational behavior that has been induced by groundwater withdrawal of the Tertiary detrital aquifer of Madrid (Spain). The spatial and temporal evolution of ground surface displacement was estimated by processing two datasets of radar satellite images (SAR) using Persistent Scatterer Interferometry (PSI). The first SAR dataset was acquired between April 1992 and November 2000 by ERS-1 and ERS-2 satellites, and the second one by the ENVISAT satellite between August 2002 and September 2010. The spatial distribution of PSI measurements reveals that the magnitude of the displacement increases gradually towards the center of the well field area, where approximately 80 mm of maximum cumulated displacement is registered. The correlation analysis made between displacement and piezometric time series provides a correlation coefficient greater than 85% for all the wells. The elastic and inelastic components of measured displacements were separated, observing that the elastic component is, on average, more than 4 times the inelastic component for the studied period. Moreover, the hysteresis loops on the stress–strain plots indicate that the response is in the elastic range. These results demonstrate the quasi-elastic behavior of the aquifer. During the aquifer recovery phase ground surface uplift almost recovers from the subsidence experienced during the preceding extraction phase. Taking into account this unique aquifer system, a one dimensional elastic model was calibrated in the period 1997–2000. Subsequently, the model was used to predict the ground surface movements during the period 1992–2010. Modeled displacements were validated with PSI displacement measurements, exhibiting an error of 13% on average, related with the inelastic component of deformation occurring as a long-term trend in low permeability fine-grained units. This result further demonstrates the quasi-elastic deformational behavior of this unique aquifer system.

State-building in Iraq since 2003: the Challenges and Lessons. Jean Monnet Occasional Paper No. 12/2014

Introduction. In 2003, Iraq was invaded by the US coalition forces that ousted Saddam Hussein’s regime from power before occupying the whole country. The intension, declared by the then American George W. Bush, was to ‘build a decent and democratic society at the centre of the Middle East’ that ‘will become a place of progress and peace.’1 In 2014, three years after the withdrawal of the last American soldier, however, it is difficult to overestimate or exaggerate what is at stake. National unity and territorial integrity have never been so seriously threatened since the country is experiencing the internal fighting in its modern history. Many parts of Iraq, including the northern oil city of Kirkuk, long claimed as an integral part of the semi-autonomous region of Kurdistan, are out of the control of the central government. Large areas in the north including the strategic city of Mosul were seized by the fighters of the Islamic State, an Al-Qaeda offshoot, formerly known as ISIS, who threatened to invade the Kurdistan region before being attacked by airstrikes by the US. They proclaimed a caliphate on both sides of the border with Syria, where they also control vast territory.

Russia in Crisis: Year One. OSW Report, January 2010

Economic conditions which had favoured Russia’s development suddenly changed in mid-2008. The Russian economy was hit, on the one hand, by a drastic slump in oil prices (which fell from nearly US$150 to US$50 between July 2008 and January 2009), and on the other by the outflow of investors (a net of US$130 billion of capital left Russia in the fourth quarter of 2008). Within several months, the financial crisis became an economic crisis affecting the entire economy. The financial reserves accumulated in times of prosperity (more than US$162 billion in the stabilisation funds and nearly US$598 billion in the currency and gold reserve) alleviated the negative impact of the crisis, although this failed to prevent the deep declines in macroeconomic indicators. Russia is one of the states most severely affected by the crisis. In the first half of 2009, its GDP fell by 10.4% compared to the same period in the previous year, while industrial production dropped by nearly 15%, and a decrease in investments of over 18% was reported. The poor economic performance has strongly affected the Russian budget, which reported a deficit for the first time in ten years in 2009. During the first year of the crisis (August 2008 – September 2009), Russia’s financial reserves were seriously reduced as a result of the government’s anti-crisis policy and interventions from the central bank: the reserve fund decreased by nearly 45% to US$76 billion, and the central bank’s reserves shrunk by nearly US$200 billion to US$409 billion. Meanwhile, however, the money in the National Welfare Fund, which had been intended almost entirely to subsidise the Pensions Fund between 2010 and 2015, rose almost three-fold (to US$90 billion). According to government forecasts, the money from the reserve fund is also supposed to be spent fully in 2010. The financial crisis has triggered a dynamic outflow of capital from the Russian market. So-called speculative capital was the first to demonstrate the lack of confidence in the Russian market. In the first half of 2009, the growth rate of long-term investments also decreased noticeably, although no spectacular withdrawal of direct investments from Russia has been observed. The economic crisis has also halted the foreign expansion of Russian private capital, while state-owned capital strengthened its position as an investor. Russia’s raw materials companies continue to be the main category of foreign investors; however, new technologies are gaining prominence as the second main direction of Russian investments.

The finance-welfare state nexus. ACES Cases No. 2013.1

At the height of the financial crisis, the Western welfare state prevented a repeat of the Great Depression. But there were also suggestions that social policy had contributed to the crisis, particularly by promoting households’ access to credit in pursuit of welfare goals. Others claim that it was the withdrawal of state welfare that led to the disaster. Against this background that motivated our interest, we propose a systematic way of assessing the relationship between financial market and public welfare provisions. We use structural vector auto-regression to establish the causal link and its direction. Two hypotheses about this relationship can be inferred from the literature. First, the notion that welfare states ‘decommodify’ livelihoods or that there is an equity-efficiency tradeoff would suggest that welfare states substitute to varying degrees for financial market offers of insurance and savings. By contrast, welfare states may support private interests selectively and/or help markets for households to function better; thus the nexus would be one of complementarity. Our empirical strategy is to spell out the causal mechanisms that can account for a substitutive or complementary relationship and then to see whether advanced econometric techniques find evidence for the existence of either of these mechanisms in six OECD countries. We find complementarity between public welfare (spending and tax subsidies) and life insurance markets for four out of our six countries, notably even for the United States. Substitution between welfare and finance is the more plausible interpretation for France and the Netherlands, which is surprising. Data availability constrains us from testing the implications for the welfare state contribution to the crisis directly but our findings suggest that the welfare state cannot generally be blamed for the financial crisis.

Ukraine, Russia and the EU. Breaking the deadlock in the Minsk process. CEPS Working Document No. 423 / June 2016

Although the Minsk process brought about a de-escalation of the conflict in Eastern Ukraine, not all of its 13 points have been implemented, including a ceasefire and withdrawal of heavy weaponry. In the absence of a military option, economic sanctions have become the core instrument of the EU and the US, to respond to Russia’s aggression. At the end of June 2016, when EU Heads of State and Government meet to discuss the extension of sanctions against Russia, they should bear in mind that Russia did not implement the commitments it took upon itself in the framework of the Minsk agreements. Given the persistent deadlock in the Ukraine crisis, the leaders of the EU ought to agree to prolong the sanctions against Russia, push for the renegotiation of the Minsk II agreement and widen the ‘Normandy format’ to include the US and bolster reforms in Ukraine.

Desistência da sala de aula : fatores determinantes no município de Girau do Ponciano

Enquadramento: As características do ensino contribuíram para o desenvolvimento de sintomas que desencadeiam a desistência do professor da sala de aula, não sendo Girau do Ponciano exceção. Eles são um problema de gestão pública que requer esforços conjuntos para aliviar esta situação. As causas que aumentam esse fato tem as suas repercussões sobre a saúde dos professores e dizem também respeito às condições de trabalho. Objetivos: Determinar a existência de fatores que mostram a desistência e o afastamento da sala de aula dos professores das escolas municipais da cidade de Girau do Ponciano. Métodos: O perfil sociodemográfico revelou tratar-se de indivíduos maioritariamente do sexo feminino 88,8%, com cerca de 40 anos e possuindo o ensino superior 75,9%,sendo que 68,5% são os mais velhos em tempo de serviço. O instrumento de colheita de dados sob a forma de Questionários permitiu colher informações relativas à caracterização sociodemográfica, ao trabalho e à saúde dos professores. Resultados: Constatou-se que os participantes tinham problemas de saúde psicoemocionais (50,0%); Osteoarticulares (16,6%); relacionados à voz (7,4%); auditivos (1,8%); respiratórios (1,8%) e circulatórios (3,7%). A presença de problemas relacionados com a saúde foi identificada em (77,7%) como fator determinante para a desistência da sala de aula, sendo que (85,1%) revelaram que não possuíam motivação para o trabalho da docência. Não praticam atividade física (48,8%) e a maioria detinha experiência de sala de aula de 10 a 13 anos, totalizando (68,5%). Conclusão: As evidências encontradas sustentam a necessidade de investimento na prevenção de doenças e cuidados especiais com a saúde do docente que deve ser orientado numa abordagem global dos fatores de risco irrompidos na profissão, encarando a prevenção como uma tarefa de todos; governo, sociedades científicas, profissionais de saúde. A investigação e a análise dos dados empíricos é essencial, contribuindo para dar suporte às decisões da gestão e administração escolar e política da escola contemporânea. Palavras-chave: Trabalho Docente; Saúde do Trabalhador; Professor.

Old-age and survivors insurance program analysis.

Report 2-3 published by Federal Security Agency, Social Security Administration, Bureau of Old-Age and Survivors Insurance, Division of Program Analysis.

Changes in neuronal protein 22 expression and cytoskeletal association in the alcohol-dependent and withdrawn rat brain

The action of alcohol on neuronal pathways has been an issue of increasing research focus, with numerous findings contradicting the previously accepted idea that its effect is nonspecific. The human NP22 (hNP22) gene was revealed by its elevated expression in the frontal cortex of the human alcoholic. The sequences of hNP22 and the rat orthologue rNP22 contain a number of domains consistent with those of cytoskeletal-interacting proteins. Localization of rNP22 is restricted to the cytoplasm and processes of neurons and it colocalizes with elements of the microfilament and microtubule matrices including filamentous actin (F-actin), alpha-tubulin, tau, and microtubule-associated protein 2 (MAP2). Withdrawal of Wistar rats after alcohol dependence induced by alcohol vapor produced elevated levels of rNP22 mRNA and protein in the cortex, CA2, and dentate gyrus regions of the hippocampus. In contrast, there was decreased rNP22 expression in the striatum after chronic ethanol exposure. Chronic ethanol exposure did not markedly alter rNP22 colocalization with F-actin, alpha-tubulin, or MAP2, although colocalization at the periphery of the neuronal soma with F-actin was observed only after chronic ethanol exposure and withdrawal. Rat NP22 colocalization with MAP2 was reduced during withdrawal, whereas association with alpha-tubulin and actin was maintained. These findings suggest that the effect of chronic ethanol exposure and withdrawal on rNP22 expression is region selective. Rat NP22 may affect microtubule or microfilament function, thereby regulating the neuroplastic changes associated with the development of alcohol dependence and physical withdrawal.

Brisbane Airport: An alluvial landscape veiled by marine sediments

At Brisbane Airport, the construction of a diversion channel for Kedron Brook exposed a former beach, low cliff and sand spit, which, with their associated sediments and acid sulfate soils, demonstrate a postglacial high sea-level 1.3 - 1.4 m above present mean sea-level. The beach appears to date from 4000 to 5000 y BP. It varies in level where it lies above soft ground; these variations, and sag depressions that follow buried streamlines, indicate sediment consolidation since withdrawal of the sea from the former shore. Most of the area consists of former estuarine deposits, mangrove and saline marshes, and stranded tidal flats on which acid sulfate soils are widely developed. The modern landforms mostly reproduce subsurface features, to the extent that the surface relief replicates the landscape transgressed by the sea 7000 years ago. A small rise of sea-level possibly to +0.65 m occurred about 2000-3000 years ago. Foredunes near the present shore that are related to a slightly lower level 1000 - 500 years ago (-0.25 m) are currently subject to wave erosion.

BEM-ESTAR SUBJETIVO E AUTOEFICÁCIA EM DEPENDENTES DE COCAÍNA/CRACK

Este estudo teve por objetivo identificar e descrever associações entre bem-estar subjetivo, construto formado por satisfação geral com a vida e afetos positivos e negativos,e autoeficáciapara abstinência de drogas em dependentes de cocaína/crack em processo de abstinência. Utilizou, para avaliar as variáveis, as Escalas de Afetos Positivos e Negativos, de Satisfação Geral com a Vida, de Autoeficácia para Abstinência de Drogas, de Avaliação para Mudança da Universidade de Rhode Island e um questionário de dados sócio-demográficos e socioculturais. Participaram 70 homens, dependentes de cocaína/crack, jovens e de baixa escolaridade.Eram pessoas de rendimentos de até três salários mínimos (63%), que foram internadas mais de uma vez (65%), autodeclaradas abstinentes no momento da coleta dos dados. Os participantes possuíam níveis médiosde autoeficácia para abstinência de drogas, níveis baixos de bem-estar subjetivo, e estavam satisfeitos com suas vidas. Cálculos de correlação de Pearson revelaram que não há associação entre bem-estar subjetivoe autoeficácia para abstinência de drogas, entre prontidão para mudança no consumo de drogas e bem-estar subjetivo, nem entre prontidão para mudança no consumo de drogas eautoeficácia para abstinência de drogas. Resultados de análise de variância revelaram que não houve diferençasnos níveis de bem-estar subjetivo entreos diferentes os agrupamentos de prontidão para mudanças nem entre as médias de autoeficácia para abstinência de drogas entre os diferentes agrupamentos de prontidão para mudanças no consumo de drogas. A discussão abordou os resultados diante do fato de a internação dos participantes ter sido involuntária ou voluntária, do tempo de internação, do seu estágio de prontidão para mudar seu comportamento de consumo de drogas e das características de seu grupo de abstinência diante da literatura da área. Finalmente, apontou, em conclusão, limitações e agenda de pesquisa futura.

Gram-positive infections in patients with end-stage renal disease

Gram-positive microorganisms, specifically coagulase-negative staphylococci are the most common species recovered from clinical culture specimens of patients with end-stage renal disease. The propensity of coagulase-negative staphylococci (CNS) to cause infection in this patient group has been widely debated. However, it is still unclear how this usually avirulent commensal microorganism produces infection that contributes to high rates of morbidity and mortality in patients with end-stage renal disease. The aim of this thesis was to investigate the rate, geographical distribution, molecular and phenotypic mechanisms of Gram-positive microorganisms associated with infection in renal dialysis patients. In addition, it sought to assess the value of early serological diagnosis of dialysis catheter-associated infection and the effect of antimicrobial treatment regimens on the faecal carriage of enteric microorganisms. In this study, the incidence of haemodialysis catheter-associated infection was established with the Meditrend audit tool. This tool was used to assess the infection outcomes of catheter insertion and management procedures until the catheter was explanted. Introduction of a catheter management protocol decreased the incidence of catheter-related infection. Staphylococcal species recovered from episodes of haemodialysis catheter-associated infection and continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis were genotyped by determination of macrorestriction profiles with pulsed-field gel electrophoresis. This highlighted horizontal transfer of microorganisms between different patients and the environment. The phenotypic characteristics of these strains were also investigated to determine characteristics that could be used as markers for dialysis catheter-associated infection. The expression of elastase, lipase and esterase by CNS was significantly associated with infection. A rapid enzyme-linked immunosorbent assay incorporating a novel staphylococcal antigen (lipid S) was used to evaluate the early detection of anti-staphylococcal immunoglobulin gamma in patient sera. The comparison of culture positive and culture negative patients demonstrated a steady state of immune activation in both groups. However anti-lipid S serum antibody titres > 1000 were found to be a predictor of infection. The effect on faecal carriage of vancomycin resistant enterococci (VRE) and Clostridium difficile toxins in patients treated with CAPD when empiric cephalosporin therapy was substituted for piperacillin/tazobactam was investigated. The introduction of piperacillin/tazobactam demonstrated a decrease in the faecal carriage of VRE.

Diabetic patient education and motivation. Available in 2 volumes.

Diabetes mellitus is a condition which requires a high degree of patient cooperation in self-management to achieve optimal glycaemic control. The concept of patient education, to enhance the treatment and management of diabetes, is well recognised. Several diabetes education programmes have already been described, but increased knowledge of diabetes did not necessarily result in improved self-mangement or glycaemic control. Other factors, such as attitudes and motivations, may therefore be particuarly important. The aims of the present study were to investigate the influence of patients' attitudes to diabetes, and to develop motivational aspects which enable the application of knowledge to enhance self-management and compliance with treatment. Thirty-one insulin-dependent diabetic (IDD) patients entered into a 12 month educational programme, particularly designed to increase motivation. Patients' attitudes to diabetes, their knowledge and self-management skills were assessed using questionnaires and practical tests, and parameters of glycaemic control were measured. The progress of these patients was compared at intervals with a close matched group of 25 control IFF patients who continued to receive routine clinic care. Patients completing the educational programme achieved better glycaemic control (p< 0.05), greater knowledge (p< 0.001), more favourable attitudes (p< 0.03) and increased competence in management skills (p< 0.02) compared with the control group. Evaluation procedures indicated that the programme was acceptable to the patients, and was successful in terms of increasing patient motivation. Six months after completion of the programme, glycaemic control deteriorated, although knowledge, attitudes and management skills were unchanged. This might reflect the withdrawal of extrinsic motivation, attention and supervision provided during the programme. It is recommended that consideration be given to the development of patients' intrinsic motivation to achieve maximum benefit from diabetes education programmes.