Cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation.

OBJECTIVES: The aims of this study were to assess the 1-year cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation to prevent both rejection and infectious complications. METHODS: Patients (pts) transplanted from January 2000 to March 2003 (Group A) and treated with a conventional protocol were compared with pts submitted to a combined regimen including universal cytomegalovirus (CMV) prophylaxis between April 2003 and July 2005 (Group B). Costs were computed from the hospital accounting system for hospital stays, and official tariffs for outpatient visits. Patients with incomplete costs data were excluded from analysis. RESULTS: Fifty-three patients were analyzed in Group A, and 60 in Group B. Baseline characteristics including CMV serostatus were not significantly different between the two groups. Over 12 months after transplantation, acute rejections decreased from 41.5 percent in Group A to 6.7 percent in Group B (p < .001), and CMV infections from 47 percent to 15 percent (p < .001). Overall, readmissions decreased from 68 percent to 55 percent (p = .160), and average hospital days from 28 +/- 19 to 20 +/- 11 days (p < .007). The average number of outpatient visits decreased from 49 +/- 10 to 39 +/- 8 (p < .001). Average 1-year immunosuppressive and CMV prophylaxis costs (per patient) increased from CHF20,402 +/- 7,273 to 27,375 +/- 6,063 (p < .001), graft rejection costs decreased from CHF4,595 +/- 10,182 to 650 +/- 3,167 (p = .005), CMV treatment costs from CHF2,270 +/- 6,161 to 101 +/- 326 (p = .008), and outpatient visits costs from CHF8,466 +/- 1'721 to 6,749 +/- 1,159 (p < .001). Altogether, 1-year treatment costs decreased from CHF39'957 +/- 16,573 to 36,204 +/- 6,901 (p = .115). CONCLUSIONS: The new combined regimen administered in Group B was significantly more effective, and its additional costs were more than offset by savings associated with complications avoidance.

Avaluació dels nivells de nitrats i duresa a l'aigua de consum a quatre zones d'Espanya participants a l'estudi epidemiològic Infància i Medi Ambientl (INMA)

L’aigua és un dels components bàsics per a la vida i una font d’exposició a contaminants ubiqua, ja que tota la població en consumeix. L’estudi epidemiològic INMA avaluarà si l’exposició a nitrats durant l’embaràs i a la duresa de l’aigua durant la infància es relaciona amb el baix pes al néixer i l’èczema atòpica, respectivament. Objectiu: Fer una avaluació dels nivells de nitrats i duresa de l’aigua en aigua de consum de la població de l’estudi INMA. Metodologia: l’estudi descriptiu realitzat a quatre de les set cohorts INMA, a Astúries, Guipúscoa, Sabadell i València. S’ha recopilat dades dels nivells de nitrats i duresa a l’aigua de consum dels municipis durant el període d’interès (2003 al 2008 i 2004 al 2012), a través d’ajuntaments i companyies d’aigua. S’ha calculat la mitjana, la desviació estàndard, el màxim i el mínim dels nivells de nitrat i de duresa en total i segons l’àrea geogràfica, l’any i l’estació. A Sabadell s’han fet tres mostrejos d’aigua per analitzar la duresa a diferents punts de la ciutat. Resultats: el nivell promig de nitrats (mg/L NO3-) és de 4,2 a Astúries, 4,0 a Guipúscoa, 9,2 a Sabadell i 15,2 a València. El nivell promig de duresa (mg/L CaCO3) és de 89,1 a Astúries, 132,7 al Guipúscoa, 178,3 a València i 230,9 a Sabadell. En l’anàlisi que es va realitzar a Sabadell, es detecta una duresa lleugerament inferior a la reportada sense variabilitat geogràfica. No s’observa una pauta clara de variabilitat estacional ni de variabilitat temporal tant per nitrats com per duresa. Conclusions: S’ha detectat variabilitat en els nivells de nitrats i duresa de l’aigua a les zones d’estudi. Els nivells de nitrats són moderats i els més alts es troben a zones agrícoles de València. La duresa de l’aigua és força alta degut al domini calcari dels subsòls de les zones d’estudi.

Other compounds isolated from Simira glaziovii and the ¹H and 13C NMR chemical shift assignments of new 1-epi-castanopsol

A new triterpene, 1-epi-castanopsol, besides eleven known compounds: sitosterol, stigmasterol, campesterol, lupeol, lupenone, simirane B, syringaresinol, scopoletin, isofraxidin, 6,7,8-trimethoxycoumarin and harman, were isolated from the wood of Simira glaziovii. The structures of the known compounds were defined by 1D, 2D ¹H, 13C NMR spectra data analyses and comparison with literature data. The detailed spectral data analyses allowed the definition of the structure of the new 1-epi isomer of castanopsol and performance of ¹H and 13C NMR chemical shift assignments.

Hydrological simulation using SWAT model in headwater basin in Southeast Brazil

Hydrological models are important tools that have been used in water resource planning and management. Thus, the aim of this work was to calibrate and validate in a daily time scale, the SWAT model (Soil and Water Assessment Tool) to the watershed of the Galo creek , located in Espírito Santo State. To conduct the study we used georeferenced maps of relief, soil type and use, in addition to historical daily time series of basin climate and flow. In modeling were used time series corresponding to the periods Jan 1, 1995 to Dec 31, 2000 and Jan 1, 2001 to Dec 20, 2003 for calibration and validation, respectively. Model performance evaluation was done using the Nash-Sutcliffe coefficient (E NS) and the percentage of bias (P BIAS). SWAT evaluation was also done in the simulation of the following hydrological variables: maximum and minimum annual daily flowsand minimum reference flows, Q90 and Q95, based on mean absolute error. E NS and P BIAS were, respectively, 0.65 and 7.2% and 0.70 and 14.1%, for calibration and validation, indicating a satisfactory performance for the model. SWAT adequately simulated minimum annual daily flow and the reference flows, Q90 and Q95; it was not suitable in the simulation of maximum annual daily flows.

Logistics of North-West Russia and Rail Baltica: Standpoints of Private Sector

The main aims of the present report are to describe the current state of railway transport in Russia, and to gather standpoints of Russian private transportation logistics sector towards the development of new railway connection called Rail Baltica Growth Corridor, connecting North-West Russia with Germany through the Baltic States and Poland. North-West Russia plays important role not only in Russian logistics, but also wider European markets as in container sea ports handling is approx. 2.5 mill. TEU p.a. and handling volume in all terminals is above 190 million tons p.a. The whole transportation logistics sector is shortly described as an operational environment for railways – this is done through technical and economic angles. Transportation development is always going in line with economics of the country, so the analysis on economical development is also presented. Logistics integration of the country is strongly influenced by its engagement in the international trade. Although, raw material handling at sea ports and container transports (imports) are blossoming, domestic transportation market is barely growing (in long-term perspective). Thus, recent entrance of Russia into World Trade Organization (WTO) is analyzed theme in this research, as the WTO is an important regulator of the foreign trade and enabler of volume growth in foreign trade related transportation logistics. However, WTO membership can influence negatively the development of Russia’s own industry and its volumes (these have been uncompetitive in global markets for decades). Data gathering in empirical part was accomplished by semi-structured case study interviews among North-West Russian logistics sector actors (private). These were conducted during years 2012-2013, and research compiles findings out of ten case company interviews. Although, there was no sea port involved in the study, most of the interviewed companies relied in European Logistics within significant parts in short sea shipping and truck combined transportation chains (in Russian part also using railways). As the results of the study, it could be concluded that Rail Baltica is seen as possible transport corridor in most of the interviewed companies, if there is enough cargo available. However, interviewees are a bit sceptical, because major and large-scale infrastructural improvements are needed. Delivery time, frequency and price level are three main factors influencing the attractiveness of Rail Baltica route. Price level is the most important feature, but if RB can offer other advantages such as higher frequency, shorter lead times or more developed set of value-added services, then some flexibility is possible for the price level. Environmental issues are not the main criteria of today, but are recognized and discussed among customers. Great uncertainty exists among respondents e.g. on forthcoming sulphur oxide ban on Baltic Sea shipping (whether or not it is going to be implemented in Russia). Rather surprisingly, transportation routes to Eastern Europe and Mediterranean area are having higher value and price space than those to Germany/Central Europe. Border crossing operations (traction monopoly at rails and customs), gauge widths as well as unclear decision-making processes (in Russia), are named as hindering factors. Performance standards for European connected logistics among Russian logistics sector representatives are less demanding as compared to neighbourhood countries belonging to EU.

Seasonal variation in migratory body condition, corticosterone secretion, oxidative stress and biotransformation activity in barn swallows (Hirundo rustica L.)

I studied the associations between migration-related physiological regulation (corticosterone) and body condition of barn swallows (Hirundo rustica L.). An additional purpose was to determine whether oxidative stress and biotransformation activity vary seasonally. Since physiological regulation, biotransformation activity and the stress involved may be important factors for body condition during migration; they may have direct effects on migration success. This in turn may influence other important life history stages, such as breeding and moult. In the thesis I used barn swallow data of the Finnish Ringing Centre (1997–2009), consisting of all juveniles ringed in the nests and recaptured from night roosts later the same autumn. Before the autumn migration in Finland I also captured, ringed and sampled barn swallows from night roosts in 2003, 2006, 2007 and 2011. Samples preceding spring migration in South Africa were collected in 2007. Juvenile barn swallows started to migrate southward in mid-August (first broods). Second broods started their migration at a younger age and almost a month later than first broods (mid-September). Barn swallows increased body mass and accumulated fat for the autumn migration. In the course of the autumn they seemed to be able to prevent the loss of energy already accumulated, since the proportional overnight mass loss, fat loss and faecal production decreased. Surprisingly, corticosterone, the major energy-regulating hormone in birds, seemed not to be involved in the fuelling process. Previous studies with warblers, sparrows and shorebirds had shown that during migration, the baseline levels of corticosterone were elevated in order to facilitate fuelling. It is possible that for Finnish barn swallows the most important fuelling place is in southern Europe, since northern and eastern populations migrate via the Balkan Peninsula. However, the adrenocortical stress response of Finnish barn swallows in good body condition was lower than that of those in poor body condition. Birds clearly suppressed the response, probably to prevent the catabolic effects of excessive corticosterone levels; birds cannot afford to lose muscle mass before migration. South African barn swallows had high levels of baseline corticosterone, but this may have been associated with the high oxidative damage and biotransformation activity of those birds. Barn swallows in spring and summer had low biotransformation activity and intermediate oxidative stress, which was probably related to breeding. Autumn birds had low biotransformation activity and oxidative stress but high redox enzyme activities in some migration-related enzymes.

Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients

Ventilator-associated pneumonia (VAP) remains one of the major causes of infection in the intensive care unit (ICU) and is associated with the length of hospital stay, duration of mechanical ventilation, and use of broad-spectrum antibiotics. We compared the frequency of VAP 10 months prior to (pre-intervention group) and 13 months after (post-intervention group) initiation of the use of a heat and moisture exchanger (HME) filter. This is a study with prospective before-and-after design performed in the ICU in a tertiary university hospital. Three hundred and fourteen patients were admitted to the ICU under mechanical ventilation, 168 of whom were included in group HH (heated humidifier) and 146 in group HME. The frequency of VAP per 1000 ventilator-days was similar for both the HH and HME groups (18.7 vs 17.4, respectively; P = 0.97). Duration of mechanical ventilation (11 vs 12 days, respectively; P = 0.48) and length of ICU stay (11 vs 12 days, respectively; P = 0.39) did not differ between the HH and HME groups. The chance of developing VAP was higher in patients with a longer ICU stay and longer duration of mechanical ventilation. This finding was similar when adjusted for the use of HME. The use of HME in intensive care did not reduce the incidence of VAP, the duration of mechanical ventilation, or the length of stay in the ICU in the study population.

p16 (INK4a) has clinicopathological and prognostic impact on oropharynx and larynx squamous cell carcinoma

CDKN2A encodes proteins such as p16 (INK4a), which negatively regulate the cell-cycle. Molecular genetic studies have revealed that deletions in CDKN2A occur frequently in cancer. Although p16 (INK4a) may be involved in tumor progression, the clinical impact and prognostic implications in head and neck squamous cell carcinoma (HNSCC) are controversial. The objective of this study was to evaluate the frequency of the immunohistochemical expression of p16 (INK4a) in 40 oropharynx and 35 larynx from HNSCC patients treated in a single institution and followed-up at least for 10 years in order to explore potential associations with clinicopathological outcomes and prognostic implications. Forty cases (53.3%) were positive for p16 (INK4a) and this expression was more intense in non-smoking patients (P = 0.050), whose tumors showed negative vascular embolization (P = 0.018), negative lymphatic permeation (P = 0.002), and clear surgical margins (P = 0.050). Importantly, on the basis of negative p16 (INK4a) expression, it was possible to predict a probability of lower survival (P = 0.055) as well as tumors presenting lymph node metastasis (P = 0.050) and capsular rupture (P = 0.0010). Furthermore, increased risk of recurrence was observed in tumors presenting capsular rupture (P = 0.0083). Taken together, the alteration in p16 (INK4a) appears to be a common event in patients with oropharynx and larynx squamous cell carcinoma and the negative expression of this protein correlated with poor prognosis.

An investigation into the effects of homopteran honeydew sugars versus floral nectar sugars on black fly longevity, flight performance and digestion /

Floral nectar is thought to be the primary carbohydrate source for most dipteran species. However, it has been shown that black flies (Burgin & Hunter 1997 a,b,c), mosquitoes (Foster 1995; Burkett et al. 1999; Russell & Hunter 2002), deer flies (Magnarelli & Burger 1984; Janzen & Hunter 1998; Ossowski & Hunter 2000), horse flies (Schutz & Gaugler 1989; Hunter & Ossowski 1999) and sand flies (MacVicker et al. 1990; Wallbanks et al. 1990; Cameron et al. 1992, 1995; Schlein & Jacobson 1994, 1999; Hamilton & EI Naiem 2000) feed on homopteran honeydew as well as floral nectar. Prior to 1997 floral nectar was thought to be the main source of carbohydrates for black flies. However, Burgin & Hunter (1 997a) demonstrated that up to 35% of black flies had recently consumed meals of homo pte ran honeydew. This information has necessitated a re-assessment of many life history aspects of black flies. Attempts are being made to examine the effects of nectar versus honeydew on black fly fecundity and parasite transmission (Hazzard 2003). Recently, Stanfield and Hunter (unpublished data) have shown that in female black flies, honeydew sugars produce flights of longer distance and duration than do nectar sugars. This thesis examines two aspects of black fly biology as it relates to sugar meal consumption. First, the effects of honeydew and nectar on black fly longevity are examined. Second, the proximate causation behind longer flight performances in honeydew-fed flies will be examined. The comparison between these two sources is important because nectar is composed of mainly simple sugars (monosaccharides and disaccharides) whereas honeydew is composed of both simple and complex sugars (including trisaccharides and tetrasaccharides ).

An Examination of Youth Perceptions and Understandings of their Experiences with Extrajudicial Sanctions in Relation to Key Principles of the YCJA

It is unclear how the principles of meaningful consequences, fair and proportionate accountability, and rehabilitation and reintegration under the Youth Criminal Justice Act (2003) are understood and experienced by youth participating in diversion from youth court. Interviews with 20 youth revealed that, from their understanding, extrajudicial sanctions were viewed as accomplishing the goals of meaningful consequences and fair and proportionate accountability relatively well, but less emphasis was placed on rehabilitation and reintegration. The findings suggest that there may be a need an examination of the spectrum of responses available to youth under the umbrella of Extrajudicial Sanctions and their ability to achieve the key principles of the legislation. Implications for both youth and policy are addressed.

Explaining the Great Divergence: Medium and Message on the Eurasian Land Mass, 1700-1850

Between 1700 and 1850, per-capita income doubled in Europe while falling in the rest of Eurasia. Neither geography nor economic institutions can explain this sudden divergence. Here the consequences of differences in communications technology are examined. For the first time, there appeared in Europe a combination of a standardized medium (national vernaculars with a phonetic alphabet) and a non-standardized message (competing religious, political and scientific ideas). The result was an unprecedented fall in the cost of combining ideas and burst of productivity-raising innovation. Elsewhere, decreasing standardization of the medium and increasing standardization of the message blocked innovation.

University-Industry Relations and Some Lessons from Biotech

Social Sciences and Humanities Research Council

Chronique, enquête et silence : autopsie de la présentation du conflit interne par la presse de Lima jusqu’au massacre d’Uchuraccay, 1960-1983

En 2003, la Commission de vérité et de réconciliation du Pérou (CVR) publie un rapport sur la période de guerre interne et de violence qui a déchiré le pays entre 1980 et 2000. Ce rapport étudie ces deux décennies pour faire la lumière sur les événements et évaluer la position de divers secteurs de la société afin que les Péruviens puissent se réconcilier avec un pan de leur histoire. Dans son rapport, la CVR consacre une section aux médias, notamment la presse écrite, et salue le rôle « important » qu’ils ont joué, tout en notant au passage que leur couverture du conflit n’a pas favorisé la pacification du pays et a même pu la compromettre par moments. Ce mémoire vise à étudier la couverture de la guerre interne par les trois quotidiens péruviens les plus importants pour le tirage, Expreso, El Comercio, et La República. Il porte surtout sur la période comprise entre le début des hostilités, le 17 mai 1980, et le massacre de huit journalistes dans le village andin d’Uchuraccay, le 26 janvier 1983. Un regard est également jeté sur l’évolution du journalisme au Pérou depuis les années 1960, marquées par l’élection d’un gouvernement démocratique et aussi par l’instauration d’un régime militaire qui se maintiendra au pouvoir pendant 12 ans. Les bouleversements au cours de cette période difficile expliquent, au moins en partie, le désintérêt initialement manifesté par ces quotidiens, au-delà des différences idéologiques manifestes, à l’endroit des premiers pas du Sentier Lumineux et de sa « guerre populaire ».

Marginalization and Transnationalizing Movements: How Does One Relate to the Other?

The main objective of this chapter is to address the following theoretical issue: How are the transnationalization and the marginalization processes related? We suggest that in order to understand more accurately how marginalized people’s movements and transnationalization processes are embedded, we need to open our understanding of transnationalization processes to see what the actors do when they build transnationalizing movements. In order to analyze experiences of poor people’s movement transnationalizing, we propose first to consider transnationalization as a social practice of solidarities building and second, as practices of “translation,” a search of recognition beyond borders.

Wittgenstein And Labyrinth Of ‘Actual Infinity’: The Critique Of Transfinite Set Theory

In order to explain Wittgenstein’s account of the reality of completed infinity in mathematics, a brief overview of Cantor’s initial injection of the idea into set- theory, its trajectory (including the Diagonal Argument, the Continuum Hypothesis and Cantor’s Theorem) and the philosophic implications he attributed to it will be presented. Subsequently, we will first expound Wittgenstein’s grammatical critique of the use of the term ‘infinity’ in common parlance and its conversion into a notion of an actually existing (completed) infinite ‘set’. Secondly, we will delve into Wittgenstein’s technical critique of the concept of ‘denumerability’ as it is presented in set theory as well as his philosophic refutation of Cantor’s Diagonal Argument and the implications of such a refutation onto the problems of the Continuum Hypothesis and Cantor’s Theorem. Throughout, the discussion will be placed within the historical and philosophical framework of the Grundlagenkrise der Mathematik and Hilbert’s problems.