Effect of insulin resistance on monounsaturated fatty acid levels : a multi-cohort non-targeted metabolomics and mendelian randomization study

Insulin resistance (IR) and impaired insulin secretion contribute to type 2 diabetes and cardiovascular disease. Both are associated with changes in the circulating metabolome, but causal directions have been difficult to disentangle. We combined untargeted plasma metabolomics by liquid chromatography/mass spectrometry in three non-diabetic cohorts with Mendelian Randomization (MR) analysis to obtain new insights into early metabolic alterations in IR and impaired insulin secretion. In up to 910 elderly men we found associations of 52 metabolites with hyperinsulinemic-euglycemic clamp-measured IR and/or β-cell responsiveness (disposition index) during an oral glucose tolerance test. These implicated bile acid, glycerophospholipid and caffeine metabolism for IR and fatty acid biosynthesis for impaired insulin secretion. In MR analysis in two separate cohorts (n = 2,613) followed by replication in three independent studies profiled on different metabolomics platforms (n = 7,824 / 8,961 / 8,330), we discovered and replicated causal effects of IR on lower levels of palmitoleic acid and oleic acid. A trend for a causal effect of IR on higher levels of tyrosine reached significance only in meta-analysis. In one of the largest studies combining "gold standard" measures for insulin responsiveness with non-targeted metabolomics, we found distinct metabolic profiles related to IR or impaired insulin secretion. We speculate that the causal effects on monounsaturated fatty acid levels could explain parts of the raised cardiovascular disease risk in IR that is independent of diabetes development.

Falls and the Social Isolation of Older Adults in the National Health and Aging Trends Study

Thesis (Ph.D.)--University of Washington, 2016-08

Relación de los estilos de liderazgo en el desempeño de la administración de las IPS hospitalarias de II y III nivel de complejidad de la ciudad de Manizales.

El liderazgo ha sido sujeto de varios estudios, confrontaciones y equivocaciones que lo han conllevado a múltiples y subjetivas interpretaciones y por consiguiente disparidad de actuaciones, siendo el sector salud no ajeno a esta situación. Sin embargo, no se discute la importancia que este conlleva en el actuar a nivel laboral y su influencia y/o relación con los resultados y objetivos organizacionales. Es por ello que esta investigación de corte cuantitativo se diseñó para identificar la relación de los estilos de liderazgo y el desempeño administrativo, siendo enfocado principalmente en los altos y medios directivos pues son estos los responsables de la obtención y mantenimiento de óptimos resultados para la sostenibilidad empresarial. Con el objetivo de identificar la relación específica de los estilos de liderazgo con el desempeño administrativo, el presente estudio se acogió a los indicadores de desempeño definidos por Bass y Avolio (Esfuerzo Extra, Satisfacción y Eficacia del Líder) aplicando por consiguiente el cuestionario Multifactorial de Liderazgo (MLQ) adaptado por Vega, Villa & Zavala, Villalón, siendo éste no solo uno de los instrumentos mas utilizados y estandarizados para el estudio del liderazgo, sino que también permite analizar la frecuencia de su uso, la primacía de cada estilo de liderazgo y especialmente y con objeto del presente estudio, la identificación subyacente del estilo de liderazgo de Rango Completo o Total. El presente cuestionario fue aplicada de forma presencial a los Gerentes Generales, Directores Médicos, Directores Científicos, Directores Administrativos y principales personas a cargo de las IPS hospitalarias de II y III nivel de complejidad de la ciudad de Manizales. En un principio se encontró que el estilo de liderazgo como variable principal mas utilizado por los altos y medios directivos de las IPS hospitalarias de II y III nivel de complejidad de la ciudad de Manizales es el Transformacional, seguido por el Pasivo Evasivo con su comportamiento Dirección por Excepción Activa y por último el Liderazgo Transaccional. Sin embargo no se encontró relación alguna entre los estilos de liderazgo como variables primarias con los indicadores de desempeño, comprobando por último que el Liderazgo de Rango Completo o Total es el estilo de liderazgo que tiene relación directa y positiva con los indicadores de desempeño Esfuerzo Extra, Satisfacción y Eficacia del Líder. Lo anterior permitió no solo apoyar la premisa relacionada con la importancia del liderazgo en toda organización, sino también considerar la importancia de ampliar el estudio incluyendo factores de causalidad que han determinado e influido en la aparición del los estilos de liderazgo.

Myocardial blood flow quantification by Rb-82 cardiac PET/CT: A detailed reproducibility study between two semi-automatic analysis programs.

BACKGROUND: Several analysis software packages for myocardial blood flow (MBF) quantification from cardiac PET studies exist, but they have not been compared using concordance analysis, which can characterize precision and bias separately. Reproducible measurements are needed for quantification to fully develop its clinical potential. METHODS: Fifty-one patients underwent dynamic Rb-82 PET at rest and during adenosine stress. Data were processed with PMOD and FlowQuant (Lortie model). MBF and myocardial flow reserve (MFR) polar maps were quantified and analyzed using a 17-segment model. Comparisons used Pearson's correlation &#961; (measuring precision), Bland and Altman limit-of-agreement and Lin's concordance correlation &#961;c = &#961;·C b (C b measuring systematic bias). RESULTS: Lin's concordance and Pearson's correlation values were very similar, suggesting no systematic bias between software packages with an excellent precision &#961; for MBF (&#961; = 0.97, &#961;c = 0.96, C b = 0.99) and good precision for MFR (&#961; = 0.83, &#961;c = 0.76, C b = 0.92). On a per-segment basis, no mean bias was observed on Bland-Altman plots, although PMOD provided slightly higher values than FlowQuant at higher MBF and MFR values (P < .0001). CONCLUSIONS: Concordance between software packages was excellent for MBF and MFR, despite higher values by PMOD at higher MBF values. Both software packages can be used interchangeably for quantification in daily practice of Rb-82 cardiac PET.

Management of Customer Co-development in Business-to-Business Markets

Management of customer co-development means involving customers in the development of new products and services, and coordinating the process. In business-tobusiness markets, customer co-development enables the development of innovations that better match customer needs and strengthens customer relationships. However, close collaboration with customers can hamper the innovativeness of new products and lead to overly customized solutions. Therefore, the management of co-development is crucial to its success. Yet the existing research on management of co-development has mainly focused on selecting the right collaboration partners, and the field lacks understanding on how to manage the tensions inherent in customer co-development. The purpose of this thesis is to increase understanding on the management of the codevelopment. The thesis is divided into two parts. The first comprises the literature review and conclusions for the whole study, and the second presents four publications. From the methodological perspective, the research papers follow exploratory qualitative research design. The empirical data comprise interviews with 60 persons, representing 25 different organizations, and a group of 11 end users. The study conceptualizes management of customer co-development in three dimensions 1) relational co-development processes, 2) co-development challenges and paradoxes, and 3) internal customer involvement processes. The findings contribute to the customersupplier relationship, innovation, and marketing management literatures by providing a framework on supplier-customer co-development, addressing co-development paradoxes and their management processes, and suggesting practices for customer involvement. For practitioners, the findings provide tools to manage the challenges related to codevelopment with customers.

Laparoscopic approach in abdominal emergencies: a 5-year experience at a single center

Background. Laparoscopy is ever more common in both elective and emergency surgery. In fact, in abdominal emergencies it enables the resolution of preoperative diagnostic doubts as well as treatment of the underlying disease. We present a retrospective study of the results of a 5-year experience at a single center. Patients and methods. Between September 2006 and August 2011, 961 patients were treated via laparoscopy, including 486 emergency cases (15 gastroduodenal perforation; 165 acute cholecystitis; 255 acute appendicitis; 15 pelvic inflammatory disease and non-specific abdominal pain [NSAP]; 36 small bowel obstruction). All procedures were conducted by a team trained in laparoscopic surgery. Results. The conversion rate was 22/486 patients (4.53%). A definitive laparoscopic diagnosis was possible in over 96% of cases, and definitive treatment via laparoscopy was possible in most of these. Conclusions Our own experience confirms the literature evidence that laparoscopy is a valid option in the surgical treatment of abdominal emergencies. In any case, it must be performed by a dedicated and highly experienced team. Correct patient selection is also important, to enable the most suitable approach for each given situation.

Análisis de las Olimpiadas Nacionales de Química en Costa Rica: alcances y retos para la población joven

La Escuela de Química ha promovido programas y proyectos académicos como las Olimpiadas de Química que estimulen y mejoren el aprendizaje de esta ciencia. Como competencia se identifican estudiantes de alto desempeño escolar y se promueven espacios de autosuperación sana y estimula el pensamiento científico. Después de más de una década de existencia, los datos se han compilado y organizado para analizar estadísticamente los primeros 10 años mediante el programa SPSS 11.5. Este artículo incluye análisis estadísticos para cada una de las ediciones, que incluye variabilidad y  significancia. La información se presenta en forma esquemática, y considera variables como género, ubicación geográfica de las instituciones educativas y modalidad. Se obtuvo una diferencia significativa entre hombres y mujeres, (T= 2,961, P < 0,03 participación eliminatoria, categoría A) y (T= 3,640, P < 0,00 notas eliminatoria, categoría A). Un patrón similar se obtiene en la modalidad educativa y ubicación geográfica.  Cuantitativamente, se demuestra el interés y entusiasmo creciente por la participación. Ya han pasado más de 10 años, y la Olimpiada de Química en Costa Rica es un programa consolidado, de alta credibilidad a nivel nacional e internacional que delinea futuros científicos en campos vinculados con las ciencias exactas y naturales.

Utilização de bagaço de maçã como ingrediente alimentar em iogurte com potencial efeito benéfico para a saúde

O desenvolvimento de alimentos funcionais evoluiu consideravelmente ao longo dos anos e a capacidade tecnológica para produzir um alimento com compostos fisiologicamente ativos tem crescido significativamente. O presente trabalho teve como objetivo criar um novo alimento, utilizando um subproduto proveniente da indústria agroalimentar. O alimento seleccionado foi o iogurte natural, o qual foi enriquecido com um extrato de bagaço de maçã. O bagaço de maçã contém compostos fenólicos e fibra, mostrando atividade antioxidante significativa e por conseguinte apresenta um potencial efeito positivo na saúde. Avaliaram-se características químicas do bagaço de maçã e das farinhas obtidas a partir deste subproduto, designadamente: acidez, teor em açúcares totais e redutores, cinza, matéria gorda, humidade, proteína bruta, fibra dietética insolúvel e solúvel. O extrato aquoso obtido a partir do subproduto foi também caracterizado quanto ao seu conteúdo fenólico e atividade antioxidante. O iogurte produzido com incorporação do extrato de bagaço de maçã foi estudado do ponto de vista de parâmetros químicos tais como acidez, açúcares totais, cinza, humidade, proteína bruta, pH e fibra bruta, conteúdo em fenólicos totais e atividade antioxidante. O subproduto, os extratos e o iogurte foram também avaliados quanto à sua carga microbiológica. Na caracterização química do bagaço foram obtidos os seguintes valores, expressos em base seca: 2,0±0,01% de acidez (expressa em equivalentes de ácido málico); 15,96±1,53% de açúcares totais; 13,35±1,91% de açúcares redutores; 1,88±0,07% de cinza, 2,49±0,5% de matéria gorda, 81,17±1,98% de humidade e 5,01±0,01% de proteína bruta. Quanto ao seu conteúdo em fibra dietética, o bagaço contém na sua composição 65,80% de fibra dietética insolúvel e 4,90% de fibra dietética solúvel. A farinha obtida após secagem a 60 °C do bagaço de maçã apresentou, na base seca, 1,9±0,04% de acidez, 10,57±1,31% de açúcares totais; 8,50±1,00% de açúcares redutores; 2,22±0,04%de cinza, 4,73±0,11% de matéria gorda, 6,34±0,62% de humidade e 5,40±0,26% de proteína. A atividade antioxidante do extrato aquoso, (AQ_6X10) obtido do bagaço de maçã, utilizado para incorporação no iogurte, determinada através do método ABTS foi de 5,00±1,28µmol TE/g amostra e apresentou um teor em compostos fenólicos de 221,42±0,734 mg EAG/ 100g de extrato, na base seca. Ao nível microbiológico o extrato revelou parâmetros aceitáveis, de acordo com a tabela 13 (anexos 3), para utilização como ingrediente alimentar. Os iogurtes produzidos foram analisados quimicamente. O iogurte, com extrato aquoso de bagaço de maçã incorporado, apresentou 89,64±0,00% de humidade, 0,93±0,00% de acidez (expressa em equivalentes de ácido láctico); 6,42±0,26% de açúcares totais; 0,74%±0,00% de cinza, 3,83±0,00% de proteína bruta e 0,2±0,00% de fibra bruta. O seu conteúdo em compostos fenólicos foi de 12,41±1,69mg EAG/ 100g de iogurte, e a sua atividade antioxidante foi 54,84±4,40 µmol TE/g iogurte. Avaliou-se ainda o iogurte no que diz respeito ao crescimento de bactérias lácticas e constatou-se, por comparação com o iogurte de controlo, que estas se desenvolveram normalmente ao longo do processo de fabrico. A análise microbiológica revelou ainda que o iogurte é seguro do ponto de vista alimentar de acordo com a Tabela 15 (anexos 3). A análise sensorial realizada aos iogurtes demonstrou que o iogurte fortificado apresentou uma aceitação muito boa pelo painel de provadores. O presente estudo demonstrou que o bagaço de maçã, um subproduto das indústrias agroalimentares, é seguro do ponto de vista microbiológico, podendo ser utilizado na preparação de ingredientes alimentares para serem incorporados, por exemplo em iogurte, conferindo-lhe características que se destacam pelo maior teor em fibra e atividade antioxidante em relação ao iogurte não enriquecido, e atributos sensoriais apelativos em termos de textura e sabor.

Consumo de pornografía por las y los adolescentes del colegio Manuel J. Calle de la ciudad de Cuenca, 2008

Con un diseño cuantitativo cualitativo se incluyó una población de estudio de 961 alumnos y alumnas asistentes y matriculados en el año lectivo 2008-2009 de los cuales se excluyeron 48. Después de cinco reuniones de trabajo se recopiló la información cuantitativa por medio de un formulario de entrevista autoaplicado y complementado con una discusión de grupo focal de 5 participantes para ser analizada cualitativamente. Resultados: el 66,7% (n = 617) de los participantes fueron varones y el 33,3% (n = 296) mujeres. El 74,7% de los encuestados estuvo entre 10 y 16 años. El 78,7% de la población de estudio tenía conocimientos previos sobre material pornográfico y lo había utilizado. De ellos los varones fueron el 79,6%. Las razones que les llevaron a conocer la pornografía fueron: curiosidad (46,3%), los amigos (44,8%) y los familiares (6,8%). Para el 59,8% de los entrevistados resulta fácil conseguir material pornográfico. Las películas en CD y DVD (67,4%) y las páginas de Internet (31,2%) son los principales medios. Las revistas y la televisión por cable permiten un 27,8% del acceso. El 60.7% de los entrevistados señaló que la finalidad de uso de este material era obtener información más real sobre la sexualidad. Un 21,6% justificó el uso como opción para aprender nuevas técnicas y los restantes señalaron que mejoraban la satisfacción sexual, las fantasías o mejoraban la relación con la pareja. Sobre el significado de ver pornografía el 50,1% la calificó de imprudente y uno de cada tres estudiantes la consideró desagradable (38,4%), agradable (38%) nocivo (36,7%) y hasta beneficioso (21,1%). Los factores asociados al consumo de material pornográfico fueron los CDs, DVDs, revistas y TV por cable, no solamente como medios sino como material de muy fácil acceso. El análisis del grupo focal mostró algunas censuras, de parte de las mujeres, para el consumo de pornografía y de su presencia sin control en el escenario estudiantil del adolescente. Calificaron como negocio ilícito e inmoral de repercusiones reprochables e impredescibles. Discusión: e consumo de pornografía, sin perjuicio de la utilidad que pueda generar, es más una problemática social que debe enfrentársele. Para orientar la actuación de los adolescentes se requiere la participación activa de la sociedad civil, a efecto de lograr aminorar el impacto que genera este tipo de conductas sin control

Use of ordinal outcomes in vascular prevention trials: comparison with binary outcomes in published trials

Background and Purpose—Vascular prevention trials mostly count “yes/no” (binary) outcome events, eg, stroke/no stroke. Analysis of ordered categorical vascular events (eg, fatal stroke/nonfatal stroke/no stroke) is clinically relevant and could be more powerful statistically. Although this is not a novel idea in the statistical community, ordinal outcomes have not been applied to stroke prevention trials in the past. Methods—Summary data on stroke, myocardial infarction, combined vascular events, and bleeding were obtained by treatment group from published vascular prevention trials. Data were analyzed using 10 statistical approaches which allow comparison of 2 ordinal or binary treatment groups. The results for each statistical test for each trial were then compared using Friedman 2-way analysis of variance with multiple comparison procedures. Results—Across 85 trials (335 305 subjects) the test results differed substantially so that approaches which used the ordinal nature of stroke events (fatal/nonfatal/no stroke) were more efficient than those which combined the data to form 2 groups (P0.0001). The most efficient tests were bootstrapping the difference in mean rank, Mann–Whitney U test, and ordinal logistic regression; 4- and 5-level data were more efficient still. Similar findings were obtained for myocardial infarction, combined vascular outcomes, and bleeding. The findings were consistent across different types, designs and sizes of trial, and for the different types of intervention. Conclusions—When analyzing vascular events from prevention trials, statistical tests which use ordered categorical data are more efficient and are more likely to yield reliable results than binary tests. This approach gives additional information on treatment effects by severity of event and will allow trials to be smaller. (Stroke. 2008;39:000-000.)

Análisis de la ejecución presupuestaria en el gobierno autónomo descentralizado de la parroquia Checa en el período 2013

La presente Tesis se basa en el Análisis de la Ejecución presupuestaria del Gobierno Autónomo Descentralizado de la Parroquia Checa en el periodo 2013, para establecer si el presupuesto fue ejecutado de acuerdo al Plan Operativo Anual y se cumplió con los objetivos y metas propuestas en este año. En el Capítulo 1 se estudia al Gobierno Autónomo Descentralizado de la Parroquia Checa su misión, visión, funciones, competencias, estructura orgánica y funcional, reglamento interno de la junta Parroquial. En el Capítulo 2 se hemos recolecta información conceptual para esta investigación sobre el presupuesto, principios presupuestarios y el ciclo presupuestario además de información basada en leyes como el Código Orgánico de Organización Territorial, Autonomía y Descentralización, La Constitución de la República, Normativa de Presupuesto, Tesorería. En el Capítulo 3 se realiza la aplicación práctica mediante indicadores de calidad y de Gestión Financiera de cada una de las partidas presupuestarias de ingresos y gastos establecidas en la ejecución Presupuestaria en el año 2013 y su respectivo análisis. En el Capítulo 4 tenemos las Conclusiones y Recomendaciones emitidas al Gobierno Autónomo Descentralizado de la Parroquia Checa sobre la gestión realizada después de haber aplicado los indicadores de calidad y de Gestión Financiera.

Influência das espécies ativas na absorção de intersticiais durante a carbonitretação a plasma do TI

Physical-chemical properties of Ti are sensible to the presence of interstitial elements. In the case of thermochemical treatments plasma assisted, the influence of different active species is not still understood. In order to contribute for such knowledge, this work purposes a study of the role played by the active species atmosphere into the Ar N2 CH4 carbonitriding plasma. It was carried out a plasma diagnostic by OES (Optical Emission Spectroscopy) in the z Ar y N2 x CH4 plasma mixture, in which z, y and x indexes represent gas flow variable from 0 to 4 sccm (cm3/min). The diagnostic presents abrupt variations of emission intensities associated to the species in determined conditions. Therefore, they were selected in order to carry out the chemical treatment and then to investigate their influences. Commercial pure Ti disks were submitted to plasma carbonitriding process using pre-established conditions from the OES measurements while some parameters such as pressure and temperature were maintained constant. The concentration profiles of interstitial elements (C and N atoms) were determined by Resonant Nuclear Reaction Analysis (NRA) resulting in a depth profile plots. The reactions used were 15N(&#961;,αγ)12C and 12C(α,α)12C. GIXRD (Grazing Incidence X-Ray Diffraction) analysis was used in order to identify the presence of phases on the surface. Micro-Raman spectroscopy was used in order to qualitatively study the carbon into the TiCxN1 structure. It has been verified which the density species effectively influences more the diffusion of particles into the Ti lattice and characteristics of the layer formed than the gas concentration. High intensity of N2 + (391,4 nm) and CH (387,1 nm) species promotes more diffusion of C and N. It was observed that Hα (656,3 nm) species acts like a catalyzer allowing a deeper diffusion of nitrogen and carbon into the titanium lattice.

Abundance of sedentary consumers and sessile organisms along the wave exposure gradient of subtropical rocky shores of the south-west Atlantic

Sedentary consumers play an important role on populations of prey and, hence, their patterns of abundance, distribution and coexistence on shores are important to evaluate their potential influence on ecosystem dynamics. Here, we aimed to describe their spatio-temporal distribution and abundance in relation to wave exposure in the intertidal rocky shores of the south-west Atlantic to provide a basis for further understanding of ecological processes in this system. The abundance and composition of the functional groups of sessile organisms and sedentary consumers were taken by sampling the intertidal of sheltered and moderately exposed shores during a period of one year. The sublittoral fringe of sheltered areas was dominated by macroalgae, while the low midlittoral was dominated by bare rock and barnacles. In contrast, filter-feeding animals prevailed at exposed shores, probably explaining the higher abundance of the predator Stramonita haemastoma at these locations. Limpets were more abundant at the midlittoral zone of all shores while sea urchins were exclusively found at the sublittoral fringe of moderately exposed shores, therefore, adding grazing pressure on these areas. The results showed patterns of coexistence, distribution and abundance of those organisms in this subtropical area, presumably as a result of wave action, competition and prey availability. It also brought insights on the influence of top-down and bottom-up processes in this area.

Operant and Respondent Procedures to Establish Social Stimuli as Reinforcers in Children with Autism

According to the DSM-IV- TR (American Psychiatric Association, 2000), one of the core deficits in autism is in the impairment of social interaction. Some have suggested that underlying these deficits is the reality that individuals with autism do not find social stimuli to be as reinforcing as other types of stimuli (Dawson, 2008). An interesting and growing body of literature supports the notion that symptoms in autism may be caused by a general reduction in social motivation (Chevallier et al., 2012). A review of the literature suggests that social orienting and social motivation are low in individuals with autism, and including social motivation as a target for therapeutic intervention should be pursued (Helt et al., 2008). Through our understanding of learning processes, researchers in behavior analysis and related fields have been able to use conditioning procedures to change the function of neutral or ineffective stimuli, including tokens (Ayllon & Azrin, 1968), facial expressions (Gewirtz & Pelaez-Nogueras, 1992) and praise (Dozier et al., 2012). The current study aimed to use operant and respondent procedures to condition social stimuli that were empirically shown to not be reinforcing prior to conditioning. Further, this study aimed to compare the two procedures in their effectiveness to condition social stimuli to function as reinforcers, and in their maintenance of effects over time. Using a multiple-baseline, multi-element design, one social stimulus was conditioned under each procedure to compare the different response rates following conditioning. Finally, the study sought to determine if conditioning social stimuli to function as reinforcers had any effect on the social functioning of young children with autism. Six children diagnosed with autism between the ages of 18 months and 3 years participated. Results show that the respondent procedure (pairing) resulted in more robust and enduring effects than the operant procedure (Sd procedure). Results of a social communication assessment (ESCS, Mundy et al., 2003) before and after conditioning demonstrate gains in all areas of social communication, particularly in the areas of initiating and responding to joint attention.

Tes Kaines diathekes apanta = Noui Testamenti omnia.

Texto en griego clásico