860 resultados para first-year experience


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Durante el siglo XV Cerdeña desempeña, gracias a su posicionamiento geográfico en el centro del Mediterráneo, un papel muy importante en la red de comercio internacional. Este movimiento económico-cultural fomenta una extensa producción artística que está caracterizada por depender fuertemente de la presencia en la isla de talleres y artistas catalanes. Al día de hoy se conoce muy poco la presencia y las características de la pintura del gótico tardío en la Cerdeña. Las dificultades encontradas por los investigadores en la reconstrucción de la historia del arte sarda de esta época son numerosas y difíciles de solucionar. El problema depende de la falta de fuentes documentales (directas e indirectas), de la gran dispersión de muchísimas obras, de la inaccesibilidad de unas de las obras más interesantes; del desplazamiento casi total de las obras de su sitio original, y del total anonimato de la mayoría de los artistas. En estas condiciones la única solución para alcanzar nuevos elementos científicos es: integrar los conocimientos procedente de las fuentes documentales; ampliar la practica metodológica (multidisciplinariedad), conectar el tejido sardo (pintura, miniatura, grabados) con el ámbito internacional. El objetivo final es introducir la pintura sarda en un contexto más amplio, para poder descubrir el sistema de modelos y de relaciones artísticas, que la conectan con el mundo artístico mediterráneo. El trabajo de este primer año ha sido particularmente intenso y complicado por las dificultades encontradas en ponerse en un tema tan vasto como lo de la pintura y los modelos figurativos de la segunda mitad del siglo XV. Principales objetivos: averiguar toda la bibliografía conocida sobre el tema e intentar ampliar los estudios cada vez que se encontraban indicios sobre posibles autores y obras sardas; empezar el trabajo de catalogación de las obras pictóricas (conocidas o recien descubiertas.)

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Background:¦Hirschsprung's disease (HSCR) is a congenital malformation of the enteric nervous system due to the¦arrest of migration of neural crest cells to form the myenteric and submucosal plexuses. It leads to an anganglionic intestinal segment, which is permanently contracted causing intestinal obstruction. Its incidence is approximately 1/5000 birth, and males are more frequently affected with a male/female ratio of 4/1. The diagnosis is in most cases made within the first year of life. The rectal biopsy of the mucosa and sub-mucosa is the diagnostic gold standard.¦Purpose:¦The aim of this study was to compare two surgical approaches for HSCR, the Duhamel technique and the transanal endorectal pull-through (TEPT) in term of indications, duration of surgery, duration of hospital stay, postoperative treatment, complications, frequency of enterocolitis and functional outcomes.¦Methods:¦Fifty-nine patients were treated for HSCR by one of the two methods in our department of pediatric¦surgery between 1994 and 2010. These patients were separated into two groups (I: Duhamel, II: TEPT), which were compared on the basis of medical records. Statistics were made to compare the two groups (ANOVA test). The first group includes 43 patients and the second 16 patients. It is noteworthy that twenty-four patients (about 41% of all¦patients) were referred from abroad (Western Africa). Continence was evaluated with the Krickenbeck's score.¦Results:¦Statistically, this study showed that operation duration, hospital stay, postoperative fasting and duration of postoperative antibiotics were significantly shorter (p value < 0.05) in group II (TEPT). But age at operation and length of aganglionic segment showed no significant difference between the two groups. The continence follow-up showed generally good results (Krickenbeck's scores 1; 2.1; 3.1) in both groups with a slight tendency to constipation in group I and soiling in group II.¦Conclusion:¦We found two indications for the Duhamel method that are being referred from a country without¦careful postoperative surveillance and/or having a previous colostomy. Even if the Duhamel technique tends to be replaced by the TEPT, it remains the best operative approach for some selected patients. TEPT has also proved some advantages but must be followed carefully because, among other points, of the postoperative dilatations. Our postoperative standards, like digital rectal examination and anal dilatations seem to reduce the occurrence of complications like rectal spur and anal/anastomosis stenosis, respectively in the Duhamel method and the TEPT technique.

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The dentate gyrus is one of only two regions of the mammalian brain where substantial neurogenesis occurs postnatally. However, detailed quantitative information about the postnatal structural maturation of the primate dentate gyrus is meager. We performed design-based, stereological studies of neuron number and size, and volume of the dentate gyrus layers in rhesus macaque monkeys (Macaca mulatta) of different postnatal ages. We found that about 40% of the total number of granule cells observed in mature 5-10-year-old macaque monkeys are added to the granule cell layer postnatally; 25% of these neurons are added within the first three postnatal months. Accordingly, cell proliferation and neurogenesis within the dentate gyrus peak within the first 3 months after birth and remain at an intermediate level between 3 months and at least 1 year of age. Although granule cell bodies undergo their largest increase in size during the first year of life, cell size and the volume of the three layers of the dentate gyrus (i.e. the molecular, granule cell and polymorphic layers) continue to increase beyond 1 year of age. Moreover, the different layers of the dentate gyrus exhibit distinct volumetric changes during postnatal development. Finally, we observe significant levels of cell proliferation, neurogenesis and cell death in the context of an overall stable number of granule cells in mature 5-10-year-old monkeys. These data identify an extended developmental period during which neurogenesis might be modulated to significantly impact the structure and function of the dentate gyrus in adulthood.

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AIM To determine the opinions of infectious diseases professionals on the possibilities of monitoring patients with HIV in Primary Care. DESIGN Qualitative study using in-depth interviews. LOCATION Infectious Diseases Unit in the University Hospital "Virgen de la Victoria" in Málaga. PARTICIPANTS Health professionals with more than one year experience working in infectious diseases. A total of 25 respondents: 5 doctors, 15 nurses and 5 nursing assistants. METHOD Convenience sample. Semi-structured interviews were used that were later transcribed verbatim. Content analysis was performed according to the Taylor and Bogdan approach with computer support. Validation of information was made through additional analysis, expert participation, and feedback of part of the results to the participants. RESULTS Hospital care professionals considered the disease-related complexity of HIV, treatment and social aspects that may have an effect on the organizational level of care. Professionals highlighted the benefits of specialized care, although opinions differed between doctors and nurses as regards follow up in Primary Care. Some concerns emerged about the level of training, confidentiality and workload in Primary Care, although they mentioned potential advantages related to accessibility of patients. CONCLUSIONS Physicians perceive difficulties in following up HIV patients in Primary Care, even for those patients with a good control of their disease. Nurses and nursing assistants are more open to this possibility due to the proximity to home and health promotion in Primary Care.

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Treball de recerca on analitzo els elements socials i culturals que influeixen en la vivència de la maternitat, en el cas de tres dones. Em proposo intentar copsar de quina forma tres dones que han estat mares al segle XXI experimenten la seva pròpia maternitat i així intentar dilucidar fins a quin punt aquestes tres dones viuen aquesta situació personal present, en clau de passat. Quan escric passat, em refereixo al segle XIX, quan es va institucionalitzar el concepte de l'ideal maternal.

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Background and objectives In humans, circulating CD4(+)CD25(high) T cells contain mainly regulatory T cells (Treg; FoxP3(+)IL-7R alpha(low)), but a small subset is represented by activated effector T cells (Tact; FoxP3(-)IL-7R alpha(high)). The balance between Tact and Treg may be important after transplantation. The aim of this study was first to analyze and correlate CD4(+)CD25(high) Tact and Treg with the clinical status of kidney transplant recipients and second to study prospectively the effect of two immunosuppressive regimens on Tact/Treg during the first year after transplantation.Design, setting, participants, & measurements CD4(+)CD25(high) Tact and Treg were analyzed by flow cytometry, either retrospectively in 90 patients greater than 1 year after kidney transplantation (cross-sectional analysis) or prospectively in 35 patients receiving two immunosuppressive regimens after kidney transplantation (prospective analysis).Results A higher proportion of Tact and a lower proportion of Treg were found in the majority of kidney recipients. In chronic Immoral rejection, a strikingly higher proportion of Tact was present. A subgroup of stable recipients receiving calcineurin inhibitor-free immunosuppression (mycophenolate mofetil, azathioprine, or sirolimus) had Tact values that were similar to healthy individuals. In the prospective analysis, the proportion of Tact significantly increased in both immunosuppression groups during the first year after transplantation.Conclusions These data highlight distinct patterns in the proportion of circulating Tact depending on the clinical status of kidney recipients. Moreover, the prospective analysis demonstrated an increase in the proportion of Tact, regardless of the immunosuppressive regimen. The measurement of Tact, in addition to Treg, may become a useful immune monitoring tool after kidney transplantation. Clin J Am Soc Nephrol 6: 2025-2033, 2011. doi: 10.2215/CJN.09611010

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BACKGROUND: Enfuvirtide was shown to be highly effective in treatment- experienced patients. Data on discontinuation of enfuvirtide and switch to new antiretroviral drugs are scarce. We aimed to evaluate the efficacy and the impact of discontinuing and/or switching enfuvirtide on virologic and clinical parameters in clinical practice. METHODS: All HIV-infected individuals participating in the Swiss HIV Cohort Study who were treated with enfuvirtide for at least 4 weeks in combination with an optimized background antiretroviral regimen were included in this study. RESULTS: A total of 151 patients were analyzed. The median baseline CD4 cell count was 108 cells/microL (interquartile range [IQR] 50-206) and HIV RNA was 4.7 log10 copies/mL (IQR 4.1-5.2). Virologic suppression, defined as a viral load below 50 copies/mL at 12 months, was achieved by 57.6% of patients. Overall, a median CD4 cell increase of 121 cells/microL (IQR 50-189) from baseline was noted. Up to 50% of patients discontinued enfuvirtide within the first year of treatment, mainly because of the patient's choice. After discontinuation of enfuvirtide, high rates of virologic failure and clinical progression were observed, notably when CD4 cell count at stopping enfuvirtide was below 100 cells/microL and no switch to new potent antiretroviral drugs such as darunavir, maraviroc, or raltegravir was performed. CONCLUSIONS: Enfuvirtide provides high virologic and immunologic response in treatment-experienced patients in the setting of clinical practice. Enfuvirtide should not be discontinued but should be replaced by new potent antiretrovirals, particularly in case of severe immunosuppression.

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INTRODUCTION: Gain weight after transplantation is relatively common, also tends to be multifactorial and can be influenced by glucocorticoids and immunosuppressive medications, delayed graft function and cause serious health complications. OBJECTIVES: Assess changes in weight, degree of obesity and body mass index as well as the effect of immunosuppressive treatment over these 5 years after kidney transplantation. METHODS: The samples were 119 kidney transplant recipients, 70 men and 49 women, that attended the query post for five years. All patients were measured Pretransplant and post (from 1st year to the 5th year) weight, height and body mass index calculated by the formula weight/size2 relating it to immunosuppressive treatment taking. RESULTS: There is a considerable increase of body mass index, weight and degree of obesity in the first year after transplantation to increase more slowly in the next four years. The type of immunosuppressive treatment influence the weight and degree of obesity that occurs in this period of time. CONCLUSIONS: A high prevalence there are overweight and obesity after the transplant especially during the first year. A year patients earn an average of 6.6 kg in weight and an average of 2.5 kg/m2 in their BMI. During treatment should minimize doses of steroids and include dietary treatment and adequate physical exercise

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The aim of this working paper is to analyze the inclusion of political humor into the set of actions used by opponents to the Syrian regime during the first year of a state-wide uprising in 2011. The research argues that although political humor has traditionally been seen mainly as a concealed voice against dominant elites, it can nevertheless take a confrontational stance and challenge a regime. In this paper we assess the role of political humor in challenging the legitimacy of the Syrian State through the battle for the signification of events. We will work with a theoretical framework that draws its assumptions from social movements’ studies and cultural studies. Through the assessment of the importance of discourse and the role of ideological domination to a regime we will see how the first year of the Syrian uprising included widespread acts of political humor as part of the strategy against the regime.

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This paper investigates the factors in_uencing grade performance in two different high school tracks (academic and vocational), including the effect of the amount of work achieved while studying. The empirical strategy analyzes grade progression through the outcomes, passing, repeating and dropping out, conditioning on previous outcomes, and dealing with the endogeneity introduced by the working variable. The analysis is based on a unique Spanish data with information on schooling and labor histories. Findings show that working reduces performance in both tracks, mainly during the first year, although the ffects are less detri- mental in the vocational path. Additionally, good performance in compulsory education, at- tending a private high school, or having high-educated parents improve outcomes, particularly in academic high school.

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BACKGROUND: The influence of anti-T-cell therapy in the immunogenicity of the influenza vaccine in kidney transplant recipients remains unclear. METHODS: During the 2010 to 2011 influenza season, we evaluated the immune response to the inactivated trivalent influenza vaccine in kidney transplant recipients having received Thymoglobulin or basiliximab as induction therapy. A hemagglutination inhibition assay was used to assess the immunogenicity of the vaccine. The primary outcome was geometric mean titers of hemagglutination inhibition after influenza vaccination. RESULTS: Sixty patients (Thymoglobulin n=22 and basiliximab n=38) were included. Patients in the Thymoglobulin group were older (P=0.16), showed higher creatinine levels (P=0.16) and had more frequently received a previous transplant (P=0.02). There were no significant differences in geometric mean titers for any of the three viral strains between groups (P=0.69 for H1N1, P=0.56 for H3N2, and P=0.7 for B strain). Seroconversion to at least one viral strain was seen in 15 (68%) of 22 patients in the Thymoglobulin group and 28 (73%) of 38 in the basiliximab group (P=0.77). In patients vaccinated during the first year after receiving anti-T-cell therapy (n=25), there was a trend toward lower vaccine responses in the Thymoglobulin group. Patients who received Thymoglobulin showed lower CD4 cell counts and lower levels of IgM, at an average of 16.2 months after transplantation. A multivariate analysis showed that only the absence of mycophenolate was associated with a better vaccine response (odds ratio=9.47; 95% confidence interval, 1.03-86.9; P=0.047). CONCLUSION: No significant differences were seen in immunogenicity of the influenza vaccine in kidney transplant recipients having received either Thymoglobulin or basiliximab.

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Le rétinoblastome représente 11% de tous les cancers apparaissant pendant la première année de vie. Pour éviter les effets secondaires de la chimiothérapie systémique ou de la radiothérapie externe, de nouveaux médicaments et de nouvelles techniques de traitement focalisé ont été développés. Des voies d'administration telles la voie périoculaire (topotécan) ou la voie artérielle ophtalmique directe (carboplatine) sont utilisées aujourd'hui dans certains cas résistants. La radiothérapie actuelle, appliquée exclusivement en deuxième intention, fait appel également à des techniques ciblées, permettant d'éviter les tissus sains et de réduire le risque de cancers radio-induits non oculaires. La radiothérapie stéréotaxique conformationnelle ou conformale et la proton-thérapie font ainsi partie du nouvel arsenal thérapeutique du rétinoblastome. Retinoblastoma represents 11% of all cancers during the first year of life. New drugs and focal treatments have been developed in order to avoid the side effects of systemic chemotherapy and external radiotherapy. New targeted and local administration strategies such as periocular chemotherapy (topotecan) or direct ophthalmic artery delivery (carboplatin), are already used today in selected resistant cases. Radiotherapy, presently indicated only as a second-line treatment, is also subject to new techniques, targeting tumors more closely to avoid involving healthy tissue and reduce the risk of radio-induced nonocular tumors. Stereotactic conformal radiotherapy and proton therapy may thus be included in the new range of treatment methods in retinoblastoma

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Els deserts constitueixen aproximadament un terç de la superfície terrestre i estan caracteritzats per la seva aridesa extrema. Els Sàhara, la zona àrida més gran del Nord d’Àfrica és, amb diferencia, el desert més gran del mon. Ocupa una extensió de més de 9 milions de kilòmetres quadrats, expandint-se 5500 km a través del nord d’Àfrica, des de l’oceà Atlàntic fins el mar Roig. El desert d’Aràbia es troba a l’est del Sàhara i és aproximadament una octava part més petit. Tot i el seu clima tan extrem, les flores i faunes dels deserts acostumen a ser relativament riques, el que fa que ens preguntem com aquestes biotes han estat adquirides i com es mantenen. En aquest projecte utilitzem els rèptils com a model d’estudi, un dels habitants més comuns dels deserts. El propòsit d’aquest projecte era utilitzar filogènies moleculars de diversos taxons de rèptils dels deserts del nord d’Àfrica i Aràbia per respondre Quan i Com els deserts han adquirit la seva fauna de rèptils endèmica (origen i diversificació), i de quina manera aquestes faunes s’han mantingut fins ara (adaptació). Però més enllà de les dades morfològiques i les eines de filogènia molecular, els paràsits representen una alternativa excitant i innovadora dins del camp de la biologia evolutiva. En aquest sentit, aquest projecte de beca proposava anar més lluny i utilitzar els paràsits com a eina (biological tags) per millor entendre l’historia evolutiva dels seus hostes en base a una aproximació biogeogràfica i co-evolutiva. Els objectius durant aquest primer any de projecte han sigut: 1) Estudiar l’origen i diversificació de la fauna de rèptils endèmica dels deserts del Sàhara i Aràbia, 2) caracteritzar la comunitat d’ecto- haemoparàsits de les espècies d’estudi, 3) posar a punt un estudi comparatiu de la filogeografia i estructuració genètica d’hostes i paràsits.

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El principal objectiu del projecte era desenvolupar millores conceptuals i metodològiques que permetessin una millor predicció dels canvis en la distribució de les espècies (a una escala de paisatge) derivats de canvis ambientals en un context dominat per pertorbacions. En un primer estudi, vàrem comparar l'eficàcia de diferents models dinàmics per a predir la distribució de l'hortolà (Emberiza hortulana). Els nostres resultats indiquen que un model híbrid que combini canvis en la qualitat de l'hàbitat, derivats de canvis en el paisatge, amb un model poblacional espacialment explícit és una aproximació adequada per abordar canvis en la distribució d'espècies en contextos de dinàmica ambiental elevada i una capacitat de dispersió limitada de l'espècie objectiu. En un segon estudi abordarem la calibració mitjançant dades de seguiment de models de distribució dinàmics per a 12 espècies amb preferència per hàbitats oberts. Entre les conclusions extretes destaquem: (1) la necessitat de que les dades de seguiment abarquin aquelles àrees on es produeixen els canvis de qualitat; (2) el biaix que es produeix en la estimació dels paràmetres del model d'ocupació quan la hipòtesi de canvi de paisatge o el model de qualitat d'hàbitat són incorrectes. En el darrer treball estudiarem el possible impacte en 67 espècies d’ocells de diferents règims d’incendis, definits a partir de combinacions de nivells de canvi climàtic (portant a un augment esperat de la mida i freqüència d’incendis forestals), i eficiència d’extinció per part dels bombers. Segons els resultats dels nostres models, la combinació de factors antropogènics del regim d’incendis, tals com l’abandonament rural i l’extinció, poden ser més determinants per als canvis de distribució que els efectes derivats del canvi climàtic. Els productes generats inclouen tres publicacions científiques, una pàgina web amb resultats del projecte i una llibreria per a l'entorn estadístic R.

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Critical real-time ebedded (CRTE) Systems require safe and tight worst-case execution time (WCET) estimations to provide required safety levels and keep costs low. However, CRTE Systems require increasing performance to satisfy performance needs of existing and new features. Such performance can be only achieved by means of more agressive hardware architectures, which are much harder to analyze from a WCET perspective. The main features considered include cache memòries and multi-core processors.Thus, althoug such features provide higher performance, corrent WCET analysis methods are unable to provide tight WCET estimations. In fact, WCET estimations become worse than for simple rand less powerful hardware. The main reason is the fact that hardware behavior is deterministic but unknown and, therefore, the worst-case behavior must be assumed most of the time, leading to large WCET estimations. The purpose of this project is developing new hardware designs together with WCET analysis tools able to provide tight and safe WCET estimations. In order to do so, those pieces of hardware whose behavior is not easily analyzable due to lack of accurate information during WCET analysis will be enhanced to produce a probabilistically analyzable behavior. Thus, even if the worst-case behavior cannot be removed, its probabilty can be bounded, and hence, a safe and tight WCET can be provided for a particular safety level in line with the safety levels of the remaining components of the system. During the first year the project we have developed molt of the evaluation infraestructure as well as the techniques hardware techniques to analyze cache memories. During the second year those techniques have been evaluated, and new purely-softwar techniques have been developed.