Cytomegalovirus Immunoglobulin After Thoracic Transplantation: An Overview

Cytomegalovirus (CMV) is a highly complex pathogen which, despite modern prophylactic regimens, continues to affect a high proportion of thoracic organ transplant recipients. The symptomatic manifestations of CMV infection are compounded by adverse indirect effects induced by the multiple immunomodulatory actions of CMV. These include a higher risk of acute rejection, cardiac allograft vasculopathy after heart transplantation, and potentially bronchiolitis obliterans syndrome in lung transplant recipients, with a greater propensity for opportunistic secondary infections. Prophylaxis for CMV using antiviral agents (typically oral valganciclovir or intravenous ganciclovir) is now almost universal, at least in high-risk transplants (D+/R-). Even with extended prophylactic regimens, however, challenges remain. The CMV events can still occur despite antiviral prophylaxis, including late-onset infection or recurrent disease, and patients with ganciclovir-resistant CMV infection or who are intolerant to antiviral therapy require alternative strategies. The CMV immunoglobulin (CMVIG) and antiviral agents have complementary modes of action. High-titer CMVIG preparations provide passive CMV-specific immunity but also exert complex immunomodulatory properties which augment the antiviral effect of antiviral agents and offer the potential to suppress the indirect effects of CMV infection. This supplement discusses the available data concerning the immunological and clinical effects of CMVIG after heart or lung transplantation

Accessing talent : the foundation of a U.S. Army Officer Corps strategy /

This is the fourth of six monographs focused upon officer talent management in the U.S. Army. In it, the authors continue their examination of how the U.S. Army accesses, develops, retains, and employs officer talent. In particular, they focus upon the ways in which dynamic labor market conditions and generational preferences have shaped service propensity among potential officer prospects.

Beyond the Bauhaus : Cultural Modernity in Breslau, 1918-1933 /

The Breslau arts scene during the Weimar period was one of the most vibrant in all of Germany, yet it has disappeared from memory and historiography. Breslau was a key center for innovative artistic production during the Weimar Republic; recovery of its history will shed new light on German cultural dynamics in the 1920s. Such a study has art historical significance because of the incredible extent of innovation that occurred in almost every intellectual field, advances that formed the basis for aesthetic modernism internationally and continue to affect the course of visual art and architecture today. Architecture education, just one example in many, is still largely based on a combination of the Bauhaus model from the 1920s and the model developed at the Breslau Academy of Fine and Applied Art. The exploratory attitude encouraged in Weimar era arts endeavors, as opposed to the conformism of academic art, is still a core value promoted in contemporary art and architecture circles. Given the long-lasting influence of Weimar culture on modernism one would expect to find a spate of studies examining every aspect of its cultural production, but this is not the case. Recent scholarship is almost exclusively focused on Berlin and the Dessau Bauhaus. Although both interests are understandable, the creative explosion was not confined to these cities but was part of a larger cultural ethos that extended into many of the smaller regional centers. The Expressionist associations the Blaue Reiter in Munich and Brücke in Dresden are two well-known examples. Equally, innovation was not confined to a few monumental projects like the Stuttgart Weissenhofsiedlung but part of a broader national cultural ethos. The dispersion of modernism occurred partly because of the political history of Germany as a loosely joined confederation of small city states and principalities that had strong individual cultural identities before unification in 1871 but also because of the German propensity to value and take intense pride in the Heimat, understood both as the hometown and the region. Heimatliebe translated into generous support for cultural institutions in outlying cities. Host to a roster of internationally acclaimed artists and architects, major collectors, arts organizations, museums, presses, galleries, and one of the premier German arts academies of the day, Breslau boasted a thriving modern arts scene until 1933 when the Nazis began their assault on so-called "degenerate" art. This book charts the cultural production of Breslau-based artists, architects, art collectors, urban designers, and arts educators, who were especially interesting because they operated in the space between the margins of Weimar-era cultural debates. Rather than accepting the radical position of the German avant-garde or the reactionary position of German conservatives, many Breslauers sought a middle ground. It is the first book in English to address this history and presents the history in a manner unique to any studies currently on the market. 'Beyond the Bauhaus' explores the polyvalent and contradictory nature of cultural production in Breslau in order to expand the cultural and geographic scope of Weimar history; the book asserts a reciprocal dimension to the relationship between regional culture and national culture, between centers like Breslau and the capital Berlin. With major international figures like the painters Otto Mueller and Oskar Moll, architects Hans Scharoun and Adolf Rading, urban planners Max Berg and Ernst May, collectors Ismar Littmann and Max Silberberg, and an art academy that by 1929 was considered the best in Germany, Breslau clearly had significance to narratives of Weimar cultural production. 'Beyond the Bauhaus' contributes the history of German culture during the Weimar Republic. It belongs alongside histories of art, architecture, urban design, exhibition, collecting, and culture; histories of the Bauhaus; histories of arts education more broadly; and German history. The readership would include those interested in German history; German art, architecture, urban design, planning, collecting, and exhibition history; in the avant-garde; the development of arts academies and arts pedagogy; and the history of Breslau and Silesia.

Innovation and internationalization of Latin American services

Innovation and internationalization in services are key drivers of structural transformation, productivity growth and overall economic performance in Latin America. The services sector accounts for two thirds of the region’s GDP and provides over 60% of its employment. These shares are higher than in other developing regions, but still lower than in countries with higher levels of per capita income. The spread of information and communication technologies in Latin America over the past three decades has vastly enhanced both the tradability of services and the sector’s propensity to innovate. Long considered unrelated processes, both internationalization and innovation are today widely recognized as key and complementary sources of firm-level competitiveness and human capital enhancement. The advent of many novel types of business and consumer services is furthermore a key factor in the rising insertion of Latin American firms in regional and global value chains and transnational production networks, which are now the predominant form of organization of international production and trade. This volume explores three different levels of interaction between internationalization and innovation in the services sector in Latin America. Part I analyses the role of services in manufacturing and other sectors’ global value chains from a theoretical perspective, drawing on the experiences of Brazil and Mexico. Part II reviews innovation and internationalization policies and their effects on the performance of the services sector. Part III presents a series of case studies on innovation and internationalization linkages in Brazil, Chile, Costa Rica and Mexico. The book concludes that, in order for Latin American countries and firms to upgrade into services value chains, public and private initiatives must generate a host of regional public goods —enhanced investment climates, supply of skills, greater access to finance, improved protection of intellectual property, better value appropriation, enhanced efforts at standardization and quality certification— to strengthen the links between innovation and internationalization.

Efecto de las TIC en el rendimiento educativo: el Programa Conectar Igualdad en la Argentina

El objetivo de este trabajo consiste en determinar cuál es el “premio”, en términos de rendimiento educativo, de los estudiantes beneficiados con el Programa Conectar Igualdad con respecto a aquellos que no participaron en él. Con este fin, se emplea la técnica de emparejamiento o método de psm (propensity score matching). Se describen los antecedentes del Programa, así como el marco teórico con que se definen los factores explicativos del rendimiento educativo y que posiblemente inciden en la probabilidad de participar en el Programa. La población bajo estudio son los estudiantes de 15 años de la Argentina. Se emplean datos del Programa Internacional de Evaluación de Estudiantes (PISA) correspondientes al año 2012. De acuerdo con los resultados obtenidos, existen diferencias estadísticamente significativas en el rendimiento educativo promedio derivadas de la participación en el Programa Conectar Igualdad.

Capacidades e performance dos Tribunais de Contas no Brasil

O presente estudo visa à análise da relação entre as capacidades, conforme definidas por Brinkerhoff (2010), e a performance das Cortes de Contas brasileiras. As capacidades no atual estudo se referem à quantidade de funcionários de cada Tribunal de Contas, seu orçamento, percentual de servidores do seu quadro efetivo e cumprimento das normas constitucionais quanto a sua formação. A performance foi medida pelas variáveis: “Produtividade”, ou o número de processos julgados ou apreciados pelos Ministros ou Conselheiros; “Iniciativa”, ou seja, quantidade de fiscalizações in loco realizadas; “Valor das multas e débitos imputados”, entendidas como a propensão a punir das Cortes de Contas; e “Grau de rejeição das contas de governo”, que é definida como a razão do número de pareceres prévios rejeitando as contas de governo pelo total de pareceres emitidos. A atual pesquisa parte do estudo de Melo, Pereira e Figueiredo (2009) - que identifica diversas relações entre a estrutura dos Tribunais de Contas e sua atuação - propondo novas variáveis para uma análise mais ampla e real da performance das Cortes de Contas. As hipóteses do estudo foram testadas por meio de regressão estatística utilizando o método de mínimos quadrados. Os dados foram coletados diretamente dos Tribunais de Contas. Os testes realizados confirmaram que a quantidade de recursos humanos de cada Corte influencia positivamente todas as variáveis de performance referidas anteriormente, e que quanto maior o orçamento de cada Tribunal maior sua produtividade, sua iniciativa e o valor das multas e débitos imputados. O presente estudo também comprovou que quanto maior o percentual de servidores do quadro efetivo da Corte de Contas, maior é sua produtividade, o que corrobora as teorias de Evans (2004). A partir dos dados coletados na pesquisa, foi possível verificar que o percentual médio de servidores efetivos nas Corte de Contas é de 69% enquanto nas Cortes Judiciárias esse percentual é de 89%. Isso mostra que há bastante margem para aumento da produtividade dos órgãos de contas. Conclui-se que quanto mais recursos financeiros e humanos disponíveis, e quanto maior o percentual de servidores concursados, mais os Tribunais de Contas são produtivos, sancionadores e proativos.

Methods to Control for Bias in Observational Studies

Thesis (Master's)--University of Washington, 2016-06

What is the Impact of the Underserved Pathway program on Entering an Underserved Family Medicine Residency? A Comparison of Three Approaches for Estimating the Average Treatment Effect

Thesis (Master's)--University of Washington, 2016-06

Policy-Oriented Learning Among National Forest Stakeholders in the Pacific Northwest: Changes in Policy Beliefs Since Adoption of the Northwest Forest Plan

Thesis (Master's)--University of Washington, 2016-06

The role of morphine-6-glucuronide (M6G) in pain control

Morphine-6beta-D-glucuronide (M6G) is an analgesically active metabolite of morphine, accounting for approximate to10% of the morphine dose when administered by systemic routes to humans. Although M6G is more hydrophilic than morphine, it crosses the blood-brain barrier, albeit relatively slowly. For this reason, it is generally thought that, after chronic dosing, M6G contributes significantly to the analgesic effects of systemically administered morphine. Owing to its polar nature, M6G is cleared from the systemic circulation primarily via renal elimination. As M6G accumulates in patients with renal impairment, there is an increased risk of M6G-induced respiratory depression in renal failure patients who are being dosed chronically with systemic morphine. Consistent with its analgesic and respiratory depressant properties, M6G binds to the p-opioid receptor in a naloxone-reversible manner. Although the affinity of M6G for the mu-opioid receptor is similar to or slightly less than that of morphine, preclinical studies in rodents show that M6G is one to two orders of magnitude more potent than morphine when administered by central routes. This major discrepancy between the markedly higher intrinsic antinociceptive potency of M6G relative to morphine, despite their similar p-opioid receptor binding affinities, is difficult to reconcile. It has been proposed that M6G mediates its pain-relieving effects through a novel 'M6G opioid receptor', while others have argued that M6G may have higher efficacy than morphine for transduction of intracellular events. When administered by parenteral routes to rodents, M6G's antinociceptive potency is no more than twofold higher than morphine. In humans, the analgesic efficacy and respiratory depressant potency of M6G relative to morphine have been assessed in a number of short-term studies involving the intrathecal or intravenous routes of administration. For example, in hip replacement patients, intrathecal M6G provided excellent postoperative analgesia but the occurrence of late respiratory depression in 10% of these patients raised serious concern about safety. In postoperative patients, intravenous M6G administered by means of patient-controlled analgesia (PCA), or bolus plus PCA, produced no analgesia in one study and limited analgesia in another. Similarly, there was a lack of significant analgesia in healthy volunteers who received intravenous M6G for the alleviation of experimental pain (carbon dioxide applied to the nasal mucosa). In contrast, satisfactory analgesia was produced by bolus doses of intravenous M6G administered to patients with cancer pain, and to healthy volunteers with experimentally-induced ischaemic, electrical or thermal (ice water) pain. Studies to date in healthy volunteers suggest that intravenous M6G may be a less potent respiratory depressant and have a lower propensity for producing nausea and vomiting than morphine. However, it is unclear whether equi-analgesic doses of M6G and morphine were compared. Clearly, more extensive short-term trials, together with studies involving chronic M6G administration, are necessary before the potential clinical utility of M6G as an analgesic drug in its own right can be determined.

Merkel-cell carcinoma of the skin

Merkel-cell carcinoma (MCC) is a rare form of skin cancer of neuroendocrine origin that has been described as the most aggressive cutaneous malignancy. The cell of origin is thought to be the Merkel cell or skin-pressure receptor. It has the propensity for dermal-lymphatic invasion, and nodal and haematogenous spread. Factors that have been implicated in its cause include exposure to sunlight and immunosuppression. The tumour has many similarities to small-cell carcinoma of the lung, with intrinsic sensitivity to ionising radiation and chemotherapy, and an aggressive metastatic potential. The best treatment outcomes can be achieved with early diagnosis and the integration of surgery, radiation, and chemotherapy. The treatment challenges for the clinician are often enormous because many of the patients are elderly and because lesions occur in difficult sites such as the head and neck region and the lower leg.

The Migration of Doctors and Nurses from South Pacific Island Nations

Little is known of the structure of the international migration of skilled health professionals. Accelerated migration of doctors and nurses from the Pacific island states of Fiji, Samoa and Tonga to the Pacific periphery is part of the globalization of health care. The findings from a recent survey of 251 doctors and nurses from the three island countries are reported here. Key determinants of both present migration status and future migration intentions were analyzed using econometric methods. Nurses' and doctors' propensities to migrate are influenced by both income and non-income factors, including ownership of businesses and houses. Migrants also tend to have more close relatives overseas, to have trained there, and so experienced superior working conditions. Migration propensities vary between countries, and between nurses and doctors within countries. Tongan nurses have a higher propensity to migrate, mainly because of greater relative earnings differentials, but are also more likely to return home. The role of kinship ties, relative income differentials and working conditions is evident in other developing country contexts. Remittances and return migration, alongside business investment, bring some benefits to compensate for the skill drain. National development policies should focus on encouraging return migration, alongside retention and recruitment, but are unlikely to prevent out migration. (C) 2003 Elsevier Ltd. All rights reserved.

Relationship between ash content and R-70 self-heating rate of Callide Coal

Borecore samples from the Trap Gully pit at Callide have been assessed using the R-70 self-heating test. The highest R-70 self-heating rate value was 16.22 degrees C/h, which is consistent with the subbituminous rank of the coal. R-70 decreases significantly with increasing mineral matter content, as defined by the ash content of the coal. This effect is due to the mineral matter in the coal acting as a heat sink. A trendline equation has been fitted to the borecore data from the Trap Gully pit: R-70 = 0.0029 x ash(2) - 0.4889 x ash + 20.644, where all parameters are on a dry-basis. This relationship can be used to model the self-heating hazard of the pit, both vertically and laterally. (c) 2005 Elsevier B.V All rights reserved.

Comparison of the R-70 self-heating rate of New Zealand and Australian coals to Suggate rank parameter

Samples from New Zealand and Australia have been tested in an adiabatic oven to assess the effect of rank on the R-70 selfheating rate of coal. A non-linear relationship can be defined for coals from both countries using the revised Suggate rank (S-r) parameter. Subbituminous coals have the highest R-70 self-heating rate values, which are 20 times that of high volatile A bituminous coals on a dry mineral matter free basis (similar to 1 cf. 20 degrees C h(-1)). However, the moderating effects of moisture and mineral matter can reduce this difference to only 2-3 times for coal in-situ. (c) 2005 Elsevier B.V All rights reserved.

Morningness-eveningness orientation, optimal time-of-day and attitude change: Evidence for the systematic processing of a persuasive communication

This study investigates the effects of morningness-eveningness orientation and time-of-day on persuasion. In an attitude change paradigm, 120 female participants read a persuasive message that consisted of six counter-attitudinal arguments (anti-voluntary euthanasia) either in the morning (8:30 a.m.) or in the evening (7:00 p.m.). Attitude change was assessed by measuring attitudes towards the target issue before and after exposure to the message. Message processing was assessed by thought-listing and message recall tasks. Self-reported mood and arousal were monitored throughout. Participants were classified into M- and E-types according to their scores on the Horne and Ostberg (1976) MEQ questionnaire. When tested at their respective optimal time-of-day (i.e., morning for M-types/evening for E-types), M- and E-types reported higher energetic arousal, greater agreement with the message, greater message-congruent thinking, and a propensity for superior message recall compared to M- and E-types tested at their nonoptimal time-of-day (i.e., evening for M-types/morning for E-types). The attitude change in those tested at their optimal time-of-day was mediated by the level of message-congruent thinking. Results are interpreted in terms of the Elaboration Likelihood Model of persuasion. (c) 2005 Elsevier Ltd. All rights reserved.