Studio caso-controllo multicentrico su distacco di retina e movimentazione manuale di carichi

Obiettivo Valutare l’ipotesi secondo cui la movimentazione manuale di carichi possa essere un fattore di rischio per il di distacco di retina. Metodi Si è condotto uno studio caso-controllo ospedaliero multicentrico, a Bologna, (reparto di Oculistica del policlinico S. Orsola Malpighi, Prof. Campos), e a Brescia (reparto di oculistica “Spedali Civili” Prof. Semeraro). I casi sono 104 pazienti operati per distacco di retina. I controlli sono 173 pazienti reclutati tra l’utenza degli ambulatori del medesimo reparto di provenienza dei casi. Sia i casi che i controlli (all’oscuro dall’ipotesi in studio) sono stati sottoposti ad un’intervista, attraverso un questionario strutturato concernente caratteristiche individuali, patologie pregresse e fattori di rischio professionali (e non) relativi al distacco di retina. I dati relativi alla movimentazione manuale di carichi sono stati utilizzati per creare un “indice di sollevamento cumulativo―ICS” (peso del carico sollevato x numero di sollevamenti/ora x numero di anni di sollevamento). Sono stati calcolati mediante un modello di regressione logistica unconditional (aggiustato per età e sesso) gli Odds Ratio (OR) relativi all’associazione tra distacco di retina e vari fattori di rischio, tra cui la movimentazione manuale di carichi. Risultati Oltre alla chirurgia oculare e alla miopia (fattori di rischio noti), si evidenzia un trend positivo tra l’aumento dell’ICS e il rischio di distacco della retina. Il rischio maggiore si osserva per la categoria di sollevamento severo (OR 3.6, IC 95%, 1.5–9.0). Conclusione I risultati, mostrano un maggiore rischio di sviluppare distacco di retina per coloro che svolgono attività lavorative che comportino la movimentazione manuale di carichi e, a conferma di quanto riportato in letteratura, anche per i soggetti miopi e per coloro che sono stati sottoposti ad intervento di cataratta. Si rende quindi evidente l’importanza degli interventi di prevenzione in soggetti addetti alla movimentazione manuale di carichi, in particolare se miopi.

Changing epidemiology of HIV anonymous testing in Switzerland for 1996-2006

QUESTIONS UNDER STUDY: To assess whether the prevalence of HIV positive tests in clients at five anonymous testing sites in Switzerland had increased since the end of the 1990s, and ascertain whether there had been any concurrent change in the proportions of associated risk factors. METHODS: Baseline characteristics were analysed, by groups of years, over the eleven consecutive years of data collected from the testing sites. Numbers of HIV positive tests were presented as prevalence/1000 tests performed within each category. Multivariable analyses, stratified by African nationality and risk group of heterosexuals or men who have sex with men (MSM), were done controlling simultaneously for a series of variables. Odds ratios (ORs) were reported together with their 95% confidence intervals (CI). P values were calculated from likelihood ratio tests. RESULTS: There was an increase in the prevalence of positive tests in African heterosexuals between 1996-1999 and 2004-2006, rising from 54.2 to 86.4/1000 and from 5.6 to 25.2/1000 in females and males respectively. The proportion of MSM who knew that one or more of their sexual partners was infected with HIV increased from 2% to 17% and the proportion who reported having more than five sexual partners in the preceding two years increased from 44% to 51%. CONCLUSIONS: Surveillance data from anonymous testing sites continue to provide useful information on the changing epidemiology of HIV and thus inform public health strategies against HIV.

Changes in species composition in alpine snowbeds with climate change inferred from small-scale spatial patterns

Alpine snowbeds are characterised by a very short growing season. However, the length of the snow-free period is increasingly prolonged due to climate change, so that snowbeds become susceptible to invasions from neighbouring alpine meadow communities. We hypothesised that spatial distribution of species generated by plant interactions may indicate whether snowbed species will coexist with or will be out-competed by invading alpine species – spatial aggregation or segregation will point to coexistence or competitive exclusion, respectively. We tested this hypothesis in snowbeds of the Swiss Alps using the variance ratio statistics. We focused on the relationships between dominant snowbed species, subordinate snowbed species, and potentially invading alpine grassland species. Subordinate snowbed species were generally spatially aggregated with each other, but were segregated from alpine grassland species. Competition between alpine grassland and subordinate snowbed species may have caused this segregation. Segregation between these species groups increased with earlier snowmelt, suggesting an increasing importance of competition with climate change. Further, a dominant snowbed species (Alchemilla pentaphyllea) was spatially aggregated with subordinate snowbed species, while two other dominants (Gnaphalium supinum and Salix herbacea) showed aggregated patterns with alpine grassland species. These dominant species are known to show distinct microhabitat preferences suggesting the existence of hidden microhabitats with different susceptibility to invaders. These results allow us to suggest that alpine snowbed areas are likely to be reduced as a consequence of climate change and that invading species from nearby alpine grasslands could outcompete subordinate snowbed species. On the other hand, microhabitats dominated by Gnaphalium or Salix seem to be particularly prone to invasions by non-snowbed species.

Diabetes genes and risk of prostate cancer in the Atherosclerosis Risk in Communities study

Prostate cancer (PrCa) is a leading cause of morbidity and mortality, yet the etiology remains uncertain. Meta-analyses show that PrCa risk is reduced by 16% in men with type 2 diabetes (T2D), but the mechanism is unknown. Recent genome-wide association studies and meta-analyses have found single nucleotide polymorphisms (SNPs) that consistently predict T2D risk. We evaluated associations of incident PrCa with 14 T2D SNPs in the Atherosclerosis Risk in Communities (ARIC) study. From 1987-2000, there were 397 incident PrCa cases ascertained from state or local cancer registries among 6,642 men (1,560 blacks and 5,082 whites) aged 45-64 years at baseline. Genotypes were determined by TaqMan assay. Cox proportional hazards models were used to assess the association between PrCa and increasing number of T2D risk-raising alleles for individual SNPs and for genetic risk scores (GRS) comprised of the number of T2D risk-raising alleles across SNPs. Two-way gene-gene interactions were evaluated with likelihood ratio tests. Using additive genetic models, the T2D risk-raising allele was associated with significantly reduced risk of PrCa for IGF2BP2 rs4402960 (hazard ratio [HR]=0.79; P=0.07 among blacks only), SLC2A2 rs5400 (race-adjusted HR=0.85; P=0.05) and UCP2 rs660339 (race-adjusted HR=0.84; P=0.02), but significantly increased risk of PrCa for CAPN10 rs3792267 (race-adjusted HR=1.20; P=0.05). No other SNPs were associated with PrCa using an additive genetic model. However, at least one copy of the T2D risk-raising allele for TCF7L2 rs7903146 was associated with reduced PrCa risk using a dominant genetic model (race-adjusted HR=0.79; P=0.03). These results imply that the T2D-PrCa association may be partly due to shared genetic variation, but these results should be verified since multiple tests were performed. When the combined, additive effects of these SNPs were tested using a GRS, there was nearly a 10% reduction in risk of PrCa per T2D risk-raising allele (race-adjusted HR=0.92; P=0.02). SNPs in IGF2BP2, KCNJ11 and SLC2A2 were also involved in multiple synergistic gene-gene interactions on a multiplicative scale. In conclusion, it appears that the T2D-PrCa association may be due, in part, to common genetic variation. Further knowledge of T2D gene-PrCa mechanisms may improve understanding of PrCa etiology and may inform PrCa prevention and treatment.^

Comportamiento a fatiga por cortante de elementos lineales de hormigón armado sin cercos

Las estructuras de hormigón son susceptibles de sufrir los efectos asociados a las acciones de fatiga cuando estas se ven sometidas a un elevado número de cargas repetidas. Muchas de estas estructuras no requieren armadura transversal para cumplir los condicionantes de dimensionamiento estático como por ejemplo las losas superiores de tableros de puentes, los muros de contención, las losas de transición de puentes, las torres eólicas o las estructuras marítimas. La mayor parte de los códigos de diseño vigentes no incluyen una comprobación específica del nivel de seguridad a cortante de estas estructuras para acciones de fatiga, y aquellas que lo hacen prefieren utilizar expresiones de tipo empírico basadas en curvas S-N que relacionan el número de ciclos resistentes con el valor de la carga aplicada. A pesar de que el empleo de curvas S-N es de gran utilidad desde un punto de vista práctico, estas curvas no permiten comprender el proceso de rotura por cortante para cargas repetidas. El objetivo principal de esta Tesis es el de estudiar el comportamiento a cortante de elementos de hormigón armado sin cercos sometidos a fatiga. Además, el análisis es ampliado al estudio del comportamiento transversal de los voladizos de las losas superiores de tableros de puentes de hormigón que de forma habitual son diseñados sin armadura de cortante. De forma habitual estos elementos se diseñan atendiendo a criterios de dimensionamiento estáticos sin tener en cuenta la resistencia a cortante cuando se ven sometidos a cargas cíclicas. A pesar de que las cargas de fatiga son inferiores a aquellas que producen el fallo estático, es importante tener en cuenta el comportamiento de estos elementos ante cargas repetidas. Los trabajos experimentales existentes en vigas de hormigón armado sin cercos evidenciaron diferencias significativas entre los modos de fallo ante cargas estáticas y cíclicas. Estos trabajos llegaron a la conclusión de que estos elementos diseñados para tener un fallo dúctil por flexión pueden llegar a desarrollar un tipo de fallo frágil por cortante cuando se ven sometidos a cargas repetidas. El proceso de rotura por cortante en elementos de hormigón armado sin cercos sometidos a fatiga es un proceso complejo que debe ser estudiado en profundidad debido al carácter frágil de este tipo de fallo. Los trabajos experimentales permitieron comprobar que el origen de este fallo tiene lugar tras la formación de una fisura de cortante a partir de una fisura de flexión formada durante los primeros ciclos en el vano de cortante. Tras la formación de esta fisura, esta se va propagando hacia la cabeza de compresión hasta que finalmente se produce el fallo como consecuencia de la destrucción de la cabeza de compresión cuando la altura alcanzada por esta es insuficiente para resistir la fuerza de compresión aplicada en esta zona. Por otra parte, la propagación de esta fisura diagonal puede desarrollarse por completo en el instante en el que esta se forma derivando en un tipo de fallo por cortante más frágil que el anterior. El proceso de fatiga es estudiado en esta Tesis mediante un modelo mecánico. Por una parte, se propone un modelo predictivo para determinar el número de ciclos acumulados hasta que se forma la fisura diagonal en función del estado tensional que se tiene en la punta de una fisura crítica de flexión formada en los primeros ciclos. Por otra parte, la resistencia a fatiga tras la formación de la fisura diagonal se analiza teniendo en cuenta el daño por fatiga acumulado en la cabeza de compresión y las variables que afectan a la propagación de esta fisura de cortante. Para la evaluación de la resistencia a fatiga tras la formación de la fisura crítica de cortante en este tipo de elementos, se plantea un modelo teórico basado en conceptos de Mecánica de la Fractura adaptados al hormigón. Este modelo puede ser aplicado a vigas de hormigón armado sin cercos de canto constante o variable siguiendo diferentes procedimientos. Una campaña experimental ha sido llevada a cabo con el objetivo de estudiar el comportamiento a cortante de vigas de hormigón armado sin cercos de canto variable sometidas a cargas estáticas y de fatiga. Se han desarrollado un total de diez ensayos estáticos y de fatiga para diferentes niveles de carga y esbelteces de cortante, teniendo lugar diferentes modos de fallo. Estos elementos fueron diseñados para reproducir, a escala real y de forma simplificada, los voladizos laterales de las losas superiores de tableros de puentes de carretera de hormigón. Los resultados experimentales demostraron que el tipo de fallo desarrollado depende de varios parámetros como por ejemplo el nivel de carga máxima, el nivel de oscilación de tensiones en la armadura longitudinal, la esbeltez de cortante o la calidad del hormigón utilizado entre otros. Para valores similares de esbeltez de cortante, los ensayos de fatiga realizados permitieron comprobar que la rotura por cortante de estos elementos está asociada a niveles de carga máxima elevados, mientras que el fallo por fatiga de la armadura longitudinal tiene mayor probabilidad de ocurrir en elementos sometidos a elevados niveles de oscilación de tensiones en esta armadura. Además, estos ensayos han sido analizados a través del modelo propuesto para tratar de comprender el comportamiento resistente de estos elementos sometidos a cargas de fatiga. Concrete structures are able to suffer fatigue when they are subjected to high number of cyclic loads. Many of these need not shear reinforcement to satisfy static design requirements, such as bridge deck slabs, retaining walls, bridge approach slabs, wind towers or maritime structures among others. Many codes of practice do not include a verification of the shear fatigue safety. Moreover, those which include it still prefer empirical S-N-based approaches that provide the number of cycles as a function of applied forces. S-N models are practical but they do not provide information to understand the shear fatigue process. The main objective of this Thesis is to study shear behaviour of reinforced concrete elements without stirrups subjected to fatigue loads. In addition, the analysis is extended in order to study the transverse behaviour of cantilever slabs of concrete bridges that traditionally are designed without shear reinforcement. These elements usually are designed on the basis of static strength and it is unusual that codes consider fatigue strength of concrete in shear. Accordingly, it is important to take into account the fatigue behaviour of structural members subjected to cyclic loads although these loads are lower than those which produce the static failure. Existing experimental works show important differences between the static and cyclic failure modes of reinforced concrete beams without stirrups. These works concluded that beams without transverse reinforcement, designed to have a ductile failure mode in flexure, can submit a brittle shear failure mode when they are subjected to repeated loads. Shear fatigue failure of reinforced concrete beams without stirrups is a rather complex process from the mechanical viewpoint. Since it leads to a brittle failure mode it should be better understood. Experimental evidence indicates that a diagonal crack first develops from the inclination of flexural cracks in the shear span. Thereafter, the diagonal crack propagates into the compression zone. Failure normally takes place by the destruction of the compression zone when its depth is too small to resist the applied force. The propagation of the diagonal crack can also be instantaneous, leading to sudden diagonal cracking fatigue failure rather than shear-compression failure. Fatigue process is studied in this Thesis on a mechanical basis. On the one hand, a predictive model is derived to obtain the number of cycles up to diagonal cracking, as a function of the stress state at the tip of a critical flexural crack. On the other hand, the residual fatigue strength after diagonal cracking is analyzed taking into account the fatigue damage accumulated by the compression zone and the variables affecting the propagation of the diagonal crack. In order to assess the residual fatigue strength after diagonal cracking of such elements, a theoretical model is proposed based on concepts from fracture mechanics adapted to concrete. This model can be successfully applied for straight or haunched reinforced concrete beams without stirrups following different procedures. In order to achieve a more advanced knowledge in this subject, an experimental campaign has been carried out with the aim of study the shear behaviour of reinforced concrete haunched beams without stirrups subjected to static and fatigue loads. A total of ten static and fatigue tests have been performed with distinct load levels and shear span-to-depth ratios, presenting different failures modes. These elements were designed to reproduce in a simplified form the cantilever slab of concrete bridges at real scale. Experimental results showed that the type of failure depends on several parameters as for example the maximum load level, the stress oscillation level on the longitudinal reinforcement, the shear span-to-depth ratio or the quality of the concrete used among others. For a similar value of the shear span-to-depth ratio, tests evidenced that shear fatigue failure is related to high maximum load levels, while steel fatigue failure is easier to occur in elements subjected to high stress oscillation level on the reinforcement bars. Besides, these tests have been analyzed through the proposed model in order to clarify the structural behaviour of such elements subjected to fatigue loads.

Field evaluation of miles-per-gallon meters. Final report.

Transportation Systems Center, Cambridge, Mass.

Bem-estar subjetivo de genitores e prevalência de diagnósticos psiquiátricos de crianças

Bem-estar subjetivo (BES) envolve um conjunto de categorias com componentes cognitivos e emocionais utilizados pelas pessoas para avaliar sua própria vida. Não se trata de uma avaliação objetiva feita por observadores com relação à qualidade de vida de uma pessoa, mas da avaliação subjetiva de cada indivíduo sobre a qualidade de sua própria vida, sobre a satisfação experimentada no quotidiano. Assim, BES representa uma avaliação pessoal sobre quão feliz o indivíduo se sente, independentemente do contexto e das condições socioeconômicas, da saúde, do sucesso e de outras variáveis que poderiam permitir uma avaliação objetiva de qualidade de vida. Supõe-se que pais de crianças com problemas avaliem-se como menos felizes do que outros e que o diagnóstico de problemas esteja associado a um menor relato de BES. Assim, o objetivo deste estudo foi verificar relações entre bem-estar subjetivo de genitores e diagnósticos psiquiátricos de crianças. Para a realização deste estudo foram aplicados questionários para 70 genitores com filhos em atendimento psicológico na Unidade de Saúde da Criança e Adolescente. Resultados de análises de variância, testes t e de qui-quadrados revelaram não haver relações entre bem-estar subjetivo dos pais e presença de transtorno em seus filhos. Sequer houve diferenças entre BES de pais e mães ou entre BES de genitores de meninos e meninas. Além disso, esses genitores possuíam níveis razoáveis de BES, composto por bons índices de satisfação geral com a vida e balanço emocional baixo, o que revela uma quase neutralidade afetiva. Discussões apontam para a necessidade de estudos que complementem esses achados.

Durability assessment of polymer trileaflet heart valves

The durability of a polymer trileaflet valve is dependent on leaflet stress concentrations, so valve designs that reduce stress can, hypothetically, increase durability. Design aspects that are believed to contribute to reduced leaflet stress include stent flexibility, parabolic coaptation curvature, and leaflet anisotropy. With this in mind, the purpose of this investigation was to elucidate what specific combinations of these parameters promote optimal acute and long-term valve function. A combination of four stent designs, seven leaflet reinforcement materials, and three coaptation geometries were evaluated through a combination of experimentation and modeling. Static tensile and Poisson’s ratio tests and dynamic tensile fatigue testing were used to evaluate the individual leaflet components; and hydrodynamic testing and accelerated valve fatigue was used to assess complete valve prototypes. The two most successful designs included a 0.40 mm thick knit-reinforced valve with a fatigue life of 10.35 years, and a 0.20 mm thick knit-reinforced valve with a 28.9 mmHg decrease in pressure drop over the former. A finite element model was incorporated to verify the impact of the above-mentioned parameters on leaflet stress concentrations. Leaflet anisotropy had a large impact on stress concentrations, and matching the circumferential modulus to that of the natural valve showed the greatest benefit. Varying the radial modulus had minimal impact. Varying coaptation geometry had no impact, but stent flexibility did have a marked effect on the stress at the top of the commissure, where a completely rigid stent resulted in a higher peak stress than a flexible stent (E = 385 MPa). In conclusion, stent flexibility and leaflet anisotropy do effect stress concentrations in the SIBS trileaflet valve, but coaptation geometry does not. Regions of high stress concentrations were linked to failure locations in vitro, so a fatigue prediction model was developed from the S/N curves generated during dynamic tensile testing of the 0.20 mm knit-reinforced leaflets. Failure was predicted at approximately 400 million cycles (10 years) at the top of the commissure. In vitro fatigue of this valve showed failure initiation after approximately 167 million cycles (4.18 years), but it was related to a design defect that is subsequently being changed.

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

Purpose: Over half the HIV-infected persons in the Caribbean, the second most HIV-impacted region in the world, live in Haiti. Using secondary data from a parent study, this research assessed the effects of psychological and social factors on antiretroviral therapy (ART) adherence among Haitian, HIV-positive, female alcohol users. Theoretical Foundation and Research Questions: Using the Theory of Planned Behavior/Reasoned Action and the Information, Motivation, Behavior skills model as guiding theoretical frameworks, the study examined the effectiveness of an adapted cognitive behavioral stress management (CBSM-A) intervention in improving ART adherence. The effect of psychological factors (depression, anxiety, beliefs about medicine, and social support), social factors (stigma, relationship status, and educational attainment), and alcohol on adherence to ART was assessed. Methods: The sample consisted of 116 female ART patients who were randomly assigned to the CBSM-A intervention or the wait-list control group. Participants completed intervention sessions as well as pre- and post-test assessments. Analyses of variance, t-tests, and point biserial correlations were used to test hypotheses. Results: Surprisingly, ART adherence rates significantly decreased for both groups combined [F (1, 108) = 8.79, p = .004]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post assessment. On average, depression decreased significantly among participants in the CBSM-A group only [(t (62) = 5.54, p < .001)]. For both groups combined, alcohol use significantly decreased between baseline and post-assessment [(F (1, 78) = 34.70, p < .001)]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post-assessment. None of the variables were significantly correlated with ART adherence. Discussion: Adherence to ART did not improve in this sample, nor were any of the variables significantly associated with adherence. The findings suggest that additional supportive and psychological services may be needed in order to promote higher adherence to ART among HIV-positive females. More research may be needed on this sample; a focus on mental health issues, partner conflict, family and sexual history may allow for better targeting and more successful interventions.

Acceptable vs. marginal police officers' psychological ratings : a longitudinal comparison of job performance

Archival research was conducted on the inception of preemployment psychological testing, as part of the background screening process, to select police officers for a local police department. Various issues and incidents were analyzed to help explain why this police department progressed from an abbreviated version of a psychological battery, to a much more sophisticated and comprehensive set of instruments. While doubts about psychological exams do exist, research has shown that many are valid and reliable in predicting job performance of police candidates. During a three year period, a police department hired 162 candidates (133 males and 29 females) who received "acceptable" psychological ratings and 71 candidates (58 males and 13 females) who received "marginal" psychological ratings. A document analysis consisted of variables that have been identified as job performance indicators which police psychological testing tries to predict, and "screen in" or "screen out" appropriate applicants. The areas of focus comprised the 6-month police academy, the 4-month Field Training Officer (FTO) Program, the remaining probationary period, and yearly performance up to five years of employment. Specific job performance variables were the final academy grade average, supervisors' evaluation ratings, reprimands, commendations, awards, citizen complaints, time losses, sick time usage, reassignments, promotions, and separations. A causal-comparative research design was used to determine if there were significant statistical differences in these job performance variables between police officers with "acceptable" psychological ratings and police officers with "marginal" psychological ratings. The results of multivariate analyses of variance, t-tests, and chi-square procedures as applicable, showed no significant differences between the two groups on any of the job performance variables.

Durability Assessment of Polymer Trileaflet Heart Valves

The durability of a polymer trileaflet valve is dependent on leaflet stress concentrations, so valve designs that reduce stress can, hypothetically, increase durability. Design aspects that are believed to contribute to reduced leaflet stress include stent flexibility, parabolic coaptation curvature, and leaflet anisotropy. With this in mind, the purpose of this investigation was to elucidate what specific combinations of these parameters promote optimal acute and long-term valve function. A combination of four stent designs, seven leaflet reinforcement materials, and three coaptation geometries were evaluated through a combination of experimentation and modeling. Static tensile and Poisson’s ratio tests and dynamic tensile fatigue testing were used to evaluate the individual leaflet components; and hydrodynamic testing and accelerated valve fatigue was used to assess complete valve prototypes. The two most successful designs included a 0.40 mm thick knit-reinforced valve with a fatigue life of 10.35 years, and a 0.20 mm thick knit-reinforced valve with a 28.9 mmHg decrease in pressure drop over the former. A finite element model was incorporated to verify the impact of the above-mentioned parameters on leaflet stress concentrations. Leaflet anisotropy had a large impact on stress concentrations, and matching the circumferential modulus to that of the natural valve showed the greatest benefit. Varying the radial modulus had minimal impact. Varying coaptation geometry had no impact, but stent flexibility did have a marked effect on the stress at the top of the commissure, where a completely rigid stent resulted in a higher peak stress than a flexible stent (E = 385 MPa). In conclusion, stent flexibility and leaflet anisotropy do effect stress concentrations in the SIBS trileaflet valve, but coaptation geometry does not. Regions of high stress concentrations were linked to failure locations in vitro, so a fatigue prediction model was developed from the S/N curves generated during dynamic tensile testing of the 0.20 mm knit-reinforced leaflets. Failure was predicted at approximately 400 million cycles (10 years) at the top of the commissure. In vitro fatigue of this valve showed failure initiation after approximately 167 million cycles (4.18 years), but it was related to a design defect that is subsequently being changed.

Cross-sectoral differences in the drivers of innovation: evidence from the Irish Community Innovation Survey

Purpose: The purpose of this paper is to analyse differences in the drivers of firm innovation performance across sectors. The literature often makes the assumption that firms in different sectors differ in their propensity to innovate but not in the drivers of innovation. The authors empirically assess whether this assumption is accurate through a series of econometric estimations and tests. Design/methodology/approach: The data used are derived from the Irish Community Innovation Survey 2004-2006. A series of multivariate probit models are estimated and the resulting coefficients are tested for parameter stability across sectors using likelihood ratio tests. Findings: The results indicate that there is a strong degree of heterogeneity in the drivers of innovation across sectors. The determinants of process, organisational, new to firm and new to market innovation varies across sectors suggesting that the pooling of sectors in an innovation production function may lead to biased inferences. Research limitations/implications: The implications of the results are that innovation policies targeted at stimulating innovation need to be tailored to particular industries. One size fits all policies would seem inappropriate given the large degree of heterogeneity observed across the drivers of innovation in different sectors. Originality/value: The value of this paper is that it provides an empirical test as to whether it is suitable to group sectoral data when estimating innovation production functions. Most papers simply include sectoral dummies, implying that only the propensity to innovate differs across sectors and that the slope of the coefficient estimates are in fact consistent across sectors.

Análise experimental e numérica do comportamento de estruturas de solo reforçado com geossintéticos : solo granular versus fino

As estruturas de solo reforçado com geossintéticos são normalmente constituídas por solos granulares com boas propriedades físicas e mecânicas. O uso de apenas este tipo de solos pode proporcionar o aumento, por vezes insustentável, do custo da execução das estruturas e o aumento do seu impacto ambiental. Deste modo, as estruturas de solo reforçado perdem a sua vantagem competitiva em relação a outros tipos de estruturas (muros de betão, muros de gravidade, muros de gabiões, etc.). Para resolver este problema podem ser utilizados outros tipos de solos (solos locais, finos, com propriedades físicas e mecânicas piores mas, no entanto, mais baratos) para a execução deste tipo de estruturas. De forma geral, com este estudo pretendeu-se contribuir para o incremento do conhecimento sobre a utilização de solos finos para a construção de estruturas de solo reforçado (muros e taludes). Para tal avaliaram-se as diferenças no comportamento mecânico dos materiais compósitos (solo granular reforçado versus solo fino reforçado) e das estruturas de solo reforçado constituídas com os dois tipos de solos. Assim, os objetivos deste estudo foram avaliar: a influência de vários parâmetros nas propriedades mecânicas e na capacidade de carga dos solos reforçados com geossintéticos; a influência de vários parâmetros no dimensionamento das estruturas de solo reforçado; e o comportamento das estruturas dimensionadas (incluindo a estabilidade global e a influência do processo construtivo) recorrendo a uma ferramenta numérica (PLAXIS). Para cumprir os objetivos propostos foram realizadas análises experimentais em laboratório (análise do comportamento do solo reforçado através de ensaios triaxiais e de California Bearing Ratio) e análises numéricas (dimensionamento de estruturas de solo reforçado; modelação numérica do comportamento através de uma ferramenta numérica comercial com o método dos elementos finitos). Os resultados dos ensaios experimentais mostraram que o comportamento mecânico e a capacidade de carga do solo foram incrementados com a inclusão das camadas de geossintético. Este efeito variou com os diversos parâmetros analisados mas, de forma geral, foi mais importante no solo fino (solo com propriedades mecânicas piores). As análises numéricas mostraram que as estruturas de solo fino precisaram de maior densidade de reforços para serem estáveis. Além disso, as estruturas de solo fino foram mais deformáveis e o efeito do seu processo construtivo foi mais importante (principalmente para estruturas de solo fino saturado).

Prevalence and associations of Trypanosoma spp. and Sodalis glossinidius with intrinsic factors of tsetse flies

Trypanosomiasis has been identified as a neglected tropical disease in both humans and animals in many regions of sub-Saharan Africa. Whilst assessments of the biology of trypanosomes, vectors, vertebrate hosts and the environment have provided useful information about life cycles, transmission, and pathogenesis of the parasites that could be used for treatment and control, less information is available about the effects of interactions among multiple intrinsic factors on trypanosome presence in tsetse flies from different sites. It is known that multiple species of tsetse flies can transmit trypanosomes but differences in their vector competence has normally been studied in relation to individual factors in isolation, such as: intrinsic factors of the flies (e.g. age, sex); habitat characteristics; presence of endosymbionts (e.g. Wigglesworthia glossinidia, Sodalis glossinidius); feeding pattern; host communities that the flies feed on; and which species of trypanosomes are transmitted. The purpose of this study was to take a more integrated approach to investigate trypanosome prevalence in tsetse flies. In chapter 2, techniques were optimised for using the Polymerase Chain Reaction (PCR) to identify species of trypanosomes (Trypanosoma vivax, T. congolense, T. brucei, T. simiae, and T. godfreyi) present in four species of tsetse flies (Glossina austeni, G. brevipalpis, G. longipennis and G. pallidipes) from two regions of eastern Kenya (the Shimba Hills and Nguruman). Based on universal primers targeting the internal transcribed spacer 1 region (ITS-1), T. vivax was the predominant pathogenic species detected in flies, both singly and in combination with other species of trypanosomes. Using Generalised Linear Models (GLMs) and likelihood ratio tests to choose the best-fitting models, presence of T. vivax was significantly associated with an interaction between subpopulation (a combination between collection sites and species of Glossina) and sex of the flies (X2 = 7.52, df = 21, P-value = 0.0061); prevalence in females overall was higher than in males but this was not consistent across subpopulations. Similarly, T. congolense was significantly associated only with subpopulation (X2 = 18.77, df = 1, P-value = 0.0046); prevalence was higher overall in the Shimba Hills than in Nguruman but this pattern varied by species of tsetse fly. When associations were analysed in individual species of tsetse flies, there were no consistent associations between trypanosome prevalence and any single factor (site, sex, age) and different combinations of interactions were found to be significant for each. The results thus demonstrated complex interactions between vectors and trypanosome prevalence related to both the distribution and intrinsic factors of tsetse flies. The potential influence of the presence of S. glossinidius on trypanosome presence in tsetse flies was studied in chapter 3. A high number of Sodalis positive flies was found in the Shimba Hills, while there were only two positive flies from Nguruman. Presence or absence of Sodalis was significantly associated with subpopulation while trypanosome presence showed a significant association with age (X2 = 4.65, df = 14, P-value = 0.0310) and an interaction between subpopulation and sex (X2 = 18.94, df = 10, P-value = 0.0043). However, the specific associations that were significant varied across species of trypanosomes, with T. congolense and T. brucei but not T. vivax showing significant interactions involving Sodalis. Although it has previously been concluded that presence of Sodalis increases susceptibility to trypanosomes, the results presented here suggest a more complicated relationship, which may be biased by differences in the distribution and intrinsic factors of tsetse flies, as well as which trypanosome species are considered. In chapter 4 trypanosome status was studied in relation to blood meal sources, feeding status and feeding patterns of G. pallidipes (which was the predominant fly species collected for this study) as determined by sequencing the mitochondrial cytochrome B gene using DNA extracted from abdomen samples. African buffalo and African elephants were the main sources of blood meals but antelopes, warthogs, humans, giraffes and hyenas were also identified. Feeding on multiple hosts was common in flies sampled from the Shimba Hills but most flies from Nguruman had fed on single host species. Based on Multiple Correspondence Analysis (MCA), host-feeding patterns showed a correlation with site of sample collection and Sodalis status, while trypanosome status was correlated with sex and age of the flies, suggesting that recent host-feeding patterns from blood meal analysis cannot predict trypanosome status. In conclusion, the complexity of interactions found suggests that strategies of tsetse fly control should be specific to particular epidemic areas. Future studies should include laboratory experiments that use local colonies of tsetse flies, local strains of trypanosomes and local S. glossinidius under controlled environmental conditions to tease out the factors that affect vector competence and the relative influence of external environmental factors on the dynamics of these interactions.

The role of heart rate as a risk marker for predicting adverse outcomes

Cardiovascular disease is one of the leading causes of death around the world. Resting heart rate has been shown to be a strong and independent risk marker for adverse cardiovascular events and mortality, and yet its role as a predictor of risk is somewhat overlooked in clinical practice. With the aim of highlighting its prognostic value, the role of resting heart rate as a risk marker for death and other adverse outcomes was further examined in a number of different patient populations. A systematic review of studies that previously assessed the prognostic value of resting heart rate for mortality and other adverse cardiovascular outcomes was presented. New analyses of nine clinical trials were carried out. Both the original and extended Cox model that allows for analysis of time-dependent covariates were used to evaluate and compare the predictive value of baseline and time-updated heart rate measurements for adverse outcomes in the CAPRICORN, EUROPA, PROSPER, PERFORM, BEAUTIFUL and SHIFT populations. Pooled individual patient meta-analyses of the CAPRICORN, EPHESUS, OPTIMAAL and VALIANT trials, and the BEAUTIFUL and SHIFT trials, were also performed. The discrimination and calibration of the models applied were evaluated using Harrell’s C-statistic and likelihood ratio tests, respectively. Finally, following on from the systematic review, meta-analyses of the relation between baseline and time-updated heart rate, and the risk of death from any cause and from cardiovascular causes, were conducted. Both elevated baseline and time-updated resting heart rates were found to be associated with an increase in the risk of mortality and other adverse cardiovascular events in all of the populations analysed. In some cases, elevated time-updated heart rate was associated with risk of events where baseline heart rate was not. Time-updated heart rate also contributed additional information about the risk of certain events despite knowledge of baseline heart rate or previous heart rate measurements. The addition of resting heart rate to the models where resting heart rate was found to be associated with risk of outcome improved both discrimination and calibration, and in general, the models including time-updated heart rate along with baseline or the previous heart rate measurement had the highest and similar C-statistics, and thus the greatest discriminative ability. The meta-analyses demonstrated that a 5bpm higher baseline heart rate was associated with a 7.9% and an 8.0% increase in the risk of all-cause and cardiovascular death, respectively (both p less than 0.001). Additionally, a 5bpm higher time-updated heart rate (adjusted for baseline heart rate in eight of the ten studies included in the analyses) was associated with a 12.8% (p less than 0.001) and a 10.9% (p less than 0.001) increase in the risk of all-cause and cardiovascular death, respectively. These findings may motivate health care professionals to routinely assess resting heart rate in order to identify individuals at a higher risk of adverse events. The fact that the addition of time-updated resting heart rate improved the discrimination and calibration of models for certain outcomes, even if only modestly, strengthens the case that it be added to traditional risk models. The findings, however, are of particular importance, and have greater implications for the clinical management of patients with pre-existing disease. An elevated, or increasing heart rate over time could be used as a tool, potentially alongside other established risk scores, to help doctors identify patient deterioration or those at higher risk, who might benefit from more intensive monitoring or treatment re-evaluation. Further exploration of the role of continuous recording of resting heart rate, say, when patients are at home, would be informative. In addition, investigation into the cost-effectiveness and optimal frequency of resting heart rate measurement is required. One of the most vital areas for future research is the definition of an objective cut-off value for the definition of a high resting heart rate.