Reconsidering Partisan Memorial Landscapes in un-brotherly and disunited times

Cultural landscapes are the product of innumerable changes wrought by generations in order to meet their aspirations, vanities, ambitions and weaknesses (Sudjic 2006: p.326). The inescapable nature of architecture makes it the ideal vehicle for those in power to manifest their authority, taste and will in the landscape by the buildings and monuments they construct and conserve and also the historical events and myths they commemorate and disseminate.
In the 1960s, many Yugoslav landscapes were altered by the construction of abstract Partisan spomenik (monuments) which dominated the skylines of former battle sites. This paper will discuss the how the collapse of Socialist ‘regime of memory’ and Yugoslavia has left these landscapes as legacies of a lost world of yesterday. It will consider how changing values are reflected by physical landscape changes and also by how and which critical events are commemorated.

Essays on optimal fiscal and monetary policies

Cette thèse se compose de trois articles sur les politiques budgétaires et monétaires optimales. Dans le premier article, J'étudie la détermination conjointe de la politique budgétaire et monétaire optimale dans un cadre néo-keynésien avec les marchés du travail frictionnels, de la monnaie et avec distortion des taux d'imposition du revenu du travail. Dans le premier article, je trouve que lorsque le pouvoir de négociation des travailleurs est faible, la politique Ramsey-optimale appelle à un taux optimal d'inflation annuel significativement plus élevé, au-delà de 9.5%, qui est aussi très volatile, au-delà de 7.4%. Le gouvernement Ramsey utilise l'inflation pour induire des fluctuations efficaces dans les marchés du travail, malgré le fait que l'évolution des prix est coûteuse et malgré la présence de la fiscalité du travail variant dans le temps. Les résultats quantitatifs montrent clairement que le planificateur s'appuie plus fortement sur l'inflation, pas sur l'impôts, pour lisser les distorsions dans l'économie au cours du cycle économique. En effet, il ya un compromis tout à fait clair entre le taux optimal de l'inflation et sa volatilité et le taux d'impôt sur le revenu optimal et sa variabilité. Le plus faible est le degré de rigidité des prix, le plus élevé sont le taux d'inflation optimal et la volatilité de l'inflation et le plus faible sont le taux d'impôt optimal sur le revenu et la volatilité de l'impôt sur le revenu. Pour dix fois plus petit degré de rigidité des prix, le taux d'inflation optimal et sa volatilité augmentent remarquablement, plus de 58% et 10%, respectivement, et le taux d'impôt optimal sur le revenu et sa volatilité déclinent de façon spectaculaire. Ces résultats sont d'une grande importance étant donné que dans les modèles frictionnels du marché du travail sans politique budgétaire et monnaie, ou dans les Nouveaux cadres keynésien même avec un riche éventail de rigidités réelles et nominales et un minuscule degré de rigidité des prix, la stabilité des prix semble être l'objectif central de la politique monétaire optimale. En l'absence de politique budgétaire et la demande de monnaie, le taux d'inflation optimal tombe très proche de zéro, avec une volatilité environ 97 pour cent moins, compatible avec la littérature. Dans le deuxième article, je montre comment les résultats quantitatifs impliquent que le pouvoir de négociation des travailleurs et les coûts de l'aide sociale de règles monétaires sont liées négativement. Autrement dit, le plus faible est le pouvoir de négociation des travailleurs, le plus grand sont les coûts sociaux des règles de politique monétaire. Toutefois, dans un contraste saisissant par rapport à la littérature, les règles qui régissent à la production et à l'étroitesse du marché du travail entraînent des coûts de bien-être considérablement plus faible que la règle de ciblage de l'inflation. C'est en particulier le cas pour la règle qui répond à l'étroitesse du marché du travail. Les coûts de l'aide sociale aussi baisse remarquablement en augmentant la taille du coefficient de production dans les règles monétaires. Mes résultats indiquent qu'en augmentant le pouvoir de négociation du travailleur au niveau Hosios ou plus, les coûts de l'aide sociale des trois règles monétaires diminuent significativement et la réponse à la production ou à la étroitesse du marché du travail n'entraîne plus une baisse des coûts de bien-être moindre que la règle de ciblage de l'inflation, qui est en ligne avec la littérature existante. Dans le troisième article, je montre d'abord que la règle Friedman dans un modèle monétaire avec une contrainte de type cash-in-advance pour les entreprises n’est pas optimale lorsque le gouvernement pour financer ses dépenses a accès à des taxes à distorsion sur la consommation. Je soutiens donc que, la règle Friedman en présence de ces taxes à distorsion est optimale si nous supposons un modèle avec travaie raw-efficace où seule le travaie raw est soumis à la contrainte de type cash-in-advance et la fonction d'utilité est homothétique dans deux types de main-d'oeuvre et séparable dans la consommation. Lorsque la fonction de production présente des rendements constants à l'échelle, contrairement au modèle des produits de trésorerie de crédit que les prix de ces deux produits sont les mêmes, la règle Friedman est optimal même lorsque les taux de salaire sont différents. Si la fonction de production des rendements d'échelle croissant ou decroissant, pour avoir l'optimalité de la règle Friedman, les taux de salaire doivent être égales.

Adhésion au traitement antidiabétique oral chez les adultes atteints de diabète de type 2 : déterminants et interventions visant à l'améliorer

Introduction : Le diabète de type 2 est une maladie évolutive débilitante et souvent mortelle qui atteint de plus en plus de personnes dans le monde. Le traitement antidiabétique non-insulinique (TADNI) notamment le traitement antidiabétique oral (TADO) est le plus fréquemment utilisé chez les adultes atteints de cette maladie. Toutefois, plusieurs de ces personnes ne prennent pas leur TADO tel que prescrit posant ainsi la problématique d’une adhésion sous-optimale. Ceci entraîne des conséquences néfastes aussi bien pour les patients que pour la société dans laquelle ils vivent. Il serait donc pertinent d’identifier des pistes de solution à cette problématique. Objectifs : Trois objectifs de recherche ont été étudiés : 1) Explorer la capacité de la théorie du comportement planifié (TCP) à prédire l’adhésion future au TADNI chez les adultes atteints de diabète de type 2, 2) Évaluer l’efficacité globale des interventions visant à améliorer l’adhésion au TADO chez les adultes atteints de diabète de type 2 et étudier l’influence des techniques de changement de comportement sur cette efficacité globale, et 3) Évaluer l’efficacité globale de l’entretien motivationnel sur l’adhésion au traitement médicamenteux chez les adultes atteints de maladie chronique et étudier l’influence des caractéristiques de cette intervention sur son efficacité globale. Méthodes : Pour l’objectif 1 : Il s’agissait d’une enquête web, suivie d’une évaluation de l’adhésion au TADNI sur une période de 30 jours, chez des adultes atteints de diabète de type 2, membres de Diabète Québec. L’enquête consistait à la complétion d’un questionnaire auto-administré incluant les variables de la TCP (intention, contrôle comportemental perçu et attitude) ainsi que d’autres variables dites «externes». Les informations relatives au calcul de l’adhésion provenaient des dossiers de pharmacie des participants transmis via la plateforme ReMed. Une régression linéaire multivariée a été utilisée pour estimer la mesure d’association entre l’intention et l’adhésion future au TADNI ainsi que l’interaction entre l’adhésion passée et l’intention. Pour répondre aux objectifs 2 et 3, deux revues systématiques et méta-analyses ont été effectuées et rapportées selon les lignes directrices de PRISMA. Un modèle à effets aléatoires a été utilisé pour estimer l’efficacité globale (g d’Hedges) des interventions et son intervalle de confiance à 95 % (IC95%) dans chacune des revues. Nous avons également quantifié l’hétérogénéité (I2 d’Higgins) entre les études, et avons fait des analyses de sous-groupe et des analyses de sensibilité. Résultats : Objectif 1 : Il y avait une interaction statistiquement significative entre l’adhésion passée et l’intention (valeur-p= 0,03). L’intention n’était pas statistiquement associée à l’adhésion future au TADNI, mais son effet était plus fort chez les non-adhérents que chez les adhérents avant l’enquête web. En revanche, l’intention était principalement prédite par le contrôle comportemental perçu à la fois chez les adhérents [β= 0,90, IC95%= (0,80; 1,00)] et chez les non-adhérents passés [β= 0,76, IC95%= (0,56; 0,97)]. Objectif 2 : L’efficacité globale des interventions sur l’adhésion au TADO était de 0,21 [IC95%= (-0,05; 0,47); I2= 82 %]. L’efficacité globale des interventions dans lesquelles les intervenants aidaient les patients et/ou les cliniciens à être proactifs dans la gestion des effets indésirables était de 0,64 [IC95%= (0,31; 0,96); I2= 56 %]. Objectif 3 : L’efficacité globale des interventions (basées sur l’entretien motivationnel) sur l’adhésion au traitement médicamenteux était de 0,12 [IC95%= (0,05; 0,20); I2= 1 %. Les interventions basées uniquement sur l’entretien motivationnel [β= 0,18, IC95%= (0,00; 0,36)] et celles dans lesquelles les intervenants ont été coachés [β= 0,47, IC95%= (0,03; 0,90)] étaient les plus efficaces. Aussi, les interventions administrées en face-à-face étaient plus efficaces que celles administrées par téléphone [β= 0,27, IC95%=(0,04; 0,50)]. Conclusion : Il existe un écart entre l’intention et l’adhésion future au TADNI, qui est partiellement expliqué par le niveau d’adhésion passée. Toutefois, il n’y avait pas assez de puissance statistique pour démontrer une association statistiquement significative entre l’intention et l’adhésion future chez les non-adhérents passés. D’un autre côté, quelques solutions au problème de l’adhésion sous-optimale au TADO ont été identifiées. En effet, le fait d’aider les patients et/ou les cliniciens à être proactifs dans la gestion des effets indésirables contribue efficacement à l’amélioration de l’adhésion au TADO chez les adultes atteints de diabète de type 2. Aussi, les interventions basées sur l’entretien motivationnel améliorent efficacement l’adhésion au traitement médicamenteux chez les adultes atteints de maladie chronique. L’entretien motivationnel pourrait donc être utilisé comme un outil clinique pour soutenir les patients dans l’autogestion de leur TADO.

Shining Examples of Service When the Lights Went Out: Hotel Employees and Service Recovery during the Blackout of 2003

The electrical outage in the summer of 2003 that interrupted power to thousands of hotels wrought a variety of facilities failures and service-process problems. Fortunately, strong service-recovery efforts from hotel employees mitigated the worst of the blackout’s effects. Using survey data from hotel managers who experienced the blackout, this study highlights those employee actions that most contributed to immediate service recovery; however, the study also reveals limited organizational learning or efforts to failsafe hospitality service from the eventuality of future power failures.

Searching for Predictive Subgroups

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

Controle social do espaço público: uma análise do conselho turístico pólo costa das dunas

The managing Conselho of public politics constitute one of the main experiences of democracy in Brazil contemporary representing a conquest for construction of a democratic institutionalism. The historical newness consists of the intensification and the institutionalization of the dialogue between government and society - in public and plural canals - as condition for an allocation more efficient joust and of the public resources. In this context the present study it objectified to understand from readings of the performance of represented group of bencheses the dynamics of functioning of the Tourist Conselho Pólo Costa das Dunas while space of participation and social control. The bibliographical research contemplated diverse sources in order to compile knowledge of credential authors in the quarrel of inherent subjects to the civil society and the public sphere to the construction of the citizenship to the conception formation and dynamics of the social control through Conselho of public politics. A qualitative perspective the case study was adopted as research method and for attainment of the data interviews with the members of the Conselho had been carried through beyond consultation the referring documents the dynamics of functioning of the Conselho. The profiles capacities and limitations of the members of the Conselho had been identified constitution social and dynamic organization of functioning of the Conselho and the readings of the members of the Conselho concerning the power to decide instances and participation. The results had shown that the allotment of being able in the Conselho does not occur of equal form. The functions of coordination of the activities of the Conselho are assumed by the representatives of the public agencies. Level of qualification of council members also if presents as difficulty to development of activities of Conselho since the majority of the interviewed ones disclosed unreliability and unfamiliarity when thematic specific that runs away from its organizacional reality they are boarded in the assemblies. Of this form the Conselho if presents more as half of institutional legitimation of what half of characterization of the creation of a public sphere properly said. Finally he could himself be concluded that a democratic culture inexists that inside crosses practical the institutional ones of the Conselho thus limiting the possibility to reach the effective social control of the public politics of tourism in the Rio Grande do Norte

The Influence of Geology and Season on Macroinvertebrates in Belizean Streams: Implications for Tropical Bioassessment

Considerable attention has been paid to the potentially confounding effects of geological and seasonal variation on outputs from bioassessments in temperate streams, but our understanding about these influences is limited for many tropical systems. We explored variation in macroinvertebrate assemblage composition and the environmental characteristics of 3rd- to 5th-order streams in a geologically heterogeneous tropical landscape in the wet and dry seasons. Study streams drained catchments with land cover ranging from predominantly forested to agricultural land, but data indicated that distinct water-chemistry and substratum conditions associated with predominantly calcareous and silicate geologies were key determinants of macroinvertebrate assemblage composition. Most notably, calcareous streams were characterized by a relatively abundant noninsect fauna, particularly a pachychilid gastropod snail. The association between geological variation and assemblage composition was apparent during both seasons, but significant temporal variation in compositional characteristics was detected only in calcareous streams, possibly because of limited statistical power to detect change at silicate sites, or the limited extent of our temporal data. We discuss the implications of our findings for tropical bioassessment programs. Our key findings suggest that geology can be an important determinant of macroinvertebrate assemblages in tropical streams and that geological heterogeneity may influence the scale of temporal response in characteristic macroinvertebrate assemblages.

La inevitable inconsistencia del Zeus/Júpiter épico

Durante años la investigación literaria ha encontrado fruición en buscar y encontrar inconsistencias narrativas en la Tebaida de Estacio. Concretamente, hay cierto grado de consenso respecto a que las incongruencias en que incurre Júpiter son debidas a negligencia o incuria por parte del poeta. De hecho, no se puede negar que el soberano del cielo se contradice en las ocasiones en que alude a su relación con el Destino. No obstante, no será únicamente el poeta flavio el objeto de mi atención en este artículo. Hoy día se continúa acudiendo a la autoridad filosófica de Séneca (fundamentalmente a Dial. 1.5.8) siempre que el Zeus/Júpiter poshomérico (también el virgiliano) incurre en lo que hemos dado en considerar «incoherencias». Sin embargo, excepción hecha de las composiciones hesiódicas, el estatuto teológico de Zeus/Júpiter es altamente inestable en toda la tradición literaria griega y romana. Quizá deberíamos aceptar, entonces, que durante siglos los que estudiamos literatura antigua hemos tendido a prescindir de la voz autorial y de su autoridad omnímoda para manipular el material literario preexistente con el objeto de generar nuevos significados y nuevas cosmovisiones. En definitiva, nos hemos mostrado proclives a calificar de inconsistencias todo aquello que no se adecua a nuestras expectativas o prejuicios.

Relações entre mecanismos de coordenação e controle com desempenho organizacional: um estudo nas instituições públicas de ensino médio de Natal

This research aimed at relating coordination and control forms to organizational performance. The multicase study was applied in two public high schools: Centro Federal de Educação Tecnológica do Rio Grande do Norte and Floriano Cavalcanti. In order to accomplish these objectives, it was developed a qualitative analysis and considered coordination and control forms of several authors. Also was considered Sander´s (1984) model of organizational performance. The mentioned model considers two criteria to analyze organizational performance: one instrumental (efficiency and efficacy) and other substantive (effectiveness e relevance). The research attempts to show the importance of balancing these criteria in a way that effectiveness and relevance becomes more important at schools. It was proven that the use of bureaucratic coordination forms has the power to influence the evaluation on the instrumental technique. At the same time, it was observed that the use of mechanisms based on the autonomy of the school is related to efficiency and efficacy. The object of this research can be considered successful

Developing Innovative TEL Practice in Teacher Education

This interactive symposium will focus on the use of different technologies in developing innovative practice in teacher education at one university in England. Technology Enhanced Learning (TEL) is a field of educational policy and practice that has the power to ignite diametrically opposing views and reactions amongst teachers and teacher educators, ranging across a spectrum from immense enthusiasm to untold terror. In a field where the skills and experience of individuals vary from those of digital natives (Prensky 2001) to lags and lurkers in digital spaces, the challenges of harnessing the potential of TEL are complex. The challenges include developing the IT skills of trainees and educators and the creative application of these skills to pedagogy in all areas of the curriculum. The symposium draws on examples from primary, secondary and post-compulsory teacher education to discuss issues and approaches to developing research capacity and innovative practice using different etools, many of which are freely available. The first paper offers theoretical and policy perspectives on finding spaces in busy professional lives to engage in research and develop research-informed practice. It draws on notions of teachers as researchers, practitioner research and evidenc-ebased practice to argue that engagement in research is integral to teacher education and an empowering source of creative professional learning for teachers and teacher educators. Whilst acknowledging the challenges of this stance, examples from our own research practice illustrate how e-tools can assist us in building the capacity and confidence of staff and students in researching and enhancing teaching, learning and assessment practice. The second paper discusses IT skills development through the TEL pathway for trainee teachers in secondary education across different curriculum subjects. The lead tutor for the TEL pathway will use examples of activities developed with trainee teachers and university subject tutors to enhance their skills in using e-tools, such as QR codes, Kahoot, Padlet, Pinterest and cloud based learning. The paper will also focus on how these skills and tools can be used for action Discussant - the wider use of technologies in a university centre for teacher education; course management, recruitment and mentor training. research, evaluation and feedback and for marking and administrative tasks. The discussion will finish with thoughts on widening trainee teachers’ horizons into the future direction of educational technology. The third paper considers institutional policies and strategies for promoting and embedding TEL, including an initiative called ‘The Learning Conversation’, which aims ‘to share, highlight, celebrate, discuss, problematise, find things out...’ about TEL through an online space. The lead for ‘The Learning Conversation’ will offer reflections on this and other initiatives across the institution involving trainee teachers, university subject tutors, librarians and staff in student support services who are using TEL to engage, enthuse and support students on campus and during placements in schools. The fourth paper reflects on the use of TEL to engage with trainee teachers in post-compulsory education. This sector of education and training is more fragmented than primary and secondary schools sectors and so the challenges of building a community of practice that can support the development of innovative practice are greater.

Narrative transportation in global brand content

People understand life and events around them through narratives. Narratives are a new way for marketers to convey messages to consumers about their brands and products. Brand narratives are an effective way to reach out to people due to their influential nature. Narratives have a power to change beliefs and attitudes, making them relevant and interesting for any marketer. The power of narratives has to do with narrative transportation, which narratives can trigger in people. A transported person is more likely to perceive brand or product in a more positive light. The creators of the narrative are able to influence the content of the narrative through message factors that work as antecedents for narrative transportation. This study explored narrative transportation qualities of well established advertisements. The study uses qualitative content analysis to analyze and identify narrative transportation antecedents among Cannes Lion grand prix winners in the film category between years 2005 to 2015 (15 in total). The narrative transportation antecedents are identifiable characters, imaginable plot and verisimilitude, which were used in the analysis of the data. The study analyzes the winners to make judgment on whether they can trigger narrative transportation or not. It was found that the Cannes Lion grand prix winner advertisement mostly had identifiable narratives in them. In most of the advertisement (ten out of fifteen) at least two out of three antecedents were found, thus most of them are able to trigger narrative transportation. The study also found that most narratives in the advertisement were able to be linked to the main brand narrative of the advertiser. In four of the advertisements the link to the brand narrative was not able to be established. The study concludes by discussing certain factors and aspects of the advertisements that were identified to further enhance the narrative transportation qualities of the advertisement.

Nonparametric Evaluation of Quantitative Traits in Population-Based Association Studies when the Genetic Model is Unknown

Statistical association between a single nucleotide polymorphism (SNP) genotype and a quantitative trait in genome-wide association studies is usually assessed using a linear regression model, or, in the case of non-normally distributed trait values, using the Kruskal-Wallis test. While linear regression models assume an additive mode of inheritance via equi-distant genotype scores, Kruskal-Wallis test merely tests global differences in trait values associated with the three genotype groups. Both approaches thus exhibit suboptimal power when the underlying inheritance mode is dominant or recessive. Furthermore, these tests do not perform well in the common situations when only a few trait values are available in a rare genotype category (disbalance), or when the values associated with the three genotype categories exhibit unequal variance (variance heterogeneity). We propose a maximum test based on Marcus-type multiple contrast test for relative effect sizes. This test allows model-specific testing of either dominant, additive or recessive mode of inheritance, and it is robust against variance heterogeneity. We show how to obtain mode-specific simultaneous confidence intervals for the relative effect sizes to aid in interpreting the biological relevance of the results. Further, we discuss the use of a related all-pairwise comparisons contrast test with range preserving confidence intervals as an alternative to Kruskal-Wallis heterogeneity test. We applied the proposed maximum test to the Bogalusa Heart Study dataset, and gained a remarkable increase in the power to detect association, particularly for rare genotypes. Our simulation study also demonstrated that the proposed non-parametric tests control family-wise error rate in the presence of non-normality and variance heterogeneity contrary to the standard parametric approaches. We provide a publicly available R library nparcomp that can be used to estimate simultaneous confidence intervals or compatible multiplicity-adjusted p-values associated with the proposed maximum test.

Conversor de energia das ondas em energia elétrica com dispositivo de coluna de água oscilante: simulação numérica e estudo geométrico

Os oceanos representam um dos maiores recursos naturais, possuindo expressivo potencial energético, podendo suprir parte da demanda energética mundial. Nas últimas décadas, alguns dispositivos destinados à conversão da energia das ondas dos oceanos em energia elétrica têm sido estudados. No presente trabalho, o princípio de funcionamento do conversor do tipo Coluna de Água Oscilante, do inglês Oscillating Water Colum, (OWC) foi analisado numericamente. As ondas incidentes na câmara hidro-pneumática da OWC, causam um movimento alternado da coluna de água no interior da câmara, o qual produz um fluxo alternado de ar que passa pela chaminé. O ar passa e aciona uma turbina a qual transmite energia para um gerador elétrico. O objetivo do presente estudo foi investigar a influência de diferentes formas geométricas da câmara sobre o fluxo resultante de ar que passa pela turbina, que influencia no desempenho do dispositivo. Para isso, geometrias diferentes para o conversor foram analisadas empregando modelos computacionais 2D e 3D. Um modelo computacional desenvolvido nos softwares GAMBIT e FLUENT foi utilizado, em que o conversor OWC foi acoplado a um tanque de ondas. O método Volume of Fluid (VOF) e a teoria de 2ª ordem Stokes foram utilizados para gerar ondas regulares, permitindo uma interação mais realista entre o conversor, água, ar e OWC. O Método dos Volumes Finitos (MVF) foi utilizado para a discretização das equações governantes. Neste trabalho o Contructal Design (baseado na Teoria Constructal) foi aplicado pela primeira vez em estudos numéricos tridimensionais de OWC para fim de encontrar uma geometria que mais favorece o desempenho do dispositivo. A função objetivo foi a maximização da vazão mássica de ar que passa através da chaminé do dispositivo OWC, analisado através do método mínimos quadrados, do inglês Root Mean Square (RMS). Os resultados indicaram que a forma geométrica da câmara influencia na transformação da energia das ondas em energia elétrica. As geometrias das câmaras analisadas que apresentaram maior área da face de incidência das ondas (sendo altura constante), apresentaram também maior desempenho do conversor OWC. A melhor geometria, entre os casos desse estudo, ofereceu um ganho no desempenho do dispositivo em torno de 30% maior.

Estimating glomerular filtration rate in acute coronary syndromes: Different equations, different mortality risk prediction

AIMS: Renal dysfunction is a powerful predictor of adverse outcomes in patients hospitalized for acute coronary syndrome. Three new glomerular filtration rate (GFR) estimating equations recently emerged, based on serum creatinine (CKD-EPIcreat), serum cystatin C (CKD-EPIcyst) or a combination of both (CKD-EPIcreat/cyst), and they are currently recommended to confirm the presence of renal dysfunction. Our aim was to analyse the predictive value of these new estimated GFR (eGFR) equations regarding mid-term mortality in patients with acute coronary syndrome, and compare them with the traditional Modification of Diet in Renal Disease (MDRD-4) formula. METHODS AND RESULTS: 801 patients admitted for acute coronary syndrome (age 67.3±13.3 years, 68.5% male) and followed for 23.6±9.8 months were included. For each equation, patient risk stratification was performed based on eGFR values: high-risk group (eGFR<60ml/min per 1.73m2) and low-risk group (eGFR⩾60ml/min per 1.73m2). The predictive performances of these equations were compared using area under each receiver operating characteristic curves (AUCs). Overall risk stratification improvement was assessed by the net reclassification improvement index. The incidence of the primary endpoint was 18.1%. The CKD-EPIcyst equation had the highest overall discriminate performance regarding mid-term mortality (AUC 0.782±0.20) and outperformed all other equations (ρ<0.001 in all comparisons). When compared with the MDRD-4 formula, the CKD-EPIcyst equation accurately reclassified a significant percentage of patients into more appropriate risk categories (net reclassification improvement index of 11.9% (p=0.003)). The CKD-EPIcyst equation added prognostic power to the Global Registry of Acute Coronary Events (GRACE) score in the prediction of mid-term mortality. CONCLUSION: The CKD-EPIcyst equation provides a novel and improved method for assessing the mid-term mortality risk in patients admitted for acute coronary syndrome, outperforming the most widely used formula (MDRD-4), and improving the predictive value of the GRACE score. These results reinforce the added value of cystatin C as a risk marker in these patients.

Ecological drivers of a vector borne pathogen: distribution and abundance of Borrelia burgdorferi sensu lato and its vector Ixodes ricinus in Scotland

Vector-borne disease emergence in recent decades has been associated with different environmental drivers including changes in habitat, hosts and climate. Lyme borreliosis is among the most important vector-borne diseases in the Northern hemisphere and is an emerging disease in Scotland. Transmitted by Ixodid tick vectors between large numbers of wild vertebrate host species, Lyme borreliosis is caused by bacteria from the Borrelia burgdorferi sensu lato species group. Ecological studies can inform how environmental factors such as host abundance and community composition, habitat and landscape heterogeneity contribute to spatial and temporal variation in risk from B. burgdorferi s.l. In this thesis a range of approaches were used to investigate the effects of vertebrate host communities and individual host species as drivers of B. burgdorferi s.l. dynamics and its tick vector Ixodes ricinus. Host species differ in reservoir competence for B. burgdorferi s.l. and as hosts for ticks. Deer are incompetent transmission hosts for B. burgdorferi s.l. but are significant hosts of all life-stages of I. ricinus. Rodents and birds are important transmission hosts of B. burgdorferi s.l. and common hosts of immature life-stages of I. ricinus. In this thesis, surveys of woodland sites revealed variable effects of deer density on B. burgdorferi prevalence, from no effect (Chapter 2) to a possible ‘dilution’ effect resulting in lower prevalence at higher deer densities (Chapter 3). An invasive species in Scotland, the grey squirrel (Sciurus carolinensis), was found to host diverse genotypes of B. burgdorferi s.l. and may act as a spill-over host for strains maintained by native host species (Chapter 4). Habitat fragmentation may alter the dynamics of B. burgdorferi s.l. via effects on the host community and host movements. In this thesis, there was lack of persistence of the rodent associated genospecies of B. burgdorferi s.l. within a naturally fragmented landscape (Chapter 3). Rodent host biology, particularly population cycles and dispersal ability are likely to affect pathogen persistence and recolonization in fragmented habitats. Heterogeneity in disease dynamics can occur spatially and temporally due to differences in the host community, habitat and climatic factors. Higher numbers of I. ricinus nymphs, and a higher probability of detecting a nymph infected with B. burgdorferi s.l., were found in areas with warmer climates estimated by growing degree days (Chapter 2). The ground vegetation type associated with the highest number of I. ricinus nymphs varied between studies in this thesis (Chapter 2 & 3) and does not appear to be a reliable predictor across large areas. B. burgdorferi s.l. prevalence and genospecies composition was highly variable for the same sites sampled in subsequent years (Chapter 2). This suggests that dynamic variables such as reservoir host densities and deer should be measured as well as more static habitat and climatic factors to understand the drivers of B. burgdorferi s.l. infection in ticks. Heterogeneity in parasite loads amongst hosts is a common finding which has implications for disease ecology and management. Using a 17-year data set for tick infestations in a wild bird community in Scotland, different effects of age and sex on tick burdens were found among four species of passerine bird (Chapter 5). There were also different rates of decline in tick burdens among bird species in response to a long term decrease in questing tick pressure over the study. Species specific patterns may be driven by differences in behaviour and immunity and highlight the importance of comparative approaches. Combining whole genome sequencing (WGS) and population genetics approaches offers a novel approach to identify ecological drivers of pathogen populations. An initial analysis of WGS from B. burgdorferi s.s. isolates sampled 16 years apart suggests that there is a signal of measurable evolution (Chapter 6). This suggests demographic analyses may be applied to understand ecological and evolutionary processes of these bacteria. This work shows how host communities, habitat and climatic factors can affect the local transmission dynamics of B. burgdorferi s.l. and the potential risk of infection to humans. Spatial and temporal heterogeneity in pathogen dynamics poses challenges for the prediction of risk. New tools such as WGS of the pathogen (Chapter 6) and blood meal analysis techniques will add power to future studies on the ecology and evolution of B. burgdorferi s.l.