Prevalence of colonizing bacteria and their association with primary bacteremias in hemodialysis of a university hospital

to be from 2.5 to 5.5 cases per 1,000 catheter-day. the clinical impact is relevant and increases the cost of the HD Unit. Methods: The present study is the irst of 2 phases. It was conducted from January to December of 2012, and included all patients and nurses who were in the HD Unit. The prevalence of Gramnegative bacilli (GNB) and methicillin-resistant Staphylococcus aureus (MrSA) colonizing the nasal passages and the skin is described. Also, phenotypic association was sought by genus, species and sensitivities between colonizing bacterial strains and blood cultures with GNB and MRSA. Results: the study included 70 patients and 10 nurses. the prevalence of nasal colonization in patients by GNB was 9% and 6% in the pericatheter, and no nursing GNB colonization was discovered. The prevalence of MRSA nasal colonization was 19% and 6% in the pericatheter for patients and in the nurses the nasal colonization was 50% and 10% in the hands. We identiied 29 cases of primary bacteremia. The primary bacteremia rate is 1.5 per 1,000 catheter-day or 0.4 episodes per patient per year. Conclusion: We demonstrated a high prevalence of MrSA colonization in patients and nurses in the HD Unit. No relationship was found between primary bacteremia by GNB and patients and nurses’ bacteria colonization by the phenotypic comparison.

Cribado ecográfico de displasia de cadera en lactantes entre 6 y 12 semanas de edad, Hospital Vicente Corral Moscoso Cuenca, 2005

Con el objetivo de detectar la prevalencia de signos ecográficos de displasia de cadera en lactantes menores de doce semanas de vida y su asociación con factores de riesgo, se realiza un estudio transversal con 206 lactantes entre seis y doce semanas de vida atendidos en consulta externa del HVCM y que cumplieron con los criterios de inclusión. Se utilizó ecógrafo SONOACE con transductor lineal de 5 MHz y programa incorporado para medición de caderas pediátricas siguiendo la técnica ecográfica combinada de Graft y Harke. Resultados: la prevalencia de signos ecográficos de displasia del desarrollo de la cadera (DDC) fue del 16.0correspondiendo el 14a caderas inestables (tipo Ha), 1.5a caderas subluzadas (tipo Hd) y 0,5a caderas luxadas (tipo III). Al confrontar factores de riesgo se encontró asociación estadística con las variables genralidad p:0.00, prematuridad p:0.00; coexistencia con malformaciones óseas p:0.00 y neurológicas p:0.00; historia familiar DDC p:0.04; ortolam+ p:0.04 y asimetría de pliegues glúteos p:0.00. El resto de variables como sexo femenino, presentación pelviana y otras no mostraron diferencia significativa en el estudio. Discusión: la DDC es una patología multifactorial bastante frecuente en el medio y que puede ser detectada tempranamente mediante valoración ecográfica lo que hasta las doce semanas de vida no se consigue con los estudios radiológicos y que incluso podría pasar inavertida qnte un correcto examen clínico

Evaluation of Calretinin as a New Marker in the Diagnosis of Hirschsprung Disease

Background: Hirschsprung’s disease (HD) is a congenital intestinal motility disorder with absence of ganglion cells in the colonic wall. Diagnosis of the disease is mainly based on the identification of the lack of ganglion cells in the pathology sections of the colon which is very difficult and time consuming and also needs several serial cut sections. There are many proposed markers in this field in the literature but none of them has been satisfactory. Calretinin immunohistochemistry (IHC) has been introduced as a new diagnostic marker to overcome the problems in diagnosis of this disease about 5 years ago. However there are few studies regarding the benefits and pitfalls of this marker. Objectives: The aim of this study is to determine the diagnostic value of calretinin IHC in detecting aganglionosis (HD). Patients and Methods: 27 HD patients and 28 non-Hirschsprung’s disease (NHD) patients were collected in a prospective study and calretinin IHC was performed on 31 aganglionic and 51 normoganglionic full wall thickness sections of colectomies (some of the cases had more than 1 section). The IHC slides were evaluated by two pathologists and the diagnostic value was calculated in comparison with gold standard which is the presence or absence of ganglion cells in serial Hematoxylin and Eosin (HE) stained sections of the colectomies. Results: There was great concordance between the final diagnosis of both pathologists and gold standard (k > 0.9). Calretinin immunostaining showed 100% specificity and positive predictive value and more than 90% sensitivity and negative predictive value. High agreement was present between the two pathologists (k > 0.9). Conclusions: Calretinin IHC is a very convenient, useful and valuable method to demonstrate aganglionosis in HD patients. Loss of calretinin immunostaining in lamina propria and submucosa is characteristic of HD.

Synbiotic supplementation promotes improvement of chronic diarrhea of unknown etiology in patient with chronic kidney disease and provides better outcomes in dialysis

Background: Chronic kidney disease (CKD) patients often have gastrointestinal symptoms which may result in malnutrition and a negative impact on their quality of life. Modulation of the gut microbiota can be a strategy to promote host health and homeostasis. Case report: The authors present a case of chronic diarrhea in a hemodialysis (HD) patient with an unknown etiology. After about one year and several failed interventions, synbiotic therapy was performed. The diarrhea episodes ceased after three months of daily supplementation and both biochemical and nutritional parameters improved. Synbyotic therapy promoted clinical benefits in this patient. Discussion: Therefore, this simple therapy may be a promising alternative in CKD and it should be tested in larger studies.

Aportación de la bioimpedancia espectroscópica en el estado nutricional y de hidratación del paciente en hemodiálisis: impacto en la morbi-mortalidad

Aportación de la bioimpedancia espectroscópica en la valoración del estado de nutrición e hidratación del paciente en hemodiálisis. Impacto en la morbimortalidad. Los pacientes con enfermedad renal crónica tienen una mortalidad muy superior a la población general, siendo la principal causa la cardiovascular (Foley et al. 2005; Locatelli et al. 2004). Como consecuencia del gran impacto que tienen el estado nutricional ( Pifer et al. 2002; Gracia Iguacel et al. 2013) y la sobrehidratación (Kalantar Zadeh et al. 2009; Wizemann et al. 2009; Agarwal et al. 2010; Chazot et al. 2012) en la mortalidad, en los ultimos años se han desarrollado distintos métodos de análisis de la composición corporal, entre los cuales se encuentra la Bioimpedancia Espectroscópica (BIS). Esta herramienta permite cuantificar los diversos compartimentos del cuerpo (fundamentalmente masa magra, masa grasa y agua corporal) proporcionando al clínico información útil para la toma de decisiones, fundamentalmente en lo que respecta a la sobrecarga de volumen, aspecto fundamental en el manejo del paciente en hemodiálisis (López Gómez et al. 2011). La justificación de esta investigación se basa en existen pocos estudios longitudinales que analicen la evolución en el tiempo de marcadores nutricionales bioquímicos clásicos así como parámetros de bioimpedancia y su asociación con la morbimortalidad; no existiendo aún consenso sobre si los distintos marcadores pronósticos son mas predictivos con medidas basales o con medidas de seguimiento en el tiempo, por lo que nuestro trabajo puede contribuir a clarificar este aspecto. Además, existe un desconocimiento sobre el estado inflamatorio, la prevalencia de DPE y de sobrehidratación en la población en hemodiálisis de nuestro entorno por lo que consideramos importante analizarla para saber dónde estamos y en qué podemos mejorar. Objetivos: 1.- Impacto de la composición corporal así como de marcadores nutricionales bioquímicos e inflamatorios seguidos en el tiempo, sobre la morbimortalidad (evento compuesto muerte-hospitalización). 2.- Prevalencia del Síndrome de Desgaste Proteico Energético en función de distintas herramientas utilizadas para su valoración (criterios ISRNM, score MIS, y bioimpedancia).3.-Correlación entre los parámetros de bioimpedancia y parámetros bioquímicos nutricionales e inflamatorios. 4.- Análisis de la evolución en el tiempo de los parámetros bioquímicos, antropométricos y de bioimpedancia en el global de la muestra y en distintos grupos atendiendo al sexo, presencia de diabetes y grado de inflamación.. Diseño: Estudio observacional prospectivo de 15 meses de duración (Octubre/2013-Dic/2014) en pacientes prevalentes en hemodiálisis. Se ha realizado un corte transversal con los datos del primer mes de inclusión del paciente en el estudio (basal), a partir del cual se ha iniciado el seguimiento en el tiempo cada 2 meses. La mediana de seguimiento del estudio ha sido de 12 meses (RI 10-13 m). Pacientes y métodos: el nº de pacientes incluidos en el estudio fue de 169. Se incluyeron los pacientes estables, con mas de 3 meses en HD, excluyendose pacientes con ingreso reciente, proceso infeccioso o inflamatorio en 3 meses previos, neoplasia activa, marcapasos unipolar o con umbral de sensibilidad desconocido. Todos los pacientes firmaron el consentimiento informado. La prevalencia de DPE se analizó en el momento inicial y final del estudio. Para el análisis de la morbimortalidad se consideraron todos los ingresos de causa no programada, así como los éxitus por cualquier causa. Las funciones de supervivencia se calcularon mediante el análisis de Kaplan-Meier Para la identificación de las variables predictoras independientes del evento compuesto (muerte y / u hospitalización) se realizó un modelo de Cox univariante con las variables analíticas ( basal, media, mediana, máximo y mínimo) y demográficas y un modelo de Cox ajustado por edad,sexo e IMC con los parámetros de bioimpedancia . Las variables que dieron significativas en estos modelos (P < 0,05) se introdujeron en un modelo de Cox multivariante. Resultados. La prevalencia de DPE según criterios del ISRNM fue del 9.3 % en el momento basal, y del 4,3% en el momento de finalización del estudio. La prevalencia de sobrehidratación medida como AvROH fue del 20,1%. Durante el periodo de seguimiento se produjeron cambios significativos fundamentalmente en el índice de tejido graso (ITG) y en la sobrehidratación en los meses de verano (AvROH y TAFO). El 26% de la población de estudio tuvo al menos un ingreso hospitalario. 21 pacientes fallecieron durante el seguimiento (12,4% de la población). La principal causa de ingreso y éxitus fue la cardiovascular; consituyendo el 35% de los ingresos y el 57% de los éxitus. Los parámetros que presentaron asociación con el evento compuesto fueron: TAFO mínimo (HR 1.319: IC 95% 1.029-1.691; p= 0.029), PCR mediana (HR 1.032; IC 95% 1.014-1.050; p=0.001), albúmina máxima (HR 0.286; IC95% 0.085-0.966), colesterol total (HR 1.011; IC 95% 1.003-1.019; p=0.007) y nivel de 25 OH vit D (HR 0.947; IC 95% 0.915-0.981); p= 0.002). Conclusiones: El principal resultado de nuestro trabajo fue que la sobrehidratación, (medida como TAFO) se asoció de forma independiente con la morbimortalidad, y que las medidas seguidas en el tiempo (TAFO mínimo) tuvieron un mayor poder predictivo que las medidas basales. Adicionalmente; el estado nutricional e inflamatorio, medido mediante parámetros individuales, supuso un mayor impacto en la morbimortalidad que parámetros agrupados, como el score MIS o el síndrome DPE según criterios ISRNM. En nuestro estudio hemos encontrado importantes diferencias en la prevalencia de DPE en función de la herramienta utilizada (criterios ISRNM, MIS y parámetros de bioimpedancia). Finalmente, la periodicidad de la medición de las diferentes variables a lo largo del seguimiento nos ha permitido apreciar los cambios estacionales en los parámetros de bioimpedancia, los cuales se han acompañado de cambios en sentido inverso de algunos de los parámetros bioquímicos nutricionales.

Two roads to planet detection

One of the most exciting discoveries in astrophysics of the last last decade is of the sheer diversity of planetary systems. These include "hot Jupiters", giant planets so close to their host stars that they orbit once every few days; "Super-Earths", planets with sizes intermediate to those of Earth and Neptune, of which no analogs exist in our own solar system; multi-planet systems with planets smaller than Mars to larger than Jupiter; planets orbiting binary stars; free-floating planets flying through the emptiness of space without any star; even planets orbiting pulsars. Despite these remarkable discoveries, the field is still young, and there are many areas about which precious little is known. In particular, we don't know the planets orbiting Sun-like stars nearest to our own solar system, and we know very little about the compositions of extrasolar planets. This thesis provides developments in those directions, through two instrumentation projects.

The first chapter of this thesis concerns detecting planets in the Solar neighborhood using precision stellar radial velocities, also known as the Doppler technique. We present an analysis determining the most efficient way to detect planets considering factors such as spectral type, wavelengths of observation, spectrograph resolution, observing time, and instrumental sensitivity. We show that G and K dwarfs observed at 400-600 nm are the best targets for surveys complete down to a given planet mass and out to a specified orbital period. Overall we find that M dwarfs observed at 700-800 nm are the best targets for habitable-zone planets, particularly when including the effects of systematic noise floors caused by instrumental imperfections. Somewhat surprisingly, we demonstrate that a modestly sized observatory, with a dedicated observing program, is up to the task of discovering such planets.

We present just such an observatory in the second chapter, called the "MINiature Exoplanet Radial Velocity Array," or MINERVA. We describe the design, which uses a novel multi-aperture approach to increase stability and performance through lower system etendue, as well as keeping costs and time to deployment down. We present calculations of the expected planet yield, and data showing the system performance from our testing and development of the system at Caltech's campus. We also present the motivation, design, and performance of a fiber coupling system for the array, critical for efficiently and reliably bringing light from the telescopes to the spectrograph. We finish by presenting the current status of MINERVA, operational at Mt. Hopkins observatory in Arizona.

The second part of this thesis concerns a very different method of planet detection, direct imaging, which involves discovery and characterization of planets by collecting and analyzing their light. Directly analyzing planetary light is the most promising way to study their atmospheres, formation histories, and compositions. Direct imaging is extremely challenging, as it requires a high performance adaptive optics system to unblur the point-spread function of the parent star through the atmosphere, a coronagraph to suppress stellar diffraction, and image post-processing to remove non-common path "speckle" aberrations that can overwhelm any planetary companions.

To this end, we present the "Stellar Double Coronagraph," or SDC, a flexible coronagraphic platform for use with the 200" Hale telescope. It has two focal and pupil planes, allowing for a number of different observing modes, including multiple vortex phase masks in series for improved contrast and inner working angle behind the obscured aperture of the telescope. We present the motivation, design, performance, and data reduction pipeline of the instrument. In the following chapter, we present some early science results, including the first image of a companion to the star delta Andromeda, which had been previously hypothesized but never seen.

A further chapter presents a wavefront control code developed for the instrument, using the technique of "speckle nulling," which can remove optical aberrations from the system using the deformable mirror of the adaptive optics system. This code allows for improved contrast and inner working angles, and was written in a modular style so as to be portable to other high contrast imaging platforms. We present its performance on optical, near-infrared, and thermal infrared instruments on the Palomar and Keck telescopes, showing how it can improve contrasts by a factor of a few in less than ten iterations.

One of the large challenges in direct imaging is sensing and correcting the electric field in the focal plane to remove scattered light that can be much brighter than any planets. In the last chapter, we present a new method of focal-plane wavefront sensing, combining a coronagraph with a simple phase-shifting interferometer. We present its design and implementation on the Stellar Double Coronagraph, demonstrating its ability to create regions of high contrast by measuring and correcting for optical aberrations in the focal plane. Finally, we derive how it is possible to use the same hardware to distinguish companions from speckle errors using the principles of optical coherence. We present results observing the brown dwarf HD 49197b, demonstrating the ability to detect it despite it being buried in the speckle noise floor. We believe this is the first detection of a substellar companion using the coherence properties of light.

Part-time and fractional staff in the learning and skills sector

This Universities and College Union Launch Event presentation reported on the findings of Learning and Skills Research Network (LSRN) London and South East (LSE) Regional Research Project. The presentation reflected on research carried out during 2002-06 on the development and deployment of part-time staff in the Learning and Skills Sector. Although the lifelong learning sector is the largest UK education sector, little attention has as yet been paid to the role of LSC sector part-time staff. Worrying trends of an increasing casualisation of staffing have been reported. The role of part-timers as highly committed (philanthropic) but generally underpaid and exploited staff (ragged-trousered) emerged from the data collected by this investigation, which examined the role of part-timers in several colleges and adult education institutions in London and the South East. The metaphor of the 'ragged-trousered philanthropist' was consciously selected to investigate the interactivity between philantrophy, employment practices for PT staff, and education as social action, in addressing the need for good practice to achieve quality outcomes in learning and teaching. The results are to some extent transferable to other education and training sectors employing part-time staff, e.g. higher education institutions and work-based training organisations.

Moderating effects of gender in the relationships between daily stress, coping styles and hopelessness depression in adolescents

The hopelessness depression (HD) theory assumes a number of contributing factors to the development of hopelessness expectations and HD symptoms. Studies carried out to test HD theory have generally supported the prediction that a negative attributional style contributes to the development of hopelessness expectations and HD symptoms, although the evidence is less consistent for adolescents. Due to these inconsistent results, as well as the assumption advanced by HD theory that other factors aside from attributional style may contribute to the development of HD, in this study we examined the potential role of adolescents’ daily stress and coping styles as contributing factors to HD at these ages, and the effects of gender on these relationships. Seiffge-Krenke (1995) showed that stress in daily life plays a particularly relevant role during adolescence and described three coping styles used by adolescents to face daily stress: active and internal approach-oriented styles, which are considered functional and complementary, and avoidant style, considered dysfunctional. In this study, secondary students (N = 480; aged 13–17) completed the Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974), the Hopelessness Depression Symptoms Questionnaire (Metalsky & Joiner, 1997), the Problem Questionnaire ((Seiffge-Krenke, 1995) and the Coping Across Situations Questionnaire (Seiffge-Krenke, 1995). To test the role of daily stress and coping styles in the prediction of hopelessness expectations and HD symptoms, two four-step hierarchical multiple regression analyses were conducted. In these analyses, gender was introduced first, daily stress was introduced second, the three coping styles were entered in a third step, and the moderating effects of gender on the associations of the predictor variables (daily stress and each coping style) with the criterion variables (hopelessness expectations or HD symptoms) were introduced in a fourth step. Results showed a moderating effect of gender on the relationship between daily stress and hopelessness expectations, which revealed a significant effect for boys despite the fact that girls experienced more daily stress than boys, thus suggesting an inoculation effect in girls. It was also found a gender-dependent role of coping styles in the prediction of HD symptoms, revealing a protective effect for the active style in girls and for the internal style in boys. This suggests that girls would benefit from being more action-prone and boys more reflection-prone in order to prevent HD. These findings indicate that programmes aimed to promote coping skills in adolescents would benefit from being gender-adapted.

A SCR Model based on Reactor and Engine Experimental Studies for a Cu-zeolite Catalyst

A NOx reduction efficiency higher than 95% with NH3 slip less than 30 ppm is desirable for heavy-duty diesel (HDD) engines using selective catalytic reduction (SCR) systems to meet the US EPA 2010 NOx standard and the 2014-2018 fuel consumption regulation. The SCR performance needs to be improved through experimental and modeling studies. In this research, a high fidelity global kinetic 1-dimensional 2-site SCR model with mass transfer, heat transfer and global reaction mechanisms was developed for a Cu-zeolite catalyst. The model simulates the SCR performance for the engine exhaust conditions with NH3 maldistribution and aging effects, and the details are presented. SCR experimental data were collected for the model development, calibration and validation from a reactor at Oak Ridge National Laboratory (ORNL) and an engine experimental setup at Michigan Technological University (MTU) with a Cummins 2010 ISB engine. The model was calibrated separately to the reactor and engine data. The experimental setup, test procedures including a surrogate HD-FTP cycle developed for transient studies and the model calibration process are described. Differences in the model parameters were determined between the calibrations developed from the reactor and the engine data. It was determined that the SCR inlet NH3 maldistribution is one of the reasons causing the differences. The model calibrated to the engine data served as a basis for developing a reduced order SCR estimator model. The effect of the SCR inlet NO2/NOx ratio on the SCR performance was studied through simulations using the surrogate HD-FTP cycle. The cumulative outlet NOx and the overall NOx conversion efficiency of the cycle are highest with a NO2/NOx ratio of 0.5. The outlet NH3 is lowest for the NO2/NOx ratio greater than 0.6. A combined engine experimental and simulation study was performed to quantify the NH3 maldistribution at the SCR inlet and its effects on the SCR performance and kinetics. The uniformity index (UI) of the SCR inlet NH3 and NH3/NOx ratio (ANR) was determined to be below 0.8 for the production system. The UI was improved to 0.9 after installation of a swirl mixer into the SCR inlet cone. A multi-channel model was developed to simulate the maldistribution effects. The results showed that reducing the UI of the inlet ANR from 1.0 to 0.7 caused a 5-10% decrease in NOx reduction efficiency and 10-20 ppm increase in the NH3 slip. The simulations of the steady-state engine data with the multi-channel model showed that the NH3 maldistribution is a factor causing the differences in the calibrations developed from the engine and the reactor data. The Reactor experiments were performed at ORNL using a Spaci-IR technique to study the thermal aging effects. The test results showed that the thermal aging (at 800°C for 16 hours) caused a 30% reduction in the NH3 stored on the catalyst under NH3 saturation conditions and different axial concentration profiles under SCR reaction conditions. The kinetics analysis showed that the thermal aging caused a reduction in total NH3 storage capacity (94.6 compared to 138 gmol/m3), different NH3 adsorption/desorption properties and a decrease in activation energy and the pre-exponential factor for NH3 oxidation, standard and fast SCR reactions. Both reduction in the storage capability and the change in kinetics of the major reactions contributed to the change in the axial storage and concentration profiles observed from the experiments.

Progress in understanding of the molecular basis underlying functional diversification of cyclic di-nucleotide turnover proteins

Cyclic di-GMP was the first cyclic di-nucleotide second messenger described, presaging the discovery of additional cyclic di-nucleotide messengers in bacteria and eukaryotes. The GGDEF diguanylate cyclase (DGC) and EAL and HD-GYP phosphodiesterase (PDE) domains conduct the turnover of cyclic di-GMP. These three unrelated domains belong to superfamilies that exhibit significant variations in function, to include both enzymatically active and inactive members with a subset involved in synthesis and degradation of other cyclic di-nucleotides. Here we summarize current knowledge of sequence and structural varitions that underpin the functional diversification of cyclic di-GMP turnover proteins. Moreover, we highlight that superfamily diversification is not restricted to cyclic di-GMP signaling domains, as particular DHH/DHHA1 domain and HD domain proteins have been shown to act as cyclic di-AMP phosphodiesterases. We conclude with a consideration of the current limitations that such diversity of action places on bioinformatic prediction of the roles of GGDEF, EAL and HD-GYP domain proteins.

Integration of process planning and scheduling using mobile-agent based approach in a networked manufacturing environment

Effective and efficient implementation of intelligent and/or recently emerged networked manufacturing systems require an enterprise level integration. The networked manufacturing offers several advantages in the current competitive atmosphere by way to reduce, by shortening manufacturing cycle time and maintaining the production flexibility thereby achieving several feasible process plans. The first step in this direction is to integrate manufacturing functions such as process planning and scheduling for multi-jobs in a network based manufacturing system. It is difficult to determine a proper plan that meets conflicting objectives simultaneously. This paper describes a mobile-agent based negotiation approach to integrate manufacturing functions in a distributed manner; and its fundamental framework and functions are presented. Moreover, ontology has been constructed by using the Protégé software which possesses the flexibility to convert knowledge into Extensible Markup Language (XML) schema of Web Ontology Language (OWL) documents. The generated XML schemas have been used to transfer information throughout the manufacturing network for the intelligent interoperable integration of product data models and manufacturing resources. To validate the feasibility of the proposed approach, an illustrative example along with varied production environments that includes production demand fluctuations is presented and compared the proposed approach performance and its effectiveness with evolutionary algorithm based Hybrid Dynamic-DNA (HD-DNA) algorithm. The results show that the proposed scheme is very effective and reasonably acceptable for integration of manufacturing functions.

Deindustrialisation and industrial communities: the Lanarkshire coalfields c.1947-1983

This thesis examines deindustrialisation, the declining contribution of industrial activities to economic output and employment, in Lanarkshire, Scotland’s largest coalfield between the early nineteenth and mid-twentieth century. It focuses on contraction between the National Coal Board’s (NCB) vesting in 1947 and the closure of Lanarkshire’s last colliery, Cardowan, in 1983. Deindustrialisation was not the natural outcome of either market forces or geological exhaustion. Colliery closures and falling coal employment were the result of policy-makers’ decisions. The thesis consists of four thematic chapters: political economy, moral economy, class and community, and generation and gender. The analysis is based on archival sources including Scottish Office reports and correspondence relating to regional policy, and NCB records. These are supported by National Union of Mineworkers Scottish Area and STUC meeting minutes, and oral history testimonies from over 30 men and women with Lanarkshire coalfield backgrounds, as well as two focus groups. The first two chapters analyse the process of deindustrialisation, with the first offering a top-down perspective and the second a bottom-up viewpoint. In chapter one deindustrialisation is analysed through changes in political economy. Shifts in labour market structure are examined through the development of regional policy and its administration by the Scottish Office. The analysis centres upon a policy network of Scottish business elites and civil servants who shaped a vision of modernisation via industrial diversification through attracting inward investment. In chapter two the perspective shifts to community and workforce. It analyses responses to coalfield contraction through a moral economy of customary rights to colliery employment. A detailed investigation of Lanarkshire colliery closures between the 1940s and 1980s emphasises the protracted nature of deindustrialisation. Chapters three and four consider the social and cultural structures which shaped the moral economy but were heavily altered by deindustrialisation. Chapter three focuses on the dense networks that linked occupation, community, and class consciousness. Increasing coalfield centralisation and remote control of pits from NCB headquarters in London, and mounting hostility to coal closures, contributed to an accentuated sense of Scottish-ness. Chapter four illuminates gender and generational dimensions. The differing experiences of cohorts of men who faced either early retirement, redundancy or transfer to alternative sectors, or those who never attained anticipated industrial employment due to final closures, are analysed in terms of constructions of masculinity and the endurance of cultural as well as material losses. This is counterpoised to women who gained industrial work in assembly plants and the perceived gradual attainment of an improved economic and social position whilst continuing to navigate structures of patriarchy.

Asociación de las violencias física, sexual y comunitaria con el embarazo en adolescentes: análisis multinivel

Objetivos Determinar si existe asociación entre la exposición a violencia, experimentada a nivel individual o municipal, y el embarazo adolescente en mujeres Colombianas entre 13 y 19 años de edad que contestaron la Encuesta de Demografía y Salud en el año 2010. Métodos Estudio de corte transversal, nacional y multinivel. Se tomaron datos de dos niveles jerárquicos: Nivel- 1: Datos individuales de una muestra representativa de 13.313 mujeres entre 13 y 19 años de edad provenientes de La Encuesta Nacional de Demografía y Salud del año 2010 y Nivel- 2: Datos municipales de 258 municipios provenientes de las estadísticas vitales del DANE. Resultados La prevalencia del embarazo adolescente fue del 16.8% IC 95% [16.2-17.4]. El análisis mostró que la asociación entre embarazo adolescente y violencia tanto individual, representada como violencia sexual [OR= 6.99 IC99% 4.80-10.10] y violencia física [OR= 1.74 IC99% 1.47-2.05] así como la violencia municipal medida con tasas de homicidios altas [OR= 1.99 IC99% 1.29-3.07] y muy altas [OR= 2.10 IC99% 1.21-3.61] se mantuvo estadísticamente significativa después de ajustar por las variables: Edad [OR= 1.81 IC99% 1.71-1.91], ocupación [OR= 1.62 IC99% 1.37-1.93], educación primaria o sin educación [OR= 2.20 IC99% 1.47-3.30], educación secundaria [OR= 1.70 IC99% 1.24-2.32], asistir al colegio [OR= 0.18 IC99% 0.15-0.21], conocimiento en la fisiología reproductiva [OR= 1.28 IC99% 1.06-1.54], el índice de riqueza Q1, Q2, Q3 [OR= 2.18 IC99% 1.42-3.34], [OR= 2.00 IC99% 1.39-2.28], [OR= 1.82 IC99% 1.92-2.25] y alto porcentaje de Necesidades básicas insatisfechas a nivel municipal [OR= 2.34 IC99% 1.55-3.52]. Conclusiones Este estudio mostró una relación significativamente estadística entre la violencia sexual y física con el inicio de relaciones sexuales y embarazo adolescente después de controlar por factores sociodemográficos y conocimientos en reproducción sexual en mujeres colombianas de 13 a 19 años en el año 2010. Esta asociación debe continuar siendo estudiada para lograr optimizar las estrategias de prevención y disminuir la tasa actual de embarazos adolescentes en el país y sus consecuencias.

Impacto de los Niveles de Tacrolimus en el Rechazo al Injerto y la Tasa de Filtración Glomerular en Pacientes con Trasplante Hepático realizado en la FCI-IC entre 2009 y 2014

Introducción: El tacrolimus es el medicamento de elección para evitar el rechazo al injerto hepático. Su dosis se ajusta a partir de los niveles séricos que se toman periódicamente para asegurar rango terapéutico. Además, niveles elevados se asocian con disfunción renal postrasplante. Sin embargo, no hay consenso frente a los niveles adecuados para pacientes con trasplante hepático. Objetivo: Determinar la relación entre los niveles de tacrolimus y la presencia de rechazo agudo al injerto hepático en pacientes con trasplante hepático realizado en la Fundación Cardioinfantil – Instituto de Cardiología (FCI-IC). Determinar la relación entre los niveles de tacrolimus y la TFG en pacientes con trasplante hepático realizado en la FCI-IC. Métodos: Estudio observacional tipo cohorte histórica en pacientes adultos con trasplante hepático realizado en la FCI-IC entre 2009-2014. Resultados: No se encontró una asociación estadísticamente significativa entre los niveles de tacrolimus y la presencia de rechazo agudo, en sus diferentes definiciones (OR=1,02, p=0,14 y OR=1,01, p=0,29) incluso al ajustar por otras covariables (OR=1,03, p=0,10 y OR=1,02, p=0,25). No fue posible corroborar el diagnóstico con biopsia porque no todos la tenían. Si bien la relación entre los niveles de tacrolimus y la TFG fue estadísticamente significativa (p≤0,001), tiene bajo impacto clínico, pues la TFG disminuyó menos de un punto por cada incremento en 1 ng/ml en los niveles de tacrolimus. Conclusiones: Se necesitan más estudios para establecer la relación entre la exposición a tacrolimus y estos desenlaces para definir si es seguro disminuir su dosis con el fin de reducir los eventos adversos.