We have analyzed the incidence and risk factors for the occurrence of invasive aspergillosis (IA) among 219 consecutive recipients of an allogeneic hematopoietic SCT after a reduced-intensity conditioning regimen (Allo-RIC). Twenty-seven patients developed an IA at a median of 218 days (range 24-2051) post-Allo-RIC, for a 4-year incidence of 13% (95% confidence interval 4-24%). In multivariate analysis, risk factors for developing IA were steroid therapy for moderate-to-severe graft vs host disease (GVHD) (Hazard Ratio (HR) 2.9, P=0.03), occurrence of a lower respiratory tract infection (LRTI) by a respiratory virus (RV) (HR 4.3, P<0.01) and CMV disease (HR 2.8, P=0.03). Variables that decreased survival after Allo-RIC were advanced disease phase (HR 1.9, P=0.02), steroid therapy for moderate-to-severe GVHD (HR 2.2, P<0.01), not developing chronic GVHD (HR 4.3, P<0.01), occurrence of LRTI by an RV (HR 3.4, P<0.01) and CMV disease (HR 2, P=0.01), whereas occurrence of IA had no effect on survival (P=0.5). Our results show that IA is a common infectious complication after an Allo-RIC, which occurs late post-transplant and may not have a strong effect on survival. An important observation is the possible role of LRTI by conventional RVs as risk factors for IA.

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From 1997 to 2007, Spain suffered from major cases of political corruption associated with local urban development. To analyse their causes, this article examines the institutional mechanisms designed to monitor and control the performance of local policy-makers and to ensure they operated independently from private influence. It also analyses their actual effectiveness with reference to particular cases of local corruption unveiled during that decade. The Spanish case shows that local representatives had a large amount of power in distributing financial gains within the municipality, but faced little pressure to account for their actions. It argues that insufficient control mechanisms on the activities of local representatives from 1997 to 2007 can adequately explain the intensity and spread of local corruption in Spain. Points for practitioners The article contributes to a better understanding of the factors and the causes that explain local corruption, particularly in countries where local governments fit with the ‘strong-mayor’ type. Following the Local Integrity System framework, it provides a strategy to analyse the role and impact of control mechanisms, distinguishing between internal and external controls, and administrative and judicial controls. The article also helps to understand, and presents evidence of, the mismatch between ‘formal’ institutional mechanisms on the one hand, and their actual implementation and effects on the other.

cuya inclusión en las aulas universitarias está requiriendo un cambio de mentalidad tanto en el profesorado como en estudiantes. La investigación que se presentamos consta de dos estudios. En el primero se analiza el perfil de aprendizaje de 443 estudiantes universitarios, de las cinco ramas de conocimiento, en función de la consideración sobre el uso que hacen de las TIC en el aula. En el segundo de los estudios, en el que han participado 365 estudiantes de la rama de ciencias sociales y jurídicas, se ha llevado a cabo una experiencia de innovación en enseñanza-aprendizaje mediada por TIC con Webs Didácticas. Los resultados obtenidos permiten establecer que una valoración positiva de las TIC se relaciona positivamente con un enfoque profundo de aprendizaje, y que las experiencias de aprendizaje mediadas por TIC son valoradas positivamente por parte de los estudiantes.

A prospective study of 45 central venous catheters was conducted to assess, by strain delineation, the turnover of skin and catheter hub (superficial) colonization and the relative contributions of catheter hub and skin colonization to catheter tip colonization. Serial quantitative cultures of skin and catheter hub were performed. Catheter tip, blood, and specimens for culture from targeted superficial sites (TSSs) were also collected at the time of catheter removal. Strains from 17 tip-positive catheters were delineated by pulsed-field gel electrophoresis. Only 12 (28.6%) of 42 skin strains and 14 (31.1%) of 45 catheter hub strains were found to be present at the time of catheter removal. In addition, only 9 (29.0%) of the 31 tip-colonizing strains were present on TSSs. Moreover, 15 (48.4%) of the 31 tip-colonizing strains had a superficial origin, and the other 16 (51.6%) were of unknown origin. In catheters suspected of infection, cultures of TSSs had a negative predictive value for catheter-related bacteremia of 94.4% but a positive predictive value of 44.4%. When the causative agent was identified (to the strain level) these values dropped to 80.9 and 18.7%, respectively. The study shows that skin and catheter hub colonization is a common, dynamic phenomenon. Strains recovered from TSSs showed a low level of correlation with strains from previous cultures of specimens from superficial sites and catheter tip isolates. Consequently, TSSs cannot be recommended for use in determining the therapy. However, catheter-related bacteremia is uncommon when cultures of TSSs are negative.

The purpose of the study is to determine the incidence and distribution of paravascular lamellar holes (PLH) around retinal vessels in highly myopic eyes and their relationship with macular retinoschisis (MR). We examined 306 eyes of 178 patients with high myopia, performing multiple scans of the posterior pole within the retinal vascular arcades using spectral-domain OCT. Type of staphyloma was determined. PLH were divided into three groups: holes only (group 1), holes extending below vessels (group 2), and holes in an area of paravascular retinoschisis (group 3). OCT showed that 96/306 eyes (31.4 %) had PLH mainly along the infero-temporal arcade (39.9 %). Type V and IX staphylomas had a higher proportion of PLH in the infero-temporal arcade than other staphylomas. Group 3 eyes presented higher rates of myopia and staphyloma. MR was detected in 10/27 eyes (37 %) in Group 3, but only in 2/33 eyes (6.1 %) in Group 1. No MR was found in Group 2. PLH are relatively common in highly myopic eyes and mainly distributed in the inferior temporal arcade. Findings from this descriptive study suggest that distribution of PLH might be related to the type of staphyloma. Further studies are needed to evaluate the relevance of PLH in the pathogenesis of MR.