Anàlisis, disseny i implementació d'una aplicació de gestió d'històries mèdiques per un sistema multi centres mitjançant tecnologia J2EE, i tecnologia de xarxes de bases de dades

El treball final de carrera 'HISMED', es basa en l'anàlisi, disseny, investigació e implementació d'una aplicació dins l'àmbit assistencial sanitari amb la premissa de voler ser un sistema per oferir un servei sanitari de millor qualitat, i crear un entorn en el qual investigadors, laboratoris, metges i personal docent comparteixen dades amb una rellevància cabdal per les seves professions. Oferint-los una eina de consulta molt potent en quant a l'obtenció de dades clíniques, que els permet explotar la informació segons convingui el cas.

NanoImpactNet - building a multi-stakeholder dialogue on the health and environmental impact of nanomaterials

NanoImpactNet (NIN) is a multidisciplinary European Commission funded network on the environmental, health and safety (EHS) impact of nanomaterials. The 24 founding scientific institutes are leading European research groups active in the fields of nanosafety, nanorisk assessment and nanotoxicology. This 4-year project is the new focal point for information exchange within the research community. Contact with other stakeholders is vital and their needs are being surveyed. NIN is communicating with 100s of stakeholders: businesses; internet platforms; industry associations; regulators; policy makers; national ministries; international agencies; standard-setting bodies and NGOs concerned by labour rights, EHS or animal welfare. To improve this communication, internet research, a questionnaire distributed via partners and targeted phone calls were used to identify stakeholders' interests and needs. Knowledge gaps and the necessity for further data mentioned by representatives of all stakeholder groups in the targeted phone calls concerned: • the potential toxic and safety hazards of nanomaterials throughout their lifecycles; • the fate and persistence of nanoparticles in humans, animals and the environment; • the associated risks of nanoparticle exposure; • greater participation in: the preparation of nomenclature, standards, methodologies, protocols and benchmarks; • the development of best practice guidelines; • voluntary schemes on responsibility; • databases of materials, research topics and themes, but also of expertise. These findings suggested that stakeholders and NIN researchers share very similar knowledge needs, and that open communication and free movement of knowledge will benefit both researchers and industry. Subsequently a workshop was organised by NIN focused on building a sustainable multi-stakeholder dialogue. Specific questions were asked to different stakeholder groups to encourage discussions and open communication. 1. What information do stakeholders need from researchers and why? The discussions about this question confirmed the needs identified in the targeted phone calls. 2. How to communicate information? While it was agreed that reporting should be enhanced, commercial confidentiality and economic competition were identified as major obstacles. It was recognised that expertise was needed in the areas of commercial law and economics for a wellinformed treatment of this communication issue. 3. Can engineered nanomaterials be used safely? The idea that nanomaterials are probably safe because some of them have been produced 'for a long time', was questioned, since many materials in common use have been proved to be unsafe. The question of safety is also about whether the public has confidence. New legislation like REACH could help with this issue. Hazards do not materialise if exposure can be avoided or at least significantly reduced. Thus, there is a need for information on what can be regarded as acceptable levels of exposure. Finally, it was noted that there is no such thing as a perfectly safe material but only boundaries. At this moment we do not know where these boundaries lie. The matter of labelling of products containing nanomaterials was raised, as in the public mind safety and labelling are connected. This may need to be addressed since the issue of nanomaterials in food, drink and food packaging may be the first safety issue to attract public and media attention, and this may have an impact on 'nanotechnology as a whole. 4. Do we need more or other regulation? Any decision making process should accommodate the changing level of uncertainty. To address the uncertainties, adaptations of frameworks such as REACH may be indicated for nanomaterials. Regulation is often needed even if voluntary measures are welcome because it mitigates the effects of competition between industries. Data cannot be collected on voluntary bases for example. NIN will continue with an active stakeholder dialogue to further build on interdisciplinary relationships towards a healthy future with nanotechnology.

Management of a post-operative multi-resistant infectious spondylitis associated with a kyphotic deformity.

Anterior spinal infection (prevertebral abscess and/or discitis) after posterior instrumentation for vertebral fractures is a challenging complication, since a new implant may become necessary anteriorly, in a septic environment. Generally accepted management guidelines are yet to be established. The authors present a case of posterior instrumentation for fractures of T12 and L1, complicated after 9 months with an anterior infection (prevertebral abscess and discitis) with extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (E. coli). This case is unique in that the multi-resistant organism was isolated only after the second stage of infection treatment, which consisted of anterior débridement and anterior implantation of titanium cages and rods. In this particular case, infection was controlled despite implantation of multiple cages, screws and rods, and fusion was achieved, by means of intravenous antibiotic treatment for 12 months. At the latest follow-up, 24 months post surgery, there was no evidence of infection. This problem case may be helpful for surgeons confronted with spinal deformities secondary to infections with multi-resistant organisms.

Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study

Background Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). Methods Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. Results Base-line differences in functional capacity – significantly lower in the intervention group (RR: 1.52 95%CI: 1.05–2.21; p = 0.0016) – disappeared at six months (RR: 1.31 95%CI: 0.87–1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77–59.34 vs. 60.50 95%CI: 53.63–67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67–57.92 vs. 66.26 95%CI: 60.66–71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22–10.62 vs. 3.24 95%CI: 1.37–5.310; p = 0.0001) and, on average, required fewer home care visits (9.40 95%CI: 7.89–10.92 vs.11.30 95%CI: 9.10–14.54). No differences were found in terms of frequency of visits to A&E or hospital re-admissions. Furthermore, patients in the control group perceived higher levels of satisfaction (16.88; 95%CI: 16.32–17.43; range: 0–21, vs. 14.65 95%CI: 13.61–15.68; p = 0,001). Conclusion A home care service model that includes nurse-led case management streamlines access to healthcare services and resources, while impacting positively on patients' functional ability and caregiver burden, with increased levels of satisfaction.

Studies about the atomic capabilities concept for linear control systems in physical multi-agent environments

This paper shows the impact of the atomic capabilities concept to include control-oriented knowledge of linear control systems in the decisions making structure of physical agents. These agents operate in a real environment managing physical objects (e.g. their physical bodies) in coordinated tasks. This approach is presented using an introspective reasoning approach and control theory based on the specific tasks of passing a ball and executing the offside manoeuvre between physical agents in the robotic soccer testbed. Experimental results and conclusions are presented, emphasising the advantages of our approach that improve the multi-agent performance in cooperative systems

Adaption of Courses and Learning Environment to the User Context in dotLRN

The explosive growth of Internet during the last years has been reflected in the ever-increasing amount of the diversity and heterogeneity of user preferences, types and features of devices and access networks. Usually the heterogeneity in the context of the users which request Web contents is not taken into account by the servers that deliver them implying that these contents will not always suit their needs. In the particular case of e-learning platforms this issue is especially critical due to the fact that it puts at stake the knowledge acquired by their users. In the following paper we present a system that aims to provide the dotLRN e-learning platform with the capability to adapt to its users context. By integrating dotLRN with a multi-agent hypermedia system, online courses being undertaken by students as well as their learning environment are adapted in real time

Virtual Environment: assistance in nursing care for the deaf based on the protocol of Primary Care

Objective: Presenting a Virtual Environment (VE) based on the Protocol of Treatment of Hypertension and Diabetes Mellitus type 2, used in Primary Care for evaluation of dietary habits in nursing consultations. Method: An experimental study applied by two nurses and a nurse manager, in a sample of 30 deaf patients aged between 30 and 60 years. The environment was built in Visual Basic NET and offered eight screens about feeding containing food pictures, videos in Libras (Brazilian sign language) and audio. The analysis of the VE was done through questionnaires applied to patients and professionals by the Poisson statistical test. Results: The VE shows the possible diagnostics in red, yellow, green and blue colors, depending on the degree of patients’ need. Conclusion: The environment obtained excellent acceptance by patients and nurses, allowing great interaction between them, even without an interpreter. The time in consultation was reduced to 15 minutes, with the preservation of patient privacy.

Multi-faceted functions of secretory IgA at mucosal surfaces.

Secretory IgA (SIgA) plays an important role in the protection and homeostatic regulation of intestinal, respiratory, and urogenital mucosal epithelia separating the outside environment from the inside of the body. This primary function of SIgA is referred to as immune exclusion, a process that limits the access of numerous microorganisms and mucosal antigens to these thin and vulnerable mucosal barriers. SIgA has been shown to be involved in avoiding opportunistic pathogens to enter and disseminate in the systemic compartment, as well as tightly controlling the necessary symbiotic relationship existing between commensals and the host. Clearance by peristalsis appears thus as one of the numerous mechanisms whereby SIgA fulfills its function at mucosal surfaces. Sampling of antigen-SIgA complexes by microfold (M) cells, intimate contact occurring with Peyer's patch dendritic cells (DC), down-regulation of inflammatory processes, modulation of epithelial, and DC responsiveness are some of the recently identified processes to which the contribution of SIgA has been underscored. This review aims at presenting, with emphasis at the biochemical level, how the molecular complexity of SIgA can serve these multiple and non-redundant modes of action.

Implementing interactive computing in an object-oriented environment

Statistical computing when input/output is driven by a Graphical User Interface is considered. A proposal is made for automatic control ofcomputational flow to ensure that only strictly required computationsare actually carried on. The computational flow is modeled by a directed graph for implementation in any object-oriented programming language with symbolic manipulation capabilities. A complete implementation example is presented to compute and display frequency based piecewise linear density estimators such as histograms or frequency polygons.

Three Continents, one Language: Studying English in a Portuguese Landscape (Brazil, Cape Verde and Portugal)

Unlike other languages, English has spread to all continents and become a truly global language, a process observable in countries, like Brazil, Cape Verde, and Portugal, located in three different continents, and sharing a common official language: Portuguese. This relatively recent development has contributed to the wide exposure to English and the growing influence of the language in their societies, being used with lingua franca communicative purposes, which raises pedagogical issues. Our aim is to map the exposure and use of English as a Lingua Franca in these Portuguese speaking countries through a comparative study of the results from three case studies (Berto 2009, Cavalheiro 2008 and Nunes 2010). By taking into consideration the findings from questionnaires answered by students and teachers of English, it compares and contrasts the respondents’ opinions on the profile of English teachers — native vs. non-native —, the varieties of English to be taught, and the language teaching resources available. In addition, it explores the learners’ interests, motives and purposes in relation to English and the potential communicative interactions between all speakers, so as to better understand ELF in English language education, and how these factors affect or should affect pedagogical practices in a Portuguese environment.

Agriculture and Environment Task Force Report To the Rebuild Iowa Advisory Commission, August 2008

The Rebuild Iowa Agriculture and Environment Task Force respectfully submits its report to the Rebuild Iowa Advisory Commission (RIAC) for consideration of the impacts of the tornadoes, storms, high winds, and flooding affecting Iowa’s agriculture sector and environment. The Task Force was required to address very complex and multi-faceted issues. Understanding that there were a broad range of immediate concerns, as well as critical issues that need to be addressed in the future, the Task Force structured its work in two sessions. To better address the issues and priorities of the Task Force, this report categorizes the issues as agriculture, conservation, environment, and livestock.

The Relationship between Teachers and Students in the Classroom: Communicative Language Teaching Approach and Cooperative Learning Strategy to Improve Learning

The aim of this research is to to investigate how a supportive relationship between teachers and students in the classroom can improve the learning process. By having a good relationship with students, teachers can offer to students chances to be motivated and feel engaged in the learning process. Students will be engaged actively in the learning instead of being passive learners. I wish to investigate how using communicative approach and cooperative learning strategies while teaching do affect and improve students’ learning performance. To achieve these goals qualitative data collection was used as the primary method. The results show that teachers and students value a supportive and caring relationship between them and that interaction is essential to the teacher-student relationship. This sense of caring and supporting from teachers motivates students to become a more interested learner. Students benefit and are motivated when their teachers create a safe and trustful environment. And also the methods and strategies teachers uses, makes students feel engaged and stimulated to participate in the learning process. The students have in their mind that a positive relationship with their teachers positively impacts their interest and motivation in school which contributes to the enhancement of the learning process.

La Multi-metodología Autobiográfica Extendida (MAE). Una estrategia cualitativa para estudiar la identidad, los fondos de conocimiento y las formas de vida

La multi-metodología autobiográfica es una aproximación cualitativa que combina distintas técnicas para estudiar la construcción narrativa de la identidad. El objetivo de este artículo es ofrecer una revisión de dicho enfoque a partir de una expansión de los distintos instrumentos cualitativos utilizados. Más concretamente, la multi-metodología autobiográfica extendida (MAE) consta de cuatro grupos de técnicas: entrevistas en profundidad (historia de vida, entrevista de fondos de conocimiento y la entrevista de Durand), el retrato o dibujo identitario revisado (dibujo identitario, auto-definición, tarea identitaria de las diez definiciones), el análisis de los artefactos-rutinas-formas de vida (diario de una semana, detección de artefactos, rutinas a través de fotografías, rutinas educativas a través de fotografías ) y la utilización de distintos “mapas psicológicos o psicogeográficos” (cronograma, genograma, ecomapa, geomapa y mapa relacional). Después de definir la identidad, los fondos de conocimiento y las formas de vida como posibles objetos de estudio en ciencias sociales, el artículo describe e ilustra las distintas técnicas que componen la metodología propuesta. Se concluye recomendando la triangulación de técnicas cualitativas narrativas basadas en el lenguaje, el caso de las tradicionales entrevistas en profundidad, con determinados procedimientos visuales, a partir de la utilización de fotografías o representaciones gráficas

Supplemental Information to the August 2008 Agriculture and Environment Task Force Report, August 2008

The Rebuild Iowa Agriculture and Environment Task Force respectfully submits its report to the Rebuild Iowa Advisory Commission (RIAC) for consideration of the impacts of the tornadoes, storms, high winds, and flooding affecting Iowa’s agriculture sector and environment. The Task Force was required to address very complex and multi-faceted issues. Understanding that there were a broad range of immediate concerns, as well as critical issues that need to be addressed in the future, the Task Force structured its work in two sessions. To better address the issues and priorities of the Task Force, this report categorizes the issues as agriculture, conservation, environment, and livestock.

Management of nanomaterials safety in research environment

Despite numerous discussions, workshops, reviews and reports about responsible development of nanotechnology, information describing health and environmental risk of engineered nanoparticles or nanomaterials is severely lacking and thus insufficient for completing rigorous risk assessment on their use. However, since preliminary scientific evaluations indicate that there are reasonable suspicions that activities involving nanomaterials might have damaging effects on human health; the precautionary principle must be applied. Public and private institutions as well as industries have the duty to adopt preventive and protective measures proportionate to the risk intensity and the desired level of protection. In this work, we present a practical, 'user-friendly' procedure for a university-wide safety and health management of nanomaterials, developed as a multi-stakeholder effort (government, accident insurance, researchers and experts for occupational safety and health). The process starts using a schematic decision tree that allows classifying the nano laboratory into three hazard classes similar to a control banding approach (from Nano 3 - highest hazard to Nano1 - lowest hazard). Classifying laboratories into risk classes would require considering actual or potential exposure to the nanomaterial as well as statistical data on health effects of exposure. Due to the fact that these data (as well as exposure limits for each individual material) are not available, risk classes could not be determined. For each hazard level we then provide a list of required risk mitigation measures (technical, organizational and personal). The target 'users' of this safety and health methodology are researchers and safety officers. They can rapidly access the precautionary hazard class of their activities and the corresponding adequate safety and health measures. We succeed in convincing scientist dealing with nano-activities that adequate safety measures and management are promoting innovation and discoveries by ensuring them a safe environment even in the case of very novel products. The proposed measures are not considered as constraints but as a support to their research. This methodology is being implemented at the Ecole Polytechnique de Lausanne in over 100 research labs dealing with nanomaterials. It is our opinion that it would be useful to other research and academia institutions as well. [Authors]