El mercat del vi espanyol als Estats Units

L’objecte d’estudi d’aquest projecte final, és el mercat del vi espanyol als Estats Units. Es tracta d’un mercat relativament jove degut a que la cultura del vi per un nord-americà amb una renda mitja es nova. Encara així, els Estats Units es el tercer país amb major consum per volum del món. Per tal de poder entendre millor aquest mercat, s’estudiaran les diferents característiques del país, les regions on es produeix el vi i la seva distribució i els diferents agents que s’impliquen en aquest procés en el país. Un cop analitzat els aspectes econòmics i les característiques més importants d’Estats Units, es realitzarà una anàlisi de l’oferta i de la demanda del sector del vi en aquest país per poder realitzar una comparativa més endavant amb el mercat del vi espanyol i de la perspectiva que es té a Estats Units sobre aquest tipus de vi. Un aspecte molt important que s’ha observat es la dificultat d’accés al mercat del vi a Estats Units. Per això, s’ha dedicat un capítol sencer a analitzar els diferents controls i regulacions que s’han de tenir en compte alhora d’importar vi a aquest país americà. Per últim, es realitza un anàlisi del mercat del vi espanyol i la perspectiva que es té dels vins espanyols a Estats Units. En aquest capítol s’analitzarà sobre tot la producció, el consum i les exportacions espanyoles i s’explicarà amb detall el concepte de denominacions d’origen.

Développement et validation d'une méthode de calcul indépendant des unités moniteur basée sur les simulations Monte Carlo pour la vérification des traitements IMRT

Résumé : La radiothérapie par modulation d'intensité (IMRT) est une technique de traitement qui utilise des faisceaux dont la fluence de rayonnement est modulée. L'IMRT, largement utilisée dans les pays industrialisés, permet d'atteindre une meilleure homogénéité de la dose à l'intérieur du volume cible et de réduire la dose aux organes à risque. Une méthode usuelle pour réaliser pratiquement la modulation des faisceaux est de sommer de petits faisceaux (segments) qui ont la même incidence. Cette technique est appelée IMRT step-and-shoot. Dans le contexte clinique, il est nécessaire de vérifier les plans de traitement des patients avant la première irradiation. Cette question n'est toujours pas résolue de manière satisfaisante. En effet, un calcul indépendant des unités moniteur (représentatif de la pondération des chaque segment) ne peut pas être réalisé pour les traitements IMRT step-and-shoot, car les poids des segments ne sont pas connus à priori, mais calculés au moment de la planification inverse. Par ailleurs, la vérification des plans de traitement par comparaison avec des mesures prend du temps et ne restitue pas la géométrie exacte du traitement. Dans ce travail, une méthode indépendante de calcul des plans de traitement IMRT step-and-shoot est décrite. Cette méthode est basée sur le code Monte Carlo EGSnrc/BEAMnrc, dont la modélisation de la tête de l'accélérateur linéaire a été validée dans une large gamme de situations. Les segments d'un plan de traitement IMRT sont simulés individuellement dans la géométrie exacte du traitement. Ensuite, les distributions de dose sont converties en dose absorbée dans l'eau par unité moniteur. La dose totale du traitement dans chaque élément de volume du patient (voxel) peut être exprimée comme une équation matricielle linéaire des unités moniteur et de la dose par unité moniteur de chacun des faisceaux. La résolution de cette équation est effectuée par l'inversion d'une matrice à l'aide de l'algorithme dit Non-Negative Least Square fit (NNLS). L'ensemble des voxels contenus dans le volume patient ne pouvant être utilisés dans le calcul pour des raisons de limitations informatiques, plusieurs possibilités de sélection ont été testées. Le meilleur choix consiste à utiliser les voxels contenus dans le Volume Cible de Planification (PTV). La méthode proposée dans ce travail a été testée avec huit cas cliniques représentatifs des traitements habituels de radiothérapie. Les unités moniteur obtenues conduisent à des distributions de dose globale cliniquement équivalentes à celles issues du logiciel de planification des traitements. Ainsi, cette méthode indépendante de calcul des unités moniteur pour l'IMRT step-andshootest validée pour une utilisation clinique. Par analogie, il serait possible d'envisager d'appliquer une méthode similaire pour d'autres modalités de traitement comme par exemple la tomothérapie. Abstract : Intensity Modulated RadioTherapy (IMRT) is a treatment technique that uses modulated beam fluence. IMRT is now widespread in more advanced countries, due to its improvement of dose conformation around target volume, and its ability to lower doses to organs at risk in complex clinical cases. One way to carry out beam modulation is to sum smaller beams (beamlets) with the same incidence. This technique is called step-and-shoot IMRT. In a clinical context, it is necessary to verify treatment plans before the first irradiation. IMRT Plan verification is still an issue for this technique. Independent monitor unit calculation (representative of the weight of each beamlet) can indeed not be performed for IMRT step-and-shoot, because beamlet weights are not known a priori, but calculated by inverse planning. Besides, treatment plan verification by comparison with measured data is time consuming and performed in a simple geometry, usually in a cubic water phantom with all machine angles set to zero. In this work, an independent method for monitor unit calculation for step-and-shoot IMRT is described. This method is based on the Monte Carlo code EGSnrc/BEAMnrc. The Monte Carlo model of the head of the linear accelerator is validated by comparison of simulated and measured dose distributions in a large range of situations. The beamlets of an IMRT treatment plan are calculated individually by Monte Carlo, in the exact geometry of the treatment. Then, the dose distributions of the beamlets are converted in absorbed dose to water per monitor unit. The dose of the whole treatment in each volume element (voxel) can be expressed through a linear matrix equation of the monitor units and dose per monitor unit of every beamlets. This equation is solved by a Non-Negative Least Sqvare fif algorithm (NNLS). However, not every voxels inside the patient volume can be used in order to solve this equation, because of computer limitations. Several ways of voxel selection have been tested and the best choice consists in using voxels inside the Planning Target Volume (PTV). The method presented in this work was tested with eight clinical cases, which were representative of usual radiotherapy treatments. The monitor units obtained lead to clinically equivalent global dose distributions. Thus, this independent monitor unit calculation method for step-and-shoot IMRT is validated and can therefore be used in a clinical routine. It would be possible to consider applying a similar method for other treatment modalities, such as for instance tomotherapy or volumetric modulated arc therapy.

Does the working environment influence health care professionals' values, meaning in life and religiousness? Palliative care units compared with maternity wards.

CONTEXT: Increased altruism, self-transcendence, and quests for meaning in life (MiL) have been found in palliative care (PC) patients and their families who experience the finiteness of life. Similar changes were observed in healthy subjects who were experimentally confronted with their mortality. OBJECTIVES: The study investigated how daily experiences of the transitoriness of life influence PC health care professionals' (HCPs) values, MiL, and religiousness. METHODS: In a cross-sectional study, the Schwartz Value Survey, the Schedule for Meaning in Life Evaluation, and the Idler Index of Religiosity were used to investigate personal values, MiL, and private religiousness. HCPs working in PC (confronted with death) were compared with a control group of HCPs working at maternity wards (MWs) using multivariate models. Differences were considered to be statistically significant at P < 0.05. RESULTS: Seventy PC- and 70 MW-HCPs took part in the study (response rate 74.0%). No differences between the groups were found in overall MiL satisfaction scores. PC-HCPs were significantly more religious than MW-HCPs; they listed spirituality and nature experience more often as areas in which they experience MiL. Furthermore, hedonism was more important for PC-HCPs, and they had higher scores in openness-to-change values (stimulation and self-direction). MW-HCPs were more likely to list family as a MiL area. They assigned more importance to health and scored higher in conservation values (conformity and security). Duration of professional experience did not influence these results. CONCLUSION: Basic differences in values, MiL, and religiousness between PC-HCPs and MW-HCPs might have influenced the choice of working environment because no effect of job duration was observed. Longitudinal research is needed to confirm this hypothesis.

Spatial distribution of motor units recruited during electrical stimulation of the quadriceps muscle versus the femoral nerve.

INTRODUCTION: In this study we investigated differences in the spatial recruitment of motor units (MUs) in the quadriceps when electrical stimulation is applied over the quadriceps belly versus the femoral nerve. METHODS: M-waves and mechanical twitches were evoked using over-the-quadriceps and femoral nerve stimulation of gradually increasing intensity from 22 young, healthy subjects. Spatial recruitment was investigated using recruitment curves of M-waves recorded from the vastus medialis (VM) and vastus lateralis (VL) and of twitches recorded from the quadriceps. RESULTS: At maximal stimulation intensity (Imax), no differences were found between nerve and over-the-quadriceps stimulation. At submaximal intensities, VL M-wave amplitude was higher for over-the-quadriceps stimulation at 40% Imax, and peak twitch force was greater for nerve stimulation at 60% and 80% Imax. CONCLUSIONS: For the VM, MU spatial recruitment during nerve and over-the-quadriceps stimulation of increasing intensity occurred in a similar manner, whereas significant differences were observed for the VL. Muscle Nerve, 2013.

A European survey on current practices in epilepsy monitoring units and implications for patients' safety.

OBJECTIVE: This study aimed to survey current practices in European epilepsy monitoring units (EMUs) with emphasis on safety issues. METHODS: A 37-item questionnaire investigating characteristics and organization of EMUs, including measures for prevention and management of seizure-related serious adverse events (SAEs), was distributed to all identified European EMUs plus one located in Israel (N=150). RESULTS: Forty-eight (32%) EMUs, located in 18 countries, completed the questionnaire. Epilepsy monitoring unit beds are 1-2 in 43%, 3-4 in 34%, and 5-6 in 19% of EMUs; staff physicians are 1-2 in 32%, 3-4 in 34%, and 5-6 in 19% of EMUs. Personnel operating in EMUs include epileptologists (in 69% of EMUs), clinical neurophysiologists trained in epilepsy (in 46% of EMUs), child neurologists (in 35% of EMUs), neurology and clinical neurophysiology residents (in 46% and in 8% of EMUs, respectively), and neurologists not trained in epilepsy (in 27% of EMUs). In 20% of EMUs, patients' observation is only intermittent or during the daytime and primarily carried out by neurophysiology technicians and/or nurses (in 71% of EMUs) or by patients' relatives (in 40% of EMUs). Automatic detection systems for seizures are used in 15%, for body movements in 8%, for oxygen desaturation in 33%, and for ECG abnormalities in 17% of EMUs. Protocols for management of acute seizures are lacking in 27%, of status epilepticus in 21%, and of postictal psychoses in 87% of EMUs. Injury prevention consists of bed protections in 96% of EMUs, whereas antisuffocation pillows are employed in 21%, and environmental protections in monitoring rooms and in bathrooms are implemented in 38% and in 25% of EMUs, respectively. The most common SAEs were status epilepticus reported by 79%, injuries by 73%, and postictal psychoses by 67% of EMUs. CONCLUSIONS: All EMUs have faced different types of SAEs. Wide variation in practice patterns and lack of protocols and of precautions to ensure patients' safety might promote the occurrence and severity of SAEs. Our findings highlight the need for standardized and shared protocols for an effective and safe management of patients in EMUs.

Ethnic sensitive substance abuse work : services for non-Finnish speaking clients in substance abuse treatment units in Finland today

The purpose of this study was to examine the current situation in substance abuse treatment units in Finland in taking non-Finnish speaking clients into consideration. The initiative for this research came from the Development of Alcohol and Drugs Intervention group at Stakes (National Research and Development Centre for Welfare and Health). Their aim was to gather information about the functioning and relevance of the quality assessment forms based on the quality recommendations for substance abuse work, filled in by substance abuse treatment units. The ethnic issue was chosen as the main approach in the study. The aim of this research was to answer the following questions: what is the readiness and competence in substance abuse treatment units in Finland to receive and encounter non-Finnish speaking clients, how is the quality of these services assessed and/or developed in the units, and what has been the role and functioning of the quality recommendations and quality assessment forms in working with non-Finnish speaking clients. The research methods used in the study were both quantitative and qualitative. The information concerning language services provided in the units was gathered from the quality assessment forms and basic information forms found in the database maintained by Stakes. The total amount of units found in the database was 267. In addition to that, semi-structured theme-interviews were carried out in four substance abuse treatment units in order to get a more deep understanding of how the services function in practice. The few number of non-Finnish speaking clients in the units may explain to a certain degree the results of the research. The results however showed that there is still space for improving the services. In the light of quality recommendations, the degree of language options provided in substance abuse treatment units in Finland today is low. Also the quantity of interpreter services provided in the units is scarce. There could also be unified guidelines specially tailored for substance abuse treatment units on how to work with ethnic minorities, as the knowledge is currently adopted from several different instances. The quality recommendations as well as quality assessment forms were valued and applied in the units appropriately and were also perceived to have an effect on the functioning, and quality, in the units.

Factors affecting tightness of package

Työn tarkoituksena oli tutkia kartonkipohjaisten pakkausmateriaalien läpäisyominaisuuksia sekä pakkausten tiiveyteen vaikuttavia tekijöitä. Työssä verrattiin skaivatun ja skaivaamattoman raakareunan sekä tölkkien pohjaratkaisujen ominaisuuksia vesihöyryn- ja hapen läpäisevyydessä, kun käytetty kartonki oli molemmin puolin polymeeripäällystetty. Tiiveysominaisuuksia tutkittiin myös vuotomittauksin, värjäyksin ja elektronimikroskoopilla. Kuivan elintarvikkeen säilytystestillä ja kilpailijapakkausanalyyseillä oli tarkoituksena myös saada selville eri pakkausmateriaalien ja pakkauksien läpäisevyys- ja tiiveysominaisuuksia. Pakkauksen saumoilla oli yhtä suuri tai suurempi vaikutus vesihöyryn läpäisyssä kuin itse materiaalilla, kun pakkaus oli molemmin puolin polymeeripäällystetty kartonkikuppi. Skaivatun sauman vesihöyrynläpäisy oli vain 4-10 % pienempi kuin raakareunallisen sauman. Pakkauksen ulkopuolisten raakareunojen suojaaminen pienensi vesihöyrynläpäisevyyttä 30 %. Kun pakkauksen sisäpuolen raaka-reuna oli suojattu teipillä, saumoilla ei ollut niin suurta vaikutusta vesihöyryn läpäisyyn verrattuna materiaaliin. Raakareunan määrällä tölkin pohjassa tai pienillä vuodoilla tölkin saumoissa ei ollut merkitystä vesihöyryn läpäisyyn. Hapenläpäisyssä oli tärkeää ehyt barrierkerros. Polymeerisen barrierkerroksen reiät ja sauman skaivaus vaikuttivat enemmän kuin vesihöyryn läpäisyssä. Mitä enemmän tölkin pohjassa oli raakareunaa, sitä suurempi oli sen hapenläpäisy. Pakkauksen konvertointi, koneen säädöt ja lämmön kohdistus, ovat saattaneet aiheuttaa värjäyksellä havaitut barrierkerroksen mikroreiät. Kaupalliset kuiva-ainepakkaukset sisälsivät pääasiassa alumiinilaminaatin vesihöyryn, hapen ja valon suojana, kun tuotteena oli maitojauhetta ja rasvaa sisältävä elintarvike. Kuitenkin, jos pakkausmateriaali sisälsi vain ohuen sumutetun alumiinikerroksen, sen barrieriominaisuus ei ollut yhtä hyvä kuin alumiinilaminaatin. Äidinmaidonkorvikkeen säilytystestissä seurattiin eri analyysein tuotteen laatua kolmen kuukauden säilytyksen ajan. Pakkauksen vesihöyryn läpäisyominaisuus osoittautui tärkeimmäksi, sillä kosteuden vaikutus tuotteen laadun heikkenemisessä oli suurin. Hapen vaikutus on myös olennainen ja siten hyvä hapenestokerros sekä tiiveys ovat myös tärkeitä pakkauksen ominaisuuksia.

The tightness performance of pre-formed trays as package

Suojakaasupakkaaminen (MAP) on yleistynyt viime aikoina, koska sen avulla voidaan säilöä tuoreita tai vähän käsiteltyjä elintarvikkeita pidempään. Suurin syy hyllyiän pidentymiseen on hiilidioksidin aiheuttama mikrobien kasvun hidastuminen. Toisaalta huolena on patogeenisten mikrobien lisääntyminen anaerobisissa olosuhteissa. Pidempi säilyvyys voidaan saavuttaa myös käyttämällä vähemmän lisä- ja säilöntäaineita. Samalla suojakaasupakkaaminen kuitenkin vähentää myös pilaantuneiden tuotteiden määrää. Eniten suojakaasua käytetään lihan pakkaamisessa. Suojakaasupakkaamisessa elintarvikepakkaukseen syötetään normaalista huoneilmasta poikkeava kaasuseos. Pääasiassa kaasuseos koostuu hiilidioksidista, hapesta ja typestä. Lisäksi voidaan käyttää pieniä määriä hiilimonoksidia, argonia ja rikkidioksidia. Kaasuseoksen koostumus määräytyy elintarvikkeiden ominaisuuksien ja vaatimusten perusteella. Halutun kaasukoostumuksen tulee säilyä pakkauksessa muutamasta päivästä muutamaan kuukauteen riippuen elintarvikkeesta. Siksi tärkein pakkaukselta vaadittava ominaisuus on riittävä kaasutiiveys ja erityisesti hapenläpäisevyys. Koska suurin osa suojakaasupakkauksista on tällä hetkellä muovisia, tutkittiin kokeellisessa osiossa kartonkipakkausten tiiveysominaisuuksia. Kokeet tehtiin vertailemalla erilaisten vuoka- ja kansimateriaalien vaikutusta pakkausten tiiveyteen. Vuokien onnistuminen oli suurin yksittäinen tuloksiin vaikuttanut tekijä. Epäonnistuneen vuoan vaikutukset näkyivät myös saumauksessa, koska saumaustyökalun ja vuoan piti sopia yhteen. Lisäksi näkymättömät mikroreiät hankaloittivat todellisten vuotokohtien paikallistamista. Vuototestausten perusteella materiaaleille löydettiin kuitenkin viitteelliset optimiparametrit. Tärkein saumauksessa vaikuttanut tekijä oli sopivan saumauslämpötilan valinta. Prässättyjen vuokien laatu oli epätasainen. Siksi erityisesti rinnakkaisten kansitus- ja hapenläpäisymittausten väliset erot olivat merkitseviä. Lisäksi prässäys laski materiaalien hapenläpäisyominaisuuksia. Yksittäisten vuokien tiiveysominaisuudet täyttivät kuitenkin kaupallisille kaasupakkauksille asetetut vaatimukset. Vesihöyrynläpäisevyydessä materiaalin vesihöyrynläpäisy oli merkittävämpää kuin vesihöyryn kulkeutuminen vuotokohtien tai epäonnistuneiden saumojen kautta.

Transfer pricing tool development process based on valve package production costs

Tämän diplomityön päätavoitteena oli parantaa kehitetyn kustannusperusteisen siirtohinnoittelutyökalun ominaisuuksia osastokohtaisen kustannusarviointiprosessin käyttöön. Työ on vaikeutunut lähimenneisyyden heikosta hintakyselyiden vastauskyvystä. Työn pääongelmana oli kerätä luotettavaa tuotannonohjausjärjestelmän kustannusaineistoa osittain vanhentuneista vakioventtiilien koneistus- ja materiaalitiedosta. Tutkimuksessa käytetyt tärkeimmät tutkimusmenetelmät voidaan jakaa siirtohinnoittelu- ja kustannusarvioprosessien kirjallisuustutkimukseen, kenttäanalyysiin ja nykyisen Microsoft Excel –siirtohinnoittelutyökalun kehittämiseen eri osastojen rajapinnassa. Siirtohinnoittelumenetelmät ovat yleisesti jaettu kustannus-, markkina- ja neuvotteluperusteisiin malleihin, jotka harvoin sellaisenaan kohtaavat siirtohinnoittelulle asetetut tavoitteet. Tämä ratkaisutapa voi johtaa tilanteisiin, jossa kaksi erillistä menetelmää sulautuvat yhteen. Lisäksi varsinaiseen siirtohinnoittelujärjestelmään yleensä vaikuttavat useat sisäiset ja ulkoiset tekijät. Lopullinen siirtohinnoittelumenetelmä tulisi ehdottomasti tukea myös yrityksen visiota ja muita liiketoiminnalle asetettuja strategioita. Työn tuloksena saatiin laajennettu Microsoft Excel –sovellus, joka vaatii sekä vuosittaista että kuukausittaista erikoisventtiilimateriaalien hinta- ja toimitusaikatietojen päivittämistä. Tämä ratkaisutapa ehdottomasti parantaa kustannusarviointiprosessia, koska myös alihankkijatietoja joudutaan tutkimaan systemaattisesti. Tämän jälkeen koko siirtohinnoitteluprosessia voidaan kehittää muuntamalla kokoonpano- ja testaustyövaiheiden kustannusrakennetta toimintoperustaisen kustannuslaskentamallin mukaiseksi.

Carbon balance of Fibre-Based Package

Customers are more and more interested in the environmental impacts of the products they purchase. Different labels give the required environmental information to consumers and the labels might affect to the consuming decisions. The European Union has set a plan for sustainable consuming, which encourages industry and commerce to calculate carbon footprints for the products. A term “carbon footprint” means carbon dioxide emissions across the product lifecycle. In this thesis, carbon footprints are calculated for two different fibre-based packages. In the end, greenhouse gas emissions from fibre-package production are compared to greenhouse gas emissions from PET bottle production. The data for mill processes is exact and monitored in the mill. In addition, data was gathered from raw material and material suppliers, customers, official records, KCL-eco databases and literature. The data for PET bottle is sourced from literature. End-of-life operations affect greatly on the carbon footprint of a fibre-based package. The results show that the carbon footprint is smallest when used packages are recycled. Recycling saves also natural resources. If used packages are not recyclable for some reason, it is recommended to use them in energy production. Through waste incineration fossil fuels could be substituted and greenhouse gas emissions avoided.

Improved predictive mapping of indoor radon concentrations using ensemble regression trees based on automatic clustering of geological units.

PURPOSE: According to estimations around 230 people die as a result of radon exposure in Switzerland. This public health concern makes reliable indoor radon prediction and mapping methods necessary in order to improve risk communication to the public. The aim of this study was to develop an automated method to classify lithological units according to their radon characteristics and to develop mapping and predictive tools in order to improve local radon prediction. METHOD: About 240 000 indoor radon concentration (IRC) measurements in about 150 000 buildings were available for our analysis. The automated classification of lithological units was based on k-medoids clustering via pair-wise Kolmogorov distances between IRC distributions of lithological units. For IRC mapping and prediction we used random forests and Bayesian additive regression trees (BART). RESULTS: The automated classification groups lithological units well in terms of their IRC characteristics. Especially the IRC differences in metamorphic rocks like gneiss are well revealed by this method. The maps produced by random forests soundly represent the regional difference of IRCs in Switzerland and improve the spatial detail compared to existing approaches. We could explain 33% of the variations in IRC data with random forests. Additionally, the influence of a variable evaluated by random forests shows that building characteristics are less important predictors for IRCs than spatial/geological influences. BART could explain 29% of IRC variability and produced maps that indicate the prediction uncertainty. CONCLUSION: Ensemble regression trees are a powerful tool to model and understand the multidimensional influences on IRCs. Automatic clustering of lithological units complements this method by facilitating the interpretation of radon properties of rock types. This study provides an important element for radon risk communication. Future approaches should consider taking into account further variables like soil gas radon measurements as well as more detailed geological information.

Dépistage du risque d'allergie et prévention en maternité : enquête des pratiques AllerNaiss [Screening for the risk of allergy and prevention in French maternity units: A survey].

Allergy has been on the rise for half a century and concerns nearly 30% of children; it has now become a real public health problem. The guidelines on prevention of allergy set up by the French Society of Paediatrics (SFP) and the European Society of Paediatric Allergology and Clinical Immunology (ESPACI) are based on screening children at risk through a systematic search of the family history and recommend, for children at risk, exclusive breastfeeding whenever possible or otherwise utilization of hypoallergenic infant formula, which has demonstrated efficacy. The AllerNaiss practice survey assessed the modes of screening and prevention of allergy in French maternity units in 2012. The SFP guidelines are known by 82% of the maternity units that took part in the survey, and the ESPACI guidelines by 55% of them. A screening strategy is in place in 59% of the participating maternity wards, based on local consensus for 36% of them, 13% of the units having a written screening procedure. Screening is based on the search for a history of allergy in first-degree relatives (99%) during pregnancy (51%), in the delivery room (50%), and after delivery (89%). A mode of prevention of the risk of allergy exists in 62% of the maternity units, most often in writing (49%). A hypoallergenic infant formula is prescribed for non-breastfed children in 90% of the units. The survey shows that there is a real need for formalization of allergy risk screening and prevention of allergy in newborns in French maternity units.