Guide for World Class Commissioners Promoting Health and Well-being: Reducing Inequalities

One of the core missions of commissioners is to reduce health inequalities. Promoting health and well-being is necessary but not sufficient, and it is essential thatimprovements in commissioning and consequent improvements in service delivery, will not widen the gapbetween different groups in society. It is, of course,already difficult enough to decide how to commission services to promote health and well-being. There are practical, economic and ethical issues involved, but if in addition the commissioner wishes to ensure that the gap between the most healthy and the least healthy does not widen, they will have to think hard and commission carefully. It is also crystal clear that it would be wrong to let 152 Primary Care Trusts find out for themselves how to do this. Firstly, it would be a massive waste of resources, and secondly, many Primary Care Trusts would be unable to deliver. This Guide has been produced by knowledge harvesting; by gathering the knowledge that commissioners have created and accrued, about successes as well as failures; and blending it into a single readable Guide.

Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer

BACKGROUND: Mediastinal lymph-node dissection was compared to systematic mediastinal lymph-node sampling in patients undergoing complete resection for non-small cell lung cancer with respect to morbidity, duration of chest tube drainage and hospitalization, survival, disease-free survival, and site of recurrence. METHODS: A consecutive series of one hundred patients with non-small-cell lung cancer, clinical stage T1-3 N0-1 after standardized staging, was divided into two groups of 50 patients each, according to the technique of intraoperative mediastinal lymph-node assessment (dissection versus sampling). Mediastinal lymph-node dissection consisted of removal of all lymphatic tissues within defined anatomic landmarks of stations 2-4 and 7-9 on the right side, and stations 4-9 on the left side according to the classification of the American Thoracic Society. Systematic mediastinal lymph-node sampling consisted of harvesting of one or more representative lymph nodes from stations 2-4 and 7-9 on the right side, and stations 4-9 on the left side. RESULTS: All patients had complete resection. A mean follow-up time of 89 months was achieved in 92 patients. The two groups of patients were comparable with respect to age, gender, performance status, tumor stage, histology, extent of lung resection, and follow-up time. No significant difference was found between both groups regarding the duration of chest tube drainage, hospitalization, and morbidity. However, dissection required a longer operation time than sampling (179 +/- 38 min versus 149 +/- 37 min, p < 0.001). There was no significant difference in overall survival between the two groups; however, patients with stage I disease had a significantly longer disease-free survival after dissection than after sampling (60.2 +/- 7 versus 44.8 +/- 8 months, p < 0.03). Local recurrence was significantly higher after sampling than after dissection in patients with stage I tumor (12.5% versus 45%, p = 0.02) and in patients with nodal tumor negative mediastinum (N0/N1 disease) (46% versus 13%, p = 0.004). CONCLUSION: Our results suggest that mediastinal lymph-node dissection may provide a longer disease-free survival in stage I non-small cell lung cancer and, most importantly, a better local tumor control than mediastinal lymph-node sampling after complete resection for N0/N1 disease without leading to increased morbidity.

Determinació de l’efecte de la temperatura en l’eficàcia de les matèries actives 6-benziladenina i àcid naftalè acètic emprades en l’aclarida química de pomera

Estudi de l’ efecte de les condicions ambientals,concretament de la temperatura, sobre l’eficàcia de les principals matèries actives, àcid naftalè acètic (ANA) i 6- benziladenina (6-BA), emprades en l’aclarida química de les pomeres

Avaluació de la pèrdua de qualitat de la poma “Fuji” deguda al dany produït pel cop de sol

Estudi de l’afectació del cop de sol a les pomes de varietat fuji, sobretot tenint en compte que l’aspecte visual té una repercussió econòmica molt important

Contribució al coneixement del cicle biològic de la carpocapsa (Cydia pomonella (L.)) de pomes i peres a Girona: estimació de l’entrada en diapausa de la població de segona generació

Estudi de la Cydia pomonella (L.), corc de les pomes i de les peres que és una plaga molt important en tot l’àmbit estatal i del control que cal fer-ne per tal d’evitar la pèrdua total o parcial de la collita

TFC - Desenvolupament d'aplicacions per dispositius mòbils - .Castells - Memòria final

Aquesta memòria representa un resum final del projecte .Castells desenvolupat com a Treball Finalde Carrera dins de l'àrea Desenvolupament d'aplicacions per dispositius mòbils dels estudisd'Enginyeria Tècnica Informàtica de Gestió de la Universitat Oberta de Catalunya.El projecte .Castells permet a qualsevol persona que participi en un castell fer persistent en unabase de dades la seva participació i generar estadístiques de les dades desades. Igualmentl'aplicació incorpora informació útil del món casteller.El document explica com s'ha creat l'aplicació des del principi fins al final: introducció al projecte,anàlisi del sistema, disseny tècnic, implementació i conclusions.És important destacar que el projecte .Castells és un projecte desenvolupat utilitzant l'IDE Xcoded'Apple, el llenguatge de programació Objective-C i l'iOS SDK 5 com a principals eines i que, tot ique pot funcionar a dispositius iPad, està pensat principalment per ser utilitzat sobre dispositiusmòbils iPhone d'Apple.

Video presentació projecte .Castells

Video presentació projecte .Castells

Towards no-scar cardiac surgery - minimally invasive access through umbilicus for aortic valve replacement.

There is an ever-growing trend towards less-invasive procedures in all fields of medicine. We designed an animal study to prove the concept that trans-apical aortic valve replacement from an incision within the umbilicus through a single channel for instruments is feasible, which would be a major leap towards no-scar cardiac surgery. In three adult pigs, after creating a single 3-cm incision at a place where the human umbilicus would be, we introduced a 30F sheath through a tunnel created by an endoscopic vein-harvesting device up to the cardiac apex, through it and up to the left ventricle simulating the approach for trans-apical aortic valve replacement. We used a standard Amplatz nitinol occluder to seal the defect in ventricle wall later. The animals were followed up for 1h. Blood loss was minimal, and no tamponade occurred in any of the animals. In addition, we performed a test with water column static pressure to evaluate the impact of preclotting on the sealing properties of the occluders: 1 min flow-through was 2860+/-176 ml for the standard occluders and 348+/-56 ml for preclotted occluders (p<0.001).

Determinació de la data òptima de collita de la poma 'Granny Smith' en base a paràmetres de qualitat del fruit

La varietat de poma ‘Granny Smith’ es cull actualment atenent al temps transcorregut des de la floració de l’arbre, i no als paràmetres de qualitat del fruit. Els objectius d’aquest treball són determinar la data òptima de collita segons el grau de satisfacció dels consumidors (mitjançant la realització d’un tast de consumidors), relacionar la sensibilitat a l’escaldat superficial amb els paràmetres de maduresa a collita (valorant fruit a fruit després d’un període de conservació en cambra frigorífica de 5 mesos) i la posta a punt del DA-meter com a eina per a la gestió de la collita de la ‘Granny Smith’. Les conclusions del treball han estat: els consumidors han valorat més positivament la fruita collida més verda, però aquesta presenta l’inconvenient que té una afectació per escaldat superficial molt més elevada que la collida en un estat de maduresa més avançat. Pel que fa al DA-meter, encara no està preparat per ser utilitzat com a eina per a la gestió de la collita de la ‘Granny Smith’ tal com està concebut actualment

Power and selection of contract terms: The case from the Brazilian orange juice sector

ABSTRACT We propose a model to explain how contract terms are selected in the presence of a form of economic power: contract power. The orange juice sector is used to illustrate an analysis that demonstrates the effects of contract power on the economic organization of the sector. We define contract power as the ability to exploit contractual gaps or failures of contractual provisions, which are strategically left incomplete. Empirical evidence from content analysis of antitrust documents supports the logic of contract power in the orange juice sector in three forms: avoiding changes to payment methods from weight to solid contents (quality); using information asymmetries to manipulate indexes that calculate the formula of orange prices; and deliberately harvesting oranges late in order to dehydrate the fruit, which consequently reduces weight and price. The paper contributes to understanding the selection of contract terms and the debate about how antitrust offices can deal with this issue.

Free-living energy expenditure assessed by two different methods in rural Gambian men.

OBJECTIVE: To assess total free-living energy expenditure (EE) in Gambian farmers with two independent methods, and to determine the most realistic free-living EE and physical activity in order to establish energy requirements for rural populations in developing countries. DESIGN: In this cross-sectional study two methods were applied at the same time. SETTING: Three rural villages and Dunn Nutrition Centre Keneba, MRC, The Gambia. SUBJECTS: Eight healthy, male subjects were recruited from three rural Gambian villages in the sub-Sahelian area (age: 25 +/- 4y; weight: 61.2 +/- 10.1 kg; height: 169.5 +/- 6.5 cm, body mass index: 21.2 +/- 2.5 kg/m2). INTERVENTION: We assessed free-living EE with two inconspicuous and independent methods: the first one used doubly labeled water (DLW) (2H2 18O) over a period of 12 days, whereas the second one was based on continuous heart rate (HR) measurements on two to three days using individual regression lines (HR vs EE) established by indirect calorimetry in a respiration chamber. Isotopic dilution of deuterium (2H2O) was also used to assess total body water and hence fat-free mass (FFM). RESULTS: EE assessed by DLW was found to be 3880 +/- 994 kcal/day (16.2 +/- 4.2 MJ/day). Expressed per unit body weight the EE averaged 64.2 +/- 9.3 kcal/kg/d (269 +/- 38 kJ/kg/d). These results were consistent with the EE results assessed by HR: 3847 +/- 605 kcal/d (16.1 +/- 2.5 MJ/d) or 63.4 +/- 8.2 kcal/kg/d (265 +/- 34kJ/kg/d). Physical activity index, expressed as a multiple of basal metabolic rate (BMR), averaged 2.40 +/- 0.41 (DLW) or 2.40 +/- 0.28 (HR). CONCLUSIONS: These findings suggest an extremely high level of physical activity in Gambian men during intense agricultural work (wet season). This contrasts with the relative food shortage, previously reported during the harvesting period. We conclude that the assessment of EE during the agricultural season in non-industrialized countries needs further investigations in order to obtain information on the energy requirement of these populations. For this purpose the use of the DLW and HR methods have been shown to be useful and complementary.

An integrated approach for the assessment of HAB dynamics in two NW Mediterranean bays from a GEOHAB perspective

Alfacs and Fangar Bay in the Ebro Delta, NW Mediterranean are the major sites in Catalonia for shellfish cultivation. These bays are subject to occasional closures in shellfish harvesting due to the presence of phycotoxins. Fish kills have also been associated with harmful algal blooms. The comparison of phytoplankton dynamics in both bays offers the opportunity to reveal differences in bloom patterns of species known to be harmful for the ecosystem and aquaculture activities. Field research is underway under the GEOHAB framework within the Core Research Project on HABs in Fjords and Coastal Embayments. The overall objective of this study is to improve our understanding of HAB biogeographical patterns, and key elements driving bloom dynamics in time and space within these semi-constrained embayments. Via the comparative approach we aim to improve the prediction for monitoring purposes, with a focus on Karlodinium spp. associated with massive kills of aquaculture species. This objective is addressed by incorporating long-term time series of phytoplankton identification and enumeration with the first results of recent field work in both bays. The latter includes the application of optical sensors, to yield a complementary view with enhanced spatial and temporal resolution of bloom phenomena.

Plataforma distribuida para la clasificación de clases de isomorfia de curvas hiperelípticas de género 2 sobre cuerpos finitos de característica 2

Análisis, desarrollo e implementación de una plataforma distribuida constituida por varios ordenadores de una red local en un sistema Grid, utilizando la técnica de Harvesting. De forma concreta lo que se calculará con la plataforma será un problema matemático consistente en la clasificación de curvas hiperelípticas de género 2 sobre cuerpos binarios. Los resultados de este proyecto pueden ser válidos con fines criptográficos de forma general. Se pretende separar el cálculo matemático de la plataforma, para que ésta sea reutilizable.

Desenvolupament d'un node sensor sense fils autoalimentat. Mòdul piezo-magnètic

En aquest projecte es pretén implementar un dispositiu capaç de ser auto-suficient i no dependre de cap tipus de pila, bateria o fil elèctric que l’abasteixi d’energia elèctrica. El dispositiu recol·lectarà la energia magnètica generada per la corrent elèctrica a un fil i la transformarà en energia elèctrica, que serà emmagatzemada per el seu posterior ús. A demès, aquest projecte s’ha desenvolupat en col·laboració amb un segon projecte, dintre del qual s’implementarà una xarxa de sensors, mitjançant el protocol MIWI. Aquest projecte es divideix en tres grans blocs. El primer bloc del projecte serà una introducció teòrica de tots els coneixements relacionats amb el concepte d’energy harvesting i els mecanismes físic implicats. Al segon bloc podrem veure com s’han realitzat els càlculs, simulacions i posada en marxa, dels diferents elements que formaran el dispositiu recol·lector d’energia. Per últim en el tercer bloc veurem el prototip ja implementat. Es valoraran els resultats obtinguts, i es veuran els temps que necessitarà per alimentar al microcontrolador.