Estimation of lung cancer diagnosis and treatment costs based on a patient-level analysis in Catalonia (Spain)

Background: Assessing of the costs of treating disease is necessary to demonstrate cost-effectiveness and to estimate the budget impact of new interventions and therapeutic innovations. However, there are few comprehensive studies on resource use and costs associated with lung cancer patients in clinical practice in Spain or internationally. The aim of this paper was to assess the hospital cost associated with lung cancer diagnosis and treatment by histology, type of cost and stage at diagnosis in the Spanish National Health Service. Methods: A retrospective, descriptive analysis on resource use and a direct medical cost analysis were performed. Resource utilisation data were collected by means of patient files from nine teaching hospitals. From a hospital budget impact perspective, the aggregate and mean costs per patient were calculated over the first three years following diagnosis or up to death. Both aggregate and mean costs per patient were analysed by histology, stage at diagnosis and cost type. Results: A total of 232 cases of lung cancer were analysed, of which 74.1% corresponded to non-small cell lung cancer (NSCLC) and 11.2% to small cell lung cancer (SCLC); 14.7% had no cytohistologic confirmation. The mean cost per patient in NSCLC ranged from 13,218 Euros in Stage III to 16,120 Euros in Stage II. The main cost components were chemotherapy (29.5%) and surgery (22.8%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs but an increase in chemotherapy costs. In SCLC patients, the mean cost per patient was 15,418 Euros for limited disease and 12,482 Euros for extensive disease. The main cost components were chemotherapy (36.1%) and other inpatient costs (28.7%). In both groups, the Kruskall-Wallis test did not show statistically significant differences in mean cost per patient between stages. Conclusions: This study provides the costs of lung cancer treatment based on patient file reviews, with chemotherapy and surgery accounting for the major components of costs. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain.

Guia temàtica Biblioteca ETSAB: Museu Marès (Antic Tribunal de la Inquisició)

Postprint (author’s final draft)

Impacts of climate change on water resources in the Mediterranean basin : a case study in Catalonia, Spain

Most climate change projections show important decreases in water availability in the Mediterranean region by the end of this century. We assess those main climate change impacts on water resources in three medium-sized catchments with varying climatic conditions in north-eastern Spain. A combination of hydrological modelling and climate projections with B1 and A2 IPCC emission scenarios is performed to infer future stream flows. The largest reduction (22-48% for 2076-2100) of stream flows is expected in the headwaters of the two wettest catchments, while lower decreases (22-32% for 2076-2100) are expected in the drier one. In all three catchments, autumn and summer are the seasons with the most notable projected decreases in stream flow, 50% and 34%, respectively (2076-2100). Thus, ecological flows might be noticeably impacted by climate change in the catchments, especially in the headwaters of those wet catchments.

Choosing the optimal energy system for buildings and districts

The purpose of this master’s thesis was to develop a method to be used in the selection of an optimal energy system for buildings and districts. The term optimal energy system was defined as the energy system which best fulfils the requirements of the stakeholder on whose preferences the energy systems are evaluated. The most influential stakeholder in the process of selecting an energy system was considered to be the district developer. The selection method consisted of several steps: Definition of the district, calculating the energy consumption of the district and buildings within the district, defining suitable energy system alternatives for the district, definition of the comparing criteria, calculating the parameters of the comparing criteria for each energy system alternative and finally using a multi-criteria decision method to rank the alternatives. For the purposes of the selection method, the factors affecting the energy consumption of buildings and districts and technologies enabling the use of renewable energy were reviewed. The key element of the selection method was a multi-criteria decision making method, PROMETHEE II. In order to compare the energy system alternatives with the developed method, the comparing criteria were defined in the study. The criteria included costs, environmental impacts and technological and technical characteristics of the energy systems. Each criterion was given an importance, based on a questionnaire which was sent for the steering groups of two district development projects. The selection method was applied in two case study analyses. The results indicate that the selection method provides a viable and easy way to provide the decision makers alternatives and recommendations regarding the selection of an energy system. Since the comparison is carried out by changing the alternatives into numeric form, the presented selection method was found to exclude any unjustified preferences over certain energy systems alternatives which would affect the selection.

A Comparative Study of the Effectiveness of a Prefabricated Appliance and a Stabilization Appliance in the Treatment of Myofascial pain and Headache

The aim of this thesis was to evaluate the short- and long-term effectiveness of a prefabricated occlusal appliance (R) on patients with myofascial pain and headache by comparing it with the treatment of the stabilization appliance (S). Another aim was to evaluate the effect of appliance treatment on stress-related salivary parameters like cortisol and IgA, as well as on flow rate values in these patients. Sixty-five patients diagnosed with myofascial temporomandibular disorder (TMD) pain, of whom 94% suffered concomitantly from headache, at two centres for Stomatognathic Physiology, one in Sweden and one in Finland, were included in this randomized controlled trial using Research Diagnostic Criteria for TMD (RDC/TMD), with history questionnaires and clinical examinations performed at baseline and at 6- and 10-weeks, and 6- and 12-month follow-ups. Patients were randomly assigned either to the R or the S group. Treatment outcome was measured according to IMMPACT (Initiative on Methods, Measurements, and Pain Assessment in Clinical Trials), i.e. four chronic pain outcome domains: pain intensity, overall improvement, physical and emotional functioning. Changes in frequency and intensity of headache were recorded. Thirty-nine patients participated in the saliva study. Salivary analyses were performed at 6 and 10 weeks. The results revealed no differences between groups at baseline. At all follow-ups, all four outcome measures, as well as frequency and intensity of headache, showed statistically significant within-group improvement compared to baseline, without significant differences between groups. No treatment-induced changes in saliva parameters could be registered. In conclusion, the effectiveness of the prefabricated appliance seemed to be similar to that of the stabilization appliance in alleviating myofascial pain, and frequency and intensity of headache, in the short as well as the long term. However, no changes in salivary parameters were observed during treatment.

Petri Net approach for modelling system integration in intelligent buildings

In this paper, a Petri Net approach is introduced for modelling and simulation of control strategies in Intelligent Building. In this context, it is claimed that integration with other building systems can be achieved in a more systematic way considering a mechatronic approach (i.e. multidisciplinary concepts applied to the development of systems). The case study is the Ambulatory Building of Medical School Hospital of University of São Paulo. Particularly, the developed methodology is applied to the elevator system and to the HVAC (Heating, Ventilation and Air Conditioning) system. It is shown that using this approach, the control systems could be integrated, improving performance.

Six months residence and rravels in México ; containing remarks onthe present state of New Spain, its natural productions, state of society, manufactures, trade, agriculture and antiquities

UANL

Arbitration under the regulations on the guarantee of new residential buildings in Quebec

Dans ma mémoire, j’ai discuté les concepts d’arbitrage comme méthode de résolution d’un litige et par après, je donne un court historique de l’acceptation d’arbitrage au Québec. Le Chapitre I étudie la structure des règlements du R.B.Q., qui est un gendre d’arbitrage obligatoire institutionnelle, et j’inclus les diverses procédures dans ce système d’arbitrage. La sécurité offert par le plan de garantie règle par le R.B.Q. est discuté dans le Chapitre II en autant qu’il est relié avec le system d’arbitrage R.B.Q., y compris la structure du plan et le contenu de la sécurité. Chapitre III parle des recours disponible aux Bénéficiares ainsi que les avantages et désavantages de l’arbitrage sous les Règlements du R.B.Q. Un court étude comparative de quatre autres juridictions est recherché en Chapitre IV, incluant notre voisin, Ontario, les Etats-Unis et on croise dans les juridictions de Royaume Unie et Allemagne. En conclusion, j’établis que notre système d’arbitrage sous le Règlement protéges notre publique plus que d’autres juridictions. Je suggère des améliorations au système, par contre, incluant l’agrandissement du plan de garantie, l’ajout des pouvoirs donnés aux arbitres américains et ensuite d’intègré un système d’arrêt semblable aux Royaumes Unis.

An approach to compatible new buildings in historic urban environments : case study in the Arabian Gulf region

Cette thèse contribue à l'état actuel des connaissances sur la compatibilité des nouveaux bâtiments avec les environnements urbains historiques. Elle suit un mode de présentation classique: Introduction, Revue de Littérature, Méthodologie, Résultats, Discussion et Conclusion. Le problème étudié est le manque d'orientation pour intégrer les processus de développement et de sauvegarde dans les contextes établis. La littérature récente révèle que les règles de préservation, aussi appelées normes et lignes directrices, ne peuvent pas garantir une relation compatible entre une intervention et son milieu. La pensée contemporaine dans le domaine de la conservation et de la gestion du patrimoine invite donc l’exploration d'autres moyens pour lier la nouvelle architecture à l'ancienne. Ainsi, le présent projet de recherche explore une approche alternative aux règles de préservation en vue d’atteindre le but de nouveaux bâtiments compatibles et d’améliorer la prise de décision fondée sur les valeurs. Pour produire des résultats spécifiques et convaincants, un cas a été sélectionné. Celui-ci est une ville dans la région du Golfe Arabe : la Ville de Koweït. Le résultat principal est le développement d’une approche, mise en œuvre en posant des questions approfondies sur le lieu, la conception et la construction des nouveaux bâtiments. Les questions suggérées dans la thèse mettent l’accent sur les valeurs patrimoniales et les choix de conception afin de permettre un changement réfléchi au sein des environnements urbains historiques. Elles aident aussi à évaluer les nouvelles propositions de projets au cas par cas. Pour démontrer comment cette approche pourrait être présentée et utilisée par les requérants et les évaluateurs, un modèle théorique est proposé. Ce modèle a ensuite été discuté avec des professionnels locaux et internationaux qui ont identifié ses forces et ses limites. En conclusion, l’ensemble des résultats montre que la mise à disposition de règles et / ou de questions approfondies n’est pas une solution satisfaisante puisqu’il y a d'autres enjeux importants qui devraient être abordés: comment appliquer l'orientation efficacement une fois qu’elle a été créée, comment développer la compétence liée à la prise de décision fondée sur les valeurs et comment insérer la conservation du patrimoine dans la mentalité du gouvernement local et des communautés. Lorsque ces enjeux seront traités, le patrimoine pourra devenir partie intégrante du processus de planification, ce qui est le but ultime. Enfin, cinq axes de recherche sont recommandés pour poursuivre l’exploration des idées introduites dans cette étude.

Regional flows of domestic tourism in Spain = Flujos regionales del turismo doméstico en España

The paper analyses the regional flows of domestic tourism that took place in Spain in year 2000, contributing to the state of knowledge on tourism required by authorities and private firms when faced with decision making, for example, for regional infrastructure planning. Although tourism is one of the main income-generating economic activities in Spain, domestic tourism has received little attention in the literature compared to inbound tourism. The paper uses among others, gravitational model tools and concentration indices, to analyse regional concentration of both domestic demand and supply; tourism flows among regions, and the causes that may explain the observed flows and attractiveness between regions. Among the most remarkable results are the high regional concentration of demand and supply, and the role of population and regional income as explanatory variables. Also remarkable are the attractiveness of own region and neighbour ones, and that domestic tourism may be acting as a regional income redistributing activity

GRASS GIS for the distinction of vegetation from buildings using LiDAR altimetric data

La tecnología LiDAR (Light Detection and Ranging), basada en el escaneado del territorio por un telémetro láser aerotransportado, permite la construcción de Modelos Digitales de Superficie (DSM) mediante una simple interpolación, así como de Modelos Digitales del Terreno (DTM) mediante la identificación y eliminación de los objetos existentes en el terreno (edificios, puentes o árboles). El Laboratorio de Geomática del Politécnico de Milán – Campus de Como- desarrolló un algoritmo de filtrado de datos LiDAR basado en la interpolación con splines bilineares y bicúbicas con una regularización de Tychonov en una aproximación de mínimos cuadrados. Sin embargo, en muchos casos son todavía necesarios modelos más refinados y complejos en los cuales se hace obligatorio la diferenciación entre edificios y vegetación. Este puede ser el caso de algunos modelos de prevención de riesgos hidrológicos, donde la vegetación no es necesaria; o la modelización tridimensional de centros urbanos, donde la vegetación es factor problemático. (...)

Entrepreneurship research in Spain : Developments and distinctiveness

Resumen tomado de la publicaci??n

Job stress and burnout in residential child care workers in Spain. ' Estr??s laboral y burnout en educadores de acogimiento residencial en Espa??a'

Resumen tomado de la publicaci??n. Resumen tambi??n en ingl??s