White-collar pay.

Mode of access: Internet.

Tackling health inequalities in primary care: an exploration of GPs’ experience at the frontline

In Scotland, life expectancy and health outcomes are strongly tied to socioeconomic status. Specifically, socioeconomically deprived areas suffer disproportionately from high levels of premature multimorbidity and mortality. To tackle these inequalities in health, challenges in the most deprived areas must be addressed. One avenue that merits attention is the potential role of general medical practitioners (GPs) in helping to address health inequalities, particularly due to their long-term presence in deprived communities, their role in improving patient and population health, and their potential advocacy role on behalf of their patients. GPs can be seen as what Lipsky calls ‘street-level bureaucrats’ due to their considerable autonomy in the decisions they make surrounding individual patient needs, yet practising under the bureaucratic structure of the NHS. While previous research has examined the applicability of Lipsky’s framework to the role of GPs, there has been very little research exploring how GPs negotiate between the multiple identities in their work, how GPs ‘socially construct’ their patients, how GPs view their potential role as ‘advocate’, and what this means in terms of the contribution of GPs to addressing existing inequalities in health. Using semi-structured interviews, this study explored the experience and views of 24 GPs working in some of Scotland’s most deprived practices to understand how they might combat this growing health divide via the mitigation (and potential prevention) of existing health inequalities. Participants were selected based on several criteria including practice deprivation level and their individual involvement in the Deep End project, which is an informal network comprising the 100 most deprived general practices in Scotland. The research focused on understanding GPs’ perceptions of their work including its broader implications, within their practice, the communities within which they practise, and the health system as a whole. The concept of street-level bureaucracy proved to be useful in understanding GPs’ frontline work and how they negotiate dilemmas. However, this research demonstrated the need to look beyond Lipsky’s framework in order to understand how GPs reconcile their multiple identities, including advocate and manager. As a result, the term ‘street-level professional’ is offered to capture more fully the multiple identities which GPs inhabit and to explain how GPs’ elite status positions them to engage in political and policy advocacy. This study also provides evidence that GPs’ social constructions of patients are linked not only to how GPs conceptualise the causes of health inequalities, but also to how they view their role in tackling them. In line with this, the interviews established that many GPs felt they could make a difference through advocacy efforts at individual, community and policy/political levels. Furthermore, the study draws attention to the importance of practitioner-led groups—such as the Deep End project—in supporting GPs’ efforts and providing a platform for their advocacy. Within this study, a range of GPs’ views have been explored based on the sample. While it is unclear how common these views are amongst GPs in general, the study revealed that there is considerable scope for ‘political GPs’ who choose to exercise discretion in their communities and beyond. Consequently, GPs working in deprived areas should be encouraged to use their professional status and political clout not only to strengthen local communities, but also to advocate for policy change that might potentially affect the degree of disadvantage of their patients, and levels of social and health inequalities more generally.

Increasing value add in white collar work using lean methods

The efficient indirect office work brings competitive advantage for companies in a rapidly changing business environment. The direct work methods in factory floors have been developed already for decades, but the office work is an area where the potential to improve the value add has not been studied and utilized systematically so far. The first objective of the thesis work is to find useful method for identifying and managing value add using literature. The usefulness of the method is validated in the case company`s environment. The second objective of the work is to understand what kind of effort is required to create more efficient target setting for the white collar employees. The operative level targets should be linked more tightly to the company strategy. Lean methods are selected as a tool for the improvement, since they are widely used in all kinds of industries and they are already familiar in other functions in the case company. Based on the literature review, suitable improvement methods are selected. The core of the lean is to identify the value add of a customer and eliminate the waste. Also visual control, cross functional work team, flow office and continuous improvement are used. The methods are tested in one production line and the results and feedback indicate that methods are useful in the studied environment.

Evaluación de los patrones de movimiento en la competición para optimizar el proceso de entrenamiento en la élite del tenis de formación a partir de la tecnología GPS.

241 p.

Clinical diagnosis and management of suspicious pigmented skin lesions: A survey of GPs

BACKGROUND The ability of general practitioners to make important clinical decisions about the diagnosis and management of skin lesions is poorly understood.METHODS A questionnaire on the diagnosis and management of eight photographed skin lesions was sent to 150 GPs in southeast Queensland.RESULTS The questionnaire was completed by 114 GPs (response rate 77%). General practitioners’ provisional diagnoses and management of photographed skin lesions were mostly or always correct, and there was general high consistency between diagnosis and intended management. Pigmented seborrhoeic keratoses were the most difficult lesions for GPs to diagnose correctly. Whether a lesion was different to usual moles appears to have the strongest association with clinical diagnosis.DISCUSSION The high ability of GPs as measured in this artificial study is encouraging. The strong association between identifying moles that appear different to usual and correct clinical diagnoses suggest that unless GPs can increase the number of skin lesions they see as part of their typical workload, their clinical ability may not increase further. Article in Australian family physician 34(1) · January 2005

Condução autónoma – localização de um veículo com base em odometria, IMU e GPS

A Condução de um veículo automóvel tem-se tornado cada vez mais automatizada ao longo dos anos. Este processo tem-se vindo a desenvolver com o intuito de facilitar cada vez mais a condução dos veículos, de prevenir acidentes rodoviários ou ainda de ser utilizado em operações militares. Este trabalho tem como principal foco o estudo da aplicação de dois dos principais métodos de cálculo da localização probabilística à localização de um veículo automóvel autónomo: o Filtro Estendido de Kalman e o Filtro de Partículas. Foram implementadas várias versões de ambos os filtros, quer em simulação, quer num veículo real, tendo por base, em termos de sensores, a odometria do robô, uma unidade inercial e um GPS. Este trabalho surge na continuação de vários projetos anteriores, com foco no desenvolvimento de um veículo autónomo de baixo custo, acrescentando-lhe a funcionalidade de se localizar. Neste sentido, o trabalho desenvolvido servirá de base para a navegação autónoma em trabalhos futuros.

Long-period oscillations in GPS Up time series. Study over the European/Mediterranean area

The surface of the Earth is subjected to vertical deformations caused by geophysical and geological processes which can be monitored by Global Positioning System (GPS) observations. The purpose of this work is to investigate GPS height time series to identify interannual signals affecting the Earth’s surface over the European and Mediterranean area, during the period 2001-2019. Thirty-six homogeneously distributed GPS stations were selected from the online dataset made available by the Nevada Geodetic Laboratory (NGL) on the basis of the length and quality of the data series. The Principal Component Analysis (PCA) is the technique applied to extract the main patterns of the space and time variability of the GPS Up coordinate. The time series were studied by means of a frequency analysis using a periodogram and the real-valued Morlet wavelet. The periodogram is used to identify the dominant frequencies and the spectral density of the investigated signals; the second one is applied to identify the signals in the time domain and the relevant periodicities. This study has identified, over European and Mediterranean area, the presence of interannual non-linear signals with a period of 2-to-4 years, possibly related to atmospheric and hydrological loading displacements and to climate phenomena, such as El Niño Southern Oscillation (ENSO). A clear signal with a period of about six years is present in the vertical component of the GPS time series, likely explainable by the gravitational coupling between the Earth’s mantle and the inner core. Moreover, signals with a period in the order of 8-9 years, might be explained by mantle-inner core gravity coupling and the cycle of the lunar perigee, and a signal of 18.6 years, likely associated to lunar nodal cycle, were identified through the wavelet spectrum. However, these last two signals need further confirmation because the present length of the GPS time series is still too short when compared to the periods involved.

Raffinamento della posizione ottenuta da un GPS tramite misure di fase

Questa tesi elabora un sistema di filtraggio delle pseudodistanze calcolate da un ricevitore GPS, al fine di ottenere un miglior posizionamento. Infatti, dopo aver analizzato e quindi filtrato i dati in ingresso tramite l’impiego delle misure di fase, si può ottenere una precisione nell’ordine dei centimetri. La tecnica di filtraggio prende il nome di carrier-smoothing e permette di selezionare le misure di pseudorange mediante le misure di ADR (Accumulated Delta Range) grazie all’applicazione di una struttura a filtro complementare. Per svolgere questo tipo di lavoro, non è stato necessario l’utilizzo di un ricevitore GPS fisico, ma è stato realizzato, nell’ambiente Matlab/Simulink, un simulatore GNSS (Global Navigation Satellite System) che sostanzialmente emula quello che farebbe un ricevitore.

Implementazione di ambiente simulativo per validazione di sistemi di navigazione GPS in LEO

Il lavoro di questa tesi è stato implementare su Matlab un algoritmo numerico che permettesse di determinare la posizione di un utilizzatore mediante misure GPS. In particolare, dopo un'introduzione al sistema GPS e alla navigazione GPS, è stato analizzato il contenuto dei LOG di ESEO e si è proceduto all'implementazione dell'algoritmo sul calcolatore. Lo scopo ultimo della tesi è stato verificare l'accuratezza di tale algoritmo, mediante il calcolo degli errori con le posizioni reali e mediante una verifica tramite calcolo del range geometrico.

Comparative descriptions of eggs from three species of Rhodnius (Hemiptera: Reduviidae: Triatominae)

The authors describe and compare the morphological and ultrastructural characteristics of eggs from the three most recent described species of the genus Rhodnius Stål, 1859, which have not previously been studied. These species are Rhodnius colombiensis (Mejia, Galvão & Jurberg 1999), Rhodnius milesi (Carcavallo, Rocha, Galvão & Jurberg 2001) and Rhodnius stali (Lent, Jurberg & Galvão 1993). The results revealed that there are similarities in the exochorial architecture of optical microscopy and scanning electron microscopy; these include the predominance of hexagonal cells that are common to all Rhodnius species and variable degrees of lateral flattening, which is common not only to species of this genus, but also to the Rhodniini tribe. Differences in overall colour, the presence of a collar in R. milesi, a longitudinal bevel in R. stali and the precise length of R. colombiensis can be useful distinguishing features. As a result of this study, the key for egg identification proposed by Barata in 1981 can be updated.

A primeira planta cartográfica da cidade de São Paulo

The first known plan of the city of Sao Paulo, made in 1810 by Rufino Felizardo e Costa, is analyzed with emphasis on the cartographic and astronomical details: the precision, scale, magnetic declination, and orientation in relation to the north, the prime meridian, the precision of the coordinates (latitude and longitude) and others. An analytic methodology is followed, observing the plan and formulating questions. To answer then, resources of modern technologies are employed (digital cartography, GPS) as well as knowledge of the history of cartography. The work is justified by the fact that there are no cartographic studies about this important document.

Description and Phylogenetic Relationships of a New Genus and Species of Lizard (Squamata, Gymnophthalmidae) from the Amazonian Rainforest of Northern Brazil

Marinussaurus curupira, a new genus and species of Gymnophthalmidae lizard is described from Iranduba, state of Amazonas, Brazil. The genus is characterized by an elongate body; short and stout pentadactyl limbs; all digits clawed; single frontonasal; two prefrontals; absence of frontoparietals; interparietal and parietals forming a straight posterior margin, with interparietal shorter than parietals; distinctive ear opening and eyelid; few temporals; three pairs of chin shields; nasal divided; a distinct collar; smooth, mainly hexagonal, dorsal scales; smooth quadrangular ventral scales; two precloacal and three femoral pores on each side in males; pores between three or four scales. Parsimony (PAR) and partitioned Bayesian (BA) phylogenetic analyses with morphological and molecular data recovered the new genus as a member of the Ecpleopodini radiation of the Cercosaurinae. A close relationship of the new genus with Arthrosaura is postulated.

A New Genus of Microteiid Lizard from the Caparao Mountains, Southeastern Brazil, with a Discussion of Relationships among Gymnophthalminae (Squamata)

A new genus and species of microteiid lizard is described based on a series of specimens obtained at Parque Nacional do Caparao (20 degrees 28'S, 41 degrees 49'W), southeastern Brazil, along the division line between the States of Minas Gerais and Espirito Santo. The new lizard occurs in isolated high-altitude, open, rocky habitats above the altitudinal lit-nits of the Atlantic forest. It is characterized by the presence of prefrontals, frontoparietals, parietals, interparietal, and occipital scales; ear opening and eyelid distinct; three pairs of genials; absence of collar; lanceolate and mucronate dorsal scales; six regular transverse and longitudinal series of smooth ventrals that are longer than wide, with the lateral ones narrower. Maximum parsimony (MP) and partitioned Bayesian (PBA) phylogenetic analyses based on morphological and molecular characters with all known genera of Gymnophthalminae (except for Scriptosaura) Plus Rhachisaurus recovered this new lizard in a clade having Colobodactylus and Heterodactylus as its closest relatives. Both analyses recovered the monophyly of Gymnophthalminae and Gymnophthalmini. The monophyly of the Heterodactylini received moderate support in MP analyses but was not recovered in PBA. To eliminate classification controversy between these results, the present concept of Heterodactylini is restricted to accommodate the new genus, Colobodactylus and Heterodactylus, and a new tribe Iphisiini is proposed to allocate Alexandresaurus, Iphisa, Colobosaura, Acratosaura, and Stenolepis. Current phylogenetic knowledge of Gymnophthalminae suggests that fossoriality and increase of body elongation arose as adaptive responses to avoid extreme surface temperatures, either cold or hot, depending on circumstances.

A numerical model for the description of the nonlinear behaviour of multi-leaf masonry walls

A nonlinear finite element model was developed to simulate the nonlinear response of three-leaf masonry specimens, which were subjected to laboratory tests with the aim of investigating the mechanical behaviour of multiple-leaf stone masonry walls up to failure. The specimens consisted of two external leaves made of stone bricks and mortar joints, and an internal leaf in mortar and stone aggregate. Different loading conditions, typologies of the collar joints, and stone types were taken into account. The constitutive law implemented in the model is characterized by a damage tensor, which allows the damage-induced anisotropy accompanying the cracking process to be described. To follow the post-peak behaviour of the specimens with sufficient accuracy it was necessary to make the damage model non-local, to avoid mesh-dependency effects related to the strain-softening behaviour of the material. Comparisons between the predicted and measured failure loads are quite satisfactory in most of the studied cases. (c) 2007 Elsevier Ltd. All rights reserved.

A QUALITY MANAGEMENT SYSTEM FOR POSITIONING WITH GNSS TECHNOLOGY

This paper presents a proposal for a Quality Management System for a generic GNSS Surveying Company as an alternative for management and service quality improvements. As a result of the increased demand for GNSS measurements, a large number of new or restructured companies were established to operate in that market. Considering that GNSS surveying is a new process, some changes must be performed in order to accommodate the old surveying techniques and the old fashioned management to the new reality. This requires a new management model that must be based on a well-described procedure sequence aiming at the Total Management Quality for the company. The proposed Quality Management System was based on the requirements of the Quality System ISO 9000:2000, applied to the whole company, focusing on the productive process of GNSS surveying work.