Sorting out measures and definitions of screening participation to improve comparability: The example of colorectal cancer.

Participation is a key indicator of the potential effectiveness of any population-based intervention. Defining, measuring and reporting participation in cancer screening programmes has become more heterogeneous as the number and diversity of interventions have increased, and the purposes of this benchmarking parameter have broadened. This study, centred on colorectal cancer, addresses current issues that affect the increasingly complex task of comparing screening participation across settings. Reports from programmes with a defined target population and active invitation scheme, published between 2005 and 2012, were reviewed. Differences in defining and measuring participation were identified and quantified, and participation indicators were grouped by aims of measure and temporal dimensions. We found that consistent terminology, clear and complete reporting of participation definition and systematic documentation of coverage by invitation were lacking. Further, adherence to definitions proposed in the 2010 European Guidelines for Quality Assurance in Colorectal Cancer Screening was suboptimal. Ineligible individuals represented 1% to 15% of invitations, and variable criteria for ineligibility yielded differences in participation estimates that could obscure the interpretation of colorectal cancer screening participation internationally. Excluding ineligible individuals from the reference population enhances comparability of participation measures. Standardised measures of cumulative participation to compare screening protocols with different intervals and inclusion of time since invitation in definitions are urgently needed to improve international comparability of colorectal cancer screening participation. Recommendations to improve comparability of participation indicators in cancer screening interventions are made.

Tolerance-inducing immunosuppressive strategies in clinical transplantation: an overview.

The significant development of immunosuppressive drug therapies within the past 20 years has had a major impact on the outcome of clinical solid organ transplantation, mainly by decreasing the incidence of acute rejection episodes and improving short-term patient and graft survival. However, long-term results remain relatively disappointing because of chronic allograft dysfunction and patient morbidity or mortality, which is often related to the adverse effects of immunosuppressive treatment. Thus, the induction of specific immunological tolerance of the recipient towards the allograft remains an important objective in transplantation. In this article, we first briefly describe the mechanisms of allograft rejection and immune tolerance. We then review in detail current tolerogenic strategies that could promote central or peripheral tolerance, highlighting the promises as well as the remaining challenges in clinical transplantation. The induction of haematopoietic mixed chimerism could be an approach to induce robust central tolerance, and we describe recent encouraging reports of end-stage kidney disease patients, without concomitant malignancy, who have undergone combined bone marrow and kidney transplantation. We discuss current studies suggesting that, while promoting peripheral transplantation tolerance in preclinical models, induction protocols based on lymphocyte depletion (polyclonal antithymocyte globulins, alemtuzumab) or co-stimulatory blockade (belatacept) should, at the current stage, be considered more as drug-minimization rather than tolerance-inducing strategies. Thus, a better understanding of the mechanisms that promote peripheral tolerance has led to newer approaches and the investigation of individualized donor-specific cellular therapies based on manipulated recipient regulatory T cells.

Itinerari d'educació ambiental i sensorial de Sant Pere del Burgal

El Parc Natural de l’Alt Pirineu (PNAP) va ser creat l’any 2003. Actualment, el parc està desenvolupant una xarxa d’itineraris d’Educació Ambiental (EA). L’Ecomuseu de la Vall d’Àneu (EVA) ofereix rutes guiades al sender del Monestir de Sant Pere del Burgal, ja senyalitzat i equipat pel PNAP, en estar inscrit al seu àmbit territorial. Es tracta d’un sender de fàcil accés i recorregut, molt ample al primer tram tot oferint una gran varietat d’aspectes d’interès. L’objectiu principal del present projecte és plantejar un itinerari d’EA sensorial adaptat als col·lectius amb mobilitat reduïda i persones invidents. Amb aquesta finalitat es desenvolupen continguts i materials didàctics i es determinen les accions que els articularan. En un primer moment s'ha analitzat la viabilitat de l’itinerari aplicant el protocol de valoració dissenyat pel grup Edukamb. La puntuació obtinguda és de 74 punts sobre 100, corroborant la idoneïtat del seu recorregut pels visitants. En el disseny de l’itinerari, s’han determinat els elements i processos d’interès a l’entorn, s’han proposat quatre parades sensorials i una pasarel·la de fusta al primer tram i quatre parades de component antropològica i la instal·lació d’una corda perimetral al segon tram. Finalment també, la instal·lació de maquetes tridimensionals tàctils, una descriptiva dels aspectes i les parades de l’itinerari a l’inici del camí i una arquitectònica de l’entorn del monestir en arrivar al mateix. S’han proposat millores en la senyalització present, alternatives i complements al material pedagògic considerat al projecte i el disseny de protocols de valoració per itineraris adaptats a tot tipus de col·lectius.

Intellectual outcome in children and adolescents with acute lymphoblastic leukaemia treated with chemotherapy alone: age- and sex-related differences.

One of the most relevant concerns in long-term survivors of paediatric acute lymphoblastic leukaemia (ALL) is the development of neuropsychological sequelae. The majority of the published studies report on patients treated with chemotherapy and prophylactic central nervous system (CNS) irradiation, little is known about the outcome of patients treated with chemotherapy-only regimens. Using the standardised clinical and neuropsychological instruments of the SPOG Late Effects Study, the intellectual performance of 132 paediatric ALL patients treated with chemotherapy only was compared to that of 100 control patients surviving from diverse non-CNS solid tumours. As a group, ALL and solid tumour survivors showed normal and comparable intellectual performances (mean global IQ 104.6 in both groups). The percentage of patients in the borderline range (global IQ between 70 and 85) was comparable and not higher as expected (10% cases and 13% controls, expected 16%). Only 2 (2%) of the former ALL and 1 (1%) of the solid tumour patients were in the range of mental retardation (global IQ<70). Former known risk factors described in children treated with prophylactic CNS irradiation, like a younger age at diagnosis of ALL and female gender, remained valid in chemotherapy-only treated patients. The abandonment of prophylactic CNS irradiation and its replacement by a more intensive systemic and intrathecal chemotherapy led to a reduction, but not the disappearance of late neuropsychological sequelae.

Successful treatment of trilateral retinoblastoma with conventional and high-dose chemotherapy plus radiotherapy: a case report.

Trilateral retinoblastoma (TRB) is a rare condition characterized by an intracranial neuroblastic tumor associated with bilateral or unilateral retinoblastoma (RB). The outcome is almost always fatal. An 18-month-old patient with familial bilateral RB was referred for a pineal lesion detected on a screening by magnetic resonance imaging. The child, considered inoperable by 2 different neurosurgical teams, was treated with conventional chemotherapy (methotrexate, vincristine, vepeside, cyclophosphamide, and carboplatin) plus tandem transplantation (vepeside/carboplatin and thiotepa/mephalan) followed by local radiotherapy. At 80 months from the diagnosis of TRB, the patient is alive and in complete remission, with no neuropsychologic consequences. An early and aggressive treatment may improve the prognosis of TRB.

Estudi comparatiu del sòl d'una vinya de Sant Pere de Ribes

Treball de recerca realitzat per una alumna d'ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l'any 2009. Anàlisi comparatiu de diferents propietats del sòl d’una vinya on s’ha observat que els peus presenten un creixement desigual. A partir d'una observació a simple vista de les plantes de la vinya i del sòl sobre el qual es desenvolupen, es proposa la hipòtesi de que el sòl pot ser un factor determinant per aquest creixement desigual. Després de fer una recerca bibliogràfica sobre l’edafologia, les propietats del sòl i els tipus de sòl que es poden trobar als voltants de Sant Pere de Ribes, l’autora ha fet una selecció de propietats físico-químiques que poden estar més relacionades amb el creixement de les plantes. Després de fer el mostreig i seguir els protocols de laboratori s’han analitzat els resultats i s’han redactat les conclusions. Les propietats estudiades han permès determinar els tipus de sòl, uns sòls de textures entre franco-arenoses i areno-franques. S’ha trobat també una correlació entre les diverses propietats estudiades: un sòl de porositat elevada, que presenta valors alts de velocitat d’infiltració i per tant amb baixa capacitat de retenció d’aigua disponible, no sembla el sòl ideal per al desenvolupament de les plantes de vinya. A partir del treball es plantegen noves incògnites sobre les adaptacions dels ceps a aquests tipus de sòl o sobre la qualitat del raïm que s'hi pot desenvolupar.

Disseny i implantació d'un directori d'empleats i sistema de login únic

El objetivo de este proyecto es implantar una solución de directorio de empleados que unifique toda la información de empleados, usuarios, grupos y controles de acceso a aplicaciones de una multinacional farmacéutica.

Creació d'un media center amb software lliure

Treball de recerca realitzat per un alumne d'ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l'any 2009. L’objectiu d’aquest treball de recerca és la creació d’un dispositiu encarregat de centralitzar totes les necessitats multimèdia de casa nostra i distribuir aquest contingut a tots els terminals de la xarxa local d’una manera senzilla i automatitzada. Aquest dispositiu s’ha dissenyat per estar connectat a una televisió d’alta definició, que permetrà la reproducció i l’organització de tot el nostre multimèdia d’una manera còmoda i fàcil. El media center s’encarrega de gestionar la nostra filmoteca, fototeca, biblioteca musical i sèries de TV de manera transparent i automàtica. A més a més, l’usuari pot accedir a tot el multimèdia emmagatzemat al media center des de qualsevol dispositiu de la xarxa local a través de protocols com CIFS o UPnP, en un intent de replicar el cloud computing a escala local. El dispositiu ha estat dissenyat per a suportar tot tipus de formats i subtítols, assegurant la compatibilitat total amb arxius lliures de DRM. El seu disseny minimalista i silenciós el fa perfecte per a substituir el reproductor de DVD de la sala. Tot això sense oblidar el seu baix consum, de l’ordre d’un 75% inferior al d’un PC convencional.

Disseny d'un adaptador d'IPs per a NoCs tolerants a falles

L’aparició d’un nou paradigma per al disseny de sistemes multiprocessador, les NoC; requereixen una manera d’adaptar els IP cores ja existents i permetre la seva connexió en xarxa. Aquest projecte presenta un disseny d’una interfície que aconsegueix adaptar un IP core existent, el LEON3; del protocol del bus AMBA al protocol de la xarxa. D’aquesta manera i basant-nos en idees d’interfícies discutides en l’estat de l’art, aconseguim desacoblar el processador del disseny i topologia de la xarxa.

Mòdul basat en regles per la gestió de laboratoris d'anàlisis clíniques

L'objectiu d'aquest projecte és desenvolupar el mòdul de Rule Engine (mòdul basat en regles), que com a part de l'Omega v4, vol dotar a un laboratori de les eines necessàries per comunicar-se amb les màquines d'anàlisis clíniques i poder gestionar de la manera més senzilla tots els aspectes relacionats amb el laboratori i el seu treball diari.

Treatment of advanced soft-tissue sarcomas using a combined strategy of high-dose ifosfamide, high-dose doxorubicin and salvage therapies.

Having determined in a phase I study the maximum tolerated dose of high-dose ifosfamide combined with high-dose doxorubicin, we now report the long-term results of a phase II trial in advanced soft-tissue sarcomas. Forty-six patients with locally advanced or metastatic soft-tissue sarcomas were included, with age <60 years and all except one in good performance status (0 or 1). The chemotherapy treatment consisted of ifosfamide 10 g m(-2) (continuous infusion for 5 days), doxorubicin 30 mg m(-2) day(-1) x 3 (total dose 90 mg m(-2)), mesna and granulocyte-colony stimulating factor. Cycles were repeated every 21 days. A median of 4 (1-6) cycles per patient was administered. Twenty-two patients responded to therapy, including three complete responders and 19 partial responders for an overall response rate of 48% (95% CI: 33-63%). The response rate was not different between localised and metastatic diseases or between histological types, but was higher in grade 3 tumours. Median overall survival was 19 months. Salvage therapies (surgery and/or radiotherapy) were performed in 43% of patients and found to be the most significant predictor for favourable survival (exploratory multivariate analysis). Haematological toxicity was severe, including grade > or =3 neutropenia in 59%, thrombopenia in 39% and anaemia in 27% of cycles. Three patients experienced grade 3 neurotoxicity and one patient died of septic shock. This high-dose regimen is toxic but nonetheless feasible in multicentre settings in non elderly patients with good performance status. A high response rate was obtained. Prolonged survival was mainly a function of salvage therapies.

Epidémiologie clinique: définitions, utilités et raisons pour un développement en Suisse. [Clinical epidemiology: definitions, uses and reasons for development in Switzerland].

Clinical epidemiology is the most currently used name for a comparatively new branch of medicine covering a certain number of activities related to the practice of clinical medicine, but using epidemiological techniques and methods. Clinical epidemiology has only just begun to be known in Europe, whereas units are being increasingly developed and expanded in North America, particularly within the clinical departments of hospitals. The methods it offers are valid for both practicing physicians and hospital doctors (or those being trained in hospitals) and serve the purpose of promoting a better quality medical service, especially where a more adequate evaluation of the effectiveness of diagnostic methods, therapy and prognosis in medicine is concerned. Clinical epidemiology proposes a methodology of medical reasoning and of decision-making, as well as techniques intended to facilitate the indispensable task of keeping up with advances in medical knowledge.

Current Molecular Imaging of Spinal Tumors in Clinical Practice.

Energy metabolism measurements in spinal cord tumors, as well as in osseous spinal tumors/metastasis in vivo, are rarely performed only with molecular imaging (MI) by positron emission tomography (PET). This imaging modality developed from a small number of basic clinical science investigations followed by subsequent work that influenced and enhanced the research of others. Apart from precise anatomical localization by coregistration of morphological imaging and quantification, the most intriguing advantage of this imaging is the opportunity to investigate the time course (dynamics) of disease-specific molecular events in the intact organism. Most importantly, MI represents one of the key technologies in translational molecular neuroscience research, helping to develop experimental protocols that may later be applied to human patients. PET may help monitor a patient at the vertebral level after surgery and during adjuvant treatment for recurrent or progressive disease. Common clinical indications for MI of primary or secondary CNS spinal tumors are: (i) tumor diagnosis, (ii) identification of the metabolically active tumor compartments (differentiation of viable tumor tissue from necrosis) and (iii) prediction of treatment response by measurement of tumor perfusion or ischemia. While spinal PET has been used under specific circumstances, a question remains as to whether the magnitude of biochemical alterations observed by MI in CNS tumors in general (specifically spinal tumors) can reveal any prognostic value with respect to survival. MI may be able to better identify early disease and to differentiate benign from malignant lesions than more traditional methods. Moreover, an adequate identification of treatment effectiveness may influence patient management. MI probes could be developed to image the function of targets without disturbing them or as treatment to modify the target's function. MI therefore closes the gap between in vitro and in vivo integrative biology of disease. At the spinal level, MI may help to detect progression or recurrence of metastatic disease after surgical treatment. In cases of nonsurgical treatments such as chemo-, hormone- or radiotherapy, it may better assess biological efficiency than conventional imaging modalities coupled with blood tumor markers. In fact, PET provides a unique possibility to correlate topography and specific metabolic activity, but it requires additional clinical and experimental experience and research to find new indications for primary or secondary spinal tumors.

Protocolo para el estudio constructivo previo a las intervenciones en el patrimonio arquitectónico

Informe amb la descripció dels protocols d'estudi adequats per a l'anàlisi prèvia, durant i posterior de les intervencions en monuments per a l'augment del seu grau d'accessibilitat.

Helminth parasites of conventionally mantained laboratory mice

The spectrum of intestinal parasites present in the SwissWebster, C57B1/6 and DBA/2 mice strains from different animal houses was identified and prevalences compared. Three parasites were observed during the course ofthis study, namely the cestode. Vampirolepis nana (Siebold, 1852) Spasskii, 1954(=Hymenolepis nana) and the nematodes Aspiculuris tetraptera (Nitzsch, 1821) Schulz, 1924 and Syphacia obvelata (Rudolphi, 1802) Seurat, 1916. The scope of thisinvestigation has been widened to also include morphometric data on the parasites, to further simplify their identification, since the presence of helminths in laboratory animals is regarded as a restricting factor for the proper attainment of experimental protocols.