Design of a case management model for people with chronic disease (Heart Failure and COPD). Phase I: modeling and identification of the main components of the intervention through their actors: patients and professionals (DELTA-ICE-PRO Study

Background Chronic diseases account for nearly 60% of deaths around the world. The extent of this silent epidemic has not met determined responses in governments, policies or professionals in order to transform old Health Care Systems, configured for acute diseases. There is a large list of research about alternative models for people with chronic conditions, many of them with an advanced practice nurse as a key provider, as case management. But some methodological concerns raise, above all, the design of the intervention (intensity, frequency, components, etc). Methods/Design Objectives: General: To develop the first and second phases (theorization and modeling) for designing a multifaceted case-management intervention in people with chronic conditions (COPD and heart failure) and their caregivers. Specific aims: 1) To identify key events in people living with chronic disease and their relation with the Health Care System, from their point of view. 2) To know the coping mechanisms developed by patients and their caregivers along the story with the disease. 3) To know the information processing and its utilization in their interactions with health care providers. 4) To detect potential unmet needs and the ways deployed by patients and their caregivers to resolve them. 5) To obtain a description from patients and caregivers, about their itineraries along the Health Care System, in terms of continuity, accessibility and comprehensiveness of care. 6) To build up a list of promising case-management interventions in patients with Heart Failure and COPD with this information in order to frame it into theoretical models for its reproducibility and conceptualization. 7) To undergo this list to expert judgment to assess its feasibility and pertinence in the Andalusian Health Care. Design: Qualitative research with two phases: For the first five objectives, a qualitative technique with biographic stories will be developed and, for the remaining objectives, an expert consensus through Delphi technique, on the possible interventions yielded from the first phase. The study will be developed in the provinces of Almería, Málaga and Granada in the Southern Spain, from patients included in the Andalusian Health Care Service database with the diagnosis of COPD or Heart Failure, with the collaboration of case manager nurses and general practitioners for the assessment of their suitability to inclusion criteria. Patients and caregivers will be interviewed in their homes or their Health Centers, with their family or their case manager nurse as mediator. Discussion First of a series of studies intended to design a case-management service for people with heart failure and COPD, in the Andalusian Health Care System, where case management has been implemented since 2002. Accordingly with the steps of a theoretical model for complex interventions, in this study, theorization and intervention modeling phases will be developed.This research was carried out with the support of one research grant, awarded by the Regional Health Ministry of Andalusia (Exp. 0222/2008

Osteosarcoma growth on trabecular bone mimicking structures manufactured via laser direct write

This paper describes the direct laser write of a photocurable acrylate-based PolyHIPE (High Internal Phase Emulsion) to produce scaffolds with both macro- and microporosity, and the use of these scaffolds in osteosarco-ma-based 3D cell culture. The macroporosity was introduced via the application of stereolithography to produce a clas-sical woodpile structure with struts having an approximate diameter of 200 ?m and pores were typically around 500 ?m in diameter. The PolyHIPE retained its microporosity after stereolithographic manufacture, with a range of pore sizes typically between 10 and 60 ?m (with most pores between 20 and 30 ?m). The resulting scaffolds were suitable substrates for further modification using acrylic acid plasma polymerisation. This scaffold was used as a structural mimic of the trabecular bone and in vitro determination of biocompatibility using cultured bone cells (MG63) demon-strated that cells were able to colonise all materials tested, with evidence that acrylic acid plasma polymerisation im-proved biocompatibility in the long term. The osteosarcoma cell culture on the 3D printed scaffold exhibits different growth behaviour than observed on tissue culture plastic or a flat disk of the porous material; tumour spheroids are ob-served on parts of the scaffolds. The growth of these spheroids indicates that the osteosarcoma behave more akin to in vivo in this 3D mimic of trabecular bone. It was concluded that PolyHIPEs represent versatile biomaterial systems with considerable potential for the manufacture of complex devices or scaffolds for regenerative medicine. In particular, the possibility to readily mimic the hierarchical structure of native tissue enables opportunities to build in vitro models closely resembling tumour tissue

Osteosarcoma growth on trabecular bone mimicking structures manufactured via laser direct write

This paper describes the direct laser write of a photocurable acrylate-based PolyHIPE (High Internal Phase Emulsion) to produce scaffolds with both macro- and microporosity, and the use of these scaffolds in osteosarco-ma-based 3D cell culture. The macroporosity was introduced via the application of stereolithography to produce a clas-sical woodpile structure with struts having an approximate diameter of 200 ?m and pores were typically around 500 ?m in diameter. The PolyHIPE retained its microporosity after stereolithographic manufacture, with a range of pore sizes typically between 10 and 60 ?m (with most pores between 20 and 30 ?m). The resulting scaffolds were suitable substrates for further modification using acrylic acid plasma polymerisation. This scaffold was used as a structural mimic of the trabecular bone and in vitro determination of biocompatibility using cultured bone cells (MG63) demon-strated that cells were able to colonise all materials tested, with evidence that acrylic acid plasma polymerisation im-proved biocompatibility in the long term. The osteosarcoma cell culture on the 3D printed scaffold exhibits different growth behaviour than observed on tissue culture plastic or a flat disk of the porous material; tumour spheroids are ob-served on parts of the scaffolds. The growth of these spheroids indicates that the osteosarcoma behave more akin to in vivo in this 3D mimic of trabecular bone. It was concluded that PolyHIPEs represent versatile biomaterial systems with considerable potential for the manufacture of complex devices or scaffolds for regenerative medicine. In particular, the possibility to readily mimic the hierarchical structure of native tissue enables opportunities to build in vitro models closely resembling tumour tissue

Local electroexfoliation of graphene with a STM tip

Graphite surfaces can be manipulated by several methods to create graphene structures of different shapes and sizes. Scanning tunneling microscopy (STM) can be used to create these structures either through mechanical contact between the tip and the surface or through electro-exfoliation. In the latter, the mechanisms involved in the process of exfoliation with an applied voltage are not fully understood. Here we show how a graphite surface can be locally exfoliated in a systematic manner by applying an electrostatic force with a STM tip at the edge of a terrace, forming triangular flakes several nanometers in length. We demonstrate, through experiments and simulations, how these flakes are created by a two-step process: first a voltage ramp must be applied at the edge of the terrace, and then the tip must be scanned perpendicularly to the edge. Ab-initio electrostatic calculations reveal that the presence of charges on the graphite surface weakens the interaction between layers allowing for exfoliation at voltages in the same range as those used experimentally. Molecular dynamics simulations show that a force applied locally on the edge of a step produces triangular flakes such as those observed under STM. Our results provide new insights towards surface modification that can be extended to other layered materials

The abundances and distributions of molluscs in the southern Iberian Peninsula: A comparison of marine and terrestrial systems

Molluscs are the second most diverse of all animal phyla, and occur in many habitat types. They are, therefore, a particularly good phylum with which to compare and contrast differences between ecosystems. Mollusc data from a number of sites along the southern coast of the Iberian Peninsula are analysed to study patterns of diversity and distribution using a range of multivariate techniques. Within each site, data are presented from three locations -fully terrestrial, rocky intertidal and soft bottom benthic (10 m and 20 m depths)- all in close proximity. The species are then classified in relation to morphology and size, and analysed at supraspecific levels to elucidate underlying patterns. The observed patterns are briefly discussed, with particular reference to the differential scope and importance of controlling factors in each ecosystem, such as dispersal processes. The results from the systems are compared and discussed in the context of ecological and evolutionary constraints in Mollusca.Los moluscos constituyen el segundo filo animal más diverso y se encuentran en muchos tipos de hábitat, por lo que son idóneos para establecer comparaciones entre distintos ecosistemas. Se han analizado los datos de los moluscos obtenidos en una serie de emplazamientos que cubrían el sur de la península Ibérica para determinar, empleando distintas técnicas multivariantes, los patrones de diversidad y distribución de estos organismos. Los datos se tomaron de ejemplares capturados en lugares del medio terrestre próximos a la línea de costa, de la franja intermareal rocosa y de sedimentos de fondos marinos situados a 10 y 20 m de profundidad. Las especies fueron clasificadas atendiendo a la morfología y el tamaño, y se analizaron a nivel supraespecífico para elucidar los patrones generales, que se discuten aquí, brevemente, con especial énfasis en las diferencias según la importancia de los factores que controlan cada ecosistema, como, por ejemplo, los procesos de dispersión. Los resultados de los distintos sistemas se comparan y discuten en el contexto de las tendencias ecológicas y evolutivas de los moluscos.Instituto Español de Oceanografí

Accurate placement of epiescleral plaque in brachytherapy of choroideal melanoma

Salvadó Jassans, JosepPla general de l'obra: A Lluís Millet. Es veu la figura, en bronze, del músic i fundador de l'Orfeó Català, en el gest de dirigir. Està situada a l'exterior del Palau de la Música Catalana

Interoperabilidad en Sistemas Domóticos Mediante Pasarela Infrarrojos-ZigBee

La domótica consiste en la aplicación de técnicas provenientes de la automática industrial al hogar con objeto de ofrecer servicios que aporten, entre otras cosas, confort, seguridad y eficiencia energética a los usuarios. Hasta el momento la penetración de dichas técnicas en los hogares ha sido reducida. Una de las razones fundamentales de esta lenta transposición de técnicas de control al hogar es la dificultad de integración entre los diferentes sistemas presentes en el hogar. En este artículo se presenta un desarrollo encaminado a mejorar la integración de los sistemas domóticos con aquellos dispositivos que sean controlables mediante infrarrojos. En concreto se ha desarrollado una pasarela inalámbrica que permite a una red domótica el envío de tramas de infrarrojos. De esta manera se posibilita un despliegue rápido y económico de los nodos que sean necesarios para integrar dispositivos tales como los sistemas de aire acondicionado en una red domótica.Ministerio de Industria, Turismo y Comercio MITC-09-TSI-020100-2009-359Ministerio de Educación DPI2008-05818Junta de Andalucía TEP0272