Digital Photography in the Diagnosis and Follow-up of Ocular Diseases

Purpose: The aim of the present study was to develop and test new digital imaging equipment and methods for diagnosis and follow-up of ocular diseases. Methods: The whole material comprised 398 subjects (469 examined eyes), including 241 patients with melanocytic choroidal tumours, 56 patients with melanocytic iris tumours, 42 patients with diabetes, a 52-year old patient with chronic phase of VKH disease, a 30-year old patient with an old blunt eye injury, and 57 normal healthy subjects. Digital 50° (Topcon TRC 50 IA) and 45° (Canon CR6-45NM) fundus cameras, a new handheld digital colour videocamera for eye examinations (MediTell), a new subtraction method using the Topcon Image Net Program (Topcon corporation, Tokyo, Japan), a new method for digital IRT imaging of the iris we developed, and Zeiss photoslitlamp with a digital camera body were used for digital imaging. Results: Digital 50° red-free imaging had a sensitivity of 97.7% and two-field 45° and 50° colour imaging a sensitivity of 88.9-94%. The specificity of the digital 45°-50° imaging modalities was 98.9-100% versus the reference standard and ungradeable images that were 1.2-1.6%. By using the handheld digital colour video camera only, the optic disc and central fundus located inside 20° from the fovea could be recorded with a sensitivity of 6.9% for detection of at least mild NPDR when compared with the reference standard. Comparative use of digital colour, red-free, and red light imaging showed 85.7% sensitivity, 99% specificity, and 98.2 % exact agreement versus the reference standard in differentiation of small choroidal melanoma from pseudomelanoma. The new subtraction method showed growth in four of 94 melanocytic tumours (4.3%) during a mean ±SD follow-up of 23 ± 11 months. The new digital IRT imaging of the iris showed the sphincter muscle and radial contraction folds of Schwalbe in the pupillary zone and radial structural folds of Schwalbe and circular contraction furrows in the ciliary zone of the iris. The 52-year-old patient with a chronic phase of VKH disease showed extensive atrophy and occasional pigment clumps in the iris stroma, detachment of the ciliary body with severe ocular hypotony, and shallow retinal detachment of the posterior pole in both eyes. Infrared transillumination imaging and fluorescein angiographic findings of the iris showed that IR translucence (p=0.53), complete masking of fluorescence (p=0.69), presence of disorganized vessels (p=0.32), and fluorescein leakage (p=1.0) at the site of the lesion did not differentiate an iris nevus from a melanoma. Conclusions: Digital 50° red-free and two-field 50° or 45° colour imaging were suitable for DR screening, whereas the handheld digital video camera did not fulfill the needs of DR screening. Comparative use of digital colour, red-free and red light imaging was a suitable method in the differentiation of small choroidal melanoma from different pseudomelanomas. The subtraction method may reveal early growth of the melanocytic choroidal tumours. Digital IRT imaging may be used to study changes of the stroma and posterior surface of the iris in various diseases of the uvea. It contributed to the revealment of iris atrophy and serous detachment of the ciliary body with ocular hypotony together with the shallow retinal detachment of the posterior pole as new findings of the chronic phase of VKH disease. Infrared translucence and angiographic findings are useful in differential diagnosis of melanocytic iris tumours, but they cannot be used to determine if the lesion is benign or malignant.

CAD Standardization in Construction – a Process View

There has been a demand for uniform CAD standards in the construction industry ever since the large-scale introduction of computer aided design systems in the late 1980s. While some standards have been widely adopted without much formal effort, other standards have failed to gain support even though considerable resources have been allocated for the purpose. Establishing a standard concerning building information modeling has been one particularly active area of industry development and scientific interest within recent years. In this paper, four different standards are discussed as cases: the IGES and DXF/DWG standards for representing the graphics in 2D drawings, the ISO 13567 standard for the structuring of building information on layers, and the IFC standard for building product models. Based on a literature study combined with two qualitative interview studies with domain experts, a process model is proposed to describe and interpret the contrasting histories of past CAD standardisation processes.

Struggling over subjectivity: A discursive analysis of strategic development in a group

We have seen growing interest in discursive perspectives on strategy. This perspective holds great promise for development of an understanding on how strategy discourse and subjectivity are intertwined. We wish to add to this existing research by outlining a discursive struggle approach to subjectivity. To understand the complex subjectification and empowering/disempowering effects of organizational strategy discourse, this approach focuses on organization-specific discourse mobilizations an various ways of resistance. Drawing on an analysis of the discourses and practices of ‘strategic development’ in an engineering and consulting group we provide an empirical illustration of such struggles over subjectivity. In particular, we report three examples of competing ways of making sense of and giving sense to strategic development, with specific subjectification tendencies. First, we show how corporate management can mobilize and appropriate a specific kind of discourse to attempt to gain control of the organization, which tends to reproduce managerial hegemony, but also trigger discursive and other forms of resistance. Second, we will illustrate how middle managers resist this hegemony by initiating a strategy discourse of their own to create room for manoeuvre in controversial situations. Third, we show how project engineers can distance themselves from managerial-initiated strategy discourses to maintain a viable identity despite all kinds of pressures. Although our examples are case-specific, we believe that similar discursive dynamics also characterize strategizing in other organizations.

Toksoplasman esiintyvyys suomalaisissa kissoissa

Toxoplasma gondii on kokkideihin kuuluva alkueläinloinen. Sen pääisäntiä ovat kissaeläimet, joissa tapahtuvan suvullisen lisääntymisen tuloksena tuotetaan ympäristöön ookystia. Väli-isäntiä voivat olla kaikki tasalämpöiset eläimet. Toksoplasma muodostaa isäntien kudoksiin infektiivisiä kudoskystia. Ihminen voi saada tartunnan syömällä kudoskystia tai ookystia, tai sikiö voi infektoitua jo kohdussa istukan kautta. Toxoplasma gondii voi aiheuttaa isäntänsä vakavan sairastumisen ja on siksi maailmanlaajuisesti merkittävä zoonoottinen loinen. Toksoplasman torjunnassa on oleellista tuntea alueen kissojen toksoplasmaseroprevalenssi ja arvioida ympäristön ookystakuormitusta: seropositiivisten kissojen voidaan olettaa joskus erittäneen ookystia. Tässä tutkimuksessa selvitettiin toksoplasman esiintymistä suomalaisissa kissoissa: suoralla agglutinaatiotestillä (ToxoScreen-DA) määritettiin IgG-vasta-aineiden esiintymistä seerumissa sekä vasta-ainetasoja (tiitteri). Flotac® - flotaatiomenetelmällä tutkittiin ookystien esiintymistä ulostenäytteissä. Tutkimuksessa selvitettiin kissojen toksoplasma-vasta-aineiden esiintymiseen vaikuttavia tekijöitä: serologisessa tutkimuksessa oli mukana sekä löytöettä rotukissoja, ja lisäksi tutkittiin kissojen sukupuolen, iän, sekä rotukissoilla lihansyönnin vaikutusta vastaaineiden esiintymiseen seerumissa. Serologisessa tutkimuksessa 398 kissan aineistossa seroprevalenssiksi saatiin 48,2 %. Tutkituista 369 rotukissasta 49,9 % oli seropositiivisia, kun taas 27 tutkitusta löytökissasta seropositiivisia oli 25,9 % (P<0,05). Sukupuolella ei todettu olevan merkitystä kissan seropositiivisuuteen. Aikuiset kissat olivat nuoria kissoja useammin seropositiivisia (53,7 % vs. 23,5 %) (P<0,001), koska kerran tartunnan saaneen kissan seerumista voidaan todeta vasta-aineita, ja vanhemmat kissat ovat nuoria todennäköisemmin ehtineet törmätä loiseen elämänsä aikana ja saada tartunnan. Ruokavalio oli tiedossa 347 rotukissalta, ja näistä 270 (77,8 %) oli joskus saanut raakaa lihaa. Raakaa lihaa saaneista kissoista 151 (55,9 %) oli seropositiivisia; 77 kissasta, jotka eivät olleet saaneet raakaa lihaa sitä vastoin ainoastaan 26 (33,8 %) oli seropositiivisia (P<0,001). Ulostenäytteistä 131 kissan aineistosta 1,5 % eritti toksoplasman kaltaisia ookystia ulosteessaan tutkimushetkellä. Suomessa kissojen ravinnon ja toksoplasmaseropositiivisuuden välistä yhteyttä ei ole aikaisemmin tutkittu. Näiden uusien tulosten valossa olisi toksoplasman torjunnassa erityisen tärkeää kiinnittää huomiota loisen tartuntareitteihin kissan osalta. Kissoja ei tulisi ruokkia raa’alla lihalla: kissalle annettava liha olisi hyvä kuumentaa yli 67ºC:een tai pakastaa alle -12ºC:n lämpötilassa toksoplasmatartunnan ehkäisemiseksi.