Home Blood Pressure Measurement – Epidemiology and Clinical Application

Verenpaineen kotimittaus − epidemiologia ja kliininen käyttö Kohonnutta verenpainetta, maailmanlaajuisesti merkittävintä ennenaikaiselle kuolemalle altistavaa riskitekijää, ei voida tunnistaa tai hoitaa ilman tarkkoja ja käytännöllisiä verenpaineen mittausmenetelmiä. Verenpaineen kotimittaus on saavuttanut suuren suosion potilaiden keskuudessa. Lääkärit eivät ole kuitenkaan vielä täysin hyväksyneet verenpaineen kotimittausta, sillä riittävä todistusaineisto sen toimivuudesta ja eduista on puuttunut. Tämän tutkimuksen tarkoituksena oli osoittaa, että kotona mitattu verenpaine (kotipaine) on perinteistä vastaanotolla mitattua verenpainetta (vastaanottopaine) tarkempi, ja että se on tehokas myös kliinisessä käytössä. Tutkimme kotipaineen käyttöä verenpainetaudin diagnosoinnissa ja hoidossa. Lisäksi tarkastelimme kotipaineen yhteyttä verenpainetaudin aiheuttamiin kohde-elinvaurioihin. Ensimmäinen aineisto, joka oli edustava otos Suomen aikuisväestöstä, koostui 2 120 45–74-vuotiaasta tutkimushenkilöstä. Tutkittavat mittasivat kotipainettaan viikon ajan ja osallistuivat terveystarkastukseen, johon sisältyi kliinisen tutkimuksen ja haastattelun lisäksi sydänfilmin otto ja vastaanottopaineen mittaus. 758 tutkittavalle suoritettiin lisäksi kaulavaltimon seinämän intima-mediakerroksen paksuuden (valtimonkovettumataudin mittari) mittaus ja 237:lle valtimon pulssiaallon nopeuden (valtimojäykkyyden mittari) mittaus. Toisessa aineistossa, joka koostui 98 verenpainetautia sairastavasta potilaasta, hoitoa ohjattiin satunnaistamisesta riippuen joko ambulatorisen eli vuorokausirekisteröinnillä mitatun verenpaineen tai kotipaineen perusteella. Vastaanottopaine oli kotipainetta merkittävästi korkeampi (systolisen/diastolisen paineen keskiarvoero oli 8/3 mmHg) ja yksimielisyys verenpainetaudin diagnoosissa kahden menetelmän välillä oli korkeintaan kohtalainen (75 %). 593 tutkittavasta, joilla oli kohonnut verenpaine vastaanotolla, 38 %:lla oli normaali verenpaine kotona eli ns. valkotakkiverenpaine. Verenpainetauti voidaan siis ylidiagnosoida joka kolmannella potilaalla seulontatilanteessa. Valkotakkiverenpaine oli yhteydessä lievästi kohonneeseen verenpaineeseen, matalaan painoindeksiin ja tupakoimattomuuteen, muttei psykiatriseen sairastavuuteen. Valkotakkiverenpaine ei kuitenkaan vaikuttaisi olevan täysin vaaraton ilmiö ja voi ennustaa tulevaa verenpainetautia, sillä siitä kärsivien sydän- ja verisuonitautien riskitekijäprofiili oli normaalipaineisten ja todellisten verenpainetautisten riskitekijäprofiilien välissä. Kotipaineella oli vastaanottopainetta vahvempi yhteys verenpainetaudin aiheuttamiin kohde-elinvaurioihin (intima-mediakerroksen paksuus, pulssiaallon nopeus ja sydänfilmistä todettu vasemman kammion suureneminen). Kotipaine oli tehokas verenpainetaudin hoidon ohjaaja, sillä kotipaineeseen ja ambulatoriseen paineeseen, jota on pidetty verenpainemittauksen ”kultaisena standardina”, perustuva lääkehoidon ohjaus johti yhtä hyvään verenpaineen hallintaan. Tämän ja aikaisempien tutkimusten tulosten pohjalta voidaan todeta, että verenpaineen kotimittaus on selkeä parannus perinteiseen vastaanotolla tapahtuvaan verenpainemittaukseen verrattuna. Verenpaineen kotimittaus on käytännöllinen, tarkka ja laajasti saatavilla oleva menetelmä, josta voi tulla jopa ensisijainen vaihtoehto verenpainetautia diagnosoitaessa ja hoitaessa. Verenpaineen mittauskäytäntöön tarvitaan muutos, sillä näyttöön perustuvan lääketieteen perusteella vaikuttaa, että vastaanotolla tapahtuvaa verenpainemittausta tulisi käyttää vain seulontatarkoitukseen.

Market Potential of Northwest Russia for Telemedicine Applications

The level of health care in Russia is mostly still below the western standards, but lately it has been developing quite positively. Many ICT solutions (telemedicine applications) have been developed for health care in Finland, but since the domestic market is so small, it’s necessary to expand to foreign markets to make the Finnish R&D projects more profitable. Telemedicine applications are not yet widely used in Russia, but since the health care system is going through fast changes, leapfrog effects can be expected and new modern applications and technologies will be implemented. This will open numerous business opportunities for Finnish technology developers. This thesis aims to be the first evaluation of the market and form an outlook of the health care system and telemedicine applications already utilized in Russia. The results of this study can be used for focusing further research ultimately aiming at technology implementation. The study showed that there is potential for many types of telemedicine solutions, e.g. electronic patient records and home monitoring systems; providing that further research in this field is needed.

Market Potential of Northwest Russia for Telemedicine Applications

The level of health care in Russia is mostly still below the western standards, but lately it has been developing quite positively. Many ICT solutions (telemedicine applications) have been developed for health care in Finland, but since the domestic market is so small, it’s necessary to expand to foreign markets to make the Finnish R&D projects more profitable. Telemedicine applications are not yet widely used in Russia, but since the health care system is going through fast changes, leapfrog effects can be expected and new modern applications and technologies will be implemented. This will open numerous business opportunities for Finnish technology developers. This thesis aims to be the first evaluation of the market and form an outlook of the health care system and telemedicine applications already utilized in Russia. The results of this study can be used for focusing further research ultimately aiming at technology implementation. The study showed that there is potential for many types of telemedicine solutions, e.g. electronic patient records and home monitoring systems; providing that further research in this field is needed.

Enhancement of R&D project management system

Stora Enso has research centres in Finland, Sweden and Germany. The research centres use PIMS as a research project invoicing and monitoring system. Possible reorganization and new financing model for R&D functions have been considered and the project management system should be developed to support the new operation model. The objective of this thesis is to find a model for R&D project management, and to present the project management system of Stora Enso, and to discuss if the current system could be developed to respond to the new needs or should it be replaced with another system. The theoretical part of the study describes challenges in R&D project management, and presents different project characteristics, and methods for managing R&D project portfolio. It is also described how the project management system can support project monitoring and controlling, and how inter-project learning can be enhanced. The empirical part of the study presents the current project management system of Stora Enso and how the system should be developed to support Stora Enso’s R&D functions better. In conclusion, it is stated that there is no relevant reason to replace PIMS with another system, because PIMS can be developed to support R&D project management better with a hybrid system. It is also suggested that the new financing model should not be implemented before more comprehensive analysis of its effects is conducted.

Noradrenergic stimulation enhances human action monitoring

Noradrenergic neurotransmission has been associated with the modulation of higher cognitive functions mediated by the prefrontal cortex. In the present study, the impact of noradrenergic stimulation on the human action-monitoring system, as indexed by eventrelated brain potentials, was examined. After the administration of a placebo or the selective 2 -adrenoceptor antagonist yohimbine, which stimulates firing in the locus ceruleus and noradrenaline release, electroencephalograpic recordings were obtained from healthy volunteers performing a letter flanker task. Yohimbine led to an increase in the amplitude of the error-related negativity in conjunction with a significant reduction of action errors. Reaction times were unchanged, and the drug did not modify the N2 in congruent versus incongruent trials, a measure of preresponse conflict, or posterror adjustments as measured by posterror slowing of reaction time. The present findings suggest that the locus ceruleusnoradrenaline system exerts a rather specific effect on human action monitoring.

Implementing gateway monitoring service for infrastructure sensor networks

Wireless sensor networks and its applications have been widely researched and implemented in both commercial and non commercial areas. The usage of wireless sensor network has developed its market from military usage to daily use of human livings. Wireless sensor network applications from monitoring prospect are used in home monitoring, farm fields and habitant monitoring to buildings structural monitoring. As the usage boundaries of wireless sensor networks and its applications are emerging there are definite ongoing research, such as lifetime for wireless sensor network, security of sensor nodes and expanding the applications with modern day scenarios of applications as web services. The main focus in this thesis work is to study and implement monitoring application for infrastructure based sensor network and expand its usability as web service to facilitate mobile clients. The developed application is implemented for wireless sensor nodes information collection and monitoring purpose enabling home or office environment remote monitoring for a user.

On Dynamic Monitoring Methods for Networks-on-Chip

Rapid ongoing evolution of multiprocessors will lead to systems with hundreds of processing cores integrated in a single chip. An emerging challenge is the implementation of reliable and efficient interconnection between these cores as well as other components in the systems. Network-on-Chip is an interconnection approach which is intended to solve the performance bottleneck caused by traditional, poorly scalable communication structures such as buses. However, a large on-chip network involves issues related to congestion problems and system control, for instance. Additionally, faults can cause problems in multiprocessor systems. These faults can be transient faults, permanent manufacturing faults, or they can appear due to aging. To solve the emerging traffic management, controllability issues and to maintain system operation regardless of faults a monitoring system is needed. The monitoring system should be dynamically applicable to various purposes and it should fully cover the system under observation. In a large multiprocessor the distances between components can be relatively long. Therefore, the system should be designed so that the amount of energy-inefficient long-distance communication is minimized. This thesis presents a dynamically clustered distributed monitoring structure. The monitoring is distributed so that no centralized control is required for basic tasks such as traffic management and task mapping. To enable extensive analysis of different Network-on-Chip architectures, an in-house SystemC based simulation environment was implemented. It allows transaction level analysis without time consuming circuit level implementations during early design phases of novel architectures and features. The presented analysis shows that the dynamically clustered monitoring structure can be efficiently utilized for traffic management in faulty and congested Network-on-Chip-based multiprocessor systems. The monitoring structure can be also successfully applied for task mapping purposes. Furthermore, the analysis shows that the presented in-house simulation environment is flexible and practical tool for extensive Network-on-Chip architecture analysis.

Real-time adaptive control of ultra-fast laser scribing process with spectrometer online monitoring

There exist several researches and applications about laser welding monitoring and parameter control but not a single one have been created for controlling of laser scribing processes. Laser scribing is considered to be very fast and accurate process and thus it would be necessary to develop accurate turning and monitoring system for such a process. This research focuses on finding out whether it would be possible to develop real-time adaptive control for ultra-fast laser scribing processes utilizing spectrometer online monitoring. The thesis accurately presents how control code for laser parameter tuning is developed using National Instrument's LabVIEW and how spectrometer is being utilized in online monitoring. Results are based on behavior of the control code and accuracy of the spectrometer monitoring when scribing different steel materials. Finally control code success is being evaluated and possible development ideas for future are presented.

Real-time monitoring of laser scribing process utilizing high-speed camera

Currently, laser scribing is growing material processing method in the industry. Benefits of laser scribing technology are studied for example for improving an efficiency of solar cells. Due high-quality requirement of the fast scribing process, it is important to monitor the process in real time for detecting possible defects during the process. However, there is a lack of studies of laser scribing real time monitoring. Commonly used monitoring methods developed for other laser processes such a laser welding, are sufficient slow and existed applications cannot be implemented in fast laser scribing monitoring. The aim of this thesis is to find a method for laser scribing monitoring with a high-speed camera and evaluate reliability and performance of the developed monitoring system with experiments. The laser used in experiments is an IPG ytterbium pulsed fiber laser with 20 W maximum average power and Scan head optics used in the laser is Scanlab’s Hurryscan 14 II with an f100 tele-centric lens. The camera was connected to laser scanner using camera adapter to follow the laser process. A powerful fully programmable industrial computer was chosen for executing image processing and analysis. Algorithms for defect analysis, which are based on particle analysis, were developed using LabVIEW system design software. The performance of the algorithms was analyzed by analyzing a non-moving image from the scribing line with resolution 960x20 pixel. As a result, the maximum analysis speed was 560 frames per second. Reliability of the algorithm was evaluated by imaging scribing path with a variable number of defects 2000 mm/s when the laser was turned off and image analysis speed was 430 frames per second. The experiment was successful and as a result, the algorithms detected all defects from the scribing path. The final monitoring experiment was performed during a laser process. However, it was challenging to get active laser illumination work with the laser scanner due physical dimensions of the laser lens and the scanner. For reliable error detection, the illumination system is needed to be replaced.

Electrophysiological correlates of performance monitoring in middle and late adolescence

The ability to monitor and evaluate the consequences of ongoing behaviors and coordinate behavioral adjustments seems to rely on networks including the anterior cingulate cortex (ACC) and phasic changes in dopamine activity. Activity (and presumably functional maturation) of the ACC may be indirectly measured using the error-related negativity (ERN), an event-related potential (ERP) component that is hypothesized to reflect activity of the automatic response monitoring system. To date, no studies have examined the measurement reliability of the ERN as a trait-like measure of response monitoring, its development in mid- and late- adolescence as well as its relation to risk-taking and empathic ability, two traits linked to dopaminergic and ACC activity. Utilizing a large sample of 15- and 18-year-old males, the present study examined the test-retest reliability of the ERN, age-related changes in the ERN and other components of the ERP associated with error monitoring (the Pe and CRN), and the relations of the error-related ERP components to personality traits of risk propensity and empathy. Results indicated good test-retest reliability of the ERN providing important validation of the ERN as a stable and possibly trait-like electrophysiological correlate of performance monitoring. Ofthe three components, only the ERN was of greater amplitude for the older adolescents suggesting that its ACC network is functionally late to mature, due to either structural or neurochemical changes with age. Finally, the ERN was smaller for those with high risk propensity and low empathy, while other components associated with error monitoring were not, which suggests that poor ACe function may be associated with the desire to engage in risky behaviors and the ERN may be influenced by the extent of individuals' concern with the outcome of events.

Frontal Lobe Function and Performance Monitoring following Total Sleep Deprivation

Imaging studies have shown reduced frontal lobe resources following total sleep deprivation (TSD). The anterior cingulate cortex (ACC) in the frontal region plays a role in performance monitoring and cognitive control; both error detection and response inhibition are impaired following sleep loss. Event-related potentials (ERPs) are an electrophysiological tool used to index the brain's response to stimuli and information processing. In the Flanker task, the error-related negativity (ERN) and error positivity (Pe) ERPs are elicited after erroneous button presses. In a Go/NoGo task, NoGo-N2 and NoGo-P3 ERPs are elicited during high conflict stimulus processing. Research investigating the impact of sleep loss on ERPs during performance monitoring is equivocal, possibly due to task differences, sample size differences and varying degrees of sleep loss. Based on the effects of sleep loss on frontal function and prior research, it was expected that the sleep deprivation group would have lower accuracy, slower reaction time and impaired remediation on performance monitoring tasks, along with attenuated and delayed stimulus- and response-locked ERPs. In the current study, 49 young adults (24 male) were screened to be healthy good sleepers and then randomly assigned to a sleep deprived (n = 24) or rested control (n = 25) group. Participants slept in the laboratory on a baseline night, followed by a second night of sleep or wake. Flanker and Go/NoGo tasks were administered in a battery at 1O:30am (i.e., 27 hours awake for the sleep deprivation group) to measure performance monitoring. On the Flanker task, the sleep deprivation group was significantly slower than controls (p's <.05), but groups did not differ on accuracy. No group differences were observed in post-error slowing, but a trend was observed for less remedial accuracy in the sleep deprived group compared to controls (p = .09), suggesting impairment in the ability to take remedial action following TSD. Delayed P300s were observed in the sleep deprived group on congruent and incongruent Flanker trials combined (p = .001). On the Go/NoGo task, the hit rate (i.e., Go accuracy) was significantly lower in the sleep deprived group compared to controls (p <.001), but no differences were found on false alarm rates (i.e., NoGo Accuracy). For the sleep deprived group, the Go-P3 was significantly smaller (p = .045) and there was a trend for a smaller NoGo-N2 compared to controls (p = .08). The ERN amplitude was reduced in the TSD group compared to controls in both the Flanker and Go/NoGo tasks. Error rate was significantly correlated with the amplitude of response-locked ERNs in control (r = -.55, p=.005) and sleep deprived groups (r = -.46, p = .021); error rate was also correlated with Pe amplitude in controls (r = .46, p=.022) and a trend was found in the sleep deprived participants (r = .39, p =. 052). An exploratory analysis showed significantly larger Pe mean amplitudes (p = .025) in the sleep deprived group compared to controls for participants who made more than 40+ errors on the Flanker task. Altered stimulus processing as indexed by delayed P3 latency during the Flanker task and smaller amplitude Go-P3s during the Go/NoGo task indicate impairment in stimulus evaluation and / or context updating during frontal lobe tasks. ERN and NoGoN2 reductions in the sleep deprived group confirm impairments in the monitoring system. These data add to a body of evidence showing that the frontal brain region is particularly vulnerable to sleep loss. Understanding the neural basis of these deficits in performance monitoring abilities is particularly important for our increasingly sleep deprived society and for safety and productivity in situations like driving and sustained operations.

Factores que influyen en la actividad de trasplantes en Colombia año 2013. Desde la perspectiva de pacientes renales y de expertos en trasplante de riñón, hígado y corazón

Antecedentes: Se encuentran datos oficiales sobre trasplante de órganos en Colombia desde 2005 del Instituto Nacional de Salud y desde 2008 para riñón por la Cuenta de Alto Costo. Los datos no ofrecen explicación del número de inscritos en lista de espera para trasplante renal, al comparar con otros países: Colombia 4,68% vs. Argentina 27,58% o Estados Unidos 21,73%. Por otra parte no existen datos acerca de factores que influyen en el seguimiento pos-trasplante y no se tienen de sobrevida del receptor y del injerto. Metodología: Investigación de metodología mixta cuantitativa y cualitativa a partir de la información disponible en los informes oficiales y teniendo como fuente primaria pacientes y expertos en el cuidado de paciente antes y después del trasplante. Resultados: Los factores para acceder o no a lista de espera y seguimiento más mencionados son sistema de salud, aspectos éticos en cuanto remisión y autorización. Emerge como categoría la necesidad de un sistema de vigilancia en trasplantes. En la parte cuantitativa se trasplantan más personas si viven en una ciudad con grupo de trasplante 17,6 vs. 8,05%, si pertenecen al régimen contributivo O.R 3,37 p<0,00001, si no tienen diabetes O.R 3,22 p<0,0001 ni hipertensión arterial O.R 2,42 p<0,0001. No se encontró diferencia en cuanto a género O.R 1,01 p 0,57. Conclusiones: Se proponen ajustes al sistema de salud, de la normatividad, de la educación de la promoción de la donación y trasplante en todos los niveles del público y del personal de salud.

A web 2.0 user interface for wide-area resource monitoring

Resource monitoring in distributed systems is required to understand the 'health' of the overall system and to help identify particular problems, such as dysfunctional hardware or faulty system or application software. Monitoring systems such as GridRM provide the ability to connect to any number of different types of monitoring agents and provide different views of the system, based on a client's particular preferences. Web 2.0 technologies, and in particular 'mashups', are emerging as a promising technique for rapidly constructing rich user interfaces, that combine and present data in intuitive ways. This paper describes a Web 2.0 user interface that was created to expose resource data harvested by the GridRM resource monitoring system.

Performance of a BP c-Si building Integrated PV system after 15years of installation

In this study, the performance, yield and characteristics of a 15 year old photovoltaic system installation has been investigated. The technology, BP Saturn modules which were steel-blue polycrystalline silicon cells are no longer in production. A bespoke monitoring system was designed and purpose built to monitor the characteristics of 6 strings, of 18 modules connected in series. The total output of the system is configured to 6.5kWp (series to parallel configuration). The PV system is demonstrating system outputs to be inferior by 0.7% per year. However,efficiency values in comparison to standard test conditions have remained practically the same. This output though very relevant to the possible performance and stability of aging cells, requires additional parametric studies to develop a more robust argument. The result presented in this paper is part of an on going investigation into PV system aging effects.

Assessing the performance of a building integrated BP c-Si PV system

In this study, the performance, yield and characteristics of a 16 year old photovoltaic (PV) system installation have been investigated. The technology, BP Saturn modules which were steel-blue polycrystalline silicon cells are no longer in production. A bespoke monitoring system has been designed to monitor the characteristics of 6 refurbished strings, of 18 modules connected in series. The total output of the system is configured to 6.5 kWp (series to parallel configuration). In addition to experimental results, the performance ratio (PR) of known values was simulated using PVSyst, a simulation software package. From calculations using experimental values, the PV system showed approximately 10% inferior power outputs to what would have been expected as standard test conditions. However, efficiency values in comparison to standard test conditions and the performance ratio (w75% from PVSyst simulations) over the past decade have remained practically the same. This output though very relevant to the possible performance and stability of aging cells, requires additional parametric studies to develop a more robust argument. The result presented in this paper is part of an on-going investigation into PV system aging effects.