Supporting life-long competence development using the TENCompetence infrastructure: a first experiment

This paper describes an experiment to explore the effects of the TENCompetence infrastructure for supporting lifelong competence development which is now in development. This infrastructure provides structured, multi-leveled access to learning materials, based upon competences. People can follow their own learning path, supported by a listing of competences and their components, by competence development plans attached to competences and by the possibility to mark elements as complete. We expected the PCM to have an effect on (1) control of participants of their own learning, and (2) appreciation of their learning route, (3) of the learning resources, (4) of their competence development, and (5) of the possibilities of collaboration. In the experiment, 44 Bulgarian teachers followed a distance learning course on a specific teaching methodology for six weeks. Part of them used the TENCompetence infrastructure, part used an infrastructure which was similar, except for the characterizing elements mentioned above. The results showed that in the experimental condition, more people passed the final competence assess-ment, and people felt more in control of their own learning. No differences between the two groups were found on the amount and appreciation of collaboration and on further measures of competence development.

Cognition, mood and fatigue in patients in the early stage of multiple sclerosis.

QUESTION UNDER STUDY: Cognitive impairment occurs during multiple sclerosis (MS) and contributes to the burden of the disease, but its effect in the initial phase of MS still needs to be better understood. METHODS: We prospectively studied 127 early MS patients presenting with a clinically isolated syndrome (CIS) or definite MS, a mean disease duration of 2.6 years, and with minor disability (mean Expanded Disability Status Scale score 1.8). Patients were tested for long-term memory, executive functions, attention, fatigue, mood disorders, functional handicap and quality of life (QoL). Twenty-one CIS patients were excluded from study as the diagnosis of MS could not be confirmed. RESULTS: Over the 106 MS patients analysed, 31 (29.3%) were cognitively impaired (23.6% for memory, 10.4% for attention and 5.7% for executive functions). Cognitive deficits were already present in CIS patients in whom the diagnosis was not yet confirmed (20%). Impaired cognition was associated with anxiety (p = 0.05), depression(p = 0.004), fatigue (p = 0.03), handicap (p <0.001) and a lower QoL (p <0.001). After adjustment for QoL, handicap, depression, anxiety and fatigue were no longer associated with the presence of cognitive deficits. CONCLUSIONS: In this well-defined early MS group one third of the patients already exhibited cognitive deficits, which were usually apparent in an effortful learning situation and were generally mild. Mood disorders, fatigue, handicap and decreased QoL were all associated with the occurrence of cognitive deficits. QoL itself appeared to take all the other factors into account. Our results confirm the existence of an interplay between cognitive, affective and functional changes and fatigue in early MS.

Very long half-life of paroxetine following intoxication in an extensive cytochrome P4502D6 metabolizer

A very long half-life of paroxetine (195 h instead of the usual value of around 16 h) was measured after an overdose with 2 g paroxetine and 1 g clorazepate in a patient who was an extensive cytochrome P4502D6 metabolizer. The patient recovered well without any clinically significant complications. A consequence of the close monitoring of paroxetine levels in this patient was that it was decided not to reintroduce any other antidepressant despite her suicide attempt, until normal levels of paroxetine had been reached, which took over 1 month.

Devenir à long terme des patients intubés pour état de mal asthmatique [Late outcome after life-threatening asthma]

Pour connaître le devenir à long terme des patients intubés pour état de mal asthmatique, nous avons recontacté en 1990 les 34 patients qui avaient présenté, entre 1978 et 1988, quarante épisodes de détresse respiratoire aiguë. Deux patients sont vivants mais ont été perdus de vue, 3 sont morts dont un seul d'état de mal asthmatique 6 mois après l'épisode initial. Des 29 patients restants (7 hommes et 22 femmes, âge moyen de 48,5 ans) représentant un suivi moyen de 9,6 ans, quinze n'ont jamais été réhospitalisés; des 14 autres, seuls 5 ont requis une intubation et une ventilation mécanique lors d'un épiode ultérieur. La majorité des hospitalisations ultérieures (81%) sont survenues dans les 6 ans suivant l'épiode initial

Health-related quality of life in long-term survivors of relapsed childhood acute lymphoblastic leukemia.

BACKGROUND: Relapses occur in about 20% of children with acute lymphoblastic leukemia (ALL). Approximately one-third of these children can be cured. Their risk for late effects is high because of intensified treatment, but their health-related quality of life (HRQOL) was largely unmeasured. Our aim was to compare HRQOL of ALL survivors with the general population, and of relapsed with non-relapsed ALL survivors. METHODOLOGY/PRINCIPAL FINDINGS: As part of the Swiss Childhood Cancer Survivor Study (SCCSS) we sent a questionnaire to all ALL survivors in Switzerland who had been diagnosed between 1976-2003 at age <16 years, survived ≥5 years, and were currently aged ≥16 years. HRQOL was assessed with the Short Form-36 (SF-36), which measures four aspects of physical health and four aspects of mental health. A score of 50 corresponded to the mean of a healthy reference population. We analyzed data from 457 ALL survivors (response: 79%). Sixty-one survivors had suffered a relapse. Compared to the general population, ALL survivors reported similar or higher HRQOL scores on all scales. Survivors with a relapse scored lower in general health perceptions (51.6) compared to those without (55.8;p=0.005), but after adjusting for self-reported late effects, this difference disappeared. CONCLUSION/SIGNIFICANCE: Compared to population norms, ALL survivors reported good HRQOL, even after a relapse. However, relapsed ALL survivors reported poorer general health than non-relapsed. Therefore, we encourage specialists to screen for poor general health in survivors after a relapse and, when appropriate, specifically seek and treat underlying late effects. This will help to improve patients' HRQOL.

GDP and life expectancy in Italy and Spain over the long-run (1861-2008): insights from a timeseries approach

The article presents and discusses long-run series of per capita GDP and life expectancy for Italy and Spain (1861-2008). After refining the available estimates in order to make them comparable and with the avail of the most up-to-date researches, the main changes in the international economy and in technological and sociobiological regimes are used as analytical frameworks to re-assess the performances of the two countries; then structural breaks are searched for and Granger causality between the two variables is investigated. The long-run convergence notwithstanding, significant cyclical differences between the two countries can be detected: Spain began to modernize later in GDP, with higher volatility in life expectancy until recent decades; by contrast, Italy showed a more stable pattern of life expectancy, following early breaks in per capita GDP, but also a negative GDP break in the last decades. Our series confirm that, whereas at the early stages of development differences in GDP tend to mirror those in life expectancy, this is no longer true at later stages of development, when, if any, there seems to be a negative correlation between GDP and life expectancy: this finding is in line with the thesis of a non-monotonic relation between life expectancy and GDP and is supported by tests of Granger causality.

Multivariable regression analysis and hot-spot stress approach into fatigue life estimations of welded joints

Kolmen eri hitsausliitoksen väsymisikä arvio on analysoitu monimuuttuja regressio analyysin avulla. Regression perustana on laaja S-N tietokanta joka on kerätty kirjallisuudesta. Tarkastellut liitokset ovat tasalevy liitos, krusiformi liitos ja pitkittäisripa levyssä. Muuttujina ovat jännitysvaihtelu, kuormitetun levyn paksuus ja kuormitus tapa. Paksuus effekti on käsitelty uudelleen kaikkia kolmea liitosta ajatellen. Uudelleen käsittelyn avulla on varmistettu paksuus effektin olemassa olo ennen monimuuttuja regressioon siirtymistä. Lineaariset väsymisikä yhtalöt on ajettu kolmelle hitsausliitokselle ottaen huomioon kuormitetun levyn paksuus sekä kuormitus tapa. Väsymisikä yhtalöitä on verrattu ja keskusteltu testitulosten valossa, jotka on kerätty kirjallisuudesta. Neljä tutkimustaon tehty kerättyjen väsymistestien joukosta ja erilaisia väsymisikä arvio metodeja on käytetty väsymisiän arviointiin. Tuloksia on tarkasteltu ja niistä keskusteltu oikeiden testien valossa. Tutkimuksissa on katsottu 2mm ja 6mm symmetristäpitkittäisripaa levyssä, 12.7mm epäsymmetristä pitkittäisripaa, 38mm symmetristä pitkittäisripaa vääntökuormituksessa ja 25mm/38mm kuorman kantavaa krusiformi liitosta vääntökuormituksessa. Mallinnus on tehty niin lähelle testi liitosta kuin mahdollista. Väsymisikä arviointi metodit sisältävät hot-spot metodin jossa hot-spot jännitys on laskettu kahta lineaarista ja epälineaarista ekstrapolointiakäyttäen sekä paksuuden läpi integrointia käyttäen. Lovijännitys ja murtumismekaniikka metodeja on käytetty krusiformi liitosta laskiessa.

Use of field measurements in fatigue analysis of forestry cranes

Tässä työssä on esitetty väsyttävän kuormituksen mittaamiseen ja mittausdatan jälkikäsittelyyn sekä väsymismitoitukseen liittyviä menetelmiä. Menetelmien sovelluskohteena oli metsäkoneen kuormain, joka on väsyttävästi kuormitettu hitsattu rakenne. Teoriaosassa on kuvattu väsymisilmiötä ja väsymismitoitusmenetelmiä sekä kuormitusten tunnistamiseen ja mittausten jälkikäsittelyyn liittyviä menetelmiä. Yleisimmin käytettyjen väsymismitoitusmenetelmien rinnalle on esitetty luotettavuuteen perustuvaa väsymismitoitusmenetelmää. Kuormainten suunnittelussa on keveys- j a kestoikävaatimusten takia erityisen suuri merkitys väsymisen huomioimisella. Rakenteille on ominaista tietyt toiminnan kannalta välttämättömät hitsatut yksityiskohdat, jotka usein määräävät koko rakenteen kestoiän. Koska nämä ongelmakohdat pystytään useimmiten tunnistamaan jo suunnitteluvaiheessa, voidaan yksityiskohtien muotoilulla usein parantaa huomattavasti koko rakenteen kestoikää. Näiden yksityiskohtien optimointi on osittain mahdollista toteuttaa ilman kuormituskertymätietoa, mutta useimmiten kuormitusten tunnistaminen on edellytys parhaan ratkaisun löytymiselle. Tällöin toistaiseksi paras keino todellisen väsyttävän kuormituksen tunnistamiseksi on pitkäaikaiset kenttämittaukset. Kenttämittauksilla selvitetään rakenteeseen kohdistuvat kuormitukset venymäliuskojen avulla. Kuormitusten tunnistamisella on erityisen suuri merkitys kun halutaan määrittää rakenteen kestoikä. Väsyminen ja väsyttävä kuormitus ovat kuitenkin tilastollisia muuttujia j a yksittäiselle rakenteelle ei ole mahdollista määrittää tarkkaa k estoikää. Tilastollisia menetelmiä käyttäen on kuitenkin mahdollista määrittää rakenteen vaurioitumisriski. Laskettaessa vaurioitumisriskiä suurelle määrälle yksittäisiä rakenteita voidaan muodostaa tarkkojakin ennusteita mahdollisten vaurioiden lukumäärästä. Tällöin kuormituskertymätiedosta voi olla tavanomaisen suunnittelun lisäksi laajempaa hyötyä esimerkiksi takuukäsittelyssä. Tässä työssä on sovellettu esitettyjä teorioita käytännössä metsäkoneen harvesterin puomiston väsymistarkasteluun. Kyseisen rakenteen kuormituksia mitattiin kahden viikon aikana yhteensä 35 tuntia, jonka perusteella laskettiin väsyttävän kuormituksen tilastollinen jakauma esimerkkitapaukselle. Mittauksen perusteella ei voitu tehdä kuitenkaan johtopäätöksiä tuotteen koko elinkaaren kuormituksista eikä muiden samanlaisten tuotteiden kuormituksista, koska mitattu otos oli suhteellisen lyhyt ja rajoittui vain yhteen käyttäjään ja muutamaan käyttökohteeseen. Menetelmien testaamiseksi kyseinen otos oli kuitenkin riittävä. Kuormituskertymätietoa käytettiin hyväksi myös laatumääritysten muodostamisessaesimerkkitapaukselle. Murtumismekaniikkaan perustuvalla menetelmällä arvioitiinharvesteripilarin valun mahdollisten valuvirheiden suurin sallittu koko. Luotettavuuteen pohjautuvan mitoitusmenettelyn tarve näyttää olevanlisääntymässä, joten pitkäaikaisten kenttämittausten tehokas hyödyntäminen tulee olemaan keskeinen osa väsymismitoitusta lähitulevaisuudessa. Menetelmiä olisi mahdollista tehostaa yhdistämällä kuormituskertymään erilaisia kuormitusten suhteen riippuvia tunnettuja suureita kuten käsiteltävän puun halkaisija. Todellisettuotekohtaiset tilastolliset jakaumat kuormituksista voitaisiin muodostaa mahdollisesti tehokkaammin, jos esimerkiksi kuormitusten riippuvuus metsätyypistä pystyttäisiin ensin määrittämään.

Health Related Quality of Life after Childhood Cancer - A Finnish Nationwide survey

The purpose of this Finnish epidemiological nationwide cross-sectional study was to evaluate the Health Related Quality of Life (HRQL) of young people that have survived childhood cancer at least four years after cancer diagnosis. The study aims were (1) to increase knowledge and understanding about the relationship between childhood cancer and its treatment and HRQL of childhood cancer survivors and (2) to identify survivors who need and could benefit from ongoing long-term follow-up, as well as (3) to identify what kind of aftercare the childhood cancer survivors will possibly need. HRQL and fatigue of currently still young survivors of extracranial childhood malignancies were evaluated with self-reports and parent proxy reports. HRQL was measured with age-appropriate generic instruments: PedsQL™, SF-36, 15D, 16D and 17D. Fatigue for children and adolescents aged below 18 years was measured with the PedsQL™ Multidimensional Fatigue Scale Finnish version. PedsQL™ parent-proxy and the PedsQL™ Multidimensional Fatigue Scale Parentproxy instruments were used to assess the perception of the parents on HRQL and fatigue of their children and adolescents. Postal-survey questionnaires were mailed to 852 childhood cancer survivors aged 11-27 years and their randomly selected gender-, age and living-place matched controls, as well as under 18-year-old children´s parents. A total of 474 survivors, 595 controls, 209 survivor’s parent and 253 control’s parent replied. The mean age of survivors at the time of the study was 18.4 years. The mean length of survival was 12.3 years, and the mean age at diagnosis 5.5 years. The most of the Finnish childhood cancer survivors evaluated that their HRQL as good. Survivors rated their HRQL equal or higher than their controls. The only dimension where the survivors scored poorer than the controls was the 15D mobility dimension. Survivors of childhood cancer did not suffer from significant fatigue. There were subgroups of childhood cancer survivors who had poorer level of HRQL, and suffered from fatigue more than the reference group. The demographic factors that associated with poorer HRQL were female gender, greater weight, living alone, need of remedial education, an additional non-cancer diagnosis, survivors with siblings, and self-reported unhappiness. Disease-related factors that associated with poorer HRQL were higher age at the time of diagnosis, the diagnosis of Wilms tumor, neuroblastoma, or osteosarcoma, and treatment with stem cell transplantation. The factors associated with more fatigue in survivors were male gender, older age at evaluation, the need of remedial education at school, lower overall average grade in the latest school marks report, length of survival more than 10 years, lower HRQL-scores, and a sarcoma diagnosis. However, all the used demographic and disease related factors explained only about one third of the variation in the HRQL scores. In open questions, the survivors were most worried about their physical health, but were also worried about their mental health, cancer inheritance, late-effects, and fertility and relapse issues. It seems that there are subgroups of survivors who need and could benefit from ongoing long-term follow-up. In the future, the survivors of childhood cancer need more information about their physical and mental health, as well as on their cancer inheritance, possible late-effects including fertility issues, and on the risk of relapse.

Handwritten statement (3 pages) regarding life licenses to shoot at Long Point

Handwritten statement (3 pages) regarding life licenses to shoot at Long Point, Oct. 4, 1881.

Notice to members and life members of the Long Point Co. from Louis N. Hayne

Notice to members and life members of the Long Point Co. from Louis N. Hayne stating that members permitting a punter or employee to shoot will not be permitted to take a punter or employee into the marsh until such further measures will be enforced, June 7, 1886.