Missed appointments in an outpatient clinic for adolescents, an approach to predict the risk of missing.

PURPOSE: To predict the risk of an adolescent patient to miss an appointment, based on the previous appointments and on the characteristics of the patient and the appointment. METHODS: Two thousand one hundred ninety-three (1873 females) patients aged 12 to 20 years having scheduled at least four appointments were included. We assessed the rate of missed nonexcused appointments of each patient. Second, a Markovian multilevel model was used to predict the risk of defaulting. RESULTS: Forty-five percent of the patients have not missed even once, and 14% of females and 17% of males have missed >25% of their appointments. Females show two types of behaviors (an abstract concept that groups individuals based on a combination of their appointment-keeping and their recorded type of healthcare need) depending on the diagnosis. Somatic, gynecology, violence, and counseling diagnoses are mostly grouped together. In this group, having already missed and having an appointment with a paramedical provider increases the risk of missing. In the second group (eating disorders and psychiatric diagnoses) having already missed and a longer delay between appointments influence the risk of missing, although the risk is lower for this latter group. Males only show one type of behavior regarding missed appointments. Having missed a previous appointment, being older, having cancelled the next to last appointment and the type of diagnosis explain the risk of missing. CONCLUSIONS: Patients who have already defaulted have a higher risk of defaulting again. Means of control regarding missed appointments should consequently focus on defaulters, to decrease the associated workload. Reminders could be a solution for the follow-up appointments scheduled with a long delay.

Cardiac raptor deletion impairs adaptive hypertrophy, alters metabolic gene expression and causes heart failure in mice

Background: Mammalian target of rapamycin (mTOR), a central regulator of cell growth, is found in two structurally and functionally distinct multiprotein complexes called mTOR complex (mTORC)1 and mTORC2. The specific roles of each of these branches of mTOR signaling have not been dissected in the adult heart. In the present study, we aimed to bring new insights into the function of cardiac mTORC1-mediated signaling in physiological as well as pathological situations.Methods: We generated mice homozygous for loxP-flanked raptor and positive for the tamoxifen-inducible Cre recombinase (MerCreMer) under control of the α- myosin heavy chain promoter. The raptor gene encodes an essential component of mTORC1. Gene ablation was induced at the age of 10-12 weeks, and two weeks later the raptor cardiac-knockout (raptor-cKO) mice started voluntary cagewheel exercise or were subjected to transverse aortic constriction (TAC) to induce pressure overload.Results: In sedentary raptor-cKO mice, ejection fractions gradually decreased, resulting in significantly reduced values at 38 days (P < 0.001). Raptor-cKO mice started to die during the fifth week after the last tamoxifen injection. At that time, the mortality rate was 36% in sedentary (n = 11) and 64% in exercising (n = 14) mice. TAC-induced pressure overload resulted in severe cardiac dysfunction already at earlier timepoints. Thus, at 7-9 days after surgery, ejection fraction and fractional shortening values were 22.3% vs 43.5% and 10.2% vs 21.5% in raptor-cKO vs wild-type mice, respectively. This was accompanied by significant reductions of ventricular wall and septal thickness as well as an increase in left ventricular internal diameter. Moreover, ventricular weight to tibial length ratios were increased in wild-type, but not in the raptor-cKO TAC mice. Together, this shows that raptor-cKO mice rapidly developed dilated cardiomyopathy without going through a phase of adaptive hypertrophy. Expression of ANP and β-MHC was induced in all raptor-cKO mice irrespective of the cardiac load conditions. Consistent with reduced mTORC1 activity, phosphorylation of ribosomal S6 kinase and 4E-BP1 was blunted, indicating reduced protein synthesis. Moreover, expression of multiple genes involved in the regulation of energy metabolism was altered, and followed by a shift from fatty acid to glucose oxidation.Conclusion: Our study suggests that mTORC1 coordinates protein and energy metabolic pathways in the heart. Moreover, we demonstrate that raptor is essential for the cardiac adaptation to increased workload and importantly, also for normal physiological cardiac function.

Auditory localisation and recognition after left inferior collicular lesion: effects of work load on cortical activation patterns (fMRI study)

Evidence from neuropsychological and activation studies (Clarke et al., 2oo0, Maeder et al., 2000) suggests that sound recognitionand localisation are processed by two anatomically and functionally distinct cortical networks. We report here on a case of a patientthat had an interruption of auditory information and we show: i) the effects of this interruption on cortical auditory processing; ii)the effect of the workload on activation pattern.A 36 year old man suffered from a small left mesencephalic haemotrhage, due to cavernous angioma; the let% inferior colliculuswas resected in the surgical approach of the vascular malformation. In the acute stage, the patient complained of auditoryhallucinations and of auditory loss in right ear, while tonal audiometry was normal. At 12 months, auditory recognition, auditorylocalisation (assessed by lTD and IID cues) and auditory motion perception were normal (Clarke et al., 2000), while verbal dichoticlistening was deficient on the right side.Sound recognition and sound localisation activation patterns were investigated with fMRI, using a passive and an activeparadigm. In normal subjects, distinct cortical networks were involved in sound recognition and localisation, both in passive andactive paradigm (Maeder et al., 2OOOa, 2000b).Passive listening of environmental and spatial stimuli as compared to rest strongly activated right auditory cortex, but failed toactivate left primary auditory cortex. The specialised networks for sound recognition and localisation could not be visual&d onthe right and only minimally on the left convexity. A very different activation pattern was obtained in the active condition wherea motor response was required. Workload not only increased the activation of the right auditory cortex, but also allowed theactivation of the left primary auditory cortex. The specialised networks for sound recognition and localisation were almostcompletely present in both hemispheres.These results show that increasing the workload can i) help to recruit cortical region in the auditory deafferented hemisphere;and ii) lead to processing auditory information within specific cortical networks.References:Clarke et al. (2000). Neuropsychologia 38: 797-807.Mae.der et al. (2OOOa), Neuroimage 11: S52.Maeder et al. (2OOOb), Neuroimage 11: S33

Multidimensional Adaptations for Open Learning Management Systems

Our work is focused on alleviating the workload for designers of adaptive courses on the complexity task of authoring adaptive learning designs adjusted to specific user characteristics and the user context. We propose an adaptation platform that consists in a set of intelligent agents where each agent carries out an independent adaptation task. The agents apply machine learning techniques to support the user modelling for the adaptation process

Can the impact of bed closure in intensive care units be reliably monitored?

OBJECTIVE: To assess the properties of various indicators aimed at monitoring the impact on the activity and patient outcome of a bed closure in a surgical intensive care unit (ICU). DESIGN: Comparison before and after the intervention. SETTING: A surgical ICU at a university hospital. PATIENTS: All patients admitted to the unit over two periods of 10 months. INTERVENTION: Closure of one bed out of 17. MEASUREMENTS AND RESULTS: Activity and outcome indicators in the ICU and the structures upstream from it (emergency department, operative theater, recovery room) and downstream from it (intermediate care units). After the bed closure, the monthly medians of admitted patients and ICU hospital days increased from 107 (interquartile range 94-112) to 113 (106-121, P=0.07) and from 360 (325-443) to 395 (345-436, P=0.48), respectively, along with the linear trend observed in our institution. All indicators of workload, patient severity, and outcome remained stable except for SAPS II score, emergency admissions, and ICU readmissions, which increased not only transiently but also on a mid-term basis (10 months), indicating that the process of patient care delivery was no longer predictable. CONCLUSIONS: Health care systems, including ICUs, are extraordinary flexible, and can adapt to multiple external constraints without altering commonly used activity and outcome indicators. It is therefore necessary to set up multiple indicators to be able to reliably monitor the impact of external interventions and intervene rapidly when the system is no longer under control.

A Framework for Building Hypercubes Using MapReduce

The European Space Agency's Gaia mission will create the largest and most precise three dimensional chart of our galaxy (the Milky Way), by providing unprecedented position, parallax, proper motion, and radial velocity measurements for about one billion stars. The resulting catalogue will be made available to the scientific community and will be analyzed in many different ways, including the production of a variety of statistics. The latter will often entail the generation of multidimensional histograms and hypercubes as part of the precomputed statistics for each data release, or for scientific analysis involving either the final data products or the raw data coming from the satellite instruments. In this paper we present and analyze a generic framework that allows the hypercube generation to be easily done within a MapReduce infrastructure, providing all the advantages of the new Big Data analysis paradigmbut without dealing with any specific interface to the lower level distributed system implementation (Hadoop). Furthermore, we show how executing the framework for different data storage model configurations (i.e. row or column oriented) and compression techniques can considerably improve the response time of this type of workload for the currently available simulated data of the mission. In addition, we put forward the advantages and shortcomings of the deployment of the framework on a public cloud provider, benchmark against other popular solutions available (that are not always the best for such ad-hoc applications), and describe some user experiences with the framework, which was employed for a number of dedicated astronomical data analysis techniques workshops.

A Framework for Building Hypercubes Using MapReduce

The European Space Agency's Gaia mission will create the largest and most precise three dimensional chart of our galaxy (the Milky Way), by providing unprecedented position, parallax, proper motion, and radial velocity measurements for about one billion stars. The resulting catalogue will be made available to the scientific community and will be analyzed in many different ways, including the production of a variety of statistics. The latter will often entail the generation of multidimensional histograms and hypercubes as part of the precomputed statistics for each data release, or for scientific analysis involving either the final data products or the raw data coming from the satellite instruments. In this paper we present and analyze a generic framework that allows the hypercube generation to be easily done within a MapReduce infrastructure, providing all the advantages of the new Big Data analysis paradigmbut without dealing with any specific interface to the lower level distributed system implementation (Hadoop). Furthermore, we show how executing the framework for different data storage model configurations (i.e. row or column oriented) and compression techniques can considerably improve the response time of this type of workload for the currently available simulated data of the mission. In addition, we put forward the advantages and shortcomings of the deployment of the framework on a public cloud provider, benchmark against other popular solutions available (that are not always the best for such ad-hoc applications), and describe some user experiences with the framework, which was employed for a number of dedicated astronomical data analysis techniques workshops.

Oops! Another medication error : a literature review of contributing factors and methods to prevent medication errors

The purpose of this bachelor's thesis was to chart scientific research articles to present contributing factors to medication errors done by nurses in a hospital setting, and introduce methods to prevent medication errors. Additionally, international and Finnish research was combined and findings were reflected in relation to the Finnish health care system. Literature review was conducted out of 23 scientific articles. Data was searched systematically from CINAHL, MEDIC and MEDLINE databases, and also manually. Literature was analysed and the findings combined using inductive content analysis. Findings revealed that both organisational and individual factors contributed to medication errors. High workload, communication breakdowns, unsuitable working environment, distractions and interruptions, and similar medication products were identified as organisational factors. Individual factors included nurses' inability to follow protocol, inadequate knowledge of medications and personal qualities of the nurse. Developing and improving the physical environment, error reporting, and medication management protocols were emphasised as methods to prevent medication errors. Investing to the staff's competence and well-being was also identified as a prevention method. The number of Finnish articles was small, and therefore the applicability of the findings to Finland is difficult to assess. However, the findings seem to fit to the Finnish health care system relatively well. Further research is needed to identify those factors that contribute to medication errors in Finland. This is a necessity for the development of methods to prevent medication errors that fit in to the Finnish health care system.

Test automation in Basic Acceptance Testing of S60 platform

Perushyväksymistestaus on oleellinen osa S60 alustan julkaisukandidaatin maturiteetin seurannassa. Perushyväksymistestausta tehdään myös ohjelmiston julkistamiskelpoisuuden varmistamiseksi. Testaustulokset halutaan aina mahdollisimman nopeasti. Lisäksi testaustiimin työmäärä on hiljalleen kasvanut, koska projekteja onenemmän ja korjauksia sisältäviä ja räätälöityjä settejä testataan enemmän. Tässä diplomityössä tutkitaan lyhentäisikö testisetin osan automatisointi testien ajoaikaa ja helpottaisiko se testaajien työtaakkaa. Tarkastelu toteutetaan automatisoimalla osa testisetistä ja kokemuksia esitellään tässä lopputyössä.

Osaamisen johtaminen asiakaspalvelutyön muutoksessa

Yrityksen muuttuva toimintaympäristö asettaa uusia vaatimuksia henkilöstön osaamiselle. Tässä pro gradu tutkielmassa tutkin ICT-yrityksen asiakaspalvelussa tarvittavaa tämän hetken osaamista ja tulevaisuuden osaamistarpeita sekä asiakaspalveluhenkilöstön että heidän esimiestensä näkökulmasta. Tutkimuksen kohderyhmänä on Päijät-Hämeen Puhelin Oyj:n asiakaspalveluhenkilöstö. Tutkimuson tapaustutkimus ja tutkimusaineisto on kerätty kyselytutkimuksella, teemahaastatteluilla ja havainnoilla. Tutkimuksen mukaan tällä hetkellä asiakaspalvelun tärkeimmät osaamisalueet ovat: stressinsietokyky, asiakaspalvelutaidot, myyntitaidot, priorisointitaidot ja tuote- ja palvelutuntemus. Suurimmat osaamistarpeisiin vaikuttaneet tietoliikennealalla tapahtuneet muutokset ovattietoliikennealan merkityksen kasvaminen, kilpailun lisääntyminen, tekniikan jatkuva kehittyminen, asiakaskontaktien lisääntyminen ja kuluttajakäyttäytymisen muutos. Merkittävin muutos alalla seuraavan viiden vuoden aikana tulee olemaan kilpailun edelleen kiristyminen ja työmäärän edelleen kasvaminen. Nämä muutokset tulevat vaikuttamaan tulevaisuuden keskeisimpiin osaamistarpeisiin niin, että tulevaisuuden keskeisimmät osaamistarpeet ovat stressinsietokykyja uusien asioiden omaksumiskyky.

Johtajiin kohdistuvat paineet ja vaatimukset

Tutkimuksen tarkoituksena oli kertoa johtajien kokemista paineista ja vaatimuksista. Tutkimuksessa käytiin läpi johtajien nykytilaan vaikuttavia tekijöitä, heidän kokemiaan paineita, ylitöitä sekä paineiden vaikutuksia. Lisäksi tehtiin selkoa kannusteista, jotka motivoivat johtajia töihinsä. Tutkimus oli luonteeltaan kvalitatiivinen ja sen pääasiallinen aineisto koostui kuudesta syvällisestä suomalaisten miesjohtajien teemahaastattelusta. Tutkimuksen tulokset tukivat monilta osin aikaisempaa tutkimusta. Johtajat kokivat kovaa painetta niin sijoittajaomistajien, kuin myös asiakkaiden suunnalta. Myös perheen ja vaativan työn yhteensovittamisessa oli monella johtajalla ollut ongelmia - muun muassa ylipitkien työviikkojen takia. Erilaisista kannusteista merkittävimmiksi tekijäksi nousi työn mielenkiintoisuus ja haastavuus. Vaikka johtajan työ antaa paljon, se myös vaatii tekijältään samalla mitalla.

Data-parallel computation in parallel and distributed environments

The past few decades have seen a considerable increase in the number of parallel and distributed systems. With the development of more complex applications, the need for more powerful systems has emerged and various parallel and distributed environments have been designed and implemented. Each of the environments, including hardware and software, has unique strengths and weaknesses. There is no single parallel environment that can be identified as the best environment for all applications with respect to hardware and software properties. The main goal of this thesis is to provide a novel way of performing data-parallel computation in parallel and distributed environments by utilizing the best characteristics of difference aspects of parallel computing. For the purpose of this thesis, three aspects of parallel computing were identified and studied. First, three parallel environments (shared memory, distributed memory, and a network of workstations) are evaluated to quantify theirsuitability for different parallel applications. Due to the parallel and distributed nature of the environments, networks connecting the processors in these environments were investigated with respect to their performance characteristics. Second, scheduling algorithms are studied in order to make them more efficient and effective. A concept of application-specific information scheduling is introduced. The application- specific information is data about the workload extractedfrom an application, which is provided to a scheduling algorithm. Three scheduling algorithms are enhanced to utilize the application-specific information to further refine their scheduling properties. A more accurate description of the workload is especially important in cases where the workunits are heterogeneous and the parallel environment is heterogeneous and/or non-dedicated. The results obtained show that the additional information regarding the workload has a positive impact on the performance of applications. Third, a programming paradigm for networks of symmetric multiprocessor (SMP) workstations is introduced. The MPIT programming paradigm incorporates the Message Passing Interface (MPI) with threads to provide a methodology to write parallel applications that efficiently utilize the available resources and minimize the overhead. The MPIT allows for communication and computation to overlap by deploying a dedicated thread for communication. Furthermore, the programming paradigm implements an application-specific scheduling algorithm. The scheduling algorithm is executed by the communication thread. Thus, the scheduling does not affect the execution of the parallel application. Performance results achieved from the MPIT show that considerable improvements over conventional MPI applications are achieved.

Procurement in Project Implementation

Tutkimus keskittyy hankintatoimen kehittämiseen osana laitosprojektien toteutusta. Työ pohjautuu empiiriseltä taustaltaan Pöyry Oyj:n projektiliiketoimintaan ja työn tarkastelunäkökulmaksi onvalittu projektihallinnosta vastaavan yrityksen näkökulma. Tutkimus on hyvin käytännönläheinen ¿ se lähtee hankinnan ja sen seurannan ongelmista ja pyrkii tarjoamaan niihin uudenlaisia ratkaisuja. Pohjimmiltaan tutkimus kuuluu teollisuustalouden piiriin, vaikka tietojärjestelmätieteellä on vahva tukirooli. Työn tavoitteet ja tulokset liittyvät teollisuustaloudelle ominaisesti yrityksen toiminnan kehittämiseen, käytetyt välineet ja ratkaisut puolestaan hyödyntävät tietojärjestelmätieteen antamia mahdollisuuksia. Tutkimuksessa on käytetty konstruktiivista tutkimusotetta, jonka mukaisesti on luotu innovatiivisia konstruktioita ratkaisemaan aitoja reaalimaailman ongelmia ja tätä kautta tuotettu kontribuutioita teollisuustaloudelle. Tavoitteena oli järjestää hankintatoimi ja sen seuranta suurissa laitosprojekteissa tehokkaammin. Tätä varten uudistettiin ensin projektihallinnon ja hankintatoimen toimintaohjeet vastaamaan paremmin nykyajan vaatimuksia. Toimintaohjeiden perusteella ryhdyttiin toteuttamaan hankintaohjelmistoa, joka pystyisi kattamaan kaikki toimintaohjeissa kuvatut piirteet. Lopulta hankintaohjelmisto toi mukanaan uusia piirteitä projektihallintoon ja hankintatoimeen ja nämä sisällytettiin toimintaohjeisiin. Tähän kehitystyöhön ryhdyttiin, jotta laitosprojektien projektihallinto ja hankintatoimi toimisivat paremmin, eli pienemmin kustannuksin tuottaen projekteissa tarvittavat tulokset nopeammin, tarkemmin ja laadukkaammin. Tutkimuksella on kolmenlaisia tuloksia: hankintatoimen parannetut metodit, hankintaohjelmiston pohjana olevat toiminta- ja laskentamallit sekä implementaationa hankintasovellus. Uudistetut projekti- ja hankintaohjeet kuvaavat hankintatoiminnan parannettuja metodeja. Hankintaohjelmistoasuunnitellessa ja kehitettäessä tehdyt kuvaukset sisältävät uusia malleja niin hankintaprosessille kuin hankinnan seuraamiseksi suurissa laitosprojekteissa. Itse ohjelmisto on tuloksena implementaatio, joka perustuu parannettuihin hankintametodeihin ja uusiin toiminta- ja laskentamalleihin. Uudistetut projekti- ja hankintaohjeet ovat olleet käytössä Pöyry Oyj:ssä vuodesta 1991. Vuosien varrella nämä toimintaohjeet ovat auttaneet ja tukeneet satojen laitosprojektientoteutusta ja ylläpitäneet Pöyry Oyj:n kilpailukykyä kansainvälisenä projektitalona. Hankintasovellus puolestaan on ollut käytössä useissa projekteissa ja sen on havaittu pienentävän hankintatoimen suoria työkustannuksia laitosprojekteissa. Sovelluksen katsotaan myös tuovan epäsuoria kustannussäästöjä parempien hankintapäätösten muodossa, mutta näiden säästöjen suuruutta ei pystytä luotettavasti arvioimaan.