Quelques abus de la statistique dans la recherche médicale [Various abuses of statistics in medical research].

Statistics has become an indispensable tool in biomedical research. Thanks, in particular, to computer science, the researcher has easy access to elementary "classical" procedures. These are often of a "confirmatory" nature: their aim is to test hypotheses (for example the efficacy of a treatment) prior to experimentation. However, doctors often use them in situations more complex than foreseen, to discover interesting data structures and formulate hypotheses. This inverse process may lead to misuse which increases the number of "statistically proven" results in medical publications. The help of a professional statistician thus becomes necessary. Moreover, good, simple "exploratory" techniques are now available. In addition, medical data contain quite a high percentage of outliers (data that deviate from the majority). With classical methods it is often very difficult (even for a statistician!) to detect them and the reliability of results becomes questionable. New, reliable ("robust") procedures have been the subject of research for the past two decades. Their practical introduction is one of the activities of the Statistics and Data Processing Department of the University of Social and Preventive Medicine, Lausanne.

Practical applications of a systematic approach to the chemical abatement of pollutants in water and air

The present dissertation is devoted to the systematic approach to the development of organic toxic and refractory pollutants abatement by chemical decomposition methods in aqueous and gaseous phases. The systematic approach outlines the basic scenario of chemical decomposition process applications with a step-by-step approximation to the most effective result with a predictable outcome for the full-scale application, confirmed by successful experience. The strategy includes the following steps: chemistry studies, reaction kinetic studies in interaction with the mass transfer processes under conditions of different control parameters, contact equipment design and studies, mathematical description of the process for its modelling and simulation, processes integration into treatment technology and its optimisation, and the treatment plant design. The main idea of the systematic approach for oxidation process introduction consists of a search for the most effective combination between the chemical reaction and the treatment device, in which the reaction is supposed to take place. Under this strategy,a knowledge of the reaction pathways, its products, stoichiometry and kinetics is fundamental and, unfortunately, often unavailable from the preliminary knowledge. Therefore, research made in chemistry on novel treatment methods, comprisesnowadays a substantial part of the efforts. Chemical decomposition methods in the aqueous phase include oxidation by ozonation, ozone-associated methods (O3/H2O2, O3/UV, O3/TiO2), Fenton reagent (H2O2/Fe2+/3+) and photocatalytic oxidation (PCO). In the gaseous phase, PCO and catalytic hydrolysis over zero valent ironsare developed. The experimental studies within the described methodology involve aqueous phase oxidation of natural organic matter (NOM) of potable water, phenolic and aromatic amino compounds, ethylene glycol and its derivatives as de-icing agents, and oxygenated motor fuel additives ¿ methyl tert-butyl ether (MTBE) ¿ in leachates and polluted groundwater. Gas-phase chemical decomposition includes PCO of volatile organic compounds and dechlorination of chlorinated methane derivatives. The results of the research summarised here are presented in fifteenattachments (publications and papers submitted for publication and under preparation).

Practical Solutions for Increased Safety in Paper Mill Operations

Tämä diplomityö käsittelee työterveys- ja työturvallisuushallinnan (TTT) sekä ympäristönsuojelun ongelmia ja riskejä, joita tehdasalueen toiminnanharjoittaja kohtaa ulkoistaessaan tehdastoimintojaan ja siirtyessään käyttämään 24 h ulkoisia kunnossapitopalveluja. Teoriaosa selventää ulkoistukseen liittyviä lainmukaisia määräyksiä ja vaatimuksia koskien terveyden, turvallisuuden ja ympäristöongelmien hallintaa sellu-, paperi- ja kartonkitehtaissa Euroopassa, Yhdysvalloissa ja Suomessa. TTT-toiminnan tason sekä ympäristönsuojelun tason mittaamisen ongelmat tuodaan esille. Olemassa olevia kansainvälisiä TTT-johtamisjärjestelmien ja ympäristöjärjestelmien standardeja, riskien hallintatyökaluja ja ohjelmia esitellään lyhyesti. Käytännön osa toteutettiin tapaustutkimuksena, jonka kohteena oli Äänekosken tehdaskombinaatti ja kemianteollisuuden laitos, Noviant CMC Oy. TTT-hallintatoimien ja ympäristönsuojelun ongelmia tutkitaan tehdastoimintoja ulkoistettaessa. Integroidun johtamisjärjestelmän auditointimenettelyt, ulkoistuksen kohdealueet, pk-yrityksien riskien hallinta ja ulkoisten työntekijöiden turvallisuuskoulutus ovat erityisen tarkastelun alla. Käyttäen hyväksi kerättyä TTT- ja ympäristöaineistoa, suunniteltiin malli ja sisältöehdotus uudelle internet-selain tyyppiselle työkalulle TTT- ja ympäristöasioiden hallinnan avuksi. Työkalu on tarkoitettu palvelemaan Noviant CMC Oy:n eri sidosryhmien tarpeita. Diplomityön käytännön osa muodostaa pohjan JP MILLSAFE - pilottiprojektille, joka käynnistettiin internet-selain tyyppisen turvallisuuspalvelusovelluksen kehittämiseksi palvelemaan Äänekosken tehdaskombinaatin eri sidosryhmien tarpeita.

Practical guidance and considerations for transitioning patients from oxcarbazepine or carbamazepine to eslicarbazepine acetate--Expert opinion.

There is currently a lack of guidance on methodology and special considerations for transitioning patients from oxcarbazepine (OXC) or carbamazepine (CBZ) to eslicarbazepine acetate (ESL), if deemed clinically necessary. An advisory panel of epilepsy experts was convened to share their experience on the use of adjunctive ESL in clinical practice and to provide practical recommendations to help address this gap. When changing over from OXC to ESL, an OXC:ESL dose ratio of 1:1 should be employed to calculate the ESL target dose, and the changeover can take place overnight. No changes to comedication are required. Since CBZ has a different mechanism of action to ESL and is a stronger inducer of cytochrome P450 (CYP) enzymes, the transitioning of patients from CBZ to ESL requires careful consideration on a patient-by-patient basis. In general, a CBZ:ESL dose ratio of 1:1.3 should be employed to calculate the ESL target dose, and patients should be transitioned over a minimum period of 1-2weeks. Special considerations include adjustment of titration schedule and target dose in elderly patients and those with hepatic or renal impairment and potential adjustment of comedications metabolized by CYP enzymes. In summary, due to structural distinctions between ESL, OXC, and CBZ, which affect mechanism of action and tolerability, there are clinical situations in which it may be appropriate to consider transitioning patients from OXC or CBZ to ESL. Changing patients over from OXC to ESL is generally more straightforward than transitioning patients from CBZ to ESL, which requires careful consideration.

How to Prepare a Patient for Transarterial Radioembolization? A Practical Guide.

Transarterial radioembolization consist in delivering small particles loaded with Yttrium90, a pure beta emitter, in order to treat primary and secondary liver tumors. This treatment needs precaution since inadequate delivery of these beads can lead to severe complications. Moreover, a precise radiation dosing is crucial to achieve a good clinical success and to avoid complications such as radioembolization-induced liver disease. This review describes all the precautions and highlights clinical and technical considerations that need to be taken to avoid complications.

Differences in seasonal price patterns among second home rentals and hotels: Empirical evidence and practical implications

Hotels and second home rentals are two of the most important tourist accommodation options in Spain. In terms of seasonality, almost all previous studies have analysed tourism demand from the point of view either of total arrivals or the number of tourists lodged in a single accommodation type (hotels, rural accommodation, etc). However, there are no studies focusing on price seasonality orcomparing seasonality among different accommodation types. By using seasonality indicators and a price index constructed by means of hedonic methods, this paper aims to shed some light on seasonal pricing patterns among second home rentals and hotels. The paper relies on a 2004 database of 144 hotels and 1,002 apartments on the Costa Brava (northeast Spain). The results show that prices for second home rentals display a smoother seasonal pattern than hotels due to reduced price differences between shoulder (May and October) and peak periods (August)

Evaluation du risque de récidive dans les expertises pénales: quels outils? Quets indicateurs? Quelles pratiques [Risk assessment in forensic psychiatric reports: what kind assessment instrument? What indicator? What practical?].

Here we present results of studies conducted by the Research Unit of Legal Psychiatry and Psychology of Lausanne about risk assessment and protective factors in the evaluation of violence recidivism. It aims to help experts in considering the relevance and use of tools at their disposal. Particular attention is given to the significance of protective factors and impulsive dimensions, as to the inter-raters process that leads to the final deliberations.

Validity of silhouette showcards as a measure of body size and obesity in a population in the African region : a practical research tool for general-purpose surveys.

BACKGROUND: The purpose of this study is to validate the Pulvers silhouette showcard as a measure of weight status in a population in the African region. This tool is particularly beneficial when scarce resources do not allow for direct anthropometric measurements due to limited survey time or lack of measurement technology in face-to-face general-purpose surveys or in mailed, online, or mobile device-based surveys. METHODS: A cross-sectional study was conducted in the Republic of Seychelles with a sample of 1240 adults. We compared self-reported body sizes measured by Pulvers' silhouette showcards to four measurements of body size and adiposity: body mass index (BMI), body fat percent measured, waist circumference, and waist to height ratio. The accuracy of silhouettes as an obesity indicator was examined using sex-specific receiver operator curve (ROC) analysis and the reliability of this tool to detect socioeconomic gradients in obesity was compared to BMI-based measurements. RESULTS: Our study supports silhouette body size showcards as a valid and reliable survey tool to measure self-reported body size and adiposity in an African population. The mean correlation coefficients of self-reported silhouettes with measured BMI were 0.80 in men and 0.81 in women (P < 0.001). The silhouette showcards also showed high accuracy for detecting obesity as per a BMI ≥ 30 (Area under curve, AUC: 0.91/0.89, SE: 0.01), which was comparable to other measured adiposity indicators: fat percent (AUC: 0.94/0.94, SE: 0.01), waist circumference (AUC: 0.95/0.94, SE: 0.01), and waist to height ratio (AUC: 0.95/0.94, SE: 0.01) amongst men and women, respectively. The use of silhouettes in detecting obesity differences among different socioeconomic groups resulted in similar magnitude, direction, and significance of association between obesity and socioeconomic status as when using measured BMI. CONCLUSIONS: This study highlights the validity and reliability of silhouettes as a survey tool for measuring obesity in a population in the African region. The ease of use and cost-effectiveness of this tool makes it an attractive alternative to measured BMI in the design of non-face-to-face online- or mobile device-based surveys as well as in-person general-purpose surveys of obesity in social sciences, where limited resources do not allow for direct anthropometric measurements.

Eye lens monitoring for interventional radiology personnel: dosemeters, calibration and practical aspects of H p (3) monitoring. A 2015 review.

A thorough literature review about the current situation on the implementation of eye lens monitoring has been performed in order to provide recommendations regarding dosemeter types, calibration procedures and practical aspects of eye lens monitoring for interventional radiology personnel. Most relevant data and recommendations from about 100 papers have been analysed and classified in the following topics: challenges of today in eye lens monitoring; conversion coefficients, phantoms and calibration procedures for eye lens dose evaluation; correction factors and dosemeters for eye lens dose measurements; dosemeter position and influence of protective devices. The major findings of the review can be summarised as follows: the recommended operational quantity for the eye lens monitoring is H p (3). At present, several dosemeters are available for eye lens monitoring and calibration procedures are being developed. However, in practice, very often, alternative methods are used to assess the dose to the eye lens. A summary of correction factors found in the literature for the assessment of the eye lens dose is provided. These factors can give an estimation of the eye lens dose when alternative methods, such as the use of a whole body dosemeter, are used. A wide range of values is found, thus indicating the large uncertainty associated with these simplified methods. Reduction factors from most common protective devices obtained experimentally and using Monte Carlo calculations are presented. The paper concludes that the use of a dosemeter placed at collar level outside the lead apron can provide a useful first estimate of the eye lens exposure. However, for workplaces with estimated annual equivalent dose to the eye lens close to the dose limit, specific eye lens monitoring should be performed. Finally, training of the involved medical staff on the risks of ionising radiation for the eye lens and on the correct use of protective systems is strongly recommended.

A medição da grandeza practical peak voltage na prática radiológica

OBJETIVO: O objetivo deste trabalho foi estudar a grandeza practical peak voltage (PPV), determinada a partir da forma de onda de tensão aplicada a tubos radiológicos, e compará-la com algumas definições de kVp para diferentes tipos de geradores: monofásico (onda completa, clínico), trifásico (seis pulsos, clínico) e potencial constante (industrial). MATERIAIS E MÉTODOS: O trabalho envolveu a comparação do PPV medido invasivamente (utilizando um divisor de tensão) com a resposta de dois medidores comerciais não invasivos, além dos valores de outras grandezas usadas para medição da tensão de pico aplicada ao tubo de raios X, e a análise da variação do PPV com a ondulação percentual da tensão (ripple). RESULTADOS: Verificou-se que a diferença entre o PPV e as definições mais comuns de tensão de pico aumenta com o ripple. Os valores de PPV variaram em até 3% e 5%, respectivamente, na comparação entre medições invasivas e não invasivas feitas com os equipamentos trifásico e monofásico. CONCLUSÃO: Os resultados demonstraram que a principal grandeza de influência que afeta o PPV é o ripple da tensão. Adicionalmente, valores de PPV obtidos com medidores não invasivos devem ser avaliados considerando que eles dependem da taxa de aquisição e da forma de onda adquirida pelo instrumento.

Construcció d'un equip per a la producció de cervesa artesana

Catalunya és un dels territoris on hi ha hagut més auge del sector de la cervesa artesana, i són molt nombroses les microcerveseries i les botigues especialitzades on es poden trobar els recursos materials necessaris, a més de ser centres difusió de coneixements relacionats. Així, doncs, aquest projecte està emmarcat en un context que permet el desenvolupament de tècniques d’elaboració de cervesa artesana. Aquest projecte es basa en la construcció d’un equip amb materials reutilitzats i amb un pressupost limitat que permet reproduir a petita escala els processos d’elaboració que es duen a terme en les microcerveseries artesanes actuals. El projecte s’ha assentat sobre la comprensió dels fonaments teòrics i pràctics del procés d’elaboració de cervesa, i amb l’experiència inicial d’elaboració de cervesa amb un equip bàsic de tipus homebrewer. Per minimintzar costos els tancs s’han construït a partir de barrils de cervesa i les parts sobrants s’han aprofitat per a altres elements. S’han emprat elements quotidians com una olla a pressió i s’ha construït un sistema regulador de pressió (per al tanc de fermentació cilindrocònic isobàric construït) en lloc d’adquirir-lo. S’ha posat l’èmfasi en minimitzar la necessitat de manipulació manual durant l’elaboració. Per tant, s’han instal·lat els components de l’equip formant un circuit tancat amb sistema de bombeig, i s’ha incorporat un sistema que permet el control i la lectura de les temperatures de cada procés. Altres elements són el sistema de filtres amb mecanisme de tub en forma d’ela (que permet l’extracció del most dels tanc de maceració i de cocció d’una manera efectiva i sense necessitat de manipulació) i el sistema de dutxa (que permet automatitzar el procés de rentat i filtrat). Un element que distingeix aquest equip d’altres equips emprats en algunes microcerveseries artesanes és el tanc de fermentació cilindrocònic isobàric amb vàlvula controladora de pressió, que permet prescindir de la doble fermentació en ampolla, ja que permet aprofitar el gas carbònic produït durant la fermentació per la carbonatació de la cervesa. Es pot concloure que gràcies a les seves característiques, l’equip permet realitzar successives elaboracions obtenint el mateix producte amb les mateixes característiques organolèptiques, principalement gràcies a la cambra de fermentació, que permet realitzar les etapes de fermentació, maduració i clarificació controlant la temperatura desitjada; al tanc de maceració amb aïllament, que permet realitzar el procés a temperatura constant sense pèrdues tèrmiques i al sistema de control de temperatura de totes les etapes. L’únic inconvenient és que, degut a la manca pressupostària, ha estat impossible l’adquisició d’un sistema d’embotellament isobàric que permeti realitzar l’embotellament sense pèrdues del gas carbònic. Per tant, el producte final pot embotellar-se amb una lleugera pèrdua de gas o es pot emmagatzemar en el mateix fermentador cilindrocònic per al seu consum directe, a l’estil d’alguns brewpubs.

Sedation palliative: aspects cliniques pratiques [Clinical and practical aspects of palliative sedation]

Un certain nombre de patients palliatifs en fin de vie présentent des symptômes qui ne peuvent pas être soulagés malgré la mise en oeuvre de tous les moyens traditionnels à disposition. Pour ces patients, lorsque des symptômes réfractaires induisent une souffrance intolérable, la sédation palliative est un moyen de dernier recours qui peut leur offrir un soulagement transitoire ou même définitif. Tout en présentant les enjeux éthiques, cet article explore les dimensions cliniques d'ordre pratique qui peuvent se présenter lors d'une sédation palliative chez un patient en fin de vie. Patients at the end-of-life may present with refractory symptoms which cannot be adequately relieved despite the use of all traditional means. When refractory symptoms lead to intolerable suffering, palliative sedation is a last recourse temporary or definitive treatment. While discussing ethical issues, clinical practice dimensions of palliative sedation are explored in this article