Déclaration et traitement des événements indésirables en médecine interne [Incident-reporting electronic-based system in internal medicine].

How to recognize, announce and analyze incidents in internal medicine units is a daily challenge that is taught to all hospital staff. It allows suggesting useful improvements for patients, as well as for the medical department and the institution. Here is presented the assessment made in the CHUV internal medicine department one year after the beginning of the institutional procedure which promotes an open process regarding communication and risk management. The department of internal medicine underlines the importance of feedback to the reporters, ensures the staff of regular follow-up concerning the measures being taken and offers to external reporters such as general practioners the possibility of using this reporting system too.

Whole-body MRI: comprehensive evaluation on a 48-channel 3T MRI system in less than 40 minutes. Preliminary results

OBJECTIVE: To evaluate a comprehensive MRI protocol that investigates for cancer, vascular disease, and degenerative/inflammatory disease from the head to the pelvis in less than 40 minutes on a new generation 48-channel 3T system. MATERIALS AND METHODS: All MR studies were performed on a 48-channel 3T MR scanner. A 20-channel head/neck coil, two 18-channel body arrays, and a 32-channel spine array were employed. A total of 4 healthy individuals were studied. The designed protocol included a combination of single-shot T2-weighted sequences, T1-weighted 3D gradient-echo pre- and post-gadolinium. All images were retrospectively evaluated by two radiologists independently for overall image quality. RESULTS: The image quality for cancer was rated as excellent in the liver, pancreas, kidneys, lungs, pelvic organs, and brain, and rated as fair in the colon and breast. For vascular diseases ratings were excellent in the aorta, major branch vessel origins, inferior vena cava, portal and hepatic veins, rated as good in pulmonary arteries, and as poor in the coronary arteries. For degenerative/inflammatory diseases ratings were excellent in the brain, liver and pancreas. The inter-observer agreement was excellent. CONCLUSION: A comprehensive and time efficient screening for important categories of disease processes may be achieved with high quality imaging in a new generation 48-channel 3T system.

Presence of air in the hepatic portal system in association with umbilical venous catheter malposition

The authors report a case of umbilical venous catheter malposition with air in the portal venous system in a preterm neonate. Initially, the hypothesis of necrotizing enterocolitis was considered, but the newborn progressed with no finding of disease and the air disappeared at follow-up radiography. The differential diagnosis of such a finding can avoid unnecessary clinical treatments.

Electric propulsion system in a modern sports car

In this thesis an electric propulsion system is designed on a device level using Cadence ORCAD. The vehicle belongs to the Helsinki Metropolia University of Applied Sci-ences and it is to compete in the Automotive X-Prize competition held in the USA. In this thesis the electric propulsion system and related electric safety measures are designed. Also electro-magnetic compatibility and interferences present in the system are examined by examining the birth mechanisms and transmission paths of interference. Per device effects of interference and solutions to minimize them were examined and proposed. Suitability of permanent magnet synchronous machines for passenger vehicle use was examined by examining the torque production capability of the motor and the torque requirements of the vehicle. Also a short overview of history of electric vehicles is given.

Embedded controller system in crane application

The thesis studies possibility of using embedded controller in a crane application and furthermore defines requirements when designing such a controller. Basic crane control architectures are considered and compared. Then embedded controller product life cycle is described: considering such issues like microcontroller selection, software/hardware design and application development tools. Finally, available embedded controller is described and used for implementing crane control.

Spectrophotometric study of the chromium(III)/azide system in the ultraviolet region and its analytical application

A sensitive and alternative method for the spectrophotometric determination of chromium(III) based on the formation of chromium(III)/azide complexes was established by investigating a new band in the ultraviolet region. The best experimental conditions for the analytical determination of this metallic ion were: ligand and perchloric acid analytical concentration = 493 and 12.0 mmol L-1, respectively; aqueous medium; T = 25.0 ºC; contact time = 1 hour. The maximum molar absorptivity coefficient occurred at 287 nm (average 1.481 ± 0.008 ´ 10(4) L mol-1 cm-1), leading to the determination of metal ion concentrations one hundred times lower than the ones formerly determined in the visible region. The system obeys Beer's Law and is suitable for chromium determination in the 0.702-2.81 mg L-1 concentration range (15-65% T, 1.00 cm-width quartz cells). Analytical applications of the current method were tested with a nutritional supplement containing chromium. Results were compared with those obtained with atomic absorption spectrometry.

Insulation System in an Integrated Motor Compressor

A high-speed and high-voltage solid-rotor induction machine provides beneficial features for natural gas compressor technology. The mechanical robustness of the machine enables its use in an integrated motor-compressor. The technology uses a centrifugal compressor, which is mounted on the same shaft with the high-speed electrical machine driving it. No gearbox is needed as the speed is determined by the frequency converter. The cooling is provided by the process gas, which flows through the motor and is capable of transferring the heat away from the motor. The technology has been used in the compressors in the natural gas supply chain in the central Europe. New areas of application include natural gas compressors working at the wellheads of the subsea gas reservoir. A key challenge for the design of such a motor is the resistance of the stator insulation to the raw natural gas from the well. The gas contains water and heavy hydrocarbon compounds and it is far harsher than the sales gas in the natural gas supply network. The objective of this doctoral thesis is to discuss the resistance of the insulation to the raw natural gas and the phenomena degrading the insulation. The presence of partial discharges is analyzed in this doctoral dissertation. The breakdown voltage of the gas is measured as a function of pressure and gap distance. The partial discharge activity is measured on small samples representing the windings of the machine. The electrical field behavior is also modeled by finite element methods. Based on the measurements it has been concluded that the discharges are expected to disappear at gas pressures above 4 – 5 bar. The disappearance of discharges is caused by the breakdown strength of the gas, which increases as the pressure increases. Based on the finite element analysis, the physical length of a discharge seen in the PD measurements at atmospheric pressure was approximated to be 40 – 120 m. The chemical aging of the insulation when exposed to raw natural gas is discussed based on a vast set of experimental tests with the gas mixture representing the real gas mixture at the wellhead. The mixture was created by mixing dry hydrocarbon gas, heavy hydrocarbon compounds, monoethylene glycol, and water. The mixture was chosen to be more aggressive by increasing the amount of liquid substances. Furthermore, the temperature and pressure were increased, which resulted in accelerated test conditions. The time required to detect severe degradation was thus decreased. The test program included a comparison of materials, an analysis of the e ects of di erent compounds in the gas mixture, namely water and heavy hydrocarbons, on the aging, an analysis of the e ects of temperature and exposure duration, and also an analysis on the e ect of sudden pressure changes on the degradation of the insulating materials. It was found in the tests that an insulation consisting of mica, glass, and epoxy resin can tolerate the raw natural gas, but it experiences some degradation. The key material in the composite insulation is the resin, which largely defines the performance of the insulation system. The degradation of the insulation is mostly determined by the amount of gas mixture di used into it. The di usion was seen to follow Fick’s second law, but the coe cients were not accurately defined. The di usion was not sensitive to temperature, but it was dependent upon the thermodynamic state of the gas mixture, in other words, the amounts of liquid components in the gas. The weight increase observed was mostly related to heavy hydrocarbon compounds, which act as plasticizers in the epoxy resin. The di usion of these compounds is determined by the crosslink density of the resin. Water causes slight changes in the chemical structure, but these changes do not significantly contribute to the aging phenomena. Sudden changes in pressure can lead to severe damages in the insulation, because the motion of the di used gas is able to create internal cracks in the insulation. Therefore, the di usion only reduces the mechanical strength of the insulation, but the ultimate breakdown can potentially be caused by a sudden drop in the pressure of the process gas.

Understanding change processes in business networks : a study of convergence in Finnish telecommunications 1985-2005

Aktörer inom telekommunikationsbranschen i Finland har genomgått en intensiv förändring under de senaste 25 åren, från 1980-talets självständiga företag till företag beroende av varandra, och även av aktörer inom närliggande branscher. I dag skapas telekommunikationsmarknaden inte endast av operatörerna, utan också av mediebolag (t.ex. MTV Media) och IT-företag (t.ex. TietoEnator). Gränserna mellan olika industrier håller därmed på att suddas ut - ett fenomen som allmänt benämns som teknologisk konvergens. Konvergens innebär att någonting integreras; det kan handla om t.ex. teknologier (telefoni och Internet), företag (AOL och Time Warner), industrier (telekom, media och IT-branscherna), tjänster (mobilt TV), produkter (PDA) osv. Detta innebär att ytterst få telekomaktörer ensamma kan vidareutveckla marknaden och tekniska lösningar. Samarbete mellan aktörer krävs; mobiltelefontillverkare, innehållsproducenter, operatörer osv. bör intesifiera sitt samarbete för att kunna erbjuda attraktiva tjänster och produkter till kunder och slutanvändare. Avhandlingen fokuserar speciellt på affärsnätverk och samarbetsmönster mellan nätverksaktörer som medel för att få tillgång till resurser som krävs i en konvergenskarakteriserad affärsomgivning. Avhandlingen lyfter fram vad den teknologiska konvergensen har inneburit för telekomaktörer, dvs. att företag tvingats förändra sina strategier och verksamhetsmodeller. För många företag i branschen har anpassningen till konvergenstänkande varit utmanande, och i vissa fall kan man till och med tala om att företagen upplevt en identitetskris. Den utförda forskningen visar att konvergens uppfattas på marknaden som en pågående förändringsprocess, där varje telekomaktör är tvungen att utvärdera sin roll och position i relation till andra aktörer inom branschen. Konvergensprocesser forsätter i framtiden med ökad intensitet. Aktörerna skapar medvetet sin omgivning genom att agera i olika roller, som kan sträcka sig över industrigränser. Avhandlingen påvisar även att externa händelser och industrikontexten påverkar dynamiken i ett affärsnätverk.

The development and evaluation of a distance learning system in ophthalmology

INTRODUCTION: Web-based e-learning is a teaching tool increasingly used in many medical schools and specialist fields, including ophthalmology. AIMS: this pilot study aimed to develop internet-based course-based clinical cases and to evaluate the effectiveness of this method within a graduate medical education group. METHODS: this was an interventional randomized study. First, a website was built using a distance learning platform. Sixteen first-year ophthalmology residents were then divided into two randomized groups: one experimental group, which was submitted to the intervention (use of the e-learning site) and another control group, which was not submitted to the intervention. The students answered a printed clinical case and their scores were compared. RESULTS: there was no statistically significant difference between the groups. CONCLUSION: We were able to successfully develop the e-learning site and the respective clinical cases. Despite the fact that there was no statistically significant difference between the access and the non access group, the study was a pioneer in our department, since a clinical case online program had never previously been developed.

NADPH-Dependent Thioredoxin System In Regulation of Chloroplast Functions

Photosynthesis, the process in which carbon dioxide is converted into sugars using the energy of sunlight, is vital for heterotrophic life on Earth. In plants, photosynthesis takes place in specific organelles called chloroplasts. During chloroplast biogenesis, light is a prerequisite for the development of functional photosynthetic structures. In addition to photosynthesis, a number of other metabolic processes such as nitrogen assimilation, the biosynthesis of fatty acids, amino acids, vitamins, and hormones are localized to plant chloroplasts. The biosynthetic pathways in chloroplasts are tightly regulated, and especially the reduction/oxidation (redox) signals play important roles in controlling many developmental and metabolic processes in chloroplasts. Thioredoxins are universal regulatory proteins that mediate redox signals in chloroplasts. They are able to modify the structure and function of their target proteins by reduction of disulfide bonds. Oxidized thioredoxins are restored via the action of thioredoxin reductases. Two thioredoxin reductase systems exist in plant chloroplasts, the NADPHdependent thioredoxin reductase C (NTRC) and ferredoxin-thioredoxin reductase (FTR). The ferredoxin-thioredoxin system that is linked to photosynthetic light reactions is involved in light-activation of chloroplast proteins. NADPH can be produced via both the photosynthetic electron transfer reactions in light, and in darkness via the pentose phosphate pathway. These different pathways of NADPH production enable the regulation of diverse metabolic pathways in chloroplasts by the NADPH-dependent thioredoxin system. In this thesis, the role of NADPH-dependent thioredoxin system in the redox-control of chloroplast development and metabolism was studied by characterization of Arabidopsis thaliana T-DNA insertion lines of NTRC gene (ntrc) and by identification of chloroplast proteins regulated by NTRC. The ntrc plants showed the strongest visible phenotypes when grown under short 8-h photoperiod. This indicates that i) chloroplast NADPH-dependent thioredoxin system is non-redundant to ferredoxinthioredoxin system and that ii) NTRC particularly controls the chloroplast processes that are easily imbalanced in daily light/dark rhythms with short day and long night. I identified four processes and the redox-regulated proteins therein that are potentially regulated by NTRC; i) chloroplast development, ii) starch biosynthesis, iii) aromatic amino acid biosynthesis and iv) detoxification of H₂O₂. Such regulation can be achieved directly by modulating the redox state of intramolecular or intermolecular disulfide bridges of enzymes, or by protecting enzymes from oxidation in conjunction with 2-cysteine peroxiredoxins. This thesis work also demonstrated that the enzymatic antioxidant systems in chloroplasts, ascorbate peroxidases, superoxide dismutase and NTRC-dependent 2-cysteine peroxiredoxins are tightly linked up to prevent the detrimental accumulation of reactive oxygen species in plants.

Soil organic matter pools in a tropical savanna under agroforestry system in Northeastern Brazil

This study aimed at quantifying total organic carbon stocks and its pools in Acrisol under agroforestry systems with six (AFS6) and thirteen years old (AFS13), slash-and-burn agriculture (SBA) and savanna native forest (SNF) in northeastern Brazil. Soil samples were collected at 0-0.05 m, 0.05-0.10 m, 0.10-0.20 m and 0.20-0.40 m depths in the dry and rainy seasons to evaluate total organic carbon (TOC) stocks and labile carbon (LC), fulvic acid fraction (C-FAF), humic acid fraction (C-HAF), humin (C-HF) and microbial biomass carbon (Cmic) contents. Additionally, carbon management index (CMI) was determined. Higher TOC stocks (97.7 and 81.8 Mg ha-1 for the 0-0.40 m depth in the dry and rainy seasons, respectively) and LC, humic substances and Cmic contents were observed in the AFS13 in all the depths. CMI also was higher in the AFS13 (0-0. 05 m: 158 and 86; 0.05-0.10 m: 171 and 67, respectively for the dry and rainy seasons) especially when compared to the SBA (0-0.05 m: 5.6 and 5.4; 0.05-0.10 m: 5.3 and 5.8, respectively for dry and rainy seasons). The agroforestry systems increased soil quality through the conservation of organic matter and can be considered an excellent strategy to assurance sustainability in tropical soil of Northeastern Brazil

Email marketing in business-to-business relationship

The objective of this study is to find out how email marketing is conducted towards existing customers in Company X. The first chapter of the study focuses on theoretical literature on direct marketing, especially on solicited and unsolicited email marketing, and on relationship marketing. The following relationship marketing areas: database marketing, customer retention, trust and commitment, loyalty, engagement and satisfaction are described and the possibilities to use email marketing within these entities of relationship marketing. The empirical second part of the study revealed that email marketing tactics to be used on relationship marketing in Company X are little used and there is potential for significant improvements in relationship marketing especially with marketing automation tools.