Sähkön ja lämmön yhteistuotannon optimointi

Työn tavoitteena oli suunnitella ja toteuttaa sähkön ja lämmön yhteistuotantolaitoksen tuotannon optimointi. Optimoinnin kriteerinä on tuotannon kannattavuus. Pyrittiin luomaan optimointimalli, joka ottaa optimoinnissa huomioon erityisesti kaukolämmön kulutusennusteen muutokset sekä sähkön pörssihinnan vaihtelut. Tuotannon kannalta olennaisin kriteeri on kaukolämmön kulutusennusteen pohjalta arvioidun kaukolämpökuorman tyydyttäminen mahdollisimman tehokkaasti ja taloudellisesti. Sähkön tuotannon merkittävimmiksi kriteereiksi muodostuivat sähkön tuotannon ennustettavuus ja tuotannon maksimointi sähkön pörssihinnan asettamissa puitteissa. Optimointiohjelmaa ei ole tarkoitus kytkeä suoraan voimalaitoksen ajojärjestelmään, vaan siitä on tarkoitus tulla erillinen ajosuunnittelijan työkalu. Itse ajosuunnitteluun vaikuttaa usein monipuolisemmat suunnittelukriteerit kuin pelkästään tuotannon tuottavuus. Näiden eri kriteerien painotuksia ei ohjelmassa huomioida, vaan ne päättää ajosuunnittelija. Tuloksena saatiin aikaan optimointiohjelma, joka laskee valittujen tuotantovaihtoehtojen kokonaistuotot eri kaukolämmön kulutusennusteiden ja sähkön pörssihintaennusteiden pohjalta.

Diagnostic microbiologique de la pneumonie [Microbiological diagnosis of pneumonia].

Les pneumonies causent une mortalité et une morbidité significatives. De manière simplifiée, deux types de pneumonie sont décrits : la pneumonie communautaire et la pneumonie nosocomiale avec le pneumocoque et l'Haemophilus influenzae comme causes principales pour la première, le Pseudomonas et diverses entérobactéries pour la deuxième. La réalité est cependant plus complexe puisque l'on distingue aussi la pneumonie d'aspiration par exemple. La culture est très importante dans le cas des pneumonies nosocomiales car elle permet de déterminer la sensibilité aux antibiotiques de l'agent infectieux et d'adapter le traitement. Pour les patients immunosupprimés, le diagnostic différentiel est plus large et la recherche par tests moléculaires de certains virus, de champignons filamenteux et du Pneumocystis peut se révéler informative. Pneumonia is an importance cause of mortality and morbidity in adults. Two types of pneumonia are defined: community-acquired and nosocomial pneumonia with their corresponding etiology such as pneumococci or Haemophilus influenzae and Pseudomonas or enterobacteriaceae, respectively. However, the reality is more complex with aspiration pneumonia, pneumonia in immunocompromised patient, and pneumonia in ventilated patients. Culture in the case of nosocomial pneumonia is especially important to obtain the antibiotic susceptibility of the infectious agent and to adjust therapy. Moreover for immunocompromised patients, the differential diagnosis is much wider looking for viruses, filamentous fungi and Pneumocystis can be very informative, using new molecular assays.

2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer.

To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The 2nd ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines of treatment in advanced disease, early-stage disease and locally advanced disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on locally advanced disease.

Comparative study of two needle models in terms of deflection during inferior alveolar nerve block

Objectives: The purpose of this study is to determine the possible differences in deflection between two needles of same length and external gauge but with different internal gauges during truncal block of the inferior alveolar nerve. The initial working hypothesis was that greater deflection may be expected with larger internal gauge needles. Study design: Four clinicians subjected 346 patients to inferior alveolar nerve block and infiltrating anesthesia of the buccal nerve trajectory for the surgical or conventional extraction of the lower third molar. A nonautoaspirating syringe system with 2 types of needle was used: a standard 27-gauge x 35-mm needle with an internal gauge of 0.215 mm or an XL Monoprotect® 27-gauge x 35-mm needle with an internal gauge of 0.265 mm. The following information was systematically recorded for each patient: needle type, gender, anesthetic technique (direct or indirect truncal block) and the number of bone contacts during the procedure, the patient-extraction side, the practitioner performing the technique, and blood aspiration (either positive or negative). Results: 346 needles were used in total. 190 were standard needles (27-gauge x 35-mm needle with an internal gauge of 0.215 mm) and 156 were XL Monoprotect®. Incidence of deflection was observed in 49.1% of cases (170 needles) where 94 were standard needles and 76 XL Monoprotect®. Needle torsion ranged from 0º and 6º. Conclusions: No significant differences were recorded in terms of deflection and internal gauge, operator, patient-extraction side, the anesthetic technique involved and the number of bone contacts during the procedure

Are patients with non-invasive papillary thyroid carcinoma, follicular variant (niFV-PTC) and minimally invasive follicular thyroid carcinoma with capsular invasion only (miFTC-CIO) overtreated?An institutional experience

Background. Recently several meetings and position papers advocate a change in terminology regarding thyroid neoplasms with indolent behavior, proposing the term "tumor" instead of "carcinoma". This change concerns non-invasive papillary thyroid carcinoma, follicular variant (niFV-PTC) and minimally invasive follicular thyroid carcinoma with capsular invasion only (miFTC-CIO). The aim of our study was to evaluate the impact of considering niFV-PTC and miFTC-CIO as lesions of low malignant potential, and to see how this change would influence patient management at our institution. Methods. A 32 months retrospective review of all well differentiated thyroid carcinomas (WDTC) (papillary and follicular carcinomas) diagnosed at our institution was performed, excluding tumors of uncertain malignant potential as well as poorly differentiated and anaplastic carcinomas. We retrieved cases of niFV-PTC and miFTC-CIO, reviewed histological slides to confirm diagnosis and recorded patient treatment. Results. A total of 9 (7.3%) niFV-PTC (4 males and 5 females, aged between 30 and 68 years, mean: 50.8 years old) and 2 (1.6%) cases of miFTC-CIO (2 females, 31 and 51 years old) were identified out of 122 WDTC diagnosed in the study period. The initial treatment consisted in 5 lobectomies and 6 total thyroidectomies (3 because of a compressive goiter, 2 because of a fine-needle aspiration diagnosis of suspicious for papillary thyroid carcinoma and 1 because of a fine-needle aspiration diagnosis of papillary carcinoma). The treatment following the histological diagnosis consisted in 4 thyroidectomy completions among patients who underwent simple lobectomy (4/5, 80%) and 9/11 (82%) radioablations with I131. Conclusions. The incidence of niFV-PTC is low at our institution, probably because we apply strict diagnostic criteria for this lesion. Simple lobectomy with negative margins is the treatment of choice in cases diagnosed as niFV-PTC and miFTC-CIO, due to the indolent course of these neoplasms. All cases with thyroidectomy completions and radioablations could have been avoided. As a consequence, the change of such terminology heavily impacts the malignancy risk evaluated cytologically as well as patients' management.

Kuljetuslajin yhteys kannattavuuteen etelä- ja itäsuomalaisissa kuljetusyrityksissä

Tämä Pro-Gradu –tutkielma tarkastelee etelä- ja itäsuomalaisia kuljetusyrityksiä kannattavuuden, vakavaraisuuden ja maksuvalmiuden näkökulmasta kuljetuslajeittain. Tutkielman pyrkimyksenä on valottaa Etelä- ja Itä-Suomen läänien kilpailuympäristöä numeeristen tunnuslukujen ja tilinpäätöserien perusteella. Päätavoitteena on osoittaa, onko kuljetuslajien välillä kannattavuuseroja. Tutkielma koostuu teoriaosasta sekä empiirisestä osasta, jonka aineisto koostuu etelä- ja itäsuomalaisten kuljetusyritysten tilinpäätöstiedoista ja tunnusluvuista. Tutkimuksen empiirinen aineisto on kerätty haulla Amadeus–tietokannasta ja postikyselynä haun tuottamilta yrityksiltä. Aineistoa on analysoitu kvantitatiivisilla menetelmillä SPSS–ohjelmistolla. Tuloksista selviää, että kuljetuslajilla on yhteys kannattavuuteen ROCE–tunnusluvulla mitattuna. Kannattavuuden osa-alueita, kuten tuottoja, kustannuksia ja sidottua pääomaa analysoitiin erikseen, mutta kannattavuuseroille ei silti löydetty selitystä.

Traditional cockney and popular London speech

This paper gives a full description of the phonetics and phonology of Traditional Cockney and Popular London speech, treating these varieties as constituting a continuum rather than two separate dialects. Exemplification of the vowels, diphthongs and consonants is provided, both in isolate words and in connected speech, along with their range of variation. The frequencies of the vowels have been charted on the basis of the pronunciation of three elderly male speakers. Regarding the consonants, there are detailed observations on the features typically associated with the linguistic varieties examined: strong aspiration of unvoiced plosives, glottalization, H-dropping, L-vocalization and TH-fronting. A section on prosody provides coverage of lexical stress, rhythm and intonation. The paper takes into account up-to-date research on these phenomena, but does not deal with the most recent vowel shifts, some of which form part of Multi-cultural London English.

Abcès pulmonaires: évolution dans la prise en charge [Lung abscess: changes in the management?].

L'abcès pulmonaire se présente de manière très pléomorphe selon les germes initialement impliqués. Des symptômes gé­ néraux et une évolution souvent subaiguë sont retrouvés en cas d'aspiration de la flore oropharyngée, chez des patients avec des troubles de l'état de conscience ou de la déglutition. L'infection est très souvent polymicrobienne, avec présence de germes anaérobes dans deux tiers des cas. La prise en charge consiste en un traitement antibiotique prolongé, jusqu'à résolution ou stabilité de l'image radiologique. En cas d'état toxique ou d'absence de drainage bronchique spontané, un drainage de l'abcès est à discuter. Les sanctions chirurgicales sont peu souvent nécessaires et envisagées indépendamment de la taille de l'abcès excepté lors de néoplasie sous-jacente. Lung abscess occurs in very pleomorphic according to germs initially involved. The mechanism commonly found is an aspiration of the oropharyngeal flora in patients with disorders of consciousness or swallowing. The infection is polymicrobial, with presence of anaerobic germs in 2/3 of the cases. The support consists of a prolonged antibiotic treatment, as well as anaerobic until resolution or stability of the radiological image. In case of prolonged toxic state, drainage of the abscess is to be discussed especially if there is no airways drainage. Surgical sanctions is rarely needed regardless of the size of the abscess, unless underlying carcinoma is present.

Congenital lobar emphysema presenting as an airway foreign body.

We report here the case of a 15 months old girl presenting with clinical signs and radiological exams highly suggestive of a foreign body (FB) aspiration. Diagnostic endoscopy revealed an overlooked bronchial malformation responsible for a congenital lobar emphysema (CLE). CLE presenting after one year of age is rare and can easily be misdiagnosed. Therefore, the possibility of an overlooked CLE needs to be known and evoked as an alternative diagnosis when dealing with children presenting with suspected FB aspirations. We report on this unexpected, yet misleading presentation of CLE and review the available literature on the subject.

Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in The Bethesda System for Reporting Thyroid Cytopathology.

BACKGROUND: Recent discussions have focused on redefining noninvasive follicular variant of papillary thyroid carcinoma (NI-FVPTC) as a neoplasm rather than a carcinoma. This study assesses the potential impact of such a reclassification on the implied risk of malignancy (ROM) for the diagnostic categories of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). METHODS: The study consisted of consecutive fine-needle aspiration biopsy (FNAB) cases collected between January 1, 2013 and June 30, 2014 from 5 academic institutions. Demographic information, cytology diagnoses, and surgical pathology follow-up were recorded. The ROM was calculated with and without NI-FVPTC and was presented as a range: all cases (ie, overall risk of malignancy [OROM]) versus those with surgical follow-up only. RESULTS: The FNAB cohort consisted of 6943 thyroid nodules representing 5179 women and 1409 men with an average age of 54 years (range, 9-94 years). The combined average ROM and OROM for the diagnostic categories of TBSRTC were as follows: nondiagnostic, 4.4% to 25.3%; benign, 0.9% to 9.3%; atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 12.1% to 31.2%; follicular neoplasm (FN), 21.8% to 33.2%; suspicious for malignancy (SM), 62.1% to 82.6%; and malignant, 75.9% to 99.1%. The impact of reclassifying NI-FVPTC on the ROM and OROM was most pronounced and statistically significant in the 3 indeterminate categories: the AUS/FLUS category had a decrease of 5.2% to 13.6%, the FN category had a decrease of 9.9% to 15.1%, and the SM category had a decrease of 17.6% to 23.4% (P < .05), whereas the benign and malignant categories had decreases of 0.3% to 3.5% and 2.5% to 3.3%, respectfully. The trend of the effect on the ROM and OROM was similar for all 5 institutions. CONCLUSIONS: The results from this multi-institutional cohort indicate that the reclassification of NI-FVPTC will have a significant impact on the ROM for the 3 indeterminate categories of TBSRTC. Cancer Cytopathol 2016;124:181-187. © 2015 American Cancer Society.

Clinical and videofluoroscopic diagnosis of dysphagia in chronic encephalopathy of childhood

Objective To evaluate the contribution of deglutition videofluoroscopy in the clinical diagnosis of dysphagia in chronic encephalopathy of childhood. Materials and Methods The study sample consisted of 93 children diagnosed with chronic encephalopathy, in the age range between two and five years, selected by convenience among patients referred to the authors' institution by speech therapists, neurologists and gastroenterologists in the period from March 2010 to September 2011. The data collection was made at two different moments, by different investigators who were blind to each other. Results The method presented low sensitivity for detecting aspiration with puree consistency (p = 0.04). Specificity and negative predictive value were high for clinical diagnosis of dysphagia with puree consistency. Conclusion In the present study, the value for sensitivity in the clinical diagnosis of dysphagia demonstrates that this diagnostic procedure may not detect any change in the swallowing process regardless of the food consistency used during the investigation. Thus, the addition of the videofluoroscopic method can significantly contribute to the diagnosis of dysphagia.

Is there any association between Hashimoto’s thyroiditis and thyroid cancer? A retrospective data analysis

AbstractObjective:To evaluate the association between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC).Materials and Methods:The patients were evaluated by ultrasonography-guided fine needle aspiration cytology. Typical cytopathological aspects and/or classical histopathological findings were taken into consideration in the diagnosis of HT, and only histopathological results were considered in the diagnosis of PTC.Results:Among 1,049 patients with multi- or uninodular goiter (903 women and 146 men), 173 (16.5%) had cytopathological features of thyroiditis. Thirty-three (67.4%) out of the 49 operated patients had PTC, 9 (27.3%) of them with histopathological features of HT. Five (31.3%) out of the 16 patients with non-malignant disease also had HT. In the groups with HT, PTC, and PCT+HT, the female prevalence rate was 100%, 91.6%, and 77.8%, respectively. Mean age was 41.5, 43.3, and 48.5 years, respectively. No association was observed between the two diseases in the present study where HT occurred in 31.1% of the benign cases and in 27.3% of malignant cases (p = 0.8).Conclusion:In spite of the absence of association between HT and PCT, the possibility of malignancy in HT should always be considered because of the coexistence of the two diseases already reported in the literature.

Emprego de nebulizador pneumático de ICP-MS como câmara de diluição em sistemas de injeção em fluxo para determinações multielementares

An automatic dispenser based on a flow-injection system used to introduce sample and analytical solution into an inductively coupled plasma mass spectrometer through a spray chamber is proposed. Analytical curves were constructed after the injection of 20 to 750 µL aliquots of a multielement standard solution (20.0 µg L-1 in Li, Be, Al, V, Cr, Mn, Ni, Co, Cu, Zn, As, Se, Sr, Ag, Cd, Ba, Tl, Pb) and the acquisition of the integrated transient signals. The linear concentration range could be extended to ca. five decades. The performance of the system was checked by analyzing a NIST 1643d reference material. Accuracy could be improved by the proper selection of the injected volume. Besides good precision (r.s.d. < 2%), the results obtained with the proposed procedure were closer to the certified values of the reference material than those obtained by direct aspiration or by injecting 125 µL of several analytical solutions and samples.

Graft materials in oral surgery: revision

Oral implantology is a common procedure in dentistry, especially for fully or partially edentulous patients. The implants must be placed in the best location from both the aesthetic and functional point of view. Because of this it is increasingly more frequent to resort to regeneration techniques that use substitutes of the bone itself, in order to be able to insert the implants in the most appropriate location. Material and Methodology: A review was performed on the literature from the last ten years based on the following search limitations: "graft materials', 'allograft', 'xenograft', 'autologous graft" and 'dentistry". Results: 241 works were obtained that after reading their respective summaries, they were reduced to 38, and 9 previous works were included in order to summarize the concepts. Discussion: Autologous grafts are the 'gold standard' of the bone regeneration. They have obvious advantages, but they also have drawbacks. This is why allogeneic and xenogeneic tissues are used. The former because of their clear similarity with the recipient's tissue and the latter due to their wide availability. Given that these grafts also have drawbacks, the industry has developed synthetic materials that have properties similar to those of human bone tissue. However, as of today, the ideal material to substitute human bone has not yet been found. In recent years the tendency has been to combine these synthetic materials with the patient's own bone, which is extracted during drilling in implant placement, with bone marrow aspiration, or with bone morphogenetic proteins. Thus the intention is to equip these substances with the osteogenic capacity. Conclusions: There is currently no ideal graft material, with the exception of those materials that come directly from the patient. We hope that in the coming years we will have products that will allow us to perform rehabilitations with better results and provide a better quality of life for our patients, especially those who have more complex situations to resolve, like the patients that are operated on for head and neck cancer

Päätöksenteon tukeminen kaivosalan yrityksen toiminnanohjausjärjestelmäratkaisun valinnassa

Diplomityön tavoitteena oli tutkia kohdeyrityksen toiminnanohjaukseen sovellettujen tietojärjestelmien nykytilaa ja pyrkiä tunnistamaan siinä vaikuttavia, kehittämistä vaativia kohteita. Nykytilan kartoituksen perusteella työssä oli määrä laatia vertailu liiketoiminnan ohjaamiseen soveltuvien vaihtoehtoisten järjestelmäratkaisuiden välillä. Perusteellisen selvitystyön ja vaihtoehtojen vertailun avulla pyrittiin tuottamaan päätöksentekoa helpottavaa materiaalia kohdeyrityksen toiminnanohjausjärjestelmäratkaisun valinnan tueksi. Keskeisimpinä menetelminä tutkimuksessa hyödynnettiin asiakaskeskeistä toiminnanohjausjärjestelmän käyttöönottomenetelmää C-CEI:tä sekä analyyttistä hierarkiaprosessia AHP:tä. Tutkimuksen perusteella havaittiin, että onnistunut tietojärjestelmäratkaisun valinta edellyttää perusteellista liiketoiminnan nykytilan selvitystä. Yritysten on myös tärkeää tiedostaa, että tällaisiin monikriteerisiin ja hankaliin päätöksentekotilanteisiin on olemassa useita erilaisia päätöksenteon tukimenetelmiä, joiden avulla päätöksenteon ongelmaa kyetään selkeyttämään ja siten helpottamaan ratkaisun löytämistä.