The Mixed Management of Patients' Medical Records: Responsibility Sharing Between the Patient and the Physician

Through this article, we propose a mixed management of patients' medical records, so as to share responsibilities between the patient and the Medical Practitioner by making Patients responsible for the validation of their administrative information, and MPs responsible for the validation of their Patients' medical information. Our proposal can be considered a solution to the main problem faced by patients, health practitioners and the authorities, namely the gathering and updating of administrative and medical data belonging to the patient in order to accurately reconstitute a patient's medical history. This method is based on two processes. The aim of the first process is to provide a patient's administrative data, in order to know where and when the patient received care (name of the health structure or health practitioner, type of care: out patient or inpatient). The aim of the second process is to provide a patient's medical information and to validate it under the accountability of the Medical Practitioner with the help of the patient if needed. During these two processes, the patient's privacy will be ensured through cryptographic hash functions like the Secure Hash Algorithm, which allows pseudonymisation of a patient's identity. The proposed Medical Record Search Engines will be able to retrieve and to provide upon a request formulated by the Medical ractitioner all the available information concerning a patient who has received care in different health structures without divulging the patient's identity. Our method can lead to improved efficiency of personal medical record management under the mixed responsibilities of the patient and the MP.

Beyond Conditionality versus Cooperation: Power and Resistance in the Case of EU Mobility Partnerships and Swiss Migration Partnerships

Migration partnerships (MPs) have become a key instrument in global migration governance. In contrast to traditional unilateral approaches, MPs emphasize a more comprehensive and inclusive tackling of migration issues between countries of origin, transit, and destination. Due to this cooperation-oriented concept, most of the existing studies on MPs neglect power questions within partnerships in line with the official discourse, reflecting a broader trend in the international migration governance literature. Others take an instrumentalist view in analysing the power of partnerships or focus on soft power. Illustrated with the examples of the European Mobility Partnerships (EU MPs) and the Swiss Migration Partnerships (CH MPs), we conduct an analysis based on a concept of productive power drawing on post-structural and post-colonial insights. Our main argument is that in contrast to their seemingly consent-oriented and technical character, MPs are sites of intense (discursive) struggles, and (re-)produce meanings, subjects, and resistances. A productive power analysis allows us to move beyond the dichotomy in the literature between coercion and cooperation, as well as between power and resistance more broadly.

Efeitos gênicos de caracteres associados à eficiência no uso de nitrogênio em milho

Os objetivos deste trabalho foram determinar o controle genético da eficiência no uso do nitrogênio (EUN), identificar a importância das eficiências na absorção (EAN) e na utilização (EUtN) na sua composição, e quantificar relação entre produção de matéria seca da parte aérea (MPS) e do sistema radicular com a EUN e com seus componentes. Foram avaliadas 41 combinações híbridas em duas disponibilidades de N: baixa (BN) e alta (AN). Utilizou-se o delineamento de blocos ao acaso com duas repetições, em arranjo fatorial simples (combinação híbrida x disponibilidade de N). As análises estatísticas foram realizadas por meio das equações de modelos mistos. Correlações de elevada magnitude foram detectadas entre EAN e EUN, bem como entre essas eficiências e a MPS, tanto em BN como em AN. Em ambas as disponibilidades de N, efeitos genéticos aditivos apresentaram maior importância para os caracteres associados à EUN. Dessa forma, a seleção baseada no desempenho individual de linhagens quanto à MPS pode possibilitar a obtenção de genótipos com alta EUN. Independentemente da disponibilidade de N, a EAN é o componente mais importante da EUN.

Avaluació integral de l'impacte del màster en lideratge de la transformació socioeducativa

Aquest article analitza els resultats obtinguts amb l’avaluació de l’impacte del Màster enPedagogia Social i Comunitària: Lideratge de la Transformació Socioeducativa (MPS) i presenta les característiques del mètode d’avaluació proposat. La necessitat de determinar quins són els canvis (tant personals com laborals) que generen las formacions i la voluntat de millora contínua dels programes ha fomentat la posada en pràctica de diferents mecanismes d’avaluació d’impacte. Aquest estudi, a més d’avaluar genèricament l’impacte, ho fa en profunditat, proposa millores concretes de les formacions a estudi i posa el client (els estudiants) al centre de la recerca.

Conditioning of multiple-point statistics facies simulations to tomographic images

Geophysical tomography captures the spatial distribution of the underlying geophysical property at a relatively high resolution, but the tomographic images tend to be blurred representations of reality and generally fail to reproduce sharp interfaces. Such models may cause significant bias when taken as a basis for predictive flow and transport modeling and are unsuitable for uncertainty assessment. We present a methodology in which tomograms are used to condition multiple-point statistics (MPS) simulations. A large set of geologically reasonable facies realizations and their corresponding synthetically calculated cross-hole radar tomograms are used as a training image. The training image is scanned with a direct sampling algorithm for patterns in the conditioning tomogram, while accounting for the spatially varying resolution of the tomograms. In a post-processing step, only those conditional simulations that predicted the radar traveltimes within the expected data error levels are accepted. The methodology is demonstrated on a two-facies example featuring channels and an aquifer analog of alluvial sedimentary structures with five facies. For both cases, MPS simulations exhibit the sharp interfaces and the geological patterns found in the training image. Compared to unconditioned MPS simulations, the uncertainty in transport predictions is markedly decreased for simulations conditioned to tomograms. As an improvement to other approaches relying on classical smoothness-constrained geophysical tomography, the proposed method allows for: (1) reproduction of sharp interfaces, (2) incorporation of realistic geological constraints and (3) generation of multiple realizations that enables uncertainty assessment.

RAAKAPUUKULJETUKSET VENÄJÄN RAUTATEILLÄ, SEKÄ SUOMEN JA VENÄJÄN VÄLISESSÄ YHDYSLIIKENTEESSÄ

Työssä on aluksi tarkasteltu Venäjän raakapuukuljetuksiin vaikuttavia tekijöitä siten, että ne selittäisivät parhaalla mahdollisella tavalla raakapuukuljetuksien tulevaisuutta sekä niissä käytettävän liikkuvan kaluston kehitystä Venäjällä. Lopuksi työssä on keskitytty raakapuukuljetuksissa käytettävän liikkuvan kaluston tämän hetkiseen tilaan ja ongelmiin. Reformi, joka on saanut alkunsa tarpeesta sopeutua markkinatalouden asettamiin vaatimuksiin, poistaa MPS:ltä kaksinaisroolin rahoittajana ja viranomaistahona sekä tuo mukanaan suuria muutoksia nykyiseen tariffipolitiikkaan. Tariffipolitiikka määrittelee Venäjällä mitä kuljetusmuotoa kannattaa käyttää ja millä kalustolla kuljetuksia suorittaa. Venäjän MPS:n uudistuksen kautta kuljetukset ovat avautuneet vuonna 2001 ensimmäistä kertaa yksityisille operaattoriyrityksille. Liikkuvan kaluston puute on Venäjällä rautatietoimialan tämän hetkisistä ongelmista suurin. Venäjän MPS:llä ei ole varaa tehdä riittäviä investointeja liikkuvaan kalustoon, jotta kaikki kuljetukset saataisiin suoritettua. Nykyinen raakapuun kuljetuskalusto on erittäin huonokuntoista. Puutavaravaunuista on jo tällä hetkellä jatkuva pula. Puutavarakuljetuksissa käytettävät vaunut ovat Vok-vaunuja, pankkovaunuja ja puutavaran erikoiskuljetusvaunuja. Vaikka pankkorakenteiset Vo-vaunut ovat kasvattaneet suosiotaan itäisessä yhdysliikenteessämme on niissä huomattavia rakenteellisia ongelmia. Nämä ongelmat johtuvat Venäjän vaunuteollisuuden käyttämistä huonolaatuisista teräksistä ja teollisuuden valmistusmenetelmistä.

Blood microvesicles: from proteomics to physiology

Phospholipid vesicles of less than 1 μm are present in blood in physiological state and their concentration may vary under pathological conditions. Various names such as exosomes (EXS) and microparticles (MPS) have been used to designate these extracellular vesicles (EVS). Although EXs and MPS possibly arise from separate mechanisms, they share numerous similarities representing a challenge for their purification and characterization. These vesicles generally originate from various types of cells such as red blood cells, platelets, leukocytes or endothelial cells but also from tumor cells. They participate in numerous biological processes including hemostasis. It is therefore of major scientific interest to characterize the protein content of these different types of EVS and that of their membranes in order to elucidate the essential functions of these dynamic vesicular compartments. Proteomics has been shown to be a particularly adequate tool in this study field. This review attempts to link proteomic data with physiological roles and functions of blood EVS.

Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients

OBJECTIVE: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. MATERIALS AND METHODS: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with 99mTc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. RESULTS: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). CONCLUSION: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia.

Fractionation of wood hydrolysate by ultrafiltration membranes at high temperature

Ultrafiltration (UF) is already used in pulp and paper industry and its demand is growing because of the required reduction of raw water intake and the separation of useful compounds from process waters. In the pulp and paper industry membranes might be exposed to extreme conditions and, therefore, it is important that the membrane can withstand them. In this study, extractives, hemicelluloses and lignin type compounds were separated from wood hydrolysate in order to be able to utilise the hemicelluloses in the production of biofuel. The performance of different polymeric membranes at different temperatures was studied. Samples were analysed for total organic compounds (TOC), lignin compounds (UV absorption at 280 nm) and sugar. Turbidity, conductivity and pH were also measured. The degree of fouling of the membranes was monitored by measuring the pure water flux before and comparing it with the pure water flux after the filtration of hydrolysate. According to the results, the retention of turbidity was observed to be higher at lower temperature compared to when the filtrations were operated at high temperature (70 °C). Permeate flux increased with elevated process temperature. There was no detrimental effect of temperature on most of the membranes used. Microdyn-Nadir regenerated cellulose membranes (RC) and GE-Osmonics thin film membranes seemed to be applicable in the chosen process conditions. The Polyethersulphone (NF-PES-10 and UH004P) and polysulphone (MPS-36) membranes used were highly fouled, but they showed high retentions for different compounds.

Pork Barrel politics in semi-democracies: the Spanish 'Parlamentary roads', 1874-1915

This paper analyzes the effects of parliamentary representation on road infrastructure expenditure during the Spanish Restoration. Using a panel dataset of Spanish provinces in 1880-1914 we find that the allocation of administrative resources among provinces depended both on the delegation characteristics (such as the share of MPs with party leadership positions, and their degree of electoral independence), and the regime"s global search for stability. These results point to the importance of electoral dynamics within semi-democratic political systems, and offer an example of the influence of government tactics on infrastructure allocation.

Pork Barrel politics in semi-democracies: the Spanish 'Parlamentary roads', 1874-1915

This paper analyzes the effects of parliamentary representation on road infrastructure expenditure during the Spanish Restoration. Using a panel dataset of Spanish provinces in 1880-1914 we find that the allocation of administrative resources among provinces depended both on the delegation characteristics (such as the share of MPs with party leadership positions, and their degree of electoral independence), and the regime"s global search for stability. These results point to the importance of electoral dynamics within semi-democratic political systems, and offer an example of the influence of government tactics on infrastructure allocation.

Kokoonpanon ohjauksen kehittäminen maa- ja metsätalouskoneteollisuudessa

Kehitetään maa- ja metsätalouskoneita valmistavan yrityksen kokoonpanoohjausta imu- ja työntöohjausmenetelmin. Luodaan sopiva järjestelmä toimintaympäristöön.

Prevenção da transmissão vertical do HIV: atitude dos obstetras em Salvador, Brasil

OBJETIVO: avaliar as atitudes e conhecimento dos obstetras das maternidades públicas da cidade de Salvador (MPS) sobre as recomendações do Ministério da Saúde para a profilaxia da transmissão vertical do vírus humano da imunodeficiência (HIV) e terapia antiretroviral em gestantes. Avaliou-se também a influência das condições de trabalho, disponibilidade da testagem rápida e da terapia antiretroviral em relação à aplicação destas recomendações. MÉTODOS: realizou-se um estudo de corte transversal entre agosto e novembro de 2005, envolvendo 129/152 (85%) dos obstetras de todas as MPS. Utilizou-se como instrumento um questionário anônimo, estruturado e auto-explicativo, com questões sobre as características da população, condições de trabalho e disponibilidade de insumos, conhecimento e atitudes relacionadas ao aconselhamento e testagem para o HIV e condutas com as pacientes (uso da zidovudina (AZT), reconhecimento de fatores de risco, escolha e manejo da via de parto e cuidados no puerpério). RESULTADOS: dos obstetras, 69% referiram conhecer integralmente as recomendações do Ministério da Saúde; 90,7% concordaram com a solicitação compulsória da testagem rápida para o HIV; 63,6% escolheram a cesariana para via de parto; 38% contra-indicaram o parto por via vaginal; 37,5% recomendaram isolamento das pacientes soropositivas e 58,1% indicaram laqueadura tubária. A maioria (90%) dos sujeitos referiram a existência de fatores prejudiciais à aplicabilidade das recomendações, sendo que os mais apontados foram a realização inadequada e a indisponibilidade das informações do pré-natal na admissão. Embora a testagem rápida estivesse disponível, apenas um terço dos entrevistados afirmou que o resultado estava sempre disponível em tempo hábil. CONCLUSÕES: algumas atitudes relacionadas à assistência à gestante com HIV foram discordantes das recomendações do Ministério da Saúde. Na opinião dos entrevistados a inadequação do pré-natal e a indisponibilidade do resultado da testagem rápida influenciam negativamente na aplicação das recomendações para profilaxia da transmissão vertical do HIV.

GIS assessing traditional and modern agricultural land use/land cover change. A case study 1959-2005: Rekijoki, Somero, SW-Finland

Finland’s rural landscape has gone through remarkable changes from the 1950’s, due to agricultural developments. Changed farming practices have influenced especially traditional landscape management, and modifications in the arable land structure and grasslands transitions are notable. The review of the previous studies reveal the importance of the rural landscape composition and structure to species and landscape diversity, whereas including the relevance in presence of the open ditches, size of the field and meadow patches, topology of the natural and agricultural landscape. This land-change study includes applying remote sensed data from two time series and empirical geospatial analysis in Geographic Information Systems (GIS). The aims of this retrospective research is to detect agricultural landscape use and land cover change (LULCC) dynamics and discuss the consequences of agricultural intensification to landscape structure covering from the aspects of landscape ecology. Measurements of LULC are derived directly from pre-processed aerial images by a variety of analytical procedures, including statistical methods and image interpretation. The methodological challenges are confronted in the process of landscape classification and combining change detection approaches with landscape indices. Particular importance is paid on detecting agricultural landscape features at a small scale, demanding comprehensive understanding of such agroecosystems. Topological properties of the classified arable land and valley are determined in order to provide insight and emphasize the aspect the field edges in the agricultural landscape as important habitat. Change detection dynamics are presented with change matrix and additional calculations of gain, loss, swap, net change, change rate and tendencies are made. Transition’s possibility is computed following Markov’s probability model and presented with matrix, as well. Thesis’s spatial aspect is revealed with illustrative maps providing knowledge of location of the classified landscape categories and location of the dynamics of the changes occurred. It was assured that in Rekijoki valley’s landscape, remarkable changes in landscape has occurred. Landscape diversity has been strongly influenced by modern agricultural landscape change, as NP of open ditches has decreased and the MPS of the arable plot has decreased. Overall change in the diversity of the landscape is determined with the decrease of SHDI. Valley landscape considered as traditional land use area has experienced major transitional changes, as meadows class has lost almost one third of the area due to afforestation. Also, remarkable transitions have occurred from forest to meadow and arable land to built area. Boundaries measurement between modern and traditional landscape has indicated noticeable proportional increase in arable land-forest edge type and decrease in arable land-meadow edge type. Probability calculations predict higher future changes for traditional landscape, but also for arable land turning into built area.

Epävarmuuksien hallinta MRP-ympäristössä

Tämä kandidaatintyö käsittelee MRP-ympäristöön liittyviä epävarmuuksia ja niiden hallintaa. Työssä esitellään MRP ja sen suhde tuotannonsuunnitteluun. Tämän jälkeen MRP:hen liittyvät epävarmuudet jaetaan loogisiin kokonaisuuksiin ja eritellään kirjallisuuden perusteella niiden vaikutuksia yrityksen ja MRP:n suorituskykyyn. Viimeisenä esitellään keinoja, joilla epävarmuuksia voidaan hallita. MRP-ympäristön epävarmuudet voidaan jakaa ulkoisiin ja sisäisiin epävarmuuksiin. Ulkoiset epävarmuudet johtuvat yrityksen ulkopuolisista tekijöitä kuten kysynnästä ja toimituksista. Sisäiset epävarmuudet puolestaan johtuvat yrityksen sisäisistä tekijöistä kuten saannosta tai läpimenoajoista. Nämä epävarmuudet johtavat kustannusten kasvamiseen, toimitusten viivästymiseen ja tuotannon ja tuotantosuunnitelmien hermostuneisuuteen. Epävarmuuksien hallintaan on tunnistettu useita eri menetelmiä: varmuusvarastot, varmuusläpimenoajat, MPS:n jäädyttäminen ja suunnitteluhorisontin valinta, hedging, saantotekijät, ylituotanto ja täydennyserien sopiva valinta. Kukin näistä hallintakeinoista soveltuu parhaiten tietyn epävarmuuden hallintaan. Kullakin hallintakeinolla on myös haitallisia vaikutuksia MRP-järjestelmän toiminnalle.