Mediterranean diet and risk of endometrial cancer: a pooled analysis of three italian case-control studies.

BACKGROUND: Some components of the Mediterranean diet have favourable effects on endometrial cancer, and the Mediterranean diet as a whole has been shown to have a beneficial role on various neoplasms. METHODS: We analysed this issue pooling data from three case-control studies carried out between 1983 and 2006 in various Italian areas and in the Swiss Canton of Vaud. Cases were 1411 women with incident, histologically confirmed endometrial cancer, and controls were 3668 patients in hospital for acute diseases. We measured the adherence to the Mediterranean diet using a Mediterranean Diet Score (MDS), based on the nine dietary components characteristics of this diet, that is, high intake of vegetables, fruits/nuts, cereals, legumes, fish; low intake of dairy products and meat; high monounsaturated to saturated fatty acid ratio; and moderate alcohol intake. We estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) for increasing levels of the MDS (varying from 0, no adherence, to 9, maximum adherence) using multiple logistic regression models, adjusted for major confounding factors. RESULTS: The adjusted OR for a 6-9 components of the MDS (high adherence) compared with 0-3 (low adherence) was 0.43 (95% CI 0.34-0.56). The OR for an increment of one component of MDS diet was 0.84 (95% CI 0.80-0.88). The association was consistent in strata of various covariates, although somewhat stronger in older women, in never oral contraceptive users and in hormone-replacement therapy users. CONCLUSIONS: Our study provides evidence for a beneficial role of the Mediterranean diet on endometrial cancer risk, suggesting a favourable effect of a combination of foods rich in antioxidants, fibres, phytochemicals, and unsaturated fatty acids.

Potential health-care service utilization substitution effects induced by case management for emergency department frequent users

BACKGROUND: In most of the emergency departments (ED) in developed countries, a subset of patients visits the ED frequently. Despite their small numbers, these patients are the source of a disproportionally high number of all ED visits, and use a significant proportion of healthcare resources. They place a heavy economic burden on hospital and healthcare systems budgets overall. Several interventions have been carried out to improve the management of these ED frequent users. Case management has been shown in some North American studies to reduce ED utilization and costs. In these studies, cost analyses have been carried out from the hospital perspective without examining the costs induced by healthcare consumed in the community. However, case management might reduce ED visits and costs from the hospital's perspective, but induce substitution effects, and increase health service utilization outside the hospital. This study examined if an interdisciplinary case-management intervention-compared to standard ED care -reduced costs generated by frequent ED users not only from the hospital perspective, but also from the healthcare system perspective-that is, from a broader perspective taking into account the costs of healthcare services used outside the hospital. METHODS: In this randomized controlled trial, 250 adult frequent emergency department users (5 or more visits during the previous 12 months) who visited the ED of the University Hospital of Lausanne, Switzerland, between May 2012 and July 2013 were allocated to one of two groups: case management intervention (CM) or standard ED care (SC), and followed up for 12 months. Depending on the perspective of the analysis, costs were evaluated differently. For the analysis from the hospital's perspective, the true value of resources used to provide services was used as a cost estimate. These data were obtained from the hospital's analytical accounting system. For the analysis from the health-care system perspective, all health-care services consumed by users and charged were used as an estimate of costs. These data were obtained from health insurance providers for a subsample of participants. To allow comparisons in a same time period, individual monthly average costs were calculated. Multivariate linear models including a fixed effect "group" were run using socio-demographic characteristics and health-related variables as controlling variables (age, gender, educational level, citizenship, marital status, somatic and mental health problems, and risk behaviors).

Scenario analysis in evaluation of emerging technology - Case Bluetooth

Tutkimuksen tavoitteena oli selvittää millaisia ympäristöskenaarioita tietoliikenteelle toimialana voidaan rakentaa ja mitkä näistä skenaarioista suosivat Bluetoothin diffuusiota ja kehittymistä nykyisten tuote- ja palvelunäkemysten valossa. Lisäksi pyrittiin arvioimaan, mitkä ympäristötekijät ja suuntaukset saattavat vaikuttaa Bluetoothin diffuusioon. Tutkimus rajoittui eurooppalaisen tietoliikenneympäristön tarkasteluun viiden vuoden aikana. Tietoliikennetoimialan nykytilaa ja tulevaisuutta koskevan kirjallisuuden pohjalta luotiin kolme alustavaa skenaariorunkoa. Näitä runkoja arvioitiin asiantuntijahaastattelujen avulla, jotta skenaarioista saataisiin monipuolisempia ja niiden johdonmukaisuutta voitaisiin parantaa. Lopullisia skenaarioita verrattiin Bluetoothin käyttökohteista esitettyihin näkemyksiin. Skenaarioiden teemat olivat “Fokusoidut bisnessovellukset”, “Viihdettä massoille” sekä “Tietoa kaikille”. Havaittiin, että Bluetoothin omaksumiseen vaikuttavat eniten seuraavat tekijät: teknologian sosiaalinen hyväksyntä, toimialan halukkuus teknologian edistämiseen sekä Bluetoothin ja sen kilpailijoiden kehittyminen jatkossa.

Market Opportunities Analysis for Logistics Solutions Provider Case Danzas Solutions

Tutkielman tavoitteena oli suunitella markkina-analyysi ja sitä käyttäen määritellä Danzasin Solutions liiketoimintayksikön mahdollisuuksia laajentaa toimintaansa Suomen terveydenhuolto/ lääke- ja elektroniikka/ telekommunikaatiosektoreilla. Danzas Solutions toimisi logistiikkaintegraattorina toimittamalla kokonaisvaltaisia logistisia ratkaisuja. Tutkimus tehtiin haastattelemalla neljää Danzasin asiakasta. Mahdollisimman laajan ja yleistettävän tuloksen saamiseksi haastateltavat valitiin logistiikan ulkoistamisasteeltaan vaihteleviksi. Tutkimus tehtiin ensin tutkimalla sekundääristä informaatiota markkinoilta ja täydentämällä sitä haastatteluista saadulla kvalitatiivisella primääri informaatiolla ja case yrityksen sisäisellä analyysillä. Painopiste tutkimuksessa oli selvittää yritysten ulkoistamiseen ja logistiikkakumppanin valintaan vaikuttavia kriteereitä. Logistiikkaintegraattorille suurimmat mahdollisuudet löytyvät elektroniikka/ telekommunikaatiosektorilta. Logistiikka tällä sektorilla on vaativaa ja yrityksillä ei ole resursseja hallita sitä itse. Terveydenhuolto/ lääkesektorilla yrityksillä on yleensä muut keinot jakeluketjun hallintaan ja ne eivät tarvitse logistiikkaintegraattorin palveluita.

Use of scenario analysis in studying emerging technology – Case Grid computing

Tutkimuksen selvitettiin miten skenaarioanalyysia voidaan käyttää uuden teknologian tutkimisessa. Työssä havaittiin, että skenaarioanalyysin soveltuvuuteen vaikuttaa eniten teknologisen muutoksen taso ja saatavilla olevan tiedon luonne. Skenaariomenetelmä soveltuu hyvin uusien teknologioiden tutkimukseen erityisesti radikaalien innovaatioiden kohdalla. Syynä tähän on niihin liittyvä suuri epävarmuus, kompleksisuus ja vallitsevan paradigman muuttuminen, joiden takia useat muut tulevaisuuden tutkimuksen menetelmät eivät ole tilanteessa käyttökelpoisia. Työn empiirisessä osiossa tutkittiin hilaverkkoteknologian tulevaisuutta skenaarioanalyysin avulla. Hilaverkot nähtiin mahdollisena disruptiivisena teknologiana, joka radikaalina innovaationa saattaa muuttaa tietokonelaskennan nykyisestä tuotepohjaisesta laskentakapasiteetin ostamisesta palvelupohjaiseksi. Tällä olisi suuri vaikutus koko nykyiseen ICT-toimialaan erityisesti tarvelaskennan hyödyntämisen ansiosta. Tutkimus tarkasteli kehitystä vuoteen 2010 asti. Teorian ja olemassa olevan tiedon perusteella muodostettiin vahvaan asiantuntijatietouteen nojautuen neljä mahdollista ympäristöskenaariota hilaverkoille. Skenaarioista huomattiin, että teknologian kaupallinen menestys on vielä monen haasteen takana. Erityisesti luottamus ja lisäarvon synnyttäminen nousivat tärkeimmiksi hilaverkkojen tulevaisuutta ohjaaviksi tekijöiksi.

Ammattikorkeakoulun imago pk-yritysten keskuudessa. Case: Lahden ammattikorkeakoulu

Tutkielman tavoitteena on selvittää ammattikorkeakoulun imagoa pk-yritysten keskuudessa. Työ on kaksiosainen. Tutkimuksen teoriaosassa keskitytään palvelujen laadun teorioihin ja siihen, miten laatu voi vaikuttaa ammattikorkeakoulun imagoon. Tutkimuksen empiirinen osuus tehtiin kvantitatiivisena tutkimuksena. Kyselylomake lähetettiin noin 1500 päijäthämäläiselle pk-yritykselle. Tulosten analysoinnissa käytettiin SPSS-ohjelmaa. Tutkimus osoitti, että Lahden ammattikorkeakoulun imago oli vielä selkiytymätön, mutta sen tärkeys alueelle oli kiistaton. Lahden ammattikorkeakoulun johtoryhmän ja päijäthämäläisten pk-yritysten käsitykset olivat samansuuntaisia. Palveluja pidettiin keskimäärin hyvinä ja konkreettista hyötyä antavina. Pk-yritykset toivoivat opiskelijoilta lisää käytännön osaamista ja työharjoittelua sekä ammattikorkeakoululta lisää yhteydenottoja. Internetiä ei juurikaan käytetty etsittäessä tietoja Lahden ammattikorkeakoulun kotisivuilta tai rekrytointi-palveluista. Pääasiallisin tieto löytyi lehdistä ja esitteistä. Kyselyyn vastanneet pk-yrittäjät olivat keskimäärin keski-ikäisiä ja suuriin ikäluokkiin kuuluvia pienyrittäjiä, joilla oli ollut teollisuusyritys yli kymmenen vuotta.

Particle shape and orientation in laser diffraction and static image analysis size distribution analysis of micrometer sized rectangular particles

Laser diffraction (LD) and static image analysis (SIA) of rectangular particles [United States Pharmacopeia, USP30-NF25, General Chapter <776>, Optical Miroscopy.] have been systematically studied. To rule out sample dispersion and particle orientation as the root cause of differences in size distribution profiles, we immobilize powder samples on a glass plate by means of a dry disperser. For a defined region of the glass plate, we measure the diffraction pattern as induced by the dispersed particles, and the 2D dimensions of the individual particles using LD and optical microscopy, respectively. We demonstrate a correlation between LD and SIA, with the scattering intensity of the individual particles as the dominant factor. In theory, the scattering intensity is related to the square of the projected area of both spherical and rectangular particles. In traditional LD the size distribution profile is dominated by the maximum projected area of the particles (A). The diffraction diameters of a rectangular particle with length L and breadth B as measured by the LD instrument approximately correspond to spheres of diameter ØL and ØB respectively. Differences in the scattering intensity between spherical and rectangular particles suggest that the contribution made to the overall LD volume probability distribution by each rectangular particle is proportional to A2/L and A2/B. Accordingly, for rectangular particles the scattering intensity weighted diffraction diameter (SIWDD) explains an overestimation of their shortest dimension and an underestimation of their longest dimension. This study analyzes various samples of particles whose length ranges from approximately 10 to 1000 μm. The correlation we demonstrate between LD and SIA can be used to improve validation of LD methods based on SIA data for a variety of pharmaceutical powders all with a different rectangular particle size and shape.

What are the success factors for Spanish textile firms? An exploratory multiple-case study

The objective of this article is to identify differential traits of successful SMEs in comparison to average SME firms in the textile and clothing sector. The method used is the multiple case-study of 12 firms based on qualitative and quantitative data obtained by means of in-depth interviews. Building on recent academic literature, we use four main dimensions that may explain success: i) knowledge generation (R&D) and acquisition; ii) innovation activity; iii) product and market characteristics and iv) strategic characteristics. Our results indicate that a higher R&D intensity and knowledge acquisition do not explain success. The main differential characteristic is that successful firms have a higher level of innovation activity, since innovation is their strategic priority, being a result of perceiving the key success factors of their markets differently. From the analysis it also follows that the prevalent strategy of successful firms is the niche strategy, with a demand pull focus, and a high proximity to the customer

An interactive web-GIS tool for risk analysis: a case study in the Fella River basin, Italy

This paper presents a prototype of an interactive web-GIS tool for risk analysis of natural hazards, in particular for floods and landslides, based on open-source geospatial software and technologies. The aim of the presented tool is to assist the experts (risk managers) in analysing the impacts and consequences of a certain hazard event in a considered region, providing an essential input to the decision-making process in the selection of risk management strategies by responsible authorities and decision makers. This tool is based on the Boundless (OpenGeo Suite) framework and its client-side environment for prototype development, and it is one of the main modules of a web-based collaborative decision support platform in risk management. Within this platform, the users can import necessary maps and information to analyse areas at risk. Based on provided information and parameters, loss scenarios (amount of damages and number of fatalities) of a hazard event are generated on the fly and visualized interactively within the web-GIS interface of the platform. The annualized risk is calculated based on the combination of resultant loss scenarios with different return periods of the hazard event. The application of this developed prototype is demonstrated using a regional data set from one of the case study sites, Fella River of northeastern Italy, of the Marie Curie ITN CHANGES project.

Modelling body mass index and endometrial cancer risk in a pooled-analysis of three case-control studies.

OBJECTIVE: To quantify the relation between body mass index (BMI) and endometrial cancer risk, and to describe the shape of such a relation. DESIGN: Pooled analysis of three hospital-based case-control studies. SETTING: Italy and Switzerland. POPULATION: A total of 1449 women with endometrial cancer and 3811 controls. METHODS: Multivariate odds ratios (OR) and 95% confidence intervals (95% CI) were obtained from logistic regression models. The shape of the relation was determined using a class of flexible regression models. MAIN OUTCOME MEASURE: The relation of BMI with endometrial cancer. RESULTS: Compared with women with BMI 18.5 to <25 kg/m(2) , the odds ratio was 5.73 (95% CI 4.28-7.68) for women with a BMI ≥35 kg/m(2) . The odds ratios were 1.10 (95% CI 1.09-1.12) and 1.63 (95% CI 1.52-1.75) respectively for an increment of BMI of 1 and 5 units. The relation was stronger in never-users of oral contraceptives (OR 3.35, 95% CI 2.78-4.03, for BMI ≥30 versus <25 kg/m(2) ) than in users (OR 1.22, 95% CI 0.56-2.67), and in women with diabetes (OR 8.10, 95% CI 4.10-16.01, for BMI ≥30 versus <25 kg/m(2) ) than in those without diabetes (OR 2.95, 95% CI 2.44-3.56). The relation was best fitted by a cubic model, although after the exclusion of the 5% upper and lower tails, it was best fitted by a linear model. CONCLUSIONS: The results of this study confirm a role of elevated BMI in the aetiology of endometrial cancer and suggest that the risk in obese women increases in a cubic nonlinear fashion. The relation was stronger in never-users of oral contraceptives and in women with diabetes. TWEETABLE ABSTRACT: Risk of endometrial cancer increases with elevated body weight in a cubic nonlinear fashion.

Robotic-Assisted Surgery Improves the Quality of Total Mesorectal Excision for Rectal Cancer Compared to Laparoscopy: Results of a Case-Controlled Analysis.

BACKGROUND: The use of a robotic surgical system is claimed to allow precise traction and counter-traction, especially in a narrow pelvis. Whether this translates to improvement of the quality of the resected specimen is not yet clear. The aim of the study was to compare the quality of the TME and the short-term oncological outcome between robotic and laparoscopic rectal cancer resections. METHODS: 20 consecutive robotic TME performed in a single institution for rectal cancer (Rob group) were matched 1:2 to 40 laparoscopic resections (Lap group) for gender, body mass index (BMI), and distance from anal verge on rigid proctoscopy. The quality of TME was assessed by 2 blinded and independent pathologists and reported according to international standardized guidelines. RESULTS: Both samples were well matched for gender, BMI (median 25.9 vs. 24.2 kg/m(2), p = 0.24), and level of the tumor (4.1 vs. 4.8 cm, p = 0.20). The quality of the TME was better in the Robotic group (complete TME: 95 vs. 55 %; p = 0.0003, nearly complete TME 5 vs. 37 %; p = 0.04, incomplete TME 0 vs. 8 %, p = 0.09). A trend for lower positive circumferential margin was observed in the Robotic group (10 vs. 25 %, p = 0.1). CONCLUSIONS: These results suggest that robotic-assisted surgery improves the quality of TME for rectal cancer. Whether this translates to better oncological outcome needs to be further investigated.

Reconsidering the analysis of the uses of ICTs by political parties : an application to the Catalan case

For years a literature on the uses that political parties make of information andcommunication technologies (ICTs) has been developed. It is a rapidly increasing, rich,and interesting field in the forefront of the investigation in political science. Generally,these works start from the expectation that the ICTs have a regenerative potential forliberal democracies and for the political parties as well. In developed societies, politicalparties have experienced some transformations that have leaded them to an increasingdivorce with the public. This divorce is shown by the decay of party adscription andmembership, and also by the decay of the conventional political participation. In thetheoretical discussion this situation has been described as ¿the crisis of the democracy¿(Norris, 1999). According to the more radically oriented scholars this crisis reflects theincapacities of liberal democracies. In this sense, ICTs suppose a great opportunity tosurpass the representative institutions and to institutionalize new forms of directdemocracy. More moderate scholars have considered that ICTs offer the opportunity for¿renaissance¿ for representative institutions, as they can reinforce the bonds between thepublic and its representatives.

An analysis of the evolution of hydrometeorological extremes in newspapers: the case of Catalonia, 1982-2006

This contribution analyzes the evolution of perception of certain natural hazards over the past 25 years in a Mediterranean region. Articles from newspapers have been used as indicator. To this end a specific Spanish journal has been considered and an ACCESS database has been created with the summarized information from each news item. The database includes data such as the location of each specific article in the newspaper, its length, the number of pictures and figures, the headlines and a summary of the published information, including all the instrumental data. The study focused on hydrometeorological extremes, mainly floods and droughts, in the northeast of the Iberian Peninsula. The number of headlines per event, trends and other data have been analyzed and compared with "measured" information, in order to identify any bias that could lead to an erroneous perception of the phenomenon. The SPI index (a drought index based on standardized accumulated precipitation) has been calculated for the entire region, and has been used for the drought analysis, while a geodatabase implemented on a GIS built for all the floods recorded in Catalonia since 1900 (INUNGAMA) has been used to analyze flood evolution. Results from a questionnaire about the impact of natural hazards in two specific places have been also used to discuss the various perceptions between rural and urban settings. Results show a better correlation between the news about drought or water scarcity and SPI than between news on floods in Catalonia and the INUNGAMA database. A positive trend has been found for non-catastrophic floods, which is explained by decrease of the perception thresholds, the increase of population density in the most flood-prone areas and changes in land use.

Case-Crossover Analysis of Air Pollution Health Effects: A Systematic Review of Methodology and Application

Case-crossover is one of the most used designs for analyzing the health-related effects of air pollution. Nevertheless, no one has reviewed its application and methodology in this context. Objective: We conducted a systematic review of case-crossover (CCO) designs used to study the relationship between air pollution and morbidity and mortality, from the standpoint of methodology and application.Data sources and extraction: A search was made of the MEDLINE and EMBASE databases.Reports were classified as methodologic or applied. From the latter, the following information was extracted: author, study location, year, type of population (general or patients), dependent variable(s), independent variable(s), type of CCO design, and whether effect modification was analyzed for variables at the individual level. Data synthesis: The review covered 105 reports that fulfilled the inclusion criteria. Of these, 24 addressed methodological aspects, and the remainder involved the design’s application. In the methodological reports, the designs that yielded the best results in simulation were symmetric bidirectional CCO and time-stratified CCO. Furthermore, we observed an increase across time in the use of certain CCO designs, mainly symmetric bidirectional and time-stratified CCO. The dependent variables most frequently analyzed were those relating to hospital morbidity; the pollutants most often studied were those linked to particulate matter. Among the CCO-application reports, 13.6% studied effect modification for variables at the individual level.Conclusions: The use of CCO designs has undergone considerable growth; the most widely used designs were those that yielded better results in simulation studies: symmetric bidirectional and time-stratified CCO. However, the advantages of CCO as a method of analysis of variables at the individual level are put to little use

Assigning and combining probabilities in single-case designs: A second study

The present study builds on a previous proposal for assigning probabilities to the outcomes computed using different primary indicators in single-case studies. These probabilities are obtained comparing the outcome to previously tabulated reference values and reflect the likelihood of the results in case there was no intervention effect. The current study explores how well different metrics are translated into p values in the context of simulation data. Furthermore, two published multiple baseline data sets are used to illustrate how well the probabilities could reflect the intervention effectiveness as assessed by the original authors. Finally, the importance of which primary indicator is used in each data set to be integrated is explored; two ways of combining probabilities are used: a weighted average and a binomial test. The results indicate that the translation into p values works well for the two nonoverlap procedures, with the results for the regression-based procedure diverging due to some undesirable features of its performance. These p values, both when taken individually and when combined, were well-aligned with the effectiveness for the real-life data. The results suggest that assigning probabilities can be useful for translating the primary measure into the same metric, using these probabilities as additional evidence on the importance of behavioral change, complementing visual analysis and professional's judgments.