Development of a control banding tool for nanomaterials

Control banding (CB) can be a useful tool for managing the potential risks of nanomaterials. The here proposed CB, which should be part of an overall risk control strategy, groups materials by hazard and emission potential. The resulting decision matrix proposes control bands adapted to the risk potential levels and helps define an action plan. If this plan is not practical and financially feasible, a full risk assessment is launched. The hazard banding combines key concepts of nanomaterial toxicology: translocation across biological barriers, fibrous nature, solubility, and reactivity. Already existing classifications specific to the nanomaterial can be used "as is." Otherwise, the toxicity of bulk or analogous substances gives an initial hazard band, which is increased if the substance is not easily soluble or if it has a higher reactivity than the substance. The emission potential bands are defined by the nanomaterials' physical form and process characteristics. Quantities, frequencies, and existing control measures are taken into account during the definition of the action plan. Control strategies range from room ventilation to full containment with expert advice. This CB approach, once validated, can be easily embedded in risk management systems. It allows integrating new toxicity data and needs no exposure data. [Authors]

Endoscopic Approach and Management of Parasellar Lesions

The parasellar region is the location of a wide variety of inflammatory and benign or malignant lesions. A pathological diagnostic strategy may be difficult to establish relying solely on imaging data. Percutaneous biopsy through the foramen ovale using the Hartel technique has been developed for decision-making process. It is an accurate diagnostic tool allowing pathological diagnosis to determine the best treatment strategy. However, in some cases, this procedure may fail or may be inappropriate particularly for anterior parasellar lesions. Over these past decades, endoscopy has been widely developed and promoted in many indications. It represents an interesting alternative approach to parasellar lesions with low morbidity when compared to the classic microscopic sub-temporal extradural approach with or without orbito-zygomatic removal. In this chapter, we describe our experience with the endoscopic approach to parasellar lesions. We propose a complete overview of surgical anatomy and describe methods and results of the technique. We also suggest a model of a decision-making tree for the diagnosis and treatment of parasellar lesions.

Electroencephalography (EEG) for neurological prognostication after cardiac arrest and targeted temperature management; rationale and study design.

BACKGROUND: Electroencephalography (EEG) is widely used to assess neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by inter-rater variability. The American Clinical Neurophysiology Society (ACNS) has recently proposed a standardized EEG-terminology for critical care to address these limitations. METHODS/DESIGN: In the TTM-trial, 399 post cardiac arrest patients who remained comatose after rewarming underwent a routine EEG. The presence of clinical seizures, use of sedatives and antiepileptic drugs during the EEG-registration were prospectively documented. DISCUSSION: A well-defined terminology for interpreting post cardiac arrest EEGs is critical for the use of EEG as a prognostic tool. TRIAL REGISTRATION: The TTM-trial is registered at ClinicalTrials.gov (NCT01020916).

Evaluation of a clinical tool for early etiology identification in status epilepticus.

OBJECTIVES: Because early etiologic identification is critical to select appropriate specific status epilepticus (SE) management, we aim to validate a clinical tool we developed that uses history and readily available investigations to guide prompt etiologic assessment. METHODS: This prospective multicenter study included all adult patients treated for SE of all but anoxic causes from four academic centers. The proposed tool is designed as a checklist covering frequent precipitating factors for SE. The study team completed the checklist at the time the patient was identified by electroencephalography (EEG) request. Only information available in the emergency department or at the time of in-hospital SE identification was used. Concordance between the etiology indicated by the tool and the determined etiology at hospital discharge was analyzed, together with interrater agreement. RESULTS: Two hundred twelve patients were included. Concordance between the etiology hypothesis generated using the tool and the finally determined etiology was 88.7% (95% confidence interval (CI) 86.4-89.8) (κ = 0.88). Interrater agreement was 83.3% (95% CI 80.4-96) (κ = 0.81). SIGNIFICANCE: This tool is valid and reliable for identification early the etiology of an SE. Physicians managing patients in SE may benefit from using it to identify promptly the underlying etiology, thus facilitating selection of the appropriate treatment.

Thermal modeling and management in ultrathin chip stack technology

This paper presents a thermal modeling for power management of a new three-dimensional (3-D) thinned dies stacking process. Besides the high concentration of power dissipating sources, which is the direct consequence of the very interesting integration efficiency increase, this new ultra-compact packaging technology can suffer of the poor thermal conductivity (about 700 times smaller than silicon one) of the benzocyclobutene (BCB) used as both adhesive and planarization layers in each level of the stack. Thermal simulation was conducted using three-dimensional (3-D) FEM tool to analyze the specific behaviors in such stacked structure and to optimize the design rules. This study first describes the heat transfer limitation through the vertical path by examining particularly the case of the high dissipating sources under small area. First results of characterization in transient regime by means of dedicated test device mounted in single level structure are presented. For the design optimization, the thermal draining capabilities of a copper grid or full copper plate embedded in the intermediate layer of stacked structure are evaluated as a function of the technological parameters and the physical properties. It is shown an interest for the transverse heat extraction under the buffer devices dissipating most the power and generally localized in the peripheral zone, and for the temperature uniformization, by heat spreading mechanism, in the localized regions where the attachment of the thin die is altered. Finally, all conclusions of this analysis are used for the quantitative projections of the thermal performance of a first demonstrator based on a three-levels stacking structure for space application.

Early tailored assertive community case management for hard-to-engage adolescents suffering from psychiatric disorders: an exploratory pilot study.

AIM: The study aims to evaluate the effects of assertive community treatment (ACT) on the mental health and overall functioning of adolescents suffering from severe psychiatric disorders and who refuse any traditional child psychiatric care. There are a few studies evaluating the effects of ACT on a population of adolescents with psychiatric disorders. This short report highlights the impact of an ACT programme tailored to the needs of these patients, not only as an alternative to hospitalization, but also as a new form of intervention for patients that are difficult to engage. METHODS: The effect of ACT on 35 adolescents using the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) as a measuring tool in pre- and post-intervention was evaluated. RESULTS: The results show that the intervention was associated with a significant improvement on the HoNOSCA overall score, with the following items showing significant amelioration: hyperactivity/focus problems, non-organic somatic symptoms, emotional symptoms, scholastic/language skills, peer relationships, family relationships and school attendance. CONCLUSION: ACT appears as a feasible intervention for hard-to-engage adolescents suffering from psychiatric disorders. The intervention seems to improve their mental health and functioning. This pilot study may serve as a basis to prepare a controlled study that will also take the costs of the intervention into account.

Artificial-Intelligence-Based Optimization of the Management of Snow Removal Assets and Resources Final Report, October 2002

Geographic information systems (GIS) and artificial intelligence (AI) techniques were used to develop an intelligent snow removal asset management system (SRAMS). The system has been evaluated through a case study examining snow removal from the roads in Black Hawk County, Iowa, for which the Iowa Department of Transportation (Iowa DOT) is responsible. The SRAMS is comprised of an expert system that contains the logical rules and expertise of the Iowa DOT’s snow removal experts in Black Hawk County, and a geographic information system to access and manage road data. The system is implemented on a mid-range PC by integrating MapObjects 2.1 (a GIS package), Visual Rule Studio 2.2 (an AI shell), and Visual Basic 6.0 (a programming tool). The system could efficiently be used to generate prioritized snowplowing routes in visual format, to optimize the allocation of assets for plowing, and to track materials (e.g., salt and sand). A test of the system reveals an improvement in snowplowing time by 1.9 percent for moderate snowfall and 9.7 percent for snowstorm conditions over the current manual system.

Diagnosis and management of blunt great vessel trauma.

Traditionally, thoracic aortic rupture, suspected after blunt thoracic trauma, is characterized by a chest radiograph showing a widened mediastinum. The diagnostic machinery consecutively activated still depends heavily on the pressure as additional traumatic lesions. A patient with additional cranio-cerebral trauma would typically undergo contrast-enhanced computed tomography or magnetic resonance imaging of head, chest, and other regions. In a number of patients these analyses would confirm the presence of blood in the mediastinum without formal proof of an aortic disruption. This is because mediastinal hematomas may be caused not only by an aortic rupture, but also by numerous other blood sources including fractures of the spine and other macro- and microvascular lesions providing similar images. Therefore, aortic angiography became our preferred diagnostic tool to identify or rule out acute traumatic lesions of not only the aorta but with great vessels. However recently, a number of traumatic aortic transsections have been identified by transoesophageal echocardiography (TEE). TEE has the additional advantage of being a bed-side procedure providing additional information about cardiac function. The latter analysis allows for identification and quantification of cardiac contusions, post-traumatic myocardial infarctions, and valvar lesions which are of prime importance to develop an adequate surgical strategy and to assess the risk of the numerous emergency procedures required in patients with polytrauma. The standard approach for repair of isthmic aortic rupture is through a lateral thoracotomy. Distal and proximal control of the aorta can be achieved in a substantial number of cases before complete aortic rupture occurs and a higher proportion of direct suture repair can be achieved under such circumstances. Most proximal descending aortic procedures are performed without cardiopulmonary bypass (clamp and go) but paraplegia may occur before, during, or after the procedure. Ascending aortic lesions and disruption of the aortic arch, the supra-aortic vessels, the main pulmonary arteries, the great veins as well as cardiac lesions are best approached through a sternotomy, which may have to be extended. Cardiopulmonary bypass allowing for deep hypothermia and circulatory arrest is often required and carries its own complications. It is not clear whether the increasing proportion of ascending aortic and cardiac lesions which are observed nowadays are due to a change in trauma mechanics (i.e., speed limits, seat belts, air-bags), an improvement of the diagnostic tools or both.

Creation and Validation of Chronojump-Boscosystem: A Free Tool to Measure Vertical Jumps

Measuring the height of the vertical jump is an indicator of the strength and power of the lower body. The technological tools available to measure the vertical jump are black boxes and are not open to third-party verification or adaptation. We propose the creation of a measurement system called Chronojump-Boscosystem, consisting of open hardware and free software. Methods: A microcontroller was created and validated using a square wave generator and an oscilloscope. Two types of contact platforms were developed using different materials. These platforms were validated by the minimum pressure required for activation at different points by a strain gauge, together with the on/off time of our platforms in respect of the Ergojump-Boscosystem platform by a sample of 8 subjects performing submaximal jumps with one foot on each platform. Agile methodologies were used to develop and validate the software. Results: All the tools fall under the free software / open hardware guidelines and are, in that sense, free. The microcontroller margin of error is 0.1%. The validity of the fiberglass platform is 0.95 (ICC). The management software contains nearly 113.000 lines of code and is available in 7 languages.

Randomized trial of a computerized coronary heart disease risk assessment tool in HIV-infected patients receiving combination antiretroviral therapy.

BACKGROUND: Exposure to combination antiretroviral therapy (cART) can lead to important metabolic changes and increased risk of coronary heart disease (CHD). Computerized clinical decision support systems have been advocated to improve the management of patients at risk for CHD but it is unclear whether such systems reduce patients' risk for CHD. METHODS: We conducted a cluster trial within the Swiss HIV Cohort Study (SHCS) of HIV-infected patients, aged 18 years or older, not pregnant and receiving cART for >3 months. We randomized 165 physicians to either guidelines for CHD risk factor management alone or guidelines plus CHD risk profiles. Risk profiles included the Framingham risk score, CHD drug prescriptions and CHD events based on biannual assessments, and were continuously updated by the SHCS data centre and integrated into patient charts by study nurses. Outcome measures were total cholesterol, systolic and diastolic blood pressure and Framingham risk score. RESULTS: A total of 3,266 patients (80% of those eligible) had a final assessment of the primary outcome at least 12 months after the start of the trial. Mean (95% confidence interval) patient differences where physicians received CHD risk profiles and guidelines, rather than guidelines alone, were total cholesterol -0.02 mmol/l (-0.09-0.06), systolic blood pressure -0.4 mmHg (-1.6-0.8), diastolic blood pressure -0.4 mmHg (-1.5-0.7) and Framingham 10-year risk score -0.2% (-0.5-0.1). CONCLUSIONS: Systemic computerized routine provision of CHD risk profiles in addition to guidelines does not significantly improve risk factors for CHD in patients on cART.

Asset Management Program Enhancement Plan: Baseline Assessment Phases I and II, 2015

This project resulted in the development of a framework for making asset management decisions on low-volume bridges. The research focused on low-volume bridges located in the agricultural counties of Iowa because recent research has shown that these counties have the greatest percentage of structurally deficient bridges in the nation. Many of the same counties also have the highest crop yields in the state, creating a situation where detours caused by deficient bridges on farm-to-market roads increase the cost to transport the crops. Thus, the research proposed the use of social return on investment (SROI), a tool used by international institutions such as the World Bank, as an asset management metric to gauge to the socioeconomic impact of structurally deficient bridges on the state in an effort to provide quantified justification to fund improvements on low-volume assets such as these rural bridges. The study found that combining SROI with current asset management metrics like average daily traffic (ADT) made it possible to prioritize the bridges in such a way that the limited resources available are allocated in a manner that promotes a more equitable distribution and that directly benefits the user, in this case Iowa farmers. The result is a system that more closely aligns itself with the spirit of MAP-21, in that infrastructure investments are used to facilitate economic growth for Iowa’s agricultural economy.

La néphropathie ischémique par athérosclérose aortorénale : acquisitions thérapeutiques [Atherosclerotic renal artery disease management update]

In the case of atherosclerotic renal artery disease, the best conclusive results lie principally not in the degree of the stenosis but rather in the degree the renal parenchymal disease beyond the stenosis itself. These determining factors involve the controlling of the patients blood pressure, the improvement in the renal function and the beneficial results to the cardiovascular system. Besides the indispensable medical treatment, a revascularisation by angioplasty may be indicated. This procedure with or without vascular stent often allows satisfactory angiographic results. A treatment by surgical revascularisation is only recommended in the case of extensive atherosclerotic lesions of the aorta, complex lesions of the latter or an abdominal aortic aneurism. Although the frequency of restenosis of angioplasty with stent remains extremely low, the risk of cholesterol emboli due to the diffuse atherosclerotic lesions of the abdominal aorta, must be considered at the time of each aortic catheterization. The therapeutic approach of atherosclerotic renal artery disease must be dictated by the whole cardiovascular risk factors and by the threat of target organs. The control of the blood pressure and the maintenance of the renal function must be integrated in the decisional algorithm as well as the possible risks in carrying out an eventual revascularisation procedure. Finally, the renal angioplasty should in numerous situations be integrated in the overall assumption of responsibility of the atherosclerotic vascular diseases, and should be part of the medical treatment. Several questions still do exist; at what moment an atherosclerotic renal artery stenosis should and e considered critical, and which procedure should be considered for which patient? The purpose of this review is to propose a decisional tool for individualized treatments in the light of results from randomized and controlled studies.

Implementation of an Integrated Activity-Based Costing in a Holistic Database Management System and its Implications for Operations Management

Diplomityössä on tutkittu reaaliaikaisen toimintolaskennan toteuttamista suomalaisen lasersiruja valmistavan PK-yrityksen tietojärjestelmään. Lisäksi on tarkasteltu toimintolaskennan vaikutuksia operatiiviseen toimintaan sekä toimintojen johtamiseen. Työn kirjallisuusosassa on käsitelty kirjallisuuslähteiden perusteella toimintolaskennan teorioita, laskentamenetelmiä sekä teknisessä toteutuksessa käytettyjä teknologioita. Työn toteutusosassa suunniteltiin ja toteutettiin WWW-pohjainen toimintolaskentajärjestelmä case-yrityksen kustannuslaskennan sekä taloushallinnon avuksi. Työkalu integroitiin osaksi yrityksen toiminnanohjaus- sekä valmistuksenohjausjärjestelmää. Perinteisiin toimintolaskentamallien tiedonkeruujärjestelmiin verrattuna case-yrityksessä syötteet toimintolaskentajärjestelmälle tulevat reaaliaikaisesti osana suurempaa tietojärjestelmäintegraatiota.Diplomityö pyrkii luomaan suhteen toimintolaskennan vaatimusten ja tietokantajärjestelmien välille. Toimintolaskentajärjestelmää yritys voi hyödyntää esimerkiksi tuotteiden hinnoittelussa ja kustannuslaskennassa näkemällä tuotteisiin liittyviä kustannuksia eri näkökulmista. Päätelmiä voidaan tehdä tarkkaan kustannusinformaatioon perustuen sekä määrittää järjestelmän tuottaman datan perusteella, onko tietyn projektin, asiakkuuden tai tuotteen kehittäminen taloudellisesti kannattavaa.

Reporting customer information for sales management

Elektroniikan alihankintapalveluiden (EMS) liiketoimintaympäristössä yritykset toimivat pääasiassa asiakkaiden projektien ja ulkoistamispäätösten keskellä. Tämän tyyppisessä liiketoimintaympäristössä on asiakas keskeisessä roolissa, kuten liiketoiminnassa yleensäkin. Termi EMS sisältää koko tuotteen elinkaaren aina suunnittelusta myynnin jälkeisiin palveluihin. Asiakkaan olessa erittäin tärkeä yritykselle, on myös selvitettävä mitkä asiakkaat ovat yrityksen kannalta arvokkaimmat. Tämän tutkimuksen tavoitteena oli selvittää myyntijohdon tietotarpeet sekä löytää selkeä ja helppokäyttöinen tapa tuoda tarvittava informaatio heidän käyttöönsä. Tietotarpeet selvitettiin haastatteluilla ja kyselytutkimuksella ja sopivan järjestelmän löytämisessä käytettiin prototyyppi-lähestymistä, jotta saataisiin selville täyttääkö valittu järjestelmä myyntijohdon tarpeet. Nk. dashboard-mittaristot ovat hyvä tapa tuoda asiakasinformaatiota päätöksenteontueksi. Tälläisillä mittaristoilla voidaan myös yhdistellä eri lähteistä olevaa tietoa ja tuoda se ymmärrettävässä muodossa esiin. Tässä tutkimuksessa kuvataan mittariston suunnittelu myyntijohdon tarpeisiin. Ensimmäisenä tutkitaan kyselyn avulla myyntijohtajien tiedon tarpeet ja tämän jälkeen etsitään sopiva tekninen sovellus ja ratkaistaan tiedon siirtoihin liittyvät ongelmat. Kun ensimmäinen versio on valmis, esitellään se myyntijohdolle, jotta saadaan kerättyä kommentit seuraavaan versioon.

Service Management for Service Desk

Palvelunhallinnan kehittäminen Service Desk ympäristöön johtaa parempaan työnkulun hallintaan. Service Deskin päätehtävänä on toimia ainoana yhteyspisteenä asiakkaalta tietohallinto-osastolle. Jokainen yhteydenottopitää kirjata ja se pitäisi olla jäljitettävissä. Tapahtumien eli insidenttien kirjaaminen tapahtuu pääasiassa Service Desk -funktiossa, joka omistaa niistä jokaisen. Tapahtumien hallintaprosessin tehtävänä on etsiä loppukäyttäjän tai IT-infrastruktuurin monitorointityökalun ilmoittamalle insidentille mahdollisimman nopea ratkaisu. Insidentit saattavat johtaa ongelmiin, jotka käsitellään erillisessä prosessissa. Ongelmien hallintaprosessi yrittää etsiä vikatilanteen pohjimmaisen syyn. Kun pohjimmaisin syy on löytynyt, prosessi lähettää muutospyynnön muutosten hallintaprosessille. Jotta päästään mahdollisimman hyvään tehokkuuteen, pitää määrittää asiakasrajapinta sekä mittarit. ITIL-malli tarjoaa prosessit IT-palvelunhallinnan kehittämiselle. Kansainvälisesti tunnettuna 'de factO' standardina sitä voidaan soveltaa globaaleissa yrityksissä. Tässä työssä keskitytään erään lääkkeiden jakelussa toimivan yrityksen tietohallinto-osaston Help Deskin nykytilan määrittämiseen. Työssä myös kuvataan tietohallinto-osaston tavoitetila, jossa keskitytään Service Deskin IT palvelunhallinnan kehittämiseen. Muut prosessit ja mittarit on kuvattu niiltä osin, jotka tulee huomioida Service Deskin seuraamisen ja ohjaamisen kannalta.