The Macklin effect: a frequent etiology for pneumomediastinum in severe blunt chest trauma.

STUDY OBJECTIVES: To review the etiology and pathophysiology of pneumomediastinum in severe blunt trauma, with a special interest in one of its possible origins, the Macklin effect. The Macklin effect relates to a three-step pathophysiologic process: blunt traumatic alveolar ruptures, air dissection along bronchovascular sheaths, and spreading of this blunt pulmonary interstitial emphysema into the mediastinum. The clinical relevance of the Macklin effect was also evaluated. SETTING: A university hospital serving as a reference trauma center. PATIENTS: A selection of 51 patients with severe blunt trauma between 1995 and 2000. Inclusion criteria: Severe trauma or high-speed deceleration justifying chest CT; if chest CT demonstrated a pneumomediastinum, bronchoscopy and esophagoscopy were performed to rule out tracheobronchial or esophageal injury. DESIGN: Retrospective analysis of patients' clinical files, chest CT, and bronchoscopy and esophagoscopy reports. The Macklin effect was diagnosed when an air collection adjacent to a bronchus and a pulmonary vessel could be clearly identified on the chest CT. Clinical relevance of the Macklin effect was statistically evaluated regarding its repercussions on the pulmonary gas exchange function, the respective durations of intensive care and total hospital stay, and the associated injuries. RESULTS: Twenty (39%) Macklin effects and 5 tracheobronchial injuries (10%) were identified. One tracheobronchial injury occurred simultaneously with the Macklin effect. The presence of the Macklin effect affected neither the clinical profile nor the result of pulmonary gas analysis on hospital admission, but was associated with a significant (p < 0.001) lengthening of the intensive care stay. CONCLUSIONS: The Macklin effect is present in 39% of severe blunt traumatic pneumomediastinum detected by CT. Its identification does not rule out a tracheobronchial injury. The Macklin effect reflects severe trauma, since it is associated with significantly prolonged intensive care stay.

The influence of bacterial activity on phosphorite formation in the Miocene Monterey Formation, California

Authigenic phosphorites from the Miocene Monterey Formation (California) including an autochthonous phosphatic laminite were analyzed for molecular biomarkers, element content, and sulfur isotopic composition of associated pyrite and sulfate to evaluate the role of bacterial activity in the precipitation of phosphate minerals. The phosphorites formed in a depositional environment typified by upwelling with dynamic bottom currents and hardground formation. Pyrite enclosed in the phosphorites shows delta S-34 values as low as -36.5 parts per thousand VCDT, which is consistent with bacterial sulfate reduction. In a three-step extraction phosphorite dissolution extraction procedure, molecular fossils of sulfate-reducing bacteria (di-O-alkyl glycerol ethers and short-chain branched fatty acids i- and ai-C-15:0, i- and ai-C-17:0, and 10MeC(16:0)) were preferentially released from the mineral lattice. This suggests that the molecular fossils were tightly bound to carbonate fluorapatite, indicating that sulfate-reducing bacteria were involved in mineral formation. A close association of sulfate-reducing bacteria with large sulfide-oxidizing bacteria, which was previously suggested to favor carbonate fluorapatite precipitation, could neither be confirmed nor excluded for the Miocene Monterey Formation phosphorites. (C) 2012 Elsevier B.V. All rights reserved.

The frequency and prognostic impact of dic(9;20)(p13.2;q11.2) in childhood B-cell precursor acute lymphoblastic leukemia: results from the NOPHO ALL-2000 trial.

The dic(9;20)(p13.2;q11.2) is reported to be present in ∼2% of childhood B-cell precursor acute lymphoblastic leukemia (BCP ALL). However, it easily escapes detection by G-banding analysis and its true prevalence is hence unknown. We performed interphase fluorescence in situ hybridization analyses-in a three-step manner-using probes for: (i) CDKN2A at 9p21, (ii) 20p and 20q subtelomeres and (iii) cen9 and cen20. Out of 1033 BCP ALLs diagnosed from 2001 to 2006, 533 were analyzed; 16% (84/533) displayed 9p21 deletions, of which 30% (25/84) had dic(9;20). Thus, dic(9;20)-positivity was found in 4.7% (25/533), making it the third most common genetic subgroup after high hyperdiploidy and t(12;21)(p13;q22). The dic(9;20) was associated with a female predominance and an age peak at 3 years; 18/25 (72%) were allocated to non-standard risk treatment at diagnosis. Including cases detected by G-banding alone, 29 dic(9;20)-positive cases were treated according to the NOPHO ALL 2000 protocol. Relapses occurred in 24% (7/29) resulting in a 5-year event-free survival of 0.69, which was significantly worse than for t(12;21) (0.87; P=0.002) and high hyperdiploidy (0.82; P=0.04). We conclude that dic(9;20) is twice as common as previously surmised, with many cases going undetected by G-banding analysis, and that dic(9;20) should be considered a non-standard risk abnormality.

Impact of mycelia on the accessibility of fluorene to PAH-degrading bacteria.

Mycelia have been recently shown to actively transport polycyclic aromatic hydrocarbons (PAH) in water-unsaturated soil over the range of centimeters, thereby efficiently mobilizing hydrophobic PAH beyond their purely diffusive transport in air and water. However, the question if mycelia-based PAH transport has an effect on PAH biodegradation was so far unsolved. To address this, we developed a laboratory model microcosm mimicking air-water interfaces in soil. Chemical analyses demonstrated transport of the PAH fluorene (FLU) by the mycelial oomycete Pythium ultimum that was grown along the air-water interfaces. Furthermore, degradation of mycelia-transported FLU by the bacterium Burkholderia sartisoli RP037-mChe was indicated. Since this organism expresses eGFP in response to a FLU flux to the cell, it was also as a bacterial reporter of FLU bioavailability in the vicinity of mycelia. Confocal laser scanning microscopy (CLSM) and image analyses revealed a significant increase of eGFP expression in the presence of P. ultimum compared to controls without mycelia or FLU. Hence, we could show that physically separated FLU becomes bioavailable to bacteria after transport by mycelia. Experiments with silicon coated glass fibers capturing mycelia-transported FLU guided us to propose a three-step mechanism of passive uptake, active transport and diffusion-driven release. These experiments were also used to evaluate the contributions of these individual steps to the overall mycelial FLU transport rate.

Ohutlevy-yrityksen mekaanisen valmistuksen tehostaminen

Diplomityön tavoitteena on tehostaa ohutlevytuotteita valmistavan yrityksen toimintaa ja parantaa tuotannon ohjattavuutta. Tuotannon tehostamisessa keskitytään minimoimaan asetusajat, pienentämään eräkokoja ja investoimaan valmistusta helpottaviin työkoneisiin tai -laitteisiin. Tuotannon ohjattavuutta kehitetään helpottamalla visuaalista seurantaa, layout-muutoksilla ja FiFo-ohjauksen käyttöönotolla. Kaikilla kehitystoimenpiteillä pyritään lyhentämään tuotannon läpimenoaikaa ja vähentämään keskeneräisen tuotannon määrää. Tavoitteena on luoda pohja Lean-valmistukselle. Kehitystoimenpiteet keskitetään useimmiten pullonkauloiksi muodostuville osastoille. Kapeikkojen avaamisessa hyödynnetään CIM-projektin mukaisesti tehtäviä investointeja. Uudella robottisärmäysyksiköllä mahdollistetaan litistäminen ja särmääminen yhdellä asetuksella. Kokoonpano-osaston sijaintia muutettiin ja osaston layoutista tehtiin linjamainen. Tuotannonohjauksen kehittämiseksi luotiin yksinkertainen kolmen askeleen kehitysmalli.

Robust Estimates of the Negative Binomial Model

We consider robust parametric procedures for univariate discrete distributions, focusing on the negative binomial model. The procedures are based on three steps: ?First, a very robust, but possibly inefficient, estimate of the model parameters is computed. ?Second, this initial model is used to identify outliers, which are then removed from the sample. ?Third, a corrected maximum likelihood estimator is computed with the remaining observations. The final estimate inherits the breakdown point (bdp) of the initial one and its efficiency can be significantly higher. Analogous procedures were proposed in [1], [2], [5] for the continuous case. A comparison of the asymptotic bias of various estimates under point contamination points out the minimum Neyman's chi-squared disparity estimate as a good choice for the initial step. Various minimum disparity estimators were explored by Lindsay [4], who showed that the minimum Neyman's chi-squared estimate has a 50% bdp under point contamination; in addition, it is asymptotically fully efficient at the model. However, the finite sample efficiency of this estimate under the uncontaminated negative binomial model is usually much lower than 100% and the bias can be strong. We show that its performance can then be greatly improved using the three step procedure outlined above. In addition, we compare the final estimate with the procedure described in

Meta-analysis of the influence of bonding parameters on the clinical outcome of tooth-colored cervical restorations

PURPOSE: To meta-analyze the literature on the clinical performance of Class V restorations to assess the factors that influence retention, marginal integrity, and marginal discoloration of cervical lesions restored with composite resins, glass-ionomer-cement-based materials [glass-ionomer cement (GIC) and resin-modified glass ionomers (RMGICs)], and polyacid-modified resin composites (PMRC). MATERIALS AND METHODS: The English literature was searched (MEDLINE and SCOPUS) for prospective clinical trials on cervical restorations with an observation period of at least 18 months. The studies had to report about retention, marginal discoloration, marginal integrity, and marginal caries and include a description of the operative technique (beveling of enamel, roughening of dentin, type of isolation). Eighty-one studies involving 185 experiments for 47 adhesives matched the inclusion criteria. The statistical analysis was carried out by using the following linear mixed model: log (-log (Y /100)) = β + α log(T ) + error with β = log(λ), where β is a summary measure of the non-linear deterioration occurring in each experiment, including a random study effect. RESULTS: On average, 12.3% of the cervical restorations were lost, 27.9% exhibited marginal discoloration, and 34.6% exhibited deterioration of marginal integrity after 5 years. The calculation of the clinical index was 17.4% of failures after 5 years and 32.3% after 8 years. A higher variability was found for retention loss and marginal discoloration. Hardly any secondary caries lesions were detected, even in the experiments with a follow-up time longer than 8 years. Restorations placed using rubber-dam in teeth whose dentin was roughened showed a statistically significantly higher retention rate than those placed in teeth with unprepared dentin or without rubber-dam (p < 0.05). However, enamel beveling had no influence on any of the examined variables. Significant differences were found between pairs of adhesive systems and also between pairs of classes of adhesive systems. One-step self-etching had a significantly worse clinically index than two-step self-etching and three-step etch-and-rinse (p = 0.026 and p = 0.002, respectively). CONCLUSION: The clinical performance is significantly influenced by the type of adhesive system and/or the adhesive class to which the system belongs. Whether the dentin/enamel is roughened or not and whether rubberdam isolation is used or not also significantly influenced the clinical performance. Composite resin restorations placed with two-step self-etching and three-step etch-and-rinse adhesive systems should be preferred over onestep self-etching adhesive systems, GIC-based materials, and PMRCs.

Quality assessment of primary care for common mental disorders in isolated communities: Taking advantage of health records.

INTRODUCTION: This article is part of a research study on the organization of primary health care (PHC) for mental health in two of Quebec's remote regions. It introduces a methodological approach based on information found in health records, for assessing the quality of PHC offered to people suffering from depression or anxiety disorders. METHODS: Quality indicators were identified from evidence and case studies were reconstructed using data collected in health records over a 2-year observation period. Data collection was developed using a three-step iterative process: (1) feasibility analysis, (2) development of a data collection tool, and (3) application of the data collection method. The adaptation of quality-of-care indicators to remote regions was appraised according to their relevance, measurability and construct validity in this context. RESULTS: As a result of this process, 18 quality indicators were shown to be relevant, measurable and valid for establishing a critical quality appraisal of four recommended dimensions of PHC clinical processes: recognition, assessment, treatment and follow-up. CONCLUSIONS: There is not only an interest in the use of health records to assess the quality of PHC for mental health in remote regions but also a scientific value for the rigorous and meticulous methodological approach developed in this study. From the perspective of stakeholders in the PHC system of care in remote areas, quality indicators are credible and provide potential for transferability to other contexts. This study brings information that has the potential to identify gaps in and implement solutions adapted to the context.

La evaluación de la actividad reflexiva a partir del portafolio del estudiante

Reflective competence is considered one of the key competencies of students‟ education in all teaching levels and in the daily practice of professionals. A lack of conceptual clarity can lead to critical difficulties for teachers when designing activities that promote reflective skills and also to confusion on the part of the students who have to put them into practice. A short introduction to the scientific study of reflective activity which tries to set the stage of the investigation as well as an innovative experience within the framework of the first year of the Degree in Psychology Studies are presented here. This study presents the work on the reflective skills through a reflective portfolio. Five hierarchical levels of reflection are specified as a guide for the making of the portfolio for the students, and as a support for the mentoring and assessment tasks of teachers. As a conclusion, a three-step model for the training of „reflective beginners‟ is outlined

Stereoselective syntheses of (+)- isoretronecanol and (+)-5-epi-tashiromine via addition of chiral titanium (iv) enolates to cyclic n-acyliminium ions

The stereoselective addition of the titanium (IV) enolates derived from (S)-4-isopropyl-N-4-chlorobutyryl-1,3-thiazolidine-2-thione (8) and from (S)-4-isopropyl-N-4-chloropentanoyl-1,3-thiazolidine-2-thione (9) to N-Boc-2-methoxypyrrolidine (5b) afforded the addition products (+)-10 and (+)-11 in 84% yield in both cases, as 8.6:1 and 10:1 diastereoisomeric mixtures, respectively. A three-step sequence allowed to convert these adducts to (+)-isoretronecanol (1) and (+)-5-epi-tashiromine (2) in 43% and 49% overall yield, respectively.

The importance of pre-treatment of spent hydrotreating catalysts on metals recovery

This work describes a three-step pre-treatment route for processing spent commercial NiMo/Al2O3 catalysts. Extraction of soluble coke with n-hexane and/or leaching of foulant elements with oxalic acid were performed before burning insoluble coke under air. Oxidized catalysts were leached with 9 mol L-1 sulfuric acid. Iron was the only foulant element partially leached by oxalic acid. The amount of insoluble matter in sulfuric acid was drastically reduced when iron and/or soluble coke were previously removed. Losses of active phase metals (Ni, Mo) during leaching with oxalic acid were compensated by the increase of their recovery in the sulfuric acid leachate.

DERIVATIZACIÓN Y CARACTERIZACIÓN ESPECTROSCÓPICA DE UN BIOPOLÍMERO A BASE DE L -LISINA CON ANÁLOGOS DE LA D-BIOTINA: CO -POLI(L-LISINA)-GRAFT -(ε-N-[X-D -BIOTINIL]-L-LISINA)

We report the single-step derivatization reaction of a biopolymer based onL -lysine with D -biotin analogs:Co -poly(L -lysine)-graft-(ε-N -[X-D-biotinyl]-L -lysine) (PLL-X-Biotin). The valeric acid carboxylate of D -biotin is activated to an NHS ester for direct modification of amine groups in proteins and other macromolecules. NHS esters react by nucleophilic attack of an amine in the carbonyl group, releasing the NHS group, and forming a stable amide linkage. NHS-X-Biotin is the simplest biotinylation reagent commercially available. In contrast withD -biotin, it has a longer spacer arm off the valeric acid side chain allowing better binding potential for avidin or streptavidin probes. Derivatization of poly(L -lysine) (PLL) with NHS-X-Biotin led to a copolymer PLL-X-Biotin. UV-Visible, IR-FT and 1H NMR characteristics derived from synthesis are briefly discussed.

Endoscopic biliary procedures: studies on cannulation and stenting

Deep cannulation is a prerequisite for successful endoscopic retrograde cholangiopancreatography (ERCP) procedures. Of the biliary procedures, stenting is one of the most common. This study was carried out to investigate current and controversial issues regarding biliary cannulation and stenting. The double guidewire (DGW) technique was studied to analyze its safety and feasibility in biliary cannulation as a single procedure and as a part of the novel three-step cannulation protocol. Female gender was evaluated in regard to difficult cannulation. The use of an angled and a straight tipped guidewire in biliary cannulation was studied in a prospective, randomized trial. Additionally, the patency of the novel antireflux plastic biliary stent was compared to the patency of the conventional plastic biliary stent in a prospective, randomized setting. The DGW method seems safe and feasible as an alternative cannulation technique in biliary cannulation. Female gender was not associated significantly with difficult biliary cannulation in our study, although the cannulation times seemed to be longer and the alternative cannulation techniques seemed to be needed more often in females than males. According to the results of this thesis, an angled tipped guidewire may facilitate biliary cannulation. In controversy to the previous result presented in the literature, the antireflux plastic biliary stent tested herein should not be used, as the patency of the stent was significantly shorter compared to the conventional plastic stent.

Startup IPR strategies: Why should startup companies protect their intellectual property?

This thesis studies intellectual property right (also: IPR) strategies from the perspective of high growth startup companies. Due to technology development and intellectualization of business, large part of companies’ assets are nowadays intangible. At the same time, the importance of protection instruments designed to protect these intangible assets, intellectual property rights, is increasing. Utilization of these instruments, however, requires understanding of the functioning of the IPR system, as well as financial resources. Startup companies aiming for growth need to be able compete with more established companies also in relation to intangible assets, but they might not have the required knowledge ot resources to fully utilize IPRs in their business. This research aims to understand what are the benefits a startup company can have from protecting their IPRs, and how can the company achieve those benefits. Based on a review of previous literature, altogether 11 benefits of IPR registration were recognized. To answer to the research questions, six half-structured interviews were conducted with experts form different fields, all with experience in working with startup companies and IPR issues. The interviews were analyzed using different methods of qualitative data analysis, mainly derived from grounded theory and case study methods. As a result, out of the 11 benefits recognized from earlier literature, 8 were recognized to be relevant for startup companies. The most central benefits were recognized to be linked with the financial lifecycle of the startup company, including increasing credibility of the startup and stimulating an investment. In addition it was noticed, that startup companies are mainly able to utilize these benefits at later stages of their lifecycle. However, to be able to utilize the benefits at later stages, the startup company needs to be aware of the functioning of the IPR system and might need to apply for appropriate protection already early on. As a result of this study, a three-step model was formed to describe different levels of IPR utilization. The first level of the model represents the minimum level of understanding that every startup company should have regarding IPRs. The second level views IPR strategy from a risk management perspective, including securing the minimum protection of the company’s own IPRs, contract management and establishing processes for handling IPR issues. The last stage reflects strategic use of IPRs. At this third stage intellectual property rights have a central role in the startup company’s business, and they are used in the company’s value creation.

Performance measurement and management in a collaborative network

This study concerns performance measurement and management in a collaborative network. Collaboration between companies has been increased in recent years due to the turbulent operating environment. The literature shows that there is a need for more comprehensive research on performance measurement in networks and the use of measurement information in their management. This study examines the development process and uses of a performance measurement system supporting performance management in a collaborative network. There are two main research questions: how to design a performance measurement system for a collaborative network and how to manage performance in a collaborative network. The work can be characterised as a qualitative single case study. The empirical data was collected in a Finnish collaborative network, which consists of a leading company and a reseller network. The work is based on five research articles applying various research methods. The research questions are examined at the network level and at the single network partner level. The study contributes to the earlier literature by producing new and deeper understanding of network-level performance measurement and management. A three-step process model is presented to support the performance measurement system design process. The process model has been tested in another collaborative network. The study also examines the factors affecting the process of designing the measurement system. The results show that a participatory development style, network culture, and outside facilitators have a positive effect on the design process. The study increases understanding of how to manage performance in a collaborative network and what kind of uses of performance information can be identified in a collaborative network. The results show that the performance measurement system is an applicable tool to manage the performance of a network. The results reveal that trust and openness increased during the utilisation of the performance measurement system, and operations became more transparent. The study also presents a management model that evaluates the maturity of performance management in a collaborative network. The model is a practical tool that helps to analyse the current stage of the performance management of a collaborative network and to develop it further.