Recommendations for raloxifene use in daily clinical practice in the Swiss setting.

BACKGROUND/AIM: Raloxifene is the first selective estrogen receptor modulator that has been approved for the treatment and prevention of osteoporosis in postmenopausal women in Europe and in the US. Although raloxifene reduces the risk of invasive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer, it is approved in that indication in the US but not in the EU. The aim was to characterize the clinical profiles of postmenopausal women expected to benefit most from therapy with raloxifene based on published scientific evidence to date. METHODS: Key individual patient characteristics relevant to the prescription of raloxifene in daily practice were defined by a board of Swiss experts in the fields of menopause and metabolic bone diseases and linked to published scientific evidence. Consensus was reached about translating these insights into daily practice. RESULTS: Through estrogen agonistic effects on bone, raloxifene reduces biochemical markers of bone turnover to premenopausal levels, increases bone mineral density (BMD) at the lumbar spine, proximal femur, and total body, and reduces vertebral fracture risk in women with osteopenia or osteoporosis with and without prevalent vertebral fracture. Through estrogen antagonistic effects on breast tissue, raloxifene reduces the risk of invasive estrogen-receptor positive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer. Finally, raloxifene increases the incidence of hot flushes, the risk of venous thromboembolic events, and the risk of fatal stroke in postmenopausal women at increased risk for coronary heart disease. Postmenopausal women in whom the use of raloxifene is considered can be categorized in a 2 × 2 matrix reflecting their bone status (osteopenic or osteoporotic based on their BMD T-score by dual energy X-ray absorptiometry) and their breast cancer risk (low or high based on the modified Gail model). Women at high risk of breast cancer should be considered for treatment with raloxifene. CONCLUSION: Postmenopausal women between 50 and 70 years of age without climacteric symptoms with either osteopenia or osteoporosis should be evaluated with regard to their breast cancer risk and considered for treatment with raloxifene within the framework of its contraindications and precautions.

Debris flow modeling for susceptibility mapping at regional to national scale in Norway

Debris flows and related landslide processes occur in many regions all over Norway and pose a significant hazard to inhabited areas. Within the framework of the development of a national debris flows susceptibility map, we are working on a modeling approach suitable for Norway with a nationwide coverage. The discrimination of source areas is based on an index approach, which includes topographic parameters and hydrological settings. For the runout modeling, we use the Flow-R model (IGAR, University of Lausanne), which is based on combined probabilistic and energetic algorithms for the assessment of the spreading of the flow and maximum runout distances. First results for different test areas have shown that runout distances can be modeled reliably. For the selection of source areas, however, additional factors have to be considered, such as the lithological and quaternary geological setting, in order to accommodate the strong variation in debris flow activity in the different geological, geomorphological and climate regions of Norway.

Ultra high throughput sequencing excludes MDH1 as candidate gene for RP28-linked retinitis pigmentosa.

PURPOSE: Mutations in IDH3B, an enzyme participating in the Krebs cycle, have recently been found to cause autosomal recessive retinitis pigmentosa (arRP). The MDH1 gene maps within the RP28 arRP linkage interval and encodes cytoplasmic malate dehydrogenase, an enzyme functionally related to IDH3B. As a proof of concept for candidate gene screening to be routinely performed by ultra high throughput sequencing (UHTs), we analyzed MDH1 in a patient from each of the two families described so far to show linkage between arRP and RP28. METHODS: With genomic long-range PCR, we amplified all introns and exons of the MDH1 gene (23.4 kb). PCR products were then sequenced by short-read UHTs with no further processing. Computer-based mapping of the reads and mutation detection were performed by three independent software packages. RESULTS: Despite the intrinsic complexity of human genome sequences, reads were easily mapped and analyzed, and all algorithms used provided the same results. The two patients were homozygous for all DNA variants identified in the region, which confirms previous linkage and homozygosity mapping results, but had different haplotypes, indicating genetic or allelic heterogeneity. None of the DNA changes detected could be associated with the disease. CONCLUSIONS: The MDH1 gene is not the cause of RP28-linked arRP. Our experimental strategy shows that long-range genomic PCR followed by UHTs provides an excellent system to perform a thorough screening of candidate genes for hereditary retinal degeneration.

Expérience de dix ans de réanimation chirurgicale d'un centre hospitalier universitaire. Détermination d'un critère d'identification des patients à risque de décéder de coagulopathie irréversible [10 years experience in surgical resuscitation at a university hospital center. Determination of a criterion for identifying patients at risk for fatal irreversible coagulopathy]

The authors evaluated ten years of surgical reanimation in the University Centre of Lausanne (CHUV). Irreversible coagulopathy (IC) is the predominant cause of death for the polytraumatized patient. Acidosis, hypothermy, and coagulation troubles are crucial elements of this coagulopathy. The authors looked for a criterion allowing the identification of dying of IC. In a retrospective study, laboratory results of pH, TP, PTT, thrombocyte count and the need for blood transfusion units were checked for each major step of the primary evaluation and treatment of the polytraumatized patients. These results were considered as critical according to criteria of the literature (30). The authors conclude that the apparation of a third critical value may be useful to identify the polytraumatized patient at risk of dying of IC status. This criterion may also guide the trauma team in selecting a damage control surgical approach (DCS). This criterion was then introduced into an algorithm involving the Emergency Department, the operating room and the Intensive Care Unit. This criterion is a new tool to address the patient at the crucial moment to the appropriate hospital structure.

Measuring potentially avoidable hospital readmissions.

The objectives of this study were to develop a computerized method to screen for potentially avoidable hospital readmissions using routinely collected data and a prediction model to adjust rates for case mix. We studied hospital information system data of a random sample of 3,474 inpatients discharged alive in 1997 from a university hospital and medical records of those (1,115) readmitted within 1 year. The gold standard was set on the basis of the hospital data and medical records: all readmissions were classified as foreseen readmissions, unforeseen readmissions for a new affection, or unforeseen readmissions for a previously known affection. The latter category was submitted to a systematic medical record review to identify the main cause of readmission. Potentially avoidable readmissions were defined as a subgroup of unforeseen readmissions for a previously known affection occurring within an appropriate interval, set to maximize the chance of detecting avoidable readmissions. The computerized screening algorithm was strictly based on routine statistics: diagnosis and procedures coding and admission mode. The prediction was based on a Poisson regression model. There were 454 (13.1%) unforeseen readmissions for a previously known affection within 1 year. Fifty-nine readmissions (1.7%) were judged avoidable, most of them occurring within 1 month, which was the interval used to define potentially avoidable readmissions (n = 174, 5.0%). The intra-sample sensitivity and specificity of the screening algorithm both reached approximately 96%. Higher risk for potentially avoidable readmission was associated with previous hospitalizations, high comorbidity index, and long length of stay; lower risk was associated with surgery and delivery. The model offers satisfactory predictive performance and a good medical plausibility. The proposed measure could be used as an indicator of inpatient care outcome. However, the instrument should be validated using other sets of data from various hospitals.

Issue review : electronic document management system, or EDMS.

This issue review provides an overview of the electronic document management system, or EDMS, project, withing the judicial branch and courts.

Study of OSEM with different subsets in grating-based X-ray differential phase-contrast imaging.

Impressive developments in X-ray imaging are associated with X-ray phase contrast computed tomography based on grating interferometry, a technique that provides increased contrast compared with conventional absorption-based imaging. A new "single-step" method capable of separating phase information from other contributions has been recently proposed. This approach not only simplifies data-acquisition procedures, but, compared with the existing phase step approach, significantly reduces the dose delivered to a sample. However, the image reconstruction procedure is more demanding than for traditional methods and new algorithms have to be developed to take advantage of the "single-step" method. In the work discussed in this paper, a fast iterative image reconstruction method named OSEM (ordered subsets expectation maximization) was applied to experimental data to evaluate its performance and range of applicability. The OSEM algorithm with different subsets was also characterized by comparison of reconstruction image quality and convergence speed. Computer simulations and experimental results confirm the reliability of this new algorithm for phase-contrast computed tomography applications. Compared with the traditional filtered back projection algorithm, in particular in the presence of a noisy acquisition, it furnishes better images at a higher spatial resolution and with lower noise. We emphasize that the method is highly compatible with future X-ray phase contrast imaging clinical applications.

Spatial mapping of exciton lifetimes in single ZnO nanowires

We investigate the spatial dependence of the exciton lifetimes in single ZnO nanowires. We have found that the free exciton and bound exciton lifetimes exhibit a maximum at the center of nanowires, while they decrease by 30% towards the tips. This dependence is explained by considering the cavity-like properties of the nanowires in combination with the Purcell effect. We show that the lifetime of the bound-excitons scales with the localization energy to the power of 3/2, which validates the model of Rashba and Gurgenishvili at the nanoscale.

New directions in Stochastic Multicriteria Acceptability Analysis

Decisions taken in modern organizations are often multi-dimensional, involving multiple decision makers and several criteria measured on different scales. Multiple Criteria Decision Making (MCDM) methods are designed to analyze and to give recommendations in this kind of situations. Among the numerous MCDM methods, two large families of methods are the multi-attribute utility theory based methods and the outranking methods. Traditionally both method families require exact values for technical parameters and criteria measurements, as well as for preferences expressed as weights. Often it is hard, if not impossible, to obtain exact values. Stochastic Multicriteria Acceptability Analysis (SMAA) is a family of methods designed to help in this type of situations where exact values are not available. Different variants of SMAA allow handling all types of MCDM problems. They support defining the model through uncertain, imprecise, or completely missing values. The methods are based on simulation that is applied to obtain descriptive indices characterizing the problem. In this thesis we present new advances in the SMAA methodology. We present and analyze algorithms for the SMAA-2 method and its extension to handle ordinal preferences. We then present an application of SMAA-2 to an area where MCDM models have not been applied before: planning elevator groups for high-rise buildings. Following this, we introduce two new methods to the family: SMAA-TRI that extends ELECTRE TRI for sorting problems with uncertain parameter values, and SMAA-III that extends ELECTRE III in a similar way. An efficient software implementing these two methods has been developed in conjunction with this work, and is briefly presented in this thesis. The thesis is closed with a comprehensive survey of SMAA methodology including a definition of a unified framework.

Prediction of hip fracture risk by quantitative ultrasound in more than 7000 Swiss women > or =70 years of age: comparison of three technologically different bone ultrasound devices in the SEMOF study.

To compare the prediction of hip fracture risk of several bone ultrasounds (QUS), 7062 Swiss women > or =70 years of age were measured with three QUSs (two of the heel, one of the phalanges). Heel QUSs were both predictive of hip fracture risk, whereas the phalanges QUS was not. INTRODUCTION: As the number of hip fracture is expected to increase during these next decades, it is important to develop strategies to detect subjects at risk. Quantitative bone ultrasound (QUS), an ionizing radiation-free method, which is transportable, could be interesting for this purpose. MATERIALS AND METHODS: The Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk (SEMOF) study is a multicenter cohort study, which compared three QUSs for the assessment of hip fracture risk in a sample of 7609 elderly ambulatory women > or =70 years of age. Two QUSs measured the heel (Achilles+; GE-Lunar and Sahara; Hologic), and one measured the heel (DBM Sonic 1200; IGEA). The Cox proportional hazards regression was used to estimate the hazard of the first hip fracture, adjusted for age, BMI, and center, and the area under the ROC curves were calculated to compare the devices and their parameters. RESULTS: From the 7609 women who were included in the study, 7062 women 75.2 +/- 3.1 (SD) years of age were prospectively followed for 2.9 +/- 0.8 years. Eighty women reported a hip fracture. A decrease by 1 SD of the QUS variables corresponded to an increase of the hip fracture risk from 2.3 (95% CI, 1.7, 3.1) to 2.6 (95% CI, 1.9, 3.4) for the three variables of Achilles+ and from 2.2 (95% CI, 1.7, 3.0) to 2.4 (95% CI, 1.8, 3.2) for the three variables of Sahara. Risk gradients did not differ significantly among the variables of the two heel QUS devices. On the other hand, the phalanges QUS (DBM Sonic 1200) was not predictive of hip fracture risk, with an adjusted hazard risk of 1.2 (95% CI, 0.9, 1.5), even after reanalysis of the digitalized data and using different cut-off levels (1700 or 1570 m/s). CONCLUSIONS: In this elderly women population, heel QUS devices were both predictive of hip fracture risk, whereas the phalanges QUS device was not.

Läpinäkyvyys venäläisissä pörssiyhtiöissä - yhtiöiden Internetissä julkaisema informaatio

Tutkielman ensisijaisena tavoitteena oli selvittää, miten corporate governance eli hyvä hallintotapa on kehittynyt Venäjällä. Tutkimuksessa keskityttiin eritoten yritystoiminnan läpinäkyvyyteen ja siihen, minkälaista informaatiota yritysten pitäisi vuosittain julkaista. Tutkimuksessa tutkittiin minkälaista informaatiota Moskovan pörssiin listautuneet yritykset julkaisevat. Tavoitteena oli tutkia, julkaisevatko yritykset informaatiota OECD:n corporate governancve suositusten mukaisesti. Tutkimusmenetelmänä käytettiin havaintotutkimusta. Tutkimuksessa saatiin selkeä kuvasiitä, mitä corporate governance tarkoittaa ja siitä miten se on kehittynyt Venäjällä. Tutkimuksen aineisto kerättiin Moskovan pörssiin listautuneista yrityksistä, koska Venäjä tutkimuskohteena on mielenkiintoinen ja koska corporate governance teema on vasta viime vuosina tullut ajankohtaiseksi venäläisissä yrityksissä. Tutkimuksessa saadut tulokset osoittavat, että yritykset julkaisevat informaatiota melko hajanaisesti ja pörssi joutuu edelleen tyytymään puutteelliseen informaatioon. Venäjän yritystoiminnasta puuttuu vakaus, ja instituutiot eivät vielätue corporate governance -suositusten toimeenpanemista ainakaan kovin hyvin. Myös toimiala ja yrityksen omistusrakenne vaikuttavat jonkin verran siihen, minkälaista tietoa yritys tuottaa. Eri toimialojen välillä on huomattaviakin eroja sen suhteen, miten kattavasti niistä on saatavissa informaatiota. Omistusrakenne on tämän tutkimuksen yrityksissä erilainen kuin Venäjällä yleensä ja ulkomaista omistusta on paljon.

Similarity measure based classification

Luokittelujärjestelmää suunniteltaessa tarkoituksena on rakentaa systeemi, joka pystyy ratkaisemaan mahdollisimman tarkasti tutkittavan ongelma-alueen. Hahmontunnistuksessa tunnistusjärjestelmän ydin on luokitin. Luokittelun sovellusaluekenttä on varsin laaja. Luokitinta tarvitaan mm. hahmontunnistusjärjestelmissä, joista kuvankäsittely toimii hyvänä esimerkkinä. Myös lääketieteen parissa tarkkaa luokittelua tarvitaan paljon. Esimerkiksi potilaan oireiden diagnosointiin tarvitaan luokitin, joka pystyy mittaustuloksista päättelemään mahdollisimman tarkasti, onko potilaalla kyseinen oire vai ei. Väitöskirjassa on tehty similaarisuusmittoihin perustuva luokitin ja sen toimintaa on tarkasteltu mm. lääketieteen paristatulevilla data-aineistoilla, joissa luokittelutehtävänä on tunnistaa potilaan oireen laatu. Väitöskirjassa esitetyn luokittimen etuna on sen yksinkertainen rakenne, josta johtuen se on helppo tehdä sekä ymmärtää. Toinen etu on luokittimentarkkuus. Luokitin saadaan luokittelemaan useita eri ongelmia hyvin tarkasti. Tämä on tärkeää varsinkin lääketieteen parissa, missä jo pieni tarkkuuden parannus luokittelutuloksessa on erittäin tärkeää. Väitöskirjassa ontutkittu useita eri mittoja, joilla voidaan mitata samankaltaisuutta. Mitoille löytyy myös useita parametreja, joille voidaan etsiä juuri kyseiseen luokitteluongelmaan sopivat arvot. Tämä parametrien optimointi ongelma-alueeseen sopivaksi voidaan suorittaa mm. evoluutionääri- algoritmeja käyttäen. Kyseisessä työssä tähän on käytetty geneettistä algoritmia ja differentiaali-evoluutioalgoritmia. Luokittimen etuna on sen joustavuus. Ongelma-alueelle on helppo vaihtaa similaarisuusmitta, jos kyseinen mitta ei ole sopiva tutkittavaan ongelma-alueeseen. Myös eri mittojen parametrien optimointi voi parantaa tuloksia huomattavasti. Kun käytetään eri esikäsittelymenetelmiä ennen luokittelua, tuloksia pystytään parantamaan.

Matkapuhelimen puhelinmuistiopalvelimen tietorakenteiden ja lajittelualgoritmien analysointi ja suunnittelu

Puhelinmuistio on yksi matkapuhelimen käytetyimmistä ominaisuuksista. Puhelinmuistion tulee siksi olla kaikissa tilanteissa mahdollisimman nopeasti käytettävissä. Tämä edellyttää puhelinmuistiopalvelimelta tehokkaita tietorakenteita ja lajittelualgoritmeja. Nokian matkapuhelimissa puhelinmuistiopalvelin käyttää hakurakenteena järjestettyjä taulukoita. Työn tavoitteena oli kehittää puhelinmuistiopalvelimen hakutaulukoiden lajittelu mahdollisimman nopeaksi. Useita eri lajittelualgoritmeja vertailtiin ja niiden suoritusaikoja analysoitiin eri tilanteissa. Insertionsort-lajittelualgoritmin todettiin olevan nopein algoritmi lähes järjestyksessä olevien taulukoiden lajitteluun. Analyysin perusteella Quicksort-algoritmi lajittelee nopeimmin satunnaisessa järjestyksessä olevat taulukot. Quicksort-insertionsort –hybridialgoritmin havaittiin olevan paras lajittelualgoritmi puhelinmuistion lajitteluun. Sopivalla parametroinnilla tämä algoritmi on nopea satunnaisessa järjestyksessä olevalle aineistolle. Se kykenee hyödyntämään lajiteltavassa aineistossa valmiina olevaa järjestystä. Algoritmi ei kasvata merkittävästi muistinkulutusta. Uuden algoritmin ansiosta hakutaulukoiden lajittelu nopeutuu parhaimmillaan useita kymmeniä prosentteja.

Tarkkoihin matkustajatietoihin perustuva hissiohjausjarjestelma

Työssä esitetään geneettisten algoritmien käyttöön perustuva hissiohjausjärjestelmä, jossa ohjauspaatosten tekemisessä hyödynnetään tarkkoja matkustajatietoja. Tämä hissiohjausjärjestelmä soveltuu käytettäväksi muun muassa kohde-allokointiin perus-tuvassa hissijärjestelmässä, jossa matkustajat antavat hissikutsun yhteydessä kohde-kerrostietonsa. Esitetty ohjausjärjestelmä soveltuu käytettäväksi ulkokutsun välittömään tai jatkuvaan allokointiin perustuvassa hissijärjestelmässä. Työn kirjallisessa osuudessa esitetään parannuksia aiemmin esitettyihin hissiohjausjärjestelmiin ja käydään läpi erilaisia kohde-allokointiin perustuvia hissijärjestelmiä. Työssä kuvataan uusi matkustaja-ohjaustapa, joka vähentää matkustajan tekemän hissikutsun välittömään palveluun liittyviä hissiohjausongelmia. Tarkkoja matkustajatietoja hyödyntämällä hissijärjestelmä kykenee sekä tarjoamaan matkustajille yksilöllistä palvelua että kuljettamaan matkustajia tehokkaasti.

Spatial mapping of exciton lifetimes in single ZnO nanowires

We investigate the spatial dependence of the exciton lifetimes in single ZnO nanowires. We have found that the free exciton and bound exciton lifetimes exhibit a maximum at the center of nanowires, while they decrease by 30% towards the tips. This dependence is explained by considering the cavity-like properties of the nanowires in combination with the Purcell effect. We show that the lifetime of the bound-excitons scales with the localization energy to the power of 3/2, which validates the model of Rashba and Gurgenishvili at the nanoscale.