Koneellisen annosjakelupalvelun aloittaminen - lääkehoidon tarkistus ja sen vaikutus potilaan lääkehoitoon

Farmaseuttisilla palveluilla tarkoitetaan apteekkien palveluita, joissa hyödynnetään apteekin farmaseuttisen henkilökunnan tietoja ja taitoja. Farmaseuttiset palvelut voidaan jakaa farmaseuttisiin perus- ja erityispalveluihin. Farmaseuttiset peruspalvelut kattavat apteekkien lakisääteiset tehtävät, kun taas farmaseuttisilla erityispalveluilla pyritään ottamaan aktiivisempi rooli asiakkaan terveyden edistämisessä. Koneellinen annosjakelupalvelu on farmaseuttinen erityispalvelu. Koneellisessa annosjakelupalvelussa lääkkeet jaetaan kerta-annospusseihin annostusajankohdan mukaan. Kun uusi asiakas aloittaa koneellinen annosjakelupalvelun, tarkistetaan asiakkaan lääkitys yhteensopimattomien ja turhien lääkkeiden osalta. Palvelun aloitushetkellä huomioidaan myös lääkevalmisteiden sopivuus koneelliseen annosjakeluun sekä tarkistetaan valmisteiden annosteluajankohdat. Koneellisessa annosjakelupalvelussa asiakkaan lääkehoidosta muodostetaan lääkityskortti, josta kokonaislääkehoito on helppo tarkistaa. Erikoistyön tavoitteena oli selvittää millainen lääkehoidon arviointi tai tarkistus koneellisen annosjakelupalvelun aloittamisen yhteydessä tehdään ja miten palvelun aloittavien asiakkaiden kokonaislääkehoitotieto saadaan selvitettyä. Lisäksi selvitettiin millaisia muutoksia lääkehoitoihin tehdään palvelun aloittamisen yhteydessä, mitkä ovat muutosten syyt sekä millainen on asiakkaan kokonaislääkehoito. Kyselylomake lähetettiin kaikkiin apteekkeihin, jotka tilasivat koneellista annosjakelua sopimusvalmistuksena Espoonlahden apteekilta syyskuussa 2010. Tutkimus suoritettiin semistrukturoidulla kirjallisella kyselyllä, joka sisälsi sekä avoimia kysymyksiä että monivalintakysymyksiä. Kyselyyn saatiin 147 vastausta ja vastausprosentiksi muodostui 45. Vastauksia kyselyyn saatiin koko Mannersuomen alueelta ja kaikkien kokoluokkien apteekeilta. Koneellisen annosjakelupalvelun aloittavat henkilöt ovat pääasiassa iäkkäitä, jotka ovat kotihoidon piirissä, asuvat hoitokodissa tai palveluasumisen yksikössä. Asiakkaiden lääkitystietojen keräämisessä hyödynnetään lääkityskorttia, mutta lääkityskortin tietoja päivitetään myös muista lähteistä. Asiakkaiden lääkityksille tehdään useimmiten lääkehoidon tarkistus moniammatillisena yhteistyönä. Lääkehoidolle tehdyt muutokset johtuvat pääasiassa lääkevaihdosta, annosjakelukoneen lääkevalikoimasta tai puolittamisen välttämisestä. Lääkehoidoissa on vain vähän yhteisvaikutuksia, jotka johtavat lääkevalmisteen käytön lopettamiseen. Lääkehoidon tarkistuksella ei ollut suurta vaikutusta asiakkaiden käyttämien lääkevalmisteiden määrään. Palvelun aloittamisen jälkeen asiakkaalla on käytössään keskimäärin 11 lääkevalmistetta, joista seitsemää jaellaan koneellisesti. Lääkeaineryhmistä eniten käytettyjä ovat hermostoon vaikuttavat sekä sydän- ja verisuonisairauksien lääkkeet, joita kumpaakin on käytössä keskimäärin kolme jokaisella uudella koneellisen annosjakelupalvelun asiakkaalla sekä palvelun aloittamista ennen että sen jälkeen.

A Hybrid Multilevel Inverter Topology for an Open-End Winding Induction-Motor Drive Using Two-Level Inverters in Series With a Capacitor-Fed H-Bridge Cell

In this paper, a new five-level inverter topology for open-end winding induction-motor (IM) drive is proposed. The open-end winding IM is fed from one end with a two-level inverter in series with a capacitor-fed H-bridge cell, while the other end is connected to a conventional two-level inverter. The combined inverter system produces voltage space-vector locations identical to that of a conventional five-level inverter. A total of 2744 space-vector combinations are distributed over 61 space-vector locations in the proposed scheme. With such a high number of switching state redundancies, it is possible to balance the H-bridge capacitor voltages under all operating conditions including overmodulation region. In addition to that, the proposed topology eliminates 18 clamping diodes having different voltage ratings compared with the neutral point clamped inverter. On the other hand, it requires only one capacitor bank per phase, whereas the flying-capacitor scheme for a five-level topology requires more than one capacitor bank per phase. The proposed inverter topology can be operated as a three-level inverter for full modulation range, in case of any switch failure in the capacitor-fed H-bridge cell. This will increase the reliability of the system. The proposed scheme is experimentally verified on a four-pole 5-hp IM drive.

Open-circuit potential—time transients of alkaline porous iron electrodes at various states-of-charge

Open-circuit potential—time transients during the discharge of alkaline porous iron electrodes at various states-of-charge have been studied. From this, it has been possible to arrive at a correlation between the parameters of self-discharge kinetics of the electrode and observed open-circuit potential—recovery time constants. The study provides a method of estimate the state-of-charge of the rechargeable iron electrodes. As a hydrogen evolution reaction inevitably occurs on alkaline iron electrodes, the kinetics of the reaction have also been investigated.

Structure and superconducting properties of Tl1?yPbyY1?xCaxSr2Cu2O7star, open: Dependence of Tc on hole concentration

Structure and superconducting properties of Tl1?yPbyY1?xCaxSr2Cu2O7 (y=0.0, 0.1, 0.25 and 0.5) , derived from the parent insulator TlYSr2Cu2O7, have been investigated for different values of x. XANES studies show Pb to be in the 4+ state while Tl is in the 3+ state, suggesting thereby that in this series, (x?y) approximately corresponds to the hole concentration. The in-plane Cu---O distance decreases with increase in x for all values of y. The apical Cu---O distance as well as the Tl(Pb)---O(2) distance show anomalies at x=0.5 in the series with y=0.25; at this composition, Tc also reaches a maximum. In general, the composition (value of x) at which the Tc of Tl1?yPbyY1?xCaxSr2Cu2O7 reaches a maximum depends on the Pb content and the maximum Tc itself increases with increase in y, reaching a value of 105 K at y=0.5. More interestingly, a maximum Tc occurs at an (x?y) value of not, vert, similar0.25, which is close to the hole concentration at maximum Tc in other cuprate superconductors containing two CuO2 layers.

Doing marriage and parenthood: The division of household labour across two life course events

The current study is a longitudinal investigation into changes in the division of household labour across transitions to marriage and parenthood in the UK. Previous research has noted a more traditional division of household labour, with women performing the majority of housework, amongst spouses and couples with children. However, the bulk of this work has been cross-sectional in nature. The few longitudinal studies that have been carried out have been rather ambiguous about the effect of marriage and parenthood on the division of housework. Theoretically, this study draws on gender construction theory. The key premise of this theory is that gender is something that is performed and created in interaction, and, as a result, something fluid and flexible rather than fixed and stable. The idea that couples 'do gender' through housework has been a major theoretical breakthrough. Gender-neutral explanations of the division of household labour, positing rational acting individuals, have failed to explicate why women continue to perform an unequal share of housework, regardless of socioeconomic status. Contrastingly, gender construction theory situates gender as the key process in dividing household labour. By performing and avoiding certain housework chores, couples fulfill social norms of what it means to be a man and a woman although, given the emphasis on human agency in producing and contesting gender, couples are able to negotiate alternative gender roles which, in turn, feed back into the structure of social norms in an ever-changing societal landscape. This study adds extra depth to the doing gender approach by testing whether or not couples negotiate specific conjugal and parent roles in terms of the division of household labour. Both transitions hypothesise a more traditional division of household labour. Data comes from the British Household Panel Survey, a large, nationally representative quantitative survey that has been carried out annually since 1991. Here, data tracks the same 776 couples at two separate time points - 1996 and 2005. OLS regression is used to test whether or not transitions to marriage and parenthood have a significant impact on the division of household labour whilst controlling for host of relevant socio-economic factors. Results indicate that marriage has no significant effect on how couples partition housework. Those couples making the transition from cohabitation to marriage do not show significant changes in housework arrangements from those couples who remain cohabiting in both waves. On the other hand, becoming parents does lead to a more traditional division of household labour whilst controlling for socio-economic factors which accompany the move to parenthood. There is then some evidence that couples use the site of household labour to 'do parenthood' and generate identities which both use and inform socially prescribed notions of what it means to be a mother and a father. Support for socio-economic explanations of the division of household labour was mixed although it remains clear that they, alone, cannot explain how households divide housework.

"Oma entinen on palannut takaisin elämään" : Kuntoutuksen vaikuttavuus aikuisena kuuroutuneiden henkilöiden elämänhallintaan ja psykososiaaliseen hyvinvointiin

Objective The objective of this study was to learn about the psychosocial well-being and life management of Finnish adults with late deafness or hearing loss and to observe the effectiveness of the rehabilitation courses they participated in. Methods For my study I used indicators which were suitable for the evaluation of life management and psychosocial well-being of late-deafened adults. The first part of the study was conducted during 2009 as a questionnaire on three rehabilitation courses in Kopola, a course center of the Finnish Federation of Hard of Hearing. The follow-up study was done at the third period of the courses during 2009 2010. The questionnaire contained both open and structured questions. The questionnaire consisted of five areas concerning life management and psychosocial well-being: sense of coherence (life management), human relations and social support, mood, self-esteem and satisfaction with life. I also asked the participants to reflect on their experiences of group rehabilitation. Results and conclusions The participants consisted of seven women and three men. They were approximately 63 years old and were all retired. Loss of hearing was described to have affected their social life, free time, and in general made their lives more difficult. From the course the participants hoped to gain new skills such as signed speech and lip-reading, uplift their mood, accept their loss of hearing and experience peer support. After the courses they replied that they had more close relations with whom they also were a little more in contact with. More participants were satisfied with e.g. their ability to take care of themselves, their free time, financial situation, family life, mental resources and physical shape. Majority of the participants showed symptoms of depression when the courses started, but at the end of the courses these signs had moderated or disappeared for most of them. The participants felt that during the rehabilitation they had been heard, respected, accepted and been taken care of. The course provided the possibility for confiding, and the discussions gave the participants support and consolidation. In conclusion, the course affected positively on the acclimatization to the hearing loss and the empowerment of the participants. The results of this study can be utilized in disability services, the development of rehabilitation and in the social- and health services of senior citizens.

Constructing a Community : Myths and Realities of the Open Development Model

The open development model of software production has been characterized as the future model of knowledge production and distributed work. Open development model refers to publicly available source code ensured by an open source license, and the extensive and varied distributed participation of volunteers enabled by the Internet. Contemporary spokesmen of open source communities and academics view open source development as a new form of volunteer work activity characterized by hacker ethic and bazaar governance . The development of the Linux operating system is perhaps the best know example of such an open source project. It started as an effort by a user-developer and grew quickly into a large project with hundreds of user-developer as contributors. However, in hybrids , in which firms participate in open source projects oriented towards end-users, it seems that most users do not write code. The OpenOffice.org project, initiated by Sun Microsystems, in this study represents such a project. In addition, the Finnish public sector ICT decision-making concerning open source use is studied. The purpose is to explore the assumptions, theories and myths related to the open development model by analysing the discursive construction of the OpenOffice.org community: its developers, users and management. The qualitative study aims at shedding light on the dynamics and challenges of community construction and maintenance, and related power relations in hybrid open source, by asking two main research questions: How is the structure and membership constellation of the community, specifically the relation between developers and users linguistically constructed in hybrid open development? What characterizes Internet-mediated virtual communities and how can they be defined? How do they differ from hierarchical forms of knowledge production on one hand and from traditional volunteer communities on the other? The study utilizes sociological, psychological and anthropological concepts of community for understanding the connection between the real and the imaginary in so-called virtual open source communities. Intermediary methodological and analytical concepts are borrowed from discourse and rhetorical theories. A discursive-rhetorical approach is offered as a methodological toolkit for studying texts and writing in Internet communities. The empirical chapters approach the problem of community and its membership from four complementary points of views. The data comprises mailing list discussion, personal interviews, web page writings, email exchanges, field notes and other historical documents. The four viewpoints are: 1) the community as conceived by volunteers 2) the individual contributor s attachment to the project 3) public sector organizations as users of open source 4) the community as articulated by the community manager. I arrive at four conclusions concerning my empirical studies (1-4) and two general conclusions (5-6). 1) Sun Microsystems and OpenOffice.org Groupware volunteers failed in developing necessary and sufficient open code and open dialogue to ensure collaboration thus splitting the Groupware community into volunteers we and the firm them . 2) Instead of separating intrinsic and extrinsic motivations, I find that volunteers unique patterns of motivations are tied to changing objects and personal histories prior and during participation in the OpenOffice.org Lingucomponent project. Rather than seeing volunteers as a unified community, they can be better understood as independent entrepreneurs in search of a collaborative community . The boundaries between work and hobby are blurred and shifting, thus questioning the usefulness of the concept of volunteer . 3) The public sector ICT discourse portrays a dilemma and tension between the freedom to choose, use and develop one s desktop in the spirit of open source on one hand and the striving for better desktop control and maintenance by IT staff and user advocates, on the other. The link between the global OpenOffice.org community and the local end-user practices are weak and mediated by the problematic IT staff-(end)user relationship. 4) Authoring community can be seen as a new hybrid open source community-type of managerial practice. The ambiguous concept of community is a powerful strategic tool for orienting towards multiple real and imaginary audiences as evidenced in the global membership rhetoric. 5) The changing and contradictory discourses of this study show a change in the conceptual system and developer-user relationship of the open development model. This change is characterized as a movement from hacker ethic and bazaar governance to more professionally and strategically regulated community. 6) Community is simultaneously real and imagined, and can be characterized as a runaway community . Discursive-action can be seen as a specific type of online open source engagement. Hierarchies and structures are created through discursive acts. Key words: Open Source Software, open development model, community, motivation, discourse, rhetoric, developer, user, end-user

Open Content Licenses

The EU Directive harmonising copyright, Directive 2001/29/EC, has been implemented in all META-NORD countries. The licensing schemas of open content/open source and META-SHARE as well as CLARIN are discussed shortly. The status of the licensing of tools and resources available at the consortium partners are outlined. The aim of the article is to compare a set of open content and open source license and provide some guidance on the optimal use of licenses provided by META-NET and CLARIN for licensing the tools and resources for the benefit of the language technology community.

Five-level inverter scheme for an open-end winding induction machine with less number of switches

Higher level of inversion is achieved with a less number of switches in the proposed scheme. The scheme proposes a five-level inverter for an open-end winding induction motor which uses only two DC-link rectifiers of voltage rating of Vdc/4, a neutral-point clamped (NPC) three-level inverter and a two-level inverter. Even though the two-level inverter is connected to the high-voltage side, it is always in square-wave operation. Since the two-level inverter is not switching in a pulse width modulated fashion and the magnitude of switching transient is only half compared to the convention three-level NPC inverter, the switching losses and electromagnetic interference is not so high. The scheme is experimentally verified on a 2.5 kW induction machine.

A numerical study of division of flow in open channels

A two-dimensional numerical model which employs the depth-averaged forms of continuity and momentum equations along with k-e turbulence closure scheme is used to simulate the flow at the open channel divisions. The model is generalised to flows of arbitrary geometries and MacCormack finite volume method is used for solving governing equations. Application of cartesian version of the model to analyse the flow at right-angled junction is presented. The numerical predictions are compared with experimental data of earlier investigators and measurements made as part of the present study. Performance of the model in predicting discharge distribution, surface profiles, separation zone parameters and energy losses is evaluated and discussed in detail. To illustrate the application of the numerical model to analyse the flow in acute angled offtakes and streamlined branch entries, a few computational results are presented.

Effect of open joint on stress wave propagation

Stress wave characteristics are drastically altered by joints and other inhomogenities. This paper addresses the effect of an open joint on stress wave transmission. An elastodynamic analysis is developed to supplement and explain some recent observations by Fourney and Dick(1995) on open as well as filled joints. The analytical model developed here assuming spherical symmetry can be extended to filled joints between dissimilar media, but results are presented only for open joints separating identical materials. As a special case, stress wave transmission across a joint with no gap is also addressed.

On some geometric invariants associated to the space of flat connections on an open space

A geometric invariant is associated to the parabolic moduli space on a marked surface and is related to the symplectic structure of the moduli space.

New open-framework phosphate and phosphite compounds of gallium

Five new open-framework compounds of gallium have been synthesized by hydrothermal methods and their structures determined by single crystal X-ray diffraction studies. The compounds, C8N4H26]Ga6F4(PO4)(6)], I, C5N3H11]Ga3F2(PO4)(3)]center dot H2O, II, C6N3H19]Ga-4(C2O4)(PO4)(4)(H2PO4)]center dot 2H(2)O, III, Ga2F3(HPO4)(PO4)]center dot 2H(3)O, IV, and C3N2H5](2)Ga-4(H2O)(3)(HPO3)(7)], V, possess three-dimensional structures. All the compounds are formed by the connectivity between the Ga polyhedra and phosphite/phosphate units. The observation of SBU-6 (I and II) and spiro-5 (IV) secondary building units (SBUs) are noteworthy. The flexibility of the formation of gallium phosphate frameworks has been established by the isolation of two related structures (I and II) from the same SBU units but different organic amines. Some of the present structures have close resemblance to the gallium phosphate phases known earlier. The compounds have been characterized by CHN analysis, powder XRD, IR, and TGA. (C) 2011 Elsevier B. V. All rights reserved.