A new multidisciplinary home care telemedicine system to monitor stable chronic human immunodeficiency virus-infected patients: a randomized study.

Background: Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals. Methodology: We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out. Findings: Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4 + T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels 90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care. Conclusions: Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection.

Debating as a classroom tool for adapting learning outcomes to the European higher education area

The creation of the European Higher Education Area has meant a number of significant changes to the educational structures of the university community. In particular, the new system of European credits has generated the need for innovation in the design of curricula and teaching methods. In this paper, we propose debating as a classroom tool that can help fulfill these objectives by promoting an active student role in learning. To demonstrate the potential of this tool, a classroom experiment was conducted in a bachelor’s degree course in Industrial Economics -Regulation and Competition-, involving a case study in competition policy and incorporating the techniques of a conventional debate -presentation of standpoints, turns, right to reply and summing up-. The experiment yielded gains in student attainment and positive assessments of the subject. In conclusion, the incorporation of debating activities helps students to acquire the skills, be they general or specific, required to graduate successfully in Economics.

Importance of amoebae as a tool to isolate amoeba-resisting microorganisms and for their ecology and evolution: the Chlamydia paradigm.

Free-living amoebae are distributed worldwide and are frequently in contact with humans and animals. As cysts, they can survive in very harsh conditions and resist biocides and most disinfection procedures. Several microorganisms, called amoeba-resisting microorganisms (ARMs), have evolved to survive and multiply within these protozoa. Among them are many important pathogens, such as Legionella and Mycobacteria, and also several newly discovered Chlamydia-related bacteria, such as Parachlamydia acanthamoebae, Estrella lausannensis, Simkania negevensis or Waddlia chondrophila whose pathogenic role towards human or animal is strongly suspected. Amoebae represent an evolutionary crib for their resistant microorganisms since they can exchange genetic material with other ARMs and develop virulence traits that will be further used to infect other professional phagocytes. Moreover, amoebae constitute an ideal tool to isolate strict intracellular microorganisms from complex microbiota, since they will feed on other fast-growing bacteria, such as coliforms potentially present in the investigated samples. The paradigm that ARMs are likely resistant to macrophages, another phagocytic cell, and that they are likely virulent towards humans and animals is only partially true. Indeed, we provide examples of the Chlamydiales order that challenge this assumption and suggest that the ability to multiply in protozoa does not strictly correlate with pathogenicity and that we should rather use the ability to replicate in multiple and diverse eukaryotic cells as an indirect marker of virulence towards mammals. Thus, cell-culture-based microbial culturomics should be used in the future to try to discover new pathogenic bacterial species.

Undressing of Waddlia chondrophila to enrich its outer membrane proteins to develop a new species-specific ELISA.

Waddlia chondrophila, an obligate intracellular bacterium of the Chlamydiales order, is considered as an agent of bovine abortion and a likely cause of miscarriage in humans. Its role in respiratory diseases was questioned after the detection of its DNA in clinical samples taken from patients suffering from pneumonia or bronchiolitis. To better define the role of Waddlia in both miscarriage and pneumonia, a tool allowing large-scale serological investigations of Waddlia seropositivity is needed. Therefore, enriched outer membrane proteins of W. chondrophila were used as antigens to develop a specific ELISA. After thorough analytical optimization, the ELISA was validated by comparison with micro-immunofluorescence and it showed a sensitivity above 85% with 100% specificity. The ELISA was subsequently applied to human sera to specify the role of W. chondrophila in pneumonia. Overall, 3.6% of children showed antibody reactivity against W. chondrophila but no significant difference was observed between children with and without pneumonia. Proteomic analyses were then performed using mass spectrometry, highlighting members of the outer membrane protein family as the dominant proteins. The major Waddlia putative immunogenic proteins were identified by immunoblot using positive and negative human sera. The new ELISA represents an efficient tool with high throughput applications. Although no association with pneumonia and Waddlia seropositivity was observed, this ELISA could be used to specify the role of W. chondrophila in miscarriage and in other diseases.

Chemical profiling: a tool to decipher the structure and organisation of illicit drugs markets: an 8-year study in Western Switzerland

Illicit drug analyses usually focus on the identification and quantitation of questioned material to support the judicial process. In parallel, more and more laboratories develop physical and chemical profiling methods in a forensic intelligence perspective. The analysis of large databases resulting from this approach enables not only to draw tactical and operational intelligence, but may also contribute to the strategic overview of drugs markets. In Western Switzerland, the chemical analysis of illicit drug seizures is centralised in a laboratory hosted by the University of Lausanne. For over 8 years, this laboratory has analysed 5875 cocaine and 2728 heroin specimens, coming from respectively 1138 and 614 seizures operated by police and border guards or customs. Chemical (major and minor alkaloids, purity, cutting agents, chemical class), physical (packaging and appearance) as well as circumstantial (criminal case number, mass of drug seized, date and place of seizure) information are collated in a dedicated database for each specimen. The study capitalises on this extended database and defines several indicators to characterise the structure of drugs markets, to follow-up on their evolution and to compare cocaine and heroin markets. Relational, spatial, temporal and quantitative analyses of data reveal the emergence and importance of distribution networks. They enable to evaluate the cross-jurisdictional character of drug trafficking and the observation time of drug batches, as well as the quantity of drugs entering the market every year. Results highlight the stable nature of drugs markets over the years despite the very dynamic flows of distribution and consumption. This research work illustrates how the systematic analysis of forensic data may elicit knowledge on criminal activities at a strategic level. In combination with information from other sources, such knowledge can help to devise intelligence-based preventive and repressive measures and to discuss the impact of countermeasures.

Development of power flows around Baltic countries with new grid links

In the Thesis main focus is done on power flow development paths around the Baltic States as well as on market-based requirements for creation of the common Baltic electricity market. Current market regulations between the countries are presented; barriers for creating competitive common Baltic power market and for electricity trading with third countries are clarified; solutions are offered and corresponding road map is developed. Future power development paths around the Baltic States are analysed. For this purpose the 330 kV transmission grid of Estonia, Latvia and Lithuania is modelled in a power flow tool. Power flow calculations are carried out for winter and summer peak and off-peak load periods in 2020 with different combinations of interconnections. While carrying out power balance experiments several power flow patterns in the Baltic States are revealed. Conclusions are made about security of supply, grid congestion and transmission capacity availability for different scenarios.

Tool-supported invariant-based programming

The development of correct programs is a core problem in computer science. Although formal verification methods for establishing correctness with mathematical rigor are available, programmers often find these difficult to put into practice. One hurdle is deriving the loop invariants and proving that the code maintains them. So called correct-by-construction methods aim to alleviate this issue by integrating verification into the programming workflow. Invariant-based programming is a practical correct-by-construction method in which the programmer first establishes the invariant structure, and then incrementally extends the program in steps of adding code and proving after each addition that the code is consistent with the invariants. In this way, the program is kept internally consistent throughout its development, and the construction of the correctness arguments (proofs) becomes an integral part of the programming workflow. A characteristic of the approach is that programs are described as invariant diagrams, a graphical notation similar to the state charts familiar to programmers. Invariant-based programming is a new method that has not been evaluated in large scale studies yet. The most important prerequisite for feasibility on a larger scale is a high degree of automation. The goal of the Socos project has been to build tools to assist the construction and verification of programs using the method. This thesis describes the implementation and evaluation of a prototype tool in the context of the Socos project. The tool supports the drawing of the diagrams, automatic derivation and discharging of verification conditions, and interactive proofs. It is used to develop programs that are correct by construction. The tool consists of a diagrammatic environment connected to a verification condition generator and an existing state-of-the-art theorem prover. Its core is a semantics for translating diagrams into verification conditions, which are sent to the underlying theorem prover. We describe a concrete method for 1) deriving sufficient conditions for total correctness of an invariant diagram; 2) sending the conditions to the theorem prover for simplification; and 3) reporting the results of the simplification to the programmer in a way that is consistent with the invariantbased programming workflow and that allows errors in the program specification to be efficiently detected. The tool uses an efficient automatic proof strategy to prove as many conditions as possible automatically and lets the remaining conditions be proved interactively. The tool is based on the verification system PVS and i uses the SMT (Satisfiability Modulo Theories) solver Yices as a catch-all decision procedure. Conditions that were not discharged automatically may be proved interactively using the PVS proof assistant. The programming workflow is very similar to the process by which a mathematical theory is developed inside a computer supported theorem prover environment such as PVS. The programmer reduces a large verification problem with the aid of the tool into a set of smaller problems (lemmas), and he can substantially improve the degree of proof automation by developing specialized background theories and proof strategies to support the specification and verification of a specific class of programs. We demonstrate this workflow by describing in detail the construction of a verified sorting algorithm. Tool-supported verification often has little to no presence in computer science (CS) curricula. Furthermore, program verification is frequently introduced as an advanced and purely theoretical topic that is not connected to the workflow taught in the early and practically oriented programming courses. Our hypothesis is that verification could be introduced early in the CS education, and that verification tools could be used in the classroom to support the teaching of formal methods. A prototype of Socos has been used in a course at Åbo Akademi University targeted at first and second year undergraduate students. We evaluate the use of Socos in the course as part of a case study carried out in 2007.

Measuring Processes of a New Packaging Solutions with the Balanced Scorecard, case DigiCup

The aim of this study was to create a Balanced Scorecard to the DigiCup solution. The first goal was to create process descriptions to the few critical processes. The second goal was to define appropriate measurements, according to customer survey as well as following the Balanced Scorecard process description, to manage the critical success factors. The overall goal of this study was to create a performance measurement system for the solution which guides the operation towards continuous improvement. This study was conducted by using both qualitative and quantitative methods, and the analysis was done by using a case study method. The material was gathered from the current customers, the management and the employees using structured, semi-structured and open group and individual interviews. The current customers were divided into retailers and direct customers of the DigiCup solution. The questions which the customers were asked were related to the information about interviewee, company, business strategy, market, satisfaction survey and future requirements. The management defined the strategy and took part in specifying the perspectives, objectives and measurements to the Balanced Scorecard of the DigiCup solution. The employees participated into the choosing of the metrics. The material consisted from altogether sixteen interviews. At the beginning of the study the product development, the order-delivery as well as the printing processes was chosen to be the critical processes of the DigiCup solution. These processes were concentrated on already in the literature review while trying to find the characteristics of these processes as well as the critical success factors and the appropriate measurements, which could be utilized when creating the Balanced Scorecard to the DigiCup solution according to the customer survey. The appropriate perspectives, objectives and measurements were found to the DigiCup solution. The chosen measures works as a basis for the development of IT-reporting tool. As a conclusion it can be stated that when discussing a new business, where the objectives are changing according to which development’s phases the company is in, the measurement should be updated often enough.

Internet-based breast cancer patient’s pathway as an empowering patient educational tool

This three-phase study was conducted to examine the effect of the Breast Cancer Patient’s Pathway program (BCPP) on breast cancer patients’ empowering process from the viewpoint of the difference between knowledge expectations and perceptions of received knowledge, knowledge level, quality of life, anxiety and treatment-related side effects during the breast cancer treatment process. The BCPP is an Internet-based patient education tool describing a flow chart of the patient pathway during the breast treatment process, from breast cancer diagnostic tests to the follow-up after treatments. The ultimate goal of this study was to evaluate the effect of the BCPP to the breast cancer patient’s empowerment by using the patient pathway as a patient education tool. In phase I, a systematic literature review was carried out to chart the solutions and outcomes of Internet-based educational programs for breast cancer patients. In phase II, a Delphi study was conducted to evaluate the usability of web pages and adequacy of their content. In phase III, the BCPP program was piloted with 10 patients and patients were randomised to an intervention group (n=50) and control group (n=48). According to the results of this study, the Internet is an effective patient education tool for increasing knowledge, and BCPP can be used as a patient education method supporting other education methods. However, breast cancer patients’ perceptions of received knowledge were not fulfilled; their knowledge expectations exceed the perceived amount of received knowledge. Although control group patients’ knowledge expectations were met better with the knowledge they received in hospital compared to the patients in the intervention group, no statistical differences were found between the groups in terms of quality of life, anxiety and treatment-related side effects. However, anxiety decreased faster in the intervention group when looking at internal differences between the groups at different measurement times. In the intervention group the relationship between the difference between knowledge expectations and perceptions of received knowledge correlated significantly with quality of life and anxiety. Their knowledge level was also significant higher than in the control group. These results support the theory that the empowering process requires patient’s awareness of knowledge expectations and perceptions of received knowledge. There is a need to develop patient education to meet patients’ perceptions of received knowledge, including oral and written education and BCPP, to fulfil patient’s knowledge expectations and facilitate the empowering process. Further research is needed on the process of cognitive empowerment with breast cancer patients. There is a need for new patient education methods to increase breast cancer patients’ awareness of knowing.

Microbusiness: A new social business model to alleviate poverty in developing countries?

Poverty alleviation views have shifted from seeing the poor as victims or as potential consumers, to seeing them as gainers. Social businesses include microfinancing and microfranchising, which engage people at the bottom of the pyramid using business instead of charity. There are, however, social business firms that do not fit to the existing social business model theory. These firms provide markets to poor producers and mix traditional, local craftsmanship with western design. Social business models evolve faster than the academic literature can study them. This study contributes to filling this gap. The purpose of this Master’s thesis is to develop the concept of social business as poverty alleviation method in developing countries. It also aims; 1) to describe the means for poverty alleviation in developing countries; 2) to introduce microbusiness as a social business model; and 3) to examine the challenges of microbusinesses. Qualitative case study is used as a research strategy and theme interviews as a data collecting method. The empirical data is gathered from four interviews of Finnish or Finnish-owned firms that employ microbusiness – Mifuko, Tensira, Mangomaa and Tikau – and this is supported with secondary data including articles on case companies. The results show that microbusiness is a valid new social business model that aims at poverty alleviation by engaging the poor at the bottom of the pyramid. It is possible to map the value proposition, value constellation, and economic and social profit equations of the case firms. Two major types of firms emerge from the results; the first consists of design-oriented firms that emphasize the quality and design of the products, and the second consists of bazaar-like firms whose product portfolio is less sophisticated and who promote more the stories of the products – not the design. All microbusiness firms provide markets, promote traditional handicrafts, form close relationships to their producers, and aim at enhancing lives through their businesses. The attitudes towards social businesses are sometimes negative, but this is changing for the better. In conclusion, microbusiness answers to two different needs at the same time – consumers’ needs for ethical products and the social needs of the producers – but the social need is the ultimate reason why the entrepreneurs started business. Microbusiness continues as a poverty alleviation tool that sees the poor as gainers; by providing them steady employment, microbusiness increases the poor’s self-esteem and enables them for a better living. Academic literature has not been able to offer enough alternative business models to cover all social businesses; the current study contributes to this by concluding that microbusiness is another social business model.

Critical aspects on the behavior of material from the mechanical tool-workpiece interaction in single point diamond turning

Some material aspects such as grain size, purity and anisotropy exert an important influence on surface quality, especially in single point diamond turning. The aim of this paper is to present and discuss some critical factors that can limit the accuracy of ultraprecision machining of non-ferrous metals and to identify the effects of them on the cutting mechanism with single point diamond tools. This will be carried out through observations of machined surfaces and chips produced using optical and scanning electron microscopy. Solutions to reduce the influence of some of these limiting factors related with the mechanism of generation of mirror-like surfaces will be discussed.

Application of cutting fluids in machining processes

In the last decade a lot has been discussed about the suitability of using cutting fluid in abundance to cool and lubricate machining processes. The use of cutting fluid generally causes economy of tools and it becomes easier to keep tight tolerances and to maintain workpiece surface properties without damages. In the other hand, it brings also some problems, like fluid residuals and human diseases. Because of them some alternatives has been sought to minimise or even avoid the use of cutting fluid in machining operations. Some of these alternatives are dry cutting and cutting with minimum quantity of fluid (MQF). The main goal of this work is to discuss these tendencies. Therefore, topics like kinds and methods of applications of modern cutting fluids and what are new in this area will unavoidably be considered. MQF and dry cutting techniques, their applications and where it is not possible to apply them will also be focused. To exemplify the topics, this work will describe some of the researches been developed in two important Brazilian Universities: State University of Campinas (UNICAMP) and Federal University of Uberlândia (UFU).

Investigation on diamond turning of silicon crystal - generation mechanism of surface cut with worn tool

This paper discusses the effect of tool wear on surface finish in single-point diamond turning of single crystal silicon. The morphology and topography of the machined surface clearly show the type of cutting edge wear reproduced onto the cutting grooves. Scanning electron microscopy is used in order to correlate the cutting edge damage and microtopography features observed through atomic force microscopy. The possible wear mechanisms affecting tool performance and surface generation during cutting are also discussed. The zero degree rake angle single point diamond tool presented small nicks on the cutting edge. The negative rake angle tools presented more a type of crater wear on the rake face. No wear was detected on flank face of the diamond tools.

“Development work thesis” as a tool for continuing professional education

Julkaisumaa: 158 TW TWN Taiwan

Perspectives for using light quality knowledge as an advanced ecophysiological weed management tool

The current knowledge of light quality effects on plant morphogenesis and development represents a new era of understanding on how plant communities perceive and adjust to available resources. The most important consequences of light quality cues, often mediated by decreasing in red far-red ratios with respect to the spectral composition of incident sunlight radiation, affecting weed-crop interaction are the increased plant height and shoot to root ratio in anticipation of competition by light quantity, water or nutrients. Although the concepts related to light quality have been extensively studied and several basic process of this phenomenon are well known, little applications of photomorphogenic signaling currently are related to agricultural problems or weed management. The objectives of this review are to describe how light quality change can be a triggering factor of interspecific interference responses, to analyze how this phenomenon can be used to predict weed interference, to reevaluate the critical periods of interference concept, and to discuss its potential contribution towards developing more weed competitive crop varieties. Knowledge on light quality responses involved in plant sensing of interspecific competition could be used to identify red/far-red threshold values, indicating when weed control should be started. Light quality alterations by weeds can affect grain crop development mainly in high yielding fields. Unlike the traditional concept or the critical period of competition, light quality mediated interference implies that the critical period for weed control could start before the effects of direct resource (water, nutrients and available light) limitation actually occur. The variability in light quality responses among crop genotypes and the identification of mutants insensitive to light quality effects indicate that this characteristic can be selected or modified to develop cultivars with enhanced interspecific interference ability. Knowledge on light quality-elicited responses represents a new possibility to understand the underlying biology of interspecific interference, and could be used in the development of new weed management technologies.