Row Crop Response to Topsoil Restored on Borrow Areas, HR-186, Supplemental Report, 1982

Borrow areas are created where soil is needed to provide fill for construction projects. This research evaluated (1) the changes in row crop productivity resulting from removal of soil for highway construction in Iowa and (2) restoration methods which included: depth of topsoil, subsoil tillage, manure application, and two years of legume growth prior to row cropping. The research was carried out from 1977-1981 at four locations. Corn and soybean y1elds from borrow areas have been below, equal to; and greater than yields from undisturbed, neighboring farmland. Little or no yield increase was noted from restored topsoil at coarse textured sites. At finer textured sites, a marked yield increase of both crops occurred after the addition of 6 inches of topsoil but little added yield increase resulted from restoring 12 inches of topsoil. Subsoil tillage has shown little or no beneficial effect on crop yields. The manure treatment has resulted in a corn yield increase but only in the first year after application.

Soil fertility and upland rice yield after biochar application in the Cerrado

The objective of this work was to evaluate the effect of biochar made from Eucalyptus on soil fertility, and on the yield and development of upland rice. The experiment was performed during two years in a randomized block design with four replicates, in a sandy loam Dystric Plinthosol. Four doses of NPK 05-25-15, annually distributed in stripes (0, 100, 200 and 300 kg ha-1), and four doses of biochar (0, 8, 16 and 32 Mg ha-1), applied once in the first year - alone or with NPK - were evaluated. In the first year, biochar positively affected soil fertility [total organic carbon (TOC), Ca, P, Al, H+Al, and pH], at 0-10 cm soil depth, and it was the only factor with significant effect on yield. In the second year, the effect of biochar diminished or was overcome by the fertilizer. TOC moved down in the soil profile to the 0-20 cm depth, influencing K availability in this layer. In the second year, there was a significant interaction between biochar and the fertilizer on plant growth and biomass dry matter accumulation.

Metastatic choroidal paraganglioma.

PURPOSE: To describe a patient with metastatic choroidal paraganglioma that was locally controlled with radiotherapy. DESIGN: Interventional clinicopathologic case report. PARTICIPANT: One patient with metastatic choroidal paraganglioma. METHODS: Interventional clinicopathologic case report and systematic search of the literature. MAIN OUTCOME MEASURES: Description of clinicopathologic features, treatment methods, and outcome. RESULTS: A 50-year-old man had a nonpigmented atypical choroidal mass with secondary retinal detachment in the left eye. After incisional biopsy, the diagnosis of paraganglioma was established. Metastatic work-up revealed vertebral, mediastinal, and pulmonary metastases of a nonsecretory, malignant paraganglioma without tracer uptake. The primary tumor was not identified. The ocular tumor regressed after stereotaxic radiotherapy. Two years later, recurrent lesions developed in the contralateral eye, which also was irradiated. CONCLUSIONS: Malignant paraganglioma can metastasize in the choroid and should be included in the differential diagnosis of a nonpigmented choroidal mass. Stereotaxic radiation therapy is an effective treatment method. To the authors' knowledge, this is the first report of a patient with choroidal paraganglioma. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Self-perception of aging and vulnerability to adverse outcomes at the age of 65-70 years.

OBJECTIVES. This study examines the relationship between self-perception of aging and vulnerability to adverse outcomes in adults aged 65-70 years using data from a cohort of 1,422 participants in Lausanne, Switzerland. METHODS: A positive or negative score of perception of aging was established using the Attitudes Toward Own Aging subscale including 5 items of the Philadelphia Geriatric Center Morale Scale. Falls, hospitalizations, and difficulties in basic and instrumental activities of daily living (ADL) collected in the first 3 years of follow-up were considered adverse outcomes. The relationship between perception and outcomes were evaluated using multiple logistic regression models adjusting for chronic medical conditions, depressive feelings, living arrangement, and socioeconomic characteristics. RESULTS: The strongest associations of self-perception of aging with outcomes were observed for basic and instrumental ADL. Associations with falls and hospitalizations were not constant but could be explained by health characteristics. CONCLUSIONS: A negative self-perception of aging is an indicator of risk for future disability in ADL. Factors such as a low-economic status, living alone, multiple chronic medical conditions, and depressive feelings contribute to a negative self-perception of aging but do not explain the relationship with incident activities of daily living disability.

Concurrent or Sequential Adjuvant Letrozole and Radiotherapy after Conservative Surgery for Early-stage Breast Cancer: Long-term Results of the Cohort Phase 2 Randomized Trial

Purpose/Objective(s): Letrozole radiosensitizes breast cancer cells in vitro. In clinical settings, no data exist for the combination of letrozole and radiotherapy. We assessed concurrent and sequential radiotherapy and letrozole in the adjuvant setting.Materials/Methods: The present study is registered with ClinicalTrials.gov, number NCT00208273. This Phase 2 randomized trial was undertaken in two centers in France and one in Switzerland between January 12, 2005, and February 21, 2007. One hundred fifty postmenopausal women with early-stage breast cancer were randomly assigned after conserving surgery to either concurrent radiotherapy and letrozole (n = 75) or sequential radiotherapy and letrozole (n = 75). Randomization was open label with a minimization technique, stratified by investigational centers, chemotherapy (yes vs. no), radiation boost (yes vs. no), and value of radiation-induced lymphocyte apoptosis (#16% vs. .16%). The whole breast was irradiated to a total dose of 50 Gy in 25 fractions over 5 weeks. In the case of supraclavicular and internal mammary node irradiation, the dose was 44 - 50 Gy. Letrozole was administered orally once daily at a dose of 2 - 5 mg for 5 years (beginning 3 weeks pre-radiotherapy in the concomitant group, and 3 weeks postradiotherapy in the sequential group). The primary endpoint was the occurrence of acute (during and within 6 weeks of radiotherapy) and late (within 2 years) radiation-induced Grade 2 or worse toxic effects of the skin and lung (functional pulmonary test and lung CT-scan). Analyses were by intention-to-treat. The long-term follow-up after 2 years was only performed in Montpellier (n = 121) and evaluated skin toxicity (clinical examination every 6 months), lung fibrosis (one CT-scan yearly), cosmetic outcome.Results: All patients were analyzed apart from 1 in the concurrent group who withdrew consent before any treatment.Within the first 2 years (n = 149), no lung toxicity was identified by CT scan and no modification from baseline was noted by the lung diffusion capacity test. Two patients in each group had Grade 2 or worse late effects (both radiation-induced subcutaneous fibrosis [RISF]). After 2 years (n = 121), and with a median follow-up of 50 months (38-62), 2 patients (1 in each arm) presented a Grade 3 RISF. No lung toxicity was identified by CT scan. Cosmetic results (photographies) and quality of life was good to excellent. All patients who had Grade 3 subcutaneous fibrosis had an RILA value of 16% or less, irrespective of the sequence with letrozole.Conclusions:With long-term follow-up, letrozole can be safely delivered shortly after surgery and concomitantly with radiotherapy.

Effective corporate governance : experimental evidence on international auditors'judgments and the contribution of financial accounting education

1 Summary This dissertation deals with two major aspects of corporate governance that grew in importance during the last years: the internal audit function and financial accounting education. In three essays, I contribute to research on these topics which are embedded in the broader corporate governance literature. The first two essays consist of experimental investigations of internal auditors' judgments. They deal with two research issues for which accounting research lacks evidence: The effectiveness of internal controls and the potentially conflicting role of the internal audit function between management and the audit committee. The findings of the first two essays contribute to the literature on internal auditors' judgment and the role of the internal audit function as a major cornerstone of corporate governance. The third essay theoretically examines a broader issue but also relates to the overall research question of this dissertation: What contributes to effective corporate governance? This last essay takes the perspective that the root for quality corporate governance is appropriate financial accounting education. r develop a public interest approach to accounting education that contributes to the literature on adequate accounting education with respect to corporate governance and accounting harmonization. The increasing importance of both the internal audit function and accounting education for corporate governance can be explained by the same recent fundamental changes that still affect accounting research and practice. First, the Sarbanes-Oxley Act of 2002 (SOX, 2002) and the 8th EU Directive (EU, 2006) have led to a bigger role for the internal audit function in corporate governance. Their implications regarding the implementation of audit committees and their oversight over internal controls are extensive. As a consequence, the internal audit function has become increasingly important for corporate governance and serves a new master (i.e. the audit committee) within the company in addition to management. Second, the SOX (2002) and the 8th EU Directive introduced additional internal control mechanisms that are expected to contribute to the reliability of financial information. As a consequence, the internal audit function is expected to contribute to a greater extent to the reliability of financial statements. Therefore, effective internal control mechanisms that strengthen objective judgments and independence become important. This is especially true when external- auditors rely on the work of internal auditors in the context of the International Standard on Auditing (ISA) 610 and the equivalent US Statement on Auditing Standards (SAS) 65 (see IFAC, 2009 and AICPA, 1990). Third, the harmonization of international reporting standards is increasingly promoted by means of a principles-based approach. It is the leading approach since a study of the SEC (2003) that was required by the SOX (2002) in section 108(d) was in favor of this approach. As a result, the Financial Accounting Standards Board (FASB) and the International Accounting Standards Board (IASB) commit themselves to the development of compatible accounting standards based on a principles-based approach. Moreover, since the Norwalk Agreement of 2002, the two standard setters have developed exposure drafts for a common conceptual framework that will be the basis for accounting harmonization. The new .framework will be in favor of fair value measurement and accounting for real-world economic phenomena. These changes in terms of standard setting lead to a trend towards more professional judgment in the accounting process. They affect internal and external auditors, accountants, and managers in general. As a consequence, a new competency set for preparers and users of financial statements is required. The basil for this new competency set is adequate accounting education (Schipper, 2003). These three issues which affect corporate governance are the initial point of this dissertation and constitute its motivation. Two broad questions motivated a scientific examination in three essays: 1) What are major aspects to be examined regarding the new role of the internal audit function? 2) How should major changes in standard setting affect financial accounting education? The first question became apparent due to two published literature reviews by Gramling et al. (2004) and Cohen, Krishnamoorthy & Wright (2004). These studies raise various questions for future research that are still relevant and which motivate the first two essays of my dissertation. In the first essay, I focus on the role of the internal audit function as one cornerstone of corporate governance and its potentially conflicting role of serving both management and the audit committee (IIA, 2003). In an experimental study, I provide evidence on the challenges for internal auditors in their role as servant for two masters -the audit committee and management -and how this influences internal auditors' judgment (Gramling et al. 2004; Cohen, Krishnamoorthy & Wright, 2004). I ask if there is an expectation gap between what internal auditors should provide for corporate governance in theory compared to what internal auditors are able to provide in practice. In particular, I focus on the effect of serving two masters on the internal auditor's independence. I argue that independence is hardly achievable if the internal audit function serves two masters with conflicting priorities. The second essay provides evidence on the effectiveness of accountability as an internal control mechanism. In general, internal control mechanisms based on accountability were enforced by the SOX (2002) and the 8th EU Directive. Subsequently, many companies introduced sub-certification processes that should contribute to an objective judgment process. Thus, these mechanisms are important to strengthen the reliability of financial statements. Based on a need for evidence on the effectiveness of internal control mechanisms (Brennan & Solomon, 2008; Gramling et al. 2004; Cohen, Krishnamoorthy & Wright, 2004; Solomon & Trotman, 2003), I designed an experiment to examine the joint effect of accountability and obedience pressure in an internal audit setting. I argue that obedience pressure potentially can lead to a negative influence on accountants' objectivity (e.g. DeZoort & Lord, 1997) whereas accountability can mitigate this negative effect. My second main research question - How should major changes in standard setting affect financial accounting education? - is investigated in the third essay. It is motivated by the observation during my PhD that many conferences deal with the topic of accounting education but very little is published about what needs to be done. Moreover, the Endings in the first two essays of this thesis and their literature review suggest that financial accounting education can contribute significantly to quality corporate governance as argued elsewhere (Schipper, 2003; Boyce, 2004; Ghoshal, 2005). In the third essay of this thesis, I therefore focus on approaches to financial accounting education that account for the changes in standard setting and also contribute to corporate governance and accounting harmonization. I argue that the competency set that is required in practice changes due to major changes in standard setting. As the major contribution of the third article, I develop a public interest approach for financial accounting education. The major findings of this dissertation can be summarized as follows. The first essay provides evidence to an important research question raised by Gramling et al. (2004, p. 240): "If the audit committee and management have different visions for the corporate governance role of the IAF, which vision will dominate?" According to the results of the first essay, internal auditors do follow the priorities of either management or the audit committee based on the guidance provided by the Chief Audit executive. The study's results question whether the independence of the internal audit function is actually achievable. My findings contribute to research on internal auditors' judgment and the internal audit function's independence in the broader frame of corporate governance. The results are also important for practice because independence is a major justification for a positive contribution of the internal audit function to corporate governance. The major findings of the second essay indicate that the duty to sign work results - a means of holding people accountable -mitigates the negative effect of obedience pressure on reliability. Hence, I found evidence that control .mechanisms relying on certifications may enhance the reliability of financial information. These findings contribute to the literature on the effectiveness of internal control mechanisms. They are also important in the light of sub-certification processes that resulted from the Sarbanes-Oxley Act and the 8th EU Directive. The third essay contributes to the literature by developing a measurement framework that accounts for the consequences of major trends in standard setting. Moreovér, it shows how these trends affect the required .competency set of people dealing with accounting issues. Based on this work, my main contribution is the development of a public interest approach for the design of adequate financial accounting curricula. 2 Serving two masters: Experimental evidence on the independence of internal auditors Abstract Twenty nine internal auditors participated in a study that examines the independence of internal auditors in their potentially competing roles of serving two masters: the audit committee and management. Our main hypothesis suggests that internal auditors' independence is not achievable in an institutional setting in which internal auditors are accountable to two different parties with potentially differing priorities. We test our hypothesis in an experiment in which the treatment consisted of two different instructions of the Chief audit executive; one stressing the priority of management (cost reduction) and one stressing the priority of the audit committee (effectiveness). Internal auditors had to evaluate internal controls and their inherent costs of different processes which varied in their degree of task complexity. Our main results indicate that internal auditors' evaluation of the processes is significantly different when task complexity is high. Our findings suggest that internal auditors do follow the priorities of either management or the audit committee depending on the instructions of a superior internal auditor. The study's results question whether the independence of the internal audit function is actually achievable. With our findings, we contribute to research on internal auditors' judgment and the internal audit function's independence in the frame of corporate governance.

Evolution and sedimentology of a channel fill in the sandy braided South Saskatchewan River and its comparison to the deposits of an adjacent compound bar

The depositional stratigraphy of within-channel deposits in sandy braided rivers is dominated by a variety of barforms (both singular `unit' bars and complex `compound' bars), as well as the infill of individual channels (herein termed `channel fills'). The deposits of bars and channel fills define the key components of facies models for braided rivers and their within-channel heterogeneity, knowledge of which is important for reservoir characterization. However, few studies have sought to address the question of whether the deposits of bars and channel fills can be readily differentiated from each other. This paper presents the first quantitative study to achieve this aim, using aerial images of an evolving modern sandy braided river and geophysical imaging of its subsurface deposits. Aerial photographs taken between 2000 and 2004 document the abandonment and fill of a 1 3 km long, 80 m wide anabranch channel in the sandy braided South Saskatchewan River, Canada. Upstream river regulation traps the majority of very fine sediment and there is little clay (<1%) in the bed sediments. Channel abandonment was initiated by a series of unit bars that stalled and progressively blocked the anabranch entrance, together with dune deposition and stacking at the anabranch entrance and exit. Complete channel abandonment and subsequent fill of up to 3 m of sediment took approximately two years. Thirteen kilometres of ground-penetrating radar surveys, coupled with 18 cores, were obtained over the channel fill and an adjacent 750 m long, 400 m wide, compound bar, enabling a quantitative analysis of the channel and bar deposits. Results show that, in terms of grain-size trends, facies proportions and scale of deposits, there are only subtle differences between the channel fill and bar deposits which, therefore, renders them indistinguishable. Thus, it may be inappropriate to assign different geometric and sedimentological attributes to channel fill and bar facies in object-based models of sandy braided river alluvial architecture.

Development of advanced silicon radiation detectors for harsh radiation environment

This thesis describes the development of advanced silicon radiation detectors and their characterization by simulations, used in the work for searching elementary particles in the European Organization for Nuclear Research, CERN. Silicon particle detectors will face extremely harsh radiation in the proposed upgrade of the Large Hadron Collider, the future high-energy physics experiment Super-LHC. The increase in the maximal fluence and the beam luminosity up to 1016 neq / cm2 and 1035 cm-2s-1 will require detectors with a dramatic improvement in radiation hardness, when such a fluence will be far beyond the operational limits of the present silicon detectors. The main goals of detector development concentrate on minimizing the radiation degradation. This study contributes mainly to the device engineering technology for developing more radiation hard particle detectors with better characteristics. Also the defect engineering technology is discussed. In the nearest region of the beam in Super-LHC, the only detector choice is 3D detectors, or alternatively replacing other types of detectors every two years. The interest in the 3D silicon detectors is continuously growing because of their many advantages as compared to conventional planar detectors: the devices can be fully depleted at low bias voltages, the speed of the charge collection is high, and the collection distances are about one order of magnitude less than those of planar technology strip and pixel detectors with electrodes limited to the detector surface. Also the 3D detectors exhibit high radiation tolerance, and thus the ability of the silicon detectors to operate after irradiation is increased. Two parameters, full depletion voltage and electric field distribution, is discussed in more detail in this study. The full depletion of the detector is important because the only depleted area in the detector is active for the particle tracking. Similarly, the high electric field in the detector makes the detector volume sensitive, while low-field areas are non-sensitive to particles. This study shows the simulation results of full depletion voltage and the electric field distribution for the various types of 3D detectors. First, the 3D detector with the n-type substrate and partial-penetrating p-type electrodes are researched. A detector of this type has a low electric field on the pixel side and it suffers from type inversion. Next, the substrate is changed to p-type and the detectors having electrodes with one doping type and the dual doping type are examined. The electric field profile in a dual-column 3D Si detector is more uniform than that in the single-type column 3D detector. The dual-column detectors are the best in radiation hardness because of their low depletion voltages and short drift distances.

Using narratives to study the impact of social networks on the educational paths of immigrant students

This paper presents the qualitative data collection process aimed at the study of the impactsocial relations and networks have on educational paths of immigrant students. In theframework of a R & D longitudinal study funded by the Ministry of Science and Innovation(2012-2014), the research team tracked the path of 87 immigrant students, from whom only 17successfully achieved the transition through the first and second year of Post-16 Education.A vast range of literature notes that relationships are an important part of migration process andsocial integration analysis, as well as school history in terms of success or failure. Through thefieldwork researchers collect the personal networks of all immigrant students from 3 highschools who were at that time attending last course of compulsory school. The network structureinfluences their social capital and therefore determines the resources, goods and types of supportindividuals can access. All these aspects are influential elements in the configuration anddevelopment of academic trajectories of immigrant students.At the end of the second year of Post-16 Education (two years later), the study captures personalnetworks of these students again, analyses and discusses their evolution and influence on theirpaths through qualitative interviews. Such interviews facilitated the discussion of theirrelationships while providing interesting narratives that are presented in the text. In order to do so, the biographical interpretive narrative method of interviewing is implemented.

Using narratives to study the impact of social networks on the educational paths of immigrant students

This paper presents the qualitative data collection process aimed at the study of the impactsocial relations and networks have on educational paths of immigrant students. In theframework of a R & D longitudinal study funded by the Ministry of Science and Innovation(2012-2014), the research team tracked the path of 87 immigrant students, from whom only 17successfully achieved the transition through the first and second year of Post-16 Education.A vast range of literature notes that relationships are an important part of migration process andsocial integration analysis, as well as school history in terms of success or failure. Through thefieldwork researchers collect the personal networks of all immigrant students from 3 highschools who were at that time attending last course of compulsory school. The network structureinfluences their social capital and therefore determines the resources, goods and types of supportindividuals can access. All these aspects are influential elements in the configuration anddevelopment of academic trajectories of immigrant students.At the end of the second year of Post-16 Education (two years later), the study captures personalnetworks of these students again, analyses and discusses their evolution and influence on theirpaths through qualitative interviews. Such interviews facilitated the discussion of theirrelationships while providing interesting narratives that are presented in the text. In order to do so, the biographical interpretive narrative method of interviewing is implemented.

Jätteen määrän vähentäminen ja jätteenkäsittelymahdollisuuksien selvittäminen pinnoitetehtaassa

EU:n mukanaan tuomat uudet vaatimukset jätteenpoltolle aiheuttavat suuria muutoksia Dynea Overlays Oy:n jätteen käsittelylle. Samalla tehdasalueella tapahtuva jätteenpoltto päättyy todennäköisesti vuoden 2005 lopulla. Tästä syystä tehtaalla syntyville jätteille haettiin uusia hävitysreittejä. Jokaiselle jätejakeelle löydettiin uusi hävitysvaihtoehto, jotka pääosin ovat jätteen hyödyntämistä energiana. Pinnoitejätteet, kovetetut hartsit ja kuitujäte hyödynnetään energiana, tyhjät kertakäyttökontit joko otetaan uudelleenkäyttöön tai toimitetaan purettuina metallin- ja muovinkeräykseen. Työn toinen tavoite oli jätteen määrän vähentäminen. Jätteen määrää vähentämällä saadaan alennettua jätteenkäsittelykustannuksia sekä parannettua saantoa. Saanto on mittari, jota seurataan Dynean kaikilla pinnoitetehtailla ympäri maailmaa. Yrityksen johto on asettanut tavoitteeksi nostaa saannon vuoden 2003 tasolta 90 % tasolle 93 % vuoden 2004 loppuun mennessä. Jo vuoden 2004 ensimmäisinä kuukausina saanto näyttää parantuneen tavoitetasolle asiaan kiinnitetyn huomion ja tarkentuneen raportoinnin seurauksena.

Genotypic classification of patients with Wolfram syndrome: insights into the natural history of the disease and correlation with phenotype

Purpose: Wolfram syndrome is a degenerative, recessive rare disease with an onset in childhood. It is caused by mutations in WFS1 or CISD2 genes. More than 200 different variations in WFS1 have been described in patients with Wolfram syndrome, which complicates the establishment of clear genotype-phenotype correlation. The purpose of this study was to elucidate the role of WFS1 mutations and update the natural history of the disease. Methods: This study analyzed clinical and genetic data of 412 patients with Wolfram syndrome published in the last 15 years. Results: (i) 15% of published patients do not fulfill the current ­inclusion criterion; (ii) genotypic prevalence differences may exist among countries; (iii) diabetes mellitus and optic atrophy might not be the first two clinical features in some patients; (iv) mutations are nonuniformly distributed in WFS1; (v) age at onset of diabetes mellitus, hearing defects, and diabetes insipidus may depend on the patient"s genotypic class; and (vi) disease progression rate might depend on genotypic class. Conclusion: New genotype-phenotype correlations were established, disease progression rate for the general population and for the genotypic classes has been calculated, and new diagnostic criteria have been proposed. The conclusions raised could be important for patient management and counseling as well as for the development of treatments for Wolfram syndrome.

Estimating the Price and Demand Development of Some Paperboard Grades

Työn tavoitteena oli luoda malli, jonka avulla voitaisiin ennustaa kartonkituotteiden hinnan ja kysynnän kehitystä. Työssä kerättiin aluksi tietoa kartonkimarkkinoista haastattelujen ja tilastotietojen avulla. Näiden perusteella luotiin malli, joka kuvaa kartonkimarkkinoiden ja -teollisuuden rakennetta. Erityisesti kiinnitettiin huomiota asiakkaiden tilauskäyttäytymiseen, tuotannonohjaukseen sekä hinnan muodostumiseen. Työssä käytettiin ennustemenetelmänä systeemidynamiikkaa. Oleellista oli löytää systeemissä esiintyvät tärkeimmät takaisinkytkennät ja systeemin avainmuuttujat. Kun kaikille mallin muuttujille oli määritetty yhtälöt ja vakioille annettu arvot, voitiin mallia simuloida, ja saada ennusteet halutuille muuttujille. Työssä esitettiin ennusteet kartonkimarkkinoiden tärkeimmille parametreille kahden vuoden päähän. Työssä tarkasteltiin myös, miten muutokset mallin käyttäytymistä säätelevissä muuttujissa vaikuttavat tuloksiin. Jotta pystyttäisiin paremmin selvittämään koko kartonkiteollisuuden dynamiikka, lisätutkimusta tarvittaisiin vielä eri kartonkilajien substituutiomahdollisuuksista ja hintojen riippuvuuksista. Mielenkiintoista olisi myös tietää, miten tuotannon käyttöasteiden muutokset ja hinnan vaihtelut vaikuttavat liiketoiminnan kannattavuuteen valmistajien näkökulmasta.

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.

Frequency of and Risk Factors for Depression among Participants in the Swiss HIV Cohort Study (SHCS).

OBJECTIVES: We studied the incidence and prevalence of, and co-factors for depression in the Swiss HIV Cohort Study. METHODS: Depression-specific items were introduced in 2010 and prospectively collected at semiannual cohort visits. Clinical, laboratory and behavioral co-factors of incident depression among participants free of depression at the first two visits in 2010 or thereafter were analyzed with Poisson regression. Cumulative prevalence of depression at the last visit was analyzed with logistic regression. RESULTS: Among 4,422 participants without a history of psychiatric disorders or depression at baseline, 360 developed depression during 9,348 person-years (PY) of follow-up, resulting in an incidence rate of 3.9 per 100 PY (95% confidence interval (CI) 3.5-4.3). Cumulative prevalence of depression during follow-up was recorded for 1,937/6,756 (28.7%) participants. Incidence and cumulative prevalence were higher in injection drug users (IDU) and women. Older age, preserved work ability and higher physical activity were associated with less depression episodes. Mortality (0.96 per 100 PY, 95% CI 0.83-1.11) based upon 193 deaths over 20,102 PY was higher among male IDU (2.34, 1.78-3.09), female IDU (2.33, 1.59-3.39) and white heterosexual men (1.32, 0.94-1.84) compared to white heterosexual women and homosexual men (0.53, 0.29-0.95; and 0.71, 0.55-0.92). Compared to participants free of depression, mortality was slightly elevated among participants with a history of depression (1.17, 0.94-1.45 vs. 0.86, 0.71-1.03, P = 0.033). Suicides (n = 18) did not differ between HIV transmission groups (P = 0.50), but were more frequent among participants with a prior diagnosis of depression (0.18 per 100 PY, 95%CI 0.10-0.31; vs. 0.04, 0.02-0.10; P = 0.003). CONCLUSIONS: Depression is a frequent co-morbidity among HIV-infected persons, and thus an important focus of care.