Development of Paperboard Forming Tools with a Focus on Intelligent Manufacturing

Tämä diplomityö käsittelee kartonginmuovaukseen käytettävien puristintyökalujen kehittämistä. Työntavoitteina oli kehittää työkalutekniikan suunnittelua ja valmistusta edullisemmaksi, nopeammaksi ja työkaluja toiminnoiltaan tehokkaammiksi. Työn tuli sisältää myös ohjeet työkalujen suunnittelemiseksi ja valmistamiseksi jatkoa ajatellen. Työn aikana selvitettiin mahdollisia työkalurakennevaihtoehtoja, valmistusmateriaaleja sekä niiden käsittelymenetelmiä ja lastuamista sekä sen tarjoamia mahdollisuuksia valmistusmenetelmänä. Työkalupari suunniteltiin modulaariseksi siten, että uusia työkaluja varten vain osa komponenteista täytyy valmistaa uudelleen, samalla työkalun osien lukumäärää pienennettiin merkittävästi. Valmistusmateriaaliksi valittiin hyvin lastuttava työkaluteräs ja sen koneistaminen tapahtui vaakakaraisessa koneistuskeskuksessa. Työn loppuvaiheessa työkalukokonaisuudelle tehtiin kustannuslaskelma jaoteltuna eri työvaiheille sekä komponenteittain. Työkalu asennettiin puristimeen ja sille suoritettiin käyttötestaus. Työn aikana karttuneen kokemuksen sekä koekäytön perusteella tehtiin jatkokehitysehdotuksia.

Long-Term Follow-Up of Multilayer Amniotic Membrane Transplantation (MLAMT) for Non-Traumatic Corneal Perforations or Deep Ulcers with Descemetocele.

Background: To evaluate the long-term efficacy of multilayer amniotic membrane transplantation for reconstruction of epithelium and stroma in non-traumatic corneal perforations (less than 2 mm) or deep ulcers with descemetocele.Design: Retrospective, non-comparative, interventional case series.Patients and Methods: Eleven consecutive patients with non-traumatic corneal perforations or deep corneal ulcers with descemetocele refractory to conventional treatments: herpetic or zoster keratitis (n = 4), Sjögren's syndrome (n = 2), rosacea (n = 1), hydrops (n = 1), mucous membrane pemphigoid (n = 1), bacterial keratitis (n = 1) and perforation after protontherapy for melanoma (n = 1). Intervention was: multilayer amniotic membrane transplantation with cryopreserved amniotic membrane. Complication rate and clinical outcome were evaluated in this long-term follow-up.Results: Mean follow-up was 32 months (12 to 60). Integration of the multilayer amniotic membrane was obtained in 10 cases after one year. Corneal epithelium healed above the membrane in 10 cases within 3 weeks and remained stable after 32 months in 9 cases. Thickness of the stroma was increased and remained stable during the follow-up in 9 cases. In one case herpetic keratitis recurred with a corneal perforation. The clearing of the amniotic membrane was gradually obtained over a period of 11 months. Complications occurred in 15 % of the eyes during the long-term follow-up.Conclusion: Multilayer amniotic membrane transplantation is a safe and efficient technique for a long restoration of the corneal integrity after non-traumatic corneal perforations or deep corneal ulcers with descemetocele. Long-term prognosis of these eyes depends of the gravity of the initial disease.

Tuloksellisen suhteen muodostaminen ulkoistavan yrityksen ja palveluntarjoajan välillä

Ulkoistaminen on strateginen työkalu, jonka avulla tehostetaan ja parannetaan toimintaa. Sen avulla pystytään keskittymään omaan ydintoimintaan. Ulkoistamiseen liittyy hyötyjen lisäksi myös riskejä, joita on ennakoitava ja mietittävä etukäteen ennen ulkoistamista. Ulkoistamispäätöstä on katsottava strategisesta näkökulmasta ja sitä, millainen suhde toimittajan kanssahalutaan luoda. Hyvän ulkoistamissuhteen muodostamiseen tarvitaan ensin selvittää syy ulkoistamiselle. Tutkielmassa tarkasteltiin kuinka solmitaan tuloksellinen suhde ulkoistavan yrityksen ja palveluntarjoajan välille teoreettisella tarkastelulla. Teoreettinen viitekehys rakentui ulkoistamisprosessin eri vaiheisiin liittyvien teorioiden tarkastelulla, joiden avulla haettiin vastausta tutkimusongelmaan ja tuomalla esiin asioita, joilla on suuri merkitys suhteen onnistumisen kannalta. Tutkimuksen mukaan ulkoistaminen on suunniteltava ja tehtävä huolellisesti. Ulkoistamisprosessin avulla pystytään projekti jakamaan viiteen vaiheeseen ja jokainen vaihe on tärkeä suhteen onnistumisen kannalta. Sopimuksen allekirjoittamisen jälkeen, on suhdetta johdettava ja hallittava koko ajan. Johtamistapavaatii uudistumista, sillä toimittajan kanssa muodostettu suhde eroaa sisäisen henkilökunnan johtamisesta. Onnistuakseen suhde vaatii sen syvyyden, laajuuden, toimintatapojen ja kommunikoinnin määrittämisen. Hyvä suhde perustuu luottamukseen, avoimuuteen, tasapuolisuuteen, kemiaan ja kommunikointiin osapuolten kesken

Cognition et psychopathologie chez les nonagénaires et centenaires vivant en établisement médico-social gériatrique en Suisse : focalisation sur l'anosognosie = [Cognition and psychopathology in nonagenarians and centenarians living in geriatric nursing homes in Switzerland : a focus on anosognosia]

Les nonagénaires et centenaires voient actuellement leur nombre augmenter considérablement, beaucoup d'entre eux vivant en maison de retraite. Pour cette population, on dispose de très peu de données au sujet de la Symptomatologie psychiatrique et des capacités cognitives autres que mnésiques. Cette étude exploratoire se concentre sur l'anosognosie et ses liens avec les symptômes psychiatriques et cognitifs courants. Cinquante-huit sujets âgés de 90 ans ou plus ont été recrutés dans des établissements médico-sociaux gériatriques et divisés en 5 groupes selon le Mini Mental State Examination (MMSE). Les évaluations incluent le test des 5 mots, le CLOX, les fluences lexicales et catégorielles, le questionnaire d'anosognosie- démence (AQ-D), l'inventaire neuropsychiatrique (NPI) et l'index de comorbidité de Charlson. Les sujets étudiés présentent une atteinte cognitive modérée, le MMSE moyen (±DS) étant à 15.41 ± 7.04. L'anosognosie augmente avec l'atteinte cognitive, étant associée avec tous les domaines cognitifs, mais aussi avec les symptômes psychopathologiques d'apathie et d'agitation. Les sujets ayant une atteinte cognitive légère semblent moins anosognosiques que ceux avec l'atteinte cognitive la plus faible ou ceux ne présentant aucune atteinte. Ni l'anosognosie ni les symptômes psychopathologiques ne sont liés aux comorbidités somatiques. Chez les résidents très âgés étudiés vivant en maison de retraite, l'anosognosie est principalement légère. Elle est associée à des changements cognitifs, mais aussi psychopathologiques. Des investigations supplémentaires sont toutefois nécessaires pour déterminer s'il existe un lien causal entre l'anosognosie et les atteintes psychopathologiques.

Aspects opératoires et péri-opératoires de la stimulation cérébrale profonde [Operative and perioperative aspects of deep brain stimulation].

La stimulation cérébrale profonde (SCP) nécessite l'implantation chirurgicale d'un système comprenant électrodes cérébrales et boîtier(s) de stimulation. Les noyaux cérébraux visés par la méthodologie stéréotaxique d'implantation doivent être visualisés au mieux par une imagerie à haute résolution. La procédure chirurgicale d'implantation des électrodes se fait si possible en anesthésie locale pour faire des mesures électro-physiologiques et tester en peropératoire l'effet de la stimulation, afin d'optimiser la position de l'électrode définitive. Dans un deuxième temps, le ou les générateur(s) d'impulsions sont implantés en anesthésie générale. La SCP pour les mouvements anormaux a une très bonne efficacité et un risque de complications graves faible quoique non nul. Les complications liées au matériel sont les plus fréquentes. Deep brain stimulation (DBS) requires the surgical implantation of a system including brain electrodes and impulsion generator(s). The nuclei targeted by the stereotaxic implantation methodology have to be visualized at best by high resolution imaging. The surgical procedure for implanting the electrodes is performed if possible under local anaesthesia to make electro-physiological measurements and to test intra-operatively the effect of the stimulation, in order to optimize the position of the definitive electrode. In a second step, the impulsion generator(s) are implanted under general anaesthesia. DBS for movement disorders has a very good efficacy and a low albeit non-zero risk of serious complications. Complications related to the material are the most common.

Impact of open-ocean convection on particle fluxes and sediment dynamics in the deep margin of the Gulf of Lions.

Abstract. The deep outer margin of the Gulf of Lions and the adjacent basin, in the western Mediterranean Sea, are regularly impacted by open-ocean convection, a major hydrodynamic event responsible for the ventilation of the deep water in the western Mediterranean Basin. However, the impact of open-ocean convection on the flux and transport of particulate matter remains poorly understood. The variability of water mass properties (i.e., temperature and salinity), currents, and particle fluxes were monitored between September 2007 and April 2009 at five instrumented mooring lines deployed between 2050 and 2350-m depth in the deepest continental margin and adjacent basin. Four of the lines followed a NW-SE transect, while the fifth one was located on a sediment wave field to the west. The results of the main, central line SC2350 ("LION") located at 42 02.50 N, 4 410 E, at 2350-m depth, show that open-ocean convection reached midwater depth ( 1000-m depth) during winter 2007-2008, and reached the seabed ( 2350-m depth) during winter 2008-2009. Horizontal currents were unusually strong with speeds up to 39 cm s−1 during winter 2008-2009. The measurements at all 5 different locations indicate that mid-depth and near-bottom currents and particle fluxes gave relatively consistent values of similar magnitude across the study area except during winter 2008-2009, when near-bottom fluxes abruptly increased by one to two orders of magnitude. Particulate organic carbon contents, which generally vary between 3 and 5 %, were abnormally low ( 1 %) during winter 2008-2009 and approached those observed in surface sediments (0.6 %). Turbidity profiles made in the region demonstrated the existence of a bottom nepheloid layer, several hundred meters thick, and related to the resuspension of bottom sediments. These observations support the view that open-ocean deep convection events in the Gulf of Lions can cause significant remobilization of sediments in the deep outer margin and the basin, with a subsequent alteration of the seabed likely impacting the functioning of the deep-sea ecosystem.

Delayed presentation of deep penetrating trauma to the subaxial cervical spine.

PURPOSE: To present a rare case of deep penetrating neck trauma in which a retained foreign body in the cervical spine (a broken knife blade) resulted in delayed radicular injury. We describe the surgical management using a retrojugular approach. CASE REPORT: Our patient sustained a stab wound to the supraclavicular triangle from a small pocketknife. He was initially managed in a local hospital by simple primary wound closure without any radiological examinations, and was discharged home. The patient re-consulted in a delayed fashion with mild local persistent neck pain. Subsequent radiological investigations revealed a foreign body (the broken blade of a pocket knife) embedded in the left neural foramen between the C6 and C7 vertebrae penetrating the disc space. The blade was lying between the left C7 nerve root and the ipsilateral vertebral artery (VA) at the transition of V1 and V2 segments. Initial neurological evaluation was normal. Some days later, the patient developed a delayed left C7 radicular deficit. We undertook urgent exploration along the wound corridor through a retrojugular, transforaminal approach with successful removal of the blade. DISCUSSION: To our knowledge, this is a unique case where a retained foreign body penetrated the soft tissues of the neck, embedding deep in the vertebral column without vascular, aerodigestive or significant primary neurological injury, while causing delayed neck pain and delayed onset radicular injury. We describe our surgical management for removal of the retained blade. The retrojugular approach gives excellent access to all of the important anatomical structures of the neck from an anterolateral approach.

Bilateral deep brain stimulation: the placement of the second electrode is not necessarily less accurate than that of the first one.

BACKGROUND: Deep brain stimulation (DBS) is recognized as an effective treatment for movement disorders. We recently changed our technique, limiting the number of brain penetrations to three per side. OBJECTIVES: The first aim was to evaluate the electrode precision on both sides of surgery since we implemented this surgical technique. The second aim was to analyse whether or not the electrode placement was improved with microrecording and macrostimulation. METHODS: We retrospectively reviewed operation protocols and MRIs of 30 patients who underwent bilateral DBS. For microrecording and macrostimulation, we used three parallel channels of the 'Ben Gun' centred on the MRI-planned target. Pre- and post-operative MRIs were merged. The distance between the planned target and the centre of the implanted electrode artefact was measured. RESULTS: There was no significant difference in targeting precision on both sides of surgery. There was more intra-operative adjustment of the second electrode positioning based on microrecording and macrostimulation, which allowed to significantly approach the MRI-planned target on the medial-lateral axis. CONCLUSION: There was more electrode adjustment needed on the second side, possibly in relation with brain shift. We thus suggest performing a single central track with electrophysiological and clinical assessment, with multidirectional exploration on demand for suboptimal clinical responses.

Cardiovascular disease and the changing face of global public health : a focus on low and middle income countries

Eighty percent of the global 17 million deaths due to cardiovascular disease (CVD) occur in low and middle income countries (LMICs). The burden of CVD and other noncommunicable diseases (NCDs) is expected to markedly increase because of the global aging of the population and increasing exposure to detrimental lifestyle-related risk in LMICs. Interventions to reduce four main risks related to modifiable behaviors (tobacco use, unhealthy diet, low physical activity and excess alcohol consumption) are key elements for effective primary prevention of the four main NCDs (CVD, cancer, diabetes and chronic pulmonary disease). These behaviors are best improved through structural interventions (e.g., clean air policy, taxes on cigarettes, new recipes for processed foods with reduced salt and fat, urban shaping to improve mobility, etc.). In addition, health systems in LMICs should be reoriented to deliver integrated cost-effective treatment to persons at high risk at the primary health care level. The full implementation of a small number of highly cost effective, affordable and scalable interventions ("best buys") is likely to be the necessary and sufficient ingredient for curbing NCDs in LMICs. NCDs are both a cause and a consequence of poverty. It is therefore important to frame NCD prevention and control within the broader context of social determinants and development agenda. The recent emphasis on NCDs at a number of health and economic forums (including the September 2011 High Level Meeting on NCDs at the United Nations) provides a new opportunity to move the NCD agenda forward in LMICs.

Ultra-Deep Pyrosequencing Detects Conserved Genomic Sites and Quantifies Linkage of Drug-Resistant Amino Acid Changes in the Hepatitis B Virus Genome

Selection of amino acid substitutions associated with resistance to nucleos(t)ide-analog (NA) therapy in the hepatitis B virus (HBV) reverse transcriptase (RT) and their combination in a single viral genome complicates treatment of chronic HBV infection and may affect the overlapping surface coding region. In this study, the variability of an overlapping polymerase-surface region, critical for NA resistance, is investigated before treatment and under antiviral therapy, with assessment of NA-resistant amino acid changes simultaneously occurring in the same genome (linkage analysis) and their influence on the surface coding region.

Climate change impacts on lakes: an integrated ecological perspective based on a multi-faceted approach, with special focus on shallow lakes

Freshwater ecosystems and their biodiversity are presently seriously threatened by global development and population growth, leading to increases in nutrient inputs and intensification of eutrophication-induced problems in receiving fresh waters, particularly in lakes. Climate change constitutes another threat exacerbating the symptoms of eutrophication and species migration and loss. Unequivocal evidence of climate change impacts is still highly fragmented despite the intensive research, in part due to the variety and uncertainty of climate models and underlying emission scenarios but also due to the different approaches applied to study its effects. We first describe the strengths and weaknesses of the multi-faceted approaches that are presently available for elucidating the effects of climate change in lakes, including space-for-time substitution, time series, experiments, palaeoecology and modelling. Reviewing combined results from studies based on the various approaches, we describe the likely effects of climate changes on biological communities, trophic dynamics and the ecological state of lakes. We further discuss potential mitigation and adaptation measures to counteract the effects of climate change on lakes and, finally, we highlight some of the future challenges that we face to improve our capacity for successful prediction.

Deep radio images of the HEGRA and Whipple TeV sources in the Cygnus OB2 region.

The modern generation of Cherenkov telescopes has revealed a new population of gamma-ray sources in the Galaxy. Some of them have been identified with previously known X-ray binary systems while other remain without clear counterparts a lower energies. Our initial goal here was reporting on extensive radio observations of the first extended and yet unidentified source, namely TeV J2032+4130. This object was originally detected by the HEGRA telescope in the direction of the Cygnus OB2 region and its nature has been a matter of debate during the latest years. The situation has become more complex with the Whipple and MILAGRO telescopes new TeV detections in the same field which could be consistent with the historic HEGRA source, although a different origin cannot be ruled out. Aims.We aim to pursue our radio exploration of the TeV J2032+4130 position that we initiated in a previous paper but taking now into account the latest results from new Whipple and MILAGRO TeV telescopes. The data presented here are an extended follow up of our previous work. Methods.Our investigation is mostly based on interferometric radio observations with the Giant Metre Wave Radio Telescope (GMRT) close to Pune (India) and the Very Large Array (VLA) in New Mexico (USA). We also conducted near infrared observations with the 3.5 m telescope and the OMEGA2000 camera at the Centro Astronómico Hispano Alemán (CAHA) in Almería (Spain). Results.We present deep radio maps centered on the TeV J2032+4130 position at different wavelengths. In particular, our 49 and 20 cm maps cover a field of view larger than half a degree that fully includes the Whipple position and the peak of MILAGRO emission. Our most important result here is a catalogue of 153 radio sources detected at 49 cm within the GMRT antennae primary beam with a full width half maximum (FWHM) of 43 arc-minute. Among them, peculiar sources inside the Whipple error ellipse are discussed in detail, including a likely double-double radio galaxy and a one-sided jet source of possible blazar nature. This last object adds another alternative counterpart possibility to be considered for both the HEGRA, Whipple and MILAGRO emission. Moreover, our multi-configuration VLA images reveal the non-thermal extended emission previously reported by us with improved angular resolution. Its non-thermal spectral index is also confirmed thanks to matching beam observations at the 20 and 6 cm wavelengths.