Patient-ventilator asynchrony during noninvasive pressure support ventilation and neurally adjusted ventilatory assist in infants and children.

OBJECTIVES: To document the prevalence of asynchrony events during noninvasive ventilation in pressure support in infants and in children and to compare the results with neurally adjusted ventilatory assist. DESIGN: Prospective randomized cross-over study in children undergoing noninvasive ventilation. SETTING: The study was performed in a PICU. PATIENTS: From 4 weeks to 5 years. INTERVENTIONS: Two consecutive ventilation periods (pressure support and neurally adjusted ventilatory assist) were applied in random order. During pressure support (PS), three levels of expiratory trigger (ETS) setting were compared: initial ETS (PSinit), and ETS value decreased and increased by 15%. Of the three sessions, the period allowing for the lowest number of asynchrony events was defined as PSbest. Neurally adjusted ventilator assist level was adjusted to match the maximum airway pressure during PSinit. Positive end-expiratory pressure was the same during pressure support and neurally adjusted ventilator assist. Asynchrony events, trigger delay, and cycling-off delay were quantified for each period. RESULTS: Six infants and children were studied. Trigger delay was lower with neurally adjusted ventilator assist versus PSinit and PSbest (61 ms [56-79] vs 149 ms [134-180] and 146 ms [101-162]; p = 0.001 and 0.02, respectively). Inspiratory time in excess showed a trend to be shorter during pressure support versus neurally adjusted ventilator assist. Main asynchrony events during PSinit were autotriggering (4.8/min [1.7-12]), ineffective efforts (9.9/min [1.7-18]), and premature cycling (6.3/min [3.2-18.7]). Premature cycling (3.4/min [1.1-7.7]) was less frequent during PSbest versus PSinit (p = 0.059). The asynchrony index was significantly lower during PSbest versus PSinit (40% [28-65] vs 65.5% [42-76], p < 0.001). With neurally adjusted ventilator assist, all types of asynchronies except double triggering were reduced. The asynchrony index was lower with neurally adjusted ventilator assist (2.3% [0.7-5] vs PSinit and PSbest, p < 0.05 for both comparisons). CONCLUSION: Asynchrony events are frequent during noninvasive ventilation with pressure support in infants and in children despite adjusting the cycling-off criterion. Compared with pressure support, neurally adjusted ventilator assist allows improving patient-ventilator synchrony by reducing trigger delay and the number of asynchrony events. Further studies should determine the clinical impact of these findings.

Cross-Border Innovation Support Platform for the SMEs: The Case of St. Petersburg Corridor Region

Työssä tutkitaan eri mekanismeja rajojen ylittävään innovaatioiden edistämiseen pienten ja keskisuurten yritysten näkökulmasta. Case ympäristönä on Kaakkois-Suomen ja Luoteis-Venäjän alueeli Pietarin Corridor. Tavoitteena on löytää tarkemmat määritykset ja rajauksetnäille mekanismeille. Teoriassa muodostettiin viitekehys rajojen ylittävälle innovaatioiden edistämismallille. Mallin pohjalta toteutettiinhaastattelututkimus, joka suoritettiin case-ympäristössä. Haastattelujoukko koostui yritysten edustajista, tutkimus-henkilöstöstä sekä julkisista toimijoista. Innovaatiojärjestelmä oli avoin uusille toimintamenetelmille.Menetelmien toteuttamistapa kuitenkin jakoi mielipiteitä. Toimijoiden välille tarvitaan parempaa yhteistyötä ja tämän kautta selkeämpää kommunikointia yritysten suuntaan. Innovaatioiden edistämiseen ehdotetaan Innovation Relay Centre tyyppisen toiminnan laajentamista Corridorin alueelle sekä sen käyttämän teknologioiden välittämismallin sekä kansainvälisen verkoston hyödyntämistä. Edistämisen tukena tulisi käyttää innovaatiotietokanta-työkalua.

A support system for evaluating a suitable joining method in the production of sheet metal goods

This report illustrates a comparative study of various joining methods involved in sheet metal production. In this report it shows the selection of joining methods, which includes comparing the advantages and disadvantages of a method over the other ones and choosing the best method for joining. On the basis of various joining process from references, a table is generated containing set of criterion that helps in evaluation of various sheet metal joining processes and in selecting the most suitable process for a particular product. Three products are selected and a comprehensive study of the joining methods is analyzed with the help of various parameters. The table thus is the main part of the analysis process of this study and can be advanced with the beneficial results. It helps in a better and easy understanding and comparing the various methods, which provides the foundation of this study and analysis. The suitability of the joining method for various types of cases of different sheet metal products can be tested with the help of this table. The sections of the created table display the requirements of manufacturing. The important factor has been considered and given focus in the table, as how the usage of these parameters is important in percentages according to particular or individual case. The analysis of the methods can be extended or altered by changing the parameters according to the constraint. The use of this table is demonstrated by pertaining the cases from sheet metal production.

Simulation of stromatolite growth using diffusion-limited aggregation and a discrete model of biogeochemical exchanges in microbial mat

Resume : Mieux comprendre les stromatolithes et les tapis microbiens est un sujet important en biogéosciences puisque cela aide à l'étude des premières formes de vie sur Terre, a mieux cerner l'écologie des communautés microbiennes et la contribution des microorganismes a la biominéralisation, et même à poser certains fondements dans les recherches en exobiologie. D'autre part, la modélisation est un outil puissant utilisé dans les sciences naturelles pour appréhender différents phénomènes de façon théorique. Les modèles sont généralement construits sur un système d'équations différentielles et les résultats sont obtenus en résolvant ce système. Les logiciels disponibles pour implémenter les modèles incluent les logiciels mathématiques et les logiciels généraux de simulation. L'objectif principal de cette thèse est de développer des modèles et des logiciels pour aider a comprendre, via la simulation, le fonctionnement des stromatolithes et des tapis microbiens. Ces logiciels ont été développés en C++ en ne partant d'aucun pré-requis de façon a privilégier performance et flexibilité maximales. Cette démarche permet de construire des modèles bien plus spécifiques et plus appropriés aux phénomènes a modéliser. Premièrement, nous avons étudié la croissance et la morphologie des stromatolithes. Nous avons construit un modèle tridimensionnel fondé sur l'agrégation par diffusion limitée. Le modèle a été implémenté en deux applications C++: un moteur de simulation capable d'exécuter un batch de simulations et de produire des fichiers de résultats, et un outil de visualisation qui permet d'analyser les résultats en trois dimensions. Après avoir vérifié que ce modèle peut en effet reproduire la croissance et la morphologie de plusieurs types de stromatolithes, nous avons introduit un processus de sédimentation comme facteur externe. Ceci nous a mené a des résultats intéressants, et permis de soutenir l'hypothèse que la morphologie des stromatolithes pourrait être le résultat de facteurs externes autant que de facteurs internes. Ceci est important car la classification des stromatolithes est généralement fondée sur leur morphologie, imposant que la forme d'un stromatolithe est dépendante de facteurs internes uniquement (c'est-à-dire les tapis microbiens). Les résultats avancés dans ce mémoire contredisent donc ces assertions communément admises. Ensuite, nous avons décidé de mener des recherches plus en profondeur sur les aspects fonctionnels des tapis microbiens. Nous avons construit un modèle bidimensionnel de réaction-diffusion fondé sur la simulation discrète. Ce modèle a été implémenté dans une application C++ qui permet de paramétrer et exécuter des simulations. Nous avons ensuite pu comparer les résultats de simulation avec des données du monde réel et vérifier que le modèle peut en effet imiter le comportement de certains tapis microbiens. Ainsi, nous avons pu émettre et vérifier des hypothèses sur le fonctionnement de certains tapis microbiens pour nous aider à mieux en comprendre certains aspects, comme la dynamique des éléments, en particulier le soufre et l'oxygène. En conclusion, ce travail a abouti à l'écriture de logiciels dédiés à la simulation de tapis microbiens d'un point de vue tant morphologique que fonctionnel, suivant deux approches différentes, l'une holistique, l'autre plus analytique. Ces logiciels sont gratuits et diffusés sous licence GPL (General Public License). Abstract : Better understanding of stromatolites and microbial mats is an important topic in biogeosciences as it helps studying the early forms of life on Earth, provides clues re- garding the ecology of microbial ecosystems and their contribution to biomineralization, and gives basis to a new science, exobiology. On the other hand, modelling is a powerful tool used in natural sciences for the theoretical approach of various phenomena. Models are usually built on a system of differential equations and results are obtained by solving that system. Available software to implement models includes mathematical solvers and general simulation software. The main objective of this thesis is to develop models and software able to help to understand the functioning of stromatolites and microbial mats. Software was developed in C++ from scratch for maximum performance and flexibility. This allows to build models much more specific to a phenomenon rather than general software. First, we studied stromatolite growth and morphology. We built a three-dimensional model based on diffusion-limited aggregation. The model was implemented in two C++ applications: a simulator engine, which can run a batch of simulations and produce result files, and a Visualization tool, which allows results to be analysed in three dimensions. After verifying that our model can indeed reproduce the growth and morphology of several types of stromatolites, we introduced a sedimentation process as an external factor. This lead to interesting results, and allowed to emit the hypothesis that stromatolite morphology may be the result of external factors as much as internal factors. This is important as stromatolite classification is usually based on their morphology, imposing that a stromatolite shape is dependant on internal factors only (i.e. the microbial mat). This statement is contradicted by our findings, Second, we decided to investigate deeper the functioning of microbial mats, We built a two-dimensional reaction-diffusion model based on discrete simulation, The model was implemented in a C++ application that allows setting and running simulations. We could then compare simulation results with real world data and verify that our model can indeed mimic the behaviour of some microbial mats. Thus, we have proposed and verified hypotheses regarding microbial mats functioning in order to help to better understand them, e.g. the cycle of some elements such as oxygen or sulfur. ln conclusion, this PhD provides a simulation software, dealing with two different approaches. This software is free and available under a GPL licence.

Special commentary : a call for intensive metabolic support.

PURPOSE OF REVIEW: This special commentary addresses recent clinical reviews regarding appropriate nutrition and metabolic support in the critical care setting. RECENT FINDINGS: There are divergent approaches between North America and Europe for the use of early nutrition support and combined enteral nutrition and parenteral nutrition support possibly due to the commercial availability of specific parenteral nutrients. The advent of intensive insulin therapy has changed the landscape of metabolic support in the intensive care unit, and previous notions about infective risk of parenteral nutrition will need to be re-addressed. Patients with brain failure may benefit from an intensive insulin therapy with a blood glucose target that is higher than that used in patients without brain failure. Patients with heart failure may benefit from the addition of nutritional pharmacology that targets proximate oxidative pathophysiological pathways. Intradialytic parenteral nutrition may be viewed as another form of supplemental parenteral nutrition when enteral nutrition is insufficient in patients on hemodialysis in the intensive care unit. SUMMARY: It is proposed that intensive metabolic support be routinely implemented in the intensive care unit based on the following steps: intensive insulin therapy with an appropriate blood glucose target, nutrition risk assessment, early and if needed combined enteral nutrition and parenteral nutrition to target 20-25 kcal/kg/day and 1.2-1.5 g protein/kg/day, and nutritional and metabolic monitoring.

Task Support in Scenario Process: Case LUT 2016

This thesis attempts to find whether scenario planning supports the organizational strategy as a method for addressing uncertainty. The main issues are why, what and how scenario planning fits in organizational strategy and how the process could be supported to make it more effective. The study follows the constructive approach. It starts with examination of competitive advantage and the way that an organization develops strategy and how it addresses the uncertainty in its operational environment. Based on the conducted literature review, scenario methods would seem to provide versatile platform for addressing future uncertainties. The construction is formed by examining the scenario methods and presenting suitable support methods, which results in forming of the theoretical proposition for supporter scenario process. The theoretical framework is tested in laboratory conditions, and the results from the test sessions are used a basis for scenario stories. The process of forming the scenarios and the results are illustrated and presented for scrutiny

Investigation of discrete imaging models and iterative image reconstruction in differential X-ray phase-contrast tomography.

Differential X-ray phase-contrast tomography (DPCT) refers to a class of promising methods for reconstructing the X-ray refractive index distribution of materials that present weak X-ray absorption contrast. The tomographic projection data in DPCT, from which an estimate of the refractive index distribution is reconstructed, correspond to one-dimensional (1D) derivatives of the two-dimensional (2D) Radon transform of the refractive index distribution. There is an important need for the development of iterative image reconstruction methods for DPCT that can yield useful images from few-view projection data, thereby mitigating the long data-acquisition times and large radiation doses associated with use of analytic reconstruction methods. In this work, we analyze the numerical and statistical properties of two classes of discrete imaging models that form the basis for iterative image reconstruction in DPCT. We also investigate the use of one of the models with a modern image reconstruction algorithm for performing few-view image reconstruction of a tissue specimen.

Troubleshooting in extracorporeal life support.

Since the first clinical use of extracorporeal circulation in the last century [1] by John Gibbon and the first successful mechanical support of the left ventricular function by Forest Dodrill [2], the progress of techniques and technologies has helped to develop minimised systems for extracorporeal circulatory and respiratory support. However, the fact is that, despite the advanced technologies used for extracorporeal support, successful application in order to be benefit a critically ill population requires highly trained and skilled teams. Application of these highly sophisticated techniques in life-saving situations inside and/or outside the operating room is a procedure with certain pitfalls and dangers. The aim of this review is to provide a short overview of the technical aspects of extracorporeal circulation, with a look at the recent literature and clinical experiences focusing on technical as well surgical considerations regarding the urgent and/or emergent usage of a central as well as peripheral extracorporeal system.

The power of support: an exploration of the mentoring relationship

Tutkimuksen pääasiallisena tavoitteena on selvittää ne moninaiset näkökulmat, joita mentori sekä mentoroitava läpikäyvät osallistuessaan mentorointiohjelmaan. Tutkimuksen avulla pyritään myös selvittämään vastaavanlaisen tuen saannin tehokkuutta sekä mentoroinnin sisältäminen elementtien hyödyllisyyttä. Pyrkimyksenä on myös selvittää sekä ymmärtää ne dynaamiset mentorointiprosessin ominaisuudet molempien prosessiin osallistuvien tahojen näkökulmasta. Tutkimuksen teoriaosuudessa käsitellään mentorointia, mentorointiin liittyviä vuorovaikutussuhteita sekä näihin liittyviä eri näkökulmia. Teoria koostuu monipuolisesta, kansainvälisestä sekä kotimaisesta kirjallisuudesta. Tutkimuksen aineiston keruu suoritetaan puolistrukturoiduilla avoimilla haastatteluilla, jotka suoritetaan järjestämällä kahdenkeskisiä teemahaastatteluita. Mentorointisuhteella on todettu olevan voimakas vaikutus siihen osallistuvien henkilöiden elämään. Mentorointisuhteen tarkoituksellisuus on tullut todettua myös kun itse vuorovaikutussuhde on osoittautunut hyödylliseksi osallistujille. Mentoroitavilla on odotuksia, että mentorit täyttävät seuraavanlaisia rooleja: neuvonantaja, roolimalli sekä mahdollisesti tukea antava ystävä. Kaikissa läpikäydyissä tapauksissa mentori pystyi tarjoamaan jonkun näistärooleista mentoroitavalle. Mentoroitava, puolestaan, otti tämän tuen vastaan jahyötyi siitä.

Improving globally distributed software development and support processes - A workflow view

We propose a new approach and related indicators for globally distributed software support and development based on a 3-year process improvement project in a globally distributed engineering company. The company develops, delivers and supports a complex software system with tailored hardware components and unique end-customer installations. By applying the domain knowledge from operations management on lead time reduction and its multiple benefits to process performance, the workflows of globally distributed software development and multitier support processes were measured and monitored throughout the company. The results show that the global end-to-end process visibility and centrally managed reporting at all levels of the organization catalyzed a change process toward significantly better performance. Due to the new performance indicators based on lead times and their variation with fixed control procedures, the case company was able to report faster bug-fixing cycle times, improved response times and generally better customer satisfaction in its global operations. In all, lead times to implement new features and to respond to customer issues and requests were reduced by 50%.

Value added logistical support service. Part 1 : Trends and new concept model

The aim of `Valssi' study was to find out the service requirements in `business-to-business' (B2B) markets and to present a new logistics service concept, where the traditional logistics service is expanded with significant manufacturing and value addedfacilities. The traditional third-party logistics service providers are not necessarily able to offer services, which cover widely the needs of potential customers. The study has been outlined to spare part markets in metal industry. In the second phase of the Valssi-project the aim is to examine the economical conditions and potentiality of the new logistics business concept. This research report (Part 1) concentrates on examining current trends in global and domestic logistics markets. Based on detailed survey among the participating companies, the study presents basis for a new logistics business concept model. The developed concept consists of 12 different service modules, which are split into deeper details of processes. The integration of worldwide supplier and service provider network together with customer companies systems is a challenge. The report focuses on evaluating the requirements for the new business concept from the customer-companies point of view. The study paints an overall picture of distribution and service provider network including an abstract about the software and system integration possibilities. As a result of the survey, it can be concluded that thereis need for the new business concept among the participating companies, and a modular service concept meets the requirements of them, because the new sophisticated concept considers the specialities involved in spare part logistics in metal industry.

Developing Support for Scenario Process: A Scenario Study on Lappeenranta University of Technology from 2006 to 2016

Epävarmuus ei ole outoa enää julkishallinon alueellakaan. Globalisaation,tietotalous ja muut yksityissektoria ravistelleet ilmiöt ovat lisänneet mielenkiintoa erilaisiin tekniikoihin joilla voidaan lievittää epävarmuudesta aiheutuvia ongelmia. Tämä raportti kuvailee skenaariosuunnittelun käyttöä eräänä mahdollisuutena epävarmuuden hallintaan julkishallinnossa ja yksityissektorilla. Raportti sijoittuu samaan skenaariotutkimuksen jatkumoon edellisten LTY:ssä toteutettujen skenaariotutkimusten kanssa. tutkimus valottaa tutkimuksen ja käytännön työn nykytilaa helposti hyödynnettävässä muodossa. Rapostin kontribuutio on kuvata tutkimukseen perustuva tuettu skenaarioprosessi ja syntyneet skenaariot, keskittyen prosessin tukemiseen eri menetelmin.

Value added logistical support service: logistiikan palveluiden tarjoajat Suomessa. osa 4

Tämä osatutkimus on VALSSI- tutkimusprojektin (Value Added Logistical Support Service) neljäs osavaihe. VALSSI- tutkimuksen tarkoituksena on ollut selvittää logistiikkapalveluiden vaatimuksia business-to-business (B2B) ympäristössä ja määrittää logistiikkapalveluiden palvelukonsepti, jossa perinteiset logistiikkapalvelut on laajennettu tuotannollisilla ja lisäarvoa tuottavilla palveluilla. Tutkimuksen tarkoituksena on ollut tuottaa ulkoistamista helpottavaa materiaalia erityisesti varastoinnin ja kuljetusten osalta. Edellisistä osavaiheista on saatavilla tutkimusraportit yliopiston Internet-sivuilta(www.lut.fi/tutkimus/valore). Tämän tutkimuksen tarkoituksena oli kartoittaa Suomessa toimivien logistiikkapalveluyritysten palvelutarjonta. Tutkimus on keskittynyt palveluntarjoajiin, jotka tarjoavat erikoistunutta logistiikkaa (mm. tuotannollisia palveluita, hankintoja ja pakkauspalveluita) asiakkailleen. Tutkimukseen osallistuneet yritykset olivat suomalaisia ja kansainvälisiä sekä kuljetuspalveluita tarjoavia että logistiikkapalveluyrityksiä sekä alihankkijoina/tukkureina toimivia palveluntarjoajia. Huomionarvoista onkin, että moni yrityksistä käytti markkinoilta saatavia kuljetuspalveluita eikä toiminut itse kuljetusoperaattorina. Logistiikkapalveluyrityksissä huomattiin eroavaisuuksia asiakaspalvelun laajuudessa, ICT strategioissa, hankintojen ja kotiinkutsujen organisoinnissa, tuotannollisissa palveluissa sekä paluulogistiikassa. Varsinaiset varastointipalvelut ovat homogeenisia ja varastointiin liittyvät pakkaamispalvelut ovat pääasiassasamankaltaisia. Markkinoilla toimivien tukkukauppiaiden logistiikkaprosessit eroavat perinteisistä palveluntarjoajista. Tukkurit hoitavat laajasti mm. asiakaspalvelua, teknistä tukea sekä erikoistuneita tuotannollisia palveluita. Nykypäivänä asiakkaat asettavat enemmän vaatimuksia logistiikkapalveluyrityksen prosesseille ja prosessien johtamiselle. Tulevaisuudessa Suomessa ja maailmalla toimivat logistiikkapalveluyritykset tulevat toimimaan yhteistyöverkoissa Itä- Euroopan maat ovat entistä suuremmassa roolissa uusia jakelukanavia ja palveluita mietittäessä. Jo nyt on huomattavissa, että asiakkaat vaativat logistiikan palvelutarjoajia tarjoamaan entistä monipuolisempia ja tuotteistetumpia palveluita.