Self Instructional Math, HR-324, 1995

The Self Instructional Math course book is designed to provide a basic math knowledge for those involved in the planning, design, and construction of highways. It was developed in a manner to allow the student to take the course with minimal supervision and at times that the work schedule allows. The first version of the course was developed in the early 1970's and due to its popularity was revised in the early 1990's to reflect changes in the highway construction math needs. The anticipated move to metric (System International) measurements by the highway industry has necessitated the need to change the math course problem values to metric units. The course includes the latest in Iowa DOT policy information relative to the selection and use of metric values for highway design, and construction. Each unit of the book contains instructional information, section quizzes and a comprehensive examination. All problem values are expressed in metric rather than dual (english and SI) units. The appendix contains useful conversion factors to assist the reader in making the change to metric.

Tuomioistuinten valvonnan kehityksestä ja nykytilasta

English summary: Development and current status of the supervision of courts (s.1278)

Religious coping in schizophrenia patients : spiritual support in medical care and pastoral counselling

Following an introduction focusing on the role of religion in the treatment of psychosis, the first part of this paper describes an initial study in which the role of spirituality and religiosity was assessed in 115 patients with schizophrenia in Geneva (Switzerland) and 126 in Trois-Rivières (Quebec). These themes have been shown to be highly prevalent for these patients, though their clinicians are often unaware of this prevalence. The following part of the paper presents a second study where religious supervision was offered to clinicians in Geneva. Comparison between forty patients who received spiritual assessment and opportunities to work on religious topics with their clinicians was made with thirty patients without religious intervention. In the supervisory sessions, six different types of religious interventions were suggested. Outcomes at three months show that patients of the intervention group maintain their interest for help in religious matters while clinicians' interest in integrating religious topics in discussions with their patients has decreased. The third and main part of the paper is devoted to an analysis of the suggested interventions from the viewpoint of the study of religions. Five aspects of religion are distinguished, and explanations of the reasons some of them are easier to manage for clinicians are proposed. The paper concludes with proposals for the education of clinicians to help them to differentiate different kinds of religious coping and to recognize when it could be helpful to refer the patient to a pastoral counsellor.

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial

Background Depression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence. Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression. Design A therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions). Method Participants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder, with a score of 19 or above on the Beck depression inventory, second edition (BDI-II) and presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct) as assessed using the RGT. The BDI-II is the primary outcome measure, collected at baseline, at the end of therapy, and at 3- and 12-month follow-up; other secondary measures are also used. Discussion We expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression, thus resulting in a significant contribution to the psychological treatment of depression. Trial registration ISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

Speaking from the Inside: Challenges Faced by Communication Researchers Investigating Disease-Related Issues in a Hospital Setting.

This commentary came from within the framework of integrating the humanities in medicine and from accompanying research on disease-related issues by teams involving clinicians and researchers in medical humanities. The purpose is to reflect on the challenges faced by researchers when conducting emotionally laden research and on how they impact observations and subsequent research findings. This commentary is furthermore a call to action since it promotes the institutionalization of a supportive context for medical humanities researchers who have not been trained to cope with sensitive medical topics in research. To that end, concrete recommendations regarding training and supervision were formulated.

Effect of intradialytic resistance band exercise on physical function in patients on maintenance hemodialysis: a pilot study.

Although physical activity is recommended in patients on maintenance hemodialysis (MHD), randomized controlled trials testing the effects of exercise in this population have given conflicting results. In general, aerobic exercises mostly failed to produce improvements in physical function, whereas resistance exercises, although less studied, appeared to be more promising. The use of sophisticated materials such as leg press and free weights may preclude widespread application of resistance training in patients on MHD. Simple and cheap elastic bands may thus be an attractive alternative. We tested the feasibility of a supervised intradialytic resistance band exercise training program, and its effects on physical function, in patients on MHD. A total of 11 unselected adult patients on MHD from our center, aged 70 ± 10.7 (mean ± standard deviation) years, including 8 men and 3 women, accepted to follow the program under the supervision of qualified physiotherapists. Thirty-six exercise sessions of moderate intensity (twice a week, mean duration 40 minutes each, during 4.5 to 6 months), mainly involving leg muscles against an elastic resistance, were performed. The exercise program was well tolerated and all patients completed it. Statistically significant improvements were observed in the following tests: Tinetti test, 23.9 ± 3.9 points before versus 25.7 ± 3.5 points after the program (P = .022); the Timed Up and Go test, 12.1 ± 6.6 versus 10 ± 5.8 seconds (P = .0156). Improvements in the 6-minute walk distance and in the one-leg balance tests just failed to reach statistical significance. In this single-center pilot study, an intradialytic resistance band exercise program was feasible, well tolerated, and showed encouraging results on physical function.

Online teaching of inflammatory skin pathology by a French-speaking International University Network.

INTRODUCTION: Developments in technology, web-based teaching and whole slide imaging have broadened the teaching horizon in anatomic pathology. Creating online learning material including many types of media such as radiologic images, whole slides, videos, clinical and macroscopic photographs, is now accessible to most universities. Unfortunately, a major limiting factor to maintain and update the learning material is the amount of resources needed. In this perspective, a French-national university network was initiated in 2011 to build joint online teaching modules consisting of clinical cases and tests. The network has since expanded internationally to Québec, Switzerland and Ivory Coast. METHOD: One of the first steps of the project was to build a learning module on inflammatory skin pathology for interns and residents in pathology and dermatology. A pathology resident from Québec spent 6 weeks in France and Switzerland to develop the contents and build the module on an e-learning Moodle platform under the supervision of two dermatopathologists. The learning module contains text, interactive clinical cases, tests with feedback, virtual slides, images and clinical photographs. For that module, the virtual slides are decentralized in 2 universities (Bordeaux and Paris 7). Each university is responsible of its own slide scanning, image storage and online display with virtual slide viewers. RESULTS: The module on inflammatory skin pathology includes more than 50 web pages with French original content, tests and clinical cases, links to over 45 virtual images and more than 50 microscopic and clinical photographs. The whole learning module is being revised by four dermatopathologists and two senior pathologists. It will be accessible to interns and residents in the spring of 2014. The experience and knowledge gained from that work will be transferred to the next international resident whose work will be aimed at creating lung and breast pathology learning modules. CONCLUSION: The challenges of sustaining a project of this scope are numerous. The technical aspect of whole-slide imaging and storage needs to be developed by each university or group. The content needs to be regularly updated and its accuracy reviewed by experts in each individual domain. The learning modules also need to be promoted within the academic community to ensure maximal benefit for trainees. A collateral benefit of the project was the establishment of international partnerships between French-speaking universities and pathologists with the common goal of promoting pathology education through the use of multi-media technology including whole slide imaging.

Psychiatrie [Psychiatry].

The novelties in clinical psychiatry are close to somatic medicine adaptation. The clinical staging concept in psychiatry (as in cancerology) is the result of an early intervention strategy in psychotic disorders. A differentiated mode of understanding of the phases of psychiatric disorders allows a prevention oriented approach. Individualized therapeutic programmes in accordance with specific problematics favors the orientation towards focalised follow-ups, for instance CBT programmes on Internet may be proposed to patients motivated and rather autonomous. Others, on the contrary, less accessible to health care should benefit of the support of a mobile team and specific coaching to return to vocational services. Systematic follow-up of the metabolic syndrome, often induced by atypical antipsychotics, belongs to those basic adjustment processes.

Naistutkijaksiko tiedemaailmassa? - ohjauksen jännitteitä

Summary: Becoming a female researcher - tension points in graduate study supervision

Vuorovaikutusilmiöt työnohjauksessa

Summary: Interaction in Supervision

The impact of information on patient preferences in different delivery patterns: a contingent valuation study of prescription versus OTC drugs.

OBJECTIVES: Our analysis assessed the impact of information on patients' preferences in prescription versus over-the-counter (OTC) delivery systems. METHODS: A contingent valuation (CV) study was implemented, randomly assigning 534 lay people into the receipt of limited or extended information concerning new influenza drugs. In each information arm, people answered two questions: the first asked about willingness to pay (WTP) for the new prescription drug; the second asked about WTP for the same drug sold OTC. RESULTS: We show that WTP is higher for the OTC scenario and that the level of information plays a significant role in the evaluation of the OTC scenario, with more information being associated with an increase in the WTP. In contrast, the level of information provided has no impact on WTP for prescription medicine. Thus, for the kind of drug considered here (i.e. safe, not requiring medical supervision), a switch to OTC status can be expected to be all the more beneficial, as the patient is provided with more information concerning the capability of the drug. CONCLUSIONS: Our results shed light on one of the most challenging issues that health policy makers are currently faced with, namely the threat of a bird flu pandemic. Drug delivery is a critical component of pandemic influenza preparedness. Furthermore, the congruence of our results with the agency and demand theories provides an important test of the validity of using WTP based on CV methods.

Kuparituotetehtaan tuoterakenteen ja logistisen tehokkuuden kehittäminen

Tässä tutkimuksessa on keskitytty tutkimaan kuparituotetehtaan tuoterakennetta ja tilausten kohdistumispisteitä sekä esittämäänparannusehdotuksia näiden suhteen. Valssaamon prosessivarasto on kokenut huomattavan pienennyksen ja tavoitteena on, että tästä huolimatta tuotantoa pystyttäisiin ohjaamaan vähemmin resurssein, materiaalipulasta kärsimättä ja nopeammin läpimenoajoin. Lisäksi työssä esitetään muita tuotantoprosessiin liittyviä kehitysehdotuksia, jotka tukevat tuotannon virtaviivaistamista ja varastosaldojen vähentämistä. Teoriaosuudessa selitetään Lean-tuotannon toimivuuttavalssaamon kaltaisessa toimintaympäristössä. Teoriaosuudessa on käsitelty Lean-tuotannon lisäksi myös Agile- ja Leagile-teorioita, koska myös näiden teorioidenyhteensopivuus valssaamon tuotantoon on merkittävä. Empiirisessä osassa on kuvattu tuotantoprosessin ja tuoterakenteen nykytila sekä esitetty kehitysehdotuksianäiden kehittämiseen esiteltyjen teorioiden pohjalta. Tutkimuksen perusteella esitetään muutoksia tämänhetkiseen tuoterakenteeseen, koska nykyisen kaltainen tuoterakenne on jäänyt osittain turhaksi varastojen siirryttyä tuotannon alkupäähän. Lisäksi ehdotetaan kuumavalssaussuunnitelmasta luopumista ja kuumavalssaimen ohjaussyklin lyhentämistä vuorokauden mittaiseksi, sekä esitetään, miten tuotantoon tulisi välittää nykyistä tarkempaa tietoa tilauksien valmistumisajankohdista.

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial

Background Depression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence. Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression. Design A therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions). Method Participants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder, with a score of 19 or above on the Beck depression inventory, second edition (BDI-II) and presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct) as assessed using the RGT. The BDI-II is the primary outcome measure, collected at baseline, at the end of therapy, and at 3- and 12-month follow-up; other secondary measures are also used. Discussion We expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression, thus resulting in a significant contribution to the psychological treatment of depression. Trial registration ISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

Koulutuskuntayhtymän hankintalogistiikan nykytilan selvitys ja kehittäminen

Työn tavoitteena oli kartoittaa Etelä-Karjalan koulutuskuntayhtymän hankintaprosessin nykytila, analysoida saatuja tuloksia ja pohtia menetelmiä hankintatoimintaan liittyvien prosessien parantamiseksi. Päähuomio kohdistettiin materiaalihankintoihin. Julkisia hankintoja ohjaavat lait ja asetukset, joiden keskeisimmät tavoitteet ovat avoimuus, tasapuolisuus ja syrjimättömyys. Lisäksi laki viranomaisen toiminnan julkisuudesta vaikuttaa asiakirjojen julkisuuteen hankintaprosessin aikana.Tutkimuksessa havaittiin, että erittäin suuri osa ostoista on markkamääräisesti pieniä ostoja, jotka aiheuttavat hintaansa nähden suuret hankintakustannukset. Toimittajia on paljon ja rahallisesti pienten toimittajien määrä on erittäin suuri. Tästä on seurauksena se, että toimittajayhteistyö on useiden toimittajien kanssa hyvin satunnaista ja toimitusten valvonta ja toimittajaseuranta vaikeutuu. Toimittajien kehittämiseen ei tästä johtuen enää riitä resursseja. Toimittajayhteistyö julkisiin hankintoihin erikoistuneen kauppatalon kanssa on vasta alullaan ja yhteistyön määrä vaihtelee paljon eri koulutusyksiköissä. Yllättäviä tuloksia tuotti toimittajan hintojen kehitys sopimuskauden aikana. Hinnoissa oli tapahtunut kaikissa tuoteryhmissä huomattavaa nousua vuoden aikana.Hankintatoimintaa voidaan kehittää nopeuttamalla nykyisiä prosesseja hyväksikäyttäen olemassa olevaa Intranet-tekniikkaa. Samoin sähköinen kaupankäynti on useissa tuoteryhmissä varteenotettava ja tulevaisuudessa edelleen kehittyvä vaihtoehto. Toimittajaseurantaa tulee tehostaa ja toimittajien kanssa tulee pyrkiä avoimeen ja jatkuvaan yhteistyöhön.Hankintayhteistyön kehittäminen omistajakuntien kanssa ja Etelä-Karjalan julkisen sektorin yhteishankintoihin sitoutuminen olisivat tehokas tapa säästää hankintakustannuksissa.

Räjähdyssuojausasiakirjan vaatima riskin arviointi muille kuin sähkölaitteille

Turvatekniikan keskuksella (TUKES) on valvottavanaan noin 1 000 teollisuuslaitosta, joissa on räjähdysvaarallisia tiloja. Olosuhdedirektiivin (1999/92/EY) mukainen kansal-linen asetus (VNa 576/2003) tuli voimaan 1.9.2003. Asetus koskee uusia räjähdysvaa-rallisia tiloja välittömästi, kun taas käytössä olevat tilat on saatettava sen mukaisiksi 30.6.2006 mennessä. Asetus edellyttää, että työnantaja laatii räjähdysvaarallisille tiloille räjähdyssuojausasiakirjan ja arvioi kirjallisesti näissä tiloissa käytettävien, ilman Ex-merkkiä olevien työvälineiden riskin. Räjähdyssuojausasiakirjan ja kirjallisena tehdyn riskin arvioinnin eräs keskeinen tarkoitus on varmistaa mahdollisten syttymislähteiden laaja-alainen hallinta ja pienentää onnettomuusriskiä. Tässä diplomityössä selvitetään, mitä riskin arvioinnin täytyy sisältää ja etsitään tehokas menetelmä arvioinnin tekoon. Kolmelta yritykseltä saatiin tutkittavaksi niiden alalle tyypillinen muu kuin sähkölaite, jota käytetään räjähdysvaarallisessa tilassa. Laitteiden tuli olla Ex-merkittömiä ja olla ollut käytössä ennen asetuksen voimaan tuloa. Laitteiden ja niiden dokumenttien tutkimisella testattiin eri menetelmien soveltuvuutta riskin arviointiin. Samalla selvitettiin jo käytössä olevien laitteiden turvallisuustaso. Jokaisen pilottitapauksen kohdalla on arvioinnissa menetelty eri tavoin. Työssä esitellään keskeisimmät menetelmät, joilla riskin arviointi voidaan tehdä. Suosi-tuksena esitellään ratkaisumalli, jonka avulla voidaan päätellä laitteen tarvitsema riskinarviointimenetelmä. Pilottitapauksia arvioitiin laitteiden sijoituksen ja lukumäärän pohjalta. Suosituksena on, että riskin arvioinnissa lähdetään liikkeelle itse laitteesta ja sen soveltuvuudesta räjähdysvaaralliseen tilaan. Tällä tavalla pystytään kohdistamaan käytössä olevat resurssit paremmin niihin laitteisiin, jotka vaativat tarkemman riskin arvioinnin. Pilottitapausten perusteella räjähdysvaaralliseen tilaan tarkoitetut laitteet soveltuivat käytettäväksi tarkoitetussa käytössään. Räjähdyssuojausasiakirjaa varten on dokumentoitava tiedot niiden käytöstä, mahdollisista syttymislähteistä ja suojaavista toimenpiteistä.