Effect Estimation of an Innovative Nursing Intervention to Improve Delirium among Home-Dwelling Older Adults: A Randomized Controlled Pilot Trial.

AIMS: Estimating the effect of a nursing intervention in home-dwelling older adults on the occurrence and course of delirium and concomitant cognitive and functional impairment. METHODS: A randomized clinical pilot trial using a before/after design was conducted with older patients discharged from hospital who had a medical prescription to receive home care. A total of 51 patients were randomized into the experimental group (EG) and 52 patients into the control group (CG). Besides usual home care, nursing interventions were offered by a geriatric nurse specialist to the EG at 48 h, 72 h, 7 days, 14 days, and 21 days after discharge. All patients were monitored for symptoms of delirium using the Confusion Assessment Method. Cognitive and functional statuses were measured with the Mini-Mental State Examination and the Katz and Lawton Index. RESULTS: No statistical differences with regard to symptoms of delirium (p = 0.085), cognitive impairment (p = 0.151), and functional status (p = 0.235) were found between the EG and CG at study entry and at 1 month. After adjustment, statistical differences were found in favor of the EG for symptoms of delirium (p = 0.046), cognitive impairment (p = 0.015), and functional status (p = 0.033). CONCLUSION: Nursing interventions to detect delirium at home are feasible and accepted. The nursing interventions produced a promising effect to improve delirium.

Educational intervention for parents of adolescents with chronic illness: a pre-post test pilot study.

OBJECTIVE: This pilot experimental study tested the feasibility and intended effect of an educational intervention for parents to help them assist their adolescent child with chronic illness (CI) in becoming autonomous. METHODS: A two-phase pre-post pilot intervention study targeting parents of adolescents with CI was conducted. Parents were allocated to group 1 and 2 and received the four-module intervention consecutively. Intended effect was measured through online questionnaires for parents and adolescents before, at 2 months after, and at 4-6 months after the intervention. Feasibility was assessed through an evaluation questionnaire for parents. RESULTS: The most useful considered modules concerned the future of the adolescent and parents and social life. The most valued aspect was to exchange with other parents going through similar problems and receiving a new outlook on their relationship with their child. For parents, improvement trends appeared for shared management, parent protection, and self-efficacy, and worsening trends appeared for coping skills, parental perception of child vulnerability, and parental stress. For adolescents, improvement trends appeared for self-efficacy and parental bonding and worsening trends appeared for shared management and coping skills. CONCLUSION: Parents could benefit from peer-to-peer support and education as they support the needed autonomy development of their child. Future studies should test an online platform for parents to find peer support at all times and places.

A pilot study identifying a set of microRNAs as precise diagnostic biomarkers of acute kidney injury

In the last decade, Acute Kidney Injury (AKI) diagnosis and therapy have not notably improved probably due to delay in the diagnosis, among other issues. Precocity and accuracy should be critical parameters in novel AKI biomarker discovery. microRNAs are key regulators of cell responses to many stimuli and they can be secreted to the extracellular environment. Therefore, they can be detected in body fluids and are emerging as novel disease biomarkers. We aimed to identify and validate serum miRNAs useful for AKI diagnosis and management. Using qRT-PCR arrays in serum samples, we determined miRNAs differentially expressed between AKI patients and healthy controls. Statistical and target prediction analysis allowed us to identify a panel of 10 serum miRNAs. This set was further validated, by qRT-PCR, in two independent cohorts of patients with relevant morbi-mortality related to AKI: Intensive Care Units (ICU) and Cardiac Surgery (CS). Statistical correlations with patient clinical parameter were performed. Our results demonstrated that the 10 selected miRNAs (miR-101-3p, miR-127-3p, miR-210-3p, miR-126-3p, miR-26b-5p, miR-29a-3p, miR-146a-5p, miR-27a-3p, miR-93-3p and miR-10a-5p) were diagnostic biomarkers of AKI in ICU patients, exhibiting areas under the curve close to 1 in ROC analysis. Outstandingly, serum miRNAs estimated before CS predicted AKI development later on, thus becoming biomarkers to predict AKI predisposition. Moreover, after surgery, the expression of the miRNAs was modulated days before serum creatinine increased, demonstrating early diagnostic value. In summary, we have identified a set of serum miRNAs as AKI biomarkers useful in clinical practice, since they demonstrate early detection and high diagnostic value and they recognize patients at risk.

Abolishing mammography screening programs?

Biller-Andorno and Jüni (2014), in a widely debated commentary published in the May 22 issue of the New England Journal of Medicine, accept the concept that mammography every 2 years from age 50 can decrease breast cancer mortality by 20%, that is, from five to four deaths per 1000 women over a 10-year period. Both the absolute and the relative risk of breast cancer death may vary depending on the baseline mortality rates in various populations and on the impact of screening mammography in reducing breast cancer mortality, which may well vary around the 20% estimate adopted. We accept, therefore, that there are still uncertainties in the absolute and relative impact of mammography screening on breast cancer mortality, given the different study schemes and mammography intervals, the differences in populations, and the continuous improvements in technology (Warner, 2011; Independent UK Panel on Breast Cancer Screening, 2012). We also agree on the observation that mammography has an appreciable impact on breast cancer mortality (Bosetti et al., 2012), but clearly a much smaller one on total mortality.

Evaluation of an eLearning pilot course based on user experiences: corporate case study

Diplomityön tavoitteena oli arvioida sähköisen oppimisen soveltuvuutta kohdeyrityksessä ja selvittää, voidaanko luokkahuonekoulutusta korvata sähköisen oppimisen kursseilla. Tietojärjestelmän raportoinnista tehtiin sähköisen oppimisen kurssi, joka oli koekäytössä. Koekäytön jälkeen tehtiin käyttäjäkysely, kerättiin käyttötietoja kurssista ja tehtiin haastatteluja. Koekäyttäjien kokemuksista tehdyn arvioinnin perusteella sähköinen oppiminen soveltuu käytettäväksi selkeiden asioiden koulutukseen kohdeyrityksessä, mutta se ei voi kokonaan korvata luokkahuonekoulutusta. Luokkahuonekoulutuksessa tulisi keskittyä monimutkaisempiin asioihin ja ongelmanratkaisuun. Positiivisten tulosten perusteella sähköisen oppimisen kehittämistä päätettiin jatkaa yrityksessä. Sähköisen oppimisen kurssin avulla saadaan kustannussäästöjä kohdeyrityksessä, kun käyttäjämäärä on suurempi kuin 66. Jos koko koekäytössä olleen kurssin kohdeyleisö suorittaa kurssin sähköisesti, ovat kustannukset vain noin 15% vastaavista kustannuksista luokkahuoneessa järjestettynä. Lisäksi sähköisen oppimisen tehokkuutta tutkittiin ja koekäytössä olleen kurssin arvioitiin olevan positiivinen työssä kehitetyn Consensus-mallin mukaan.

Effects of inorganic nitrogen (NH4Cl) and biodegradable organic carbon (CH3COONa) additions on a pilot-scale seawater biofilter

Biofilters degrade only a small fraction of the natural organic matter (NOM) contained in seawater which is the leading cause of biofouling in downstream processes. This work studies the effects of chemical additions on NOM biodegradation by biofilters. In this work, biofiltration of seawater with an empty bed contact time (EBCT) of 6 min and a hydraulic loading rate of 10 m h-1 reduces the biological oxygen demand (BOD7) by 8%, the dissolved organic carbon (DOC) by 6% and the UV absorbance at 254 nm (A254) by 7%. Different amounts of ammonium chloride are added to the seawater (up to twice the total dissolved nitrogen in untreated seawater) to study its possible effect on the removal of NOM by a pilot-scale biofilter. Seawater is amended with different amounts of easily biodegradable dissolved organic carbon (BDOC) supplied as sodium acetate (up to twice the DOC) for the same purpose. The results of this work reveal that the ammonium chloride additions do not significantly affect NOM removal and the sodium acetate is completely consumed by the biofiltration process. For both types of chemical additions, the BOD7, DOC and A254 in the outlet stream of the biofilter are similar to the values for the untreated control. These results indicate that this biofilter easily removes the BDOC from the seawater when the EBCT is not above 6 min. Furthermore, nitrogen does not limit the NOM biodegradation in seawater under these experimental conditions.

Tuning Performance of Multi-threaded programs

Diplomityö tarkastelee säikeistettyä ohjelmointia rinnakkaisohjelmoinnin ylemmällä hierarkiatasolla tarkastellen erityisesti hypersäikeistysteknologiaa. Työssä tarkastellaan hypersäikeistyksen hyviä ja huonoja puolia sekä sen vaikutuksia rinnakkaisalgoritmeihin. Työn tavoitteena oli ymmärtää Intel Pentium 4 prosessorin hypersäikeistyksen toteutus ja mahdollistaa sen hyödyntäminen, missä se tuo suorituskyvyllistä etua. Työssä kerättiin ja analysoitiin suorituskykytietoa ajamalla suuri joukko suorituskykytestejä eri olosuhteissa (muistin käsittely, kääntäjän asetukset, ympäristömuuttujat...). Työssä tarkasteltiin kahdentyyppisiä algoritmeja: matriisioperaatioita ja lajittelua. Näissä sovelluksissa on säännöllinen muistinkäyttökuvio, mikä on kaksiteräinen miekka. Se on etu aritmeettis-loogisissa prosessoinnissa, mutta toisaalta huonontaa muistin suorituskykyä. Syynä siihen on nykyaikaisten prosessorien erittäin hyvä raaka suorituskyky säännöllistä dataa käsiteltäessä, mutta muistiarkkitehtuuria rajoittaa välimuistien koko ja useat puskurit. Kun ongelman koko ylittää tietyn rajan, todellinen suorituskyky voi pudota murto-osaan huippusuorituskyvystä.

Packet Switched UMTS Pilot System

Universal Mobile Telecommunication System (UMTS) on Third Generation Partnership Project (3GPP) –organisaation määrittelemä matkaviestinjärjestelmä. UMTS tukee sekä piiri- että pakettikytkentäistä tiedonsiirtoa ja mahdollistaa langattoman, suurinopeuksisen Internet-yhteyden. Diplomityön tarkoituksena on kuvata Nokia Research Center:n toteuttama kolmannen sukupolven 3GPP yhteensopiva pakettikytkentäinen koejärjestelmä. Työssä on käytetty uutta lähestymistapaa protokollakehitykseen, yhdistämällä eri työkaluilla tuotettuja protokollia yhdeksi kokonaisuudeksi. Liikenteen vaihtuessa lähitulevaisuudessa suurelta osin pakettikytkentäiseksi on mietittävä keinoja palvelunlaadun takaamiseksi. Näitä keinoja tutkittiin käyttämällä työssä toteutettua koejärjestelmää testialustana. Koejärjestelmää esiteltiin useissa konferensseissa ja se toimitettiin monille teleoperaattoreille.

The Swiss reform of the allocation of tasks : The conventions-programs as a new partnership model for vertical cooperation ?

This research examines the impacts of the Swiss reform of the allocation of tasks which was accepted in 2004 and implemented in 2008 to "re-assign" the responsibilities between the federal government and the cantons. The public tasks were redistributed, according to the leading and fundamental principle of subsidiarity. Seven tasks came under exclusive federal responsibility; ten came under the control of the cantons; and twenty-two "common tasks" were allocated to both the Confederation and the cantons. For these common tasks it wasn't possible to separate the management and the implementation. In order to deal with nineteen of them, the reform introduced the conventions-programs (CPs), which are public law contracts signed by the Confederation with each canton. These CPs are generally valid for periods of four years (2008-11, 2012-15 and 2016-19, respectively). The third period is currently being prepared. By using the principal-agent theory I examine how contracts can improve political relations between a principal (Confederation) and an agent (canton). I also provide a first qualitative analysis by examining the impacts of these contracts on the vertical cooperation and on the implication of different actors by focusing my study on five CPs - protection of cultural heritage and conservation of historic monuments, encouragement of the integration of foreigners, economic development, protection against noise and protection of the nature and landscape - applied in five cantons, which represents twenty-five cases studies.

Psychotherapy for Personality Disorders in a Natural Setting: A Pilot Study over Two Years of Treatment.

Long-term assessment of the effects of psychotherapy for personality disorders (PDs) in a natural environment is an important task. Such research contributes to enlarge the practice-based evidence, embedded in broad collaborations between clinicians and researchers in psychotherapy for PDs. The present pilot study used rigorous assessment procedures and incorporated feedback loops of outcome information to the therapists in demonstrating the effects of psychotherapy for PD in a natural setting. The number of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for any PD was the primary outcome (along with psychological distress, depression, impulsiveness, and quality of life as secondary measures), assessed at intake, 6, 12, 18, and 24 months of psychotherapy for N = 13 patients with PD. Data were analyzed using hierarchical linear modeling. Results demonstrated a large pre-post effect (d = 2.22) for the observer-rated measure (primary outcome), and small to medium effects for the secondary outcomes; these results were corroborated by a steady decrease of symptoms over all five time points, which was significant for several outcomes. These results add a piece to the literature by demonstrating the effects of long-term psychotherapy for PDs in increasingly diverse contexts and suggest that practice-oriented research can be carried out in a collaborative and systematic manner.

Ohjelmistoarkkitehtuurien vertailu ja valinta monimediatuotteelle. CASE: AVO

Työn tavoitteena oli tutkia ja vertailla komponenttipohjaisia ohjelmistoarkkitehtuureita (Microsoft .NET ja J2EE). Työn tarkoituksena oli valita ohjelmistoarkkitehtuuri uudelle neuroverkkopohjaiselle urasuunnittelupalvelulle. Tässä työssä selvitettiin myös, miten luodaan kansainvälistettäviä ja lokalisoitavia sovelluksia, sekä kuinka Web-, Windows-, mobiili-, puhe- ja Digi-TV -käyttöliittymät soveltuvat uudelle urasuunnittelupalvelulle. Tutkimustyössä käytettiin alan kirjallisuutta, Microsoftin ja Sun Microsystemsin Web-sivuja. Tutkimustyössä analysoitiin Microsoft Pet Shop- ja Sun Microsystemsin Java Pet Store -esimerkkisovellusten suorituskykyvertailua. Analyysituloksiin perustuen urasuunnittelupalvelussa suositellaan käytettäväksi J2EE-arkkitehtuuria. Uudelle urasuunnittelupalvelulle toimenpide-ehdotus on komponenttipohjainen järjestelmä Web-, puhe- ja Digi-TV -käyttöliittymillä ja personoidulla sisällöllä. Järjestelmä tehdään viisivaiheisena hankkeena, johon sisältyy pilottitestejä. Uuteen urasuunnittelupalveluun liitetään mukaan opiskelijat, oppilaitokset ja työnantajat sekä asiantuntijoita neuroverkon opetusdatan määrittämiseen. Palvelu perustuu integroituun tietokantaan. Eri osajärjestelmissä tuotettua tietoa voidaan hyödyntää kaikkialla urasuunnittelupalvelussa.

Long-term effects of Roux-en-Y gastric bypass on postprandial plasma lipid and bile acids kinetics in female non diabetic subjects: A cross-sectional pilot study.

BACKGROUND AND AIMS: Formerly obese patients having undergone Roux-en-Y gastric bypass (RYGB) display both an accelerated digestion and absorption of carbohydrate and an increased plasma glucose clearance rate after meal ingestion. How RYGB effects postprandial kinetics of dietary lipids has yet not been investigated. METHODS: Plasma triglyceride (TG), apoB48, total apoB, bile acids (BA), fibroblast growth factor 19 (FGF19), and cholecystokinin (CCK) were measured in post-absorptive conditions and over 4-h following the ingestion of a mixed test meal in a cross-sectional, pilot study involving 11 formerly obese female patients 33.8 ± 16.4 months after RYGB surgery and in 11 weight- and age-matched female control participants. RESULTS: Compared to controls, RYGB patients had faster (254 ± 14 vs. 327 ± 7 min, p < 0.05) and lower (0.14 ± 0.04 vs. 0.35 ± 0.07 mM, p < 0.05) peak TG responses, but their peak apoB48 responses tended to be higher (2692 ± 336 vs. 1841 ± 228 ng/ml, p = 0.09). Their postprandial total BA concentrations were significantly increased and peaked earlier after meal ingestion than in controls. Their FGF19 and CCK concentrations also peaked earlier and to a higher value. CONCLUSIONS: The early postprandial apoB48 and BA responses indicate that RYGB accelerated the rate of dietary lipid absorption. The lower postprandial peak TG strongly suggests that the RYGB simultaneously increased the clearance of TG-rich lipoproteins. CLINICAL TRIAL REGISTRATION: NCT01891591.

Positive Emotions Program for Schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy.

BACKGROUND: Recent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression (emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments. METHODS: This pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre- and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)--an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions. RESULTS: Thirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention. DISCUSSION: Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives. CONCLUSIONS: PEPS is a promising intervention to improve anhedonia and apathy which need to be tested further in a controlled study. TRIAL REGISTRATION NUMBER: ISRCTN registry ISRCTN74048461, registered 18 may 2015.

Could machine learning improve the prediction of pelvic nodal status of prostate cancer patients? Preliminary results of a pilot study.

We tested and compared performances of Roach formula, Partin tables and of three Machine Learning (ML) based algorithms based on decision trees in identifying N+ prostate cancer (PC). 1,555 cN0 and 50 cN+ PC were analyzed. Results were also verified on an independent population of 204 operated cN0 patients, with a known pN status (187 pN0, 17 pN1 patients). ML performed better, also when tested on the surgical population, with accuracy, specificity, and sensitivity ranging between 48-86%, 35-91%, and 17-79%, respectively. ML potentially allows better prediction of the nodal status of PC, potentially allowing a better tailoring of pelvic irradiation.