Repeatability of adaptability and stability parameters of common bean in unpredictable environments

The objective of this work was to estimate the repeatability of adaptability and stability parameters of common bean between years, within each biennium from 2003 to 2012, in Minas Gerais state, Brazil. Grain yield data from trials of value for cultivation and use common bean were analyzed. Grain yield, ecovalence, regression coefficient, and coefficient of determination were estimated considering location and sowing season per year, within each biennium. Subsequently, a analysis of variance these estimates was carried out, and repeatability was estimated in the biennia. Repeatability estimate for grain yield in most of the biennia was relatively high, but for ecovalence and regression coefficient it was null or of small magnitude, which indicates that confidence on identification of common bean lines for recommendation is greater when using means of yield, instead of stability parameters.

Fructose and metabolic diseases: new findings, new questions.

There has been much concern regarding the role of dietary fructose in the development of metabolic diseases. This concern arises from the continuous increase in fructose (and total added caloric sweeteners consumption) in recent decades, and from the increased use of high-fructose corn syrup (HFCS) as a sweetener. A large body of evidence shows that a high-fructose diet leads to the development of obesity, diabetes, and dyslipidemia in rodents. In humans, fructose has long been known to increase plasma triglyceride concentrations. In addition, when ingested in large amounts as part of a hypercaloric diet, it can cause hepatic insulin resistance, increased total and visceral fat mass, and accumulation of ectopic fat in the liver and skeletal muscle. These early effects may be instrumental in causing, in the long run, the development of the metabolic syndrome. There is however only limited evidence that fructose per se, when consumed in moderate amounts, has deleterious effects. Several effects of a high-fructose diet in humans can be observed with high-fat or high-glucose diets as well, suggesting that an excess caloric intake may be the main factor involved in the development of the metabolic syndrome. The major source of fructose in our diet is with sweetened beverages (and with other products in which caloric sweeteners have been added). The progressive replacement of sucrose by HFCS is however unlikely to be directly involved in the epidemy of metabolic disease, because HFCS appears to have basically the same metabolic effects as sucrose. Consumption of sweetened beverages is however clearly associated with excess calorie intake, and an increased risk of diabetes and cardiovascular diseases through an increase in body weight. This has led to the recommendation to limit the daily intake of sugar calories.

Oulun Energian kaukolämpöverkoston ja -tuotannon kehitys vuosina 2006 - 2020

Tässä diplomityössä on tarkasteltu Oulun Energian kaukolämpötoiminnan kehitystä lähitulevaisuudessa. Työn yhteydessä selvitettiin nykyisessä tilanteessa mitoituslämpötilaa -32 oC vastaava tehotilastollisen analyysin avulla ja laadittiin kasvuennuste kaukolämmityksen tehontarpeesta seuraavalle viidelletoista vuodelle. Kasvuennusteen perusteella on tehty tarkastelu kaukolämmön varatehon riittävyydestä. Verkoston tehonsiirtokykyä nykyisissä ja tulevaisuuden kuormitustilanteissa on tarkasteltu Process VisioninGrades Heating -verkostolaskentaohjelmiston avulla. Tarkastelun perusteella kaukolämpöverkoston siirtokyky on kohtalaisen hyvä. Verkoston ongelmakohtia ovat länsi-itäsuunnassa olevat siirtolinjat. Varatehon määrä tulee laskemaan lähivuosina alle suositeltavan määrän, mikäli uutta lämmöntuotantokapasiteettia ei rakenneta. Alkuvaiheessa paras ratkaisu tilanteen korjaamiseksi olisi uusien lämpökeskusten rakentaminen sekä kaupungin etelä- että itä-osiin. 2010-luvulla tarve uuden voimalaitoksen rakentamiselle kaukolämpötehon tarpeen kattamiseksi tulee kasvamaan.

Insurance coverage of pediatric burns: Switzerland versus USA.

Burn care and research have significantly improved over the past years. However, insurance coverage of such treatments does not reflect the improvements in this multi-disciplinary field. Government insurance policies in first world countries renown for burn care treatment, such as Switzerland and the United States, have not adapted to the complexity and longitudinal nature of burn care. Using case studies from both countries, we have analyzed both the institutional and policy approach to pediatric burn treatment coverage. Subsequently, by presenting the Shriners burn care model, we offer a policy recommendation to both the Swiss and the American governments to better their present legislation and infrastructure on pediatric burn coverage.

Ydinvoimalaitoksen tuotannon ylläpitoprosessin suorituskyvyn mittaaminen

Kilpailun kiristyminen on pakottanut ydinvoimalaitoksia parantamaan tehokkuuttaan etsimällä uusia toimintatapoja. Heräte työn teettämiseen syntyi tutkimuksen case-kohteen Loviisan voimalaitoksen kiinnostuksesta Balanced Scorecard (BSC) -johtamisjärjestelmää,sen käyttöönoton mahdollisia vaikutuksia sekä BSC:n ja prosessiajattelun yhdistämistä kohtaan. Tutkimuksen tavoitteena on rakentaa Loviisan voima-laitoksen tuotannon ylläpitoprosessille BSC-mittaristo. Tämä edellyttää selvitystä siitä, mitä erityispiirteitä ydinvoimalaitoksiin liittyy strategisen suorituskyvyn mittaamisen kohteena. Lisäksi tavoitteena on selvittää, mikä tulisi prosessikohtaisten tuloskorttien rooli olla Loviisan voimalaitoksen BSC-järjestelmässä. Tavoitteenaon myös muodostaa suositus toimintamallista, jolla BSC voitaisiin ottaa käyttöön Loviisan voimalaitoksella, sekä selvittää, mitä vaikutuksia käyttöönotolla voiolla. Ydinvoimalaitoksen erityispiirteitä ovat muutokset toimintaympäristössä, viranomais-valvonta, toiminnan pitkäjänteisyys, laaja osaamis- ja tietotarve sekä turvallisuuden ja tiettyjen sidosryhmäsuhteiden merkityksen korostuminen. Johtuen erityispiirteistä Kaplanin ja Nortonin alkuperäistä asiakasnäkökulmaa muutetaan kattamaan sidosryhmät laajemmin. Tuotannon ylläpitoprosessin tuloskortissa vähiten painottuva näkö-kulma on henkilöstön ja uudistumisen näkökulma. Osa laitostason kriittisistä menestystekijöistä todetaan prosessin kannalta epäolennaisiksi. Prosessikohtaiset tuloskortit osoittautuvat vaikeasti hyödynnettäviksi linjaorganisaation ohjaamisessa. Strategiakartta todetaan hyväksi työvälineeksi BSC:nlaadinnassa. Toivasen projektimalli arvioidaan sopivaksi välineeksi mahdolliseen BSC:n käyttöönottoon Loviisan voimalaitoksella. Henkilöstön rooli ja erityispiirteiden vaikutukset tulee kuitenkin tarkistaa ennen mallin käyttöä. BSC-järjestelmän käyttöönoton arvioidaan selkeyttävän voimalaitoksen mittaristokokonaisuutta sekä parantavan syy-seuraussuhteiden hahmottamista ja alempien tasojen tavoitteiden kytkentää laitostason tavoitteisiin.

A RecommendationSystem for a Web Shop

Tämän työn tarkoituksena on käytännöllisen suositusjärjestelmäratkaisun kehittäminen verkkokauppaympäristöön olemassaolevaa teoriatietoa käyttäen. Työn ensimmäisessä osiossa tarkastellaan ensin tapoja lähdetiedon keräämiseksi järjestelmää varten. Tämän jälkeen käydään läpi eri menetelmiä suosituksen toteuttamiseksi. Lisäksi tutustutaan yleisiin ongelmiin eri menetelmien kanssa. Seuraavaksi tutkitaan miten järjestelmän käyttämään suositustietoa voidaan ryhmitellä. Tämänjälkeen arvioidaan esitettyjä menetelmiä yleisesti tunnettujen kriteerien perusteella. Suositusjärjestelmän toteutustyö on kuvattuna työn toisessa osiossa. Toteutettu ohjelmisto on asennettu kahteen erilliseen toimintaympäristöön.

Patent foramen ovale in patients with ischaemic stroke of unknown cause: to close? "pro closure" position

There is ample epidemiological and anecdotal evidence that a PFO increases the risk of stroke both in young and elderly patients, although only in a modest way: PFOs are more prevalent in patients with cryptogenic (unexplained) stroke than in healthy subjects, and are more prevalent in cryptogenic stroke than in strokes of other causes. Furthermore, multiple case series confirm an association of paradoxical embolism across a PFO in patients with deep vein thrombosis and/or pulmonary emboli.2. Is stroke recurrence risk in PFO-patients really not elevated when compared to PFO-free patients, as suggested by traditional observational studies? This finding is an epidemiological artifact called "the paradox of recurrence risk research" (Dahabreh & Kent, JAMA 2011) and is due to one (minor) risk factor, such as PFO, being wiped out by other, stronger risk factors in the control population.3. Having identified PFO as a risk factor for a first stroke and probably also for recurrences, we have to treat it, because treating risk factors always has paid off. No one would nowadays question the aggressive treatment of other risk factors of stroke such as hypertension, atrial fibrillation, smoking, or hyperlipidemia.4. In order to be effective, the preventive treatment has to control the risk factor (i.e. close effectively the PFO), and has to have little or no side effects. Both these conditions are now fulfilled thanks to increasing expertise of cardiologists with technically advanced closure devices and solid back up by multidisciplinary stroke teams.5. Closing a PFO does not dispense us from treating other stroke risk factors aggressively, given that these are cumulative with PFO.6. The most frequent reason why patients have a stroke recurrence after PFO closure is not that closure is ineffective, but that the initial stroke etiology is insufficiently investigated and not PFO related, and that the recurrence is due to another mechanism because of poor risk factor control.7. Similarly, the randomized CLOSURE study was negative because a) patients were included who had a low chance that their initial event was due to the PFO, b) patients were selected with a low chance that a PFO-related recurrence would occur, c) there was an unacceptable high rate of closure-related side effects, and d) the number of randomized patients was too small for a prevention trial.8. It is only a question of time until a sufficiently large randomized clinical trial with true PFO-related stroke patients and a high PFO-related recurrence risk will be performed and show the effectiveness of this closure9. PFO being a rather modest risk factor for stroke does not mean we should prevent our patients from getting the best available prevention by the best physicians in the best stroke centers Therefore, a PFO-closure performed by an excellent cardiologist following the recommendation of an expert neurovascular specialist after a thorough workup in a leading stroke center is one of the most effective stroke prevention treatments available in 2011.

Traitement de la douleur chronique: rôle de la stimulation transcrânienne du cortex moteur [Treatment of chronic pain: transcranial stimulation of the motor cortex?].

Chronic pain refractory to medical therapy poses a therapeutic challenge. The repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS) modulate brain activity offering a new approach. Current evidence suggests a potential therapeutic efficacy of motor cortex stimulation for the treatment of pain, but does not (yet) support their recommendation for clinical practice. These methods allow to deepen our knowledge in the pathophysiology of chronic pain while providing new therapeutic approaches.

Das GRADE-System: ein internationaler Ansatz zur Vereinheitlichung der Graduierung von Evidenz und Empfehlungen in Leitlinien. [The GRADE System: an international approach to standardize the graduation of evidence and recommendations in guidelines]

Clinical practice guidelines have become an important source of information to support clinicians in the management of individual patients. However, current guideline methods have limitations that include the lack of separating the quality of evidence from the strength of recommendations. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group, an international collaboration of guideline developers, methodologists, and clinicians have developed a system that addresses these shortcomings. Core elements include transparent methodology for grading the quality of evidence, the distinction between quality of the evidence and strength of a recommendation, an explicit balancing of benefits and harms of health care interventions, an explicit recognition of the values and preferences that underlie recommendations. The GRADE system has been piloted in various practice settings to ensure that it captures the complexity involved in evidence assessment and grading recommendations while maintaining simplicity and practicality. Many guideline organizations and medical societies have endorsed the system and adopted it for their guideline processes.

Mobile music marketing: willingness towards mobile music recommendations and viral marketing

Matkapuhelimet ovat uusia markkinointikanavia, joiden avulla ihmiset voidaan tavoittaa melkein missä ja milloin vain. Mobiilimarkkinoinnin avulla on mahdollista lähettää henkilökohtaisia mainosviestejä tai tarjota kullekin parhaiten sopivia palveluja. Viraalimarkkinointia voidaan käyttää apuna viestien levittämisessä, aivan kuten internetmainonnassa. Tässä tutkimuksessa on keskitytty matkapuhelimiin lähetettäviin musiikkisuosituksiin sekä siihen miten ihmiset suhtautuvat niihin ja olisivatko he valmiita lähettämään viestejä edelleen kavereilleen. Mobiilimusiikkikysely tehtiin, jotta saataisiin selville asiakkaiden halukkuutta vastaanottaa musiikkisuosituksia matkapuhelimiin, sekä heidän halukkuuttaan viraalimarkkinointia kohtaan. Kyselyyn vastasi kaiken kaikkiaan lähes1300 opiskelijaa. Kyselyn tulokset osoittavat, että lisätutkimusta tulisi tehdä alle 18-vuotiaiden matkapuhelimenkäyttäjien joukossa. Tutkimuksen perusteella löydettiin tekijöitä, jotka vaikuttavat opiskelijoiden halukkuuteen vastaanottaa musiikkisuosituksia matkapuhelimiinsa sekä heidän halukkuuttaan viraalimarkkinointiin.

Patients who attend a private practice vs a university outpatient clinic: how do they differ?

Although interpersonal continuity is commonly assumed to be essential for care, some patients prefer to attend a university outpatient clinic where physicians change regularly and interpersonal continuity of care is not ensured. The aim of this exploratory study was to evaluate the differences between patients attending a university outpatient clinic and patients frequenting a private practice, explore their patterns of care-seeking and their understanding of continued care. We conducted a cross-sectional study of patients attending the university medical outpatient clinic (OC) in Lausanne, Switzerland and ten randomly selected private general practices (PP). Eligible patients were >30 years, Swiss nationals or long term residents, with one or more chronic conditions and attending the same practice for >3 years. They were asked to complete a questionnaire on sociodemographic data, use of medical resources and reasons for choosing and remaining at the same practice. Semi-structured interviews were conducted with a randomly selected subset of 26 patients to further explore their preferences. 329 patient questionnaires were completed, 219 by PP and 110 by OC patients. OC patients tended to be of lower socioeconomic status than PP patients. The main reason for choosing a PP were personal recommendation, while a higher percentage of patients chose the OC because they could obtain a first appointment quickly. A higher percentage of PP patients accorded importance to physician communication skills and trust, whereas a higher percentage of OC patients favoured investigation facilities. Qualitative data suggested that although OC and PP patients reported different reasons for consulting, their expectations on the medical and relationship level were similar. Our study suggests that the two groups of patients belong to different social backgrounds, have different patterns of care-seeking and attach importance to different aspects of care continuity. However, patients' expectations and perceptions of the physician-patient relationship are similar.

Endovascular coiling compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: an update.

OBJECT: In 1999 we reported that 94% of unruptured middle cerebral artery (MCA) aneurysms managed prospectively between 1993 and 1997, according to a protocol favoring endovascular coiling, were best treated by surgical clipping. The goal of the current study was to delineate the most appropriate treatment option for unruptured MCA aneurysms today, considering the technical advances in imaging and in endovascular treatment. METHODS: 35 consecutive patients harboring 40 unruptured MCA aneurysms were treated between 1997 and December 2000. Patients with unruptured cerebral aneurysms are managed prospectively according to the same protocol as reported previously [1]: the primary treatment recommendation is endovascular packing with Guglielmi detachable coils (GDCs). Surgical clipping is recommended after failed attempt at coil placement or in the presence of angioanatomical features that contraindicate that type of endovascular therapy. RESULTS: One unruptured MCA aneurysm was treated by endovascular embolization, 37 unruptured MCA aneurysms were clipped, whereas 2 unruptured MCA aneurysms were trapped with simultaneous extracranial-intracranial revascularization. Postoperative angiography revealed complete exclusion of all aneurysms. Preservation of vascular permeability was demonstrated in all clip-reconstructed aneurysms, despite arterial branches frequently originating from the aneurysmal base. Cerebral revascularization of the distal MCA was successful in the 2 patients with giant aneurysms. None of the patients presented permanent disabling complications from the treatment of the unruptured MCA aneurysm. CONCLUSION: Despite major technical advances in imaging and in endovascular treatment of cerebral aneurysms, surgical clipping still is the most efficient treatment for unruptured MCA aneurysms at the beginning of the new millennium.

Management of faecal incontinence and constipation in adults with central neurological diseases.

BACKGROUND: People with neurological disease have a much higher risk of both faecal incontinence and constipation than the general population. There is often a fine dividing line between the two conditions, with any management intended to ameliorate, one risking precipitating the other. Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people. Current bowel management is largely empirical with a limited research base. OBJECTIVES: To determine the effects of management strategies for faecal incontinence and constipation in people with neurological diseases affecting the central nervous system. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Trials Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE and all reference lists of relevant articles. Date of the most recent searches: May 2000. SELECTION CRITERIA: All randomised or quasi-randomised trials evaluating any types of conservative, or surgical measure for the management of faecal incontinence and constipation in people with neurological diseases were selected. Specific therapies for the treatment of neurological diseases that indirectly affect bowel dysfunction have also been considered. DATA COLLECTION AND ANALYSIS: All three reviewers assessed the methodological quality of eligible trials and two reviewers independently extracted data from included trials using a range of pre-specified outcome measures. MAIN RESULTS: Only seven trials were identified by the search strategy and all were small and of poor quality. Oral medications for constipation were the subject of four trials. Cisapride does not seem to have clinically useful effects in people with spinal cord injuries (two trials). Psyllium was associated with increased stool frequency in people with Parkinson's disease but not altered colonic transit time (one trial). Some rectal preparations to initiate defecation produced faster results than others (one trial). Different time schedules for administration of rectal medication may produce different bowel responses (one trial). Mechanical evacuation may be more effective than oral or rectal medication (one trial). The clinical significance of any of these results is difficult to interpret. REVIEWER'S CONCLUSIONS: It is not possible to draw any recommendation for bowel care in people with neurological diseases from the trials included in this review. Bowel management for these people must remain empirical until well-designed controlled trials with adequate numbers and clinically relevant outcome measures become available.

Hallituksen riippumattomuus Suomen corporate governance -suosituksessa

Tutkimuksen tavoitteena on tutkia, kuinka Suomen vuonna 2004 voimaan tullut corporate governance -suositus tukee hallituksen riippumattomuutta. Tutkimuksessa määritellään hallituksen riippumattomuuden käsite. Tämän määritelmän avulla tarkastellaan, kuinka Suomen corporate governance -suosituksessa ohjataan hallituksen riippumattomuutta. Tutkimus on kvalitatiivinen tutkimus, joka on luonteeltaan osittain teoreettinen ja osittain normatiivinen. Tutkimusstrategiassayhdistyvät deskriptiivisyys ja komparatiivisuus. Tutkimuksessa Suomen corporategovernance -suosituksen hallituksen riippumattomuutta koskevia suosituksia verrataan toisaalta päämies-agenttiteorian pohjalta muodostettuun riippumattoman hallituksen määritelmään ja toisaalta keskeisimpiin ulkomaisiin corporate governance -säännöstöihin. Riippumattomaksi hallitukseksi määriteltiin hallitus, jonka toimintaa toimiva johto tai merkittävä osakkeenomistaja ei voi suoraan tai välillisesti dominoida. Suomen suosituksessa voidaan nähdä pyrkimys kohti riippumaton-ta hallitusta. Suomen suositus ei kuitenkaan tue hallituksen riippumattomuutta parhaalla mahdollisella tavalla. Sekä toimivalle johdolle että yhtiön merkittäville osakkeenomistajille jää valtaa vaikuttaa hallituksen toimintaan enemmän kuin osakkeenomistajien etujen kannalta olisi suositeltavaa.

Adoption av träkomposit teknologi på svenska trähusmarknaden

Syftet med uppsatsen är att kategorisera träkomposit teknologi adoption på svenska trähusmarknaden genom fallstudie av trähustillverkare och fasadbehandlare. Som undersöknings metod har intervjueroch facklitteratur använts. Med hjälp av litteraturmaterialet sammanställdes enteoretisk referensram, vad efter sedan fallföretagen intervjuades. Genom insamlade sekundärdata betraktades företaget i den teoretiska referensramen. Undersökningens teorin baserar sig på adoption av innovation. Inledningsvis redogörs traditionell segmentering av industriella marknader och sedan segmentering efter kundlivscykel. Tyngdpunkten är ändå på teknologi adoption livscykel. Empirin är fallstudie av modul, storblock trähustillverkare och fasadbehandlare. Företagets situation studeras inom teoretiska referensramen för att kunna göra en analys avadoptionen och göra slutsatser om produktlanseringen. Rekommendation är några aspekter som innobuild bör beakta vid försäljning av Fasec-fasadsystem. Undersökningen torde kunna användas som stöd vid adoption av en innovation.