Involuntary treatment of alcohol-dependent patients: a study of 17 consecutive cases of civil commitment.

AIM: To investigate the baseline and follow-up characteristics of a group of alcohol-dependent patients being treated under civil commitment. METHODS: This study involved a cross-sectional comparative analysis of baseline characteristics and a follow-up survey of a group of committed alcoholic patients. The study was undertaken in the Alcohol Unit of a 1,000-bed general and university hospital. The study included 17 consecutive cases of civil commitment (representing 15 patients, of whom 2 were committed twice) and a comparative group of 34 randomly selected age- and sex-matched patients. Baseline characteristics of the cases (at the time of commitment) and of patients from the comparative group were collected from medical records, including sociodemographic data, medical condition, patterns of drinking and number and dates of previous treatments for alcohol-related problems. A structured follow-up interview of the cases provided information on their medical condition, social status, patterns of alcohol use, type and duration of residential treatment as well as their perceptions of commitment. RESULTS: During a 4-year period, our Unit referred 23 cases of alcohol-dependent patients (out of 367) to the Guardianship Authority, requesting civil commitment. On 17 occasions, patients were committed to residential treatment, including 2 patients who underwent commitment on two separate occasions, thus representing a total of 15 different patients. In comparison with age- and sex-matched patients seen at the Unit, the cases were characterized by multiple medical, social and psychological alcohol-related impairments. At the time of follow-up, 14 out of 15 patients were alive, among whom 10 agreed to be interviewed. Eight of these reported complete abstinence, whereas 9 considered their alcohol problem as less severe than before. The average duration of commitment was 29 weeks. The majority of patients retrospectively considered the measure as having been justified and useful. The patients' satisfaction with the decision to commit was higher among women than among men. Health-related quality of life at the time of follow-up, as assessed by the MOS 36-Item Short Form Health Survey questionnaire, was good on average and better than that usually reported by other cohorts of alcoholics undergoing treatment. CONCLUSIONS: The usefulness of residential civil commitment of certain severely impaired alcohol-dependent patients is underscored. This study suggests that civil commitment not only may save the lives of endangered patients but could also be a health-promoting measure that may sometimes allow for recovery from dependence. Unexpectedly, this measure was retrospectively well accepted by many patients, who considered the commitment decision as having been justified and useful.

Unconsciousness and sedation as precipitating factors of diabetic ketoacidosis.

The aim of this study was to identify medico-legal situations characterized by increased vitreous glucose concentrations, potentially lethal blood 3-hydroxybutyrate levels and conditions that could either incapacitate or lead to death on their own. The above was investigated in order to verify whether prolonged states of unconsciousness may play a role in precipitating diabetic ketoacidosis. Six groups of medico-legal situations (corresponding to 206 autopsy cases) were identified. Among these, three cases were characterized by pathologically increased vitreous glucose and blood 3-hydroxybutyrate levels. In one case diabetic ketoacidosis coexisted with underlying features that might have potentially incapacitated or lead to death on their own, whereas in two cases it corresponded with potentially lethal or lethal drug concentrations. The results of this study highlight the usefulness of systematically performing biochemistry in order to identify diabetic ketoacidosis-related deaths, even when autopsy and toxicology results provide apparently conclusive findings.

Prediction of plant species distributions across six millennia.

The usefulness of species distribution models (SDMs) in predicting impacts of climate change on biodiversity is difficult to assess because changes in species ranges may take decades or centuries to occur. One alternative way to evaluate the predictive ability of SDMs across time is to compare their predictions with data on past species distributions. We use data on plant distributions, fossil pollen and current and mid-Holocene climate to test the ability of SDMs to predict past climate-change impacts. We find that species showing little change in the estimated position of their realized niche, with resulting good model performance, tend to be dominant competitors for light. Different mechanisms appear to be responsible for among-species differences in model performance. Confidence in predictions of the impacts of climate change could be improved by selecting species with characteristics that suggest little change is expected in the relationships between species occurrence and climate patterns.

Use of aggregating cell cultures for toxicological studies.

Relatively simple techniques are now available which allow the preparation of large quantities of highly reproducible aggregate cultures from fetal rat brain or liver cells, and to grow them in a chemically defined medium. Since these cultures exhibit extensive histotypic cellular reorganization and maturation, they offer unique possibilities for developmental studies. Therefore, the purpose of the present study was to investigate the usefulness of these cultures in developmental toxicology. Aggregating brain cell cultures were exposed at different developmental stages to model drugs (i.e., antimitotic, neurotoxic, and teratogenic agents) and assayed for their responsiveness by measuring a set of biochemical parameters (i.e., total protein and DNA content, cell type-specific enzyme activities) which permit a monitoring of cellular growth and maturation. It was found that each test compound elicited a distinct, dose-dependent response pattern, which may ultimately serve to screen and classify toxic drugs by using mechanistic criteria. In addition, it could be shown that aggregating liver cell cultures are capable of toxic drug activation, and that they can be used in co-culture with brain cell aggregates, providing a potential model for complementary toxicological and metabolic studies.

Monitoring bank performance in the presence of risk

This paper proposes a managerial control tool that integrates risk in efficiency scores. Building on existing efficiency specifications, our proposal reflects the real banking technology and accurately models the relationship between desirable and undesirable outputs. Specifically, the undesirable output is defined as non-performing loans to capture credit risk, and is linked only to the relevant dimension of the output set. We empirically illustrate how our efficiency measure functions for managerial control purposes. The application considers a unique dataset of Costa Rican banks during 1998-2012. Efficiency scores? implications are mostly discussed at bank-level, and their interpretations are enhanced by using accounting ratios. We also show the usefulness of our tool for corporate governance by examining performance changes around executive turnover. Results confirm that appointing CEOs from outside the bank significantly improves performance, thus suggesting the potential benefits of new organisational practices.

Alternative tests for correct specification of conditional predictive densities

We propose new methods for evaluating predictive densities that focus on the models' actual predictive ability in finite samples. The tests offer a simple way of evaluatingthe correct specification of predictive densities, either parametric or non-parametric.The results indicate that our tests are well sized and have good power in detecting mis-specification in predictive densities. An empirical application to the Survey ofProfessional Forecasters and a baseline Dynamic Stochastic General Equilibrium modelshows the usefulness of our methodology.

Priorities and hierarchical accounts of translation

This paper is a study of the concept of priority and its use together with the notion of hierarchy in academic writing and theoretical models of translation. Hierarchies and priorities can be implicit or explicit, prescribed, suggested or described. The paper starts, chronologically, wtih Nida and Levý’s hierarchical accounts of translation and follows their legacy in scholars as different as Newmark and Gutt. The concept of priorities is hinted at also in didactic models (Nord) as well as in norm-theoretical and accounts of translation (Toury and Chesterman) within Descriptive Translation Studies. All of these authors are analyzed and commented. The paper calls for a more systematic and straightforward account of translational priorities, and proposes a few conceptual tools that stem from this research model, including the concepts of ambition and richness of a translation. Finally, the paper concludes with an adaptation of Lakoff and Johnson’s view of prototypicality and its potential usefulness in research into and the understanding of translation.

The French adaptation of the Health of the Nation Outcome Scale for Children and Adolescents Self-Rated Form (F-HoNOSCA-SR): Validation and clinical routine use.

The current study aimed to explore the validity of an adaptation into French of the self-rated form of the Health of the Nation Outcome Scales for Children and Adolescents (F-HoNOSCA-SR) and to test its usefulness in a clinical routine use. One hundred and twenty nine patients, admitted into two inpatient units, were asked to participate in the study. One hundred and seven patients filled out the F-HoNOSCA-SR (for a subsample (N=17): at two occasions, one week apart) and the strengths and difficulties questionnaire (SDQ). In addition, the clinician rated the clinician-rated form of the HoNOSCA (HoNOSCA-CR, N=82). The reliability (assessed with split-half coefficient, item response theory (IRT) models and intraclass correlations (ICC) between the two occasions) revealed that the F-HoNSOCA-SR provides reliable measures. The concurrent validity assessed by correlating the F-HoNOSCA-SR and the SDQ revealed a good convergent validity of the instrument. The relationship analyses between the F-HoNOSCA-SR and the HoNOSCA-CR revealed weak but significant correlations. The comparison between the F-HoNOSCA-SR and the HoNOSCA-CR with paired sample t-tests revealed a higher score for the self-rated version. The F-HoNSOCA-SR was reported to provide reliable measures. In addition, it allows us to measure complementary information when used together with the HoNOSCA-CR.

Prédire la survenue d'un diabète: la place de scores cliniques et/ou génétiques [Genetic and/or clinical scores to anticipate the onset of diabetes]

Diabetes represents an important health burden on our society: for example in Lausanne (Switzerland) 16% of the adult population have abnormal glucose homeostasis and 6% have diabetes, of which about a third is not aware. Some guidelines identify the "at risk" population for which screening seems indicated. Simple clinical scores have been developed at allow to better estimate the risk of diabetes and hence to potentially better target screening of the disease. The recent discovery of more that 18 genetic variants associated with an increased risk to develop the diseased has allowed to include individual genotype into genetic risk scores. We will discuss in this article the usefulness of these genetic score, how they compare to clinical score, their implication for clinical practice as well as their potential ethical or economical consequences.

Optinen merkintunnistus satamaliikenteessä ja junavaunujen tunnistamisessa

Optisella merkintunnistuksella on tärkeä rooli nykypäivän automaatiossa. Optisen merkintunnistuksen eri sovellusalueet vaihtelevat dokumenttien tekstin tunnistamisesta ajoneuvojen tunnistamiseen ja erilaisten tuotanto- ja kokoonpanolinjojen automaatioon ja laadun tarkkailuun. Tässä työssä keskitytään optisen merkintunnistuksen käyttöön satamaliikenteessä. Työ jakaantuu kahteen osaan. Ensimmäisessä osassa esitellään satamien kannalta kaksi yleisintä ja samalla tärkeintä optisen merkintunnistuksen sovellusaluetta: rekisterikilpien tunnistus ja konttien tunnistus. Työn jälkimmäinen osa käsittelee junavaunujen tunnistamista optisen merkintunnistuksen avulla. Satamissa toimiva vaunukalusto ja niissä esiintyvät tunnisteet esitellään. Vaunujen tunnistamisen toteuttava konenäköjärjestelmä, sen vaativat laitteet sekä kuvankäsittelyn ja kuva-analyysin vaiheet käydään läpi. Kuva-analyysion jaettu työssä neljään päävaiheeseen: esikäsittely, segmentointi, piirreirrotus ja luokittelu. Kustakin vaiheesta esitetään useita eri menetelmiä, joiden käyttökelpoisuutta esitettyyn ongelmaan arvioidaan työn lopussa.

Verkko-opetuksenhyödyntäminen uusien työntekijöiden koulutuksen haasteisiin vastaamisessa

Työn tarkoituksena oli kehittää verkko-oppimisympäristö sahatavaran jatkojalostusprosessien uusien ja työtehtävää vaihtavien työntekijöiden perehdytykseen. Työssä tutkittiin myös miten verkko-oppimisympäristöä voidaan käyttää osaamisen siirrossa. Työssä haastateltiin työnjohtajia ja työntekijöiden perehdyttämisestä vastaavia henkilöitä siitä, mitkä ovat ongelmat ja haasteet sahatavaran jatkojalostuksen alueella tietämyksen siirrossa uusille työntekijöille. Työssä tarkasteltiin tiedon syntymistä ja siirtämistä tietojohtamisen, sekä oppivan organisaation teorioiden avulla. Työssä selvitettiin myös mitkä ovat verkko-oppimisympäristöjen vahvuudet ja heikkoudet tiedonsiirrossa, sekä miten verkko-oppimisympäristö voisi toimia osana tiedonsiirtojärjestelmää. Haasteiksi uusien työntekijöiden koulutuksessa nousi esille neljä teemaa. Ne olivat laatutietous, turvallisuus, taloudellisuus jamotivaatio oppimiseen. Verkko-oppimisen vahvuuksia pyrittiin käyttämään mahdollisimman tehokkaasti hyväksi esiin nousseisiin haasteisiin vastaamisessa. Verkko-oppimisen vahvuuksia ovat eri mediaelementtien käyttö kuten kuvat, videot ja animaatiot. Työn tuloksia käytettiin hyväksi verkko-oppimisympäristön teossa. Lopuksi tehtiin myös ehdotus verkko-oppimisympäristön käytöstä osana tiedonsiirtojärjestelmää. Järjestelmän käyttö riippuu sen sisällön hyödyllisyydestä ja jatkuvasta päivityksestä.

Guideline adaptation: an approach to enhance efficiency in guideline development and improve utilisation.

BACKGROUND: Developing and updating high-quality guidelines requires substantial time and resources. To reduce duplication of effort and enhance efficiency, we developed a process for guideline adaptation and assessed initial perceptions of its feasibility and usefulness. METHODS: Based on preliminary developments and empirical studies, a series of meetings with guideline experts were organised to define a process for guideline adaptation (ADAPTE) and to develop a manual and a toolkit made available on a website (http://www.adapte.org). Potential users, guideline developers and implementers, were invited to register and to complete a questionnaire evaluating their perception about the proposed process. RESULTS: The ADAPTE process consists of three phases (set-up, adaptation, finalisation), 9 modules and 24 steps. The adaptation phase involves identifying specific clinical questions, searching for, retrieving and assessing available guidelines, and preparing the draft adapted guideline. Among 330 registered individuals (46 countries), 144 completed the questionnaire. A majority found the ADAPTE process clear (78%), comprehensive (69%) and feasible (60%), and the manual useful (79%). However, 21% found the ADAPTE process complex. 44% feared that they will not find appropriate and high-quality source guidelines. DISCUSSION: A comprehensive framework for guideline adaptation has been developed to meet the challenges of timely guideline development and implementation. The ADAPTE process generated important interest among guideline developers and implementers. The majority perceived the ADAPTE process to be feasible, useful and leading to improved methodological rigour and guideline quality. However, some de novo development might be needed if no high quality guideline exists for a given topic.

Henkilöstöraportointi - tunnuslukujen valinta ja seuraaminen henkilöstöstrategian toteuttamisessa, case: UPM-Kymmene Oyj, Voikkaa

Tutkimusalueena on henkilöstöraportointi ja henkilöstötilinpäätöksen tekeminen. Tavoitteena on selvittää henkilöstöraportoinnin tekemisestä saatava taloudellinen hyöty yritykselle. Teoriaosuudessa olen käyttänyt deskriptiivistä tutkimusmenetelmää ja empiriaosuudessa normatiivista. Empiriaosuus on rajattu UPM-Kymmene Oyj:n Voikkaan paperitehtaaseen. Case-organisaatiolle valitaan henkilöstötunnusluvut ja kehitetään sille sopiva henkilöstötunnuslukujen seurannan malli. Tunnusluvut ovat työkaluna analysoitaessa henkilöstön tämän hetkistä rakennetta, laatua ja työhyvinvointia. Pitkän aikavälin tuloksen tekemisessä henkilöstön osaamisella, työkyvyllä ja työmotivaatiolla on suuri merkitys. Osaamisen kehittymistä ja työhyvinvointia on seurattava kyselyillä. Brändilupausten, kuten esim. laadun ja osaamisen kehittämisen seurannassa voidaan myös hyödyntää henkilöstöraportoinnin tuottamia tunnuslukuja. Henkilöstöraportointi tuottaa informaatiota eri sidosryhmille: omistajat, sijoittajat, henkilöstö, asiakkaat, pankit, analyytikot ja toimittajat.

Feasibility of Therapeutic Drug Monitoring (TDM) for Imatinib: Preliminary considerations on the dosage adjustment approach for CML patients enrolled in the Imatinib Concentration Monitoring (I-COME) study

Background: As imatinib pharmacokinetics are highly variable, plasma levels differ largely between patients under the same dosage. Retrospective studies in chronic myeloid leukemia (CML) patients showed significant correlations between low levels and suboptimal response, and between high levels and poor tolerability. Monitoring of plasma levels is thus increasingly advised, targeting trough concentrations of 1000 μg/L and above. Objectives: Our study was launched to assess the clinical usefulness of systematic imatinib TDM in CML patients. The present preliminary evaluation questions the appropriateness of dosage adjustment following plasma level measurement to reach the recommended trough level, while allowing an interval of 4-24 h after last drug intake for blood sampling. Methods: Initial blood samples from the first 9 patients in the intervention arm were obtained 4-25 h after last dose. Trough levels in 7 patients were predicted to be significantly away from the target (6 <750 μg/L, and 1 >1500 μg/L with poor tolerance), based on a Bayesian approach using a population pharmacokinetic model. Individual dosage adjustments were taken up in 5 patients, who had a control measurement 1-4 weeks after dosage change. Predicted trough levels were confronted to anterior model-based extrapolations. Results: Before dosage adjustment, observed concentrations extrapolated at trough ranged from 359 to 1832 μg/L (median 710; mean 804, CV 53%) in the 9 patients. After dosage adjustment they were expected to target between 720 and 1090 μg/L (median 878; mean 872, CV 13%). Observed levels of the 5 recheck measurements extrapolated at trough actually ranged from 710 to 1069 μg/L (median 1015; mean 950, CV 16%) and had absolute differences of 21 to 241 μg/L to the model-based predictions (median 175; mean 157, CV 52%). Differences between observed and predicted trough levels were larger when intervals between last drug intake and sampling were very short (~4 h). Conclusion: These preliminary results suggest that TDM of imatinib using a Bayesian interpretation is able to bring trough levels closer to 1000 μg/L (with CV decreasing from 53% to 16%). While this may simplify blood collection in daily practice, as samples do not have to be drawn exactly at trough, the largest possible interval to last drug intake yet remains preferable. This encourages the evaluation of the clinical benefit of a routine TDM intervention in CML patients, which the randomized Swiss I-COME study aims to.

L'immunoscintigraphie par les anticorps monoclonaux radiomarqués. Evolution d'une méthode de diagnostic du cancer et espoir d'une nouvelle forme de thérapie [Immunoscintigraphy using radio-labeled monoclonal antibodies. Development of a method of cancer diagnosis and hopes for a new form of therapy].

Personal results are presented to illustrate the development of immunoscintigraphy for the detection of cancer over the last 12 years, from the early experimental results in nude mice grafted with human colon carcinoma to the most modern form of immunoscintigraphy applied to patients, using I123 labeled Fab fragments from monoclonal anti-CEA antibodies detected by single photon emission computerized tomography (SPECT). The first generation of immunoscintigraphy used I131 labeled, immunoadsorbent purified, polyclonal anti-CEA antibodies and planar scintigraphy, as the detection system. The second generation used I131 labeled monoclonal anti-CEA antibodies and SPECT, while the third generation employed I123 labeled fragments of monoclonal antibodies and SPECT. The improvement in the precision of tumor images with the most recent forms of immunoscintigraphy is obvious. However, we think the usefulness of immunoscintigraphy for routine cancer management has not yet been entirely demonstrated. Further prospective trials are still necessary to determine the precise clinical role of immunoscintigraphy. A case report is presented on a patient with two liver metastases from a sigmoid carcinoma, who received through the hepatic artery a therapeutic dose (100 mCi) of I131 coupled to 40 mg of a mixture of two high affinity anti-CEA monoclonal antibodies. Excellent localisation in the metastases of the I131 labeled antibodies was demonstrated by SPECT and the treatment was well tolerated. The irradiation dose to the tumor, however, was too low at 4300 rads (with 1075 rads to the normal liver and 88 rads to the bone marrow), and no evidence of tumor regression was obtained. Different approaches for increasing the irradiation dose delivered to the tumor by the antibodies are considered.