Padrões de captação de constraste do útero TC e RM

Ao contrário da ecografia e da ressonância magnética (RM), a tomografia computadorizada (TC) não é uma técnica de primeira linha no estudo da patologia pélvica feminina. Contudo, a TC é frequentemente utilizada na avaliação de patologia pélvica não ginecológica, nomeadamente em contexto de urgência ou de seguimento, na qual os órgãos ginecológicos são englobados. Nestas situações, o padrão de captação de contraste endovenoso pelo corpo e colo do útero na TC pode ser de difícil interpretação e por vezes simular patologia, dado o amplo espectro de padrões de captação de contraste endovenoso, de variantes anatómicas e/ou de patologia subjacente. Neste artigo as autoras revêm e ilustram os padrões de captação de contraste endovenoso pelo útero em TC e RM e possíveis pitfalls, permitindo diferenciar os aspectos normais e patológicos do útero em TC.

Estratificação do carcinoma do colo do útero pré e pós-terapêutica - uma perspectiva global

O carcinoma do colo do útero é um dos tumores malignos mais frequentes a nível mundial. Para garantir a uniformização de critérios entre países com diferentes recursos, o estadiamento deste tumor permanece clínico, segundo as orientações da Federação Internacional de Ginecologia e Obstetrícia, e tem por principal objectivo a identificação das doentes que são candidatas à cirurgia. A avaliação radiológica é amplamente recomendada, quando disponível, com o objectivo de aumentar a acuidade do diagnóstico, assegurando a optimização terapêutica, sendo também recomendada no seguimento. Importa, assim, que o radiologista tenha presente não só o protocolo técnico adequado na suspeita de carcinoma do colo do útero e o respectivo espectro de apresentação radiológica, mas também algumas características da própria doença e possíveis abordagens terapêuticas, de forma a incluir no seu relatório toda a informação relevante. A ressonância magnética permanece o principal pilar na avaliação radiológica destas doentes, embora recentemente o papel da tomografia computorizada por emissão de positrões tenha vindo a ganhar relevo, sobretudo no que respeita à avaliação ganglionar e ao despiste de recidiva. Neste artigo as autoras dão uma perspectiva aprofundada da avaliação radiológica do carcinoma do colo do útero, deste o diagnóstico ao seguimento pós-terapêutico, à luz dos estudos mais recentes.

Estadiamento do carcinoma do colo do útero por ressonância magnética – comparação com os achados anátomo-patológicos

Objectivo: Avaliar a acuidade da Ressonância Magnética (RM) no estadiamento do carcinoma do colo do útero, comparando os achados em RM com os resultados Anátomo-Patológicos da peça operatória. Material e Métodos: Foi efectuado um estudo retrospectivo que incluiu 41 doentes operadas com o diagnóstico de carcinoma do colo do útero e previamente submetidas a RM para estadiamento, entre Janeiro de 2007 e Dezembro de 2009. Foram analisados os seguintes factores de estadiamento e prognóstico: dimensão do tumor, invasão dos paramétrios, invasão da vagina e metástases ganglionares. A dimensão do tumor determinada por RM foi comparada com a medição na peça operatória através da análise do declive e ordenada na origem de uma recta de regressão entre os dois métodos. Resultados: O tumor foi visualizado por RM na maioria dos casos (35 doentes, 85.4%). Nas restantes 6 doentes a avaliação anátomo-patológica revelou um tumor com menos de 6 mm de diâmetro. A dimensão do tumor foi adequadamente avaliada por RM, sem diferenças estatisticamente significativas entre a medição por RM e na peça operatória. Foi confirmado o elevado valor preditivo negativo da RM na exclusão de invasão dos paramétrios previamente reportado, com apenas 2 falsos negativos em que a anatomia patológica demonstrou apenas invasão microscópica focal. A invasão da vagina foi correctamente avaliada em 30 doentes (85.7%), tendo-se verificado nos restantes casos 2 falsos negativos e 3 falsos positivos. Em relação às metástases ganglionares verificaram-se 4 falsos negativos, no total das 41 doentes avaliadas. Conclusão: A dimensão do tumor, invasão dos paramétrios, invasão da vagina e metástases ganglionares foram adequadamente avaliadas por RM, confirmando a capacidade da RM no estadiamento do carcinoma do colo do útero.

Entrevista al DR. Josep Fontana

Resumen Los entrevistadores dialogan con Fontana acercad de los problemas teóricos y metodológicos de la investigación histórica. Abstract The interviewers discuss theoretical and methodological problems of history investigation  with Fontana.

Levels of awareness of professional ethics used as a sensitizing method in project-based learning

There is a need for educational frameworks for computer ethics education. This discussion paper presents an approach to developing students’ moral sensitivity, an awareness of morally relevant issues, in project-based learning (PjBL). The proposed approach is based on a study of IT professionals’ levels of awareness of ethics. These levels are labelled My world, The corporate world, A shared world, The client’s world and The wider world. We give recommendations for how instructors may stimulate students’ thinking with the levels and how the levels may be taken into account in managing a project course and in an IS department. Limitations of the recommendations are assessed and issues for discussion are raised.

Process mining manifesto

Process mining techniques are able to extract knowledge from event logs commonly available in today’s information systems. These techniques provide new means to discover, monitor, and improve processes in a variety of application domains. There are two main drivers for the growing interest in process mining. On the one hand, more and more events are being recorded, thus, providing detailed information about the history of processes. On the other hand, there is a need to improve and support business processes in competitive and rapidly changing environments. This manifesto is created by the IEEE Task Force on Process Mining and aims to promote the topic of process mining. Moreover, by defining a set of guiding principles and listing important challenges, this manifesto hopes to serve as a guide for software developers, scientists, consultants, business managers, and end-users. The goal is to increase the maturity of process mining as a new tool to improve the (re)design, control, and support of operational business processes.

Glider path-planning for optimal sampling of mesocale eddies

Ocean gliders constitute an important advance in the highly demanding ocean monitoring scenario. Their effciency, endurance and increasing robustness make these vehicles an ideal observing platform for many long term oceanographic applications. However, they have proved to be also useful in the opportunis-tic short term characterization of dynamic structures. Among these, mesoscale eddies are of particular interest due to the relevance they have in many oceano-graphic processes.

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010 : a systematic analysis for the Global Burden of Disease Study 2010

Background Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs). Methods Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. Findings Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient −0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. Interpretation Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world. Funding Bill & Melinda Gates Foundation.

Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition

Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Maaseutuopistoista Yliopistoon : Maatalous- ja metsätieteiden tutkimus- ja opetustoiminnan akatemisoitumisprosessi Helsingin Yliopistossa vuoteen 1945

From Provincial Institutes to the University. The Academisation Process of the Research and Teaching of Agricultural and Forest Sciences at the University of Helsinki before 1945. This study focuses on the teaching and research conducted in the Faculty of Agriculture and Forestry at the University of Helsinki, as well as in its predecessor, the Section of Agriculture and Economics before 1945. The study falls into the field of university history. Its key research question is the academisation process, an example of which is the academisation process of the teaching and research of agricultural and forest sciences in Finland. From a perspective of university history, the study looks at academisation as the beginning of university-level teaching and research in these fields, or their relocation to a university or another institute of university standing. In addition to the above, the academisation process also includes the establishment of the position of the subjects and their acceptance as part of university activity. Academic closure, on the other hand, prevents the academisation of new subjects. In Finland, the preliminary stage of the academisation of the research and teaching of the agriculture and forestry was the Age of Utility, when questions concerning the subjects became part of clerical and civil service training at the Royal Academy of Turku in the mid-18th century. In the mid-19th century, as a result of social and economic development, agricultural and forestry professionals needed more theoretical professional training. At that time, the Imperial Alexander University was focused on traditional professional training and theoretical education, so, because of this academic closure, practical training for agronomists and foresters was organised at first outside the University at the Mustiala Agricultural Institute and the Evo Forest Institute. In the late 19th century, discussion began on the reform of higher agricultural and forestry education. This led, from the 1890s, to the academisation of higher agricultural and forestry education and research at the Alexander University. Academisation was followed by a transitional stage, during which the work of the Section of Agriculture and Economics, which had begun in 1902, became more established in about 1910. The position of the agricultural and forest sciences was, however, largely temporary, because of the planned Agricultural University. A sign of this establishment and of the rise in scientific status of the subjects was the commencement of operations of the Faculty of Agriculture and Forestry in 1924. Furthermore, as a consequence of the development of the subjects and the collapse of the Agricultural University project, agricultural and forest sciences gradually began to be accepted at the University of Helsinki from the end of the 1920s. This led to the allocation of sites for the faculty buildings and research farms, and to the building of ‘Metsätalo’ before the Second World War. Key words: academisation, academisation process, academic closure, university history, University of Helsinki, Faculty of Agriculture and Forestry, agricultural sciences, forest sciences, agronomy training, forestry training

Atomic Layer Deposition for optical applications: metal fluoride thin films and novel devices

Thin films of various metal fluorides are suited for optical coatings from infrared (IR) to ultraviolet (UV) range due to their excellent light transmission. In this work, novel metal fluoride processes have been developed for atomic layer deposition (ALD), which is a gas phase thin film deposition method based on alternate saturative surface reactions. Surface controlled self-limiting film growth results in conformal and uniform films. Other strengths of ALD are precise film thickness control, repeatability and dense and pinhole free films. All these make the ALD technique an ideal choice also for depositing metal fluoride thin films. Metal fluoride ALD processes have been largely missing, which is mostly due to a lack of a good fluorine precursor. In this thesis, TiF4 precursor was used for the first time as the fluorine source in ALD for depositing CaF2, MgF2, LaF3 and YF3 thin films. TaF5 was studied as an alternative novel fluorine precursor only for MgF2 thin films. Metal-thd (thd = 2,2,6,6-tetramethyl-3,5-heptanedionato) compounds were applied as the metal precursors. The films were grown at 175 450 °C and they were characterized by various methods. The metal fluoride films grown at higher temperatures had generally lower impurity contents with higher UV light transmittances, but increased roughness caused more scattering losses. The highest transmittances and low refractive indices below 1.4 (at 580 nm) were obtained with MgF2 samples. MgF2 grown from TaF5 precursor showed even better UV light transmittance than MgF2 grown from TiF4. Thus, TaF5 can be considered as a high quality fluorine precursor for depositing metal fluoride thin films. Finally, MgF2 films were applied in fabrication of high reflecting mirrors together with Ta2O5 films for visible region and with LaF3 films for UV region. Another part of the thesis consists of applying already existing ALD processes for novel optical devices. In addition to the high reflecting mirrors, a thin ALD Al2O3 film on top of a silver coating was proven to protect the silver mirror coating from tarnishing. Iridium grid filter prototype for rejecting IR light and Ir-coated micro channel plates for focusing x-rays were successfully fabricated. Finally, Ir-coated Fresnel zone plates were shown to provide the best spatial resolution up to date in scanning x-ray microscopy.