Improving outcome of childhood bacterial meningitis by simplified treatment : Experience from Angola

Background Acute bacterial meningitis (BM) continues to be an important cause of childhood mortality and morbidity, especially in developing countries. Prognostic scales and the identification of risk factors for adverse outcome both aid in assessing disease severity. New antimicrobial agents or adjunctive treatments - except for oral glycerol - have essentially failed to improve BM prognosis. A retrospective observational analysis found paracetamol beneficial in adult bacteraemic patients, and some experts recommend slow β-lactam infusion. We examined these treatments in a prospective, double-blind, placebo-controlled clinical trial. Patients and methods A retrospective analysis included 555 children treated for BM in 2004 in the infectious disease ward of the Paediatric Hospital of Luanda, Angola. Our prospective study randomised 723 children into four groups, to receive a combination of cefotaxime infusion or boluses every 6 hours for the first 24 hours and oral paracetamol or placebo for 48 hours. The primary endpoints were 1) death or severe neurological sequelae (SeNeSe), and 2) deafness. Results In the retrospective study, the mortality of children with blood transfusion was 23% (30 of 128) vs. without blood transfusion 39% (109 of 282; p=0.004). In the prospective study, 272 (38%) of the children died. Of those 451 surviving, 68 (15%) showed SeNeSe, and 12% (45 of 374) were deaf. Whereas no difference between treatment groups was observable in primary endpoints, the early mortality in the infusion-paracetamol group was lower, with the difference (Fisher s exact test) from the other groups at 24, 48, and 72 hours being significant (p=0.041, 0.0005, and 0.005, respectively). Prognostic factors for adverse outcomes were impaired consciousness, dyspnoea, seizures, delayed presentation, and absence of electricity at home (Simple Luanda Scale, SLS); the Bayesian Luanda Scale (BLS) also included abnormally low or high blood glucose. Conclusions New studies concerning the possible beneficial effect of blood transfusion, and concerning longer treatment with cefotaxime infusion and oral paracetamol, and a study to validate our simple prognostic scales are warranted.

Tilasto Suomen eläkkeensaajista kunnittain 2009

Tilasto Suomen eläkkeensaajista kunnittain perustuu Eläketurvakeskuksen ja Kansaneläkelaitoksen rekistereihin. Julkaisua on tuotettu vuodesta 1993 lähtien. Tilaston sisältöä on vuosien varrella jonkin verran uudistettu. Tarkempaa tietoa sisältöön kohdistuneista muutoksista on laatuselosteen kohdassa 4 Tilastojen yhtenäisyys ja vertailukelpoisuus sivulla 93. Julkaisu sisältää kuntakohtaista tietoa kaikista työ- ja kansaneläkkeensaajista sekä eläkemenosta. Tietoja on eläkkeensaajien lukumääristä, eläkkeiden suuruuksista sekä kokonaiseläkemenosta. Luokittelijoina ovat mm. eläkelaji, eläkkeensaajan ikä, eläkkeen suuruus ja eläkejärjestelmä. Koko maata koskevaa tietoa löytyy laajemmin julkaisusta Tilasto Suomen eläkkeensaajista, jota on julkaistu vuodesta 1981 lähtien.

Tilasto Suomen eläkkeensaajista 2009

Tilasto Suomen eläkkeensaajista perustuu Eläketurvakeskuksen ja Kansaneläkelaitoksen rekistereihin. Julkaisua on tuotettu vuodesta 1981 lähtien. Vuosina 1981–1990 kirja julkaistiin erikseen suomen- ja ruotsinkielisenä. Ruotsinkielinen osa sisälsi suppean englanninkielisen liitteen. Vuodesta 1991 lähtien julkaisu on ollut kolmikielinen. Julkaisu sisältää tietoja kaikista työ- ja kansaneläkkeensaajista, eläkkeelle siirtyneistä ja eläkemenosta. Tietoja on kaikista eläkkeensaajista sekä erikseen Suomessa ja ulkomailla asuvista eläkkeensaajista, poikkeuksena eläkkeelle siirtyneet, joista ei ainakaan toistaiseksi tehdä erillistä tilastoa ulkomailla asuvista. Tilasto on ilmestynyt osana Suomen virallista tilastoa vuodesta 2003 lähtien. Laatuseloste on julkaisun liitteessä 1. Julkaisun alussa on kuvaus eläkejärjestelmästä ja eläke-etuuksista sekä tilastossa käytetyistä käsitteistä. Liitteessä 2 on suppea yhteenveto keskeisistä eläkelainsäädännön muutoksista.

A participatory approach to tactical forest planning.

The paper examines the needs, premises and criteria for effective public participation in tactical forest planning. A method for participatory forest planning utilizing the techniques of preference analysis, professional expertise and heuristic optimization is introduced. The techniques do not cover the whole process of participatory planning, but are applied as a tool constituting the numerical core for decision support. The complexity of multi-resource management is addressed by hierarchical decision analysis which assesses the public values, preferences and decision criteria toward the planning situation. An optimal management plan is sought using heuristic optimization. The plan can further be improved through mutual negotiations, if necessary. The use of the approach is demonstrated with an illustrative example, it's merits and challenges for participatory forest planning and decision making are discussed and a model for applying it in general forest planning context is depicted. By using the approach, valuable information can be obtained about public preferences and the effects of taking them into consideration on the choice of the combination of standwise treatment proposals for a forest area. Participatory forest planning calculations, carried out by the approach presented in the paper, can be utilized in conflict management and in developing compromises between competing interests.

Uterine cervix nitric oxide and human papillomavirus infection in women

Most women acquire genital high risk human papillomavirus (HPV) infection during their lifetime, but seldom the infection persists and leads to cervical cancer. However, currently it is not possible to identify the women who will develop HPV mediated cervical cancer and this often results to large scale follow-up and overtreatment of the likely spontaneously regressing infection. Thus, it is important to obtain more information on the course of HPV and find markers that could help to identify HPV infected women in risk for progression of cervical lesions and ultimately cancer. Nitric oxide is a free radical gas that takes part both in immune responses and carcinogenesis. Nitric oxide is produced also by cervical cells and therefore, it is possible that cervical nitric oxide could affect also HPV infection. In the present study, including 801 women from the University of Helsinki between years of 2006 and 2011, association between HPV and cervical nitric oxide was evaluated. The levels of nitric oxide were measured as its metabolites nitrate and nitirite (NOx) by spectrophotometry and the expression of nitric oxide producing enzymes endothelial and inducible synthases (eNOS, iNOS) by Western blotting. Women infected with HPV had two-times higher cervical fluid NOx levels compared with non-infected ones. The expression levels of both eNOS and iNOS were higher in HPV-infected women compared with non-infected. Another sexually transmitted disease Chlamydia trachomatis that is an independent risk factor for cervical cancer was also accompanied with elevated NOx levels, whereas vaginal infections, bacterial vaginosis and candida, did not have any effect on NOx levels. The meaning of the elevated HPV related cervical nitric oxide was evaluated in a 12 months follow-up study. It was revealed that high baseline cervical fluid NOx levels favored HPV persistence with OR 4.1. However, low sensitivity (33%) and high false negative rate (67%) restrict the clinical use of the current NOx test. This study indicated that nitric oxide favors HPV persistence and thus it seems to be one of the cofactor associated with a risk of carcinogenesis.

Emergenssi tieteessä ja teologiassa : Huomioita Philip Claytonin emergenssiteoriasta

Tässä työssä tarkastellaan emergenssiä luonnontieteellisenä, metafyysisenä ja teologisena käsitteenä, ja erityisesti Philip Claytonin emergenssiteoriaa. Tutkimuskohteena on Philip Claytonin kirja Mind and Emergence From Quantum to Consciousness ja tutkimusmetodina käsitteellinen analyysi. Kun emergenssiä tarkastellaan metafyysisenä teoriana, se on mahdollista nähdä fysikalismille ja dualismille vaihtoehtoisena filosofisena katsantokantana todellisuuteen. Fysikalismi on havaittavaa todellisuutta koskeva näkemys, jonka mukaan kaikki ilmiöt ovat lopulta palautettavissa fysiikkaan ja selitettävissä fysiikan käsittein. Dualismi taas on näkemys, että erityisesti ihmisen mieli ja tietoisuus ovat jotain fysikaaliseen maailmaan nähden täysin erilaista ja siitä riippumatonta. Emergenssiteoriassa maailman nähdään kehittyvänä kokonaisuutena, jossa kompleksisuuden kasvun myötä syntyy jatkuvasti uusia ominaisuuksia. Nämä ominaisuudet eivät ole palautettavissa niihin rakenteisiin, joiden pohjalta ne ovat syntyneet. Niiden syntymistä ei ole mahdollista luonnontieteellisin tai muinkaan menetelmin ennakoida. Emergenssin heikossa muodossa tämä ennakoimattomuus on vain episteeminen, tiedon mahdollisuuksiin liittyvä rajoitus, ja kausaalisia vaikutuksia esiintyy ainoastaan fysikaalisten objektien tasolla. Metafyysinen teoria edellyttää kuitenkin vahvaa emergenssiä, jossa syntyvillä ominaisuuksilla on fysikaalisesta perustastaan riippumatonta kausaalista vaikutusta. Tätä kutsutaan alaspäin -kausaalisuudeksi. Käsitys todellisuudesta on monistinen ja holistinen. Kaikki olemassa oleva on kehittynyt samasta aineksesta, mutta ei ole palautettavissa siihen. Maailmassa on ontologisesti toisistaan poikkeavia todellisuuden tasoja. Todellisuus on enemmän kuin osiensa summa. Emergenssille on tarjottu myös teologisia sovelluksia. Kun fysikalismissa uskonnolliselle uskolle ei jää tilaa ja dualismi on luonnontieteen näkökulmasta ongelmallinen, emergenssistä on etsitty filosofista viitekehystä, jossa luonnontiede ja uskonto olisivat sovitettavissa yhteen. Ensimmäisessä luvussa käsitellään fysikalismia ja dualismia ja erityisesti filosofista ja luonnontieteellistä kritiikkiä, jota niitä vastaan voidaan esittää. Toisessa luvussa tarkastellaan erilaisia mahdollisuuksia määritellä emergenssin käsite ja esitellään erityisesti Philip Claytonin käsityksiä heikosta ja vahvasta emergenssistä, emergenssistä luonnontieteissä sekä ihmismielestä fysikaaliseen maailmaan nähden emergenttinä ilmiönä. Emergenssi mainitaan monien sellaisten ilmiöiden yhteydessä, joita on pyritty tutkimaan kaaosteorian ja kompleksisuuden tutkimuksen keinoin. Työn kolmannessa luvussa pyritään antamaan kuva emergenssin suhteesta näihin teorioihin ja ylipäätään moderniin fysiikkaan. Philip Clayton on luonut emergenssiteorian pohjalta myös teologisen teorian, jossa käsitys Jumalasta luojana ja Jumalan vaikutus maailmassa pyritään sovittamaan yhteen emergentin todellisuuskäsityksen kanssa. Tätä teologista teoriaa esitellään ja arvioidaan työn neljännessä luvussa.

V-CE Sensing for IGBT Protection in NPC Three Level Converters-Causes For Spurious Trippings and Their Elimination

Neutral point clamped (NPC), three level converters with insulated gate bipolar transistor devices are very popular in medium voltage, high power applications. DC bus short circuit protection is usually done, using the sensed voltage across collector and emitter (i.e., V-CE sensing), of all the devices in a leg. This feature is accommodated with the conventional gate drive circuits used in the two level converters. The similar gate drive circuit, when adopted for NPC three level converter protection, leads to false V-CE fault signals for inner devices of the leg. The paper explains the detailed circuit behavior and reasons, which result in the occurrence of such false V-CE fault signals. This paper also illustrates that such a phenomenon shows dependence on the power factor of the supplied three-phase load. Finally, experimental results are presented to support the analysis. It is shown that the problem can be avoided by blocking out the V-CE sense fault signals of the inner devices of the leg.

Phage Displayed Short Peptides against Cells of Candida albicans Demonstrate Presence of Species, Morphology and Region Specific Carbohydrate Epitopes

Candida albicans is a commensal opportunistic pathogen, which can cause superficial infections as well as systemic infections in immuocompromised hosts. Among nosocomial fungal infections, infections by C. albicans are associated with highest mortality rates even though incidence of infections by other related species is on the rise world over. Since C. albicans and other Candida species differ in their susceptibility to antifungal drug treatment, it is crucial to accurately identify the species for effective drug treatment. Most diagnostic tests that differentiate between C. albicans and other Candida species are time consuming, as they necessarily involve laboratory culturing. Others, which employ highly sensitive PCR based technologies often, yield false positives which is equally dangerous since that leads to unnecessary antifungal treatment. This is the first report of phage display technology based identification of short peptide sequences that can distinguish C. albicans from other closely related species. The peptides also show high degree of specificity towards its different morphological forms. Using fluorescence microscopy, we show that the peptides bind on the surface of these cells and obtained clones that could even specifically bind to only specific regions of cells indicating restricted distribution of the epitopes. What was peculiar and interesting was that the epitopes were carbohydrate in nature. This gives insight into the complexity of the carbohydrate composition of fungal cell walls. In an ELISA format these peptides allow specific detection of relatively small numbers of C. albicans cells. Hence, if used in combination, such a test could help accurate diagnosis and allow physicians to initiate appropriate drug therapy on time.

Bayesian Decentralized Spectrum Sensing in Cognitive Radio Networks

This paper considers the problem of spectrum sensing, i.e., the detection of whether or not a primary user is transmitting data by a cognitive radio. The Bayesian framework is adopted, with the performance measure being the probability of detection error. A decentralized setup, where N sensors use M observations each to arrive at individual decisions that are combined at a fusion center to form the overall decision is considered. The unknown fading channel between the primary sensor and the cognitive radios makes the individual decision rule computationally complex, hence, a generalized likelihood ratio test (GLRT)-based approach is adopted. Analysis of the probabilities of false alarm and miss detection of the proposed method reveals that the error exponent with respect to M is zero. Also, the fusion of N individual decisions offers a diversity advantage, similar to diversity reception in communication systems, and a tight bound on the error exponent is presented. Through an analysis in the low power regime, the number of observations needed as a function of received power, to achieve a given probability of error is determined. Monte-Carlo simulations confirm the accuracy of the analysis.

Knowledge-based clustering

In the knowledge-based clustering approaches reported in the literature, explicit know ledge, typically in the form of a set of concepts, is used in computing similarity or conceptual cohesiveness between objects and in grouping them. We propose a knowledge-based clustering approach in which the domain knowledge is also used in the pattern representation phase of clustering. We argue that such a knowledge-based pattern representation scheme reduces the complexity of similarity computation and grouping phases. We present a knowledge-based clustering algorithm for grouping hooks in a library.

Link failure detection for maintaining session continuity in packet data networks

A link failure in the path of a virtual circuit in a packet data network will lead to premature disconnection of the circuit by the end-points. A soft failure will result in degraded throughput over the virtual circuit. If these failures can be detected quickly and reliably, then appropriate rerouteing strategies can automatically reroute the virtual circuits that use the failed facility. In this paper, we develop a methodology for analysing and designing failure detection schemes for digital facilities. Based on errored second data, we develop a Markov model for the error and failure behaviour of a T1 trunk. The performance of a detection scheme is characterized by its false alarm probability and the detection delay. Using the Markov model, we analyse the performance of detection schemes that use physical layer or link layer information. The schemes basically rely upon detecting the occurrence of severely errored seconds (SESs). A failure is declared when a counter, that is driven by the occurrence of SESs, reaches a certain threshold.For hard failures, the design problem reduces to a proper choice;of the threshold at which failure is declared, and on the connection reattempt parameters of the virtual circuit end-point session recovery procedures. For soft failures, the performance of a detection scheme depends, in addition, on how long and how frequent the error bursts are in a given failure mode. We also propose and analyse a novel Level 2 detection scheme that relies only upon anomalies observable at Level 2, i.e. CRC failures and idle-fill flag errors. Our results suggest that Level 2 schemes that perform as well as Level 1 schemes are possible.

Multivariate nonlinear ensemble prediction of daily chaotic rainfall with climate inputs

The basic characteristic of a chaotic system is its sensitivity to the infinitesimal changes in its initial conditions. A limit to predictability in chaotic system arises mainly due to this sensitivity and also due to the ineffectiveness of the model to reveal the underlying dynamics of the system. In the present study, an attempt is made to quantify these uncertainties involved and thereby improve the predictability by adopting a multivariate nonlinear ensemble prediction. Daily rainfall data of Malaprabha basin, India for the period 1955-2000 is used for the study. It is found to exhibit a low dimensional chaotic nature with the dimension varying from 5 to 7. A multivariate phase space is generated, considering a climate data set of 16 variables. The chaotic nature of each of these variables is confirmed using false nearest neighbor method. The redundancy, if any, of this atmospheric data set is further removed by employing principal component analysis (PCA) method and thereby reducing it to eight principal components (PCs). This multivariate series (rainfall along with eight PCs) is found to exhibit a low dimensional chaotic nature with dimension 10. Nonlinear prediction employing local approximation method is done using univariate series (rainfall alone) and multivariate series for different combinations of embedding dimensions and delay times. The uncertainty in initial conditions is thus addressed by reconstructing the phase space using different combinations of parameters. The ensembles generated from multivariate predictions are found to be better than those from univariate predictions. The uncertainty in predictions is decreased or in other words predictability is increased by adopting multivariate nonlinear ensemble prediction. The restriction on predictability of a chaotic series can thus be altered by quantifying the uncertainty in the initial conditions and also by including other possible variables, which may influence the system. (C) 2011 Elsevier B.V. All rights reserved.

Data rectification and detection of trend shifts in jet engine path measurements using median filters and fuzzy logic

Filtering methods are explored for removing noise from data while preserving sharp edges that many indicate a trend shift in gas turbine measurements. Linear filters are found to be have problems with removing noise while preserving features in the signal. The nonlinear hybrid median filter is found to accurately reproduce the root signal from noisy data. Simulated faulty data and fault-free gas path measurement data are passed through median filters and health residuals for the data set are created. The health residual is a scalar norm of the gas path measurement deltas and is used to partition the faulty engine from the healthy engine using fuzzy sets. The fuzzy detection system is developed and tested with noisy data and with filtered data. It is found from tests with simulated fault-free and faulty data that fuzzy trend shift detection based on filtered data is very accurate with no false alarms and negligible missed alarms.

DNA Free Energy-Based Promoter Prediction and Comparative Analysis of Arabidopsis and Rice Genomes

The cis-regulatory regions on DNA serve as binding sites for proteins such as transcription factors and RNA polymerase. The combinatorial interaction of these proteins plays a crucial role in transcription initiation, which is an important point of control in the regulation of gene expression. We present here an analysis of the performance of an in silico method for predicting cis-regulatory regions in the plant genomes of Arabidopsis (Arabidopsis thaliana) and rice (Oryza sativa) on the basis of free energy of DNA melting. For protein-coding genes, we achieve recall and precision of 96% and 42% for Arabidopsis and 97% and 31% for rice, respectively. For noncoding RNA genes, the program gives recall and precision of 94% and 75% for Arabidopsis and 95% and 90% for rice, respectively. Moreover, 96% of the false-positive predictions were located in noncoding regions of primary transcripts, out of which 20% were found in the first intron alone, indicating possible regulatory roles. The predictions for orthologous genes from the two genomes showed a good correlation with respect to prediction scores and promoter organization. Comparison of our results with an existing program for promoter prediction in plant genomes indicates that our method shows improved prediction capability.