Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study.

BACKGROUND: Conversion disorder (CD) is no longer a diagnosis of exclusion. The new DSM-V criteria highlight the importance of 'positive signs' on neurological examination. Only few signs have been validated, and little is known about their reliability. OBJECTIVE: The aim was to examine the clinical value of bedside positive signs in the diagnosis of CD presenting with weakness, gait or sensory symptoms by assessing their specificity, sensitivity and their inter-rater reliability. PATIENTS AND METHODS: Standardised video recorded neurological examinations were performed in 20 consecutive patients with CD and 20 'organic' controls. Ten previously validated sensory and motor signs were grouped in a scale. Thirteen additional motor/sensory 'positive signs', 14 gait patterns and 1 general sign were assessed in a pilot validation study. In addition, two blinded independent neurologists rated the video recordings to assess the inter-rater reliability (Cohen's κ) of each sign. RESULTS: A score of ≥4/14 on the sensory motor scale showed a 100% specificity (CI 85 to 100) and a 95% sensitivity (CI 85 to 100). Among the additional tested signs, 10 were significantly more frequent in CD than controls. The interobserver agreement was acceptable for 23/38 signs (2 excellent, 10 good, 11 moderate). CONCLUSIONS: Our study confirms that six bedside 'positive signs' are highly specific for CD with good-excellent inter-rater reliability; we propose to consider them as 'highly reliable signs'. In addition 13 signs could be considered as 'reliable signs' and six further signs as 'suggestive signs' while all others should be used with caution until further validation is available.

Lake-level and salinity reconstruction from diatom analyses in Quillagua Formation (Late Neogene, Central Andean Forearc, Northern Chile)

A sedimentary and micropaleontological study of the Quillagua Formation provides a detailed paleohydrological reconstruction of the lacustrine system which occupied the present-day hyperarid Quillagua-Llamara fore-arc Basin (Northern Chile) from lattermost Miocene to Early Pliocene times.

Level Set Methods in Image Processing

This thesis gives an overview of the use of the level set methods in the field of image science. The similar fast marching method is discussed for comparison, also the narrow band and the particle level set methods are introduced. The level set method is a numerical scheme for representing, deforming and recovering structures in an arbitrary dimensions. It approximates and tracks the moving interfaces, dynamic curves and surfaces. The level set method does not define how and why some boundary is advancing the way it is but simply represents and tracks the boundary. The principal idea of the level set method is to represent the N dimensional boundary in the N+l dimensions. This gives the generality to represent even the complex boundaries. The level set methods can be powerful tools to represent dynamic boundaries, but they can require lot of computing power. Specially the basic level set method have considerable computational burden. This burden can be alleviated with more sophisticated versions of the level set algorithm like the narrow band level set method or with the programmable hardware implementation. Also the parallel approach can be used in suitable applications. It is concluded that these methods can be used in a quite broad range of image applications, like computer vision and graphics, scientific visualization and also to solve problems in computational physics. Level set methods and methods derived and inspired by it will be in the front line of image processing also in the future.

Investigating Neuroanatomical Features in Top Athletes at the Single Subject Level.

In sport events like Olympic Games or World Championships competitive athletes keep pushing the boundaries of human performance. Compared to team sports, high achievements in many athletic disciplines depend solely on the individual's performance. Contrasting previous research looking for expertise-related differences in brain anatomy at the group level, we aim to demonstrate changes in individual top athlete's brain, which would be averaged out in a group analysis. We compared structural magnetic resonance images (MRI) of three professional track-and-field athletes to age-, gender- and education-matched control subjects. To determine brain features specific to these top athletes, we tested for significant deviations in structural grey matter density between each of the three top athletes and a carefully matched control sample. While total brain volumes were comparable between athletes and controls, we show regional grey matter differences in striatum and thalamus. The demonstrated brain anatomy patterns remained stable and were detected after 2 years with Olympic Games in between. We also found differences in the fusiform gyrus in two top long jumpers. We interpret our findings in reward-related areas as correlates of top athletes' persistency to reach top-level skill performance over years.

Defining supply chain service level priorities in an international polyolefin company

Tutkimuksen tarkoituksena oli selvittää, ovatko asiakkaiden kanssa sovitut kaupintavarastojärjestelyt liiketoiminnallisesti oikeutettuja vai ovatko ne pääasiassa vain asiakkaan palvelua. Tavoitteiksi asetettiin tutkia logististen palveluiden tärkeyttä, etsiä eri näkökohtia asiakaskohtaisten varastojen ja varastopalveluiden tarjoamiselle, löytää mahdollisia korvaavia tai vastaavia palveluita, sekä esitellä menetelmä toimitusketjun palvelutason priorisoimiseksi ja hallitsemiseksi. Työhön tarvittu kaupallinen aineisto koskien tuotteita ja asiakaita saatiin yrityksen tietojärjestelmästä. Muut taustatiedot kerättiin yrityksen toimintaohjeista, keskustelemalla ja haastattelemalla henkilöstöä, sekä seuraamalla yrityksen toimintaa työnteon ohessa. Tutkimus on jaettu kirjallisuus- ja case-osuuteen. Työn case-tulokset osoittavat, että nykyiset kaupintavarastoasiakkaat pääosin ansaitsevat lisäarvoa tuottavan varastopalvelun. Tutkimuksesta saadut kokemukset ja tiedot auttavat tekemään lisäarviointeja, koskien myös yrityksen muita tuotantolaitoksia. Työstä saatuja kokonaishyötyjä on vielä tässä vaiheessa vaikea arvioida.

Serum 25-hydroxyvitamin D level and kidney function decline in a Swiss general adult population.

Molecular evidence suggests that levels of vitamin D are associated with kidney function loss. Still, population-based studies are limited and few have considered the potential confounding effect of baseline kidney function. This study evaluated the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline, and incidence of CKD and albuminuria. Baseline (2003-2006) and 5.5-year follow-up data from a Swiss adult general population were used to evaluate the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline (annual loss >3 ml/min per 1.73 m(2)), and incidence of CKD and albuminuria. Serum 25-hydroxyvitamin D was measured at baseline using liquid chromatography-tandem mass spectrometry. eGFR and albuminuria were collected at baseline and follow-up. Multivariate linear and logistic regression models were used considering potential confounding factors. Among the 4280 people included in the analysis, the mean±SD annual eGFR change was -0.57±1.78 ml/min per 1.73 m(2), and 287 (6.7%) participants presented rapid eGFR decline. Before adjustment for baseline eGFR, baseline 25-hydroxyvitamin D level was associated with both mean annual eGFR change and risk of rapid eGFR decline, independently of baseline albuminuria. Once adjusted for baseline eGFR, associations were no longer significant. For every 10 ng/ml higher baseline 25-hydroxyvitamin D, the adjusted mean annual eGFR change was -0.005 ml/min per 1.73 m(2) (95% confidence interval, -0.063 to 0.053; P=0.87) and the risk of rapid eGFR decline was null (odds ratio, 0.93; 95% confidence interval, 0.79 to 1.08; P=0.33). Baseline 25-hydroxyvitamin D level was not associated with incidence of CKD or albuminuria. The association of 25-hydroxyvitamin D with eGFR decline is confounded by baseline eGFR. Sufficient 25-hydroxyvitamin D levels do not seem to protect from eGFR decline independently from baseline eGFR.

Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks.

OBJECTIVE: The objective was to compare a brief interdisciplinary psychotherapeutic intervention to standard care as treatments for patients recently diagnosed with severe motor conversion disorder or nonepileptic attacks. METHODS: This randomized controlled trial of 23 consecutive patients compared (a) an interdisciplinary psychotherapeutic intervention group receiving four to six sessions by a consultation liaison psychiatrist, the first and last sessions adding a neurological consultation and a joint psychiatric and neurological consultation, and (b) a standard care group. After intervention, patients were assessed at 2, 6 and 12 months with the Somatoform Dissociation Questionnaire (SDQ-20), Clinical Global Impression scale, Rankin scale, use of medical care, global mental health [Montgomery and Asberg Depression Rating Scale, Beck Depression Inventory, mental health component of Short Form (SF)-36] and quality of life (SF-36). We calculated linear mixed models. RESULTS: Our intervention brought a statistically significant improvement of physical symptoms [as measured by the SDQ-20 (P<.02) and the Clinical Global Impression scale (P=.02)] and psychological symptoms [better scores on the mental health component of the SF-36 (P<.05) and on the Beck Depression Inventory (P<.05)] and a reduction in new hospital stays after intervention (P<.05). CONCLUSION: A brief psychotherapeutic intervention taking advantage of a close collaboration with neurology consultants in the setting of consultation liaison psychiatry appears effective.

Implementing IAS 2 and IAS 36. Case: Eimo Oyj

Tutkimuksen päätavoitteena oli tutkia IFRS -standardiston vaikutuksia esimerkkiyrityksessä. Tutkimuksen kohteena olivat varastot sekä omaisuuserien arvonalentuminen. Varastojen käsittelyn osalta työn tarkoituksena oli luoda malli valmistuksen yleismenojen aktivointia varten. Omaisuuserien arvonalentumista koskevassa osassa tarkoituksena oli selvittää arvonalentumistestauksen tärkeimmät vaiheet sekä ehdottaa rahavirtaa kerryttäviä yksiköitä esimerkkiyritykselle. Tutkimusmenetelmänä on laadullinen case-tutkimus. Empiiristä tutkimustietoa kerätään osallistuvan havainnoinnin, haastattelujen ja keskustelujen avulla. Tutkimuksen tuloksena todettiin, että IFRS -standardien vaikutukset ovat laajasti koko esimerkkiyritystä koskevia. Varastoja koskevassa osassa todettiin, että valmistuksen yleismenot tulee allokoida muovitehtaille ruiskupuristustuntien perusteella ja muottitehtaille miestyötuntien perusteella. Omaisuuserien arvonalentumista koskien todettiin liiketoiminnan nopeasti muuttuvan luonteen vaikeuttavan ennusteiden laatimista. Rahavirtaa kerryttäviksi yksiköiksi ehdotettiin tehdastasoa.

Operative level purchasing in pharmaceutical wholesale trade

Tämän tutkintotyön tavoitteena on selvittää operatiivista ostotoimintaa, joka sisältää oikea-aikaisen tilausrytmin ja tasapainoisen tilausmäärän määrityksen sekä saapuvan tavaravirran mukauttamisen myyntiin tai kulutukseen kokonaisuutena. Tässä tutkimuksessa tarkastellaan myös varastojen merkitystä ja ostotoiminnan kannalta keskeisimpiä tehokkaaseen varastonohjaukseen liittyviä tunnuslukuja. Tutkimus sisältää lääkkeiden toimitusketjun kuvauksen, koska se poikkeaa merkittävästi muista toimialoista. Tämä tutkintotyö on syntetisoiva kirjallisuustutkimus. Tutkintotyön empiirisessä osassa analysoidaan aluksi case-yrityksen vaihto-omaisuusvaraston ohjausta ostotoiminnan näkökulmasta ABC analyysiin pohjautuen. Tämän jälkeen ostotoimintaa analysoidaan tarkemmin tiettyjen toimittajien osalta. Lopuksi laaditaan optimaalinen tilausrytmi ja tilausmäärät sekä ostobudjetti yhden toimittajan tuotteille. ABC analyysia voidaan hyödyntää työkaluna määriteltäessä miten erilaisten tuotteiden materiaalivirtoja tulisi ostotoiminnan kannalta ohjata. Analyysi perustuu resurssien keskittämiseen sinne missä tuotto on suurin.