Pegfilgrastim to accelerate neutrophil engraftment following peripheral blood stem cell transplant and reduce the duration of neutropenia, hospitalization, and use of intravenous antibiotics: a phase II study in multiple myeloma and lymphoma and comparison with filgrastim-treated matched controls.

This trial was aimed to explore the efficacy of pegfilgrastim to accelerate neutrophil engraftment after stem cell autotransplant. Twenty patients with multiple myeloma and 20 with lymphoma received pegfilgrastim 6 mg on day +1. Forty cases treated with daily filgrastim starting at median day +7 (5-7), matched by age, sex, diagnosis, high-dose chemotherapy schedule, CD34 +  cell-dose, and prior therapy lines, were used for comparison. Median time to neutrophil engraftment was 9.5 vs. 11 days for pegfilgrastim and filgrastim, respectively (p < 0.0001). Likewise, duration of neutropenia, intravenous antibiotic use, and hospitalization favored pegfilgrastim, while platelet engraftment, transfusion requirement, and fever duration were equivalent in both groups. No grade  ≥ 3 toxicities were observed. Patients with lymphoma performed similarly to the entire cohort, while patients with myeloma showed faster neutrophil engraftment and shorter neutropenia but not shorter hospitalization and antibiotic use. The possibility of different outcomes for lymphoma and myeloma suggests that stratification by diagnosis may be useful in future phase III studies.

Associations between mood, anxiety or substance use disorders and inflammatory markers after adjustment for multiple covariates in a population-based study.

Inflammation is one possible mechanism underlying the associations between mental disorders and cardiovascular diseases (CVD). However, studies on mental disorders and inflammation have yielded inconsistent results and the majority did not adjust for potential confounding factors. We examined the associations of several pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α) and high sensitive C-reactive protein (hsCRP) with lifetime and current mood, anxiety and substance use disorders (SUD), while adjusting for multiple covariates. The sample included 3719 subjects, randomly selected from the general population, who underwent thorough somatic and psychiatric evaluations. Psychiatric diagnoses were made with a semi-structured interview. Major depressive disorder was subtyped into "atypical", "melancholic", "combined atypical-melancholic" and "unspecified". Associations between inflammatory markers and psychiatric diagnoses were assessed using multiple linear and logistic regression models. Lifetime bipolar disorders and atypical depression were associated with increased levels of hsCRP, but not after multivariate adjustment. After multivariate adjustment, SUD remained associated with increased hsCRP levels in men (β = 0.13 (95% CI: 0.03,0.23)) but not in women. After multivariate adjustment, lifetime combined and unspecified depression were associated with decreased levels of IL-6 (β = -0.27 (-0.51,-0.02); β = -0.19 (-0.34,-0.05), respectively) and TNF-α (β = -0.16 (-0.30,-0.01); β = -0.10 (-0.19,-0.02), respectively), whereas current combined and unspecified depression were associated with decreased levels of hsCRP (β = -0.20 (-0.39,-0.02); β = -0.12 (-0.24,-0.01), respectively). Our data suggest that the significant associations between increased hsCRP levels and mood disorders are mainly attributable to the effects of comorbid disorders, medication as well as behavioral and physical CVRFs.

Use of field measurements in fatigue analysis of forestry cranes

Tässä työssä on esitetty väsyttävän kuormituksen mittaamiseen ja mittausdatan jälkikäsittelyyn sekä väsymismitoitukseen liittyviä menetelmiä. Menetelmien sovelluskohteena oli metsäkoneen kuormain, joka on väsyttävästi kuormitettu hitsattu rakenne. Teoriaosassa on kuvattu väsymisilmiötä ja väsymismitoitusmenetelmiä sekä kuormitusten tunnistamiseen ja mittausten jälkikäsittelyyn liittyviä menetelmiä. Yleisimmin käytettyjen väsymismitoitusmenetelmien rinnalle on esitetty luotettavuuteen perustuvaa väsymismitoitusmenetelmää. Kuormainten suunnittelussa on keveys- j a kestoikävaatimusten takia erityisen suuri merkitys väsymisen huomioimisella. Rakenteille on ominaista tietyt toiminnan kannalta välttämättömät hitsatut yksityiskohdat, jotka usein määräävät koko rakenteen kestoiän. Koska nämä ongelmakohdat pystytään useimmiten tunnistamaan jo suunnitteluvaiheessa, voidaan yksityiskohtien muotoilulla usein parantaa huomattavasti koko rakenteen kestoikää. Näiden yksityiskohtien optimointi on osittain mahdollista toteuttaa ilman kuormituskertymätietoa, mutta useimmiten kuormitusten tunnistaminen on edellytys parhaan ratkaisun löytymiselle. Tällöin toistaiseksi paras keino todellisen väsyttävän kuormituksen tunnistamiseksi on pitkäaikaiset kenttämittaukset. Kenttämittauksilla selvitetään rakenteeseen kohdistuvat kuormitukset venymäliuskojen avulla. Kuormitusten tunnistamisella on erityisen suuri merkitys kun halutaan määrittää rakenteen kestoikä. Väsyminen ja väsyttävä kuormitus ovat kuitenkin tilastollisia muuttujia j a yksittäiselle rakenteelle ei ole mahdollista määrittää tarkkaa k estoikää. Tilastollisia menetelmiä käyttäen on kuitenkin mahdollista määrittää rakenteen vaurioitumisriski. Laskettaessa vaurioitumisriskiä suurelle määrälle yksittäisiä rakenteita voidaan muodostaa tarkkojakin ennusteita mahdollisten vaurioiden lukumäärästä. Tällöin kuormituskertymätiedosta voi olla tavanomaisen suunnittelun lisäksi laajempaa hyötyä esimerkiksi takuukäsittelyssä. Tässä työssä on sovellettu esitettyjä teorioita käytännössä metsäkoneen harvesterin puomiston väsymistarkasteluun. Kyseisen rakenteen kuormituksia mitattiin kahden viikon aikana yhteensä 35 tuntia, jonka perusteella laskettiin väsyttävän kuormituksen tilastollinen jakauma esimerkkitapaukselle. Mittauksen perusteella ei voitu tehdä kuitenkaan johtopäätöksiä tuotteen koko elinkaaren kuormituksista eikä muiden samanlaisten tuotteiden kuormituksista, koska mitattu otos oli suhteellisen lyhyt ja rajoittui vain yhteen käyttäjään ja muutamaan käyttökohteeseen. Menetelmien testaamiseksi kyseinen otos oli kuitenkin riittävä. Kuormituskertymätietoa käytettiin hyväksi myös laatumääritysten muodostamisessaesimerkkitapaukselle. Murtumismekaniikkaan perustuvalla menetelmällä arvioitiinharvesteripilarin valun mahdollisten valuvirheiden suurin sallittu koko. Luotettavuuteen pohjautuvan mitoitusmenettelyn tarve näyttää olevanlisääntymässä, joten pitkäaikaisten kenttämittausten tehokas hyödyntäminen tulee olemaan keskeinen osa väsymismitoitusta lähitulevaisuudessa. Menetelmiä olisi mahdollista tehostaa yhdistämällä kuormituskertymään erilaisia kuormitusten suhteen riippuvia tunnettuja suureita kuten käsiteltävän puun halkaisija. Todellisettuotekohtaiset tilastolliset jakaumat kuormituksista voitaisiin muodostaa mahdollisesti tehokkaammin, jos esimerkiksi kuormitusten riippuvuus metsätyypistä pystyttäisiin ensin määrittämään.

Integrating Use of Customer Information Throughout Multiple Sales Channels to Create Customer Competence

Customer knowledge management (CKM) practices enable organizations to create customer competence with systematic use of customer information that is integrated throughout the organization. Nonetheless, organizations are not able to fully exploit the vast amount of data available. Previous research on use of customer information is limited especially in a multichannel environment. The aim of this study was to identify the main obstacles for utilizing customer information efficiently across multiple sales channels. The study was conducted as a single case study in order to gain deeper understanding of the research problem. The empirical findings indicate that lack of CKM practices and a common goal are major challenges obstructing effective utilization of customer information. Furthermore, decentralized organizational structure and insufficient analytical skills create obstacles for information sharing and capabilities to process information and create new knowledge. The implications of the study suggest that in order to create customer competence organizations should shift their focus from technology to the organizational factors affecting use of information and implement CKM practices throughout the organization.

Vulnerability to adverse consequences of drinking and problem drinker status as predicted by risky drinking behaviours, drug use, sex differences and affect : a test of multiple models /

Although alcohol problems and alcohol consumption are related, consumption does not fully account for differences in vulnerability to alcohol problems. Therefore, other factors should account for these differences. Based on previous research, it was hypothesized that risky drinking behaviours, illicit and prescription drug use, affect and sex differences would account for differences in vulnerability to alcohol problems while statistically controlling for overall alcohol consumption. Four models were developed that were intended to test the predictive ability of these factors, three of which tested the predictor sets separately and a fourth which tested them in a combined model. In addition, two distinct criterion variables were regressed on the predictors. One was a measure of the frequency that participants experienced negative consequences that they attributed to their drinking and the other was a measure of the extent to which participants perceived themselves to be problem drinkers. Each of the models was tested on four samples from different populations, including fIrst year university students, university students in their graduating year, a clinical sample of people in treatment for addiction, and a community sample of young adults randomly selected from the general population. Overall, support was found for each of the models and each of the predictors in accounting for differences in vulnerability to alcohol problems. In particular, the frequency with which people become intoxicated, frequency of illicit drug use and high levels of negative affect were strong and consistent predictors of vulnerability to alcohol problems across samples and criterion variables. With the exception of the clinical sample, the combined models predicted vulnerability to negative consequences better than vulnerability to problem drinker status. Among the clinical and community samples the combined model predicted problem drinker status better than in the student samples.

Exploring teachers' use of multiple intelligences with elementary-aged exceptional students

The purpose ofthis qualitative study was to explore teachers' reflections on Multiple Intelligences theory and the processes they engage in when using the theory with elementary-aged exceptional students. FOllr public school teachers took part in the study. An introductory observation visit, semistructured in-depth interviews, field notes, and teachers' own written reflections served as data sources. Content-analysis was applied to review the data for thenles related to the research topic. The findings indicated several benefits of using Multiple Intelligences. This tlleory appeared to affect teachers' views of exceptionalleamers, directing the teachers' fOClIS to the students' potentials. It also seemed to have value for assisting teachers in planning an inclusive approacll, enhancing exceptional students' self-esteem, developing nletacognition, and prolTIoting cognitive engagement. Finally, the findings suggest that Multiple Intelligences has inlplications for teachers' professional development to reach a more diverse range of students.

The meaning of multiple medication use in adults: A qualitative study

Over half of prescribed medications are not taken as prescribed, resulting in health and economic consequences. Using constructivist grounded theory, 15 interviews were conducted to develop a theory on understanding the medication adherence choices of individuals, who were between the ages of 40 to 55, were diagnosed with a chronic condition, and taking three or more medications. The results indicate that participants are engaging in self-management strategies, with massive variance in adherence behaviours. Medications are sacrificed for personal and financial reasons, resonating with feelings of fear for the person’s current situation and future. Individuals are struggling with who they have become to who they once were, which becomes related to their medications. Finally, individuals are citing the impact of their physician; citing barriers to communication and Canada’s health care system. Participants’ experiences provided an understanding of the meanings individuals associate with their medications and how this impacts their decision-making.

The Efficient Use of Multiple Sources of a Nonrenewable Resource under Supply Cost Uncertainty

Uncertainties as to future supply costs of nonrenewable natural resources, such as oil and gas, raise the issue of the choice of supply sources. In a perfectly deterministic world, an efficient use of multiple sources of supply requires that any given market exhausts the supply it can draw from a low cost source before moving on to a higher cost one; supply sources should be exploited in strict sequence of increasing marginal cost, with a high cost source being left untouched as long as a less costly source is available. We find that this may not be the efficient thing to do in a stochastic world. We show that there exist conditions under which it can be efficient to use a risky supply source in order to conserve a cheaper non risky source. The benefit of doing this comes from the fact that it leaves open the possibility of using it instead of the risky source in the event the latter’s future cost conditions suddenly deteriorate. There are also conditions under which it will be efficient to use a more costly non risky source while a less costly risky source is still available. The reason is that this conserves the less costly risky source in order to use it in the event of a possible future drop in its cost.

Data Security in Fault Tolerant Hard Real Time Systems- Use of Time Dependant Multiple Random Cipher Code

The present research problem is to study the existing encryption methods and to develop a new technique which is performance wise superior to other existing techniques and at the same time can be very well incorporated in the communication channels of Fault Tolerant Hard Real time systems along with existing Error Checking / Error Correcting codes, so that the intention of eaves dropping can be defeated. There are many encryption methods available now. Each method has got it's own merits and demerits. Similarly, many crypt analysis techniques which adversaries use are also available.

Are multiple-choice tests a suitable method to evaluate students' knowledge? : against the extensive use of multiple-choice evaluation test. '¿Son los test de opción múltiple un método adecuado para evaluar el conocimiento de los estudiantes? : en contra del uso extensivo del test de evaluación de opción múltiple'.

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