Medical record search engines, using pseudonymised patient identity: an alternative to centralised medical records

Purpose The purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. Methods We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. Results We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. Conclusions Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities.

Characterization and management of rockslide hazard at Turtle Mountain, Alberta, Canada

In 1903, more than 30 million m3 of rock fell from the east slopes of Turtle Mountain in Alberta, Canada, causing a rock avalanche that killed about 70 people in the town of Frank. The Alberta Government, in response to continuing instabilities at the crest of the mountain, established a sophisticated field laboratory where state-of-the-art monitoring techniques have been installed and tested as part of an early-warning system. In this chapter, we provide an overview of the causes, trigger, and extreme mobility of the landslide. We then present new data relevant to the characterization and detection of the present-day instabilities on Turtle Mountain. Fourteen potential instabilities have been identified through field mapping and remote sensing. Lastly, we provide a detailed review of the different in-situ and remote monitoring systems that have been installed on the mountain. The implications of the new data for the future stability of Turtle Mountain and related landslide runout, and for monitoring strategies and risk management, are discussed.

Treatment modification in human immunodeficiency virus-infected individuals starting combination antiretroviral therapy between 2005 and 2008.

BACKGROUND: Adverse effects of combination antiretroviral therapy (CART) commonly result in treatment modification and poor adherence. METHODS: We investigated predictors of toxicity-related treatment modification during the first year of CART in 1318 antiretroviral-naive human immunodeficiency virus (HIV)-infected individuals from the Swiss HIV Cohort Study who began treatment between January 1, 2005, and June 30, 2008. RESULTS: The total rate of treatment modification was 41.5 (95% confidence interval [CI], 37.6-45.8) per 100 person-years. Of these, switches or discontinuations because of drug toxicity occurred at a rate of 22.4 (95% CI, 19.5-25.6) per 100 person-years. The most frequent toxic effects were gastrointestinal tract intolerance (28.9%), hypersensitivity (18.3%), central nervous system adverse events (17.3%), and hepatic events (11.5%). In the multivariate analysis, combined zidovudine and lamivudine (hazard ratio [HR], 2.71 [95% CI, 1.95-3.83]; P < .001), nevirapine (1.95 [1.01-3.81]; P = .050), comedication for an opportunistic infection (2.24 [1.19-4.21]; P = .01), advanced age (1.21 [1.03-1.40] per 10-year increase; P = .02), female sex (1.68 [1.14-2.48]; P = .009), nonwhite ethnicity (1.71 [1.18-2.47]; P = .005), higher baseline CD4 cell count (1.19 [1.10-1.28] per 100/microL increase; P < .001), and HIV-RNA of more than 5.0 log(10) copies/mL (1.47 [1.10-1.97]; P = .009) were associated with higher rates of treatment modification. Almost 90% of individuals with treatment-limiting toxic effects were switched to a new regimen, and 85% achieved virologic suppression to less than 50 copies/mL at 12 months compared with 87% of those continuing CART (P = .56). CONCLUSIONS: Drug toxicity remains a frequent reason for treatment modification; however, it does not affect treatment success. Close monitoring and management of adverse effects and drug-drug interactions are crucial for the durability of CART.

Python -ohjelmointiopas, versio 1

Python -ohjelmointiopas sisältää perustietoa ohjelmoinnista yleisesti sekä esittelee yksinkertaisia perusrakenteita, joiden pohjalta myös ohjelmoinnista mitään tietämätön ihminen voi luontevasti siirtyä ohjelmoinnin pariin. Opas on suunniteltu siten, että sen käyttäjän ei tarvitse osata etukäteen ohjelmoida, opas aloittaa käyttöympäristön asennuksesta, siihen tutustumisesta ja jatkaa siitä ohjelmointikeskeisimpiin aiheisiin.

Exploration of the social dimension of corporate responsibility in a welfare state

This study focuses on corporate social responsibility (or CSR)as the latest dimension to emerge in the corporate responsibility and sustainability agenda, which in the recent past has rapidly risen to the top of the list of concerns for civil societies worldwide. Despite the continuing debates and discussions about the scope, benefits, and impacts of CSR to business and community in various sectors, levels, and types of society, many companies have moved forward to confront the opportunities and challenges of CSR. Thus, this study is about those proactive companies with a focus on the importance of CSR and its management inside and outside the company. It is an exploration and learning from the experience of Finnish companies, as well as other actors interested or involved in shaping the course of CSR, locally and globally. It also looks closely at how national culture affects the views, thinking, and management of CSR in a welfare state. This dissertation primarily draws on the analyses of information collected from a series of qualitative interviews and the existing literature in the area. This is complemented by an analysis of written and published documents on CSR from various sources. The results of the study give insightful information and detailed descriptions of a roadmap useful in learning and understanding CSR in Finnish companies. Despite the varying conceptual connotations, essential roadmap indicators point to the importance of framing CSR within the corporate responsibility concept, Finnish development and the welfare state system, globalization, stakeholders, and the pursuit of sustainable development as the main drivers of CSR, the remarkable progress of CSR in companies, and identification of key management areas and practices relevant to CSR. Similarly,the study reveals the importance of culture as essential in understanding and learning CSR. Finnish culture has a positive influence on the views, thinking, and management practices of CSR issues. Such a positive influence of culture, therefore, makes it easy for business people to discuss and understand CSR, because those CSR issues are already considered common and taken-for-granted by Finns and are implicit in the welfare state provisions. The experience of Finnish companies in implementing CSR policies in the supply chain is a concrete proactive step in advancing the message of CSR, that is, to bring companies and suppliers together to work on improving and strengthening relationships towards socially responsible practices worldwide. Such a forward step to deal with CSR issues in the supply chain reflects the companies' commitments and belief that CSR can be managed with the suppliers and gain positive benefits. Despite the problems and complexities, particularly in the global supply chain, managing CSR for Finnish companies presents new opportunities and challenges that are expected to intensify in the near future. The focus on CSR policy implementation inthe supply chain points to the importance of companies taking initiatives and forging cooperation with suppliers with the aim of addressing and improving CSR questions in the supply chains. The proactive stance of Finnish companies toward CSR is complemented by the active supporting role of important societalactors such as the government and NGOs. These actors carry out various promotional efforts and campaigns, thus bringing CSR into the mainstream of Finnish companies and strengthening the synergistic learning about CSR within the Finnish business and civil circles. The efforts of the government and NGOs to promote CSR are indicative of the importance of multipartite involvement and the emergence of better civil regulations. Likewise, their drive to learn from each other, exchange experiences, and contribute in CSR debates facilitated the evolution of CSRnetworks in the country. The results of this study add to the mounting evidence that CSR, in general, has created a new dimension in managing corporate sustainability. This study provides compelling empirical evidence and some direct quotations about CSR in the Finnish context. This information can be used to learn and gain new useful insights, approaches, and concepts for managing CSR.

Is blood still thicker than water? A life-course perspective on the transformation of family and friends' roles in personal networks

This thesis addresses the issue of the moving boundaries between family and friends' roles in personal networks, adopting a life-course perspective and using Switzerland as a case study. In a period of major changes in personal life happening in contemporary Western societies, understanding the organization of personal networks intertwined with the unfolding of individual life courses is of prime importance in facing new challenges with regard to social integration. The data stem from a representative national survey carried out in 2011 named Family tiMes, including 803 individuals born either in 1950-1955 or in 1970-1975. An innovative research design was adopted, combing cross-sectional ego-centered network data and retrospective longitudinal life-course data. The results show continuing boundaries between family and friends' roles and that family keeps a prominent role in personal networks despite the notable importance of friendship ties. One relationship stands out above all, that with the partner, followed quite a few steps behind by those with children. Regarding life courses, de-standardization tendencies were found in family formation and also a persistent gendering of occupational trajectories. Two kinds of life trajectories are particularly intertwined with personal networks, co-residence and partnership trajectories, both related to the unfolding of family life. In particular, transition to parenthood functions as a turning point in individuals' lives, deeply transforming their sociability. Finally, a twofold pluralization process was identified, affecting simultaneously the organization of personal networks and the unfolding of individual life courses. This thesis contributes to the literature on the sociology of family and personal life, and to fruitful interlinkage between the network approach and the life-course perspective.

Cambios y tendencias de la formación en España, del Primer al Segundo programa nacional de Formación Profesional

A la formación se le asigna capacidad para favorecer la productividad, la competitividad y el acceso a una ocupación. Teniendo en cuenta esta característica, el artículo analiza los cambios y tendencias de la formación inicial, continua y ocupacional en España desde la aprobación del primer Programa Nacíonal de Formación Profesional en 1993, hasta el segundo Programa aprobado en 1998. En este sentido, se observa que los tres subsistemas de formación no están exentos de ciertos puntos débiles que dificultan la plena consecución de los objetivos que tienen asignados y que en ciertos aspectos no han sido corregidos en el nuevo Programa Nacional de Formación Profesional.

Black holes by analytic continuation

In the context of a two-dimensional exactly solvable model, the dynamics of quantum black holes is obtained by analytically continuing the description of the regime where no black hole is formed. The resulting spectrum of outgoing radiation departs from the one predicted by the Hawking model in the region where the outgoing modes arise from the horizon with Planck-order frequencies. This occurs early in the evaporation process, and the resulting physical picture is unconventional. The theory predicts that black holes will only radiate out an energy of Planck mass order, stabilizing after a transitory period. The continuation from a regime without black hole formationaccessible in the 1+1 gravity theory consideredis implicit in an S-matrix approach and suggests in this way a possible solution to the problem of information loss.

Task complexity, the Cognition Hypothesis and second language learning and performance

In this paper we describe a taxonomy of task demands which distinguishes between Task Complexity, Task Condition and Task Difficulty. We then describe three theoretical claims and predictions of the Cognition Hypothesis (Robinson 2001, 2003b, 2005a) concerning the effects of task complexity on: (a) language production; (b) interaction and uptake of information available in the input to tasks; and (c) individual differences-task interactions. Finally we summarize the findings of the empirical studies in this special issue which all address one or more of these predictions and point to some directions for continuing, future research into the effects of task complexity on learning and performance.

Nosturivaihteiden kunnonvalvontajärjestelmän kehittäminen värähtelymittauksia käyttäen

Työssä selvitettiin värähtelymittauksien käyttömahdollisuuksia nosturivaihteiden ennakoivassa kunnonvalvonnassa. Työ on painottunut lähinnä värähtelymittausten mittaus- ja analyysiteknisten näkökohtien tarkasteluun ja toimii niiltä osin al-kuselvityksenä värähtelymittauspohjaisen kunnonvalvontajärjestelmän luomiselle. Kirjallisuuden mukaan yleisimpiä ja käyttökelpoisimpia värähtelyanalyysejä vaihteistojen kunnonvalvonnassa ovat spektri-, kepstri-, ja demodulointitekniik-kaan perustuvat analyysit, joita kokeiltiin vauriokokeilla. Työssä käsitellään myös iskusysäysmenetelmää ja aikatason tunnuslukuja. Vauriokokeilla saatiin tietoa hammasvaurioiden havaitsemisesta värähtelymittauksilla, mutta laakerivaurioista kaivataan sen sijaan vielä lisää tietoa. Hammasvaurioiden tarkastelussa spektri-analyysin ohella PeakVue -analyysi osoittautui tehokkaaksi, kun siinä käytettiin sopivaa suodatusaluetta. Lisäksi työhön on koottu kokemuksia nosturivaihteiden käytännön värähtelymittauksista ja annettu ohjeita niiden suorittamisesta. Työn tulokset osoittavat, että värähtelymittauspohjaisella kunnonvalvontajärjes-telmällä voidaan parantaa nostovaihteiden ennakoivaa kunnonvalvontaa. Nosto-vaihteiden värähtelymittauksia kannattaa siis ehdottomasti jatkaa ja kunnonval-vontajärjestelmää edelleen kehittää. Siirtovaihteiden valvonta värähtelymittauksilla on sen sijaan hankalaa niiden epävakaan kuormitustilan vuoksi.

Transferring control demands across incidental learning tasks - Stronger sequence usage in serial reaction task after shortcut option in letter string checking

After incidentally learning about a hidden regularity, participants can either continue to solve the task as instructed or, alternatively, apply a shortcut. Past research suggests that the amount of conflict implied by adopting a shortcut seems to bias the decision for vs. against continuing instruction-coherent task processing. We explored whether this decision might transfer from one incidental learning task to the next. Theories that conceptualize strategy change in incidental learning as a learning-plus-decision phenomenon suggest that high demands to adhere to instruction-coherent task processing in Task 1 will impede shortcut usage in Task 2, whereas low control demands will foster it. We sequentially applied two established incidental learning tasks differing in stimuli, responses and hidden regularity (the alphabet verification task followed by the serial reaction task, SRT). While some participants experienced a complete redundancy in the task material of the alphabet verification task (low demands to adhere to instructions), for others the redundancy was only partial. Thus, shortcut application would have led to errors (high demands to follow instructions). The low control demand condition showed the strongest usage of the fixed and repeating sequence of responses in the SRT. The transfer results are in line with the learning-plus-decision view of strategy change in incidental learning, rather than with resource theories of self-control.

DATA WAREHOUSING IN A GLOBAL METAL INDUSTRIAL COMPANY

Työn tavoittena oli selvittää, miten tietovarastointi voi tukea yrityksessä tapahtuvaa päätöksentekoa. Tietovarastokomponenttien ja –prosessien kuvauksen jälkeen on käsitelty tietovarastoprojektin eri vaiheita. Esitettyä teoriaa sovellettiin käytäntöön globaalissa metalliteollisuusyrityksessä, jossa tietovarastointikonseptia testattiin. Testauksen perusteella arvioitiin olemassa olevan tiedon tilaa sekä kahden käytetyn ohjelmiston toimivuutta tietovarastoinnissa. Yrityksen operatiivisten järjestelmien tiedon laadun todettiin olevan tutkituilta osin epäyhtenäistä ja puutteellista. Siksi tiedon suora yrityslaajuinen hyödyntäminen luotettavien ja hyvälaatuisten raporttien luonnissa on vaikeaa. Lisäksi eri yksiköiden välillä havaittiin epäyhtenäisyyttä käytettyjen liiketoiminnan käsitteiden sekä järjestelmien käyttötapojen suhteen. Testauksessa käytetyt ohjelmistot suoriutuivat perustietovarastoinnista hyvin, vaikkakin joitain rajoituksia ja erikoisuuksia ilmenikin. Työtä voidaan pitää ennen varsinaista tietovarastoprojektia tehtävänä esitutkimuksena. Jatkotoimenpiteinä ehdotetaan testauksen jatkamista nykyisillä työkaluilla kohdistaen tavoitteet konkreettisiin tuloksiin. Tiedon laadun tärkeyttä tulee korostaa koko organisaatiossa ja olemassa olevan tiedon laatua pitää parantaa tulevaisuudessa.

Metsäteollisuuden jätevesien häiriöpäästöt ja niihin varautuminen. CASE: Kaakkois-Suomi

Metsäteollisuuden jätevesien normaaleja jatkuvia päästöjä hallitaan yhä paremmin. Tästä syystä niin sanottujen häiriöpäästöjen merkitys vesien kuormittajana kasvaa. Työssä tarkasteltiin 14 Kaakkois-Suomen metsäteollisuuden toiminnanharjoittajan jätevesien häiriöpäästöjä.Työn tavoitteena oli selvittää minkälaisia ja kuinka paljon poikkeuksellisia tilanteita on viime vuosina esiintynyt. Työssä selvitettiin mitkä syyt olivat aiheuttaneet häiriöpäästöjä, mitä vaikutuksia häiriöillä oli jätevesipäästöihin sekä kuinka tilanteissa oli toimittu. Työn teoriaosassa tarkasteltiin metsäteollisuuden tuotantoprosessien ja jätevedenpuhdistuksen mahdollisia häiriöpäästölähteitä sekä niiden ominaispiirteitä. Lisäksi tarkasteltiin häiriöpäästöjen vaikutuksia ja seurauksia toiminnanharjoittajien ja lupaviranomaisten näkökulmasta sekä kuinka häiriöpäästöihin tulee lainsäädännön ja ympäristöjärjestelmien mukaan varautua. Tutkimusosio koostui toiminnanharjoittajille lähetetystä häiriöpäästökyselystä, viranomaisille lähetetyistä häiriöpäästöilmoituksista sekä VAHTI –tietokannan vesipäästötiedoista. Kaikilla toiminnanharjoittajilla esiintyi häiriöpäästöjä. Häiriöpäästöt aiheuttivat lupaehtojen ylityksiä vuosina 1998-2003 yhteensä 66 kappaletta. Suurimpana syynä häiriöpäästöihin olivat prosessihäiriöt. Useimmiten häiriöpäästöt olivat usean eri syyn summa. Häiriöpäästöjen ilmoittamiskäytäntö viranomaisille vaihtelee, vaikka lupaehdoissa häiriö- ja poikkeustilanteet on määritelty kaikille lähes samalla tavalla. Jotkut ilmoittavat kaikista päästölisäyksistä, kun taas toiset ainoastaan merkittävistä. Osa ilmoittaa häiriöpäästöistä puhelimitse, jolloin ilmoituksesta ei jää kirjallista dokumenttia. Kaikista lupaehtojen ylityksistä ei ole tehty kirjallista ilmoitusta. Lupaehdoissa on häiriö- ja poikkeustilanteet määritelty sen verran suppeasti, että toiminnanharjoittajat soveltavat niitä haluamallaan tavalla. Valvontaviranomaiset puuttuvat häiriötilanteisiin lähinnä kehottamalla toiminnanharjoittajia poistamaan häiriötilanteet. Viranomaiset eivät ole määränneet toiminnan keskeyttämistä häiriöpäästöjen poistamiseksi. Yhdestä häiriöpäästöstä on tehty rikosilmoitus.

Les xarxes i el desenvolupament professional dels docents

Durant molts anys l"educació ha pogut mantenir, amb poques variacions, el seu model clàssic d"ensenyament. No obstant això, les modificacions derivades de la societat de la informació plantegen nous escenaris que requereixen una revisió profunda dels diversos components de què consta l"educació: metodologies, modalitats d"ensenyament, coneixements, recursos utilitzats, organització, etc.

Morphological, hydrological, biogeochemical and ecological changes and challenges in river restoration - the Thur River case study

River restoration can enhance river dynamics, environmental heterogeneity and biodiversity, but the underlying processes governing the dynamic changes need to be understood to ensure that restoration projects meet their goals, and adverse effects are prevented. In particular, we need to comprehend how hydromorphological variability quantitatively relates to ecosystem functioning and services, biodiversity as well as ground-and surface water quality in restored river corridors. This involves (i) physical processes and structural properties, determining erosion and sedimentation, as well as solute and heat transport behavior in surface water and within the subsurface; (ii) biogeochemical processes and characteristics, including the turnover of nutrients and natural water constituents; and (iii) ecological processes and indicators related to biodiversity and ecological functioning. All these aspects are interlinked, requiring an interdisciplinary investigation approach. Here, we present an overview of the recently completed RECORD (REstored CORridor Dynamics) project in which we combined physical, chemical, and biological observations with modeling at a restored river corridor of the perialpine Thur River in Switzerland. Our results show that river restoration, beyond inducing morphologic changes that reshape the river bed and banks, triggered complex spatial patterns of bank infiltration, and affected habitat type, biotic communities and biogeochemical processes. We adopted an interdisciplinary approach of monitoring the continuing changes due to restoration measures to address the following questions: How stable is the morphological variability established by restoration? Does morphological variability guarantee an improvement in biodiversity? How does morphological variability affect biogeochemical transformations in the river corridor? What are some potential adverse effects of river restoration? How is river restoration influenced by catchment-scale hydraulics [GRAPHICS] and which feedbacks exist on the large scale? Beyond summarizing the major results of individual studies within the project, we show that these overarching questions could only be addressed in an interdisciplinary framework.