Patient doses in CT examinations in Switzerland: implementation of national diagnostic reference levels.

Diagnostic reference levels (DRLs) were established for 21 indication-based CT examinations for adults in Switzerland. One hundred and seventy-nine of 225 computed tomography (CT) scanners operated in hospitals and private radiology institutes were audited on-site and patient doses were collected. For each CT scanner, a correction factor was calculated expressing the deviation of the measured weighted computed tomography dose index (CTDI) to the nominal weighted CTDI as displayed on the workstation. Patient doses were corrected by this factor providing a realistic basis for establishing national DRLs. Results showed large variations in doses between different radiology departments in Switzerland, especially for examinations of the petrous bone, pelvis, lower limbs and heart. This indicates that the concept of DRLs has not yet been correctly applied for CT examinations in clinical routine. A close collaboration of all stakeholders is mandatory to assure an effective radiation protection of patients. On-site audits will be intensified to further establish the concept of DRLs in Switzerland.

Inferring ultraviolet anatomical exposure patterns while distinguishing the relative contribution of radiation components

Exposure to solar ultraviolet (UV) radiation is the main causative factor for skin cancer. UV exposure depends on environmental and individual factors, but individual exposure data remain scarce. UV irradiance is monitored via different techniques including ground measurements and satellite observations. However it is difficult to translate such observations into human UV exposure or dose because of confounding factors (shape of the exposed surface, shading, behavior, etc.) A collaboration between public health institutions, a meteorological office and an institute specialized in computing techniques developed a model predicting the dose and distribution of UV exposure on the basis of ground irradiation and morphological data. Standard 3D computer graphics techniques were adapted to develop this tool, which estimates solar exposure of a virtual manikin depicted as a triangle mesh surface. The amount of solar energy received by various body locations is computed for direct, diffuse and reflected radiation separately. The radiation components are deduced from corresponding measurements of UV irradiance, and the related UV dose received by each triangle of the virtual manikin is computed accounting for shading by other body parts and eventual protection measures. The model was verified with dosimetric measurements (n=54) in field conditions using a foam manikin as surrogate for an exposed individual. Dosimetric results were compared to the model predictions. The model predicted exposure to solar UV adequately. The symmetric mean absolute percentage error was 13%. Half of the predictions were within 17% range of the measurements. This model allows assessing outdoor occupational and recreational UV exposures, without necessitating time-consuming individual dosimetry, with numerous potential uses in skin cancer prevention and research. Using this tool, we investigated solar UV exposure patterns with respect to the relative contribution of the direct, diffuse and reflected radiation. We assessed exposure doses for various body parts and exposure scenarios of a standing individual (static and dynamic postures). As input, the model used erythemally-weighted ground irradiance data measured in 2009 at Payerne, Switzerland. A year-round daily exposure (8 am to 5 pm) without protection was assumed. For most anatomical sites, mean daily doses were high (typically 6.2-14.6 SED) and exceeded recommended exposure values. Direct exposure was important during specific periods (e.g. midday during summer), but contributed moderately to the annual dose, ranging from 15 to 24% for vertical and horizontal body parts, respectively. Diffuse irradiation explained about 80% of the cumulative annual exposure dose. Acute diffuse exposures were also obtained for cloudy summer days. The importance of diffuse UV radiation should not be underestimated when advocating preventive measures. Messages focused on avoiding acute direct exposures may be of limited efficiency to prevent skin cancers associated with chronic exposure (e.g., squamous cell carcinomas).

P-wave velocities of samples from the Penninic of the western Alps along NFP20-west seismic-reflection profiles

Using the transit pulse method, we have determined compressional wave velocities of rocks from various geological units belonging to the Penninic zone along the NFP20-West profiles of the Swiss western Alps. The velocities have been measured at confining pressures up to 400 MPa, along three orthogonal axes defined by the macrostructure of the rocks. The samples analysed show a degree of metamorphism ranging from greenschist to eclogite facies. This collection includes schists, dolomites, gneisses and ophiolitic rocks. The mean velocities range from 5.9 km/s for a quartzitic calcschist to 7.9 km/s for an eclogitic metagabbro. The velocity anisotropy is as high as 20 %. The range of acoustic impedance is wide, from 15 to 27 10(6) kg/m2s. From these measurements, normal incident reflection coefficients for likely rock assemblages within and between geological units were estimated in order to interpret zone of the strong reflections recorded along the seismic profiles. Reflection coefficients as high as 0.17 could be determined.

Logistiikkayrityksen sijoittuminen Venäjälle - Venäjän logistiikkasektori ja potentiaaliset sijoittumiskohteet

Venäjän voimakas talouskasvu on lisännyt merkittävästi myös logistiikkapalveluiden kysyntää maassa. Suuren pinta-alan, markkinapotentiaalin ja Euroopan ja Aasian välisen maantieteellisen sijainnin tarjoaman merkittävän kauttakulkupotentiaalin ansiosta Venäjä on erityisen kiinnostava investointikohde logistiikkayrityksille. Talouskasvu ei ole kuitenkaan jakautunut tasaisesti ja tämän vuoksi investoijan onkin syytä tarkoin selvittää minne Venäjän sisällä sijoittua. Tässä työssä on kartoitettu Venäjän logistiikkasektoria ja liikenneinfrastruktuuria sekä tarkasteltu kilpailutilannetta tavoitteena löytää logistiikkayrityksellekeskeisimmät sijaintikohteet Venäjällä. Moskova ja Pietari on rajattu tutkimuksen ulkopuolelle. Alan kirjallisuuteen ja aiheesta aiemmin laadittuihin tutkimuksiin perehtymällä on selvitetty yritysten sijaintipaikanvalinnalle asettamat tärkeimmät kriteerit. Logistiikkayrityksille toimivalla infrastruktuurilla on luonnollisesti oleellinen merkitys sijaintipaikkaa valittaessa, riittävän suuren markkinapotentiaalin ollessa toinen erittäin merkittävä kriteeri. Kirjallisuustarkastelun pohjalta potentiaalisiksi kohteiksi logistiikkayritykselle valikoitui 22 kaupunkia eri puolilta Venäjää. Monikriteerianalyysiin perustuvan pisteytysmenetelmän avulla toteutetussa potentiaalisten kohteiden luokittelussa kiinnostavimmiksi sijoittumiskohteiksi kohosivat Etelä-Venäjällä, Mustanmeren rannikolla sijaitsevat merkittävät satamakaupungit. Kehittyneen infrastruktuurin, merkittävän markkinapotentiaalin sekä suotuisten taloudellisten toimintaedellytysten ansiosta tarjoavat nämä erityisen merkittävän investointipotentiaalin logistiikkayrityksille.

Job accessibility, employment and job-education mismatch in the metropolitan area of Barcelona

This paper analyses the effect of job accessibility by public and private transport on labour market outcomes in the metropolitan area of Barcelona. Beyond employment, we consider the effect of job accessibility on job-education mismatch, which represents a relevant aspect of job quality. We adopt a recursive system of equations that models car availability, employment and mismatch. Public transport accessibility appears as an exogenous variable in the three equations. Even though it may reflect endogenous residential sorting, falsification proofs suggest that the estimated effect of public transport accessibility is not entirely driven by the endogenous nature of residential decisions.

Transitoreitin valintaan vaikuttavat tekijät autotoimialalla: AHP:n soveltaminen

Tämän työn tavoitteena on selvittää transitoreitin valintaan vaikuttavat tekijät sekä Suomen reitin kilpailutekijät verrattuna Baltian maiden, Saksan-Puolan ja Venäjän omiensatamien reitteihin. Lisäksi tavoitteena on testata analyyttista hierarkiaprosessia (AHP) transitoreitin valintaan. Työssä hyödynnetään Suomessa, Venäjällä ja Baltian maissa logistiikkayritysten, ministeriöiden ja viranomaisten kanssa tehtyjä asiantuntijahaastatteluja. Lisäksi suurimmille autotoimialan yrityksille toteutetaan kysely transitoreitin valintaan vaikuttavista tekijöistä. Työssä muodostetaan hierarkia reitin valintaan vaikuttavista tekijöistä. Lisäksi lasketaan analyyttisen hierarkiaprosessin mukaiset painotukset reitin valintaan vaikuttaville tekijöille ja eri reittien kilpailukykyerään autotoimialan vastaajan tapauksessa.

TEP/TDM en radiothérapie : indications et perspectives [PET/CT and radiotherapy: indications and potential applications].

The implementation of new techniques of imaging in the daily practice of the radiation oncologist is a major advance in these last 10 years. This allows optimizing the therapeutic intervals and locoregional control of the disease while limiting side effects. Among them, positron emission tomography (PET) offers an opportunity to the clinician to obtain data relative to the tumoral biological mechanisms, while benefiting from the morphological images of the computed tomography (CT) scan. Recently hybrid PET/CT has been developed and numerous studies aimed at optimizing its use in the planning, the evaluation of the treatment response and the prognostic value. The choice of the radiotracer (according to the type of cancer and to the studied biological mechanism) and the various methods of tumoral delineation, require a regular update to optimize the practices. We propose throughout this article, an exhaustive review of the published researches (and in process of publication) until December 2011, as user guide of PET/CT in all the aspects of the modern radiotherapy (from the diagnosis to the follow-up): biopsy guiding, optimization of treatment planning and dosimetry, evaluation of tumor response and prognostic value, follow-up and early detection of recurrence versus tumoral necrosis. In a didactic purpose, each of these aspects is approached by primary tumoral location, and illustrated with representative iconographic examples. The current contribution of PET/CT and its perspectives of development are described to offer to the radiation oncologist a clear and up to date reading in this expanding domain.

Vapaa-alueen konttiliikenteeseen liittyvät tullivastuut

Työn tavoitteena oli selvittää tullivastuiden jakautuminen toimijoiden välillä kontin eri kulkuvaiheissa sekä kartoittaa mahdolliset ongelmakohdat. Aluksi selvitettiin toimintaa nykyisessä muodossa ja transitoliikenteen kehitystä viime vuosina Suomessa sekä Trans-Siperian radan merkitystä transitoliikenteelle. Työssä tarkasteltiin tullilainsäädäntöä tullittomille tavarankäsittelyalueille ja sentoteuttamista Mustolan logistiikkakeskuksen vapaa-alueella. Tullilainsäädännöiija nykyisen vapaa-alueen toiminnan pohjalta tutkittiin eri vaihtoehtoja, joita tullittomat tavarankäsittelyalueet tarjoavat. Toimintaa vapaa-alueella tarkasteltiin turvallisuuden ja palvelun tehokkuuden varmistamiseksi. Tullivastuut ja velvollisuudet vapaa-alue toiminnassa ovat erittäin yksiselitteiset tullilainsäädännön perusteella. Toiminnassa ei havaittu puutteita tullivarastoinnista aiheutuvien vastuiden ja velvollisuuksien täyttämisessä. Vapaa-alueen toiminnassa tiedon kulku ja sen reaaliaikaisuus ovat turvallisuuden kannalta erittäin tärkeitä.

Management of faecal incontinence and constipation in adults with central neurological diseases.

BACKGROUND: People with neurological disease have a much higher risk of both faecal incontinence and constipation than the general population. There is often a fine dividing line between the two conditions, with any management intended to ameliorate, one risking precipitating the other. Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people. Current bowel management is largely empirical with a limited research base. OBJECTIVES: To determine the effects of management strategies for faecal incontinence and constipation in people with neurological diseases affecting the central nervous system. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Trials Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE and all reference lists of relevant articles. Date of the most recent searches: May 2000. SELECTION CRITERIA: All randomised or quasi-randomised trials evaluating any types of conservative, or surgical measure for the management of faecal incontinence and constipation in people with neurological diseases were selected. Specific therapies for the treatment of neurological diseases that indirectly affect bowel dysfunction have also been considered. DATA COLLECTION AND ANALYSIS: All three reviewers assessed the methodological quality of eligible trials and two reviewers independently extracted data from included trials using a range of pre-specified outcome measures. MAIN RESULTS: Only seven trials were identified by the search strategy and all were small and of poor quality. Oral medications for constipation were the subject of four trials. Cisapride does not seem to have clinically useful effects in people with spinal cord injuries (two trials). Psyllium was associated with increased stool frequency in people with Parkinson's disease but not altered colonic transit time (one trial). Some rectal preparations to initiate defecation produced faster results than others (one trial). Different time schedules for administration of rectal medication may produce different bowel responses (one trial). Mechanical evacuation may be more effective than oral or rectal medication (one trial). The clinical significance of any of these results is difficult to interpret. REVIEWER'S CONCLUSIONS: It is not possible to draw any recommendation for bowel care in people with neurological diseases from the trials included in this review. Bowel management for these people must remain empirical until well-designed controlled trials with adequate numbers and clinically relevant outcome measures become available.

TRAKET II - Turvallisuus ja ympäristövaikutukset transitoliikenteessa

Tämätutkimus on osa TRAKET -hanketta, jossa keskitytään Luoteis-Venäjälle vievien transitoreittien kilpailukyvyn selvittämiseen. Tässä osatutkimuksessa tarkastellaan Suomen kautta kulkevan transitoliikenteen ympäristövaikutuksia ja turvallisuusnäkökohtia sekä niiden aiheuttamien kustannusten muuttumista liikennemäärän kasvaessa. Raportissa annetaan kehityssuosituksia ympäristö- ja onnettomuustilanteen parantamiseksi. Lisäksi tutkimuksessa esitetään uusien, transitoliikenteen osapuolille tarkoitettujen, lisäpalvelujen synnyttämiseen tarvittavia toimia.

TRAKET - Transitoketjujen kilpailukyky

Tämä tutkimus on osa TRAKET-hanketta, jossa keskitytään Luoteis-Venäjälle vievien transitoreittien kilpailukyvyn selvittämiseen. Tässä tutkimusraportissa käsitellään transitoliikenteen reittien valintaan liittyviä päätöksentekokriteereitä ja verrataan niitä keskenään. Tutkimuksessa selvitetään transitoreitin valintaan vaikuttavat tekijät auto-, arvoelektroniikka- ja kosmetiikkatoimialoilla. Raportissa analysoidaan Suomen transitoreitin kilpailutekijät ja verrataan niitä vaihtoehtoisiin Baltian maiden, Saksan¿Puolan ja Venäjän omien satamien reitteihin.

Dos raros incunables en lengua catalana

En este trabajo se ofrece una panorámica de los estimables fondos incunables de La Casa del Libro (San Juan, Puerto Rico) y se analizan los contenidos de dos impresos barceloneses en lengua catalana de temática religiosa: Vida e transit de Sanct Jheronim (1493) y Gamaliel (c. 1493). El examen de ambos ejemplares confirma su importancia, en especial del segimdo, pues se trata de un ejemplar único en el mundo. También se apuntan diversos aspectos de su dilatada trayectoria y se ofrece una hipótesis sobre su origen.

Medical physicists' implication in radiological diagnostic procedures: results after 1 y of experience.

Since January 2008-de facto 2012-medical physics experts (MPEs) are, by law, to be involved in the optimisation process of radiological diagnostic procedures in Switzerland. Computed tomography, fluoroscopy and nuclear medicine imaging units have been assessed for patient exposure and image quality. Large spreads in clinical practice have been observed. For example, the number of scans per abdominal CT examination went from 1 to 9. Fluoroscopy units showed, for the same device settings, dose rate variations up to a factor of 3 to 7. Quantitative image quality for positron emission tomography (PET)/CT examinations varied significantly depending on the local image reconstruction algorithms. Future work will be focused on promoting team cooperation between MPEs, radiologists and radiographers and on implementing task-oriented objective image quality indicators.

Diagnostic and Prognostic Impact of pc-ASPECTS Applied to Perfusion CT in the Basilar Artery International Cooperation Study.

BACKGROUND AND PURPOSE: The posterior circulation Acute Stroke Prognosis Early CT Score (pc-APECTS) applied to CT angiography source images (CTA-SI) predicts the functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). We assessed the diagnostic and prognostic impact of pc-ASPECTS applied to perfusion CT (CTP) in the BASICS registry population. METHODS: We applied pc-ASPECTS to CTA-SI and cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) parameter maps of BASICS patients with CTA and CTP studies performed. Hypoattenuation on CTA-SI, relative reduction in CBV or CBF, or relative increase in MTT were rated as abnormal. RESULTS: CTA and CTP were available in 27/592 BASICS patients (4.6%). The proportion of patients with any perfusion abnormality was highest for MTT (93%; 95% confidence interval [CI], 76%-99%), compared with 78% (58%-91%) for CTA-SI and CBF, and 46% (27%-67%) for CBV (P < .001). All 3 patients with a CBV pc-ASPECTS < 8 compared to 6/23 patients with a CBV pc-ASPECTS ≥ 8 had died at 1 month (RR 3.8; 95% CI, 1.9-7.6). CONCLUSION: CTP was performed in a minority of the BASICS registry population. Perfusion disturbances in the posterior circulation were most pronounced on MTT parameter maps. CBV pc-ASPECTS < 8 may indicate patients with high case fatality.

Delay-sensitive and delay-insensitive deconvolution perfusion-CT: similar ischemic core and penumbra volumes if appropriate threshold selected for each.

INTRODUCTION: Perfusion-CT (PCT) processing involves deconvolution, a mathematical operation that computes the perfusion parameters from the PCT time density curves and an arterial curve. Delay-sensitive deconvolution does not correct for arrival delay of contrast, whereas delay-insensitive deconvolution does. The goal of this study was to compare delay-sensitive and delay-insensitive deconvolution PCT in terms of delineation of the ischemic core and penumbra. METHODS: We retrospectively identified 100 patients with acute ischemic stroke who underwent admission PCT and CT angiography (CTA), a follow-up vascular study to determine recanalization status, and a follow-up noncontrast head CT (NCT) or MRI to calculate final infarct volume. PCT datasets were processed twice, once using delay-sensitive deconvolution and once using delay-insensitive deconvolution. Regions of interest (ROIs) were drawn, and cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) in these ROIs were recorded and compared. Volume and geographic distribution of ischemic core and penumbra using both deconvolution methods were also recorded and compared. RESULTS: MTT and CBF values are affected by the deconvolution method used (p < 0.05), while CBV values remain unchanged. Optimal thresholds to delineate ischemic core and penumbra are different for delay-sensitive (145 % MTT, CBV 2 ml × 100 g(-1) × min(-1)) and delay-insensitive deconvolution (135 % MTT, CBV 2 ml × 100 g(-1) × min(-1) for delay-insensitive deconvolution). When applying these different thresholds, however, the predicted ischemic core (p = 0.366) and penumbra (p = 0.405) were similar with both methods. CONCLUSION: Both delay-sensitive and delay-insensitive deconvolution methods are appropriate for PCT processing in acute ischemic stroke patients. The predicted ischemic core and penumbra are similar with both methods when using different sets of thresholds, specific for each deconvolution method.