Treatment deviating from guidelines does not influence status epilepticus prognosis.

Status epilepticus (SE) prognosis is related to nonmodifiable factors (age, etiology), but the exact role of drug treatment is unclear. This study was undertaken to address the prognostic role of treatment adherence to guidelines (TAG). We prospectively studied over 26 months a cohort of adults with incident SE (excluding postanoxic). TAG was assessed in terms of drug doses (± 30 % of recommendations) and medication sequence; its prognostic impact on mortality and return to baseline conditions was adjusted for etiology, SE severity [Status Epilepticus Severity Score (STESS)], and comorbidities. Of 225 patients, 26 (12 %) died and 82 (36 %) were discharged with a new handicap; TAG was observed in 142 (63 %). On univariate analysis, age, etiology, SE severity, and comorbidities were significantly related to outcome, while TAG was associated with neither outcome nor likelihood of SE control. Logistic regression for mortality identified etiology [odds ratio (OR) 18.8, 95 % confidence interval (CI) 4.3-82.8] and SE severity (STESS ≥ 3; OR 1.7, 95 % CI 1.2-2.4) as independent predictors, and for lack of return to baseline, again etiology (OR 7.4, 95 % CI 3.9-14.0) and STESS ≥ 3 (OR 1.7, 95 % CI 1.4-2.2). Similar results were found for the subgroup of 116 patients with generalized-convulsive SE. Receiver operator characteristic (ROC) analyses confirmed that TAG did not improve outcome prediction. This study of a large SE cohort suggests that treatment adherence to recommendations using current medications seems to play a negligible prognostic role (class III), confirming the importance of the biological background. Awaiting further treatment trials, it appears mandatory to apply resources towards identification of new therapeutic approaches.

Quantitative Ultrasound of the Heel and Fracture Risk Assessment: an Updated Meta-Analysis

Objectives: Quantitative ultrasound (QUS) is an attractive method for assessing fracture risk because it is portable, inexpensive, without ionizing radiation, and available in areas of the world where DXA is not readily accessible or affordable. However, the diversity of QUS scanners and variability of fracture outcomes measured in different studies is an important obstacle to widespread utilisation of QUS for fracture risk assessment. We aimed in this review to assess the predictive power of heel QUS for fractures considering different characteristics of the association (QUS parameters and fracture outcomes measured, QUS devices, study populations, and independence from DXA-measured bone density).Materials/Methods : We conducted an inverse-variance randomeffects meta-analysis of prospective studies with heel QUS measures at baseline and fracture outcomes in their follow-up. Relative risks (RR) per standard deviation (SD) of different QUS parameters (broadband ultrasound attenuation [BUA], speed of sound &SOS;, stiffness index &SI;, and quantitative ultrasound index [QUI]) for various fracture outcomes (hip, vertebral, any clinical, any osteoporotic, and major osteoporotic fractures) were reported based on study questions.Results : 21 studies including 55,164 women and 13,742 men were included with a total follow-up of 279,124 person-years. All four QUS parameters were associated with risk of different fractures. For instance, RR of hip fracture for 1 SD decrease of BUA was 1.69 (95% CI 1.43-2.00), SOS was 1.96 (95% CI 1.64-2.34), SI was 2.26 (95%CI 1.71-2.99), and QUI was 1.99 (95% CI 1.49-2.67). Validated devices from different manufacturers predicted fracture risks with a similar performance (meta-regression p-values>0.05 for difference of devices). There was no sign of publication bias among the studies. QUS measures predicted fracture with a similar performance in men and women. Meta-analysis of studies with QUS measures adjusted for hip DXA showed a significant and independent association with fracture risk (RR/SD for BUA =1.34 [95%CI 1.22-1.49]).Conclusions : This study confirms that QUS of the heel using validated devices predicts risk of different fracture outcomes in elderly men and women. Further research and international collaborations are needed for standardisation of QUS parameters across various manufacturers and inclusion of QUS in fracture risk assessment tools. Disclosure of Interest : None declared.

Synchronous Digital Hierarchy implementation to a Radio Transmission Node

Kiristyville markkinoille on aina tuotava jotain uutta tarjottavaa ja SDH-kortti on yksi sellainen tuote jonka Nokia Networks julkistaa osaksi uutta Nokia Flexihub Nodea. Tavoitteena on suunnitella VC-12kanavoitu STM-1 kortti yhdistämään ylemmän tason tietoliikenneverkko suuren kapasiteetin radioon. Ennen kuin markkinoilla on valmis tuote, on sen takana valtaisa määrä työtä. Erilaisia dokumentteja on pitänyt tuottaa ja sopimuksia tehdä. Esimerkiksi vaatimusmäärittelyt on oltava selvät, jotta tiedetään mitä tuotteelta halutaan. Tätä ennen on kuitenkin pitänyt ymmärtää miten SDHtoimii ja miten otsikkotavuja käsitellään. Myös erilaiset piirivalinnat aiheuttavat miettimistä, sillä markkinoilla on runsaasti valmiita piirejä SDH signaalinkäsittelyyn. Varma tiedonsiirto on tärkeää puhelinoperaattorille ja siksi joudutaan miettimään varmennuksia ja niiden toteuttamista. Myös synkronointi on tärkeä osa SDH järjestelmää ja sen toteuttaminen hyvin on tärkeää. Hälytykset on otettava huomioon ja mietittävä, miten niiden käsittely saadaan hoidettua järkevästi, ilman että mikään järjestelmän osa ruuhkautuu kohtuuttomasti. Tässä Diplomityössä on tutustuttu SDH-järjestelmään, otsikkotavujen käsittelyyn ja vaatimusmäärittelyihin.

IFRS and Asymmetrical Information: Empirical Evidence from the Finnish Stock Markets

Tutkimuksen tavoitteena on selvittää kansainvälisiin tilinpäätösstandardeihin siirtymisen vaikutuksia epäsymmetriseen informaatioon Suomen osake-markkinoilla. Suomalaisten tilinpäätöskäytäntöjen ja kansainvälisten standardien eroja on selvitetty ensin laadullisin menetelmin,jonka jälkeen on tehty asymmetrisen informaation markkinapohjaisiin mittareihinperustuva kvantitatiivinen tutkimus. Yleisiin eroavaisuuksiin liittyvän selvityksen lisäksi on tutkittu erikseen erityisesti standardimuutoksen vaikutusta älylliseen pääomaan liittyvään informaation asymmetriaan. Empiirisessä osiossa älyllisen pääoman epäsuoraksi mitaksi on valittu kehitys- ja tutkimusmenojen suhde taseen loppusummaan. Kuten oletus oli, sekä laadullisen että empiirisen osion tulokset viittaavat siihen, että IFRS:n myötä informaatioympäristö on parantunut. Uudet standardit vaativat laajempaa ja tarkempaa informaation julkaisua liittyen älylliseen pääomaan, mikä ei ole kuitenkaan havaittavissa valituissa mittareissa

Challenging the "inoffensiveness" of regular cannabis use by its associations with other current risky substance use--a census of 20-year-old Swiss men.

3,537 men enrolling in 2007 for mandatory army recruitment procedures were assessed for the co-occurrence of risky licit substance use among risky cannabis users. Risky cannabis use was defined as at least twice weekly; risky alcohol use as 6+ drinks more than once/monthly, or more than 20 drinks per week; and risky tobacco use as daily smoking. Ninety-five percent of all risky cannabis users reported other risky use. They began using cannabis earlier than did non-risky users, but age of onset was unrelated to other risky substance use. A pressing public health issue among cannabis users stems from risky licit substance use warranting preventive efforts within this age group.

Ympäristöraportointimallinkehittäminen vesihuoltolaitokselle

Diplomityössä tarkastellaan ympäristöraportointia yrityksen ympäristöviestinnässä.Työn kirjallisuusosuudessa syvennytään ympäristöraporttien toteutukseen, tavoitteisiin, mahdollisuuksiin sekä raportointiohjeisiin ja -periaatteisiin. Työn kirjallisuusosassa käsitellään myös ympäristöjohtamista ja yrityksen sidosryhmiä. Diplomityön kirjallisuusosan ja yrityksen ohjauksen perusteella Joensuun Vedelle on kehitetty ympäristöraportointimalli, jota käyttäen yritys voi tehdä vuosittaista ympäristöraportointiaan. Ympäristöraportointimallin laadinta perustui erilaisiin raportointimalleihin, raportointiperiaatteisiin ja raportointiohjeisiin, kuten muiden muassa Global Reporting Initiativen (GRI) vapaaehtoiseen yhteiskuntavastuun raportointiohjeistoon ja Kirjanpitolautakunnan (KILA) yleisohjeeseen ympäristöasioiden kirjaamisesta, laskennasta ja esittämisestä tilinpäätöksessä. Joensuun Vedelle laaditunympäristöraportointimallin tavoitteena oli luoda laitokselle ympäristöraportti,joka sisältää merkittävimmät ympäristönäkökohdat, taloudellista vastuuta käsittelevän ympäristötilinpäätöksen sekä tietoa tärkeistä sosiaalisen vastuun asioista. Ympäristöraportin sisältämän tiedon kokoamisella haluttiin myös saada kokonaisvaltaista näkemystä, vuoden 2005 Joensuun, Kiihtelysvaaran ja Tuupovaaran kuntaliitoksen takia laajentuneen, Joensuun Veden toiminnan ympäristövaikutuksista. Diplomityössä on esitetty Joensuun Veden vuoden 2005 ympäristöraportin kokoamisenvaiheet sekä tulokset. Ympäristöraportointimalli täytti sille asetetut tavoitteet. Ympäristöraportin sisältöä tulee kuitenkin jatkossa kehittää sekä raportoitavan aineiston alkuperäisen dokumentoinnin osalta että sidosryhmien mielipiteidenja vaatimusten mukaisesti.

Recommendations for term and late preterm infants at risk for perinatal bacterial infection.

Since publication of the initial guidelines for the prevention of group B streptococcal disease in 1996, the incidence of perinatal infection has decreased significantly. Intrapartum antibiotic prophylaxis together with appropriate management of neonates at increased risk for early-onset sepsis not only reduces morbidity and mortality, but also decreases the burden of unnecessary or prolonged antibiotic therapy. This article provides healthcare workers in Switzerland with evidence-based and best-practice derived guidelines for the assessment and management of term and late preterm infants (>34 weeks) at increased risk for perinatal bacterial infection. Management of neonates at increased risk for early-onset sepsis depends on clinical presentation and risk factors. Asymptomatic infants with risk factors for early-onset sepsis should be observed closely in an inpatient setting for the first 48 hours of life. Symptomatic neonates must be treated promptly with intravenous antibiotics. As clinical and laboratory signs of neonatal infection are nonspecific, it is mandatory to reevaluate the need for continued antibiotic therapy after 48 hours.

Läpinäkyvyys venäläisissä pörssiyhtiöissä - yhtiöiden Internetissä julkaisema informaatio

Tutkielman ensisijaisena tavoitteena oli selvittää, miten corporate governance eli hyvä hallintotapa on kehittynyt Venäjällä. Tutkimuksessa keskityttiin eritoten yritystoiminnan läpinäkyvyyteen ja siihen, minkälaista informaatiota yritysten pitäisi vuosittain julkaista. Tutkimuksessa tutkittiin minkälaista informaatiota Moskovan pörssiin listautuneet yritykset julkaisevat. Tavoitteena oli tutkia, julkaisevatko yritykset informaatiota OECD:n corporate governancve suositusten mukaisesti. Tutkimusmenetelmänä käytettiin havaintotutkimusta. Tutkimuksessa saatiin selkeä kuvasiitä, mitä corporate governance tarkoittaa ja siitä miten se on kehittynyt Venäjällä. Tutkimuksen aineisto kerättiin Moskovan pörssiin listautuneista yrityksistä, koska Venäjä tutkimuskohteena on mielenkiintoinen ja koska corporate governance teema on vasta viime vuosina tullut ajankohtaiseksi venäläisissä yrityksissä. Tutkimuksessa saadut tulokset osoittavat, että yritykset julkaisevat informaatiota melko hajanaisesti ja pörssi joutuu edelleen tyytymään puutteelliseen informaatioon. Venäjän yritystoiminnasta puuttuu vakaus, ja instituutiot eivät vielätue corporate governance -suositusten toimeenpanemista ainakaan kovin hyvin. Myös toimiala ja yrityksen omistusrakenne vaikuttavat jonkin verran siihen, minkälaista tietoa yritys tuottaa. Eri toimialojen välillä on huomattaviakin eroja sen suhteen, miten kattavasti niistä on saatavissa informaatiota. Omistusrakenne on tämän tutkimuksen yrityksissä erilainen kuin Venäjällä yleensä ja ulkomaista omistusta on paljon.

Adverse tissue reaction to corrosion at the neck-stem junction after modular primary total hip arthroplasty.

Complications related to the neck-stem junction of modular stems used for total hip arthroplasty (THA) are generating increasing concern. A 74-year-old male had increasing pain and a cutaneous reaction around the scar 1 year after THA with a modular neck-stem. Imaging revealed osteolysis of the calcar and a pseudo-tumour adjacent to the neck-stem junction. Serum cobalt levels were elevated. Revision surgery to exchange the stem and liner and to resect the pseudo-tumour was performed. Analysis of the stem by scanning electron microscopy and by energy dispersive X-ray and white light interferometry showed fretting corrosion at the neck-stem junction contrasting with minimal changes at the head-neck junction. Thus, despite dry assembly of the neck and stem on the back table at primary THA, full neck-stem contact was not achieved, and the resulting micromotion at the interface led to fretting corrosion. This case highlights the mechanism of fretting corrosion at the neck-stem interface responsible for adverse local tissue reactions. Clinical and radiological follow-up is mandatory in patients with dual-modular stems.

A novel TMPRSS3 missense mutation in a DFNB8/10 family prevents proteolytic activation of the protein.

Pathogenic mutations in TMPRSS3, which encodes a transmembrane serine protease, cause non-syndromic deafness DFNB8/10. Missense mutations map in the low density-lipoprotein receptor A (LDLRA), scavenger-receptor cysteine-rich (SRCR), and protease domains of the protein, indicating that all domains are important for its function. TMPRSS3 undergoes proteolytic cleavage and activates the ENaC sodium channel in a Xenopus oocyte model system. To assess the importance of this gene in non-syndromic childhood or congenital deafness in Turkey, we screened for mutations affected members of 25 unrelated Turkish families. The three families with the highest LOD score for linkage to chromosome 21q22.3 were shown to harbor P404L, R216L, or Q398X mutations, suggesting that mutations in TMPRSS3 are a considerable contributor to non-syndromic deafness in the Turkish population. The mutant TMPRSS3 harboring the novel R216L missense mutation within the predicted cleavage site of the protein fails to undergo proteolytic cleavage and is unable to activate ENaC, thus providing evidence that pre-cleavage of TMPRSS3 is mandatory for normal function.

Patents in the Information and Communications Technology Sector - Development Trends, Problem Areas and Pressures for Change

The patent system was created for the purpose of promoting innovation by granting the inventors a legally defined right to exclude others in return for public disclosure. Today, patents are being applied and granted in greater numbers than ever, particularly in new areas such as biotechnology and information andcommunications technology (ICT), in which research and development (R&D) investments are also high. At the same time, the patent system has been heavily criticized. It has been claimed that it discourages rather than encourages the introduction of new products and processes, particularly in areas that develop quickly, lack one-product-one-patent correlation, and in which theemergence of patent thickets is characteristic. A further concern, which is particularly acute in the U.S., is the granting of so-called 'bad patents', i.e. patents that do not factually fulfil the patentability criteria. From the perspective of technology-intensive companies, patents could,irrespective of the above, be described as the most significant intellectual property right (IPR), having the potential of being used to protect products and processes from imitation, to limit competitors' freedom-to-operate, to provide such freedom to the company in question, and to exchange ideas with others. In fact, patents define the boundaries of ownership in relation to certain technologies. They may be sold or licensed on their ownor they may be components of all sorts of technology acquisition and licensing arrangements. Moreover, with the possibility of patenting business-method inventions in the U.S., patents are becoming increasingly important for companies basing their businesses on services. The value of patents is dependent on the value of the invention it claims, and how it is commercialized. Thus, most of them are worth very little, and most inventions are not worth patenting: it may be possible to protect them in other ways, and the costs of protection may exceed the benefits. Moreover, instead of making all inventions proprietary and seeking to appropriate as highreturns on investments as possible through patent enforcement, it is sometimes better to allow some of them to be disseminated freely in order to maximize market penetration. In fact, the ideology of openness is well established in the software sector, which has been the breeding ground for the open-source movement, for instance. Furthermore, industries, such as ICT, that benefit from network effects do not shun the idea of setting open standards or opening up their proprietary interfaces to allow everyone todesign products and services that are interoperable with theirs. The problem is that even though patents do not, strictly speaking, prevent access to protected technologies, they have the potential of doing so, and conflicts of interest are not rare. The primary aim of this dissertation is to increase understanding of the dynamics and controversies of the U.S. and European patent systems, with the focus on the ICT sector. The study consists of three parts. The first part introduces the research topic and the overall results of the dissertation. The second part comprises a publication in which academic, political, legal and business developments that concern software and business-method patents are investigated, and contentiousareas are identified. The third part examines the problems with patents and open standards both of which carry significant economic weight inthe ICT sector. Here, the focus is on so-called submarine patents, i.e. patentsthat remain unnoticed during the standardization process and then emerge after the standard has been set. The factors that contribute to the problems are documented and the practical and juridical options for alleviating them are assessed. In total, the dissertation provides a good overview of the challenges and pressures for change the patent system is facing,and of how these challenges are reflected in standard setting.

Railcarrier in Intermodal Freight Transportation Network

The major objective of this thesis is to describe and analyse how a railcarrier is engaged in an intermodal freight transportation network through its role and position. Because of the fact that the role as a conceptualisation has a lot of parallels with the position, both these phenomena are evaluated theoretically and empirically. VR Cargo (a strategical business unitof the Finnish railway company VR Ltd.) was chosen to be the focal firm surrounded by the actors of the focal net. Because of the fact that networks are sets of relationships rather than sets of actors, it is essential to describe the dimensions of the relationships created through the time thus having a past, presentand future. The roles are created during long common history shared by the actors especially when IM networks are considered. The presence of roles is embeddedin the tasks, and the future is anchored to the expectations. Furthermore, in this study role refers to network dynamics, and to incremental and radical changes in the network, in a similar way as position refers to stability and to the influences of bonded structures. The main purpose of the first part of the study was to examine how the two distinctive views that have a dominant position in modern logistics ¿ the network view (particularly IMP-based network approach) and the managerial view (represented by Supply Chain Management) differ, especially when intermodalism is under consideration. In this study intermodalism was defined as a form of interorganisational behaviour characterized by the physical movement of unitized goods with Intermodal Transport Units, using more than one mode as performed by the net of operators. In this particular stage the study relies mainly on theoretical evaluation broadened by some discussions with the practitioners. This is essential, because the continuous dialogue between theory and practice is highly emphasized. Some managerial implications are discussed on the basis of the theoretical examination. A tentative model for empirical analysis in subsequent research is suggested. The empirical investigation, which relies on the interviews among the members in the focal net, shows that the major role of the focal company in the network is the common carrier. This role has some behavioural and functional characteristics, such as an executive's disclosure expressing strategic will attached with stable and predictable managerial and organisational behaviour. Most important is the notion that the focal company is neutral for all the other operators, and willing to enhance and strengthen the collaboration with all the members in the IM network. This also means that all the accounts are aimed at being equal in terms of customer satisfaction. Besides, the adjustments intensify the adopted role. However, the focal company is also obliged tosustain its role as it still has a government-erected right to maintain solely the railway operations on domestic tracks. In addition, the roles of a dominator, principal, partner, subcontractor, and integrator were present appearing either in a dyadic relationship or in net(work) context. In order to reveal differentroles, a dualistic interpretation of the concept of role/position was employed.

Lossless compression of hyperspectral images

Technological progress has made a huge amount of data available at increasing spatial and spectral resolutions. Therefore, the compression of hyperspectral data is an area of active research. In somefields, the original quality of a hyperspectral image cannot be compromised andin these cases, lossless compression is mandatory. The main goal of this thesisis to provide improved methods for the lossless compression of hyperspectral images. Both prediction- and transform-based methods are studied. Two kinds of prediction based methods are being studied. In the first method the spectra of a hyperspectral image are first clustered and and an optimized linear predictor is calculated for each cluster. In the second prediction method linear prediction coefficients are not fixed but are recalculated for each pixel. A parallel implementation of the above-mentioned linear prediction method is also presented. Also,two transform-based methods are being presented. Vector Quantization (VQ) was used together with a new coding of the residual image. In addition we have developed a new back end for a compression method utilizing Principal Component Analysis (PCA) and Integer Wavelet Transform (IWT). The performance of the compressionmethods are compared to that of other compression methods. The results show that the proposed linear prediction methods outperform the previous methods. In addition, a novel fast exact nearest-neighbor search method is developed. The search method is used to speed up the Linde-Buzo-Gray (LBG) clustering method.

Cure de hernie inguinale en ambulatoire [Outpatient hernia surgery].

Inguinal hernias are frequent and have an enormous socio-economic impact. Surgical treatment is indicated in most of the patients to relieve symptoms and to prevent complications. Modem treatment should focus on low complication and recurrence rates, short recovery times, and--last but not least acceptable costs. Inguinal hernia repair can be carried out by an open or minimal invasive approach. Surgery is traditionally performed under general anesthesia, but local or locoregional anesthesia are other feasible options. Nowadays, inguinal hernia surgery can easily performed as an outpatient procedure. However, stringent selection criteria, an optimized infrastructure and a close and standardized follow-up are mandatory prerequisites in order to obtain excellent results under secure conditions.

Post-market environmental monitoring of Bt maize in Spain: Non-target effects of varieties derived from the event MON810 on predatory fauna

The Spanish Government has established post-market environmental monitoring (PMEM) as mandatory for genetically modified (GM) crop varieties cultivated in Spain. In order to comply with this regulation, effects of Bt maize varieties derived from the event MON810 on the predatory fauna were monitored for two years in northeast and central Spain. The study was carried out with a randomized block design in maize fields of 3-4 ha on which the abundance of plant-dwelling predators and the activity-density of soil-dwelling predators in Bt vs. non-Bt near-isogenic varieties were compared. To this end, the plots were sampled by visual inspection of a certain number of plants and pitfall traps 6 or 7 times throughout two seasons. No significant differences in predator densities on plants were found between Bt and non-Bt varieties. In the pitfall traps, significant differences between the two types of maize were found only in Staphylinidae, in which trap catches in non-Bt maize were higher than in Bt maize in central Spain. Based on the statistical power of the assays, surrogate arthropods for PMEM purposes are proposed; Orius spp. and Araneae for visual sampling and Carabidae, Araneae, and Staphylinidae for pitfall trapping. The other predator groups recorded in the study, Nabis sp. and Coccinellidae in visual sampling and Dermaptera in pitfall trapping, gave very poor power results. To help to establish a standardized protocol for PMEM of genetically modified crops, the effect-detecting capacity with a power of 0.8 of each predator group is given.