ASTRAL-R score predicts non-recanalisation after intravenous thrombolysis in acute ischaemic stroke.

Intravenous thrombolysis (IVT) as treatment in acute ischaemic strokes may be insufficient to achieve recanalisation in certain patients. Predicting probability of non-recanalisation after IVT may have the potential to influence patient selection to more aggressive management strategies. We aimed at deriving and internally validating a predictive score for post-thrombolytic non-recanalisation, using clinical and radiological variables. In thrombolysis registries from four Swiss academic stroke centres (Lausanne, Bern, Basel and Geneva), patients were selected with large arterial occlusion on acute imaging and with repeated arterial assessment at 24 hours. Based on a logistic regression analysis, an integer-based score for each covariate of the fitted multivariate model was generated. Performance of integer-based predictive model was assessed by bootstrapping available data and cross validation (delete-d method). In 599 thrombolysed strokes, five variables were identified as independent predictors of absence of recanalisation: Acute glucose > 7 mmol/l (A), significant extracranial vessel STenosis (ST), decreased Range of visual fields (R), large Arterial occlusion (A) and decreased Level of consciousness (L). All variables were weighted 1, except for (L) which obtained 2 points based on β-coefficients on the logistic scale. ASTRAL-R scores 0, 3 and 6 corresponded to non-recanalisation probabilities of 18, 44 and 74 % respectively. Predictive ability showed AUC of 0.66 (95 %CI, 0.61-0.70) when using bootstrap and 0.66 (0.63-0.68) when using delete-d cross validation. In conclusion, the 5-item ASTRAL-R score moderately predicts non-recanalisation at 24 hours in thrombolysed ischaemic strokes. If its performance can be confirmed by external validation and its clinical usefulness can be proven, the score may influence patient selection for more aggressive revascularisation strategies in routine clinical practice.

Cam-tekniikan opetusohjelma

Tässä työssä keskitytään rakentamaan opetusohjelma, jonka avulla pyritään kehittämään tietokoneavusteisten valmistusjärjestelmien käyttöä puutuotteiden valmistuksessa. Tavoitteena on cam-teknologian opetustyön ja oppimistapahtuman selkeyttäminen sekä järjestelmän opetuksessa tarvittavan koulutusaineiston luominen. Suunnittelussa pyritään vastaamaan puutuoteteollisuuden tämän hetken tarpeisiin, jotta koulutettavat pystyisivät toimimaan nykyaikaisten cam-järjestelmien parissa. Opetusohjelma sisältää opetuskokonaisuuksia cam-järjestelmän rakenteesta, sen toteuttamisesta ja käytöstä. Lisäksi työssä sovelletaan toteutettua opetusohjelmaa erilaisten kohderyhmien opetussuunnitelmissa ja tutkitaan verkkopohjaisen oppimisympäristön luonnetta ja sen mahdollista käyttöä cam-tekniikan opetuksessa.

Product management in global sales operations

Työn tavoitteena oli määrittää myyntikonfiguraattorissa käytettävän tuotemallin yleinen rakenne. Ensin selvitettiin tuotemallin luomista ja konseptin suunnittelua kirjallisuuden ja asiantuntijoiden haastattelujen avulla. Asiantuntijoiden haastattelut toteutettiin vapaamuotoisesti kysymyslistaa apuna käyttäen. Tämän lisäksi työssä pohditaan sähköisen liiketoiminnan roolia sekä myyntikonfiguraattorin tulevaisuuden näkymiä. Diplomityössä käsitellään tuotemallia yleisellä tasolla. Toinen näkökulma käsittelee tuotemallia tietoteknisissä sovelluksissa käytettyjen menetelmien pohjalta. Tuotemallin muodostaminen aloitettiin asiakkaalle näkyvästä osasta eli myyntikonfiguraattorin ulkoasusta. Seuraava ongelma oli standardoida tuotetta ja tarjousta kuvaavat dokumentit globaalisti. Tähän ratkaisuun päädyttiin haastattelujen sekä asiantuntijoiden kokoontumisien pohjalta. Loppuosa diplomityöstä käsittelee myyntikonfiguraattorin asemaa kohdeyrityksen sähköisessä liiketoiminnassa sekä esittelee erään näkemyksen myyntikonfiguraattorin yhteenliittymästä asiakashallinta- ja tuotetiedonhallinta järjestelmiin. Diplomityössä saavutettiin asetetut tavoiteet: Myyntikonfigurattori yhtenäistää kohdeyrityksen hinnoittelua globaalisti, nopeuttaa tarjouksentekoprosessia, helpottaa uuden tuotteen lanseerausta ja standardoi tuotemallin globaalisti. Myyntikonfiguraattorin integrointi muihin tietojärjestelmiin tehostaa myynnin toimintoja. Haasteeksi jää loppukäyttäjien kannustaminen tehokkaaseen käyttöön sekä ylläpidon toteuttaminen. Ilman käyttäjiä ja heidän innostustaan voi projekti menettää johdon luottamuksen.

Security in multicast communication

Multicast is one method to transfer information in IPv4 based communication. Other methods are unicast and broadcast. Multicast is based on the group concept where data is sent from one point to a group of receivers and this remarkably saves bandwidth. Group members express an interest to receive data by using Internet Group Management Protocol and traffic is received by only those receivers who want it. The most common multicast applications are media streaming applications, surveillance applications and data collection applications. There are many data security methods to protect unicast communication that is the most common transfer method in Internet. Popular data security methods are encryption, authentication, access control and firewalls. The characteristics of multicast such as dynamic membership cause that all these data security mechanisms can not be used to protect multicast traffic. Nowadays the protection of multicast traffic is possible via traffic restrictions where traffic is allowed to propagate only to certain areas. One way to implement this is packet filters. Methods tested in this thesis are MVR, IGMP Filtering and access control lists which worked as supposed. These methods restrict the propagation of multicast but are laborious to configure in a large scale. There are also a few manufacturerspecific products that make possible to encrypt multicast traffic. These separate products are expensive and mainly intended to protect video transmissions via satellite. Investigation of multicast security has taken place for several years and the security methods that will be the results of the investigation are getting ready. An IETF working group called MSEC is standardizing these security methods. The target of this working group is to standardize data security protocols for multicast during 2004.

Communication challenges in virtual teams – a case study of implementing computer-mediated communication technologies in inter-organisational virtual teams

This thesis seeks to answer, if communication challenges in virtual teams can be overcome with the help of computer-mediated communication. Virtual teams are becoming more common work method in many global companies. In order for virtual teams to reach their maximum potential, effective asynchronous and synchronous methods for communication are needed. The thesis covers communication in virtual teams, as well as leadership and trust building in virtual environments with the help of CMC. First, the communication challenges in virtual teams are identified by using a framework of knowledge sharing barriers in virtual teams by Rosen et al. (2007) Secondly, the leadership and trust in virtual teams are defined in the context of CMC. The performance of virtual teams is evaluated in the case study by exploiting these three dimensions. With the help of a case study of two virtual teams, the practical issues related to selecting and implementing communication technologies as well as overcoming knowledge sharing barriers is being discussed. The case studies involve a complex inter-organisational setting, where four companies are working together in order to maintain a new IT system. The communication difficulties are related to inadequate communication technologies, lack of trust and the undefined relationships of the stakeholders and the team members. As a result, it is suggested that communication technologies are needed in order to improve the virtual team performance, but are not however solely capable of solving the communication challenges in virtual teams. In addition, suitable leadership and trust between team members are required in order to improve the knowledge sharing and communication in virtual teams.

Dekontaminointimenetelmien arviointi ja toimintaprosessien tehostaminen Loviisan voimalaitoksella

Tämän diplomityön lähtökohtana oli Loviisan voimalaitoksella 2006 käynnistyneen valvonta-alueen laajennusprojektin (VAJAKO) uudistettavien dekontaminointitilojen tehostaminen. Diplomityössä arvioitiin Loviisan voimalaitoksen dekontaminointikeskuksissa käytössä olevien puhdistusmenetelmien tehokkuutta ja toimivuutta. Tämän lisäksi työssä tutkittiin tarkemmin kahta "uutta" dekontaminointimenetelmää, joista toisen menetelmän toimivuutta kokeiltiin pienimuotoisen kokeen avulla. Dekontaminointimenetelmien arviointi ja toimintaprosessien tehostaminen tehtiin kirjalliseen materiaaliin, käyttäjiltä saatuihin kommentteihin sekä kokeista saatuihin tuloksiin perustuen. Dekontaminointimenetelmien arviointi aloitettiin kirjallisen materiaalin tutustumisella, jonka perusteella valittiin kaksi tarkemmin tutkittavaa menetelmää. Kirjalliseen materiaaliin pohjautuvaa tietoa verrattiin käytännön kokemuksiin vierailemalla mm. Forsmarkin, Oskarshamnin, Olkiluodon ja Ringhalsin ydinvoimalaitoksissa. Työntekijöiltä saatujen tietojen sekä kirjalliseen materiaaliin pohjautuen valittiin toinen tutkituista menetelmistä käytännön kokeeseen. Kokeessa tutkittiin menetelmän toimivuutta mm. dekontaminointituloksen, puhdistusajan ja syntyvän nestemäisen jätteen määrän perusteella. Kokeista saadut tulokset yhdistettiin kirjallisen materiaalin ja käyttäjiltä saatujen kokemusten kanssa yhdeksi kokonaisuudeksi. Työssä tarkasteltiin myös Loviisan voimalaitoksen metalliromujen käsittelyprosessin toimivuutta. Toimivuuden arvioinnissa kiinnitettiin erityistä huomiota syntyperäisen lajittelun parantamiseen, jonka seurauksena puhtaiden metalliromujen dekontaminointitarve vähenee käytännössä.

Image quality in CT: From physical measurements to model observers.

Evaluation of image quality (IQ) in Computed Tomography (CT) is important to ensure that diagnostic questions are correctly answered, whilst keeping radiation dose to the patient as low as is reasonably possible. The assessment of individual aspects of IQ is already a key component of routine quality control of medical x-ray devices. These values together with standard dose indicators can be used to give rise to 'figures of merit' (FOM) to characterise the dose efficiency of the CT scanners operating in certain modes. The demand for clinically relevant IQ characterisation has naturally increased with the development of CT technology (detectors efficiency, image reconstruction and processing), resulting in the adaptation and evolution of assessment methods. The purpose of this review is to present the spectrum of various methods that have been used to characterise image quality in CT: from objective measurements of physical parameters to clinically task-based approaches (i.e. model observer (MO) approach) including pure human observer approach. When combined together with a dose indicator, a generalised dose efficiency index can be explored in a framework of system and patient dose optimisation. We will focus on the IQ methodologies that are required for dealing with standard reconstruction, but also for iterative reconstruction algorithms. With this concept the previously used FOM will be presented with a proposal to update them in order to make them relevant and up to date with technological progress. The MO that objectively assesses IQ for clinically relevant tasks represents the most promising method in terms of radiologist sensitivity performance and therefore of most relevance in the clinical environment.

Association between frailty and delirium in older adult patients discharged from hospital.

BACKGROUND: Delirium and frailty - both potentially reversible geriatric syndromes - are seldom studied together, although they often occur jointly in older patients discharged from hospitals. This study aimed to explore the relationship between delirium and frailty in older adults discharged from hospitals. METHODS: Of the 221 patients aged >65 years, who were invited to participate, only 114 gave their consent to participate in this study. Delirium was assessed using the confusion assessment method, in which patients were classified dichotomously as delirious or nondelirious according to its algorithm. Frailty was assessed using the Edmonton Frailty Scale, which classifies patients dichotomously as frail or nonfrail. In addition to the sociodemographic characteristics, covariates such as scores from the Mini-Mental State Examination, Instrumental Activities of Daily Living scale, and Cumulative Illness Rating Scale for Geriatrics and details regarding polymedication were collected. A multidimensional linear regression model was used for analysis. RESULTS: Almost 20% of participants had delirium (n=22), and 76.3% were classified as frail (n=87); 31.5% of the variance in the delirium score was explained by frailty (R (2)=0.315). Age; polymedication; scores of the Confusion Assessment Method (CAM), instrumental activities of daily living, and Cumulative Illness Rating Scale for Geriatrics; and frailty increased the predictability of the variance of delirium by 32% to 64% (R (2)=0.64). CONCLUSION: Frailty is strongly related to delirium in older patients after discharge from the hospital.

Stratégies de communication au service de la formation: quelques outils pratiques [Effective communication strategies to frame the trainer-trainee dialogue in the clinical setting].

Communication between trainer and trainee plays a central role in teaching and learning in the clinical environment. There are various strategies to frame the dialogue between trainee and trainer. These strategies allow trainers to be more effective in their supervision, which is important in our busy clinical environment. Communication strategies are well adapted to both in- and out-patient settings, to both under- and postgraduate contexts. This article presents three strategies that we think are particularly useful. They are meant to give feedback, to ask questions and to present a case.

CLIL FAQ’s: Orientacions per a introduir l’anglès a l’aula universitària

“CLIL FAQs: Orientacions per a introduir l’anglès a l’aula universitària” és una publicació oberta dirigida als docents que assumeixen el repte d’introduir una llengua estrangera a l’aula. Es tracta d’un recull d’orientacions sorgides de la pràctica d’un equip interdisciplinari de professors de la Facultat de Ciències de l’Educació de la Universitat Autònoma de Barcelona en el marc d’un projecte de Millora de la Qualitat Docent (Ref. 2010MQD00132). La publicació exposa una sèrie de preguntes o FAQs (Frequent Asked Questions) que creiem que tot docent CLIL es podria fer abans d’introduir l’anglès a l’aula. El grup de docents implicats en el projecte, després de dissenyar coordinadament una sèrie d’activitats en anglès i d’implantar-les a les seves respectives assignatures, ha elaborat aquest llistat de FAQs que miren de respondre amb reflexions, suggeriments d’acció, estratègies didàctiques, exemples i recursos sorgits de la pròpia experiència. En aquest article situem el projecte en el context català, presentem com es va dur a terme i us expliquem què podeu trobar en la publicació que se’n deriva. A mode de conclusió oferim algunes reflexions del grup sobre el treball en equip interdisciplinari, la introducció del multilingüisme a l’aula, els contextos CLIL i la resposta dels alumnes.

Implementació d’un sistema SCADA a la cèl·lula de fabricació flexible MPS+2000C

L’Escola Politècnica Superior de la Universitat de Vic disposa d’una cèl·lula de fabricació flexible del fabricant Festo, que simula un procés d’emmagatzematge automàtic, aquesta cèl·lula esta composta per quatre estacions de muntatge diferenciades i independents, l’estació palets, l’estació plaques, l’estació magatzem intermedi i l’estació transport. Cada una d’aquestes estacions està formada per sensors i actuadors elèctrics i pneumàtics del fabricant Festo que van connectats a un PLC SIEMENS S7-300.Els quatre PLC’s (un per cada estació) estan connectats entre ells mitjançant el bus de comunicacions industrials Profibus. L’objectiu d’aquest treball consisteix en l’adaptació de la programació dels PLC’s i la realització d’un SCADA per tal de controlar el funcionament del conjunt de la cèl·lula de fabricació a través del software Vijeo Citect, d’aquesta manera es coneixerà el funcionament de la cèl·lula i permetrà treure’n rendiment per la docència. Aquest projecte ha estat realitzat en quatre fases principals. 1. Estudi i coneixement de les estacions, en aquesta fase s’han estudiat els manuals de funcionament de les estacions i s’han interpretat els codis de programació dels seus PLCs, amb l’objectiu de conèixer bé el programa per tal de interaccionar-hi més endavant amb el sistema SCADA 2. Disseny i programació del sistema SCADA, en aquesta fase s’ha realitzat tot el disseny gràfic de les pantalles de la interfície SCADA així com la programació dels objectes, la connexió amb els PLCs i la base de dades. 3. Posada en marxa del sistema complert, quan es coneixia abastament el funcionament de les estacions i el sistema SCADA estava completat s’ha fet la posada en marxa del conjunt i s’ha comprovat el correcte funcionament i interacció dels sistemes. 4. Realització de la memòria del projecte, en aquesta ultima fase s’ha realitzat la memòria del projecte on s’expliquen les característiques i funcionament de totes les estacions i del sistema SCADA. La conclusió més rellevant obtinguda en aquest treball, és la clara visualització de la potència i simplicitat que han aportat els sistemes SCADA al món de l’automatització, anys enrere per la supervisió de l’estat d’un sistema automatitzat era necessari disposar d’un gran espai amb grans panells de control formats per una gran quantitat de pilots lluminosos, potenciòmetres, interruptors, polsadors, displays i sobretot un voluminós i complexa cablejat, gràcies als sistemes SCADA avui en dia tot això pot quedar reduït a un PC o terminal tàctil, amb pantalles gràfiques clares i una gran quantitat d’opcions de supervisió control i configuració del sistema automatitzat.

“L’Emozione di conoscere e il desiderio di esistere”: Què és i com afecta la seva pràctica en el desenvolupament de l'autonomia de l'infant

El treball que es presenta a continuació pretén fer un aprofundiment en la metodologia pedagògica “Emozione di conoscere e desiderio di esistere”, nascuda a Itàlia i usada com a referent en l’Educació Especial, amb la intensió de poder valorar de quina manera afecta la seva pràctica en el desenvolupament de l’autonomia de l’infant. Per fer-ho, s’ha fet un recull dels estudis més rellevants relacionats amb el mètode “Emozione di conocscere” i amb el concepte d’autonomia. Seguidament, s’ha fet una observació acurada per poder descriure la posada en pràctica d’un projecte basat en aquesta metodologia i analitzar com aquest intervé en desenvolupar dita competència en els alumnes. Tot això, emmarcat dins l’escenari de la “Scuola Elementare Pirazzini”, situada al centre – nord d’Itàlia.

Computed tomography angiography in patients with active gastrointestinal bleeding

Abstract Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding.

The role of advanced nursing in lung cancer: A framework based development.

PURPOSE: Advanced Practice Lung Cancer Nurses (APLCN) are well-established in several countries but their role has yet to be established in Switzerland. Developing an innovative nursing role requires a structured approach to guide successful implementation and to meet the overarching goal of improved nursing sensitive patient outcomes. The "Participatory, Evidence-based, Patient-focused process, for guiding the development, implementation, and evaluation of advanced practice nursing" (PEPPA framework) is one approach that was developed in the context of the Canadian health system. The purpose of this article is to describe the development of an APLCN model at a Swiss Academic Medical Center as part of a specialized Thoracic Cancer Center and to evaluate the applicability of PEPPA framework in this process. METHOD: In order to develop and implement the APLCN role, we applied the first seven phases of the PEPPA framework. RESULTS: This article spreads the applicability of the PEPPA framework for an APLCN development. This framework allowed us to i) identify key components of an APLCN model responsive to lung cancer patients' health needs, ii) identify role facilitators and barriers, iii) implement the APLCN role and iv) design a feasibility study of this new role. CONCLUSIONS: The PEPPA framework provides a structured process for implementing novel Advanced Practice Nursing roles in a local context, particularly where such roles are in their infancy. Two key points in the process include assessing patients' health needs and involving key stakeholders.

Escola, llengua i immigració a Catalunya. Algunes reflexions

L’article planteja que el model d’immersió lingüística que ha produït excel·lents resultats sobre la competència lingüística dels alumnes autòctons, presenta problemes a l’hora d’aplicar-lo a l’alumnat d’origen estranger, independentment de quina sigui la seva llengua inicial. Això és així perquè, d’una banda, aquests estudiants presenten un escenari d’escolarització molt diversificat, i de l’altra, perquè les seves actituds lingüístiques són diferents de les que s’havien conegut fins ara. Tot plegat comporta que, pel que fa a les habilitats lingüístiques, assoleixin uns resultats més baixos que els autòctons