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.

Apple biological and physiological disorders in the orchard and in postharvest according to production system

The study aimed to evaluate the incidence of biological and physiological disorders in the field and postharvested apples cvs. Gala, Fuji and Catarina grown in four production systems: conventional, organic transition, integrated and organic. Apples were evaluated for damages related to biological and physiological disorders in the orchard and after harvest. The greatest damages were attributed to pests, especially Anastrepha fraterculus in the organic system and Grapholita molesta in the organic transition. Apples produced in organic orchards had higher damage levels caused by postharvest physiological disorders than those grown in other production systems. For apples becoming from organic orchards most of the damage was due to lenticels breakdown and degeneration ('Gala'), and bitter pit ('Fuji' and 'Catarina'). The incidence of postharvest rot was not influenced by apple production system.

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.

Hardness of FRHC-Cu determined by statistical analysis

A statistical indentation method has been employed to study the hardness value of fire-refined high conductivity copper, using nanoindentation technique. The Joslin and Oliver approach was used with the aim to separate the hardness (H) influence of copper matrix, from that of inclusions and grain boundaries. This approach relies on a large array of imprints (around 400 indentations), performed at 150 nm of indentation depth. A statistical study using a cumulative distribution function fit and Gaussian simulated distributions, exhibits that H for each phase can be extracted when the indentation depth is much lower than the size of the secondary phases. It is found that the thermal treatment produces a hardness increase, due to the partly re-dissolution of the inclusions (mainly Pb and Sn) in the matrix.

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.

On the computation of reducible invariant tori on a parallel computer

We present an algorithm for the computation of reducible invariant tori of discrete dynamical systems that is suitable for tori of dimensions larger than 1. It is based on a quadratically convergent scheme that approximates, at the same time, the Fourier series of the torus, its Floquet transformation, and its Floquet matrix. The Floquet matrix describes the linearization of the dynamics around the torus and, hence, its linear stability. The algorithm presents a high degree of parallelism, and the computational effort grows linearly with the number of Fourier modes needed to represent the solution. For these reasons it is a very good option to compute quasi-periodic solutions with several basic frequencies. The paper includes some examples (flows) to show the efficiency of the method in a parallel computer. In these flows we compute invariant tori of dimensions up to 5, by taking suitable sections.

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.

Longitudinal monitoring of endogenous steroids in human serum by UHPLC-MS/MS as a tool to detect testosterone abuse in sports.

The detection of testosterone abuse in sports is routinely achieved through the 'steroidal module' of the Athlete Biological Passport by GC-MS(/MS) quantification of selected endogenous anabolic androgenic steroids (EAAS) from athletes' urines. To overcome some limitations of the "urinary steroid profile" such as the presence of confounding factors (ethnicity, enzyme polymorphism, bacterial contamination, and ethanol), ultrahigh performance liquid chromatography (UHPLC) measurements of blood concentrations of testosterone, its major metabolites, and precursors could represent an interesting and complementary strategy. In this work, two UHPLC-MS/MS methods were developed for the quantification of testosterone and related compounds in human serum, including major progestogens, corticoids, and estrogens. The validated methods were then used for the analyses of serum samples collected from 19 healthy male volunteers after oral and transdermal testosterone administration. Results from unsupervised multiway analysis allowed variations of target analytes to be assessed simultaneously over a 96-h time period. Except for alteration of concentration values due to the circadian rhythm, which concerns mainly corticosteroids, DHEA, and progesterone, significant variations linked to the oral and transdermal testosterone administration were observed for testosterone, DHT, and androstenedione. As a second step of analysis, the longitudinal monitoring of these biomarkers using intra-individual thresholds showed, in comparison to urine, significant improvements in the detection of testosterone administration, especially for volunteers with del/del genotype for phase II UGT2B17 enzyme, not sensitive to the main urinary marker, T/E ratio. A substantial extension of the detection window after transdermal testosterone administration was also observed in serum matrix. The longitudinal follow-up proposed in this study represents a first example of 'blood steroid profile' in doping control analysis, which can be proposed in the future as a complement to the 'urinary module' for improving steroid abuse detection capabilities.

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.

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.

Influência da matéria orgânica na adsorção do fungicida triadimenol pelo solo

The adsorption of triadimenol (1-(4-chlorophenoxy)-3,3-dimethyl-1-(1H-1,2,4-triazol-1-yl)butan-2-ol) on soil samples with varying contents of organic matter was studied. The adsorption was described by means of the Freundlich's isoterm. An increase in the capacity of adsorption was observed as the content of organic carbon in the matrix increased. That effect was observed when removing the organic matter from the soil, when adding a urban waste compost to the soil sample as well as to the soil sample without organic matter, and also after leaving proportions of urban waste compost incubated in these matrices for a period of 120 days. The results show that the adsorption of the triadimenol in the soil is dependent of its content of organic carbon.

Efeito do polietilenoglicol e da albumina na imobilização de lipase microbiana e na catálise em meio orgânico

Poly (ethylene) glycol (PEG) and bovine serum albumin (BSA), as additive agents, were used to enhance the activity of immobilized microbial lipase in organic solvent. Controlled pore silica (CPS) was selected as matrix and different immobilization procedures were evaluated: directly lipase binding on CPS and simultaneous addition of lipase and additive agent on the same support. The highest coupling yield (59.6%) was attained when the immobilization procedure was performed at lipase loading of 150 U/g support in the presence of PEG-1.500. This immobilized system was used in esterification reactions under repeated batch cycles and the biocatalyst half-life was found to increase 2.7 times when compared with the control.

Determinação voltamétrica de metais em águas e fluidos biológicos empregando mineralização de amostras com radiação ultravioleta

This work describes the optimization of pretreatment steps for the destruction of organic matter in samples of waters and biological fluids, by using an UV irradiation system with a high power UV radiation source (400 W). The efficiency of the system constructed for the photo-decomposition of samples of model waters, natural waters and biological fluids was investigated by performing recovery experiments of the metallic species Zn(II), Cd(II), Pb(II), Cu(II), Al(III) and Fe(III). The use of UV irradiation allowed the liberation of metals bound to the organic matrix and the determination of the total content of elements in the samples.