Time to identify cardiac arrest and provide dispatch-assisted cardio-pulmonary resuscitation in a criteria-based dispatch system.

INTRODUCTION: Dispatch-assisted cardiopulmonary resuscitation (DA-CPR) plays a key role in out-of-hospital cardiac arrests. We sought to measure dispatchers' performances in a criteria-based system in recognizing cardiac arrest and delivering DA-CPR. Our secondary purpose was to identify the factors that hampered dispatchers' identification of cardiac arrests, the factors that prevented them from proposing DA-CPR, and the factors that prevented bystanders from performing CPR. METHODS AND RESULTS: We reviewed dispatch recordings for 1254 out-of-hospital cardiac arrests occurring between January 1, 2011 and December 31, 2013. Dispatchers correctly identified cardiac arrests in 71% of the reviewed cases and 84% of the cases in which they were able to assess for patient consciousness and breathing. The median time to recognition of the arrest was 60s. The median time to start chest compression was 220s. CONCLUSIONS: This study demonstrates that performances from a criteria-based dispatch system can be similar to those from a medical-priority dispatch system regarding out-of-hospital cardiac arrest (OHCA) time recognition and DA-CPR delivery. Agonal breathing recognition remains the weakest link in this sensitive task in both systems. It is of prime importance that all dispatch centers tend not only to implement DA-CPR but also to have tools to help them reach this objective, as today it should be mandatory to offer this service to the community. In order to improve benchmarking opportunities, we completed previously proposed performance standards as propositions.

Iterative reconstruction in CT : using mathematical model observers to determine low dose images' trustworthiness

La tomodensitométrie (TDM) est une technique d'imagerie pour laquelle l'intérêt n'a cessé de croitre depuis son apparition au début des années 70. De nos jours, l'utilisation de cette technique est devenue incontournable, grâce entre autres à sa capacité à produire des images diagnostiques de haute qualité. Toutefois, et en dépit d'un bénéfice indiscutable sur la prise en charge des patients, l'augmentation importante du nombre d'examens TDM pratiqués soulève des questions sur l'effet potentiellement dangereux des rayonnements ionisants sur la population. Parmi ces effets néfastes, l'induction de cancers liés à l'exposition aux rayonnements ionisants reste l'un des risques majeurs. Afin que le rapport bénéfice-risques reste favorable au patient il est donc nécessaire de s'assurer que la dose délivrée permette de formuler le bon diagnostic tout en évitant d'avoir recours à des images dont la qualité est inutilement élevée. Ce processus d'optimisation, qui est une préoccupation importante pour les patients adultes, doit même devenir une priorité lorsque l'on examine des enfants ou des adolescents, en particulier lors d'études de suivi requérant plusieurs examens tout au long de leur vie. Enfants et jeunes adultes sont en effet beaucoup plus sensibles aux radiations du fait de leur métabolisme plus rapide que celui des adultes. De plus, les probabilités des évènements auxquels ils s'exposent sont également plus grandes du fait de leur plus longue espérance de vie. L'introduction des algorithmes de reconstruction itératifs, conçus pour réduire l'exposition des patients, est certainement l'une des plus grandes avancées en TDM, mais elle s'accompagne de certaines difficultés en ce qui concerne l'évaluation de la qualité des images produites. Le but de ce travail est de mettre en place une stratégie pour investiguer le potentiel des algorithmes itératifs vis-à-vis de la réduction de dose sans pour autant compromettre la qualité du diagnostic. La difficulté de cette tâche réside principalement dans le fait de disposer d'une méthode visant à évaluer la qualité d'image de façon pertinente d'un point de vue clinique. La première étape a consisté à caractériser la qualité d'image lors d'examen musculo-squelettique. Ce travail a été réalisé en étroite collaboration avec des radiologues pour s'assurer un choix pertinent de critères de qualité d'image. Une attention particulière a été portée au bruit et à la résolution des images reconstruites à l'aide d'algorithmes itératifs. L'analyse de ces paramètres a permis aux radiologues d'adapter leurs protocoles grâce à une possible estimation de la perte de qualité d'image liée à la réduction de dose. Notre travail nous a également permis d'investiguer la diminution de la détectabilité à bas contraste associée à une diminution de la dose ; difficulté majeure lorsque l'on pratique un examen dans la région abdominale. Sachant que des alternatives à la façon standard de caractériser la qualité d'image (métriques de l'espace Fourier) devaient être utilisées, nous nous sommes appuyés sur l'utilisation de modèles d'observateurs mathématiques. Nos paramètres expérimentaux ont ensuite permis de déterminer le type de modèle à utiliser. Les modèles idéaux ont été utilisés pour caractériser la qualité d'image lorsque des paramètres purement physiques concernant la détectabilité du signal devaient être estimés alors que les modèles anthropomorphes ont été utilisés dans des contextes cliniques où les résultats devaient être comparés à ceux d'observateurs humain, tirant profit des propriétés de ce type de modèles. Cette étude a confirmé que l'utilisation de modèles d'observateurs permettait d'évaluer la qualité d'image en utilisant une approche basée sur la tâche à effectuer, permettant ainsi d'établir un lien entre les physiciens médicaux et les radiologues. Nous avons également montré que les reconstructions itératives ont le potentiel de réduire la dose sans altérer la qualité du diagnostic. Parmi les différentes reconstructions itératives, celles de type « model-based » sont celles qui offrent le plus grand potentiel d'optimisation, puisque les images produites grâce à cette modalité conduisent à un diagnostic exact même lors d'acquisitions à très basse dose. Ce travail a également permis de clarifier le rôle du physicien médical en TDM: Les métriques standards restent utiles pour évaluer la conformité d'un appareil aux requis légaux, mais l'utilisation de modèles d'observateurs est inévitable pour optimiser les protocoles d'imagerie. -- Computed tomography (CT) is an imaging technique in which interest has been quickly growing since it began to be used in the 1970s. Today, it has become an extensively used modality because of its ability to produce accurate diagnostic images. However, even if a direct benefit to patient healthcare is attributed to CT, the dramatic increase in the number of CT examinations performed has raised concerns about the potential negative effects of ionising radiation on the population. Among those negative effects, one of the major risks remaining is the development of cancers associated with exposure to diagnostic X-ray procedures. In order to ensure that the benefits-risk ratio still remains in favour of the patient, it is necessary to make sure that the delivered dose leads to the proper diagnosis without producing unnecessarily high-quality images. This optimisation scheme is already an important concern for adult patients, but it must become an even greater priority when examinations are performed on children or young adults, in particular with follow-up studies which require several CT procedures over the patient's life. Indeed, children and young adults are more sensitive to radiation due to their faster metabolism. In addition, harmful consequences have a higher probability to occur because of a younger patient's longer life expectancy. The recent introduction of iterative reconstruction algorithms, which were designed to substantially reduce dose, is certainly a major achievement in CT evolution, but it has also created difficulties in the quality assessment of the images produced using those algorithms. The goal of the present work was to propose a strategy to investigate the potential of iterative reconstructions to reduce dose without compromising the ability to answer the diagnostic questions. The major difficulty entails disposing a clinically relevant way to estimate image quality. To ensure the choice of pertinent image quality criteria this work was continuously performed in close collaboration with radiologists. The work began by tackling the way to characterise image quality when dealing with musculo-skeletal examinations. We focused, in particular, on image noise and spatial resolution behaviours when iterative image reconstruction was used. The analyses of the physical parameters allowed radiologists to adapt their image acquisition and reconstruction protocols while knowing what loss of image quality to expect. This work also dealt with the loss of low-contrast detectability associated with dose reduction, something which is a major concern when dealing with patient dose reduction in abdominal investigations. Knowing that alternative ways had to be used to assess image quality rather than classical Fourier-space metrics, we focused on the use of mathematical model observers. Our experimental parameters determined the type of model to use. Ideal model observers were applied to characterise image quality when purely objective results about the signal detectability were researched, whereas anthropomorphic model observers were used in a more clinical context, when the results had to be compared with the eye of a radiologist thus taking advantage of their incorporation of human visual system elements. This work confirmed that the use of model observers makes it possible to assess image quality using a task-based approach, which, in turn, establishes a bridge between medical physicists and radiologists. It also demonstrated that statistical iterative reconstructions have the potential to reduce the delivered dose without impairing the quality of the diagnosis. Among the different types of iterative reconstructions, model-based ones offer the greatest potential, since images produced using this modality can still lead to an accurate diagnosis even when acquired at very low dose. This work has clarified the role of medical physicists when dealing with CT imaging. The use of the standard metrics used in the field of CT imaging remains quite important when dealing with the assessment of unit compliance to legal requirements, but the use of a model observer is the way to go when dealing with the optimisation of the imaging protocols.

Parallel declines in species and genetic diversity driven by anthropogenic disturbance: a multispecies approach in a French Atlantic dune system.

Numerous studies assess the correlation between genetic and species diversities, but the processes underlying the observed patterns have only received limited attention. For instance, varying levels of habitat disturbance across a region may locally reduce both diversities due to extinctions, and increased genetic drift during population bottlenecks and founder events. We investigated the regional distribution of genetic and species diversities of a coastal sand dune plant community along 240 kilometers of coastline with the aim to test for a correlation between the two diversity levels. We further quantify and tease apart the respective contributions of natural and anthropogenic disturbance factors to the observed patterns. We detected significant positive correlation between both variables. We further revealed a negative impact of urbanization: Sites with a high amount of recreational infrastructure within 10 km coastline had significantly lowered genetic and species diversities. On the other hand, a measure of natural habitat disturbance had no effect. This study shows that parallel variation of genetic and species diversities across a region can be traced back to human landscape alteration, provides arguments for a more resolute dune protection, and may help to design priority conservation areas.

4/16

Sleep problems among detainees are common. Appropriate evaluation and treatment remain challenging in correctional settings. However, this is not primarily a problem of resources; rather, it is, to a great extent, an issue of adequate training. Correctional health professionals need appropriate education regarding insomnia evaluation and management. Guidelines should be based on the principle of equivalence of care and should take into account all evidence from research in the community and in correctional settings. Educational material from outside prisons exists and should be made available to detainees and health professionals (Falloon et al., 2011; Sateia & Nowell, 2004). Priority should be given to changes in prison conditions and to nonpharmacological treatment. There is no evidence-based justification to replace BZD prescriptions with antipsychotics or antidepressants. In correctional settings, prescriptions of antipsychotics and antidepressants for sleep problems can increase risk due to polypharmacy and higher suicide risks. Correctional physicians should monitor and document the evaluation and treatment practice concerning insomnia complaints to improve safe, evidence-based treatment.

Evolution of mammographic image quality in the state of Rio de Janeiro

Objective:To evaluate the evolution of mammographic image quality in the state of Rio de Janeiro on the basis of parameters measured and analyzed during health surveillance inspections in the period from 2006 to 2011.Materials and Methods:Descriptive study analyzing parameters connected with imaging quality of 52 mammography apparatuses inspected at least twice with a one-year interval.Results:Amongst the 16 analyzed parameters, 7 presented more than 70% of conformity, namely: compression paddle pressure intensity (85.1%), films development (72.7%), film response (72.7%), low contrast fine detail (92.2%), tumor mass visualization (76.5%), absence of image artifacts (94.1%), mammography-specific developers availability (88.2%). On the other hand, relevant parameters were below 50% conformity, namely: monthly image quality control testing (28.8%) and high contrast details with respect to microcalcifications visualization (47.1%).Conclusion:The analysis revealed critical situations in terms of compliance with the health surveillance standards. Priority should be given to those mammography apparatuses that remained non-compliant at the second inspection performed within the one-year interval.

La educación en valores democráticos en los manuales de la asignatura Educación para la Ciudadanía

Este artículo aporta los resultados de un estudio sobre legislación educativa y manuales de Educación para la Ciudadanía con el objeto de visibilizar la presencia de la educación en valores democráticos y su evolución en el contexto de los cambios sociales y políticos recientes. En la primera parte, nos adentramos en la reflexión sobre la moral y la vivencia de los valores en nuestras realidades, con el objeto de analizar la dimensión ética de la sociedad. Abordamos el debate de la crisis de valores y se realizan propuestas sobre la dimensión teleológica y axiológica de la educación en y para la democracia. En la segunda parte, se aporta la síntesis del estudio de la presencia de la educación en valores en algunas leyes educativas aprobadas a partir de la Constitución Española de 1978. Se describe cómo se ha incorporado la educación en valores a la normativa y qué formas ha ido adoptando. Se dedica especial atención al área de Educación para la Ciudadanía propuesta en la loe como espacio de formación ética y política. En el último apartado sobre educación en valores y manuales de ciudadanía se presentan, en primer lugar, diferentes significados y principios de ciudadanía para enmarcar teóricamente la investigación. A continuación, se visualizan los resultados del análisis de contenido de los valores presentes en una muestra de manuales de Educación para la Ciudadanía editados en el marco de desarrollo de la loe. Nuestro interés ha sido mostrar cómo los libros de texto traducen la legislación, qué valores de la democracia priorizan y cómo los conceptualizan. Se finaliza el artículo con las conclusiones que recogen un conjunto de apuntes en los que se considera la crisis como posibilidad y se propone seguir avanzando en proyectos de democracia, ciudadanía y educación en valores innovadores.

Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism.

Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism. Azorin JM, Bowden CL, Garay RP, Perugi G, Vieta E, Young AH. Source Department of Psychiatry, CHU Sainte Marguerite, Marseilles, France. Abstract About half of all bipolar patients have an alcohol abuse problem at some point of their lifetime. However, only one randomized, controlled trial of pharmacotherapy (valproate) in this patient population was published as of 2006. Therefore, we reviewed clinical trials in this indication of the last four years (using mood stabilizers, atypical antipsychotics, and other drugs). Priority was given to randomized trials, comparing drugs with placebo or active comparator. Published studies were found through systematic database search (PubMed, Scirus, EMBASE, Cochrane Library, Science Direct). In these last four years, the only randomized, clinically relevant study in bipolar patients with comorbid alcoholism is that of Brown and colleagues (2008) showing that quetiapine therapy decreased depressive symptoms in the early weeks of use, without modifying alcohol use. Several other open-label trials have been generally positive and support the efficacy and tolerability of agents from different classes in this patient population. Valproate efficacy to reduce excessive alcohol consumption in bipolar patients was confirmed and new controlled studies revealed its therapeutic benefit to prevent relapse in newly abstinent alcoholics and to improve alcohol hallucinosis. Topiramate deserves to be investigated in bipolar patients with comorbid alcoholism since this compound effectively improves physical health and quality of life of alcohol-dependent individuals. In conclusion, randomized, controlled research is still needed to provide guidelines for possible use of valproate and other agents in patients with a dual diagnosis of bipolar disorder and substance abuse or dependence.

A qualitative study of adolescents with medically unexplained symptoms and their parents

Il est fréquent en médecine de premier recours de rencontrer des adolescents exprimant des symptômes somatiques pour lesquels aucune des investigations entreprises n'a permis de rendre compte d'une pathologie organique. De tels symptômes sont retrouvés dans la littérature sous la terminologie de symptômes médicalement inexpliqués (MUS) ou des troubles fonctionnels. Bien que la prévalence des adolescents souffrant de MUS est fréquente, les médecins éprouvent encore beaucoup de difficultés à prendre en charge et communiquer avec ces patients, principalement en raison d'une incompréhension de leurs besoins et préoccupations tant dans leur vie quotidienne que lors d'une consultation au cabinet. Le but de notre étude est de comprendre les expériences et vécus des adolescents avec des MUS ainsi que de leurs parents afin d'aider le praticien dans la compréhension de son patient dans sa globalité et ainsi d'améliorer sa prise en charge. Dans le premier article présenté, nous nous sommes intéressés à la vie quotidienne de ces adolescents en étudiant leurs relations avec leur famille et leur entourage ainsi que les répercussions sur leurs parcours scolaire et leurs activités extrascolaires. Dans le second article nous nous sommes penchés sur les relations qu'entretiennent ces adolescents et leurs parents avec le système de santé. Nous avons collecté des données qualitatives en moyennant des groupes focus incluant 16 adolescents atteints de troubles fonctionnels et leurs parents. L'analyse a permis de faire émerger les difficultés que ces jeunes et leurs familles vivent au quotidien et comment ils sont confrontés à la solitude dû principalement à l'incompréhension sociale. Les résultats mettent aussi en évidence l'insatisfaction de ces jeunes et de leurs parents par rapport à la prise en charge médical, notamment en raison d'un manque de communication. -- Medically unexplained symptoms (MUS) are common among adolescents and are frequently encountered in primary care. Our aim was to explore how these adolescents and their parents experience the condition and its impact on their daily lives and to provide recommendations for health professionals. Using a qualitative approach, six focus groups and two individual interviews were conducted. These involved a total of ten adolescents with different types of MUS and sixteen parents. The respondents were recruited in a university hospital in Switzerland. A thematic analysis was conducted according to the Grounded Theory. The analysis of the data highlighted four core themes: disbelief, being different, concealing symptoms, and priority to adolescent's health. Transcending these themes was a core issue regarding the discrepancy between the strategies that adolescents and their parents use to cope with the symptoms. Health professionals should be made aware of the emotional needs of these patients and their families.

Äitiys kulttuurisina odotuksina

Tutkimuksen kohteena ovat äitiydelle tuotetut kulttuuriset odotukset, joita tarkastellaan kahdella yhteiskunnallisella keskustelufoorumilla. Tutkimuksessa tarkastellaan yhtäältä lastensuojelun perhetyössä toimivien ammattilaisten ja toisaalta median puhetta äitiydestä. Tutkimuksen tavoitteena on tehdä näkyväksi vaihtoehtoisia tapoja konstruoida äitiyttä hyvänä tai riittämättömänä sekä haastaa pohtimaan erilaisten tulkintojen perusteita ja seurauksia lastensuojelutyössä. Kulttuuriset, äitiyttä koskevat odotukset vaikuttavat myös siihen, miten äitiys henkilökohtaisella tasolla koetaan. Äitiyden kulttuurista määrittelyä analysoidaan kahdesta tekstiaineistosta. Yhtenä aineistona ovat Stakesissa vuonna 1999 toteutetun Perhetyöprojektin yhteydessä kerätyt, lastensuojelussa toimivien perhetyöammattilaisten ryhmäkeskustelut. Toisena aineistona on projektin ajankohtana ilmestyneistä suomalaisista naisten- ja perhelehdistä (Kotiliesi, Anna, Kaksplus) kerätyt äitien haastattelut. Tutkimuksessa kysytään 1) Mihin ammattilaisten äitejä koskeva huolipuhe kiinnittyy ja millaisia kulttuurisia äitiyden odotuksia se konstruoi? 2) Millaisia äitiyden odotuksia median äitihaastattelut konstruoivat? 3) Millaisen äitiyden odotushorisontin nämä puhekäytännöt yhdessä tuottavat? Analyysin teoreettis-metodologisina kulmakivinä ovat sosiaalinen konstruktionismi ja feministinen tietokäsitys. Analyysimenetelmänä on laadullinen, aineistojen ehdoilla etenevä, feministisesti ja kriittisesti sävyttynyt lukutapa, joka hyödyntää teemoittelun, diskurssianalyysin ja feministisen metodologian ideoita ja käsitteitä. Analysoitavana olevissa keskusteluissa äitiyttä konstruoidaan lapsen tarpeiden (ammattilaiset) ja naisen tarpeiden (media) näkökulmista. Ammattilaiset puhuvat tilanteista, joissa äitien toiminta rikkoo kulttuurista hyvän äidin kuvaa, vaarantaa lapsen hyvinvointia ja äitiyteen joudutaan puuttumaan ammatillisesti. Ammattilaisten tulkinnat kuvaavat taitavaa lapsen edun näkökulmasta tehtyä arviointia, jonka kiintopisteenä ovat äidit yksilöllisine ominaisuuksineen ja piirteineen. Ammatillisen huolipuheen keskiössä ovat äidin vuorovaikutussuhteet sekä äidin tunteet, käyttäytyminen ja asenteet. Riittävää äitiyttä konstruoi kodin luominen, kiintymyssuhteen rakentaminen ja lapsen ensisijaiseksi asettaminen. Sen sijaan vaikuttaa siltä, ettei äitiyden arviointia juurikaan tehdä suhteessa äidin muihin identiteetteihin tai äitiyden toteuttamisen kontekstiin. Paikoin ammattilaisten tulkinnat heijastavat myös stereotyyppisiä ja idealistisia odotuksia, joita vasten äitiyttä arvioidaan. Tällaiset piirteet voivat kertoa siitä, että äitien avuntarpeet jäävät lastensuojelutyössä kohtaamatta ja ymmärtämättä. Mediapuhe äitiydestä käydään naiseuden ja äitiyden mallien antamisen kontekstissa. Puheen keskiössä ovat mediajulkisuuteen päässeiden naisten äidiksi tuloon ja äitiyden toteuttamiseen liittyvät valinnat ja käyttäytyminen. Mediapuhe on puhetta kulttuuristen ja ammatillisten äitiyden odotusten rikkomisesta, uudelleen tulkinnasta ja niiden muovaamisesta itselle sopiviksi. Mediapuheessa hyvää äitiyttä konstruoi äidin itsenäisyys ja oma aika, sosiaalisen elämän rikkaus, ammatillinen identiteetti ja persoonalliset valinnat. Aineistojen kautta rakentuu moninaisten ja ristiriitaisten, äitejä eri suuntaan vetävien kulttuuristen odotusten kirjo. Odotukset jäsentyvät neljälle ulottuvuudelle: 1) lapselle omistautuva – itseään toteuttava, 2) emotionaalinen side – rationaalinen tehtävä, 3) odotuksia toteuttava – omaehtoinen, 4) itsenäinen - äitiyttä jakava. Äitiyden toteuttaminen kulttuurisesti ”oikein” on näiden odotusten välissä tasapainoilua. Ulottuvuuksien kautta esille tulevat kaksoisviestit voivat heikentää äitien itsetuntoa, tuottaa riittämättömyyden tunteita tai yllyttää suorittamaan äitiyttä. Myös äitiyden ammatillinen tukeminen edellyttää tasapainoilua, jottei äitejä idealisoida tai syyllistetä kulttuurisia odotuksia vasten.

Rationing problems with payoff thresholds

An extension of the standard rationing model is introduced. Agents are not only identi fied by their respective claims over some amount of a scarce resource, but also by some payoff thresholds. These thresholds introduce exogenous differences among agents (full or partial priority, past allocations, past debts, ...) that may influence the final distribution. Within this framework we provide generalizations of the constrained equal awards rule and the constrained equal losses rule. We show that these generalized rules are dual from each other. We characterize the generalization of the equal awards rule by using the properties of consistency, path-independence and compensated exemption. Finally, we use the duality between rules to characterize the generalization of the equal losses solution.

Identifying strategies for mitigating the global warming impact of the EU-25 economy using a multi-objective input-output approach

Global warming mitigation has recently become a priority worldwide. A large body of literature dealing with energy related problems has focused on reducing greenhouse gases emissions at an engineering scale. In contrast, the minimization of climate change at a wider macroeconomic level has so far received much less attention. We investigate here the issue of how to mitigate global warming by performing changes in an economy. To this end, we make use of a systematic tool that combines three methods: linear programming, environmentally extended input output models, and life cycle assessment principles. The problem of identifying key economic sectors that contribute significantly to global warming is posed in mathematical terms as a bi criteria linear program that seeks to optimize simultaneously the total economic output and the total life cycle CO2 emissions. We have applied this approach to the European Union economy, finding that significant reductions in global warming potential can be attained by regulating specific economic sectors. Our tool is intended to aid policymakers in the design of more effective public policies for achieving the environmental and economic targets sought.

Tehtaan alueella tapahtuvan välivarastoinnin laadunvarmistus

Sisälogistiikassa on monissa eri vaiheissa varastointia. Raaka-aineita, keskeneräisiä ja valmiita tuotteita joudutaan varastoimaan yrityksen tiloissa. Varastoinnin laatuun tulee kiinnittää huomiota kaikissa vaiheissa. Varastoinnin laadunhallintaan voidaan käyttää standardin ISO 9000 mukaista laadunhallinta järjestelmää, johon kuuluu osa-alueina johdon vastuu, resurssien hallinta tuotteen toteuttaminen sekä mittaus, analysointi ja parantaminen. Logistiikan ja varastoinnin laadun tärkein mittari on asiakastyytyväisyys. Asiakkaat päättävät loppukädessä onko tuote tai palvelu vaatimusten mukainen, joten asiakkaan määrittelemien vaatimusten täyttäminen on ensiarvoisen tärkeää. Muita varastoinnin mittareita ovat suorituskyvyn mittarit sisältäen laatu- ja kustannusmittarit sekä uudistumiskyky. Työn empiriaosassa on kartoitettu Metso Paper Oy:n Rautpohjan yksikön välivarastoinnin mahdollisia laatupuutteita erilaisilla mittareilla. Tuloksien perusteella on kehitetty toimintamalli, kartoitettu ohjeistusta vaativat tahot sekä ehdotus seurannan järjestämisestä. Työssä on myös tarkasteltu vastuun jakautumista välivarastoinnin osalta.

Research Priorities for seabirds: Improving seabird conservation and management in the 21st century

Seabirds are facing a growing number of threats in both terrestrial and marine habitats, and many populations have experienced dramatic changes over past decades. Years of seabird research have improved our understanding of seabird populations and provided a broader understanding of marine ecological processes. In an effort to encourage future research and guide seabird conservation science, seabird researchers from 9 nations identified the 20 highest priority research questions and organized these into 6 general categories: (1) population dynamics, (2) spatial ecology, (3) tropho-dynamics, (4) fisheries interactions, (5) response to global change, and (6) management of anthropogenic impacts (focusing on invasive species, contaminants and protected areas). For each category, we provide an assessment of the current approaches, challenges and future directions. While this is not an exhaustive list of all research needed to address the myriad conservation challenges seabirds face, the results of this effort represent an important synthesis of current expert opinion across sub-disciplines within seabird ecology. As this synthesis highlights, research, in conjunction with direct management, education, and community engagement, can play an important role in facilitating the conservation and management of seabird populations and of the ocean ecosystems on which they and we depend.

Managing Customer Retention in Health and Fitness Club Industry

The objective of this study is to resolve how customer retention is managed in Finnish health and fitness clubs, and how is this comparable with the theoretical aspects of customer retention. It is also discussed how the process leading to customer retention is handled, and what the essential elements of customer retention and loyalty are specifically in the health and fitness club industry. In addition, it is discussed to what extent do health and fitness club companies implement the elements of customer retention in their businesses. Finally, there is discussion about the relationship and priority between the behavioral and attitudinal methods of creating retention in the companies. The data was collected by interviewing the management of six health and fitness clubs from different geographical regions in Finland. Results indicated that the most important constructs concerning customer retention were switching barriers, pricing strategy, competitive aspect, corporate image, service quality, employee retention, and customer satisfaction. In addition, the implementation of customer retention was found to vary between different sized companies and companies from different geographical locations. Moreover, it was discovered that the companies put more effort in constructs that are considered to create customer loyalty instead of retention.

Métodos imunoquímicos para análise de contaminantes ambientais: conceitos, estado da arte e perspectivas

Immunoassay techniques provide simple, powerful and inexpensive methods for analysis of environmental contaminants. However, the acceptance of immunoassays is dependent on the clear demonstration of quality and validity compared to more traditional techniques. In this review, primarily, the understanding and the fundamentals of immunoassay methods are given in order to make good use of immunoassays, especially of EIA tests. Special attention is given to the concepts related to the enzyme-linked immunosorbent assay (ELISA) formats, such as inhibition concentration at 50% (IC50), detection limit (LOD), cross-reactivity (CR %). It is also explained why some immunoassays are quantitative methods whereas others can only be used as screening methods. A list of main commercial kits for detection of priority pollutants is given in order to help analysts. Others formats, such as flow-injection immunoassay analysis (FIIA), immunoassay chromatography and immunosensors are also cited.