Verbrennungen--Von der Bagatelle zur Katastrophe [Burns--from trifle case to mass casualty]

Burn injuries are very frequent, most being trifle cases. Nevertheless every year about 200 patients need to be treated in one of the two specialised Swiss burns centres. Admission criteria are burns > 15% body surface or burns to critical areas (face neck, hands, genitalia, joints) and electrical injuries. The paper reviews the physiophathology of the burn wound which differs depending on the thermal or electrical aetiology. The airway may be threatened due to true inhalation, but also to burns to the face or neck. In major burns >20% body surface in adults, or > 10% in children, fluid resuscitation will be required; oral hydration is generally sufficient by smaller burns. Surgical treatment of 2nd and 3rd degree burns starts within the first 24 days after injury. While complex treatment is generally available in peace time, a major accident such as a disco-fire that can generate hundreds casualties in a few minutes, can threaten our system and force the adoption of triage rules, and simplified treatments. Attitudes to adopt in such conditions are discussed.

An embedded real-time red peach detection system based on an OV7670 camera, ARM Cortex-M4 processor and 3D Look-Up Tables

This work proposes the development of an embedded real-time fruit detection system for future automatic fruit harvesting. The proposed embedded system is based on an ARM Cortex-M4 (STM32F407VGT6) processor and an Omnivision OV7670 color camera. The future goal of this embedded vision system will be to control a robotized arm to automatically select and pick some fruit directly from the tree. The complete embedded system has been designed to be placed directly in the gripper tool of the future robotized harvesting arm. The embedded system will be able to perform real-time fruit detection and tracking by using a three-dimensional look-up-table (LUT) defined in the RGB color space and optimized for fruit picking. Additionally, two different methodologies for creating optimized 3D LUTs based on existing linear color models and fruit histograms were implemented in this work and compared for the case of red peaches. The resulting system is able to acquire general and zoomed orchard images and to update the relative tracking information of a red peach in the tree ten times per second.

Discovery of a 29-gene panel in peripheral blood mononuclear cells for the detection of colorectal cancer and adenomas using high throughput real-time PCR.

Colorectal cancer (CRC) is the second leading cause of cancer-related death in developed countries. Early detection of CRC leads to decreased CRC mortality. A blood-based CRC screening test is highly desirable due to limited invasiveness and high acceptance rate among patients compared to currently used fecal occult blood testing and colonoscopy. Here we describe the discovery and validation of a 29-gene panel in peripheral blood mononuclear cells (PBMC) for the detection of CRC and adenomatous polyps (AP). Blood samples were prospectively collected from a multicenter, case-control clinical study. First, we profiled 93 samples with 667 candidate and 3 reference genes by high throughput real-time PCR (OpenArray system). After analysis, 160 genes were retained and tested again on 51 additional samples. Low expressed and unstable genes were discarded resulting in a final dataset of 144 samples profiled with 140 genes. To define which genes, alone or in combinations had the highest potential to discriminate AP and/or CRC from controls, data were analyzed by a combination of univariate and multivariate methods. A list of 29 potentially discriminant genes was compiled and evaluated for its predictive accuracy by penalized logistic regression and bootstrap. This method discriminated AP >1cm and CRC from controls with a sensitivity of 59% and 75%, respectively, with 91% specificity. The behavior of the 29-gene panel was validated with a LightCycler 480 real-time PCR platform, commonly adopted by clinical laboratories. In this work we identified a 29-gene panel expressed in PBMC that can be used for developing a novel minimally-invasive test for accurate detection of AP and CRC using a standard real-time PCR platform.

The economic relevance of climate variables in agriculture: the case of Spain

We estimate how climate variables affect price and acreage of productive farmland using the Ricardian approach. Furthermore, we use our estimations to evaluate the joint effects of possible cli- mate changes within the time horizon of 2010 and 2050. Our results show that the price of rainfed land in Spain tends to increase but rainfed acreage decreases. On the other hand, the effect on irrigated farmland price and acreage presents some mixed results, however, in the long run the dominant pattern is clearly increasing for both prices and acreage.

Re-writing and Its Pedagogical Value: A Case Study

Tenint en compte el temps i la energia que els mestres i professors dediquen a la correcció de redaccions i produccions escrites i el poc efecte que aquestes semblen tenir en altres produccions dels aprenents, es va dissenyar la recerca que es presenta en aquest article. Els resultats de l'estudi semblen suggerir que les correccions no faciliten l'aprenentatge. Com presentem aquesta activitat de retroalimentació a l'alumnat i la posició que li donem dins d'un enfocament basat en el procés de l'escriptura seran clau per fer que les correccions siguin facilitadores de l'aprenentatge de la producció escrita.

Tuberous sclerosis: literature review and case report

Tuberous sclerosis (TS) or Bourneville"s disease is a rare, multisystemic genetic disorder. It involves alterations to ectodermal and mesodermal cell differentiation and proliferation, causing benign hamartomatous tumors, neurofibromas and angiofibromas in the brain and other vital organs including the kidney, heart, eyes, lungs, skin and mucosa. It also affects the central nervous system and produces neurological dysfunctions such as seizures, mental retardation and behavior disorders. Tuberous (rootshaped) growths develop in the brain, and calcify over time, becoming hard and sclerotic, hence the name given to the disease. Although inheritance is autosomal dominant, 60-70% of cases occur through spontaneous mutations. The disease is related to some mutations or alterations in two genes, named TSC1 and TSC2. Discovered in 1997, TSC1 is located on chromosome 9q34 and produces a protein called hamartin. TSC2, discovered in 1993, is located on chromosome 16p13 and produces a protein called tuberin. The prevalence of the disease is 1/6000-10,000 live newborns, and it is estimated that there are 1-2 million sufferers worldwide. This paper presents a literature review and a family case report of a mother and two of her daughters with oral features of TS

Are Evaluation of ICTs Investment Using Decision Support Systems:Case Applications from Distributor's and End User's Perspective Group Decision

The evaluation of investments in advanced technology is one of the most important decision making tasks. The importance is even more pronounced considering the huge budget concerning the strategic, economic and analytic justification in order to shorten design and development time. Choosing the most appropriate technology requires an accurate and reliable system that can lead the decision makers to obtain such a complicated task. Currently, several Information and Communication Technologies (ICTs) manufacturers that design global products are seeking local firms to act as their sales and services representatives (called distributors) to the end user. At the same time, the end user or customer is also searching for the best possible deal for their investment in ICT's projects. Therefore, the objective of this research is to present a holistic decision support system to assist the decision maker in Small and Medium Enterprises (SMEs) - working either as individual decision makers or in a group - in the evaluation of the investment to become an ICT's distributor or an ICT's end user. The model is composed of the Delphi/MAH (Maximising Agreement Heuristic) Analysis, a well-known quantitative method in Group Support System (GSS), which is applied to gather the average ranking data from amongst Decision Makers (DMs). After that the Analytic Network Process (ANP) analysis is brought in to analyse holistically: it performs quantitative and qualitative analysis simultaneously. The illustrative data are obtained from industrial entrepreneurs by using the Group Support System (GSS) laboratory facilities at Lappeenranta University of Technology, Finland and in Thailand. The result of the research, which is currently implemented in Thailand, can provide benefits to the industry in the evaluation of becoming an ICT's distributor or an ICT's end user, particularly in the assessment of the Enterprise Resource Planning (ERP) programme. After the model is put to test with an in-depth collaboration with industrial entrepreneurs in Finland and Thailand, the sensitivity analysis is also performed to validate the robustness of the model. The contribution of this research is in developing a new approach and the Delphi/MAH software to obtain an analysis of the value of becoming an ERP distributor or end user that is flexible and applicable to entrepreneurs, who are looking for the most appropriate investment to become an ERP distributor or end user. The main advantage of this research over others is that the model can deliver the value of becoming an ERP distributor or end user in a single number which makes it easier for DMs to choose the most appropriate ERP vendor. The associated advantage is that the model can include qualitative data as well as quantitative data, as the results from using quantitative data alone can be misleading and inadequate. There is a need to utilise quantitative and qualitative analysis together, as can be seen from the case studies.

Potential health-care service utilization substitution effects induced by case management for emergency department frequent users

BACKGROUND: In most of the emergency departments (ED) in developed countries, a subset of patients visits the ED frequently. Despite their small numbers, these patients are the source of a disproportionally high number of all ED visits, and use a significant proportion of healthcare resources. They place a heavy economic burden on hospital and healthcare systems budgets overall. Several interventions have been carried out to improve the management of these ED frequent users. Case management has been shown in some North American studies to reduce ED utilization and costs. In these studies, cost analyses have been carried out from the hospital perspective without examining the costs induced by healthcare consumed in the community. However, case management might reduce ED visits and costs from the hospital's perspective, but induce substitution effects, and increase health service utilization outside the hospital. This study examined if an interdisciplinary case-management intervention-compared to standard ED care -reduced costs generated by frequent ED users not only from the hospital perspective, but also from the healthcare system perspective-that is, from a broader perspective taking into account the costs of healthcare services used outside the hospital. METHODS: In this randomized controlled trial, 250 adult frequent emergency department users (5 or more visits during the previous 12 months) who visited the ED of the University Hospital of Lausanne, Switzerland, between May 2012 and July 2013 were allocated to one of two groups: case management intervention (CM) or standard ED care (SC), and followed up for 12 months. Depending on the perspective of the analysis, costs were evaluated differently. For the analysis from the hospital's perspective, the true value of resources used to provide services was used as a cost estimate. These data were obtained from the hospital's analytical accounting system. For the analysis from the health-care system perspective, all health-care services consumed by users and charged were used as an estimate of costs. These data were obtained from health insurance providers for a subsample of participants. To allow comparisons in a same time period, individual monthly average costs were calculated. Multivariate linear models including a fixed effect "group" were run using socio-demographic characteristics and health-related variables as controlling variables (age, gender, educational level, citizenship, marital status, somatic and mental health problems, and risk behaviors).

Frequent users of the emergency department in a universal health coverage system : a randomized controlled trial of a case-management intervention

BACKGROUND: Frequent emergency department users represent a small number of patients but account for a large number of emergency department visits. They should be a focus because they are often vulnerable patients with many risk factors affecting their quality of life (QoL). Case management interventions have resulted in a significant decrease in emergency department visits, but association with QoL has not been assessed. One aim of our study was to examine to what extent an interdisciplinary case management intervention, compared to standard emergency care, improved frequent emergency department users' QoL. METHODS: Data are part of a randomized, controlled trial designed to improve frequent emergency department users' QoL and use of health-care resources at the Lausanne University Hospital, Switzerland. In total, 250 frequent emergency department users (≥5 attendances during the previous 12 months; ≥ 18 years of age) were interviewed between May 2012 and July 2013. Following an assessment focused on social characteristics; social, mental, and somatic determinants of health; risk behaviors; health care use; and QoL, participants were randomly assigned to the control or the intervention group (n=125 in each group). The final sample included 194 participants (20 deaths, 36 dropouts, n=96 in the intervention group, n=99 in the control group). Participants in the intervention group received a case management intervention by an interdisciplinary, mobile team in addition to standard emergency care. The case management intervention involved four nurses and a physician who provided counseling and assistance concerning social determinants of health, substance-use disorders, and access to the health-care system. The participants' QoL was evaluated by a study nurse using the WHOQOL-BREF five times during the study (at baseline, and at 2, 5.5, 9, and 12 months). Four of the six WHOQOL dimensions of QoL were retained here: physical health, psychological health, social relationship, and environment, with scores ranging from 0 (low QoL) to 100 (high QoL). A linear, mixed-effects model with participants as a random effect was run to analyze the change in QoL over time. The effects of time, participants' group, and the interaction between time and group were tested. These effects were controlled for sociodemographic characteristics and health-related variables (i.e., age, gender, education, citizenship, marital status, type of financial resources, proficiency in French, somatic and mental health problems, and behaviors at risk).

Integrating Financial Perspective to Quality Orientated Management System. Case: ALSTOM Finland Oy

Tutkimuksen päätavoitteena on tutkia taloudellisen näkökulman integroimista laatuajatteluun pohjautuvaan johtamisjärjestelmään esimerkkiyrityksessä. Johtamisjärjestelmän tulee tuottaa tietoa johdon strategiselle päätöksenteolle ja lisäksi täyttää laatujärjestelmän (ISO 9001:2000) asettamat vaatimukset. Tutkimuksen kohteena oleva työkalu on balanced scorecard (tasapainotettu tuloskortti). Työn tarkoituksena on ehdottaa balanced scorecard- talouden tunnuslukuja esimerkkiyritykselle. Tutkimuksen tavoitteisiin päästään empiiristä tutkimusta varten tehdyn teoreettisen viitekehyksen avulla. Empiiristä tutkimustietoa kerätään osallistuvan havainnoinnin, haastattelujen ja keskustelujen avulla. Tutkimusmenetelmänä on laadullinen case -tutkimus. Balanced scorecardin eri näkökulmille ehdotettiin tunnuslukuja empiirisen tutkimuksen pohjalta. Lisäksi talouden näkökulmaa tutkittiin tarkemmin. Tutkimuksen johtopäätöksenä esitettiin, että taloudelliset tunnusluvut mittaavat ensisijaisesti strategiaa eivätkä laatua. Lisäksi huomioitiin, että tuloskorttien tulisi olla koekäytössä ennen bonuspalkkauksen ja balanced scorecardin yhdistämistä.

Diagnosis by imaging : the case of textbooks of diseases of the nervous system (1850-1920)

Les traités scientifiques ne font que depuis peu d'années l'objet d'études en histoire des sciences. Pourtant, ces traités ont énormément à apporter car ils renseignent sur la manière de raisonner des auteurs, ainsi que sur le développement d'une discipline. Dans ce travail de doctorat, différents traités des maladies du système nerveux ont été dépouillés, notamment le traité de Sémiologie des affections du système nerveux (1914) de Jules Dejerine (1849-1917). Ce traité a été analysé de trois manières différentes. Il a tout d'abord été comparé à une édition précédente publiée sous forme de chapitre (1901), révélant un large remodelage du contenu du traité, suggérant une évolution rapide de la discipline neurologique en l'espace de quelques années. Deuxièmement, l'analyse de la Sémiologie a permis de recréer un réseau de professionnels avec qui Jules Dejerine était en contact et, en parcourant les livres publiés par ces auteurs, il a été possible de décrire de quelle manière ces auteurs se citent mutuellement. Finalement, ces livres contiennent de nombreuses illustrations, qui sont associées à la notion de « preuve » : les auteurs utilisent des images sous forme de dessins, de photographies ou de schémas qui illustrent des patients ou des pièces anatomiques pour « montrer » la maladie ou la lésion. Chaque illustration a un rôle à jouer pour décrire la lésion, montrer la progression de la maladie et elle aide le médecin à poser le diagnostic. Grâce à ces trois axes de recherche, un traité devient un outil de travail dynamique, qui évolue au fil des rééditions, influencé par les critiques et commentaires retrouvés dans d'autres traités et articles, et par les progrès accomplis dans la discipline traitée. Des, passages et certaines images de l'ouvrage circulent également de traité en traité et véhiculent l'autorité de l'auteur de ces passages et images qui en viennent à représenter la maladie. Ce transfert d'images joue également un rôle dans la standardisation du diagnostic et dans l'unification de la neurologie à travers le monde occidental au début du XXe siècle, une période charnière pour l'histoire de la médecine. -- Au début du XXe siècle, la neurologie est une jeune spécialité médicale qui se développe rapidement. Les différents médecins publient des traités, communiquent entre eux et échangent leurs données. Un traité scientifique est un outil de travail dynamique qui évolue avec les rééditions et le développement d'une discipline. Ces ouvrages recèlent toutes sortes d'informations et leur analyse ne fait que depuis peu de temps l'objet d'études en histoire des sciences. Ces traités regorgent notamment d'illustrations qui sont associées à la notion de « preuve » : les auteurs utilisent des images sous forme de dessins, de photographies ou de schémas qui représentent des patients ou des pièces anatomiques afin de « montrer » la maladie ou la lésion. Chaque illustration a un rôle à jouer pour décrire la pathologie, montrer la progression de la maladie et elle aide le médecin à poser le diagnostic. Les auteurs des traités, qui viennent d'Europe et d'Amérique du Nord, se citent mutuellement, permettant au lecteur de recréer leur réseau de professionnels au niveau international. De plus, comme ces auteurs réutilisent les observations et les illustrations des autres, celles-ci circulent de traité en traité et en viennent à représenter la maladie. Ce transfert d'images joue également un rôle dans la standardisation du diagnostic et dans l'unification de la neurologie à travers le monde occidental au début du XXe siècle, une période charnière pour l'histoire de la médecine. -- Until recently, the study of textbooks has been neglected in the history of the sciences. However, textbooks can provide fruitful sources of information regarding the way authors work and the development of a particular discipline. This dissertation reviews editions of a single textbook, the Sémiologie des affections du système nerveux (1914) by Jules Dejerine (1849-1917). This textbook enabled the description of three axes of research. Firstly, by comparing the book to a first edition published as a chapter, one can acknowledge an extensive remodeling of the content of the book, suggesting a vast increase in knowledge over time. Secondly, by looking at the authors that Dejerine quotes repeatedly, it becomes possible to recreate his professional network, to review the works of these authors and to determine how they cross-reference each other. Thirdly, these textbooks contain numerous medical illustrations, which are linked with the concept of "proof;" the authors demonstrate a willingness to "show" the lesion or the pathology by publishing an image. Drawings, schematic representations, radiographies, or photographs of patients or of anatomical preparations all have their own purpose in describing the lesion and the progression of the disease. They assist in the diagnosis of the pathology. By looking at all of these aspects, it is therefore possible to conclude that a neurological textbook is a dynamic object that evolves through re-editions, comments and references found in other textbooks and by the circulations of parts of these books, such as the images. The illustrations also carry the author's authority, since their ongoing use claims that the work by the owner of the image has been endorsed by others. At the same time, it validates the borrowers' arguments. By using medical illustrations from different authors worldwide, the authors are also making a claim to a common language, to a similar way of examining patients, and about how much they depend on medical imagery to prove their points. In that sense, by focusing upon these textbooks, one can affirm that neurology already existed as a worldwide specialty at the turn of the twentieth century. Much more than mere accompaniments to the text, images were of paramount importance to the unification of neurology.

Effect of radar rainfall time resolution on the predictive capability of a distributed hydrologic model

The performance of a hydrologic model depends on the rainfall input data, both spatially and temporally. As the spatial distribution of rainfall exerts a great influence on both runoff volumes and peak flows, the use of a distributed hydrologic model can improve the results in the case of convective rainfall in a basin where the storm area is smaller than the basin area. The aim of this study was to perform a sensitivity analysis of the rainfall time resolution on the results of a distributed hydrologic model in a flash-flood prone basin. Within such a catchment, floods are produced by heavy rainfall events with a large convective component. A second objective of the current paper is the proposal of a methodology that improves the radar rainfall estimation at a higher spatial and temporal resolution. Composite radar data from a network of three C-band radars with 6-min temporal and 2 × 2 km2 spatial resolution were used to feed the RIBS distributed hydrological model. A modification of the Window Probability Matching Method (gauge-adjustment method) was applied to four cases of heavy rainfall to improve the observed rainfall sub-estimation by computing new Z/R relationships for both convective and stratiform reflectivities. An advection correction technique based on the cross-correlation between two consecutive images was introduced to obtain several time resolutions from 1 min to 30 min. The RIBS hydrologic model was calibrated using a probabilistic approach based on a multiobjective methodology for each time resolution. A sensitivity analysis of rainfall time resolution was conducted to find the resolution that best represents the hydrological basin behaviour.

The snow storm of the 8th of March 2010 in Barcelona: a paradigmatic case

A heavy precipitation event swept over Catalonia (NE Spain) on 8 March 2010, with a total amount that ex- ceeded 100mm locally and snowfall of more than 60cm near the coast. Unusual for this region and at this time of the year, this snowfall event affected mainly the coastal region and was accompanied by thunderstorms and strong wind gusts in some areas. Most of the damage was due to"wet snow", a kind of snow that favours accretion on power lines and causes line-breaking and subsequent interruption of the electricity supply. This paper conducts an interdisciplinary analysis of the event to show its great societal impact and the role played by the recently developed social networks (it has been called the first"Snowfall 2.0"), as well to analyse the meteorologi- cal factors associated with the major damage, and to propose an indicator that could summarise them. With this aim, the paper introduces the event and its societal impact and com- pares it with other important snowfalls that have affected the Catalan coast, using the PRESSGAMA database. The sec- ond part of the paper shows the event"s main meteorological features and analyses the near-surface atmospheric variables responsible for the major damage through the application of the SAFRAN (Système d"analyse fournissant des renseigne- ments atmosphériques à la neige) mesoscale analysis, which, together with the proposed"wind, wet-snow index" (WWSI), allows to estimate the severity of the event. This snow storm provides further evidence of our vulnerability to natural haz- ards and highlights the importance of a multidisciplinary ap- proach in analysing societal impact and the meteorological factors responsible for this kind of event.

Toimitusjohtajavaihdokset ja muuttunut pankkityö - case: Savonlinnan Osuuspankki 1981 - 2001

Tutkielman tavoitteena oli tarkastella Savonlinnan Osuuspankissa toteutettuja muutoksia vuosina 1981 – 2001, ja sitä, miten henkilöstö on kokenut muutokset pankkityössä. Erityisesti tarkoitus oli tutkia, miten henkilöstö on kokenut toimitusjohtajavaihdokset. Tutkielma toteutettiin teoreettis-empiirisesti. Empiirinen osuus koottiin haastattelemalla kahdeksaa pankin työntekijää. Lisäksi apuna käytettiin pankista saatavaa kirjallista materiaalia. Kolmas osa empiriasta on tutkijan oma työhistoria pankissa ja tuona aikana tehdyt havainnot. Henkilöstö suhtautuu toimitusjohtajavaihdoksiin positiivisen odottavasti. Vahva sitoutuminen organisaatioon auttaa sopeutumaan jatkuviin muutoksiin. Muutosten tarpeellisuus ymmärretään paremmin ja niihin sitoudutaan, kun tietoa muutoksen tarpeellisuudesta saadaan riittävästi, ja kun henkilöstö pääsee osallistumaan muutoksen suunnitteluun. Muutosten ansiosta henkilöstö kokee usein myös oman osaamisensa ja uransa myönteisen kehittymisen

Brandihallinta tavaramerkkihierarkian kehittämisen lähtökohtana. Case: Atria Oy

Tutkielman tarkoituksena oli ymmärtää, millä tekijöillä brandejä hallitaan. Tavoitteena oli kuvata ja analysoida Atria Oy:n tekemän kokonaisvaltaisen brandihierarkian muutos, selvittää organisaation rooli muutoksessa ja tunnistaa oikeat mitattavat tekijät brandin hallintaan. Tutkimusmenetelmä oli kvalitatiivinen. Tutkimus suoritettiin case-yrityksen avainhenkilöille sekä kahdelle ulkopuoliselle suunnittelutoimistolle. Aineiston keruu tehtiin teemahaastatteluin. Tutkimuksen perusteella brandistrategiset muutokset vaativat aikaa ja vahvaa osaamista, mutta hyvin suunniteltuna ja toteutettuna lopputuloksena on kestävä kokonaisuus. Tutkimuksen tuloksena kehitettiin malli brandihallintaan.