The pneumonia severity index: a decade after the initial derivation and validation

The prognosis of community-acquired pneumonia ranges from rapid resolution of symptoms and full recovery of functional status to the development of severe medical complications and death. The pneumonia severity index is a rigorously studied prediction rule for prognosis that objectively stratifies patients into quintiles of risk for short-term mortality on the basis of 20 demographic and clinical variables routinely available at presentation. The pneumonia severity index was derived and validated with data on >50,000 patients with community-acquired pneumonia by use of well-accepted methodological standards and is the only pneumonia decision aid that has been empirically shown to safely increase the proportion of patients given treatment in the outpatient setting. Because of its prognostic accuracy, methodological rigor, and effectiveness and safety as a decision aid, the pneumonia severity index has become the reference standard for risk stratification of community-acquired pneumonia

Kernel-based mapping of orographic rainfall enhancement in the Swiss Alps as detected by weatherradar

In this paper, we develop a data-driven methodology to characterize the likelihood of orographic precipitation enhancement using sequences of weather radar images and a digital elevation model (DEM). Geographical locations with topographic characteristics favorable to enforce repeatable and persistent orographic precipitation such as stationary cells, upslope rainfall enhancement, and repeated convective initiation are detected by analyzing the spatial distribution of a set of precipitation cells extracted from radar imagery. Topographic features such as terrain convexity and gradients computed from the DEM at multiple spatial scales as well as velocity fields estimated from sequences of weather radar images are used as explanatory factors to describe the occurrence of localized precipitation enhancement. The latter is represented as a binary process by defining a threshold on the number of cell occurrences at particular locations. Both two-class and one-class support vector machine classifiers are tested to separate the presumed orographic cells from the nonorographic ones in the space of contributing topographic and flow features. Site-based validation is carried out to estimate realistic generalization skills of the obtained spatial prediction models. Due to the high class separability, the decision function of the classifiers can be interpreted as a likelihood or susceptibility of orographic precipitation enhancement. The developed approach can serve as a basis for refining radar-based quantitative precipitation estimates and short-term forecasts or for generating stochastic precipitation ensembles conditioned on the local topography.

Longevity differs among sexes but is not affected by repeated immune activation in voles (Microtus arvalis)

Investment of resources in immune defences, despite obvious short-term benefits, may be detrimental to long-term maintenance and thus decrease longevity in absence of parasites. In addition, females and males may differ in immune investment and intrinsic longevity because they are subjected to different degrees of sexual competition and extrinsic mortality. In order to test if sex-specific investment in mounting an immune response reduced longevity, we compared the longevity of captive male and female common voles Microtus arvalis regularly challenged with keyhole limpet haemocyanin, an antigen which elicits the production of antibodies, to the longevity of voles injected with the corresponding antigen-free buffer (phosphate-buffered saline). Injections were repeated every 28 days to mimic a chronic infection. The magnitude of immune response did not vary between males and females and did not affect longevity. Overall, females lived longer than males, independently of the immune challenge. Thus, the long-term costs of immunity seem small in voles. The longevity pattern is consistent with the prediction that male-biased predation or parasitism in the wild causes reduced intrinsic lifespan, but this reduction is not mediated by a decrease in male immunity

Astrocyte-neuron lactate transport is required for long-term memory formation.

We report that, in the rat hippocampus, learning leads to a significant increase in extracellular lactate levels that derive from glycogen, an energy reserve selectively localized in astrocytes. Astrocytic glycogen breakdown and lactate release are essential for long-term but not short-term memory formation, and for the maintenance of long-term potentiation (LTP) of synaptic strength elicited in vivo. Disrupting the expression of the astrocytic lactate transporters monocarboxylate transporter 4 (MCT4) or MCT1 causes amnesia, which, like LTP impairment, is rescued by L-lactate but not equicaloric glucose. Disrupting the expression of the neuronal lactate transporter MCT2 also leads to amnesia that is unaffected by either L-lactate or glucose, suggesting that lactate import into neurons is necessary for long-term memory. Glycogenolysis and astrocytic lactate transporters are also critical for the induction of molecular changes required for memory formation, including the induction of phospho-CREB, Arc, and phospho-cofilin. We conclude that astrocyte-neuron lactate transport is required for long-term memory formation.

Deficit in memory consolidation (abnormal forgetting rate) in childhood temporal lobe epilepsy. Pre and postoperative long-term observation.

Deficits in memory consolidation have been reported in adult patients with epilepsy but, not to our knowledge, in children. We report the long-term follow-up (9 y. o. to 18 y. o.) of a boy who suffered from temporal lobe epilepsy and underwent a left temporal lobectomy with amygdalo-hippocampal resection at the age of 10. He showed an abnormal forgetting rate when trying to encode new information and a significant deficit for retrieving remote episodic memories (when compared with his twin brother), both consistent with a consolidation disorder. His memory condition slightly improved after cessation of the epilepsy, nevertheless did not normalize. No standard memory assessment could pinpoint his memory problem, hence an adapted methodology was needed. We discuss the nature of the memory deficit, its possible causes and its clinical implications.

Kernel-based Mapping of Meteorological Fields in Complex Orography

Due to the advances in sensor networks and remote sensing technologies, the acquisition and storage rates of meteorological and climatological data increases every day and ask for novel and efficient processing algorithms. A fundamental problem of data analysis and modeling is the spatial prediction of meteorological variables in complex orography, which serves among others to extended climatological analyses, for the assimilation of data into numerical weather prediction models, for preparing inputs to hydrological models and for real time monitoring and short-term forecasting of weather.In this thesis, a new framework for spatial estimation is proposed by taking advantage of a class of algorithms emerging from the statistical learning theory. Nonparametric kernel-based methods for nonlinear data classification, regression and target detection, known as support vector machines (SVM), are adapted for mapping of meteorological variables in complex orography.With the advent of high resolution digital elevation models, the field of spatial prediction met new horizons. In fact, by exploiting image processing tools along with physical heuristics, an incredible number of terrain features which account for the topographic conditions at multiple spatial scales can be extracted. Such features are highly relevant for the mapping of meteorological variables because they control a considerable part of the spatial variability of meteorological fields in the complex Alpine orography. For instance, patterns of orographic rainfall, wind speed and cold air pools are known to be correlated with particular terrain forms, e.g. convex/concave surfaces and upwind sides of mountain slopes.Kernel-based methods are employed to learn the nonlinear statistical dependence which links the multidimensional space of geographical and topographic explanatory variables to the variable of interest, that is the wind speed as measured at the weather stations or the occurrence of orographic rainfall patterns as extracted from sequences of radar images. Compared to low dimensional models integrating only the geographical coordinates, the proposed framework opens a way to regionalize meteorological variables which are multidimensional in nature and rarely show spatial auto-correlation in the original space making the use of classical geostatistics tangled.The challenges which are explored during the thesis are manifolds. First, the complexity of models is optimized to impose appropriate smoothness properties and reduce the impact of noisy measurements. Secondly, a multiple kernel extension of SVM is considered to select the multiscale features which explain most of the spatial variability of wind speed. Then, SVM target detection methods are implemented to describe the orographic conditions which cause persistent and stationary rainfall patterns. Finally, the optimal splitting of the data is studied to estimate realistic performances and confidence intervals characterizing the uncertainty of predictions.The resulting maps of average wind speeds find applications within renewable resources assessment and opens a route to decrease the temporal scale of analysis to meet hydrological requirements. Furthermore, the maps depicting the susceptibility to orographic rainfall enhancement can be used to improve current radar-based quantitative precipitation estimation and forecasting systems and to generate stochastic ensembles of precipitation fields conditioned upon the orography.

Prepupal Building Behavior in Drosophila melanogaster and Its Evolution under Resource and Time Constraints.

Structures built by animals are a widespread and ecologically important 'extended phenotype'. While its taxonomic diversity has been well described, factors affecting short-term evolution of building behavior within a species have received little experimental attention. Here we describe how, given the opportunity, wandering Drosophila melanogaster larvae often build long tunnels in agar substrates and embed their pupae within them. These embedded larvae are characterized by a longer egg-to-pupariation developmental time than larvae that pupate on the surface. Assuming that such building behaviors are likely to be energetically costly and/or time consuming, we hypothesized that they should evolve to be less pronounced under resource or time limitation. In accord with this prediction, larvae from populations evolved for 160 generations under a regime that combines larval malnutrition with limited developmental time dug shorter tunnels than larvae from control unselected populations. However, the proportion of larvae that embedded before pupation did not differ between the malnutrition-adapted and control populations, suggesting that tunnel length and likelihood of embedding before pupation are controlled by different genetic loci. The behaviors exhibited by wandering larvae of Drosophila melanogaster prior to pupation offer a model system to study evolution of animal building behaviors because the tunneling and embedding phenotypes are simple, facultative and highly variable.

Aikasarja-analyysimenetelmien soveltuvuus maakaasun; hinnoittelussa käytettyjen sidonnaisuustekijöiden ennustamisessa: Case Gasum Oy

Tässä tutkielmassatarkastellaan maakaasun hinnoittelussa käytettyjen sidonnaisuustekijöiden hintadynamiikkaa ja niiden vaikutusta maakaasun hinnanmuodostukseen. Pääasiallisena tavoitteena on arvioida eri aikasarjamenetelmien soveltuvuutta sidonnaisuustekijöiden ennustamisessa. Tämä toteutettiin analysoimalla eri mallien ja menetelmien ominaisuuksia sekä yhteen sovittamalla nämä eri energiamuotojen hinnanmuodostuksen erityispiirteisiin. Tutkielmassa käytetty lähdeaineisto on saatu Gasum Oy:n tietokannasta. Maakaasun hinnoittelussa käytetään kolmea sidonnaisuustekijää seuraavilla painoarvoilla: raskaspolttoöljy 50%, indeksi E40 30% ja kivihiili 20%. Kivihiilen ja raskaan polttoöljyn hinta-aineisto koostuu verottomista dollarimääräisistä kuukausittaisista keskiarvoista periodilta 1.1.1997 - 31.10.2004. Kotimarkkinoiden perushintaindeksin alaindeksin E40 indeksi-aineisto, joka kuvaa energian tuottajahinnan kehitystä Suomessa ja koostuu tilastokeskuksen julkaisemista kuukausittaisista arvoista periodilta 1.1.2000 - 31.10.2004. Tutkimuksessa tarkasteltujen mallien ennustuskyky osoittautui heikoksi. Kuitenkin tuloksien perusteella voidaan todeta, että lyhyellä aikavälillä EWMA-malli antoi harhattomimman ennusteen. Muut testatuista malleista eivät kyenneet antamaan riittävän luotettavia ja tarkkoja ennusteita. Perinteinen aikasarja-analyysi kykeni tunnistamaan aikasarjojen kausivaihtelut sekä trendit. Lisäksi liukuvan keskiarvon menetelmä osoittautui jossain määrin käyttökelpoiseksi aikasarjojen lyhyen aikavälin trendien identifioinnissa.

Osingon irtoamisen kurssivaikutus suomalaisissa pörssiyhtiöissä vuosina 1994-2002

Tutkielmassa analysoitiin osingon irtoamisen vaikutusta osakekursseihin suomalaisissa pörssiyrityksissä vuosina 1994-2002. Osingon irtoamisen aikaista hinnoittumistehokkuutta tutkittiin pääasiassa niin sanotun markkinakorjatun kurssilaskusuhteen avulla. Saatujen tulosten mukaan ulkomaalaiset sijoittajat ja/ tai lyhytaikaista kauppaa käyvät markkinaosapuolet ovat toimineet hinnanmäärittäjinä Suomen osakemarkkinoilla tutkimusperiodin aikana. Lisäksi havaittiin tilastollisesti merkitsevä ero osakeindeksin nousu- ja laskupäivien keskimääräisten kurssilaskusuhteiden välillä. Osingon irtoamisen osuessa laskupäivälle osakekurssit laskivat huomattavasti vähemmän suhteessa osingon määrään kuin osingon irrotessa nousupäivänä. Tutkimuksessa havaittiin myös korkean osinkotuottoprosentin yrityksillä keskimääräisen kurssilaskusuhteen olevan suurempi muihin yrityksiin verrattuna.

Spatial radial maze procedures and setups to dissociate local and distal relational spatial frameworks in humans.

BACKGROUND: Radial maze tasks have been used to assess optimal foraging and spatial abilities in rodents. The spatial performance was based on a capacity to rely on a configuration of local and distant cues. We adapted maze procedures assessing the relative weight of local cues and distant landmarks for arm choice in humans. NEW METHOD: The procedure allowed testing memory of places in four experimental setups: a fingertip texture-groove maze, a tactile screen maze, a virtual radial maze and a walking size maze. During training, the four reinforced positions remained fixed relative to local and distal cues. During subsequent conflict trials, these frameworks were made conflictive in the prediction of reward locations. RESULTS: Three experiments showed that the relative weight of local and distal relational cues is affected by different factors such as cues' nature, visual access to the environment, real vs. virtual environment, and gender. A fourth experiment illustrated how a walking maze can be used with people suffering intellectual disability. COMPARISON WITH EXISTING METHODS: In our procedure, long-term (reference) and short-term (working) memory can be assessed. It is the first radial task adapted to human that enables dissociating local and distal cues, to provides an indication as to their relative salience. Our mazes are moveable and easily used in limited spaces. Tasks are performed with realistic and spontaneous though controlled exploratory movements. CONCLUSION: Our tasks enabled highlighting the use of different strategies. In a clinical perspective, considering the use of compensatory strategies should orient towards adapted behavioural rehabilitation.

Analysis of Earnings, Stock Prices and Bond Yields: The Fed Model Approach

Prediction of the stock market valuation is a common interest to all market participants. Theoretically sound market valuation can be achieved by discounting future earnings of equities to present. Competing valuation models seek to find variables that affect the equity market valuation in a way that the market valuation can be explained and also variables that could be used to predict market valuation. In this paper we test the contemporaneous relationship between stock prices, forward looking earnings and long-term government bond yields. We test this so-called Fed model in a long- and short-term time series analysis. In order to test the dynamics of the relationship, we use the cointegration framework. The data used in this study spans over four decades of various market conditions between 1964-2007, using data from United States. The empirical results of our analysis do not give support for the Fed model. We are able to show that the long-term government bonds do not play statistically significant role in this relationship. The effect of forward earnings yield on the stock market prices is significant and thus we suggest the use of standard valuation ratios when trying to predict the future paths of equity prices. Also, changes in the long-term government bond yields do not have significant short-term impact on stock prices.

Long-term treatment with insulin induces apoptosis in brown adipocytes: role of oxidative stress

Trying to define the precise role played by insulin regulating the survival of brown adipocytes, we have used rat fetal brown adipocytes maintained in primary culture. The effect of insulin on apoptosis and the mechanisms involved were assessed. Different from the known effects of insulin as a survival factor, we have found that long-term treatment (72 h) with insulin induces apoptosis in rat fetal brown adipocytes. This process is dependent on the phosphatidylinositol 3-kinase/mammalian target of rapamycin/p70 S6 kinase pathway. Short-term treatment with the conditioned medium from brown adipocytes treated with insulin for 72 h mimicked the apoptotic effect of insulin. During the process, caspase 8 activation, Bid cleavage, cytochrome c release, and activation of caspases 9 and 3 are sequentially produced. Treatment with the caspase inhibitor, benzyloxycarbonyl-Val-Ala-Asp (Z-VAD), prevents activation of this apoptotic cascade. The antioxidants, ascorbic acid and superoxide dismutase, also impair this process of apoptosis. Moreover, generation of reactive oxygen species (ROS), probably through reduced nicotinamide adenine dinucleotide phosphate oxidases, and a late decrease in reduced glutathione content are produced. According to this, antioxidants prevent caspase 8 activation and Bid cleavage, suggesting that ROS production is an important event mediating this process of apoptosis. However, the participation of uncoupling protein-1, -2, and -3 regulating ROS is unclear because their levels remain unchanged upon insulin treatment for 72 h. Our data suggest that the prolonged hyperinsulinemia might cause insulin resistance through the loss of brown adipose tissue.

Effect of short-duration lipid supplementation on fat oxidation during exercise and cycling performance.

The effect of intramyocellular lipids (IMCLs) on endurance performance with high skeletal muscle glycogen availability remains unclear. Previous work has shown that a lipid-supplemented high-carbohydrate (CHO) diet increases IMCLs while permitting normal glycogen loading. The aim of this study was to assess the effect of fat supplementation on fat oxidation (Fox) and endurance performance. Twenty-two trained male cyclists performed 2 simulated time trials (TT) in a randomized crossover design. Subjects cycled at ∼53% maximal voluntary external power for 2 h and then followed 1 of 2 diets for 2.5 days: a high-CHO low-fat (HC) diet, consisting of CHO 7.4 g·kg(-1)·day(-1) and fat 0.5 g·kg(-1)·day(-1); or a high-CHO fat-supplemented (HCF) diet, which was a replication of the HC diet with ∼240 g surplus fat (30% saturation) distributed over the last 4 meals of the diet period. On trial morning, fasting blood was sampled and Fox was measured during an incremental exercise; a ∼1-h TT followed. Breath volatile compounds (VOCs) were measured at 3 time points. Mental fatigue, measured as reaction time, was evaluated during the TT. Plasma free fatty acid concentration was 50% lower after the HCF diet (p < 0.0001), and breath acetone was reduced (p < 0.05) "at rest". Fox peaked (∼0.35 g·kg(-1)) at ∼42% peak oxygen consumption, and was not influenced by diet. Performance was not significantly different between the HCF and HC diets (3369 ± 46 s vs 3398 ± 48 s; p = 0.39), nor were reaction times to the attention task and VOCs (p = NS for both). In conclusion, the short-term intake of a lipid supplement in combination with a glycogen-loading diet designed to boost intramyocellular lipids while avoiding fat adaptation did not alter substrate oxidation during exercise or 1-hour cycling performance.

Identification of Low-Risk Patients with Acute Symptomatic Pulmonary Embolism for Outpatient Therapy.

RATIONALE: Patients with acute symptomatic pulmonary embolism (PE) deemed to be at low risk for early complications might be candidates for partial or complete outpatient treatment. OBJECTIVES: To develop and validate a clinical prediction rule that accurately identifies patients with PE and low risk of short-term complications and to compare its prognostic ability with two previously validated models (i.e., the Pulmonary Embolism Severity Index [PESI] and the Simplified PESI [sPESI]) METHODS: Multivariable logistic regression of a large international cohort of patients with PE prospectively enrolled in the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry. MEASUREMENTS AND MAIN RESULTS: All-cause mortality, recurrent PE, and major bleeding up to 10 days after PE diagnosis were determined. Of 18,707 eligible patients with acute symptomatic PE, 46 (0.25%) developed recurrent PE, 203 (1.09%) bled, and 471 (2.51%) died. Predictors included in the final model were chronic heart failure, recent immobilization, recent major bleeding, cancer, hypotension, tachycardia, hypoxemia, renal insufficiency, and abnormal platelet count. The area under receiver-operating characteristic curve was 0.77 (95% confidence interval [CI], 0.75-0.78) for the RIETE score, 0.72 (95% CI, 0.70-0.73) for PESI (P < 0.05), and 0.71 (95% CI, 0.69-0.73) for sPESI (P < 0.05). Our RIETE score outperformed the prognostic value of PESI in terms of net reclassification improvement (P < 0.001), integrated discrimination improvement (P < 0.001), and sPESI (net reclassification improvement, P < 0.001; integrated discrimination improvement, P < 0.001). CONCLUSIONS: We built a new score, based on widely available variables, that can be used to identify patients with PE at low risk of short-term complications, assisting in triage and potentially shortening duration of hospital stay.

Kysynnän ennakointiprosessin kehittäminen leipomoyrityksessä

Tämän työn tarkoituksena on kehittää lyhyen tähtäimen kysynnän ennakointiprosessia VAASAN Oy:ssä, jossa osa tuotteista valmistetaan kysyntäennakoiden perusteella. Valmistettavien tuotteiden luonteesta johtuva varastointimahdollisuuden puuttuminen, korkea toimitusvarmuustavoite sekä tarvittavien ennakoiden suuri määrä asettavat suuret haasteet kysynnän ennakointiprosessille. Työn teoriaosuudessa käsitellään kysynnän ennustamisen tarvetta, ennusteiden käyttökohteita sekä kysynnän ennustamismenetelmiä. Pelkällä kysynnän ennustamisella ei kuitenkaan päästä toimitusketjun kannalta optimaaliseen lopputulokseen, vaan siihen tarvitaan kokonaisvaltaista kysynnän hallintaa. Se on prosessi, jonka tavoitteena on tasapainottaa toimitusketjun kyvykkyydet ja asiakkaiden vaatimukset keskenään mahdollisimman tehokkaasti. Työssä tutkittiin yrityksessä kolmen kuukauden aikana eksponentiaalisen tasoituksen menetelmällä laadittuja ennakoita sekä ennakoijien tekemiä muutoksia niihin. Tutkimuksen perusteella optimaalinen eksponentiaalisen tasoituksen alfa-kerroin on 0,6. Ennakoijien tilastollisiin ennakoihin tekemät muutokset paransivat ennakoiden tarkkuutta ja ne olivat erityisen tehokkaita toimituspuutteiden minimoimisessa. Lisäksi työn tuloksena ennakoijien käyttöön saatiin monia päivittäisiä rutiineja helpottavia ja automatisoivia työkaluja.