Off-label utilization of antidepressants

Rapport de synthèse : De nombreuses études sont effectuées sur les antidépresseurs avant leur mise sur le marché, puis des règles précises sont établies pour leur prescription dans des indications délimitées. Leur utilisation dans des indications «off-label » (hors indication officiellement admise) manque souvent de validation par des bases de données scientifiques et leur prescription se base le plus souvent sur un consensus proposé par des experts. Le but du présent travail a été d'étudier les habitudes de prescription de psychiatres d'hôpitaux en ce qui concerne les antidépresseurs, en comparant des patients traités pour une dépression et des troubles anxieux avec des patients recevant un traitement «off-label ». Pour cette étude, les données d'utilisation de médicaments sont celles recueillies lors de 6 jours de référence, entre avril 1999 et novembre 2001, à l'hôpital psychiatrique de Lausanne (Suisse) comprenant 98 lits. La prescription de médicaments chez 174 patients a été prise en compte. Tandis que le diagnostic n'influençait pas le choix entre des nouveaux et anciens antidépresseurs, les patients présentant un trouble anxieux avaient un risque 4.5 fois (p < 0.05) plus élevé et les patients présentant un autre diagnostic 8 fois plus élevé de recevoir une comédication antipsychotique, en comparaison avec des patients dont le diagnostic primaire était un trouble dépressif. De plus, les patients recevant comme comédication un hypnotique non-benzodiazépine avaient moins de risque que l'on prescrive un ancien antidépresseur (p < 0.05). Alors que les patients avec un trouble anxieux et ceux souffrant d'une dépression majeure recevaient un antidépresseur à des doses comparables, les patients répondant à une indication off-label étaient de préférence traités avec des doses plus faibles. Les résultats de cette étude suggèrent que les psychiatres d'hôpitaux développent des préférences en ce qui concerne le choix de la classe d'antidépresseurs, et qu'ils les utilisent alors aussi bien dans des indications reconnues que non-reconnues. Puis ils semblent adapter la dose et la comédication en tenant compte du diagnostic, ce qui confirme l'hypothèse initiale de l'étude,

Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunction score.

OBJECTIVES: in a retrospective study, attempts have been made to identify individual organ-dysfunction risk profiles influencing the outcome after surgery for ruptured abdominal aortic aneurysms. METHODS: out of 235 patients undergoing graft replacement for abdominal aortic aneurysms, 57 (53 men, four women, mean age 72 years [s.d. 8.8]) were treated for ruptured aneurysms in a 3-year period. Forty-eight preoperative, 13 intraoperative and 34 postoperative variables were evaluated statistically. A simple multi-organ dysfunction (MOD) score was adopted. RESULTS: the perioperative mortality was 32%. Three patients died intraoperatively, four within 48 h and 11 died later. A significant influence for pre-existing risk factors was identified only for cardiovascular diseases. Multiple linear-regression analysis indicated that a haemoglobin <90 g/l, systolic blood pressure <80 mmHg and ECG signs of ischaemia at admission were highly significant risk factors. The cause of death for patients, who died more than 48 h postoperatively, was mainly MOD. All patients with a MOD score >/=4 died (n=7). These patients required 27% of the intensive-care unit (ICU) days of all patients and 72% of the ICU days of the non-survivors. CONCLUSION: patients with ruptured aortic aneurysms from treatment should not be excluded. However, a physiological scoring system after 48 h appears justifiable in order to decide on the appropriateness of continual ICU support.

The Utilization of Agriculturally Derived Lignin as an Antioxidant in Asphalt Binder, TR-557, 2008

Oxidation is the primary cause of long-term aging in asphalt pavements. As a pavement oxidizes, it stiffens and can eventually crack. The use of an antioxidant as a performance enhancer in an asphalt binder could delay aging, thus increasing the life of an asphalt pavement. Lignin is a highly available and well-studied antioxidant. A wet-mill ethanol plant produces several co-products, some of which contain lignin. The use of lignin from ethanol production could provide a benefit to asphalt pavements and also give more value to the co-products. The following research examined the effects of lignin on asphalt pavements. Three lignin-containing co-products were separately combined with four asphalt binders in varying amounts to determine the optimum amount of co-product that would provide the greatest benefit to the asphalt binders. The asphalt binder and co-product blends were evaluated according to Superpave specifications and performance graded on a continuous scale. The data indicated a stiffening effect on the binder caused by the addition of the co-products. The more a co-product was added, the more a binder stiffened. Binder stiffening benefited the high temperature properties and the low temperature binder properties were negatively affected. However, the low temperature stiffening effects were small and in many cases not significant. The co-products had an overall effect of widening the temperature range of the binders. This result suggests some antioxidant activity between the binder and the lignin. Testing with a fourth co-product with no lignin supported the idea that lignin acts as an antioxidant. The samples with no lignin aged significantly more than the samples with lignin. Infrared spectrometry also supported the idea that lignin acts as an antioxidant by observing decreases in some oxidative aging products.

Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study.

BACKGROUND: Drug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management. METHODS: A population-based survey of 9254 persons aged 25-64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP >or= 160/95 mmHg) at the initial contact, 253 (47%) had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval. RESULTS: Among the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both). Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services) and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance). Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care. CONCLUSION: Low utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases.

Utilization of Knowledge Management in Business Process Modeling and Process Improvements

Tutkimuksen tavoitteena on tutkia telekommunikaatioalalla toimivan kohdeyrityksen ohjelmistojen toimitusprosessia° Tutkimus keskittyy mallintamaan toimitusprosessin, määrittelemään roolit ja vastuualueet, havaitsemaan ongelmakohdat ja ehdottamaan prosessille kehityskohteita. Näitä tavoitteita tarkastellaan teoreettisten prosessimallinnustekniikoiden ja tietojohtamisen SECI-prosessikehyksen läpi. Tärkein tiedonkeruun lähde oli haastatteluihin perustuva tutkimus, johon osallistuvat kaikki kohdeprosessiin kuuluvat yksiköt. Mallinnettu toimitusprosessi antoi kohdeyritykselle paremman käsityksen tarkasteltavasta prosessista ja siinä toimivien yksiköiden rooleistaja vastuualueista. Parannusehdotuksia olivat tiedonjaon kanavoinnin määritteleminen, luottamuksen ja sosiaalisten verkostojen parantaminen, ja tietojohtamisen laajamittainen implementointi.

A Sequential Allocation Problem: The Asymptotic Distribution of Resources

In this paper we consider a sequential allocation problem with n individuals. The first individual can consume any amount of some endowment leaving the remaining for the second individual, and so on. Motivated by the limitations associated with the cooperative or non-cooperative solutions we propose a new approach. We establish some axioms that should be satisfied, representativeness, impartiality, etc. The result is a unique asymptotic allocation rule. It is shown for n = 2; 3; 4; and a claim is made for general n. We show that it satisfies a set of desirable properties. Key words: Sequential allocation rule, River sharing problem, Cooperative and non-cooperative games, Dictator and ultimatum games. JEL classification: C79, D63, D74.

Design for Customer Needs: Utilization of Quality Function Deployment in Product Development

Kansainvälisen kaupan kiristyessä yrityksien kyky täyttää asiakasketjunsa lailliset, sosiaaliset ja toiminnalliset asiakastarpeet tulee punnituksi. Globaalisuuden lisääntyessä asiakasketju voi sisältää toimintoja samanaikaisesti yli sadassa maassa. Jotta asiakasketjun tarpeet voidaan sisällyttää tuotteeseen tehokkaasti yhä useammat yritykset ovat siirtyneet käyttämään Quality Function Deployment nimistä projektijohto- ja laatutyökalua. Quality Function Deployment työkalu auttaa yritystä muuntamaan sisäisten ja ulkoisten asiakkaittensa tarpeet, tuotefunktioiksi ja tuotespesifikaatioiksi. Näin tehdessä voidaan uuden tuotteen kehitysaikaa ja hintaa alentaa merkittävästi suunnittelmalla tuote alunalkaen paremmin. QFD:tä on käytetty useissa yrityksissä Aasiassa, Pohjois-Amerikassa ja Euroopassa, sen kehittämisen jälkeen Japanissa 1960 luvulla. Tämä diplomityö antaa teoreettisen ja käytännön kuvauksen siitä miten QFD:tä kannatta käyttää ja mitä sen avulla voidaan saavuttaa vastaten kysymykseen "miten minä, ja yritykseni hyötyy jos käytän QFD:tä".

Optimised Utilization of Bioenergy in Poland

The aim of the study was to ford out the availability of biomasses, which are available for energy production, in Poland. Biomasses which were examined were forest residues and surplus straw. Availability was examined by 16 Polish voivodeships, which are provinces in Poland. After fording out the amounts of biomasses for energy production was examined the need of biomass in the biggest CHP plants in Poland. It was expected that all the plants uses 15 % of biomass as the fuel. In the first parts of the report are explained the legislation which effects to biomass use in energy production in EU level and in Polish level. Also the combustion methods best for biomasses are explained by examples. After this, is studied the general situation of renewable energy use in Poland and the facts about the country. In the last parts it's explained the calculations and is shown the example cases. When it was found out the needs and supply of biomass it was examined by examples how it could be transported to the plants from the producers. Also was examined costs effected, if there were logistical terminals between the producer and the end user. The estimation was done by setting prices for the biomass, and fording out average costs for producing and transporting biomass. There are a lot of surplus biomasses in Poland which could be used for energy production, and this is a one way to reach the goals that EU has set of renewable energies. But because biomasses doesn't have such a good calorific value, it isn't worth able to transport it very long distances. In the research was set the prices for producer 9€/MWh and for end user 15€/MWh, the maximum transportation distance for forest residues was 52 km and for straw 56 km. These are example estimations and it has to be remembered that there are a lot of factors that makes inaccurate. The model is really sensitive and by changing one parameter the results change a lot.

Utilization of Sn/Nb2O5 composite for the removal of methylene blue

In this work, the oxidation of methylene blue textile dye in the presence of hydrogen peroxide, using niobium oxide impregnated with different proportions of tin (1, 5 and 10% in mass) as catalyst was studied. The materials were characterized by TPR, XPS, XRD and FTIR. The oxidation tests monitored by ESI-MS showed that the composite containing the higher amount of tin was the most efficient in the removal of the dye. The XRD, XPS, and TPR data presented evidence of the formation of the tin-niobium oxide composite containing Sn0 and supported SnO2.

Utilization of non-wood pulp in different fibers products

The correct utilization of non-wood raw material allows reducing tree cutting and reduces emissions of carbon dioxide from burning of non-wood plants on farmers fields. Also it allows increasing economical situation in regions that non-wood plants are grown and where they are converted into pulp and paper. Also it gives positive effect on population pressure of work by addition of working place. In the literature survey included an overview of the historical meaning of non-wood pulp on developing paper production and structure of non-wood pulps. Moreover, anatomical and chemical composition of straw, reed and bamboo were studied more detailed. Also, an overview of the utilization of non-wood pulp in papermaking was made. Especially tissue, tree-free and release papers were reviewed. In the experimental part the goal was to investigate suitability of non-wood pulp like wheat straw pulp and bamboo pulp for different fiber products. Finally release and tree-free paper products were selected for experimental studies. It was discovered that wheat straw, especially screened wheat straw, showed good results for release paper. Also utilization of wheat straw and bamboo pulp in tree-free paper showed good results and suitability of these non-wood pulps for tree-free paper production. Also it was noticed that addition of wheat straw pulp gave positive effect on initial wet strength for release and tree-free paper.

Utilization of a Time Domain Simulator in the Technical and Economic Analysis of a Wind Turbine Electric Drive Train

The amount of installed wind power has been growing exponentially during the past ten years. As wind turbines have become a significant source of electrical energy, the interactions between the turbines and the electric power network need to be studied more thoroughly than before. Especially, the behavior of the turbines in fault situations is of prime importance; simply disconnecting all wind turbines from the network during a voltage drop is no longer acceptable, since this would contribute to a total network collapse. These requirements have been a contributor to the increased role of simulations in the study and design of the electric drive train of a wind turbine. When planning a wind power investment, the selection of the site and the turbine are crucial for the economic feasibility of the installation. Economic feasibility, on the other hand, is the factor that determines whether or not investment in wind power will continue, contributing to green electricity production and reduction of emissions. In the selection of the installation site and the turbine (siting and site matching), the properties of the electric drive train of the planned turbine have so far been generally not been taken into account. Additionally, although the loss minimization of some of the individual components of the drive train has been studied, the drive train as a whole has received less attention. Furthermore, as a wind turbine will typically operate at a power level lower than the nominal most of the time, efficiency analysis in the nominal operating point is not sufficient. This doctoral dissertation attempts to combine the two aforementioned areas of interest by studying the applicability of time domain simulations in the analysis of the economicfeasibility of a wind turbine. The utilization of a general-purpose time domain simulator, otherwise applied to the study of network interactions and control systems, in the economic analysis of the wind energy conversion system is studied. The main benefits of the simulation-based method over traditional methods based on analytic calculation of losses include the ability to reuse and recombine existing models, the ability to analyze interactions between the components and subsystems in the electric drive train (something which is impossible when considering different subsystems as independent blocks, as is commonly done in theanalytical calculation of efficiencies), the ability to analyze in a rather straightforward manner the effect of selections other than physical components, for example control algorithms, and the ability to verify assumptions of the effects of a particular design change on the efficiency of the whole system. Based on the work, it can be concluded that differences between two configurations can be seen in the economic performance with only minor modifications to the simulation models used in the network interaction and control method study. This eliminates the need ofdeveloping analytic expressions for losses and enables the study of the system as a whole instead of modeling it as series connection of independent blocks with no lossinterdependencies. Three example cases (site matching, component selection, control principle selection) are provided to illustrate the usage of the approach and analyze its performance.

Utilization of Incident Reporting in The Finnish Maritime Industry

Marine traffic is expected to increase rapidly in the future, both in the Baltic Sea and in the Gulf of Finland. As the number of vessels in the area increases, so does the risk of serious marine accidents. To help prevent such accidents in the future, the International Maritime Organization (IMO) has put forth the International Safety Management Code (the ISM Code), which aims to improve the safety of the vessels. The second work package of the Development of maritime safety culture (METKU) project investigates the effects of the ISM Code and potential areas of improvement in maritime safety. The first phase in the work package used a literature review to determine how maritime safety culture could be improved. Continuous improvement, management commitment and personnel empowerment and motivation were found to be essential. In the second phase, shipping companies and administrators were interviewed. It was discovered that especially incident reporting based on continuous improvement was felt to be lacking. This third phase aims to take a closer look at incident reporting and suggest improvements based on the findings. Both the IMO and national legislation encourage shipping companies in incident reporting, and on the national level a shared incident reporting system (ForeSea) is being pushed forward. The objective of this research project was to find out the IMO’s attitude towards incident reporting, to establish a theoretical framework of reference in incident reporting, and to observe how reporting is actually being employed on the seas. Existing incident reporting systems were also researched. The study was carried out using a literature review and the results previously gathered in interviews. The results of phase two were elaborated further for themes relating to incident reporting. According to the findings of this research, the theoretical background of incident reporting dates back to the early 20th century. Although some theories are widely accepted, some have also received criticism. The lack of a concise, shared terminology poses major difficulties in maritime incident reporting and in determining its efficiency. A central finding is the fact that existing incident reporting focuses mostly on information flow away from the ship, whereas the backward information flow is much less planned and monitored. In incident reporting, both nationally and internationally, stakeholders are plenty. The information produced by these parties is scattered, however, and thus not very usable. Based on this research, the centralizing of this information should be made a priority. Traditionally, the success of incident reporting has been determined statistically, from the number of reported incidents. Yet existing reporting systems have not been designed with such statistical analysis in mind, so different methodologies might yield a more comprehensive view. The previous findings of seafarers and management (including shipping companies and administration) having differing views on safety work and safety management were backed up by the results of this study. Seafarers find seamanship and storytelling important, while management wants a more systematic and broad approach on safety matters. The research project was carried out by the Centre for Maritime Studies of the University of Turku, in the Kotka unit (Maritime Logistics Research), with coordination by the Kotka Maritime Research Centre. The major financiers of the project were the European Union and the city of Kotka. The financing authority was the Regional Council of Päijät-Häme. Partners in the project were the shipping companies Finnlines Oyj, Kristina Cruises Oy, Meriaura Oy and VG-Shipping Oy, and the ports of Helsinki, Kotka and Hamina. The partners provided both funding for the project and information for the research.

Utilization of Automatic Meter Reading in the Improvement of a District Heating System

A district heating system comprises production facilities, a distribution network, and heat consumers. The utilization of new energy metering and reading system (AMR) is increasing constantly in district heating systems. This heuristic study shows how the AMR system can be exploited in finding optimization opportunities in district heating system. In this study, the district heating system is mainly considered from the viewpoint of operational optimization. The focus is on the core processes, heat production and distribution. Three objectives were set to this study. The first one was to examine general optimization opportunities in district heating systems. Second, to figure out the benefits of AMR for general optimization opportunities. Finally, to define a methodology for process improvement endeavors. This study shows, through a case study, the usefulness of AMR in specifying current deficiencies in a district heating system. Based on a literature review, the methodology for the improvement of business processes is presented. Additionally, some issues related to future competitiveness of district heating are concerned. As a conclusion, some optimization objectives are considered more desirable than others. Study shows that AMR is useful in the specification of optimization targets in the district heating system. Further steps in optimization process were not examined in detail. That would seem to be interesting topic for further studies.