Ancient dispersal of the human fungal pathogen Cryptococcus gattii from the Amazon rainforest

Over the past two decades, several fungal outbreaks have occurred, including the high-profile 'Vancouver Island' and 'Pacific Northwest' outbreaks, caused by Cryptococcus gattii, which has affected hundreds of otherwise healthy humans and animals. Over the same time period, C. gattii was the cause of several additional case clusters at localities outside of the tropical and subtropical climate zones where the species normally occurs. In every case, the causative agent belongs to a previously rare genotype of C. gattii called AFLP6/VGII, but the origin of the outbreak clades remains enigmatic. Here we used phylogenetic and recombination analyses, based on AFLP and multiple MLST datasets, and coalescence gene genealogy to demonstrate that these outbreaks have arisen from a highly-recombining C. gattii population in the native rainforest of Northern Brazil. Thus the modern virulent C. gattii AFLP6/VGII outbreak lineages derived from mating events in South America and then dispersed to temperate regions where they cause serious infections in humans and animals.

Effectiveness of a specialized outpatient palliative care service as experienced by patients and caregivers.

Abstract Objectives: In Germany since 2007 patients with advanced life-limiting diseases are eligible for Specialized Outpatient Palliative Care (SOPC). To provide this service, SOPC teams have been established as a new facility in the health care system. The objective of this study was to evaluate the effectiveness of one of the first SOPC teams based at the Munich University Hospital. Methods: All patients treated by the SOPC team and their primary caregivers were eligible for this prospective nonrandomized study. The main topics of the surveys before and after involvement of the SOPC team were: for patients, the assessment of symptom burden (Minimal Documentation System for Palliative Medicine, MIDOS), satisfaction with quality of palliative care (Palliative Outcome Scale, POS), and quality of life (McGill Quality of Life Questionnaire, MQOL); for caregivers, burden of care (Häusliche Pflegeskala, home care scale, HPS), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), and quality of life (Quality of Life in Life-Threatening Illness-Family Carer Version, QOLLTI-F). Results: Of 100 patients treated between April and November 2011, 60 were included in the study (median age 67.5 years, 55% male, 87% oncological diseases). In 23 of 60 patients, only caregivers could be interviewed. The median interval between the first and second interview was 2.5 weeks. Quality of life increased significantly in patients (p<0.05) and caregivers (p<0.001), as did the patients' perception of quality of palliative care (POS, p<0.001), while the caregivers' psychological distress and burden of care significantly decreased (HADS, p<0.001; HPS, p<0.001). Conclusions: The involvement of an SOPC team leads to a significant improvement in the quality of life of patients and caregivers and can lower the burden of home care for the caregivers of severely ill patients.

Enhanced MDIR receiver for space-time dispersive channels

A particular property of the matched desiredimpulse response receiver is introduced in this paper, namely,the fact that full exploitation of the diversity is obtained withmultiple beamformers when the channel is spatially and timelydispersive. This particularity makes the receiver specially suitablefor mobile and underwater communications. The new structureprovides better performance than conventional and weightedVRAKE receivers, and a diversity gain with no needs of additionalradio frequency equipment. The baseband hardware neededfor this new receiver may be obtained through reconfigurabilityof the RAKE architectures available at the base station. Theproposed receiver is tested through simulations assuming UTRAfrequency-division-duplexing mode.

Joint array combining and MLSE for single-user receivers in multipath Gaussian multiuser channels

The well-known structure of an array combiner along with a maximum likelihood sequence estimator (MLSE) receiveris the basis for the derivation of a space-time processor presentinggood properties in terms of co-channel and intersymbol interferencerejection. The use of spatial diversity at the receiver front-endtogether with a scalar MLSE implies a joint design of the spatialcombiner and the impulse response for the sequence detector. Thisis faced using the MMSE criterion under the constraint that thedesired user signal power is not cancelled, yielding an impulse responsefor the sequence detector that is matched to the channel andcombiner response. The procedure maximizes the signal-to-noiseratio at the input of the detector and exhibits excellent performancein realistic multipath channels.

System identification using a linear combination of cumulant slices

In this paper we develop a new linear approach to identify the parameters of a moving average (MA) model from the statistics of the output. First, we show that, under some constraints, the impulse response of the system can be expressed as a linear combination of cumulant slices. Then, thisresult is used to obtain a new well-conditioned linear methodto estimate the MA parameters of a non-Gaussian process. Theproposed method presents several important differences withexisting linear approaches. The linear combination of slices usedto compute the MA parameters can be constructed from dif-ferent sets of cumulants of different orders, providing a generalframework where all the statistics can be combined. Further-more, it is not necessary to use second-order statistics (the autocorrelation slice), and therefore the proposed algorithm stillprovides consistent estimates in the presence of colored Gaussian noise. Another advantage of the method is that while mostlinear methods developed so far give totally erroneous estimates if the order is overestimated, the proposed approach doesnot require a previous estimation of the filter order. The simulation results confirm the good numerical conditioning of thealgorithm and the improvement in performance with respect to existing methods.

Treatment intensification and risk factor control: toward more clinically relevant quality measures.

BACKGROUND: Intensification of pharmacotherapy in persons with poorly controlled chronic conditions has been proposed as a clinically meaningful process measure of quality. OBJECTIVE: To validate measures of treatment intensification by evaluating their associations with subsequent control in hypertension, hyperlipidemia, and diabetes mellitus across 35 medical facility populations in Kaiser Permanente, Northern California. DESIGN: Hierarchical analyses of associations of improvements in facility-level treatment intensification rates from 2001 to 2003 with patient-level risk factor levels at the end of 2003. PATIENTS: Members (515,072 and 626,130; age >20 years) with hypertension, hyperlipidemia, and/or diabetes mellitus in 2001 and 2003, respectively. MEASUREMENTS: Treatment intensification for each risk factor defined as an increase in number of drug classes prescribed, of dosage for at least 1 drug, or switching to a drug from another class within 3 months of observed poor risk factor control. RESULTS: Facility-level improvements in treatment intensification rates between 2001 and 2003 were strongly associated with greater likelihood of being in control at the end of 2003 (P < or = 0.05 for each risk factor) after adjustment for patient- and facility-level covariates. Compared with facility rankings based solely on control, addition of percentages of poorly controlled patients who received treatment intensification changed 2003 rankings substantially: 14%, 51%, and 29% of the facilities changed ranks by 5 or more positions for hypertension, hyperlipidemia, and diabetes, respectively. CONCLUSIONS: Treatment intensification is tightly linked to improved control. Thus, it deserves consideration as a process measure for motivating quality improvement and possibly for measuring clinical performance.

Turbokoneen rakenneoptimointi ja mittausjärjestelyt

Tässä diplomityössä käsitellään erään tuotekehitysprojektissa tehdyn turbokoneen prototyypin takuumittauksia. Takuumittauksilla on tarkoitus varmistaa alustavasti valmistetun prototyypin toimivuus. Mittauksista saatuja arvoja on lopuksi tarkoitus verrata suunnitteluarvoihin, jolloin nähdäänkuinka hyvin suunnitelmat ja alustavat suunnittelulaskelmat ovat onnistuneet koskien tätä turbokonetta. Työssä esitellään pääpiirteissään laitteen toiminta. Takuumittauksia varten tarpeelli-set mitattavat suureet ja vaihtoehtoiset mittausmenetelmät on esitelty. Lisäksi on suunniteltu mittausjärjestelmä PI-kaavioineen, jolla pystytään saamaan riittävän kat-tava mittaustulos laajuus. Työssä on myös esitelty miten mittaustuloksista saadaan tarvittavat vertailuarvot verrattavaksi alustaviin suunnittelulaskelmiin. Tämä diplomityö on tehty, että alustavat mittaussuunnitelmat olisi valmiina olemassa jotta varsinainen takuumittauslaitteisto pystytään rakentamaan nopeasti turbokoneen prototyypin valmistuttua. Lopuksi saadun mittausotannan käsitteleminen on myös selvempää, koska riittävät teoreettiset perusteet mittausaineiston käsittelemiseen on myös kerätty tähän työhön. Työssä käsiteltävän mittausjärjestelmän pääpaino on virtaus ja lämpöteknisillä mitta-uksilla. Myös sähköteknisiä mittauksia ja turbokoneen rakenteellisen toimivuuden mittauksia on käsitelty tässä työssä. Tässä diplomityö antaa kattavat perustiedot tarvittaviin mittausmenetelmiin ja miten varsinainen mittaustieto saadaan jalostettua vertailtavaan muotoon. Siinä käsitellään myös vaikeuksia joita toimivanmittausjärjestelmän kehittämisessä on otettava huo-mioon.  

Aktiivinen melunvaimennus ampumaradalla

Aktiivinen melunvaimennus (active noise control, ANC) onkauan tunnettu ja sovellettu tekniikka. Kuitenkaan sitä ei ole aiemmin sovellettu impulssimaiseen satunnaiseen meluun. Tässä diplomityössä tutkitaan aktiivisenmelunvaimennuksen soveltuvuutta ampumaradan melunvaimennukseen. Ampumarata äärimmäisenä tapauksena asettaa korkean vaatimustason laitteistolle ja sen komponenteille. Suurin haaste on etsiä sopivat laitteiston komponentit, jotka tuottavat ja kestävät suurta äänenpainetasoa. Myös muuttuvat sääolosuhteet asettavat vaatimuksensa laitteiden mekaaniselle kestävyydelle sekä säänkestävyydelle. Työssä paneuduttiin erityisesti selvittämään, mitä kaupallisesti saatavilla olevia komponentteja voidaan hyödyntää aktiiviseen impulssimelunvaimennusjärjestelmään. Kaupallisten komponenttien soveltuvuutta aktiiviseen impulssimelunvaimennukseen analysoitiin laboratorio- ja kenttämittauksin. Työssä esitetään myös tulokset yksinkertaisella koelaitteistolla saavutetusta vaimennuksesta kenttäolosuhteissa.

Carbon isotope fractionation for cotton genotype selection

The objective of this work was to evaluate the carbon isotope fractionation as a phenomic facility for cotton selection in contrasting environments and to assess its relationship with yield components. The experiments were carried out in a randomized block design, with four replicates, in the municipalities of Santa Helena de Goiás (SHGO) and Montividiu (MONT), in the state of Goiás, Brazil. The analysis of carbon isotope discrimination (Δ) was performed in 15 breeding lines and three cultivars. Subsequently, the root growth kinetic and root system architecture from the selected genotypes were determined. In both locations, Δ analyses were suitable to discriminate cotton genotypes. There was a positive correlation between Δ and seed-cotton yield in SHGO, where water deficit was more severe. In this site, the negative correlations found between Δ and fiber percentage indicate an integrative effect of gas exchange on Δ and its association with yield components. As for root robustness and growth kinetic, the GO 05 809 genotype performance contributes to sustain the highest values of Δ found in MONT, where edaphoclimatic conditions were more suitable for cotton. The use of Δ analysis as a phenomic facility can help to select cotton genotypes, in order to obtain plants with higher efficiency for gas exchange and water use.

Franchisingin soveltuvuus vanhustenhuoltolaitosten liiketoiminnassa

Työn tavoitteena on tutkia franchising-liiketoimintamallin soveltuvuutta kasvustrategiaksi vanhustenhuoltolaitosten toimialalla sekä mandollisuutta toteuttaa franchising-liiketoiminnan mukainen järjestelmä Finnish Wellbeing Center (FWBC) tyylisten vanhustenhuoltolaitosten monistamiseksi tämän hetkisistä Iähtokohdista. Yleisen soveltuvuuden tutkimista lähestytään kahdesta eri näkökulmasta, jotka myös muodostavat työn teoriaosuuden. Ensinnäkin perehdytään franchising liiketoimintamalliin perusteellisesti sekä käydään läpi soveltuvuustekijät hyvien ja huonojen puolien, toimialan luonteen ja franchisingiin sopivien liiketoimintakonseptien kannalta. Tämän jälkeen tutustutaan vanhustenhuollon palveluiden järjestämiseen. Palveluita tarjotaan erityylisissä palvelutiloissa riippuen vanhuksen kuntoisuusasteesta. Näistä valitaan päiväkeskukset, palveluasuminen sekä vanhainkodit franchisingin soveltuvuuden tarkasteluun. Työn empiriaosan tulokset viittaavat siihen, että vanhustenhuoltolaitosten soveltuvuus franchising-liiketoimintamalliin korreloi selvästi vanhusten kuntoisuusasteeseen. Päiväkeskusten liiketoimintaa voisi kasvattaa franchising menetelmällä, siinä missä palveluasumisen ja vanhainkotien soveltuvuus on vain teoreettinen. FWBC-projektissa franchising-liiketoimintamallia ei voida toteuttaa nykyisistä lähtökohdista, koska varsinainen franchisoitava toiminta ei ole täysin suomalaisen osapuolen hallussa. FWBC-vanhustenhuoltolaitos on vanhainkotityyppinen, joka ei sovellu franchisoitavaksi työn ensimmäisen johtopäätöksen perusteella. Mahdollisuus tämän hetkisen liiketoiminnan parantamiseen voisi löytyä tuotemerkki-franchisoinnista, jota nykyinen toimintatapa jo sinällään muistuttaa.

Ambient intelligence application based on environmental measurements performed with an assistant mobile robot

This paper proposes the use of an autonomous assistant mobile robot in order to monitor the environmental conditions of a large indoor area and develop an ambient intelligence application. The mobile robot uses single high performance embedded sensors in order to collect and geo-reference environmental information such as ambient temperature, air velocity and orientation and gas concentration. The data collected with the assistant mobile robot is analyzed in order to detect unusual measurements or discrepancies and develop focused corrective ambient actions. This paper shows an example of the measurements performed in a research facility which have enabled the detection and location of an uncomfortable temperature profile inside an office of the research facility. The ambient intelligent application has been developed by performing some localized ambient measurements that have been analyzed in order to propose some ambient actuations to correct the uncomfortable temperature profile.

Aktiivinen meluntorjunta ulkotiloissa

Ympäristömelu on nyky-yhteiskunnassa kasvava ongelma. Perinteisesti tätä melua on pyritty vähentämään passiivisen melunvaimennuksen avulla, kuten tienvarsien melumuureilla. Melua voidaan kuitenkin vaimentaa myös aktiivisellameluntorjunnalla (ANC, active noise control). Tässä työssä selvitetäänmitä ongelmia kohdataan, kun ANC-järjestelmää suunnitellaan ulkotiloihin ja mitä ominaisuuksia tällaiselta järjestelmältä vaaditaan. Työssä tutkitaan myös miten vaihtuvat ympäristöolosuhteet ja ulkoakustiset ilmiöt vaikuttavat ANC-järjestelmän toimintaan. Tutkimuksen pohjalta toteutetaan oma ANC-järjestelmä, jonka suorituskykyä työssä mitataan sekä komponentti- että järjestelmätasolla. Myös järjestelmän toimivuuteen vaikuttavia tekijöitä kartoitetaan mittausten avulla. Erikoistapauksena työssä selvitetään voiko suunnitellulla ANC-järjestelmällä vaimentaa impulssimaista melua paikallisesti.

Green Field fluteboard factory infrastructure requirements in Russia

Russian corrugated board market is rapidly developing. Owing to that Russia becomes more and more attractive to the companies ¿ world leaders in corrugated board production. Thus, in order to strengthen or even to maintain its market position the firm should uninterruptedly develop improving volume and quality of the products. At the same time operations in the Russian market are commonlyassociated with various types of risks which should be avoided. Unfortunately, the information of the Russian corrugated board market is not systematized yet there is almost no theoretical background in this areaand, therefore, the thesis is mainly based on the practical experience of the managers of Stora Enso. The goal of the paper is to define and describe the main particularities of Russian corrugated board market which are lying in different areas and to concentrate on the difficultieswith which a corrugated board factory may face while functioning in the Russian market. The contribution of the thesis consists of forming general requirements and principles while establishing a corrugated boardproduction facility and maintaining its operations in order to avoid risks, to save time and financial resources and as a result to operate in the Russian market obtaining higher profits.

Modeling of Pressurizer Using APROS and TRACE Thermal Hydraulic Codes

Diplomityön tavoitteena on paineistimen yksityiskohtainen mallintaminen APROS- ja TRACE- termohydrauliikkaohjelmistoja käyttäen. Rakennetut paineistinmallit testattiin vertaamalla laskentatuloksia paineistimen täyttymistä, tyhjentymistä ja ruiskutusta käsittelevistä erilliskokeista saatuun mittausdataan. Tutkimuksen päätavoitteena on APROSin paineistinmallin validoiminen käyttäen vertailuaineistona PACTEL ATWS-koesarjan sopivia paineistinkokeita sekä MIT Pressurizer- ja Neptunus- erilliskokeita. Lisäksi rakennettiin malli Loviisan ydinvoimalaitoksen paineistimesta, jota käytettiin turbiinitrippitransientin simulointiin tarkoituksena selvittää mahdolliset voimalaitoksen ja koelaitteistojen mittakaavaerosta johtuvat vaikutukset APROSin paineistinlaskentaan. Kokeiden simuloinnissa testattiin erilaisia noodituksia ja mallinnusvaihtoehtoja, kuten entalpian ensimmäisen ja toisen kertaluvun diskretisointia, ja APROSin sekä TRACEn antamia tuloksia vertailtiin kattavasti toisiinsa. APROSin paineistinmallin lämmönsiirtokorrelaatioissa havaittiin merkittävä puute ja laskentatuloksiin saatiin huomattava parannus ottamalla käyttöön uusi seinämälauhtumismalli. Työssä tehdyt TRACE-simulaatiot ovat osa United States Nuclear Regulatory Commissionin kansainvälistä CAMP-koodinkehitys-ja validointiohjelmaa.

Vaccines safety; effect of supervision or SMS on reporting rates of adverse events following immunization (AEFI) with meningitis vaccine (MenAfriVac?): a randomized controlled trial.

BACKGROUND: To ensure vaccines safety, given the weaknesses of the national pharmacovigilance system in Cameroon, there is a need to identify effective interventions that can contribute to improving AEFI reporting. OBJECTIVE: To assess the effect of: (i) sending weekly SMS, or (ii) weekly supervisory visits on AEFI reporting rate during a meningitis immunization campaign conducted in Cameroon in 2012 using the meningitis A conjugate vaccine (MenAfriVac?). METHODS: Health facilities that met the inclusion criteria were randomly assigned to receive: (i) a weekly standardized SMS, (ii) a weekly standardized supervisory visits or (iii) no intervention. The primary outcome was the reported AEFI incidence rate from week 5 to 8 after the immunization campaign. Poisson regression model was used to estimate the effect of interventions after adjusting for health region, type of health facility, type and position of health workers as well as the cumulative number of AEFI reported from weeks 1 to 4. RESULTS: A total of 348 (77.2%) of 451 health facility were included, and 116 assigned to each of three groups. The incidence rate of reported AEFI per 100 health facility per week was 20.0 (15.9-24.1) in the SMS group, 40.2 (34.4-46.0) in supervision group and 13.6 (10.1-16.9) in the control group. Supervision led to a significant increase of AEFI reporting rate compared to SMS [adjusted RR=2.1 (1.6-2.7); p<0.001] and control [RR=2.8(2.1-3.7); p<0.001)] groups. The effect of SMS led to some increase in AEFI reporting rate compared to the control group, but the difference was not statistically significant [RR=1.4(0.8-1.6); p=0.07)]. CONCLUSION: Supervision was more effective than SMS or routine surveillance in improving AEFI reporting rate. It should be part of any AEFI surveillance system. SMS could be useful in improving AEFI reporting rates but strategies need to be found to improve its effectiveness, and thus maximize its benefits.