Implementation of bayesian therapeutic drug monitoring in modern patient care

The variability observed in drug exposure has a direct impact on the overall response to drug. The largest part of variability between dose and drug response resides in the pharmacokinetic phase, i.e. in the dose-concentration relationship. Among possibilities offered to clinicians, Therapeutic Drug Monitoring (TDM; Monitoring of drug concentration measurements) is one of the useful tool to guide pharmacotherapy. TDM aims at optimizing treatments by individualizing dosage regimens based on blood drug concentration measurement. Bayesian calculations, relying on population pharmacokinetic approach, currently represent the gold standard TDM strategy. However, it requires expertise and computational assistance, thus limiting its large implementation in routine patient care. The overall objective of this thesis was to implement robust tools to provide Bayesian TDM to clinician in modern routine patient care. To that endeavour, aims were (i) to elaborate an efficient and ergonomic computer tool for Bayesian TDM: EzeCHieL (ii) to provide algorithms for drug concentration Bayesian forecasting and software validation, relying on population pharmacokinetics (iii) to address some relevant issues encountered in clinical practice with a focus on neonates and drug adherence. First, the current stage of the existing software was reviewed and allows establishing specifications for the development of EzeCHieL. Then, in close collaboration with software engineers a fully integrated software, EzeCHieL, has been elaborated. EzeCHieL provides population-based predictions and Bayesian forecasting and an easy-to-use interface. It enables to assess the expectedness of an observed concentration in a patient compared to the whole population (via percentiles), to assess the suitability of the predicted concentration relative to the targeted concentration and to provide dosing adjustment. It allows thus a priori and a posteriori Bayesian drug dosing individualization. Implementation of Bayesian methods requires drug disposition characterisation and variability quantification trough population approach. Population pharmacokinetic analyses have been performed and Bayesian estimators have been provided for candidate drugs in population of interest: anti-infectious drugs administered to neonates (gentamicin and imipenem). Developed models were implemented in EzeCHieL and also served as validation tool in comparing EzeCHieL concentration predictions against predictions from the reference software (NONMEM®). Models used need to be adequate and reliable. For instance, extrapolation is not possible from adults or children to neonates. Therefore, this work proposes models for neonates based on the developmental pharmacokinetics concept. Patients' adherence is also an important concern for drug models development and for a successful outcome of the pharmacotherapy. A last study attempts to assess impact of routine patient adherence measurement on models definition and TDM interpretation. In conclusion, our results offer solutions to assist clinicians in interpreting blood drug concentrations and to improve the appropriateness of drug dosing in routine clinical practice.

Kylmämuovattujen putkipalkkien X-liitosten äärikestävyyden ja jäykkyyden määrittäminen sekä materiaalimallin kehittäminen

Työssä on tutkittu elementtimenetelmän avulla kylmämuovattujen nelikulmaisten putkipalkkien materiaalimallin kehittämistä ja putkipalkkien X-liitosten jäykkyyden ja äärikestävyyden määrittämistä. Työn tavoitteena on tutkia kylmämuovauksen vaikutuksia putkipalkkiprofiilin materiaaliominaisuuksiin materiaalikokeiden ja elementtianalyysien avulla sekä kehittää putkipalkille anisotrooppista materiaalimallia. Työssä määritettyjä materiaalimalleja on sovellettu X-liitosten elementtimalleihin, joiden käyttäytymistä on verrattu äärikestävyyskokeiden tuloksiin. Tutkimuksen perusteella Eurocode 3:n mitoitusohjeita voidaan turvallisesti soveltaa kylmämuovattujen putkipalkkien X-liitosten laskennassa. Työssä tehtyjen materiaalikokeiden ja elementtianalyysien perusteella materiaalin anisotrooppisuuden vaikutus liitoksen kestävyyteen on vähäistä, ja putkipalkin pituussuuntaista materiaalimallia voidaan soveltaa myös kehäsuuntaisille materiaaliominaisuuksille. Materiaalikokeiden simulointi osoittaa, että elementtimenetelmää voidaan käyttää materiaalimallin määrittämisen apuvälineenä.

Hylky- ja vesijärjestelmän vaikutus kartongin tuotepuhtauteen

Kirjallisuusosassa käsitellään paperi- ja kartonkikoneiden eri vesijärjestelmiä, vedenkäytön vähentämistä ja sen vaikutusta prosessiin. Mikrobiologiaa, mikrobien aiheuttamia prosessiongelmia, mikrobien torjuntaa ja simulointia on myös käsitelty kirjallisuusosassa. Kokeellisessa osassa laadittiin Kartonkikone 1:n massa- ja vesijärjestelmän mikrobiologisen puhtauden simulointimalli Balas-prosessisimulointiohjelmalla. Kartongin mikrobiologinen puhtaus määritettiin kokonaispesäkelukuna. Kokeellinen osa sisälsi pilot-mittakaavan suodatinkoeajoja, joissa määritettiin tarvittavat erotusparametrit simulointimallille, selvitettiin Dynasand-hiekkasuodattimen soveltuvuus suihkuvesien puhdistukseen, Dynadisc-kiekkosuodattimen käyttökelpoisuus kiertoveden puhdistukseen kiertovesisuodattimena ja hiekkasuodattimien esisuodattimena sekä UV-reaktorin soveltuvuus suodatettujen vesien desifiointiin. Simulointimallilla tarkasteltiin eri prosessivaihtoehtojen vaikutus kartongin mikrobiologiseen puhtauteen. Suihkuvesien puhdistaminen hiekkasuodattimilla alentaa kokonaispesäkelukua vain vähän. Koneen ajettavuus paranee suihkuputkien roskaryöppyjen ja viiraosan limoittumisen vähenemisen takia. Kiertovesijärjestelmän pelkkä jakaminen hylkyprosessi- ja sakeudensäätövedeksi aiheuttaa kokonaispesäkeluvun kasvun prosessista poistettavien vesien puhdistumisen takia. Kokonaispesäkeluku minimoidaan poistamalla ylimääräinen vesi hylkysaostajan suodoksena. Suodatettua hylkysaostajan suodoksen ja viiraveden seosta käytetään sekä sakeudensäätö- että hylkyprosessivedeksi. Hylkymassalla on dominoiva vaikutus kokonaispesäkelukuun. Suurin vähennys kokonaispesäkeluvussa saadaan estämällä mikrobikasvu hylkymassassa. Tämä voidaan tehdä kuumentamalla hylkymassa 80 °C:n höyryllä. Suodatuskoeajojen perusteella Dynasand-hiekkasuodattimella voidaan puhdistaa pisaralämmönvaihtimelta saatavaa lämmintä suihkuvettä. Esisuodatettua kiertovettä voidaan puhdistaa Dynasand-hiekkasuodattimella viiran johtotelojen suihkuvedeksi. Dynadisc-kiekkosuodatinta voidaan käyttää hiekkasuodattimen esisuodattimena ja kiertovesisuodattimena. UV-säteily poistaa tehokkaasti mikrobeja suodatetuista vesistä.

Bancs de proves per motors de modelisme

Són habituals entre els aeromodelistes les discussions que giren al voltant de la potència dels motors d’explosió i quina hèlix va millor. La manca d’informació tècnica dels motors i de les hèlix fa que aquestes discussions de vegades tinguin una validesa molt limitada, doncs es fonamenten simplement en les sensacions i percepcions subjectives de cadascun dels pilots, sobretot quan es parla de potència. En aquest projecte s’utilitzarà un dinamòmetre inercial, consistent en un volant d’inèrcia el qual s’accelerarà fins assolir les revolucions per minut màximes. La acceleració d’aquest volant mesurat en intervals de temps regulars i conegut el moment d’inèrcia del volant ens permetrà calcular el parell motor i la potència a diferents règims de revolucions per minut. Per altra banda es pretén comparar diferents hèlix muntades en un mateix motor per poder-ne comparar la tracció a diferents revolucions per minut. La tracció es mesurarà utilitzant una cèl·lula de càrrega. Les dades d’ambdós bancs de proves seran recollits i emmagatzemats per un PC amb un software fet a mida per aquest projecte. Una vegada finalitzat cada test es mostraran les dades obtingudes, tant els numèricament com gràficament, permetent a més comparar el resultat de diferents tests, de diferents motors i de diferents hèlix.

Luotettavuuspohjaisen verkostoanalysointijärjestelmän kehittäminen

Sähköverkon luotettavuuden tarkastelu sähköverkkoyhtiöissä on hyvin ajankohtaista tällä hetkellä. Siihen löytyvät hyvät kannusteet sähköverkkoliiketoimintaa säätelevästä regulaatiomallista sekä nykyisestä ikääntyvästä sähköverkosta. Se on monin paikoin lähellä käyttöikänsä loppua, ja sitä rakennettaessa ei välttämättä ole kiinnitetty kovin suurta huomiota luotettavuustarkasteluun. Kandidaatintyönä on kehitetty analysointijärjestelmä, jonka avulla pystytään tarkastelemaan sähköverkon pitkän aikavälin suunnittelua ottamalla huomioon myös sähköverkon keskeytyksistä aiheutuvat kustannukset. Analysoinnissa käytettävä järjestelmä toimii Microsoftin Excel taulukkolaskennassa. Analysointijärjestelmän avulla saadaan mallinnettua keskeytyskustannusten vaikutuksia erilaisiin investointiohjelmiin ja voidaan helposti vertailla useiden verkostorakeiden tuomia hyötyjä ja niistä aiheutuvia kustannuksia.

«Me quedaré con lo positivo»: Análisis de blogs de mujeres con cáncer de mama

En este artículo se analizan siete blogs escritos por mujeres con cáncer de mama. En primer lugar, se indaga sobre su forma de concebir el cuerpo en relación, por un lado, al impacto del cáncer en los órganos y procesos corporales ligados a la feminidad y, por el otro, a su carácter mortal. En segundo lugar, se analiza su atribución de agencia en relación a la enfermedad y su curación. Se observa que la responsabilidad en la curación se atribuye principalmente a los médicos, pero aparece con fuerza la idea que la mujer se puede sanar mediante cambios en su estilo de vida y a través del pensamiento positivo. Este establece un marco en el que las afectadas de cáncer encuentran dificultades para reconocer y expresar aspectos considerados negativos del proceso como la rabia, la desesperación o el miedo a la muerte, al mismo tiempo que marca una distinción entre pacientes con trayectorias de éxito en su curación y los que no lo consiguen, que son culpabilizados.

Towards a Network Government? A critical analysis of current assessment methods for e-Government

Contemporary public administrations have become increasingly more complex, having to cordinate actions with emerging actors in the public and the private spheres. In this scenario the modern ICTs have begun to be seen as an ideal vehicle to resolve some of the problems of public administration. We argue that there is a clear need to explore the extent to which public administrations are undergoing a process of transformation towards a netowork government linked to the systematic incorporation of ICTs in their basic activities. Through critically analysing a selection of e-government evaluation reports, we conclude that research should be carried out if we are to build a solid government assessment framework based on network-like organisation characteristics.

Factors explaining urban transport systems in large European cities: A cross-sectional approach

The paper analyses the link between human capital and regional economic growth in the European Union. Using different indicat The importance of effective and efficient mobility in large cities is becoming essential for planners and citizens due to its impact in terms of social, economic and geographic development. The aim of this research is to determine factors explaining urban transport systems by estimating aggregate supply and demand equations for 45 large European cities. Supply and Demand equations are separately and jointly determined using OLS and SUR estimation models. On one hand, our findings suggest the importance of economic variables on the supply of public transport. On the other, we highlight the role of those factors influencing the generalized cost of transport as main drivers of demand for public transit. Additionally, regional variables are introduced to capture institutional heterogeneity in this service, and we find that regional patterns are powerful explanatory determinants of urban transportation systems in Europe.

Testes de desempenho de eletrodos: eletrodos de referência

This paper is designed to divulge some tests found in books, articles and international technical standards, by means of which it is possible to evaluate the performance of reference electrode widely used in potentiometric and voltammetric methods. The reference potential (Eref), junction resistance (Rj), the ability of keeping up the potential when current is flowing (polarizability), and of generating junction potentials (Ej) are applied to some commercial electrodes. The results obtained are amply discussed and some corrective procedures are suggested when the electrode fails.

Caracterização hidrogeoquímica de água subterrânea em área de influência de futuras instalações de usinas hidrelétricas: bacia hidrográfica do rio Taquari-Antas/RS, Brasil

The identification and characterization of the hydrochemistry of the groundwaters has been done for seven wells. The sampling occurred during three bimonthly campaigns. The results classified the waters as of the calcium bicarbonated type for the majority of the samples, except for one well, whose composition is of the sodium bicarbonated type. The major ions found and how they determine the quality parameters are consistent with the reactions of mineral dissolution of the majority of volcanic rocks and the reactions with intrusion of alkaline rock in only one well. Anomalous values of nitrate in some wells alert to the impact of especially polluting sources at the time the reservoirs of the hydroeletric plant were formed.

Ionospheric tomography using GNSS reflections

In this paper, we report a preliminary analysis of the impact of Global Navigation Satellite System Reflections (GNSS-R) data on ionospheric monitoring over the oceans. The focus will be on a single polar Low Earth Orbiter (LEO) mission exploiting GNSS-R as well as Navigation (GNSS-N) and Occultation (GNSS-O) total electron content (TEC) measurements. In order to assess impact of the data, we have simulated GNSS-R/O/N TEC data as would be measured from the LEO and from International Geodesic Service (IGS) ground stations, with an electron density (ED) field generated using a climatic ionospheric model. We have also developed a new tomographic approach inspired by the physics of the hydrogen atom and used it to effectively retrieve the ED field from the simulated TEC data near the orbital plane. The tomographic inversion results demonstrate the significant impact of GNSS-R: three-dimensional ionospheric ED fields are retrieved over the oceans quite accurately, even as, in the spirit of this initial study, the simulation and inversion approaches avoided intensive computation and sophisticated algorithmic elements (such as spatio-temporal smoothing). We conclude that GNSS-R data over the oceans can contribute significantly to a Global/GNSS Ionospheric Observation System (GIOS). Index Terms Global Navigation Satellite System (GNSS), Global Navigation Satellite System Reflections (GNSS-R), ionosphere, Low Earth Orbiter (LEO), tomography.

Patson Approach versus the Standard Approach for increasing breast reconstruction rates in women undergoing mastectomy. A randomized, controlled, open-label clinical trial

Breast cancer is the most prevalent neoplasm among women in the majority of countries worldwide. Breast cancer treatment include mastectomy which is associated to strong impact in women. Breast reconstruction is an option for many women to re-establish their body image and also to decrease psychological impact. However, breast reconstruction rates are low and many factors are involved in not undergoing breast reconstruction. Patient involvement in the decision-making process increases breast reconstruction rates and is associated to higher satisfaction and less anxiety and depression symptoms. More physician-patient relation and more education in terms of breast reconstruction are needed to achieve our objective. A new approach of medical care, called Patson Approach, is created in order to meet our goal with more patient involvement, as well as, physician and psychological counsellingObjective: to increase breast reconstruction rates in women who are candidates for breast reconstruction after mastectomy and are included in the Patson Approach compared to women included in the Standard ApproachMethods: the study design will be a randomized, controlled, open-label clinical trial. 62 patients will be recruited during two years and randomly divided in two groups, 31 will be included in the Standard Approach and 31 will be included in the Patson Approach. Preoperative and postoperative appointments are established in order to do a follow-up of the patients and collect all the data

Em busca da conservação ambiental: a contribuição da percepção ambiental para a formação e atuação dos profissionais da Química

Planet transformations caused by human intervention in the last 200 years are largely due to chemical impact. Therefore, this study aimed to identify and analyze the environmental perception of undergraduate students and lecturers in the Chemistry course of the Federal University of Lavras, accounting for the topics "Environmental Definition" and "Relationship between Chemistry and Environment". Two thematic axes for discussion were proposed using theories of Social Representation and Environmental Complexity, with the aim of stimulating the conservationist reasoning and actions. Such axes were proposed to give support to the education of chemists at the undergraduate level.

Tuplakuori-rakenne eristettyihin muoviputkiin

Eristettyjen muoviputkien kuljetus- tai asennusvaiheessa on mahdollista, että putken suojakuori rikkoutuu mekaanisen iskun vaikutuksesta ja putken sisään pääsee vettä. Huonoimmassa tapauksessa vesi pääsee etenemään suojakuoren ja eristekerroksen välissä talon sisälle ja aiheuttaa mittavat kosteusvahingot. Tämän diplomityön tarkoituksena oli selvittää, onko eristetylle muoviputkelle mahdollista toteuttaa tuotantotaloudellisesti tuplakuori-rakenne. Tuplakuoren tarkoituksena oli tässä työssä estää putken sisärakenteisiin päässeen veden eteneminen putken pitkittäissuunnassa. Diplomityössä käsiteltiin muutamia vaihtoehtoisia ratkaisuja toteuttaa tuplakuori-rakenne joista lopulta päädyttiin keskittymään muovikalvon käyttöön. Muovikalvon käytöllä oli lähinnä kaksi tarkoitusta. Tärkeimpänä oli saada muovikalvo sulamaan eristekerroksen ja suojakuoren väliin. Tällöin sulanut muovikalvo toimisi liiman tavoin ja hitsaisi eristekerroksen ja suojakuoren toisiinsa kiinni. Näin veden eteneminen eristekerroksen ja suojakuoren välissä saataisiin estetyksi. Muovikalvo oli myös tarkoitus kiristää eristepaketin päälle niin kireälle, että eristepaketin halkaisijaa saataisiin pienennettyä. Muovikalvon käyttöön perehdyttiin suorittamalla tuotantolinjalla koeajoja. Koeajoissa kokeiltiin erilaisia ja erikokoisia putkituotteita erilaisilla tuotantoparametreilla. Näin pyrittiin löytämään parhaat parametrit ja arvot, joilla muovikalvoa pystyttäisiin tulevaisuudessa käyttämään jatkuvassa tuotannossa. Koeajojen tuloksista voitiin havaita, että kalvoitetut putkituotteet käyttäytyivät tuotannossa hyvin eri tavoin.

Distribution and role of macrophytes in coastal lagoons : implications of critical shifts

Crossroads, crucibles and refuges are three words that may describe natural coastal lagoon environments. The words refer to the complex mix of marine and terrestrial influences, prolonged dilution due to the semi-enclosed nature and the function of a habitat for highly diverse plant and animal communities, some of which are endangered. To attain a realistic picture of the present situation, high vulnerability to anthropogenic impact should be added to the description. As the sea floor in coastal lagoons is usually entirely photic, macrophyte primary production is accentuated compared with open sea environments. There is, however, a lack of proper knowledge on the importance of vegetation for the general functioning of coastal lagoon ecosystems. The aim of this thesis is to assess the role of macrophyte diversity, cover and species identity over temporal and spatial scales for lagoon functions, and to determine which steering factors primarily restrict the qualitative and quantitative composition of vegetation in coastal lagoons. The results are linked to patterns of related trophic levels and the indicative potential of vegetation for assessment of general conditions in coastal lagoons is evaluated. This thesis includes five field studies conducted in flads and glo-flads in the brackish water northern Baltic Sea. Flads and glo-flads are defined as a Baltic variety of coastal lagoons, which due to an inlet threshold and post-glacial landuplift slowly will be isolated from the open sea. This process shrinks inlet size, increases exposure and water retention, and is called habitat isolation. The studied coastal lagoons are situated in the archipelago areas of the eastern coast of Sweden, the Åland Islands and the south-west mainland of Finland, where land-uplift amounts to ca. 5 mm/ per year. Out of 400 evaluated sites, a total of 70 lagoons varying in inlet size, archipelago position and anthropogenic influence to cover for essential environmental variation were chosen for further inventory. Vegetation composition, cover and richness were measured together with several hydrographic and morphometric variables in the lagoons both seasonally and inter-annually to cover for general regional, local and temporal patterns influencing lagoon and vegetation development. On smaller species-level scale, the effects of macrophyte species identity and richness for the fish habitat function were studied by examining the influence of plant interaction on juvenile fish diversity. Thus, the active election of plant monoand polycultures by fish and the diversity of fish in the respective culture were examined and related to plant height and water depth. The lagoons and vegetation composition were found to experience a regime shift initiated by increased habitat isolation along with land-uplift. Vegetation composition altered, richness decreased and cover increased forming a less isolated and more isolated regime, named the vascular plant regime and charophyte regime, respectively according to the dominant vegetation. As total phosphorus in the water, turbidity and the impact of regional influences decreased in parallel, the dominance of charophytes and increasing cover seemed to buffer and stabilize conditions in the charophyte regime and indicated an increased functional role of vegetation for the lagoon ecosystem. The regime pattern was unaffected by geographical differences, while strong anthropogenic impact seemed to distort the pattern due to loss of especially Chara tomentosa L. in the charophyte regime. The regimes were further found unperturbed by short-time temporal fluctuations. In fact the seasonal and inter-annual dynamics reinforced the functional difference between the regimes by the increasing role of vegetation along habitat isolation and the resemblance to lake environments for the charophyte regime. For instance, greater total phosphorus and chlorophyll a concentrations in the water in the beginning of the season in the charophyte regime compared with the vascular plant regime presented a steeper reduction to even lower values than in the vascular plant regime along the season. Despite a regional importance and positive relationship of macrophyte diversity in relation to trophic diversity, species identity was underlined in the results of this thesis, especially with decreasing spatial scale. This result was supported partly by the increased role of charophytes in the functioning of the charophyte regime, but even more explicitly by the species-specific preference of juvenile fish for tall macrophyte monocultures. On a smaller species-level scale, tall plant species in monoculture seemed to be able to increase their length, indicating that negative selection forms preferred habitat structures, which increase fish diversity. This negative relationship between plant and fish diversity suggest a shift in diversity patterns among trohic levels on smaller scale. Thus, as diversity patterns seem complex and diverge among spatial scales, it might be ambiguous to extend the understanding of diversity relationships from one trophic level to the other. All together, the regime shift described here presents similarities to the regime development in marine lagoon environments and shallow lakes subjected to nutrient enrichment. However, due to nutrient buffering by vegetation with increased isolation and water retention as a consequence of the inlet threshold, the development seems opposite to the course along an eutrophication gradient described in marine lagoons lacking an inlet threshold, where the role of vegetation decreases. Thus, the results imply devastating consequences of inlet dredging (decreasing isolation) in terms of vegetation loss and nutrient release, and call for increased conservational supervision. Especially the red listed charophytes would suffer negatively from such interference and the consequences are likely to also deteriorate juvenile fish production. The fact that a new species to Finland, Chara connivens Salzm. Ex. Braun 1835 was discovered during this study further indicates a potential of the lagoons serving as refuges for rare species.