Ability of physicians to diagnose influenza and usefulness of a rapid influenza antigen test in febrile returning travelers: A randomized controlled trial.

BACKGROUND: Fever is a frequent cause of medical consultation among returning travelers. The objectives of this study were to assess whether physicians were able to identify patients with influenza and whether the use of an influenza rapid diagnostic test (iRDT) modified the clinical management of such patients. METHODS: Randomized controlled trial conducted at 2 different Swiss hospitals between December 2008 and November 2012. Inclusion criteria were 1) age ≥18 years, 2) documented fever of ≥38 °C or anamnestic fever + cough or sore throat within the last 4 days, 3) illness occurring within 14 days after returning from a trip abroad, 4) no definitive alternative diagnosis. Physicians were asked to estimate the likelihood of influenza on clinical grounds, and a single nasopharyngeal swab was taken. Thereafter patients were randomized into 2 groups: i) patients with iRDT (BD Directigen A + B) performed on the nasopharyngeal swab, ii) patients receiving usual care. A quantitative PCR to detect influenza was done on all nasopharyngeal swabs after the recruitment period. Clinical management was evaluated on the basis of cost of medical care, number of X-rays requested and prescription of anti-infective drugs. RESULTS: 100 eligible patients were referred to the investigators. 93 patients had a naso-pharyngeal swab for a PCR and 28 (30%) swabs were positive for influenza. The median probability of influenza estimated by the physician was 70% for the PCR positive cases and 30% for the PCR negative cases (p < 0.001). The sensitivity of the iRDT was only 20%, and specificity 100%. Mean medical cost for the patients managed with iRDT and without iRDT were USD 581 (95%CI 454-707) and USD 661 (95%CI 522-800) respectively. 14/60 (23%) of the patients managed with iRDT were prescribed antibiotics versus 13/33 (39%) in the control group (p = 0.15). No patient received antiviral treatment. CONCLUSION: Influenza was a frequent cause of fever among these febrile returning travelers. Based on their clinical assessment, physicians had a higher level of suspicion for influenza in PCR positive cases. The iRDT used in this study showed a disappointingly low sensitivity and can therefore not be recommended for the management of these patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT00821626.

Diagnosis of endocrine disease: High-yield thyroid fine-needle aspiration cytology: an update focused on ancillary techniques improving its accuracy.

Thyroid fine-needle aspiration (FNA) cytology is a fast growing field. One of the most developing areas is represented by molecular tests applied to cytological material. Patients that could benefit the most from these tests are those that have been diagnosed as 'indeterminate' on FNA. They could be better stratified in terms of malignancy risk and thus oriented with more confidence to the appropriate management. Taking in to consideration the need to improve and keep high the yield of thyroid FNA, professionals from various fields (i.e. molecular biologists, endocrinologists, nuclear medicine physicians and radiologists) are refining and fine-tuning their diagnostic instruments. In particular, all these developments aim at increasing the negative predictive value of FNA to improve the selection of patients for diagnostic surgery. These advances involve terminology, the application of next-generation sequencing to thyroid FNA, the use of immunocyto- and histo-chemistry, the development of new sampling techniques and the increasing use of nuclear medicine as well as molecular imaging in the management of patients with a thyroid nodule. Herein, we review the recent advances in thyroid FNA cytology that could be of interest to the 'thyroid-care' community, with particular focus on the indeterminate diagnostic category.

Keskisuuren teknologiayrityksen logistiikkaratkaisujen arviointi

Asiakkaat ovat nykyisin yhä tietoisempia tuotteen tuomasta arvosta. Uusiksi kilpailutekijöiksi ovat hinnan sijasta muodostumassa asiakaslähtöisyys, toiminnan laadukkuus ja yrityksen kyky synkronoida liiketoimintaprosesseja yhteistyössä asiakkaiden kanssa. Toimitusketjun hallinta on avainasemassa, kun pyritään saavuttamaan kilpailuetua uudessa kilpailutilanteessa. Yrityksien haasteeksi muodostuu koko arvoketjun kattavan strategisen yhteensopivuuden saavuttaminen sekä tasapainon löytäminen reagoivuuden ja tehokkuuden välille. Diplomityö käsittelee kohdeyrityksen nykyistä toimitusketjua ja kartoittaa kuinka eri logistiikkaratkaisut vaikuttaisivat yrityksen toimitusketjun materiaalivirtoihin ja kustannusrakenteeseen sekä kilpailukykyyn tulevaisuudessa. Työssä pyritään arvioimaan myös eri ratkaisujen vahvuuksia ja heikkouksia sekä käyttöönottoon liittyviä haasteita. Muutoksia on pyritty arvioimaan luomalla nykytilakuvauksen pohjalta simulointimalleja, joiden avulla voidaan mallintaa sekä materiaalivirtojen että kustannuksien muutoksia. Empiriaosassa on kuvattu eri logistiikkaratkaisujen vaikutukset materiaalivirtoihin ja logistiikkatoimintojen kokonaiskustannuksiin, sekä niiden edut ja haitat. Tämä mandollistaa eri logistiikkaratkaisujen arvioinnin ja tuo esille kuinka nykyistä toimitusketjua olisi kehitettävä, jotta kohdeyritys pystyy tulevaisuudessa parantamaan kilpailukykyään kustannustehokkaasti.

Evaluation of steroidomics by liquid chromatography hyphenated to mass spectrometry as a powerful analytical strategy for measuring human steroid perturbations.

This review presents the evolution of steroid analytical techniques, including gas chromatography coupled to mass spectrometry (GC-MS), immunoassay (IA) and targeted liquid chromatography coupled to mass spectrometry (LC-MS), and it evaluates the potential of extended steroid profiles by a metabolomics-based approach, namely steroidomics. Steroids regulate essential biological functions including growth and reproduction, and perturbations of the steroid homeostasis can generate serious physiological issues; therefore, specific and sensitive methods have been developed to measure steroid concentrations. GC-MS measuring several steroids simultaneously was considered the first historical standard method for analysis. Steroids were then quantified by immunoassay, allowing a higher throughput; however, major drawbacks included the measurement of a single compound instead of a panel and cross-reactivity reactions. Targeted LC-MS methods with selected reaction monitoring (SRM) were then introduced for quantifying a small steroid subset without the problems of cross-reactivity. The next step was the integration of metabolomic approaches in the context of steroid analyses. As metabolomics tends to identify and quantify all the metabolites (i.e., the metabolome) in a specific system, appropriate strategies were proposed for discovering new biomarkers. Steroidomics, defined as the untargeted analysis of the steroid content in a sample, was implemented in several fields, including doping analysis, clinical studies, in vivo or in vitro toxicology assays, and more. This review discusses the current analytical methods for assessing steroid changes and compares them to steroidomics. Steroids, their pathways, their implications in diseases and the biological matrices in which they are analysed will first be described. Then, the different analytical strategies will be presented with a focus on their ability to obtain relevant information on the steroid pattern. The future technical requirements for improving steroid analysis will also be presented.

Sinisen meren strategia kilpailuedun näkökulmasta

Tutkielman tavoitteena on kuvata Sulake Corporation Oyj:n päätymistä kilpailemattomalle markkina-alueelle eli siniselle merelle Habbo Hotel — tuotteen avulla. Tutkimusongelmana on, mitä toimenpiteitä sinisen meren strategian toteutuminen vaatii. Tutkimusongelmaan on pyritty vastaamaan tarkastelemalla tutkimuskohteen kilpailuedun luomista ja tarkastelussa on hyödynnetty sinisen meren strategiaa sekä ulkoista ja sisäistä ympäristöä kilpailuedun lähteenä. Tutkielma on tehty kvalitatiivisella tutkimusmenetelmällä ja aineistoa on kerätty teemahaastattelulla, yrityksen Iehdistötiedotteista, seminaariesityksistä sekä julkisista aineistoista. Käytettyjen tutkimusmenetelmien sekä analyysin kautta saadut tutkimustulokset kuvaavat tavoitteen mukaisesti niitä tekijöitä, jotka ovat vaikuttaneet kilpailemattomalle markkina-alueelle päätymiseen. Johtopäätöksenä voidaan esittää, että kilpailemattomalle markkina-alueelle päätymisen syyksi ei tässä tapauksessa voida osoittaa mitään yksittäistä syytä tai kilpailuetua. Näin ollen tämän tutkimuksen valossa voidaan todeta, että kilpailematonta markkina-aluetta ei ole mandollista järjestelmällisesti luoda. Kilpailua ei myöskään saada merkityksettömäksi, vaikka yritys olisikin kilpailemattomalla markkina-alueella. Arvoinnovaation seurauksena yrityksen on kuitenkin mandollista toteuttaa samanaikaisesti kahta kilpailustrategiaa; kustannusjohtajuutta sekä differointia.

Improving the performance of the single-dish Cherenkov telescope MAGIC through the use of signal timing

The Cherenkov light flashes produced by Extensive Air Showers are very short in time. A high bandwidth and fast digitizing readout, therefore, can minimize the influence of the background from the light of the night sky, and improve the performance in Cherenkov telescopes. The time structure of the Cherenkov image can further be used in single-dish Cherenkov telescopes as an additional parameter to reduce the background from unwanted hadronic showers. A description of an analysis method which makes use of the time information and the subsequent improvement on the performance of the MAGIC telescope (especially after the upgrade with an ultra fast 2 GSamples/s digitization system in February 2007) will be presented. The use of timing information in the analysis of the new MAGIC data reduces the background by a factor two, which in turn results in an enhancement of about a factor 1.4 of the flux sensitivity to point-like sources, as tested on observations of the Crab Nebula.

The Intestinal Microbiota Contributes to the Ability of Helminths to Modulate Allergic Inflammation.

Intestinal helminths are potent regulators of their host's immune system and can ameliorate inflammatory diseases such as allergic asthma. In the present study we have assessed whether this anti-inflammatory activity was purely intrinsic to helminths, or whether it also involved crosstalk with the local microbiota. We report that chronic infection with the murine helminth Heligmosomoides polygyrus bakeri (Hpb) altered the intestinal habitat, allowing increased short chain fatty acid (SCFA) production. Transfer of the Hpb-modified microbiota alone was sufficient to mediate protection against allergic asthma. The helminth-induced anti-inflammatory cytokine secretion and regulatory T cell suppressor activity that mediated the protection required the G protein-coupled receptor (GPR)-41. A similar alteration in the metabolic potential of intestinal bacterial communities was observed with diverse parasitic and host species, suggesting that this represents an evolutionary conserved mechanism of host-microbe-helminth interactions.

Improving anterior deltoid activity in a musculoskeletal shoulder model - an analysis of the torque-feasible space at the sternoclavicular joint.

Modelling the shoulder's musculature is challenging given its mechanical and geometric complexity. The use of the ideal fibre model to represent a muscle's line of action cannot always faithfully represent the mechanical effect of each muscle, leading to considerable differences between model-estimated and in vivo measured muscle activity. While the musculo-tendon force coordination problem has been extensively analysed in terms of the cost function, only few works have investigated the existence and sensitivity of solutions to fibre topology. The goal of this paper is to present an analysis of the solution set using the concepts of torque-feasible space (TFS) and wrench-feasible space (WFS) from cable-driven robotics. A shoulder model is presented and a simple musculo-tendon force coordination problem is defined. The ideal fibre model for representing muscles is reviewed and the TFS and WFS are defined, leading to the necessary and sufficient conditions for the existence of a solution. The shoulder model's TFS is analysed to explain the lack of anterior deltoid (DLTa) activity. Based on the analysis, a modification of the model's muscle fibre geometry is proposed. The performance with and without the modification is assessed by solving the musculo-tendon force coordination problem for quasi-static abduction in the scapular plane. After the proposed modification, the DLTa reaches 20% of activation.

Sinisen meren strategia kilpailuedun näkökulmasta

Tutkielman tavoitteena on kuvata Sulake Corporation Oyj:n päätymistä kilpailemattomalle markkina-alueelle eli siniselle merelle Habbo Hotel – tuotteen avulla. Tutkimusongelmana on, mitä toimenpiteitä sinisen meren strategian toteutuminen vaatii. Tutkimusongelmaan on pyritty vastaamaan tarkastelemalla tutkimuskohteen kilpailuedun luomista ja tarkastelussa on hyödynnetty sinisen meren strategiaa sekä ulkoista ja sisäistä ympäristöä kilpailuedun lähteenä. Tutkielma on tehty kvalitatiivisella tutkimusmenetelmällä ja aineistoa on kerätty teemahaastattelulla, yrityksen lehdistötiedotteista, seminaariesityksistä sekä julkisista aineistoista. Käytettyjen tutkimusmenetelmien sekä analyysin kautta saadut tutkimustulokset kuvaavat tavoitteen mukaisesti niitä tekijöitä, jotka ovat vaikuttaneet kilpailemattomalle markkina-alueelle päätymiseen. Johtopäätöksenä voidaan esittää, että kilpailemattomalle markkinaalueelle päätymisen syyksi ei tässä tapauksessa voida osoittaa mitään yksittäistä syytä tai kilpailuetua. Näin ollen tämän tutkimuksen valossa voidaan todeta, että kilpailematonta markkina-aluetta ei ole mahdollista järjestelmällisesti luoda. Kilpailua ei myöskään saada merkityksettömäksi, vaikka yritys olisikin kilpailemattomalla markkina-alueella. Arvoinnovaation seurauksena yrityksen on kuitenkin mahdollista toteuttaa samanaikaisesti kahta kilpailustrategiaa; kustannusjohtajuutta sekä differointia.

Dual-Energy CT: Basic Principles, Technical Approaches, and Applications in Musculoskeletal Imaging (Part 1).

In recent years, technological advances have allowed manufacturers to implement dual-energy computed tomography (DECT) on clinical scanners. With its unique ability to differentiate basis materials by their atomic number, DECT has opened new perspectives in imaging. DECT has been used successfully in musculoskeletal imaging with applications ranging from detection, characterization, and quantification of crystal and iron deposits; to simulation of noncalcium (improving the visualization of bone marrow lesions) or noniodine images. Furthermore, the data acquired with DECT can be postprocessed to generate monoenergetic images of varying kiloelectron volts, providing new methods for image contrast optimization as well as metal artifact reduction. The first part of this article reviews the basic principles and technical aspects of DECT including radiation dose considerations. The second part focuses on applications of DECT to musculoskeletal imaging including gout and other crystal-induced arthropathies, virtual noncalcium images for the study of bone marrow lesions, the study of collagenous structures, applications in computed tomography arthrography, as well as the detection of hemosiderin and metal particles.

Managing manufacturing data and improving its accuracy

There are two main objects in this study: First, to prove the importance of data accuracy to the business success, and second, create a tool for observing and improving the accuracy of ERP systems production master data. Sub-objective is to explain the need for new tool in client company and the meaning of it for the company. In the theoretical part of this thesis the focus is in stating the importance of data accuracy in decision making and it's implications on business success. Also basics of manufacturing planning are introduced in order to explain the key vocabulary. In the empirical part the client company and its need for this study is introduced. New master data report is introduced, and finally, analysing the report and actions based on the results of analysis are explained. The main results of this thesis are finding the interdependence between data accuracy and business success, and providing a report for continuous master data improvement in the client company's ERP system.

Does Rigidity of Prices Hide Collusion?

Cartel detection is one of the most basic and most complicated tasks of competition authorities. In recent years, however, variance filters have provided a fairly simple tool for rejecting the existence of price-fixing, with the added advantage that the methodology requires only a low volume of data. In this paper we analyze two aspects of variance filters: 1- the relationship established between market structure and price rigidity, and 2- the use of different benchmarks for implementing the filters. This paper addresses these two issues by applying a variance filter to a gasoline retail market characterized by a set of unique features. Our results confirm the positive relationship between monopolies and price rigidity, and the variance filter's ability to detect non-competitive behavior when an appropriate benchmark is used. Our findings should serve to promote the implementation of this methodology among competition authorities, albeit in the awareness that a more exhaustive complementary analysis is required.

Dual-Energy CT: Basic Principles, Technical Approaches, and Applications in Musculoskeletal Imaging (Part 2).

In recent years, technological advances have allowed manufacturers to implement dual-energy computed tomography (DECT) on clinical scanners. With its unique ability to differentiate basis materials by their atomic number, DECT has opened new perspectives in imaging. DECT has been successfully used in musculoskeletal imaging with applications ranging from detection, characterization, and quantification of crystal and iron deposits, to simulation of noncalcium (improving the visualization of bone marrow lesions) or noniodine images. Furthermore, the data acquired with DECT can be postprocessed to generate monoenergetic images of varying kiloelectron volts, providing new methods for image contrast optimization as well as metal artifact reduction. The first part of this article reviews the basic principles and technical aspects of DECT including radiation dose considerations. The second part focuses on applications of DECT to musculoskeletal imaging including gout and other crystal-induced arthropathies, virtual noncalcium images for the study of bone marrow lesions, the study of collagenous structures, applications in computed tomography arthrography, as well as the detection of hemosiderin and metal particles.

Mother-offspring competition promotes colonization success.

Colonization is the crucial process underlying range expansions, biological invasions, and metapopulation dynamics. Which individuals leave their natal population to colonize empty habitats is a crucial question and is presently unresolved. Dispersal is the first step in colonization. However, not all dispersing individuals are necessarily good colonizers. Indeed, in some species, the phenotype of dispersers differs depending on the selective pressures that induce dispersal. In particular, kin-based interactions, a factor driving social evolution, should induce different social response profiles in nondispersing and dispersing individuals. Kin competition (defined here as between the mother and offspring) has been proven to produce dispersers with a particular phenotype that may enhance their colonizing ability. By using the common lizard (Lacerta vivipara), we conducted a multipopulation experiment to study the effect of kin competition on dispersal and colonization success. We manipulated mother-offspring interactions, which are the most important component of kin competition in the studied species, at the family and population levels and measured the consequences on colonization success. We demonstrate that mother-offspring competition at the population level significantly influences colonization success. Increased competition at the population level enhanced the colonization rate of the largest juveniles as well as the growth and survival of the colonizers. Based on these results, we calculated that kin-induced colonization halves the extinction probability of a newly initiated population. Because interactions between relatives are likely to affect the ability of a species to track habitat modifications, kin-based dispersal should be considered in the study of invasion dynamics and metapopulation functioning.

Improving the molecular diagnosis of Chlamydia psittaci and Chlamydia abortus infection with a species-specific duplex real-time PCR.

Chlamydia psittaci and Chlamydia abortus are closely related intracellular bacteria exhibiting different tissue tropism that may cause severe but distinct infection in humans. C. psittaci causes psittacosis, a respiratory zoonotic infection transmitted by birds. C. abortus is an abortigenic agent in small ruminants, which can also colonize the human placenta and lead to foetal death and miscarriage. Infections caused by C. psittaci and C. abortus are underestimated mainly due to diagnosis difficulties resulting from their strict intracellular growth. We developed a duplex real-time PCR to detect and distinguish these two bacteria in clinical samples. The first PCR (PCR1) targeted a sequence of the 16S-23S rRNA operon allowing the detection of both C. psittaci and C. abortus. The second PCR (PCR2) targeted the coding DNA sequence CPSIT_0607 unique to C. psittaci. The two PCRs showed 100 % detection for ≥ 10 DNA copies per reaction (1000 copies ml- 1). Using a set of 120 samples, including bacterial reference strains, clinical specimens and infected cell culture material, we monitored 100 % sensitivity and 100 % specificity for the detection of C. psittaci and C. abortus for PCR1. When PCR1 was positive, PCR2 could discriminate C. psittaci from C. abortus with a positive predictive value of 100 % and a negative predictive value of 88 %. In conclusion, this new duplex PCR represents a low-cost and time-saving method with high-throughput potential, expected to improve the routine diagnosis of psittacosis and pregnancy complication in large-scale screening programs and also during outbreaks.