937 resultados para Best Possible Medication History (BPMH)
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I hope you will find a great deal of challenge and personal satisfaction in your employment with the State. You have an important role in accomplishing the goals of your department and of state government. The State has a proud tradition built on the excellence of its employees and their work. We challenge you to help maintain and improve upon this tradition. You soon will discover that our pride is contagious! As a state employee, it is very important that you always present the best possible image to the public. Remember to act promptly, be courteous, and treat people, our customers, respectfully. Your actions will make a lasting impression .... be sure it is a positive one. This is your employee handbook. This information is based on Iowa Department of Administrative Services – Human Resources Enterprise (DAS-HRE) rules and policies. Much of the information in this handbook is also covered in the State’s collective bargaining agreements. Where there are differences between a collective bargaining agreement and this handbook, the collective bargaining agreement prevails for employees covered by the agreement. Where there are differences between this handbook and DAS-HRE rules and policies, DAS-HRE rules and policies prevail. Some of the employee benefit plans described in this handbook are subject to legal requirements concerning reporting and disclosure. This handbook contains highlights of those plans. For complete details about benefit plans, consult the benefit handbooks and the official plan documents. In case of any discrepancy, the official plan documents prevail. Of course, changes in laws may affect the benefit programs described in this handbook. The State of Iowa reserves the right to amend the contents of this handbook at any time without prior notice. The provisions of this handbook and other policies do not establish contractual rights or conditions of employment between the State and its employees.
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The treatment of multiple myeloma has undergone significant changes in the recent past. The arrival of novel agents, especially thalidomide, bortezomib and lenalidomide, has expanded treatment options and patient outcomes are improving significantly. This article summarises the discussions of an expert meeting which was held to debate current treatment practices for multiple myeloma in Switzerland concerning the role of the novel agents and to provide recommendations for their use in different treatment stages based on currently available clinical data. Novel agent combinations for the treatment of newly diagnosed, as well as relapsed multiple myeloma are examined. In addition, the role of novel agents in patients with cytogenetic abnormalities and renal impairment, as well as the management of the most frequent side effects of the novel agents are discussed. The aim of this article is to assist in treatment decisions in daily clinical practice to achieve the best possible outcome for patients with multiple myeloma.
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Objective: Health status measures usually have an asymmetric distribution and present a highpercentage of respondents with the best possible score (ceiling effect), specially when they areassessed in the overall population. Different methods to model this type of variables have beenproposed that take into account the ceiling effect: the tobit models, the Censored Least AbsoluteDeviations (CLAD) models or the two-part models, among others. The objective of this workwas to describe the tobit model, and compare it with the Ordinary Least Squares (OLS) model,that ignores the ceiling effect.Methods: Two different data sets have been used in order to compare both models: a) real datacomming from the European Study of Mental Disorders (ESEMeD), in order to model theEQ5D index, one of the measures of utilities most commonly used for the evaluation of healthstatus; and b) data obtained from simulation. Cross-validation was used to compare thepredicted values of the tobit model and the OLS models. The following estimators werecompared: the percentage of absolute error (R1), the percentage of squared error (R2), the MeanSquared Error (MSE) and the Mean Absolute Prediction Error (MAPE). Different datasets werecreated for different values of the error variance and different percentages of individuals withceiling effect. The estimations of the coefficients, the percentage of explained variance and theplots of residuals versus predicted values obtained under each model were compared.Results: With regard to the results of the ESEMeD study, the predicted values obtained with theOLS model and those obtained with the tobit models were very similar. The regressioncoefficients of the linear model were consistently smaller than those from the tobit model. In thesimulation study, we observed that when the error variance was small (s=1), the tobit modelpresented unbiased estimations of the coefficients and accurate predicted values, specially whenthe percentage of individuals wiht the highest possible score was small. However, when theerrror variance was greater (s=10 or s=20), the percentage of explained variance for the tobitmodel and the predicted values were more similar to those obtained with an OLS model.Conclusions: The proportion of variability accounted for the models and the percentage ofindividuals with the highest possible score have an important effect in the performance of thetobit model in comparison with the linear model.
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Surgical tumor removal is often the treatment of choice in patients with head and neck squamous cell carcinoma. Depending on the extent of tumor resection, large defects are often produced in the individual head and neck regions, necessitating reconstructive surgery to avoid further functional impairment. In principle, this decision depends on the size and location of the defect, the aesthetic importance of the region and the functional significance of the area to be replaced. Reconstructive free flap procedures in patients who have undergone radiotherapy or exhibit vessel depletion in the neck due to multiple previous surgical interventions are particularly challenging. In order to ensure the best possible outcomes of surgical oncology therapies under difficult circumstances, this paper discusses the important factors and variables that can increase the success rate of microvascular grafts in irradiated or multiply resected patients.
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In 2008, two highly discussed trials regarding the impact of glycemic control in type 2 diabetes, ACCORD and AVANCE, have been published. They showed a modest benefit of optimal glycemic control on morbidity and conflicting results on mortality, with an excess in the intensive treatment group of ACCORD. However several questionable aspects can be pointed out, the most prominent being the very limited duration of the intervention. This constrasts strongly with the long-term postintervention outcomes of UKPDS, which show a persistant benefit of glycemic control during 10 years of post-trial follow-up. These findings emphasize the need for an individualized approach of type 2 diabetic patients, aiming at the best possible control of all risk factors while minimizing the risk of hypoglycemia.
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The aim of this article is to make a contribution to the regional reflection with regard to autism spectrum disorders (ASDs) at a key moment in which the authorities are requested by the users, professionals in the fields of health, pedagogy and education to put forward a structured answer to a multitude of expressed needs. The question for the creation of a competence pole of an academic tertiary level is posed in order to advise in the best possible way the families who do not know how to orient themselves in the maze and contradictions of the proposed solutions and to help the professionals who are submerged by an ever increasing demand of services exceeding the means of the existing institutions and who cannot justify their choices among the various existing theoretical and scientific models.
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A study of type II cements at the Iowa State Highway Commission concluded that the amount of tricalcium aluminate in the cement appears to have an inverse effect on concrete durability. This conclusion agrees with the results of the Kansas Highway Department's study to determine the combination of cement and aggregate which would produce the best possible durability factor. This study is a result of the questions raised following the completion of the project at the Iowa State Highway Commission. This project is being conducted on a larger scale so. that more definite conclusions can be drawn. The purpose of this project is to determine if the amount of tricalcium aluminate in type II cements has an inverse effect on the durability of concrete.
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Advances in implant design, surgical technique, peri-operative antimicrobial prophylaxis and laminar airflow operating room environment have made total joint arthroplasty one of the most successful surgical procedures of all times. Orthopaedic implants, however, remain prone to microbial contamination resulting in persistent risk of implant-associated infection. Treatment of infections associated with orthopaedic devices usually requires appropriate surgical intervention combined with a prolonged antimicrobial therapy. The choice of the best possible treatment regimen depends on duration and pathogenesis of infection, stability of the implant, antimicrobial susceptibility of the pathogen and condition of the surrounding soft tissue. In addition towell known diagnostic procedures new promising tools for rapid and correct microbial diagnosis are being developed as correct diagnosis of the responsible micro-organism and this is paramount for successful treatment of prosthetic joint infection.
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Forensic science is increasingly relied upon by law enforcement to assist in solvingcrime and gaining convictions, and by the judicial system in the adjudication ofspecific criminal cases. However, the value of forensic science relative to the workinvolved and the outcome of cases has yet to be established in the Australiancontext. Previous research in this area has mainly focused on the science andtechnology, rather than examining how people can use forensic services/science tothe best possible advantage to produce appropriate justice outcomes. This fiveyearproject entails an investigation into the effectiveness of forensic science inpolice investigations and court trials. It aims to identify when, where and howforensic science can add value to criminal investigations, court trials and justiceoutcomes while ensuring the efficient use of available resources initially in theVictorian and the ACT criminal justice systems and ultimately across Australiaand New Zealand. This paper provides an overview of the rationale and aims ofthe research project and discusses current work-in-progress.
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Reconstruction of defects in the craniomaxillofacial (CMF) area has mainly been based on bone grafts or metallic fixing plates and screws. Particularly in the case of large calvarial and/or craniofacial defects caused by trauma, tumours or congenital malformations, there is a need for reliable reconstruction biomaterials, because bone grafts or metallic fixing systems do not completely fulfill the criteria for the best possible reconstruction methods in these complicated cases. In this series of studies, the usability of fibre-reinforced composite (FRC) was studied as a biostable, nonmetallic alternative material for reconstructing artificially created bone defects in frontal and calvarial areas of rabbits. The experimental part of this work describes the different stages of the product development process from the first in vitro tests with resin-impregnated fibrereinforced composites to the in vivo animal studies, in which this FRC was tested as an implant material for reconstructing different size bone defects in rabbit frontal and calvarial areas. In the first in vitro study, the FRC was polymerised in contact with bone or blood in the laboratory. The polymerised FRC samples were then incubated in water, which was analysed for residual monomer content by using high performance liquid chromatography (HPLC). It was found that this in vitro polymerisation in contact with bone and blood did not markedly increase the residual monomer leaching from the FRC. In the second in vitro study, different adhesive systems were tested in fixing the implant to bone surface. This was done to find an alternative implant fixing system to screws and pins. On the basis of this study, it was found that the surface of the calvarial bone needed both mechanical and chemical treatments before the resinimpregnated FRC could be properly fixed onto it. In three animal studies performed with rabbit frontal bone defects and critical size calvarial bone defect models, biological responses to the FRC implants were evaluated. On the basis of theseevaluations, it can be concluded that the FRC, based on E-glass (electrical glass) fibres forming a porous fibre veil enables the ingrowth of connective tissues to the inner structures of the material, as well as the bone formation and mineralization inside the fibre veil. Bone formation could be enhanced by using bioactive glass granules fixed to the FRC implants. FRC-implanted bone defects healed partly; no total healing of defects was achieved. Biological responses during the follow-up time, at a maximum of 12 weeks, to resin-impregnated composite implant seemed to depend on the polymerization time of the resin matrix of the FRC. Both of the studied resin systems used in the FRC were photopolymerised and the heat-induced postpolymerisation was used additionally.
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In this master's thesis, material characteristics which includes material database will be developed, through which will be managed process device deliveries device selections. The analysed bulk materials exact values serve as basic data when choosing glass- and dried product industry raw material equipment solutions. In this study, the material database function structure will be divided into classified bulk materials characteristics and process device guidelines and planning which they are based on. In order to achieve the best possible advantage in use of the material database, the raw material handling with the process equipment has to be controlled with the help of database bulk material information. With the help of material database, the personnel of the company will find the needed material and device information to implement the processes. The structure of the database enables adding of information, and hence the database will be always kept updated. The material database uses free PhpOpenDatabase software programme, which adapts itself flexibly with the software and requirements of the company. The material frame and considered features of the material database were determined by the requirements of the company's device technology. National and international classifications were used as help. The collected material information was analysed and the correspondence between internal study results and found classifications were determined. As presented before, on the grounds of chosen and specified material features, also the controllability of device selecting and solutions was improved with device-specific screening and planning guidelines. As material frame of the material database was chosen ANSI/CEMA Standard 550. Its almost 1000 bulk materials form an extensive database frame. Over 600 of these raw materials have been determined according to classification. However, the most important ones are the materials of glass- and dried material plants, which consist of the last part of material frame. The analysis will be sustained and material information will be completed primarily of material part with test run in one's own material laboratory.
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Diplomityön tavoitteena oli tunnistaa kohdeyrityksessä kehitysmahdollisuuksia. Kehitysmahdollisuuksien etsiminen käyttäjätukiprosessin aloitettiin prosessin nykytilan analysoinnilla, jolla pyrittiin tunnistamaan prosessin ominaisuuksia sekä ongelma-alueita, joita korjaamalla prosessia voitiin tehostaa. Tutkimus on jaettu teoria ja empiria osaan.Teorian alussa käsitellään tietotekniikkapalveluiden organisointia, jotta ymmärretään toiminnanohjausjärjestelmien ja niihin liittyvien tukiprosessien merkitys yrityksissä. Tämän jälkeen perehdytään prosessijohtamiseen ja sen keinoihin liiketoimintaprosessien kehittämiseen. Tuloksena voidaan sanoa, että prosessien virtaviivaistaminen on nopea ja edullinen tapa tehostaa prosessin toimintaa ja päivittää vanha prosessi vastaamaan yrityksen nykyisiä tarpeita. Prosessien virtaviivaistamisella ei saada suuria kustannussäästöjä, vaan hyödyt liittyvät prosessin tehostumiseen. Virtaviivaistetusta prosessista on poistettu turhat toiminnot ja se on suunniteltu vastaamaan tarkoitustaan parhaalla mahdollisella tavalla. Näin prosessin virtaviivaistaminen lisää myös asiakkaan kokemaa arvoa.
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Nowadays the used fuel variety in power boilers is widening and new boiler constructions and running models have to be developed. This research and development is done in small pilot plants where more faster analyse about the boiler mass and heat balance is needed to be able to find and do the right decisions already during the test run. The barrier on determining boiler balance during test runs is the long process of chemical analyses of collected input and outputmatter samples. The present work is concentrating on finding a way to determinethe boiler balance without chemical analyses and optimise the test rig to get the best possible accuracy for heat and mass balance of the boiler. The purpose of this work was to create an automatic boiler balance calculation method for 4 MW CFB/BFB pilot boiler of Kvaerner Pulping Oy located in Messukylä in Tampere. The calculation was created in the data management computer of pilot plants automation system. The calculation is made in Microsoft Excel environment, which gives a good base and functions for handling large databases and calculations without any delicate programming. The automation system in pilot plant was reconstructed und updated by Metso Automation Oy during year 2001 and the new system MetsoDNA has good data management properties, which is necessary for big calculations as boiler balance calculation. Two possible methods for calculating boiler balance during test run were found. Either the fuel flow is determined, which is usedto calculate the boiler's mass balance, or the unburned carbon loss is estimated and the mass balance of the boiler is calculated on the basis of boiler's heat balance. Both of the methods have their own weaknesses, so they were constructed parallel in the calculation and the decision of the used method was left to user. User also needs to define the used fuels and some solid mass flowsthat aren't measured automatically by the automation system. With sensitivity analysis was found that the most essential values for accurate boiler balance determination are flue gas oxygen content, the boiler's measured heat output and lower heating value of the fuel. The theoretical part of this work concentrates in the error management of these measurements and analyses and on measurement accuracy and boiler balance calculation in theory. The empirical part of this work concentrates on the creation of the balance calculation for the boiler in issue and on describing the work environment.
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Lappeenrannan teknillisen korkeakoulun sähkötekniikan osasto muutti 1.8.2005 sähkötekniikan tutkinnon kaksiportaiseksi ja vastaamaan näin Bologna-prosessia ja Suomen yliopistolainsäädäntöä. Tutkinnonuudistuksen myötä osasto haluaa varmistaa sähkötekniikan tutkintojen laadun ja vertailtavuuden sekä parantaa opiskelijoidensekä henkilökunnan liikkuvuutta. Tutkintojen laatu ja vertailtavuus osoitetaan sähkötekniikan osaston benchmark-projektilla, jossa kerätään tietoja maisteri- ja tohtorintutkintoa tarjoavista eurooppalaisista yliopistoista. Diplomityö käsittää BM-projektin kolmannen vaiheen suunnittelun ja toteutuksen sisältäen teoriaa benchmark-projekteille tyypillisistä toimintatavoista. Hyväksi havaitut menetelmiä, kuten kyselyt ja matriisit, on tässä työssä otettu soveltuvin osin sähkötekniikan osaston BM-projektin työkaluiksi. Diplomityössä analysoidaan työkalujen avulla BM-kumppaneilta kerättyjä tietoja sekä esitetään ratkaisuja, miten sähkötekniikan osastolla voidaan jatkaa parhaiden toimintatapojen löytämistä.
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Diplomityössä tutkitaan kolmea erilaista virtausongelmaa CFD-mallinnuksella. Yhteistä näille ongelmille on virtaavana aineena oleva ilma. Lisäksi tapausten perinteinen mittaus on erittäin vaikeaa tai mahdotonta. Ensimmäinen tutkimusongelma on tarrapaperirainan kuivain, jonka tuotantomäärä halutaan nostaa kaksinkertaiseksi. Tämä vaatii kuivatustehon kaksinkertaistamista, koska rainan viipymäaika kuivausalueella puolittuu. Laskentayhtälöillä ja CFD-mallinnuksella tutkitaan puhallussuihkun nopeuden ja lämpötilan muutoksien vaikutusta rainan pinnan lämmön- ja massansiirtokertoimiin. Tuloksena saadaan varioitujen suureiden sekä massan- ja lämmönsiirtokertoimien välille riippuvuuskäyrät, joiden perusteella kuivain voidaan säätää parhaallamahdollisella tavalla. Toinen ongelma käsittelee suunnitteilla olevan kuparikonvertterin sekundaarihuuvan sieppausasteen optimointia. Ilman parannustoimenpiteitä käännetyn konvertterin päästöistä suurin osa karkaa ohi sekundaarihuuvan. Tilannetta tutkitaan konvertterissa syntyvän konvektiivisen nostevirtauksen eli päästöpluumin sekä erilaisten puhallussuihkuratkaisujen CFD-mallinnuksella. Tuloksena saadaan puhallussuihkuilla päästöpluumia poikkeuttava ilmaverho. Suurin osa nousevasta päästöpluumista indusoituu ilmaverhoon ja kulkeutuu poistokanavaan. Kolmas tutkittava kohde on suunnitteilla oleva kuparielektrolyysihalli, jossa ilmanvaihtoperiaatteena on luonnollinen ilmanvaihto ja mekaaninen happosumun keräysjärjestelmä. Ilmanvaihtosysteemin tehokkuus ja sisäilman virtaukset halutaan selvittää ennen hallin rakentamista. CFD-mallinnuksella ja laskentayhtälöillä tutkitaan lämpötila- ja virtauskentät sekä hallin läpi virtaava ilmamäärä ja ilmanvaihtoaste. Tulo- ja poistoilma-aukkojen mitoitukseen ja sijoitukseen liittyvät suunnitteluarvot varmennetaan sekä löydetään ilmanvaihdon ongelmakohdat. Ongelmakohtia tutkitaan ja niille esitetään parannusehdotukset.