Reconditioning of the trabeculo-descemet's membrane with the 532-nm Nd : YAG (SLT) laser after deep sclerectomy.

The purpose of this study was to evaluate the intraocular pressure (IOP)-lowering effect of modified goniopuncture with the 532-nm Nd : YAG selective laser trabeculoplasty (SLT) laser on eyes after deep sclerectomy with collagen implant (DSCI). This was an interventional cased series. The effects of modified goniopuncture on eyes with insufficient IOP-lowering after DSCI were observed. Goniopuncture was performed using a Q-switched, frequency-doubled 532-nm Nd : YAG laser (SLT-goniopuncture, SLT-G). Outcome measures were amount of IOP-lowering and rapidity of decrease after laser intervention. In all, 10 eyes of 10 patients with a mean age of 71.0±7.7 (SD) years were treated with SLT-G. The mean time of SLT-G after DSCI procedure was 7.1±10.9 months. SLT-G decreased IOP from an average of 16.1±3.4 mm Hg to 14.2±2.8 mm Hg (after 15 min), 13.6±3.9 mm Hg (at 1 day), 12.5±4.1 mm Hg (at 1 month), and 12.6±2.5 (at 6 months) (P<0.0125). There were no complications related to the intervention. Patients in this series achieved an average 22.5% of IOP reduction after SLT-G. The use of the SLT laser appears to be an effective and safe alternative to the traditional Nd : YAG laser for goniopuncture in eyes after DSCI, with potential advantages related to non-perforation of trabeculo-descemet's membrane (TDM).

Recombinant human tumor necrosis factor: an efficient agent for cancer treatment.

Recombinant human TNF (rhTNF) has a selective effect on endothelial cells in tumour angiogenic vessels. Its clinical use has been limited because of its property to induce vascular collapsus. TNF administration through isolated limb perfusion (ILP) for regionally advanced melanomas and soft tissue sarcomas of the limbs was shown to be safe and efficient. When combined to the alkylating agent melphalan, a single ILP produces a very high objective response rate. ILP with TNF and melphalan provided the proof of concept that a vasculotoxic strategy combined to chemotherapy may produce a strong anti-tumour effect. The registered indication of TNF-based ILP is a regional therapy for regionally spread tumours. In soft tissue sarcomas, it is a limb sparing neoadjuvant treatment and, in melanoma in-transit metastases, a curative treatment. Despite its demonstrated regional efficiency TNF-based ILP is unlikely to have any impact on survival. High TNF dosages induce endothelial cells apoptosis, leading to vascular destruction. However, lower TNF dosage produces a very strong effect that is to increase the drug penetration into the tumour, presumably by decreasing the intratumoural hypertension resulting in better tumour uptake. TNF-ILP allowed the identification of the role of alphaVbeta3 integrin deactivation as an important mechanism of antiangiogenesis. Several recent studies have shown that TNF targeting is possible, paving the way to a new opportunity to administer TNF systemically for improving cancer drug penetration. TNF was the first agent registered for the treatment of cancer that improves drug penetration in tumours and selectively destroys angiogenic vessels.

Heart failure and community-acquired pneumonia: cases for home hospital?

BACKGROUND: Home hospital is advocated in many western countries in spite of limited evidence of its economic advantage over usual hospital care. Heart failure and community-acquired pneumonia are two medical conditions which are frequently targeted by home hospital programs. While recent trials were devoted to comparisons of safety and costs, the acceptance of home hospital for patients with these conditions remains poorly described. OBJECTIVE: To document the medical eligibility and final transfer decision to home hospital for patients hospitalized with a primary diagnosis of heart failure or community-acquired pneumonia. DESIGN: Longitudinal study of patients admitted to the medical ward of acute care hospitals, up to the final decision concerning their transfer. SETTING: Medical departments of one university hospital and two regional teaching Swiss hospitals. PATIENTS: All patients admitted over a 9 month period to the three settings with a primary diagnosis of heart failure (n= 301) or pneumonia (n=441). MEASUREMENTS: Presence of permanent exclusion criteria on admission; final decision of (in)eligibility based on medical criteria; final decision regarding the transfer, taking into account the opinions of the family physician, the patient and informal caregivers. RESULTS: While 27.9% of heart failure and 37.6% of pneumonia patients were considered to be eligible from a medical point of view, the program acceptance by family physicians, patients and informal caregivers was low and a transfer to home hospital was ultimately chosen for just 3.8% of heart failure and 9.6% of pneumonia patients. There were no major differences between the three settings. CONCLUSIONS: In the case of these two conditions, the potential economic advantage of home hospital over usual inpatient care is compromised by the low proportion of patients ultimately transferred.

Anti-HLA antibody repertoire after IVIg infusion in highly sensitized patients waiting for kidney transplantation.

Polyclonal intravenous immunoglobulin (IVIg) treatment reduces crossmatch positivity and increases rates of transplantation in highly sensitised patients (HS). We quantified the panel reactive antibody (PRA) by microlymphocytotoxicity (MLCC), and we analysed anti-HLA class I and class II IgG specific antibody repertoire by Luminex before and after IVIg infusion alone in HS patients awaiting kidney transplantation. Five patients received three monthly infusions of 1 g/kg of IVIg. Serum samples collected pre and post IVIg treatment were submitted for PRA analysis by MLCC. Anti-class I and anti-class II antibody specificities were then tested by Luminex. We focused on the anti-HLA class I and class II antibodies directed against HLA expressed by a previous graft. We also analysed the anti-HLA antibody repertoire in three patients who had not received IVIg infusion. The PRA level determined by MLCC decreased significantly in one of the five patients, dropping from 40% to 17%. The Luminex assay showed fluctuations of the anti-HLA antibody levels over time, but no significant longterm modifications of the anti-HLA antibody repertoire were observed, even in the patient with a strong and prolonged reduction of the PRA determined by MLCC. Our results show that IVIg at 1 g/kg is not sufficient to reduce PRA and does not modify the repertoire of specific anti-HLA antibody determined by Luminex.

Electronic Construction Collaboration - Phase 1, 2009

Bridge construction projects are becoming increasingly complex as the demand for context-sensitive solutions, aesthetic designs, and accelerated bridge construction becomes more prevalent. In addition, the Iowa Department of Transportation (Iowa DOT) is entering a phase of design and construction of large border bridges, such as the I-80 (let 2008 for $56 million) and US 34 bridges over the Missouri River and I-74 over the Mississippi River. Compared to typical construction projects, these bridges generate more contractor Requests for Information (RFIs), Value Engineering (VE) proposals, Requests for Changes (RFCs), and shop drawings. Management of these submittals is a significant challenge for Resident Construction Engineers (RCEs) and other Iowa DOT staff. In addition, some submittals require cross-departmental and project consultant reviews. Commercially available software exists for managing submittals and project collaboration teams; in-house solutions may also be possible. Implementation is intended to speed construction submittal review time, reduce incidence of delay claims, and free up Iowa DOT staff from project management administrative tasks. Researchers from Iowa State University working with the Iowa DOT conducted a multi-pronged approach to indentify a web-based collaboration solution for Iowa DOT bridge projects. An investigation was launched to determine the functional needs of the Iowa DOT. Commercially available software programs were also evaluated to find what functionality is currently available. A Request for Proposals (RFP) was written to select a commercial web-based collaboration solution for pilot testing. In the second phase of research, a solution will be selected and implemented on two pilot projects. Lessons learned from these pilot projects will assist the Iowa DOT in developing and implementing a long-term solution to improve the management of Iowa DOT bridge projects.

08025-015 Remsen Source Water Protection Final Report

The City of Remsen is proactively addressing an increase of nitrates in their public water supply before it becomes a financial catastrophe for them. An intensive assessment was conducted by the Iowa DNR Source Water Protection program as one of four pilot projects in the state. This assessment far surpassed standard desktop assessments and gathered monitoring information in-the-field led by a local watershed group. This was incorporated into a computer modeling program to help the local watershed group discuss alternatives. This comprehensive approach clearly identified the source of nitrate infiltration as a cropland area adjacent to the City well field. Many options were evaluated but only one option provided an economical, viable and secure answer to the water supply needs of Remsen for generations to come. The watershed planning group chose to seek the purchase of this critical area of cropland and convert it to a deep rooted mixture of native grasses. This WIRB funding is intended to be used to acquire a small area totaling 21.1 acres. It represents about 22% of the total local project effort. This will be added to the existing City well field of 40.2 acres and another piece of adjacent property, 35.34 acres, that the City recently acquired as part of an overall aggressive program to protect the community water supply. The City has a signed purchase agreement for 14.4 acres of the 21.1 and a strong verbal commitment to obtain the remaining 5.7 acres. This project has been very active for almost 2 years and is ready to implement immediately upon funding notification. The establishment of native grasses, funded by the local chapter of Pheasants Forever, will take approximately the next three years of operation & maintenance.

Prevention of cutaneous melanoma: an epidemiological evaluation of the Swiss campaign.

A national information program, focusing on the main recognized risk factors (primary prevention) and on the potential benefits of early detection (secondary prevention) of cutaneous malignant melanoma, was launched in Switzerland in May 1988. The first campaign, based on a pilot study conducted in 1986 in the canton of Basel, was followed by a recall campaign in July 1989. This report describes the organization of this program and presents an assessment of its initial impact. The number of newly diagnosed cases increased more than twofold (+ 116%) in the two months following the launch of the first campaign (May to June 1988). This trend was accompanied by a statistically significant shift of case distribution towards younger ages (< 60 years; p = 0.003), and a non-significant shift was observed towards less advanced lesions (thickness < or = 1.5 mm). The incidence decreased quickly, though in the twelve month period between the two campaigns it remained 21% higher than before the inception of the program. No appreciable effects were detected from the recall campaign and no difference was seen among regions or between sexes.

Initial results on in vivo human coronary MR angiography at 7 T.

Seven tesla (T) MR imaging is potentially promising for the morphologic evaluation of coronary arteries because of the increased signal-to-noise ratio compared to lower field strengths, in turn allowing improved spatial resolution, improved temporal resolution, or reduced scanning times. However, there are a large number of technical challenges, including the commercial 7 T systems not being equipped with homogeneous body radiofrequency coils, conservative specific absorption rate constraints, and magnified sample-induced amplitude of radiofrequency field inhomogeneity. In the present study, an initial attempt was made to address these challenges and to implement coronary MR angiography at 7 T. A single-element radiofrequency transmit and receive coil was designed and a 7 T specific imaging protocol was implemented, including significant changes in scout scanning, contrast generation, and navigator geometry compared to current protocols at 3 T. With this methodology, the first human coronary MR images were successfully obtained at 7 T, with both qualitative and quantitative findings being presented.

Use of anisotropic modelling in electrical impedance tomography: description of method and preliminary assessment of utility in imaging brain function in the adult human head.

Electrical Impedance Tomography (EIT) is an imaging method which enables a volume conductivity map of a subject to be produced from multiple impedance measurements. It has the potential to become a portable non-invasive imaging technique of particular use in imaging brain function. Accurate numerical forward models may be used to improve image reconstruction but, until now, have employed an assumption of isotropic tissue conductivity. This may be expected to introduce inaccuracy, as body tissues, especially those such as white matter and the skull in head imaging, are highly anisotropic. The purpose of this study was, for the first time, to develop a method for incorporating anisotropy in a forward numerical model for EIT of the head and assess the resulting improvement in image quality in the case of linear reconstruction of one example of the human head. A realistic Finite Element Model (FEM) of an adult human head with segments for the scalp, skull, CSF, and brain was produced from a structural MRI. Anisotropy of the brain was estimated from a diffusion tensor-MRI of the same subject and anisotropy of the skull was approximated from the structural information. A method for incorporation of anisotropy in the forward model and its use in image reconstruction was produced. The improvement in reconstructed image quality was assessed in computer simulation by producing forward data, and then linear reconstruction using a sensitivity matrix approach. The mean boundary data difference between anisotropic and isotropic forward models for a reference conductivity was 50%. Use of the correct anisotropic FEM in image reconstruction, as opposed to an isotropic one, corrected an error of 24 mm in imaging a 10% conductivity decrease located in the hippocampus, improved localisation for conductivity changes deep in the brain and due to epilepsy by 4-17 mm, and, overall, led to a substantial improvement on image quality. This suggests that incorporation of anisotropy in numerical models used for image reconstruction is likely to improve EIT image quality.

T-Flux implant versus Healon GV in deep sclerectomy.

PURPOSE: To compare the efficacy and safety of T-Flux implant versus Healon GV in deep sclerectomy. METHODS: Randomized prospective trial of 23 eyes of 20 patients with medically uncontrolled open angle glaucoma over a period of 24 months, who underwent deep sclerectomy with either Healon GV or T-Flux implant. RESULTS: Mean postoperative intraocular pressure was 13.2 +/- 3.0 mm Hg with T-Flux implant (group 1) and 12.2 +/- 3.5 mm Hg with Healon GV (group 2), with a pressure reduction of 53.0% in group 1 (13.2 mm Hg vs. 28.1 mm Hg) and of 48.1% in group 2 (12.2 mm Hg vs. 23.5 mm Hg). Qualified and complete successes were 100% and 95.4% respectively. Pressures equal to or less than 15 mm Hg were 81.8% in group 1 and 90.9% in group 2 with or without treatment, and 63.6% in group 1 and 81.8% in group 2 without treatment. The number of glaucoma treatments dropped from 2.5 +/- 0.9 to 0.4 +/- 0.7 in group 1 and from 2.2 +/- 1.0 to 0.2 +/- 0.4 in group 2. The goniopuncture rate was 63.6% in group 1 and 36.4% in group 2, with a mean pressure drop of 6.1 +/- 3.9 mm Hg and 3.25 +/- 1.2 mm Hg respectively. Overall, slit-lamp diagnosed surgery-related complications included positive Seidel (13.6%), hyphaema (22.7%), choroidal detachment, and iris incarceration (4.5% each). At 2 years, ultrasound biomicroscopy showed mainly low reflective (40.1%) and flattened (36.4%) blebs. Principally latter ones were associated with the need for adjunctive treatment. A hypoechoic area in the suprachoroidal space was seen in at least 59.1% of eyes at 2 years and was not associated with lower intraocular pressure. CONCLUSION: Deep sclerectomy is an effective and safe surgery. However, longer follow up and larger study groups are required to assess the additional benefit of nonabsorbable implants.

Delivery of European Cross-Border Health Care and the Relevance and Effects of EU Regulations and Judicial Processes with Reference to Delivery of Drugs and Blood Donor Information Material.

Valtion rajat ylittävät terveyspalvelut Euroopan unionissa sekä Euroopan unionin säädösten merkitys ja vaikutus erityisesti lääkejakeluun ja verenluovuttajille jaettavaan tiedotusaineistoon Valtion rajat ylittävä terveydenhuolto on suuren kiinnostuksen kohteena Euroopan unionissa. Resurssien hyödyntäminen parhaalla mahdollisella tavalla ja tiedon keskittäminen ovat tarpeen terveydenhuollon kustannusten alati noustessa. Terveydenhuoltopalvelut kuuluvat Euroopan sisämarkkinoiden vapaan liikkuvuuden piiriin. Euroopan unionilla ei ole kuitenkaan toimivaltaa säädellä terveydenhuoltojärjestelmiä, vaan sen mahdollisuudet ovat enimmäkseen kansanterveyden edistämisessä ja suojelussa, myös muilla toimialueilla kuin terveydenhuollossa. Tutkimuksen tavoitteena oli tutkia Euroopan unionin säädösten vaikutusta terveydenhuoltosektoriin, erityisesti valtion rajat ylittäviin terveydenhuoltopalveluihin. Erityiskohteena olivat lääkemääräyksen toimittaminen toisen Euroopan unionin jäsenmaan apteekista, resepti-lääkkeiden maahantuonti omaan henkilökohtaiseen käyttöön, sähköisen lääkemääräyksen käyttö kansallisesti ja mahdollisuudet sen käyttöön eri jäsenmaiden välillä, online-apteekkien soveltuvuus Euroopan unionin sisämarkkinoille sekä verenluovuttajille jaettavan tiedotusaineiston yhtenäistämistarve Euroopan unionin alueella. Tutkimuksen osa-alueiden aineisto koottiin vuosina 1999–2003, jolloin Euroopan unioniin kuului 15 jäsenmaata. Apteekit toimittivat useimmiten myös ei-kansalliset, toisessa Euroopan unionin jäsenmaassa annetut lääkemääräykset. Kaikki jäsenmaat rajoittivat lääkemääräyksen vaativien lääkkeiden maahantuontia. Rajoituksia oli maahantuontimäärissä ja -tavoissa. Lisäksi sairasvakuutuskorvausten saaminen ulkomailla lunastetuista reseptilääkkeistä oli hankalaa. Sähköiset lääkemääräykset olivat käytössä vain kahdessa maassa, mutta useissa maissa suunniteltiin niiden kokeilua. Standardit ja käyttöjärjestelmät olivat erilaisia eri maissa. Euroopan unionin alueelle on perustettu online-apteekkeja, joiden toiminta on kuitenkin vaatimatonta. Verenluovuttajille annettava tiedotusaineisto ei missään maassa täyttänyt veridirektiivin vaatimuksia. Tutkimuksen tulokset osoittivat kansallisten käytäntöjen eroavaisuuksien rajoittavan valtion rajat ylittäviä terveydenhuoltopalveluita. Vaikka Euroopan unionin tavoitteena ei ole yhtenäistää terveydenhuoltojärjestelmiä, on tarpeen arvioida uudelleen unionin ja jäsenmaiden välistä työnjakoa. Kansalliset terveydenhuoltojärjestelmät eivät ole erillään Euroopan sisämarkkinoista, jotka merkittävästi vaikuttavat terveydenhuoltoon.

Materiaalien läpimenoajan lyhennyskeinot tulologistiikan osalta

Diplomityön tavoitteena oli löytää keinoja ja toimintamalleja materiaalien läpimenoajan lyhentämiseen lähinnä ostonimikkeiden osalta. Taustalla on konsernin tavoitteet, lisäksi tavoitteena on vähentää ulkoistetun varastoinnin tarvetta. Ensin selvitettiin nykytilanne nimikeanalyysien ja työntekijöiden haastattelujen avulla. Läpimenoaikaan vaikuttavat taustatekijät esiteltiin. Seuraavaksi tutkittiin konsernin varastonkierron analysointiin tarkoitetun ohjelmiston käyttöönotto- ja hyödyntämismahdollisuuksia. Lisäksi muodostettiin laskentamalleja varmuusvarastojen ja eräkokojen tason optimointiin. Lopulta muodostettiin toimintamalli logistiikan tehostamiseksi, johon liittyy ehdotukset eri henkilöiden toimista logistiikan tehostamiseksi. Erillisenä tarkastelukohteena oli varastossa seisovien nimikkeiden hävittämisrutiinin kehittäminen. Läpimenoaikojen lyhentämisessä on runsaasti potentiaalia kun tärkeiden nimikkeiden varmuusvarastoihin ja eräkokoihin kiinnitetään huomiota. Tärkeää on yhteistyö oston ja tuotannon ja toisaalta toimittajien kanssa. Tietoteknisten apuvälineiden kehittäminen parantaisi toimintaedellytyksiä, mutta suurimpiin ongelmakohtiin voidaan puuttua myös nykyisillä välineillä. Toiminta kannattaa aloittaa erillisistä kohteista joiden lähtökohtana on havaitut ongelmat. Koulutus ja asennemuokkaus on keskeisellä sijalla alkuvaiheessa, lisäksi jokaisen asianosaisen tulisi asettaa henkilökohtaiset tavoitteet.

Toimintolaskennan soveltuminen Fingrid Verkko Oy:n kustannuslaskentaan

Tutkimuksen tavoitteena oli selvittää toimintolaskennan soveltuvuus esimerkkiyritykseen. Lähtökohtana oli kiinteiden kustannusten kohdistaminen tuotteille ja tuotekustannusten parempi hallinta.Lopputuloksiin on tässä casetutkimuksessa ennen kaikkea päästy kyseisen Fingrid Verkko Oy:n nykyistä laskentaa tutkimalla. Toimintolaskentakirjallisuuden ja artikkeleiden pohjalta laadittiin teoriaosuus, minkä tarkoituksena oli antaa riittävää tietoa yritykselle toimintolaskennasta sekä sen soveltamisesta. Tutkimuksessa päädyttiin kahteen merkittävään lopputulokseen. Ensinnäkin siihen, että toimintoperusteinen kustannuslaskentaa ei voida toteuttaa yrityksessä pilottiprojektin omaisesti kohdistettuna yksittäiseen tuotteeseen. Haluttaessa kertaluontoisesti jälkilaskennalla testata toimintolaskennan tuotteiden kannattavuuksia, täytyy koko yrityksen ja tässä tapauksessa myös konsernin osallistua projektiin. Toiseksi toimintolaskennan todettiin olevan yleensäkin epäsopiva yritykselle. Huomioitavaa on yrityksen prosessin luonne, jossa jokainen tuote on erillinen tilaus tai projekti. Yrityksen kustannuslaskentaa tulee kuitenkin kehittää, ratkaisu tähän voisi olla nykyisen laskentatavan tarkentaminen siten että kiinteistä kustannuksista osa saataisiin kohdennettua resurssien ajankäytön mukaan nykyisille kustannuspaikoille.

Rakennusprojektin laadunvarmistuksen automatisointi mobiiliteknologialla

Rakennusprojekteissa yksi haastava osa-alue on laadunvarmistus: Suomen elementtitehtailla se tapahtuu tällä hetkellä käsityöllä, eikä automaatiota käytetä. Lappeenrannan teknillisen yliopiston Mobilding-hankkeessa rakennuselementteihin upotetaan radiotunnisteita, joiden avulla elementit voidaan tunnistaa langattomasti ja yksilöllisesti, sekä yhdistää tietojärjestelmän tietoon. Käyttäen hyväksi kykyä tunnistaa elementit sähköisesti, tässä diplomityössä keskitytään ratkaisemaan laadunvarmistuksen haastetta automatisoimalla prosessia. Työssä kartoitetaan laadunvarmistuksen nykytila rakennusteollisuudessa ja sen pohjalta suunnitellaan ja tuotetaan laadunvarmistusjärjestelmä. Toteutettava järjestelmä kykenee havainnoimaan poikkeuksia reaktiona käyttäjien syötteeseen ja valvomaan projektin aikataulutusta käyttäen hyväksi elementtien tilatietoja. Havaituista poikkeuksista tiedotetaan automaattisesti. Järjestelmään toteutetaan rajapinta Web Service-teknologioilla, jolloin sitä voidaan käyttää matkapuhelimella. Työn tuloksena saatavaa järjestelmää testataan pilottihankkeissa ja siitä saadaan pohja laadunvarmistuksen jatkokehitykselle.