Psychiatric disorders are a common prognostic marker for worse outcome in patients with idiopathic intracranial hypertension

Objective Idiopathic intracranial hypertension (IIH) is aetiologically unknown disorder that associates with endocrinological disturbances, including dysfunction of hypothalamic-pituitary-adrenal-axis. Neuroendocrinological dysfunctions have also been characterized in psychiatric disorders, and therefore we investigated the presence of psychiatric disorders of patients with IIH in a well-defined cohort. Patients and Methods A total of 51 patients with IIH were included. Patient demographics, symptoms, imaging data, ophthalmological and clinical findings were collected. Results At the time of diagnosis the mean age was 32.5years (SD 10.7), the body mass index was 37.1 kg/m2 (SD 7.4), and the opening pressure 29.1 mmHg (SD 6.2). A total of 88.2% of patients were female and 45.1% were diagnosed with a psychiatric co-morbidity prior to IIH diagnosis. The mean follow-up time was 4.4 years (SD 5.4). The overall treatment outcome was significantly poorer on a group of patients with psychiatric diagnosis when compared to individuals without such history (p = 0.001), but there were no differences in the resolution of papilledema (p = 0.405). Patients with IIH and psychiatric disorders had more often empty sella on their imaging at diagnosis when compared to patients without psychiatric co-morbidity (p = 0.044). Conclusion Psychiatric disorders are highly prevalent in patients with IIH and associate with worse subjective outcomes. These findings advocate for monitoring the mental health of patients with IIH and warrant further multidisciplinary research to understand the potentially underlying psychosocial and neuroendocrinological mechanisms.Peer reviewe

Kerrostalon betonirungon työnjohtaminen

Opinnäytetyössä tarkastellaan Rakennus-Järvi Oy:n toteuttamaa As.oy Salon Helmen 5-kerroksisen kerrostalon betonirungon työnjohtamista sekä siihen liittyviä keskeisiä työtehtäviä. Kohde sijaitsee Salon keskustassa, jonka maanrakennustyöt olivat alkaneet vuoden 2015 maaliskuussa. Opinnäytetyön tavoitteena on kuvata kerrostalon betonirungon rakentamiseen sisältyviä työmaamestarin tehtäviä kaupunkialueella. Näitä ovat mm. tuotannon suunnittelu riittävän varhaisessa vaiheessa ennen tehtävän varsinaista aloittamista. Tämä sisältää jokaiselle tehtävälle erikseen luotavan tehtävä- ja aikataulusuunnitelman sekä niiden valvontaa. Runkotyövaiheeseen liittyy yleensä myös aliurakkana hankittavaa työvoimaa ja materiaalitoimituksia sekä niistä erikseen tehtäviä aliurakkasopimuksia. Aihealueet käydään läpi teoriaosuudessa, johon on kerätty tärkeimmät tiedot viitaten mm. Ratu-kortteihin ja rakennusalan kirjallisuuteen. Kolmannessa osassa kerrotaan aihealueittain työn lopputuloksesta ja luodaan omia johtopäätöksiä teoriasta sekä sen soveltuvuudesta työmaakäytäntöön. Opinnäytetyön viimeisessä osassa pohditaan opiskelijan omaa osaamista ja kehittymistarpeita ja kerrotaan opiskelijan omista kokemuksista työmaalla. Lisäksi mietitään, mihin alueisiin opiskelija kaipaa vielä lisää kokemusta tullakseen paremmaksi työmaamestariksi.The objective of this thesis was the work management in the building of the concrete frame for a 5-storey apartment house as well as the main assignments of the work. Rakennus–Järvi Oy completed As.oy Salon Helmi concrete frame work and the site master's tasks which are related to it. The target is located in the center of Salo and I worked there as the site master since March 2015 from the beginning of the ground work. The objective of this thesis is to describe the site master's tasks in the building of the concrete frame of an apartment house in an urban area. These, among others, will be the planning of the production at an early stage before the actual beginning of building work. This contains a task plan and schedule plan of every task. The site master must also have the needed labor and negotiate material deliveries and subcontract agreements. The subject matters are introduced in the theoretical part of this work. This is followed by an account on how the theory was applied on the site in practice. The third part of the thesis is about the author’s personal expertise and his development needs. The experience is necessary in order to become a better site master

Making water models more inclusive and interdisciplinary to underpin sustainable development

Reliable predictions of water systems’ response to external pressures and ongoing changes arehighly important to ensure informed decision-making to support sustainable water resourcesmanagement for human use and the functioning of healthy ecosystems. Recent strongdevelopment of numerical models offers a potential to understand and forecast water systemsunder anthropogenic and climatic influences to provide information for decision-making, processunderstanding of the ‘unseen’ part of the water cycle and hazard risk analysis. However, thereliability of numerical model predictions is strongly influenced by various sources ofuncertainties, data qualities and assumptions, and often lacks stakeholders' point-of-view. A new,improved approach is needed and in this paper, we present six basic principles to improve thereliability and accuracy of numerical water model predictions considering explicitly stakeholders'needs and, thereby, better serving the society. Six highlighted principles are: (i) clearly defining theobjectives and the purpose of the model, sustaining them during the entire modelling process; (ii)incorporating expert and local community knowledge through stakeholders' feedback; (iii)implementing a multi-model approach in which a range of conceptualizations are explored ; (iv)considering and representing the uncertainties arising from model inputs, parameters, conceptualmodel structure and measurement/information error; (v) translating the results to concrete andunderstandable strategies that policymakers can use for their informed decision-making; and (vi)long term capacity building and monitoring data collection to reduce knowledge gaps, test andimprove predictions. We argue that implementing these six principles reduces uncertainties,improves the predictive capacity of the numerical water models, and ensures informed decision-making to support sustainable water resources management and thereby serve society better

Procedures performed during neurosurgery residency in Europe

International audienceAbstract Background In a previous article ( 10.1007/s00701-019-03888-3 ), preliminary results of a survey, aiming to shed light on the number of surgical procedures performed and assisted during neurosurgery residency in Europe were reported. We here present the final results and extend the analyses. Methods Board-certified neurosurgeons of European Association of Neurosurgical Societies (EANS) member countries were asked to review their residency case logs and participate in a 31-question electronic survey (SurveyMonkey Inc., San Mateo, CA). The responses received between April 25, 2018, and April 25, 2020, were considered. We excluded responses that were incomplete, from non-EANS member countries, or from respondents that have not yet completed their residency. Results Of 430 responses, 168 were considered for analysis after checking in- and exclusion criteria. Survey responders had a mean age of 42.7 ± 8.8 years, and 88.8% were male. Responses mainly came from surgeons employed at university/teaching hospitals (85.1%) in Germany (22.0%), France (12.5%), the United Kingdom (UK; 8.3%), Switzerland (7.7%), and Greece (7.1%). Most responders graduated in the years between 2011 and 2019 (57.7%). Thirty-eight responders (22.6%) graduated before and 130 responders (77.4%) after the European WTD 2003/88/EC came into effect. The mean number of surgical procedures performed independently, supervised or assisted throughout residency was 540 (95% CI 424–657), 482 (95% CI 398–568), and 579 (95% CI 441–717), respectively. Detailed numbers for cranial, spinal, adult, and pediatric subgroups are presented in the article. There was an annual decrease of about 33 cases in total caseload between 1976 and 2019 (coeff. − 33, 95% CI − 62 to − 4, p = 0.025). Variables associated with lesser total caseload during residency were training abroad (1210 vs. 1747, p = 0.083) and female sex by trend (947 vs. 1671, p = 0.111), whereas case numbers were comparable across the EANS countries ( p = 0.443). Conclusion The final results of this survey largely confirm the previously reported numbers. They provide an opportunity for current trainees to compare their own case logs with. Again, we confirm a significant decline in surgical exposure during training between 1976 and 2019. In addition, the current analysis reveals that female sex and training abroad may be variables associated with lesser case numbers during residency