Long-term light-curves of transient X-ray pulsars as a tool to study disk−magnetosphere interaction

X-ray pulsars are highly magnetized neutron stars in close binary systems accreting matter from a normal companion star. Their strong magnetic fields channel the accreting matter onto the magnetic poles of the neutron star, releasing an enormous amount of energy in the form of X-rays. If the matter accreted from the stellar companion carries a large amount of angular momentum, it will generally form an accretion disk around the neutron star. The strong magnetic field of the neutron star will effectively truncate the accretion disk at the magnetospheric radius, which defines the space around the X-ray pulsar known as the magnetosphere. The observed behavior of the X-ray pulsar will depend on several factors, including the rate at which mass is being accreted. At low mass accretion rates, the magnetosphere will be able to extend further out, and if the mass accretion rate drops below some critical value, accreting matter will be stopped by the centrifugal barrier created by the neutron star’s rapidly spinning magnetosphere. This is known as the propeller effect, because matter is basically flung out by the rapidly spinning magnetosphere. The propeller effect is generally used to explain the declining phases of the outbursts of transient X-ray pulsars into quiescence. Another phenomenon recently proposed for transient X-ray pulsars is the possibility of accretion from a cold accretion disk at low mass accretion rates. This is caused by a thermal-viscous instability developing in the accretion disk and is commonly invoked to explain the characteristic outbursts of dwarf novae, where the theory is encapsulated in the disk instability model (DIM). During the decay of dwarf nova outbursts, a propagating cooling front will appear in the accretion disk, and when this front reaches the inner disk radius, the entire disk will be in a cold state of neutral hydrogen. In this thesis, the data from observations made by the Swift observatory have been analyzed with the intent to test the possibility of the appearance of a propagating cooling front during the decaying phases of the outbursts of transient X-ray pulsars. The light-curves of three sources (SMC X-2, 4U 0115+63, V 0332+53) were fitted with a smoothed spline representing the observed behavior, which was subsequently compared to the modeled luminosity decay caused by the propagation of a cooling front. The result of the analysis is that by modeling the expected behavior of a cooling front propagating through the accretion disk, the luminosity decay of these transient X-ray pulsar’s outbursts can be well explained without the need to invoke the propeller effect. Additionally, the obtained αcold values are consistent with the values commonly used in the DIM

What is the Added Value of Web-based Learning and Teaching? The Case of Tampere University of Technology

In: A.J. Kallenberg and M.J.J.M. van de Ven (Eds), 2002, The New Educational Benefits of ICT in Higher Education: Proceedings. Rotterdam: Erasmus Plus BV, OECR ISBN 90-9016127-9The purpose of this paper is to describe added value in web-based learning. The question is how contexts and situations influence added value and what university students think of it. The added value in a given learning context should not be generalized to all contexts

Staphylococcus aureus bakteriemi - en av de mest allvarliga och allt oftare förekommande blododlingspositiva infektionerna

English summar

Kokemuksia Suomen ja Kreikan päivähoidosta

Opinnäytteessä verrataan Suomen ja Kreikan päivähoitoa. Työn tarkoituksena on johdattaa lukija kahden erilaisen maan päivähoitoon ja niiden moninaisuuteen. Työ on kolmiosainen ja se sisältää teorian, havainnot ja pohdinnan. Havainnot ja liitteenä olevat päiväkirjat toimivat työn kulmakivinä. Opinnäyte rakentuu havaintojen pohjalta, joissa vertaillaan kahden eri maan kasvatuskäytäntöjä kokemusten kautta. Näin ollen jokainen voi omalla kohdallaan pohtia mitkä käytännöt olisivat toimivia omassa työssä lasten parissa. Työ ei pyri kertomaan kaikkea Suomen eikä Kreikan päivähoidosta, vaan tarkoitus on tuoda häivähdys molempien maiden ominaista tapaa toimia. Työ sisältää avainsanojen lisäksi kaksi erillistä päiväkirjaa. Nämä päiväkirjat johdattavat lukijan syvemmälle kirjoittajan ajatuksiin. Työn tarkoituksena on olla lukijalleen innostava esimerkki siitä, kuinka eri tavalla asioita voidaan hoitaa lapsen etua ajatellen. Ammattikorkeakoulun opiskelijalle työ avaa näkökulman toiseen maailmaan ja tapaan hoitaa asioita sosiaalialalla. Opinnäytetyö ei pyri saavuttamaan tuloksia tai kehittämään uutta vanhan käytännön tilalle. Työn tehtävänä on kertoa päivähoidon toiminnasta sellaisena kuin ne on havaittu arkisten tilanteiden ja toiminnan seuraamisen kautta. Kokemukset ja havainnot ovat kahden ihmisen henkilökohtaisia ja yhteen sovittamia näkökulmia päivähoidosta. Näin ollen kokemukset ovat todellisia, eikä niitä voida käyttää muuhun tarkoitukseen irrallaan tästä työstä.In this study the Finnish and the Greek daycare system were compared. The aim of the study was to introduce the difference of the daycare systems in these two countries. The study is divided into three parts, including the theory, observation and conclusion. Observation and the diary that is attached are the basis of the work. The study is based on the observations of the two different countries and their ways of upbringing. The objective of this study was not to describe everything of the day care system in Finland and Greece but to give an idea of the practice of both countries. The work includes the keywords and two separate diaries. These diaries lead the reader deeper into the thoughts of the writer. The function of the work is to be an inspiring ex-ample of the different ways things can be done and still have the best interest of the child in mind. For the college student this study expands the understanding of another way of handling things in social services. This study does not aim to achieve results or develop a new practice to replace the old one. However, the aim was to explain the function of the daycare system by observing everyday activities and common situations. The experience and the observations are both from personal viewpoints and mutual discussions of two persons. Therefore the experience is real and it is not to be used for other purposes than this work

Prognostic impact of hyperglycemia at onset of methicillin-sensitive Staphylococcus aureus bacteraemia

Previous reports have associated hyperglycemia to poor outcome among aged and comorbid Staphylococcus aureus bacteraemia (SAB) patients. However, the prognostic impact of hyperglycemia in SAB irrespective of age and underlying conditions including a diagnosis of diabetes has received little attention. The objective here was to evaluate the prognostic relevance of hyperglycemia at onset of methicillin-sensitive SAB (MS-SAB). It was a retrospective study of MS-SAB patients. Blood glucose was measured within 24 h of positive blood cultures. The patient cohort was analyzed en bloc and by categorization according to age, underlying conditions and a diagnosis of diabetes. Altogether 161 patients were identified. High initial blood glucose levels were observed among diabetics (p <0.001), patients with deep infections (p <0.05) and poor outcome at 28- or 90-days (p <0.05). Receiver operating characteristics presented the glucose cut-off level of 7.2 mmol/L as a significant predictor of mortality with an area under the curve of 0.63 (95% CI 0.52-0.75, p <0.05). Blood glucose ae7.2 mmol/L connected to higher 28- (9 vs. 20%, p <0.05) and 90-day (14 vs. 29%, p <0.01) mortality. In Cox proportional hazard regression the blood glucose cut-off value of 7.2 mmol/L significantly predicted 90-day mortality (HR, 2.12; 95% CI, 1.01-4.46; p <0.05). Among young and healthy non-diabetics the negative prognostic impact of high glucose was further accentuated (HR 7.46, p <0.05). High glucose levels had no prognostic impact among diabetics. Hyperglycemia at SAB onset may associate to poor outcome. The negative prognostic impact is accentuated among young and healthy non-diabetics.Peer reviewe

Formal Infectious Diseases Specialist Consultation Improves Long-term Outcome of Methicillin-Sensitive Staphylococcus aureus Bacteremia

Staphylococcus aureus on bakteeri, joka voi aiheuttaa vakavia bakteremioita. Tutkimuksen tarkoituksena oli selvittää, parantaako infektiotautien erikoislääkärin kirjallinen konsultaatio potilaan pitkän aikavälin ennustetta metisilliinille herkän Staphylococcus aureuksen (MS-SA) aiheuttamassa bakteremiassa verrattuna infektiolääkärin puhelinkonsultaatioon tai konsultaation puutteeseen. Aiemmin on osoitettu, että infektiolääkärin kirjallinen konsultaatio parantaa potilaan lyhyen aikavälin ennustetta, mutta pidemmän aikavälin seurantatutkimuksia tästä ei ole saatavilla. Tutkimuksessa seurattiin 10 vuoden ajan sairaskertomuksista ja väestörekisteristä HUS-alueen potilaita vuosilta 1999-2002 ja 2006-2007, jotka olivat sairastaneet MS-SA -bakteremian. Potilaita oli yhteensä 440. Potilaat, jotka kuolivat ensimmäisen 90 päivän aikana (73) poissuljettiin, jotta tapaukset eivät sekoittaisi pitkän aikavälin tuloksia. Infektio hoidettiin infektiolääkärin kirjallisen konsultaation ohjein 304 potilaalla (83%) ja epävirallisella konsultaatiolla tai ilman konsultaatiota 63 potilaalla (17%). Potilaille, jotka saivat infektiolääkärin kirjallisen konsultaation, tehtiin muun muassa enemmän radiologisia tutkimuksia ja heidän infektiotaan hoidettiin useammin kapeakirjoisella penisilliinillä sekä rifampisiinilla ja harvemmin kefalosporiineilla, vankomysiinillä, klindamysiinillä ja karbapeneemeillä verrattuna kontrolliryhmään. Tutkimuksessa selvisi, että infektiolääkärin kirjallinen konsultaatio paransi potilaan ennustetta vielä 1, 3 ja 10 vuoden kohdalla verrattuna epäviralliseen konsultaatioon tai ilman konsultaatiota hoidettuihin potilaisiin. 1 ja 3 vuoden kohdalla kirjallisen konsultaation saaneilla potilailla riski menehtyä oli 4-5 kertaa pienempi ja 10 vuoden kohdalla riski oli 2 kertaa pienempi kuin verrokeilla. Kirjallinen konsultaatio vähensi myös uuden bakteremian riskiä 10 vuoden seurantajakson aikana: 1 ja 3 vuoden kohdalla riski oli 3 kertaa pienempi ja 10 vuoden kohdalla 2 kertaa pienempi kuin verrokeilla

Formal Infectious Diseases Specialist Consultation Improves Long-term Outcome of Methicillin-Sensitive Staphylococcus aureus Bacteremia

Staphylococcus aureus on bakteeri, joka voi aiheuttaa vakavia bakteremioita. Tutkimuksen tarkoituksena oli selvittää, parantaako infektiotautien erikoislääkärin kirjallinen konsultaatio potilaan pitkän aikavälin ennustetta metisilliinille herkän Staphylococcus aureuksen (MS-SA) aiheuttamassa bakteremiassa verrattuna infektiolääkärin puhelinkonsultaatioon tai konsultaation puutteeseen. Aiemmin on osoitettu, että infektiolääkärin kirjallinen konsultaatio parantaa potilaan lyhyen aikavälin ennustetta, mutta pidemmän aikavälin seurantatutkimuksia tästä ei ole saatavilla. Tutkimuksessa seurattiin 10 vuoden ajan sairaskertomuksista ja väestörekisteristä HUS-alueen potilaita vuosilta 1999-2002 ja 2006-2007, jotka olivat sairastaneet MS-SA -bakteremian. Potilaita oli yhteensä 440. Potilaat, jotka kuolivat ensimmäisen 90 päivän aikana (73) poissuljettiin, jotta tapaukset eivät sekoittaisi pitkän aikavälin tuloksia. Infektio hoidettiin infektiolääkärin kirjallisen konsultaation ohjein 304 potilaalla (83%) ja epävirallisella konsultaatiolla tai ilman konsultaatiota 63 potilaalla (17%). Potilaille, jotka saivat infektiolääkärin kirjallisen konsultaation, tehtiin muun muassa enemmän radiologisia tutkimuksia ja heidän infektiotaan hoidettiin useammin kapeakirjoisella penisilliinillä sekä rifampisiinilla ja harvemmin kefalosporiineilla, vankomysiinillä, klindamysiinillä ja karbapeneemeillä verrattuna kontrolliryhmään. Tutkimuksessa selvisi, että infektiolääkärin kirjallinen konsultaatio paransi potilaan ennustetta vielä 1, 3 ja 10 vuoden kohdalla verrattuna epäviralliseen konsultaatioon tai ilman konsultaatiota hoidettuihin potilaisiin. 1 ja 3 vuoden kohdalla kirjallisen konsultaation saaneilla potilailla riski menehtyä oli 4-5 kertaa pienempi ja 10 vuoden kohdalla riski oli 2 kertaa pienempi kuin verrokeilla. Kirjallinen konsultaatio vähensi myös uuden bakteremian riskiä 10 vuoden seurantajakson aikana: 1 ja 3 vuoden kohdalla riski oli 3 kertaa pienempi ja 10 vuoden kohdalla 2 kertaa pienempi kuin verrokeilla

Infectious diseases specialist consultation in Staphylococcus lugdunensis bacteremia

Publisher Copyright: Copyright: © 2021 Forsblom et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background Commensal coagulase negative Staphylococcus lugdunensis may cause severe bacteremia (SLB) and complications. Treatment of SLB is not fully established and we wanted to evaluate if infectious diseases specialist consultation (IDSC) would improve management and prognosis. Methods Multicenter retrospective study of SLB patients followed for 1 year. Patients were stratified according to bedside (formal), telephone (informal) or lack of IDSC within 7 days of SLB diagnosis. Results Altogether, 104 SLB patients were identified: 24% received formal bedside and 52% informal telephone IDSC whereas 24% were managed without any IDSC. No differences in demographics, underlying conditions or severity of illness were observed between the groups. Patients with bedside IDSC, compared to telephone IDSC or lack of IDSC, had transthoracic echocardiography more often performed (odds ratio [OR] 4.00; 95% confidence interval [CI] 1.31–12.2; p = 0.012) and (OR 16.0; 95% CI, 4.00–63.9; P<0.001). Bedside IDSC was associated with more deep infections diagnosed compared to telephone IDSC (OR, 7.44; 95% CI, 2.58–21.4; p<0.001) or lack of IDSC (OR, 9.56; 95% CI, 2.43–37.7; p = 0.001). The overall mortality was 7%, 10% and 17% at 28 days, 90 days and 1 year, respectively. Considering all prognostic parameters, patients with IDSC, compared to lack of IDSC, had lower 90 days and 1 year mortality (OR, 0.11; 95% CI, 0.02–0.51; p = 0.005) and (OR, 0.22; 95% CI, 0.07–0.67; p = 0.007). Conclusion IDSC may improve management and outcome of Staphylococcus lugdunensis bacteremia.Peer reviewe

Adherence to special diets and its association with meeting the nutrient recommendations in individuals with type 1 diabetes

Not much is known about adherence to special diets in type 1 diabetes, characteristics of individuals with special diets, and whether such practices should raise concerns with respect to meeting the dietary recommendations. In this study, we assessed the frequencies of adherence to special diets, in a population of individuals with type 1 diabetes, and investigated the association between special diet adherence and dietary intake, measured as dietary patterns and nutrient intakes. During the Finnish Diabetic Nephropathy Study visit, participants with type 1 diabetes (n = 1429) were instructed to complete a diet questionnaire inquiring about the adherence to special diets. The participants also completed a food record, from which energy and nutrient intakes were calculated. In all, 36.6% participants reported adhering to some special diet. Most commonly reported special diets were lactose-free (17.1%), protein restriction (10.0%), vegetarian (7.0%), and gluten-free (5.6%) diet. Special diet adherents were more frequently women, older, had longer diabetes duration, and more frequently had various diabetes complications. Mean carbohydrate intakes were close to the lower levels of the recommendation in all diet groups, which was reflected in low mean fibre intakes but high frequencies of meeting the sucrose recommendations. The recommendation for saturated fatty acid intake was frequently unmet, with the highest frequencies observed in vegetarians. Of the micronutrients, vitamin D, folate, and iron recommendations were most frequently unmet, with some differences between the diet groups. Special diets are frequently followed by individuals with type 1 diabetes. The adherents are more frequently women, and have longer diabetes duration and more diabetes complications. Achieving the dietary recommendations differed between diets, and depended on the nutrient in question. Overall, intakes of fibre, vitamin D, folate, and iron fell short of the recommendations.Peer reviewe

Microbiological Etiology and Treatment of Complicated Skin and Skin Structure Infections in Diabetic and Nondiabetic Patients in a Population-Based Study

Background. Diabetes is a major risk factor for skin and skin structure infection (SSSI), and the global burden of diabetics with SSSI is enormous. The more complex microbiology of diabetic foot infection (DFI) is well established, but it is not known whether microbiological etiology differs between diabetics and nondiabetics in other disease entities under the umbrella of complicated SSSI (cSSSI). Methods. This retrospective, population-based study included patients with cSSSI, and it was conducted in 2 Nordic cities with a low prevalence of antimicrobial resistance. In analyses, patients (N = 460) were separated into 3 groups: diabetics (n = 119), nondiabetics (n = 271), and patients with DFI (n = 70). Results. After exclusion of patients with DFI, there was no difference in the microbiological etiology or initial antimicrobial treatment of cSSSI between diabetics and nondiabetics. Gram-positive bacteria encountered 70% of isolations in diabetics and 69% in nondiabetics, and the empirical treatment covered initial pathogens in 81% and 86% of patients, respectively. However, diabetes was the only background characteristic in the propensity score-adjusted analysis associated with broad-spectrum antimicrobial use and longer antibiotic treatment duration. Patients with DFI had Gram-negative and polymicrobial infection more often than nondiabetics. Conclusions. These observations suggest that diabetics without DFI are not different in the causative agents of cSSSI, although they are more exposed to antimicrobial therapy of inappropriate extended spectrum and long duration. Broad-spectrum coverage was clearly needed only in DFI. A clear opportunity for antimicrobial stewardship was detected in the rapidly growing population of diabetic patients with cSSSI.Peer reviewe