Assessment of neuroleptic-induced movement disorders in a naturalistic schizophrenia population

The prevalence and assessment of neuroleptic-induced movement disorders (NIMDs) in a naturalistic schizophrenia population that uses conventional neuroleptics were studied. We recruited 99 chronic schizophrenic institutionalized adult patients from a state nursing home in central Estonia. The total prevalence of NIMDs according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) was 61.6%, and 22.2% had more than one NIMD. We explored the reliability and validity of different instruments for measuring these disorders. First, we compared DSM-IV with the established observer rating scales of Barnes Akathisia Rating Scale (BARS), Simpson-Angus Scale (SAS) (for neuroleptic-induced parkinsonism, NIP) and Abnormal Involuntary Movement Scale (AIMS) (for tardive dyskinesia), all three of which have been used for diagnosing NIMD. We found a good overlap of cases for neuroleptic-induced akathisia (NIA) and tardive dyskinesia (TD) but somewhat poorer overlap for NIP, for which we suggest raising the commonly used threshold value of 0.3 to 0.65. Second, we compared the established observer rating scales with an objective motor measurement, namely controlled rest lower limb activity measured by actometry. Actometry supported the validity of BARS and SAS, but it could not be used alone in this naturalistic population with several co-existing NIMDs. It could not differentiate the disorders from each other. Quantitative actometry may be useful in measuring changes in NIA and NIP severity, in situations where the diagnosis has been made using another method. Third, after the relative failure of quantitative actometry to show diagnostic power in a naturalistic population, we explored descriptive ways of analysing actometric data, and demonstrated diagnostic power pooled NIA and pseudoakathisia (PsA) in our population. A subjective question concerning movement problems was able to discriminate NIA patients from all other subjects. Answers to this question were not selective for other NIMDs. Chronic schizophrenia populations are common worldwide, NIMD affected two-thirds of our study population. Prevention, diagnosis and treatment of NIMDs warrant more attention, especially in countries where typical antipsychotics are frequently used. Our study supported the validity and reliability of DSM-IV diagnostic criteria for NIMD in comparison with established rating scales and actometry. SAS can be used with minor modifications for screening purposes. Controlled rest lower limb actometry was not diagnostically specific in our naturalistic population with several co-morbid NIMDs, but it may be sensitive in measuring changes in NIMDs.Väitoskirjatyö "Assessment of neuroleptic-induced movement disorders in a naturalistic schizophrenia population" osoittaa, että kroonista skitsofreniaa sairastavilla, vanhoja psykoosilääkkeitä saavilla potilailla on runsaasti liikehäirioitä ja usein useampi liikehäiriö samanaikasesti. Tutkimus vertaili ja arvioi eri mittauskeinojen käyttökelpoisuutta vanhojen psykoosilääkkeiden aiheuttamien neurologisten haittavaikutusten arvioinnissa. Psykoosien lääkehoidon ensimmäistä kehitysvaihetta edustavat, 1950-luvulla käyttöön tulleet tavanomaiset psykoosilääkkeet ovat tehokkaita psykoosin ns. positiivisen oireisiin, mutta niiden käyttöä ovat rajoittaneet erilaiset haittavaikutukset. Keskeisimpiä näistä ovat mm. pakkoliikkeinä, vapinana ja jäykkyytenä ilmenevät neurologiset oireet, jotka esiintyessään heikentävät potilaan hoitomyöntyvyyttä, mikä vaarantaa pitkällä aikavälillä hoidon toteutumisen. Tästä johtuen kahden viimeisen vuosikymmenen aikana on pyritty kehittämään tehokkaampia ja paremmin siedettyjä psykoosilääkkeitä, joiden käyttömahdollisuudet kuitenkin vaihtelevat maasta toisen niiden korkeasta hinnasta johtuen. Tutkimus toteutettiin poikkileikkaustutkimuksena Viron suurimmassa psykiatrisessa hoitokodissa. Tutkimuksen osallistuneet 99 potilasta olivat keski-ikäisiä, pitkään skitsofrenian takia hoidettavina olleita potilaita, joista noin 80 prosenttia käytti vanhoja/ tavanomaisia psykoosilääkkeitä. Heistä noin 60 prosentilla oli todettavissa jokin neurologinen haittaoire, jonka esiintyvyyttä ja haittaavuutta arviointiin eri arviointimenetelmin sekä uutta tekniikkaa edustavalla aktometrialla. Tutkimuksessa käytettiin haastatteluun ja havainnointiin perustuvina mittausmenetelminä nykyiseen diagnostiseen järjestelmään perustuvaa liikehäiriöiden arvioitia, Barnesin akatisia-astekkoa (BARS), Simpson-Angusin parkinsonismiastekkoa (SAS) ja tardiivin dyskinesian arvioimiseksi epänormaalien tahattomien liikkeiden asteikkoa (AIMS). Aktometria osoittautui arviointiastekkojen rinnalla hyödylliseksi lisäarviointimenetelmäksi, joka ei kuitenkaan yksinään osoittautunut riittäväksi em. liikehäiriöiden alamuotojen erotusdiagnostiikassa

Software Infrastructure and Course Design of a Robotics Course

Käesolev töö käsitleb robootika kursuse disaini ja arenduse protsessi. Käsitletav kursus on Tartu Ülikoolis üheks võimalikuks lähtepunktiks robootika valdkonda sisenemiseks. Disaini protsessis on kasutatud elemente tegevusuuringu ülesehitusest ning DevOps nime kandvast süsteemiarenduse kultuurist. Mõlemale praktikale omane tsükliline paranduste tegemine harmoniseerub hästi tänapäevase robootika kursuse jaoks vajaliku kiire arenguga. Taristu kui kood (infrastructure as code), versioonihaldussüsteemid ja püüd rakendada pideva integratsiooni (continuous integration) põhimõtteid - on kõik osa kursuse arengust. Robootika kursus on teemaks oleva kahe toimumiskorra jooksul aidanud arendada enam kui saja tudengi teadmisi mõningatest tänapäevases robootikas kasutatavatest töövahenditest ja tehnoloogiatest. Töös kajastatud kursuse arendusprotsess on toetanud robootikaalaste teadmistega tudengite ning nende juhendajate järelkasvu, mis loob aluse keerukamate kursuste arendamiseks ja kasvatab tehnoloogiainstituudi - ning ülikooli üldisemalt - võimekust olla koostööpartner robootika valdkonnas. Autor kandis vastutava õppejõu rolli, juhtides kursuse arendust, uute tehnoloogiate kasutamist ning juurutamist. Töö eesmärk on olla läbitud arengu, tehtud valikute, ning nende põhjenduste süstematiseeritud dokumentatsioon.This thesis covers the design and development process of a robotics course. The course in question serves as an entry point into the field of robotics in the University of Tartu. The design of the thesis draws on the ideas of educational action research and the infrastructure of the course on the software development and information technology operations practices (DevOps). Cycles of improvements, which are core to both of these practices, are in tune with the rapid evolution required of a modern robotics course.Infrastructure as code, version control systems, and incentive towards continuous integration are all used in the development process. The two runs of the course covered by the thesis have advanced the knowledge of more than a hundred students in some of the modern tools and technologies used in robotics. Altogether, the development of the course has helped to reinforce the line-up of students and instructors available for projects andmore advanced courses in the Institute of Technology and the university as a whole. The author, being the lecturer in charge leading the development the course and also pushing for the use of new technology and maintaining chosen solutions. The thesis serves as an organised documentation on the evolution process and reasoning for the choices made

Regional Development Sustainability Analysis Consept

Problems associated with the qualitative analysis and quantitative measurement of sustainability, and opportunities for connecting the concept with the methodological basis of development assessment and the essence of the subject that values sustainability are dealed. The goal of article is to work out the basics for analysis of the regional development in a country in terms and framework of sustainability concept. The article starts by outlining the definition of sustainability, which is followed by an analysis of the nature of sustainability. The third subsection highlights the demands of the decision-making process in guaranteeing sustainability and then considers sustainability in a competitive environment. In the second part of article the sustainable development conception is implemented in regional development sustainability analysis

Secure and Efficient Mix-Nets

Mix-net on süsteem, mis võimaldab saavutada anonüümsuse arvutite vahelises suhtluses. Mix-net võtab sisendiks kasutajate krüptogrammid ja väljastab krüptogrammid juhuslikult segatud järjekorras. Mix-net'id võimaldavad turvalise e-valimise ning paljude teiste anonüümsust vajavate rakenduste konstrueerimist. Mix-net'ide ehitamisel on oluline võimalus veenduda, et segamine toimuks korrektselt. Samas ei saa mix-net avaldada, kuidas segamine toimus, kuna sellega kaoks anonüümsus. Võimalik lahendus sellele probleemile on nullteadmusprotokolli kasutamine.\n\r\n\rAntud magistritöös uuritakse J. Furukawa 2005. aastal välja pakutud nullteadmusprotokolli krüptogrammide segamise jaoks. Esiteks antakse detailne ja kergemini loetav kirjeldus Furukawa segamise ja segamis-dekrüpteerimise nullteadmusprotokollidest. Lisaks pakutakse välja kaks uut permutatsioonimaatriksi kirjeldust ning kaks lihtsat muudatust segamise protokollile, mis aitavad vähendada ajalist keerukust.Mix-net is a system that can provide anonymity in a computer network. Mix-net takes as an input user's ciphertexts and outputs them in a shuffled order. Secure e-voting and variety of other applications can be built on top of mix-net architecture.\n\r\n\rMajor challenge of constructing mix-nets lies in efficiently proving that shuffling was done correctly. Mix-net cannot reveal the permutation because that would break the anonymity. One solution is to provide a zero-knowledge proof.\n\r\n\rThis thesis studies a zero-knowledge shuffle argument proposed by J. Furukawa in 2005.\n\r\n\rFirstly, we provide a more detailed and easily readable description of the shuffle and shuffle-decryption zero-knowledge protocols than in the original paper. Secondly, we provide two new characterizations of a permutation matrix and two simple modifications of\n\rthe shuffle protocol that reduce the computational complexity

Kolmekuulise jõutreeningu programmi ja poolmaratoni jooksmise mõju arterite jäikusele ning vere biomarkeritele hästitreenitud meessportlastel

Väitekirja elektrooniline versioon ei sisalda publikatsiooneArterite jäikus iseloomustab arterite laienemisvõimet vererõhu mõjul. Arterite jäikuse suurenemise korral suureneb ka südame vasaku vatsakese koormus, mis põhjustab selle ülemäärast hüpertroofiat. Varasemad uuringud on näidanud, et kehalisel aktiivsusel on arterite jäikusele soodne mõju. Paraku enamus neist uuringuist on teostatud treenimata, ülekaalulistel või kõrge vererõhuga isikutel, rakendades kerge kuni mõõduka intensiivsusega aeroobseid koormusi. Tippsportlaste kehalised koormused on väga suured, ületades oluliselt kehalise aktiivsuse üldisi soovitusi. Selle kohta, kuidas mõjub arterite jäikusele jõutreening, on vähe andmeid. Samas on jõualade sportlastel võrreldes vastupidavusalade esindajatega täheldatud sagedamini kõrgvererõhktõbe ja südame ülemäärast hüpertroofiat. Aeroobsetel koormustel on südame-vereringesüsteemile üldiselt soodne toime. Teisalt on teada, et vastupidavusaladel võib võistluste ajal pingutuse intensiivsus olla väga kõrge, ületades anaeroobse läve. Selline olukord esineb näiteks poolmaratoni jooksuvõistlustel. Seega on õigustatud küsimus, kas korduvad jõutreeningule omased intensiivsed koormused või ühekordne tugev vastupidavuslik pingutus võistlustel ning sellele järgnev puudulik taastumine võivad suurendada sportlaste kardiovaskulaarse riski taset, sealhulgas mõjudes negatiivselt arterite jäikusele. Arterite seisundit võivad mõjutada ka koormusest tingitud põletikulised protsessid ning oksüdatiivse stressi taseme tõus. Käesoleva doktoritöö raames uurisime erineva suunitluse ja kestusega kehaliste koormuste mõju arterite jäikusele ning selle seoseid vere biomarkeritega hästitreenitud meessportlastel. Leidsime, et kolmekuuline jõutreening alandas oluliselt jõutõstjate perifeerset ja tsentraalset süstoolset vererõhku, samas arterite jäikus ei muutunud. Esiletõstmist väärib tõsiasi, et uuritavatel rakendatud juhendatud jõutreeninguprogramm mõjutas soodsalt südame vasaku ja parema vatsakese funktsiooni ning HDL-kolesterooli taset vereseerumis. Sellel osal uuritavatest, kellel oli suhteliselt kõrgem oksüdatiivse stressi tase, ilmnes väikese ulatusega negatiivne muutus arterite jäikuses. Ühekordne poolmaratoni jooksuvõistluse läbimine erineva treenitusega jooksjatel arterite jäikusele olulist mõju ei avaldanud. Võistlusjärgsel taastumisperioodil seondus mõningane arterite jäikuse halvenemine kõrgema treenituse taseme ja võistlusdistantsi läbimise lühema ajaga.Arterial stiffness characterizes the ability of the arteries to dilate under the influence of blood pressure. In case of stiffed arteries, the chronically increased load on the heart may lead to excessive ventricular hypertrophy. Previous studies have shown beneficial effect of exercise on arterial stiffness. However, most of these studies have been performed in untrained, obese or hypertensive subjects involved in low to moderate intensity aerobic exercise training. On the other hand, training loads in well-trained athletes are usually much higher, far exceeding the generally recommended physical activity level. Furthermore, there is lack of data on the effect of strength training on arterial stiffness in competitive powerlifting athletes. At the same time, an increased prevalence of hypertension and myocardial hypertrophy has been reported in strength-trained athletes compared to endurance athletes. Generally, aerobic endurance exercise has a beneficial effect on the cardiovascular system. Nevertheless, the intensity of acute physical load during competition in well-trained endurance athletes is very high, exceeding the anaerobic threshold. Such an intensive exertion is characteristic of a competitive half-marathon race, for example. Therefore, an important question arises: whether an intense strength training program or a competitive half-marathon race followed by an incomplete recovery will cause adverse effects on the cardiovascular system, including increased arterial stiffness. In addition, the inflammatory response and oxidative stress induced by intense exercise may contribute to adverse changes in arterial stiffness. In the framework of this doctoral thesis we evaluated the effects of 12-week supervised strength training and a competitive half-marathon race on arterial stiffness and related cardiovascular risk markers. Our results reveal that the 12-week pre-season strength training program had a beneficial effect on the brachial and central systolic blood pressure in male elite powerlifters and it also improved their left and right ventricular function. Strength training did not affect arterial stiffness in our athletes. Similarly, a half-marathon race had no significant influence on arterial stiffness in competitive and recreational male athletes during the post-competition recovery period. Nevertheless, regression analysis revealed that relatively higher training status and faster finish time correlated with relatively higher oxidative stress level and unfavourable shifts in arterial stiffness.https://www.ester.ee/record=b550873

Attractiveness of Central and Eastern European Countries for Foreign Direct Investment in the Context of European Integration: The Case of Estonia

Foreign direct investment (FDI) flows in the world have increased rapidly during the last decade. Most of the FDI inflows are targeted to developed countries (78% in 1999, about fifth of the flows are going to developing countries and Central and Eastern European transition countries are the host countries for only 2% of the world FDI. The necessity of foreign investments in the transition countries is the result of industrial restructuring in post-socialist Eastern Europe and the Baltic countries. New markets, lower production costs and higher profit rates have been the main motivators in investing to the transition countries. Privatization programs of some of these countries have also facilitated foreign direct investments. Lankes and Venables (1996) and Lankes and Stern (1998) have noted that previous studies have shown predominance of market seeking investors in Central and Eastern European countries and factor cost considerations appeared to be of less importance for the majority of investments. A study by Meyer (1995) showed also that local market of Central and Eastern European countries is the primary motive in making foreign direct investments and factor costs played only a secondary role in investing to those markets at the beginning of the transition process. Several other studies (for example Barrell et al. 1999; Borsos-Torstila 1998; Éltetö 1999, Garibaldi et al. 1999; Guimaraes et al. 1997; Holland et al. 1998a, 1998b; Wang et al. 1995; Ziacik 2000 have also shown the significance of the determinants that are important for these types of investors in explaining the foreign investments’ flows into the transition countries. Two other types of foreign investors are not so important due to the relative lack of natural resources and strategic assets in Central and Eastern European transition countries. However, it has to be considered that there are quite big differences in the shares of different types of foreign investors between countries and sectors. A number of Central and Eastern European transition countries are in the middle of process of integration to the European Union now. Economic integration has impact on the movement of the foreign direct investment. The main aim of this paper is to find out the possible changes in attractiveness of investment climate of the Central and Eastern European transition countries in the context of European integration. Taking into account this aim, paper is divided into four parts: * At first, theoretical foundations of foreign direct investments movements and results of the previous empirical research are presented. * Then, theoretical foundations of the impact of regional integration on foreign direct investment flows is discussed. * After this, determinants of FDI inflows in Central and Eastern European countries and in Estonia are analyzed by using generalized component, regression and multinominal logistic analysis, * Finally potential changes in attractiveness of the Central and Eastern European transition countries are discussed and some economic-political recommendations for the governments are presented. REFERENCES: 1. Barrell, R., Pain, N. Trade Restraints and Japanese Direct Investment Flows. - European Economic Review, 1999, Vol. 43, pp. 29-45. 2. Borsos-Torstila, J. Determinants of Foreign Direct Investment Operations of Finnish Multinational Companies in Transition Economies in 1990-1995. Helsinki, 1998, 180 p. 3. Ëltetö, A. The Impact of FDI on the Foreign Trade of Central European Countries. – Materials of the workshop "Impact of Foreign Direct Investment on the International Competitiveness of CEEC Manufacturing and EU Enlargement", Budapest, November 19-20, 1999, 23 p. 4. Garibaldi, P., Mora, N., Sahay, R., Zettelmeyer, J. What Moves Capital to Transition Economies? – Materials of the IMF Conference "A Decade of Transition: Achievements and Challenges", February, 1999, 49 p. 5. Guimaraes, P., Rolfe, R.J., Doupnik, T., Woodward, D.P. The Locational Determinants of Foreign Direct Investment in Central Europe. – SSRN Journal, 1997, July, 17 p. 6. Holland, D., Pain, N. The Determinants and Impact of Foreign Direct Investment in the Transition Economies: A Panel Data Analysis. – Materials of the conference “Convergence or Divergence: Aspirations and Reality in Central and Eastern Europe and Russia” Buckinghamshire, 1998a, pp. 300-325. 7. Holland D., Pain, N. The Diffusion of Innovations in Central and Eastern Europe: A Study of the Determinants and Impact of Foreign Direct Investment. – Materials of the conference “Convergence or Divergence: Aspirations and Reality in Central and Eastern Europe and Russia”, Buckinghamshire, 1998b, 49 p. 8. Lankes, H.-P., Stern, N. Capital Flows to Eastern Europe and the Former Soviet Union. – EBRD Working Paper, 1998, No. 27, 31 p. 9. Lankes, H.-P., Venables, A.J. Foreign Direct Investment in Economic Transition: The Changing Pattern of Investments. – Economies of Transition, 1996, Vol. 4, No. 2 pp. 331-347. 10. Meyer, K. Direct Foreign Investment in Eastern Europe: The Role of Labor Costs. - Comparative Economic Studies, 1995, Vol. 37, No. 4, pp. 69-88 (cited by http://www.ebscohost.com pp. 1-16). 11. Wang, Z.Q., Swain, N.J. The Determinants of Foreign Direct Investment in Transforming Economies: Empirical Evidence from Hungary and China. – Weltwirtschaftlisches Archiv, 1995, Band 131, pp. 359-382. 12. Ziacik, T. An Assessment of the Estonian Investment Climate: Results of a Survey of Foreign Investors and Policy Implications. – BOFIT Discussion Papers, 2000, No. 3, 52 p.

Local Fiscal Equalization in Estonia: Is a Reform Necessary?

Estonian municipalities should perform a broad range of functions, while their fiscal resources are often limited and large disparities in fiscal capacity prevail among them. Moreover, the power to regulate fiscal affairs is mostly in the hands of the central government. We discuss how a strict application of the connexity principle can protect municipalities from the fiscal bottleneck. We also recommend the introduction of the principle of parallelism and investigate its effects on the unconditional, down-flow grant system in Estonia. In particular the procedure of determining the total sum of block grants appears to be changed.fiscal equalization, municipal finance, connexity, principles of parallelism, Estonia

The role of the nordic dimension for foreign trade relations of baltic states

Baltic Sea Region (BRS) can be seen as one good example of an attempt to integrate countries with different development levels. In the long run the Baltic Sea could be seen as the internal sea of European Union. However, as different are the development stages of BRS countries, different is their co-operation experience with European Union (EU). Foreign trade can be seen as one possibility for facilitating economic cooperation between countries. Foreign trade must have a positive impact on economic development of trading partners, when they are equal in the level of development, and foster economic growth even then, when their are unequal. Nevertheless, the one assumption of the theory is a free trade, but this assumption is not always fulfilled. Baltics as small transition countries have from one side not many possibilities for influencing foreign trade, because we are price and conditions takers. From other side, we are small enough to get more favourable conditions in trading with economic blocks and developed countries. Nevertheless, the better conditions compared to other third and associated countries, that we achieved for trading with EU, do not guarantee automatically higher volumes and more equal conditions in trade with above mentioned countries. Encouraging is the fact that European Union Council has approved the Action Plan for the Northern Dimension with external and cross-border policies of the European Union 2000-2003. The aim of current paper is to analyse the current situation in foreign trade of three Baltic States (Estonia, Latvia, Lithuania) in the context of fostering economic co-operation in Nordic Dimension. To accomplish this aim: - We analyse the openness or closeness of the trade in Baltic Sea region, find out its positive and negative aspects. -We will look at geographical distribution of foreign trade of three Baltics and analyse it. -We analyse the commodity structure of foreign trade of three Baltics with countries in BSR. -We will analyse the possibilities and risks of current situation in Baltics’ foreign trade in the context of economic globalisation and integration. Data of national statistic bureaus and national banks will be used for comparing the situation in Baltics’ foreign trade. The analysis will not cover transit trade and trade with services.

Die Entwicklung der Konzeption der Nachhaltigkeitsanalyse

This article concerns limits and development possibilities of the sustainability analysis concept. Discussed are the qualitative sustainability measurement, and connections to the methodological basis of development assessment and the essence of evaluating sustainability. At first the sustainability definition is tackled, followed by an analysis of the nature of sustainability. The third section highlights the requirements for decision making that guarantees sustainabilit