Kliininen epidemiologia hoidon tehon arvioinnissa

Vertaisarvioitu.• Luotettavin arvio hoidon tehosta saadaan meta-analyysistä, joka perustuu satunnaistettuihin hoitokokeisiin. • Päätetapahtumanäytön tulisi olla potilaalle merkityksellistä, kuten ennalta- ehkäisevässä hoidossa vähenemä sairastavuudessa tai kuolleisuudessa, eikä pelkkä muutos tapahtumien riskiä kuvaavissa korvikemuuttujissa. • Absoluuttisena vaikutuksena mitattuna ennaltaehkäisevästä hoidosta hyötyy todennäköisemmin suuremman kuin pienemmän sairastumisriskin potilas.Peer reviewe

Uncertainty in multispectral lidar signals caused by incidence angle effects

Multispectral terrestrial laser scanning (TLS) is an emerging technology. Several manufacturers already offer commercial dual or three wavelength airborne laser scanners, while multispectral TLS is still carried out mainly with research instruments. Many of these research efforts have focused on the study of vegetation. The aim of this paper is to study the uncertainty of the measurement of spectral indices of vegetation with multispectral lidar. Using two spectral indices as examples, we find that the uncertainty is due to systematic errors caused by the wavelength dependency of laser incidence angle effects. This finding is empirical, and the error cannot be removed by modelling or instrument modification. The discovery and study of these effects has been enabled by hyperspectral and multispectral TLS, and it has become a subject of active research within the past few years. We summarize the most recent studies on multi-wavelength incidence angle effects and present new results on the effect of specular reflection from the leaf surface, and the surface structure, which have been suggested to play a key role. We also discuss the consequences to the measurement of spectral indices with multispectral TLS, and a possible correction scheme using a synthetic laser footprint.publishedVersionPeer reviewe

Nuorten terveystietoisuus ja liikunta-aktiivisuus

Tutkimuksessa selvitetään, miten terveyteen liittyvien asioiden arvostaminen heijastuu nuorten ja nuorten aikuisten keskuudessa heidän liikuntakäyttäytymiseensä. Tutkimuksen aineistona on turkulaisille 14–28-vuotiaille nuorille (n = 689) keväällä 2013 tehty kysely, jossa koottiin tietoa heidän tämänhetkisestä elämäntilanteestaan, vapaa-ajanviettotavoistaan, hyvinvoinnistaan ja liikuntasuhteestaan. Tutkimustulosten mukaan nuorten vähäisessä liikunnan harrastamisessa ei ole kysymys tiedon puutteesta ja terveellisten elämäntapojen väheksymisestä. Terveysulottuvuus oli yleisesti ottaen tärkeä nuorten liikunta-aktiivisuuden taustatekijä. Liikunnallisesti aktiiviset pitivät monia terveellisiin elämäntapoihin liittyviä asioita hieman tärkeämpinä kuin vähemmän liikkuvat. Tytöt ja nuoret naiset arvostivat näitä tekijöitä poikia ja nuoria miehiä korkeammalle. Nuorilla oli myös vahva pyrkimys oman liikunta-aktiivisuutensa lisäämiseen

Type 1 tyrosinemia in Finland: a nationwide study

Background Introduction of nitisinone and newborn screening (NBS) have transformed the treatment of type 1 tyrosinemia, but the effects of these changes on the long-term outcomes remain obscure. Also, the predictors for later complications, the significance of drug levels and the normalization of laboratory and imaging findings are poorly known. We investigated these issues in a nationwide study. Results Type 1 tyrosinemia was diagnosed in 22 children in 1978-2019 in Finland. Incidence was 1/90,102, with a significant enrichment in South Ostrobothnia (1/9990). Median age at diagnosis was 5 (range 0.5-36) months, 55% were girls and 13 had homozygotic Trp262X mutation. Four patients were detected through screening and 18 clinically, their main findings being liver failure (50% vs. 100%, respectively, p = 0.026), ascites (0% vs. 53%, p = 0.104), renal tubulopathy (0% vs. 65%, p = 0.035), rickets (25% vs. 65%, p = 0.272), growth failure (0% vs. 66%, p = 0.029), thrombocytopenia (25% vs. 88%, p = 0.028) and anaemia (0% vs. 47%, p = 0.131). One patient was treated with diet, seven with transplantation and 14 with nitisinone. Three late-diagnosed (6-33 months) nitisinone treated patients needed transplantation later. Kidney dysfunction (86% vs. 7%, p = 0.001), hypertension (57% vs. 7%, p = 0.025) and osteopenia/osteoporosis (71% vs. 14%, p = 0.017) were more frequent in transplanted than nitisinone-treated patients. Blood/serum alpha-fetoprotein decreased rapidly on nitisinone in all but one patient, who later developed intrahepatic hepatocellular carcinoma. Liver values normalized in 31 months and other laboratory values except thrombocytopenia within 18 months. Imaging findings normalized in 3-56 months excluding five patients with liver or splenic abnormalities. Low mean nitisinone concentration was associated with higher risk of severe complications (r = 0.758, p = 0.003) despite undetectable urine succinylacetone. Conclusions Prognosis of type 1 tyrosinemia has improved in the era of nitisinone, and NBS seems to provide further benefits. Nevertheless, the long-term risk for complications remains, particularly in the case of late diagnosis and/or insufficient nitisinone levels.Peer reviewe

Type 1 tyrosinemia in Finland: a nationwide study

Background Introduction of nitisinone and newborn screening (NBS) have transformed the treatment of type 1 tyrosinemia, but the effects of these changes on the long-term outcomes remain obscure. Also, the predictors for later complications, the significance of drug levels and the normalization of laboratory and imaging findings are poorly known. We investigated these issues in a nationwide study. Results Type 1 tyrosinemia was diagnosed in 22 children in 1978-2019 in Finland. Incidence was 1/90,102, with a significant enrichment in South Ostrobothnia (1/9990). Median age at diagnosis was 5 (range 0.5-36) months, 55% were girls and 13 had homozygotic Trp262X mutation. Four patients were detected through screening and 18 clinically, their main findings being liver failure (50% vs. 100%, respectively, p = 0.026), ascites (0% vs. 53%, p = 0.104), renal tubulopathy (0% vs. 65%, p = 0.035), rickets (25% vs. 65%, p = 0.272), growth failure (0% vs. 66%, p = 0.029), thrombocytopenia (25% vs. 88%, p = 0.028) and anaemia (0% vs. 47%, p = 0.131). One patient was treated with diet, seven with transplantation and 14 with nitisinone. Three late-diagnosed (6-33 months) nitisinone treated patients needed transplantation later. Kidney dysfunction (86% vs. 7%, p = 0.001), hypertension (57% vs. 7%, p = 0.025) and osteopenia/osteoporosis (71% vs. 14%, p = 0.017) were more frequent in transplanted than nitisinone-treated patients. Blood/serum alpha-fetoprotein decreased rapidly on nitisinone in all but one patient, who later developed intrahepatic hepatocellular carcinoma. Liver values normalized in 31 months and other laboratory values except thrombocytopenia within 18 months. Imaging findings normalized in 3-56 months excluding five patients with liver or splenic abnormalities. Low mean nitisinone concentration was associated with higher risk of severe complications (r = 0.758, p = 0.003) despite undetectable urine succinylacetone. Conclusions Prognosis of type 1 tyrosinemia has improved in the era of nitisinone, and NBS seems to provide further benefits. Nevertheless, the long-term risk for complications remains, particularly in the case of late diagnosis and/or insufficient nitisinone levels.Peer reviewe

Numerical investigation of 3-D constraint effects on brittle fracture in SE(B) and C(T) specimens

This investigation employs 3-D nonlinear finite element analyses to conduct an extensive parametric evaluation of crack front stress triaxiality for deep notch SE(B) and C(T) specimens and shallow notch SE(B) specimens, with and without side grooves. Crack front conditions are characterized in terms of J-Q trajectories and the constraint scaling model for cleavage fracture toughness proposed previously by Dodds and Anderson. The 3-D computational results imply that a significantly less strict size/deformation limit, relative to the limits indicated by previous plane-strain computations, is needed to maintain small-scale yielding conditions at fracture by a stress- controlled, cleavage mechanism in deep notch SE(B) and C(T) specimens. Additional new results made available from the 3-D analyses also include revised {eta}-plastic factors for use in experimental studies to convert measured work quantities to thickness average and maximum (local) J-values over the crack front

Kabul Times. (Kabul, Afghanistan), 1973-05-19

Kabul Times. (Kabul, Afghanistan), 1973-05-19; Volume 12; Number 4