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BACKGROUND AND OBJECTIVES: Instrumentation in correction operations for spinal deformities carries a 0.5-5% risk of injuring the spinal cord. The wake-up test is used for early detection of these injuries. In this study we compared the effects of propofol and midazolam during wake-up test in scoliosis surgery. METHODS: Thirty patients were randomly assigned as group P and group M. Anesthesia was induced with propofol 2.5 mg kg-1 for group P or midazolam 0.5 mg kg-1 for group M with remifentanil 0.5 µg kg-1 and cisatracurium 0.15 mg kg-1 for both groups. At the maintenance of anesthesia O2/air and infusions of remifentanil and cisatracurium were used. In group P, propofol 6-10 mg kg-1 h-1 and in group M, midazolam 0.5 mg mg kg-1 were preferred. Approximately 15 min before the wake-up test, all drugs were discontinued. At the wake-up test, anesthesiologist asked the patients to open their eyes and squeeze his/her hand at every 30 s until the patients responded. Then patients were told to wiggle their toes. Hemodynamic parameters, time of eye-opening, appropriate movement upon verbal command were evaluated. BIS frequency throughout the operation was recorded. RESULTS: The eye opening time was 9 ± 2.15 min in group P and 7 ± 3.15 min in group M. Motor movement time was 12 ± 2.55 min in group P and 21.25 ± 3.93 min in group M. CONCLUSION: Propofol provided better wake-up conditions and conducted a better neurologic assessment within the same BIS values than midazolam.

The Latin American debt crisis, which broke out in August 1982, was the first global financial crisis in the postwar period. While the crisis started in the "periphery", it constituted a threat to the "core" of the world economy, as the banking system was under severe pressure. Alongside the IMF, the BIS played an important role in coordinating the international response to the crisis. Moreover, a lot of work at the BIS in the second half of the 1970s had aimed at restraining the debt build-up. Discussions on the rising debt levels were highly influential in shaping the BIS view of financial stability, with the "macroprudential" concept at its core. However, in the analysis of the debt buildup, the role of financial innovations was not really captured. In this paper, we focus on the Latin American debt crisis, discussing first the debt build-up, different initiatives to restrain lending and the BIS role in the management of the crisis. We then turn to the ensuing efforts to strengthen the financial system and the emerging BIS approach to financial stability.

University of Technology, Sydney. Faculty of Engineering and Information Technology. Business information systems (BIS) projects succeed or fail because of people. A better understanding of the people who analyse/design BIS could lead to more successes. This study of the qualitatively different ways that analyst/designers’ conceive of and approach their work improves our understanding. Twenty interviews with analyst/designers with varying expertise and years of experience were analysed, interpreted, and described using a research method that evolved from orthodox phenomenography. This evolved method itself contributes to phenomenography. The significant contributions are: 1) GIFTed data analysis, a data analysis technique incorporating Gestalt theory, types of intentionality, and Gurwitsch’s field theory of consciousness; 2) a generic conception-of analytical framework; 3) a generic approach-to analytical framework. The categories resulting from the phenomenographic analysis, and which describe analyst/designers’ awareness of analysis/design, are treated as Gestalts. The categories form two sets: conceptions and approaches. The five conception categories are: 1) Differentiate analysis/design as something other than programming; 2) Catalogue separate analysis/design tasks into a sequential and orderly activity; 3) Idealise analysis/design as how to deliver what the client wants; 4) Contrast actual and ideal analysis—what and design—how; 5) Integrate exploring the organisation and problem with creating an abstract solution. The four approach categories are: 1) An ad hoc process that as quickly as possible delivers something to the client and solves the problem; 2) An atomistic process that produces artefacts to show that some analysis and design took place; 3) A circumscribed process that produces the best artefacts and solution; 4) An adjustable process that shares an understanding of the problem and a vision of the solution to satisfice stakeholders. Ten relationships between conception and approach categories were deemed rational. Five relationships, which are the relationships between the highest approach category to which a conception category is related, were selected for closer examination. These five Gestalts of analysis/design, the cowboy, the cataloguer, the methodist, the magician, and the master are described as parallel Gestalts at the field or theme level of the categories and as development life cycles. All these results reveal at a collective level a number of different ways analyst/designers experience analysis/design, thus contributing to a people-centred foundation for research aimed at increasing BIS project successes.

A professor of fiscal and tributary law, Giulio Tremonti served in Berlusconi’s governments as Minister of Economy and Finance in 1994-5, 2001-4, 2005-6, and 2008-11. An active participant in high-profile policy-making and trend-setting meetings within European institutions, the G7 and G8, as well as the Aspen Institute, Tremonti has been the promoter of the Global Legal Standard, which the OECD adopted in 2009.

Background Although telemedicine is one of the key initiatives of the World Health Organization, no study has explored the feasibility and efficacy of teleanaesthesia. This bi-centre pilot study investigates the feasibility of transcontinental anaesthesia. Methods Twenty patients aged ≥18 yr undergoing elective thyroid surgery for ≥30 min were enrolled in this study. The remote and local set-up was composed of a master-computer (Montreal) and a slave-computer (Pisa). Standard Internet connection, remote desktop control, and video conference software were used. All patients received total i.v. anaesthesia controlled remotely (Montreal). The main outcomes were feasibility, clinical performance, and controller performance of transcontinental anaesthesia. The clinical performance of hypnosis control was the efficacy to maintain bispectral index (BIS) at 45: ‘excellent', ‘good', ‘poor', and ‘inadequate' control represented BIS values within 10, from 11 to 20, from 21 to 30, or >30% from target. The clinical performance of analgesia was the efficacy to maintain Analgoscore values at 0 (−9 to 9); −3 to +3 representing ‘excellent' pain control, −3 to −6 and +3 to +6 representing ‘good' pain control, and −6 to −9 and +6 to +9 representing ‘insufficient' pain control. The controller performance was evaluated using Varvel parameters. Results Transcontinental anaesthesia was successful in all 20 consecutive patients. The clinical performance of hypnosis showed an ‘excellent and good' control for 69% of maintenance time, and the controller performance showed an average global performance index of 57. The clinical performance of analgesia was ‘excellent and good' for 92% of maintenance time, and the controller performance showed a global performance index of 1118. Conclusions Transcontinental anaesthesia is feasible; control of anaesthesia shows good performance indexes. Clinical registration number NCT01331096.

High-risk surgery represents 12.5% of cases but contributes 80% of deaths in the elderly population. Reduction in morbidity and mortality by the use of intervention strategies could result in thousands of lives being saved and savings of up to £400m per annum in the UK. This has resulted in the drive towards goal-directed therapy and intraoperative flow optimization of high-risk surgical patients being advocated by authorities such as the National Institute of Health and Care Excellence and the Association of Anaesthetists of Great Britain and Ireland. Conventional intraoperative monitoring gives little insight into the profound physiological changes occurring as a result of anesthesia and surgery. The build-up of an oxygen debt is associated with a poor outcome and strategies have been developed in the postoperative period to improve outcomes by repayment of this debt. New monitoring technologies such as minimally invasive cardiac output, depth of anesthesia and cerebral oximetry can minimize oxygen debt build-up. This has the potential to reduce complications and lessen the need for postoperative optimization in high-dependency areas. Flow monitoring has thus emerged as essential during intraoperative monitoring in high-risk surgery. However, evidence suggests that current optimization strategies of deliberately increasing flow to meet predefined targets may not reduce mortality. Could the addition of depth of anesthesia and cerebral and tissue oximetry monitoring produce a further improvement in outcomes? Retrospective studies indicate a combination of excessive depth of anesthesia hypotension and low anesthesia requirement results in increased mortality and length of hospital stay. Near infrared technology allows assessment and maintenance of cerebral and tissue oxygenation, a strategy, which has been associated with improved outcomes. The suggestion that the brain is an index organ for tissue oxygenation, especially in the elderly, indicates a role for this technology in the intraoperative period to assess the adequacy of oxygen delivery and reduce the build-up of an oxygen debt. The aim of this article is to make the case for depth of anesthesia and cerebral oximetry alongside flow monitoring as a strategy for reducing oxygen debt during high-risk surgery and further improve outcomes in high-risk surgical patients.

Pirmoje darbo dalyje yra nagrinėjamos organizacijų ekonominės problemos ir ieškoma kaip tos problemos gali būti pašalintos. Išanalizavus kokios gali būti problemos pradėta analizuoti intelektualios verslo sistemos, kaip vienas geriausių sprendimo būdų. Darbe taip pat nagrinėjama intelektualių sistemų apibrėţimas, paaiškinama architektūra ir išskiriama kuo BIS skiriasi nuo kitų informacinių valdymo sistemų. Antroje dalyje yra nagrinėjamos pagrindinės problemos susijusios su intelektualiomis verslo sistemomis ir jų diegimu organizacijose. Analizuojama šiuo metu labiausiai paplitusios technologijos OLAP ir QlikView, kurios naudoja atmintį duomenų krovimui. Analizuojami jų privalumai ir trūkumai taip pat skirtumai. Trečioje dalyje analizuojama intelektualių verslo sistemų projektavimo metodika. Keliami klausimai ką reikia daryti, kad gautume sistemą atitinkančią organizacijos lūkesčius. Analizuojama projektavimo struktūra naudojant UML diagramas, taip pat elementų svarba pačioje sistemoje. Ketvirtoje dalyje yra projektuojami intelektualių verslo sistemų modeliai, kurie yra tik pavyzdiniai, kurie parodo kokie privalumai ir kaip veikia intelektualios verslo sistemos vykdant pirkimo funkcijas panaudojant marketinginius principus. In the first part of master thesis analyzing the main problems, which are in organization management. The main purpose of this part is to find a solution how can resolve this problems. Business intelligence systems are the best solution. In this part analyzing business intelligence systems definition, architecture and also analyze what is different in business intelligence systems comparing with other informatics management systems. The second part of work analyzes business intelligence problems related with creation, developing and using BIS. Analyze the most popular tools like OALP and QlikView. Compare the OLAP and QlikView. Analyze QlikView like data loading from memory. Explain the advantages and disadvantages of QlikView and OLAP. The third part analyzes designing and planning of business intelligence systems. Analyze what is the main purpose to create good system which will be useful in organizations. In this part also analyze the UML modems for BIS. In the last part is presenting solutions for problems which was analyzed in the second part. The examples are created using UML diagrams.

Die zielgesteuerte Propofolinfusion (TCI, target controlled infusion) mit der Verwendung des pharmakokinetischen Datensatzes nach Marsh ist schon in vielen Studien angewandt worden. Das computergesteuerte Infusionssystem berechnet anhand einer vorgegebenen Propofolplasmazielkonzentration, des Körpergewichtes und eines bereits in dem System einprogrammierten pharmakokinetischen Datensatzes die aktuelle Propofolkonzentration im Blut. Gleichzeitig kalkuliert sie die Infusionsrate, welche erforderlich ist, um die gewünschte Zielkonzentration zu erreichen. Ob der kardiopulmonale Bypass bei kardiochirurgischen Patienten einen besonderen Einfluss auf die Berechnung der Narkosemittelkonzentration hat, und ob die Kardioplegie einen Verdünnungseffekt aufweist, sollte noch näher untersucht werden. Propofolplasmazielkonzentrationen für die Narkoseeinleitung von 4 µg/ml und von 2 µg/ml für die Narkoseaufrechterhaltung haben sich in Voruntersuchungen bereits bewährt. Nach Genehmigung des Antrages durch die Ethikkommission wurden 59 Patienten in die Untersuchung eingeschlossen. Zu vier definierten Zeitpunkten wurde den Patienten Blut abgenommen um dieses mittels Hochleistungsflüssigkeitschromatographie (HPLC) quantitativ auf Propofol zu untersuchen. Die Ergebnisse wurden dann mit den jeweiligen von dem TCI-Gerät berechneten Konzentrationen verglichen. Die Messzeitpunkte waren definiert mit T1 15 Minuten nach Narkoseeinleitung, T2 15, T3 30 Minuten nach erster Kardioplegiegabe und T4 5 Minuten nach Protamingabe. Des weiteren wurden die Patienten während der Narkose zusätzlich mittels Bispektral-Index und Entropie überwacht. Eine signifikante Korrelation zwischen der gemessenen und der berechneten Propofolplasmakonzentration konnte zu keinem Zeitpunkt festgestellt werden. Die zusätzlich berechneten Maße für die Genauigkeit des TCI-Systems (prediction error, Median performance error, Median absolute performance error) zeigten, dass das Gerät die Konzentrationen von Propofol zum Messzeitpunkt T1 bis T3 zu niedrig und zu T4 zu hoch einschätzte. Einen Einfluss des Alters, des Geschlechtes und des BMI auf den MDPE-Wert gab es nicht. Ein Verdünnungseffekt der Kardioplegie auf die gemessene Propofolplasmakonzentration konnte nicht nachgewiesen werden. Die EEG-Parameter korrelierten nicht mit der gemessenen und auch nicht mit der berechneten Propofolplasmakonzentration. Offensichtlich ist das Marsh-Modell der TCI zumindest bei diesem untersuchten Patientenkollektiv nicht verlässlich genug, da die gemessene und die berechnete Propofolkonzentration zu jedem der 4 untersuchten Zeitpunkte signifikant voneinander abweichen. Für die Berechnung der Propofolplasmakonzentration fehlen dem Computersystem der TCI wohl weitere Informationen über die Pharmakokinetik des jeweiligen Individuums. Zudem werden äußere Einflüsse (z.B. durch den kardiopulmonalen Bypass) auf die Pharmakokinetik nicht mit berücksichtigt. Die Ergebnisse zeigen auch, dass die EEG-Parameter der BIS und Entropie zumindest für den intraoperativen Verlauf nicht adäquat auf Narkoseveränderungen zu reagieren scheinen.

Univerzita Karlova v Praze Fakulta sociálních věd Institut politologických studií Projekt k bakalářské práci Vedoucí práce: JUDr. PhDr. Tomáš Karásek, Ph.D. Tomáš Ryza 21. 5. 2011 Název práce: Srovnání vývoje zpravodajských služeb v ČR a SR po roce 1989 Anotace: Zpravodajské služby jsou jednou z nejproblematičtějších složek každého státu. Pokud stát využívá zpravodajských služeb příliš a dá jim velké pravomoci, dostává se automaticky pod neustálý tlak kritiky svých občanů. Pokud naopak poskytne zpravodajským službám pravomocí málo, dosadí "slabého" ředitele nebo zavede příliš mnoho kontrolních mechanismů, jako tomu bylo v ČSFR krátce po revoluci v roce 1989, může dojít k zablokování funkčnosti těchto služeb a zvýšení zranitelnosti státu. Specifickým problémem s tím spojeným je počet služeb, kterými stát disponuje. Větší množství je sice náročnější na státní rozpočet, na druhou stranu zpravodajská činnost zasahuje do řady oblastí, které se nemusí navzájem slučovat, pokud budou přiřazeny pouze jedné službě. S velkým množstvím služeb je však na druhou stranu spojeno riziko neefektivity celého systému, nepřirozeného toku informací a jejich zamlčování či dokonce zneužívání v konkurenčním boji jednotlivých služeb. Ve své bakalářské práci se proto pokusím zodpovědět otázku, jakými zpravodajskými systémy disponují...

Objective: During surgery, lower cranial nerve (CN) EMG may show spontaneous activity without a surgical correlation. These episodes have been observed in association with sudden patient movement. In the study presented, this activity was quantified and correlated with the Bispectral Index (BIS) in [for full text, please go to the a.m. URL], 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS)

Yleisanestesia koostuu kolmesta eri osatekijästä, jotka ovat tajuttomuus, reagoimattomuus kirurgian aikaansaamille ärsykkeille ja liikkumattomuus. Tajuttomuutta eli anestesian hypnoottista komponenttia voidaan mitata erilaisilla aivosähkökäyrän (EEG) tulkintaan pohjautuvilla laitteilla. Näistä laitteista onkin tullut hyvin suosittuja, sillä niiden on todettu vähentävän leikkauksenaikaisen hereillä olon riskiä ja nopeuttavan anestesiasta toipumista. Nämä laitteet rekisteröivät aivosähkökäyrää potilaan otsalta ja ohimolta. Rekisteröity aivosähkökäyrä muutetaan laitteen toimesta lukuarvomuotoon, ja kullekin laitteelle on annettu suositus siitä, mitä lukuarvoja anestesian aikana tulisi tavoitella. Otsalihasten lihassähkökäyrä (EMG) on yksi häiriötekijä, joka saattaa tehdä näiden laitteiden tulkinnasta vaikeaa tai jopa mahdotonta. Tämän väitöskirjan tutkimuksissa selvitettiin 133 nukutetulla potilaalla, kuinka EMG:n ja EEG:n reaktiivisuus kivuliaalle ärsykkeelle vaikuttaa kahden anestesian syvyyden mittaamiseen tarkoitetun laitteen (BIS ja Entropy) toimintaan. Lisäksi tutkittiin, voiko anestesiologi nähdä EMG:n anestesiamonitorilta paljaalla silmällä, jolloin laitteen antama virheellisen korkea lukema ei johtaisi tarpeettomaan anestesia-aineiden lisäämiseen. Väitöstutkimus osoitti, että 1) voimakas EMG-reaktio nostaa anestesian syvyyden mittaamiseen käytettyjen indeksien lukuarvoja, 2) EEG:n ja EMG:n taajuusalueet ovat osittain päällekkäisiä, joten niiden erottaminen Entropia- ja BIS-laitteiden algoritmeilla on käytännössä mahdotonta, 3) leikkauksen loputtua tapahtuva, lihasrelaksaation kumoamisen aiheuttama nousu Entropyn ja BIS:n lukuarvoissa on mitä todennäköisimmin EMG:n aiheuttamaa, 4) anestesian aikaiseen monitorointiin tarkoitettuja laitteita tulee edelleen kehittää, ja 5) anestesiologin tulisi tietää riittävästi anestesian aikaisista EEG:n ja EMG:n muutoksista, jotta vältettäisiin anestesia-aineiden ali- tai liika-annostelu. During the last 15 years, monitoring the hypnotic component of general anaesthesia has become routine in clinical practise. Several commercially available methods have been introduced for this purpose. These monitors are based on either spontaneous electroencephalogram (EEG) or mid-latency auditory-evoked potentials (MLAEP). These monitors have been reported to decrease the incidence of intraoperative awareness, to reduce the amount of anaesthetic drugs given to the patient, and to reduce recovery time after anaesthesia. The most widely used of these monitors is the Bispectral Index Scale (BIS). Another EEG-based depth of anaesthesia monitor is Entropy. The EEG analysed by these depth of anaesthesia monitors is collected from the forehead of the patient, therefore, rendering the methods vulnerable to confounding factors. One obvious confounding factor is the electromyographic (EMG) arousal caused by the frontal muscles. Also, different types of EEG arousal can produce changes in the numerical values of the depth of anaesthesia monitors without a change in the actual depth of anaesthesia, making the interpretation of depth of anaesthesia monitors very challenging for the anaesthesiologist. The aim of this doctoral thesis was to study the effect of EMG and EEG arousal on the numerical values of BIS and Entropy, and to investigate if an anaesthesiologist is able to detect EMG arousal visually on the anaesthesia monitor. In Study I, 31 patients undergoing gynaecological surgery under general anaesthesia were studied. The patients were anaesthetized with propofol-nitrous oxide (N2O) or propofol-N2O-remifentanil. The one-channel EEG collected by the Entropy strip was analysed off-line. Intubation of the trachea produced EMG arousal in 13/16 and 15/15 patients with and without remifentanil, respectively. EMG arousal caused a significant rise in Entropy values, even during propofol-induced burst suppression. The EMG activity started at frequencies below 20 Hz, contaminating the interpretation of the Entropy values. In Study II, 38 patients were studied during skin incision, a typical noxious stimulus. Again, the one-channel EEG collected by the Entropy strip was analysed to discover the incidence of skin incision-associated EMG and EEG arousal under sevoflurane-N2O or sevoflurane-N2O-rocuronium anaesthesia. Skin incision caused EMG arousal in 0/19 and 13/19 patients with and without rocuronium, respectively. Skin incision produced EEG arousal in 17/19 and 15/19 patients with and without rocuronium. EEG arousal was classified as beta arousal in 30 patients, causing an increase in Entropy values. EEG delta arousal (two patients) caused a decrease in Entropy values. The power spectra of EEG and EMG overlapped significantly. In Study III, during light propofol-remifentanil anaesthesia, the neuromuscular blockade (NMB) of 30 patients was antagonized with neostigmine or sugammadex, and the numerical values of BIS and Entropy were studied. The reversal of NMB caused a strong rise in the numerical values of Entropy and BIS in 5/15 patients with neostigmine, and in 5/15 patients with sugammadex. The EEG analysis suggested that the cause for the increasing values was the EMG contamination of EEG. In patients without EMG arousal, no EEG change was seen, and Entropy and BIS values remained unchanged. In Study IV, the EEG information seen on the anaesthesia monitor of 34 patients under general anaesthesia was recorded with a high-definition video camera, and compared with the one-channel EEG collected by the Entropy monitor. The EMG arousal was only partly detectable on the anaesthesia monitor using 100 ?V scale, suggesting that technological improvements to the depth of anaesthesia monitoring are warranted. In conclusion, the numerical values of depth of anaesthesia monitors are affected by EMG and EEG arousals. EMG arousal and EEG beta arousal increase the index values, while EEG delta arousal decreases the index values. The rise in the numerical values of BIS and Entropy during the reversal of NMB is most likely caused by EMG; however, a small change in EEG may be difficult to see underneath a strong EMG activity. Finally, in order to make detection of EMG arousal more accurate, technological improvements are warranted. However, anaesthesiologists using depth of anaesthesia monitoring should also have the skills to interpret the raw biosignal on the monitor screen, in order to avoid over- and underdosing of anaesthetic agents.

Informatizacija medicinskih procesa, dokumentiranja i izvješćivanja u bolničkom okruženju predstavlja veliki izazov za medicinske informacijske sustave, kako opće tako i specijalističke. Ovaj rad opisuje osnovne procese i tehnologije u informatizaciji bolničke ustanove na primjeru BIS sustava kao centralnog informacijskog sustava i RIS i PACS sustava kao specijalističkih sustava za radiološke procese. Rad nudi opis osnovnih tehnologija i koncepata korištenih pri izradi i implementaciji ovih sustava s posebnim naglaskom na sigurnost sustava i odgovornosti bolničkog informatičkog centra. Opisane su različite organizacijske jedinice i procedure u procesu bolničke obrade pacijenata kao podloga za razumijevanje zadataka navedenih sustava. Uz to je ilustriran proces evaluacije postojećeg stanja, odabira adekvatnih rješenja, implementacije, prilagodbe i održavanja navedenih sustava s posebnim naglaskom na tehnološku platformu i ključne sudionike navedenih procesa. Including information technologies in medical processes, documentation and reporting in hospitals is a great challenge for medical information systems, general and specialist alike. This thesis describes basic processes and technologies used in bringing information technologies to hospitals through the instance of HIS (Hospital Information System) as the central information system, as well as RIS (Radiology Information System) and PACS (Picture Archiving and Communication System) as specialized radiology systems. The thesis offers descriptions of basic technologies and concepts used in the process of design and implementation of these systems. A special emphasis is given to the security issues and the responsibilities of IT centers in hospitals. The thesis further describes organizational entities in hospitals and related procedures in patient healthcare as a basis for better comprehension of abovementioned information systems. The process of evaluation, selection, implementation, adaptation and maintenance of abovementioned systems is described with special emphasis given to issues of technologies used and key participants of these processes.

Background and Purpose: It was already shown that neuroaxial anaesthesia has sedative effects. The scope of our study was to find out whether the combined caudal epidural block with 0.19% bupivacaine decreases the sevoflurane requirement because of its synergistic hypnotic effect in comparison to balanced anaesthesia with intravenous alfentanil and sevoflurane in children. Materials and Methods: Forty boys aged 1–7 years were included in the study; they were undergoing elective orchidopexy. Children were randomized in two groups: A (caudal block) and B (IV analgesia with opioid). Each child in group A received a caudal epidural block in a dosage of 0.19% bupivacaine 2.5 mg/kg. In group B the loading dose of alfentanil was 20 μg/kg, followed by intermittent doses of 10–20 μg/kg. Anaesthesia hypnosis was controlled by the clinical parameters and by the Bispectral Index monitor (BIS). We measured end-tidal sevoflurane concentration (sevoE) at 5-minute intervals. The aim was to maintain the BIS values near 50 through increments or decrements in sevoflurane concentration. Results and Conclusion: No difference in end-tidal sevoflurane concentration (sevoE) values was observed between the two groups.We do suppose that due to the low level of caudal blockwe could not confirm synergism between caudal epidural block with local anaesthetic and sevoflurane.

Cilj i ustroj studije Cilj je ove studije upozoriti na prepreke koje otežavaju informacijski pismenom, umreženom pacijentu korištenje postojećih zdravstvenih informacijskih sustava jer mu oni ili nisu primjereno dostupni, ili nisu koliko bi bilo moguće informativni. Budući se ne zasnivaju na udruživosti podataka zasnovanoj na semantičkim tehnologijama, nedostatno su i neaktualno povezivi uz problematične mogućnostim provjere meritornosti. Postupci nspekcija koda zaglavlja i web sadržaja 6 aktualnih javnih web stranica-portala: dvaju najvećih zagrebačkih kliničkih bolničkih centara, dvije zagrebačke kliničke bolnice, stranica Ministarstva zdravstva i socijalne skrbi kao i stranica Hrvatskog zavoda za zdravstveno osiguranje. Analiza slučaja pacijenta. Analiza sadržaja web portala. Intervju. Rezultati U vrijeme izvođenja ove studije – prvih deset mjeseci 2011. godine, u njihovim sadržajima nije nađena upotreba semantičkih tehnologija (RDF, RDF microformat, RDFa) koje nude on-line povezivost. Iako se putem javnih web stranica daju osnovne upute potrebne u pripremi pregleda pacijentima, vrše prijave pacijenata, objavljuju liste čekanja, managementi nekih od intervjuiranih održavatelja web sučelja bolnica, organizaciju javnih web sučelja bolnica čak i ne percipiraju sastavnim dijelom "dominantnih funkcija svojih bolničkih informacijskih sustava. Praćenje lutanja i vrste kontradiktornih uputa na slučaju pacijenta od trenutka kada mu je terapija propisana do trenutka njegove primjene pokazuje kako je fokus izgrađenih domaćih bolničkih informacijskih sustava javnih klinika neinformativan kako pacijentima tako i liječnicima zbunjujući, a njegova pretežita usmjerenost na tzv. administrativne funkcije - lista lijekova i pravo na njih, upute pacijentima i lista čekanja te praćenje i naplata usluga nedostatno učinkovita u odnosu na suvremene zdravstvene informacijske sustave. Razgovorom sa tvorcima i implementatorima njihovih rješenja utvrdili smo da nisu zasnovani na semantički udruživim podacima – te da su nedostatno interoperabilni. Zaključci (najviše 500 znakova): Analizom sadržaja dostupnih web portala javnih bolnica razlučuju se raznovrsne skupine njihovih funkcija: kontakta, mjesta i vremena dostupa, vrsta, načina pružanja usluga i njihove strukture, dostupnosti resursa, socijalne ravnopravnosti (liste čekanja), uputa za preglede, prevencijski informacije, kliničkih smjernica, raspravaljanje kontroverznih spoznaja, zakonom regulirane objava, informacije koje svjedoče o kompentencijama i ugledu institucije, strukovne obavjesti, sestrinske informacije, sinkronizacijske informacije, informacije o pravima pacijenata, obavijesti: o događajima, skupovima, kritične obavijesti, manifestacije zajedništva i obilježavanje državnih praznika, edukacijski sadržaji... Objavljivanje nekih regulirano je odredbama različitih razina, drugih web kulturom, trećih potrebama i specifičnostima institucije... Šuma je to podataka kojim vizualno oblikovanje web stranica slabo pomaže a često i šteti. Njihova semantički interoperabilna reprezentacija pospješila bi pronalaženje te omogućila instituciji koja ih publicira efikasnije održavanje s nadzorom njihove vjerodostojnosti. Garancija vjerodostojnosti sadržaja objavljenih digitalno kao i putem Interneta jedna od najtraženijih funkcija on-line znanja. Autorima koji nastoje osigurati argumentirano, provjerivo i programski povezivo prikazivanje podataka, kvalificiranu bi podršku trebale pružiti i institucije koje pretendiraju na ocjenu visoke kvalitete i vjerodostojnosti svog ugleda, U, nazovimo je, zdravstvenoj informativnosti, očituju se i odgovornost, kompetentnost, interoperabilnosti... Odgovornost za nekoruptivno izračunavanje TCO-a zahtijeva konceptualnu i strategijska obuhvatnost te bi procjena povoljnosti ponude koju donosi ili ne donosi upotreba otvorenog koda trebala prethoditi svakoj usporedbi ponuda u sklopu javne nabave modula ili funkcija javnih zdravstvenih informacijskih sustava. Odgovornost za međubolničku udruživost podataka zasnovanu na semantičkim tehnologijama, prenosivost i povezivost elektronskih zdravstvenih zapisa, koja jedino garantira mobilnost, još nitko nije preuzeo. Stoga vjerojatno interoperabilnost nismo našli u kodu javnih domaćih portala kliničkih bolnica, ne sadržava ju još ni domaća strategijska terminologija niti obećanja informatizacije koja bi trebala ostvariti bolnicu bez papira... Opisano, zatečeno stanje domaćih zdravstvenih web portala javnih institucija ostalo je u povijesti weba 1. Stoga su domaći pacijenti a jednako tako i njihovi liječnici, domaće zdravstvene on-line informacije primorani prikupljati isključivo surfanjem, boreći se s jezičnim stilovima, načinima prezentiranja informacija (npr. u tablicama na webu o pravima na određeni lijek koje se razlikuju od onih kojima raspolažu liječnici), najmaštovitijim dizajnima, gubeći vrijeme a i živce u otkrivanju pozicija na kojima se nalaze i najosnovnije informacije koje traže. Njihovu meritornost ili efikasnost terapija osvjetljavati će razmjenom iskustava kroz društvene mreže, savjete na portalima različitih provenijencija... Umjesto surfanja, primjena Semantičkih tehnologija ubrzat će im nalaženje vjerodostojnih informacija. Potrebno bi bilo podržati ju bilo ustrojavanjem posebne institucije koja bi pružala podršku interoperabilnosti bilo kroz raznovrsne druge, inovativne načine...

Uvod Moderne informatičke-komunikacijske aplikacije uvelike su ubrzale vrijeme potrebno za izdavanje nalaza te poboljšale kvalitetu usluga koje pružaju medicinsko-biokemijski laboratoriji. Kako bi proces zadržao stalnu kvalitetu te odgovorio na zahtjev akreditacijske norme za medicinske laboratorije, namede se potreba validacije cjelokupnog procesa prijenosa podataka od laboratorijske opreme, preko laboratorijskog informatičkog sustava (LIS) sve do bolničkog informatičkog sustava (BIS) u Zavodu za kliničku kemiju i laboratorijsku medicinu. Cilj rada Provjera točnosti prijenosa podataka iz smjera: a) laboratorijska oprema – LIS, b) LIS – BIS. Korištene aplikacije: LIS – BioNet (Labnet, Obrt za software inženjering, Josipovac), BIS – Grad d.o.o. informatički inženjering, Pula). Metode Postupak validacije proveden je prema referentnim dokumentima i važedim zakonskim propisima RH: Hrvatska norma HRN EN ISO 15189: Medicinski laboratoriji – Posebni zahtjevi za kvalitetu i osposobljenost AUT08-A:Vol.26, No 36: Managing and validating laboratory information systems ; Approved Guideline. (replaces AUTO8-P, vol.25, No 2) Health Level Seven Standard Version 2.5 - An application Protocol for Electronic Data Exchange in Healthcare Environments, ANSI/HL7 V2.5-2003. Rezultati Postupak validacije prijenosa podataka u LIS i BIS aplikaciju odvijao se u razdoblju od 31.03. – 13.05.2009. u Jedinicama klničke kemije te od 20.12.2010. do 23.02.2011. godine u Jedinicama laboratorijske medicine. Prijenos podataka sa laboratorijske opreme u LIS provjeravao se zadavanjem svih analiza u LIS-u pri čemu su ispisivane odgovarajude barkodirane naljepnice. Laboratorijski analizatori su preko barkodiranih naljepnica dobivali podatak o zadanim analizama. Nakon izvršene analize, podaci dobiveni automatskim prijenosom u LIS, ispisivali su se u obliku laboratorijskog nalaza. Izvorni ispis rezultata mjerenja sa laboratorijskog analizatora se uspoređivao sa podacima iz LIS-a. Dobiveni podaci sa analizatora i LIS-a su se upisivali u odgovarajudi predložak te istinitost njihova slaganja potvrđivala potpisom osobe koja je provela validaciju (mag. med. biochem.) te odgovorne osobe iz firme koja je kreirala i instalirala aplikaciju. Prijenos podataka iz LIS-a u BIS aplikaciju provjeravao se zadavanjem svih analiza u BIS-u te kreiranjem realnih podataka u nalazu koji se formira u LIS-u. Ispisan je laboratorijski nalaz iz LIS-a te sučelje na ekranu koje je dostupno korisnicima usluga kada su laboratorijske analize završene. Dobiveni podaci iz LIS-a i BIS-a su se upisivali u odgovarajudi predložak te istinitost njihova slaganja potvrđivala potpisom osobe koja je provela validaciju (mag. med. biochem.) te odgovorne osobe iz firme koja je kreirala i instalirala aplikaciju. Zaključak Provedena validacija korištenih informatičkih aplikacija u laboratorijskom procesu osigurala je dokaz istinitosti prijenosa podataka sa laboratorijske opreme te potvrdila integritet i kvalitetu izdanog laboratorijskog nalaza. Postupak validacije osigurava odgovor na zahtjev norme koji smo obvezni provesti kao akreditirani laboratorij.

Comparaison des Propriétés Mécaniques en Flexion 4 Points des Plaques Vissées pour Vis de 3,5 et 4,5 mm

Visceral states are known to have a (detrimental) impact on our ability to exert self-control. In the current research, we investigate the impact of a visceral factor associated with inhibition, rather than with approach: bladder control. We argue that inhibitory signals are not domain specific, but can spill over to unrelated domains, resulting in increased impulse control in the behavioral domain. We show that urination urgency correlates with improved performance on color naming but not word meaning trials of a Stroop task (Study 1). In Study 2 and 3, we show that higher levels of bladder control result in an increasing ability to resist more immediate temptations in monetary decision making. We show that inhibitory spillover effects are moderated by sensitivity of the behavioral inhibition system (BIS, Study 3), and can be induced by exogenous cues (Study 4). Implications for inhibition and impulse control theories are discussed.

Visceral states are known to have a (detrimental) impact on our ability to exert self-control. In the current research, we investigate the impact of a visceral factor associated with inhibition, rather than with approach: bladder control. We argue that inhibitory signals are not domain specific, but can spill over to unrelated domains, resulting in increased impulse control in the behavioral domain. We show that urination urgency correlates with improved performance on color naming but not word meaning trials of a Stroop task (Study 1). In Study 2 and 3, we show that higher levels of bladder control result in an increasing ability to resist more immediate temptations in monetary decision making. We show that inhibitory spillover effects are moderated by sensitivity of the behavioral inhibition system (BIS, Study 3), and can be induced by exogenous cues (Study 4). Implications for inhibition and impulse control theories are discussed.

This article aims to describe and analyse the creation of the Bank for International Settlements (BIS) in 1930. Based essentially on German and French archives, it will attempt to explain why the central bankers that were members of the Young Committee and subsequently the Organisation Committee for the Bank for International Settlements (COBRI) eventually reached agreement on the role and founding of the BIS, despite the ambivalent attitude of the Reichsbank and Hjalmar Schacht. In this process, the agreement of the central bankers on the idea of independence of the central banks was fundamental., Cet article s’attache à décrire et à analyser la création de la Banque des Règlements internationaux en 1930. Se fondant essentiellement sur des archives allemandes et françaises, il tente d’expliquer pourquoi les banquiers centraux membres du Comité Young puis du Comité d’organisation de la banque des règlements internationaux ont fini, malgré une attitude ambivalente de la Reichsbank et de Hjalmar Schacht, par se mettre d’accord sur les fonctions et la fondation de la BRI. Dans ce processus, l’accord des banquiers centraux sur l’idée d’indépendance des banques centrales est fondamental.

In dieser Arbeit wurde die Motivation und die Lernleistung der Individuen in einer Kategorisierungsaufgabe unter Belohnungs- und Bestrafungsbedingungen im Rahmen der revidierten Reinforcement Sensitivity-Theorie (RST) untersucht. Nach RST sollen die emotional motivationalen Systeme BAS unter Belohnung und BIS unter Bestrafung aktiviert werden. Das BIS soll mit der Persönlichkeitseigenschaft Ängstlichkeit, das BAS mit der Persönlichkeitseigenschaft Impulsivität verknüpft sein., In this work, the motivation and learning performance of individuals in a categorization task with reward and punishment conditions in the context of the revised reinforcement sensitivity theory (RST) was investigated. After RST the emotional motivational Behavior activation system (BAS) under reward and Behavior inhibiton system (BIS)under punishment are activated. The BIS is linked with the personality trait anxiety and the BAS with the personality trait impulsivity

BACKGROUND: Theoretically, L-type calcium channel blockers could modulate anesthetic effects. Nicardipine does not affect the bispectral index (BIS), but nimodipine, which can penetrate the blood-brain barrier, has not been studied. The aim of this study was to evaluate whether a single dose of intravenous nicardipine or nimodipine could affect BIS following rapid sequence intubation. METHODS: This study was done in a double-blind, randomized fashion. Anesthesia was induced with fentanyl 2 µg/kg, thiopental sodium 5 mg/kg, and 100% oxygen. After loss of consciousness, patients received rocuronium 1.0 mg/kg and either a bolus of 20 µg/kg nicardipine, nimodipine, or a comparable volume of normal saline (n = 20). Intubation was performed 1 min after study drug administration. BIS, mean blood pressure (MBP), and heart rate (HR) were measured before anesthetic induction, after loss of consciousness, before intubation, during intubation, and 1, 2 and 5 min after intubation. RESULTS: BIS dropped rapidly after induction but increased to 60 before intubation in all groups irrespective of study drug. In nimodipine, the increase in BIS during intubation was not significant compared to pre-intubation, in contrast to the other two groups, but there was no difference in BIS during intubation. HR significantly increased, but MBP just rose to pre-induction values after intubation in nicardipine and nimodipine groups. BIS, MBP, and HR following intubation increased in control group. CONCLUSIONS: A single dose of intravenous nicardipine or nimodipine could attenuate blood pressure increases but not affect BIS increases in rapid sequence intubation.

Determining depth of anesthesia is a challenging problem in the context of biomedical signal processing. Various methods have been suggested to determine a quantitative index as depth of anesthesia, but most of these methods suffer from high sensitivity during the surgery. A novel method based on energy scattering of samples in the wavelet domain is suggested to represent the basic content of electroencephalogram (EEG) signal. In this method, first EEG signal is decomposed into different sub-bands, then samples are squared and energy of samples sequence is constructed through each scale and time, which is normalized and finally entropy of the resulted sequences is suggested as a reliable index. Empirical Results showed that applying the proposed method to the EEG signals can classify the awake, moderate and deep anesthesia states similar to BIS., {"references":["B. A. Orser, Depth of anesthesia monitor and the frequency of intraoperative\nawareness, The New England Journal of Medicine, vol. 358, 2008,\npp. 1189-1191.","H.L. Kaul, N. Bharti, Monitoring depth of anesthesia, Indian J. Anesth.,\nvol. 46, 2002, pp. 323-332.","L. Shao-hua, W. Wei, D. Guan-nan, K. Jing-dong, H. Fang-xiao, T. Ming,\nRelationship between depth of anesthesia and effect-site concentration of\npropofol during induction with the target-controlled infusion technique in\nelderly patients, Chinese Medical Journal, vol. 122, 2009, pp. 935-940.","P. S. Sebel, T. A. Bowdle, M. M. Ghoneim, I. J. Rampil, R. E. Padilla, T.\nJ. Gan, and K. B. Domino, The incidence of awareness during anesthesia:\nA multicenter United States study, Anesth. Analgesia, vol. 99, 2004, pp.\n833-839.","D. R. Stanski, Monitoring depth of anesthesia, in Anesthesia, R. D. Miller,\nEd. Anesthesia, (Churchill Livingstone, New York, 1994, pp. 1127-1159).","E. W. Jensen, P. Lindholm, and S. Henneberg, Autoregressive modeling\nwith exogenous input of middle-latency auditory-evoked potentials to\nmeasure rapid changes in depth of anaesthesia, Meth. Inf. Med. vol. 35,\n1996, pp. 256-260.","H. Litvan, E. W. Jensen, J. Galan, J. Lund, B. E. Rodriguez, S. W.\nHenneberg, P. Caminal, and J. M. Villar Landeira, Comparison of\nconventional averaged and rapid averaged, autoregressive-based extracted\nauditory evoked potentials for monitoring the hypnotic level during\npropofol induction, Anesthesiology, vol. 97, 2002, pp. 351-358.","J. Rampil, A primer for EEG signal processing in anesthesia, Anesthesiology,\nvol. 89, 1998, pp. 981-1001.","J. C. Sigl and N. G. Chamoun, An introduction to Bispectral analysis\nfor the EEG, Journal of Clinical Monitoring and Computing Springer\nNetherlands, vol. 10, 1994, pp. 392-404.\n[10] P.Ch. Ivanov, A.N. Amaral, Lus, A.L. Goldberger, S. Havlin, M.G.\nRosenblum, Z.R. Struzik, H.E. Stanley, Multifractality in human heartbeat\ndynamics, Nature. vol. 399, 1999, pp. 461-465.\n[11] D. Garrett, D. A. Peterson, C. W. Anderson, M. H. Thaut, Comparison\nof Linear, Nonlinear, and Feature Selection Methods for EEG Signal\nClassification, IEEE Trans. neural systems and rehabilitation engineering,\nvol. 11, 2003, pp. 141-144.\n[12] P. Flandrin, Time-Frequency or Time-Scale Analysis, Academic Press,\nLondon, 1999.\n[13] F. Hlawatsch, G.F. Boudreaux-Bartels, Linear and quadratic timefrequency\nsignal representations, IEEE Signal Process. Mag., vol. 9, 1992,\npp. 21-67.\n[14] T. W. Schnider, C. F. Minto, S. L. Shafer, P. L. Gambus, C. Andresen,\nD. B. Goodale, and E. J. Youngs, The influence of age on propofol\npharmacodynamics, Anesthesiology, vol. 90, 1999, pp. 1502-1516.\n[15] S. L. Shafer and K. M. Gregg, Algorithms to rapidly achieve and\nmaintain stable drug concentrations at the site of drug effect with a\ncomputer- controlled infusion pump, Journal of Pharmacokinetics and\nPharmacodynamics, Springer, vol. 20, 1992, pp. 147-169.\n[16] M. M. R. F. Struys, T. De Smet, B. Depoorter, L. F. Versichelen, E.\nP. Mortier, F. J. Dumortier, S. L. Shafer, and G. Rolly, Comparison\nof plasma compartment versus two methods for effect compartmentcontrolled\ntarget-controlled infusion for propofol, Anesthesiology, vol.\n92, 2000, pp. 399-406.\n[17] Vigon L, Saatchi M R, Mayhew J E W and Fernandes R, Quantitative\nevaluation of techniques for ocular artifact filtering of EEG waveforms,\nIEE Proceedings on Science Measurement Technology, vol. 147, n.5, Sep\n2000.\n[18] Girton D G, Kamiya J, A simple on-line technique for removing eye\nmovement artifacts from the EEG, Electroencephalography and Clinical\nNeurophysiology, vol. 34, pp. 212-216, 1973.\n[19] V. J. Samar, A. Bopardikar, R. Rao, Kenneth Swartz, Wavelet Analysis\nof Neuroelectric waveforms: A Conceptual Tutorial, Brain and Laguage,\nvol. 66, 1999, pp. 7-60.\n[20] T Gasser, L Sroka and J Mocks, The transfer of EOG activity into\nthe EEG for eyes open and closed, Electroencephalography and clinical\nneurophysiology, vol. 61, 1985, pp. 181-193.\n[21] http://www.xploretat.de/tutorials/waveframe8.html\n[22] V. krishnaveni, S. jayaraman, N. malmurugan, A. kandaswamy, K. ramadoss,\nNon adaptive thresholding methods for correcting ocular artifacts\nin EEG, academic open internet journal, vol. 13, 2004.\n[23] M. Nakamura, H. Shibasaki, Elimination of EKG artifacts from EEG\nrecords: a new method of noncephalic referential EEG recording Electroencephalogr,\nClin. Neurophys. vol. 66, 1987, pp. 89-92.\n[24] H.J. Park, D.U. Jeong, K.S. Park, Automated detection and elimination\nof periodic ECG artifacts in EEG using the energy interval histogram\nmethod, IEEE Trans. Biomed. 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Two prominent theories have guided decades of research into the biological basis of human fear and anxiety. Davidson's Anterior Asymmetry and Emotion model holds that fear and anxiety derive from a single, withdrawal system, which is in turn aligned with right prefrontal regions (as part of a larger network of ingulate/subcortical structures). In contrast, Gray's Reinforcement Sensitivity Theory (RST), though originally of a similar view, has since been revised to account for an observed functional, behavioural and pharmacological distinction between fear and anxiety which Gray now aligns with two neurobiologically separable systems, the Fight, Flight, Freeze System (FFFS; fear) and the Behavioural Inhibition System (BIS; anxiety). Whilst generating a great deal of empirical interest, Davidson's withdrawal system/right prefrontal hypothesis has to date received very mixed support. It was proposed here that by applying Gray's fear/anxiety distinction to Davidson's model, some of this past inconsistency may be accounted for. Specifically, it was hypothesised that right prefrontal regions should be aligned with fear (FFFS), but not anxiety (BIS). However, although established at an animal level, Gray's BIS/FFFS distinction has received minimal attention within a human experimental setting. Thus testing this right prefrontal/FFFS hypothesis was first contingent on deriving valid methods of distinguishing the FFFS and BIS at a human level. This was initially addressed by exploring the potential relevance of existing self-report trait measures. Critically, it was observed that Gray's revised RST (which also includes a third system, the Behavioural Activation System, BAS) now closely resembles the three primary dimensions common to most three-factor models of temperament/personality. In particular, extensive conceptual, neurobiological and behavioural overlap was documented between trait models of Gray's three systems (FFFS, BIS and BAS) and Tellegen's Negative Emotionality, Constraint and Positive Emotionality superfactors. Accordingly, Constraint (in particular the Control and Harm Avoidance subscales) and Negative Emotionality (in particular the Stress Reaction subscale) were proposed as potential trait level markers of the revised BIS and FFFS respectively. This was supported in Study 1 (N=190) by observing that Control, Harm Avoidance and Stress Reaction loaded highly and exclusively onto orthogonal BIS (Control and Harm Avoidance) and FFFS (Stress Reaction) factors; two of three factors which emerged when these measures were entered into an exploratory factor analysis with measures of the old (pre-revised RST) BIS construct (i.e., Carver and White BIS scale, CW-BIS; the Trait scale of the Spielberger State Trait Anxiety Inventory, STAIT, Sensitivity to Punishment scale, SP), and existing BAS measures. Somewhat surprisingly, all old BIS measures loaded exclusively on the FFFS factor.

Tez (Yüksek Lisans) -- Kırıkkale Üniversitesi 78570 …

Basel II, dünyada birçok ülkede uygulamaya geçirilen, ülkemizde de alt yapısı büyük ölçüde olu?turulan ancak uygulamasına henüz ba?lanmamı? olan bir risk ölçümü ve yönetimi sistemidir. Basel II süreci, kredi risk ölçüm sistemleri açısından iki bölüme ayrılmakta, birincisi standart yakla?ım, diğeri ise içsel derecelendirme yakla?ımıdır. Standart yakla?ımın uygulanması, gerek bankalar gerekse de kredi talebinde bulunan ?irketler açısından önemli sonuçlar doğurmakta ve ?irketler için dı?sal kredi derecelendirmesini belirli ko?ullar dahilinde zorunlu tutmaktadır. ?irketlerin kredi değerliliğinin ölçülmesi i?lemi olan kredi derecelendirme uygulaması bu sürecin odak noktasını olu?turmaktadır.Bu çalı?manın amacı, Basel II sürecinde, kredi risk ölçümü sistemi olan standart yakla?ım kapsamında, dı?sal derecelendirme uygulamasını, i?levini ve önemini ortaya koymaktır. Bu amaçla, yöntemi tarafımızca olu?turulmu? olan bir kredi derecelendirme modeli tarafından, ?stanbul Menkul Kıymetler Borsası?na kote olan iki ?irketin kredi derecelendirme uygulaması yapılmı?tır. Uygulama sonucunda elde edilen bulgu ve sonuçlar Basel II Standart Yakla?ım kapsamında değerlendirilmi?tir. Kredi risklilik düzeyi ikinci firmaya göre daha dü?ük olduğu anla?ılan birinci ?irket, Basel II Standart Yakla?ım çerçevesinde bankalarla kredi ili?kisine girdiği takdirde daha avantajlı hale gelmekte, dü?ük risk kategorisinde yeralması sebebiyle kredi tahsis eden banka açısından kredi maliyeti daha dü?ük olmaktadır. Kredi riski orta düzeyde olduğu belirlenen ikinci ?irket için ise konunun ekonomik yansımalarının birinci firmaya göre dezavantajlı olduğu ortaya çıkmaktadır. Kredi riski birinci firmaya göre daha yüksek olan ikinci firma için kredi talebi ortaya çıktığında, ilgili banka daha fazla kar?ılık ayırmak zorunda kalacak ve bu durumu kredi faizlerine yansıtacaktır.Anahtar Kelimeler : Basel II, Standart Yakla?ım, ?çsel Derecelendirme Yakla?ımı, BIS, Kredi Riski, Kredi Derecelendirme, Finansal Risk Analizi, Kantitatif Analiz, Kalitatif Analiz. Basel II is the credit risk measurement and credit risk management system that has been executed by most of countries. Basel II has not been implemented in Turkey, but for the implementation, Turkey has prepared most of the required regulations and fundemantel groundworks. Basel II Accord comprises of two approaches. The first one is standard approach, the second one is internal based approach. Standard approach implementation results in considerable consequences for both banks and companies which request credit extending. Standard approach also requires companies to be rated by an external credit agency. Credit rating which measures credit risk of companies for banks in the Basel II standard approach, gets substantial importance in this process.The purpose of this study in the Basel II criteria and standard approach is to explain the function and importance of external credit rating. For this purpose, credit rating exercises of two publicly held companies listed in ?stanbul Stock Exchange were accomplished by using methodology which was built up. At the end of the implementation of credit rating process, results and findings of this study were analyzed in accordance with the standard approach. The first rated company which has lower credit risk than the second one, has some advantages when it has relationship with bank concerning with loan request. Since first rated company is in the low risk category, the bank who extends credit to the first rated firm has some credit cost advantages. On the other hand, the second rated company whose credit risk was determined as in the middle class risk category, endures negative economic reflection of its credit risk level as compared to the first rated company. When the second rated firm requests credit, related bank will have to allocate more capital than it does for the first rated firm. Finally, bank will reflects its additional credit cost to the interest rateKey Words : Basel II, Standard Aproach, Internal Based Approach, BIS, Credit Risk,Credit Rating, Financial Risk Analysis, Quantitative Analysis, Qualitative Analysis 157

Hintergrund. Die Durchführung sicherer, komplikationsarmer Narkosen in Kombination mit schnellem Erwachen und zeitnaher Rückkehr kognitiver Funktionen nach Operationsende scheint nach Einführung kurzwirksamer und besser steuerbarer Medikamente wir Propofol und Remifentanil, sowie der Verwendung computergesteuerter Applikationssysteme besser möglich zu sein. Basierend auf dem Marsh- Modell sind Zielkontrollierte Perfusorsysteme in der täglichen Praxis gebräuchlich. Die Zielwerte werden in den Target-controlled- Infusions-systemen (TCI) als Plasmakonzentration des Medikamentes angegeben. Unter Verwendung eines Mehrkompartimentmodell und der messbaren zeitlichen Verzögerung der Medikamentenwirkung (Hysterese) wurde ein optimiertes Infusionssystem (OTCI) entwickelt, in dem die Medikamentenkonzentration im Erfolgsorgan zur Steuerung der Anästhesietiefe genutzt wird. Methoden. Es wurden 50 Patienten die sich einer elektiven Vasovasostomie unterzogen in zwei Gruppen randomisiert. 25 Patienten wurden unter Verwendung des TCI-Systems mit Propofol anästhesiert. Bei den anderen 25 Patienten setzten wir das OTCI- System mit Propofol ein. Alle Narkosen wurden mit einem für den Untersucher verblindeten BIS- Monitor überwacht. Ergebnisse. Beide Gruppen (TCI vs. OTCI) unterschieden sich nicht in den demographischen Daten, der OP-Dauer, der Einleitungszeit, dem Wach-BIS-Wert dem Remifentanilverbrauch und dem BIS-Wert zum Extubationszeitpunkt. Die Propofoleinsparung war in der OTCI-Gruppe mit durchschnittlich 106,48mg (1071mg vs. 965mg) noch nicht signifikant. Die Gruppen unterschieden sich signifikant in der Narkosetiefe (BIS intraop. 33,2 vs. 38,5 p=0,0035), der Aufwachzeit (11,2min vs. 8,44min p=0,046) und dem BIS- Wert zum Verlegungszeitpunkt in den Aufwachraum 5 Minuten post extubationem, als Maß für die schnellere Erholung (77,04 vs. 81,84 p=0,012) zu Gunsten der OTCI-Gruppe. Schlussfolgerung. Unter Verwendung des OTCI-Verfahrens ist eine Optimierung der Anästhesieleistung möglich. Kürzere Aufwachzeiten, eine raschere kognitive Erholung bei gleicher Anästhesiesicherheit und eine mögliche Einsparung von Medikamenten, sind neben dem hohen Maß an Patientenzufriedenheit auch von betriebswirtschaftlicher Bedeutung., Background. The performance of safe anaesthesia with fewer complications combined with fast wake-up and prompt return of cognitive functions on completion of surgery appear to be possible with the introduction of rapid- acting and more controllable drugs, such as Propofol and Remifentanil, as well as the use of computerised application systems. Target-controlled perfusor systems based on the Marsh model are common in daily practice. The target values in the target-controlled infusion systems (TCI) are specified as the plasma concentration of the drug. An optimised infusion system (OTCI) was developed using a multi-compartment model and the measurable delay in drug action (hysteresis), in which the drug concentration in the target organ is used to control the depth of anaesthesia. Methods. 50 patients who underwent an elective vasovasostomy were randomised in two groups. 25 patients were anaesthetised using the TCI system with Propofol. The OTCI system with Propofol was used for the other 25 patients. All anaesthetics were monitored with a BIS monitor blinded for the investigator. Results. Both groups (TCI vs. OTCI) did not differ in their demographic data, duration of surgery, induction time, BIS wake-up value, Remifentanil consumption and BIS value to the time of extubation. The saving in Propofol was not significant in the OTCI group with a mean of 106.48 mg (1071 mg vs. 965 mg). The groups differ significantly in the depth of anaesthesia (BIS intraop. 33.2 vs. 38.5 p=0.0035), wake-up time (11.2 min vs. 8.44 min p=0.046) and BIS value to the time of transfer to the recovery room of 5 minutes post extubation, as a measure of faster recovery (77.04 vs. 81.84 p=0.012), in favour of the OTCI group. Conclusions. Optimisation of anaesthetic performance is possible using the OTCI method. Besides a higher level of patient satisfaction, shorter wake-up times, more rapid cognitive recovery with the same anaesthetic safety and potential drug savings are also of economic significance.

Summary Regional anaesthesia has become an important anaesthetic technique. Effective sedation is an essential for regional techniques too. This study compares midazolam and propofol in terms of onset & recovery from sedation, dosage and side effects of both the drugs using Bispectral Index monitoring. Ninety eight patients were randomly divided into two groups,one group recieved midazolam infusion while the other recieved propofol infusion until BIS reached 75. We observed Time to reach desired sedation, HR, MABP, time for recovery, dose to reach sedation and for maintenance of sedation and side effects if any. The time to reach required sedation was 11 min in Midazolam group(Group I) while it was 6 min in Propofol group(Group II) (p=0.0). Fall in MABP was greater with propofol. Recovery in with midazolam was slower than with propofol (18.6 ± 6.5 vs 10.10±3.65 min) (p=0.00). We concluded that both midazolam and propofol are effective sedatives, but onset and offset was quicker with propofol, while midazolam was more cardiostable.

Die Arbeit untersucht den Einfluss des Anästhetikums Xenon auf die Hämodynamik, den Bispektralindex, die Entropie des Elektroenzephalogramms, die Inzidenz therapiebedürftiger Ereignisse sowie auf die Serumwerte von NSE und Cortisol während Allgemeinanästhesien bei älteren Patienten im Vergleich zu Propofol.

En salle d’opération, les tâches de l’anesthésiste sont nombreuses. Alors que l’utilisation de nouveaux outils technologiques l’informe plus fidèlement sur ce qui se passe pour son patient, ces outils font que ses tâches deviennent plus exigeantes. En vue de diminuer cette charge de travail, nous avons considérer l’administration automatique d’agents anesthésiques en se servant de contrôle en boucle fermée. À cette fin, nous avons développé un système d’administration d’un agent anesthésique (le propofol) visant à maintenir à un niveau optimal la perte de conscience du patient pendant toute la durée d’une chirurgie. Le système comprend un ordinateur, un moniteur d’anesthésie et une pompe de perfusion. L’ordinateur est doté d’un algorithme de contrôle qui, à partir d’un indice (Bispectral IndexTM ou BIS) fournit par le moniteur d’anesthésie détermine le taux d’infusion de l’agent anesthésiant. Au départ, l’anesthésiste choisit une valeur cible pour la variable de contrôle BIS et l’algorithme, basé sur système expert, calcule les doses de perfusion de propofol de sorte que la valeur mesurée de BIS se rapproche le plus possible de la valeur cible établie. Comme interface-utilisateur pour un nouveau moniteur d’anesthésie, quatre sortes d’affichage ont été considérés: purement numérique, purement graphique, un mélange entre graphique et numérique et un affichage graphique intégré (soit bidimensionnel). À partir de 20 scenarios différents où des paramètres normaux et anormaux en anesthésie étaient présentés à des anesthésistes et des résidents, l’étude des temps de réaction, de l’exactitude des réponses et de la convivialité (évaluée par le NASA-TLX) a montré qu’un affichage qui combine des éléments graphiques et numériques était le meilleur choix comme interface du système. Une étude clinique a été réalisée pour comparer le comportement du système d’administration de propofol en boucle fermée comparativement à une anesthésie contrôlée de façon manuelle et conventionnelle où le BIS était aussi utilisé. Suite à l’approbation du comité d’éthique et le consentement de personnes ayant à subir des chirurgies générales et orthopédiques, 40 patients ont été distribués également et aléatoirement soit dans le Groupe contrôle, soit dans le Groupe boucle fermée. Après l’induction manuelle de propofol (1.5 mg/kg), le contrôle en boucle fermée a été déclenché pour maintenir l’anesthésie à une cible de BIS fixée à 45. Dans l’autre groupe, le propofol a été administré à l’aide d’une pompe de perfusion et l’anesthésiste avait aussi à garder manuellement l’indice BIS le plus proche possible de 45. En fonction du BIS mesuré, la performance du contrôle exercé a été définie comme excellente pendant les moments où la valeur du BIS mesurée se situait à ±10% de la valeur cible, bonne si comprise de ±10% à ±20%, faible si comprise de ±20% à ±30% ou inadéquate lorsque >±30%. Dans le Groupe boucle fermée, le système a montré un contrôle excellent durant 55% du temps total de l’intervention, un bon contrôle durant 29% du temps et faible que pendant 9% du temps. Le temps depuis l’arrêt de la perfusion jusqu’à l’extubation est de 9 ± 3.7 min. Dans le Groupe contrôle, un contrôle excellent, bon, et faible a été enregistré durant 33%, 33% et 15% du temps respectivement et les doses ont été changées manuellement par l’anesthésiste en moyenne 9.5±4 fois par h. L’extubation a été accomplie après 11.9 ± 3.3 min de l’arrêt de la perfusion. Dans le Groupe boucle fermée, un contrôle excellent a été obtenu plus longtemps au cours des interventions (P, In the operating room, the anaesthetist performs numerous tasks. New technological tools better inform him about the state of the patient but render his task more demanding. To alleviate the anaesthetist workload, we have considered the automatic administration of anesthetic drugs using closed-loop control. In this respect, we have developed a system for the administration of an anesthetic agent (propofol) in order to maintain loss of consciousness at an optimal level throughout a surgery. The system comprises a computer, an anaesthesia monitor and an infusion pump. A control algorithm installed on the computer determines the infusion rate of the hypnotic drug based on the Bispectral IndexTM (BIS) provided by the monitor. At first, the anaesthetist chooses a target value for the control variable BIS and the algorithm, which consists of an expert system, calculates the infusion doses of propofol in order to steer the measured BIS value closer to the target value. For the user-interface of a novel anaesthesia monitor, four display types were considered: purely numeric, purely graphical, a mixed graphical and numerical and a bi-dimensional integrated graphical display. Based on 20 different scenarios where normal and abnormal anaesthesia parameters were presented to anaesthetists and residents, the study of the reaction time, response accuracy and user-friendliness (assessed by the NASA-TLX) showed that a mixed graphical and numerical display is the best preferred for the interface of the system. A clinical study was conducted in order to compare the behaviour of the system of administering propofol in closed-loop to manually controlled anaesthesia guided by BIS. After Institutional Review Board approval and written consent, 40 patients undergoing orthopaedic or general surgery were randomly assigned to 2 groups of equal size. After manual propofol induction (1.5 mg/kg), closed loop control was used to maintain anesthesia at a target BIS of 45 (Closed-loop group); in the other group, propofol was administered manually using a syringe pump by an experienced anaesthesiologist in order to maintain a target BIS of 45 as closely as possible (Control group). The performance of the system was defined as excellent, good, poor or inadequate, when the BIS was within 10%, between 10 and 20%, between 20 and 30% or outside 30% of the target BIS, respectively. In the Closed-loop group, the system showed excellent control during 55% of the total anaesthesia time, good control during 29% of the time and poor control during 9% of the time. The time from the end of infusion to extubation was 9 ± 3.7 min. In the Control group, excellent, good and poor control were noted during 33%, 33% and 15% of the time, respectively and doses were changed 9.5 ± 4 times per h. Extubation was achieved after 11.9 ± 3.3 min from the end of infusion. In the Closed-loop group, excellent control of anesthesia occurred significantly more often (P

Available on: http://www.iariajournals.org/systems_and_measurements/sysmea_v2_n4_2009_paged.pdf; International audience; The computerization of scientific data treatment and the relatively recent awareness of the fragility of the natural world environment (Rio Conference "Earth Summit" in 1992) have led to the proliferation of Information Systems dedicated to biodiversity. Given the various data that they contain, they are complex applications, focused on the needs of one type of environmental scientist, closed to amateur's contributions and unable to support ethological information. Moreover, the data contained in these systems are hardly accessible to nonspecialists like the general public or decision-makers. At the same time, new communication protocols, like webservices ensure a better sharing of information between applications; while immersive representations of threedimensional virtual worlds, also known as metaverses, allow a more natural assimilation of information. By putting users in a reality reproduction built from information systems, all entities can be represented in a consistent virtual environment [15]. But sharing and turning Biodiversity Information System's data in a coherent metaverse is not a trivial process. It relies on an adapted architecture and the availability of specific metadata, as several virtual worlds representing several levels of details can be generated. This paper is a contribution to the enhancement of Biodiversity Information Systems in order to make them more adaptable, usable, and representable for several kinds of users: different types of specialists, amateurs, and the general public. The MABIS modular architecture is presented as an open, efficient and evolutionary model for structuring Biodiversity Information System. The advantages of its architecture allow to ease its development, store ethological data, manage, share and represent complex entities and metadata while ensuring their authentication through an evaluation process.

2004 yılında Basel II Standartlarının yayınlanmasıyla birlikte birçok Avrupa ülkesinde faaliyet gösteren bankalar bu standartlara uyum konusunda yoğun çalışmalar gerçekleştirmişlerdir. 2006 yılında bankaların Basel II standartlarına uyma zorunluluğu AB müktesebatına dahil edilmesiyle, AB'ye üyelik yolunda olan ülkeler için bu standartlara uyum zorunlu hale gelmiştir. Temel amacı bankaları krizlere karşı daha dirençli hale getirmek olarak ifade edilen Basel II standartlarına uyum konusu, Türkiye'de yasal, siyasi ve ekonomik birçok nedenden dolayı tartışılmış ve ilk başta 2008 yılında uygulanması planlanan standartlar belirtilmeyen bir süreye ertelenmiştir. Fakat AB üyeliği konusunda çalışmaları devam eden Türkiye'nin Basel II standartlarına uyum çalışmalarına hız kesmeden devam edeceği belirtilmiştir. Her ne kadar Basel II standartlarında asgari sermaye yeterlilik hesaplamaları öne çıksa da, Basel II standartları etkileri geniş ve derin olan standartlardır. Türkiye açısından bakıldığında kredilendirmedeki yöntem ve süreç değişikliği büyük önem arz etmektedir. Basel II standardıyla birlikte kredilendirmede firma için verilen derecelendirme (rating) notu, kredi limitinin tespit edilmesinde, kredi fiyatlamasında ve teminat yapısının belirlenmesinde ana faktör olarak kabul edilecektir. Günümüzde kredilendirme ise bankalarca yapılan mali tahlil ve istihbarat (MTİ) çalışmalarına göre yapılmakta olup, bu çalışmaların bankacılık sektörü açısından önemi, Basel II standartlarına uyumu ve MTİ çalışanlarının derecelendirme sistemine bakış açılarına ilişkin literatürde fazla kaynak bulunmamaktadır. Bu çalışmayla; bankacılık sektörünün üzerinde durduğu en hassas faaliyetlerden biri olan kredilendirme sürecinin MTİ çalışmaları ve bu çalışmaların temel dayanakları incelenmiş ve bu sürecin Basel II standartlarının sonucu olan derecelendirme sistemine uyumu tartışılmıştır.Bu bağlamda Türkiye'de faaliyet gösteren 4 katılım bankasının 83 MTİ uzmanına anket uygulanmıştır. Sonuçlara göre; MTİ çalışmalarıyla, Basel II standartlarının yapılmasını ön gördüğü uygulamalar arasında temel farlılıklar olmadığı, hem Basel II standartlarının önerdiği derecelendirme sisteminde hem de mali tahlil çalışmalarında firmaların kredi değerliliğini belirleyen ana faktörün firma mali verileri olduğu tespit edilmiştir. Bunun yanında firma mali verilerine olan güvenin az olduğu, bu nedenle derecelendirme sistemine olan güvenin de düşük olduğu görülmüştür. Basel II standartlarına uyum konusunda eğitim alan personelin az olduğu ve alınan eğitimin personelin tamamını tatmin etmediği tespit edilmiştir. Sonuç kısmında; yapılan bu çalışmanın bulgularından bahsedilmiş ve önerilerde bulunularak literatüre katkı sağlanmaya çalışılmıştır.Anahtar Kelimeler: Basel II, Mali Tahlil ve İstihbarat, BIS, Kredi, Risk, Sermaye, KOBİ, Katılım Bankası Lots of banks in European have started to accord Basel II standards since Basel II standards issued in 2004. Application of Basel II standards have accepted to European acquis communautaire in 2006 and it cause to be necessity to accord Basel II standards for European Union?s candidate countries like Turkey. In Turkey, application of Basel II standards, which defined as trying to increase resistance of banks against financial crises, has delayed to unknown date in 2008 because of many economic, legal and politic factors. But for Turkey application of Basel II standards is still a necessity as an EU candidate country. Although Basel II standard known as criteria about minimum capital requirement (MCR), it has many wide and deep effects to all banking activities. For instance credit process methods, credit process chancing has many considerable affect to Turkey?s banking sector. Basel II standards advice using the rating system for making decision of credit limit, credit price etc. The credit decision is given by the credit analysis and intelligence (CAI) working in present day in Turkey, but there are not much research about CAI working importance, according of Basel II standards and CAI?s workers perspective of rating system in the literature. This research tries to appear; CAI working for credit process, which is the important process of banking system, CAI working resources and according of CAI process to Basel II standards.In this context this study base on, survey results from 83 CAI workers who work 4 Participation Banks in Turkey. According to the survey there are no considerable differences between CAI process and rating process, which Basel II?s advised. It is the one result of this survey that the financial data and statements about firms are the most important criteria for rating system and CAI process. The other result shows, CAI workers don?t trust financial statement enough and it cause decreasing confidence of new rating system. The other result shows that banks? have less and not quality enough training activities about Basel II standard. There are mention more about this study?s result at the conclusion part and trying to contribute to future studies.Keywords: Basel II, The Credit Analysis and Intelligence, BIS, Credit, Risk, Capital, SMEs, Participation Bank 129

Die frühzeitige, adäquate Vorhersage des Outcome nach kardiopulmonaler Reanimation (CPR) ist selbst für erfahrene Kliniker schwierig. Das Ziel dieser prospektiven Studie war es, zu prüfen, ob die Messung des Bispektralen Index (BIS-Monitoring) als frühzeitiger Prognoseparameter während und unmittelbar nach CPR geeignet ist. Der BIS ist ein vom EEG abgeleiteter Parameter und korreliert eng mit dem zerebralen Metabolismus. Die BIS-Monitoranlage erfolgte bei 89 Patienten im Rahmen der CPR zum frühest möglichen Zeitpunkt (Drop out n = 10). 59 Patienten (74,5 %) erlangten einen Spontankreislauf und 26 Patienten (32,9 %) überlebten den Beobachtungszeitraum von einem Monat. Davon zeigten 7 Patienten (8,9 %) ein schlechtes neurologisches Outcome. Der BIS war mit einem medianen Wert von 60,5 versus 25,4 innerhalb der ersten 4 Stunden nach Reanimationsbeginn bei den neurologisch guten Patienten signifikant höher. Mittels Receiver Operating Characteristic konnte für den BIS ein Cut-off von < 40 für die Vorhersage eines schlechten neurologischen Outcome ermittelt werden (Spezifität 89,5 %, Sensitivität 85,7 %). Durch den BIS-Monitor werden auch die EEG-Anteile mit einer Amplitude unter ± 0,5 µV als sogenannte Suppression Ratio (SR) erfasst. Ein schlechtes Outcome ist mit signifikant höheren SR-Werten assoziiert. Das Nichterreichen einer SR von 0 innerhalb der ersten 4 Stunden wurde als Schwellenkriterium definiert, um ein schlechtes neurologisches Outcome vorherzusagen (Spezifität 94,7 %, Sensitivität 71,4 %). Zusammenfassend lässt sich feststellen, dass das BIS-Monitoring ein schlechtes neurologisches Outcome sehr frühzeitig, innerhalb der ersten 4 Stunden nach Reanimationsbeginn, mit hoher Wahrscheinlichkeit vorhersagt. Der besondere Vorteil des BIS-Monitoring liegt hierbei in seiner einfachen Anwendbarkeit und Interpretation, wodurch das BIS-Monitoring als Screeningmethode zur Vorhersage des neurologischen Outcome nach CPR in den klinischen Alltag integriert werden könnte.

Among the international policy institutions, the Bank for International Settlements (BIS) is known for its sensitivity to financial stability issues. Attention to the "macro-prudential" dimension of financial stability is very typical for the BIS. The Bank's macro-prudential approach first came to the fore in the 1986 Cross Report. It defined the macro-prudential domain as "the safety and soundness of the broad financial system and payments mechanism". In this paper, it will be argued that Alexandre Lamfalussy, who was at the BIS from 1976 to 1993, played a crucial role in shaping the Bank's approach to financial stability. Lamfalussy is renowned for taking a broad macroeconomic view and for focusing on the systemically important financial institutions, as the failure of one of these individual institutions would threaten the whole financial system. In Lamfalussy's view, there is thus very much an overlap between the micro- and macro-prudential dimensions of financial stability. This paper traces Lamfalussy's analysis of financial fragility and goes into the reasons for his sensitivity to it. Among the main elements involved were: a "Keynesian" Weltanschauung (that a market economy is not sufficiently self-correcting); the emphasis of Dupriez (his teacher in Louvain) on cycles; Lamfalussy's own experience as a commercial banker; BIS involvement in financial stability issues, especially the Latin American debt crisis of 1982-83; and research in the central banking community on financial innovations in the early 1980s

BACKGROUND: To guide anesthetic administration with electroencephalogram monitors in children, an adequate characterization of the anesthetic effect measured by these monitors in this population is needed. We sought to quantify and compare the dynamic profile of sevoflurane's effect measured with the cerebral state index (CST) and the bispectral index (BIS) in children.METHODS: Fifteen healthy children, aged 3-15 yr, scheduled to undergo minor surgery were prospectively studied. During the simultaneous recording of CST and % for 5 min and then decreased. BIS, the sevoflurane vaporizer was set at 6 vol End-tidal concentrations (C(ET)) were measured. The C(ET)-sevoflurane effect-site concentration equilibration and pharmacodynamics were modeled. Goodness of fit between models was compared. Data are typical value (coefficient of variation).RESULTS: Within the anesthetic depth range studied, the rate of change of sevoflurane's effect expressed as the effect-site equilibration half-life (t(1/2) k(e0)) was slower with the CST [2.0 (14) min] than with BIS [1.2 (53) min] (P CONCLUSIONS: In children, the t(1/2) k(e0) of sevoflurane and the pharmacodynamics of sevoflurane were quantified and the results were entirely dependent on the monitor used to measure its hypnotic effect. Within the anesthetic depth range studied, the rate of change of sevoflurane's effect was slower with the CST. To adequately guide sevoflurane administration with these monitors in children, these differences should be considered.

Seit der Einführung des ultrakurz wirksamen Opioids Remifentanil gewinnt dessen klinische Anwendung stets mehr an Bedeutung und es ersetzt zunehmend Lachgas als intraoperatives Analgetikum. Unklar ist jedoch, in welchem Ausmaß ein Lachgasverzicht zu einer Erhöhung der erforderlichen Opioiddosis führt. In dieser Studie werden 59 Patienten mit größtenteils unfallchirurgischen Eingriffen auf zwei Untersuchungsgruppen einfach blind randomisiert und nach einem festen Studienprotokoll anästhesiert: Die erste Gruppe erhält eine Narkose mit Propofol, Remifentanil und Lachgas (= Lachgasgruppe), während bei der zweiten Gruppe auf die Lachgasapplikation verzichtet wird (TIVA (= Totale Intravenöse Anästhesie)-Gruppe). Die Narkosetiefe wird mit Hilfe des Bispectralen Index (BIS) überwacht. Die Auswertung der gewonnenen Studiendaten erfolgt mittels des Wilcoxon-Rangsummentests. Eine lachgasfreie Narkose führt zu einer statistisch signifikanten Remifentanil-Dosissteigerung von 0,14 [0,12/0,20] µg/kg/min auf 0,17 [0,14/0,29] µg/kg/min. Bei Verzicht auf Lachgas ist bei knochenchirurgischen Eingriffen eine 18-prozentige Erhöhung der Opioiddosis erforderlich. Diese Dosiserhöhung führt nicht zu einer postoperativen Opioidtoleranz mit vermehrtem postoperativen Schmerzmittelverbrauch. Die Dosissteigerung von Remifentanil korreliert negativ mit dem BIS-Wert. Ein genereller Lachgasverzicht hat ferner keinen Einfluss auf den Patientenkomfort. Remifentanil ist ein optimaler Ersatz für Lachgas bei unfallchirurgischen Operationen.

Banverket är den myndighet som har ansvaret för järnvägstransportsystemet i Sverige och är enproducent av järnvägsinformation. En stor del av infrastrukturinformationen lagras i baninformationssystemetBIS och Banverket är förpliktad att tillhandahålla den. I nuläget är informationenåtkomlig på ett lätt sätt främst internt. Dessutom ställer dagens samhälle krav på att informationenska levereras enligt standard. Standardiseringsorgan har tagit fram standarder för geografiskinformation som svar på behovet att återanvända och samutnyttja geografiska data.Vårt examensarbete är genomfört på Banverket Verksamhetsstöds IT-avdelning och var inriktatpå att kartlägga standarder för geografisk information och utveckla en webbtjänst för BIS för attöka tillgängligheten till informationen.Rapportens kunskapsbidrag är en analys av standarder för geografisk information som är relevantaför järnvägsnätet. Resultatet har framställts genom en reflexiv analysmetod med abduktionsom angreppssätt och kvalitativa datainsamlingsmetoder.Som en praktisk del i vårt examensarbete har vi utvecklat en webbtjänst som tillhandahållerfunktionalitet för att nå data i BIS om nätanknutna företeelser och ett ramverk för att omstruktureraBIS interna format i enlighet med standarder.Vi föreslår att Banverket följer de svenska tillämpningsstandarderna SS 63 70 04, SS 63 70 06och SS 63 70 07. Enligt vårt förslag ska Banverket vidta följande åtgärder för att leverera grundläggandedata om järnvägsnät och nätanknutna företeelser enligt dessa standarder:• Analys av informationsbehov utifrån nya verklighets- och verksamhetskrav.• Dokumentation av begreppsmodell och publicering av objekttypskatalog.• Kvalitetssäkring av informationen i BIS.• Datainsamling av koordinater på noder och geometrier på länkar.• Utveckling av ny datamodell för BIS som stödjer tidsaspekter.• Översyn av BIS arkitektur och design.• Uppgradering av utvecklingsplattform.• Utveckling av transformeringar för omstrukturering av rapportresultat från BIS interna formattill standarder.• Komplettering av webbtjänsten med metoder för att leverera metadata. Användaren behövermetadata för att kunna välja objekttyper, attribut och urvalskriterier när rapportbeställningarskapas.• Komplettering av webbtjänsten med metoder för att leverera information om järnvägsnätetsinfrastruktur.

Teksten beskriver, hvordan volumen af kropsvæsker kan måles/estimeres med teknikken bio-impedans-spektroskopi (BIS). De første kapitler forudsætter kun lidt eller ingen teknisk/matematisk viden og kan forhåbentlig læses af enhver, som er interesseret i teknikken. Senere kapitler bliver mere tekniske, men indledes med opsummeringer af konklusionerne. Meningen med noterne er at give en forståelse af teknikken, dens forudsætninger og dens begrænsninger. Der tages udgangspunkt i et konkret apparatur, hvis mulige anvendelser analyseres med henvisning til peer-reviewed litteratur. The lecture notes describe how body fluid volumes can be measured/estimated using the technique bio-impedance spectroscopy (BIS). The opening chapters assume little or none technical/mathematical knowledge and can hopefully be read by anyone interested in the techneque. Later chapters become more technical, but are started with a summary of the conclusions. The aim of the lecture notes is to give an understanding of the technique, its assumptions, and its limitations. A specific BIS device is analyzed with references to peer-reviewed literature.

This work explores the consequences of the managerial discourses on flexible work mediated by technology. The study – based on a multiple case analysis – points out the relevance and the impact of information and communication technology (ICT) on both “rational” firm’s productivity and “normative” employees’ psychological contract. Finally, we suggest some implementation guidelines for successful ICT work solutions.