Magnetic resonance imaging and ultrasonography in brachial plexus birth injury

Brachial plexus birth injury (BPBI) is caused by stretching, tearing or avulsion of the C5-C8 or Th1 nerve roots during delivery. Foetal-maternal disproportion is the main reason for BPBI. The goal of this study was to find out the incidence of posterior subluxation of the humeral head during first year of life in BPBI and optimal timing of the ultrasonographic screening of the glenohumeral joint. The glenohumeral congruity and posterior subluxation of the humeral head associated to muscle atrophy were assessed and surgical treatment of the shoulder girdle as well as muscle changes in elbow flexion contracture were evaluated. The prospective, population based part of the study included all neonates born in Helsinki area during years 2003-2006. Patients with BPBI sent to the Hospital for Children and Adolescents because of decreased external rotation, internal rotation contracture or deformation of the glenohumeral joint as well as patients with elbow flexion contracture were also included in this prospective study. The incidence of BPBI was calculated to be 3.1/1000 newborns in Helsinki area. About 80% of the patients with BPBI recover totally during the follow-up within the first year of life. Permanent plexus injury at the age of one year was noted in 20% of the patients (0.64/1000 newborns). Muscle imbalance resulted in sonographically detected posterior subluxation in one third of the patients with permanent BPBI. If muscle imbalance and posterior subluxation are left untreated bony deformities will develop. All patients with internal rotation contracture of the glenohumeral joint presented muscle atrophy of the rotator cuff muscles. Especially subscapular and infraspinous muscles were affected. A correlation was found particularly between greatest thickness of subscapular muscle and subluxation of the humeral head, degree of glenoid retroversion, as well as amount of internal rotation contracture. Supinator muscle atrophy was evident among all the studied patients with elbow flexion contracture. Brachial muscle pathology seemed to be an important factor for elbow flexion contracture in BPBI. Residual dysfunction of the upper extremity may require operative treatment such as tendon lengthening, tendon transfers, relocation of the humeral head or osteotomy of the humerus. Relocation of the humeral head improved the glenohumeral congruency among patients under 5 years of age. Functional improvement without remodeling of the glenohumeral joint was achieved by other reconstructive procedures. In conclusion: Shoulder screening by US should be done to all patients with permanent BPBI at the age of 3 and 6 months. Especially atrophy of the subscapular muscle correlates with glenohumeral deformity and posterior subluxation of the humeral head, which has not been reported in previous studies. Permanent muscle changes are the main reason for diminished range of motion of the elbow and forearm. Relocation of the humeral head, when needed, should be performed under the age of 5 years.

Why Don't Students Talk? Causes of Foreign Language Communication Apprehension in English Classes: A Comparison of High Apprehensive and Low Apprehensive Upper Secondary Students.

OBJECTIVES. Oral foreign language skills are an integral part of one's social, academic and professional competence. This can be problematic for those suffering from foreign language communication apprehension (CA), or a fear of speaking a foreign language. CA manifests itself, for example, through feelings of anxiety and tension, physical arousal and avoidance of foreign language communication situations. According to scholars, foreign language CA may impede the language learning process significantly and have detrimental effects on one's language learning, academic achievement and career prospects. Drawing on upper secondary students' subjective experiences of communication situations in English as a foreign language, this study seeks, first, to describe, analyze and interpret why upper secondary students experience English language communication apprehension in English as a foreign language (EFL) classes. Second, this study seeks to analyse what the most anxiety-arousing oral production tasks in EFL classes are, and which features of different oral production tasks arouse English language communication apprehension and why. The ultimate objectives of the present study are to raise teachers' awareness of foreign language CA and its features, manifestations and impacts in foreign language classes as well as to suggest possible ways to minimize the anxiety-arousing features in foreign language classes. METHODS. The data was collected in two phases by means of six-part Likert-type questionnaires and theme interviews, and analysed using both quantitative and qualitative methods. The questionnaire data was collected in spring 2008. The respondents were 122 first-year upper secondary students, 68 % of whom were girls and 31 % of whom were boys. The data was analysed by statistical methods using SPSS software. The theme interviews were conducted in spring 2009. The interviewees were 11 second-year upper secondary students aged 17 to 19, who were chosen by purposeful selection on the basis of their English language CA level measured in the questionnaires. Six interviewees were classified as high apprehensives and five as low apprehensives according to their score in the foreign language CA scale in the questionnaires. The interview data was coded and thematized using the technique of content analysis. The analysis and interpretation of the data drew on a comparison of the self-reports of the highly apprehensive and low apprehensive upper secondary students. RESULTS. The causes of English language CA in EFL classes as reported by the students were both internal and external in nature. The most notable causes were a low self-assessed English proficiency, a concern over errors, a concern over evaluation, and a concern over the impression made on others. Other causes related to a high English language CA were a lack of authentic oral practise in EFL classes, discouraging teachers and negative experiences of learning English, unrealistic internal demands for oral English performance, high external demands and expectations for oral English performance, the conversation partner's higher English proficiency, and the audience's large size and unfamiliarity. The most anxiety-arousing oral production tasks in EFL classes were presentations or speeches with or without notes in front of the class, acting in front of the class, pair debates with the class as audience, expressing thoughts and ideas to the class, presentations or speeches without notes while seated, group debates with the class as audience, and answering to the teacher's questions involuntarily. The main features affecting the anxiety-arousing potential of an oral production task were a high degree of attention, a large audience, a high degree of evaluation, little time for preparation, little linguistic support, and a long duration.

Hantavirus infection: Insights into entry, assembly and pathogenesis

Hantaviruses (family Bunyaviridae, genus Hantavirus) are enveloped viruses incorporating a segmented, negative-sense RNA genome. Each hantavirus is carried by its specific host, either a rodent or an insectivore (shrew), in which the infection is asymptomatic and persistent. In humans, hantaviruses cause Hemorrhagic fever with renal syndrome (HFRS) in Eurasia and Hantavirus cardiopulmonary syndrome (HCPS) in the Americas. In Finland, Puumala virus (genus Hantavirus) is the causative agent of NE, a mild form of HFRS. The HFRS-type diseases are often associated with renal failure and proteinuria that might be mechanistically explained by infected kidney tubular cell degeneration in patients. Previously, it has been shown that non-pathogenic hantavirus, Tula virus (TULV), could cause programmed cell death, apoptosis, in cell cultures. This suggested that the infected kidney tubular degeneration could be caused directly by virus replication. In the first paper of this thesis the molecular mechanisms involved in TULV-induced apoptosis was further elucidated. A virus replication-dependent down-regulation of ERK1/2, concomitantly with the induced apoptosis, was identified. In addition, this phenomenon was not restricted to TULV or to non-pathogenic hantaviruses in general since also a pathogenic hantavirus, Seoul virus, could inhibit ERK1/2 activity. Hantaviruses consist of membrane-spanning glycoproteins Gn and Gc, RNA-dependent RNA polymerase (L protein) and nucleocapsid protein N, which encapsidates the viral genome, and thus forms the ribonucleoprotein (RNP). Interaction between the cytoplasmic tails of viral glycoproteins and RNP is assumed to be the only means how viral genetic material is incorporated into infectious virions. In the second paper of this thesis, it was shown by immunoprecipitation that viral glycoproteins and RNP interact in the purified virions. It was further shown that peptides derived from the cytoplasmic tails (CTs) of both Gn and Gc could bind RNP and recombinant N protein. In the fourth paper the cytoplamic tail of Gn but not Gc was shown to interact with genomic RNA. This interaction was probably rather unspecific since binding of Gn-CT with unrelated RNA and even single-stranded DNA were also observed. However, since the RNP consists of both N protein and N protein-encapsidated genomic RNA, it is possible that the viral genome plays a role in packaging of RNPs into virions. On the other hand, the nucleic acid-binding activity of Gn may have importance in the synthesis of viral RNA. Binding sites of Gn-CT with N protein or nucleic acids were also determined by peptide arrays, and they were largely found to overlap. The Gn-CT of hantaviruses contain a conserved zinc finger (ZF) domain with an unknown function. Some viruses need ZFs in entry or post-entry steps of the viral life cycle. Cysteine residues are required for the folding of ZFs by coordinating zinc-ions, and alkylation of these residues can affect virus infectivity. In the third paper, it was shown that purified hantavirions could be inactivated by treatment with cysteine-alkylating reagents, especially N-ethyl maleimide. However, the effect could not be pin-pointed to the ZF of Gn-CT since also other viral proteins reacted with maleimides, and it was, therefore, impossible to exclude the possibility that other cysteines besides those that were essential in the formation of ZF are required for hantavirus infectivity.

Omistajuus Maailmanpankin diskurssissa : muuttuvatko avun toimijoiden valtasuhteet? Tapaustutkimuksena avun uusi arkkitehtuuri ja yhteiskunnalliset voimasuhteet Mosambikissa

Samanaikaisesti, kun tämän päivän kehitysdiskurssissa painotetaan omistajuutta ja kumppanuutta, monien mielestä avunantajien asema suhteessa avunsaajiin on jopa vahvistunut entisestään. Jos vahvistuneen avunsaajan omistajuuden ajatellaan tarkoittavan vallan siirtoa avunantajilta avunsaajille, vaikuttaisi diskurssin ja käytännön välillä olevan ristiriita. Työssäni yritän selvittää eri tekijät ja historiallisen taustan, joiden seurauksena liberaali käsitteistö, etenkin omistajuus, on noussut Maailmanpankin diskurssiin. Tätä kautta pyrin selvittämään, mitä omistajuus tarkoittaa Maailmanpankille, ja millaisiin valta-asetelmiin uusi diskurssi johtaa. Työni tapaustutkimuksessa pohdin omistajuuskysymyksiä tämän päivän Mosambikissa: edesauttaako nykyinen liberaali kehitysdiskurssi vallansiirtoa Mosambikin kontekstissa a) avunantajilta avunsaajamaalle b) perimmäiselle edunsaajalle, eli kansalle. Tutkimukseni on luonteeltaan laadullinen. Historiallisen lähestymistavan kautta pyrin selvittämään taustaa ja syitä Maailmanpankin diskurssin muutokseen, ja sitä kautta selvittämään nykyään vallitsevia avunantajien ja avunsaajien välisiä valtasuhteita. Tähän käytän lähteinäni ensimmäisessä osiossa Maailmanpankin omia julkaisuja ja toisessa osiossa muita kirjallisia lähteitä. Mosambikin tapaustutkimukseni lähdeaineisto koostuu paikallisten järjestöjen ja tutkimusinstituuttien edustajille tekemistäni avoimista teemahaastatteluista sekä muista kirjallisista, Mosambikin avun kontekstia käsittelevistä lähteistä. Omistajuuskäsite Maailmanpankin diskurssissa on laajentunut huomattavasti: kun alussa omistajuudella tarkoitettiin lähinnä sitoutumista, niin nykyään se tulisi ymmärtää pyrkimyksenä lisätä avunsaajamaiden hallintaa kehitysprosesseissa, mikä puolestaan lisäisi huomattavasti avunsaajamaiden päätösvaltaa avunkäytön suhteen. Toisessa osiossa kuitenkin osoitan, että vaikka Maailmanpankki antaa omistajuusdiskurssin myötä ymmärtää, että aloitteen kehitysinterventiosta on tultava avunsaajamaalta itseltään, niin todellisuudessa asetelma on erilainen. Maailmanpankin ja muiden avunantajien keinot vaikuttaa ovat muuttuneet, mutta vaikutus on pysynyt yhä vahvana. Omistajuus- ja kumppanuusdiskurssi toimii merkittävässä asemassa nykyisessä avun kontekstissa, jossa avunantajat vaikuttavat avunsaajamaihin sisältä päin: vallankäytön mekanismit ovat enemmän piilossa. Näin ollen aloite tulee yhä vieläkin avunantajilta, ja omistajuus tarkoittaa lähinnä avunsaajamaan sitoutumista ohjelmiin. Kansalaisyhteiskunta puolestaan on otettu mukaan tukemaan avunantajien agendaa ja varmistamaan kannatus muutoksilie myös yhteiskunnan sisältä päin. Mosambikin tapaustutkimuksessa huomiot ovat jokseenkin samankaltaisia. Omistajuusdiskurssin myötä avunantajat vaikuttavat mahdollisesti yhä tehokkaammin Mosambikin hallituksen sisällä, etenkin avun käyttöön liittyvissä kysymyksissä. Mosambikin hallitus ei kuitenkaan vaikuta edes haluavan vahvempaa omistajuutta, koska nykyinen toteutettava malli palvelee sen etuja loistavasti: antamalla periksi tietyillä alueilla avunantajille hallitus vahvistaa asemiansa muiden kotimaisten toimijoiden edessä. Avunantajilla voi tahtoessaan olla tärkeä rooli avunsaajamaiden sisäisiin valtasuhteisiin vaikuttamisessa. Mosambikin esimerkin perusteella vaikuttaa kuitenkin siltä, että merkittävää muutosta kansan ja hallituksen välisissä valtasuhteissa ei ole tapahtunut.