Variations in paediatric upper respiratory surgery rates within and between two Nordic countries

Lasten ylähengitystiekirurgia (kita-nielurisojen poisto ja tärykalvon putkitus) on länsimaissa erittäin yleistä. Leikkausten lukumäärät vaihtelevat niin kansallisesti kuin kansainvälisestikin, mutta selvää syytä näille eroille ei tiedetä. Hoitosuositusten merkitys käytäntöihin on kyseenalaistettu ja voi olla, ettei hoitosuosituksia noudateta. Leikkaukset saattavat aiheuttaa lapsipotilaille psykologisen vamman, ja lisäksi niihin sisältyy komplikaatioiden, jopa kuoleman, vaara. Jotta haittoja voidaan välttää, on tärkeää tunnistaa ne lapset, jotka hyötyvät leikkauksesta. Ongelma on paitsi lääketieteellinen, myös taloudellinen: ylähengitystiekirurgiasta aiheutuu merkittäviä kuluja. Leikkausmäärien arvioiminen on tärkeää, jotta leikkauskäytäntöjä voidaan järkeistää. Tässä väitöskirjatyössä tutkittiin ylähengitystieleikkausten määriä Suomessa ja Norjassa sekä näiden kahden maan välillä. Aiempaa tutkimusta aiheesta ei kummassakaan maassa ole tehty. Kitarisanpoiston, välikorvan putkituksen, tärykalvopiston, nielurisanpoiston ja kita- ja nielurisanpoiston leikkausmäärät saatiin kansallisista tietokannoista. Lukuja verrattiin ko. maan lasten lukumäärään, maantieteelliseen sijoittumiseen sekä lasten ikään ja sukupuoleen. Lisäksi leikkausmääriä arvioitiin suhteessa korva-, nenä- ja kurkkulääkäreiden sekä yleislääkäreiden määrään, maantieteelliseen sijoittumiseen ja lääkäreiden ikään ja sukupuoleen. Leikkausten määrissä havaittiin suurta vaihtelua niin Suomessa kuin Norjassa. Suomessa suurimmat erot leikkausmäärissä löydettiin läntisen ja itäisen miljoonapiirin välillä. Läntisessä piirissä tehtiin lähes kaksin kertaa enemmän leikkauksia kuin itäisessä piirissä. Norjassa suurimmat erot olivat pohjoisen ja itäisen piirin välillä. Pohjoisessa piirissä tehtiin kaksinkertainen määrä leikkauksia itäiseen piirrin verrattuna. Suomessa tehtiin tutkimuksen koko aikavälillä enemmän kitarisanpoistoja kuin Norjassa, mutta ko. leikkausten määrä oli maassamme selvästi laskussa. Vuonna 2002 Suomessa tehtiin 2,5 kertaa enemmän kitarisanpoistoja kuin Norjassa. (Kita)nielurisanpoistoja tehtiin kuitenkin Suomessa vähemmän kuin Norjassa. Näiden leikkausten määrät pysyivät tutkimuksen aikavälillä Suomessa samalla tasolla, kun Norjassa leikkausmäärät hieman nousivat. Suomalaisia lapsia leikattiin keskimäärin paljon nuorempina kuin norjalaisia lapsia. Tutkimuksessa ei löydetty selitystä ylähengitystieleikkausten määrän suurelle vaihtelulle Suomessa ja Norjassa tai maiden välillä. Kuitenkin Suomessa tehtyjen kitarisanpoistojen huomattavan vähenemisen myötä maiden ylähengitystieleikkausten määrät lähenivät toisiaan.

Modern computed tomography techniques in stroke management

Technological development of fast multi-sectional, helical computed tomography (CT) scanners has allowed computed tomography perfusion (CTp) and angiography (CTA) in evaluating acute ischemic stroke. This study focuses on new multidetector computed tomography techniques, namely whole-brain and first-pass CT perfusion plus CTA of carotid arteries. Whole-brain CTp data is acquired during slow infusion of contrast material to achieve constant contrast concentration in the cerebral vasculature. From these data quantitative maps are constructed of perfused cerebral blood volume (pCBV). The probability curve of cerebral infarction as a function of normalized pCBV was determined in patients with acute ischemic stroke. Normalized pCBV, expressed as a percentage of contralateral normal brain pCBV, was determined in the infarction core and in regions just inside and outside the boundary between infarcted and noninfarcted brain. Corresponding probabilities of infarction were 0.99, 0.96, and 0.11, R² was 0.73, and differences in perfusion between core and inner and outer bands were highly significant. Thus a probability of infarction curve can help predict the likelihood of infarction as a function of percentage normalized pCBV. First-pass CT perfusion is based on continuous cine imaging over a selected brain area during a bolus injection of contrast. During its first passage, contrast material compartmentalizes in the intravascular space, resulting in transient tissue enhancement. Functional maps such as cerebral blood flow (CBF), and volume (CBV), and mean transit time (MTT) are then constructed. We compared the effects of three different iodine concentrations (300, 350, or 400 mg/mL) on peak enhancement of normal brain tissue and artery and vein, stratified by region-of-interest (ROI) location, in 102 patients within 3 hours of stroke onset. A monotonic increasing peak opacification was evident at all ROI locations, suggesting that CTp evaluation of patients with acute stroke is best performed with the highest available concentration of contrast agent. In another study we investigated whether lesion volumes on CBV, CBF, and MTT maps within 3 hours of stroke onset predict final infarct volume, and whether all these parameters are needed for triage to intravenous recombinant tissue plasminogen activator (IV-rtPA). The effect of IV-rtPA on the affected brain by measuring salvaged tissue volume in patients receiving IV-rtPA and in controls was investigated also. CBV lesion volume did not necessarily represent dead tissue. MTT lesion volume alone can serve to identify the upper size limit of the abnormally perfused brain, and those with IV-rtPA salvaged more brain than did controls. Carotid CTA was compared with carotid DSA in grading of stenosis in patients with stroke symptoms. In CTA, the grade of stenosis was determined by means of axial source and maximum intensity projection (MIP) images as well as a semiautomatic vessel analysis. CTA provides an adequate, less invasive alternative to conventional DSA, although tending to underestimate clinically relevant grades of stenosis.

Exhaled nitric oxide : Variability and association with bronchial hyperresponsiveness and atopy

Airway inflammation is a key feature of bronchial asthma. In asthma management, according to international guidelines, the gold standard is anti-inflammatory treatment. Currently, only conventional procedures (i.e., symptoms, use of rescue medication, PEF-variability, and lung function tests) were used to both diagnose and evaluate the results of treatment with anti-inflammatory drugs. New methods for evaluation of degree of airway inflammation are required. Nitric oxide (NO) is a gas which is produced in the airways of healthy subjects and especially produced in asthmatic airways. Measurement of NO from the airways is possible, and NO can be measured from exhaled air. Fractional exhaled NO (FENO) is increased in asthma, and the highest concentrations are measured in asthmatic patients not treated with inhaled corticosteroids (ICS). Steroid-treated patients with asthma had levels of FENO similar to those of healthy controls. Atopic asthmatics had higher levels of FENO than did nonatopic asthmatics, indicating that level of atopy affected FENO level. Associations between FENO and bronchial hyperresponsiveness (BHR) occur in asthma. The present study demonstrated that measurement of FENO had good reproducibility, and the FENO variability was reasonable both short- and long-term in both healthy subjects and patients with respiratory symptoms or asthma. We demonstrated the upper normal limit for healthy subjects, which was 12 ppb calculated from two different healthy study populations. We showed that patients with respiratory symptoms who did not fulfil the diagnostic criteria of asthma had FENO values significantly higher than in healthy subjects, but significantly lower than in asthma patients. These findings suggest that BHR to histamine is a sensitive indicator of the effect of ICS and a valuable tool for adjustment of corticosteroid treatment in mild asthma. The findings further suggest that intermittent treatment periods of a few weeks’ duration are insufficient to provide long-term control of BHR in patients with mild persistent asthma. Moreover, during the treatment with ICS changes in BHR and changes in FENO were associated. FENO level was associated with BHR measured by a direct (histamine challenge) or indirect method (exercise challenge) in steroid-naïve symptomatic, non-smoking asthmatics. Although these associations could be found only in atopics, FENO level in nonatopic asthma was also increased. It can thus be concluded that assessment of airway inflammation by measuring FENO can be useful for clinical purposes. The methodology of FENO measurements is now validated. Especially in those patients with respiratory symptoms who did not fulfil the diagnostic criteria of asthma, FENO measurement can aid in treatment decisions. Serial measurement of FENO during treatment with ICS can be a complementary or an alternative method for evaluation in patients with asthma.

Dynamical processes in the stratosphere and upper troposphere and their influence on the distribution of trace gases in the polar atmosphere

Transport plays an important role in the distribution of long-lived gases such as ozone and water vapour in the atmosphere. Understanding of observed variability in these gases as well as prediction of the future changes depends therefore on our knowledge of the relevant atmospheric dynamics. This dissertation studies certain dynamical processes in the stratosphere and upper troposphere which influence the distribution of ozone and water vapour in the atmosphere. The planetary waves that originate in the troposphere drive the stratospheric circulation. They influence both the meridional transport of substances as well as parameters of the polar vortices. In turn, temperatures inside the polar vortices influence abundance of the Polar Stratospheric Clouds (PSC) and therefore the chemical ozone destruction. Wave forcing of the stratospheric circulation is not uniform during winter. The November-December averaged stratospheric eddy heat flux shows a significant anticorrelation with the January-February averaged eddy heat flux in the midlatitude stratosphere and troposphere. These intraseasonal variations are attributable to the internal stratospheric vacillations. In the period 1979-2002, the wave forcing exhibited a negative trend which was confined to the second half of winter only. In the period 1958-2002, area, strength and longevity of the Arctic polar vortices do not exhibit significant long-term changes while the area with temperatures lower than the threshold temperature for PSC formation shows statistically significant increase. However, the Arctic vortex parameters show significant decadal changes which are mirrored in the ozone variability. Monthly ozone tendencies in the Northern Hemisphere show significant correlations (|r|=0.7) with proxies of the stratospheric circulation. In the Antarctic, the springtime vortex in the lower stratosphere shows statistically significant trends in temperature, longevity and strength (but not in area) in the period 1979-2001. Analysis of the ozone and water vapour vertical distributions in the Arctic UTLS shows that layering below and above the tropopause is often associated with poleward Rossby wave-breaking. These observations together with calculations of cross-tropopause fluxes emphasize the importance of poleward Rossby wave breaking for the stratosphere-troposphere exchange in the Arctic.

Search for the Higgs boson produced in association with Z→ℓ+ℓ- using the matrix element method at CDF II

We present a search for associated production of the standard model (SM) Higgs boson and a $Z$ boson where the $Z$ boson decays to two leptons and the Higgs decays to a pair of $b$ quarks in $p\bar{p}$ collisions at the Fermilab Tevatron. We use event probabilities based on SM matrix elements to construct a likelihood function of the Higgs content of the data sample. In a CDF data sample corresponding to an integrated luminosity of 2.7 fb$^{-1}$ we see no evidence of a Higgs boson with a mass between 100 GeV$/c^2$ and 150 GeV$/c^2$. We set 95% confidence level (C.L.) upper limits on the cross-section for $ZH$ production as a function of the Higgs boson mass $m_H$; the limit is 8.2 times the SM prediction at $m_H = 115$ GeV$/c^2$.

Search for a Higgs Boson Decaying to Two W Bosons at CDF

We present a search for a Higgs boson decaying to two W bosons in ppbar collisions at sqrt(s)=1.96 TeV center-of-mass energy. The data sample corresponds to an integrated luminosity of 3.0 fb-1 collected with the CDF II detector. We find no evidence for production of a Higgs boson with mass between 110 and 200 GeV/c^2, and determine upper limits on the production cross section. For the mass of 160 GeV/c^2, where the analysis is most sensitive, the observed (expected) limit is 0.7 pb (0.9 pb) at 95% Bayesian credibility level which is 1.7 (2.2) times the standard model cross section.

Search for the Higgs Boson Using Neural Networks in Events with Missing Energy and b-Quark Jets in pp̅ Collisions at √s=1.96 TeV

We report on a search for the standard model Higgs boson produced in association with a $W$ or $Z$ boson in $p\bar{p}$ collisions at $\sqrt{s} = 1.96$ TeV recorded by the CDF II experiment at the Tevatron in a data sample corresponding to an integrated luminosity of 2.1 fb$^{-1}$. We consider events which have no identified charged leptons, an imbalance in transverse momentum, and two or three jets where at least one jet is consistent with originating from the decay of a $b$ hadron. We find good agreement between data and predictions. We place 95% confidence level upper limits on the production cross section for several Higgs boson masses ranging from 110$\gevm$ to 150$\gevm$. For a mass of 115$\gevm$ the observed (expected) limit is 6.9 (5.6) times the standard model prediction.

Search for Long-Lived Massive Charged Particles in 1.96 TeV pp̅ Collisions

We performed a signature-based search for long-lived charged massive particles (CHAMPs) produced in 1.0 $\rm{fb}^{-1}$ of $\bar{p}p$ collisions at $\sqrt{s}=1.96$ TeV, collected with the CDF II detector using a high transverse-momentum ($p_T$) muon trigger. The search used time-of-flight to isolate slowly moving, high-$p_T$ particles. One event passed our selection cuts with an expected background of $1.9 \pm 0.2$ events. We set an upper bound on the production cross section, and, interpreting this result within the context of a stable scalar top quark model, set a lower limit on the particle mass of 249 GeV/$c^2$ at 95% C.L.

Improved Search for a Higgs Boson Produced in Association with Z→l+l- in pp̅ Collisions at √s=1.96 TeV

We present a search for the standard model Higgs boson produced with a Z boson in 4.1 fb^-1 of data collected with the CDF II detector at the Tevatron. In events consistent with the decay of the Higgs boson to a bottom-quark pair and the Z boson to electrons or muons, we set 95% credibility level upper limits on the ZH production cross section times the H -> b bbar branching ratio. Improved analysis methods enhance signal sensitivity by 20% relative to previous searches beyond the gain due to the larger data sample. At a Higgs boson mass of 115 GeV/c^2 we set a limit of 5.9 times the standard model value.

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.

Nature of chemistry in the national frame curricula for upper secondary education in Finland, Norway and Sweden

The aim of this study was to discover how current chemistry syllabi in the frame curricula for up- per secondary education in three Nordic countries (Finland, Norway, and Sweden) take into account topics related to the nature of chemistry. By qualitative content analysis, the statements related to the nature of chemistry were divided into categories. Conclusions and implications for improving the frame curricula under study were made by comparing results with research into the nature of science. Chemistry syllabi from the Nordic frame curricula analyzed take into account the aims related to the nature of chemistry in a very similar manner. The ideas that should be made more explicit in all of the analyzed curricula are: i) the limits of the chemical models and theories, ii) the relationship between chemistry and other natural sciences, iii) the importance of creativity in chemical research, iv) the concepts of evidence in science texts, v) the social nature of chemical research, and vi) chemistry as a technological practice.