New aspects of the diagnosis of Helicobacter pylori infection

Aims: Helicobacter pylori infection, although the prevalence is declining in Western world, is still responsible for several clinically important diseases. None of the diagnostic tests is perfect and in this study, the performance of three stool antigen tests was assessed. In areas of high H. pylori prevalence, the definition of patients with the greatest benefit from eradication therapy may be a problem; the role of duodenal gastric metaplasia in categorizing patients at risk for duodenal ulcer was evaluated in this respect. Whether persistent chronic inflammation and elevated H. pylori antibodies after successful eradication are associated with each other or with atrophic gastritis, a long term sequelae of H. pylori infection, were also studied. Patients and methods: The three stool antigen tests were assessed in pre- and post-eradication settings among 364 subjects in two studies as compared to the rapid urease test (RUT), histology, culture, the 13C-urea breath test (UBT) and enzyme immunoassay (EIA) based H. pylori serology. The association between duodenal gastric metaplasia with duodenal ulcer was evaluated in a retrospective study including 1054 patients gastroscopied due to clinical indications and 154 patients previously operated for duodenal ulcer. The extent of duodenal gastric metaplasia was assessed from histological specimens in different patient groups formed on the basis of gastroscopy findings and H. pylori infection. Chronic gastric inflammation (108 patients) and H. pylori antibodies and serum markers for atrophy (77 patients) were assessed in patients earlier treated for H. pylori. Results: Of the stool antigen tests studied, the monoclonal antibody-based EIA-test showed the highest sensitivity and specificity both in the pre-treatment setting (96.9% and 95.9%) and after therapy (96.9% and 97.8%). The polyclonal stool antigen test and the in-office test had at baseline a sensitivity of 91% and 94%, and a specificity of 96% and 89%, respectively and in a post-treatment setting, a sensitivity of 78% and 91%, and a specificity of 97%, respectively. Duodenal gastric metaplasia was strongly associated with H. pylori positive duodenal ulcer (odds ratio 42). Although common still five years after eradication, persistent chronic gastric inflammation (21%) and elevated H. pylori antibodies (33%) were neither associated with each other nor with atrophic gastritis. Conclusions: Current H. pylori infection can feasibly be diagnosed by a monoclonal antibody-based EIA test with the accuracy comparable to that of reference methods. The performance of the polyclonal test as compared to the monoclonal test was inferior especially in the post-treatment setting. The in-office test had a low specificity for primary diagnosis and hence positive test results should probably be confirmed with another test before eradication therapy is prescribed. The presence of widespread duodenal gastric metaplasia showed promising results in detecting patients who should be treated for H. pylori due to an increased risk of duodenal ulcer. If serology is used later on in patients with earlier successfully treated for H. pylori, it should be taken into account that H. pylori antibodies may persist elevated for years for unknown reason. However, this phenomenon was not found to be associated with persistent chronic inflammation or atrophic changes.

Multiplication of hybrid aspen (Populus tremula L. x P. tremuloides Michx.) from cuttings

The primary aim of the present study was to find an efficient and simple method of vegetative propagation for producing large numbers of hybrid aspen (Populus tremuloides L. x P. tremula Michx.) plants for forest plantations. The key objectives were to investigate the main physiological factors that affect the ability of cuttings to regenerate and to determine whether these factors could be manipulated by different growth conditions. In addition, clonal variation in traits related to propagation success was examined. According to our results, with the stem cutting method, depending on the clone, it is possible to obtain only 1−8 plants from one stock plant per year. With the root cutting method the corresponding values for two-year-old stock plants are 81−207 plants. The difference in number of cuttings between one- and two-year-old stock plants is so pronounced that it is economically feasible to grow stock plants for two years. There is no reason to use much older stock plants as a source of cuttings, as it has been observed that rooting ability diminishes as root diameter increases. Clonal variation is the most important individual factor in propagation of hybrid aspen. The fact that the efficiently sprouted clones also rooted best facilitates the selection of clones for large-scale propagation. In practice, root cuttings taken from all parts of the root system of hybrid aspen were capable of producing new shoots and roots. However, for efficient rooting it is important to use roots smaller than one centimeter in diameter. Both rooting and sprouting, as well as sprouting rate, were increased by high soil temperature; in our studies the highest temperature tested (30ºC) was the best. Light accelerated the sprouting of root cuttings, but they rooted best in dark conditions. Rooting is essential because without roots the sprouted cutting cannot survive long. For aspen the criteria for clone selection are primarily fiber qualities and growth rate, but ability to regenerate efficiently is also essential. For large-scale propagation it is very important to find clones from which many cuttings per stock plant can be obtained. In light of production costs, however, it is even more important that the regeneration ability of the produced cuttings be high.

Human trypsinogens in the pancreas and in cancer

Human pancreatic juice contains two major trypsinogen isoenzymes called trypsinogen-1 and -2, or cationic and anionic trypsinogen, respectively. Trypsinogen isoenzymes are also expressed in various normal and malignant tissues. We aimed at developing monoclonal antibodies (MAbs) and time-resolved immunofluorometric methods recognizing human trypsinogen-1 and -2, respectively. Using these MAbs and methods we purified, characterized and quantitated trypsinogen isoenzymes in serum samples, ovarian cyst fluids and conditioned cell culture media. In sera from healthy subjects and patients with extrapancreatic disease the concentration of trypsinogen-1 is higher than that of trypsinogen-2. However, in acute pancreatitis we found that the concentration of serum trypsinogen-2 is 50-fold higher than in controls, whereas the difference in trypsinogen-1 concentration is only 15-fold. This suggested that trypsinogen-2 could be used as a diagnostic marker for acute pancreatitis. In human ovarian cyst fluids tumor-associated trypsinogen-2 (TAT-2) is the predominant isoenzyme. Most notably, in mucinous cyst fluids the levels of TAT-2 were higher in borderline and malignant than in benign cases. The increased levels in association with malignancy suggested that TAT could be involved in ovarian tumor dissemination and breakage of tissue barriers. Serum samples from patients who had undergone pancreatoduodenectomy contained trypsinogen-2. Trypsinogen-1 was detected in only one of nine samples. These results suggested that the expression of trypsinogen is not restricted to the pancreas. Determination of the isoenzyme pattern by ion exchange chromatography revealed isoelectric variants of trypsinogen isoenzymes in serum samples. Intact trypsinogen isoenzymes and tryptic and chymotryptic trypsinogen peptides were purified and characterized by mass spectrometry, Western blot analysis and N-terminal sequencing. The results showed that pancreatic trypsinogen-1 and -2 are sulfated at tyrosine 154 (Tyr154), whereas TAT-2 from a colon carcinoma cell line is not. Tyr154 is located within the primary substrate binding pocket of trypsin, thus Tyr154 sulfation is likely to influence substrate binding. The previously known differences in charge, substrate specificity and inhibitor binding between pancreatic and tumor-associated trypsinogens are suggested to be caused by sulfation of Tyr154 in pancreatic trypsinogens.

Fatigue fractures in military conscripts : A study on risk factors, diagnostics and long-term consequences

Fatigue fracture is an overuse injury commonly encountered in military and sports medicine, and known to relate to intensive or recently intensified physical activity. Bone responds to increased stress by enhanced remodeling. If physical stress exceeds bone s capability to remodel, accumulation of microfractures can lead to bone fatigue and stress fracture. Clinical diagnosis of stress fractures is complex and based on patient s anamnesis and radiological imaging. Bone stress fractures are mostly low-risk injuries, healing well after non-operative management, yet, occurring in high-risk areas, stress fractures can progress to displacement, often necessitating surgical treatment and resulting in prolonged morbidity. In the current study, the role of vitamin D as a predisposing factor for fatigue fractures was assessed using serum 25OHD level as the index. The average serum 25OHD concentration was significantly lower in conscripts with fatigue fracture than in controls. Evaluating TRACP-5b bone resorption marker as indicator of fatigue fractures, patients with elevated serum TRACP-5b levels had eight times higher probability of sustaining a stress fracture than controls. Among the 154 patients with exercise induced anterior lower leg pain and no previous findings on plain radiography, MRI revealed a total of 143 bone stress injuries in 86 patients. In 99% of the cases, injuries were in the tibia, 57% in the distal third of the tibial shaft. In patients with injury, forty-nine (57%) patients exhibited bilateral stress injuries. In a 20-year follow-up, the incidence of femoral neck fatigue fractures prior to the Finnish Defence Forces new regimen in 1986 addressing prevention of these fractures was 20.8/100,000, but rose to 53.2/100,000 afterwards, a significant 2.6-fold increase. In nineteen subjects with displaced femoral neck fatigue fractures, ten early local complications (in first postoperative year) were evident, and after the first postoperative year, osteonecrosis of the femoral head in six and osteoarthritis of the hip in thirteen patients were found. It seems likely that low vitamin D levels are related to fatigue fractures, and that an increasing trend exists between TRACP-5b bone resorption marker elevation and fatigue fracture incidence. Though seldom detected by plain radiography, fatigue fractures often underlie unclear lower leg stress-related pain occurring in the distal parts of the tibia. Femoral neck fatigue fractures, when displaced, lead to long-term morbidity in a high percentage of patients, whereas, when non-displaced, they do not predispose patients to subsequent adverse complications. Importantly, an educational intervention can diminish the incidence of fracture displacement by enhancing awareness and providing instructions for earlier diagnosis of fatigue fractures.

Toiminta, valta ja kokemus organisaation muutoksessa : Tutkimus kolmesta suuryrityksestä

Action, Power and Experience in Organizational Change - A Study of Three Major Corporations This study explores change management and resistance to change as social activities and power displays through worker experiences in three major Finnish corporations. Two important sensitizing concepts were applied. Firstly, Richard Sennett's perspective on work in the new form of capitalism, and its shortcomings - the lack of commitment and freedom accompanied by the disruption to lifelong career planning and the feeling of job insecurity - offered a fruitful starting point for a critical study. Secondly, Michel Foucault's classical concept of power, treated as anecdotal, interactive and nonmeasurable, provided tools for analyzing change-enabling and resisting acts. The study bridges the gap between management and social sciences. The former have usually concentrated on leadership issues, best practices and goal attainment, while the latter have covered worker experiences, power relations and political conflicts. The study was motivated by three research questions. Firstly, why people resist or support changes in their work, work environment or organization, and the kind of analyses these behavioural choices are based on. Secondly, the kind of practical forms which support for, and resistance to change take, and how people choose the different ways of acting. Thirdly, how the people involved experience and describe their own subject position and actions in changing environments. The examination focuses on practical interpretations and action descriptions given by the members of three major Finnish business organizations. The empirical data was collected during a two-year period in the Finnish Post Corporation, the Finnish branch of Vattenfal Group, one of the leading European energy companies, and the Mehiläinen Group, the leading private medical service provider in Finland. It includes 154 non-structured thematic interviews and 309 biographies concentrating on personal experiences of change. All positions and organizational levels were represented. The analysis was conducted using the grounded theory method introduced by Straus and Corbin in three sequential phases, including open, axial and selective coding processes. As a result, there is a hierarchical structure of categories, which is summarized in the process model of change behaviour patterns. Key ingredients are past experiences and future expectations which lead to different change relations and behavioural roles. Ultimately, they contribute to strategic and tactical choices realized as both public and hidden forms of action. The same forms of action can be used in both supporting and resisting change, and there are no specific dividing lines either between employer and employee roles or between different hierarchical positions. In general, however, it is possible to conclude that strategic choices lead more often to public forms of action, whereas tactical choices result in hidden forms. The primary goal of the study was to provide knowledge which has practical applications in everyday business life, HR and change management. The results, therefore, are highly applicable to other organizations as well as to less change-dominated situations, whenever power relations and conflicting interests are present. A sociological thesis on classical business management issues can be of considerable value in revealing the crucial social processes behind behavioural patterns. Keywords: change management, organizational development, organizational resistance, resistance to change, change management, labor relations, organization, leadership

Finnish Business Repatriates' Coping Strategies

This thesis explores Finnish business repatriates’ coping strategies. Managing repatriation has been recognized as a demanding task for companies and an important issue in international human resource management. However, we still know relatively little about how repatriates respond to the demands of the return. This thesis addresses this problem by applying a process approach to coping with repatriation. The focus is on identifying repatriates’ coping strategies and the various forms of them. This study also aims to investigate what might influence the use of repatriates’ coping strategies and forms of coping. The background of this doctoral study is provided by earlier research that identified factors influencing repatriates’ adjustment, either positively or negatively. The empirical material of this doctoral thesis comprises twenty-two Phase I semi-structured interviews and ten Phase II follow-up interviews conducted for the purposes of verification. The main findings of the study are formulated as propositions. For instance, it was suggested that repatriates are likely to use different forms of problem-focused strategy more often than various forms of emotion-focused strategy. Moreover, they also are likely to use a larger range of problem-focused strategies than emotion-focused strategies. In addition, in contrast to specialists, repatriates occupying managerial positions are likely to use a greater number and a greater variety of different forms of problem-focused strategy than of emotion-focused strategy, especially in the context of preparing for their return and in different work role changes. This thesis contributes to research on repatriation, expatriation, coping and identifies implications for management.

Evaluating Option Pricing Models

This study evaluates three different time units in option pricing: trading time, calendar time and continuous time using discrete approximations (CTDA). The CTDA-time model partitions the trading day into 30-minute intervals, where each interval is given a weight corresponding to the historical volatility in the respective interval. Furthermore, the non-trading volatility, both overnight and weekend volatility, is included in the first interval of the trading day in the CTDA model. The three models are tested on market prices. The results indicate that the trading-time model gives the best fit to market prices in line with the results of previous studies, but contrary to expectations under non-arbitrage option pricing. Under non-arbitrage pricing, the option premium should reflect the cost of hedging the expected volatility during the option’s remaining life. The study concludes that the historical patterns in volatility are not fully accounted for by the market, rather the market prices options closer to trading time.

EFFEKTUTVÄRDERING INOM FÖRETAGANDEUTBILDNING

Effektutvärdering inom företagandeutbildning är ett forskningsfält som karakteriseras av brist på modeller ifråga om utvärdering. De få och hittills existerande utvärderingsmodellerna verkar ha förbisett de pedagogiska variablerna såsom utbildningens innehåll och metoder. Därför har det varit problematiskt att beskriva företagandeutbildningen i högskolor och analysera hur företagandeutbildningen bidrar till studerandes inlärning och deras förmåga att utnyttja kunskapen i näringslivet. Avhandlingen som är en deduktiv studie granskar den tidigare forskningen på området och förespråkar en tvärvetenskaplig ansats vid mätning och presentation aveffekter inom företagandeutbildning. Den nya modellen, ROEE-modellen, bidrar till teoribildningen om lärandets ”vad” och lärandets ”hur” inom företagandeutbildningen. En av de första teorierna om inlärning (Herbart 1776-1841) och Kirkpatricks (1998) fyra-stegs modell för kursutvärdering byggs ut med en ny referensram baserad på examensutbildning inom företagande. En intressant aspekt metodmässigt utgör att försöksplanering och diagnostik inom medicinens område tillämpas på företagandeutbildningen. Avhandlingen visar att variabeln innehåll i företagandeutbildningen inom examensutbildning har en klar koppling till beteendet. Ett välavvägt innehåll kan utnyttjas i arbetslivet såväl av entreprenören som av intraprenören. Vid metodval i undervisningen visar den empiriska undersökningen att variation i metoder ger de positivaste upplevelserna.