Roomalaista oikeutta kreikaksi 500-luvun Palestiinassa : Eräitä lakitermejä papyruksessa P. Petra inv. 83

Tutkimuksen tarkoituksena on analysoida eräitä lakitermejä, jotka esiintyvät papyruksessa P. Petra inv. 83. Kyseinen dokumentti, joka sisältää sopimuksen kahden naapuruksen välisen kiistan lopettamiseksi, ajoittuu todennäköisesti vuodelle 574 jKr. ja se kuuluu Jordanian Petrasta vuonna 1993 löydettyyn hiiltyneeseen papyrusarkistoon. Papyrus on tällä hetkellä vielä julkaisematon, ja tämä työ on osa siihen liittyvää perustutkimusta, jonka tarkoituksena on toisaalta selittää tekstin itsensä sisältö, toisaalta arvioida sen antaman informaation merkitystä laajemmassa historiallisessa kontekstissa. Papyrus on kirjoitettu kreikaksi, Bysantin eli Itä-Rooman valtakunnan virallisella kielellä, mutta itse lakitermeistä suurin osa liittyy alun perin latinan kielellä luotuun roomalaiseen oikeuteen. Paikallinen väestö puolestaan oli seemiläistä alkuperää, jolla ei ainoastaan ollut oma kieli, vaan jolla oli ollut ennen valtakuntaan liittämistä omat oikeustraditionsakin. Niinpä papyruksessa esiintyvien termien tutkimuksen kautta nousevat esille monenlaiset laajemmatkin kysymyksenasettelut. Lakitermejä analysoidaan pääasiassa kolmesta näkökulmasta. Ensisijaisena pyrkimyksenä on selvittää niiden tarkka merkitys asiayhteydessään, joka papyruksen fragmentaarisuuden vuoksi ei ole etukäteen selvä, ja siten edistää tekstissä puheena olevien asianhaarojen ymmärtämistä. Toiseksi termien käyttöä koskevat tulokset suhteutetaan yleiseen oikeushistoriaan ja pyritään arvioimaan niiden merkitystä Petrassa käytössä olleen oikeusjärjestelmän kannalta. Kolmas näkökulma on kielitieteellinen, sillä termien käyttö papyruksessa on nähtävä osana laajempaa kehitystä, jossa roomalaisen oikeuden vähittäinen muuttuminen bysanttilaiseksi johti kielten vaihtumiseen ja koko juridisen käsitteistön siirtymiseen latinasta kreikkaan. Siksi tässä työssä käytetään itse papyruksen analyysin lisäksi laajaa vertailumateriaalia, joka koostuu ennen kaikkea roomalaisesta ja bysanttilaisesta lakikirjallisuudesta sekä dokumentaarisesta lähdeaineistosta, etenkin egyptiläisistä papyruksista. Niin tässä papyruksessa kuin muissakin kreikankielisissä lähteissä esiintyvät roomalaiseen oikeuteen liittyvät termit voidaan jaotella suoriin lainoihin, käännöslainoihin sekä komparaatiolainoihin. Jälkimmäisillä tarkoitetaan kreikan kielessä jo aiemmin käytössä olleita termejä, jotka eivät sananmukaiselta merkitykseltään vastaa latinalaisia, mutta joita alettiin käyttää jonkin latinalaisen termin vastineina. Tutkimus tekee selväksi, että olipa kyse mistä lainakategoriasta tahansa, lakitermien siirtyessä kielestä toiseen tapahtui yleensä semanttisia muutoksia eikä termejä aina käytetty samalla tavalla kuin alkukielessä. Merkityskenttä saattoi esimerkiksi supistua taikka laajentua tai sanalle saattoi kehittyä lainautumisen jälkeen täysin uusiakin merkityksiä. Oikeushistorian suhteen on huomioitava ero virallisten säännösten ja provinsseissa noudatettujen käytäntöjen välillä. Kaiken kaikkaan Petra näyttää kuitenkin olleen kiinteä osa Bysantin valtakuntaa, jonka lakeja ainakin pääpiirteissään noudatettiin. Kaikkien termien käytötavat eivät tosin ole johdettavissa suoraan virallisiin lakikorpuksiin, mutta ne eivät myöskään sodi niitä vastaan. Roomalaisen oikeuden tuntemus näyttää olleen Petrassa jopa parempaa kuin esimerkiksi Egyptissä. Mitä tulee papyruksessa puheena oleviin konkreettisiin asianhaaroihin, termien merkityksen ymmärtäminen selventää joidenkin aspektien pääpiirteitä, kun taas yksityskohdat jäävät tekstin fragmentaarisuuden takia useimmiten epäselviksi. Avainsanat: papyrologia, Petra, roomalainen oikeus, terminologia, kreikan kieli, latinan kieli, lainasanat

Die Eigenschaften der Benennungen und ihr Einfluss auf deren Verwendung am Beispiel der Euro-Währung : Eine quantitative und kontrastive Analyse der Terminologie im Finnischen und im Deutschen

This dissertation deals with the terminology of the Euro currency. Its aims are to determine the characteristics of the designations in a certain LSP and to discover whether the recommendations and rules that have been given to the formation of designations and 'ideal' designations have any influence on the usage of the designations. The characteristics analysed include length of the designation, part of speech, form, formation method, constancy, monosemy, suitability to a concept system and degree of specialty. The study analyses the actual usage of the designations in texts and the implementation of the designations. The study is an adaptation of a terminometric survey and uses concept analysis and quantitative analysis as its basic methods. The frequency of each characteristic is measured in terms of statistics. It is assumed that the 'ideality' of a designation influences its usage, for example that if a designation is short, it is used more than its longer rivals (synonyms). The results are analysed in a corpus consisting of a compilation of different texts concerning the Euro. The corpus is divided according to three features: year (1998-2003), genre (judicial texts, annual reports and brochures) and language (Finnish and German). Each analysis is performed according to each of these features and compared with the others. The results indicate that some of the characteristics of the designations indeed seem to have an influence on the usage of the designations. For example, monosemy and suitability to the concept system often lead to the implementation of the designation having the ideal or certain value in these characteristics in the analysed Finnish material. In German material, an 'ideal' value in the characteristics leads to the implementation of the designations more often than in Finnish. The contrastive study indicates that, for example, suitability to a concept system leads to implementation of a designation in judicial texts more often than in other genres. The recommendations given to an 'ideal' designation are thus often acceptable, but they cannot be generalized for all languages in the same extent.

Proektirovanie perevodčeskih slovarej special'noj leksiki

The methodology of designing normative terminological products has been described in several guides and international standards. However, this methodology is not always applicable to designing translation-oriented terminological products which differ greatly from normative ones in terms of volume, function, and primary target group. This dissertation has three main goals. The first is to revise and enrich the stock of concepts and terms required in the process of designing an LSP dictionary for translators. The second is to detect, classify, and describe the factors which determine the characteristics of an LSP dictionary for translators and affect the process of its compilation. The third goal is to provide recommendations on different aspects of dictionary design. The study is based on an analysis of dictionaries, dictionary reviews, literature on translation-oriented lexicography, material from several dictionary projects, and the results of questionnaires. Thorough analysis of the concept of a dictionary helped us to compile a list of designable characteristics of a dictionary. These characteristics include target group, function, links to other resources, data carrier, list of lemmata, information about the lemmata, composition of other parts of the dictionary, compression of the data, structure of the data, and access structure. The factors which determine the characteristics of a dictionary have been divided into those derived from the needs of the intended users and those reflecting the restrictions of the real world (e.g. characteristics of the data carrier and organizational factors) and attitudes (e.g. traditions and scientific paradigms). The designer of a dictionary is recommended to take the intended users' needs as the starting point and aim at finding the best compromise between the conflicting factors. When designing an LSP dictionary, much depends on the level of knowledge of the intended users about the domain in question as well as their general linguistic competence, LSP competence, and lexicographic competence. This dissertation discusses the needs of LSP translators and the role of the dictionary in the process of translation of an LSP text. It also emphasizes the importance of planning lexicographic products and activities, and addresses many practical aspects of dictionary design.

A cross-linguistic study of lexical iconicity and its manifestation in bird names

Abstract This dissertation is a cross-linguistic study of lexical iconicity. The study is based on a genealogically stratified sample of 237 languages. The aim is to contribute with an empirical study to the growing dialogue focusing on different forms of lexical iconicity. The conceptual framework of the present study is based on an analysis of types and means of lexical iconicity in the sample languages. Archaeological and cultural evidence are used to tie lexical iconicity to its context. Phenomena related to lexical iconicity are studied both cross-linguistically and language-specifically. The cognitive difference between imitation and symbolism is essential. Lexical iconicity is not only about the iconic relationship between form and referents, but also about how certain iconic properties may become conventional, means used to create sound symbolism. All the sample languages show some evidence of lexical iconicity, demonstrating that it is a universal feature. Nine comparisons of onomatopoeic verbs and nouns, with samples varying between six and 141 languages, show that typologically highly different languages use similar means for creating words based on sound imitation. Two cross-linguistic comparisons of bird names demonstrate that a vast majority of the Eurasian names of the common cuckoo and the world-wide names of crow and raven of the 141 genera are onomatopoeic.

Observations sur les termes culinaires dans deux San-Antonio de Frédéric Dard

Pro gradu-työni aihe on ruokaterminologiaa käsittelevät ranskan puhekielen ja Pariisin slangin lainasanat sekä kirjailija Frédéric Dardin alias San-Antonion (1921-2000) luomat, ruokatermistöön kuuluvat uudissanat ja -sanonnat kahdessa San-Antonio-romaanissa C'est mort et ça ne sait pas sekä Le fil à couper le beurre. Näissä ns. kioskikirjallisuutta edustavissa rikosromaaneissa seikkailee puheenparttaan ruoka-alan termeillä höystävä, "erikoistehtäviä" hoitava komisario ja naistenmies, San-Antonio. Ranskankielisessä arjen kielenkäytössä vilisee ruokaan liittyviä sanoja ja sanontoja muissakin kuin varsinaisissa ruuanvalmistus- ja ateriointiyhteyksissä. Halusin tarkastella, millaisena tämä yleisesti havaitsemani ilmiö todentuu Frédéric Dardin kahdessa romaanissa, jotka olen valinnut aineistokseni. Frédéric Dard käyttää romaaneissaan varsin omaperäistä kieltä: sekä puhekieltä että Pariisin slangia. Korpukseni koostuu romaaneista poimimistani ruoka-alan termistöä sisältävistä esimerkeistä, joita valmiiseen työhön tuli 228 kappaletta. Jaoin kaikki korpuksesta löytämäni ruokatermit kahteen luokkaan sen mukaan, oliko kirjailija lainannut käyttämänsä sanan tai ilmauksen puhekielestä tai Pariisin slangista (lainatermit), vai oliko hän luonut termin tai ilmauksen itse (neologismit). Määrittelin termin tai ilmauksen neologismiksi, jos se ei esiintynyt joko laisinkaan tai ainakaan kirjailijan tarkoittamassa merkityksessä seuraavissa sanakirjoissa: Le Dictionnaire du français argotique, populaire et familier; Le Dictionnaire de l'argot moderne; Le Dictionnaire du français non conventionnel; Le Dictionnaire de l'argot; Le Dictionnaire du français argotique et populaire; L'argot chez les vrais de vrai ja Trésor de la langue française. Varsinainen tutkimus perustuu sanojen ja ilmausten merkitysten selvittämiseen ja analysointiin. Lainatermien analyysillä tarkoitan lainatermien merkitysten selvitystä em. sanakirjojen avulla. Neologismit analysoin tarkemmin käyttäen em. sanakirjoja sekä tukeutuen gastronomisten ja erityisesti kielitieteellisten lähdeteosteni tarjoamiin rakenteellisiin ja semanttisiin muodostustapoihin ja tekemällä niistä tarvittavat yhteenvedot oikean merkityksen selvittämiseksi. Käsittelin aineiston kaikki ruokatermit. Niiden valtavan lukumäärän vuoksi analysoitavien esimerkkien määrää piti rajoittaa niin, että valmiiseen työhön jäi jokaisesta termistä enintään kaksi esimerkkiä kummastakin korpuksen kirjasta eli yhteensä 228 esimerkkiä. Muut esimerkit luetteloin työn lopusta löytyvään liitteeseen. Neologismianalyysissä selvisi, että Frédéric Dard suosi erityisesti semanttisia muodostustapoja eli olemassa olevan merkityksen muuttamista metaforien ja kielikuvien avulla. Dardin rikas terminologia ja hänen humoristiset oivalluksensa ovat osaltaan rikastuttaneet ranskan puhekieltä.Työssäni totean, että Pariisin slangia ja puhekieltä on totuttu pitämään sosiaalisesti sopimattomana, marginaalisten ryhmien kielenä, vaikka sen ilmauksia saattaa nykyisin kuulla jopa akateemikkojen käyttävän, ja ilmauksia on siirtynyt slangi- ja puhekielestä yleiskieleen. Toivon työni edistävän kiinnostusta kielitaidon parantamiseen San-Antonion tyyliin tutustumisen avulla sekä herättävän mielenkiintoa ranskan kielen vivahteikkuuteen ja monimuotoisuuteen muullakin kuin yleiskielen tasolla. Kielessä ei mielestäni voi olla sellaisia osa-alueita, joiden opiskelu ja osaaminen olisi tarpeetonta.

The TRAM flap for breast reconstruction : Studies on perioperative cutaneous blood flow, vasoconstriction, and indices of obesity

Breast reconstruction is performed for 10-15 % of women operated on for breast cancer. A popular method is the TRAM (transverse rectus abdominis musculocutaneous) flap formed of the patient’s own abdominal tissue, a part of one of the rectus abdominis muscles and a transverse skin-subcutis area over it. The flap can be raised as a pedicled or a free flap. The pedicled TRAM flap, based on its nondominant pedicle superior epigastric artery (SEA), is rotated to the chest so that blood flow through SEA continues. The free TRAM flap, based on its dominant pedicle deep inferior epigastric artery (DIEA), is detached from the abdomen, transferred to the chest, and DIEA and vein are anastomosed to vessels on the chest. Cutaneous necrosis is seen in 5–60 % of pedicled TRAM flaps and in 0–15 % of free TRAM flaps. This study was the first one to show with blood flow measurements that the cutaneous blood flow is more generous in free than in pedicled TRAM flaps. After this study the free TRAM flap has exceeded the pedicled flap in popularity as a breast reconstruction method, although the free flap it is technically a more demanding procedure than the pedicled TRAM flap. In pedicled flaps, a decrease in cutaneous blood flow was observed when DIEA was ligated. It seems that SEA cannot provide sufficient blood flow on the first postoperative days. The postoperative cutaneous blood flow in free TRAM flaps was more stable than in pedicled flaps. Development of cutaneous necrosis of pedicled TRAM flaps could be predicted based on intraoperative laser Doppler flowmetry (LDF) measurements. The LDF value on the contralateral skin of the flap decreased to 43 ± 7 % of the initial value after ligation of the DIEA in flaps developing cutaneous necrosis during the next week. Endothelin-1 (ET-1) is a powerful vasoconstrictory peptide secreted by vascular endothelial cells. A correlation was found between plasma ET-1 concentrations and peripheral vasoconstriction developing during and after breast reconstructions with a pedicled TRAM flap. ET-1 was not associated with the development of cutaneous necrosis. Felodipine, a vasodilating calcium channel antagonist, had no effect on plasma ET-1 concentrations, peripheral vasoconstriction or development of cutaneous necrosis in free TRAM flaps. Body mass index and thickness of abdominal were not associated with cutaneous necrosis in pedicled TRAM flaps.

Kohti leikkaussalin tuloksellista toiminnanohjausta

Background: The aging population is placing increasing demands on surgical services, simultaneously with a decreasing supply of professional labor and a worsening economic situation. Under growing financial constraints, successful operating room management will be one of the key issues in the struggle for technical efficiency. This study focused on several issues affecting operating room efficiency. Materials and methods: The current formal operating room management in Finland and the use of performance metrics and information systems used to support this management were explored using a postal survey. We also studied the feasibility of a wireless patient tracking system as a tool for managing the process. The reliability of the system as well as the accuracy and precision of its automatically recorded time stamps were analyzed. The benefits of a separate anesthesia induction room in a prospective setting were compared with the traditional way of working, where anesthesia is induced in the operating room. Using computer simulation, several models of parallel processing for the operating room were compared with the traditional model with respect to cost-efficiency. Moreover, international differences in operating room times for two common procedures, laparoscopic cholecystectomy and open lung lobectomy, were investigated. Results: The managerial structure of Finnish operating units was not clearly defined. Operating room management information systems were found to be out-of-date, offering little support to online evaluation of the care process. Only about half of the information systems provided information in real time. Operating room performance was most often measured by the number of procedures in a time unit, operating room utilization, and turnover time. The wireless patient tracking system was found to be feasible for hospital use. Automatic documentation of the system facilitated patient flow management by increasing process transparency via more available and accurate data, while lessening work for staff. Any parallel work flow model was more cost-efficient than the traditional way of performing anesthesia induction in the operating room. Mean operating times for two common procedures differed by 50% among eight hospitals in different countries. Conclusions: The structure of daily operative management of an operating room warrants redefinition. Performance measures as well as information systems require updating. Parallel work flows are more cost-efficient than the traditional induction-in-room model.

Clinical Studies on Epidural and Spinal Postoperative Analgesia : With Special Reference to Continuous Techniques of Administration and Adjuvant Drugs

Continuous epidural analgesia (CEA) and continuous spinal postoperative analgesia (CSPA) provided by a mixture of local anaesthetic and opioid are widely used for postoperative pain relief. E.g., with the introduction of so-called microcatheters, CSPA found its way particularly in orthopaedic surgery. These techniques, however, may be associated with dose-dependent side-effects as hypotension, weakness in the legs, and nausea and vomiting. At times, they may fail to offer sufficient analgesia, e.g., because of a misplaced catheter. The correct position of an epidural catheter might be confirmed by the supposedly easy and reliable epidural stimulation test (EST). The aims of this thesis were to determine a) whether the efficacy, tolerability, and reliability of CEA might be improved by adding the α2-adrenergic agonists adrenaline and clonidine to CEA, and by the repeated use of EST during CEA; and, b) the feasibility of CSPA given through a microcatheter after vascular surgery. Studies I IV were double-blinded, randomized, and controlled trials; Study V was of a diagnostic, prospective nature. Patients underwent arterial bypass surgery of the legs (I, n=50; IV, n=46), total knee arthroplasty (II, n=70; III, n=72), and abdominal surgery or thoracotomy (V, n=30). Postoperative lumbar CEA consisted of regular mixtures of ropivacaine and fentanyl either without or with adrenaline (2 µg/ml (I) and 4 µg/ml (II)) and clonidine (2 µg/ml (III)). CSPA (IV) was given through a microcatheter (28G) and contained either ropivacaine (max. 2 mg/h) or a mixture of ropivacaine (max. 1 mg/h) and morphine (max. 8 µg/h). Epidural catheter tip position (V) was evaluated both by EST at the moment of catheter placement and several times during CEA, and by epidurography as reference diagnostic test. CEA and CSPA were administered for 24 or 48 h. Study parameters included pain scores assessed with a visual analogue scale, requirements of rescue pain medication, vital signs, and side-effects. Adrenaline (I and II) had no beneficial influence as regards the efficacy or tolerability of CEA. The total amounts of epidurally-infused drugs were even increased in the adrenaline group in Study II (p=0.02, RM ANOVA). Clonidine (III) augmented pain relief with lowered amounts of epidurally infused drugs (p=0.01, RM ANOVA) and reduced need for rescue oxycodone given i.m. (p=0.027, MW-U; median difference 3 mg (95% CI 0 7 mg)). Clonidine did not contribute to sedation and its influence on haemodynamics was minimal. CSPA (IV) provided satisfactory pain relief with only limited blockade of the legs (no inter-group differences). EST (V) was often related to technical problems and difficulties of interpretation, e.g., it failed to identify the four patients whose catheters were outside the spinal canal already at the time of catheter placement. As adjuvants to lumbar CEA, clonidine only slightly improved pain relief, while adrenaline did not provide any benefit. The role of EST applied at the time of epidural catheter placement or repeatedly during CEA remains open. The microcatheter CSPA technique appeared effective and reliable, but needs to be compared to routine CEA after peripheral arterial bypass surgery.

Maallikon suorittama defibrillaatio sydänpysähdyspotilaan hoitoketjussa

Sudden cardiac arrest (CA) is one of the leading causes of death in Europe. It has been estimated that about 40 % of CA victims have ventricular fibrillation (VF) at the time of the first heart rhythm analysis. The treatment for VF is immediate cardiopulmonary resuscitation (CPR) and rapid defibrillation. The automated external defibrillator (AED) and the concept of public access defibrillation (PAD) may be a key to shortening defibrillation delays. Recent studies have shown that PAD programs are associated with high survival rates from VF when devices have been placed in certain risk sites and used by trained laypersons. Today many public places are equipped with AEDs. The purpose of this study was to find new ways of utilizing layperson defibrillation and promote the concept of public access defibrillation (PAD). The study explored the use of AEDs by non-medical first responders in Finland and cabin crew on board a commercial aircraft. A simulated study was performed to explore the role of dispatcher assistance in layperson CPR and defibrillation. A 15-year follow-up study of 59 one-year survivors after successful out-of-hospital resuscitation was performed to evaluate the long-term quality of life of the CA patients. Although there are many AEDs in use by non-medical first responders in Finland, the results of the study showed that there are large variations between individual first response units. This is considered to be caused by the lack of national standards and regulations that would define a full integration of first-responder programmes into the Emergency Medical Services system. The goal of rapid defibrillation in five minutes after the onset of CA is difficult to achieve in Finland due to sparse population and long distances. Local PAD programs may shorten the defibrillation delays. Dispatcher assistance in defibrillation by a layperson not trained to use an AED seems feasible and does not compromise the performance of CPR. In a simulated study, the quality of mouth-to-mouth ventilation performed by laypersons was found to be better after CPR training compared with performance with dispatcher assistance before training. Training was not found to have an influence on the quality of compressions or defibrillation compared with dispatcher assistance of untrained laypersons. The target groups for CPR and defibrillation training need further evaluation. The placements of the AEDs in public areas should be known by the emergency response center and the location should be marked with an international sign. The finding that once a good neurological outcome after CA is achieved, it can be maintained for more than 10 years, encourages further efforts to improve the survival of CA patients.

Kuka kasvattaa, kuka opettaa? : Genealoginen tutkimus perheen ja koulun välisen kasvatusvastuun politiikasta

FAMILIES AND SCHOOLS AND THE POLITICS OF RESPONSIBILITIES - a genealogical study on family and school as carers and educators of the child population in modern society This study aims to uncover the politics behind such discourses in the media which have claimed the family to be totally responsible for children and which ignore the various responsibilities accorded to the state in matters concerning the child population. Using Max Weber s and Michael Mann s theorizing on the history of power relationships, feminist social history on patriarchy and Foucauldian power analytic concept of dispositif the study traces two competing child policies which have influenced the historical formation of modern generational order in Western societies. One of them is based on the interests of the hegemonic bourgeois elite and the other on the interests of the non-elite population, which were expressed during the phase of building the welfare state in Finland in the 1960 1980 s. The central strategies of the bourgeois child policy are 1) to construct the childhood years as a time for preparation and formation of the individual according to the interests of the elite, 2) to construct the family as the sole site of holistic care and responsibility of children in society, and 3) compulsory schooling of children of the non-elite population in state organized schools. To implement these strategies the elite uses strategically patriarchal cultural formations/dispositifs in modernized versions. The result has been the formation of a sexually divided and hierarchical order of care and education, where, on the one hand, there is the less important feminine care of children done by mothers at home and, on the other, the real education of the school, where children are made the object of authoritarian shaping and where the needs and the personal experiences of the child are ignored. The welfare order of care and education is based on the ethos of welfare society, where the state and the families are seen to share the responsibility for the child population. In this vein, families and schools are seen as partners who both have a caring attitude to children s welfare and learning. The study shows that discourses and terminology in the mainstream educational policy texts in Finland create a chaotic linguistic game which makes it difficult to have a rational discussion about the roles of family and school in the holistic care and education of children. This has opened the door to political discourses where familist interpretations of the question of responsibility are claimed to be based on law.

Current Care Guidelines for Cardiopulmonary Resuscitation : Implementation, skills and attitudes

Background: The national resuscitation guidelines were published in Finland in 2002 and are based on international guidelines published in 2000. The main goal of the national guidelines, available on the Internet free of charge, is early defibrillation by nurses in an institutional setting. Aim: To study possible changes in cardiopulmonary resuscitation (CPR) practices, especially concerning early defibrillation, nurses and students attitudes of guideline implementation and nurses and students ability to implement the guideline recommendations in clinical practices after publication of the Current Care (CC) guidelines for CPR 2002. Material and methods: CPR practices in Finnish health centres; especially concerning rapid defibrillation programmes, as well as the implementation of CC guidelines for CPR was studied in a mail survey to chief physicians of every health centre in Finland (Study I). The CPR skills using an automated external defibrillator (AED) were compared in a study including Objective stuctured clinical examination (OSCE) of resuscitation skills of nurses and nursing students in Finnish and Swedish hospital and institution (Studies II, III). Attitudes towards CPR-D and CPR guidelines among medical and nursing students and secondary hospital nurses were studied in surveys (Studies IV, V). The nurses receiving different CPR training were compared in a randomized trial including OSCE of CPR skills of nurses in Finnish Hospital (Study VI). Results: Two years after the publication, 40.7% of Finnish health centres used national resuscitation guidelines. The proportion of health centres having at least one AED (66%) and principle of nurse-performed defibrillation without the presence of a physician (42%) had increased. The CPR-D training was estimated to be insufficient regarding basic life support and advanced life support in the majority of health centres (Study I). CPR-D skills of nurses and nursing students in two specific Swedish and Finnish hospitals and institutions (Study II and III) were generally inadequate. The nurses performed better than the students and the Swedish nurses surpassed the Finnish ones. Geriatric nurses receiving traditional CPR-D training performed better than those receiving an Internet-based course but both groups failed to defibrillate within 60 s. Thus, the performance was not satisfactory even two weeks after traditional training (Study VI). Unlike the medical students, the nursing students did not feel competent to perform procedures recommended in the cardiopulmonary resuscitation guidelines including the defibrillation. However, the majority of nursing students felt confident about their ability to perform basic life support. The perceived ability to defibrillate correlated significantly with a positive attitude towards nurse-performed defibrillation and negatively with fear of damaging the patient s heart by defibrillation (Study IV). After the educational intervention, the nurses found their level of CPR-D capability more sufficient than before and felt more confident about their ability to perform defibrillation themselves. A negative attitude toward defibrillation correlated with perceived negative organisational attitudes toward cardiopulmonary resuscitation guidelines. After CPR-D education in the hospital, the majority (64%) of nurses hesitated to perform defibrillation because of anxiety and 27 % hesitated because of fear of injuring the patient. Also a negative personal attitude towards guidelines increased markedly after education (Study V). Conclusions: Although a significant change had occurred in resuscitation practices in primary health care after publication of national cardiopulmonary resuscitation guidelines the participants CPR-D skills were not adequate according to the CPR guidelines. The current way of teaching is unlikely to result in participants being able to perform adequate and rapid CPR-D. More information and more frequent training are needed to diminish anxiety concerning defibrillation. Negative beliefs and attitudes toward defibrillation affect the nursing students and nurses attitudes toward cardiopulmonary resuscitation guidelines. CPR-D education increased the participants self-confidence concerning CPR-D skills but it did not reduce their anxiety. AEDs have replaced the manual defibrillators in most institutions, but in spite of the modern devices the anxiety still exists. Basic education does not provide nursing students with adequate CPR-D skills. Thus, frequent training in the workplace has vital importance. This multi-professional program supported by the administration might provide better CPR-D skills. Distance learning alone cannot substitute for traditional small-group learning, tutored hands-on training is needed to learn practical CPR-D skills. Standardized testing would probably help controlling the quality of learning. Training of group-working skills might improve CPR performance.

Studies of the Human Transcriptome

Gene expression is one of the most critical factors influencing the phenotype of a cell. As a result of several technological advances, measuring gene expression levels has become one of the most common molecular biological measurements to study the behaviour of cells. The scientific community has produced enormous and constantly increasing collection of gene expression data from various human cells both from healthy and pathological conditions. However, while each of these studies is informative and enlighting in its own context and research setup, diverging methods and terminologies make it very challenging to integrate existing gene expression data to a more comprehensive view of human transcriptome function. On the other hand, bioinformatic science advances only through data integration and synthesis. The aim of this study was to develop biological and mathematical methods to overcome these challenges and to construct an integrated database of human transcriptome as well as to demonstrate its usage. Methods developed in this study can be divided in two distinct parts. First, the biological and medical annotation of the existing gene expression measurements needed to be encoded by systematic vocabularies. There was no single existing biomedical ontology or vocabulary suitable for this purpose. Thus, new annotation terminology was developed as a part of this work. Second part was to develop mathematical methods correcting the noise and systematic differences/errors in the data caused by various array generations. Additionally, there was a need to develop suitable computational methods for sample collection and archiving, unique sample identification, database structures, data retrieval and visualization. Bioinformatic methods were developed to analyze gene expression levels and putative functional associations of human genes by using the integrated gene expression data. Also a method to interpret individual gene expression profiles across all the healthy and pathological tissues of the reference database was developed. As a result of this work 9783 human gene expression samples measured by Affymetrix microarrays were integrated to form a unique human transcriptome resource GeneSapiens. This makes it possible to analyse expression levels of 17330 genes across 175 types of healthy and pathological human tissues. Application of this resource to interpret individual gene expression measurements allowed identification of tissue of origin with 92.0% accuracy among 44 healthy tissue types. Systematic analysis of transcriptional activity levels of 459 kinase genes was performed across 44 healthy and 55 pathological tissue types and a genome wide analysis of kinase gene co-expression networks was done. This analysis revealed biologically and medically interesting data on putative kinase gene functions in health and disease. Finally, we developed a method for alignment of gene expression profiles (AGEP) to perform analysis for individual patient samples to pinpoint gene- and pathway-specific changes in the test sample in relation to the reference transcriptome database. We also showed how large-scale gene expression data resources can be used to quantitatively characterize changes in the transcriptomic program of differentiating stem cells. Taken together, these studies indicate the power of systematic bioinformatic analyses to infer biological and medical insights from existing published datasets as well as to facilitate the interpretation of new molecular profiling data from individual patients.