Medicines information sources and services for consumers : A special focus on the Internet and people with depression

The range of consumer health and medicines information sources has diversified along with the increased use of the Internet. This has led to a drive to develop medicines information services and to better incorporate the Internet and e-mail into routine practice in health care and in community pharmacies. To support the development of such services more information is needed about the use of online information by consumers, particularly of those who may be the most likely to use and to benefit from the new sources and modes of medicines communication. This study explored the role and utilization of the Internet-based medicines information and information services in the context of a wider network of information sources accessible to the public in Finland. The overall aim was to gather information to develop better and more accessible sources of information for consumers and services to better meet the needs of consumers. Special focus was on the needs and information behavior among people with depression and using antidepressant medicines. This study applied both qualitative and quantitative methods. Consumer medicines information needs and sources were identified by analyzing the utilization of the University Pharmacy operated national drug information call center (Study I) and surveying Finnish adults (n=2348) use of the different medicines information sources (Study II). The utilization of the Internet as a source of antidepressant information among people with depression was explored by focus group discussions among people with depression and with current or past use of the antidepressant(s) (n=29, Studies III & IV). Pharmacy response to the needs of consumers in term of providing e-mail counseling was assessed by conducting a virtual pseudo customer study among the Finnish community pharmacies (n=161, Study V). Physicians and pharmacists were the primary sources of medicines information. People with mental disorders were more frequent users of telephone- and Internet-based medicines information sources and patient information leaflets than people without mental disorders. These sources were used to complement rather than replace information provided face-to-face by health professionals. People with depression used the Internet to seek facts about antidepressants, to share experiences with peers, and for the curiosity. They described that the access to online drug information was empowering. Some people reported lacking the skills necessary to assess the quality of online information. E-mail medication counseling services provided by community pharmacies were rare and varied in quality. Study results suggest that rather than discouraging the use of the Internet, health professionals should direct patients to use accurate and reliable sources of online medicines information. Health care providers, including community pharmacies should also seek to develop new ways of communicating information about medicines with consumers. This study determined that people with depression and using antidepressants need services enabling interactive communication not only with health care professionals, but also with peers. Further research should be focused on developing medicines information service facilitating communication among different patient and consumer groups.

Counter-figures : An Essay on Antimetaphoric Resistance: Paul Celan's Poetry and Poetics at the Limits of Figurality

Titled "An Essay on Antimetaphoric Resistance", the dissertation investigates what is here being called "Counter-figures": a term which has in this context a certain variety of applications. Any other-than-image or other-than-figure, anything that cannot be exhausted by figuration (and that is, more or less, anything at all, except perhaps the reproducible images and figures themselves) can be considered "counter-figurative" with regard to the formation of images and figures, ideas and schemas, "any graven image, or any likeness of any thing". Singularity and radical alterity, as well as temporality and its peculiar mode of uniqueness are key issues here, and an ethical dimension is implied by, or intertwined with, the aesthetic. In terms borrowed from Paul Celan's "Meridian" speech, poetry may "allow the most idiosyncratic quality of the Other, its time, to participate in the dialogue". This connection between singularity, alterity and temporality is one of the reasons why Celan so strongly objects to the application of the traditional concept of metaphor to poetry. As Celan says, "carrying over [übertragen]" by metaphor may imply an unwillingness to "bear with [mittragen]" and to "endure [ertragen]" the poem. The thesis is divided into two main parts. The first consists of five distinct prolegomena which all address the mentioned variety of applications of the term "counter-figures", and especially the rejection or critique of either metaphor (by Aristotle, for instance) or the concept of metaphor (defined by Aristotle, and sometimes deemed "anti-poetic" by both theorists and poets). Even if we restrict ourselves to the traditional rhetorico-poetical terms, we may see how, for instance, metonymy can be a counter-figure for metaphor, allegory for symbol, and irony for any single trope or for any piece of discourse at all. The limits of figurality may indeed be located at these points of intersection between different types of tropes or figures, and even between figures or tropes and the "non-figurative trope" or "pseudo-figure" called catachresis. The second part, following on from the open-ended prolegomena, concentrates on Paul Celan's poetry and poetics. According to Celan, true poetry is "essentially anti-metaphoric". I argue that inasmuch as we are willing to pay attention to the "will" of the poetic images themselves (the tropes and metaphors in a poem) to be "carried ad absurdum", as Celan invites us to do, we may find alternative ways of reading poetry and approaching its "secret of the encounter", precisely when the traditional rhetorical instruments, and especially the notion of metaphor, become inapplicable or suspicious — and even where they still seem to impose themselves.

The Influence of Constantinople on Middle Byzantine Architecture (843-1204) : A typological and morphological approach at the provincial level.

The influence of the architecture of the Byzantine capital spread to the Mediterranean provinces with travelling masters and architects. In this study the architecture of the Constantinopolitan School has been detected on the basis of the typology of churches, completed by certain morphological aspects when necessary. The impact of the Constantinopolitan workshops appears to have been more important than previously realized. This research revealed that the Constantinopolitan composite domed inscribed-cross type or cross-in-square spread everywhere to the Balkans and it was assumed soon by the local schools of architecture. In addition, two novel variants were invented on the basis of this model: the semi-composite type and the so-called Athonite type. In the latter variant lateral conches, choroi, were added for liturgical reasons. Instead, the origin of the domed ambulatory church was partly provincial. One result of this study is that the origin of the Middle Byzantine domed octagonal types was traced to Constantinople. This is attested on the basis of the archaeological evidence. Also some other architectural elements that have not been preserved in the destroyed capital have survived at the provincial level: the domed hexagonal type, the multi-domed superstructure, the pseudo-octagon and the narthex known as the lite. The Constantinopolitan architecture during the period in question was based on the Early Christian and Late Antique forms, practices and innovations and this also emerges at the provincial level.

Oral Immune Defense against Chronic Hyperplastic Candidosis

Candida yeast species are widespread opportunistic microbes, which are usually innocent opportunists unless the systemic or local defense system of the host becomes compromised. When they adhere on a fertile substrate such as moist and warm, protein-rich human mucosal membrane or biomaterial surface, they become activated and start to grow pseudo and real hyphae. Their growth is intricately guided by their ability to detect surface defects (providing secure hiding , thigmotropism) and nutrients (source of energy, chemotropism). The hypothesis of this work was that body mobilizes both non-specific and specific host defense against invading candidal cells and that these interactions involve resident epithelial cells, rapidly responding non-specific protector neutrophils and mast cells as well as the antigen presenting and responding den-dritic cell lymphocyte plasma cell system. It is supposed that Candida albicans, as a result of dar-winistic pressure, has developed or is utilizing strategies to evade these host defense reactions by e.g. adhering to biomaterial surfaces and biofilms. The aim of the study was to assess the host defense by taking such key molecules of the anti-candidal defense into focus, which are also more or less characteristic for the main cellular players in candida-host cell interactions. As a model for candidal-host interaction, sections of chronic hyperplastic candidosis were used and compared with sections of non-infected leukoplakia and healthy tissue. In this thesis work, neutrophil-derived anti-candidal α-defensin was found in the epithelium, not only diffusely all over in the epithelium, but as a strong α-defensin-rich superficial front probably able to slow down or prevent penetration of candida into the epithelium. Neutrophil represents the main host defence cell in the epithelium, to which it can rapidly transmigrate from the circulation and where it forms organized multicellular units known as microabscesses (study I). Neutrophil chemotactic inter-leukin-8 (IL-8) and its receptor (IL-8R) were studied and were surprisingly also found in the candidal cells, probably helping the candida to keep away from IL-8- and neutrophil-rich danger zones (study IV). Both leukocytes and resident epithelial cells contained TLR2, TLR4 and TLR6 receptors able to recognize candidal structures via utilization of receptors similar to the Toll of the banana fly. It seems that candida can avoid host defence via stimulation of the candida permissive TLR2 instead of the can-dida injurious TLR4 (study V). TLR also provides the danger signal to the immune system without which it will not be activated to specifically respond against candidal antigens. Indeed, diseased sites contained receptor activator of nuclear factor kappa B ligand (RANKL; II study), which is important for the antigen capturing, processing and presenting dendritic cells and for the T lymphocyte activation (study III). Chronic hyperplastic candidosis provides a disease model that is very useful to study local and sys-temic host factors, which under normal circumstances restrain C. albicans to a harmless commensal state, but failure of which in e.g. HIV infection, cancer and aging may lead to chronic infection.

The kinetics and reactivity of several polyatomic free radicals in reactions with NO2, O2, Cl2, and HCl

In this thesis, the kinetics of several alkyl, halogenated alkyl, and alkenyl free radical reactions with NO2, O2, Cl2, and HCl reactants were studied over a wide temperature range in time resolved conditions. Laser photolysis photoionisation mass spectrometer coupled to a flow reactor was the experimental method employed and this thesis present the first measurements performed with the experimental system constructed. During this thesis a great amount of work was devoted to the designing, building, testing, and improving the experimental apparatus. Carbon-centred free radicals were generated by the pulsed 193 or 248 nm photolysis of suitable precursors along the tubular reactor. The kinetics was studied under pseudo-first-order conditions using either He or N2 buffer gas. The temperature and pressure ranges employed were between 190 and 500 K, and 0.5 45 torr, respectively. The possible role of heterogeneous wall reactions was investigated employing reactor tubes with different sizes, i.e. to significantly vary the surface to volume ratio. In this thesis, significant new contributions to the kinetics of carbon-centred free radical reactions with nitrogen dioxide were obtained. Altogether eight substituted alkyl (CH2Cl, CHCl2, CCl3, CH2I, CH2Br, CHBr2, CHBrCl, and CHBrCH3) and two alkenyl (C2H3, C3H3) free radical reactions with NO2 were investigated as a function of temperature. The bimolecular rate coefficients of all these reactions were observed to possess negative temperature dependencies, while pressure dependencies were not noticed for any of these reactions. Halogen substitution was observed to moderately reduce the reactivity of substituted alkyl radicals in the reaction with NO2, while the resonance stabilisation of the alkenyl radical lowers its reactivity with respect to NO2 only slightly. Two reactions relevant to atmospheric chemistry, CH2Br + O2 and CH2I + O2, were also investigated. It was noticed that while CH2Br + O2 reaction shows pronounced pressure dependence, characteristic of peroxy radical formation, no such dependence was observed for the CH2I + O2 reaction. Observed primary products of the CH2I + O2 reaction were the I-atom and the IO radical. Kinetics of CH3 + HCl, CD3 + HCl, CH3 + DCl, and CD3 + DCl reactions were also studied. While all these reactions possess positive activation energies, in contrast to the other systems investigated in this thesis, the CH3 + HCl and CD3 + HCl reactions show a non-linear temperature dependency on the Arrhenius plot. The reactivity of substituted methyl radicals toward NO2 was observed to increase with decreasing electron affinity of the radical. The same trend was observed for the reactions of substituted methyl radicals with Cl2. It is proposed that interactions of frontier orbitals are responsible to these observations and Frontier Orbital Theory could be used to explain the observed reactivity trends of these highly exothermic reactions having reactant-like transition states.

Auktoriteetin ja järjen suhde Augustinuksen varhaisissa manikealaisvastaisissa teoksissa

Tutkielman tehtävänä on selvittää jumalallisen auktoriteetin (auctoritas divina) ja ihmisen järjen (ratio) välinen suhde Augustinuksen tietoteoriassa. Päälähteinä käytetään kolmea Augustinuksen varhaistuotannon manikealaisvastaista teosta De moribus ecclesiae catholicae et de moribus manichaeorum, De vera religione ja De utilitate credendi. Tutkielman metodina on systemaattinen analyysi. Tutkimustehtävä sisältää alakysymyksiä: Kuinka käsitepari auktoriteetti - järki suhteutuu käsitepariin uskominen (credere) - ymmärtäminen (intellegere)? Mitkä ovat järjen kyvyt, rajat ja tehtävät? Mikä on auktoriteetin tehtävä ja miksi auktoriteetteja tarvitaan? Missä määrin päälähteiden välillä on eroja? Luvussa 2 tarkastellaan sitä uskonnollis-filosofista taustaa, jonka kautta Augustinuksen käsitys auktoriteetin ja järjen suhteesta tulee ymmärrettäväksi. Vaikka Augustinus liittyykin uskon ja ymmärryksen suhteen varhaiskristilliseen traditioon, ei hänen käsitystään voida ymmärtää irrallaan platonilaisesta ja uusplatonilaisesta tietoteoriasta. Augustinuksen tietoteoria muotoutui myös vastauksessa skeptisismiin ja manikealaiseen pseudo-rationalismiin. Pääluvuissa 3, 4 ja 5 käsitellään Augustinuksen käsitystä auktoriteetin ja järjen suhteesta siten, että kussakin pääluvussa keskitytään yhteen päälähteeseen. Loppukatsauksessa (luku 6) kootaan yhteen tutkimuksen tulokset. Augustinuksen klassisesta roomalaisesta kirjallisuudesta lanseeraama käsitepari auktoriteetti - järki liittyy läheisesti toiseen käsitepariin uskominen - ymmärtäminen. Usko perustuu auktoriteettiin ja ymmärrys järkeen. Niin kuin usko edeltää ymmärrystä (credo ut intelligam), samoin auktoriteetti edeltää uskoa. Mutta toisaalta myös ymmärrys edeltää uskoa siinä mielessä, että on ymmärrettävä auktoriteetin ilmoittamat väitelauseet, jotta usko tulisi mahdolliseksi. Tietyssä mielessä myös järki edeltää auktoriteettia, sillä järki arvioi, kuka on uskomisen arvoinen. Ilman auktoriteettiin perustuvaa uskoa ihminen kykenee järjen avulla tajuamaan ainakin yhden totuuden, nimittäin sen, että kaiken epäileminen on mahdotonta. Radikaaleinkin epäilijä on varma ainakin siitä totuudesta, että hän epäilee. Augustinus antaa toisinaan ymmärtää, että ilman auktoriteettia voidaan käsittää myös Jumalan olemassaolo. Toisinaan hän taas opettaa, että tieto Jumalan olemassaolosta perustuu jumalalliseen auktoriteettiin. Ihmisen järki on rajallinen kahdessa mielessä. Ensinnäkin se ei kykene saavuttamaan varmaa tietoa aistimaailman ajallisista asioista. Varma tieto eli ymmärrys kohdistuu vain ikuisiin ja intelligiibeleihin totuuksiin. Toiseksi ihmisen järki on osallinen syntiinlankeemuksesta niin, että totuuden tavoittaminen tulee lopulta mahdottomaksi ilman auktoriteettia. Jumalallinen auktoriteetti on Augustinuksen mukaan Kristuksessa, Raamatussa ja katolisessa kirkossa. Jumalallinen auktoriteetti ilmoittaa pelastushistorian totuudet, joiden kautta ihmisen mieli puhdistuu ja kykenee kohoamaan kohti ikuisia jumalallisia totuuksia. Jumalallisen auktoriteetin ilmoittamat ikuiset totuudet ovat luonteeltaan sellaisia, että niihin on ensin uskottava, jotta ne voitaisiin myöhemmin ymmärtää (credo, quod intelligam). Auktoriteetin tehtävä on johdattaa järkeen ja järjen tehtävä on johtaa ymmärrykseen. Teoksen päälähteet opettavat pääsääntöisesti samalla tavalla käsillä olevasta aiheesta. De moribuksessa painopiste on tosin muita selkeämmin rakkaudessa: rakkaus johtaa tietoteoreettiseen täyttymykseen. De vera religionessa on vahvimpana ajatus luonnollisesta jumalatuntemuksesta. De utilitate credendi keskittyy voimakkaimmin auktoriteettiuskon puolustamiseen. Päälähteiden painotuserot johtuvat niiden erilaisesta luonteesta.

Salaisen evankelistan salaliitto : Uusin keskustelu Klemens Aleksandrialaisen kirjeestä Theodorokselle

This thesis is an assessment of the hoax hypothesis, mainly propagated in Stephen C. Carlson's 2005 monograph "The Gospel Hoax: Morton Smith's Invention of Secret Mark", which suggests that professor Morton Smith (1915-1991) forged Clement of Alexandria's letter to Theodore. This letter Smith claimed to have discovered as an 18th century copy in the monastery of Mar Saba in 1958. The Introduction narrates the discovery story of Morton Smith and traces the manuscript's whereabouts up to its apparent disappearance in 1990 following with a brief history of scholarship of the MS and some methodological considerations. Chapters 2 and 3 deal with the arguments for the hoax (mainly by Stephen C. Carlson) and against it (mainly Scott G. Brown). Chapter 2 looks at the MS in its physical aspects, and chapter 3 assesses its subject matter. I conclude that some of the details fit reasonably well with the hoax hypothesis, but on the whole the arguments against it are more persuasive. Especially Carlson's use of QDE-analysis (Questioned Document Examination) has many problems. Comparing the handwriting of Clement's letter to Morton Smith's handwriting I conclude that there are some "repeated differences" between them suggesting that Smith is not the writer of the disputed letter. Clement's letter to Theodore derives most likely from antiquity though the exact details of its character are not discussed in length in this thesis. In Chapter 4 I take a special look at Stephen C. Carlson's arguments which propose that Morton Smith hid clues of his identity to the MS and the materials surrounding it. Comparing these alleged clues to known pseudoscientific works I conclude that Carlson utilizes here methods normally reserved for building a conspiracy theory; thus Carlson's hoax hypothesis has serious methodological flaws in respect to these hidden clues. I construct a model of these questionable methods titled "a boisterous pseudohistorical method" that contains three parts: 1) beginning with a question that from the beginning implicitly contains the answer, 2) considering everything will do as evidence for the conspiracy theory, and 3) abandoning probability and thinking literally that everything is connected. I propose that Stephen C. Carlson utilizes these pseudoscientific methods in his unearthing of Morton Smith's "clues". Chapter 5 looks briefly at the literary genre I title "textual puzzle -thriller". Because even biblical scholarship follows the signs of the times, I propose Carlson's hoax hypothesis has its literary equivalents in fiction in titles like Dan Brown's "Da Vinci Code" and in academic works in titles like John Dart's "Decoding Mark". All of these are interested in solving textual puzzles, even though the methodological choices are not acceptable for scholarship. Thus the hoax hypothesis as a whole is alternatively either unpersuasive or plain bad science.

Cytokinin signalling in the regulation of cambial development

Secondary growth of plants is of pivotal importance in terrestrial ecosystems, providing a significant carbon sink in the form of wood. As plant biomass accumulation results largely from the cambial growth, it is surprising that quite little is known about the hormonal or genetic control of this important process in any plant species. The central aim of my thesis studies was to explore the function of cytokinin in the regulation of cambial development. Since their discovery as regulators of plant cell divisions, cytokinins have been assumed to participate in the control of cambial development. Evidence for this action was deduced from hormone treatment experiments, where exogenously applied cytokinin was shown to enhance cambial cell divisions in diverse plant organs and species. In my thesis work, the conservation of cytokinin signalling and homeostasis genes between a herbaceous plant, Arabidopsis, and a hardwood tree species, Populus trichocarpa. Presumably reflecting the ancient origin of cytokinin signalling system, the Populus genome contains orthologs for all Arabidopsis cytokinin signalling and homeostasis genes. Thus, genes belonging to five main families of isopentenyl transferases (IPTs), cytokinin oxidases (CKXs), two-component receptors, histidine containing phosphotransmitters (HPts) and response regulators (RRs) were identified from the Populus genome. Three subfamilies associated with cytokinin signal transduction, the CKI1-like family of two-component receptors, the AHP4-like HPts, and the ARR22-like atypical RRs, were significantly larger in Populus genome than in Arabidopsis. Potential contribution to the extensive secondary development of Populus by the members of these considerably expanded gene families will be discussed. Representatives of all cytokinin signal transduction elements were expressed in the Populus cambial zone, and most of the expressed genes appeared to be slightly more abundant on the phloem side of the meristem. The abundance of cytokinin related genes in the cambium emphasizes the important role of this hormone in the regulation of the extensive secondary growth characteristic of tree species. The function of the pseudo HPts in primary vascular development was studied in Arabidopsis root vasculature. It was demonstrated that the pseudo HPt AHP6 has a role in locally inhibiting cytokinin signalling in the protoxylem position in the Arabidopsis root, thus enabling differentiation of the protoxylem cell file. The possible role of pseudo HPts in cambial development will be discussed. The expression peak of cytokinin signalling genes in the tree cambial zone strongly indicates that cytokinin has a role in the regulation of this meristem function. To address whether cytokinin signalling is required for cambial activity, transgenic Populus trees with modified cytokinin signalling were produced. These trees were expressing a cytokinin catabolic gene from Arabidopsis, CYTOKININ OXIDASE 2, (AtCKX2) under the promoter of a Betula CYTOKININ RECEPTOR 1 (BpCRE1). The pBpCRE1::CKX2 transgenic Populus trees showed a reduced concentration of a biologically active cytokinin, correlating with their impaired cytokinin response. Furthermore, the radial growth of these trees was compromised, as illustrated by a smaller stem diameter than in wild-type trees of the same height. Moreover, the level of cambial cytokinin signalling was down-regulated in these thin-stemmed trees. The reduced signalling correlated with a decreased number of meristematic cambial cells, implicating cytokinin activity as a direct regulator of cambial cell division activity. Together, the results of my study indicate that cytokinins are major hormonal regulators required for cambial development.

Otoksen edustavuuden mittaus R-indikaattorin avulla Suomen uhritutkimuspilotissa

Tutkielmassa sovelletaan aineiston edustavuutta mittaavaa laatuindikaattoria Suomen uhritutkimuspilottiin tilanteessa, jossa ilmenee vastauskatoa. Vastauskato on kasvava ongelma tilastotutkimuksissa: jos tutkimukseen osallistuneet eivät edusta otosjoukkoa tutkittavan asian suhteen, voi vastauskadosta aiheutuva harha olla estimoiduissa tunnusluvuissa hyvinkin suuri. Tutkimuksissa näkee usein julkaistavan vastausasteen ikään kuin se kertoisi aukottomasti tutkimuksen laadusta. Pelkkä korkea vastausaste ei kuitenkaan välttämättä takaa estimaattien harhattomuutta, sillä se ei kerro mitään vastanneiden ja vastaamattomien eroista tutkittavan asian suhteen. Tarvitaan siis muita mittareita, joilla vastanneiden laatua voitaisiin paremmin arvioida, ja R-indikaattori tarjoaa yhden vaihtoehdon. R-indikaattori mittaa otosalkioiden vastausalttiuksien välistä vaihtelua. R-indikaattorin estimoiminen edellyttää siis vastausalttiuksien estimointia, mikä puolestaan edellyttää apumuuttujien olemassaoloa kaikille otosalkioille. Vastausalttiuksien estimoimiseen käytettiin linkkifunktiona sekä logistista mallia että ja Särndalin ja Lundströmin (2008) vastausvaikutusten mallia. Vastauskäyttäytymiseen vaikuttavan apumuuttujajoukon valinta tehtiin alan kirjallisuuteen perustuen (Groves & Couper 1998). Koska R-indikaattorin estimaattori on satunnaismuuttuja, täytyi sille estimoida varianssi ja mahdollinen harha (Shlomo ym. 2009). Estimoinnissa käytettiin Bootstrap-pseudotoistomenetelmää, jossa alkuperäisestä aineistosta poimitaan niin kutsuttuja pseudo-otoksia, joiden avulla R-indikaattorin estimaattorille voidaan laskea keskivirhe. Suomen uhritutkimuspilotti koostui kolmesta eri tiedonkeruumenetelmällä poimitusta otoksesta: CAPI-, CATI- CAVVIotoksesta. Vastausasteet vaihtelivat aineistoissa paljon, mutta R-indikaattorin estimaatit olivat kaikille aineistoille liki samat. Suurempi vastausaste ei siis merkinnyt parempaa edustavuutta. Lisäksi CAVVI-aineistossa muistutusviestein ja -kirjein suoritettu vastausasteen kasvattaminen huononsi edustavuutta R-indikaattorin näkökulmasta. Mielivaltainen vastausasteen kasvattaminen ei siis ole välttämättä perusteltua. R-indikaattorin estimaattorin ominaisuuksien osalta empiiriset tulokset vahvistivat RISQ-projektin aiempia tutkimustuloksia. Estimaattorin arvo oli sitä pienempi mitä enemmän vastausalttiuden mallissa oli selittäjiä, koska tällöin vastausalttiuksien varianssi kasvoi (Schouten ym. 2009). Otoskoko vaikutti merkittävästi varianssin suuruuteen: mitä pienempi otoskoko oli, sitä leveämmät olivat luottamusvälit ja sitä vaikeampi oli tehdä johtopäätöksiä edustavuudesta.