Appropriateness of colonoscopy in Europe (EPAGE II). Iron-deficiency anemia and hematochezia.

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of iron-deficiency anemia (IDA) and hematochezia, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of IDA and hematochezia was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS: IDA occurs in 2 %-5 % of adult men and postmenopausal women. Examination of both the upper and lower gastrointestinal tract is recommended in patients with iron deficiency. Colonoscopy for IDA yields one colorectal cancer (CRC) in every 9-13 colonoscopies. Hematochezia is a well-recognized alarm symptom and such patients are likely to be referred for colonoscopy. Colonoscopy is unanimously recommended in patients aged > or = 50. Diverticulosis, vascular ectasias, and ischemic colitis are common causes of acute lower gastrointestinal bleeding (LGIB); CRC is found in 0.2 %-11 % of the colonoscopies performed for LGIB. Most patients with scant hematochezia have an anorectal or a distal source of bleeding. The expert panel considered most clinical indications for colonoscopy as appropriate in the presence of IDA (58 %) or hematochezia (83 %). CONCLUSION: Despite the limitations of the published studies, guidelines unanimously recommend colonoscopy for the investigation of IDA and hematochezia in patients aged > or = 50 years. These indications were also considered appropriate by EPAGE II, as were indications in patients at low risk for CRC with no obvious cause of bleeding found during adequate previous investigations.

Inflammation-induced changes in expression and glycosylation of genetic variants of alpha 1-acid glycoprotein. Studies with human sera, primary cultures of human hepatocytes and transgenic mice.

The relative occurrence of genetic variants of human alpha 1-acid glycoprotein (AGP) in relation to changes in glycosylation was studied in sera of patients with burn injury, media of cytokine-treated primary cultures of human hepatocytes and Hep 3B cells, and sera of transgenic mice expressing the human AGP-A gene. It is concluded (i) that the glycosylation of AGP was not dependent on its genetic expression and (ii) that both the variants determined by the AGP-A gene as well as by the AGP-B/B' genes are increased after inflammation or treatment with interleukins 1 and 6.

The recent decline in mortality from Hodgkin lymphomas in central and eastern Europe

BACKGROUND: Hodgkin lymphoma (HL) is a largely curable disease and its mortality had steadily declined in western Europe since the late 1960s. Only modest declines were, however, observed in central/eastern Europe. MATERIALS AND METHODS: We updated trends in mortality from HL in various European areas up to 2004 and analyzed patterns in incidence for selected European countries providing national data. RESULTS: In most western European countries, HL mortality continued to steadily decline up to the mid 2000s. More recent reductions were also observed in eastern European countries. Overall, mortality from HL declined from 1.17/100,000 (age-standardized, world population) in 1980-1989 to 1.42/100,000 in 2000-2004 in men from the 15 member states of the European Union (EU) from western and northern Europe. In the EU 10 accession countries of central and eastern Europe, male mortality from HL was 1.42/100,000 in 1980-1984, 1.32 in 1990-1994, and declined to 0.76 in 2000-2004. Similar trends were observed in women. No consistent patterns were found for HL incidence. CONCLUSIONS: The present work confirms the persistent declines in HL mortality in western European countries, and shows favorable patterns over more recent calendar years in central/eastern ones, where rates, however, are still at levels observed in western Europe in the early 1990s.

The Roles of Cultural, Functional and Value Diversity in Innovativeness and Learning

Tutkielman tavoite on tutkia kulttuurista, funktionaalista ja arvojen diversiteettiä, niiden suhdetta innovatiivisuuteen ja oppimiseen sekä tarjota keinoja diversiteetin johtamiseen. Tämän lisäksi selvitetään linjaesimiesten haastattelujen kautta miten diversiteetti case -organisaatiossa tällä hetkellä koetaan. Organisaation diversiteetin tämänhetkisen tilan tunnistamisen kautta voidaan esittää parannusehdotuksia diversiteetin hallintaan. Tutkimus- ja tiedonkeruumenetelmänä käytetään kvalitatiivista focus group haastattelumenetelmää. Tutkimuksessa saatiin selkeä kuva kulttuurisen, funktionaalisen ja arvojen diversiteetin merkityksistä organisaation innovatiivisuudelle ja oppimiselle sekä löydettiin keinoja näiden diversiteetin tyyppien johtamiseen. Tutkimuksen tärkeä löydös on se, että diversiteetti vaikuttaa positiivisesti organisaation innovatiivisuuteen kun sitä johdetaan tehokkaasti ja kun organisaatioympäristö tukee avointa keskustelua ja mielipiteiden jakamista. Case organisaation tämänhetkistä diversiteetin tilaa selvitettäessä havaittiin että ongelma organisaatiossa ei ole diversiteetin puute, vaan paremminkin se, ettei diversiteettia osata hyödyntää. Organisaatio ei tue erilaisten näkemysten ja mielipiteiden vapaata esittämistä jahyväksikäyttöä ja siksi diversiteetin hyödyntäminen on epätäydellistä. Haastatteluissa tärkeinä seikkoina diversiteetin hyödyntämisen parantamisessa nähtiin kulttuurin muuttaminen avoimempaan suuntaan ja johtajien esimiestaitojen parantaminen.

Decoding auditory EEG responses in healthy and clinical populations: A comparative study.

BACKGROUND: Analyses of brain responses to external stimuli are typically based on the means computed across conditions. However in many cognitive and clinical applications, taking into account their variability across trials has turned out to be statistically more sensitive than comparing their means. NEW METHOD: In this study we present a novel implementation of a single-trial topographic analysis (STTA) for discriminating auditory evoked potentials at predefined time-windows. This analysis has been previously introduced for extracting spatio-temporal features at the level of the whole neural response. Adapting the STTA on specific time windows is an essential step for comparing its performance to other time-window based algorithms. RESULTS: We analyzed responses to standard vs. deviant sounds and showed that the new implementation of the STTA gives above-chance decoding results in all subjects (in comparison to 7 out of 11 with the original method). In comatose patients, the improvement of the decoding performance was even more pronounced than in healthy controls and doubled the number of significant results. COMPARISON WITH EXISTING METHOD(S): We compared the results obtained with the new STTA to those based on a logistic regression in healthy controls and patients. We showed that the first of these two comparisons provided a better performance of the logistic regression; however only the new STTA provided significant results in comatose patients at group level. CONCLUSIONS: Our results provide quantitative evidence that a systematic investigation of the accuracy of established methods in normal and clinical population is an essential step for optimizing decoding performance.

External Location Factors of Finnish Direct Investment in Central and Eastern European Transitional Economies

Tutkimuksen päätavoitteena oli selvittää suomalaisten suorien investointien maan valintaan vaikuttavia tekijöitä Itä- ja Keski-Euroopan kymmenessä siirtymätaloudessa. Empiirisessä osuudessa tarkasteltiin suomalaisten yritysten tärkeimpiä sijaintitekijöitä alueella ja yrityskohtaisten tekijöiden vaikutusta sijaintitekijöihin. Tutkimuksessa selvitettiin myös yritysten päämotiiveja investoida maihin. Laaditun investointikriteeristön mukaan maat pystyttiin laittamaan paremmuusjärjestykseen suomalaisen investoijan kannalta. Empiirisen osuuden aineisto kerättiin postikyselylomakkeella yrityksiltä, joilla on tai jotka ovat suunnittelemassa investointeja näihin maihin. Tutkimusote oli kvantitatiivinen. Tutkimustulokset osoittavat, että suomalaiset investoijat valitsevat Itä- ja Keski-Euroopan maan investointikohteeksi pääasiassa markkinapotentiaalin ja edullisten kustannusten perusteella. Myös infrastruktuuri vaikuttaa maan valintaan. Eri aloilla toimivien yritysten sijaintitekijöiden painotuksissa havaittiin eroja. Yrityksen koko ja päämotiivi vaikuttivat sijaintitekijöiden painotuksiin. Investointikriteereiden mukaan kaksi parasta investointimaata suomalaisille investoijille ovat Puola ja Viro. Vertailtaessa investointikriteereitä toteutuneisiin investointeihin voidaan todeta, että suomalaiset investoijat eivät ole hyödyntäneet investoinneilla saatavia etuja kaikissa kohdemaissa.

Harmonization of training and assessment of medical specialists in physical and rehabilitation medicine across Europe - The contribution of the UEMS Board of Physical and Rehabilitation Medicine

Background.- The main goals of the European Board of Physical and Rehabili-tation Medicine (EBPRM), founded in 1991 as the third speciality board of theUnion of European Medical Specialists (UEMS), are to harmonize pre-graduate,post-graduate and continuous medical education in physical and rehabilitationmedicine (PRM) all over Europe. The harmonization of curricula of the medi-cal specialities and the assessment of medical specialists has become one of thepriorities of the UEMS and its working groups to which the EBPRM contributes.Action.- The EBPRM will continue to promote a specific minimal undergraduatecurriculum on PRM including issues like disability, participation and handicapto be taught all over Europe as a basis for general medical practice. The EBPRMwill also expand the existing EBPRM postgraduate curriculum into a detailedcatalogue of learning objectives. This catalogue will serve as a tool to boostharmonization of the national curricula across Europe as well as to structurethe content of the MCQ examination. It would be a big step forward towardsharmonization of European PRM specialist training if an important number ofcountries would use the certifying MCQ examination of the Board as a part ofthe national assessments for PRM specialists.

Managerial Careers in the IT Industry: Women in China and in Finland

This research focuses on the career experiences of women managers in the IT industry in China and Finland, two countries with different cultures, policies, size of population, and social and economic structures regarding work-life support and equal opportunities. The object of this research is to present a cross-cultural comparison of women’s career experiences and how women themselves understand and account for their careers. The study explores how the macro and the micro levels of cultural and social processes become manifested in the lives of individual women. The main argument in this thesis is that culture plays a crucial role in making sense of women’s career experiences, although its role should be understood through its interrelationship with other social processes, e.g., institutional relations, social policies, industrial structures and organizations, as well as globalization. The interrelationship of a series of cultural and social processes affects individuals’ attitudes to, and arrangement and organization of, their work and family lives. This thesis consists of two parts. The first part introduces the research topic and discusses the overall results. The second part comprises five research papers. The main research question of the study is: How do cultural and social processes affect the experiences of women managers? Quantitative and qualitative research methods, which include in-depth interviews, Q-methodology, interpretive analysis, and questionnaires, are used in the study. The main theoretical background is culturally sensitive career theory and the theory of individual differences. The results of this study are viewed through a feminist lens. The research methodology applied allows new explorations on how demographic factors, work experiences, lifestyle issues, and organizational cultures can jointly affect women’s managerial careers. The sample group used in the research is 42 women managers working in IT companies in China (21) and Finland (21). The results of the study illustrate the impact of history, tradition, culture, institutional relations, social politics, industry and organizations, and globalization on the careers of women managers. It is claimed that the role of culture – cultural norms within nations and organizations – is of great importance in the relationship of gender and work. Women’s managerial careers are affected by multiple factors (personal, social and cultural) reflecting national and inter-individual differences. The results of the study contribute to research on careers, adding particularly to the literature on gender, work and culture, and offering a complex and holistic perspective for a richer understanding of pluralism and global diversity. The results of the study indicate how old and new career perspectives are evidenced in women managers in the IT industry. The research further contributes to an understanding of women’s managerial careers from a cross-culture perspective. In addition, the study contributes to the literature on culture and extends understanding of Hofstede’s work. Further, most traditional career theories do not perceive the importance of culture in determining an individual’s career experience and this study richens understanding of women managers’ careers and has considerable implications for international human resource management. The results of this study emphasize the need, when discussing women managers’ careers, to understand the ways by which gendering is produced rather than merely examining gender differences. It is argued that the meaning of self-knowledge is critical. Further, the environment where the careers under study develop differs greatly; China and Finland are very different – culturally, historically and socially. The findings of this study should, therefore, be understood as a holistic, specific, and contextually-bound.

Enhanced triterpene production in Tabernaemontana catharinensis cell suspension cultures in response to biotic elicitors

Cell suspension cultures of Tabernaemontana catharinensis were treated with autoclaved homogenates of Candida albicans, Fusarium oxysporum, Penicillium avelanium and Saccharomyces cerevisiae. The effects caused by the concentration, exposure time and the type of elicitor on the accumulation of pentacyclic triterpenes were monitored. When exposed to biotic elicitors for longer periods, some cell lines redoubled the production of those triterpenes. Saccharomyces cerevisiae homogenate was the best elicitor of triterpenes in all cell lines investigated.

Rheological behavior of Chlorella sp. e Scenedesmus sp. cultures in different biomass concentrations

Studies involving the use of microalgae are increasingly intensifying for the potential they present to produce biofuels, because they are a renewable energy source that does not compete directly with food production, and because they enable the obtaining of a fuel with less environmental impact when compared to fossil fuel. In this context, the use of microalgae is directly associated to its capacity to be produced on a large scale and to be extracted from the culture medium. Rheological studies are important for obtaining the information needed in the elaboration of projects and equipment that will be used in various operations existing in systems of production and extraction of algal biomass. In the evaluation of different levels of dry biomass concentration, studies have been conducted of the rheological behavior of cultures of Chlorella sp. BR001 and Scenedesmus sp. BR003. The Power Law model adjusted well to the data of shear stress as a function of strain rate. In all concentrations the cultures showed non-Newtonian behavior. It was observed to Scenedesmus sp. BR003 little effect of biomass concentration on the apparent viscosity and shear stress.

Nordic alcohol policy in Europe: the adaptation of Finland’s, Sweden’s and Norway’s alcohol policies to a new policy framework, 1994-2013

The purpose of this thesis is to study how and to which extent Finland, Sweden and Norway have adapted their alcohol policies to the framework imposed to them by the EU and the European Economic Area (EEA) since the mid-1990s. This is done by studying the underlying mechanisms that have influenced the formation of alcohol policy in the Nordic countries in that period. As a part of this analysis main differences in alcohol policies and alcohol consumption between the three countries are assessed and the phenomenon of cross-border trade with alcohol is discussed. The study examines also the development of Finnish, Norwegian and Swedish alcohol policies between 1994 and 2012 and compares the Nordic alcohol policies with other alcohol policies in Europe as the situation was in 2012. The time frame of the study spans from the mid-1990s to the end of 2013 and is divided into three phases. Studying the role of the Europeanisation process on the formation of alcohol policies has a key role in the analysis. Besides alcohol policies, the analyses comprise the development of alcohol consumption and cross-border trade with alcohol. In addition, a quantitative scale constructed to measure the strictness of alcohol policies is utilised in the analyses. The results from the scale are used to substantiate the qualitative analysis and to test whether the stereotypical view of a strict Nordic alcohol policy is still true. The results from the study clearly corroborate earlier findings on the significance of Europeanisation and the Single Market for the development of alcohol policies in the Nordic countries. Free movement of goods and unhindered competition have challenged the principle of disinterest and enabled private profit seeking in alcohol trade. The Single Market has also contributed to the increase in availability of alcohol and made it more difficult for the Nordic EU member states to maintain restrictive alcohol policies. All in all, alcohol policies in the Nordic countries are more liberal in 2013 than they were in 1994. Norway, being outside the EU has, however, managed to maintain a stricter alcohol policy than Finland and Sweden. Norway has also been spared from several EU directives that have affected Finland and Sweden, the most remarkable being the abolishment of the travellers’ import quotas for alcohol within the EU. Due to its position as a non-EU country Norway has been able to maintain high alcohol taxes without being subjected to a ”race to the bottom” regarding alcohol taxes the same way as Finland and Sweden. Finland distinguishes as the country that has liberalised its alcohol policy most during the study period. The changes in alcohol policies were not only induced by Europeanisation and the Single Market, but also by autonomous decision-making and political processes in the individual countries. Furthermore, the study shows that alcohol policy measures are implemented more widely in Europe than before and that there is a slow process of convergence going on regarding alcohol policy in Europe. Despite this, alcohol policies in the Nordic countries are still by far the strictest in all of Europe. From a Europeanisation perspective, the Nordic countries were clearly on the receiving end during the first two study phases (1994–2007), having more to adjust to rules from the EU and the Single Market than having success in uploading and shaping alcohol policy on the European and international field. During the third and final study phase (2008–2013), however, the Nordic countries have increasingly succeeded in contributing to shape the alcohol policy arena in the EU and also more widely through the WHOs global alcohol strategy. The restrictive Nordic policy tradition on which the current alcohol policies in Finland, Sweden and Norway were built on has still quite a solid evidence base. Although the basis of the restrictive alcohol policy has crumbled somewhat during the past twenty years and the policies have become less effective, nothing prevents it from being the base for alcohol policy in the Nordic countries even in the long term. In the future, all that is needed for an effective and successful alcohol policy is a solid evidence base, enough political will and support from the general public.

Management of Soft Information in Sales and Operations Planning

With a Sales and Operations Planning (S&OP) process, a company aims to manage the demand and supply by planning and forecasting. The studied company uses an integrated S&OP process to improve the company's operations. The aim of this thesis is to develop this business process by finding the best possible way to manage the soft information in S&OP, whilst also understanding the importance and types (assumptions, risks and opportunities) of soft information in S&OP. The soft information in S&OP helps to refine future S&OP planning, taking into account the uncertainties that affect the balance of the long-term demand and supply (typically 12-18 months). The literature review was used to create a framework for soft information management process in S&OP. There were not found a concrete way how to manage soft information in the existing literature. In consequence of the poor literature available the Knowledge Management literature was used as the base for the framework creation, which was seen in the very same type of information management like the soft information management is. The framework created a four-stage process to manage soft information in S&OP that included also the required support systems. First phase is collecting and acquiring soft information in S&OP, which include also categorization. The categorization was the cornerstone to identify different requirements that needs to be taken into consideration when managing soft information in S&OP process. The next phase focus on storing data, which purpose is to ensure the soft information is managed in a common system (support system) in a way that the following phase makes it available to users in S&OP who need by help of sharing and applications process. The last phase target is to use the soft information to understand assumptions and thoughts of users behind the numbers in S&OP plans. With this soft management process the support system will have a key role. The support system, like S&OP tool, ensures that soft information is stored in the right places, kept up-to-date and relevancy. The soft information management process in S&OP strives to improve the relevant soft information documenting behind the S&OP plans into the S&OP support system. The process offers an opportunity to individuals to review, comment and evaluate soft information in S&OP made by their own or others. In the case company it was noticed that without a properly documented and distributed soft information in S&OP it was seen to cause mistrust towards the planning.

Cyclic AMP increases the survival of ganglion cells in mixed retinal cell cultures in the absence of exogenous neurotrophic molecules, an effect that involves cholinergic activity

Natural cell death is a well-known degenerative phenomenon occurring during development of the nervous system. The role of trophic molecules produced by target and afferent cells as well as by glial cells has been extensively demonstrated. Literature data demonstrate that cAMP can modulate the survival of neuronal cells. Cultures of mixed retinal cells were treated with forskolin (an activator of the enzyme adenylyl cyclase) for 48 h. The results show that 50 µM forskolin induced a two-fold increase in the survival of retinal ganglion cells (RGCs) in the absence of exogenous trophic factors. This effect was dose dependent and abolished by 1 µM H89 (an inhibitor of protein kinase A), 1.25 µM chelerythrine chloride (an inhibitor of protein kinase C), 50 µM PD 98059 (an inhibitor of MEK), 25 µM Ly 294002 (an inhibitor of phosphatidylinositol-3 kinase), 30 nM brefeldin A (an inhibitor of polypeptide release), and 10 µM genistein or 1 ng/ml herbimycin (inhibitors of tyrosine kinase enzymes). The inhibition of muscarinic receptors by 10 µM atropine or 1 µM telenzepine also blocked the effect of forskolin. When we used 25 µM BAPTA, an intracellular calcium chelator, as well as 20 µM 5-fluoro-2'-deoxyuridine, an inhibitor of cell proliferation, we also abolished the effect. Our results indicate that cAMP plays an important role controlling the survival of RGCs. This effect is directly dependent on M1 receptor activation indicating that cholinergic activity mediates the increase in RGC survival. We propose a model which involves cholinergic amacrine cells and glial cells in the increase of RGC survival elicited by forskolin treatment.