Survival and Quality of Life among Patients with Severe Lower Extremity Peripheral Arterial Disease

Lower extremity peripheral arterial disease (PAD) is associated with decreased functional status, diminished quality of life (QoL), amputation, myocardial infarction, stroke, and death. Nevertheless, public awareness of PAD as a morbid and mortal disease is low. The aim of this study was to assess the incidence of major lower extremity amputation due to PAD, the extent of reamputations, and survival after major lower extremity amputation (LEA) in a population based PAD patient cohort. Furthermore, the aim was to assess the functional capacity in patients with LEA, and the QoL after lower extremity revascularization and major amputation. All 210 amputees due to PAD in 1998–2002 and all 519 revascularized patients in 1998–2003 were explored. 59 amputees alive in 2004 were interviewed using a structured questionnaire of QoL. Two of each amputee age-, gender- and domicile-matched controls filled in and returned postal self-administered QoL questionnaire as well as 231 revascularized PAD patients (the amount of these patients who engaged themselves to the study), and one control person for each patient completed postal self-administered QoL questionnaire. The incidence rate of major LEA was 24.1/100 000 person-years and it was considerably high during the years studied. The one-month mortality rate was 21%, 52% at one-year, and the overall mortality rate was 80%. When comparing the one-year mortality risk of amputees, LEAs were associated with a 7.4-fold annual mortality risk compared with the reference population in Turku. Twenty-two patients (10%) had ipsilateral transversions from BK to AK amputation. Fifty patients (24%) ended up with a contralateral major LEA within two to four amputation operations. Three bilateral amputations were performed at the first major LEA operation. Of the 51 survivors returning home after their first major LEA, 36 (71%) received a prosthesis; (16/36, 44%) and were able to walk both in- and outdoors. Of the 68 patients who were discharged to institutional care, three (4%) had a prosthesis one year after LEA. Both amputees and revascularized patients had poor physical functioning and significantly more depressive symptoms than their controls. Depressive symptoms were more common in the institutionalized amputees than the home-dwelling amputees. The surviving amputees and their controls had similar life satisfaction. The amputees felt themselves satisfied and contented, whether or not they lived in long-term care or at home. PAD patients who had undergone revascularizations had poorer QoL than their controls. The revascularized patients’ responses on their perceived physical functioning gave an impression that these patients are in a declining life cycle and that revascularizations, even when successful, may not be sufficient to improve the overall function. It is possible that addressing rehabilitation issues earlier in the care may produce a more positive functional outcome. Depressive symptoms should be recognized and thoroughly considered at the same time the patients are recovering from their revascularization operation. Also primary care should develop proper follow-up, and community organizations should have exercise groups for those who are able to return home, since they very often live alone. In rehabilitation programs we should consider not only physical disability assessment but also QoL.

Taivekartongin sävytys ja jälkikellertyminen

Taivekartongilta vaaditaan nykyisin korkealaatuista ja tasaista ulkonäköä. Pakkauksen tehtävänä on parantaa myyntiä hyvällä ulkonäöllä ja siisteydellä sekä antaa informaatiota ja käyttöohjeita. Tässä diplomityössä tutkittiin taivekartongin sävyttämistä, optisia ominaisuuksia sekä vaaleuden ja sävyjen pysyvyyttä. Kirjallisuusosassa käsiteltiin paperin ja kartongin optisia ominaisuuksia sekä esiteltiin Kubelka-Munkin teoria. Teoriaa voidaan käyttää mm. monikerroskartongin vaaleuden ja sävyjen mallintamisessa. Esillä oli paljon eri prosessitekijöitä, massoja ja kemikaaleja, jotka vaikuttavat kartongin vaaleuteen ja sävyyn. Työssä kärsiteltiin myös keinoja vaikuttaa kartongin sävyyn sävytyksellä ja sävytyksen eri tapoja. Toisaalta vaaleuden ja sävyn pysyvyyteen vaikuttaa kartongin jälkikellertyminen. Työssä tarkasteltiin jälkikellertymisen mekanismeja ja siihen vaikuttavia tekijöitä sekä esitettiin keinoja ennalta ehkäistä ja estää kellertymistä. Kokeellisessa osassa käsiteltiin massan ja päällystyspastan värjäyksen vaikutuksia ulkonäköön ja optisiin ominaisuuksiin. Sinertävillä tai violeteilla sävyväreillä voidaan pienentää mekaanisten massojen luonnollista kellertyvyyttä, jolloin valkoisuuden vaikutelma lisääntyy. Värien lisääminen heikentää vaaleutta, koska värien lisäys nostaa valon absorptiota. Tämän takia on tärkeää lisätä väri mielellään siihen kerrokseen, jossa kellertävä massa on, joka on tyypillisesti kartongin keskikerros. Pintakerrokset ovat valkaistua sellua ja niillä on tärkeä merkitys kartongin vaaleudelle, joten värin lisäys pintaan alentaisi vielä merkittävämmin kartongin kokonaisvaaleutta. Pastan värjäyksellä saadaan tasaisuutta värjäykseen, mutta sävyn säätö on tehtävä edelleen massavärjäyksellä. Pigmenttivärien käytöllä pystytään lisäämään mm. valonkestoa kartongille. Kartongin ja paperituotteiden valonkeston tutkimiseen ei ole olemassa standardia. Työssä tutkittiin laboratorio-olosuhteissa ja huonevalossa vanhentuneiden kartonkinäytteiden vertailtavuutta. Materiaalivalinnoilla pystytään vaikuttamaan valon-kestoon. Siihen vaikuttavat mm. massan laatu, lateksivalinta sekä pigmenttivärin käyttö. Mekaanista massaa sisältävät tuotteet kellertyvät pääasiassa ligniinin takia. Ligniini sisältää paljon UV-säteilyyn reagoivia ryhmiä, jotka muuttuvat värilliseksi lisäten kellertymistä. Valkaistujen sellujen vanhentuminen on suhteessa mekaaniseen massaan erittäin vähäistä. SA-lateksin havaittiin suojaavan vaaleuden menetykseltä ja lisäävän sävyn pysyvyyttä paremmin kuin SB-lateksi.

Puuelementtien teollisen tuotannon kehittäminen

Tavoitteena tässä diplomityössä oli selvittää puuelementtien teollisen tuotannon mahdollisuuksia ja kehityksen tilaa. Millaiset valmiudet puuelementtien valmistajilla on valmistaa rakennuttajien ja rakentajien edellyttämiä suur- ja tilaelementtejä puukerrostaloja varten, millaista tuotekehitystä ja tuotantoinvestointeja tarvitaan kaiken tämän mahdollistamiseksi, mikä on yritysten halukkuus ja resurssit investoida uuteen teknologiaan sekä kuinka voidaan parantaa tuotannon tehokkuutta. Ensin diplomityössä luotiin katsaus puukerrostalorakentamisen historiaan, nykytilaan, kerrostalojärjestelmiin, palomääräyksiin ja ruotsalaiseen puuelementtien valmistamisen kehityksen tilaan. Puuelementtien valmistukseen tutustumisen jälkeen laadittiin kyselylomake tutkimusta varten, joka lähettiin 64:lle puuelementtien valmistajalle. Tutkimukseen vastasi kaikkiaan 20 puuelementtien valmistajaa. Vastausprosentiksi muodostui 31 %. Tutkimuksen perusteella voidaan todeta puuelementtien valmistajien olevan pieniä ja keskisuuria pk-yrityksiä jotka valmistavat puuelementtejä pääasiassa pientaloteollisuudelle. Suomalaisten valmistajien automaation taso ja tekninen osaaminen ei juuri eroa ruotsalaisesta puuelementtien valmistuksesta. Suomessa puuelementtien valmistus puukerrostaloja varten ei ole vielä vakiintunutta samalla tavalla kuten Ruotsissa. Suomessa Puukerrostalokohteita lähtee liikkeelle tällä hetkellä vielä aivan liian vähän. Kilpailukyky ja tehokkuus tulevat kehittymään nopeasti kun teollinen valmistus saadaan riittävän korkealle tasolle.

Lengsel - en kraft til helse

The aim of this study is to explore longing and its implication for health. The overall purpose is to develop a theory model of longing. The research question is: What is the substance of longing in a caring science perspective? The model is developed based on theoretical and empirical studies, which contains three different research materials; hermeneutic reading of texts by Augustine and Kierkegaard, and interpretation of research interviews with nine women in a cancer context. The design of the study is explorative and the ontological hermeneutics of Gadamer is chosen as a guidance for understanding. The main standpoint of the study is performed within the systematic caring science, which through basic research, generates knowledge about the human desire as crucial for the deeper health processes. Through the contextual study there is a link to the clinical caring science. In the ontology of the systematic caring science, the character of longing is in touch with two different aspects. Longing is rooted in the inner source of love of the ethos of the human where the inscrutable depth exists and contains the reality beyond the visible. Further, longing is essential for human being becoming in health and suffering, through holiness as a unit of body, soul and spirit. The results of the study are presented in a theory model. The model has by abduction provided new and deeper understanding of dimensions of longing related to health. On a general level the forces in longing unfolds in two perspectives; suffering and the basis of love. There appears to be a relationship between human and the source of love in all three materials. When human opens up his life in a larger perspective, resting in love, he can manage to stand in the thrill, and acknowledge loss and emptiness. In the transparency of an inner dialogue unfolding dispair, deeper longing can be opened up so that lives are released from the source of love. The holiness of the human desire has such appeal because the holiness of the source of love is always more than the suffering and the particular. The holiness in longing seems to satisfy the hearts deepest searching. The directon of longing is performed in relation to human and the source of love. The study reveals how longing is associated with the source of love, where the holiness of longing seems to drag the human and by that gives the answer to the seeking of the heart. Dynamics forces have direction from the human suffering in the foundation and a release of the power is given back to transform, deepen and reconcile life and suffering. The movements of the power released by longing are keys to understand the suffering of human in relation to the source of love, becoming in health. By this study, results contribute to deepen the ontological core of caring science. Firstly, human in his longing is connected to the inner ethos and by that the most sacred and absolute in itself so that parts of the potential of love can be released to health. Secondly, longing is the road of reconciliation and can further expand to authentic reconciliation, where human is becoming towards unity and holiness. Thirdly, the spirituality is unfolding through longing and the transcendental is received. In longing, human is in touch with the mystery, the longing exceeds the present and moving towards eternity and infinity, and is in what is yet to come. Such deep experience of longing moments leave an impression and show the longing fulfilled.

Same- and Other-Sex Victimization : Risk Factors, Consequences, and Protection by Peers

Bullying can be viewed as goal-oriented behavior in the strive for dominance and prestige in the peer group (Salmivalli, 2010). To ensure the effectiveness of their power demonstrations, bullies often choose targets from among their vulnerable peers (Salmivalli, 2010; Veenstra et al., 2007). A large number of studies have also shown that victimization has severe consequences for the victims’ psychosocial adjustment (Reijntjes, Kamphuis, Prinzie, & Telch, 2010; Ttofi, Farrington, Lösel, & Loeber, 2011). In this thesis I investigate – based on three empirical studies – whether similar dynamics on the risk factors and consequences apply to same- and other-sex victimization. In the empirical studies, we used the data from the randomized control trial of the KiVa antibullying program for the elementary school grades 4–6 (2007–2008), and for the middle school grades 7–9 (2008–2009). We measured same- and other-sex victimization, and victims’ defending relationships by dyadic questions: “By which classmates are you victimized?” and “By which classmates are you supported, comforted, or defended?” In addition, we used self-reports and peer reports to measure adjustment and social status. The findings imply that other-sex victimization may be challenging for antibullying work. First, although targets of bullying seemed to be selected from among vulnerable peers for the most part, perceived popularity increased the risks of other-sex victimization. Popularity of these victims may falsely lead to an impression that the victims are doing well. Second, the consequences considering victims’ later psychosocial adjustment were alarming concerning girls bullied by boys. Thus, despite the fact that the targets may be perceived as popular, other-sex victimization can have even more severe consequences than same-sex victimization. Third, we found that defending relationships were mostly same-sex relationships, and consequently, we may ask whether defending is effective against other-sex bullies. Finally, the KiVa antibullying program was less effective against other-sex victimization in the adolescent sample. The findings altogether emphasize the importance of taking into account the sex composition of the bully-victim dyad, both considering future research on bullying and in the antibullying work with children and adolescents.

Brittleness of Paper

Brittleness is a well-known material characteristic but brittleness of paper is vaguely covered. The objective of this thesis was to characterize the phenomenon and causes around brittleness of paper and to clarify if it is a measurable property. Brittleness of paper was approached from the perspectives of paper physics and paper mills. Brittleness is a property of dry paper and it causes problems at the finishing stages of paper machine. According to paper physics, brittle materials fail in the elastic regime, while ductile materials can locally accumulate a plastic deformation prior to the fracture and they are often able to withstand higher stresses. Brittleness of paper is vastly affected by the surrounding conditions: paper as a hygroscopic material tries to get to the equilibrium. It is also affected by the quality of the pulp used. Measurement techniques can be divided into two categories: based on the viscoelastic behavior of paper and on the exposure to the mechanical stress of sort. The experimental part of the thesis was based on the trials with brittle and non-brittle mill-made LWC papers. It is divided into three parts: strength testing of the brittle and non-brittle papers, analysis of the conditions that may contribute the brittleness and the experimental methods to evaluate brittle behavior. The strength measurements confirmed the influence of the moisture content, but only tensile energy absorption and the fracture toughness measurements provided modest differences between the brittle and non-brittle papers. Versatile analysis of the possible contributing factors resulted into speculation, while the brittle papers contained higher amount of starch, triglycerides and steryl esters. The experimental research proved that the formation, the sensory impression and the variation of local strains may contain the crucial information of paper brittleness.

Anatomical analysis of peach palm (Bactris gasipaes) leaves cultivated in vitro, ex vitro and in vivo

The present work characterized and compared the anatomical structures of the leaves of Bactris gasipaes (Arecaceae) plants grown under different cultivation conditions (in vitro, ex vitro and in vivo) with the goal of identifying the origins of the difficulties encountered in acclimatizing micro-plants. The Quant program was used to determine leaf tissue thicknesses and areas, and histochemical tests were performed on leaf sections and analyzed using light microscopy. Stomatal and trichome densities were determined using the epidermal impression method and by scanning electronic microscopy. Our results indicated that there were no discernible alterations of the anatomical characteristics of the leaves of micro-plants cultivated under differing conditions and that the thickening of the mesophyll and the vascular fibers indicated adaptive responses to ex vitro conditions. As such, the observed difficulties in acclimatizing peach palm micro-plants to ex vitro conditions cannot be attributed to plant anatomical characteristics acquired during in vitro cultivation.

Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test

The aim of the present study was to verify the sensitivity to the carbon dioxide (CO2) challenge test of panic disorder (PD) patients with respiratory and nonrespiratory subtypes of the disorder. Our hypothesis is that the respiratory subtype is more sensitive to 35% CO2. Twenty-seven PD subjects with or without agoraphobia were classified into respiratory and nonrespiratory subtypes on the basis of the presence of respiratory symptoms during their panic attacks. The tests were carried out in a double-blind manner using two mixtures: 1) 35% CO2 and 65% O2, and 2) 100% atmospheric compressed air, 20 min apart. The tests were repeated after 2 weeks during which the participants in the study did not receive any psychotropic drugs. At least 15 of 16 (93.7%) respiratory PD subtype patients and 5 of 11 (43.4%) nonrespiratory PD patients had a panic attack during one of two CO2 challenges (P = 0.009, Fisher exact test). Respiratory PD subtype patients were more sensitive to the CO2 challenge test. There was agreement between the severity of PD measured by the Clinical Global Impression (CGI) Scale and the subtype of PD. Higher CGI scores in the respiratory PD subtype could reflect a greater sensitivity to the CO2 challenge due to a greater severity of PD. Carbon dioxide challenges in PD may define PD subtypes and their underlying mechanisms.

A randomized crossover clinical study showing that methylphenidate-SODAS improves attention-deficit/hyperactivity disorder symptoms in adolescents with substance use disorder

Our objective was to evaluate the effectiveness of a long-acting formulation of methylphenidate (MPH-SODAS) on attention-deficit/hyperactivity disorder (ADHD) symptoms in an outpatient sample of adolescents with ADHD and substance use disorders (SUD). Secondary goals were to evaluate the tolerability and impact on drug use of MPH-SODAS. This was a 6-week, single-blind, placebo-controlled crossover study assessing efficacy of escalated doses of MPH-SODAS on ADHD symptoms in 16 adolescents with ADHD/SUD. Participants were randomly allocated to either group A (weeks 1-3 on MPH-SODAS, weeks 4-6 on placebo) or group B (reverse order). The primary outcome measures were the Swanson, Nolan and Pelham Scale, version IV (SNAP-IV) and the Clinical Global Impression Scale (CGI). We also evaluated the adverse effects of MPH-SODAS using the Barkley Side Effect Rating Scale and subject reports of drug use during the study. The sample consisted of marijuana (N = 16; 100%) and cocaine users (N = 7; 43.8%). Subjects had a significantly greater reduction in SNAP-IV and CGI scores (P < 0.001 for all analyses) during MPH-SODAS treatment compared to placebo. No significant effects for period or sequence were found in analyses with the SNAP-IV and CGI scales. There was no significant effect on drug use. MPH-SODAS was well tolerated but was associated with more severe appetite reduction than placebo (P < 0.001). MPH-SODAS was more effective than placebo in reducing ADHD symptoms in a non-abstinent outpatient sample of adolescents with comorbid SUD. Randomized clinical trials, with larger samples and SUD intervention, are recommended.

Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine

The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4% in the clonazepam and paroxetine groups, respectively) and age (mean ± SD) was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01), and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04). Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95%; P = 0.001). The most common adverse events were drowsiness/fatigue (57%), memory/concentration difficulties (24%), and sexual dysfunction (11%) in the clonazepam group and drowsiness/fatigue (81%), sexual dysfunction (70%), and nausea/vomiting (61%) in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.

Sensory evaluation of "dulce de leche" with coffee and whey using different affective data analysis methods

This study sought to evaluate the acceptance of "dulce de leche" with coffee and whey. The results were analyzed through response surface, ANOVA, test of averages, histograms, and preference map correlating the global impression data with results of physical, physiochemical and sensory analysis. The response surface methodology, by itself, was not enough to find the best formulation. For ANOVA, test of averages, and preference map it was observed that the consumers' favorite "dulce de leche" were those of formulation 1 (10% whey and 1% coffee) and 2 (30% whey and 1% coffee), followed by formulation 9 (20% whey and 1.25% coffee). The acceptance of samples 1 and 2 was influenced by the higher acceptability in relation to the flavor and for presenting higher pH, L*, and b* values. It was observed that samples 1 and 2 presented higher purchase approval score and higher percentages of responses for the 'ideal' category in terms of sweetness and coffee flavor. It was found that consumers preferred the samples with low concentrations of coffee independent of the concentration of whey thus enabling the use of whey and coffee in the manufacture of dulce de leche, obtaining a new product.

Sensory and physicochemical evaluation of acerola nectar sweetened with sucrose and different sweeteners

This paper aims to evaluate the physicochemical characteristics, sensory acceptance, and purchase intent of acerola nectar sweetened with sucrose and other sweeteners (neotame, sucralose and stevia extracts with 40%, 60%, 80%, and 95% rebaudioside A). The analyses were carried out for pH, soluble solids, total titratable acidity, ascorbic acid, and colorimetry (L*a*b). The acceptance test was performed by 120 consumers who evaluated the appearance, aroma, flavor, texture, and overall impression of the samples using a 9-cm unstructured hedonic scale. Furthermore, the consumers were asked to rate overall purchase intent along the scale anchored with (1) "would definitely not purchase" to (5) "would definitely purchase." The results were evaluated using analysis of variance/Tukey test and the internal preference mapping technique. The acerola nectar samples did not differ significantly (p>0.05) between themselves in terms of vitamin C content and total titratable acidity. As for appearance and aroma, there was no significant difference (p>0.05) between the samples, and as for flavor and overall impression, the most accepted samples were those with sucrose and sucralose. The internal preference mapping indicated that the most accepted samples were those with sucrose, sucralose, and neotame were. The highest frequency of positive purchase intent scores was observed for sucrose and sucralose.

Effect of the addition of wheat fiber and partial pork back fat on the chemical composition, texture and sensory property of low-fat bologna sausage containing inulin and oat fiber

The objective of this work was to study the effect of adding wheat fiber and partial pork back fat on the quality characteristics of bologna sausage. The compound central rotating design was used with treatments containing fixed levels of inulin (5%) and oat fiber (1%) and variable levels of wheat fiber (0-4%) and pork back fat (0-10%). The pH and protein were similar in all the treatments, the fat was lower than the control treatment and the moisture content was higher than the control treatment (CF) without fibers. The wheat fiber increased the hardness and reduced cohesiveness and scores were given for overall impression. We found that it was possible to prepare low-fat bologna sausage with the addition of 6.58% fiber (5% inulin, 1% oat fiber and 0.58% wheat fiber), whilst retaining good sensory acceptability, thus reducing the pork back fat levels by between 25 and 42.75%.

Fresh pasta enrichment with protein concentrate of tilapia: nutritional and sensory characteristics

Abstract With the goal of developing and characterizing the nutritional and sensory aspects of fresh pasta supplemented with tilapia protein concentrate, four types of pasta were prepared, with inclusion of 0, 10, 20, or 30% of tilapia protein concentrate. Linear effects were observed (P < 0.01) in crude protein, total lipids, ash, carbohydrate, and caloric values; these parameters increased with increasing amounts of tilapia protein concentrate in the pasta. The concentration of Na, P, Ca, Mg, and Zn increased linearly (P < 0.01) in correlation with the increase in protein concentrate content, while Fe content decreased linearly (P < 0.01). In the sensory analysis, texture, overall impression, and the acceptance index demonstrated a cubic regression (P < 0.05), with the inclusion of 20% protein concentrate yielding the best scores. Including up to 30% of tilapia protein concentrate in pasta yields an increased nutritional value, but based on the sensory results, 20% of tilapia protein concentrate in pasta is the recommended maximum level.

Hypercalcemia and acute kidney injury caused by abuse of a parenteral veterinary compound containing vitamins A, D, and E

A previously healthy 19 year-old male presented to the hospital with anorexia, nausea, and vomiting. Laboratory studies were significant for hypercalcemia (peak calcium value of 14.8 mg/dL) and acute kidney injury (peak serum creatinine of 2.88 mg/dL). He admitted to using a parenteral formulation of vitamins A, D and E restricted for veterinary use containing 20,000,000 IU of vitamin A; 5,000,000 IU of vitamin D3; and 6,800 IU of vitamin E per 100 mL vial. The patient stated to have used close to 300 mL of the product over the preceding year. Interestingly, the young man was not interested in the massive amounts of vitamins that the product contained; he was only after the local effects of the oily vehicle. The swelling produced by the injection resulted in a silicone-like effect, which gave the impression of bigger muscles. Nevertheless, the product was absorbed and caused hypervitaminosis. The serum level of 25(OH) vitamin D was clearly elevated at 150 ng/mL (reference range from 30 to 60 ng/mL), but in most published cases of vitamin D toxicity, serum levels have been well above 200 ng/mL. His PTH level was undetectable and other potential causes of hypercalcemia were excluded. Therefore, we posit that the severity of the hypercalcemia observed in this case was the result of a synergistic effect of vitamins A and D. The patient was treated with normal saline, furosemide and zolendronic acid, with rapid normalization of calcium levels and renal function.