Operative Treatment of Ovarian Cancer and Borderline Tumors in Different Hospital Categories in Finland

Surgery is the cornerstone of ovarian cancer treatment and maximal cytoreduction is important. In the early 1980’s primary surgical treatment of ovarian cancer was performed in over 80 hospitals in Finland. The significance of the operative volume of the hospital, of the training of the surgeons and of centralization of surgical treatment has been widely discussed. The aim of the present study was to evaluate the outcome of surgical treatment of ovarian cancer in different hospital categories retrospectively and prospectively, and to analyze if any differences are reflected in survival. The retrospective study included 3851 ovarian cancer patients operated between 1983 and 1994 in Finland. The data was analyzed according to hospital category (university, central, and other) and by quartiles of the hospital operative volume. The results showed that patients operated in the highest operative volume hospitals had the best relative survival. When stratifying the analysis by the period of diagnosis (1983-1988 and 1989-1994), the university hospitals improved their performance the most. The prospective part of the thesis was initiated in 1999 and included 307 patients with invasive ovarian cancer and 65 patients with an ovarian borderline tumor. The baseline and 5-year surveys used a questionnaire that was filled in by the operating surgeons. For analysis of the 5-year followup data, the hospitals were divided into three categories (<10, 10-20, or >20 patients operated in 1999). The effect of the surgical volume was analyzed also as a continuous variable (1-47 operations per year). In university hospitals, pelvic lymphadenectomy was performed in 88 %, and para-aortic lymphadenectomy in 73 %, of the patients with stage I disease. The corresponding figures ranged from 11 % to 21 % in the other hospitals. For stage III ovarian cancer patients operated by gynecological oncologists, the estimated odds ratio for no macroscopic residual tumor was 3.0 times higher (95 % CI 1.2-7.5) than for those operated by general gynecologists. In the university and other hospitals 82% of the patients received platinum-based chemotherapy. Platinum + taxane combination was given to 63 % of the patients in the university and in 49 % in the other hospitals (p = 0.0763). Only a minority of the patients with tumors of borderline malignancy were staged according to recommendations, most often multiple peritoneal biopsies and omentectomy were neglected. FIGO stage, patient age, and residual tumor were independent prognostic factors of cancer-specific 5-year survival. A higher hospital operative volume was also a significant prognostic factor for better cancer-specific survival (p = 0.036) and disease-free survival (p = 0.048). In conclusion, ovarian cancer patients operated in high-volume university hospitals were more often optimally debulked and had a significantly better cancer-specific survival than patients operated in other hospitals. These results favor centralization of primary surgical treatment of ovarian cancer.

Muuttuvien ammattitaitovaatimusten mukaisen koulutuksen käyttöönotto toisen asteen koulutuksessa

Yritykset tarvitsevat nopealla toimitusajalla uudenlaista osaamista omaavia työntekijöitä. Tämän vuoksi kouluttajien täytyy pystyä reagoimaan nopeasti työelämän esittämiin haasteisiin Kehittämällä uusi toimintamalli muuttuvien ammattitaitovaatimusten mukaisen koulutuksen käynnistämiseksi voidaan saavuttaa mittavia taloudellisia ja ajallisia säästöjä uusien osaajien koulutuksessa. Mallin avulla tapauskohtaisesti oikeat henkilöt tekevät oikea aikaisesti juuri oikeita toimenpiteitä ja näin toimien päästään mahdollisimman lyhyeen koulutusaikaan koulutustarvesignaalien vastaanottamisesta hetkeen, jolloin opiskelijat ovat valmiita siirtymään työelämään. Mikäli koulutuksen käynnistämiseen liittyvien tehtävien kanssa työskentelevät henkilöt, joilla ei ole kokonaisnäkemystä tai heiltä puuttuu päätösvalta päätösten tekemiseksi, niin tärkeää aikaa ja energiaa kuluu hukkaan. Samoin jos signaalien oikeita kulkuväyliä työelämästä oppilaitokselle ei tunnisteta tai ei osata hyödyntää, koulutusten aloittaminen viivästyy tai koulutusjää kokonaan toteutumatta.Tiiviissä yhteistyössä metallialan yritystoiminnan jakoulutuksen järjestäjän kanssa kehitetty robotisoitu laserhitsauskoulutus mahdollistaa juuri oikeanlaista osaamista omaavien työtekijöiden tuottamisen mahdollisimman tehokkaasti. Tehokkuus on todettavissa koulutuksen käynnistämiseen ja kouluttamiseen tarvittavan ajan lyhenemisenä sekä koulutuksesta syntyvien kustannusten vähenemisenä.

The importance of sonographer experience and machine quality with regards to the role of musculoskeletal ultrasound in routine care of rheumatoid arthritis patients.

OBJECTIVES: Regarding recent progress, musculoskeletal ultrasound (US) will probably soon be integrated in standard care of patient with rheumatoid arthritis (RA). However, in daily care, quality of US machines and level of experience of sonographers are varied. We conducted a study to assess reproducibility and feasibility of an US scoring for RA, including US devices of different quality and rheumatologist with various levels of expertise in US as it would be in daily care. METHODS: The Swiss Sonography in Arthritis and Rheumatism (SONAR) group has developed a semi-quantitative score using OMERACT criteria for synovitis and erosion in RA. The score was taught to 108 rheumatologists trained in US. One year after the last workshop, 19 rheumatologists participated in the study. Scans were performed on 6 US machines ranging from low to high quality, each with a different patient. Weighted kappa was calculated for each pair of readers. RESULTS: Overall, the agreement was fair to moderate. Quality of device, experience of the sonographers and practice of the score before the study improved substantially the agreement. Agreement assessed on higher quality machine, among sonographers with good experience in US increased to substantial (median kappa for B-mode and Doppler: 0.64 and 0.41 for erosion). CONCLUSIONS: This study demonstrated feasibility and reproducibility of the Swiss US SONAR score for RA. Our results confirmed importance of the quality of US machine and the training of sonographers for the implementation of US scoring in the routine daily care of RA.

Evaluation of Teacher Education Programs by Students and Graduates

The purpose of this research was to do a repeated cross-sectional research on class teachers who study in the 4th year and also graduated at the Faculty of Education, University of Turku between the years of 2000 through 2004. Specifically, seven research questions were addressed to target the main purpose of the study: How do class teacher education masters’ degree senior students and graduates rate “importance; effectiveness; and quality” of training they have received at the Faculty of Education? Are there significant differences between overall ratings of importance; effectiveness and quality of training by year of graduation, sex, and age (for graduates) and sex and age (for senior students)? Is there significant relationship between respondents’ overall ratings of importance; effectiveness and their overall ratings of the quality of training and preparation they have received? Are there significant differences between graduates and senior students about importance, effectiveness, and quality of teacher education programs? And what do teachers’ [Graduates] believe about how increasing work experience has changed their opinions of their preservice training? Moreover the following concepts related to the instructional activities were studied: critical thinking skills, communication skills, attention to ethics, curriculum and instruction (planning), role of teacher and teaching knowledge, assessment skills, attention to continuous professional development, subject matters knowledge, knowledge of learning environment, and using educational technology. Researcher also tried to find influence of some moderator variables e.g. year of graduation, sex, and age on the dependent and independent variables. This study consisted of two questionnaires (a structured likert-scale and an open ended questionnaire). The population in study 1 was all senior students and 2000-2004 class teacher education masters’ degree from the departments of Teacher Education Faculty of Education at University of Turku. Of the 1020 students and graduates the researcher was able to find current addresses of 675 of the subjects and of the 675 graduates contacted, 439 or 66.2 percent responded to the survey. The population in study 2 was all class teachers who graduated from Turku University and now work in the few basic schools (59 Schools) in South- West Finland. 257 teachers answered to the open ended web-based questions. SPSS was used to produce standard deviations; Analysis of Variance; Pearson Product Moment Correlation (r); T-test; ANOVA, Bonferroni post-hoc test; and Polynomial Contrast tests meant to analyze linear trend. An alpha level of .05 was used to determine statistical significance. The results of the study showed that: A majority of the respondents (graduates and students) rated the overall importance, effectiveness and quality of the teacher education programs as important, effective and good. Generally speaking there were only a few significant differences between the cohorts and groups related to the background variables (gender, age). The different cohorts were rating the quality of the programs very similarly but some differences between the cohorts were found in the importance and effectiveness ratings. Graduates of 2001 and 2002 rated the importance of the program significantly higher than 2000 graduates. The effectiveness of the programs was rated significantly higher by 2001 and 2003 graduates than other groups. In spite of these individual differences between cohorts there were no linear trends among the year cohorts in any measure. In respondents’ ratings of the effectiveness of teacher education programs there was significant difference between males and females; females rated it higher than males. There were no significant differences between males’ and females’ ratings of the importance and quality of programs. In the ratings there was only one difference between age groups. Older graduates (35 years or older) rated the importance of the teacher training significantly higher that 25-35 years old graduates. In graduates’ ratings there were positive but relatively low correlations between all variables related to importance, effectiveness and quality of Teacher Education Programs. Generally speaking students’ ratings about importance, effectiveness and quality of teacher education program were very positive. There was only one significant difference related to the background variables. Females rated higher the effectiveness of the program. The comparison of students’ and graduates’ perception about importance, effectiveness, and quality of teacher education programs showed that there were no significant differences between graduates and students in the overall ratings. However there were differences in some individual variables. Students rated higher in importance of “Continuous Professional Development”, effectiveness of “Critical Thinking Skills” and “Using Educational Technology” and quality of “Advice received from the advisor”. Graduates rated higher in importance of “Knowledge of Learning Environment” and effectiveness of “Continuous Professional Development”. According to the qualitative data of study 2 some graduates expressed that their perceptions have not changed about the importance, effectiveness, and quality of training that they received during their study time. They pointed out that teacher education programs have provided them the basic theoretical/formal knowledge and some training of practical routines. However, a majority of the teachers seems to have somewhat critical opinions about the teacher education. These teachers were not satisfied with teacher education programs because they argued that the programs failed to meet their practical demands in different everyday situations of the classroom e.g. in coping with students’ learning difficulties, multiprofessional communication with parents and other professional groups (psychologists and social workers), and classroom management problems. Participants also emphasized more practice oriented knowledge of subject matter, evaluation methods and teachers’ rights and responsibilities. Therefore, they (54.1% of participants) suggested that teacher education departments should provide more practice-based courses and programs as well as closer collaboration between regular schools and teacher education departments in order to fill gap between theory and practice.

Eye lens monitoring for interventional radiology personnel: dosemeters, calibration and practical aspects of H p (3) monitoring. A 2015 review.

A thorough literature review about the current situation on the implementation of eye lens monitoring has been performed in order to provide recommendations regarding dosemeter types, calibration procedures and practical aspects of eye lens monitoring for interventional radiology personnel. Most relevant data and recommendations from about 100 papers have been analysed and classified in the following topics: challenges of today in eye lens monitoring; conversion coefficients, phantoms and calibration procedures for eye lens dose evaluation; correction factors and dosemeters for eye lens dose measurements; dosemeter position and influence of protective devices. The major findings of the review can be summarised as follows: the recommended operational quantity for the eye lens monitoring is H p (3). At present, several dosemeters are available for eye lens monitoring and calibration procedures are being developed. However, in practice, very often, alternative methods are used to assess the dose to the eye lens. A summary of correction factors found in the literature for the assessment of the eye lens dose is provided. These factors can give an estimation of the eye lens dose when alternative methods, such as the use of a whole body dosemeter, are used. A wide range of values is found, thus indicating the large uncertainty associated with these simplified methods. Reduction factors from most common protective devices obtained experimentally and using Monte Carlo calculations are presented. The paper concludes that the use of a dosemeter placed at collar level outside the lead apron can provide a useful first estimate of the eye lens exposure. However, for workplaces with estimated annual equivalent dose to the eye lens close to the dose limit, specific eye lens monitoring should be performed. Finally, training of the involved medical staff on the risks of ionising radiation for the eye lens and on the correct use of protective systems is strongly recommended.

La Incidencia de las nuevas tecnologías en los hábitos formativos de los estudiantes de magisterio = The Impact of new technologies in the learning habits of teacher students

Este trabajo persigue dos objetivos: el primero es analizar el uso de las TIC en un grupo de estudiantes de segundo curso de Magisterio de la Universidad de Girona; el segundo es analizar los documentos normativos legales que establecen el currículum de educación primaria en Cataluña para observar qué tipo de papel juegan las TIC en las nuevas programaciones educativas. La primera parte se ha llevado a cabo mediante una encuesta, cuyos resultados permiten observar tres aspectos distintos: el primero, que una parte considerable del grupo considera las TIC más como un complemento para el aprendizaje que como una forma de aprendizaje; el segundo, que a pesar de hacer un uso considerable de las TIC, el conocimiento que tienen de ellas es muy básico y utilizan aplicaciones muy genéricas; y el tercero es que una parte de sus propuestas didácticas para el uso de las TIC son propuestas tradicionales simplemente adaptadas a un nuevo instrumento, sin buscar realmente la innovación que puede suponer la incorporación de las TIC. En la segunda parte del artículo, a partir del análisis e interpretación de los documentos legales que establecen el currículum de Educación Primaria, se observa que en un mismo documento conviven aserciones sobre las TIC como complemento al aprendizaje de contenidos con otras formulaciones que consideran las TIC como constructoras de conocimiento. A partir del perfil de los estudiantes y del estado de los documentos legales, al final del artículo se hacen propuestas para formar al futuro maestro teniendo en cuenta las TIC como herramientas básicas de conocimiento

El aprendizaje reflexivo en la formación inicial del profesorado: un modelo para aprender a enseñar matemáticas = Reflective learning in the early formation of teachers: a model to learn to teach maths

In this study we analize the application of the reflective learning during initial formation mathematics teachers. This model is based on the sociocultural theories of the human learning and assumes that the interaction and the contrast make possible the coconstruction and the active reconstruction of knowledge.In order to make the study, it was left from a sample of 29 teaching students. The qualitative analysis allowed to identify factors that facilitate the incorporation of the reflective learning in university teaching, as well as the degree of effectiveness of this model to learn to teach mathematics

A pesquisa em Ensino de Química como área estratégica para o desenvolvimento da Química

This paper presents an overview of the development of chemical education as a research area and some of its contributions to society. Although science education is a relatively recent area of research, it went through an expressive development in the last decades. As in the whole world, in Brazil also such development is attested by the expressive number of scientific societies, specialized journals, and meetings with growing attendance in the areas of science education in general and chemical education in particular. Following are the main contributions of research in science education related to chemistry teaching: adoption of teaching-learning principles in chemistry education; contextualization of chemical knowledge; interdisciplinary approach to chemistry teaching; use of the history of science for the definition of contents and for the design of curricula and teaching tools; development of specific disciplines for the initial and in-service training of chemistry teachers; publication of innovative chemistry textbooks by university-based research groups; elaboration of official guidelines for high-school level; and evaluation of chemistry textbooks to be distributed to high-school students by the Brazilian government. In spite of a positive impact of such initiatives, science education in Brazil still faces many problems, as indicated by poor results in international evaluations (such as the Program for International Student Assessment). However, changes in such a scenario depend less on the research in chemical education than on the much-needed governmental initiatives aiming at the improvement of both attractiveness of teaching career and structural conditions of public schools. In conclusion, new government investments in education are necessary for continuing the development of chemistry; moreover, scientific societies and decision makers in educational policies should take into consideration the contributions originated from the chemical education research area.

Quality management of outsourcing welded structure: case China

For any international companies who wish to enter the Chinese market, quality is base on the fundamental. The companies are coming to realize the importance of quality gradually, thus companies have been put the quality problems on the agenda. The competitiveness of companies comes from quality. Quality is the key to success, and it can decide that the companies can be accepted or eliminated by the market. Due to the obvious benefits, the demand of the method of how to achieve high quality of product keeps growing. During achieving the high quality process, the main troubles come from the impact between Eastern and Western culture. Chinese culture which is different with Western one have lasted as long as five thousand years. Such a culture deeply rooted in the hearts of Chinese people, and effected generation after generation of Chinese people's working style and ways of thinking. This thesis determines how to find a good fit point between Eastern and Western culture. Doing right thing by the right way. The nature of improving quality is improving management level in fact. "How to manage, who should be managed", the thesis explains the basic and best option to achieve those. It describes three-dimension-style management to monitoring the working process. This kind of management style can inspect production process from horizontal and vertical direction. In this management way, it defines effective evaluation system to every subcontractor, and makes the companies to achieve the ultimate goal - satisfy quality. Because of the importance of human factor, the thesis determines the range of training of the inspector and welder due to the current situation of China. The results show that in order to reach reliable training effective evaluation, not only the quality of the human but also the ultimate goal of product quality.

Forecasting of wind speeds and directions with artificial neural networks

In this master’s thesis, wind speeds and directions were modeled with the aim of developing suitable models for hourly, daily, weekly and monthly forecasting. Artificial Neural Networks implemented in MATLAB software were used to perform the forecasts. Three main types of artificial neural network were built, namely: Feed forward neural networks, Jordan Elman neural networks and Cascade forward neural networks. Four sub models of each of these neural networks were also built, corresponding to the four forecast horizons, for both wind speeds and directions. A single neural network topology was used for each of the forecast horizons, regardless of the model type. All the models were then trained with real data of wind speeds and directions collected over a period of two years in the municipal region of Puumala in Finland. Only 70% of the data was used for training, validation and testing of the models, while the second last 15% of the data was presented to the trained models for verification. The model outputs were then compared to the last 15% of the original data, by measuring the mean square errors and sum square errors between them. Based on the results, the feed forward networks returned the lowest generalization errors for hourly, weekly and monthly forecasts of wind speeds; Jordan Elman networks returned the lowest errors when used for forecasting of daily wind speeds. Cascade forward networks gave the lowest errors when used for forecasting daily, weekly and monthly wind directions; Jordan Elman networks returned the lowest errors when used for hourly forecasting. The errors were relatively low during training of the models, but shot up upon simulation with new inputs. In addition, a combination of hyperbolic tangent transfer functions for both hidden and output layers returned better results compared to other combinations of transfer functions. In general, wind speeds were more predictable as compared to wind directions, opening up opportunities for further research into building better models for wind direction forecasting.

Targeted measures bring the greatest benefits for environmental protection in agriculture final report of the TEHO Plus project (2011–2014)

Targeted measures bring the greatest benefits for environmental protection in agriculture final report of the TEHO Plus project (2011–2014). Particular priority areas of the project activities included creating a training package for agri-environment advisers and testing it, farm-specific advisory services and exploitation of experiences of advice provision, putting together an information package of agri-environment issues, farm-level experiments, and development of water quality monitoring. The recommendations issued by advisers on targeting environmental measures were based on utilising geographical information material and nutrient balances. The project was implemented in cooperation by Southwest Finland Centre for Economic Development, Transport and the Environment, MTK-Satakunta and MTK-Varsinais-Suomi. The project received funding from the Ministry of Agriculture and Forestry and the Ministry of the Environment. Participating farmers, with whom environmental advice was developed and experiments were carried out, were important partners for the project. The operating area of the project was Satakunta and Varsinais-Suomi in Southwest Finland, but its outcomes can be exploited nationally. A national perspective was ensured by close cooperation with actors in different provinces. This final report describes project experiences and outcomes including environmental advisory services, training of agri-environmental advisers, farm visits and the feedback received from farmers on agri-environmental advice, development of water quality monitoring, experiments and project work.

Neuropsychological rehabilitation of memory deficits and activities of daily living in patients with Alzheimer's disease: a pilot study

Patients with Alzheimer's disease (AD) gradually lose their cognitive competence, particularly memory, and the ability to perform daily life tasks. Neuropsychological rehabilitation is used to improve cognitive functions by facilitating memory performance through the use of external aids and internal strategies. The effect of neuropsychological rehabilitation through memory training - motor movements, verbal association, and categorization - and activities of daily living (ADL) training was tested in a sample of 5 elderly out-patients (mean age: 77.4 ± 2.88 years), with mild AD (Mini-Mental State Examination score: 22.20 ± 2.17) and their caregivers. All patients had been taking rivastigmine (6-12 mg/day) for at least 3 months before being assigned to the rehabilitation sessions, and they continued to take the medication during the whole program. Just before and after the 14-week neuropsychological rehabilitation program all patients were assessed by interviewers that did not participate in the cognitive training, using the Mini-Mental State Examination, Montgomery-Alsberg Depression Rating Scale, Hamilton Anxiety Scale, Interview to Determine Deterioration in Functioning in Dementia, Functional Test, Memory Questionnaire of Daily Living for patient and caregiver, Quality of Life Questionnaire for patient and caregiver, and a neuropsychological battery. The results showed a statistically significant improvement in ADL measured by Functional Test (P = 0.04), and only a small improvement in memory and psychiatric symptoms. Our results support the view that weekly stimulation of memory and training of ADL is believed to be of great value in AD treatment, not only delaying the progress of the disease, but also improving some cognitive functions and ADL, even though AD is a progressively degenerative disease.

An MD-PhD program in Brazil: students’ concepts of science and of common sense

In 1995, a pioneering MD-PhD program was initiated in Brazil for the training of medical scientists in experimental sciences at the Federal University of Rio de Janeiro. The program’s aim was achieved with respect to publication of theses in the form of papers with international visibility and also in terms of fostering the scientific careers of the graduates. The expansion of this type of program is one of the strategies for improving the preparation of biomedical researchers in Brazil. A noteworthy absence of interest in carrying out clinical research limits the ability of young Brazilian physicians to solve biomedical problems. To understand the students’ views of science, we used qualitative and quantitative triangulation methods, as well as participant observation to evaluate the students’ concepts of science and common sense. Subjective aspects were clearly less evident in their concepts of science. There was a strong concern about "methodology", "truth" and "usefulness". "Intuition", "creativity" and "curiosity" were the least mentioned thematic categories. Students recognized the value of intuition when it appeared as an explicit option but they did not refer to it spontaneously. Common sense was associated with "consensus", "opinion" and ideas that "require scientific validation". Such observations indicate that MD-PhD students share with their senior academic colleagues the same reluctance to consider common sense as a valid adjunct for the solution of scientific problems. Overcoming this difficulty may be an important step toward stimulating the interest of physicians in pursuing experimental research.

Evaluation of novel programs in health counseling – their effectiveness in the oral health of young children, and their acceptance by parents and professionals in public dental service.

Aim and design: To evaluate family-based health counseling for young children, and to study the significance of adding parental self-care or the training of professionals to the programs. The effectiveness and acceptability of the programs were evaluated by comparing two new programs with an earlier one. Subjects and methods: The study was carried out in Vantaa, which was divided into three study areas. The subjects consisted of children born in 2008, particularly fi rstborn children, while children born in 2006 formed the historical control. The fi rst of the new programs emphasized oral hygiene and use of fl uoride, and the second program focused on proper diet and use of xylitol. The main outcome measure was mutansstreptococci (MS) in the dental biofi lm of two-year-olds, and the opinions of parents and dental professionals were evaluated using questionnaires. Results: The programs found wide acceptance among dental professionals. There were no group-related differences found in the MS scores of the two-year-olds. However, all groups combined, father’s advanced level of education and child’s proper use of xylitol were associated with negative MS scores. In the opinion of parents, the oral healthcare guidance at least somewhat met their expectations. Conclusions: The present fi ndings suggest that providing training and support for professionals in health education is important. The addition of parental self-care to supplement programs aimed at young children does not improve the program, although it may improve parental readiness to change their own health habits. Counseling for families might be best carried out through a routine patient-centered program.

Effect of the implementation of the Hazard Analysis Critical Control Point (HACCP) prerequisite program in an institutional foodservice unit in Southern Brazil

The aims of this study were to investigate the hygienic practices in the food production of an institutional foodservice unit in Southern Brazil and to evaluate the effect of implementing good food handling practices and standard operational procedures using microbiological hygiene indicators. An initial survey of the general operating conditions classified the unit as regular in terms of compliance with State safety guidelines for food service establishments. An action plan that incorporated the correction of noncompliance issues and the training of food handlers in good food handling practices and standard operational procedures were then implemented. The results of the microbiological analysis of utensils, preparation surfaces, food handlers' hands, water, and ambient air were recorded before and after the implementation of the action plan. The results showed that the implementation of this type of practice leads to the production of safer foods.