Biomarkers of Host Response Predict Primary End-Point Radiological Pneumonia in Tanzanian Children with Clinical Pneumonia: A Prospective Cohort Study.

BACKGROUND: Diagnosing pediatric pneumonia is challenging in low-resource settings. The World Health Organization (WHO) has defined primary end-point radiological pneumonia for use in epidemiological and vaccine studies. However, radiography requires expertise and is often inaccessible. We hypothesized that plasma biomarkers of inflammation and endothelial activation may be useful surrogates for end-point pneumonia, and may provide insight into its biological significance. METHODS: We studied children with WHO-defined clinical pneumonia (n = 155) within a prospective cohort of 1,005 consecutive febrile children presenting to Tanzanian outpatient clinics. Based on x-ray findings, participants were categorized as primary end-point pneumonia (n = 30), other infiltrates (n = 31), or normal chest x-ray (n = 94). Plasma levels of 7 host response biomarkers at presentation were measured by ELISA. Associations between biomarker levels and radiological findings were assessed by Kruskal-Wallis test and multivariable logistic regression. Biomarker ability to predict radiological findings was evaluated using receiver operating characteristic curve analysis and Classification and Regression Tree analysis. RESULTS: Compared to children with normal x-ray, children with end-point pneumonia had significantly higher C-reactive protein, procalcitonin and Chitinase 3-like-1, while those with other infiltrates had elevated procalcitonin and von Willebrand Factor and decreased soluble Tie-2 and endoglin. Clinical variables were not predictive of radiological findings. Classification and Regression Tree analysis generated multi-marker models with improved performance over single markers for discriminating between groups. A model based on C-reactive protein and Chitinase 3-like-1 discriminated between end-point pneumonia and non-end-point pneumonia with 93.3% sensitivity (95% confidence interval 76.5-98.8), 80.8% specificity (72.6-87.1), positive likelihood ratio 4.9 (3.4-7.1), negative likelihood ratio 0.083 (0.022-0.32), and misclassification rate 0.20 (standard error 0.038). CONCLUSIONS: In Tanzanian children with WHO-defined clinical pneumonia, combinations of host biomarkers distinguished between end-point pneumonia, other infiltrates, and normal chest x-ray, whereas clinical variables did not. These findings generate pathophysiological hypotheses and may have potential research and clinical utility.

Multiplicative interaction of functional inflammasome genetic variants in determining the risk of gout.

INTRODUCTION: The acute gout flare results from a localised self-limiting innate immune response to monosodium urate (MSU) crystals deposited in joints in hyperuricaemic individuals. Activation of the caspase recruitment domain-containing protein 8 (CARD8) NOD-like receptor pyrin-containing 3 (NLRP3) inflammasome by MSU crystals and production of mature interleukin-1β (IL-1β) is central to acute gouty arthritis. However very little is known about genetic control of the innate immune response involved in acute gouty arthritis. Therefore our aim was to test functional single nucleotide polymorphism (SNP) variants in the toll-like receptor (TLR)-inflammasome-IL-1β axis for association with gout. METHODS: 1,494 gout cases of European and 863 gout cases of New Zealand (NZ) Polynesian (Māori and Pacific Island) ancestry were included. Gout was diagnosed by the 1977 ARA gout classification criteria. There were 1,030 Polynesian controls and 10,942 European controls including from the publicly-available Atherosclerosis Risk in Communities (ARIC) and Framingham Heart (FHS) studies. The ten SNPs were either genotyped by Sequenom MassArray or by Affymetrix SNP array or imputed in the ARIC and FHS datasets. Allelic association was done by logistic regression adjusting by age and sex with European and Polynesian data combined by meta-analysis. Sample sets were pooled for multiplicative interaction analysis, which was also adjusted by sample set. RESULTS: Eleven SNPs were tested in the TLR2, CD14, IL1B, CARD8, NLRP3, MYD88, P2RX7, DAPK1 and TNXIP genes. Nominally significant (P < 0.05) associations with gout were detected at CARD8 rs2043211 (OR = 1.12, P = 0.007), IL1B rs1143623 (OR = 1.10, P = 0.020) and CD14 rs2569190 (OR = 1.08; P = 0.036). There was significant multiplicative interaction between CARD8 and IL1B (P = 0.005), with the IL1B risk genotype amplifying the risk effect of CARD8. CONCLUSION: There is evidence for association of gout with functional variants in CARD8, IL1B and CD14. The gout-associated allele of IL1B increases expression of IL-1β - the multiplicative interaction with CARD8 would be consistent with a synergy of greater inflammasome activity (resulting from reduced CARD8) combined with higher levels of pre-IL-1β expression leading to increased production of mature IL-1β in gout.

Screening of mental health and substance users in frequent users of a general Swiss emergency department.

BACKGROUND: The objectives of this study were to determine the proportions of psychiatric and substance use disorders suffered by emergency departments' (EDs') frequent users compared to the mainstream ED population, to evaluate how effectively these disorders were diagnosed in both groups of patients by ED physicians, and to determine if these disorders were predictive of a frequent use of ED services. METHODS: This study is a cross-sectional study with concurrent and retrospective data collection. Between November 2009 and June 2010, patients' mental health and substance use disorders were identified prospectively in face-to-face research interviews using a screening questionnaire (i.e. researcher screening). These data were compared to the data obtained from a retrospective medical chart review performed in August 2011, searching for mental health and substance use disorders diagnosed by ED physicians and recorded in the patients' ED medical files (i.e. ED physician diagnosis). The sample consisted of 399 eligible adult patients (≥18 years old) admitted to the urban, general ED of a University Hospital. Among them, 389 patients completed the researcher screening. Two hundred and twenty frequent users defined by >4 ED visits in the previous twelve months were included and compared to 169 patients with ≤4 ED visits in the same period (control group). RESULTS: Researcher screening showed that ED frequent users were more likely than members of the control group to have an anxiety, depressive disorder, post-traumatic stress disorder (PTSD), or suffer from alcohol, illicit drug abuse/addiction. Reviewing the ED physician diagnosis, we found that the proportions of mental health and substance use disorders diagnosed by ED physicians were low both among ED frequent users and in the control group. Using multiple logistic regression analyses to predict frequent ED use, we found that ED patients who screened positive for psychiatric disorders only and those who screened positive for both psychiatric and substance use disorders were more likely to be ED frequent users compared to ED patients with no disorder. CONCLUSIONS: This study found high proportions of screened mental health and/or substance use disorders in ED frequent users, but it showed low rates of detection of such disorders in day-to-day ED activities which can be a cause for concern. Active screening for these disorders in this population, followed by an intervention and/or a referral for treatment by a case-management team may constitute a relevant intervention for integration into a general ED setting.

Duration of anticoagulation after venous thromboembolism in real world clinical practice.

INTRODUCTION: Venous thromboembolism (VTE) carries a considerable risk of recurrence and anticoagulants should be administered for a minimum of three months. Since little is known about real life management of VTE, we aimed to describe current practice in the secondary prevention of VTE. MATERIALS AND METHODS: Using the database of an international, prospective registry on patients treated for VTE, RIETE, information was collected on risk factors for VTE and bleeding, anticoagulant treatment, and clinical outcomes during follow up. Multivariate analysis using logistic regression was performed to identify predictors of treatment duration. RESULTS: Of 6944 patients with a first episode of VTE 41.1% had unprovoked VTE, 31.8% had transient risk factors, 27.1% had cancer. After the exclusion of patients who died during the first year of observation, the rate of patients treated for >12 months was 55.1%, 41.9%, and 43.2%, respectively (p<0.001). Pulmonary embolism at presentation, recurrence while on treatment, chronic heart failure and age >65 years were independently associated with treatment for >12 months. Body weight <75 kg, anemia, cancer, and the presence of transient risk factors were associated with treatment for 12 months or less. Major bleeding occurred more frequently than recurrent VTE in patients with VTE secondary to transient risk factors and cancer; fatal bleeding was more frequent than fatal recurrent PE in all subgroups. CONCLUSIONS: We observed heterogeneous duration of anticoagulant treatment for the secondary prevention of VTE. A substantial proportion of patients, in particular those with VTE secondary to transient risk factors, may be exposed to a possibly unnecessary risk of bleeding.

Learning in later life: participation in formal, non-formal and informal activities in a nationally representative Spanish sample

This article examines the participation of Spanish older people in formal, non-formal and informal learning activities and presents a profile of participants in each kind of learning activity. We used data from a nationally representative sample of Spanish people between 60 and 75 years old (n = 4,703). The data were extracted from the 2007 Encuesta sobre la Participación de la Población Adulta en Actividades de Aprendizaje (EADA, Survey on Adult Population Involvement in Learning Activities). Overall, only 22.8 % of the sample participated in a learning activity. However, there was wide variation in the participation rates for the different types of activity. Informal activities were far more common than formal ones. Multivariate logistic regression indicated that education level and involvement in social and cultural activities were associated with likelihood of participating, regardless of the type of learning activity. When these variables were taken into account, age did not predict decreasing participation, at least in non-formal and informal activities. Implications for further research, future trends and policies to promote older adult education are discussed.

Mood and anxiety disorders across the adult lifespan: a European perspective

BACKGROUND: The World Mental Health Survey Initiative (WMHSI) has advanced our understanding of mental disorders by providing data suitable for analysis across many countries. However, these data have not yet been fully explored from a cross-national lifespan perspective. In particular, there is a shortage of research on the relationship between mood and anxiety disorders and age across countries. In this study we used multigroup methods to model the distribution of 12-month DSM-IV/CIDI mood and anxiety disorders across the adult lifespan in relation to determinants of mental health in 10 European Union (EU) countries. METHOD: Logistic regression was used to model the odds of any mood or any anxiety disorder as a function of age, gender, marital status, urbanicity and employment using a multigroup approach (n = 35500). This allowed for the testing of specific lifespan hypotheses across participating countries. RESULTS: No simple geographical pattern exists with which to describe the relationship between 12-month prevalence of mood and anxiety disorders and age. Of the adults sampled, very few aged ≥ 80 years met DSM-IV diagnostic criteria for these disorders. The associations between these disorders and key sociodemographic variables were relatively homogeneous across countries after adjusting for age. CONCLUSIONS: Further research is required to confirm that there are indeed stages in the lifespan where the reported prevalence of mental disorders is low, such as among younger adults in the East and older adults in the West. This project illustrates the difficulties in conducting research among different age groups simultaneously.

The association between obesity and back pain in nine countries: a cross-sectional study

BACKGROUND: The association between obesity and back pain has mainly been studied in high-income settings with inconclusive results, and data from older populations and developing countries are scarce. The aim of this study was to assess this association in nine countries in Asia, Africa, Europe, and Latin America among older adults using nationally-representative data. METHODS: Data on 42116 individuals ≥50 years who participated in the Collaborative Research on Ageing in Europe (COURAGE) study conducted in Finland, Poland, and Spain in 2011-2012, and the World Health Organization's Study on Global Ageing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia, and South Africa in 2007-2010 were analysed. Information on measured height and weight available in the two datasets was used to calculate Body Mass Index (BMI). Self-reported back pain occurring in the past 30 days was the outcome. Multivariable logistic regression analysis was used to assess the association between BMI and back pain. RESULTS: The prevalence of back pain ranged from 21.5% (China) to 57.5% (Poland). In the multivariable analysis, compared to BMI 18.5-24.9 kg/m(2), significantly higher odds for back pain were observed for BMI ≥35 kg/m(2) in Finland (OR 3.33), Russia (OR 2.20), Poland (OR 2.03), Spain (OR 1.56), and South Africa (OR 1.48); BMI 30.0-34.0 kg/m(2) in Russia (OR 2.76), South Africa (OR 1.51), and Poland (OR 1.47); and BMI 25.0-29.9 kg/m(2) in Russia (OR 1.51) and Poland (OR 1.40). No significant associations were found in the other countries. CONCLUSIONS: The strength of the association between obesity and back pain may vary by country. Future studies are needed to determine the factors contributing to differences in the associations observed.

Condiciones de trabajo psicosociales y desgaste psíquico en trabajadores de diversos sectores empresariales de centro-oriente, suroccidente y región Caribe en Colombia

Objetivo: Determinar la percepción de trabajadores de distintos sectores empresariales de Colombia sobre los factores psicosociales presentes en su entorno laboral y la relación entre los factores psicosociales nocivos y los síntomas subjetivos y alteraciones de la salud. Materiales y métodos: Estudio no experimental, transversal y cuantitativo. Participaron 370 trabajadores, de diferentes sectores empresariales de Colombia (Centro-Oriente, Suroccidente y región Caribe). Instrumento: batería para el estudio de las condiciones de trabajo de carácter psicosocial (CTCPS-MAC), validada para población iberoamericana, permite evaluar cuatro dimensiones: Contexto de trabajo, Contenido de trabajo, Factores individuales y Desgaste psíquico e incluye catorce factores psicosociales. Los datos se analizaron con IBM SPSS statistics 21. Se realizó análisis bivariado y regresión logística multivariante de factores psicosociales nocivos y desgaste psíquico. Resultados: Los factores formación, baja médica, contexto de trabajo, contenido de trabajo y factores individuales están asociados en este estudio con desgaste psíquico. El contexto de trabajo es la variable que infiere mayor riesgo (p=0.000; Exp (B)= 5.355) para provocar desgaste psíquico, seguida de la formación técnica o superior y del contenido del trabajo. Conclusiones: Si bien aquellos trabajadores cuya percepción nociva del contexto de trabajo (interrelación trabajo-vida familiar/personal, cultura de la organización, gestión de la empresa, etc.), del contenido de trabajo (concepción tareas, carga y ritmo de trabajo, etc.) y los que tienen formación técnica o superior tienen mayor probabilidad de padecer desgaste psíquico, se observan aspectos positivos de las condiciones de trabajo psicosocial y su influencia en los trabajadores y en las organizaciones.

Convergence in Industry Evolution

The objective of the thesis is to enhance understanding of the evolution of convergence. Previous research has shown that the technological interfaces between distinct industries are one of the major sources of new radical cross-industry innovations. Despite the fact that convergence in industry evolution has attracted a substantial managerial interest, the conceptual confusion within the field of convergence exists. Firstly, this study clarifies the convergence phenomenon and its impact to industry evolution. Secondly, the study creates novel patent analysis methods to analyze technological convergence and provide tools for anticipating the early stages of convergence. Overall the study combines the industry evolution perspective and the convergence view of industrial evolution. The theoretical background for the study consists of the industry life cycle theories, technology evolution, and technological trajectories. The study links several important concepts in analyzing industry evolution, technological discontinuities, path-dependency, technological interfaces as a source of industry transformation, and the evolutionary stagesof convergence. Based on reviewing the literature a generic understanding of industry transformation and industrial dynamics was generated. In the convergence studies, the theoretical basis is in the discussion of different convergence types and their impacts on industry evolution, and in anticipating and monitoring the stages of convergence. The study is divided in two parts. The first part gives a general overview, and the second part comprises eight research publications. Our case study is based historically on two very distinct industries of the paper and electronics companies as a test environment to evaluate the importance of emerging business sectors and technological convergence as a source of industry transformation. Both qualitative and quantitative research methodology are utilized. The results of this study reveal that technological convergence and complementary innovations from different fields have significant effect to the emerging new business sector formation. The patent-based indicators in the analysis of technological convergence can be utilized on analyzing technology competition, capability and competence development, knowledge accumulation, knowledge spill-overs, and technology-based industry transformation. The patent-based indicators can provide insights to the future competitive environment. Results and conclusions from empirical part seem not be in conflict with real observations in the industry.

Yrityksen taloudellisen menestymisen ennustaminen yritystutkimuksen avulla

Tutkielmassa selvitetään, voiko yrityksen taloudellista menestymistä ennustaa yritystutkimuksen avulla. Tutkielman aineistona on 30 heikon riskiluokan ja 30 hyvän riskiluokan omaavan yrityksen yritystutkimusraporttia. Konkurssista varoittavat tekijät on jaettu varhaisiin ja myöhäisiin varoittajiin. Varhaiset varoittajat liittyvät yrityksen reaaliprosessiin, esimerkkinä huono liikkeenjohto. Myöhäiset varoittajat ovat tilinpäätösanalyysiin perustuvia tunnuslukuja. Tässä tutkielmassa muuttujina käytetään toimitusjohtajan koulutusta, kokemusta, omistusosuutta sekä yrityksen kasvua strategiselta pohjalta ja reaalisesti. Tilinpäätöksen tunnusluvuista käytetään nettotulosta, rahoitustulosta, omavaraisuusastetta ja quick ratiota. Tutkielman perusteella voidaan todeta, että yrityksen taloudellista menestymistä ei voida ennustaa valituilla kvalitatiivisilla muuttujilla, mutta tilinpäätöksen tunnusluvut ennustavat yrityksen menestymistä.

Konkurssin ennustaminen ja makrotaloudelliset muuttujat: rakennusalan pk-yritykset

Tämän tutkimuksen tavoitteena on selvittää kannattaako makrotaloudellisia muuttujia käyttää tunnuslukujen lisäksi yrityksen konkurssin ennustamisessa. Perinteiset konkurssinennustamismallit hyödyntävät pelkästään tilinpäätöksestä saatavia tunnuslukuja eivätkä huomioi yrityksen toimintaympäristöä ja sen muutoksia. Aiemmissa tutkimuksissa makrotaloudellisilla muuttujilla on pystytty parantamaan perinteisiä ennustamismalleja. Tutkimus toteutetaan luomalla kolme erilaista konkurssinennustamismallia logistista regressioanalyysiä hyödyntäen ja vertailemalla niiden paremmuutta. Tutkimustulokset osoittavat, että rakennusalan pk-yritysten konkursseja pystytään ennustamaan kolmen tunnusluvun mallilla. Taloudellisen ajanjakson, jolta yrityksen tiedot ovat peräisin, huomioiminen ei tuo malliin lisäarvoa eikä paranna ennustamiskykyä merkittävästi.

Konkurssin ennustaminen ja makrotaloudelliset muuttujat: rakennusalan pk-yritykset

Tämän tutkimuksen tavoitteena on selvittää kannattaako makrotaloudellisia muuttujia käyttää tunnuslukujen lisäksi yrityksen konkurssin ennustamisessa. Perinteiset konkurssinennustamismallit hyödyntävät pelkästään tilinpäätöksestä saatavia tunnuslukuja eivätkä huomioi yrityksen toimintaympäristöä ja sen muutoksia. Aiemmissa tutkimuksissa makrotaloudellisilla muuttujilla on pystytty parantamaan perinteisiä ennustamismalleja. Tutkimus toteutetaan luomalla kolme erilaista konkurssinennustamismallia logistista regressioanalyysiä hyödyntäen ja vertailemalla niiden paremmuutta. Tutkimustulokset osoittavat, että rakennusalan pk-yritysten konkursseja pystytään ennustamaan kolmen tunnusluvun mallilla. Taloudellisen ajanjakson, jolta yrityksen tiedot ovat peräisin, huomioiminen ei tuo malliin lisäarvoa eikä paranna ennustamiskykyä merkittävästi.

Luottamuksen vaikutus tiedon jakamiseen ja yhteistyöhön

Tutkielman tarkoituksena oli tutkia teoreettisesti ja empiirisesti luottamuksen vaikutusta organisaatioyksiköiden väliseen tiedon jakamiseen ja yhteistyöhön. Luottamuksen näkökulmasta tarkasteltiin henkilöityvän ja ei-henkilöityvän luottamuksen vaikutusta yhdessä ja erikseen. Tiedon jakamisessa tarkasteltiin hiljaisen sekä käsitteellisen tiedon jakamista. Luottamuksen vaikutusta tiedon jakamiseen on yleisesti tutkittu, mutta tutkielman tavoitteena oli tutkia ilmiötä pankki- ja vakuutusliiketoimintaa harjoittavan kohdeorganisaation näkökulmasta. Tutkimustulokset analysoitiin kvantitatiivisilla tutkimusmenetelmillä, joista mukana oli faktorianalyysi ja lineaarinen regressio. Tämän tutkimuksen perusteella luottamuksella oli positiivinen vaikutus tiedon jakamiseen. Henkilöityvän luottamuksen vaikutus oli merkittävästi voimakkaampi kuin ei-henkilöityvän luottamuksen. Luottamuksen vaikutus yhteistyöhön oli myös positiivinen, jossa henkilöityvän ja ei-henkilöityvän luottamuksen vaikutus ja voimakkuus olivat yhtäläisiä.

Increased oxidative stress markers may be a promising indicator of risk for primary ovarian insufficiency: a cross-sectional case control study

PURPOSE: The aim of this study was to evaluate serum levels of inducible nitric oxide synthase (INOS), myeloperoxidase (MPO), total antioxidant status (TAS), and total oxidative status (TOS) in women with primary ovarian insufficiency (POI) and to compare them with healthy fertile women. We also examined the possible risk factors associated with POI.METHODS: This cross-sectional case control study was conducted in Zekai Tahir Burak Women's Health Education and Research Hospital. The study population consisted of 44 women with POI (study group) and 36 healthy fertile women (control group). In all patients, serum levels of INOS, MPO, TAS, and TOS were determined. INOS and MPO levels were measured by enzyme-linked immunosorbent assay whereas colorimetric method was used for evaluating TAS and TOS levels. Age, body mass index (BMI), obstetric history, smoking status, family history, comorbidities, sonographic findings, complete blood count values, C-reactive protein and baseline hormone levels were also analyzed. Student's t-test or Mann-Whitney U test was used to compare continuous variables between the groups; categorical data were evaluated by using Pearson χ2 or Fisher exact test, when appropriate. Binary logistic regression method was used to identify risk factors for POI.RESULTS: We found significantly elevated levels of INOS (234.1±749.5 versus133.8±143.0; p=0.005), MPO (3,438.7±1,228.6 versus 2,481.9±1,230.1; p=0.001), and TOS (4.3±1.4 versus 3.6±1.4; p=0.02) in the sera of the study group when compared to the BMI-age matched control group. However, difference in serum levels of TAS were not significant between the 2 groups (1.7±0.2 versus 1.6±0.2; p=0.15). Logistic regression method demonstrated that BMI <25 kg/m2, nulliparity, family history of POI, smoking, and elevated serum levels of INOS, MPO, and TOS were independent risk factors for POI.CONCLUSION: We found an increase in INOS, MPO, and TOS in women with POI. These serum markers may be promising in early diagnosis of POI. Further large-scale studies are required to determine whether oxidative stress markers have a role in diagnosing POI.

Measuring effects of strategic utilization of social media in business-to-business marketing: Case Greenlux Finland Oy

Utilization of social media is increasingly common in B2B marketing. Social media is an efficient and cheap marketing and communication channel available for everyone, and thus extremely attractive marketing medium. The more companies get involved in social media the more failures are reported. It is not enough for a company to just be present in social media. Succeeding on it requires hard work, investing time and money, and ability to measure and to monitor performance. With an increasing number of companies failing in utilizing social media, together with lack of research on strategic utilization of social media focusing on B2B marketing, measuring, and monitoring create a purpose for this research. The aim of this research is to discover methods for measuring and monitoring effects of strategic utilization of social media in B2B marketing. Most relevant financial and non-financial indicators are discussed, and the methods by which these can be monitored and measured. In addition, effects of strategic utilization of social media on the case company are measured and analyzed. The research methodology used in this research is a participatory action research, which includes elements of both qualitative and quantitative research methods. The case company examined in the research provides a unique opportunity to follow through all phases of strategic utilization of social media for B2B marketing purposes concluding real effects of social media to the case company, and thus gain a deep understanding about this new marketing medium in the perspective of B2B marketing. Duration of the research period is seven months. During this time, information is collected, measured, and analyzed. Case company does not have any other marketing activities simultaneously which makes it possible to examine social media apart from effects of other visible marketing activities. Effects of strategic utilization of social media can be monitored and measured in many ways. Methods that should be used depend on goals set for social media. Fundamental nature of social media requires multidimensional assessment, and thus effects should be measured, and monitored considering both financial and non-financial indicators. The results implicates that effects of strategic utilization of social media are relatively wide ranged. According to the findings, social media affects positively on brand, number of web page visitors, visitor behavior, and on distribution of awareness. According to investment calculations social media is a legitimate investment for case company. Results also implicate that by using social media case company gains conversation, arouses interest, gets attention, and creates interactivity. In addition and as a side note, winter holiday season appears to have a great effect on social media activity of B2B companies’ representatives.