Strategiatyö pienissä ja keskisuurissa kasvuyrityksissä Kouvolan seudulla

Tutkimuksen tarkoituksena oli kuvata ja ymmärtää, millaista strategiatyö on pienissä ja keskisuurissa kasvuyrityksissä ja miten sitä voitaisiin kehittää. Strategiatyötä ovat ne toimet, joita yritysten strategit tekevät strategiaprosessissa. Kirjallisuuskatsauksessa määriteltiin käsitteet ja teoreettinen viitekehys. Empiriassa kerättiin Kouvolan seudun kasvuyritysten strategeilta aineistoa lomakekyselyllä. Kahdeksan yrityksen strategeja, yrittäjäomistajia, haastattelemalla syvennettiin aineistoa. Aineiston laadullisella analyysillä tuotettiin vastaukset tutkimuskysymyksiin. Kahdessa kolmesta kohdeyrityksestä strategiatyö oli melko vakiintunutta. Strategiatyön avulla yrittäjät pyrkivät löytämään keinot hyödyntää markkinoilla havaitut mahdollisuudet ja muodostamaan tarvittavat resurssiyhdistelmät. Strategiatyö ei noudattanut selkeää, määritettyä prosessia. Strategian muotoutuminen, jalkauttaminen ja arviointi olivat strategiatyön osat, jotka olivat vuorovaikutuksessa strategin strategiajärkeilyn kautta. Strategiaa pidettiin yrityksen menestymisessä ja kasvussa tärkeänä tekijänä. Pk-kasvuyritykset ovat seudun tulevaisuuden kannalta niin tärkeä yritysryhmä, että niiden strategiatyötä olisi perusteltua kehittää yrityspalvelun toimesta ja panostuksilla.

Aerossóis atmosféricos: perspectiva histórica, fontes, processos químicos de formação e composição orgânica

This work starts with a historical perspective of the social and scientific progress related to the understanding of the atmospheric aerosol. Its origin, physical, chemical and optical characteristics, as well as its environmental behaviour are described, retracing the evolution of the concepts related to this subject over the last centuries. The main sources that contribute to atmospheric particulate matter and the modern understanding of its formation processes and constitution, focusing on the chemical pathways leading to it and on its organic components are presented. This discussion is complemented with recent evaluations of the quantities emitted by primary, secondary, biogenic and anthropogenic sources and the effects due to accumulation or dispersion of aerosols, justifying the chemical and environmental interest they engender.

Role of human hydroxysteroid (17beta) dehydrogenase type 1 (HSD17B1) in steroid-dependent diseases in females –novel indications for HSD17B1 inhibitors. Phenotypic analysis of transgenic mice overexpressing human HSD17B1.

Hormone-dependent diseases, e.g. cancers, rank high in mortality in the modern world, and thus, there is an urgent need for new drugs to treat these diseases. Although the diseases are clearly hormone-dependent, changes in circulating hormone concentrations do not explain all the pathological processes observed in the diseased tissues. A more inclusive explanation is provided by intracrinology – a regulation of hormone concentrations at the target tissue level. This is mediated by the expression of a pattern of steroid-activating and -inactivating enzymes in steroid target tissues, thus enabling a concentration gradient between the blood circulation and the tissue. Hydroxysteroid (17beta) dehydrogenases (HSD17Bs) form a family of enzymes that catalyze the conversion between low active 17-ketosteroids and highly active 17beta-hydroxysteroids. HSD17B1 converts low active estrogen (E1) to highly active estradiol (E2) with high catalytic efficiency, and altered HSD17B1 expression has been associated with several hormone-dependent diseases, including breast cancer, endometriosis, endometrial hyperplasia and cancer, and ovarian epithelial cancer. Because of its putative role in E2 biosynthesis in ovaries and peripheral target tissues, HSD17B1 is considered to be a promising drug target for estrogen-dependent diseases. A few studies have indicated that the enzyme also has androgenic activity, but they have been ignored. In the present study, transgenic mice overexpressing human HSD17B1 (HSD17B1TG mice) were used to study the effects of the enzyme in vivo. Firstly, the substrate specificity of human HSD17B1 was determined in vivo. The results indicated that human HSD17B1 has significant androgenic activity in female mice in vivo, which resulted in increased fetal testosterone concentration and female disorder of sexual development appearing as masculinized phenotype (increased anogenital distance, lack of nipples, lack of vaginal opening, combination of vagina with urethra, enlarged Wolffian duct remnants in the mesovarium and enlarged female prostate). Fetal androgen exposure has been linked to polycystic ovary syndrome (PCOS) and metabolic syndrome during adulthood in experimental animals and humans, but the genes involved in PCOS are largely unknown. A putative mechanism to accumulate androgens during fetal life by HSD17B1 overexpression was shown in the present study. Furthermore, as a result of prenatal androgen exposure locally in the ovaries, HSD17B1TG females developed ovarian benign serous cystadenomas in adulthood. These benign lesions are precursors of low-grade ovarian serous tumors. Ovarian cancer ranks fifth in mortality of all female cancers in Finland, and most of the ovarian cancers arise from the surface epithelium. The formation of the lesions was prevented by prenatal antiandrogen treatment and by transplanting wild type (WT) ovaries prepubertally into HSD17B1TG females. The results obtained in our non-clinical TG mouse model, together with a literature analysis, suggest that HSD17B1 has a role in ovarian epithelial carcinogenesis, and especially in the development of serous tumors. The role of androgens in ovarian carcinogenesis is considered controversial, but the present study provides further evidence for the androgen hypothesis. Moreover, it directly links HSD17B1-induced prenatal androgen exposure to ovarian epithelial carcinogenesis in mice. As expected, significant estrogenic activity was also detected for human HSD17B1. HSD17B1TG mice had enhanced peripheral conversion of E1 to E2 in a variety of target tissues, including the uterus. Furthermore, this activity was significantly decreased by treatments with specific HSD17B1 inhibitors. As a result, several estrogen-dependent disorders were found in HSD17B1TG females. Here we report that HSD17B1TG mice invariably developed endometrial hyperplasia and failed to ovulate in adulthood. As in humans, endometrial hyperplasia in HSD17B1TG females was reversible upon ovulation induction, triggering a rise in circulating progesterone levels, and in response to exogenous progestins. Remarkably, treatment with a HSD17B1 inhibitor failed to restore ovulation, yet completely reversed the hyperplastic morphology of epithelial cells in the glandular compartment. We also demonstrate that HSD17B1 is expressed in normal human endometrium, hyperplasia, and cancer. Collectively, our non-clinical data and literature analysis suggest that HSD17B1 inhibition could be one of several possible approaches to decrease endometrial estrogen production in endometrial hyperplasia and cancer. HSD17B1 expression has been found in bones of humans and rats. The non-clinical data in the present study suggest that human HSD17B1 is likely to have an important role in the regulation of bone formation, strength and length during reproductive years in female mice. Bone density in HSD17B1TG females was highly increased in femurs, but in lesser amounts also in tibias. Especially the tibia growth plate, but not other regions of bone, was susceptible to respond to HSD17B1 inhibition by increasing bone length, whereas the inhibitors did not affect bone density. Therefore, HSD17B1 inhibitors could be safer than aromatase inhibitors in regard to bone in the treatment of breast cancer and endometriosis. Furthermore, diseases related to improper growth, are a promising new indication for HSD17B1 inhibitors.

Mikkelin seudun teknologiayritysten kilpailukyvyn parantaminen verkostoitumisen avulla

Diplomityön tavoitteena on parantaa Mikkelin seudun teknologiayritysten kilpailukykyä verkostoitumisen avulla. Lisäksi tavoitteena on toteuttaa konkreettinen verkostoitumisprosessi ja luoda malli verkostoitumishankkeen toteuttamiseksi. Työ koostuu verkostoitumiseen liittyvästä kirjallisuuskatsauksesta ja työn ohessa toteutetuista käytännön toimenpiteistä. Kohderyhmäksi valittuihin puutuoteteollisuuden kone- ja laitevalmistajiin on perehdytty haastattelujen ja arvojärjestelmäanalyysin perusteella. Yrityksiltä on lisäksi haastattelujen yhteydessä kerätty verkostoitumisaloitteita, joiden perusteella on tehty tarvittavia jatkotoimenpiteitä. Työn tuloksena on luotu kuvaus kohdeyritysten arvojärjestelmästä Mikkelin seudulla ja edesautettu kolmen verkostoitumisprosessien käynnistymistä. Lisäksi kokemusten ja havaintojen perusteella on luotu verkostoitumismalli alueellisen kehittäjäorganisaation käyttöön.

Medidas de tensão superficial pelo método de contagem de gotas: descrição do método e experimentos com tensoativos não-iônicos etoxilados

Surface tension knowledge of surfactants aqueous solutions is important during amphiphilic molecule manufacturing and new product development, as feedback information to handle synthesis parameters to target performance. Drop counting method is an interesting simplification of drop weight method for surface tension measurements. A simple laboratory measurement device, with capability for temperature control, was assembled to allow investigation of ethoxylated surfactants. The implementation of the method was preceded by a detailed investigation of two factors that may affect the measured surface tension: drop formation velocity and surfactant ethoxylation degree. The limitations of the method are discussed on this basis.

A Theoretical investigation of a potential high energy density compound 3,6,7,8-tetranitro-3,6,7,8-tetraaza-tricyclo[3.1.1.1(2,4)]octane

The B3LYP/6-31G (d) density functional theory (DFT) method was used to study molecular geometry, electronic structure, infrared spectrum (IR) and thermodynamic properties. Heat of formation (HOF) and calculated density were estimated to evaluate detonation properties using Kamlet-Jacobs equations. Thermal stability of 3,6,7,8-tetranitro-3,6,7,8-tetraaza-tricyclo [3.1.1.1(2,4)]octane (TTTO) was investigated by calculating bond dissociation energy (BDE) at the unrestricted B3LYP/6-31G(d) level. Results showed the N-NO2 bond is a trigger bond during the thermolysis initiation process. The crystal structure obtained by molecular mechanics (MM) methods belongs to P2(1)/C space group, with cell parameters a = 8.239 Å, b = 8.079 Å, c = 16.860 Å, Z = 4 and r = 1.922 g cm-3. Both detonation velocity of 9.79 km s-1 and detonation pressure of 44.22 GPa performed similarly to CL-20. According to the quantitative standards of energetics and stability, TTTO essentially satisfies this requirement as a high energy density compound (HEDC).

PCA: uma ferramenta para identificação de traçadores químicos para água de formação e água de injeção associadas à produção de petróleo

This study describes the use of Principal Component Analysis to evaluate the chemical composition of water produced from eight oil wells in three different production areas. A total of 609 samples of produced water, and a reference sample of seawater, were characterized according to their levels of salinity, calcium, magnesium, strontium, barium and sulphate (mg L-1) contents, and analyzed by using PCA with autoscaled data. The method allowed the identification of variables salinity, calcium and strontium as tracers for formation water, and variables magnesium and sulphate as tracers for seawater.

Rukoile ja työtä tee. Onni Puhakan kehitys innovaattorista oman tien kulkijaksi

Pray and work. The development of Onni Puhakka: from innovator to nonconformist This ethnological biographical study examines the modernization which began in the mid-1800s, continued into the mid-1900s, and has changed Finnish society in many ways. This era has been studied on a general level quite extensively, but this work explores the life and everyday experiences of Onni Puhakka (1870−1955), a farmer who spent most of his life in the town of Liperi. The goal is to find new perspectives on the development of the modernization process in society through the experiences of an individual. In this study, a central theme is the rural co-operative movement represented in Finland by Pellervo as well as its development in this country and as a significant undertaking in Onni Puhakka’s life. The co-operative movement was one of the most significant sectors affecting modernization in rural communities. The main character in the study is the grandfather of the present author, and thus this research belongs to the newly accepted ethnological research tradition of studying one’s own community. Written documents, mainly collected and preserved by Onni Puhakka himself during his lifetime, form the research material. The material consists mainly of Puhakka’s extensive correspondence, personal notes and diaries, documents related to his farm, and photographs taken by him. Earlier research and other written material examining the general development of the period were used to provide a background for the study. The co-operative movement formed a comprehensive ideology for Onni Puhakka, in which the possibilities for the development of both individuals and the community were combined. His life was based on a religious conviction, and he felt that the co-operative movement was the application of Christian love for one’s neighbour in practice. At the beginning of his active working career, Puhakka was an innovator, a reformer at the forefront of progress, but quite soon he became a sworn critic of the development of the co-operative movement in particular. One of Puhakka’s criticisms of the co-operative movement was the shifting of decision-making power to professional managers and central organizations, far from the reach of local actors. A fundamental reason for his dissatisfaction was the development within the co-operative movement in which the ideological background was forgotten, and economic goals and making a profit took an excessive significance. This assessment of the co-operative movement made by Onni Puhakka and his predictions about its development were not unfounded. This has been shown by several studies examining the development of both the Pellervo and working class cooperative movements. The professionalization of management, managerialism, as well as the direct links between professional managers of local co-operatives and central organizations have lead to the situation in which fewer and fewer people make the decisions, and management has as its goal economic success and growth. Co-operative enterprises that have grown in size have become estranged from the everyday life of their members. Instead of taking care of relations with the membership of the co-op, competitive ability and the market share have become the most important concerns of the management. As the membership has become alienated, their interest in large-scale co-ops has also become largely economic. A significant change among the membership of the Pellervo movement occurred at the stage when the co-operative movement shifted from rural areas to urban centres. This meant that the commitment of the membership became much looser than it had been in the farmers’ production and consumer co-ops. From the point of view of its members, the nature of the co-operative movement has become diametrically opposed to its point of departure: the active members who previously formed the subject of the co-operative movement have become the object of the economic activities of that same movement. The co-operative movement has been transformed from the progressive agent of change of its early years into a business activity which no longer has any significant task as a social reformer. This study confirms the observations of the latest research on modernization which states that modernization has not been a straightforward and inevitable development that has lead to the present situation. For example, the criticism directed by Puhakka toward the co-operative movement includes information that shows that a few others who were initially actively involved also criticized the development of the movement. Despite his occasional frustration, Onni Puhakka continued his criticism and attempts to get the co-operative movement to change its course and return to its ‘roots’. In the early years of the cooperative movement he probably did not differ much from the other pioneers in the sense that many of them had adopted and internalized the same values and motive for being involved that he had. However, Puhakka differed from his colleagues in the sense that he was able to believe in what he called the “fundamental values” of the co-operative movement longer than many of them.

Tiedonhallinta verkostoituneessa logistiikkaketjussa – Case: VR-Yhtymä

Tiedon tehokas jakaminen ja tiedon hallinta näyttelee tärkeätä roolia yritysten kannattavuuden ja tehokkuuden kehittämisessä. Laadukkaan tiedon tehokas jakaminen ja omaksuminen korostuvat verkostoituneessa logistiikkaketjussa ja kolmannen osapuolen logistiikkaa harjoittavissa yrityksissä. Tehokkaalla tiedon jakamisella, tietämyksen hallinnalla sekä tietojohtamisen keinoilla voidaan luoda tehokkaita ja kilpailukykyisiä businessprosesseja. Työn tuloksena saavutettiin kuvaus tietojohtamisen eri näkökulmista sekä tietojohtamisesta tiedon hallinnan työkaluna. Työn teoreettisessa osuudessa käsitellään tietoa ja sen eri tasoja sekä perspektiivejä tietojohtamisessa käytettyinä syötteinä, sen prosesseina sekä lopputuloksena, joita tietojohtamisen käsitteen alla olevilla työkaluilla ja käytännöillä toteutetaan. Aiempi tutkimus osoittaa, että tietojohtaminen on yksi johtamisen malli, jonka avulla voidaan saavuttaa tehokkaan yritystoiminnan edellytykset sekä asetetut strategiset tavoit- teet. Kirjallisuuden perusteella pyrittiin kartoittamaan verkostoituneen logistiikkaketjun tiedonhallinnan esteet ja sitä rajoittavat tekijät. Työn empiirinen osuus toteutettiin kvalitatiivisena kysely- sekä haastattelututkimuksena, jonka avulla kerättiin työssä käytetty tutkimusaineisto. Työn empiirisessä osuudessa kartoitettiin kohdeorganisaation tiedonhallintaprosesseja sen kuljetustuotannon toiminnoissa, sekä niiden toteuttamista vaikeuttavia ja hidastavia tekijöitä. Empiirisen aineiston perusteella yritykselle ehdotettiin organisaation muokkaamista enemmän tiedon jakamista tu- kevaan suuntaan, joka voidaan teoriatiedon perusteella toteuttaa esimerkiksi luomalla fyysisiä ja henkisiä tiloja tietoprosessien toteuttamiselle.

Proteoliposomes as matrix vesicles' biomimetics to study the initiation of skeletal mineralization

During the process of endochondral bone formation, chondrocytes and osteoblasts mineralize their extracellular matrix by promoting the formation of hydroxyapatite (HA) seed crystals in the sheltered interior of membrane-limited matrix vesicles (MVs). Ion transporters control the availability of phosphate and calcium needed for HA deposition. The lipidic microenvironment in which MV-associated enzymes and transporters function plays a crucial physiological role and must be taken into account when attempting to elucidate their interplay during the initiation of biomineralization. In this short mini-review, we discuss the potential use of proteoliposome systems as chondrocyte- and osteoblast-derived MVs biomimetics, as a means of reconstituting a phospholipid microenvironment in a manner that recapitulates the native functional MV microenvironment. Such a system can be used to elucidate the interplay of MV enzymes during catalysis of biomineralization substrates and in modulating in vitro calcification. As such, the enzymatic defects associated with disease-causing mutations in MV enzymes could be studied in an artificial vesicular environment that better mimics their in vivo biological milieu. These artificial systems could also be used for the screening of small molecule compounds able to modulate the activity of MV enzymes for potential therapeutic uses. Such a nanovesicular system could also prove useful for the repair/treatment of craniofacial and other skeletal defects and to facilitate the mineralization of titanium-based tooth implants.

The nature experiences of wilderness recreation leaders : throwing a stone

Through this descriptive exploratory study, the ways that wilderness recreation leaders experience nature are illuminated, deconstructing the assumed environmental benefits of and practices used in outdoor recreation (Haluza-Delay, 2001). This study also offers a foundation for advancing an environmental ethic among wilderness recreation leaders, participants, and organizations. With the continued degradation of and threats to natural environments, and the rising popularity of outdoor recreation participation, the outdoor recreation professional can be a leader in promoting human reconnections to the Earth (Henderson, 1999). Leaders of outdoor recreation experiences play an important role in encouraging these revived relationships to natural settings and can contribute to the necessary environmental consciousness shift needed within Western society (Hanna, 1995; Jordan, 1996). The purpose of this research was to describe the lived-experience in nature of wilderness recreation leaders. Specifically, a phenomenological method of inquiry was used to describe the meaning of nature, the connections and relationships to nature, and the behaviours and emotions experienced in nature by a group of wilderness canoe trip leaders employed by a residential summer camp. In addition to the implications of this research, achieving this outcome provides a rich descriptive understanding of wilderness leaders' experiences—a basis from which to extend future research endeavours and programmatic practices that promote effective environmental outcomes of outdoor recreation participation. Each of the five study participants was employed in the summer of 2003 by an Ontario residential summer camp organization that sponsors extended wilderness river canoe trips for youth. Two in-depth and semi-structured interviews were performed with each participant, asking them to reflect on the canoe trip that they led for the summer camp organization during 2003. Phenomenological data was analyzed according to Colaizzi's (1978) thematic analysis process. Consistent with van Manen's (1997) emphasis on phenomenological writing, the final result presents the essence of the nature experiences of wilderness recreation leaders in the format of a narrative description. This narrative piece is the culmination of this research effort. Throughout the journey, however, various foundations within the outdoor recreation field, such as minimum impact principles, environmentally responsible behaviours, anthropocentric and ecocentric worldviews, and effective leadership are deconstructed and discussed.

The influence of familial smoking behaviours on adolescent smoking behaviours

The ability to identify adolescents who are at risk for becoming smokers may prove useful in developing effective smoking prevention programs. The purpose of this stUdy was to assess the importance of familial smoking behaviours on adolescent smoking patterns. The results were based on responses to The Grade 7 Lincoln County Smoking Survey designed by Chudzik and Partington (1994), and are a part of the "Peer Assisted Learning Program· (PAL) presented by the Niagara Regional Health Services Department, with the cooperation of a local Board of Education (Region of Niagara). The results indicate that 12% of the total group of 450 Grade 7 student respondents were current smokers at the time the data were collected (13% males and 11% females), while more than 37% of individuals indicated that they had tried smoking previously. Of the individuals who were classified as smokers, 11% reported that they smoked because their parents smoked, but only 6% reported that they smoked because their siblings smoked. More concerning, however, is the finding that 4% of smokers reported that they felt pressured to smoke by their relatives. In a society that is becoming increasingly concerned about health, it is also alarming to observe that only 50% of the respondents within this sample reported that there were no smokers (parents/siblings) in their homes. The results also indicate that 33% percent of respondents had grandparents who continued to smoke, and 53% of respondents indentified other relatives who continued to smoke.

Dr. Stuart D. Scott Papers, 1837-2010 (non-inclusive)

Dr. Stuart D. Scott has written extensively in the fields of prehistory and history. As an archaeologist, he has traveled to some of the most significant sites in the world, including Pompeii, Stonehenge, the Valley of the Kings, Egypt’s pyramids and the Taj Mahal. He spent nine months excavating with the Tikal Project in Guatemala before returning to the University of Arizona where he received a Ph.D. in 1963. He excavated in New Zealand as a Fulbright scholar in 1963-1964. In the fall of 1964, Dr. Scott started a long career in the Anthropology Department of the State University of New York. He taught graduate and undergraduate archaeology courses and continued his archaeological and historical research. In 1979, Scott established the Old Fort Niagara Archaeology in Progress Project at Old Fort Niagara in Youngstown, New York. For many years, he became involved with historical archaeology in western New York. It was during this work that he became interested in the Upper Canada Rebellion of 1837-1838 and its aftermath. Dr. Scott and his wife, Patricia Kay Scott, would use Christmas breaks, summer vacations, and sabbatical years to travel. They were repeatedly lured back to the South Pacific, conducting research in New Zealand, Australia and many of the Micronesian and Polynesian islands. To tell the whole story of the Rebellion and the prison exiles, they traveled extensively in Canada, the United States, England and Tasmania to collect archival research and to experience the scenes of this remarkable narrative. In 2004, Dr. Scott published To the Outskirts of Habitable Creation: Americans and Canadians Transported to Tasmania in the 1840s, which told the story of the men captured, tried, convicted, and exiled as a result of the Rebellion, also called the Patriot War. Other contributions include: • A collaboration with Dr. Charles Cazeau on the book Exploring the Unknown, Great Mysteries Reexamined published by Plenum Press in 1979 • The Patriot Game: New Yorkers and the Canadian Rebellion of 1837-1838, which appeared in New York History, Vol. 68, No.3. 1987 • A Frontier Spirit: The Life of James Gemmell published in Australiasian Canadian Studies, Vol. 25, No. 2 2007 • To the Outskirts of Habitable Creation which appeared in the Friends of the National Archives, Vol. 20, No. 1 2009 • Numerous academic journal publications • Service on conference panels • Various research papers and proposals Before retiring in 1997 and while still a resident of Buffalo, N.Y., Dr. Scott spent considerable time with Brock University President Emeritus James A. Gibson and History Professor Colin Duquemin. The three shared a love of Rebellion history. It was largely because of this connection that Brock University was chosen as the recipient of Dr. Scott’s research materials.

Contribution différentielle du tissu adipeux mâle et femelle dans l’établissement du diabète de type 2 et des altérations cardiovasculaires : rôle de l’apport lipidique

Au cours des dernières années, il est devenu évident que les sociétés des pays industrialisés sont à haut risque de maladies métaboliques. Une alimentation riche en énergie (lipide/glucide), combinée à une sédentarité accrue, est un facteur environnemental contribuant à l'augmentation de la prévalence de maladies reliées spécifiquement à des troubles endocriniens comme l'obésité et le diabète. Le traitement de ces désordres métaboliques doit donc passer par la connaissance et la compréhension des mécanismes moléculaires qui contrôlent ces désordres et le développement de traitements ciblés vers les facteurs responsables. Le tissu adipeux est une glande endocrine qui sécrète des substances, regroupées sous le terme d'adipokines, qui contrôlent l'homéostasie énergétique. L'augmentation de la masse adipeuse est responsable du développement de dérégulation hormonale qui mène à des dysfonctions physiologiques et métaboliques. Pour contrecarrer le développement démesuré du tissu adipeux, la signalisation insulinique ainsi que l’apport énergétique, responsables de la différenciation adipocytaire, doivent être inhibés. In vivo, la leptine, adipokine dont la concentration est corrélée à la masse adipeuse, présente des actions pro ou anti-insuliniques dans l’organisme pour réguler ce phénomène. Elle favorise l’effet inhibiteur de l’insuline sur la synthèse hépatique de glucose alors qu’elle s’oppose à son action sur l’expression des enzymes glucokinase et phosphoénol-pyruvate carboxykinase. La leptine influence aussi le taux circulant de triglycérides en diminuant sa concentration plasmatique. D'autre part, l'adiponectine, adipokine insulino- sensibilisante, voit sa sécrétion diminuée avec la prise de poids. La sensibilité à l'insuline est ainsi diminuée au fur et à mesure que le débalancement de ces deux adipokines s'accentue. La résistance à l'insuline s'installe alors pour s'opposer au stockage énergétique et à la prise illimitée de poids et la glycémie augmente. L'augmentation du glucose sanguin stimule la sécrétion d'insuline au niveau des cellules pancréatiques. C'est le diabète caractérisé par une hyperglycémie et une résistance à l'insuline. Le diabète, une des premières causes de mortalité dans le monde, est plus répandu sous sa forme non insulinodépendante (diabète de type 2, DT2) liée à l'obésité. Récemment, différents facteurs de transcription ont été identifiés comme régulateurs de l'expression d'une panoplie de gènes impliqués dans le métabolisme glucidique et lipidique. Parmi eux, les récepteurs des inducteurs de la prolifération des peroxysomes (PPAR, Peroxisome Proliferator-Activated Receptor), appartenant à la famille des récepteurs nucléaires. Les PPAR ont été démontrés comme ayant un rôle central dans le contrôle de la transcription des gènes codants pour des protéines impliquées dans le métabolisme : les adipokines. PPARg, en plus de son implication dans le contrôle de l'homéostasie glucidique et lipidique, est reconnu comme étant un facteur de transcription pivot régulant l'adipogenèse du fait de son expression majeure dans le tissu adipeux. D'autre part, il est bien établi maintenant que l'obésité et le diabète sont des facteurs contribuant au développement du processus inflammatoire vasculaire caractéristique de l’athérosclérose. En effet, les cellules endothéliales et musculaires lisses, principales composantes de la média de l’artère, sont très sensibles aux altérations métaboliques. Une diminution de la sensibilité à l’insuline entraine une réduction de la disponibilité du glucose et l’utilisation des acides gras comme alternatif par ces cellules. Ceci induit l’accumulation des acides gras oxydés dans l’intima et leur filtration dans la média pour former un core lipidique. Bien que l’induction de la dysfonction endothéliale soit impliquée très précocement, certaines études pointent l’accumulation lipidique dans les cellules musculaires lisses vasculaires (CML) et leur dysfonction comme déclencheurs de l’athérosclérose. Ce travail visait donc, dans un premier temps, à développer un modèle d'altérations métaboliques liées à la modulation de l'activité du tissu adipeux via une alimentation riche en lipides. Dans un second temps, cette étude tentait d'évaluer l’impact des adipocytes de souris sur les CML vasculaires et sur la modulation de leurs fonctions dans ce modèle d'altérations métaboliques et DT2 liés à l'alimentation et à l'obésité. Ainsi, par le biais de deux diètes pauvres en cholestérol à profil lipidique différent, nous avons développé un modèle murin présentant divers stades d'altérations du métabolisme allant jusqu'au DT2 en lien avec l'obésité chez les mâles et chez les femelles. D’autre part, des signes de cardiomyopathie ainsi qu’une modulation du taux des adipokines sont reliés à ces mêmes diètes. Parallèlement, l’activité de PPAR!2 est modulée chez les souris sous diètes enrichies en gras. Ensuite, nous avons démontré que les adipocytes, provenant de souris alimentées avec une diète enrichie en gras, modulaient la migration et la prolifération des CML comparativement au groupe contrôle. Ces modulations dépendaient en grande partie de la nature de la diète consommée, mais également du sexe de la souris. Par ailleurs, les altérations fonctionnelles des CML, couplées à des modulations géniques, sont associées aux changements du profil de sécrétion des adipokines mesurées chez les adipocytes. L’ensemble de ces travaux suggère une action directe de la nature de la stimulation du tissu adipeux blanc dans la modulation du profil de sécrétion des adipokines et l'induction du DT2 in vivo. Ces altérations de la physiologie adipocytaire se reflètent in vitro où le tissu adipeux contribue aux altérations physiopathologiques des CML liées au DT2. Ainsi, cette étude est l'une des premières à établir un lien direct entre les modulations adipocytaires et les effets de leurs sécrétions sur la physiologie des CML. Ces observations peuvent être exploitées cliniquement dans un développement futur d’outils thérapeutiques visant à prévenir et à traiter les troubles métaboliques et le DT2, en ciblant le tissu adipeux comme entité métabolique et endocrine.

L’apport des infirmières au processus de consentement aux soins en milieu pédiatrique et enjeux éthiques qui en découlent

Cette recherche, traitera de la perception qu’ont les infirmières, œuvrant en milieu pédiatrique, de leur apport dans le processus de consentement aux soins et des enjeux éthique qui en découlent. L’analyse de leurs commentaires, fait voir une extension de la définition, plus classique, du concept même de consentement, pour y inclure la dimension d’un processus enclenché et poursuivi dans le dialogue et la né-gociation; un consentement sans cesse à répéter, à renégocier. Les participantes ne parlaient guère d’autonomie mais parlent surtout de ce consen-tement aux actes de soins, actes individuels, voire routiniers. Le but recherché par l’infirmière est moins une permission donnée par le patient pour que le soignant fasse son travail en toute immunité sur le plan légal, qu’une collaboration pour permettre une cogestion de la maladie. Très souvent, les infirmières discutent de l’importance qu’a pour elles le travail d’équipe, comme la façon logique de concevoir leur travail. Il devient logique aussi d’étendre aux parents et à l’enfant la participation à l’équipe thérapeutique. Ce n’est pas dire que tout se passe sans heurt. L’enfant peut s’opposer, ou le parent. Les conflits de valeurs surgissent: conflits et détresse morale suscités chez l’infirmière par la confrontation à des croyances et des valeurs culturelles et reli-gieuses différentes de celles auxquelles l’infirmière adhèrerait plus facilement. Mais souvent, l’infirmière fait montre d’une grande sensibilité culturelle et religieuse; et il lui arrive de faire appel à des collègues qui pourraient, plus qu’elle, connaître les sys-tèmes de valeurs qui posent question. Nous nous sommes servi d’un ensemble de référents interprétatifs initiaux à titre d’un cadre conceptuel intégrant des notions tirées du modèle de soins infirmiers de Corbin et Strauss, ainsi que de la perspective proposée par l’interactionnisme symbo-lique.