Cardiovascular Risk Prediction with Ultrasound

This paper addresses primary care physicians, cardiologists, internists, angiologists and doctors desirous of improving vascular risk prediction in primary care. Many cardiovascular risk factors act aggressively on the arterial wall and result in atherosclerosis and atherothrombosis. Cardiovascular prognosis derived from ultrasound imaging is, however, excellent in subjects without formation of intimal thickening or atheromas. Since ultrasound visualises the arterial wall directly, the information derived from the arterial wall may add independent incremental information to the knowledge of risk derived from global risk assessment. This paper provides an overview on plaque imaging for vascular risk prediction in two parts: Part 1: Carotid IMT is frequently used as a surrogate marker for outcome in intervention studies addressing rather large cohorts of subjects. Carotid IMT as a risk prediction tool for the prevention of acute myocardial infarction and stroke has been extensively studied in many patients since 1987, and has yielded incremental hazard ratios for these cardiovascular events independently of established cardiovascular risk factors. However, carotid IMT measurements are not used uniformly and therefore still lack widely accepted standardisation. Hence, at an individual, practicebased level, carotid IMT is not recommended as a risk assessment tool. The total plaque area of the carotid arteries (TPA) is a measure of the global plaque burden within both carotid arteries. It was recently shown in a large Norwegian cohort involving over 6000 subjects that TPA is a very good predictor for future myocardial infarction in women with an area under the curve (AUC) using a receiver operating curves (ROC) value of 0.73 (in men: 0.63). Further, the AUC for risk prediction is high both for vascular death in a vascular prevention clinic group (AUC 0.77) and fatal or nonfatal myocardial infarction in a true primary care group (AUC 0.79). Since TPA has acceptable reproducibility, allows calculation of posttest risk and is easily obtained at low cost, this risk assessment tool may come in for more widespread use in the future and also serve as a tool for atherosclerosis tracking and guidance for intensity of preventive therapy. However, more studies with TPA are needed. Part 2: Carotid and femoral plaque formation as detected by ultrasound offers a global view of the extent of atherosclerosis. Several prospective cohort studies have shown that cardiovascular risk prediction is greater for plaques than for carotid IMT. The number of arterial beds affected by significant atheromas may simply be added numerically to derive additional information on the risk of vascular events. A new atherosclerosis burden score (ABS) simply calculates the sum of carotid and femoral plaques encountered during ultrasound scanning. ABS correlates well and independently with the presence of coronary atherosclerosis and stenosis as measured by invasive coronary angiogram. However, the prognostic power of ABS as an independent marker of risk still needs to be elucidated in prospective studies. In summary, the large number of ways to measure atherosclerosis and related changes in human arteries by ultrasound indicates that this technology is not yet sufficiently perfected and needs more standardisation and workup on clearly defined outcome studies before it can be recommended as a practice-based additional risk modifier.

Laparoscopy in the era of enhanced recovery.

Laparoscopy is one of the cornerstones in the surgical revolution and transformed outcome and recovery for various surgical procedures. Even if these changes were widely accepted for basic interventions, like appendectomies and cholecystectomies, laparoscopy still remains challenged for more advanced operations in many aspects. Despite these discussion, there is an overwhelming acceptance in the surgical community that laparoscopy did transform the recovery for several abdominal procedures. The importance of improved peri-operative patient management and its influence on outcome started to become a focus of attention 20 years ago and is now increasingly spreading, as shown by the incoming volume of data on this topic. The enhanced recovery after surgery (ERAS) concept incorporates simple measures of general management, and requires multidisciplinary collaboration from hospital staff as well as the patient and the relatives. Several studies have demonstrated a significant decrease in postoperative complication rate, length of hospital stay and reduced overall cost. The key elements of success are fluid restriction, a functioning epidural and preoperative carbohydrate intake. With the expansion of laparoscopic techniques, ERAS increasingly incorporates laparoscopic patients, especially in colorectal surgery. However, the precise impact of laparoscopy on ERAS is still not clearly defined. Increasing evidence suggests that laparoscopy itself is an additional ERAS item that should be considered as routine where feasible in order to obtain the best surgical outcomes.

The offspring of the diabetic mother--short- and long-term implications.

In the 1980s, David Barker and Colleagues proposed that the major causes of cardiovascular and metabolic diseases have their roots in early development. There is now robust evidence that an hyperglycemic intrauterine environment is responsible not only for significant short-term morbidity in the fetus and the neonate but also for an increased risk of developing diabetes as well as other chronic, noncommunicable diseases at adulthood. The risk is higher in pregestational diabetes, but unrecognized and/or poorly managed gestational diabetes (GDM) may have similar consequences. Although a relatively clear picture of the pathogenesis of the fetal and neonatal complications of maternal diabetes and of their interrelationship is available today, the intimate molecular mechanisms involved in the long term are far from being understood. While the rate of GDM is sharply increasing in association with the pandemic of obesity and of type 2 diabetes over the world, we review here the current understanding of short- and long-term outcomes of fetuses exposed to a diabetic environment.

Performance Measurement as Part of Management

To achieve success in a constantly changing environment and with ever-increasing competition, companies must develop their operations continuously. To do this, they must have a clear vision of what they want to be in the future. This vision can be attained through careful planning and strategising. One method of transforming a strategy and vision into an everyday tool used by employees is the use of a balanced performance measurement system. The importance of performance measurement in the implementation of companies' visions and strategies has grown substantially in the last ten years. Measures are derived from the company's critical success factors and from many different perspectives. There are three time dimensions: past, present and future. Many such performance measurement systems have been created since the 1990s. This is a case study whose main objective is to provide a recommendation for how the case company could make use of performance measurement to support strategic management. To answer this question, the study uses literature-based research and empirical research at the case company's premises. The theoretical part of the study consists of two sections: introducing the Balanced Scorecard and discussing how it supports strategic management and change management. The empirical part of this study determines the company's present performance measurement situation through interviews in the company. The study resulted in a recommendation to the company to start developing the Balanced Scorecard system. By setting up this kind process, the company would be able to change its focus more towards the future, beginning to implement a more process-based organisation and getting its employees to work together towards common goals.

L'anticoagulation du patient âgé en fibrillation atriale: que prescrivent les cardiologues, les gériatres et les médecins généralistes [Anticoagulation in the aged patient with atrial fibrillation: What are prescribing cardiologists, geriatricians and general practitioners?].

OBJECTIVE: To assess prescribing of anticoagulants in atrial fibrillation (AF) in the elderly, both a quantitative point of view (rate of anticoagulation) and qualitative (type of anticoagulation). Determinants of prescribing and non-prescribing were also analysed. METHODS: Prospective survey of practice, based on one clinical case and questionnaire conducted in 60 practitioners (20 cardiologists [C], 20 geriatricians [G] and 20 general practitioners [GP]). RESULTS: In reading the clinical case, 88.3% of physicians would have initiated a treatment; three types of treatments would have been chosen: AVK (68.3%), ODA (20.0%) and platelet antiaggregant (11.7%). Criteria taken into account to initiate anticoagulation varied according to the specialty. Cardiologists considered more the age criteria (C: 95.0%, G: 75.0%, MG: 60.0%; P<0.05), diabetes (C: 90.0%, G: 60.0%, MG: 55.0%; P<0.05), hypertension (C: 85.0%, G: 55.0%, MG: 60.0%; P<0.05) and female gender (C: 80.0%, G: 35.0%, MG: 25.0%; P<0.05). The quality of renal function was however a more secondary criteria (C: 15.0%, G: 5.0%, MG: 0.0%; P<0.05). General practitioners considered most frequently the presence of underlying heart disease (C: 35.0%, G: 5.0%, MG: 45.0%; P<0.05) as well as usual cardiovascular risk factors (overweight, dyslipidaemia; P<0.05). Risk of bleeding, however, was observed by 76.7% of physicians in the clinical situation presented (C: 70.0%, G: 75.0%, MG: 85.0%; P<0.05). CONCLUSION: This survey confirms that the FA remains under anticoagulated in the elderly and the barriers to the prescription of oral anticoagulation are often without rational basis.

Diagnostic approach to eosinophilic oesophagitis: Pearls and pitfalls.

Eosinophilic oesophagitis (EoE) has first been described a little over 20 years ago. EoE has been defined by a panel of international experts as a "chronic, immune/antigen-mediated, oesophageal disease, characterized clinically by symptoms related to oesophageal dysfunction and histologically by eosinophil-predominant inflammation". A value of ≥ 15 eosinophils has been defined as histologic diagnostic cutoff. Other conditions associated with oesophageal eosinophilia, such as gastro-oesophageal reflux disease (GERD), PPI-responsive oesophageal eosinophilia, or Crohn's disease should be excluded before EoE can be diagnosed. This review highlights the latest insights regarding the diagnosis and differential diagnosis of EoE.

A Social Network Analysis of Twitter: Mapping the Digital Humanities Community

Defining digital humanities might be an endless debate if we stick to the discussion about the boundaries of this concept as an academic "discipline". In an attempt to concretely identify this field and its actors, this paper shows that it is possible to analyse them through Twitter, a social media widely used by this "community of practice". Based on a network analysis of 2,500 users identified as members of this movement, the visualisation of the "who's following who?" graph allows us to highlight the structure of the network's relationships, and identify users whose position is particular. Specifically, we show that linguistic groups are key factors to explain clustering within a network whose characteristics look similar to a small world.

From "being to the self" to "become to be": on development of autonomy construction in nursing students

Objective: To understand nursing student's self-consciousness and his/her autonomy in the discipline of fundamentals of professional care in the context of a liberating pedagogical proposal. Methodology. This qualitative, case-based research in the model of Ludke and André involved 14 students participating in the discipline. Data were collected by non-participatory observation and analysis of documents. Field observation was conducted from March to July 2010 and data were collected according to the proposal of Minayo: pre-analysis, exploration of material and treatment of results. Results. We constructed two thematic units of analysis: from "being to the self" and exercise of "become to be". Conclusion. When nursing students feel more liberty, they have the opportunity to substitute the scary prospect of learning something new material to something that motivates their curiosity and leads them to become more autonomous.

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.

Maantiede poliisin apuna

Kirjallisuusarvostelu

Kaivoksen arvoverkon kehittyminen ja toimijoiden välisen tiedonvaihdon tehostaminen

Diplomityön ensisijaisena tavoitteena on tuottaa tietoa kaivoksen arvoverkon kehittymisestä ja kaivoksen arvoverkkoon kuuluvista toimijoista. Toisena tavoitteena on tunnistaa kaivosteollisuuden potentiaalisten toimittajien alalle pääsyn esteitä ja etsiä niihin ratkaisuja. Työ perustuu kolmeen toisiaan täydentävään työmenetelmään, jotka ovat suhde- ja tietoverkostoon kuuluvien asiantuntijoiden haastattelut, toimintatutkimus sekä aihetta käsittelevät julkaisut. Työssä kuvataan (1) kaivosteollisuuden arvontuottamisjärjestelmään vaikuttavat taustatekijät; (2) kaivoksen arvoverkkoon kuuluvat toimijat ja niiden tehtävät sekä (3) kaivoksen liiketoimintaverkon tyypillinen rakenne ja sen muodostumiseen vaikuttavat tekijät. Tehtyjen havaintojen perusteella esitetään sähköisen liiketoiminnan ratkaisu, joka edistää toimijoiden välistä tiedonvaihtoa ja helpottaa potentiaalisten toimittajien alalle pääsyä.

Metsähakkeeseen liittyvä liiketoiminta Keski-Suomessa

Tämän työn ensisijaisena tavoitteena on keskisuomalaisen metsähakeliiketoiminnan arvoverkon kuvaaminen, sisältäen keskeiset toimijat ja toiminnot sekä näkemyksiä innovaatiokyvykkyydestä ja informaatiosta. Toinen tavoite on uusien liiketoimintamallien esittäminen. Työ jakautuu teoreettiseen ja empiiriseen osaan. Teoreettisessa osiossa esitetään Porterin (1984) arvojärjestelmä ja Parolinin (1999) arvoverkko. Näiden avulla kuvaillaan empiirisessä osiossa selvitettyjä arvoverkon keskeisiä ominaisuuksia. Innovaatioon liittyvä teoria pohjautuu pääosin innovaatiojärjestelmän, avoimen innovaation ja käytäntölähtöisen innovaatioteorian pohjalle (Harmaakorpi ja Melkas 2008). Liiketoimintamahdollisuuksien tarkastelu perustuu usean erillisen teoreettisen viitekehyksen yhdistelmään. Empiirisen osuuden materiaali on kerätty yritys- ja asiantuntijahaastattelut. Haastattelut on suoritettu kvalitatiivisen tapaustutkimuksen tyyliin, teemahaastatteluin. Laadullisesta materiaalista rakennetut kuvaukset nojaavat vankasti työn teoreettiseen osuuteen.

Integrating eco-innovation principles into regional strategy and policy: case of Päijät-Häme region, Finland

This study focuses on the integration of eco-innovation principles into strategy and policy at the regional level. The importance of regions as a level for integrating eco-innovative programs and activities served as the point of interest for this study. Eco-innovative activities and technologies are seen as means to meet sustainable development objective of improving regions’ quality of life. This study is conducted to get an in-depth understanding and learning about eco-innovation at regional level, and to know the basic concepts that are important in integrating eco-innovation principles into regional policy. Other specific objectives of this study are to know how eco-innovation are developed and practiced in the regions of the EU, and to analyze the main characteristic features of an eco-innovation model that is specifically developed at Päijät-Häme Region in Finland. Paijät-Häme Region is noted for its successful eco-innovation strategies and programs, hence, taken as casework in this study. Both primary (interviews) and secondary data (publicly available documents) are utilized in this study. The study shows that eco-innovation plays an important role in regional strategy as reviewed based on the experience of other regions in the EU. This is because of its localized nature which makes it easier to facilitate in a regional setting. Since regional authorities and policy-makers are normally focused on solving its localized environmental problems, eco-innovation principles can easily be integrated into regional strategy. The case study highlights Päijät-Häme Region’s eco-innovation strategies and projects which are characterized by strong connection of knowledge-producing institutions. Policy instruments supporting eco-innovation (e.g. environmental technologies) are very much focused on clean technologies, hence, justifying the formation of cleantech clusters and business parks in Päijät-Häme Region. A newly conceptualized SAMPO model of eco-innovation has been developed in Päijät-Häme Region to better capture the region’s characteristics and to eventually replace the current model employed by the Päijät-Häme Regional Authority. The SAMPO model is still under construction, however, review of its principles points to some of its three important spearheads – practice-based innovation, design (eco-design) and clean technology or environmental technology (environment).

Saostuman esto prosessiputken pinnalle

Työn tarkoituksena oli tutkia kirjallisuudessa esitettyjen menetelmien soveltuvuutta estää kalsiumkarbonaatin saostuminen PCC – prosessissa paperikonelinjan massansyöttöputkessa. Menetelmien heikkoudet ja toimivuudet arvioitiin lähdetietojen perusteella, joiden perusteella tehtiin johtopäätelmiä niiden toimivuudesta prosessissa ja käytettävyydestä kalsiumkarbonaattisaostuman muodostumiseen. Kirjallisuusselvitys osoittaa, että saostuma voidaan estää kemiallisesti ja sähkökemiallisesti sekä modifioimalla materiaalipintaa. Lisäksi sen muodostuminen voidaan estää ultraääniaaltojen avulla sekä indusoimalla mahdolliseen saostuskohtaan magneetti- tai sähkökenttä. Kokeellisessa osassa keskityttiin kirjallisuuden perusteella tutkimaan kalsiumkarbonaatin saostumista kaupallisilla menetelmillä. Tutkimuksissa käytettiin erilaisia pinnoitemateriaaleja, ultraääniaaltoja sekä magneettikenttää että liuossähkökemiaa. Näiden lisäksi tutkittiin saostumisen kehittymistä putkipinnalle ajan funktiona. Kokeellisten tulosten perusteella kirjallisuudessa esitetyistä menetelmistä ei suoraan mikään sovellu sellaisenaan tutkitussa prosessissa saostuman muodostumisen estoon. Koeparametrien optimointi muuttamalla tunnettuja parametreja prosessitilanteeseen paransi kalsiumkarbonaatin liukoisuutta. Tämän tutkimuksen tuloksena löytyi menetelmäkuvaus, jolla saostumien muodostuminen putkipinnoille voidaan estää.

Innovaatiotoiminnan nykytilan kartoittaminen - Case: Mikkelin ammattikorkeakoulu

Diplomityö on tehty Mikkelin ammattikorkeakoululle tavoitteenaan kartoittaa kyseisen organisaation innovaatiotoiminnan nykytila. Tunnistamalla innovaatiotoiminnan puutteet sekä hyvät käytännöt, voidaan toimintaa kehittää määrätietoisesti. Nykytilan kartoitus toteutettiin käytäntölähtöisen innovaatiotoiminnan näkökulmasta käsin. Työn teoreettinen tausta rakentuu ammattikorkeakoulujen TKI-toiminnan muutoksen, innovaatioiden ja innovaatiotoiminnan käytäntölähtöisyyden ympärille. Empiirinen aineisto kerättiin kyselytutkimuksen avulla, joka toteutettiin Mikkelin ammattikorkea-koulun henkilöstölle keväällä 2012. Tehdyssä tutkimuksessa oli kvalitatiivisen tutkimus-menetelmän lisäksi piirteitä kvantitatiivisesta tutkimusmenetelmästä, johtuen kyselyssä esitettyjen kysymysten luonteesta. Tutkimustulosten perusteella innovaatiotoiminnan nykytila ja siihen vaikuttavat tekijät kyettiin kuvaamaan. MAMKin innovaatiotoimintaan liittyvistä osa-alueista osassa käytännöt ja puitteet tukivat käytäntölähtöistä innovaatiotoimintaa, mutta myös selkeitä kehityskohteita havaittiin. Suurimmat kehityskohteet liittyivät sisäiseen verkostoitumiseen sekä henkilöstön ja opiskelijoiden innovaatiopotentiaalin täysimääräiseen hyödyntämiseen. Saatujen tulosten perusteella esitettiin keinoja innovaatiotoiminnan tehostamiseksi ja kehittämiseksi. Saadut tulokset ja niiden pohjalta annetut kehitysehdotukset luovat hyvät lähtökohdat Mikkelin ammattikorkeakoulun innovaatiotoiminnan kehittämiselle.