The international multidisciplinary consensus conference on multimodality monitoring in neurocritical care: a list of recommendations and additional conclusions : a statement for healthcare professionals from the neurocritical care society and the European society of intensive care medicine.

Careful patient monitoring using a variety of techniques including clinical and laboratory evaluation, bedside physiological monitoring with continuous or non-continuous techniques and imaging is fundamental to the care of patients who require neurocritical care. How best to perform and use bedside monitoring is still being elucidated. To create a basic platform for care and a foundation for further research the Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to develop recommendations about physiologic bedside monitoring. This supplement contains a Consensus Summary Statement with recommendations and individual topic reviews as a background to the recommendations. In this article, we highlight the recommendations and provide additional conclusions as an aid to the reader and to facilitate bedside care.

Uses of cancer registries for public health and clinical research in Europe : results of the European Network of Cancer Registries survey among 161 population-based cancer registries during 2010-2012

AIM: To provide insight into cancer registration coverage, data access and use in Europe. This contributes to data and infrastructure harmonisation and will foster a more prominent role of cancer registries (CRs) within public health, clinical policy and cancer research, whether within or outside the European Research Area. METHODS: During 2010-12 an extensive survey of cancer registration practices and data use was conducted among 161 population-based CRs across Europe. Responding registries (66%) operated in 33 countries, including 23 with national coverage. RESULTS: Population-based oncological surveillance started during the 1940-50s in the northwest of Europe and from the 1970s to 1990s in other regions. The European Union (EU) protection regulations affected data access, especially in Germany and France, but less in the Netherlands or Belgium. Regular reports were produced by CRs on incidence rates (95%), survival (60%) and stage for selected tumours (80%). Evaluation of cancer control and quality of care remained modest except in a few dedicated CRs. Variables evaluated were support of clinical audits, monitoring adherence to clinical guidelines, improvement of cancer care and evaluation of mass cancer screening. Evaluation of diagnostic imaging tools was only occasional. CONCLUSION: Most population-based CRs are well equipped for strengthening cancer surveillance across Europe. Data quality and intensity of use depend on the role the cancer registry plays in the politico, oncomedical and public health setting within the country. Standard registration methodology could therefore not be translated to equivalent advances in cancer prevention and mass screening, quality of care, translational research of prognosis and survivorship across Europe. Further European collaboration remains essential to ensure access to data and comparability of the results.

Aorto-bronchial and aorto-pulmonary fistulation after thoracic endovascular aortic repair: an analysis from the European Registry of Endovascular Aortic Repair Complications.

OBJECTIVES: To learn upon incidence, underlying mechanisms and effectiveness of treatment strategies in patients with central airway and pulmonary parenchymal aorto-bronchial fistulation after thoracic endovascular aortic repair (TEVAR). METHODS: Analysis of an international multicentre registry (European Registry of Endovascular Aortic Repair Complications) between 2001 and 2012 with a total caseload of 4680 TEVAR procedures (14 centres). RESULTS: Twenty-six patients with a median age of 70 years (interquartile range: 60-77) (35% female) were identified. The incidence of either central airway (aorto-bronchial) or pulmonary parenchymal (aorto-pulmonary) fistulation (ABPF) in the entire cohort after TEVAR in the study period was 0.56% (central airway 58%, peripheral parenchymal 42%). Atherosclerotic aneurysm formation was the leading indication for TEVAR in 15 patients (58%). The incidence of primary endoleaks after initial TEVAR was n = 10 (38%), of these 80% were either type I or type III endoleaks. Fourteen patients (54%) developed central left bronchial tree lesions, 11 patients (42%) pulmonary parenchymal lesions and 1 patient (4%) developed a tracheal lesion. The recognized mechanism of ABPF was external compression of the bronchial tree in 13 patients (50%), the majority being due to endoleak formation, further ischaemia due to extensive coverage of bronchial feeding arteries in 3 patients (12%). Inflammation and graft erosion accounted for 4 patients (30%) each. Cumulative survival during the entire study period was 39%. Among deaths, 71% were attributed to ABPF. There was no difference in survival in patients having either central airway or pulmonary parenchymal ABPF (33 vs 45%, log-rank P = 0.55). Survival with a radical surgical approach was significantly better when compared with any other treatment strategy in terms of overall survival (63 vs 32% and 63 vs 21% at 1 and 2 years, respectively), as well as in terms of fistula-related survival (63 vs 43% and 63 vs 43% at 1 and 2 years, respectively). CONCLUSIONS: ABPF is a rare but highly lethal complication after TEVAR. The leading mechanism behind ABPF seems to be a continuing external compression of either the bronchial tree or left upper lobe parenchyma. In this setting, persisting or newly developing endoleak formation seems to play a crucial role. Prognosis does not differ in patients with central airway or pulmonary parenchymal fistulation. Radical bronchial or pulmonary parenchymal repair in combination with stent graft removal and aortic reconstruction seems to be the most durable treatment strategy.

Prostate Cancer Unit Initiative in Europe: A position paper by the European School of Oncology.

The Prostate Cancer Programme of the European School of Oncology developed the concept of specialised interdisciplinary and multiprofessional prostate cancer care to be formalized in Prostate Cancer Units (PCU). After the publication in 2011 of the collaborative article "The Requirements of a Specialist Prostate Cancer Unit: A Discussion Paper from the European School of Oncology", in 2012 the PCU Initiative in Europe was launched. A multiprofessional Task Force of internationally recognized opinion leaders, among whom representatives of scientific societies, and patient advocates gathered to set standards for quality comprehensive prostate cancer care and designate care pathways in PCUs. The result was a consensus on 40 mandatory and recommended standards and items, covering several macro-areas, from general requirements to personnel to organization and case management. This position paper describes the relevant, feasible and applicable core criteria for defining PCUs in most European countries delivered by PCU Initiative in Europe Task Force.

Rajatylittävä tuloksentasaus ja konserniverojärjestelmän uudistaminen

Ylivoimaisesti tärkeimpänä liiketoiminnan organisoitumismuotona voidaan pitää konsernia. Se muodostuu useasta juridisesti itsenäisestä yhtiöstä, jotka kokoavat yhden taloudellisen ja organisatorisen kokonaisuuden. Verotuksessa eri konserniyhtiöitä kohdellaan itsenäisinä yhtiöinä ja jokaiselle konserniyhtiölle lasketaan oma verotettava tuloksensa muista konserniyhtiöistä riippumatta. Konserniin kuuluvien yhtiöiden tuloksenmuodostus saattaa kuitenkin olla epätasaista, toiset tuottavat voittoa ja toiset tappiota. Erityisenä verohaasteena kansainvälisten konsernien välillä onkin se, että eri valtioissa sijaitsevien konserniyhtiöiden tuloksentasaus on mahdollinen vain poikkeustapauksissa. Kritiikin kohteena on ollut myös Suomen konserniverojärjestelmä. Erityisiksi ongelmiksi ovat nousseet yhtiöoikeudelliset, kirjanpidolliset ja EY-oikeudelliset asiat. Yritysten kansainvälistyessä ja laajentuessa Eurooppaan erityisesti rajatylittävä konserniavustus ja tappiontasaus ovat nousseet esille. Tästä johtuen EY-tuomioistuinkin on joutunut ottamaan kantaa tällaisiin yritysjärjestelyihin.

Eligibility to treatment and economic effect of the implementation of the new U.S. or European Society of Hypertension/European Society of Cardiology hypertension guidelines.

OBJECTIVE: To evaluate the population and economic impact of implementing the new Joint National Committee (JNC) or European Society of Hypertension (ESH)/European Society of Cardiology (ESC) hypertension guidelines in the Swiss population. METHODS: Cross-sectional, population-based sample (6708 participants) collected between 2003 and 2006 in the city of Lausanne, Switzerland. Blood pressure categories were defined according to both the JNC (JNC-7 and JNC-8) and the ESH/ESC (2007 and 2013) guidelines. RESULTS: The proportion of participants aged 35-60 years eligible for drug treatment was 25.6% [95% confidence interval (CI) 24.4-26.9%] and 24.8% (95% CI 23.6-26.0%) for the JNC-7 and the JNC-8 guidelines, respectively; for participants aged 60-75 years, the values were 62.3% (95% CI 60.1-64.5%) and 46.8% (95% CI 44.5-49.0%), respectively. Shifting from the JNC-7 to the JNC-8 guidelines would lead to an annual saving of 163.6 million Swiss francs (187.7 million US dollars or 134.5 million European euro). The proportion of participants aged 35-75 years without chronic kidney disease, diabetes mellitus or reported history of cardiovascular disease and eligible for treatment was 30.2% (95% CI 29.0-31.4%) for the ESH/ESC 2007 and 2013 guidelines. For participants with chronic kidney disease, diabetes mellitus or reported history of cardiovascular disease, the values were 73.6% (95% CI 70.8-76.3%) and 55.6% (95% CI 52.5-58.8%), respectively. Shifting from the ESH/ESC 2007 to the ESH/ESC 2013 guidelines would lead to an annual saving of 86.9 million Swiss francs (99.5 million US dollars or 71.4 million European euro). CONCLUSION: In Switzerland, shifting from the JNC-7 to the JNC-8 guidelines or from the ESH/ESC 2007 to the ESH/ESC 2013 guidelines would decrease the prevalence of patients eligible for treatment and increase the percentage of treated patients within blood pressure goals. Both strategies lead to potential savings in antihypertensive drug treatment.

Educational resources offered by the European Board of Physical and Rehabilitation Medicine (EBPRM)

Background .- Physical and Rehabilitation Medicine (PRM) is a very demanding medical speciality. To ensure high standard of research and care in PRM all across Europe, it is crucial to attract gifted trainees and offer them high quality education. At undergraduate level, many medical schools in Europe omit to offer teaching on disabled persons and on basic PRM knowledge. Thus PRM is hardly known to medical students. For postgraduate trainees access to evidence-based knowledge as well as teaching of research methodology specific to PRM, rehabilitation methodology, disability management and team building also need to be strengthened to increase the visibility of PRM. Action .- To address these issues the EBPRM proposes presently a specific undergraduate curriculum in PRM including the issues of disability, participation and handicap as a basis for general medical practice and postgraduate rehabilitation training. For PRM trainees many educational documents are now available on the EBPRM website. A growing number of educational sessions for PRM trainees take place during international and national PRM Congresses which can be accessed at low cost. Educational papers published regularly in European rehabilitation journals and European PRM Schools are offered free or at very low cost to trainees.

Dismissal of the illusion of uncertainty in the assessment of a likelihood ratio

The use of the Bayes factor (BF) or likelihood ratio as a metric to assess the probative value of forensic traces is largely supported by operational standards and recommendations in different forensic disciplines. However, the progress towards more widespread consensus about foundational principles is still fragile as it raises new problems about which views differ. It is not uncommon e.g. to encounter scientists who feel the need to compute the probability distribution of a given expression of evidential value (i.e. a BF), or to place intervals or significance probabilities on such a quantity. The article here presents arguments to show that such views involve a misconception of principles and abuse of language. The conclusion of the discussion is that, in a given case at hand, forensic scientists ought to offer to a court of justice a given single value for the BF, rather than an expression based on a distribution over a range of values.

Avainhyödyke doktriinin kehitys ja soveltaminen Euroopan yhteisön kilpailuoikeudessa

Tutkielmassa tarkastellaan avainhyödyke doktriini kehittymistä ja sen soveltamista Euroopan yhteisön kilpailuoikeudessa. Avainhyödyke doktriinissa määräävässä markkina asemassa olevalla yrityksellä on hallussaan hyödyke, palvelu tai infrastruktuuri, jonka uudelleen tuottaminen samoilla markkinoilla ei ole kannattavaa. Määräävässä asemassa olevan yrityksen kilpailijoille tai alalle pyrkiville uusille yrityksille on kuitenkin välttämätöntä päästä käyttämään kyseistä avainhyödykettä, mikäli he haluavat toimia alalla. Tällaisissa tilanteissa avainhyödykkeen haltijalle voidaan asettaa kilpailuoikeudellinen velvollisuus ryhtyä liikesuhteeseen kilpailijoiden ja alalle pyrkivien yritysten kanssa. Avainhyödyke doktriinin soveltaminen nousee erityisen tärkeäksi aloilla, joilta on juuri purettu sääntely. Näillä aloilla doktriinin voidaan katsoa turvaavan jonkinlaisen tasapuolisuuden markkinoilla ja lisäävän kilpailua. Tästä huolimatta avainhyödyke doktriinia on kritisoitu runsaasti, sillä siinä ei oteta huomioon omistusoikeutta, sopimusvapautta tai yleensä taloudellisen toimijan autonomiaa. Avainhyödyke doktriinin kilpailuoikeudellisesta ristiriitaisuudesta olennaisena osoituksena on, ettei Euroopan yhteisön tuomioistuin ei ole ottanut kantaa doktriinin olemassaoloon.

Konserniavustus - vero-oikeudellinen tutkimus vertailukohteina EU:n ja Ruotsin oikeus

Tutkielman tavoitteena oli selvittää, tulisiko Suomen konserniavustuslakia muuttaa vastaamaan paremmin EU-säädöksiä ja kansainvälistyvää yritystoimintaympäristöä. Näkökulmana uudistustarpeelle käytettiin Ruotsissa vuonna 2010 tehtyä lakiuudistusta, joka sallii rajat ylittävän niin sanotun konsernivähennyksen tietyissä erityistilanteissa. Tutkimus nojautuu lisäksi kahteen merkittävään EU-tuomioistuimen ratkaisuun koskien rajat ylittäviä tuloksentasauksia sekä primäärisen EU-oikeuden määräyksiin. Tarkastelusta on rajattu kokonaan pois konserniavustuksen yhtiöoikeudellinen ulottuvuus. Tutkimus toteutettiin käyttämällä lainopillista sekä de lege ferenda – menetelmää. Tutkimuksessa päädyttiin ehdottamaan Suomeen Ruotsin mallin mukaista rajat ylittävää niin sanottua konsernivähennystä, joka sallittaisiin tietyissä erityistilanteissa. Tutkimuksessa selvisi lisäksi, että EU:ssa on vireillä useita yritysverotuksen harmonisointiin liittyviä hankkeita mm. yhtenäisen veropohjan osalta, mutta varsinaisiin toimenpiteisiin esimerkiksi direktiivien muodossa ei ole vielä ryhdytty.

Reglering och förvaltning av produktions- och slaktdjurs välbefinnande : en offentligrättslig undersökning

Djur och djurskyddet hör till ett rättsligt regleringsområde som inte varit föremål för omfattande rättsvetenskaplig forskning i vårt land även om intresset för djurs välbefinnande ökat både i samhället och inom EU. Avhandlingen har avfattats som en artikelavhandling och är en offentligrättslig studie om djurskyddslagstiftningen och förvaltningen av djurskyddsärenden i Finland. Tematiken har behandlats både ur djurens och djurens ägares eller innehavares synvinkel med utgångspunkt i djurskyddslagstiftningen och förvaltningen av djurskyddsärenden i Finland. Forskningen är fokuserad huvudsakligen på skyddet av och välbefinnandet hos produktions- och slaktdjur även om bland annat de begrepp som granskas också berör andra djurkategorier. De övergripande frågeställningarna i avhandlingen är två. För det första, vad är det som avses med djurs välbefinnande och skydd i regleringen av djurskyddet och för det andra, hur realiseras dessa i djurskyddsmyndigheternas förvaltningsverksamhet? I forskningen presenteras och diskuteras bland annat en ny begreppskonstruktion: djurs rättsliga välbefinnande. Den empiriska delen i avhandlingen omfattar förvaltningsverksamheten inom området av djurskydd under åren 1996–2006. Sammanlagt 10468 dokument som upprättats av djurskyddsmyndigheten i samband med verkställandet av djurskyddsövervakning ingår i undersökningen. Forskningen utmynnar i en åtgärdsförteckning med förslag till utvecklingen av området för djurskydd.

Cultural Diversity, Social Cohesion, Religion: Core Values and Educational Policies in Four European Nations

In my doctoral thesis I evaluate strategies designed to cope with the multicultural nature of four European nations: Great Britain, The Netherlands, Sweden, and Denmark. I also analyse and clarify the question of the place of religion in present-day Europe. The empirical material analysed in the study consists of politicians’ statements and policy documents dealing with immigration policy and religious and values education in the four countries. In addition, I analyse statements issued by the Council of Europe regarding religious education, along with all cases relevant to religious education brought before the United Nations Human Rights Committee or the European Court of Human Rights. The theoretical framework is formed by the scholarly debate – among philosophers, sociologists and scholars of religion in education – concerning the question of a just society. Special emphasis is given to philosophical theories that are in favour of granting special group rights to religious minorities in the name of equal treatment. With regard to the question of the appropriate place of religion, I apply Kim Knott’s methodological model for locating religion in secular contexts, and Émile Durkheim’s theory as to the significance of religion and collective sentiments in uniting adherents or members of a group into a single moral community. The study shows that even when the positive side of immigration, as a potential force for the enrichment of the public culture, is acknowledged, there is anxiety as to the successful integration of immigrants. The premises and goals of immigration policies have also been questioned. One central problem is the incommensurability between the values upheld by Western liberal democracies and certain religious traditions, above all those of Islam. Great Britain, The Netherlands, Sweden, and Denmark have tightened control over their citizens’ ethical attitudes and want to regulate these as well. In coping with cultural diversity, the significance of education, especially religious education, plays a significant role; as future citizens, pupils are expected to internalise the society’s core values as well as gaining an understanding of different cultures and ways of life. It is also worth noting that both the Council of Europe and the European Court of Human Rights have recently expressed the view that one important goal of religious education is to enable pupils to be critical and autonomous with regard to different religions and moral positions. The study shows that religion is not seen as purely a personal matter. Religion is closely linked to individual and national identity, and religious traditions thus have a place in the public domain. It should be noted, however, that a religious tradition – more precisely, an interpretation of religious tradition – qualifies as a legitimate partner in the democratic decision-making process only if it shares similar values with Western European nations.

Julkiset palveluhankinnat - Hankintayksikön velvollisuudet tarjoajia kohtaan hankintapäätöksen tekemisen jälkeen

Hankintalainsäädäntö säätelee julkisia hankintoja pääasiassa kilpailutusprosessin ajan. Hankintasopimuksen tekemisen jälkeen julkisia hankintoja säätelevät tietyt hankintalain oikeussuojakeinot, julkisten hankintojen periaatteet, muu pakottava lainsäädäntö sekä yleinen sopimusoikeus. Tutkimuksen tavoitteena on selvittää niitä velvollisuuksia, joita hankintayksiköllä on tarjoajia kohtaan hankintapäätöksen syntymisen jälkeen. Tutkimuksessa käsitellään myös velvollisuuksien toteutumatta jäämisestä syntyviä tehosteita eli sanktioita. Tutkimusmenetelmänä käytetään lainoppia. Aihetta havainnollistetaan oikeustapauksilla markkinaoikeudesta, yleisistä oikeuksista sekä Euroopan yhteisön tuomioistuimesta.