Visual and spectral analysis of sleep EEG in acute hemispheric stroke

BACKGROUND: Reports on the effects of focal hemispheric damage on sleep EEG are rare and contradictory. PATIENTS AND METHODS: Twenty patients (mean age +/- SD 53 +/- 14 years) with a first acute hemispheric stroke and no sleep apnea were studied. Stroke severity [National Institute of Health Stroke Scale (NIHSS)], volume (diffusion-weighted brain MRI), and short-term outcome (Rankin score) were assessed. Within the first 8 days after stroke onset, 1-3 sleep EEG recordings per patient were performed. Sleep scoring and spectral analysis were based on the central derivation of the healthy hemisphere. Data were compared with those of 10 age-matched and gender-matched hospitalized controls with no brain damage and no sleep apnea. RESULTS: Stroke patients had higher amounts of wakefulness after sleep onset (112 +/- 53 min vs. 60 +/- 38 min, p < 0.05) and a lower sleep efficiency (76 +/- 10% vs. 86 +/- 8%, p < 0.05) than controls. Time spent in slow-wave sleep (SWS) and rapid eye movement (REM) sleep and total sleep time were lower in stroke patients, but differences were not significant. A positive correlation was found between the amount of SWS and stroke volume (r = 0.79). The slow-wave activity (SWA) ratio NREM sleep/wakefulness was lower in patients than in controls (p < 0.05), and correlated with NIHSS (r = -0.47). CONCLUSION: Acute hemispheric stroke is accompanied by alterations of sleep EEG over the healthy hemisphere that correlate with stroke volume and outcome. The increased SWA during wakefulness and SWS over the healthy hemisphere contralaterally to large strokes may reflect neuronal hypometabolism induced transhemispherically (diaschisis).

Changes in blood flow velocity in the middle and anterior cerebral arteries evoked by walking

PURPOSE: Transcranial Doppler sonography (TCD) is an established method for assessing changes in blood flow velocity (BFV) coupled to brain activity. Our objective was to investigate whether walking induces measurable changes in BFV in healthy subjects. METHODS: Changes in BFV in both middle cerebral arteries (MCAs) of 40 healthy adult subjects during walking on a treadmill were measured using bilateral TCD. In 8 of the 40 subjects, 1 anterior cerebral artery (ACA) was monitored simultaneously with the contralateral MCA. The percentage increase in BFV (BFVI%) compared with the baseline velocity (V(0)), the percentage decrease in BFV (BFVD%) compared with the V(0), and the normalized ACA-MCA ratio were analyzed. RESULTS: The overall mean (+/- standard deviation [SD]) V(0) was 59.9 +/- 11.6 cm/second in the left MCA and 60.1 +/- 12.9 cm/second in the right MCA. Women had higher V(0) values than men had. Walking evoked an initial mean overall BFVI% in both left (8.4 +/- 5.1%) and right MCAs (9.1 +/- 5.1%), followed by a decrease to below baseline values in 38 of 40 subjects. A statistically significant increase of the normalized ACA-MCA ratio was measured, indicating that changes in BFV in the ACA territory were coupled to brain activation during walking. CONCLUSIONS: The use of functional TCD showed different changes in BFV in the ACAs and MCAs during walking. This method may be an interesting tool for monitoring progress in patients with motor deficits of the legs, such as paresis.

The Role of a Non-Governmental Organization in the Improvement of Employment in Finland: A Case Study

This study discusses one Non-Governmental Organization (NGO) as an alternative institution for the improvement of employment in a Finnish city. Empirical data was collected from 16 employees and from an official of the organization using questionnaires, interviews and participant observation. The data was analyzed qualitatively and the findings revealed that, the organization plays complementary role in cooperating with the government to provide social services to underprivileged groups of people, through which the organization is able to create jobs for long-term unemployed people in the city of Jyväskylä. However, the skill development training of the organization was found to be inadequate for boosting the employability of their employees in the open labour market, once the latter’s 1-2 year contract ended. The study concluded that for the organization to become a viable alternative institution for the improvement of employment in the city of Jyväskylä, it must improve the skill development training of their employees, as well as increase collaboration with other actors that are working towards the same goals.

The Role of a Non-Governmental Organization in the Improvement of Employment in Finland: A Case Study

This study discusses one Non-Governmental Organization (NGO) as an alternative institution for the improvement of employment in a Finnish city. Empirical data was collected from 16 employees and from an official of the organization using questionnaires, interviews and participant observation. The data was analyzed qualitatively and the findings revealed that, the organization plays complementary role in cooperating with the government to provide social services to underprivileged groups of people, through which the organization is able to create jobs for long-term unemployed people in the City of Jyväskylä. However, the skill development training of the organization was found to be inadequate for boosting the employability of their employees in the open labour market, once their 1-2 year contract ended. The study concluded that for the organization to become a viable alternative institution for the improvement of employment in the City of Jyväskylä, it must improve the skill development training of their employees, as well as increase collaboration with other actors that are working towards the same goals.

Monitoring cerebral oxygenation during balloon occlusion with multichannel NIRS

We report on oxygenation changes noninvasively recorded by multichannel continuous-wave near infrared spectroscopy (CW-NIRS) during endovascular neuroradiologic interventions requiring temporary balloon occlusion of arteries supplying the cerebral circulation. Digital subtraction angiography (DSA) provides reference data on the site, timing, and effectiveness of the flow stagnation as well as on the amount and direction of collateral circulation. This setting allows us to relate CW-NIRS findings to brain specific perfusion changes. We focused our analysis on the transition from normal perfusion to vessel occlusion, i.e., before hypoxia becomes clinically apparent. The localization of the maximal response correlated either with the core (occlusion of the middle cerebral artery) or with the watershed areas (occlusion of the internal carotid artery) of the respective vascular territories. In one patient with clinically and angiographically confirmed insufficient collateral flow during carotid artery occlusion, the total hemoglobin concentration became significantly asymmetric, with decreased values in the ipsilateral watershed area and contralaterally increased values. Multichannel CW-NIRS monitoring might serve as an objective and early predictive marker of critical perfusion changes during interventions-to prevent hypoxic damage of the brain. It also might provide valuable human reference data on oxygenation changes as they typically occur during acute stroke.

Multifactor effects and evidence of potential interaction between complement factor H Y402H and LOC387715 A69S in age-related macular degeneration.

BACKGROUND: Variants in the complement cascade genes and the LOC387715/HTRA1, have been widely reported to associate with age-related macular degeneration (AMD), the most common cause of visual impairment in industrialized countries. METHODS/PRINCIPAL FINDINGS: We investigated the association between the LOC387715 A69S and complement component C3 R102G risk alleles in the Finnish case-control material and found a significant association with both variants (OR 2.98, p = 3.75 x 10(-9); non-AMD controls and OR 2.79, p = 2.78 x 10(-19), blood donor controls and OR 1.83, p = 0.008; non-AMD controls and OR 1.39, p = 0.039; blood donor controls), respectively. Previously, we have shown a strong association between complement factor H (CFH) Y402H and AMD in the Finnish population. A carrier of at least one risk allele in each of the three susceptibility loci (LOC387715, C3, CFH) had an 18-fold risk of AMD when compared to a non-carrier homozygote in all three loci. A tentative gene-gene interaction between the two major AMD-associated loci, LOC387715 and CFH, was found in this study using a multiplicative (logistic regression) model, a synergy index (departure-from-additivity model) and the mutual information method (MI), suggesting that a common causative pathway may exist for these genes. Smoking (ever vs. never) exerted an extra risk for AMD, but somewhat surprisingly, only in connection with other factors such as sex and the C3 genotype. Population attributable risks (PAR) for the CFH, LOC387715 and C3 variants were 58.2%, 51.4% and 5.8%, respectively, the summary PAR for the three variants being 65.4%. CONCLUSIONS/SIGNIFICANCE: Evidence for gene-gene interaction between two major AMD associated loci CFH and LOC387715 was obtained using three methods, logistic regression, a synergy index and the mutual information (MI) index.

Insular and caudate lesions release abnormal yawning in stroke patients.

Abnormal yawning is an underappreciated phenomenon in patients with ischemic stroke. We aimed at identifying frequently affected core regions in the supratentorial brain of stroke patients with abnormal yawning and contributing to the anatomical network concept of yawning control. Ten patients with acute anterior circulation stroke and ≥3 yawns/15 min without obvious cause were analyzed. The NIH stroke scale (NIHSS), Glasgow Coma Scale (GCS), symptom onset, period with abnormal yawning, blood oxygen saturation, glucose, body temperature, blood pressure, heart rate, and modified Rankin scale (mRS) were assessed for all patients. MRI lesion maps were segmented on diffusion-weighted images, spatially normalized, and the extent of overlap between the different stroke patterns was determined. Correlations between the period with abnormal yawning and the apparent diffusion coefficient (ADC) in the overlapping regions, total stroke volume, NIHSS and mRS were performed. Periods in which patients presented with episodes of abnormal yawning lasted on average for 58 h. Average GCS, NIHSS, and mRS scores were 12.6, 11.6, and 3.5, respectively. Clinical parameters were within normal limits. Ischemic brain lesions overlapped in nine out of ten patients: in seven patients in the insula and in seven in the caudate nucleus. The decrease of the ADC within the lesions correlated with the period with abnormal yawing (r = -0.76, Bonferroni-corrected p = 0.02). The stroke lesion intensity of the common overlapping regions in the insula and the caudate nucleus correlates with the period with abnormal yawning. The insula might be the long sought-after brain region for serotonin-mediated yawning.

Virtual car accidents of epilepsy patients, interictal epileptic activity, and medication.

OBJECTIVE To investigate effects of interictal epileptic activity (IEA) and antiepileptic drugs (AEDs) on reactivity and aspects of the fitness to drive for epilepsy patients. METHODS Forty-six adult patients with demonstration of focal or generalized bursts of IEA in electroencephalography (EEG) readings within 1 year prior to inclusion irrespective of medication performed a car driving computer test or a single light flash test (39 patients performed both). Reaction times (RTs), virtual crashes, or lapses (RT ≥ 1 s in the car or flash test) were measured in an IEA burst-triggered fashion during IEA and compared with RT-measurements during unremarkable EEG findings in the same session. RESULTS IEA prolonged RTs both in the flash and car test (p < 0.001) in individual patients up to 200 ms. Generalized IEA with spike/waves (s/w) had the largest effect on RT prolongation (p < 0.001, both tests), whereas mean RT during normal EEG, age, gender, and number of AEDs had no effect. The car test was better than the flash test in detecting RT prolongations (p = 0.030). IEA increased crashes/lapses >26% in sessions with generalized IEA with s/w. The frequency of IEA-associated RT >1 s exceeded predictions (p < 0.001) based on simple RT shift, suggesting functional impairment beyond progressive RT prolongation by IEA. The number of AEDs correlated with prolonged RTs during normal EEG (p < 0.021) but not with IEA-associated RT prolongation or crashes/lapses. SIGNIFICANCE IEA prolonged RTs to varying extents, dependent on IEA type. IEA-associated RTs >1 s were more frequent than predicted, suggesting beginning cerebral decompensation of visual stimulus processing. AEDs somewhat reduced psychomotor speed, but it was mainly the IEA that contributed to an excess of virtual accidents.

Sharpening the edge of market driven intangibles and innovations

A review of the extant literature concludes that market-driven intangibles and innovations are increasingly considered to be the most critical firm-specific resources, but also finds a lack of elaboration of which types of these resources are most important. In this paper, we incorporate these observations into a conceptual model and link it to highly developed institutional settings for the model evaluation. From the point of view of firm revenue management, we can anticipate that performance advantages created through deployment of intellectual and relational capital in marketing and innovation are more likely to be superior. In essence, they constitute the integration of organisational intangibles both in cognitive and behavioural level to create an idiosyncratic combination for each firm. Our research findings show feasible paths for sharpening the edge of market-driven intangibles and innovations. We discuss the key results for research and practice.

Institutional shifts in inter-municipal service delivery:an analysis of developments in eight Western European countries

Comparative research on inter-municipal cooperation in eight European countries shows that there is a great variety of institutional arrangements for cooperation across the different countries. Also, these arrangements tend to change over time in terms of the scope of cooperation among partners, their composition and the degree of organizational integration. This article describes and analyzes the variety of and shifts in institutional arrangements for a specific class of inter-municipal cooperation arrangements: those that are set up to provide for the joint delivery of public services. It is argued that specific arrangements are typically the outcomes of interaction between national institutional contexts,?environmental factors and local preferences.

Adaptación del sector turístico al cambio climático en España. La importancia de las acciones a escala local y en empresas turísticas

El 5º Informe del IPCC (Panel Intergubernamental de Cambio Climático, 2014) señala que el turismo será una de las actividades económicas que mayores efectos negativos experimentará en las próximas décadas debido al calentamiento térmico del planeta. En España, el turismo es una fuente principal de ingresos y de creación de puestos de trabajo en su economía. De ahí que sea necesaria la puesta en marcha de medidas de adaptación a la nueva realidad climática que, en nuestro país, va a suponer cambios en el confort climático de los destinos e incremento de extremos atmosféricos. Frente a los planes de adaptación al cambio climático en la actividad turística, elaborados por los gobiernos estatal y regional, que apenas se han desarrollado en España, la escala local muestra interesantes ejemplos de acciones de adaptación al cambio climático, desarrolladas tanto por los municipios (energía, transporte, vivienda, planificación urbanística) como por la propia empresa turística (hoteles, campings, apartamentos). Medidas de ahorro de agua y luz, fomento del transporte público y de las energías limpias, creación de zonas verdes urbanas y adaptación a los extremos atmosféricos destacan como acciones de mitigación del cambio climático en los destinos turísticos principales de nuestro país.

Vesien tila hyväksi yhdessä : Tornionjoen vesienhoitoalueen vesienhoitosuunnitelma vuosiksi 2016-2012

Tähän vesienhoitosuunnitelmaan on koottu tiedot vesien tilasta sekä vesienhoitokaudella 2016–2021 tarvittavat toimenpiteet vesien tilan parantamiseksi ja ylläpitämiseksi Tornionjoen vesienhoitoalueella. Suunnitelma kattaa Suomalais-ruotsalaisen vesienhoitoalueen Suomen puoleisen alueen. Toimenpiteillä vähennetään rehevöitymistä ja vesiympäristölle vaarallisten ja haitallisten aineiden esiintymistä sekä vesistöjen rakenteessa ja hydrologiassa tapahtuneiden muutosten vaikutuksia. Vesienoitoalueen vesien tilaan on vaikuttanut niin haja- ja pistekuormitus kuin maa- ja vesiympäristön fyysinen muokkaaminen. Vesistöjä muuttavat tekijät painottuvat vesienhoitoalueen eteläosaan. Eniten vesistöjen tilaa ovat muuttaneet uittoperkaukset sekä suo- ja metsäojitukset. Tengeliönjoen vesistössä vesistöjen säännöstely ja rakentaminen ovat muuttaneet vesien tilaa. Alueen ihmistoiminnasta sisävesiin tulevasta ravinnekuormituksesta huomattava osuus tulee hajakuormituksena maa- ja metsätaloudesta sekä hajaasutuksesta. Pistemäinen ravinnekuormitus on pääosin peräisin teollisuudesta ja yhdyskuntien jätevesistä. Teollisuuden ja taajamien jätevesien puhdistukseen on panostettu viime vuosikymmeninä voimakkaasti ja pistekuormitus ei ole nykyisellään erityisen suuri vesiensuojelullinen ongelma. Kaivosteollisuus vesienhoitoalueella on mahdollisesti kasvussa, mikä lisää vesistöjen pilaantumisriskiä etenkin metallien ja vesille haitallisten aineiden osalta. Osalla pohjavesialueista kuormittava toiminta, kuten pilaantuneet maa-alueet, maa-ainesten otto, asutus, teollinen toiminta, polttoaineiden ja kemikaalien varastointi, liikenne ja kuljetukset voivat aiheuttaa vaaraa pohjavesien hyvälle laadulle. Vesienhoitoalueen vesistöt purkautuvat Perämereen, joka on kuormitukselle herkkä murtovesialue. Valtaosa sen ravinne- ja kiintoainekuormituksesta tulee jokivesien mukana, joten kuormituksen vähentäminen valuma-alueilla parantaa myös rannikkovesien tilaa. Rannikkovesiin kohdistuu myös suoraa kuormitusta teollisuuslaitoksista ja yhdyskuntien jätevedenpuhdistamoista. Rannikkovesien tilan parantaminen kytkeytyy merenhoidon suunnitteluun.

Vesien tila hyväksi yhdessä : Tenon-Näätämöjoen-Paatsjoen vesienhoitoalueen vesienhoitosuunnitelma vuosiksi 2016-2012

Vesienhoitosuunnitelma on yleistasoinen suunnitteluasiakirja, johon on koottu ajantasaisin tieto vesienhoitoalueen pinta- ja pohjavesistä, niiden tilasta ja tilan parantamistarpeista. Vesienhoitosuunnitelmasta löytyvät muun muassa vesien tilan arvioinnin tulokset sekä pinta- ja pohjavesien seurantaohjelmat. Sen keskeinen osa on yhteenveto vesien tilan parantamiseksi suunnitelluista hoitotoimenpiteistä ja arvio niiden vaikuttavuudesta vesienhoitokautta 2016–2021 varten. Yhteenveto perustuu vesienhoitoalueen toimenpideohjelmaan. Toimenpideohjelma on vesienhoitosuunnitelmaa käyttökelpoisempi asiakirja, mikäli tarvitsee tietoa toimenpiteistä. Toimenpideohjelman toteuttamisen vaikutuksista laadittu ympäristöselostus muodostaa vesienhoitosuunnitelman luvun 13. Tenon, Näätämöjoen ja Paatsjoen vesistöistä osa sijaitsee Norjan alueella ja vesistöt muodostavat Suomalais-norjalaisen vesienhoitoalueen. Paatsjoen vesistö ulottuu myös Venäjän alueelle, mutta Venäjän puoleiset alueet eivät kuulu vesienhoitoalueeseen. Tämä vesienhoitosuunnitelma käsittelee kansainvälisen vesienhoitoalueen Suomen puoleista osaa pinta- ja pohjavesineen.