Primary total hip arthroplasty for primary osteoarthritis in Finland : A national register based analysis

The first aim of the current study was to evaluate the survival of total hip arthroplasty (THA) in patients aged 55 years and older on a nation-wide level. The second aim was to evaluate, on a nation wide-basis, the geographical variation of the incidence of primary THA for primary OA and also to identify those variables that are possibly associated with this variation. The third aim was to evaluate the effects of hospital volume: on the length of stay, on the numbers of re-admissions and on the numbers of complications of THR on population-based level in Finland. The survival of implants was analysed based on data from the Finnish Arthroplasty Register. The incidence and hospital volume data were obtained from the Hospital Discharge Register. Cementless total hip replacements had a significantly reduced risk of revision for aseptic loosening compared with cemented hip replacements. When revision for any reason was the end point in the survival analyses, there were no significant differences found between the groups. Adjusted incidence ratios of THA varied from 1.9- to 3.0-fold during the study period. Neither the average income within a region nor the morbidity index was associated with the incidence of THA. For the four categories of volume of total hip replacements performed per hospital, the length of the surgical treatment period was shorter for the highest volume group than for the lowest volume group. The odds ratio for dislocations was significantly lower in the high volume group than in the low volume group. In patients who were 55 years of age or older, the survival of cementless total hip replacements was as good as that of the cemented replacements. However, multiple wear-related revisions of the cementless cups indicate that excessive polyethylene wear was a major clinical problem with modular cementless cups. The variation in the long-term rates of survival for different cemented stems was considerable. Cementless proximal porous-coated stems were found to be a good option for elderly patients. When hip surgery was performed on with a large repertoire, the indications to perform THAs due to primary OA were tight. Socio-economic status of the patient had no apparent effect on THA rate. Specialization of hip replacements in high volume hospitals should reduce costs by significantly shortening the length of stay, and may reduce the dislocation rate.

Correction of Ocular Artifacts in EEG Recordings using Empirical Mode Decomposition

EEG recordings are often contaminated with ocular artifacts such as eye blinks and eye movements. These artifacts may obscure underlying brain activity in the electroencephalogram (EEG) data and make the analysis of the data difficult. In this paper, we explore the use of empirical mode decomposition (EMD) based filtering technique to correct the eye blinks and eye movementartifacts in single channel EEG data. In this method, the single channel EEG data containing ocular artifact is segmented such that the artifact in each of the segment is considered as some type of slowly varying trend in the dataand the EMD is used to remove the trend. The filtering is done using partial reconstruction from components of the decomposition. The method is completely data dependent and hence adaptive and nonlinear. Experimental results are provided to check the applicability of the method on real EEG data and the results are quantified using power spectral density (PSD) as a measure. The method has given fairlygood results and does not make use of any preknowledge of artifacts or the EEG data used.

Eye movements and road hazard detection: Effects of blur and distractors

Purpose To examine the effects of optical blur, auditory distractors and age on eye movement patterns while performing a driving hazard perception test (HPT). Methods Twenty young (mean age 27.1 ± 4.6 years) and 20 older (73.3 ± 5.7 years) drivers with normal vision completed a HPT in a repeated-measures counterbalanced design while their eye movements were recorded. Testing was performed under two visual (best-corrected vision and with +2.00DS blur) and two distractor (with and without auditory distraction) conditions. Participants were required to respond to road hazards appearing in the HPT videos of real-world driving scenes and their hazard response times were recorded. Results Blur and distractors each significantly delayed hazard response time, by 0.42 and 0.76s respectively (p<0.05). A significant interaction between age and distractors indicated that older drivers were more affected by distractors than young drivers (response with distractors delayed by 0.96 and 0.60s respectively). There were no other two- or three-way interaction effect on response time. With blur, both groups fixated significantly longer on hazards before responding compared to best-corrected vision. In the presence of distractors, both groups exhibited delayed first fixation on the hazards and spent less time fixating on the hazards. There were also significant differences in eye movement characteristics between groups, where older drivers exhibited smaller saccades, delayed first fixation on hazards, and shorter fixation duration on hazards compared to the young drivers. Conclusions Collectively, the findings of delayed hazard response times and alterations in eye movement patterns with blur and distractors provide further evidence that visual impairment and distractors are independently detrimental to driving safety given that delayed hazard response times are linked to increased crash risk.

The Rocky Road of Social Sustainability : The Impact of Integrated Biodiversity Conservation and Development on the Local Realities in Ranomafana National Park, Madagascar

The objective of this study is to examine the social impacts of the integrated conservation and development project (ICDP) aimed at biodiversity conservation and local socio-economic development in the Ranomafana National Park (RNP), Madagascar. Furthermore, the study explores social sustainability and justice of the ICDP in Ranomafana. This ethnographically informed impact study uses of various field methods. The research material used consists of observation, interviews (key-person and focus group), school children's writings, official statistics and project documents. Fieldwork was conducted in three phases in 2001, 2002 and 2004 in twelve villages around the park, as well as in neighbouring areas of Ranomafana. However, four of those twelve villages were chosen for closer study. This study consists of five independent articles and a concluding chapter. Social impacts were studied through reproductive health indicators as well as a life security approach. Equity and distribution of benefits and drawbacks of ICDP were analysed and the actors related to the conservation in Ranomafana were identified. The children and adolescents' environmental views were also examined. The reproductive health indicators studied showed a poor state of reproductive health in the park area. Moreover, the existing social capital in the villages seemed to be fragmented due to economic difficulties that were partly caused by the conservation regulations. The ICDP in Ranomafana did not pay attention to the heterogeneity of the affected communities even though the local beneficiaries of the ICDP varied according to their ethnicity, living place, wealth, social position and gender. In addition, various conservation actors (local people in various groups, local authorities, tourist business owners, conservation NGOs and scientists) contest their interests over the forest, conservation and its related activities. This study corroborates the same type of evidence and conclusions discussed in other similar cases elsewhere: so called social conservation programmes still cannot meet the needs of the people living near the protected areas; on the contrary, they even have a reverse impact on the people's lives. A fundamental misunderstood assumption in the conservation process in Ranomafana was to consider the local people as a problem for biodiversity conservation. Major reasons for the failure of the ICDP in Ranomafana include a lack of local institutions that would have been able to communicate as equals with the conservation NGOs as well as to transfer the tradition of the authoritarian governance in conservation management together with the over-appreciation of scientific biodiversity, and lack of will to understand the local people's rights to use the forest for their livelihoods.

Politiikan paluu : Globalisaatioliike ja julkisuus

The struggle over globalization has arguably been the most important debate in world politics of the 2000 s. This study maps the origins of this debate, its most important actors and its results so far. The focus is on the Global Justice Movement which launched the globalization debate to the mass media spotlight. Particular attention is given to the World Social Forum, the movement s global gathering, analyzed as a new form of global publics. The mediation of the debates initiated by these publics to the Finnish national context is analyzed at two levels: First, through forums for policy debate such as the Helsinki Process on Globalization and Democracy and second, through the public debate in the Finnish mass media. The study proves many common assumptions about the Global Justice Movement wrong. Rather than being a marginal actor, the movement is the initiator of the whole debate. Combining expert knowledge to carnevalistic demonstrations rarely seen in Finland, the movement gains more public attention and more members in Finland than in many other European countries. The political and economic elites are not just adversaries of the movement. Rather, the Finnish elite is divided in two. Some top politicians starting from the president and the minister for foreign affairs adopt many of the movement s claims. Later, the business elite, with support from the nation s largest newspaper, begins a counterattack to challenge the movement and its allies. The return of politics staged by the movement is, first and foremost, a phenomenon in the public sphere. Two downward trends, the decline of party politics and the traditionally strong Finnish field of politically oriented civic associations remain unchanged. This allows for the conclusion that we are witnessing a move from organizational politics towards politics in the public sphere. The study develops a theoretical perspective on social movements as actors in the public sphere. It argues that movements have, in fact, played an important role in the very development of the democratic public sphere as we know it. In the light of this observation, the study assesses the potentials and the pitfalls of social movements and their related publics to global democracy. Methodologically, the most important contribution is the development of Public Justifications Analysis, a method for analyzing political claims in media debates and the ways in which these claims are justified.

Novel application of a discrete choice experiment to identify preferences for a national healthcare-associated infection surveillance programme: A cross-sectional study

Objective: To identify key stakeholder preferences and priorities when considering a national healthcare-associated infection (HAI) surveillance programme through the use of a discrete choice experiment (DCE). Setting: Australia does not have a national HAI surveillance programme. An online web-based DCE was developed and made available to participants in Australia. Participants: A sample of 184 purposively selected healthcare workers based on their senior leadership role in infection prevention in Australia. Primary and secondary outcomes: A DCE requiring respondents to select 1 HAI surveillance programme over another based on 5 different characteristics (or attributes) in repeated hypothetical scenarios. Data were analysed using a mixed logit model to evaluate preferences and identify the relative importance of each attribute. Results: A total of 122 participants completed the survey (response rate 66%) over a 5-week period. Excluding 22 who mismatched a duplicate choice scenario, analysis was conducted on 100 responses. The key findings included: 72% of stakeholders exhibited a preference for a surveillance programme with continuous mandatory core components (mean coefficient 0.640 (p<0.01)), 65% for a standard surveillance protocol where patient-level data are collected on infected and non-infected patients (mean coefficient 0.641 (p<0.01)), and 92% for hospital-level data that are publicly reported on a website and not associated with financial penalties (mean coefficient 1.663 (p<0.01)). Conclusions: The use of the DCE has provided a unique insight to key stakeholder priorities when considering a national HAI surveillance programme. The application of a DCE offers a meaningful method to explore and quantify preferences in this setting.

Impact of riparian land use on stream insects of Kudremukh National Park, Karnataka state, India

The impact of riparian land use on the stream insect communities was studied at Kudremukh National Park located within Western Ghats, a tropical biodiversity hotspot in India. The diversity and community composition of stream insects varied across streams with different riparian land use types. The rarefied family and generic richness was highest in streams with natural semi evergreen forests as riparian vegetation. However, when the streams had human habitations and areca nut plantations as riparian land use type, the rarefied richness was higher than that of streams with natural evergreen forests and grasslands. The streams with scrub lands and iron ore mining as the riparian land use had the lowest rarefied richness. Within a landscape, the streams with the natural riparian vegetation had similar community composition. However, streams with natural grasslands as the riparian vegetation, had low diversity and the community composition was similar to those of paddy fields. We discuss how stream insect assemblages differ due to varied riparian land use patterns, reflecting fundamental alterations in the functioning of stream ecosystems. This understanding is vital to conserve, manage and restore tropical riverine ecosystems.

Medicalising Prohibition : Harm reduction in Finnish and International Drug Policy

The increase in drug use and related harms in the late 1990s in Finland has come to be referred to as the second drug wave. In addition to using criminal justice as a basis of drug policy, new kinds of drug regulation were introduced. Some of the new regulation strategies were referred to as "harm reduction". The most widely known practices of harm reduction include needle and syringe exchange programmes for intravenous drug users and medicinal substitution and maintenance treatment programmes for opiate users. The purpose of the study is to examine the change of drug policy in Finland and particularly the political struggle surrounding harm reduction in the context of this change. The aim is, first, to analyse the content of harm reduction policy and the dynamics of its emergence and, second, to assess to what extent harm reduction undermines or threatens traditional drug policy. The concept of harm reduction is typically associated with a drug policy strategy that employs the public health approach and where the principal focus of regulation is on drug-related health harms and risks. On the other hand, harm reduction policy has also been given other interpretations, relating, in particular, to human rights and social equality. In Finland, harm reduction can also be seen to have its roots in criminal policy. The general conclusion of the study is that rather than posing a threat to a prohibitionist drug policy, harm reduction has come to form part of it. The implementation of harm reduction by setting up health counselling centres for drug users with the main focus on needle exchange and by extending substitution treatment has implied the creation of specialised services based on medical expertise and an increasing involvement of the medical profession in addressing drug problems. At the same time the criminal justice control of drug use has been intensified. Accordingly, harm reduction has not entailed a shift to a more liberal drug policy nor has it undermined the traditional policy with its emphasis on total drug prohibition. Instead, harm reduction in combination with a prohibitionist penal policy constitutes a new dual-track drug policy paradigm. The study draws on the constructionist tradition of research on social problems and movements, where the analysis centres on claims made about social problems, claim-makers, ways of making claims and related social mobilisation. The research material mainly consists of administrative documents and interviews with key stakeholders. The doctoral study consists of five original articles and a summary article. The first article gives an overview of the strained process of change of drug policy and policy trends around the turn of the millennium. The second article focuses on the concept of harm reduction and the international organisations and groupings involved in defining it. The third article describes the process that in 1996 97 led to the creation of the first Finnish national drug policy strategy by reconciling mutually contradictory views of addressing the drug problem, at the same as the way was paved for harm reduction measures. The fourth article seeks to explain the relatively rapid diffusion of needle exchange programmes after 1996. The fifth article assesses substitution treatment as a harm reduction measure from the viewpoint of the associations of opioid users and their family members.

Kiista, eheys, unohdus : Vapaussodan muistaminen suojeluskunnan ja veteraaniliikkeen toiminnassa 1918-1944

Conflict, Unity, Oblivion: Commemoration of the Liberation War by the Civic Guard and the Veterans´ Union in 1918-1944 The Finnish Civil War ended in May 1918 as a victory for the white side. The war was named by the winners as the Liberation War and its legacy became a central theme for public commemorations during the interwar period. At the same time the experiences of the defeated were hindered from becoming a part of the official history of Finland. The commemoration of the war was related not only to the war experience but also to a national mission, which was seen fulfilled with the independence of Finland. Although the idea of the commemoration was to form a unifying non-political scene for the nation, the remembrance of the Liberation War rather continued than sought to reconcile to the conflict of 1918. The outbreak of the war between the Soviet Union and Finland in 1939 immediately affected the memory culture. The new myth of the Miracle of the Winter War, which referred to the unity shown by the people, required a marginalization of controversial memory of the Liberation War. This study examines from the concepts of public memory and narrative templates how the problematic experience of a civil war developed to a popular public commemoration. Instead of dealing with the manipulative and elite-centered grandiose commemoration projects, the study focuses on the more modest local level and emphasizes the significance of local memory agents and narrative templates of collective memory. The main subjects in the study are the Civil Guard and the Veterans´ Union. Essential for the widespread movement was the development of the Civic Guard from a wartime organization to a peacetime popular movement. The guards, who identified themselves trough the memories and the threats of civil war, formed a huge network of memory agents in every corner of the country. They effectively linked both local memory with official memory and the civic society with the state level. Only with the emergence of the right wing veteran movement in the 30ies did the tensions grow between the two levels of public memory. The study shows the diversity of the commemoration movement of the Liberation War. It was not only a result of a nation-state project and political propaganda, but also a way for local communities to identify and strengthen themselves in a time of political upheaval and uncertainty.

Enhancing Physics Education in the National Defence University : A design based research approach in the production of learning material

This research is connected with an education development project for the four-year-long officer education program at the National Defence University. In this curriculum physics was studied in two alternative course plans namely scientific and general. Observations connected to the later one e.g. student feedback and learning outcome gave indications that action was needed to support the course. The reform work was focused on the production of aligned course related instructional material. The learning material project produced a customized textbook set for the students of the general basic physics course. The research adapts phases that are typical in Design Based Research (DBR). The research analyses the feature requirements for physics textbook aimed at a specific sector and frames supporting instructional material development, and summarizes the experiences gained in the learning material project when the selected frames have been applied. The quality of instructional material is an essential part of qualified teaching. The goal of instructional material customization is to increase the product's customer centric nature and to enhance its function as a support media for the learning process. Textbooks are still one of the core elements in physics teaching. The idea of a textbook will remain but the form and appearance may change according to the prevailing technology. The work deals with substance connected frames (demands of a physics textbook according to the PER-viewpoint, quality thinking in educational material development), frames of university pedagogy and instructional material production processes. A wide knowledge and understanding of different frames are useful in development work, if they are to be utilized to aid inspiration without limiting new reasoning and new kinds of models. Applying customization even in the frame utilization supports creative and situation aware design and diminishes the gap between theory and practice. Generally, physics teachers produce their own supplementary instructional material. Even though customization thinking is not unknown the threshold to produce an entire textbook might be high. Even though the observations here are from the general physics course at the NDU, the research gives tools also for development in other discipline related educational contexts. This research is an example of an instructional material development work together the questions it uncovers, and presents thoughts when textbook customization is rewarding. At the same time, the research aims to further creative customization thinking in instruction and development. Key words: Physics textbook, PER (Physics Education Research), Instructional quality, Customization, Creativity

Very Low Birth Weight Infants as Young Adults : Focus on aspects of cognition, behavior and sleep

Major advances in the treatment of preterm infants have occurred during the last three decades. Survival rates have increased, and the first generations of preterm infants born at very low birth weight (VLBW; less than 1500 g) who profited from modern neonatal intensive care are now in young adulthood. The literature shows that VLBW children achieve on average lower scores on cognitive tests, even after exclusion of individuals with obvious neurosensory deficits. Evidence also exists for an increased risk in VLBW children for various neuropsychiatric disorders such as attention-deficit hyperactivity disorder (ADHD) and related behavioral symptoms. Up till now, studies extending into adulthood are sparse, and it remains to be seen whether these problems persist into adulthood. The aim of this thesis was to study ADHD-related symptoms and cognitive and executive functioning in young adults born at VLBW. In addition, we aimed to study sleep disturbances, known to adversely affect both cognition and attention. We hypothesized that preterm birth at VLBW interferes with early brain development in a way that alters the neuropsychological phenotype; this may manifest itself as ADHD symptoms and impaired cognitive abilities in young adulthood. In this cohort study from a geographically defined region, we studied 166 VLBW adults and 172 term-born controls born from 1978 through 1985. At ages 18 to 27 years, the study participants took part in a clinic study during which their physical and psychological health was assessed in detail. Three years later, 213 of these individuals participated in a follow-up. The current study is part of a larger research project (The Helsinki Study of Very Low Birth Weight Adults), and the measurements of interest for this particular study include the following: 1) The Adult Problem Questionnaire (APQ), a self-rating scale of ADHD-related symptoms in adults; 2) A computerized cognitive test battery designed for population studies (CogState®) which measures core cognitive abilities such as reaction time, working memory, and visual learning; 3) Sleep assessment by actigraphy, the Basic Nordic Sleep Questionnaire, and the Morningness-Eveningness Questionnaire. Actigraphs are wrist-worn accelerometers that separate sleep from wakefulness by registering body movements. Contrary to expectations, VLBW adults as a group reported no more ADHD-related behavioral symptoms than did controls. Further subdivision of the VLBW group into SGA (small for gestational age) and AGA (appropriate for gestational age) subgroups, however, revealed more symptoms on ADHD subscales pertaining to executive dysfunction and emotional instability among those born SGA. Thus, it seems that intrauterine growth retardation (for which SGA served as a proxy) is a more essential predictor for self-perceived ADHD symptoms in adulthood than is VLBW birth as such. In line with observations from other cohorts, the VLBW adults reported less risk-taking behavior in terms of substance use (alcohol, smoking, and recreational drugs), a finding reassuring for the VLBW individuals and their families. On the cognitive test, VLBW adults free from neurosensory deficits had longer reaction times than did term-born peers on all tasks included in the test battery, and lower accuracy on the learning task, with no discernible effect of SGA status over and above the effect of VLBW. Altogether, on a group level, even high-functioning VLBW adults show subtle deficits in psychomotor processing speed, visual working memory, and learning abilities. The sleep studies provided no evidence for differences in sleep quality or duration between the two groups. The VLBW adults were, however, at more than two-fold higher risk for sleep-disordered breathing (in terms of chronic snoring). Given the link between sleep-disordered breathing and health sequelae, these results suggest that VLBW individuals may benefit from an increased awareness among clinicians of this potential problem area. An unexpected finding from the sleep studies was the suggestion of an advanced sleep phase: The VLBW adults went to bed earlier according to the actigraphy registrations and also reported earlier wake-up times on the questionnaire. In further study of this issue in conjunction with the follow-up three years later, the VLBW group reported higher levels of morningness propensity, further corroborating the preliminary findings of an advanced sleep phase. Although the clinical implications are not entirely clear, the issue may be worth further study, since circadian rhythms are closely related to health and well-being. In sum, we believe that increased understanding of long-term outcomes after VLBW, and identification of areas and subgroups that are particularly vulnerable, will allow earlier recognition of potential problems and ultimately lead to improved prevention strategies.

The watershed simulation and forecasting system in the National Board of and the Environment

Yhteenveto: Vesistömalleihin perustuva vesistöjen seuranta- ja ennustejärjestelmä vesi- ja ympäristöhallinnossa

Global capitalism meets national spirit: Discourses in media texts on a cross-border acquisition

In this article, the authors explore media coverage of a recent acquisition across national borders. Their starting point is that the media represent a key arena of “discursive strategizing” for actors such as corporate managers. They illustrate and specify how global capitalism, as discourse relying on economic and financial rationale and exemplified here by the acquiring firm’s attempts to expand, meets national spirit, exemplified here by the complexity in selling the acquisition target to foreigners. The main contribution of this study lies in identifying how key actors draw on and mobilize rationalistic and nationalistic discourses in public discussion. The analysis illustrates that the same actors can draw on different—even contradictory—discourses at different points in time. Furthermore, different actors—even with opposing objectives—may draw on the same discourse in legitimizing their positions and pursuing specific ends.

Varities of National Metonymy in Media Accounts of International Mergers and Acquisitions

International mergers and acquisitions (M&As) often invoke national identification and national cultural differences. We argue that metonymy is a central linguistic resource through which national cultural identities and differences are reproduced in media accounts of international M&As. In this paper, we focus on two revealing cases: the acquisition of American IBM Personal Computer Division (PCD) by the Chinese company Lenovo and the acquisition of American Anheuser-Busch (A-B) by the Belgian-Brazilian company InBev. First, we identify the forms, functions and frequencies of national metonymy in media accounts of these cases. We present a typology that classifies varieties of national metonymy in international M&As. Second, we demonstrate how these metonyms combine with metaphor to generate evocative imagery, engaging wit, and subversive irony. Our findings show that national metonymy contributes to the construction of emotive frames, stereotypes, ideological differences, and threats. Combinations of national metonymy with metaphor also provide powerful means to construct cultural differences. However, combinations of metonymy with wit and irony enable the play on meanings that overturns and resists national and cultural stereotypes. This is the first study to unpack the deployment of metonymy in accounts of international M&As. In doing so, it also opens up new avenues for research into international management and the analysis of tropes in management and organization.