Long-term clinical outcome after liver transplantation

With transplant rejection rendered a minor concern and survival rates after liver transplantation (LT) steadily improving, long-term complications are attracting more attention. Current immunosuppressive therapies, together with other factors, are accompanied by considerable long-term toxicity, which clinically manifests as renal dysfunction, high risk for cardiovascular disease, and cancer. This thesis investigates the incidence, causes, and risk factors for such renal dysfunction, cardiovascular risk, and cancer after LT. Long-term effects of LT are further addressed by surveying the quality of life and employment status of LT recipients. The consecutive patients included had undergone LT at Helsinki University Hospital from 1982 onwards. Data regarding renal function – creatinine and estimated glomerular filtration rate (GFR) – were recorded before and repeatedly after LT in 396 patients. The presence of hypertension, dyslipidemia, diabetes, impaired fasting glucose, and overweight/obesity before and 5 years after LT was determined among 77 patients transplanted for acute liver failure. The entire cohort of LT patients (540 patients), including both children and adults, was linked with the Finnish Cancer Registry, and numbers of cancers observed were compared to site-specific expected numbers based on national cancer incidence rates stratified by age, gender, and calendar time. Health-related quality of life (HRQoL), measured by the 15D instrument, and employment status were surveyed among all adult patients alive in 2007 (401 patients). The response rate was 89%. Posttransplant cardiovascular risk factor prevalence and HRQoL were compared with that in the age- and gender-matched Finnish general population. The cumulative risk for chronic kidney disease increased from 10% at 5 years to 16% at 10 years following LT. GFR up to 10 years after LT could be predicted by the GFR at 1 year. In patients transplanted for chronic liver disease, a moderate correlation of pretransplant GFR with later GFR was also evident, whereas in acute liver failure patients after LT, even severe pretransplant renal dysfunction often recovered. By 5 years after LT, 71% of acute liver failure patients were receiving antihypertensive medications, 61% were exhibiting dyslipidemia, 10% were diabetic, 32% were overweight, and 13% obese. Compared with the general population, only hypertension displayed a significantly elevated prevalence among patients – 2.7-fold – whereas patients exhibited 30% less dyslipidemia and 71% less impaired fasting glucose. The cumulative incidence of cancer was 5% at 5 years and 13% at 10. Compared with the general population, patients were subject to a 2.6-fold cancer risk, with non-melanoma skin cancer (standardized incidence ratio, SIR, 38.5) and non-Hodgkin lymphoma (SIR 13.9) being the predominant malignancies. Non-Hodgkin lymphoma was associated with male gender, young age, and the immediate posttransplant period, whereas old age and antibody induction therapy raised skin-cancer risk. HRQoL deviated clinically unimportantly from the values in the general population, but significant deficits among patients were evident in some physical domains. HRQoL did not seem to decrease with longer follow-up. Although 87% of patients reported improved working capacity, data on return to working life showed marked age-dependency: Among patients aged less than 40 at LT, 70 to 80% returned to work, among those aged 40 to 50, 55%, and among those above 50, 15% to 28%. The most common cause for unemployment was early retirement before LT. Those patients employed exhibited better HRQoL than those unemployed. In conclusion, although renal impairment, hypertension, and cancer are evidently common after LT and increase with time, patients’ quality of life remains comparable with that of the general population.

Reasoning about discontinuance of information system use

While many studies have explored conditions and consequences of information systems adoption and use, few have focused on the final stages of the information system lifecycle. In this paper, I develop a theoretical and an initial empirical contribution to understanding individuals’ intentions to discontinue the use of an information system. This understanding is important because it yields implications about maintenance, retirement, and users’ switching decisions, which ultimately can affect work performance, system effectiveness, and return on technology investments. In this paper, I offer a new conceptualization of factors determining users’ intentions to discontinue the use of information systems. I then report on a preliminary empirical test of the model using data from a field study of information system users in a promotional planning routine in a large retail organization. Results from the empirical analysis provide first empirical support for the theoretical model. I discuss the work’s implications for theory on information systems continuance and dual-factor logic in information system use. I also provide suggestions for managers dealing with cessation of information systems and broader work routine change in organizations due to information system end-of-life decisions.

Analysis of stability of earthen dams in kachchh region, Gujarat, India

The Kachchh region of Gujarat, India bore the brunt of a disastrous earthquake of magnitude M-w=7.6 that occurred on January 26, 2001. The major cause of failure of various structures including earthen dams was noted to be the presence of liquefiable alluvium in the foundation soil. Results of back-analysis of failures of Chang, Tappar, Kaswati and Rudramata earth dams using pseudo-static limit equilibrium approach presented in this paper confirm that the presence of liquefiable layer contributed to lesser factors of safety leading to a base type of failure that was also observed in the field. Following the earthquake, earth dams have been rehabilitated by the concerned authority and it is imperative that the reconstructed sections of earth dams be reanalyzed. It is also increasingly realized that risk assessment of dams in view of the large-scale investment made and probabilistic analysis is necessary. In this study, it is demonstrated that the probabilistic approach when used in conjunction with deterministic approach helps in providing a rational solution for quantification of safety of the dam and in the estimation of risk associated with the dam construction. (C) 2007 Elsevier B.V. All rights reserved.

Bounding Run-Times of Local Adiabatic Algorithms

A common trick for designing faster quantum adiabatic algorithms is to apply the adiabaticity condition locally at every instant. However it is often difficult to determine the instantaneous gap between the lowest two eigenvalues, which is an essential ingredient in the adiabaticity condition. In this paper we present a simple linear algebraic technique for obtaining a lower bound on the instantaneous gap even in such a situation. As an illustration, we investigate the adiabatic un-ordered search of van Dam et al. [17] and Roland and Cerf [15] when the non-zero entries of the diagonal final Hamiltonian are perturbed by a polynomial (in log N, where N is the length of the unordered list) amount. We use our technique to derive a bound on the running time of a local adiabatic schedule in terms of the minimum gap between the lowest two eigenvalues.

Action regulation across the adult lifespan (ARAL): A metatheory of work and aging

The goals of this article are to integrate action regulation theory (ART) with the lifespan developmental perspective and to outline tenets of a new metatheory of work and aging. The action regulation across the adult lifespan (ARAL) theory explains how workers influence, and are influenced by, their environment across different time spans. First, the basic concepts of ART are described, including the sequential and hierarchical structure of actions, complete tasks and actions, foci of action regulation, and the action-regulating mental model. Second, principles of the lifespan developmental perspective are delineated, including development as a lifelong and multidirectional process, the joint occurrence of gains and losses, intraindividual plasticity, historical embeddedness, and contextualism. Third, propositions of ARAL theory are derived by analyzing workers’ action regulation from a lifespan developmental perspective (i.e., effects of aging on action regulation), and by analyzing aging and development in the work context from an ART perspective (i.e., effects of action regulation on age-related changes in cognition and personality). Fourth, we develop further propositions to integrate ART with lifespan theories of motivation and socioemotional experience. Finally, we discuss implications for future research and practice based on ARAL theory.

Expected Performance of the ATLAS Experiment - Detector, Trigger and Physics

A detailed study is presented of the expected performance of the ATLAS detector. The reconstruction of tracks, leptons, photons, missing energy and jets is investigated, together with the performance of b-tagging and the trigger. The physics potential for a variety of interesting physics processes, within the Standard Model and beyond, is examined. The study comprises a series of notes based on simulations of the detector and physics processes, with particular emphasis given to the data expected from the first years of operation of the LHC at CERN.

Hyvinvointivaltion pelastamisella huonosti voivia eläkeläisiä? – mediakeskustelua vuoden 2009 eläkeiän nostopäätöksestä

This thesis examines the media debate on pensions. The case analysed in the thesis is the debate that sharpened after the Finnish government made the decision to raise the retirement age. The analysed data consists of articles published in the printed media during one month after the decision was made on 24th of February in 2009. The aim of the study is to describe how the decision is argued about by different positions of speakers and how retirement is justified from the perspective of the individual. Furthermore, the purpose is to discover different ways of discussing the pensioner. The theoretical frame for this study is social constructivism, which understands reality as socially constructed with language. From this perspective, media texts can be seen as one form of shaping reality. The data is analysed by using different methods. Thematisation is used to discover the key topics, and quantification is used to examine the prevalence of different arguments. The method in which the speaker’s ways of speaking is analysed in different participant categories I call “a speaker position analysis”. The debate around the decision to raise the retirement age highlight the power struggle both between the government and the opposition as well as the government and employee unions. One thing all discussants agree is the need to raise the retirement age. From the individual's perspective, retirement is justified mostly with hard working conditions and inadequacy of health. The pensioner's image is appearing gloomy in most discourses. Prevailing discourses are seeing a pensioner either sick and tired or someone who is not good for work and has lost his dignity. The debate around the decision is intertwined around the concepts of welfare state and individual's well-being. In the postmodern society, human preferences are individualised. Welfare state means different things to different people, as well as the individual's subjective perception of well-being is unique. These two aspects are the ones which raise the tension in the analysed media debate.

Sense of Coherence : Determinants and consequences

ABSTRACT Sense of coherence (SOC) is a core concept within Antonovsky s salutogenic theory and is argued to be a psychological determinant of health. The present social-epidemiological study explores the associations between a wide range of generalized resistance resources of SOC among Finnish- and Swedish-speaking women and men with a view to gaining deeper insight into its developmental circumstances and determinants. Secondly, a five-year follow-up study was conducted in order to assess the stability of SOC in difficult life events. Finally the role and effect of SOC in the intentions to retire early was investigated in a prospective study. The above studies were based on two data sets: the Finnish 'Survey on Living Conditions' (ELO-94) conducted in 1994 by means of personal face-to-face interviews (N=6506), and a prospective postal survey of the 15-year Health and Social Support (HeSSup) study for which the baseline data was collected in 1998 (N=25 898) and the follow-up in 2003. The present study reveals that the level of SOC in adulthood is strongly dependent on close and successful social relationships during both childhood and adulthood, and that there is a strong association with qualitative work features. Not having a partner as well as being unable to use one s skills at work proved to threaten men s SOC in particular, whereas a lack of social support did the same for women. Otherwise, the association with generalized resistance resources turned out to be quite similar in both genders. Swedish-speaking Finns appear to have a slightly stronger SOC due to the better psycho-emotional circumstances in the childhood home and work circumstances in adulthood, in other words higher levels of generalized resistance resources compared to Finnish speakers. These language group differences did not concern any social-life factors included in the present study. The results of the five-year follow-up study suggest that SOC is not stable, and that the level clearly decreases after a negative life event. Even a strong SOC decreased during the follow-up period and, furthermore, was no more stable than a mediocre or weak SOC. There seems to be a clear and independent association with the intentions to retire early among both men and women following full adjustment. Swedish speakers appear to be less inclined to retire early than Finnish speakers. In the light of the present study, it seems that SOC is determined not only by socio-economic factors but also by close and successful social relationships during both childhood and adulthood. This applied to both genders and language groups. Interventions aimed at promoting the health of the disadvantaged should therefore focus on families with children, and extend later also to other than socio-economic spheres of life. SOC theory could also be applied in efforts to inhibit early retirement: management practices aimed at providing employees with a work environment and tasks that are comprehensible, manageable and meaningful could potentially decrease the intentions to retire early.

Reliability Analysis of Earth Dams

In the present study, results of reliability analyses of four selected rehabilitated earth dam sections, i.e., Chang, Tapar, Rudramata, and Kaswati, under pseudostatic loading conditions, are presented. Using the response surface methodology, in combination with first order reliability method and numerical analysis, the reliability index (beta) values are obtained and results are interpreted in conjunction with conventional factor of safety values. The influence of considering variability in the input soil shear strength parameters, horizontal seismic coefficient (alpha(h)), and location of reservoir full level on the stability assessment of the earth dam sections is discussed in the probabilistic framework. A comparison of results with those obtained from other method of reliability analysis, viz., Monte Carlo simulations combined with limit equilibrium approach, provided a basis for discussing the stability of earth dams in probabilistic terms, and the results of the analysis suggest that the considered earth dam sections are reliable and are expected to perform satisfactorily.

Organisation Carescapes: Researching Organisations, Work and Care

This working paper develops an approach to the analysis of care as it is evident in the policies and practices of employing organisations. We identify how notions of care are incorporated in myriad and multi-faceted ways that may support, survey and control workers, as well as having implications for employers, managers, employees and workers. Aspects of care can be found in a range of statutory duties, policies and related activities, including: health and safety, equality and diversity, parental leave, religious observance, bullying and harassment, personal development, voluntary redundancy, early retirement, employer pension schemes, grievance procedures, and dismissal. The conceptual framework of organisation carescapes is offered as an aid to the analysis of employee policies and services. These policies and services are transformed by shifts in supranational and national policies such as European Union (EU) economic strategies and national legislation on disability rights legislation, age discrimination and flexible working, and changes in labour market competitiveness. In conclusion, we consider how the framework of organisation carescapes is informing research design in our and our colleagues’ ongoing programme of research.

Total risk rating and stability analysis of embankment dams in the Kachchh Region, Gujarat, India

A method for total risk analysis of embankment dams under earthquake conditions is discussed and applied to the selected embankment dams, i.e., Chang, Tapar, Rudramata, and Kaswati located in the Kachchh region of Gujarat, India, to obtain the seismic hazard rating of the dam site and the risk rating of the structures. Based on the results of the total risk analysis of the dams, coupled non-linear dynamic numerical analyses of the dam sections are performed using acceleration time history record of the Bhuj (India) earthquake as well as five other major earthquakes recorded worldwide. The objective of doing so is to perform the numerical analysis of the dams for the range of amplitude, frequency content and time duration of input motions. The deformations calculated from the numerical analyses are also compared with other approaches available in literature, viz, Makdisi and Seed (1978) approach, Jansen's approach (1990), Swaisgood's method (1995), Bureau's method (1997). Singh et al. approach (2007), and Saygili and Rathje approach (2008) and the results are utilized to foresee the stability of dams in future earthquake scenario. (C) 2010 Elsevier B.V. All rights reserved.

Occupational chronic solvent encephalopathy in Finland 1995 - 2007 : incidence and diagnostic methods

The occurrence of occupational chronic solvent encephalopathy (CSE) seems to decrease, but still every year reveals new cases. To prevent CSE and early retirement of solvent-exposed workers, actions should focus on early CSE detection and diagnosis. Identifying the work tasks and solvent exposure associated with high risk for CSE is crucial. Clinical and exposure data of all the 128 cases diagnosed with CSE as an occupational disease in Finland during 1995-2007 was collected from the patient records at the Finnish Institute of Occupational Health (FIOH) in Helsinki. The data on the number of exposed workers in Finland were gathered from the Finnish Job-exposure Matrix (FINJEM) and the number of employed from the national workforce survey. We analyzed the work tasks and solvent exposure of CSE patients and the findings in brain magnetic resonance imaging (MRI), quantitative electroencephalography (QEEG), and event-related potentials (ERP). The annual number of new cases diminished from 18 to 3, and the incidence of CSE decreased from 8.6 to 1.2 / million employed per year. The highest incidence of CSE was in workers with their main exposure to aromatic hydrocarbons; during 1995-2006 the incidence decreased from 1.2 to 0.3 / 1 000 exposed workers per year. The work tasks with the highest incidence of CSE were floor layers and lacquerers, wooden surface finishers, and industrial, metal, or car painters. Among 71 CSE patients, brain MRI revealed atrophy or white matter hyperintensities or both in 38% of the cases. Atrophy which was associated with duration of exposure was most frequently located in the cerebellum and in the frontal or parietal brain areas. QEEG in a group of 47 patients revealed increased power of the theta band in the frontal brain area. In a group of 86 patients, the P300 amplitude of auditory ERP was decreased, but at individual level, all the amplitude values were classified as normal. In 11 CSE patients and 13 age-matched controls, ERP elicited by a multimodal paradigm including an auditory, a visual detection, and a recognition memory task under single and dual-task conditions corroborated the decrease of auditory P300 amplitude in CSE patients in single-task condition. In dual-task conditions, the auditory P300 component was, more often in patients than in controls, unrecognizable. Due to the paucity and non-specificity of the findings, brain MRI serves mainly for differential diagnostics in CSE. QEEG and auditory P300 are insensitive at individual level and not useful in the clinical diagnostics of CSE. A multimodal ERP paradigm may, however, provide a more sensitive method to diagnose slight cognitive disturbances such as CSE.

The hardness of approximating the boxicity, cubicity and threshold dimension of a graph

A k-dimensional box is the Cartesian product R-1 X R-2 X ... X R-k where each R-i is a closed interval on the real line. The boxicity of a graph G, denoted as box(G), is the minimum integer k such that G can be represented as the intersection graph of a collection of k-dimensional boxes. A unit cube in k-dimensional space or a k-cube is defined as the Cartesian product R-1 X R-2 X ... X R-k where each R-i is a closed interval oil the real line of the form a(i), a(i) + 1]. The cubicity of G, denoted as cub(G), is the minimum integer k such that G can be represented as the intersection graph of a collection of k-cubes. The threshold dimension of a graph G(V, E) is the smallest integer k such that E can be covered by k threshold spanning subgraphs of G. In this paper we will show that there exists no polynomial-time algorithm for approximating the threshold dimension of a graph on n vertices with a factor of O(n(0.5-epsilon)) for any epsilon > 0 unless NP = ZPP. From this result we will show that there exists no polynomial-time algorithm for approximating the boxicity and the cubicity of a graph on n vertices with factor O(n(0.5-epsilon)) for any epsilon > 0 unless NP = ZPP. In fact all these hardness results hold even for a highly structured class of graphs, namely the split graphs. We will also show that it is NP-complete to determine whether a given split graph has boxicity at most 3. (C) 2010 Elsevier B.V. All rights reserved.

Tree 3-spanners in 2-sep chordal graphs: Characterization and algorithms

A spanning tree T of a graph G is said to be a tree t-spanner if the distance between any two vertices in T is at most t times their distance in G. A graph that has a tree t-spanner is called a tree t-spanner admissible graph. The problem of deciding whether a graph is tree t-spanner admissible is NP-complete for any fixed t >= 4 and is linearly solvable for t <= 2. The case t = 3 still remains open. A chordal graph is called a 2-sep chordal graph if all of its minimal a - b vertex separators for every pair of non-adjacent vertices a and b are of size two. It is known that not all 2-sep chordal graphs admit tree 3-spanners This paper presents a structural characterization and a linear time recognition algorithm of tree 3-spanner admissible 2-sep chordal graphs. Finally, a linear time algorithm to construct a tree 3-spanner of a tree 3-spanner admissible 2-sep chordal graph is proposed. (C) 2010 Elsevier B.V. All rights reserved.