Wiborgs slott

Helsingfors : A.W. Gröndahl & A.C. Öhman 1845 : Dresden, Adler u. Dietze

Sawonlinna

Helsingfors : A.W. Gröndahl & A.C. Öhman 1845 : Dresden, Adler u. Dietze

Ämmäkoski vid Kajana

Helsingfors : A.W. Gröndahl & A.C. Öhman 1845 : Dresden, Adler u. Dietze

Lauritsala

Helsingfors : A.W. Gröndahl & A.C. Öhman 1845 : Dresden, Adler u. Dietze

Svensksund mid Fort Slava

Helsingfors : A.W. Gröndahl & A.C. Öhman 1845 : Dresden, Adler u. Dietze

Points to consider for prioritizing clinical genetic testing services: a European consensus process oriented at accountability for reasonableness.

Given the cost constraints of the European health-care systems, criteria are needed to decide which genetic services to fund from the public budgets, if not all can be covered. To ensure that high-priority services are available equitably within and across the European countries, a shared set of prioritization criteria would be desirable. A decision process following the accountability for reasonableness framework was undertaken, including a multidisciplinary EuroGentest/PPPC-ESHG workshop to develop shared prioritization criteria. Resources are currently too limited to fund all the beneficial genetic testing services available in the next decade. Ethically and economically reflected prioritization criteria are needed. Prioritization should be based on considerations of medical benefit, health need and costs. Medical benefit includes evidence of benefit in terms of clinical benefit, benefit of information for important life decisions, benefit for other people apart from the person tested and the patient-specific likelihood of being affected by the condition tested for. It may be subject to a finite time window. Health need includes the severity of the condition tested for and its progression at the time of testing. Further discussion and better evidence is needed before clearly defined recommendations can be made or a prioritization algorithm proposed. To our knowledge, this is the first time a clinical society has initiated a decision process about health-care prioritization on a European level, following the principles of accountability for reasonableness. We provide points to consider to stimulate this debate across the EU and to serve as a reference for improving patient management.

Influence of heart motion on cardiac output estimation by means of electrical impedance tomography: a case study.

Electrical impedance tomography (EIT) is a non-invasive imaging technique that can measure cardiac-related intra-thoracic impedance changes. EIT-based cardiac output estimation relies on the assumption that the amplitude of the impedance change in the ventricular region is representative of stroke volume (SV). However, other factors such as heart motion can significantly affect this ventricular impedance change. In the present case study, a magnetic resonance imaging-based dynamic bio-impedance model fitting the morphology of a single male subject was built. Simulations were performed to evaluate the contribution of heart motion and its influence on EIT-based SV estimation. Myocardial deformation was found to be the main contributor to the ventricular impedance change (56%). However, motion-induced impedance changes showed a strong correlation (r = 0.978) with left ventricular volume. We explained this by the quasi-incompressibility of blood and myocardium. As a result, EIT achieved excellent accuracy in estimating a wide range of simulated SV values (error distribution of 0.57 ± 2.19 ml (1.02 ± 2.62%) and correlation of r = 0.996 after a two-point calibration was applied to convert impedance values to millilitres). As the model was based on one single subject, the strong correlation found between motion-induced changes and ventricular volume remains to be verified in larger datasets.

Aortic blood pressure measured via EIT: investigation of different measurement settings.

Electrical impedance tomography (EIT) allows the measurement of intra-thoracic impedance changes related to cardiovascular activity. As a safe and low-cost imaging modality, EIT is an appealing candidate for non-invasive and continuous haemodynamic monitoring. EIT has recently been shown to allow the assessment of aortic blood pressure via the estimation of the aortic pulse arrival time (PAT). However, finding the aortic signal within EIT image sequences is a challenging task: the signal has a small amplitude and is difficult to locate due to the small size of the aorta and the inherent low spatial resolution of EIT. In order to most reliably detect the aortic signal, our objective was to understand the effect of EIT measurement settings (electrode belt placement, reconstruction algorithm). This paper investigates the influence of three transversal belt placements and two commonly-used difference reconstruction algorithms (Gauss-Newton and GREIT) on the measurement of aortic signals in view of aortic blood pressure estimation via EIT. A magnetic resonance imaging based three-dimensional finite element model of the haemodynamic bio-impedance properties of the human thorax was created. Two simulation experiments were performed with the aim to (1) evaluate the timing error in aortic PAT estimation and (2) quantify the strength of the aortic signal in each pixel of the EIT image sequences. Both experiments reveal better performance for images reconstructed with Gauss-Newton (with a noise figure of 0.5 or above) and a belt placement at the height of the heart or higher. According to the noise-free scenarios simulated, the uncertainty in the analysis of the aortic EIT signal is expected to induce blood pressure errors of at least ± 1.4 mmHg.

Polychlorinated and polybrominated biphenyls

This volume of the IARC Monographs provides evaluations of the carcinogenicity of polychlorinated biphenyls and polybrominated biphenyls. Polychlorinated biphenyls are a class of aromatic compounds comprising 209 congeners, each containing 1 to 10 chlorine atoms attached to a biphenyl nucleus. Technical products, which were manufactured to obtain a certain degree of chlorination, are mixtures of numerous congeners. These products were widely used as dielectric fluid in capacitors and transformers, and to a lesser extent in building materials. Although their production and use has been banned in most countries, these compounds are ubiquitous environmental pollutants, including in polar regions and the deep ocean, because they are persistent and bioaccumulate. Worldwide monitoring programmes have shown that polychlorinated biphenyls are present in most samples of human milk. An IARC Monographs Working Group reviewed epidemiological evidence, animal bioassays, and mechanistic and other relevant data to reach conclusions as to the carcinogenic hazard to humans of polychlorinated biphenyls, of the subclass of dioxinlike polychlorinated biphenyls, and of polybrominated biphenyls.

Turvallista liikkumista tukevat sisäkengät ikäihmisille vanhuskeskusympäristöön

Tutkimuksen tarkoituksena oli selvittää, minkälaisia sisäkenkiä ikäihmiset käyttävät vanhustenkeskuksessa ja arvioida, millä tavalla he kävelevät. Tutkimus toteutettiin Helsingissä Kustaankartanon vanhustenkeskuksen F1-osastolla maalis-huhtikuussa 2007 osana IKU-pojektia. Tutkimukseen osallistui seitsemän 70 - 94-vuotiasta, itsenäisesti ja ilman apuvälineitä liikkuvaa naisasukasta. Viisi tutkittavista käytti Pirka-sisäkenkiä, yksi sandaaleja ja yksi tohveleita. Tutkimusstrategia oli kvantitatiivis-kvalitatiivinen ja tietoa kerättiin havainnointi- ja arviointilomakkeilla sekä videotallentein. Tulokset esitettiin frekvensseinä ja prosenttiosuuksina sekä kävelyn arviointi laadullisena kuvauksena. Lähes kaikilla asukkailla oli ehjä ja terve iho. Melkein kaikilla tutkituista todettiin vaivaisenluu ja levinnyt päkiä. Vasaravarpaita ja kynsimuutoksia havaittiin alle puolella. Ikäihmisten kengistä suurin osa oli pituudeltaan sopivia, eikä kantakapissa ollut muutoksia. Kahdella oli venymisjälkiä kengän kärkiosassa. Kävelyssä oli havaittavissa normaaleja ikääntymiseen liittyviä muutoksia, jotka olivat yksilöllisiä. Osalla asukkaista varvastyöntö oli heikentynyt ja nilkan liikelaajuus koukistussuuntaan oli pienentynyt sekä osalla kävely oli matalaa ja laahaavaa. Osalla ikäihmisistä kengät olivat huonosti kiinnitetty. Kantapään ja kengän kantaosan väliin jäi 1 - 2 cm:n rako, jolloin kengät ei tue jalkaterän toimintoja ja kaatumisriski lisääntyy. Tulosten mukaan ikäihmiset näyttäisivät tarvitsevan ohjausta oikeanlaisten sisäkenkien valinnassa. Kenkien valinnassa keskeistä on huomioida yksilölliset tarpeet, jotta jokainen ikäihminen saa kävellä omille jalkaterille sopivilla kengillä. Pirka-kenkiä olisi hyvä kehittää ikäihmisten tarpeiden mukaisesti. Jalkaterapeutit ja jalkojenhoitajat voivat hyödyntää tutkimustuloksia antaessa ohjeita sisäkenkien valinnassa. Koska osalla asukkaista on jalkaterän etuosan virheasentoja, jotka vaativat leveämmän lestin sekä kärjen muodon naisten malliin, Pirka-kengässä voisi olla naisten koossa kahta erimallista kärkiosaa sekä leveyttä.

Mechanisms of Antifungal Drug Resistance.

Antifungal therapy is a central component of patient management for acute and chronic mycoses. Yet, treatment choices are restricted because of the sparse number of antifungal drug classes. Clinical management of fungal diseases is further compromised by the emergence of antifungal drug resistance, which eliminates available drug classes as treatment options. Once considered a rare occurrence, antifungal drug resistance is on the rise in many high-risk medical centers. Most concerning is the evolution of multidrug- resistant organisms refractory to several different classes of antifungal agents, especially among common Candida species. The mechanisms responsible are mostly shared by both resistant strains displaying inherently reduced susceptibility and those acquiring resistance during therapy. The molecular mechanisms include altered drug affinity and target abundance, reduced intracellular drug levels caused by efflux pumps, and formation of biofilms. New insights into genetic factors regulating these mechanisms, as well as cellular factors important for stress adaptation, provide a foundation to better understand the emergence of antifungal drug resistance.

Non-invasive prenatal testing for aneuploidy and beyond: challenges of responsible innovation in prenatal screening.

This paper contains a joint ESHG/ASHG position document with recommendations regarding responsible innovation in prenatal screening with non-invasive prenatal testing (NIPT). By virtue of its greater accuracy and safety with respect to prenatal screening for common autosomal aneuploidies, NIPT has the potential of helping the practice better achieve its aim of facilitating autonomous reproductive choices, provided that balanced pretest information and non-directive counseling are available as part of the screening offer. Depending on the health-care setting, different scenarios for NIPT-based screening for common autosomal aneuploidies are possible. The trade-offs involved in these scenarios should be assessed in light of the aim of screening, the balance of benefits and burdens for pregnant women and their partners and considerations of cost-effectiveness and justice. With improving screening technologies and decreasing costs of sequencing and analysis, it will become possible in the near future to significantly expand the scope of prenatal screening beyond common autosomal aneuploidies. Commercial providers have already begun expanding their tests to include sex-chromosomal abnormalities and microdeletions. However, multiple false positives may undermine the main achievement of NIPT in the context of prenatal screening: the significant reduction of the invasive testing rate. This document argues for a cautious expansion of the scope of prenatal screening to serious congenital and childhood disorders, only following sound validation studies and a comprehensive evaluation of all relevant aspects. A further core message of this document is that in countries where prenatal screening is offered as a public health programme, governments and public health authorities should adopt an active role to ensure the responsible innovation of prenatal screening on the basis of ethical principles. Crucial elements are the quality of the screening process as a whole (including non-laboratory aspects such as information and counseling), education of professionals, systematic evaluation of all aspects of prenatal screening, development of better evaluation tools in the light of the aim of the practice, accountability to all stakeholders including children born from screened pregnancies and persons living with the conditions targeted in prenatal screening and promotion of equity of access.

Reducing Cardiovascular Mortality Through Prevention and Management of Raised Blood Pressure: A World Heart Federation Roadmap.

Prospective epidemiological data have shown that blood pressure has a graded, continuous adverse effect on the risk of various forms of CVD (including stroke, myocardial infarction, heart failure, peripheral arterial disease and end-stage renal disease). 'Raised blood pressure' is frequently considered to be any systolic blood pressure greater than 115 mmHg. It accounts for 45% of all heart disease deaths and 51% of all stroke-related deaths [1], which together are the biggest causes of morbidity and mortality worldwide [2,3,4]. Annually, there are >17 million deaths due to CVD worldwide, of which 9.4 million are attributable to complications of raised blood pressure. This highlights the importance of both high-risk and population-based strategies in blood pressure management and control.