A case of suicide by self-injection of adrenaline.

Adrenaline (epinephrine) auto-injectors provide life-saving pre-hospital treatment for individuals experiencing anaphylaxis in a community setting. Errors in handling adrenaline auto-injectors, particularly by children and healthcare professionals, have been reported. Reports of adrenaline overdoses are limited in the medical literature. In most of these cases, accidental adrenaline administration results from medical error. Exogenous administration of catecholamine is responsible for cardiovascular and metabolic responses, which may cause supraventricular tachycardia, ventricular dysrhythmias and myocardial ischemia. The authors present a unique autopsy case involving a 34 year-old woman who intentionally self-injected adrenaline using an adrenaline auto-injector as part of a suicide plan. Catecholamines and metanephrines were measured in peripheral and cardiac blood as well as urine and vitreous humor. Based on the results of all postmortem investigations, the cause of death was determined to be cardiac dysrhythmia and cardiac arrest following adrenaline self-injection.

Säästämisen rakennemuutos – Case Nordea Pankki Suomi Oyj

Tutkimuksen tavoitteena on tutkia ja ymmärtää sitä todellisuutta, jossa asiakkaat tekevät päätöksiään säästämisen vaihtoehdoista sekä tutkia kuinka se on muuttunut viimeisten vuosien aikana. Mitkä tekijät ovat taustalla, kun todellisuus muuttuu? Mikä on eri osapuolten rooli tässä muutoksessa? Tutkielma koostuu teoreettisesta ja empiirisestä osioista. Teoreettinen osio on kirjoituspöytätutkimusta, jonka tietolähteinä ovat teoriakirjallisuus ja aikaisemmat tutkimukset säästämisen rakenteesta Suomessa ja asiakkaiden säästämisaikeista, -kohteista ja –motiiveista. Empiirisen osion aineisto koostuu 20 henkilökohtaisen pankkineuvojan ja 10 johtajan haastattelujen tulkinnasta, analysoinnista ja johtopäätöksistä. Henkilökohtaisten pankkineuvojien haastattelussa tuli ilmi, että säästämisen filosofia on muuttunut viimeisen kymmenen vuoden aikana. Säästämisen ajatus on lähentynyt sijoittamisen ajatusta. Tutkimuksessa ilmeni, että säästämisen todellisuus syntyy asiakkaiden, henkilökohtaisten pankkineuvojien ja pankinjohtajien vuorovaikutuksessa. Lisäksi merkittävässä vaikuttajan roolissa ovat myös viranomaiset, jotka säätävät puitteet säästämisen palveluiden tarjonnalle.

Optimal Exchange Rate Policy in a Growing Semi-Open Economy

This paper considers an alternative perspective to China's exchange rate policy. It studies a semi-open economy where the private sector has no access to international capital markets but the central bank has full access. Moreover, it assumes limited financial development generating a large demand for saving instruments by the private sector. The paper analyzes the optimal exchange rate policy by modeling the central bank as a Ramsey planner. Its main result is that in a growth acceleration episode it is optimal to have an initial real depreciation of the currency combined with an accumulation of reserves, which is consistent with the Chinese experience. This depreciation is followed by an appreciation in the long run. The paper also shows that the optimal exchange rate path is close to the one that would result in an economy with full capital mobility and no central bank intervention.

Jatkuvan säästämisen kohdentuminen ja sijoitustuotteiden kustannusrakenteista. Case: Etelä-Karjalan Osuuspankki

Tutkimuksen tavoitteena on selvittää Etelä-Karjalan Osuuspankin asiakkaiden jatkuvan säästämisen kohdentumista tulevaisuudessa ja samalla analysoida sijoitustuotteiden kustannusrakenteita pankin näkökulmasta. Lisaksi tutkitaan sijoittajien käyttäytymiseen vaikuttavia tekijöitä, vertaillaan eri tuotteiden arvoketjuissa kustannuksia aiheuttavia tekijöitä ja tuottojen muodostumista toisiinsa pyrkien saamaan tuotteille edullisuusjärjestys sekä selvitetään asiakkaiden ja pankin mieltymyksien kohtaamista. Tutkielman teoriaosassa määritellään käsitteet ja perehdytään aikaisempiin tutkimuksiin sijoittajakäyttäytymisestä. Teoriaosan pohjalta muodostetaan oletushypoteeseja, joita käytetään empiirisen osan jatkuvan säästämisen kyselytutkimuksen analysoinnissa. Kustannusrakenteita käsittelevässä empiirisessä osassa teoriaosaa hyödynnetään haastattelututkimuksen pohjana. Tutkimuksessa käytetään lähinnä toiminta-analyyttista tutkimusotetta. Tutkimustulosten mukaan sijoittajakäyttäytyminen tulee muuttumaan ja jatkuva säästäminen tulee kohdistumaan tileistä enemmän muihin sijoitustuotteisiin, erityisesti sijoitusrahastoihin. Sijoitustuotteiden kustannusrakenteissa ATK- ja henkilöstökulut aiheuttavat kannattavuuseroja tuotteiden välille.

Railroad Impact in Backward Economies: Spain, 1850-1913

This article reassesses the economic impact of Spanish railroads in 1850-1913, which has been usually considered to be substantially higher than in the most developed countries on the basis of the social saving methodology. The application of growth accounting techniques shows, by contrast, that the direct contribution of railroads to economic growth was lower in Spain than in the UK, mainly due to the low importance that railroad transport had within Spanish GDP before 1913.

The Aldosterone/Renin Ratio as a Diagnostic Tool for the Diagnosis of Primary Hypoaldosteronism in Newborns and Infants.

BACKGROUND/AIMS: Primary hypoaldosteronism is a rare inborn disorder with life-threatening symptoms in newborns and infants due to an aldosterone synthase defect. Diagnosis is often difficult as the plasma aldosterone concentration (PAC) can remain within the normal range and thus lead to misinterpretation and delayed initiation of life-saving therapy. We aimed to test the eligibility of the PAC/plasma renin concentration (PRC) ratio as a tool for the diagnosis of primary hypoaldosteronism in newborns and infants. Meth ods: Data of 9 patients aged 15 days to 12 months at the time of diagnosis were collected. The diagnosis of primary hypoaldosteronism was based on clinical and laboratory findings over a period of 12 years in 3 different centers in Switzerland. To enable a valid comparison, the values of PAC and PRC were correlated to reference methods. RESULTS: In 6 patients, the PAC/PRC ratio could be determined and showed constantly decreased values <1 (pmol/l)/(mU/l). In 2 patients, renin was noted as plasma renin activity (PRA). PAC/PRA ratios were also clearly decreased. The diagnosis was subsequently genetically confirmed in 8 patients. CONCLUSION: A PAC/PRC ratio <1 pmol/mU and a PAC/PRA ratio <28 (pmol/l)/(ng/ml × h) are reliable tools to identify primary hypoaldosteronism in newborns and infants and help to diagnose this life-threatening disease faster. © 2015 S. Karger AG, Basel.

Housing Wealth and Housing Decisions in Old Age: Sale and Reversion

Population ageing brings new challenges to long-term household economic decisions. In the event of old-age dependency, housing assets become a key self-insurance device. However, little empirical evidence has been reported regarding an individual"s expectations of having to use their housing wealth for such a purpose. This paper draws upon two complementary data sources to empirically examine: (1) the influence of housing assets on an individual"s willingness-to-sell (WTS) their dwelling for care purposes, and (2) the willingness to take out a reverse mortgage contract loan in the event of old-age dependency. The paper"s findings suggest that homeowners" WTS in old age is unaffected by their income or housing assets and is, rather, determined by socio-environmental housing characteristics and the individual"s health and personal needs. Conversely, the study finds that the uptake of home reversion loans is largely dependent on income or education, but not on a household"s housing assets.

Optical spectroscopy of microquasar candidates at low Galactic latitudes

We report optical spectroscopic observations of a sample of 6 low-galactic latitude microquasar candidates selected by cross-identification of X-ray and radio point source catalogs for |b|<5 degrees. Two objects resulted to be of clear extragalactic origin, as an obvious cosmologic redshift has been measured from their emission lines. For the rest, none exhibits a clear stellar-like spectrum as would be expected for genuine Galactic microquasars. Their featureless spectra are consistent with being extragalactic in origin although two of them could be also highly reddened stars. The apparent non-confirmation of our candidates suggests that the population of persistent microquasar systems in the Galaxy is more rare than previously believed. If none of them is galactic, the upper limit to the space density of new Cygnus X-3-like microquasars within 15 kpc would be 1.1\times10^{-12} per cubic pc. A similar upper limit for new LS 5039-like systems within 4 kpc is estimated to be 5.6\times10^{-11} per cubic pc.

Assessment of Immature Platelet Fraction in the Diagnosis of Wiskott-Aldrich Syndrome.

Children with Wiskott-Aldrich syndrome (WAS) are often first diagnosed with immune thrombocytopenia (ITP), potentially leading to both inappropriate treatment and the delay of life-saving definitive therapy. WAS is traditionally differentiated from ITP based on the small size of WAS platelets. In practice, microthrombocytopenia is often not present or not appreciated in children with WAS. To develop an alternative method of differentiating WAS from ITP, we retrospectively reviewed all complete blood counts and measurements of immature platelet fraction (IPF) in 18 subjects with WAS and 38 subjects with a diagnosis of ITP treated at our hospital. Examination of peripheral blood smears revealed a wide range of platelet sizes in subjects with WAS. Mean platelet volume (MPV) was not reported in 26% of subjects, and subjects in whom MPV was not reported had lower platelet counts than did subjects in whom MPV was reported. Subjects with WAS had a lower IPF than would be expected for their level of thrombocytopenia, and the IPF in subjects with WAS was significantly lower than in subjects with a diagnosis of ITP. Using logistic regression, we developed and validated a rule based on platelet count and IPF that was more sensitive for the diagnosis of WAS than was the MPV, and was applicable regardless of the level of platelets or the availability of the MPV. Our observations demonstrate that MPV is often not available in severely thrombocytopenic subjects, which may hinder the diagnosis of WAS. In addition, subjects with WAS have a low IPF, which is consistent with the notion that a platelet production defect contributes to the thrombocytopenia of WAS. Knowledge of this detail of WAS pathophysiology allows to differentiate WAS from ITP with increased sensitivity, thereby allowing a physician to spare children with WAS from inappropriate treatment, and make definitive therapy available in a timely manner.

Eri Säästämis- ja sijoitusinstrumentit eläkesäästäjän näkökulmasta

Tutkielmassa käsitellään eri sijoitus- ja säästämisinstrumentteja sekä niihin liittyviä ominaisuuksia. Tarkastelun kohteena ovat eri instrumenttien yleiset ominaisuudet, riskitasot ja tuotto-odotukset.

The Role of Railways in Export-Led Growth: The Case of Uruguay, 1870-1913

The social saving literature has highlighted the indispensable role that railways played before 1914 in several Latin American export-oriented economies, such as Mexico, Brazil and Argentina. The article analyses the case of Uruguay, a country that, by 1914, had built one of the densest railway networks in Latin America. The article shows that, in contrast to what happened in other economies of the region, the resource saving effects of the Uruguayan railways during the first globalisation were tiny due to the small share that railway output accounted for within the country's gross domestic product (GDP). Three complementary reasons are suggested to explain that result, namely: the geographical structure of the country; its sectoral specialisation; and the small scale of the Uruguayan economy. Due to these three characteristics, Uruguay was unable to benefit from railways in the way that other export-oriented Latin American economies did during the first period of globalisation. This conclusion draws attention to the geographic-specific character of railway technology.

Successful Surgical Pulmonary Embolectomy for Massive Perinatal Embolism after Emergency Cesarean Section.

Pregnant women are exposed to an increased risk for developing pulmonary embolism (PE), a main cause for maternal mortality. Surgical pulmonary embolectomy is one important therapeutic and potential life-saving armamentarium, considering pregnancy as a relative contraindication for thrombolysis. We present a case of a 36-year-old woman with massive bilateral PE after emergent caesarean delivery, requiring reanimation by external heart massage. The onset of massive intrauterine bleeding contraindicated thrombolysis and emergency surgical pulmonary embolectomy, followed by a hysterectomy, were preformed successfully. Acute surgical pulmonary embolectomy may be an option in critically diseased high-risk patients, requiring a multiteam approach, and should be part of the therapeutic armamentarium of the attending cardiac surgeon.

An outcome and cost analysis of anal fistula plug insertion vs endorectal advancement flap for complex anal fistulae.

AIM: The study aimed to compare the rate of success and cost of anal fistula plug (AFP) insertion and endorectal advancement flap (ERAF) for anal fistula. METHOD: Patients receiving an AFP or ERAF for a complex single fistula tract, defined as involving more than a third of the longitudinal length of of the anal sphincter, were registered in a prospective database. A regression analysis was performed of factors predicting recurrence and contributing to cost. RESULTS: Seventy-one patients (AFP 31, ERAF 40) were analysed. Twelve (39%) recurrences occurred in the AFP and 17 (43%) in the ERAF group (P = 1.00). The median length of stay was 1.23 and 2.0 days (P < 0.001), respectively, and the mean cost of treatment was euro5439 ± euro2629 and euro7957 ± euro5905 (P = 0.021), respectively. On multivariable analysis, postoperative complications, underlying inflammatory bowel disease and fistula recurring after previous treatment were independent predictors of de novo recurrence. It also showed that length of hospital stay ≤ 1 day to be the most significant independent contributor to lower cost (P = 0.023). CONCLUSION: Anal fistula plug and ERAF were equally effective in treating fistula-in-ano, but AFP has a mean cost saving of euro2518 per procedure compared with ERAF. The higher cost for ERAF is due to a longer median length of stay.

Effects of unit - based pricing on the waste collection demand : a meta - regression analysis

We perform a meta - analysis of 21 studies that estimate the elasticity of the price of waste collection demand upon waste quantities, a prior literature review having revealed that the price elasticity differs markedly. Based on a meta - regression with a total of 65 observations, we find no indication that municipal data give higher estimates for price elasticities than those associated with household data. Furthermore, there is no evidence that treating prices as exogenous underestimates the price elasticity. We find that much of the variation can be explained by sample size, the use of a weight - based as opposed to a volume - based pricing system, and the pricing of compostable waste. We also show that price elasticities determined in the USA and point estimations of elasticities are more elastic, but these effects are not robust to the changing of model specifications. Finally, our tests show that there is no evidence of publication bias while there is some evidence of the existence of genuine empirical effect.

PCI DSS -standardi ja sen vaatimukset kortinhaltijoiden tietojen suojaamiselle

Payment Card Industry Data Security Standard (PCI DSS) on korttiyhtiöiden kehittämä kansainvälinen tietoturvastandardi, jonka tarkoituksena on parantaa kortinhaltijoiden tietoja käsittelevien järjestelmien tietoturvaa. Standardissa määritellään vaatimukset tietojen turvalliselle tallennukselle ja käsittelylle, testaus- ja tarkastusmenetelmät sekä tarkastusvaatimukset ja tarkastuksia suorittavien tahojen sertifiointi. Standardi koskee kaikkia standardin hyväksyneiden maksukorttiyhtiöiden korttitietoja käsitteleviä tahoja. Standardin ylläpitämisestä ja kehittämisestä vastaa maksukorttiyhtiöiden perustama PCI Security Standards Council -toimielin. Syyskuussa 2006 toimielin julkaisi standardista version 1.1, joka on edelleen viimeisin versio. Tässä diplomityössä selvitettiin PCI DSS -standardin asettamat vaatimukset kortinhaltijoiden tietoja käsitteleville tahoille. Lisäksi tutkittiin mahdollisuuksia toteuttaa yksi standardin vaatimuksista, kortinhaltijoiden tietojen suojaaminen, esimerkkijärjestelmässä. Kyseinen järjestelmä on kehitetty IBM System i -palvelinympäristöön käyttäen RPG-ohjelmointikieltä.