Investigating the effect of Eye Movement Desensitization and Reprocessing (EMDR) on postoperative pain intensity in adolescents undergoing surgery: A randomized controlled trial

Aim To investigate the efficacy of Eye Movement Desensitization and Reprocessing for postoperative pain management in adolescents. Background Eye Movement Desensitization and Reprocessing is an inexpensive, non-pharmacological intervention that has successfully been used to treat chronic pain. It holds promise in the treatment of acute, postsurgical pain based on its purported effects on the brain and nervous system. Design A randomized controlled trial was used. Methods Fifty-six adolescent surgical patients aged between 12-18 years were allocated to gender-balanced Eye Movement Desensitization and Reprocessing (treatment) or non-Eye Movement Desensitization and Reprocessing (control) groups. Pain was measured using the Wong-Baker FACES® Pain Rating Scale (WBFS) before and after the intervention (or non-intervention for the control group). Findings A Wilcoxon signed-rank test demonstrated that the Eye Movement Desensitization and Reprocessing group experienced a significant reduction in pain intensity after treatment intervention, whereas the control group did not. Additionally, a Mann–Whitney U-test showed that, while there was no significant difference between the two groups at time 1, there was a significant difference in pain intensity between the two groups at time 2, with the Eye Movement Desensitization and Reprocessing group experiencing lower levels of pain. Conclusion These results suggest that Eye Movement Desensitization and Reprocessing may be an effective treatment modality for postoperative pain.

Scouts, Promoters, and Connectors: The Roles of Ratings in Nearest-Neighbor Collaborative Filtering

Recommender systems aggregate individual user ratings into predictions of products or services that might interest visitors. The quality of this aggregation process crucially affects the user experience and hence the effectiveness of recommenders in e-commerce. We present a characterization of nearest-neighbor collaborative filtering that allows us to disaggregate global recommender performance measures into contributions made by each individual rating. In particular, we formulate three roles-scouts, promoters, and connectors-that capture how users receive recommendations, how items get recommended, and how ratings of these two types are themselves connected, respectively. These roles find direct uses in improving recommendations for users, in better targeting of items and, most importantly, in helping monitor the health of the system as a whole. For instance, they can be used to track the evolution of neighborhoods, to identify rating subspaces that do not contribute ( or contribute negatively) to system performance, to enumerate users who are in danger of leaving, and to assess the susceptibility of the system to attacks such as shilling. We argue that the three rating roles presented here provide broad primitives to manage a recommender system and its community.

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.

Every method counts

In this study we explore the concurrent, combined use of three research methods, statistical corpus analysis and two psycholinguistic experiments (a forced-choice and an acceptability rating task), using verbal synonymy in Finnish as a case in point. In addition to supporting conclusions from earlier studies concerning the relationships between corpus-based and ex- perimental data (e. g., Featherston 2005), we show that each method adds to our understanding of the studied phenomenon, in a way which could not be achieved through any single method by itself. Most importantly, whereas relative rareness in a corpus is associated with dispreference in selection, such infrequency does not categorically always entail substantially lower acceptability. Furthermore, we show that forced-choice and acceptability rating tasks pertain to distinct linguistic processes, with category-wise in- commensurable scales of measurement, and should therefore be merged with caution, if at all.

With Good Reputation Size Does not Matter: Issue Frequency and the Determinants of Debt Maturity

This paper examines empirically the effect firm reputation has on the determinants of debt maturity. Utilising data from European primary bond market between 1999 and 2005, I find that the maturity choice of issuers with a higher reputation is less sensitive to macroeconomic conditions, market credit risk-premiums, prevailing firm credit quality and size of the debt issue. The annualised coupon payments are shown to be a significant factor in determining the debt maturity and reveal a monotonously increasing relationship between credit quality and debt maturity once controlled for. Finally, I show that issuers lacking a credit rating have an implied credit quality positioned between investment-grade and speculative-grade debt.

Grid interfacing of a photovoltaic system using a chain cell converter

With the rapid development of photovoltaic system installations and increased number of grid connected power systems, it has become imperative to develop an efficient grid interfacing instrumentation suitable for photovoltaic systems ensuring maximum power transfer. The losses in the power converter play an important role in the overall efficiency of a PV system. Chain cell converter is considered to be efficient as compared to PWM converters due to lower switching losses, modularized circuit layout, reduced voltage rating of the converter switches, reduced EMI. The structure of separate dc sources in chain cell converter is well suited for photovoltaic systems as there will b several separate PV modules in the PV array which can act as an individual dc source. In this work, a single phase multilevel chain cell converter is used to interface the photovoltaic array to a single phase grid at a frequency of 50Hz. Control algorithms are developed for efficient interfacing of the PV system with grid and isolating the PV system from grid under faulty conditions. Digital signal processor TMS320F 2812 is used to implement the control algorithms developed and for the generation of other control signals.

Köyhyyden perintö : Tutkimus kulttuurisen tiedon sisällöistä ja jatkuvuuksista suomalaisissa elämäkerta- ja sananlaskuaineistoissa

The Legacy of Poverty. A Study of the substance and continuity of cultural knowledge in Finnish biographical and proverbial texts The study focuses on the idea of the cultural knowledge and shared understanding that ordinary people, folk , have of the concepts and ideas about rural based poverty in Finland. Throughout 19th century and well into 20th century, the majority of the population remained agrarian and poor. By the 1950s, most people still lived in rural areas and a majority of them earned their living primarily from agriculture and forestry. Urbanization proceeded rapidly from the 1960s onwards. Even though the Nordic welfare state was firmly established in Finland by the 1970s, old forms of agrarian poverty still remained in the culture. The source material for the study consists of 99 biographies and 502 proverbs. Biographical texts include written autobiographies and interviewed biographies. A primary analyzing concept is called a poverty speech. The poverty speech has been analyzed by providing answers to the following three questions: What connotations do people attach to poverty when they speak about it? What sort of social relations arise when people speak about poverty? How is the past experience of poverty constructed in the present and in the welfare state context? Cultural knowledge is a theoretical and analytical tool that enables people to categorize information. The three questions stated above are crucial in revealing the schematic structure that people use to communicate about agrarian poverty. Categories are analyzed and processed in terms of cultural themes that contain the ideals and stereotypes of spoken motif and sub-themes. The application of theoretical and analytical premises to the poverty speech has shown that there are four cultural themes. The first theme is Power. The social connotations in the poverty speech are mostly in relation to the better-off people. Poverty does not exist without an awareness of welfare, i.e. the understanding of a certain standard of welfare above that of one's own. The second theme is about family ties as a resource and welfare network. In poverty speech, marriage is represented as a means to upgrade one's livelihood. Family members are described as supporting one another, but at the same time as being antagonists. The third theme, Work represents the work ethic that is being connected to the poverty. Hard working as a representation is attached to eligibility for `a good life´ that in Finland was to become an owner-occupier of a cottage or a flat. The fourth theme is Security. The resentment of unfair treatment is expressed by using moral superiority and rational explanations. The ruling classes in the agrarian society are portrayed as being evil and selfish with no social conscience because they did not provide enough assistance to those who needed it. During the period when the welfare benefit system was undeveloped, the poor expected the wealthier people to make a contribution to the distribution of material wealth. In the premises of cultural knowledge, both oral and written traditions are about human thinking: they deal with topics, ideas and evaluations that are relevant to their bearers. Many elements expressed in poverty speech, such as classifications and customs derived from the rural world, have been carried over into the next generation in newer contexts and a different cultural environment. Keywords: cultural knowledge, cognitive categorization, poverty, life stories, proverbs

Vieraan aksentin arviointi ja mittaaminen suomessa

In the field of second language (L2) acquisition, the term `foreign accent´ is often used to refer to speech characteristics that differ from the pronunciation of native speakers. Foreign accent may affect the intelligibility and perceived comprehensibility of speech and it is also sometimes associated with negative attitudes. The degree of L2 learners foreign accent and the speech characteristics that account for it have previously been studied through speech perception experiments and acoustic measurements. Perception experiments have shown that native listeners are easily able to identify foreign accent in speech. However to date, no studies have been done on the assessment of foreign accent in the speech of non-native speakers of Finnish. The aim of this study is to examine how native speakers of Finnish rate the degree of foreign accentedness in the speech of Russian L2 learners of Finnish. Furthermore, phonetic analysis is used to study the characteristics of speech that affect the perceived strength of foreign accent. Altogether 96 native speakers of Finnish listened to excerpts of read-aloud and spontaneous Finnish speech from ten Russian and six Finnish female speakers. The Russian speakers were intermediate and advanced learners of Finnish and had all immigrated to Finland as adults. Among the listeners, was a group of teachers of Finnish as an L2, and it was presumed that these teachers had been exposed to foreign accent in Finnish and were used to hearing it. The temporal aspects and segmental properties of speech were phonetically analysed in the speech of the Russian speakers in order to measure their effect on the perceived degree of accent. Although wide differences were observed in the use of the rating scale among the listeners, they were still quite unanimous on which speakers had the strongest foreign accent and which had the mildest. The listeners background factors had little effect on their ratings, and the ratings of the teachers of Finnish as an L2 did not differ from those of the other listeners. However, a clear difference was noted in the ratings of the two types of stimuli used in the perception experiment: the read-aloud speech was rated as more strongly accented than the spontaneous speech. It is important to note that the assessment of foreign accent is affected by many factors and their complex interactions in the experimental setting. Futher the study found that, both the temporal aspects of speech, often associated with fluency, and the number of single deviant phonetic segments contributed to the perceived degree of accentedness in the speech of the native Russian speakers.

Pain measurement and management in elderly patients : Clinical studies in long term hospital care and after cardiac surgery

The proportion of patients over 75 years of age, receiving all different types of healthcare, is constantly increasing. The elderly undergo surgery and anaesthetic procedures more often than middle-aged patients. Poor pain management in the elderly is still an issue. Although the elderly consumes the greatest proportion of prescribed medicines in Western Europe, most clinical pharmacological studies have been performed in healthy volunteers or middle-aged patients. The aim of this study was to investigate pain measurement and management in cognitively impaired patients in long term hospital care and in cognitively normal elderly patients after cardiac surgery. This thesis incorporated 366 patients, including 86 home-dwelling or hospitalized elderly with chronic pain and 280 patients undergoing cardiac surgery with acute pain. The mean age of patients was 77 (SD ± 8) years and approximately 8400 pain measurements were performed with four pain scales: Verbal Rating Scale (VRS), the Visual Analogue Scale (VAS), the Red Wedge Scale (RWS), and the Facial Pain Scale (FPS). Cognitive function, depression, functional ability in daily life, postoperative sedation and postoperative confusion were assessed with MMSE, GDS, Barthel Index, RASS, and CAM-ICU, respectively. The effects and plasma concentrations of fentanyl and oxycodone were measured in elderly (≥ 75 years) and middle-aged patients (≤ 60 years) and the opioid-sparing effect of pregabalin was studied after cardiac surgery. The VRS pain scores after movement correlated with the Barthel Index. The VRS was most successful in the groups of demented patients (MMSE 17-23, 11-16 and ≤ 10) and in elderly patients on the first day after cardiac surgery. The elderly had a higher plasma concentration of fentanyl at the end of surgery than younger patients. The plasma concentrations of oxycodone were comparable between the groups. Pain intensity on the VRS was lower and the sedation scores were higher in the elderly. Total oxycodone consumption during five postoperative days was reduced by 48% and the CAM-ICU scores were higher on the first postoperative day in the pregabalin group. The incidence of postoperative pain during movement was lower in the pregabalin group three months after surgery. This investigation demonstrates that chronic pain did not seem to impair daily activities in home-dwelling Finnish elderly. The VRS appeared to be applicable for elderly patients with clear cognitive dysfunction (MMSE ≤17) and it was the most feasible pain scale for the early postoperative period after cardiac surgery. After cardiac surgery, plasma concentrations of fentanyl in elderly were elevated, although oxycodone concentrations were at similar level compared to middle-aged patients. The elderly had less pain and were more sedated after doses of oxycodone. Therefore, particular attention must be given to individual dosing of the opioids in elderly surgical patients, who often need a smaller amount for adequate analgesia than middle-aged patients. The administration of pregabalin reduced postoperative oxycodone consumption after cardiac surgery. Pregabalin-treated patients had less confusion, and additionally to less postoperative pain on the first postoperative day and during movement at three months post-surgery. Pregabalin might be a new alternative as analgesic for acute postoperative and chronic pain management in the elderly. Its clinical role and safety remains to be verified in large-scale randomized and controlled studies. In the future, many clinical trials in the older category of patients will be needed to facilitate improvements in health care methods.

Turvallinen koulu? : Helsinkiläisten peruskoulujen turvallisuuskulttuurista ja siihen vaikuttavista tekijöistä

Objectives. This study concentrated on the aspect of physical safety in the learning environment of primary and secondary schools in Helsinki. Taking a broad perspective, the study analysed the safety culture of Helsinki schools, ranked them with a point rating system, and thoroughly investigated reasons behind their differences. Safety culture in educa-tional institutions has not been studied previously although research related to safety culture in business is abundant and some studies have considered safety culture in the healthcare sector. The study focused on the attitudes and practices of teachers concerning safety. The main research question is as follows: "What factors related to safety culture distinguish schools with an exceptional safety culture from those weaker one?" Research methods. The study used a mixed-methods approach. It s quantitative part charted the safety attitudes, values and expertise of employees in selected schools. The study also analysed physical safety in selected schools through specific safety inspections. The 14 schools in the study were selected randomly, two from each district. Altogether 388 of 475 employees returned a Webropol questionnaire (N= 475, 81,68 %). The qualitative part of the study analysed the reasons behind perceived differences in school s safety cul-ture using theme interviews with school principals. Elements of a phenomenographic research approach were also used. Results and conclusions. According to the study the distinctive features of good safety cultures in the Helsinki schools included a well-developed understanding of safety hazards and the requirements of basic safety, good safety management practices, a developed understanding of the systematic nature of safety, an appreciation of safety evidenced through everyday practices and open and communal safety-related work. The study offers result-based safety culture improvements for teachers, those responsible for school safety, principals, educational administrators, teacher educators and authorities.

Essays on labour demand and wage formation

The first essay in this thesis is on gender wage differentials among manufacturing sector white-collar workers. The wage differential is decomposed into firm, job (within-firm) and individ-ual-level components. Job-level gender segregation explains over half of the gap, while firm-level segregation is not important. After controlling for firm, job and individual characteristics, the remaining unexplained wage cap to the advantage of men is six per cent of men s mean wage. In the second essay, I study how the business cycle and gender affect the distribution of the earnings losses of displaced workers. The negative effect of displacement is large, persistent and strongest in the lowest earnings deciles. The effect is larger in a recession than in a recov-ery period, and in all periods women s earnings drop more than men s earnings. The third essay shows that the transition from steady employment to disability pension de-pends on the stringency of medical screening and the degree of experience-rating of pension costs applied to the employer. The fact that firms have to bear part of the cost of employees disability pension costs lowers both the incidence of long sick leave periods and the probabil-ity that sick leave ends in a disability pension. The fourth and fifth essays are studies on the employment, wage and profit effects of a re-gional payroll tax cut experiment conducted in northern and eastern Finland. The results show no statistically significant effect on any of the response variables.

The Role of Electronic Word of Mouth in Shaping Consumer Attitudes

The purpose of this research was to investigate the role of electronic word of mouth (eWOM) in shaping consumer attitudes towards various products and services with concentration on the consumer attitude change. eWOM has long been proven to play an important role in influencing consumer attitudes and has been researched from a variety of perspectives. This study attempts to look deeper into the process of consumer attitude change by applying as the central theory of the study the Elaboration Likelihood Model of Persuasion by Petty and Cacioppo. In the processes of examining the background academic and empirical research the Internet and Web 2.0 are closely depicted in order to understand how throughout the past centuries technology allowed the rise of various mediums where consumers can not only share their opinions online about products and services but also communicate with other consumers. Manuel Castel’s Internet Galaxy, Gildin’s, Carl and Noland’s, Hennig-Thurau, Gwinner, Walsh and Gremler’s researches on eWOM are the central works that helped to shape both the theoretical and empirical parts of this study. The mixed method approach was chosen as a research method for this study. An online survey was conducted via the Surveymonkey.com platform and eight qualitative in-depth interviews were conducted. The results of the study show that central route queues as text quality and text argumentativeness are more prominent among the research subjects and the peripheral route queues: source credibility and source expertise did not show considerable significance. Also more experience and participation consumers have with user-rating websites and applications more inclined they are to elaborate on the central route cues and are more likely to search for opinions that they consider rational and credible. Also these respondents are less inclined to search for ratings that confirm their existing beliefs about products or services. Less experience/participation they have about eWOM more likely they are to search for reviews confirmatory to their own.

Five-level inverter scheme for an open-end winding induction machine with less number of switches

Higher level of inversion is achieved with a less number of switches in the proposed scheme. The scheme proposes a five-level inverter for an open-end winding induction motor which uses only two DC-link rectifiers of voltage rating of Vdc/4, a neutral-point clamped (NPC) three-level inverter and a two-level inverter. Even though the two-level inverter is connected to the high-voltage side, it is always in square-wave operation. Since the two-level inverter is not switching in a pulse width modulated fashion and the magnitude of switching transient is only half compared to the convention three-level NPC inverter, the switching losses and electromagnetic interference is not so high. The scheme is experimentally verified on a 2.5 kW induction machine.

Performance Analysis of User Selected Subband Channel Quality Indicator Feedback Scheme of LTE

Frequency-domain scheduling and rate adaptation have helped next generation orthogonal frequency division multiple access (OFDMA) based wireless cellular systems such as Long Term Evolution (LTE) achieve significantly higher spectral efficiencies. To overcome the severe uplink feedback bandwidth constraints, LTE uses several techniques to reduce the feedback required by a frequency-domain scheduler about the channel state information of all subcarriers of all users. In this paper, we analyze the throughput achieved by the User Selected Subband feedback scheme of LTE. In it, a user feeds back only the indices of the best M subbands and a single 4-bit estimate of the average rate achievable over all selected M subbands. In addition, we compare the performance with the subband-level feedback scheme of LTE, and highlight the role of the scheduler by comparing the performances of the unfair greedy scheduler and the proportional fair (PF) scheduler. Our analysis sheds several insights into the working of the feedback reduction techniques used in LTE.

Starting scheme for load commutated inverter-fed wound field synchronous machine using an auxiliary low-power voltage source inverter

Conventional thyristor-based load commutated inverter (LCI)-fed wound field synchronous machine operates only above a minimum speed that is necessary to develop enough back emf to ensure commutation. The drive is started and brought up to a speed of around 10-15% by a complex `dc link current pulsing' technique. During this process, the drive have problems such as pulsating torque, insufficient average starting torque, longer starting time, etc. In this regard a simple starting and low-speed operation scheme, by employing an auxiliary low-power voltage source inverter (VSI) between the LCI and the machine terminals, is presented in this study. The drive is started and brought up to a low speed of around 15% using the VSI alone with field oriented control. The complete control is then smoothly and dynamically transferred to the conventional LCI control. After the control transfer, the VSI is turned off and physically disconnected from the main circuit. The advantages of this scheme are smooth starting, complete control of torque and flux at starting and low speeds, less starting time, stable operation, etc. The voltage rating of the required VSI is very low of the order of 10-15%, whereas the current rating is dependent on the starting torque requirement of the load. The experimental results from a 15.8 hp LCI-fed wound field synchronous machine are given to demonstrate the scheme.