Postmortem diagnosis of diabetes mellitus and its complications.

Diabetes mellitus has become a major cause of death worldwide and diabetic ketoacidosis is the most common cause of death in children and adolescents with type 1 diabetes. Acute complications of diabetes mellitus as causes of death may be difficult to diagnose due to missing characteristic macroscopic and microscopic findings. Biochemical analyses, including vitreous glucose, blood (or alternative specimen) beta-hydroxybutyrate, and blood glycated hemoglobin determination, may complement postmortem investigations and provide useful information for determining the cause of death even in corpses with advanced decompositional changes. In this article, we performed a review of the literature pertaining to the diagnostic performance of classical and novel biochemical parameters that may be used in the forensic casework to identify disorders in glucose metabolism. We also present a review focusing on the usefulness of traditional and alternative specimens that can be sampled and subsequently analyzed to diagnose acute complications of diabetes mellitus as causes of death.

Ohjelmistokehitysprosessi hajautetussa ympäristössä

Työn tavoitteena oli selvittää erilaisten ohjelmistokehitysprosessien soveltuvuus maantieteellisesti hajallaan oleville kehitysryhmille. Aluksi selvitettiin yleisemmin käytössä olevat ohjelmistoprosessit ja niiden pääkohdat. Selvittäminen tehtiin kirjallisuuden ja internet-sivustojen perusteella. Saatuja tuloksia verrattiin CASE – yrityksen, Komartek Oyj:n, prosesseihin. Komartek Oyj:n prosessit selvitettiin haastatteluin sekä yrityksen sisäistä dokumentaatiota hyväksikäyttäen. Toisena tehtävänä työssä käytiin läpi hajautetun kehityksen aiheuttamia erityisvaatimuksia ohjelmistoprojekteille. Kirjallisuudesta löydettyjä vaatimuksia verrattiin jälleen Komartekin tämän hetkiseen kehitystyön hajautukseen ja selvitettiin myös lähitulevaisuuden näkymiä yrityksessä.

Beyond the net generation debate: A comparison of digital learners in face-to-face and virtual universities

In the last decade, an important debate has arisen about the characteristics of today"s students due to their intensive experience as users of ICT. The main belief is that frequent use of technologies in everyday life implies that competent users are able to transfer their digital skills to learning activities. However, empirical studies developed in different countries reveal similar results suggesting that the"digital native" label does not provide evidence of a better use of technology to support learning. The debate has to go beyond the characteristics of the new generation and focus on the implications of being a learner in a digitalised world. This paper is based on the hypothesis that the use of technology to support learning is not related to whether a student belongs to the Net Generation, but that it is mainly influenced by the teaching model. The study compares behaviour and preferences towards ICT use in two groups of university students: face-to-face students and online students. A questionnaire was applied to a sample of students from five universities with different characteristics (one offers online education and four offer face-to-face education with LMS teaching support). Findings suggest that although access to and use of ICT is widespread, the influence of teaching methodology is very decisive. For academic purposes, students seem to respond to the requirements of their courses, programmes, and universities. There is a clear relationship between students" perception of usefulness regarding certain ICT resources and their teachers" suggested uses of technologies. The most highly rated technologies correspond with those proposed by teachers. The study shows that the educational model (face-to-face or online) has a stronger influence on students" perception of usefulness regarding ICT support for learning than the fact of being a digital native.

Paperikoneen kuivatusosan haihdutuksen tehostaminen

Tässä diplomityössä käsitellään paperikoneen kuivatusosan haihdutuksen tehostamista. Tutkimuksen aikana toteutettiin pienmittakaavakoe, ja suunniteltiin tuotantokonekoe. Molemmat kokeet perustuvat tutkimuksen aikana johdettuun teoriaan ja niiden tarkoituksena on kerätä lisää tietoa haihdutuksesta. Pienmittakaavakokeessa löydettiin uusi tapa tehostaa haihdutusta. Kokeen perusteella ei kuitenkaan voida varmuudella arvioida tavan hyötyjä ja soveltuvuutta tuotantokoneelle. Suositeltavaa onkin jatkossa toteuttaa työssä esitetty tuotantokonekoe, jotta auki jäävät kysymykset saavat vastauksensa ja saadaan selkeä käsitys uuden tavan hyödynnettävyydestä paperikoneen kuivatusosalla.

Päiväkirurgian toimintolaskentamalli ja DRG- hinnoittelu

Työn ensisijaisena tavoitteena oli selvittää Etelä-Karjalan keskussairaalan päiväkirurgisessa yksikössä tehtävien leikkausten toimintolaskentahinnat sekä vertailla saatuja hintoja yksikössä käytettäviin DRG- hintoihin. Toisena tavoitteena oli selvittää toimintolaskennan sovellusmahdollisuutta DRG- hinnoittelujärjestelmään. Tutkimusaineistoa kerättiin haastattelemalla yksikön henkilökuntaa. Kustannustietojen lähteenä käytettiin sairaalan laskentajärjestelmää. Aineiston tulkinnassa ja analyysissä käytettiin taulukkolaskentaohjelmistoa. Teoriaosuuden lähteinä käytettiin aiheisiin liittyvää kirjallisuutta ja artikkeleita. Leikkauksiin liittyvät toiminnot selvitettiin toimintoanalyysin avulla. Keskeisinä tuloksina saatiin yksikössä tehtävien leikkausten toimintolaskentahinnat. Vertailun tuloksena voidaan todeta, että toimintolaskenta ja DRG- hinnat eroavat toisistaan. Tutkimuksen tuloksena voidaan todeta myös se, että toimintolaskentaa voidaan soveltaa DRG- hinnoitteluun. Toimenpiteinä ehdotetaan lisätutkimuksia DRG- hinnoittelujärjestelmän ja toimintolaskennan soveltuvuudesta yhteen. Työssä kehitetyn laskentatavan oikeellisuutta tulisi selvittää laajemmin.

How useful is consolidation of public sector entities' financial statements ?

Whether or not to consolidate financial statements is dealt with in IPSAS#6. This standard is by and large based on IAS#27. It deals with the criterion according to which an entity's financial statements should be considered and which consolidation technique should be used. However, it remains silent when it comes to exposing the reason why a public sector entity should consolidate its financial statements. The literature is almost as silent as IPSAS on this issue. Which means that there is a lack of both theoretical and empirical knowledge on this subject. This paper explores the usefulness of the consolidation of financial statements (CFS) for different categories of users. It aims at investigating for which purposes consolidation is most useful and whether enlarging the scope of the consolidate group serves these purposes. Five purposes are considered: information, decision- making, accountability, risk-assessment, statistics improvement. The paper also aims at investigating if some categories of users consider CFS more useful than others. The issue is essentially empirical. Therefore it is examined in light of the results of an in-person interviews. We surveyed 25members of parliament, officials, creditors, and consultants of the Swiss central government. The results show that consolidating FS is considered especially important and useful for risk- assessment, information and accountability and to a somewhat lesser extent for decision-making and statistics improvement. Extending the scope of CFS may improve the situation when it comes to statistics but it would only marginally make CFS more relevant for decision making. Consultants and, to a lesser extent, members of the finance ministry are those respondents who deem the scope enlargement to be the most useful.

Antagonistic peptide technology for functional dissection of CLE peptides revisited.

In the Arabidopsis thaliana genome, over 1000 putative genes encoding small, presumably secreted, signalling peptides can be recognized. However, a major obstacle in identifying the function of genes encoding small signalling peptides is the limited number of available loss-of-function mutants. To overcome this, a promising new tool, antagonistic peptide technology, was recently developed. Here, this antagonistic peptide technology was tested on selected CLE peptides and the related IDA peptide and its usefulness in the context of studies of peptide function discussed. Based on the analyses, it was concluded that the antagonistic peptide approach is not the ultimate means to overcome redundancy or lack of loss-of-function lines. However, information collected using antagonistic peptide approaches (in the broad sense) can be very useful, but these approaches do not work in all cases and require a deep insight on the interaction between the ligand and its receptor to be successful. This, as well as peptide ligand structure considerations, should be taken into account before ordering a wide range of synthetic peptide variants and/or generating transgenic plants.

Quantitative TCR:pMHC Dissociation Rate Assessment by NTAmers Reveals Antimelanoma T Cell Repertoires Enriched for High Functional Competence.

Experimental models demonstrated that therapeutic induction of CD8 T cell responses may offer protection against tumors or infectious diseases providing that T cells have sufficiently high TCR/CD8:pMHC avidity for efficient Ag recognition and consequently strong immune functions. However, comprehensive characterization of TCR/CD8:pMHC avidity in clinically relevant situations has remained elusive. In this study, using the novel NTA-His tag-containing multimer technology, we quantified the TCR:pMHC dissociation rates (koff) of tumor-specific vaccine-induced CD8 T cell clones (n = 139) derived from seven melanoma patients vaccinated with IFA, CpG, and the native/EAA or analog/ELA Melan-A(MART-1)(26-35) peptide, binding with low or high affinity to MHC, respectively. We observed substantial correlations between koff and Ca(2+) mobilization (p = 0.016) and target cell recognition (p < 0.0001), with the latter independently of the T cell differentiation state. Our strategy was successful in demonstrating that the type of peptide impacted on TCR/CD8:pMHC avidity, as tumor-reactive T cell clones derived from patients vaccinated with the low-affinity (native) peptide expressed slower koff rates than those derived from patients vaccinated with the high-affinity (analog) peptide (p < 0.0001). Furthermore, we observed that the low-affinity peptide promoted the selective differentiation of tumor-specific T cells bearing TCRs with high TCR/CD8:pMHC avidity (p < 0.0001). Altogether, TCR:pMHC interaction kinetics correlated strongly with T cell functions. Our study demonstrates the feasibility and usefulness of TCR/CD8:pMHC avidity assessment by NTA-His tag-containing multimers of naturally occurring polyclonal T cell responses, which represents a strong asset for the development of immunotherapy.

Tuotekehityksen toimintolaskenta - Case Oy Sisu Auto Ab

Tutkielman tavoitteena oli tutkia toimintolaskennan soveltuvuutta tuotekehitys-kustannusten selvittämiseen ja kohdistamiseen tuotteiden katelaskennassa. Tarkoitus oli selvittää erityisesti laskennan hyödyt kuorma-autotehtaan kannalta ja rakentaa yritykselle valmis malli tuotekehityskustannusten toimintopohjaiselle laskennalle. Tutkielma on luonteeltaan konstruktiivinen case-tutkimus. Yritykselle pyrittiin teorian pohjalta luomaan käytännön ongelmaan ratkaisu rakentamalla toimintolaskentamalli, jolla yrityksen tuotekehityksen kustannukset pystytään mahdollisimman hyvin jakamaan tuotteille. Mallin rakennuksen myötä saavutettiin selkeät periaatteet kustannusten kohdistamiseen kuorma-autoille. Laskennan avulla saatujen tulosten perusteella saatiin tärkeää tuotekehitystä koskevaa tietoa, jota aikaisemmin ei oltu yrityksessä pystytty hyödyntämään tuotteiden kustannuslaskennassa. Tuloksia on mahdollisuus hyödyntää sekä operatiivisessa että strategisessa päätöksenteossa. Tutkimuksen tuloksia on tarkasteltava tieteellisesti suhteellisen suppeana, juuri kyseiseen yritykseen soveltuvana ratkaisuna.

Improving the Quality of EEG Data in Patients With Alzheimers Disease Using ICA

Does Independent Component Analysis (ICA) denature EEG signals? We applied ICA to two groups of subjects (mild Alzheimer patients and control subjects). The aim of this study was to examine whether or not the ICA method can reduce both group di®erences and within-subject variability. We found that ICA diminished Leave-One- Out root mean square error (RMSE) of validation (from 0.32 to 0.28), indicative of the reduction of group di®erence. More interestingly, ICA reduced the inter-subject variability within each group (¾ = 2:54 in the ± range before ICA, ¾ = 1:56 after, Bartlett p = 0.046 after Bonfer- roni correction). Additionally, we present a method to limit the impact of human error (' 13:8%, with 75.6% inter-cleaner agreement) during ICA cleaning, and reduce human bias. These ¯ndings suggests the novel usefulness of ICA in clinical EEG in Alzheimer's disease for reduction of subject variability.

Fatal Cervical Spine Injury From Diving Accident.

Spinal cord injuries result after diving into shallow water, often after incautious jumps head first into water of unknown depth during recreational or sport activities. Mortality is generally due to upper cervical trauma. The authors present a case of a diving-related death in a young woman who underwent medicolegal investigations. The measured water depth at the supposed dive site was 1.40 m. Postmortem radiology and autopsy revealed fractures of the body and the posterior arch of the fifth cervical vertebra, a fracture of the right transverse process of the sixth cervical vertebra and hemorrhages involving the cervical paraspinal muscles. Neuropathology showed a posterior epidural hematoma involving the whole cervical region and a symmetric laceration of the spinal cord located at the fourth and fifth cervical vertebra level, surrounded by multiple petechial hemorrhages. Toxicology revealed the presence of ethanol in both blood and urine samples. The death was attributed to cervical spine fracture (C5-C6), spinal cord contusion, and subsequent drowning. This case highlights the usefulness of postmortem radiology, examination of the deep structures of the neck, toxicology, neuropathology, and a detailed research of signs of drowning to formulate appropriate hypotheses pertaining to the cause and mechanism of death.

Post-mortem determination of insulin using chemiluminescence enzyme immunoassay: preliminary results.

Insulin determination in blood sampled during post-mortem investigation has been repeatedly asserted as being of little diagnostic value due to the rapid occurrence of decompositional changes and blood haemolysis. In this study, we assessed the feasibility of insulin determination in post-mortem serum, vitreous humour, bile, and cerebrospinal and pericardial fluids in one case of fatal insulin self-administration and a series of 40 control cases (diabetics and non-diabetics) using a chemiluminescence enzyme immunoassay. In the case of suicide by insulin self-administration, insulin concentrations in pericardial fluid and bile were higher than blood clinical reference values, though lower than post-mortem serum concentration. Insulin concentrations in vitreous (11.50 mU/L) and cerebrospinal fluid (17.30 mU/L) were lower than blood clinical reference values. Vitreous insulin concentrations in non-diabetic control cases were lower than the estimated detection limit of the method. These preliminary results tend to confirm the usefulness of insulin determination in vitreous humour in situations of suspected fatal insulin administration. Additional findings pertaining to insulin determination in bile, pericardial, and cerebrospinal fluid would suggest that analysis performed in post-mortem serum and injection sites could be complemented, in individual cases, by investigations carried out in alternative biological fluids. Lastly, these results would indicate that analysis with chemiluminescence enzyme immunoassay may provide suitable data, similar to analysis with liquid chromatography-tandem mass spectrometry (LC-MS/MS) and immunoradiometric assay, to support the hypothesis of insulin overdose. Copyright © 2015 John Wiley & Sons, Ltd.

Sisäisen tarkastuksen ja tilintarkastuksen välinen yhteistyö

Tutkimuksen tavoitteena on etsiä tarkastustahojen välistä yhteistyötä edistäviä tekijöitä sekä tutkia, mitä hyötyä yhteistyöstä on. Empiirisessä osassa tutkitaan Sisäiset tarkastajat ry:n jäsenten näkemyksiä yhteistyön hyödyllisyydestä ja tutkitaan löytyykö yhteistyötä edistäviä tekijöitä sekä vertaillaan tuloksia teoriaan. Mielipiteitä tarkastellaan erikseen julkisen sektorin ja yrityssektorin osalta ja tutkitaan onko mielipide-erot tilastollisesti merkitseviä. Keskinäinen luottamus ja arvostus, yhteistyöhalukkuus, johdon vahva tuki, riippumattomuus, säännöllinen tapaaminen, raporttien vaihtaminen ja hyvät vuorovaikutussuhteet edistävät yhteistyötä. Suunnitteluun, koordinointiin ja työnjakoon tulee kiinnittää huomiota. Sisäisen tarkastuksen organisointitavalla, koolla ja heidän ammattitaidollaan voi olla vaikutusta yhteistyön muodostumiseen. Yhteistyöstä hyötyvät molemmat tarkastustahot ja organisaatio. Yhteistyön avulla voidaan kasvattaa ammattitaitoa, saada kustannussäästöjä ja kattavampi tarkastuskokonaisuus sekä välttyä päällekkäiseltä työltä. Kyselytutkimuksen tulokset osoittivat, että yhteistyötä edistäviä tekijöitä oli melko paljon, varsinkin yrityssektorin vastaajien osalta. Edellä mainittuja hyötyjä oli saatu, mutta julkisen sektorin vastaajat olivat asiasta vähemmän samaa mieltä. Mielipide-erojen yleistettävyyteen tulee kuitenkin suhtautua kriittisesti, koska aineiston koko jäi melko pieneksi.

Palvelutasosopimus toimittajan hallinnnan työkaluna Case: IT-käyttötukipalvelu

Työn tavoitteena on selvittää palvelutasosopimuksella ja sen hallinnalla saatavaa hyötyä toimittajan hallinnassa. Tutkimusongelmaa on lähdetty selvittämään tutustumalla ensin lyhyesti toimittajan hallintaan ja laajemmin palvelutasosopimuksista ja niiden hallinnasta olemassa olevaan teoria-aineistoon. Tämän teoriapohjan perusteella palvelutasosopimuksia ja niiden hallintaa on tutkittu käytännössä case-yrityksen valossa, mahdollisimman realistiseen lopputulokseen pääsemiseksi. Palvelujen ulkoistaminen tulee tulevaisuudessa lisääntymään ja tätä kautta yritysten onnistuminen markkinoilla on yhä riippuvaisempaa niiden kyvystä hallita toimittajiaan. Palvelutasosopimukset ja prosessit niiden ympärillä ovat hyödyllisiä työkaluja toimittajan suorituksen valvonnassa ja kehittämisessä sekä toimittajasuhteen luotsaamisessa kohti kumppanuussuhdetta. Tämä edellyttää kuitenkin, että kauppakumppanit sisäistävät palvelutasosopimusten kautta saavutettavat hyödyt ja sitoutuvat koko palvelutason hallintaprosessiin.

Pain-evoked alterations on gingival blood flow and gingival crevicular fluid (GCF) neuropeptide SP and collagenase-2 (MMP-8) levels

Previous studies have demonstrated that clinical pulpal pain can induce the expression of pro-inflammatory neuropeptides in the adjacent gingival crevice fluid (GCF). Vasoactive agents such as substance P (SP) are known to contribute to the inflammatory type of pain and are associated with increased blood flow. More recent animal studies have shown that application of capsaicin on alveolar mucosa provokes pain and neurogenic vasodilatation in the adjacent gingiva. Pain-associated inflammatory reactions may initiate expression of several pro- and anti-inflammatory mediators. Collagenase-2 (MMP-8) has been considered to be the major destructive protease, especially in the periodontitis-affected gingival crevice fluid (GCF). MMP-8 originates mostly from neutrophil leukocytes, the first line of defence cells that exist abundantly in GCF, especially in inflammation. With this background, we wished to clarify the spatial extensions and differences between tooth-pain stimulation and capsaicin-induced neurogenic vasodilatation in human gingiva. Experiments were carried out to study whether tooth stimulation and capsaicin stimulation of alveolar mucosa would induce changes in GCF MMP-8 levels and whether tooth stimulation would release neuropeptide SP in GCF. The experiments were carried out on healthy human volunteers. During the experiments, moderate and high intensity painful tooth stimulation was performed by a constant current tooth stimulator. Moderate tooth stimulation activates A-delta fibres, while high stimulation also activates C-fibres. Painful stimulation of the gingiva was achieved by topical application of capsaicin-moistened filter paper on the mucosal surface. Capsaicin is known to activate selectively nociceptive C-fibres of stimulated tissue. Pain-evoked vasoactive changes in gingivomucosal tissues were mapped by laser Doppler imaging (LDI), which is a sophisticated and non-invasive method for studying e.g. spatial and temporal characteristics of pain- and inflammation-evoked blood flow changes in gingivomucosal tissues. Pain-evoked release of MMP-8 in GCF samples was studied by immunofluorometric assay (IFMA) and Western immunoblotting. The SP levels in GCF were analysed by Enzyme immunoassay (EIA). During the experiments, subjective stimulus-evoked pain responses were determined by a visual analogue pain scale. Unilateral stimulation of alveolar mucosa and attached gingiva by capsaicin evoked a distinct neurogenic vasodilatation in the ipsilateral gingiva, which attenuated rapidly at the midline. Capsaicin stimulation of alveolar mucosa provoked clear inflammatory reactions. In contrast to capsaicin stimuli, tooth stimulation produced symmetrical vasodilatations bilaterally in the gingiva. The ipsilateral responses were significantly smaller during tooth stimulation than during capsaicin stimuli. The current finding – that tooth stimulation evokes bilateral vasodilatation while capsaicin stimulation of the gingiva mainly produces unilateral vasodilatation – emphasises the usefulness of LDI in clarifying spatial features of neurogenic vasoactive changes in the intra-oral tissues. Capsaicin stimulation of the alveolar mucosa induced significant elevations in MMP-8 levels and activation in GCF of the adjacent teeth. During the experiments, no marked changes occurred in MMP-8 levels in the GCF of distantly located teeth. Painful stimulation of the upper incisor provoked elevations in GCF MMP-8 and SP levels of the stimulated tooth. The GCF MMP-8 and SP levels of the non-stimulated teeth were not changed. These results suggest that capsaicin-induced inflammatory reactions in gingivomucosal tissues do not cross the midline in the anterior maxilla. The enhanced reaction found during stimulation of alveolar mucosa indicates that alveolar mucosa is more sensitive to chemical irritants than the attached gingiva. Analysis of these data suggests that capsaicin-evoked neurogenic inflammation in the gingiva can trigger the expression and activation of MMP-8 in GCF of the adjacent teeth. In this study, it is concluded that experimental tooth pain at C-fibre intensity can induce local elevations in MMP-8 and SP levels in GCF. Depending on the role of MMP-8 in inflammation, in addition to surrogated tissue destruction, the elevated MMP-8 in GCF may also reflect accelerated local defensive and anti-inflammatory reactions.