The health of adolescents around a world in transition.

Since several years, the health of adolescents is on the agenda of ministers, decision makers and health professionals. Around the world, while there has been a steady decrease of the death rates among young children, this is not the case for young people. This is mainly linked with the fact that mortality and morbidity during this period of life is largely linked with non communicable diseases and conditions, including deaths from injuries, suicide, homicides and drug abuse. Unplanned pregnancies, illegal abortions, newly acquired HIV infections are also situations that have short and long term consequences. This paper reviews the epidemiological data pertaining to adolescent health and disease. It proposes evidence-informed avenues as how to address these issues in the field of health care (e.g. adolescent friendly services) and of prevention and health promotion. It also stresses the importance of creating safe environments for the development and well-being of young people and thus, of an interdisciplinary and inter sectorial approach to their complex health problems and challenges.

Fractures de la cheville chez le patient âgé [Ankle fractures in the elderly patient].

Ankle fractures in adults are usually managed by open reduction internal fixation. In elderly patients the surgical dilemma relates to bone quality. Osteoporosis is the enemy of internal fixation, and secure purchase of screws in osteopenic bone may be difficult to achieve. Insufficient screw purchase may lead to loss of reduction, wound breakdown, and infection. Postoperative management after osteosynthesis usually requires an extended period of restricted weight bearing. However, this is not feasible in older patients as a result of their lack of strength in the upper extremities and frequent comorbidities. Therefore, augmen- ted methods of internal fixation and specific surgical techniques have been developed using metal and bone cement. This permits this fragile population to begin early full weight bearing in a removable brace.

Redundant nerve roots of the cauda equina: review of the literature

In imaging diagnosis, redundant nerve roots of the cauda equina are characterized by the presence of elongated, enlarged and tortuous nerve roots in close relationship with a high-grade lumbar spinal canal stenosis. This is not an independent entity, but it is believed to be a consequence of the chronic compression at the level of the lumbar canal stenosis and thus may be part of the natural history of lumbar spinal stenosis. The present paper is aimed at reviewing the histopathological, electrophysiological and imaging findings, particularly at magnetic resonance imaging, as well as the clinical meaning of this entity. As the current assessment of canal stenosis and root compression is preferably performed by means of magnetic resonance imaging, this is the imaging method by which the condition is identified. The recognition of redundant nerve roots at magnetic resonance imaging is important, particularly to avoid misdiagnosing other conditions such as intradural arteriovenous malformations. The literature approaching the clinical relevance of the presence of redundant nerve roots is controversial. There are articles suggesting that the pathological changes of the nerve roots are irreversible at the moment of diagnosis and therefore neurological symptoms are less likely to improve with surgical decompression, but such concept is not a consensus.

Developmental and tissue-specific involvement of peroxisome proliferator-activated receptor-alpha in the control of mouse uncoupling protein-3 gene expression.

Uncoupling protein-3 (UCP3) is a member of the mitochondrial carrier family expressed preferentially in skeletal muscle and heart. It appears to be involved in metabolic handling of fatty acids in a way that minimizes excessive production of reactive oxygen species. Fatty acids are powerful regulators of UCP3 gene transcription. We have found that the role of peroxisome proliferator-activated receptor-α (PPARα) on the control of UCP3 gene expression depends on the tissue and developmental stage. In adults, UCP3 mRNA expression is unaltered in skeletal muscle from PPARα-null mice both in basal conditions and under the stimulus of starvation. In contrast, UCP3 mRNA is down-regulated in adult heart both in fed and fasted PPARα-null mice. This occurs despite the increased levels of free fatty acids caused by fasting in PPARα-null mice. In neonates, PPARα-null mice show impaired UCP3 mRNA expression in skeletal muscle in response to milk intake, and this is not a result of reduced free fatty acid levels. The murine UCP3 promoter is activated by fatty acids through either PPARα or PPARδ but not by PPARγ or retinoid X receptor alone. PPARδ-dependent activation could be a potential compensatory mechanism to ensure appropriate expression of UCP3 gene in adult skeletal muscle in the absence of PPARα. However, among transcripts from other PPARα and PPARδ target genes, only those acutely induced by milk intake in wild-type neonates were altered in muscle or heart from PPARα-null neonates. Thus, PPARα-dependent regulation is required for appropriate gene regulation of UCP3 as part of the subset of fatty-acid-responsive genes in neonatal muscle and heart.

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Sleep problems among detainees are common. Appropriate evaluation and treatment remain challenging in correctional settings. However, this is not primarily a problem of resources; rather, it is, to a great extent, an issue of adequate training. Correctional health professionals need appropriate education regarding insomnia evaluation and management. Guidelines should be based on the principle of equivalence of care and should take into account all evidence from research in the community and in correctional settings. Educational material from outside prisons exists and should be made available to detainees and health professionals (Falloon et al., 2011; Sateia & Nowell, 2004). Priority should be given to changes in prison conditions and to nonpharmacological treatment. There is no evidence-based justification to replace BZD prescriptions with antipsychotics or antidepressants. In correctional settings, prescriptions of antipsychotics and antidepressants for sleep problems can increase risk due to polypharmacy and higher suicide risks. Correctional physicians should monitor and document the evaluation and treatment practice concerning insomnia complaints to improve safe, evidence-based treatment.

Detection of severe obstructive sleep apnea through voice analysis

tThis paper deals with the potential and limitations of using voice and speech processing to detect Obstruc-tive Sleep Apnea (OSA). An extensive body of voice features has been extracted from patients whopresent various degrees of OSA as well as healthy controls. We analyse the utility of a reduced set offeatures for detecting OSA. We apply various feature selection and reduction schemes (statistical rank-ing, Genetic Algorithms, PCA, LDA) and compare various classifiers (Bayesian Classifiers, kNN, SupportVector Machines, neural networks, Adaboost). S-fold crossvalidation performed on 248 subjects showsthat in the extreme cases (that is, 127 controls and 121 patients with severe OSA) voice alone is able todiscriminate quite well between the presence and absence of OSA. However, this is not the case withmild OSA and healthy snoring patients where voice seems to play a secondary role. We found that thebest classification schemes are achieved using a Genetic Algorithm for feature selection/reduction.

Research Priorities for seabirds: Improving seabird conservation and management in the 21st century

Seabirds are facing a growing number of threats in both terrestrial and marine habitats, and many populations have experienced dramatic changes over past decades. Years of seabird research have improved our understanding of seabird populations and provided a broader understanding of marine ecological processes. In an effort to encourage future research and guide seabird conservation science, seabird researchers from 9 nations identified the 20 highest priority research questions and organized these into 6 general categories: (1) population dynamics, (2) spatial ecology, (3) tropho-dynamics, (4) fisheries interactions, (5) response to global change, and (6) management of anthropogenic impacts (focusing on invasive species, contaminants and protected areas). For each category, we provide an assessment of the current approaches, challenges and future directions. While this is not an exhaustive list of all research needed to address the myriad conservation challenges seabirds face, the results of this effort represent an important synthesis of current expert opinion across sub-disciplines within seabird ecology. As this synthesis highlights, research, in conjunction with direct management, education, and community engagement, can play an important role in facilitating the conservation and management of seabird populations and of the ocean ecosystems on which they and we depend.

Mekaanisen kunnossapidon palvelutuotekehitys

Teollisuuden kunnossapitoa on Suomessa perinteisesti hoidettu tehtaiden omien kunnossapito-organisaatioiden toimesta. Globaalin kilpailutilanteen vuoksi tehtaat ovat pyrkineet vähentämään kustannuksiaan vastatakseen kilpailuun. Kunnossapidon osalta tämä on tarkoittanut muun muassa tehtaiden omien kunnossapito-organisaatioiden pienentämistä ja samalla tehtaiden ulkopuolisen työvoiman käytön lisäämistä. Kilpailu kunnossapitotöistä alihankkijoiden kesken on kiivasta. Perinteisellä tuntiperusteisella laskutusmenetelmällä toimittaessa erottautuminen kilpailijoista muulla, kuin hinnalla, on monesti vaikeaa. Lisäksi kiivas hintakilpailu ei ole pitkällä aikavälillä asiakkaidenkaan etu, sillä osa toimittajista voi kaatua jättäen suuremman markkinaosuuden ja täten suuremman neuvotteluvallan pienemmälle ryhmälle. Kunnossapitotöiden organisoimisessa päästään parempaan tulokseen tuotteistamalla kunnossapitopalveluja palvelupaketeiksi. Palvelupaketti sisältää ennalta sovitun palvelukokonaisuuden ennalta sovittuun hintaa sopimusajaksi.

Estudi i implantació de programari lliure

Actualment la majoria de nosaltres sabem de l’existència de molts programes lliures, però hem tenir clar que lliure no vol dir sempre programa gratuït. Tot i que a vegades sí que pot ser-ho, es té en compte molt més que això: és una manera de pensar i entendre el programari i al llarg dels anys ha generat tot un moviment social. Considerem que un programa lliure és aquell que garanteix als usuaris la llibertat per executar, copiar, distribuir, estudiar, canviar i millorar el codi programat, com molt bé defineixen les seves llibertats bàsiques. El programari lliure el podem trobar funcionant en ordinadors personals, escoles, empreses diverses, administracions, etc. ja que la majoria de programes que utilitzenactualment, com hem vist, tenen el seu equivalent en lliure. El fet de si és viable que una empresa es passi a programari lliure, depèn ben bé del seu entorn, ja que en funció d’aquest li serà més o menys fàcil la migració. La finalitat d’aquest projecte és, primer de tot, fer un ampli estudi del món del programari lliure i del seu moviment social. S’ha fet una recerca de diferents aspectes dins del programari lliure per conèixer-lo a fons i després s’ha proposat una possible implantació d’aquest en un usuari domèstic i en una administració pública, tenint en compte tots els aspectes vistos en l’estudi, valorant si totes les idees que defensa i els beneficis que aporta són aplicables i viables en qualsevol persona i àmbit i el perquè. Com a conclusió principal en destacaria que tot i que el programa lliure disposa d’una ideologia que agrada i té uns programes tècnicament perfectes (sense que això sigui el seu objectiu principal), penso que encara hi ha molt camí per recórrer quant a una migració en grans entorns, ja que per exemple en un ajuntament una migració total és encara difícil (tot i que no impossible perquè n’hi ha que s’hi han migrat). A l’apartat d’annexos s’hi inclou un glossari amb un seguit de terminologies amb paraules que no tothom pot saber i s’ha cregut oportú incloure-les en aquest apartat. La primera vegada que apareix alguna d’aquestes paraules la podem trobar senyalitzada amb un *.

Estudo da adsorção de compostos sulfurados empregando zeólitas contendo zinco

This paper deals with an adosrption of sulphur compounds employing zeolites containing zinc. The zeolites employed were commercial NaY and Beta. The zinc was incorporated in three levels: 0.5; 1.0 and 5%. The sulphur compounds studied were benzothiophene and dibenzothiofene. The results showed that both zeolites can be employed for adsorption of benzothiophene and dibenzothiophene. The Zn incorporation (0.5%) promotes an increase in zeolites adsorption ability. The DBT adsorbs more than BT, probably because it strongly interacts with zeolite structure. The BT adsorbs more in NaY than in beta probably because the NaY zeolite has a high intern volume. This is not observed for DBT.

Strategic Orientation of Knowledge Management: Influence on Company's Performance

Nowadays, the huge part of the most important research is done in the area of interaction of two or more fields of research. They open doors for new ideas and help to find that was not possible to find before, explain simple things, which was missed because of narrow vision. This research investigates the interconnection of strategy study and knowledge management. Well-known researches (e.g. Michael Zack, 2003) point out that organization should align its' knowledge management to strategy to gain success. But this is not well developed area yet. This research contributes to the growing knowledge of knowledge management - strategy alignment. The research tests the relation between strategic orientation of knowledge management and performance of the company. It also investigates the nature of strategy typology influence on strategic orientation of knowledge management. These two points have critical importance for development of this area. Moreover, it has management implication for those practitioners, who cares about sustainable success of their company based on knowledge.

Uuden robottisolun ohjelmointitavan mahdollisuudet pienille ja keskisuurille yrityksille

Robotin ohjelmointi on aikaa vievää ja tarvitsee robotin ohjelmoinnin tuntevan operaattorin toimimaan robotin opettajana. Saadakseen robottisolun kustannustehokkaaksi operaattorilla olisi hyvä olla useampi solu hoidettavanaan samaan aikaan. Tämä ei ole suuri ongelma suurille yrityksille, joissa voi olla kymmeniä robottisoluja. Jos kyseessä on pieni tai keskisuuri yritys, automatisointi-investointi voi jäädä tekemättä ohjelmoinnin vaikeuden aiheuttaman ongelman vuoksi. Diplomityössä keskityttiin tutkimaan robotisointia pienten ja keskisuurten yritysten kannalta. Teoriaosassa on keskitytty robottisolun suunnittelun kannalta tarvittaviin perustietoihin robotin rakenteesta, ohjausjärjestelmästä, ohjelmoinnista sekä turvallisuudesta. Näiden perustietojen lisäksi on huomioitu hitsauksen automatisointia sekä taluttamalla ohjelmoitavan robottisolun tekninen konsepti. Taluttamalla ohjelmoitavan robottisolun konseptin käsittelyosassa on myös perehdytty taluttamalla ohjelmoinnin vaatimiin komponentteihin kuten voima/vääntö-anturi. Robottisolun suunnittelu on tehtävä koneasetuksen vaatimusten mukaan. Turvallisuus osiossa on käsitelty koneasetuksen vaatimuksia koneensuunnittelulle ja käytännön osassa on käsitelty Winnovan taluttamalla ohjelmoitavan robottisolun suunnittelua koneasetuksen ohjeiden mukaan. Käytännön osassa on tutkittu taluttamalla ohjelmoinnin tuomia etuja muihin ohjelmointimenetelmiin nähden sekä suoritettu investointilaskelmat taluttamalla ohjelmoitavasta ja opettamalla ohjelmoitavasta robottisolusta. Koetuloksista nähdään taluttamalla ohjelmoinnin olevan nopeampi ja yksinkertaisempi tapa ohjelmoida robottia kuin opettamalla ohjelmointi. Investointilaskelmien vertailusta nähdään taluttamalla ohjelmoinnin tulevan opettamalla ohjelmointia edullisemmaksi vaihtoehdoksi käyttökustannusten edullisuuden ansiosta.

The Role of Cytochrome P450 3A Inducers and Inhibitors in the Metabolism and the Effects of Oxycodone

Oxycodone is an opioid used in the treatment of moderate or severe pain. It is principally metabolized in the liver by cytochrome P450 3A (CYP3A) enzymes whereas approximately 10% is metabolized by CYP2D6. Little is known about the interactions between oxycodone and other drugs, herbals and nutritional substances. In this work the effects of CYP3A inducers rifampicin and St. John’s wort and CYP3A inhibitors voriconazole, grapefruit juice, ritonavir and lopinavir/ritonavir were investigated on the pharmacokinetics and pharmacodynamics of oxycodone. All studies were randomized, balanced, placebo-controlled crossover clinical studies in healthy volunteers. The plasma concentrations of oxycodone and its metabolites were determined for 48 hours and pharmacodynamic parameters were recorded for 12 hours in each study. Pharmacokinetic parameters were calculated by noncompartmental methods. Rifampicin decreased the plasma concentrations, analgesic effects, and oral bioavailability of oral oxycodone. St. John’s wort reduced the concentrations of oxycodone and diminished the self-reported drug effect. Voriconazole increased the exposure to oral oxycodone by 3.6-fold whereas grapefruit juice, which inhibits predominantly the intestinal CYP3A, elevated the mean concentrations of oxycodone by 1.7-fold. Ritonavir and lopinavir/ritonavir increased the mean AUC of oxycodone by 3.0- and 2.6-fold, respectively, and prolonged its elimination half-life. In spite of increased oxycodone plasma concentrations during concomitant administration of CYP3A inhibitors, the analgesic effects were not increased. These studies show that the induction or inhibition of CYP3A alters the pharmacokinetics and pharmacologic effects of oxycodone. The exposure to oxycodone decreased after induction and increased after inhibition of CYP3A. As a conclusion, the clinicians should avoid concomitant administration of CYP3A inducers or inhibitors and oral oxycodone. If this is not possible, they should be prepared to interactions leading to impaired analgesia after CYP3A inducers or increased adverse effects after CYP3A inhibitors and oral oxycodone.

Reading Development During Elementary School Years. Evidence from Eye Movements

The present dissertation examined reading development during elementary school years by means of eye movement tracking. Three different but related issues in this field were assessed. First of all, the development of parafoveal processing skills in reading was investigated. Second, it was assessed whether and to what extent sublexical units such as syllables and morphemes are used in processing Finnish words and whether the use of these sublexical units changes as a function of reading proficiency. Finally, the developmental trend in the speed of visual information extraction during reading was examined. With regard to parafoveal processing skills, it was shown that 2nd graders extract letter identity information approx. 5 characters to the right of fixation, 4th graders approx. 7 characters to the right of fixation, and 6th graders and adults approx. 9 characters to the right of fixation. Furthermore, it was shown that all age groups extract more parafoveal information within compound words than across adjectivenoun pairs of similar length. In compounds, parafoveal word information can be extracted in parallel with foveal word information, if the compound in question is of high frequency. With regard to the use of sublexical units in Finnish word processing, it was shown that less proficient 2nd graders use both syllables and morphemes in the course of lexical access. More proficient 2nd graders as well as older readers seem to process words more holistically. Finally, it was shown that 60 ms is enough for 4th graders and adults to extract visual information from both 4-letter and 8-letter words, whereas 2nd graders clearly needed more than 60 ms to extract all information from 8- letter words for processing to proceed smoothly. The present dissertation demonstrates that Finnish 2nd graders develop their reading skills rapidly and are already at an adult level in some aspects of reading. This is not to say that there are no differences between less proficient (e.g., 2nd graders) and more proficient readers (e.g., adults) but in some respects it seems that the visual system used in extracting information from the text is matured by the 2nd grade. Furthermore, the present dissertation demonstrates that the allocation of attention in reading depends much on textual properties such as word frequency and whether words are spatially unified (as in compounds) or not. This flexibility of the attentional system naturally needs to be captured in word processing models. Finally, individual differences within age groups are quite substantial but it seems that by the end of the 2nd grade practically all Finnish children have reached a reasonable level of reading proficiency.

Evaluation of cotton stalks destroyers

The destruction of the cotton crop residues (cotton stalks) is a mandatory procedure in Brazil for prophylactic issues, but is a subject unexplored by the research and there are few studies that deal with this issue. However, this is not encouraged in recent decades, studies aimed at developing and evaluating equipment for this purpose. The present study had the objective to evaluate six methods for mechanical destruction of cotton crop residues. Each method was defined based on the principle of operation of the active parts of the equipment, which were tested in medium texture soil and in a clayey one. The variables used to evaluate the efficiency of the equipment were the regrowth rate, the theoretical field capacity and energy demand. The equipment with convergent concave disks (DCC) and flat cutters discs from manufacturer A (CPS-a) showed the best results in cotton stalks destruction in both soil types. The harrow disc (GPD) was efficient only in clay soil. It was concluded that the equipment with convergent concave disks, among those tested, was the most efficient to destroy cotton stalks, regardless of soil type, and that the harrow disc was not included among the best performers.