The Environmental Status of the Port of HaminaKotka

This study is a part of the Ecologically Friendly Port Ust-Luga (EFP) project. The purpose of this study is to examine the environmental status of the Finnish ports and, more specifically, the Port of HaminaKotka. An analysis of the environmental status is performed mainly as a literature review, because the Finnish ports must comply with Finnish and EU legislation and with the binding international regulations and conventions created by different organizations. The International Maritime Organisation (IMO) has done groundbreaking work in the field of maritime safety and maritime environmental protection. The MARPOL convention has a great impact on decreasing pollution from international shipping and it applies to 99% of the world’s merchant tonnage. Pollution prevention covers: Oil pollution, Chemical pollution, Air pollution and GHG Emissions, Dumping of Wasted and Other Matters, Garbage, Sewage, Port Reception Facilities, Special Areas under MARPOL and Particularly Sensitive Sea Areas. There is also Pollution Prevention for other treaties like anti-fouling systems used on ships, the transfer of alien species by ships’ ballast water and the environmentally sound recycling of ships. There are more than twenty different EU and international regulations that influence ports and port operations in Finland. In addition, there is also national legislation that has an effect on Finnish ports. For the most part, the legislation for ports is common in the EU area, but the biggest and most important difference between the legislation in Finland and other EU countries is due to the Act on Environmental Impact Assessment Procedure. The Act states that the environmental impact assessment procedure shall be applied to projects that may have significant adverse environmental impacts, due to the special features of Finland`s nature and environment. In this Act, the term environmental impact refers to the direct and indirect effects inside and outside Finnish territory of a project or operations on human health, living conditions and amenity; soil, water, air, climate, organisms, interaction between them and biodiversity; community structure, buildings, landscape, townscape and cultural heritage; utilization of natural resources. In Finland, the Environmental Permit requires that ports collect all necessary information concerning environmental effects and make required reports to the Finnish authorities, stakeholders and the public. Commonly, environmental reporting is public and environmental achievements are emphasized in reporting and in media. At the moment, the problem in environmental reporting is that it’s difficult to compare data from different ports. There is enough data concerning the environmental effects and performance, but the manner of reporting and the quality of the data varies between ports. There are differences in the units and codes used, in some cases the information is not sufficient and it can even be rather unreliable. There are also differences regarding the subjects that are emphasized in reporting.

Social networks and networking facilitating internationalization: Experiences of two Finnish fashion companies

Background: Fashion is a dynamic and creative industry where larger retailers are enjoying international success. Small businesses however are struggling in the face of international expansion, as they lack the necessary resources and managerial know-how. The Finnish fashion industry has neither been able to develop the industry environment to support small and micro firms nor has Finland relevant finance or public domains, such as, seen in other Nordic countries. Networking has been recognized to facilitate organizational growth and international expansion in industries such as manufacturing and high technology. It has enabled smaller companies to gain resources, knowledge and experiences otherwise unattainable. Objective: The purpose of this study was to explore how networking has been utilized in the Finnish fashion industry. Particularly social relationships and networks are examined, as they emphasize the importance of individuals. Exploration on the past actions should also provide insight how networks and networking could be utilized and developed in the future. Main findings: It was discovered that the Finnish fashion industry (social) network is rather dense. This was mainly due to the small size of the Finnish market. In the early years of the establishment of the company, close contacts seemed to be utilized. As a company expands and extends its business, the relationships tended to move towards more utilitarian in nature. However, in some cases, the long term relationships had also affectionate features, such as trust and commitment. International networking was found to have positive impact on business opportunities. Participation to events, such as trade shows, was perceived as one of the best ways to meet new international contacts and to develop ones network. Active networking in the Finnish market, however, created both domestic and international opportunities. Furthermore, cooperation and open communication were discovered to facilitate innovation and projects. The public sector seemed to lack the interest in supporting the fashion industry according to the interviewees. The major issues for the fashion industry still concerned, among others, funding, administrative guidance and public support for developing the industry as a whole.

Supply network risks and costs in Finnish project business

This report summarizes the results of the survey HAVERI – Supply network risks in business. The survey was conducted in Finland during the spring and summer of year 2013. The survey is part of a large two-year research project started in June 2012 in Finland (on-going 06/2012–07/2014). The project is launched and financed by TEKES, the Finnish Funding Agency for Technology and Innovation, and executed together with the researchers from Lappeenranta University of Technology and Tampere University of Technology. The overall goal of this on-going research project is to find out the decision-making practices in the project-oriented companies in their purchasing decisions especially in the mechanical engineering and construction industries in Finland. The objective of the survey was to gain cross-sectional data concerning the challenges, risks and cost factors in Finnish project business companies. The results show that Finnish companies rely on their experience and supplier references in their risk management. In general, the understanding of the total cost structure varies among the industries and companies. The main cost factor in risk management was costs before the actual purchase decision. Overall, it seems that the monetary value of the whole project and capability of purchasing personnel are the main influencing factors on risk management activity in project purchasing.

Introduction of the T-10 static line parachuting capability to the NH90 helicopter

The purpose of this study was to investigate the suitability of the Finnish Defence Forces’ NH90 helicopter for parachuting operations with the T-10 static line parachute system. The work was based on the Army Command’s need to compensate for the reduction in the outsourced flight hours for the military static line parachuting training. The aim of the research was to find out the procedures and limitations with which the NH90 IOC+ or FOC version helicopter could be used for static line parachutist training with the T- 10B/MC1-1C parachutes. The research area was highly complicated and non-linear. Thus analytical methods could not be applied with sufficient confidence, even with present-day computing power. Therefore an empirical research method was selected, concentrating on flight testing supported with literature study and some calculated estimations. During three flights and 4.5 flight hours in Utti, Finland on 17−20 September 2012, a total of 44 parachute drops were made. These consisted of 16 dummy drops and 28 paratrooper jumps. The test results showed that when equipped with the floor mounted PASI-1 anchor line, the deflector bar of the NHIndustries’ Parachuting Kit and Patria’s floor protection panels the Finnish NH90 variant could be safely used for T-10B/MC1-1C static line parachuting operations from the right cabin door at airspeed range of 50−80 KIAS (∼90–150 km/h). The ceiling mounted anchor lines of the NHI’s Parachuting Kit were not usable with the T-10 system. This was due to the static lines’ unsafe behaviour in slipstream when connected to the cabin ceiling level. In conclusion, the NH90 helicopter can be used to meet the Army Command’s requirement for an additional platform for T-10 static line parachutist training. Material dropping, the effect of additional equipment and jumping from the rear ramp should be further studied.

Emotional intelligence and multicultural project leadership in Finnish-Chinese MNC context

The main goal of this thesis was to examine how the emotional intelligence skills and multicultural project leadership style of a project manager interrelate and affect the success of a project. The research methods used are literature review in theoretical part of the thesis and semi-structured interviews in empirical part of the thesis. This study is a single case study i.e. one case company was selected to be the secondary level of analysis. Within the case company, four project managers were selected as research units to form the primary level of analysis. Literature review formed the basis for the empirical research and the interview questions were derived from the literature. Findings from the interviews were mirrored against the literature review findings, based on which both conclusions and generalisations could be made. Thus, both deductive and inductive methods were utilised to get more complete picture about the research topic. In the first part of the literature review the general leadership theories and the project leadership terminology are introduced as a background for the concept of emotional intelligence and the integrated leadership model. Emotional intelligence and its interrelation to different leadership concepts are discussed during the literature review. Chinese cultural aspects affecting the way of making business, and the multicultural leadership styles of the Finnish project managers are introduced in the following part of the literature review. It was found that the most successfully used multicultural leadership styles in Finnish-Chinese context are synergistic and polycentric, and these require emotional intelligence skills. In the empirical part on this thesis the findings from the semi-structured interviews are introduced, discussed and analysed. Interviews were done in private meeting rooms, and they were recorded and transcripted to add reliability and validity. Although the sample was only four project managers, the results show that the sample is quite saturated as the responses to several questions followed the same pattern. It was found that Finnish project managers in the case company are democratic and take cultural differences into account in their project leadership. Both synergistic and polycentric leadership styles are used with Chinese team members. Emotional intelligence capabilities and the emphasis of those differ a bit depending on the interviewee. Though, the results show that EI skills and the multicultural project leadership style used in Chinese context are interrelated. The findings from the literature review and the empirical research in this thesis are similar. Though, there is need for further research as the sample was small, and this thesis is a single case study. It is recommendable to make a multi-company study with larger sample of project managers. Also multi-industry perspective is recommendable for further research.

The role of emotional branding in building brand personality from a consumer perspective

The purpose of this exploratory research is to study the role of emotional branding in building brand personality. The research is conducted from the perspective of the consumer, more specifically the Finnish Generation Y females. The aim of the thesis is to gain insights and understanding on the key concepts and contribute to the Generation Y literature. In addition, the research examines the effect of certain cultural implications on the process of building brand personality. The research was conducted as an embedded single-case study, in which qualitative data was collected through semi-structured interviews with a sample of six consumers and personal observation within one of the concept stores of the case company. In order to triangulate the data, secondary sources were utilized to gain more information about the case company. The results indicated a connection between emotional branding and the formulation of brand personality, which can be manipulated according to the brand personality drivers. Congruence with consumer self-conceptualization and set of values were discovered to strengthen the emotional bonding. As the end result, the research was able to clarify the process-thinking behind emotional branding.

The Effects of the Breast Cancer Mammography Screening Programme in Women aged 40 to 84 years in Turku, Finland (1987-2009)

The objective of this thesis was to evaluate whether a more extensive mammography screening programme (TurkuMSP) conducted by the city of Turku, had an effect on breast cancer (BC) incidence, survival, or mortality in years 1987 to 2009. Despite the fact that some studies have suggested a 20 percent reduction in BC mortality due to mammography screening, there are findings of harm to subjects, which are claimed to negate the benefits of screening. Thus, the aims of this study are most pertinent. A total of 176 908 screening examinations were performed in 36 000 women aged 40−74 during the years 1987−1997. In all, 685 primary BCs were found in the screened women, either screen-detected (n=531) or during screening intervals (n=154). Survival and BC recurrence rate of women with screen-detected BC was compared to 184 women with clinical BCs detected among individuals who did not take part in the screening. The invitation interval, which may influence the outcome, was studied in the age group 40 to 49 by inviting those born in even calendar years annually for mammography screening and those born in odd years, triennially. In addition, BC incidence and mortality in the total female population of Turku aged 40 to 84 years was compared with the respective figures of Helsinki and the rest of Finland, both during the pre-screening era (1976-1986) and the screening era (1987-2009). The study was designed to compare women by age groups, because women aged 50 to 59 were generally screened in all of Finland, whereas only in Turku women aged 40 to 49 and 60 to 74 were screened in addition. Data regarding cancer recurrence were derived from the Finnish Cancer Registry and data on deaths were collected from Statistics Finland. In survival analyses, screened women with invasive BC had a significantly higher survival rate than the women with clinical BC. The survival benefit started to appear already during the first follow-up years and was evident in all age groups. A marginal survival extension was also seen in screened women when BC had spread to ipsilateral axillary nodes already at diagnosis. Recurrence-free survival rate after BC treatment was significantly more favorable among the screened women compared with women with BC found clinically. The screening invitation interval did not significantly influence BC mortality in the subset of women aged 40 to 49 years. There were no consistent differences in the changes of BC incidence between Turku and the comparison areas during the screening era. In Turku, the BC mortality incidence in women aged 55−69 years was significantly lower during the screening era (from 1987 to 1997) compared with the pre-screening era, whereas no such change was found in the city of Helsinki or Tampere. When comparing the changes in incidence-based BC mortality during years 1987 to 2009 in Turku to those of Helsinki and the rest of Finland, there was a suggestion of more than 20 percent lower mortality in Turku among oldest age group (75-84 years) compared with the reference residential areas, but the differences were not consistently significant. Interpretation of the study results should be made with caution because there were no random control groups, and on the other hand, the number of cases in subgroups was fairly low to yield definite conclusions. Also due to the many statistical analyses, some of the findings may be due to chance. The results are, however, suggestive for a decrease of BC mortality in the elderly age groups due to wide mammography screening. This finding needs confirmation in further studies before recommending an expansion of mammography screening to women up to the age of 74 years

Gene Regulation in The Human Immune System. Gene Expression Signatures of Th2 Cell Differentiation, Type 1 Diabetes, and Intrauterine Immune Adaptation

The human immune system is constantly interacting with the surrounding stimuli and microorganisms. However, when directed against self or harmless antigens, these vital defense mechanisms can cause great damage. In addition, the understanding the underlying mechanism of several human diseases caused by aberrant immune cell functions, for instance type 1 diabetes and allergies, remains far from being complete. In this Ph.D. study these questions were addressed using genome-wide transcriptomic analyses. Asthma and allergies are characterized by a hyperactive response of the T helper 2 (Th2) immune cells. In this study, the target genes of the STAT6 transcription factor in naïve human T cells were identified with RNAi for the first time. STAT6 was shown to act as a central activator of the genes expression upon IL-4 signaling, with both direct and indirect effects on Th2 cell transcriptome. The core transcription factor network induced by IL-4 was identified from a kinetic analysis of the transcriptome. Type 1 diabetes is an autoimmune disease influenced by both the genetic susceptibility of an individual and the disease-triggering environmental factors. To improve understanding of the autoimmune processes driving pathogenesis in the prediabetic phase in humans, a unique series of prospective whole-blood RNA samples collected from HLA-susceptible children in the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) study was studied. Changes in different timewindows of the pathogenesis process were identified, and especially the type 1 interferon response was activated early and throughout the preclinical T1D. The hygiene hypothesis states that allergic diseases, and lately also autoimmune diseases, could be prevented by infections and other microbial contacts acquired in early childhood, or even prenatally. To study the effects of the standard of hygiene on the development of neonatal immune system, cord blood samples from children born in Finland (high standard of living), Estonia (rapid economic growth) and Russian Karelia (low standard of living) were compared. Children born in Russian Karelia deviated from Finnish and Estonian children in many aspects of the neonatal immune system, which was developmentally more mature in Karelia, resembling that of older infants. The results of this thesis offer significant new information on the regulatory networks associated with immune-mediated diseases in human. The results will facilitate understanding and further research on the role of the identified target genes and mechanisms driving the allergic inflammation and type 1 diabetes, hopefully leading to a new era of drug development.

The Cycle Times of Working Capital: Financial Value Chain Analysis Method

Interest towards working capital management increased among practitioners and researchers because the financial crisis of 2008 caused the deterioration of the general financial situation. The importance of managing working capital effectively increased dramatically during the financial crisis. On one hand, companies highlighted the importance of working capital management as part of short-term financial management to overcome funding difficulties. On the other hand, in academia, it has been highlighted the need to analyze working capital management from a wider perspective namely from the value chain perspective. Previously, academic articles mostly discussed working capital management from a company-centered perspective. The objective of this thesis was to put working capital management in a wider and more academic perspective and present case studies of the value chains of industries as instrumental in theoretical contributions and practical contributions as complementary to theoretical contributions and conclusions. The principal assumption of this thesis is that selffinancing of value chains can be established through effective working capital management. Thus, the thesis introduces the financial value chain analysis method which is employed in the empirical studies. The effectiveness of working capital management of the value chains is studied through the cycle time of working capital. The financial value chain analysis method employed in this study is designed for considering value chain level phenomena. This method provides a holistic picture of the value chain through financial figures. It extends the value chain analysis to the industry level. Working capital management is studied by the cash conversion cycle that measures the length (days) of time a company has funds tied up in working capital, starting from the payment of purchases to the supplier and ending when remittance of sales is received from the customers. The working capital management practices employed in the automotive, pulp and paper and information and communication technology industries have been studied in this research project. Additionally, the Finnish pharmaceutical industry is studied to obtain a deeper understanding of the working capital management of the value chain. The results indicate that the cycle time of working capital is constant in the value chain context over time. The cash conversion cycle of automotive, pulp and paper, and ICT industries are on average 70, 60 and 40 days, respectively. The difference is mainly a consequence of the different cycle time of inventories. The financial crisis of 2008 affected the working capital management of the industries similarly. Both the cycle time of accounts receivable and accounts payable increased between 2008 and 2009. The results suggest that the companies of the automotive, pulp and paper and ICT value chains were not able to self-finance. Results do not indicate the improvement of value chains position in regard to working capital management either. The findings suggest that companies operating in the Finnish pharmaceutical industry are interested in developing their own working capital management, but collaboration with the value chain partners is not considered interesting. Competition no longer occurs between individual companies, but between value chains. Therefore the financial value chain analysis method introduced in this thesis has the potential to support value chains in improving their competitiveness.

Cardiovascular responses to microinjections of GABA or anesthetics into the rostral ventrolateral medulla of conscious and anesthetized rats

The rostral ventrolateral medulla (RVLM) contains neurons involved in tonic and reflex control of arterial pressure. We describe the effects of gamma-aminobutyric acid (GABA) and anesthetics injected into the RVLM of conscious and urethane (1.2 g/kg, iv) anesthetized Wistar rats (300-350 g). In conscious rats, bilateral microinjection of GABA (50 nmol/200 nl) induced a small but significant decrease in blood pressure (from 130 ± 3.6 to 110 ± 5.6 mmHg, N = 7). A similar response was observed with sodium pentobarbital microinjection (24 nmol/200 nl). However, in the same animals, the fall in blood pressure induced by GABA (from 121 ± 8.9 to 76 ± 8.8 mmHg, N = 7) or pentobarbital (from 118 ± 4.5 to 57 ± 11.3 mmHg, N = 6) was significantly increased after urethane anesthesia. In contrast, there was no difference between conscious (from 117 ± 4.1 to 92 ± 5.9 mmHg, N = 7) and anesthetized rats (from 123 ± 6.9 to 87 ± 8.7 mmHg, N = 7) when lidocaine (34 nmol/200 nl) was microinjected into the RVLM. The heart rate variations were not consistent and only eventually reached significance in conscious or anesthetized rats. The right position of pipettes was confirmed by histology and glutamate microinjection into the RVLM. These findings suggest that in conscious animals the RVLM, in association with the other sympathetic premotor neurons, is responsible for the maintenance of sympathetic vasomotor tone during bilateral RVLM inhibition. Activity of one or more of these premotor neurons outside the RVLM can compensate for the effects of RVLM inhibition. In addition, the effects of lidocaine suggest that fibers passing through the RVLM are involved in the maintenance of blood pressure in conscious animals during RVLM inhibition.

Prenatal and perinatal risk factors for bipolar disorder

Bipolar disorder (BPD) is a severe mental disorder associated with considerable morbidity and mortality. Prenatal insults have been shown to be associated with later development of mental disorders and there is a growing interest in the potential role of prenatal and perinatal risk factors in the development of BPD. The aims of this thesis were to describe the overall study design of the Finnish Prenatal Study of Bipolar Disorders (FIPS-B) and demographic characteristics of the sample. Furthermore, it was aimed to examine the association of parental age, parental age difference, perinatal complications and maternal smoking during pregnancy with BPD. This thesis is based on FIPS-B, a nested case-control study using several nationwide registers. The cases included all people born in Finland between January 1st 1983 and December 31st 1998 and diagnosed with BPD according to the Finnish Hospital Discharge Register (FHDR) before December 31st 2008. Controls for this study were people who were without BPD, schizophrenia or diagnoses related to these disorders, identified from the Population Register Centre (PRC), and matched two-fold to the cases on sex, date of birth (+/- 30 days), and residence in Finland on the first day of diagnosis of the matched case. Conditional logistic regression models were used to examine the association between risk factors and BPD. This study included 1887 BPD cases and 3774 matched controls. The mean age at diagnosis was 19.3 years and females accounted for 68% of the cases. Mothers with the lowest educational level had the highest odds of having BPD in offspring. Being born in Eastern and Southern region of Finland increased the odds of having BPD later in life. A U-shaped distribution of odds ratio was observed between paternal age and BPD in the unadjusted analysis. Maternal age and parental age difference was not associated with BPD. Birth by planned caesarean section was associated with increased odd of BPD. Smoking during pregnancy was not associated with BPD in the adjusted analyses. Region of birth and maternal educational level were associated with BPD. Both young and old father’s age was associated with BPD. Most perinatal complications and maternal smoking during pregnancy were not associated with BPD. The findings of this thesis, considered together with previous literature, suggest that the pre- and perinatal risk factor profile varies among different psychiatric disorders.

Inviting the Audience – Interactive, Participatory, and Social Television in Finland

The television and the ways it has invited the audience to take part have been changing during the last decade. Today’s interaction, or rather participation, comes from multiplatform formats, such as TV spectacles that combine TV and web platforms in order to create a wider TV experience. Multiplatform phenomena have spread television consumption and traditional coffee table discussions to several different devices and environments. Television has become a part of the bigger puzzle of interconnected devices that operates on several platforms instead of just one. This thesis examines the Finnish television (2004–2014) through the notion of audience participation and introduces the technical, thematic, and social linkages as three different phases, interactive, participatory, social, and their most characteristic features in terms of audience participation. The aim of the study is also to focus on the idea of a possible change by addressing the possible and subtler variations that have taken place through the concept of digital television. Firstly, Finnish television history has gone through numerous trials, exploring the interactive potential of television formats. Finnish SMS-based iTV had its golden era around 2005, when nearly 50% of the television formats were to some extent interactive. Nowadays, interactive television formats have vanished due to their negative reputation and this important part of recent history is mainly been neglected in the academic scope. The dissertation focuses also on the present situation and the ways television content invites the audience to take part. “TV meets the Internet” is a global expression that characterises digital TV, and the use of the Web combined with television content is also examined. Also the linkages between television and social media are identified. Since television can nowadays be described multifaceted, the research approaches are also versatile. The research is based on qualitative content analysis, media observation, and Internet inquiry. The research material also varies. It consists of primary data: taped iTV formats, website material, and social media traces both from Twitter and Facebook and secondary data: discussion forums, observations from the media and Internet inquiry data. To sum up the results, the iTV phase represented, through its content, a new possibility for audiences to take part in a TV show (through gameful and textual features) in real-time. In participatory phase, the most characteristic features from TV-related content view, is the fact that online platform(s) were used to immerse the audience with additional material and, due to this, to extend the TV watching enjoyment beyond the actual broadcast. During the Social (media) phase, both of these features, real-timeness, and extended enjoyment through additional material, are combined and Facebook & Twitter, for example, are used to immerse people in live events (in real-time) via broadcast-related tweets and extra-material offered on a Facebook page. This thesis fills in the gap in Finnish television research by examining the rapid changes taken place on the field within the last ten years. The main results is that the development of Finnish digital television has been much more diverse and subtle than has been anticipated by following only the news, media, and contemporary discourses on the subject of television. The results will benefit both practitioners and academics by identifying the recent history of Finnish television.

Apolipoprotein E polymorphism distribution in an elderly Brazilian population: the Bambuí Health and Aging Study

Apolipoprotein E (ApoE) is one of the most extensively studied genes in the context of aging, but there are few population-based studies on ApoE polymorphism in the elderly in developing countries. The objective of the present study was to assess ApoE allele and genotype distribution in a large elderly community-based sample and its association with age, sex and skin color. Participants included 1408 subjects (80.8% of all residents aged ³60 years) residing in Bambuí city, MG, Brazil. The DNA samples were subjected to the polymerase chain reaction amplification, followed by the restriction fragment length polymorphism technique, with digestion by HhaI. Analysis was carried out taking into consideration the six ApoE genotypes (e3/e3, e3/e4, e2/e3, e4/e4, e2/e4, and e2/e2), the three ApoE alleles, and the number of ApoE4 alleles for each individual. The e3 allele predominated (80.0%), followed by e4 (13.5%) and e2 (6.5%). All six possible genotypes were observed, the e3/e3 genotype being the most frequent (63.4%). This distribution was similar to that described in other western populations. Sex was not associated with number of ApoE4 alleles. Black skin color was significantly and independently associated with the presence of two ApoE4 alleles (age-sex adjusted OR = 7.38; 95%CI = 1.93-28.25), showing that the African-Brazilian elderly have a high prevalence of the e4 allele, as observed in blacks from Africa. No association between number of ApoE4 alleles and age was found, suggesting the absence of association of ApoE genotype with mortality in this population.

Dimensionality of the premenstrual syndrome: confirmatory factor analysis of premenstrual dysphoric symptoms among college students

Premenstrual syndrome and premenstrual dysphoric disorder (PMDD) seem to form a severity continuum with no clear-cut boundary. However, since the American Psychiatric Association proposed the research criteria for PMDD in 1994, there has been no agreement about the symptomatic constellation that constitutes this syndrome. The objective of the present study was to establish the core latent structure of PMDD symptoms in a non-clinical sample. Data concerning PMDD symptoms were obtained from 632 regularly menstruating college students (mean age 24.4 years, SD 5.9, range 17 to 49). For the first random half (N = 316), we performed principal component analysis (PCA) and for the remaining half (N = 316), we tested three theory-derived competing models of PMDD by confirmatory factor analysis. PCA allowed us to extract two correlated factors, i.e., dysphoric-somatic and behavioral-impairment factors. The two-dimensional latent model derived from PCA showed the best overall fit among three models tested by confirmatory factor analysis (c²53 = 64.39, P = 0.13; goodness-of-fit indices = 0.96; adjusted goodness-of-fit indices = 0.95; root mean square residual = 0.05; root mean square error of approximation = 0.03; 90%CI = 0.00 to 0.05; Akaike's information criterion = -41.61). The items "out of control" and "physical symptoms" loaded conspicuously on the first factor and "interpersonal impairment" loaded higher on the second factor. The construct validity for PMDD was accounted for by two highly correlated dimensions. These results support the argument for focusing on the core psychopathological dimension of PMDD in future studies.

Can course format influence the performance of students in an advanced cardiac life support (ACLS) program?

Advanced cardiac life support (ACLS) is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003) and Model 2 (N = 2085; 2003-2007). Model 2 increased practical skill activities to 75% of the total versus 60% in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85% in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given). Compared to Model 1, Model 2 presented odds ratios (OR) indicating better performance in the theoretical (OR = 1.34; 95%CI = 1.10-1.64), practical (OR = 1.19; 95%CI = 0.90-1.57), and combined (OR = 1.38; 95%CI = 1.13-1.68) outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students.