Early transjugular intrahepatic portosystemic shunt in cirrhotic patients with acute variceal bleeding: a systematic review and meta-analysis of controlled trials.

INTRODUCTION: There is conflicting evidence on the benefit of early transjugular intrahepatic portosystemic shunt (TIPSS) on the survival of patients with acute variceal bleeding (AVB). AIM: To assess the effect of early TIPSS on patient prognosis. MATERIALS AND METHODS: We carried out a meta-analysis of trials evaluating early TIPSS in cirrhotic patients with AVB. RESULTS: Four studies were included. Early TIPSS was associated with fewer deaths [odds ratio (OR)=0.38, 95% confidence interval (CI)=0.17-0.83, P=0.02], with moderate heterogeneity between studies (P=0.15, I=44%). Early TIPSS was not significantly associated with fewer deaths among Child-Pugh B patients (OR=0.35, 95% CI=0.10-1.17, P=0.087) nor among Child-Pugh C patients (OR=0.34, 95% CI=0.10-1.11, P=0.074). There was no heterogeneity between studies in the Child-Pugh B analysis (P=0.6, I=0%), but there was a high heterogeneity in the Child-Pugh C analysis (P=0.06, I=60%). Early TIPSS was associated with lower rates of bleeding within 1 year (OR=0.08, 95% CI=0.04-0.17, P<0.001) both among Child-Pugh B patients, (OR=0.15, 95% CI=0.05-0.47, P=0.001) and among Child-Pugh C patients (OR=0.05, 95% CI=0.02-0.15, P<0.001), with no heterogeneity between studies. Early TIPSS was not associated with higher rates of encephalopathy (OR=0.84, 95% CI=0.50-1.42, P=0.5). CONCLUSION: Cirrhotic patients with AVB treated with early TIPSS had lower death rates and lower rates of clinically significant bleeding within 1 year compared with patients treated without early TIPSS. Additional studies are required to identify the potential risk factors leading to a poor prognosis after early TIPSS in patients with AVB and to determine the impact of the degree of liver failure on the patient's prognosis.

Tilintarkastuksen valvonta ja laadunvalvonta

Tutkimuksen tavoitteena oli selvittää tilintarkastuksen valvonnan ja laadunvalvonnan vaikutuksia tilintarkastukseen: laatuun, uskottavuuteen ja luotettavuuteen. Tavoitteeseen päästiin alatavoitteiden kautta: 1) selvittämällä tilintarkastukselle asetetut vaatimukset, 2) selvittämällä, mitä tilintarkastuksen valvonta ja laadunvalvonta sisältävät, 3) tutkimalla tilintarkastajien käsityksiä tilintarkastukselle asetetuista vaatimuksista, valvonnasta ja laadunvalvonnasta sekä tilintarkastuksen valvonnan ja laadunvalvonnan vaikutuksista ja 4) tutkimalla vieraan pääoman rahoittajien käsityksiä tilintarkastuksen laadusta, uskottavuudesta ja luotettavuudesta. Tutkimus on kvalitatiivinen, hermeneuttinen tutkimus ja siinä on tulkitseva tutkimusote. Empiirisen aineiston keräsin haastattelemalla viisi ammattitilintarkastajaa ja tekemällä sähköpostihaastattelun kahdeksalle rahoittajan edustajalle. Tilintarkastajista neljällä on kokemusta joko tilintarkastuksen laadunvalvonnasta tai valvonnasta. Lisäksi olen hyödyntänyt omaa kokemustani tutkittavasta ilmiöstä. Rahoittajan edustajat ovat kokeneita riski- ja pankkirahoittajia. Tilintarkastukselle asetetaan tiukat riippumattomuus-, ammattitaito- ja työn toteutusvaatimukset. Vaatimusten noudattamista valvotaan tilintarkastuslakiin perustuvalla valvonnalla ja pakollisella laadunvalvonnalla. Molempien valvontamuotojen tavoitteena on tilintarkastuksen laadun, uskottavuuden ja luotettavuuden varmistaminen. Erityisesti laadunvalvonnan vaikutuksesta tilintarkastuksen laatu on kohonnut. Tilintarkastajien ammattitaidon ja työmenetelmien kehittyminen ja tilintarkastuksen ammattimaistuminen on nostanut laatua. Laatu syntyy pääasiassa tilintarkastusprosessissa, jota rahoittaja ei pysty seuraamaan. Rahoittajien käsitykset laadusta ovat ristiriitaiset, mutta siitä huolimatta ammattimaista tilintarkastusta pidetään pääosin luotettavana ja uskottavana.

Identiteetti ja luopuminen perheyrityksen sukupolvenvaihdoksessa

Tutkimus on perheyrittäjyystutkimusta, se käsittelee perheyrityksessä tapahtunutta sukupolvenvaihdosta sekä siihen liittyvää luopumisen prosessia. Poikkitieteellisenä lähestymistapana käytetään sosiologisia ja psykologisia katsantokantoja identiteetin rakentumisesta ja sen muuttumisesta. Luopumiskäsitettä lähestytään perheyrittäjän identiteetin rakentumisen ja muuttumisen kautta. Tutkimus etsii vastausta neljään kysymykseen: 1. Millainen on perheyrittäjän identiteetti? 2. Miten perheyrityksen sukupolvenvaihdos vaikuttaa identiteettiin? 3. Mitä luopuminen tarkoittaa sukupolvenvaihdoksessa? 4. Mitä sukupolvenvaihdoksessa todellisuudessa tapahtuu? Tutkimuksessa paneudutaan luopujan ja jatkajan näkökulmiin, joita tarkastellaan elämänkertatarinoiden avulla. Tutkimuksen aineisto koostuu viidestä yrityksestä, joissa jollakin tasolla on sukupolvenvaihdos toteutettu. Tutkimuksessa on haastateltu kolmeatoista henkilöä. Tutkimuksen perusteella voidaan todeta, että perheyrittäjän identiteetti on hyvin kompleksinen ja vaikeasti lähestyttävä asia. Perheyrittäjän persoona on vahva ja perhe sekä yritys vaikuttavat oleellisesti sen muotoutumiseen. Individuaalisuus jää usein familistisen näkemyksen jalkoihin. Sukupolvenvaihdos vaikutti sekä luopujan että jatkajan identiteettiin ratkaisevasti. Luopujat kohtasivat kriisin miettiessään yrityksensä tulevaisuutta ja moni jatkaja puolestaan muutti elämäänsä radikaalisti siirtyessään perheyrityksen jatkajaksi. Työstä luopuminen osoittautui tutkimuksessa kriittisimmäksi tekijäksi, etenkin luopujien näkökulmasta katsottuna. Jatkajille se merkitsi oman jo mahdollisen muun uran ja työpaikan vaihtumista perheyritykseen. Luopujille se teoriassa tarkoitti eläkkeelle siirtymistä. Tutkituissa yrityksissä kukaan luopujista ei kuitenkaan ole lopettanut työn tekoa. He ovat jokapäiväinen näky yrityksessä ja enemmän tai vähemmän aktiivisesti mukana yrityksen toiminnoissa. Tämä aiheuttaa sukupolvien yhteentörmäystä ja konflikteja, tämä seikka vie paljon energiaa yrityksessä tehtävältä työltä. Työ on yrittäjälle erittäin vahva ja merkitsevä identiteetin perusta, jonka muuttaminen tai siitä luopuminen on vaikeaa.

Prevalence of Ischemic Heart Disease and Management of Coronary Risk in Daily Clinical Practice: Results from a Mediterranean Cohort of HIV-Infected Patients

There are conflicting data on the prevalence of coronary events and the quality of the management of modifiable cardiovascular risk factors (CVRF) inHIV-infected patients. Methods.We performed a retrospective descriptive study to determine the prevalence of coronary events and to evaluate the management of CVRF in a Mediterranean cohort of 3760 HIV-1-infected patients from April 1983 through June 2011. Results.We identified 81 patients with a history of a coronary event (prevalence 2.15%); 83% of them suffered an acute myocardial infarction. At the time of the coronary event, CVRF were highly prevalent (60.5% hypertension, 48% dyslipidemia, and 16% diabetes mellitus).OtherCVRF, such as smoking, hypertension, lack of exercise, and body mass index, were not routinely assessed. After the coronary event, a significant decrease in total cholesterol ( � = 0.025) and LDLcholesterol ( � = 0.004) was observed. However, the percentage of patients whomaintained LDL-cholesterol > 100mg/dL remained stable (from 46% to 41%, � = 0.103). Patients using protease inhibitors associated with a favorable lipid profile increased over time ( � = 0.028). Conclusions.The prevalence of coronary events in our cohort is low. CVRF prevalence is high and theirmanagement is far from optimal. More aggressive interventions should be implemented to diminish cardiovascular risk in HIV-infected patients.

Tiedonanto- ja selonottovelvollisuus käytetyn asunnon kaupassa

Tutkielman tavoitteena oli selvittää tiedonanto- ja selonottovelvollisuuden sekä virhevastuun jakautumista käytetyn asunnon kaupassa. Ostajan ja myyjän lisäksi tutkittiin kiinteistönvälittäjän asemaa asuntokaupassa ja asuntokaupan virhetilanteissa. Tutkielmassa havaittiin asuntokauppaa ja kiinteistökauppaa säätelevien lakien jättävän sijaa tulkinnoille ja siten oikeustapaukset tulevat täsmentämään asuntokaupan sääntöjä. Jokainen asuntokauppa on omanlaisensa ja asuntokauppaan sekä virhearviointiin vaikuttavat monet tekijät, joten selonotto- ja tiedonantovelvollisuuden välinen rajanveto jää yksittäistapauksittain ratkaistavaksi.

Osakeyhtiön hallituksen jäsenen vastuu oikeustapausten valossa

Tutkielman kohteena on osakeyhtiön hallituksen jäsenen vastuu osakeyhtiön yhtiöoikeudellisena toimielimenä ja vastuun toteutuminen käytännössä korkeimman oikeuden ratkaisujen valossa. Tutkielman tarkoituksena on hallituksen koostumuksen, tehtävien ja toiminnan kautta selvittää, miten hallituksen eri jäsenten vastuu muodostuu. Tutkielmassa pyritään selventämään osakeyhtiön hallituksen toiminnan keskeisiä vastuualueita tutkielman aineiston perusteella. Tutkielman metodina on oikeustapausten analyysi ja sitä kautta lain oikean tulkinnan hakeminen. Tässä suhteessa tutkielma on oikeusdogmaattinen tulkintatutkimus. Tutkielma osoitti, että osakeyhtiön hallituksen jäsenyyteen liittyy paitsi vastuu tehtävien hoitamisesta, myös huomattava vahingonkorvausvastuu . Vastuu voi käytännössä kohdistua paitsi yhtiöön myös osakkeenomistajaan ja erityisesti yhtiön velkojaan. Tutkielma osoitti myös, että osakeyhtiön hallituksen jäseneksi aikovan on oltava selvillä tehtävään liittyvästä oikeudellisesta vastuusta. Tehtävää ei pidä ottaa vastaan, ellei omaa tehtävän huolellisen hoitamisen vaatimaa riittävää asiantuntemusta ja ammattitaitoa.

Osakkeenomistajan suojaaminen vähemmistöosakkeiden hankinnassa - Oikeusvertaileva tarkastelu Suomen ja Delawaren käytännöistä

Tutkielmassa tarkastellaan osakkeenomistajien suojaamiskeinoja Suomessa ja Delawaressa. Oikeusvertailevaa metodia sovelletaan kolmella tasolla: lakien ja määräysten osalta, menettelyn osalta sekä suojaamiskeinojen osalta. Osakkeenomistajien katsotaan tarvitsevan suojaa vähemmistöosakkeiden hankinnan yhteydessä, sillä siinä osakkeiden vapaan vaihdettavuuden perusperiaate ja pakkolunastaminen kohtaavat. Suojaamiskeinot on jaettu etukäteisiin, menettelya koskeviin sekä hinnanmäärittelyyn liittyviin keinoihin. Etukäteisiin keinoihin voidaan laskea johdon vastuu, joka koostuu huolellisuus- ja lojaliteettivelvoitteista, ja yhtiöjärjestysmääräykset. Delawaressa johdon vastuu on määritelty Suomea tarkemmin. Yhtiöjärjestysmääräykset ovat ongelmallisia Suomessa, sillä ne saattavat olla arvopaperimarkkinalain vastaisia. Delawaressa niiden käyttö on runsasta. Menettelyyn liittyviaä suojakeinoja löytyi useita. Vähemmistönsuojaperiaatetta toteutetaan Suomessa yhdenvertaisuusperiaatetta noudattamalla sekä määräämällä lunastusoikeudesta tai -velvollisuudesta. Delawaressa vähemmistöllä on oikeus saada erityistuomioistuin Court of Chanceryn arviointi menettelyn oikeellisuudesta. Menettelyn oikeellisuutta pyritään kummassakin tutkimuskohteessa suojaamaan myös tiedonantovelvollisuudella. Lisäksi Delawaressa johdon on asetettava aina erikoiskomitea neuvottelemaan ostajan kanssa. Hinnanmäärittelyn osalta suojaa antavat käyvän hinnan vaatimus, sekä Suomessa taloudellisen yhdenvertaisuuden periaate ja Delawaressa vähemmistön oikeus saada Court of Chanceryn arviointi oikeasta hinnasta.

Feromones: el paper de l'olor en la comunicació animal

Chemical perception is considered one of the first senses used as a communication system between living organisms. Such communication is based on the emission of signals between a sender and a receiver; if the communication is chemical, these signals are called pheromones. These signals have evolved via natural selection through a mechanism known as ritualization, which converts cues (which are not adapted to communication and which the receiver picks up regardless of the interests of the sender) into signals (information that the sender transmits as an adaptative response to its previously developed perception of the receiver). When communication has evolved between actors (sender and receiver) with common interests, the honesty of the signal is taken for granted, since both want the same thing (i.e., there is no reason to deceive). If the actors have conflicting interests, however, then the possibility of deception seeps into the possible array of adaptations. This can be observed in the case of communicative mimicry. However, in other situations natural selection imposes conditions that screen the possible signals, allowing only those that meet the requirement of honesty to stabilize. These include indices and added-cost signals. The emission of pheromones plays a variety of roles in the life processes of living beings. It facilitates encounters between individuals of the same species and is heavily involved in the mechanisms of recognition of relatives. It also fosters behaviours such as altruism (cooperation between individuals that share a percentage of their genetic inheritance). In many species, including humans, chemical communication works behind the scenes to guide the choice of a sexual partner.

Executive dysfunction and memory impairment in schizoaffective disorder: a comparison with bipolar disorder, schizophrenia and healthy controls.

BACKGROUND: Deficits in memory and executive performance are well-established features of bipolar disorder and schizophrenia. By contrast, data on cognitive impairment in schizoaffective disorder are scarce and the findings are conflicting. METHOD: We used the Wechsler Memory Scale (WMS-III) and the Behavioural Assessment of the Dysexecutive Syndrome (BADS) to test memory and executive function in 45 schizophrenic patients, 26 schizomanic patients and 51 manic bipolar patients in comparison to 65 healthy controls. The patients were tested when acutely ill. RESULTS: All three patient groups performed significantly more poorly than the controls on global measures of memory and executive functioning, but there were no differences among the patient groups. There were few differences in memory and executive function subtest scores within the patient groups. There were no differences in any test scores between manic patients with and without psychotic symptoms. CONCLUSIONS: Schizophrenic, schizomanic and manic patients show a broadly similar degree of executive and memory deficits in the acute phase of illness. Our results do not support a categorical differentiation across different psychotic categories with regard to neuropsychological deficits.

Novel Roles of HCG/LH Signalling in the Mouse Mammary Gland and its Tumorigenesis.

Breast cancer is the most common cancer in women, and its development is intimately related to hormonal factors, but how hormones affect breast physiology and tumorigenesis is not sufficiently known. Pregnancy elicits long-term protection from breast cancer, but during the first ten years after pregnancy, breast cancer risk is increased. In previous studies, there has been conflicting data on the role of human chorionic gonadotropin (HCG) and the functionality of its receptor in extragonadal tissues. The aim of this study was to elucidate the role of chronically elevated HCG in mouse physiology. We have created a transgenic (TG) mouse model that overexpresses HCG. HCG is similar to lutenizing hormone (LH), but is secreted almost solely by the placenta during pregnancy. HCG and LH both bind to the LH receptor (LHR). In the current study, mammary gland tumors were observed in HCG TG mice. We elucidated the role of HCG in mammary gland signalling and the effects of LHR mediated signalling in mouse mammary gland gene expression. We also studied the effects of HCG in human breast epithelial cell cultures. Several endocrine disturbances were observed in HCGβ TG female mice, resulting in precocious puberty, infertility, obesity and pituitary and mammary gland tumors. The histology of the mammary gland tumors of HCGβ TG females resembled those observed in mouse models with activated Wnt/β-catenin signalling pathway. Wnts are involved in stem cell regulation and tumorigenesis, and are hormonally regulated in the mammary gland. We observed activated β-catenin signalling and elevated expression of Wnt5b and Wnt7b in TG tumors and mammary glands. Furthermore, we discovered that HCG directly regulates the expression of Wnt5b and Wnt7b in the mouse mammary gland. Pharmacological treatment with HCG also caused upregulation of several Wnt-pathway target genes in ovariectomized wild type (WT) mice in the presence of physiological concentrations of estradiol and progesterone. In addition, differential expression of several metabolic genes was observed, suggesting that HCG affects adipocyte function or glucose metabolism. When WT mice were transplanted with LHR deficient or wild type WT mammary epithelium, differential expression of several genes affecting the Wnt-signalling pathway was observed in microarray analysis. Diminished expression of several genes associated with LHR function in other tissues, such as the ovary, was observed in mammary glands deficient of epithelial LHR. In cultured human mammary epithelial cells HCG upregulated the expression of WNT5B, WNT7B similar to mouse, suggesting that the observations found are relevant in human physiology. These studies suggest that HCG/LHR signalling affects gene expression in non-gonadal tissues, and that Wnt-signalling is regulated by HCG/LH in human and mouse mammary glands.

The Role of the Subjectivist Position in the Probabilization of Forensic Science

This paper is concerned with the contribution of forensic science to the legal process by helping reduce uncertainty. Although it is now widely accepted that uncertainty should be handled by probability because it is a safeguard against incoherent proceedings, there remain diverging and conflicting views on how probability ought to be interpreted. This is exemplified by the proposals in scientific literature that call for procedures of probability computation that are referred to as "objective," suggesting that scientists ought to use them in their reporting to recipients of expert information. I find such proposals objectionable. They need to be viewed cautiously, essentially because ensuing probabilistic statements can be perceived as making forensic science prescriptive. A motivating example from the context of forensic DNA analysis will be chosen to illustrate this. As a main point, it shall be argued that such constraining suggestions can be avoided by interpreting probability as a measure of personal belief, that is, subjective probability. Invoking references to foundational literature from mathematical statistics and philosophy of science, the discussion will explore the consequences of this interdisciplinary viewpoint for the practice of forensic expert reporting. It will be emphasized that-as an operational interpretation of probability-the subjectivist perspective enables forensic science to add value to the legal process, in particular by avoiding inferential impasses to which other interpretations of probability may lead. Moreover, understanding probability from a subjective perspective can encourage participants in the legal process to take on more responsibility in matters regarding the coherent handling of uncertainty. This would assure more balanced interactions at the interface between science and the law. This, in turn, provides support for ongoing developments that can be called the "probabilization" of forensic science.

Personality traits and psychopathology predict burnout symptoms after two years in a sample of Catalan police officers

The operational aspects of psychological assessment are well documented (e.g. Murphy and Davidshofer, 1994). Essentially, the process involves the administration of one or more valid psychological tests in order to assess a person’s suitability to a task or situation. The resulting data and report are then used by police psychologists to assist in determining the suitability of the applicant for police duties. In Catalunya, this task is carried out during basic training for police career agent in the evaluation of psychological conditions for the use of the weapon. Police work can be one of the most stressful jobs, and it frequently leads to the development of burnout syndrome. In their day-to-day tasks, police officers are constantly subjected to various stressors (de la Fuente, Aguayo, Vargas and Cañadas, 2013). The most widely accepted definition of the burnout syndrome is one that describes it as a response to chronic work stress made up of three components: emotional exhaustion, depersonalisation and low personal accomplishment (Maslach & Jackson, 1981). Some studies showed that personality characteristics, and positive and negative affectivity explained significant variance in each of the burnout dimensions (Alarcon, Eschleman and Bowling, 2009).

Reactive Recruitment of Attentional Control in Math Anxiety: An ERP Study of Numeric Conflict Monitoring and Adaptation

This study uses event-related brain potentials (ERPs) to investigate the electrophysiological correlates of numeric conflict monitoring in math-anxious individuals, by analyzing whether math anxiety is related to abnormal processing in early conflict detection (as shown by the N450 component) and/or in a later, response-related stage of processing (as shown by the conflict sustained potential; Conflict-SP). Conflict adaptation effects were also studied by analyzing the effect of the previous trial"s congruence in current interference. To this end, 17 low math-anxious (LMA)and 17 high math-anxious (HMA) individuals were presented with a numerical Stroop task. Groups were extreme in math anxiety but did not differ in trait or state anxiety or in simple math ability. The interference effect of the current trial (incongruent-congruent) and the interference effect preceded by congruence and by incongruity were analyzed both for behavioral measures and for ERPs. A greater interference effect was found for response times in the HMA group than in the LMA one. Regarding ERPs, the LMA group showed a greater N450 component for the interference effect preceded by congruence than when preceded by incongruity, while the HMA group showed greater Conflict-SP amplitude for the interference effect preceded by congruence than when preceded by incongruity. Our study showed that the electrophysiological correlates of numeric interference in HMA individuals comprise the absence of a conflict adaptation effect in the first stage of conflict processing (N450) and an abnormal subsequent up-regulation of cognitive control in order to overcome the conflict (Conflict-SP). More concretely, our study shows that math anxiety is related to a reactive and compensatory recruitment of control resources that is implemented only when previously exposed to a stimuli presenting conflicting information

Health care workers' influenza vaccination: motivations and mandatory mask policy

BACKGROUND: Vaccination of health care workers (HCW) against seasonal influenza (SI) is recommended but vaccination rate rarely reach >30%. Vaccination coverage against 2009 pandemic influenza (PI) was 52% in our hospital, whilst a new policy requiring unvaccinated HCW to wear a mask during patient care duties was enforced. AIMS: To investigate the determinants of this higher vaccination acceptance for PI and to look for an association with the new mask-wearing policy. METHODS: A retrospective cohort study, involving HCW of three critical departments of a 1023-bed, tertiary-care university hospital in Switzerland. Self-reported 2009-10 SI and 2009 PI vaccination statuses, reasons and demographic data were collected through a literature-based questionnaire. Descriptive statistics, uni- and multivariate analyses were then performed. RESULTS: There were 472 respondents with a response rate of 54%. Self-reported vaccination acceptance was 64% for PI and 53% for SI. PI vaccination acceptance was associated with being vaccinated against SI (OR 9.5; 95% CI 5.5-16.4), being a physician (OR 7.7; 95% CI 3.1-19.1) and feeling uncomfortable wearing a mask (OR 1.7; 95% CI 1.0-2.8). Main motives for refusing vaccination were: preference for wearing a surgical mask (80% for PI, not applicable for SI) and concerns about vaccine safety (64%, 50%) and efficacy (44%, 35%). CONCLUSIONS: The new mask-wearing policy was a motivation for vaccination but also offered an alternative to non-compliant HCW. Concerns about vaccine safety and efficiency and self-interest of health care workers are still main determinants for influenza vaccination acceptance. Better incentives are needed to encourage vaccination amongst non-physician HCW.

Peatlands and plantations in Sumatra, Indonesia : Complex realities for resource governance, rural development and climate change mitigation

Peatlands play a crucial role in Indonesia's economic development, and in its stated goal of reducing greenhouse gas emissions. Improved peatland management - including a national moratorium on the granting of any new conversion licenses - forms a cornerstone of Indonesia's climate change mitigation commitment. At the same time, rapid expansion of the plantation sector is driving wide-scale drainage and conversion of peat swamp ecosystems. The province of Riau, in central Sumatra, finds itself at the crossroads of these conflicting agendas. This essay presents a case study of three islands on Riau's east coast affected by industrial timber plantation concessions. It examines the divergent experiences, perceptions and responses of communities on the islands. A mix of dramatic protests, localised everyday actions and constructive dialogue has succeeded in delaying or perhaps halting one of the concessions, while negotiations and contestation with the other two continue. With the support of regional and national non-governmental organisations and local government, communities are pursuing alternative development strategies, including the cultivation of sago, which requires no peat drainage. While a powerful political economy of state and corporate actors shapes the contours of socio-environmental change, local social movements can alter trajectories of change, promoting incremental improvements and alternative pathways.