Transcatheter coil embolization of multiple bilateral congenital coronary artery fistulae.

Coronary artery fistulae represent the most frequent congenital anomalies of the coronary arteries, but remain a relatively uncommon clinical problem. Moreover, multiple fistulae originating from both the left and the right coronary arteries and draining into the left ventricular chamber are a rare condition. Due to the low prevalence of these anomalies, the appropriate management of patients with symptomatic coronary artery fistulae is controversial. Transcatheter closure approaches have emerged as a less invasive strategy and are nowadays considered a valuable alternative to surgical correction with similar effectiveness, morbidity and mortality. The percutaneous management, however, is mainly limited by the individual anatomic features of the fistula and an appropriate patient's selection is considered as a key determining factor to achieve complete occlusion. Thus, success rates of transcatheter closure techniques reported in the literature are extremely variable and highly dependent upon the nature of the follow up, which, at present, is not standardized. The optimal management of symptomatic patients with multiple coronary artery fistulae still remains a challenging problem and has been traditionally considered as an indication for cardiac surgery. We report here the case of a patient with double bilateral congenital coronary artery fistulae arising from both the left and right coronary arteries and draining individually into the left ventricular chamber. This patient underwent successful transcatheter anterograde closure of both fistulae using a microcoil embolization technique.

Legal issues in promoting FOSS in R+D projects - Policy, Organisation and Management

Creating and using FLOSS in R+D projects raises several legal issues, which need to be managed as soon as possible - preferably during the project planning stage. Challenges in the areas of project structure and policy, licenses and licensing, exploitation strategies, community management, and FLOSS-friendliness in general all have their legal aspects, which are commented here. Some recommendations are made for assisting in the use of FLOSS in R+D projects, especially in multiple party consortiums.

The environmental effectiviness of alternative agri-environmental policy reforms : theoretical and empirical analysis

Selostus: Maatalouden ympäristöpolitiikan reformien tehokkuus ravinnepäästöjen vähentämisessä - teoreettinen ja empiirinen analyysi

Argemone mexicana decoction versus artesunate-amodiaquine for the management of malaria in Mali: policy and public-health implications.

A classic way of delaying drug resistance is to use an alternative when possible. We tested the malaria treatment Argemone mexicana decoction (AM), a validated self-prepared traditional medicine made with one widely available plant and safe across wide dose variations. In an attempt to reflect the real situation in the home-based management of malaria in a remote Malian village, 301 patients with presumed uncomplicated malaria (median age 5 years) were randomly assigned to receive AM or artesunate-amodiaquine [artemisinin combination therapy (ACT)] as first-line treatment. Both treatments were well tolerated. Over 28 days, second-line treatment was not required for 89% (95% CI 84.1-93.2) of patients on AM, versus 95% (95% CI 88.8-98.3) on ACT. Deterioration to severe malaria was 1.9% in both groups in children aged </=5 years (there were no cases in patients aged >5 years) and 0% had coma/convulsions. AM, now government-approved in Mali, could be tested as a first-line complement to standard modern drugs in high-transmission areas, in order to reduce the drug pressure for development of resistance to ACT, in the management of malaria. In view of the low rate of severe malaria and good tolerability, AM may also constitute a first-aid treatment when access to other antimalarials is delayed.

Regional Innovation Policy: Effect on SMEs in Five EU-Regions

Valtaosa eurooppalaisista yrityksistä on pk-yrityksiä, mutta tästä huolimatta seudullisen innovaatiopolitiikan vaikutusta juuri pk-yrityksiin on tutkittu melko vähän. Tämän tutkimuksen tarkoituksena on luoda yleiskuva pk-yritysten näkemykseen oman seutunsa innovaatiopolitiikasta viidellä EU:n alueella sijaitsevalla seudulla. Kirjallisuuden perusteella rakennettiin seudullista innovaatiopolitiikkaa kuvaava kysely, johon joukko pk-yrityksiä viideltä seudulta vastasi. Kyselyn tulokset kuvailtiin graafisesti, minkä lisäksi etsittiin vastauksiin vaikuttaneita tekijöitä ja yhteyksiä yritysten vastausten välillä. Tutkimus oli luonteeltaan lähinnä kvantitatiivinen. Tutkimus osoittaa, että seudullisessainnovaatiopolitiikassa on vielä paljon kehitettävää, jotta se tavoittaisi kattavasti pk-yritykset. Pk-yritysten tietoisuutta tulisi lisätä, sillä nämä eivät yleisesti ottaen näytä pitävän seudullista innovaatiopolitiikkaa menetykseen vaikuttavana tekijänä tai siihen liittyviä yhteistyömahdollisuuksia tärkeinä omalle toiminnalleen. Erot innovaatiotoiminnan seudullisessa roolissa tulivat esiin tuloksissa. Yritysten vastauksia selittäviä tekijöitä löydettiin, samoin yhteyksiä vastausten välillä, mutta varsinaisten johtopäätösten tekeminen edellyttänee laajempaa tutkimusta

Outcome of unilateral ankle arthrodesis and total ankle replacement in terms of bilateral gait mechanics.

Previous studies assessed the outcome of ankle arthrodesis (AA) and total ankle replacement (TAR) surgeries; however, the extent of postoperative recovery towards bilateral gait mechanics (BGM) is unknown. We evaluated the outcome of the two surgeries at least 2 years post rehabilitation, focusing on BGM. 36 participants, including 12 AA patients, 12 TAR patients, and 12 controls were included. Gait assessment over 50 m distance was performed utilizing pressure insoles and 3D inertial sensors, following which an intraindividual comparison was performed. Most spatiotemporal and kinematic parameters in the TAR group were indicative of good gait symmetry, while the AA group presented significant differences. Plantar pressure symmetry among the AA group was also significantly distorted. Abnormality in biomechanical behavior of the AA unoperated, contralateral foot was observed. In summary, our results indicate an altered BGM in AA patients, whereas a relatively fully recovered BGM is observed in TAR patients, despite the quantitative differences in several parameters when compared to a healthy population. Our study supports a biomechanical assessment and rehabilitation of both operated and unoperated sides after major surgeries for ankle osteoarthrosis.

Regional Innovation Policy: Effect on SMEs in Five EU-Regions

Valtaosa eurooppalaisista yrityksistä on pk-yrityksiä, mutta tästä huolimatta seudullisen innovaatiopolitiikan vaikutusta juuri pk-yrityksiin on tutkittu melko vähän. Tämän tutkimuksen tarkoituksena on luoda yleiskuva pk-yritysten näkemykseen oman seutunsa innovaatiopolitiikasta viidellä EU:n alueella sijaitsevalla seudulla. Kirjallisuuden perusteella rakennettiin seudullista innovaatiopolitiikkaa kuvaava kysely, johon joukko pk-yrityksiä viideltä seudulta vastasi. Kyselyn tulokset kuvailtiin graafisesti, minkä lisäksi etsittiin vastauksiin vaikuttaneita tekijöitä ja yhteyksiä yritysten vastausten välillä. Tutkimus oli luonteeltaan lähinnä kvantitatiivinen. Tutkimus osoittaa, että seudullisessa innovaatiopolitiikassa on vielä paljon kehitettävää, jotta se tavoittaisi kattavasti pk-yritykset. Pk-yritysten tietoisuutta tulisi lisätä, sillä nämä eivät yleisesti ottaen näytä pitävän seudullista innovaatiopolitiikkaa menetykseen vaikuttavana tekijänä tai siihen liittyviä yhteistyömahdollisuuksia tärkeinä omalle toiminnalleen. Erot innovaatiotoiminnan seudullisessa roolissa tulivat esiin tuloksissa. Yritysten vastauksia selittäviä tekijöitä löydettiin, samoin yhteyksiä vastausten välillä, mutta varsinaisten johtopäätösten tekeminen edellyttänee laajempaa tutkimusta.

Supply chain integration: studies on linking customer responsiveness and operational efficiency in logistics policy planning

Abstract The research problem in the thesis deals with improving the responsiveness and efficiency of logistics service processes between a supplier and its customers. The improvement can be sought by customizing the services and increasing the coordination of activities between the different parties in the supply chain. It is argued that to achieve coordination the parties have to have connections on several levels. In the framework employed in this research, three contexts are conceptualized at which the linkages can be planned: 1) the service policy context, 2) the process coordination context, and 3) the relationship management context. The service policy context consists of the planning methods by which a supplier analyzes its customers' logistics requirements and matches them with its own operational environment and efficiency requirements. The main conclusion related to the service policy context is that it is important to have a balanced selection of both customer-related and supplier-related factors in the analysis. This way, while the operational efficiency is planned a sufficient level of service for the most important customers is assured. This kind of policy planning involves taking multiple variables into the analysis, and there is a need to develop better tools for this purpose. Some new approaches to deal with this are presented in the thesis.The process coordination context and the relationship management context deal with the issues of how the implementation of the planned service policies can be facilitated in an inter-organizational environment. Process coordination includes typically such mechanisms as control rules, standard procedures and programs, but inhighly demanding circumstances more integrative coordination mechanisms may be necessary. In the thesis the coordination problems in third-party logistics relationship are used as an example of such an environment. Relationship management deals with issues of how separate companies organize their relationships to improve the coordination of their common processes. The main implication related to logistics planning is that by integrating further at the relationship level, companies can facilitate the use of the most efficient coordination mechanisms and thereby improve the implementation of the selected logistics service policies. In the thesis, a case of a logistics outsourcing relationship is used to demonstrate the need to address the relationship issues between the service provider andthe service buyer before the outsourcing can be done.The dissertation consists of eight research articles and a summarizing report. The principal emphasis in the articles is on the service policy planning context, which is the main theme of six articles. Coordination and relationship issues are specifically addressed in two of the papers.