Steroid-resistant idiopathic nephrotic syndrome in children: long-term follow-up and risk factors for end-stage renal disease

INTRODUTION: Steroid resistant idiopathic nephrotic syndrome (SRINS) in children is one of the leading causes of progression to chronic kidney disease stage V (CKD V)/end stage renal disease (ESRD). OBJECTIVE: The aim of this retrospective study is to evaluate the efficacy of immunosuppressive drugs (IS) and to identify risk factors for progression to ESRD in this population. METHODS: Clinical and biochemical variables at presentation, early or late steroid resistance, histological pattern and response to cyclosporine A (CsA) and cyclophosfamide (CP) were reviewed in 136 children with SRINS. The analyzed outcome was the progression to ESRD. Univariate as well as multivariate Cox-regression analysis were performed. RESULTS: Median age at onset was 5.54 years (0.67-17.22) and median follow up time was 6.1 years (0.25-30.83). Early steroid-resistance was observed in 114 patients and late resistance in 22. Resistance to CP and CsA was 62.9% and 35% respectively. At last follow-up 57 patients reached ESRD. The renal survival rate was 71.5%, 58.4%, 55.3%, 35.6% and 28.5% at 5, 10, 15, 20 and 25 years respectively. Univariate analysis demonstrated that older age at onset, early steroid-resistance, hematuria, hypertension, focal segmental glomerulosclerosis (FSGS), and resistance to IS were risk factors for ESRD. The Cox proportional-hazards regression identified CsAresistance and FSGS as the only predictors for ESRD. CONCLUSION: Our findings showed that CsA-resistance and FSGS were risk factors for ESRD.

Purple urine bag syndrome in end-stage chronic kidney disease

Introduction: When faced with violet, purple or purplish-blue urine, clinicians should consider urinary tract infection in their differential diagnosis. Case report: A 60-year-old woman with end-stage kidney disease and non-adherence to renal replacement therapy was admitted to our hospital for placement of hemodialysis catheter. During her hospitalization she had purple urine, and purple urine bag syndrome (PUBS) was diagnosed. She was effectively treated with antibiotics and her urine returned to a dark yellow color. Discussion: Although this condition is often easily treated, diagnosing PUBS in chronic renal patients probably means an increased serum concentration of indoxyl sulfate, metabolite that is involved in the progression of both CKD and cardiovascular disease. Conclusion: Hence, in the context of our renal patients, perhaps PUBS is not as benign as supposed.

Erythropoietin resistance in end-stage renal disease patient with gastric antral vascular ectasia

AbstractWe observed a case of recombinant human erythropoietin resistance caused by Gastric Antral Vascular Ectasia in a 40-year-old female with ESRD on hemodialysis. Some associated factors such as autoimmune disease, hemolysis, heart and liver disease were discarded on physical examination and complementary tests. The diagnosis is based on the clinical history and endoscopic appearance of watermelon stomach. The histologic findings are fibromuscular proliferation and capillary ectasia with microvascular thrombosis of the lamina propria. However, these histologic findings are not necessary to confirm the diagnosis. Gastric Antral Vascular Ectasia is a serious condition and should be considered in ESRD patients on hemodialysis with anemia and resistance to recombinant human erythropoietin because GAVE is potentially curable with specific endoscopic treatment method or through surgical procedure.

Erythropoietin resistance in end-stage renal disease patient with gastric antral vascular ectasia

AbstractWe observed a case of recombinant human erythropoietin resistance caused by Gastric Antral Vascular Ectasia in a 40-year-old female with ESRD on hemodialysis. Some associated factors such as autoimmune disease, hemolysis, heart and liver disease were discarded on physical examination and complementary tests. The diagnosis is based on the clinical history and endoscopic appearance of watermelon stomach. The histologic findings are fibromuscular proliferation and capillary ectasia with microvascular thrombosis of the lamina propria. However, these histologic findings are not necessary to confirm the diagnosis. Gastric Antral Vascular Ectasia is a serious condition and should be considered in ESRD patients on hemodialysis with anemia and resistance to recombinant human erythropoietin because GAVE is potentially curable with specific endoscopic treatment method or through surgical procedure.

Modelling of changes in electricity end-use and their impacts on electricity distribution

The electricity distribution sector will face significant changes in the future. Increasing reliability demands will call for major network investments. At the same time, electricity end-use is undergoing profound changes. The changes include future energy technologies and other advances in the field. New technologies such as microgeneration and electric vehicles will have different kinds of impacts on electricity distribution network loads. In addition, smart metering provides more accurate electricity consumption data and opportunities to develop sophisticated load modelling and forecasting approaches. Thus, there are both demands and opportunities to develop a new type of long-term forecasting methodology for electricity distribution. The work concentrates on the technical and economic perspectives of electricity distribution. The doctoral dissertation proposes a methodology to forecast electricity consumption in the distribution networks. The forecasting process consists of a spatial analysis, clustering, end-use modelling, scenarios and simulation methods, and the load forecasts are based on the application of automatic meter reading (AMR) data. The developed long-term forecasting process produces power-based load forecasts. By applying these results, it is possible to forecast the impacts of changes on electrical energy in the network, and further, on the distribution system operator’s revenue. These results are applicable to distribution network and business planning. This doctoral dissertation includes a case study, which tests the forecasting process in practice. For the case study, the most prominent future energy technologies are chosen, and their impacts on the electrical energy and power on the network are analysed. The most relevant topics related to changes in the operating environment, namely energy efficiency, microgeneration, electric vehicles, energy storages and demand response, are discussed in more detail. The study shows that changes in electricity end-use may have radical impacts both on electrical energy and power in the distribution networks and on the distribution revenue. These changes will probably pose challenges for distribution system operators. The study suggests solutions for the distribution system operators on how they can prepare for the changing conditions. It is concluded that a new type of load forecasting methodology is needed, because the previous methods are no longer able to produce adequate forecasts.

Tulevaisuuden lähtökohdista kansanvallan kolmiliittoon. Kansallinen Edistyspuolue ja kansallisen eheytymisen politiikka 1919–1939.

Kansallista Edistyspuoluetta ja sen toimijoita maailmansotien välisen Suomen sisäpolitiikassa tarkasteleva väitöstutkimus paneutuu puolueen kansallista eheytymistä ajaneen poliittisen linjan taustoihin, muodostumiseen ja toteutumiseen maailmansotien välisenä aikana vuosina 1919-1939. Vahvasti aineistopohjainen ja lähdekriittinen poliittisen historian tutkimus keskittyy parlamentaarisiin toimijoihin, poliittiseen kenttään ja näiden tuottamiin aineistoihin, kuten edistyspuolueen ja sen toimijoiden arkistoihin, lehdistöön ja valtiopäiväpöytäkirjoihin. Tutkimus selvittää, millainen oli edistyspuolueen kansallisen eheytymisen linja, mihin sillä pyrittiin, miten sitä toteutettiin ja miten se toteutui. Kansainvälisen vertailun kautta tutkimuksessa luodaan myös kuva suomalaisesta liberalismista ja liberalistista. Joulukuussa 1918 perustettu Kansallinen Edistyspuolue oli liberaali puolue, jonka politiikassa korostui erityisesti liberalismin sosiaalinen tulkinta. Puolueen sisäpoliittiseksi linjaksi vastaitsenäistyneessä ja sisällissodan runtelemassa valtiossa muodostui kansallisen eheytymisen edistäminen. Ajatuksen taustalla olivat K. J. Ståhlbergin tulevaisuuden lähtökohtia hahmotelleet artikkelit, jotka julkaistiin Helsingin Sanomissa huhtikuussa 1918 sisällissodan vielä riehuessa. Ståhlbergin mukaan kansalliseen eheytymiseen ei tullut pyrkiä sodan vuoksi vaan siitä huolimatta. Nuorsuomalaiselta puolueelta perityt liberaalit periaatteet täydentyivätkin edistyspuoluelaisessa ajattelussa sisällissodan ja tasavallan puolesta käydyn valtiomuototaistelun avainkokemuksilla. Itsenäisen Suomen ensimmäisiä vuosia hallinneissa keskustahallituksissa kansallista eheytymistä edistettiin sosiaalipoliittisin uudistuksin mm. oppivelvollisuus- ja asutuslakien muodossa. Myös sisällissodan vankien armahdukset olivat osa tätä ohjelmaa. Tutkimus osoittaa, että edistyspuolueen kansallisen eheytymisen politiikan keskeisenä tavoitteena oli poliittisen sovittelun kautta integroida vasemmisto osaksi parlamentaaris-demokraattista järjestelmää. Eheytyspolitiikan todellinen käyttöarvo ja edistyspuolueen poliittiset toimintamahdollisuudet alkoivat kuitenkin heiketä vuoden 1922 eduskuntavaalien jälkeen.Tutkimuksesta käy ilmi, että toteutettu eheytyspolitiikka ja sen osittainen epäonnistuminen näkyivät sekä kommunistien jatkuvana kannatuksena että sisäpoliittisen ilmapiirin oikeistolaistumisena. Tämä kehitys nosti myös edistyspuolueessa esille voimat, jotka suosivat porvariyhteistyötä ohi keskustavasemmistolaisen eheytyspoliittisen linjan. Alkuvuosien jälkeen valtiomuototaistelun koossapitävä voima heikkeni edistyspuolueen sisällä ja 1920-luvun puolivälissä käydyt linjakiistat osoittivat, että osalle puolueen jäsenistä vuoden 1918 puoluevalinnassa keskeisemmässä roolissa oli ollut tasavaltalaisuus kuin vasemmiston integrointi ja kansallinen eheytyminen. Edistyspuolueen johto ei kuitenkaan ollut valmis luopumaan eheytyspoliittisesta linjasta ja sen ympärille luodusta puolueidentiteetistä, joten porvariyhteistyötä kannattanut oikeisto-oppositio päätyi suurelta osin eroamaan puolueesta vuonna 1927. Tutkimus osoittaa, että parlamentarismin rapautuminen ja pienelle yleispuolueelle elintärkeiden yhteistyömahdollisuuksien heikkeneminen luokkapuolueiden puristuksessa johtivat edistyspuolueen kannatuksen alamäkeen sotien välisenä aikana. Se kutistui 26 kansanedustajan keskisuuresta puolueesta vain kuuden edustajan pienpuolueeksi. Puolueidentiteetin vahvuus ja keskeisten toimijoiden puolueen kokoa suurempi poliittinen painoarvo pitivät sen lakkauttamispohdinnoista huolimatta kuitenkin koossa ja kiinni politiikan ytimessä. Oikeistoradikalismin vuodet 1920–1930-lukujen taitteessa olivat edistyspuolueellesekä uhka että mahdollisuus. Tutkimuksessa käy ilmi, että vaikka kommunisminvastaisen kansanliikkeen vaatimukset olivat edistyspuoluelaisten mielestä oikeutettuja, oli kansanliikkeen niiden ajamiseksi omaksumia laittomia ja ulkoparlamentaarisia keinoja vaikea hyväksyä. Eheytyspolitiikan kannalta katsottuna melkotoivottamalta näyttänyt tilanne kääntyi kuitenkin lopulta voitoksi: äärivasemmisto eliminoitiin, äärioikeisto ajautui paitsioon ja tie maltillisen vasemmiston ja keskustan yhteistyölle aukesi jälleen. Tämä johti lopulta vuonna 1937 punamultahallitukseen ja kansanvallan kolmiliittoon Kansallisen Edistyspuolueen, SDP:n ja Maalaisliiton kesken. Kokemus siitä, että itsenäisyys oli alati uhattuna, toi suomalaiseen liberalismiin varsin nationalistisia piirteitä, joita eurooppalaisten veljespuolueiden ohjelmista ei löydy. Liberalismiin usein liitetty mielleyhtymä sen kosmopoliittisesta, kansallisvaltioita ylittävästä luonteesta jäi Suomessa sotien välisenä aikana nationalismin ja itäisen naapurin luoman uhan varjoon. Suomen sisäpoliittinen tilanne ja geopoliittinen asema loivat vaatimuksen vahvasta kansallisesta yhtenäisyydestä. Suomalainen liberalismi määrittyikin eurooppalaisia vastineitaan voimakkaammin nuorta valtiota hallinneen kansallisuusajattelun, itsesäilytysvaiston ja kansallisen eheyden vaatimusten kautta. Tutkimuksessa todetaan, että edistyspuolueen eheytyspoliittisen linjan muotoutumista ja toteutumista vuosien 1919‒1939 aikana voi pitää idealismin voittona realismista. Lukuun ottamatta reformipolitiikan vuosia edistyspuolueen pitäytyminen valitulla linjalla näyttäytyi poliittisten toimintamahdollisuuksien kannalta katsottuna ajoittain jopa epärealistiselta. Koko sotien välistä aikaa tarkastellessa voikin todeta, että se, minkä edistyspuolue poliittisten päämäärien saavuttamisen valossa voitti, sen se menetti kannatusluvuissa.

Narratives of emergence: rising powers and the end of the Third World?

This article examines recent arguments from development economists, from historians and from international relations specialists that do challenge the continued relevance of the idea of the Third World. It then examines five reasons why these arguments are wrong. We can indeed understand much about emerging powers in terms of how they are seeking to navigate and best position themselves within an existing state-centric, liberal and capitalist order whilst accepting many of the underlying assumptions and values of that order. But the nature of that navigation has been shaped by their historical trajectory and by the developmental, societal and geopolitical context of their emergence.

Den Äldsta – livet är ett tillägnande : en vårdvetenskaplig explorativ studie av ett meningsbärande budskap och en innerlig visdom

In the background of the thematic The Eldest – life is acquiring one finds both previews and myths. Wisdom belongs to these myths. The hermeneutical philosophy refers to thinking as o movement from myth to logos in a dialogical oneness. The research uncovers dimensions in the element wisdom as empowered. The experiences of older are saved for further learning and transformation to younger with reference to vulnerable situations where common regulations are no more usefull. The interest goes to an Eldest. The Eldest in the study is pictorial in accordance to the main literature in the study.The Eldest is etymological, fictive and symbolic: – a man who understands higher matters of life, even Gods holy matters. She will set the fulfillment of others as the highest endowment out of an innermost ethos and an innermost wisdom. The innermost is wisdom. The aim is to discover a meaningful message in life is acquiring. In order to see and to learn from the experiences the study aim to uncover the innermost, an innermost wisdom out of a caritative approach. This innermost is anticipated as a longing for unity and health in dayly matters and in a caring ability for the other. The main overstatement is: What will this most meaningfull and innermost by the Eldest out of a living in factual life mirrored in a caring perspective be? Two questions expired; what will the meaningful message in the acquiring be? What will the innermost wisdom in serving the good be? This message and its innermost wisdom will get an expanded meaning out of a caring sentence: Man who dare – seeing back with gratitude, seeing forward in confidence, seeing aside with love and upward in fate wear that dignity, that holiness and that mercy and empathy which belong to life in its basics. The persons attending the research are situated in two contexts. One group has roots in the Lutheran church and the other in a caring profession. The datamaterial is formed out of the usages from these persons, from the spoken (conversation) and the written word (a guestbook). The usages as particular and common are continually integrated in the leading caring sentence from the beginning of the study to the end. The usages stand by the methodological for the final message and wisdom and at the same they form the operative dimension in the study, the evident and the validity. The overarching methodological approach is in the hermeneutic philosophy in accordance with the abductive logic. The usages out of two research groups are most significant in this deductive, inductive and abductive strategy. The usages from the research groups are confronted with the caring sentence in dialogical spaces, halts. The meaning and the innermost searched for will be pictured through the abductive and hermeneutic interpretation and will stand for an articulation of and a successively expansion of meaning. A twine of horizons out of the entire dissemination, the deductive and the inductive, creates the result, as the final message as the ground for an understanding of an even more embracing meaning in an innermost wisdom. The identified bearing movement in the groups in accordance with the caring sentence goes for something higher, something higher than me, to the wellbeing of the other. A conclusion is made and a thesis is identified. This thesis is out from the usages: What can I do in a creating of this caritative? An antithesis is also identified, is a man able to look outside one own and go to something higher, something greater? The synthesis is articulated as a dialogical movement from something … to something higher. The bridge could be maturation, transcendence, the divine or wisdom. The statement finds its root in the attending groups but a difference is also identified. This higher matter is different. The contexts and their meaningfulness decide. A final statement is: learn to see man and her matters hold in life.

Tavanomaisen irtaimen esineen sale and lease back -järjestely. Tarkastelussa erityisesti vuokralleottajan sivullissuoja.

Tutkielman aiheena on tavanomaisen irtaimen esineen sale and lease back -järjestely. Järjestelyyn kuuluu nimensä mukaisesti luovutus ja takaisinvuokraus. Kokonaisjärjestelyn avulla rahoittaja ja luotonsaaja pyrkivät luomaan luotonmaksun vakuudeksi omistusoikeuteen perustuvan esinevakuuden. Järjestelyn tavoitteena on, että luotonsaajan asemassa oleva myyjä pystyisi käyttämään samaa esinettä samanaikaisesti sekä va-kuusobjektina että elinkeinotoimintansa tuotantovälineenä. Juuri siitä syystä, että luo-tonsaaja tarvitsee esinettä koko ajan elinkeinotoiminnassaan, ei panttausta voida käyttää. Tutkielma on oikeusdogmaattinen ja sen pyrkimyksenä on antaa selkeä kokonaiskäsitys irtaimen esineen sale and lease back -järjestelystä ja sen käytettävyydestä vakuusjärjestelynä. Oikeusdogmaattiselle tutkimukselle tyypillisesti tutkielmassa tarkastellaan olemassa olevaa tietomateriaalia. Keskeisimmät tutkielmassa käytetyt kirjallisuuslähteet ovat Jarno Teporan useat sale and lease back -järjestelyyn keskittyvät artikkelit, Jarmo Tuomiston omistusvakuuksia koskeva kirjallisuus sekä Erkki Havansin esineoikeudellinen perusteos Esinevakuudet. Virallislähteistä selvästi merkittävimmät ovat vuonna 1997 voimaantullut maakaari ja sen esityöt. Tutkimuksessa keskitytään erityisesti vuokralleottajan sivullissuojaan. Näin ollen tärkeimmäksi tutkimuskysymykseksi jäsentyy se, voiko sale and lease back -järjestelyssä ostajan roolissa oleva sijoittaja tai rahoittaja saavuttaa järjestelyn avulla kollisiotilanteiden varalta turvaavan vakuusaseman. Tutkimuksen kannalta keskeinen omistusvakuus-järjestely on vakuusluovutus, jollaiseksi vakuustarkoituksessa tehty sale and lease back -järjestely melko vakiintuneesti tulkitaan. Tutkimuksessa tarkastellaan mahdollisuutta hyväksyä sale and lease back -järjestely rahoittajalle dynaamista kollisiosuojaa tarjoavaksi vakuusjärjestelyksi ilman julkivarmistusta. Toisaalta selvitetään julkivarmistuksen toteuttamisen mahdollisuutta ilman hallinnansiirtoa muun muassa maakaaren 14:4.1:n 1 kohdan mukaisen kirjaamisen avulla. Nykylainsäädännön puitteissa järjestelyn hyväksyminen itsenäiseksi omistusvakuudeksi näyttää olevan epätodennäköistä ja ilman julkivarmistusta dynaaminen sivullissuoja jää saavuttamatta, vaikka järjestely on sitova inter partes. Tutkimuksen loppupäätelmissä pohditaan, voisiko sale and lease back -järjestelyyn liittyviä ongelmia ratkaista muuttamalla voimassa olevaa lainsäädäntöä tai antamalla täysin uutta lainsäädäntöä. Asiaa pohditaan myös oikeusvertailun keinoin selvittäen muiden Pohjoismaiden sekä Saksan oikeusjärjestelmien kantaa järjestelyyn.

Spiking Back

Brock Women's Volleyball in a 1977 match.

Project Summary Back

The project summary for Alphies Trough.

Back of Thistle

This view of Thistle from the northeast is taken from what is now the Jubilee Courtyard.

The human rights dilemma : an east-west encounter : Germany and China in 1996 /

Conflicts over human rights in relations between East Asia and the West have increased since the end of the Cold War. Western governments express concern about human rights standards in East Asian countries. In the East, these expressions have been perceived as interference in internal affairs. Due to dramatic economic development, East Asian nations recently have gained in pride and self-confidence as global actors. Such development is observed with suspicion in the West. Concerned about the decline of global U.S. influence, some American scholars have re-invented the notion of "culture" to point at an alleged East Asian threat. Also East Asian statesmen use the cultural argument by claiming the existence of so-called 'Asian values', which they allege are the key to Eastern economic success. This thesis argues that issues of human rights in East-West relations are not only a consequence of well-intended concern by Western governments regarding the human rights and welfare of the citizens of East Asian nations, but are in fact dominated by and used as a pawn in interplay with more complicated questions of global power and economic relations between East and West. The thesis reviews the relevance of culture in East-West relations. In the West, particularly Samuel P. Huntington with his prediction of the Clash of Civilizations stands out. Singapore's Lee Kuan Yew has been very vocal on the Eastern side. Whereas the West tries to cope with its decrease of global influence, after hundreds of years under Western hegemonism, the East believes in an Asian way of development without interference form the West. Most of this dispute revolves around the issue of human rights. The West claims the universality of rights which in fact emphasizes political and civil rights. Western countries critizise poor human rights standards in East Asia. The East, in return, accuses the West of hypocritical policies that seek global dominance. East Asian governments assert that due to a different stage of development they have to stress first their rights to development in order to assure stability. In particular, China argues this way. The country's leadership, however, shows concern about human rights and has already improved its human rights record over the past years. This thesis analyses the dispute over human rights in a case study on Germany and China. Both countries have a mutual interest in trade relations which has conflicted with Germany's criticism of China's problematic human rights record. In 1996, the two countries clashed after the German parliament passed a resolution condemning China's treatment of Tibet. This caused a lot of damage to the Chinese-German relationship which in the course of the year went back to normality. In the light of these frictions a German human rights policy that focuses on unspectacular grass-roots support of China, for example in strengthening China's legal system, would be preferable. Such co-operation must be based on mutual respect.

Will the "fight" ever end? : a critical reading of the metaphors and discourses that construct HIV/AIDS in an African context

In this thesis, I critically examine the discourses that inform how we conceptualise HIV/AIDS in Sub-Saharan Africa as they are produced in a sample of Canadian news articles, two nonfiction texts - Stephanie Nolen's 28 Stories of AIDS in Africa and Jonathan Morgan and the Bambanani Women's Group's Long Life ... Positive HIV Stories - as well as two literary texts - John Le Carre's popular fiction novel The Constant Gardener and an anthology of stories and poems from Southern Africa titled Nobody Ever Said AIDS, compiled and edited by Nobantu Rasebotsa, Meg Samuelson and Kylie Thomas. Paying particular attention to the role of metaphor in discursive formation, I have found that military metaphors, usually used in conjunction with biomedical discourses, continue to dominate what is said about HIV/AIDS. However, the use of military metaphors to conceptualise HIV/AIDS contributes to stigma and limits the effectiveness of responses to the pandemic. I argue that accessing alternative metaphors and discourses, such as biopsychosocial discourse, can lead to a more layered - and more beneficial - conceptualisation of HIV/AIDS, encouraging a more active response to the pandemic.

Towards sustainable peace : peace-building and human security

Failed and fragile states that result from intrastate war pose severe threats to the security of both the international system and individual states alike. In the post-Cold War era, the international community has come to recognize the reality of these threats and the difficulty involved in ending violence and building sustainable peace in failed and fragile states. This work focuses upon the development of a comprehensive strategy for sustainable peace-building by incorporating the tenets of the human security doctrine into the peace-building process. Through the use of case studies of The Former Yugoslav Republic of Macedonia and East Timor, the development and refinement of the doctrine of human security will occur, as well as, an understanding of how and where human security fits into the sustainable peace-building equation. The end result of the analysis is the development of a hierarchical pyramid formation that brings together human security and peace-building into one framework that ultimately creates the foundation and structure of sustainable peace-building. With the development of a sustainable peace-building structure based upon the human security doctrine, the role of Canada in the support of sustainable peace-building is analyzed in relation to the form and level of involvement that Canada undertakes and contributes to in the implementation and support of sustainable peace-building initiatives. Following from this, recommendations are provided regarding what role(s) Canada should undertake in the sustainable peace-building process that take into consideration the present and likely future capabilities of Canada to be involved in various aspects of the peace-building process. ii This paper outlines the need for a peace-building strategy that is designed to be sustainable in order that failed and fragile states resulting from intrastate conflict do not regress or collapse back into a condition of civil war, and subsequently designs such a strategy. The linking of peace-building and human security creates the required framework from which sustainable peace-building is derived. Creating sustainable peace is necessary in order to increase the likelihood that both present and future generations existing in failed and fragile states will be spared from the scourge of intrastate war.