Early nutritional determinants in cardio-metabolic programming – A prospective randomized controlled dietary intervention study

Western societies have been faced with the fact that overweight, impaired glucose regulation and elevated blood pressure are already prevalent in pediatric populations. This will inevitably mean an increase in later manifestations of cardio-metabolic diseases. The dilemma has been suggested to stem from fetal life and it is surmised that the early nutritional environment plays an important role in the process called programming. The aim of the present study was to characterize early nutritional determinants associating with cardio-metabolic risk factors in fetuses, infants and children. Further, the study was designated to establish whether dietary counseling initiated in early pregnancy can modify this cascade. Healthy mother-child pairs (n=256) participating in a dietary intervention study were followed from early pregnancy to childhood. The intervention included detailed dietary counseling by a nutritionist targeting saturated fat intake in excess of recommendations and fiber consumption below recommendations. Cardio-metabolic programming was studied by characterizing the offspring’s cardio-metabolic risk factors such as over-activation of the autonomic nervous system, elevated blood pressure and adverse metabolic status (e.g. serum high split proinsulin concentration). Fetal cardiac sympathovagal activation was measured during labor. Postnatally, children’s blood pressure was measured at six-month and four-year follow-up visits. Further, infants’ metabolic status was assessed by means of growth and serum biomarkers (32-33 split proinsulin, leptin and adiponectin) at the age of six months. This study proved that fetal cardiac sympathovagal activity was positively associated with maternal pre-pregnancy body mass index indicating adverse cardio-metabolic programming in the offspring. Further, a reduced risk of high split proinsulin in infancy and lower blood pressure in childhood were found in those offspring whose mothers’ weight gain and amount and type of fats in the diet during pregnancy were as recommended. Of note, maternal dietary counseling from early pregnancy onwards could ameliorate the offspring’s metabolic status by reducing the risk of high split proinsulin concentration, although it had no effect on the other cardio-metabolic markers in the offspring. At postnatal period breastfeeding proved to entail benefits in cardio-metabolic programming. Finally, the recommended dietary protein and total fat content in the child’s diet were important nutritional determinants reducing blood pressure at the age of four years. The intrauterine and immediate postnatal period comprise a window of opportunity for interventions aiming to reduce the risk of cardio-metabolic disorders and brings the prospect of achieving health benefits over one generation.

Lämmöntalteenoton tuotteistus, kannattavuus ja riskit vaneriteollisuudessa

Viilunkuivaus vaneriteollisuudessa on energiaintensiivinen prosessi, josta syntyvä hukkalämpö kannattaa ottaa talteen ja hyödyntää. Työ käsittelee erilaisten lämmöntalteenottovariaatioiden tuotteistusta ja kannattavuutta, sekä sisältää laitteiston riskianalyysin. Aiemman asiakaskohtaisen räätälöinnin sijaan, laitteiston modulaarinen tuoterakenne on otettava tuotteistuksen lähtökohdaksi. Modulaarisen tuoterakenteen ansiosta erilaisiin asiakastarpeisiin pystytään vastaamaan aiempaa tehokkaammin, kiitos erilaisten variaatioiden. Standardien ja yhtenäisten rajapintojen myötä muun muassa suunnittelua, projektinhoito ja myyntiä saadaan tehostettua. Lämmöntalteenottoratkaisuille luodaan kolme eri varustelutasoa: perus, korkea ja luksus. Näillä eri varianteilla pystytään vastamaan entistä kattavammin eri markkina-alueiden asiakastarpeisiin. Kannattavuuslaskelmat todistavat, että lämmöntalteenoton avulla saadaan merkittäviä energiasäästöjä ja eri laitteistovariaatiot maksavat itsensä erittäin nopeasti takaisin, vaikka esimerkiksi sähköenergian hinta nousisi radikaalisti. Lämmöntalteenoton voidaankin katsoa olevan aina erittäin kannattavaa. Laitteistosta on tunnistettu myös tekniset riskit, joihin on puututtava välittömästi sekä lukuisia toimenpide-ehdotuksia, joiden avulla laitteiston tuomintaa voidaan tehostaa ja muuttaa turvallisemmaksi. Riskianalyysi antaa myös suuntaviivoja tuotteistukselle sekä laitteiston huolto- ja käyttöohjeistolle.

Cognitive Functions After Traumatic Brain Injury. A 30-year Follow-up Study

Many cognitive deficits after TBI (traumatic brain injury) are well known, such as memory and concentration problems, as well as reduced information-processing speed. What happens to patients and cognitive functioning after immediate recovery is poorly known. Cognitive functioning is flexible and may be influenced by genetic, psychological and environmental factors decades after TBI. The general aim of this thesis was to describe the long-term cognitive course after TBI, to find variables that may contribute to it, and how the cognitive functions after TBI are associated with specific medical factors and reduced survival. The original study group consisted of 192 patients with TBI who were originally assessed with the Mild Deterioration Battery (MDB) on average two years after the injury, during the years 1966 – 1972. During a 30-year follow-up, we studied the risks for reduced survival, and the mortality of the patients was compared with the general population using the Standardized Mortality Ratio (SMR). Sixty-one patients were re-assessed during 1998-2000. These patients were evaluated with the MDB, computerized testing, and with various other neuropsychological methods for attention and executive functions. Apolipoprotein-E (ApoE) genotyping and magnetic resonance imaging (MRI) based on volumetric analysis of the hippocampus and lateral ventricles were performed. Depressive symptoms were evaluated with the short form of the Beck depression inventory. The cognitive performance at follow-up was compared with a control group that was similar to the study group in regard to age and education. The cognitive outcome of the patients with TBI varied after three decades. The majority of the patients showed a decline in their cognitive level, the rest either improved or stayed at the same level. Male gender and higher age at injury were significant risk factors for the decline. Whereas most cognitive domains declined during the follow-up, semantic memory behaved in the opposite way, showing recovery after TBI. In the follow-up assessment, the memory decline and impairments in the set-shifting domain of executive functions were associated with MRI-volumetric measures, whereas reduction in information-processing speed was not associated with the MRI measures. The presence of local contusions was only weakly associated with cognitive functions. Only few cognitive methods for attention were capable of discriminating TBI patients with and without depressive symptoms. On the other hand, most complex attentional tests were sensitive enough to discriminate TBI patients (non-depressive) from controls. This means that complex attention functions, mediated by the frontal lobes, are relatively independent of depressive symptoms post-TBI. The presence of ApoE4 was associated with different kinds of memory processes including verbal and visual episodic memory, semantic memory and verbal working memory, depending on the length of time since TBI. Many other cognitive processes were not affected by the presence of ApoE4. Age at injury and poor vocational outcome were independent risk factors for reduced survival in the multivariate analysis. Late mortality was higher among younger subjects (age < 40 years at death) compared with the general population which should be borne in mind when assessing the need for rehabilitation services and long-term follow-up after TBI.

Hakkuun, laikkumätästyksen sekä kantojen korjuun välittömät vaikutukset lahopuustoon uudistettavissa kuusikoissa

Seloste artikkelista: Immediate effects of logging, mounding and removal of logging residues and stumps on coarse woody debris in managed boreal Norway spruce stands / Ruut Rabinowitsch-Jokinen & Ilkka Vanha-Majamaa. - Julkaisussa: Silva Fennica 44 (2010) : 1, s. 51-62.

Sosiaalisten innovaatioiden edistäminen julkisissa vanhuspalveluissa, case: Kouvolan kaupunki

Tutkimuksen tarkoituksena on selvittää miten Kouvolan kaupungin kotihoidossa ja vanhuspalveluissa voidaan edistää sosiaalisten innovaatioiden syntymistä. Tutkimuksessa annetaan kontekstiin sopiva määritelmä vielä tarkentumattomalle sosiaalisen innovaation käsitteelle sekä kartoitetaan sosiaalisen innovaation syntymiseen edistävästi ja estävästi vaikuttavia tekijöitä tarkastelemalla sosiaalisen innovaation prosessia sekä hyödyntämällä sosiaalisia innovaatioita käsittelevien artikkeleiden lisäksi joitakin julkisen sektorin innovaatioita käsitteleviä artikkeleita. Tutkimus toteutetaan laadullisena tapaustutkimuksena ja aineistonkeruumenetelmänä käytetään puolistrukturoituja haastatteluita. Haastateltavat valitaan harkinnanvaraisesti kohdeorganisaatiosta Kouvolan kaupungilta ja ennen kaikkea kotihoidon ja vanhuspalveluiden palvelualueelta. Sekä aineiston keruu että sen analysointi toteutetaan teorialähtöisesti. Tutkimustulosten perusteella Kouvolan kaupungin sosiaalisten innovaatioiden syntymistä edistävinä vahvuuksina voidaan mainita muun muassa koko henkilöstön osallistuminen ideointiin ja kehittämiseen, ideoiden kartoittaminen myös oman organisaation ulkopuolelta sekä aktiivinen asiakkaiden tarpeiden ja näkökulmien kartoittaminen, joskin lähestymistapa voidaan nähdä ennemmin asiakaskeskeisenä kuin asiakaslähtöisenä. Niin ikään lähiesimiesten ja oman palvelualueen esimiesten pääasiallisesti kannustava suhtautuminen ideointiin voidaan nostaa esiin vahvuutena. Kehittämiskohteina puolestaan nousevat esille ylemmältä virkamiesjohdolta ja poliittiselta johdolta odotettu selkeämpi tuki innovoinnille sekä monipuolisten innovoinnin kannustimien kehittäminen. Toimiala- ja palvelualuerajat ylittävän sekä eri henkilöstötasojen, myös ylimmän ja poliittisen johdon, välisen avoimen vuoropuhelun sekä yhteisten tavoitteiden asettamisen tukeminen luovuutta ja luovaa ongelmanratkaisua tukevien työkalujen avulla sekä aikaa raivaamalla nousee myös esille merkittävänä kehittämiskohteena. Niin ikään foorumeita ajatustenvaihtoon, yhteiseen ideointiin ja kehittämiseen eri sidosryhmien, kuten asiakkaiden ja kolmannen sektorin, kanssa tarvitaan lisää.

SaaS and Public Cloud from Custom Application Provider’s Perspective

The main objective of this master’s thesis is to provide a comprehensive view to cloud computing and SaaS, and analyze how well CADM, a unit of Capgemini Finland Ltd., would fit to the cloud-based SaaS business. Another objective for this thesis is to investigate how public clouds would fit for CADM as a delivery model, if they would provide SaaS applications to their customers. This master’s thesis is executed by investigating characteristics of cloud computing and SaaS especially from application provider point of view. This is done by exploring what kinds of researches and analysis there have been done regarding these two phenomena during past few years. Then CADM’s current business model and operations are analyzed from SaaS’s and public cloud’s perspective. This analyzing part is conducted by using SWOT analysis which is widely used analytical tool when observing company’s strategic position and when figuring out possibilities how to improve company’s operations. The conducted analysis and observations reveals that CADM should pursue SaaS business as it could provide remarkable advantages and strengthen their position in current markets. However, pure SaaS model would not be the optimal solution for CADM because they do not have own product which could be transformed to SaaS model, and they lack of Infrastructure Management ability. Also public cloud would not be the most suitable delivery model for them if providing SaaS services. The main observation of this thesis is that CADM should adopt the SaaS model via Capgemini Immediate offering.

"Dov'è la sinistra?" Hemispatial neglect in stroke

As long as the incidence of stroke continues to grow, patients with large right hemisphere lesions suffering from hemispatial neglect will require neuropsychological evaluation and rehabilitation. The inability to process information especially that coming from the left side accompanied by the magnetic orientation to the ipsilesional side represents a real challenge for rehabilitation. This dissertation is concerned with crucial aspects in the clinical neuropsychological practice of hemispatial neglect. In studying the convergence of the visual and behavioural test batteries in the assessment of neglect, nine of the seventeen patients, who completed both the conventional subtests of the Behavioural Inattention Test and the Catherine Bergego Scale assessments, showed a similar severity of neglect and thus good convergence in both tests. However, patients with neglect and hemianopia had poorer scores in the line bisection test and they displayed stronger neglect in behaviour than patients with pure neglect. The second study examined, whether arm activation, modified from the Constraint Induced Movement Therapy, could be applied as neglect rehabilitation alone without any visual training. Twelve acute- or subacute patients were randomized into two rehabilitation groups: arm activation training or traditional voluntary visual scanning training. Neglect was ameliorated significantly or almost significantly in both training groups due to rehabilitation with the effect being maintained for at least six months. In studying the reflections of hemispatial neglect on visual memory, the associations of severity of neglect and visual memory performances were explored. The performances of acute and subacute patients with hemispatial neglect were compared with the performances of matched healthy control subjects. As hypothesized, encoding from the left side and immediate recall of visual material were significantly compromised in patients with neglect. Another mechanism of neglect affecting visual memory processes is observed in delayed visual reproduction. Delayed recall demands that the individual must make a match helped by a cue or it requires a search for relevant material from long-term memory storage. In the case of representational neglect, the search may succeed but the left side of the recollected memory still fails to open. Visual and auditory evoked potentials were measured in 21 patients with hemispatial neglect. Stimuli coming from the left or right were processed differently in both sensory modalities in acute and subacute patients as compared with the chronic patients. The differences equalized during the course of recovery. Recovery from hemispatial neglect was strongly associated with early rehabilitation and with the severity of neglect. Extinction was common in patients with neglect and it did not ameliorate with the recovery of neglect. The presence of pusher symptom hampered amelioration of visual neglect in acute and subacute stroke patients, whereas depression did not have any significant effect in the early phases after the stroke. However, depression had an unfavourable effect on recovery in the chronic phase. In conclusion, the combination of neglect and hemianopia may explain part of the residual behavioural neglect that is no longer evident in visual testing. Further research is needed in order to determine which specific rehabilitation procedures would be most beneficial in patients suffering the combination of neglect and hemianopia. Arm activation should be included in the rehabilitation programs of neglect; this is a useful technique for patients who need bedside treatment in the acute phase. With respect to the deficit in visual memory in association with neglect, the possible mechanisms of lateralized deficit in delayed recall need to be further examined and clarified. Intensive treatment induced recovery in both severe and moderate visual neglect long after the first two to first three months after the stroke.

Approaches to Supply Chain Risk Management: Identification, Analysis and Control

Supply chain risk management has emerged as an increasingly important issue in logistics as disruptions in the supply chain have become critical issues for many companies. The scientific literature on the subject is developing and in many respects the understanding of it is still in its infancy. Thus, there is a need for more information in order for scholars and practitioners to understand the causalities and interrelations that characterise the phenomenon. The aim of this dissertation is to narrow this gap by exploring key aspects of supply chain risk management through two maritime supply chains in the immediate region of the Gulf of Finland. The study contributes to the field in three different ways. Firstly, it facilitates the identification of risks on different levels of the supply chain through a systematic analysis of the processes and actors, and of the cognitive barriers that limit the actors’ visibility and their understanding of the operations and the risks involved. There is a clear need to increase collaboration and information exchange in order to improve visibility in the chain. Risk management should be a collaborative effort among the individual actors, aimed at obtaining a holistic picture. Secondly, the study contributes to the literature on risk analysis through the use of systemic frameworks that illustrate the causalities and linkages in the system, thereby making it easier to perceive the vulnerabilities. Thirdly, the study enhances current knowledge of risk control in identifying actor roles, risk visibility and risk controllability as being among the key factors determining risk-management effectiveness against supply-chain vulnerability. This dissertation is divided into two parts. The first part gives a general overview of the relevant literature, the research design and the conclusions of the study, and the second part comprises six research publications. Case-study methodology with systematic combining approach is used, where in-depth interviews, questionnaires and expert panel sessions are the main data collection methods. The study illustrates the current state of risk management in multimodal maritime supply chains, and develops frameworks for further analysis. The results imply that there are major differences between organizations in their ability to execute supply chain risk management. Further collaboration should be considered in order to facilitate the development of systematic and effective management processes.

Crop residues on short-term CO2 emissions in sugarcane production areas

The proper management of agricultural crop residues could produce benefits in a warmer, more drought-prone world. Field experiments were conducted in sugarcane production areas in the Southern Brazil to assess the influence of crop residues on the soil surface in short-term CO2 emissions. The study was carried out over a period of 50 days after establishing 6 plots with and without crop residues applied to the soil surface. The effects of sugarcane residues on CO2 emissions were immediate; the emissions from residue-covered plots with equivalent densities of 3 (D50) and 6 (D100) t ha-1 (dry mass) were less than those from non-covered plots (D0). Additionally, the covered fields had lower soil temperatures and higher soil moisture for most of the studied days, especially during the periods of drought. Total emissions were as high as 553.62 ± 47.20 g CO2 m-2, and as low as 384.69 ± 31.69 g CO2 m-2 in non-covered (D0) and covered plot with an equivalent density of 3 t ha-1 (D50), respectively. Our results indicate a significant reduction in CO2 emissions, indicating conservation of soil carbon over the short-term period following the application of sugarcane residues to the soil surface.

Correção laparoscópica de hérnia diafragmática traumática crônica

Diaphragmatic hernia secondary to blunt or penetrating trauma is rarely by itself a fatal event. However, if unpercieved, it may lead to severe complications caused by herniation of abdominal contents to the ethorax. Blunt trauma related to car accidents is the most frequent cause of diaphragmatic hernias. Associated injuries are frequently observed, provoked by severe traumas of great impact. These blunt trauma hernias occur mainly on the left side due to abdominal anatomy, since the liver is usually located on the right side. When injuries are observed on the right they tend to be more severe, generally related to major trauma of solid organs. Less frequently diaphragmatic hernias may be bilateral. The management of diaphragmatic injury would appear to be a simple matter of suturing the defect. However, peroperative diagnosis can be difficult and even at the time of surgery some diaphragmatic injuries can be overlooked if carefull exploration is not done. Associated injuries tend to divert attention from the diaphragmatic injury. Laparoscopic diagnosis and repair have been described with successfull. Laparotomy or thoracotomy can be employed for surgical repair of traumatic diaphragmatic hernias. Standard (laboratory/imaging) examinations may fail to make the diagnosis. Recently, the laparoscopic approach has proved useful for more precise evaluation of such injuries, very often allowing immediate repair of these lesions.

Hérnia diafragmática traumática crônica e fístula gastropleurocutânea

Traumatic diaphragmatic hernia is defined as a laceration of the diaphragm with an abdominal viscera herniation into the thorax. It is usually asymptomatic, with the exception of the cases with obstruction, strangulation, necrosis or perforation of the herniaded viscera. It is classified as acute, latent or chronic, in accordance with the evolutive period. At the latent phase, symptoms are indefinite and the radiological signals, which are suggestive of thoracic affections, are frequent and can induce a diagnosis error, leading to inadequate treatment.This article presents a case of chronic traumatic diaphragmatic hernia which was complicated by a gastricpleuralcutaneous fistula, due to an inadequate thoracic drainage. Considering that this is a chronic affection with an unquestionable surgical indication, due to the complications risk, it is essential to have a detailed diagnostic investigation, which aims at both avoiding an intempestive or inadequate therapeutics behaviour and reducing the affection morbimortality. Recently, the videolaparoscopic approach has proved to be more precise when compared to the other diagnostic methods, by direct visualization of the diaphragmatic laceration, allowing its correction by an immediate suture.

Treatment of Acute Otitis Media

Background: Acute otitis media (AOM) is the most common bacterial infection in young children, but the optimal management of AOM remains controversial. The aim of this study was to assess the efficacy of antimicrobial treatment, either immediate or delayed, for AOM and to compare parental experiences regarding the management of AOM in two countries with very different treatment guidelines. Methods: Altogether, 322 children participated in a randomized, double-blind, placebocontrolled trial. Children 6–35 months of age with AOM received amoxicillin-clavulanate or placebo for 7 days. The primary outcome was the time to treatment failure. In the second study, the delayed antimicrobial treatment group consisted of recipients of placebo who had received rescue treatment. The immediate antimicrobial treatment group consisted of children allocated to amoxicillin-clavulanate group. Parental expectations and opinions were evaluated by questionnaires sent via public day care in Turku, Finland, and Utrecht, the Netherlands. Results: Treatment failure occurred significantly more often in children receiving placebo as compared to antimicrobial treatment (45% vs. 19%, P<0.001). Delayed initiation of antimicrobial treatment did not worsen the recovery from AOM, but it was associated with worsening of the child’s condition, prolongation of symptoms, and absenteeism from day care and parental absenteeism from work. According to the comparative questionnaire, antimicrobial use was more common in Finland than in the Netherlands. Finnish parents believed more often than Dutch parents that antimicrobials are necessary in the treatment of AOM. Conclusions: Children with AOM benefit from antimicrobial treatment. Delayed initiation of antimicrobial does not worsen the overall recovery from AOM, but it might increase the symptom burden and create economic losses. Treatment practices and parental expectations seem to interact with each other. This needs to be considered when AOM treatment guidelines are updated.

Extração de fitobezoar gástrico por videolaparoscopia: considerações técnicas originais

Videolaparoscopic surgery has been used for treatment of almost all surgical abdominal diseases, mainly where there are no large ressections, or operative field is limited. In these situations, laparoscopic surgery has the advantages of less morbidity, quick recovery and good cosmetic results. Bezoars removal, or its mobilization, is probably included in these possible proceedings. Three non-laparotomic procedures were described: 1. endoscopic-laparoscopic; 2. videolaparoscopy and mobilization of intestinal bezoar to the cecum; 3. laparoscopy and gastrotomy for bezoar removal, through suprapubic incision or the umbilical punction. There have been only two publications describing the videolaparoscopic method for bezoar removal, and the methods applied can be complications or morbidity related. We describe one case where the applied technique is simple and easy to perform, time saving and probably less complications-related. This technique, with four trocars, utilized a plastic bag besides the stomach to be opened, followed by gastrotomy, bezoar removal and immediate introduction in the plastic bag, suture of gastrotomy and removal through the left subcostal trocar. This technique was feasible and easy to perform, with short operative time, and there were no intra or post-operative complications; the patient was discharged in the second post-operative day, and is without further problems after one year follow-up. We believe that this could be an adequate technique to perform laparoscopic gastric bezoar removal, and the rigid sequence of operative events allows a quick procedure, with minimal contamination. The videolaparoscopy seems to be an adequate access to surgical treatment of gastro-intestinal bezoars, with or without obstruction, and should be the ellected the procedure of choice to begin the surgical treatment, with convertion to laparotomy in case of any intra-operative adversity.

Arma branca retida em aorta abdominal superior

Abdominal aorta wounds carries a high immediate mortality. Few patients reach hospital care alive. There are no reports on Medline (1969-2002) about aortic wounds of foreign body with retention. A case with upper abdominal aortic wound with an inlaid blade is reported. The retained blade fixed the stomach to the surgical field, difficulting the vascular control, leading to an unconventional approach and allowing extensive contamination. The patient developed multiple organ dysfunction and died at fifth postoperative day. Singularities of an inlaid knife in upper abdominal aorta and changes in traditional approach are discussed. The authors assumed that the inlaid knife decreased the bleeding, allowing the patient arrival to the hospital, but worsened the approach to the aorta wound.

Apendicite epiplóica: resolução videolaparoscópica

Appendices epiploicae can be the site of torsion and appendagitis. Diagnosis is currently being made by ultrasonography and computerized tomography. Expectant treatment is proposed based on the assumption that epiploic appendicitis is a self limited affection. A case of torsion of a sigmoid epiploic appendage is described. The condition was missed by abdominal ultrasonography. Correct diagnosis and immediate definite treatment were performed by videolaparoscopy.