Browsing by Subject "SOCIETY"

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  • Kostiainen, Iiro; Hakaste, Liisa; Kejo, Pekka; Parviainen, Helka; Laine, Tiina; Löyttyniemi, Eliisa; Pennanen, Mirkka; Arola, Johanna; Haglund, Caj; Heiskanen, Ilkka; Schalin-Jäntti, Camilla (2019)
    BackgroundAdrenocortical carcinoma (ACC) is a rare endocrine carcinoma with poor 5-year survival rates of20 Hounsfield Units (HU) for all tumours (median 34 (21-45)), median size 92mm (20-196), Ki67 17% (1-40%), Weiss score 7 (4-9) and Helsinki score 24 (4-48). ACC was more often found in the left than the right adrenal (p5 to>10 years was achieved after repeated surgery of metastases. Overall 5-year survival was 67%, and 96% vs. 26% for ENSAT stage I-II vs. III-IV (p20 on nonenhanced CT but variable tumour size (20-196mm). Malignancy cannot be ruled out by small tumour size only. The 5-year survival of 96% in ENSAT stage I-III compares favourably to previous studies.
  • German HNPCC Consortium; Dutch Lynch Syndrome Collaborative; Finnish Lynch Syndrome Registry; Engel, Christoph; Ahadova, Aysel; Seppälä, Toni T.; Lepistö, Anna; Renkonen-Sinisalo, Laura; Vasen, Hans F. (2020)
    BACKGROUND & AIMS: Lynch syndrome is caused by variants in DNA mismatch repair (MMR) genes and associated with an increased risk of colorectal cancer (CRC). In patients with Lynch syndrome, CRCs can develop via different pathways. We studied associations between Lynch syndrome-associated variants in MMR genes and risks of adenoma and CRC and somatic mutations in APC and CTNNB1 in tumors in an international cohort of patients. METHODS: We combined clinical and molecular data from 3 studies. We obtained clinical data from 2747 patients with Lynch syndrome associated with variants in MLH1, MSH2, or MSH6 from Germany, the Netherlands, and Finland who received at least 2 surveillance colonoscopies and were followed for a median time of 7.8 years for development of adenomas or CRC. We performed DNA sequence analyses of 48 colorectal tumors (from 16 patients with mutations in MLH1, 29 patients with mutations in MSH2, and 3 with mutations in MSH6) for somatic mutations in APC and CTNNB1. RESULTS: Risk of advanced adenoma in 10 years was 17.8% in patients with pathogenic variants in MSH2 vs 7.7% in MLH1 (P <.001). Higher proportions of patients with pathogenic variants in MLH1 or MSH2 developed CRC in 10 years (11.3% and 11.4%) than patients with pathogenic variants in MSH6 (4.7%) (P = .001 and P = .003 for MLH1 and MSH2 vs MSH6, respectively). Somatic mutations in APC were found in 75% of tumors from patients with pathogenic variants in MSH2 vs 11% in MLH1 (P = .015). Somatic mutations in CTNNB1 were found in 50% of tumors from patients with pathogenic variants in MLH1 vs 7% in MSH2 (P = .002). None of the 3 tumors with pathogenic variants in MSH6 had a mutation in CTNNB1, but all had mutations in APC. CONCLUSIONS: In an analysis of clinical and DNA sequence data from patients with Lynch syndrome from 3 countries, we associated pathogenic variants in MMR genes with risk of adenoma and CRC, and somatic mutations in APC and CTNNB1 in colorectal tumors. If these findings are confirmed, surveillance guidelines might be adjusted based on MMR gene variants.
  • Martiskainen, Mari; Heiskanen, Eva; Speciale, Giovanna (2018)
    Community action has an increasingly prominent role in the debates surrounding transitions to sustainability. Initiatives such as community energy projects, community gardens, local food networks and car sharing clubs provide new spaces for sustainable consumption, and combinations of technological and social innovations. These initiatives, which are often driven by social good rather than by pure monetary motives, have been conceptualised as grassroots innovations. Previous research in grassroots innovations has largely focused on conceptualising such initiatives and analysing their potential for replication and diffusion; there has been less research in the politics involved in these initiatives. We examine grassroots innovations as forms of political engagement that is different from the 1970s' alternative technology movements. Through an analysis of community-run Energy Cafes in the United Kingdom, we argue that while present-day grassroots innovations appear less explicitly political than their predecessors, they can still represent a form of political participation. Through the analytical lens of material politics, we investigate how Energy Cafes engage in diverse - explicit and implicit, more or less conscious forms of political engagement. In particular, their work to "demystify" clients' energy bills can unravel into various forms of advocacy and engagement with energy technologies and practices in the home. Some Energy Cafe practices also make space for a needs-driven approach that acknowledges the embeddedness of energy in the household and wider society.
  • Airaksinen, Riku; Mattila, Ilkka; Jokinen, Eero; Salminen, Jukka; Puntila, Juha; Lehtinen, Miia L.; Ojala, Tilna; Rautiainen, Paula; Rahkonen, Otto; Suominen, Pertti; Pätilä, Tommi (2019)
    Background. Operative mortality after complete atrioventricular septal defect (cAVSD) repair has improved vastly. Less improvement has been demonstrated regarding late mortality and reoperation rates, however. There is evident lack of comprehensive population-based studies analyzing the history and progress of the ever-changing operative results. Methods. This is a 5-million population-based retrospective study of consecutive 388 cAVSD patients operated in Finland between 1962 and 2014. Data were collected using Children's Cardiac Surgical Registry of Children's Hospital at the Helsinki University Hospital, Finland. Mortality data and reoperation rates were analyzed on a decade-by-decade basis. Results. During the early era, overall mortality was 17.4%, operative mortality constituting 10.9%. The operative results have improved significantly over the decades, and eventually, the last decade showed no mortality. A total of 23 late deaths occurred; of these, 20 were directly heart-related. Half of the late mortality occurred during the first postoperative year. The only significant risk factor for overall mortality was an earlier decade of operation (p <0.001). Reoperation rates have not decreased but slightly increased over decades (p = 0.621), and reoperations have been performed mainly during the first year after the primary operation. Actuarial freedom from left side atrioventricular valve reoperation at 15 years was 90.9%. Conclusions. There has been an outstanding improvement in surgical results through the years even though the general operative approach has remained the same. Rates of reoperation have not been declining, but the reoperations are dated to early childhood years. The improvement in results has been ongoing. (C) 2019 by The Society of Thoracic Surgeons
  • Clayton, Aled; Boilard, Eric; Buzas, Edit I; Cheng, Lesley; Falcón-Perez, Juan Manual; Gardiner, Chris; Gustafson, Dakota; Gualerzi, Alice; Hendrix, An; Hoffman, Andrew; Jones, Jennifer; Lässer, Cecilia; Lawson, Charlotte; Lenassi, Metka; Nazarenko, Irina; O’Driscoll, Lorraine; Pink, Ryan; Siljander, Pia R-M; Soekmadji, Carolina; Wauben, Marca; Welsh, Joshua A; Witwer, Ken; Zheng, Lei; Nieuwland, Rienk (2019)
    There is an increasing interest in exploring clinically relevant information that is present in body fluids, and extracellular vesicles (EVs) are intrinsic components of body fluids (?liquid biopsies?). In this report, we will focus on blood. Blood contains not only EVs but also cells, and non-EV particles including lipoproteins. Due to the high concentration of soluble proteins and lipoproteins, blood, plasma and serum have a high viscosity and density, which hampers the concentration, isolation and detection of EVs. Because most if not all studies on EVs are single-centre studies, their clinical relevance remains limited. Therefore, there is an urgent need to improve standardization and reproducibility of EV research. As a first step, the International Society on Extracellular Vesicles organized a biomarker workshop in Birmingham (UK) in November 2017, and during that workshop several working groups were created to focus on a particular body fluid. This report is the first output of the blood EV work group and is based on responses by work group members to a questionnaire in order to discover the contours of a roadmap. From the answers it is clear that most respondents are in favour of evidence-based research, education, quality control procedures, and physical models to improve our understanding and comparison of concentration, isolation and detection methods. Since blood is such a complex body fluid, we assume that the outcome of the survey may also be valuable for exploring body fluids other than blood.
  • Ramo, Joel T.; Ripatti, Pietari; Tabassum, Rubina; Soderlund, Sanni; Matikainen, Niina; Gerl, Mathias J.; Klose, Christian; Surma, Michal A.; Stitziel, Nathan O.; Havulinna, Aki S.; Pirinen, Matti; Salomaa, Veikko; Freimer, Nelson B.; Jauhiainen, Matti; Palotie, Aarno; Taskinen, Marja-Riitta; Simons, Kai; Ripatti, Samuli (2019)
    Background-We asked whether, after excluding familial hypercholesterolemia, individuals with high low-density lipoprotein cholesterol (LDL-C) or triacylglyceride levels and a family history of the same hyperlipidemia have greater coronary artery disease risk or different lipidomic profiles compared with population-based hyperlipidemias. Methods and Results-We determined incident coronary artery disease risk for 755 members of 66 hyperlipidemic families (>2 first-degree relatives with similar hyperlipidemia) and 19 644 Finnish FINRISK population study participants. We quantified 151 circulating lipid species from 550 members of 73 hyperlipidemic families and 897 FINRISK participants using mass spectrometric shotgun lipidomics. Familial hypercholesterolemia was excluded using functional LDL receptor testing and genotyping. Hyperlipidemias (LDL-C or triacylglycerides >90th population percentile) associated with increased coronary artery disease risk in meta-analysis of the hyperlipidemic families and the population cohort (high LDL-C: hazard ratio, 1.74 [95% CI, 1.48-2.04]; high triacylglycerides: hazard ratio, 1.38 [95% CI 1.09-1.74]). Risk estimates were similar in the family and population cohorts also after adjusting for lipid-lowering medication. In lipidomic profiling, high LDL-C associated with 108 lipid species, and high triacylglycerides associated with 131 lipid species in either cohort (at 5% false discovery rate; P-value range 0.038-2.3x 10(-56)). Lipidomic profiles were highly similar for hyperlipidemic individuals in the families and the population (LDL-C: r=0.80; triacylglycerides: r=0.96; no lipid species deviated between the cohorts). Conclusions-Hyperlipidemias with family history conferred similar coronary artery disease risk as population-based hyperlipidemias. We identified distinct lipidomic profiles associated with high LDL-C and triacylglycerides. Lipidomic profiles were similar between hyperlipidemias with family history and population-ascertained hyperlipidemias, providing evidence of similar and overlapping underlying mechanisms.
  • Laakso, Senja (2017)
    Food wastage is a growing environmental, financial, and social problem: as much as one-third of all food is thrown away. Simultaneously, malnutrition is a huge problem globally, and many people even in developed countries are unable to provide for their basic needs. A lot of attention is paid to food waste prevention in the industry, retail sector, and households, whereas the role of the food service sector (such as restaurants and canteens providing food in schools, hospitals, and workplaces) has thus far been understudied. This article uses a practice theoretical approach to study a leftover lunch service first tested in Jyvaskyla in 2013. It describe how the experiment was organized, how the service has spread around Finland, and how the leftover lunch has become a routine that outlines the course of the day of the diners. These findings are used to illustrate the insights of the service for both environmental and social sustainability, and to situate the service in the field of food waste prevention and food redistribution in Finland.
  • Lehtiniemi, Tuukka; Haapoja, Jesse (2020)
    Data activism has emerged as a response to asymmetries in how data and the means of knowledge production are distributed. This article examines MyData, a data activism initiative developing principles for a new technical and commercial ecosystem in which individuals control the use of personal data. Analyzing material collected at a formative event shaping MyData activism, we examine how more just data arrangements are framed to enhance equal participation. Our analysis shows agreement on what is ultimately at stake: individual data agency and fair competition in the data economy. However, two alternatives are offered for what participation involves. Collaboration with commercial actors favors framing participation as agency in data markets, thereby potentially limiting the scope of what is at stake. The alternative framing presents a rights-based understanding of economic and civic agency, potentially leading to a broader understanding of participation in a datafied society.
  • Kavaluus, Henna; Nousiainen, Katri; Kaijaluoto, Sampsa; Seppälä, Tiina; Saarilahti, Kauko; Tenhunen, Mikko (2021)
    Background and Purpose: Magnetic resonance imaging is increasingly used in radiotherapy planning; yet, the performance of the utilized scanners is rarely regulated by any authority. The aim of this study was to determine the geometric accuracy of several magnetic resonance imaging scanners used for radiotherapy planning, and to establish acceptance criteria for such scanners. Materials and Methods: The geometric accuracy of five different scanners was measured with three sequences using a commercial large-field-of-view phantom. The distortion magnitudes were determined in spherical volumes around the scanner isocenter and in cylindrical volumes along scanner z-axis. The repeatability of the measurements was determined on a single scanner with two quality assurance sequences with three single-setup and seven repeated-setup measurements. Results: For all scanners and sequences except one, the mean and median distortion magnitude was Conclusions: All tested scanners were geometrically accurate for their current use in radiotherapy planning. The acceptance criteria of geometric accuracy for regulatory inspections of a supervising authority could be set according to these results.
  • Pyykko, Ilmari; Manchaiah, Vinaya; Zou, Jing; Levo, Hilla; Kentala, Erna (2017)
    The aim of the present study was to evaluate the prevalence and associated factors for syncope among patients with Meniere's disease (MD). An attack of syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously and without a localizing neurological deficit. The study used an across-sectional survey design. Information from a database consisting of 961 individuals was collected from the Finnish Meniere Association. The data contained case histories, general health-related quality of life (HRQoL), and impact measurements of the complaints. In the current study sample, syncope occurred in 12.3% of the patients with MD. It was more prevalent among elderly persons and among those with a longer duration of MD. Syncope was significantly associated with disturbances of otolith function reflected as Tumarkin attacks, gait and balance problems, environmental change of pressure, and physical strain. It was also associated with visual blurring; in fact, patients with otolith dysfunction in MD often experience visual field changes. It was also associated with headache, but not with migraine. Syncope was experienced as frightening and HRQoL was significantly worsened. The patient had higher anxiety scores, and suffered more from fatigue. The results demonstrate that neurally mediated syncope occurs in patients with an advanced form of MD who suffer from Tumarkin attacks due to failure in otolith function. The mechanism seems to be triggered through the vestibular sympathetic reflex when the otolith system fails due to disrupted utricular otolithic membrane mediate erroneous positional information from the otolith organ to the vasomotor centres in the brain stem and medulla.
  • Helberger, Natali; Karppinen, Kari; D'Acunto, Lucia (2018)
    Personalized recommendations in search engines, social media and also in more traditional media increasingly raise concerns over potentially negative consequences for diversity and the quality of public discourse. The algorithmic filtering and adaption of online content to personal preferences and interests is often associated with a decrease in the diversity of information to which users are exposed. Notwithstanding the question of whether these claims are correct or not, this article discusses whether and how recommendations can also be designed to stimulate more diverse exposure to information and to break potential ‘filter bubbles’ rather than create them. Combining insights from democratic theory, computer science and law, the article makes suggestions for design principles and explores the potential and possible limits of ‘diversity sensitive design’.
  • Luukkanen, J.; Kaivo-oja, J.; Vähäkari, N.; O’Mahony, T.; Korkeakoski, M.; Panula-Ontto, J.; Phonhalath, K.; Nanthavong, K.; Reincke, K.; Vehmas, J.; Hogarth, Nicholas (2019)
    A novel 'Sustainability Window' (SuWi) approach is applied for simultaneous analysis of the pillars of sustainable development; social, environmental and economic, of Lao PDR. This new method employs a variety of indicators for a comprehensive and holistic analysis of sustainable development and green inclusive economy. The analysis is grounded in the assumption that economic development is required for social development, but that simultaneously development needs to be guarded or limited to protect the environment that underpins it. As all three dimensions of sustainable development are interlinked, a comprehensive analysis requires an analytical approach that is simultaneous. The analyses provide information on minimum levels of economic development that are needed to fulfil social sustainability criteria, in tandem with the maximum economic development that avoids breaching environmental sustainability criteria. If actual economic growth lies between these minima and maxima, we can interpret that development is more sustainable with respect to the relationships embodied by the selected social and environmental indicators. The main source of data is the database of the Sustainable Society Index (SSI) developed by the Sustainable Society Foundation (SSF). The indicators used by SSI have been chosen for the Sustainability Window analysis as they can be used to assess both 'weak' and 'strong' interpretations of sustainability. Weak sustainability is defined operationally as no increase in the environmental or carbon emissions intensity of the economy, while strong sustainability is defined as no increase in absolute emissions. Further, a novel Environmental Efficiency Gap analysis has been included in the Sustainability Window. This provides information about the necessary improvement in GDP production efficiency with respect to environmental emissions. Sustainability Window combined with Environmental Efficiency Gap analysis, provides critical knowledge for planners and decision makers. It provides strategic indications of how to aim for social and environmental sustainability through economic investment and growth targets. These new methods can be used in transdisciplinary research of sustainable development and can also assist in national and regional comparisons. In the case of Lao PDR, the analysis needs to be broadened for more fundamental understanding of the gaps and weaknesses. SuWi can be used to assess the sustainable development needed to address the Sustainable Development Goals by 2030. The SuWi does not provide direct policy recommendations as such, but helps to inform decision makers about the direction of development pathways towards these key goals. (C) 2018 The Authors. Published by Elsevier Ltd.
  • Behrendt, Christian-Alexander; Bertges, Daniel; Eldrup, Nikolaj; Beck, Adam W.; Mani, Kevin; Venermo, Maarit; Szeberin, Zoltan; Menyhei, Gabor; Thomson, Ian; Heller, Georg; Wigger, Pius; Danielsson, Gudmundur; Galzerano, Giuseppe; Lopez, Cristina; Altreuther, Martin; Sigvant, Birgitta; Riess, Henrik C.; Sedrakyan, Art; Beiles, Barry; Bjorck, Martin; Boyle, Jonathan R.; Debus, E. Sebastian; Cronenwett, Jack (2018)
    Objective/Background: To achieve consensus on the minimum core data set for evaluation of peripheral arterial revascularisation outcomes and enable collaboration among international registries. Methods: A modified Delphi approach was used to achieve consensus among international vascular surgeons and registry members of the International Consortium of Vascular Registries (ICVR). Variables, including definitions, from registries covering open and endovascular surgery, representing 14 countries in ICVR, were collected and analysed to define a minimum core data set and to develop an optimum data set for registries. Up to three different levels of variable specification were suggested to allow inclusion of registries with simpler versus more complex data capture, while still allowing for data aggregation based on harmonised core definitions. Results: Among 31 invited experts, 25 completed five Delphi rounds via internet exchange and face to face discussions. In total, 187 different items from the various registry data forms were identified for potential inclusion in the recommended data set. Ultimately, 79 items were recommended for inclusion in minimum core data sets, including 65 items in the level 1 data set, and an additional 14 items in the more specific level 2 and 3 recommended data sets. Data elements were broadly divided into (i) patient characteristics; (ii) comorbidities; (iii) current medications; (iv) lesion treated; (v) procedure; (vi) bypass; (vii) endarterectomy (viii) catheter based intervention; (ix) complications; and (x) follow up. Conclusion: A modified Delphi study allowed 25 international vascular registry experts to achieve a consensus recommendation for a minimum core data set and an optimum data set for peripheral arterial revascularisation registries. Continued global harmonisation of registry infrastructure and definition of items will overcome limitations related to single country investigations and enhance the development of real world evidence. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
  • Kukkonen, Anna Kristiina; Ylä-Anttila, Matti Tuomas; Swarnakar, Pradip; Broadbent, Jeffrey; Lahsen, Myanna; Stoddart, Mark C.J. (2018)
    National climate policies are shaped by international organizations (IOs) and global norms. Drawing from World Society Theory and the Advocacy Coalition Framework (ACF), we develop two related arguments: (1) one way in which IOs can influence national climate policy is through their engagement in mass-mediated national policy debates and (2) national organizations involved in the policy process may form advocacy coalitions to support or oppose the norms promoted by IOs. To examine the role of IOs in national policy debates and the coalitions that support and oppose them, we use discourse network analysis (DNA) on over 3500 statements in 11 newspapers in Canada, the United States (US), Brazil, and India. We find that in the high-income countries that are high per capita emitters (Canada and the US), IOs are less central in the policy debates and the discourse network is strongly clustered into competing advocacy coalitions. In the lower-income countries that are low per capita emitters (Brazil and India), IOs are more central and the discourse network is less clustered. Relating these findings to earlier research, we suggest that the differences we find between high and low per capita emitters may be to some extent generalizable to the relevant country groups beyond our four cases.
  • Bonnet, Damien; Berger, Felix; Jokinen, Eero; Kantor, Paul F.; Daubeney, Piers E. F. (2017)
    BACKGROUND Heart rate reduction as a therapeutic target has been investigated in adults with heart failure (HF). Ivabradine has shown promising efficacy, but has not been evaluated in children. Currently, treatment recommendations for chronic pediatric HF are based mainly on chronic HF guidelines for adults. OBJECTIVES The authors explored the dose-response relationship of ivabradine in children with dilated cardiomyopathy and symptomatic chronic HF. The primary endpoint was >= 20% reduction in heart rate from baseline without inducing bradycardia or symptoms. METHODS This was a randomized, double-blind, placebo-controlled, phase II/III study with 12 months of follow-up. Children (n = 116) receiving stable HF therapy were randomized to either ivabradine or placebo. After an initial titration period, the dose was adjusted to attain the primary endpoint. Left ventricular function (echocardiography), clinical status (New York Heart Association functional class or Ross class), N-terminal pro-B-type natriuretic peptide, and quality of life (QOL) were assessed. RESULTS The primary endpoint was reached by 51 of 73 children taking ivabradine (70%) versus 5 of 41 taking placebo (12%) at varying doses (odds ratio: 17.24; p <0.0001). Between baseline and 12 months, there was a greater increase in left ventricular ejection fraction in patients taking ivabradine than placebo (13.5% vs. 6.9%; p = 0.024). New York Heart Association functional class or Ross class improved more with ivabradine at 12 months than placebo (38% vs. 25%; p = 0.24). There was a trend toward improvement in QOL for ivabradine versus placebo (p = 0.053). N-terminal pro-B-type natriuretic peptide levels decreased similarly in both groups. Adverse events were reported at similar frequencies for ivabradine and placebo. CONCLUSIONS Ivabradine safely reduced the resting heart rate of children with chronic HF and dilated cardiomyopathy. Ivabradine's effect on heart rate was variable, highlighting the importance of dose titration. Ivabradine treatment improved left ventricular ejection fraction, and clinical status and QOL showed favorable trends. (Determination of the efficacious and safe dose of ivabradine in paediatric patients with dilated cardiomyopathy and symptomatic chronic heart failure from ages 6 months to 18 years; ISRCTN60567801) (C) 2017 by the American College of Cardiology Foundation.
  • Sartelli, Massimo; Kluger, Yoram; Ansaloni, Luca; Coccolini, Federico; Baiocchi, Gian Luca; Hardcastle, Timothy C.; Moore, Ernest E.; May, Addison K.; Itani, Kamal M. F.; Fry, Donald E.; Boermeester, Marja A.; Guirao, Xavier; Napolitano, Lena; Sawyer, Robert G.; Rasa, Kemal; Abu-Zidan, Fikri M.; Adesunkanmi, Abdulrashid K.; Atanasov, Boyko; Augustin, Goran; Bala, Miklosh; Cainzos, Miguel A.; Chichom-Mefire, Alain; Cortese, Francesco; Damaskos, Dimitris; Delibegovic, Samir; Demetrashvili, Zaza; De Simone, Belinda; Duane, Therese M.; Ghnnam, Wagih; Gkiokas, George; Gomes, Carlos A.; Hecker, Andreas; Karamarkovic, Aleksandar; Kenig, Jakub; Khokha, Vladimir; Kong, Victor; Isik, Arda; Leppäniemi, Ari; Litvin, Andrey; Lostoridis, Eftychios; Machain, Gustavo M.; Marwah, Sanjay; McFarlane, Michael; Mesina, Cristian; Negoi, Ionut; Olaoye, Iyiade; Pintar, Tadeja; Pupelis, Guntars; Rems, Miran; Rubio-Perez, Ines; Sakakushev, Boris; Segovia-Lohse, Helmut; Siribumrungwong, Boonying; Talving, Peep; Ulrych, Jan; Vereczkei, Andras G.; Labricciosa, Francesco M.; Catena, Fausto (2018)
    Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The "surgeon champion" can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.
  • Fortino, Vittorio; Wisgrill, Lukas; Werner, Paulina; Suomela, Sari; Linder, Nina; Jalonen, Erja; Suomalainen, Alina; Marwah, Veer; Kero, Mia; Pesonen, Maria; Lundin, Johan; Lauerma, Antti; Aalto-Korte, Kristiina; Greco, Dario; Alenius, Harri; Fyhrquist, Nanna (2020)
    Contact dermatitis tremendously impacts the quality of life of suffering patients. Currently, diagnostic regimes rely on allergy testing, exposure specification, and follow-up visits; however, distinguishing the clinical phenotype of irritant and allergic contact dermatitis remains challenging. Employing integrative transcriptomic analysis and machine-learning approaches, we aimed to decipher disease-related signature genes to find suitable sets of biomarkers. A total of 89 positive patch-test reaction biopsies against four contact allergens and two irritants were analyzed via microarray. Coexpression network analysis and Random Forest classification were used to discover potential biomarkers and selected biomarker models were validated in an independent patient group. Differential gene-expression analysis identified major gene-expression changes depending on the stimulus. Random Forest classification identified CD47, BATF, FASLG, RGS16, SYNPO, SELE, PTPN7, WARS, PRC1, EXO1, RRM2, PBK, RAD54L, KIFC1, SPC25, PKMYT, HISTH1A, TPX2, DLGAP5, TPX2, CH25H, and IL37 as potential biomarkers to distinguish allergic and irritant contact dermatitis in human skin. Validation experiments and prediction performances on external testing datasets demonstrated potential applicability of the identified biomarker models in the clinic. Capitalizing on this knowledge, novel diagnostic tools can be developed to guide clinical diagnosis of contact allergies.
  • COMACARE Study Grp; Wihersaari, Lauri; Ashton, Nicholas J.; Reinikainen, Matti; Jakkula, Pekka; Pettilä, Ville; Hastbacka, Johanna; Tiainen, Marjaana; Loisa, Pekka; Friberg, Hans; Cronberg, Tobias; Blennow, Kaj; Zetterberg, Henrik; Skrifvars, Markus B. (2021)
    Purpose Neurofilament light (NfL) is a biomarker reflecting neurodegeneration and acute neuronal injury, and an increase is found following hypoxic brain damage. We assessed the ability of plasma NfL to predict outcome in comatose patients after out-of-hospital cardiac arrest (OHCA). We also compared plasma NfL concentrations between patients treated with two different targets of arterial carbon dioxide tension (PaCO2), arterial oxygen tension (PaO2), and mean arterial pressure (MAP). Methods We measured NfL concentrations in plasma obtained at intensive care unit admission and at 24, 48, and 72 h after OHCA. We assessed neurological outcome at 6 months and defined a good outcome as Cerebral Performance Category (CPC) 1-2 and poor outcome as CPC 3-5. Results Six-month outcome was good in 73/112 (65%) patients. Forty-eight hours after OHCA, the median NfL concentration was 19 (interquartile range [IQR] 11-31) pg/ml in patients with good outcome and 2343 (587-5829) pg/ml in those with poor outcome,p <0.001. NfL predicted poor outcome with an area under the receiver operating characteristic curve (AUROC) of 0.98 (95% confidence interval [CI] 0.97-1.00) at 24 h, 0.98 (0.97-1.00) at 48 h, and 0.98 (0.95-1.00) at 72 h. NfL concentrations were lower in the higher MAP (80-100 mmHg) group than in the lower MAP (65-75 mmHg) group at 48 h (median, 23 vs. 43 pg/ml,p = 0.04). PaCO(2)and PaO(2)targets did not associate with NfL levels. Conclusions NfL demonstrated excellent prognostic accuracy after OHCA. Higher MAP was associated with lower NfL concentrations.
  • Kiss, Jan; Stark, Christoffer; Nykaäen, Antti; Lemström, Karl (2020)
    Objectives. We present the outcome of the first 80 patients receiving a continuous flow left ventricular assist device at Helsinki University Hospital between December 2011 and November 2018. Design. This was a single-center retrospective study. We describe our patient management in detail. The primary end-points were death, heart transplantation, or pump explant. Data was reported in accordance with the Interagency Registry for Mechanical Circulatory Support protocol. All patients receiving an assist device during the study period were included in the data analysis. Results. Mean patient age was 53 +/- 12 years at implantation and 85% were male. Most patients suffered from dilated (48%), or ischemic (40%) cardiomyopathy. One-third of patients were bridged with venoarterial extracorporeal membrane oxygenation to assist device implantation. Implant strategy was bridge to transplant or bridge to decision in most patients (88%). Mean follow-up time on pump was 529 +/- 467 days. Survival was 98, 92, 85, 79 and 71% at 1, 3, 12, 24 and 36 months, respectively. Most common causes of death were multi-organ failure, right heart failure, or stroke. Only three patients (4%) had suspected pump thrombosis, two of which resolved with medical treatment and one resulting in death. Pump exchange or explant were not performed in a single patient. Neurological events occurred in 18%, non-disabling stroke in 8%, and fatal stroke in 4% of the patients. The incidence of device-related infection was 10%. Conclusions. Survival rates were good, although one third of patients were bridged with temporary circulatory support. We report a high level of freedom from pump thrombosis, fatal stroke, and driveline infection.
  • Int PCOS Network; Teede, Helena J.; Misso, Marie L.; Costello, Michael F.; Dokras, Anuja; Laven, Joop; Moran, Lisa; Piltonen, Terhi; Norman, Robert J.; Tapanainen, Juha (2018)
    STUDY QUESTION: What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise and consumer preference? SUMMARY ANSWER: International evidence-based guidelines, including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS. WHAT IS KNOWN ALREADY: Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial, and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. STUDY DESIGN, SIZE, DURATION: International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength. PARTICIPANTS/MATERIALS, SETTING, METHODS: Governance included a six continent international advisory and a project board, five guideline development groups, and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis and translation experts. In total, 37 societies and organizations covering 71 countries engaged in the process. Twenty face-to-face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence-based recommendations were developed and approved via consensus voting within the five guideline panels, modified based on international feedback and peer review, with final recommendations approved across all panels. MAIN RESULTS AND THE ROLE OF CHANCE: The evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: (i) considerable refinement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; (ii) reducing unnecessary testing; (iii) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life; and (iv) emphasizing evidence based medical therapy and cheaper and safer fertility management. LIMITATIONS, REASONS FOR CAUTION: Overall evidence is generally low to moderate quality, requiring significantly greater research in this neglected, yet common condition, especially around refining specific diagnostic features in PCOS. Regional health system variation is acknowledged and a process for guideline and translation resource adaptation is provided. WIDER IMPLICATIONS OF THE FINDINGS: The international guideline for the assessment and management of PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program. STUDY FUNDING/COMPETING INTEREST(S): The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine. Guideline development group members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Full details of conflicts declared across the guideline development groups are available at https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline in the Register of disclosures of interest. Of named authors, Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Laven declared grants from Ferring, Euroscreen and personal fees from Ferring, Euroscreen, Danone and Titus Healthcare. Prof. Norman has declared a minor shareholder interest in an IVF unit. The remaining authors have no conflicts of interest to declare. The guideline was peer reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREE-II criteria, and underwent methodological review. This guideline was approved by all members of the guideline development groups and was submitted for final approval by the NHMRC.