Maritime Safety Education with VR Technology (MarSEVR)

This paper presents the development of a virtual training technology that can be used in maritime safety training. This system is under testing phase and has being developed with a multidisciplinary team consisting of maritime specialists, computer scientists, business developers and VR experts. The technology is a cost effective, portable maritime training system that can be used on board, in training centers or even at home environments. Boosting situation awareness in navigation with VR-training applications is an easy and efficient method to practice whenever an officer has time for training. This can be done in an effective and fun way, giving measurable training progress indexes. The paper emphasizes on the need of VR Training in the shipping industry, the industry challenges and the description of the proof-of the-concept through the MarSEVR (Maritime Safety Education with VR) technology. The main objective in this paper is to present a prototype of the technology which can be utilized to train trainees and professionals in immersive training scenarios

Understanding developmental language disorder -The Helsinki longitudinal SLI study (HelSLI) : A study protocol

Background: Developmental language disorder (DLD, also called specific language impairment, SLI) is a common developmental disorder comprising the largest disability group in pre-school-aged children. Approximately 7% of the population is expected to have developmental language difficulties. However, the specific etiological factors leading to DLD are not yet known and even the typical linguistic features appear to vary by language. We present here a project that investigates DLD at multiple levels of analysis and aims to make the reliable prediction and early identification of the difficulties possible. Following the multiple deficit model of developmental disorders, we investigate the DLD phenomenon at the etiological, neural, cognitive, behavioral, and psychosocial levels, in a longitudinal study of preschool children. Methods: In January 2013, we launched the Helsinki Longitudinal SLI study (HelSLI) at the Helsinki University Hospital ( http://tiny.cc/HelSLI ). We will study 227 children aged 3-6 years with suspected DLD and their 160 typically developing peers. Five subprojects will determine how the child's psychological characteristics and environment correlate with DLD and how the child's well-being relates to DLD, the characteristics of DLD in monolingual versus bilingual children, nonlinguistic cognitive correlates of DLD, electrophysiological underpinnings of DLD, and the role of genetic risk factors. Methods include saliva samples, EEG, computerized cognitive tasks, neuropsychological and speech and language assessments, video-observations, and questionnaires. Discussion: The project aims to increase our understanding of the multiple interactive risk and protective factors that affect the developing heterogeneous cognitive and behavioral profile of DLD, including factors affecting literacy development. This accumulated knowledge will form a heuristic basis for the development of new interventions targeting linguistic and non-linguistic aspects of DLD. © 2018 The Author(s).Non peer reviewe

Treatment Outcome in Patients Receiving Assertive Community Treatment

In an observational study of severely mentally ill patients treated in assertive community treatment (ACT) teams, we investigated how treatment outcome was associated with demographic factors, clinical factors, and motivation for treatment. To determine psychosocial outcome, patients were routinely assessed using the Health of the Nation Outcome Scales (HoNOS). Trends over time were analyzed using a mixed model with repeated measures. The HoNOS total score was modeled as a function of treatment duration and patient-dependent covariates. Data comprised 637 assessments of 139 patients; mean duration of follow-up was 27.4 months (SD = 5.4). Substance abuse, higher age, problems with motivation, and lower educational level were associated with higher HoNOS total scores (i.e., worse outcome). To improve treatment outcome, we recommend better implementation of ACT, and also the implementation of additional programs targeting subgroups which seem to benefit less from ACT

The use of fasting vs. non-fasting triglyceride concentration for estimating the prevalence of high LDL-cholesterol and metabolic syndrome in population surveys

<p>Abstract</p> <p>Background</p> <p>For practical reasons it is not easy to obtain fasting samples in large population health surveys. Non-fasting triglyceride (Tg) values are difficult to interpret. The authors compared the accuracy of statistically corrected non-fasting Tg values with true fasting values and estimated the misclassification of subjects with high low-density lipoprotein cholesterol (LDL-C) and the metabolic syndrome.</p> <p>Methods</p> <p>Non-fasting blood was obtained from a population-based sample of 4282 individuals aged 24-75 years in the National FINRISK 2007 Study. Fasting blood samples were drawn from the same persons 3 months later. Non-fasting serum Tg values were converted into fasting values using previously published formula. LDL-C was calculated and classification of the metabolic syndrome was carried out according to three different latest guidelines.</p> <p>Results</p> <p>The median (25^th, 75th percentile) non-fasting serum Tg concentration was 1.18 (0.87, 1.72) mmol/L and after postprandial correction 1.06 (0.78, 1.52) mmol/L. The true-fasting serum Tg concentration was 1.00 (0.75, 1.38) mmol/L (<it>P </it>< 0.001) vs. non-fasting and corrected value. Bias of the corrected value was +5.9% compared with the true-fasting Tg. Of the true fasting subjects, 56.4% had LDL-C ≥3.00 mmol/L. When calculated using non-fasting serum Tg, the prevalence of high LDL-C was 51.3% and using statistically corrected Tg it was 54.8%. The prevalence of metabolic syndrome was 35.5% among fully fasted persons and among non-fasting subjects 39.7%, which after statistical correction of Tg decreased to 37.6% (P < 0.001 for all comparisons).</p> <p>Conclusions</p> <p>Correction of non-fasting serum Tg to fasting values plays a minor role in population studies but nevertheless reduces misclassification of calculated high LDL-C from 5.1 to 1.6% and the metabolic syndrome from 4.2 to 2.1%.</p

Delineating the molecular and phenotypic spectrum of the SETD1B-related syndrome

Purpose: Pathogenic variants in SETD1B have been associated with a syndromic neurodevelopmental disorder including intellectual disability, language delay, and seizures. To date, clinical features have been described for 11 patients with (likely) pathogenic SETD1B sequence variants. This study aims to further delineate the spectrum of the SETD1B-related syndrome based on characterizing an expanded patient cohort. Methods: We perform an in-depth clinical characterization of a cohort of 36 unpublished individuals with SETD1B sequence variants, describing their molecular and phenotypic spectrum. Selected variants were functionally tested using in vitro and genome-wide methylation assays. Results: Our data present evidence for a loss-of-function mechanism of SETD1B variants, resulting in a core clinical phenotype of global developmental delay, language delay including regression, intellectual disability, autism and other behavioral issues, and variable epilepsy phenotypes. Developmental delay appeared to precede seizure onset, suggesting SETD1B dysfunction impacts physiological neurodevelopment even in the absence of epileptic activity. Males are significantly overrepresented and more severely affected, and we speculate that sex-linked traits could affect susceptibility to penetrance and the clinical spectrum of SETD1B variants. Conclusion: Insights from this extensive cohort will facilitate the counseling regarding the molecular and phenotypic landscape of newly diagnosed patients with the SETD1B-related syndrome

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Course of illness, outcome and their predictors in schizophrenia:the Northern Finland 1966 Birth Cohort study

Abstract The aim of this study was to explore the prognosis and predictors of outcomes in DSM-III-R schizophrenic psychoses within the Northern Finland 1966 Birth Cohort (NFBC 1966, N = 12 017). Firstly, clinical and social outcomes were explored by using different definitions of good and poor outcomes, and early developmental, socio-demographic, illness-related and school-related predictors of outcome in schizophrenia (N = 59) were studied. Secondly, associations between early motor development and the course of illness in schizophrenia (N = 109) were explored. Thirdly, patterns of psychiatric hospitalisations in schizophrenic psychoses (N = 115) were studied. Fourthly, recovery in schizophrenia (N = 59) and other schizophrenia spectrum psychoses (N = 12) was assessed. As a result, good clinical outcome varied from 10% to 59%, and good social outcome 15–46%, depending on definition. Poor clinical outcome varied 41–77% and poor social outcome 37–54%. Lack of friends in childhood, father's high social class, lower school performance and earlier age of illness onset predicted poor outcomes. There were some associations between development and learning of basic skills at about age 1 and subsequent illness course. Those who learnt later (within normal limits) had mostly better outcomes, compared to early learners. A total of 81% of patients with schizophrenic psychoses were re-hospitalised during the follow-up and short first hospitalisation and family history of psychosis were linked to increased risk of re-hospitalisations. One (1.7%) schizophrenia subject and three (25%) subjects with other schizophrenia spectrum disorder recovered fully; one (1.7%) schizophrenia subject and two (16.7%) spectrum subjects experienced partial recovery after several years of follow-up. In this dissertation study outcomes and some predictors were analysed in a population-based sample of individuals with relatively young age and short duration of illness. In general, both clinical and social outcomes were heterogeneous and relatively poor, and the results were influenced by the definitions of outcomes. Persons having a sub-optimal developmental trajectory with family history of psychosis, poor social contacts, poor school performance, and early age of illness onset and those with short first hospitalisation seem to have the worst outcome. In addition, the neuromotor development of these individuals is complex and late development does not associate clearly with poor outcome of illness. The results of this study indicate that the outcome of schizophrenic psychoses is not good enough and that more effective treatments and rehabilitation for schizophrenia patients are needed. Also, there is a need for structured criteria for good and poor outcome and recovery in schizophrenia.Tiivistelmä Tämän tutkimuksen tavoitteena oli tutkia DSM-III-R skitsofrenian ja muiden skitsofrenian kaltaisten psykoosien taudinkulkua ja ennustetta sekä niihin liittyviä tekijöitä Pohjois-Suomen vuoden 1966 syntymäkohortissa. Ensimmäiseksi tutkimuksessa selvitettiin skitsofrenian (N = 59) taudinkulkua ja sitä ennustavia sosio-demografisia ja kehitykseen, sairauteen ja koulumenestykseen liittyviä tekijöitä. Toiseksi, tutkittiin varhaislapsuuden kehityksen ja skitsofreenisten psykoosien (N = 109) taudinkulun välistä yhteyttä. Kolmanneksi, skitsofreenista psykoosia sairastavien henkilöiden (N = 115) psykiatrisia sairaalahoitoja ja niihin liittyviä tekijöitä tutkittiin. Neljänneksi tutkimuksessa selvitettiin skitsofreniasta (N = 59) ja muista skitsofreniaspektrin psykooseista (N = 12) toipumista. Tässä tutkimuksessa 10–59 % potilaista voi kliinisesti hyvin ja 15–46 % sosiaalisesti hyvin kun taas 41–77 % voi kliinisesti ja 37–54 % sosiaalisesti huonosti. Tulokset riippuivat paljolti siitä, mitä hyvän ja huonon taudinkulun kriteereitä käytettiin. Lapsuudessa ystävien puute, isän korkea sosiaaliluokka, huono koulumenestys ja taudin varhainen alkamisikä liittyivät huonoon taudinkulkuun. Aineistosta löydettiin yhteys (normaalirajoissa olevan) myöhäisemmän kehityksen ja hyvän taudinkulun välillä. Seurannassa 81 % potilaista joutui ensimmäisen sairaalahoidon jälkeen uudelleen sairaalaan. Lyhyt ensimmäinen sairaalahoito ja suvussa esiintyvä psykoosi liittyivät kohonneeseen riskiin joutua uudelleen sairaalaan. Skitsofreniapotilaista yksi (1.7 %) oli täysin ja yksi (1.7 %) osittain toipunut. Muista skitsofreniaspektrin potilaista kolme (25 %) oli täysin ja kaksi (16.7 %) osittain toipuneita usean vuoden seurannan jälkeen. Tässä tutkimuksessa selvitettiin skitsofrenian taudinkulkua ja analysoitiin taudinkulkuun vaikuttavia tekijöitä yleisväestöön pohjautuvassa aineistossa. Tulosten mukaan skitsofreniaa sairastavien henkilöiden sosiaalinen ja kliininen taudinkulku oli vaihteleva ja enimmäkseen suhteellisen huono. Tulokset riippuivat paljon siitä, millaisia hyvän ja huonon taudinkulun kriteereitä käytettiin. Henkilöillä, joilla on suvussa psykooseja, varhainen sairastumisikä, joilla on ollut huono koulumenestys ja vähäisiä sosiaalisia kontakteja lapsuudessa, ja joilla on ollut lyhyt ensimmäinen sairaalahoito, sairauden kulku on usein huono. Skitsofreniaa sairastavien henkilöiden viivästynyt varhainen motorinen kehitys ei ole yksiselitteisesti yhteydessä huonoon taudinkulkuun. Tämän tutkimuksen tulosten perusteella skitsofrenian ennuste ei ole yleensä hyvä. Yhteiskunnan tulisi entistä enemmän panostaa skitsofreniapotilaiden kokonaisvaltaiseen hoitoon ja kuntouttamiseen. Aiemman kirjallisuuden ja tämän tutkimuksen tulosten perusteella on myös selkeä tarve yhdenmukaisille ja strukturoiduille hyvän ja huonon ennusteen ja toipumisen kriteereille skitsofreniassa

The Use of Blood Products in Adult Patients with Burns

Introduction: Burn anemia represents a common complication following a burn injury. Burn anemia etiology carries distinct features occurring at each stage of the post-injury and treatment periods resulting from different causes. We aimed to analyze the use of blood components in Finnish burn victims and to identify patient- and injury-related factors influencing their use. Methods: To study the use of blood products in burn patients, we used data collected from the Optimal Use of Blood registry, developed through co-operation between 10 major hospital districts and the Finnish Red Cross Blood Service. Burn patients 18years treated at the Helsinki University Hospital between 2005 and 2011 with an in-hospital stay 1day who received at least one transfusion during their hospital stay were included in this study. Results: Among all 558 burn patients, 192 (34%) received blood products during their hospital stay. The transfused cohort comprised 192 burn patients. The study cohort received a total of 6087units of blood components, 2422units of leukoreduced red blood cells, 1728units of leukoreduced platelets, and 420units of single-donor fresh frozen plasma or, after 2007, 1517units of Octaplas((R)) frozen plasma. All three types of blood components were administered to 29% of patients, whereas 45% received only red blood cells and 6% received only Octaplas. Transfused patients were significantly older (p Discussion: We show that Finnish adult burn patients received ample transfusions. The number of blood components transfused varied according to the anatomical location of the injury and patient survival. Whether the additional mortality is related directly to transfusions or is merely a manifestation of the more severe burn injury remains unknown.Peer reviewe