”Kun maalaisjärki loppuu, niin otetaan lakikirja käsiin”:kokeneiden opettajien ajatuksia työrauhasta ja sen muutoksesta

Tiivistelmä. Tutkimuksessa selvitettiin kokeneiden luokanopettajien käsityksiä työrauhasta, työrauhahäiriöistä, työrauhalainsäädännöstä, sekä kokemuksia näiden muutoksesta työuran aikana. Työrauhaa on tutkittu suomalaisittain aktiivisesti erityisesti 70-luvun lopussa ja 80-luvun alussa. Aikaisempien tutkimusten perusteella työrauha on käsitteenä vaikea, sillä opettajat kokevat eri asioita häiriöiksi. Työrauhan määrittely on subjektiivista. Muutos työrauhan suhteen on nähtävissä jo käytetyssä termistössä. Entisinä aikoina on puhuttu kurinpito-ongelmista ja opettaja on ollut tiedonjakaja. Nykyään kuri ymmärretään negatiiviseksi asiaksi, joka ei edistä oppilaan oppimista. Opettajan rooli on vaihtunut tiedonjakajasta oma-aloitteisesti toimivan oppilaan ohjaajaksi. Lainsäädäntöä työrauhaan liittyen on tarkennettu viimeksi vuonna 2014. Työrauhalainsäädäntöä on viime vuosina tarkennettu ottamaan entistä enemmän huomioon oppilaiden ja opettajien perusoikeuksia. Opettajan autoritääriset yksinvaltiaan keinot ylläpitää työrauhaa ovat poistuneet ja laki ottaa huomioon entistä enemmän yksilöiden oikeuksia. Suuntaus on sama opettajan ja oppilaiden välisissä suhteissa koululuokissa. Työrauhan rakentamiseen käytetään entistä enemmän oppilaslähtöisiä keinoja ja oppilaita otetaan mukaan luokan päätöksentekoon ja yhteisten sääntöjen sopimiseen. Tutkimus toteutettiin fenomenografisena tapaustutkimuksena. Tutkimuksen aineisto kerättiin haastattelemalla vähintään 10 vuotta luokanopettajana toimineita opettajia. Yhteensä tutkimukseen osallistui kuusi opettajaa, joista kolme oli miehiä ja kolme oli naisia. Tulosten kannalta sukupuolilla ei ollut oleellista merkitystä. Opettajat kokevat työrauhan tilaksi, jossa oppilaat voivat työskennellä vailla pelkoa ja häiriötekijöitä. Hyvän työrauhan edellytyksenä ei ole luokassa vallitseva hiljaisuus. Useat työskentelytavat korostivat keskustelua. Opettajien mielestä työrauha häiriintyy silloin, kun oppimista ei tapahdu. Työrauhahäiriöiden syyt olivat ensin opettajassa ja vasta sitten oppilaassa. Opettajat tarkastivat häiriötilanteessa ensin omaa käyttäytymistään tai tehtävänantoaan ennen kuin käänsivät katseen oppilaasta johtuviin seikkoihin. Työrauhaa ylläpitäessään lainsäädäntö oli opettajilla taustalla vaikuttavana tekijänä, ei ensimmäisenä mielessä työrauhaan liittyviä ratkaisuja tehdessä. Opettajat pitävät oppilaita nykyään avoimempina ja reippaampina. Opettajat myös tuovat enemmän omaa persoonaansa mukaan ja ovat helpommin lähestyttävissä. Opettajien työtavat ovat yhteisöllisempiä ja opettamistapa ohjaavampi kuin ennen. Rangaistusmenetelmät ovat oppilaslähtöisempiä. Esimerkiksi jälki-istuntoa ei enää juuri käytetä, vaan tilalla ovat kasvatuskeskustelut. Työrauhaan liittyvän lainsäädännön muutos koettiin hyväksi. Laki ottaa entistä enemmän huomioon yksilöiden oikeuksia

Treponema denticola chymotrypsin-like protease as associated with HPV-negative oropharyngeal squamous cell carcinoma

BACKGROUND: An opportunistic oral pathogen, Treponema denticola (Td), has been linked to orodigestive carcinogenesis, but its role in oropharyngeal squamous cell carcinoma (OPSCC) has remained open. We evaluated the presence of Td chymotrypsin-like protease (Td-CTLP) in a series of 201 unselected consecutive OPSCC patients, and the relation of the Td-CTLP to human papillomavirus (HPV) status, to expression of toll-like receptors (TLR) 5, 7, and 9, and to clinical parameters and patient outcome. METHODS: Clinicopathological data came from hospital registries. The expression of cell surface-bound Td-CTLP was evaluated by immunohistochemistry. Immunoexpression of TLRs 5, 7, and 9, and HPV status we studied earlier in this patient series. RESULTS: We detected Td-CTLP in 81% of the OPSCC, and especially in HPV-negative tumours (48% of all OPSCCs). Among the HPV-positive tumours (52% of all OPSCCs), low Td-CTLP expression associated with low TLR 5 and high TLR 7 expression. Among those HPV-negative, higher TLR 5 and lower TLR 7 expression associated with high Td-CTLP expression. Strong Td-CTLP expression associated with poor disease-specific survival, but no similar association among HPV-positive and HPV-negative subgroups emerged. CONCLUSIONS: Td-CTLP was highly expressed in OPSCC and was associated with the HPV status of tumour tissue.Peer reviewe

Stakeholder management in PED projects:challenges and management model

Abstract The importance of stakeholder analysis and stakeholder management is magnified as project complexity increases. Complex projects can be characterized by uncertainties arising from emerging technologies and the involvement of various types of stakeholders and their interests. Positive Energy District (PED) projects are an example of such undertaking, coupling novel energy solutions with distinct stakeholders and their diverse positions, claims, and requirements pertaining to the project. In this study, our objective is to provide a stakeholder management framework for future PED projects. The qualitative case study follows the theory elaboration methodology and aims to formulate a conceptual stakeholder management framework for PED projects. Thus, our contribution focuses on expanding the domain of project stakeholder management by characterizing and validating it in a new, time-relevant project context

Prodromal and early bvFTD:evaluating clinical features and current biomarkers

Abstract Despite the current diagnostic criteria, early diagnostics of behavioral variant of frontotemporal dementia (bvFTD) has remained challenging. Patients with bvFTD often present with misleading psychiatric phenotype, and, on the other hand, impairment in memory functions have increasingly been reported. However, impaired episodic memory is currently considered as an exclusion criterion for bvFTD. Single biofluid-based or imaging biomarkers do not currently provide sufficient sensitivity or specificity for early bvFTD diagnosis at single-subject level, although studies have suggested improved accuracy with different biomarker combinations. In this mini review, we evaluate the core clinical features of early bvFTD and summarize the most potential imaging and fluid biomarkers for bvFTD diagnostics

Brainstem atrophy is linked to extrapyramidal symptoms in frontotemporal dementia

Abstract Extrapyramidal (EP) symptoms are a known feature in a subpopulation of patients with behavioral variant frontotemporal dementia (bvFTD). Concomitant EP symptoms with FTD-like neuropsychiatric symptoms are also core features in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). This complicates the early diagnosis of these disorders. Our retrospective register study aimed to discover imaging (MRI and FDG-PET) biomarkers to differentiate PSP, CBD, and bvFTD patients with extrapyramidal symptoms (EP +) from bvFTD patients without EP symptoms (EP-). The records of 2751 patients were screened for the diagnoses and presence of EP symptoms. A total of 222 patients were submitted to imaging analysis and applicable imaging data were recovered from 139 patients. Neuroimaging data were analyzed using Freesurfer software. In the whole cohort, EP + patients showed lower volumes of gray matter compared to EP- patients in the putamen (p = 0.002), bilateral globus pallidum (p = 0.002, p = 0.042), ventral diencephalon (p = 0.002) and brain stem (p < 0.001). In the bvFTD subgroup, there was volumetric difference between EP + and EP− patients in the brain stem. FDG-PET scans in the bvFTD patient subgroup showed that EP + patients had comparative hypometabolism of the superior cerebellar peduncle (SCP) and the frontal lobes. We discovered that EP symptoms are linked to brainstem atrophy in bvFTD patients and the whole cohort. Also, evident hypometabolism in the SCP of bvFTD EP + patients was detected as compared to bvFTD EP− patients. This could indicate that the EP symptoms in these diseases have a more caudal origin in the brainstem than in Parkinson’s disease

Serum neurofilament light chain in FTLD:association with C9orf72, clinical phenotype, and prognosis

Abstract Objective: The aim of the present study was to compare the levels of serum neurofilament light chain (sNfL) in frontotemporal lobar degeneration (FTLD) patients of different clinical subtypes (bvFTD, PPA, and FTLD‐MND) and with or without the C9orf72 repeat expansion, and to correlate sNfL levels to disease progression, assessed by the brain atrophy rate and survival time. Methods: The sNfL levels were determined from 78 FTLD patients (C9orf72 repeat expansion carriers [n = 26] and non‐carriers [n = 52]) with Single Molecule Array (SIMOA). The progression of brain atrophy was evaluated using repeated T1‐weighted MRI scans and the survival time from medical records. Results: In the total FTLD cohort, sNfL levels were significantly higher in C9orf72 repeat expansion carriers compared to non‐carriers. Considering clinical phenotypes, sNfL levels were higher in the C9orf72 repeat expansion carriers than in the non‐carriers in bvFTD and PPA groups. Furthermore, sNfL levels were the highest in the FTLD‐MND group (median 105 pg/mL) and the lowest in the bvFTD group (median 27 pg/mL). Higher sNfL levels significantly correlated with frontal cortical atrophy rate and subcortical grey matter atrophy rate. The higher sNfL levels also associated with shorter survival time. Interpretation: Our results indicate that the C9orf72 repeat expansion carriers show elevated sNFL levels compared to non‐carriers and that the levels differ among different clinical phenotypes of FTLD. Higher sNfL levels correlated with a shorter survival time and cortical and subcortical atrophy rates. Thus, sNfL could prove as a potential prognostic biomarker in FTLD

Serum neurofilament light chain is a discriminative biomarker between frontotemporal lobar degeneration and primary psychiatric disorders

Abstract Due to the significant clinical overlap between frontotemporal lobar degeneration (FTLD) spectrum disorders and late-onset primary psychiatric disorders (PPD), diagnostic biomarkers reflecting the different underlying pathophysiologies are urgently needed. Thus far, elevated cerebrospinal fluid (CSF) levels of neurofilament light chain (NfL) have been reported in various neurological conditions. Furthermore, recent advancements in ultrasensitive analytical methods (e.g., single molecule array, Simoa) have enabled sensitive and less invasive NfL detection also from blood samples. In this study, we evaluated the potential of serum NfL (sNfL) as a diagnostic tool between FTLD and PPD. We analyzed sNfL levels with Simoa from 125 participants including patients from FTLD (n = 91) and PPD (n = 34) spectra. Our results show that sNfL levels are higher in the FTLD group compared to the PPD group as well as in separate clinical subtypes of FTLD compared to different psychiatric manifestations (i.e., mood or psychotic disorders). At single-subject level, discrimination between FTLD and PPD was possible with 80% sensitivity and 85% specificity (AUC = 0.850, 95% CI 0.776–0.923), and between behavioral variant frontotemporal dementia (bvFTD) and PPD with 79% sensitivity and 85% specificity (AUC = 0.830, 95% CI 0.732–0.908). These findings highlight the potential of sNfL as a discriminating biomarker for FTLD over PPD in patients with wide-ranging behavioral, psychiatric and cognitive symptoms

Low serum high-density lipoprotein cholesterol levels associate with the C9orf72 repeat expansion in frontotemporal lobar degeneration patients

Abstract Decreased levels of serum high-density lipoprotein (HDL) cholesterol have previously been linked to systemic inflammation and neurodegenerative diseases, such as Alzheimer’s disease. Here, we aimed to analyze the lipoprotein profile and inflammatory indicators, the high-sensitivity C-reactive peptide (hs-CRP) and glycoprotein acetyls (GlycA), in sporadic and C9orf72 repeat expansion-associated frontotemporal lobar degeneration (FTLD) patients. The C9orf72 hexanucleotide repeat expansion is the most frequent genetic etiology underlying FTLD. The concentrations of different lipid measures in the sera of 67 FTLD patients (15 C9orf72 repeat expansion carriers), including GlycA, were analyzed by nuclear magnetic resonance spectroscopy. To verify the state of systemic inflammation, hs-CRP was also quantified from patient sera. We found that the total serum HDL concentration was decreased in C9orf72 repeat expansion carriers when compared to non-carriers. Moreover, decreased concentrations of HDL particles of different sizes and subclass were consistently observed. No differences were detected in the very low- and low-density lipoprotein subclasses between the C9orf72 repeat expansion carriers and non-carriers. Furthermore, hs-CRP and GlycA levels did not differ between the C9orf72 repeat expansion carriers and non-carriers. In conclusion, the HDL-related changes were linked with C9orf72 repeat expansion associated FTLD but were not seen to associate with systemic inflammation. The underlying reason for the HDL changes remains unclear

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele