Identifying Cultural and Cognitive Proximity between Managers and Customers in Tornio and Haparanda Cross Border Region

Daily intercultural interactions in cross-border regions such as those between customers and managers can be a source of knowledge and ideas. However, such interactions can pose distinctive constraints and opportunities for learning and exchange of ideas. This study adopts a relatively fine–grained quantitative approach to study elements of cognitive and cultural proximity which have a major impact on these interactions. It is based on a survey of 91 managers of small service firms and 312 customers in the twin city of Tornio and Haparanda on the border between Finland and Sweden. Seven elements of proximity were identified and measured. Six elements of perceived cognitive and cultural proximity including values, conservative values towards new ideas, knowledge and use of technology, use of a foreign language, sufficiently focusing or providing specific details and ways of solving problems were found significant in terms of shaping perceptions of Swedish and Finnish managers and customers, which shape these interactions. The results enhance our understanding of how daily cross-border intercultural can be examined in the context of cross-border regional knowledge transfer

Postoperative Deterioration in Health Related Quality of Life as Predictor for Survival in Patients with Glioblastoma: A Prospective Study

BACKGROUND: Studies indicate that acquired deficits negatively affect patients' self-reported health related quality of life (HRQOL) and survival, but the impact of HRQOL deterioration after surgery on survival has not been explored. OBJECTIVE: Assess if change in HRQOL after surgery is a predictor for survival in patients with glioblastoma. METHODS: Sixty-one patients with glioblastoma were included. The majority of patients (n = 56, 91.8%) were operated using a neuronavigation system which utilizes 3D preoperative MRI and updated intraoperative 3D ultrasound volumes to guide resection. HRQOL was assessed using EuroQol 5D (EQ-5D), a generic instrument. HRQOL data were collected 1-3 days preoperatively and after 6 weeks. The mean change in EQ-5D index was -0.05 (95% CI -0.15-0.05) 6 weeks after surgery (p = 0.285). There were 30 patients (49.2%) reporting deterioration 6 weeks after surgery. In a Cox multivariate survival analysis we evaluated deterioration in HRQOL after surgery together with established risk factors (age, preoperative condition, radiotherapy, temozolomide and extent of resection). RESULTS: There were significant independent associations between survival and use of temozolomide (HR 0.30, p = 0.019), radiotherapy (HR 0.26, p = 0.030), and deterioration in HRQOL after surgery (HR 2.02, p = 0.045). Inclusion of surgically acquired deficits in the model did not alter the conclusion. CONCLUSION: Early deterioration in HRQOL after surgery is independently and markedly associated with impaired survival in patients with glioblastoma. Deterioration in patient reported HRQOL after surgery is a meaningful outcome in surgical neuro-oncology, as the measure reflects both the burden of symptoms and treatment hazards and is linked to overall survival

Segmentation of glioblastomas in early post-operative multi-modal MRI with deep neural networks

Extent of resection after surgery is one of the main prognostic factors for patients diagnosed with glioblastoma. To achieve this, accurate segmentation and classification of residual tumor from post-operative MR images is essential. The current standard method for estimating it is subject to high inter- and intra-rater variability, and an automated method for segmentation of residual tumor in early post-operative MRI could lead to a more accurate estimation of extent of resection. In this study, two state-of-the-art neural network architectures for pre-operative segmentation were trained for the task. The models were extensively validated on a multicenter dataset with nearly 1000 patients, from 12 hospitals in Europe and the United States. The best performance achieved was a 61% Dice score, and the best classification performance was about 80% balanced accuracy, with a demonstrated ability to generalize across hospitals. In addition, the segmentation performance of the best models was on par with human expert raters. The predicted segmentations can be used to accurately classify the patients into those with residual tumor, and those with gross total resection

Imaging practice in low-grade gliomas among European specialized centers and proposal for a minimum core of imaging

Objective: Imaging studies in diffuse low-grade gliomas (DLGG) vary across centers. In order to establish a minimal core of imaging necessary for further investigations and clinical trials in the field of DLGG, we aimed to establish the status quo within specialized European centers. Methods: An online survey composed of 46 items was sent out to members of the European Low-Grade Glioma Network, the European Association of Neurosurgical Societies, the German Society of Neurosurgery and the Austrian Society of Neurosurgery. Results: A total of 128 fully completed surveys were received and analyzed. Most centers (n=96, 75%) were academic and half of the centers (n=64, 50%) adhered to a dedicated treatment program for DLGG. There were national differences regarding the sequences enclosed in MRI imaging and use of PET, however most included T1 (without and with contrast, 100%), T2 (100%) and TIRM or FLAIR (20, 98%). DWI is performed by 80% of centers and 61% of centers regularly performed PWI.ConclusionA minimal core of imaging composed of T1 (w/wo contrast), T2, TIRM/FLAIR, PWI and DWI could be identified. All morphologic images should be obtained in a slice thickness of 3mm. No common standard could be obtained regarding advanced MRI protocols and PET. Importance of the study: We believe that our study makes a significant contribution to the literature because we were able to determine similarities in numerous aspects of LGG imaging. Using the proposed minimal core of imaging in clinical routine will facilitate future cooperative studies

Development and external validation of a clinical prediction model for functional impairment after intracranial tumor surgery

OBJECTIVE Decision-making for intracranial tumor surgery requires balancing the oncological benefit against the risk for resection-related impairment. Risk estimates are commonly based on subjective experience and generalized num-bers from the literature, but even experienced surgeons overestimate functional outcome after surgery. Today, there is no reliable and objective way to preoperatively predict an individual patient's risk of experiencing any functional impair-ment. METHODS The authors developed a prediction model for functional impairment at 3 to 6 months after microsurgical resection, defined as a decrease in Karnofsky Performance Status of >= 10 points. Two prospective registries in Swit- zerland and Italy were used for development. External validation was performed in 7 cohorts from Sweden, Norway, Germany, Austria, and the Netherlands. Age, sex, prior surgery, tumor histology and maximum diameter, expected major brain vessel or cranial nerve manipulation, resection in eloquent areas and the posterior fossa, and surgical approach were recorded. Discrimination and calibration metrics were evaluated. RESULTS In the development (2437 patients, 48.2% male; mean age +/- SD: 55 +/- 15 years) and external validation (2427 patients, 42.4% male; mean age +/- SD: 58 +/- 13 years) cohorts, functional impairment rates were 21.5% and 28.5%, respectively. In the development cohort, area under the curve (AUC) values of 0.72 (95% CI 0.69-0.74) were observed. In the pooled external validation cohort, the AUC was 0.72 (95% CI 0.69-0.74), confirming generalizability. Calibration plots indicated fair calibration in both cohorts. The tool has been incorporated into a web-based application available at https://neurosurgery.shinyapps.io/impairment/. CONCLUSIONS Functional impairment after intracranial tumor surgery remains extraordinarily difficult to predict, al- though machine learning can help quantify risk. This externally validated prediction tool can serve as the basis for case by-case discussions and risk-to-benefit estimation of surgical treatment in the individual patient.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Imaging practice in low-grade gliomas among European specialized centers and proposal for a minimum core of imaging.

OBJECTIVE: Imaging studies in diffuse low-grade gliomas (DLGG) vary across centers. In order to establish a minimal core of imaging necessary for further investigations and clinical trials in the field of DLGG, we aimed to establish the status quo within specialized European centers. METHODS: An online survey composed of 46 items was sent out to members of the European Low-Grade Glioma Network, the European Association of Neurosurgical Societies, the German Society of Neurosurgery and the Austrian Society of Neurosurgery. RESULTS: A total of 128 fully completed surveys were received and analyzed. Most centers (n = 96, 75%) were academic and half of the centers (n = 64, 50%) adhered to a dedicated treatment program for DLGG. There were national differences regarding the sequences enclosed in MRI imaging and use of PET, however most included T1 (without and with contrast, 100%), T2 (100%) and TIRM or FLAIR (20, 98%). DWI is performed by 80% of centers and 61% of centers regularly performed PWI. CONCLUSION: A minimal core of imaging composed of T1 (w/wo contrast), T2, TIRM/FLAIR, PWI and DWI could be identified. All morphologic images should be obtained in a slice thickness of ≤ 3 mm. No common standard could be obtained regarding advanced MRI protocols and PET. IMPORTANCE OF THE STUDY: We believe that our study makes a significant contribution to the literature because we were able to determine similarities in numerous aspects of LGG imaging. Using the proposed "minimal core of imaging" in clinical routine will facilitate future cooperative studies

Borders, planning and policy transfer:historical transformation of development discourses in the Finnish Torne Valley

Abstract European Union spatial policies have become a key institutional context in which to study policy transfer processes in European border areas. These policies are, however, only the most recent part of these transformation processes which raises a need for more historically sensitive approaches. An historical perspective is important, since border regions are historical processes with particular path-dependent development trajectories and power structures. This paper aims to contribute to the discussion concerning the transformation of European border regions by looking at the policy transfer of regional development discourses in the Finnish Torne Valley. The study material consists of strategic development documents produced by the Finnish border municipalities and the municipal-based co-operation organizations from the 1930s to 2013. The examination, based on critical discourse analysis, shows that the transformation process is driven by national trends and the dominant planning discourse. Nevertheless, the particular border setting and local discourse on ‘united Torne Valley’ have also intertwined with political and economic processes during different time periods

Local responses to state-led municipal reform in the Finnish-Swedish border region:conflicting development discourses, culture and institutions

Abstract This paper scrutinises the intersections and collisions of different development discourses in the Kemi-Tornio sub-region which lies alongside the Finnish-Swedish border within the political context of municipal reform initiated by the Finnish government in 2011–2015. By drawing on cultural political economy and institutional regional theory, this paper studies how local actors utilize different development discourses produced at (and producing) different scales to justify or contest the municipal amalgamation within the Kemi-Tornio region. In addition, the specific interest is on the how local institutional environment, and border location in particular, are mobilized and strategically used in these processes. The results, based on policy documents and qualitative interviews with key municipal actors, highlight the coexistence of three different, yet overlapping development discourses. While some municipal actors support the state-led development discourse with justification of economic reasoning, there is a strong opposing discourse emphasising the region’s history, identity and municipal self-autonomy. The latter, interestingly, resonates with the EU’s cross-border co-operation discourse; offering an alternative development strategy. Together with the path-dependent regional history, this intersection creates unbalanced power relations between municipalities both with and without a state border. Thus, this paper illustrates how different scalar discourses and institutional structures are actively utilized in municipal reform processes

Culture, institutions and power:institutionalisation of cross-border co-operation as a development strategy in Northern Finland

Abstract A predominant academic question is how and why the development paths of municipalities and regions take certain forms. In recent decades, geographers and economists in particular have investigated the dynamics of how local institutional conditions and their local mobilisation can affect development outcomes and how development is determined by “structural” forces such as state- and EU-based regulations and globalisation of the economy. Thus, the notion that historical sensitiveness and context-dependency are essential factors in local and regional development and growth has gained credence. Then again, municipalities and regions are not “islands” of development but integral parts of complex socio-spatial relations and processes. From this viewpoint, border municipalities and regions are eminently interesting research contexts as they are sites where different scalar political interests, institutional structures, and development discourses are continuously manifested, materialised and contested in the daily practices of local and regional actors. Nevertheless, this thesis argues that the existing mainstream studies investigating the development paths and prospects of border regions and municipalities are, firstly, overly EU-centric and, secondly, have an overly limited perspective on the institutional environment and legacy in which local and regional actors operate. The main attention in this regard has often been on the institutional differences between states and nationalities. In order to understand the development prospects of border areas and the preconditions of transnational regionalisation, municipal planning of border areas needs to be approached not only from the perspective of EU-driven cross-border co-operation and building of “transnational” scale, but more comprehensively. Accordingly, the present research on the Finnish-Swedish border area, which is an internal border area of the EU, takes a more historically and contextually sensitive institutional approach in this regard. Investigating the structural and discursive dynamics related to the institutionalisation of cross-border co-operation as a development strategy in the context of municipal planning enables not only identification of the conflicts and intersections between state-, EU- and local/regional-level development interests and institutional structures, but also provides room for recognising the diversity of the existing interests, strategies and motivations of local and regional actors and different interest groups involved in these institutionalisation processes. This thesis suggests that the concept of policy transfer and problematisation of the dynamics of how and why certain development strategies, policies and discourses become selected, implemented and sustained at the border municipalities offers a fruitful theoretical and political framework for examining the abovementioned issues. Accordingly, the thesis studies the intertwined relationship between local agency and the mobilisation of scalar institutional structures in regional planning and policy transfer processes by applying the Cultural Political Economy approach and strategic-relational theory on institutions (see Jessop & Sum 2013) as theoretical-methodological lenses. The thesis consists of three original research articles that form a scalar and temporal continuum. The empirical research is based on interviews conducted with key municipal and regional actors (i.e. planners, politicians, project managers and entrepreneurs), historical document material reaching back to the 1930s, as well as supplementary policy documents produced at various governmental levels. Both critical discourse analysis and content analysis are used as analysis methods. As the dynamics of municipal planning are reflected primarily against the formal institutional planning system in Finland, the study focuses on the Finnish side of the border — the Finnish Tornio Valley and the Kemi-Tornio sub-region. The results underline that the institutionalisation of cross-border co-operation as a key development strategy has been a long path-dependent process in which policy transfer processes and local mobilisation have become intertwined. While the “large-scale” development follows the Finnish national development — the transition from state-led, topdown politics to a more bottom-up, region-based development model — the investigation of these policy transfer processes also shows that the border location and the mobilisation of both the “border region identity” and the EU’s cross-border co-operation policy discourse have had a marked impact on the development path. Accordingly, they have furthered the development towards cross-border regionalisation. Moreover, border municipalities are challenging the state’s authority and the subordinated municipality-state relation by invoking this development. This development, however, is regionally contested and exemplifies the power relations both between municipalities with/without state border as well as between public and private sector actors. In the end, which development strategies become dominant or discarded in a particular context depends on how different actors and interest groups mobilise their privileged positions in relation to surrounding formal and informal institutional structures, such as municipal autonomy, EU cross-border cooperation funding schemes, trust relations, regional identity, and prevailing norms and customs. This research stands as an illustrative example that it is crucial not to consider these context-specific “soft” matters as somehow secondary to “rational” economic reasoning when investigating courses of action and economic development paths