Organisational learning in forensic fingerprint investigation : Solving critical challenges with organisational rule construction.

The present study analyses data collected from a series of developmental seminars in a fingerprint laboratory during which fingerprint examiners jointly discussed and developed their work processes, analytical methods, decision-making criteria and rules of documentation. The analysed organizational development took place in the context of moving from paper to digital documentation and from individually to collectively mastered work process. The fingerprint examiners who participated in the seminar series jointly reflected on their existing professional rules and operational practices, improvement of which was called for to facilitate organizational learning. The analysed data set consists of 10 audio-recorded developmental seminars with written documents as well as notes and decisions that were made during the seminar. The results of the study will reveal the complex ways in which the fingerprint examiners share their practical professional knowledge and collectively create decision-making criteria and rules of investigative practices so as to adapt their work practices to the changing quality requirements, evolving international standards and digitalization of research documentation.Peer reviewe

Akalasia

Vertaisarvioitu.Akalasia on harvinainen ruokatorven sairaus, joka aiheuttaa ruokatorven alasulkijan relaksaatiohäiriön ja runko-osan motiliteettihäiriön. Nämä johtavat ruuan nielemisvaikeuteen, käänteisvirtaukseen, rintakipuihin ja joskus painon vähenemiseen. Diagnoosiin päästään tarkkuusmanometrialla. Parantavaa hoitoa ei ole, mutta oireita voidaan lievittää löystyttämällä ruokatorven alasulkijaa joko endoskooppisella pallolaajennnuksella tai leikkaamalla sulkijalihas poikki joko laparoskopiassa (Heller-Dorin leikkaus) tai endoskopiassa (peroraalinen endoskooppinen myotomia, POEM). Monisairaiden potilaiden hoidossa voidaan joskus turvautua farmakologisiin hoitokeinoihin eli suun kautta otettaviin nitraatteihin tai kalsiumin estäjiin taikka botuliinitoksiiniruiskeisiin, mutta niiden teho on rajallinen. Pieni osa potilaista päätyy ruokatorviresektioon taudin edettyä.Peer reviewe

TSC-22 up-regulates collagen 3a1 gene expression in the rat heart

Background: The transforming growth factor (TGF)-beta is one of the key mediators in cardiac remodelling occurring after myocardial infarction (MI) and in hypertensive heart disease. The TGF-beta-stimulated clone 22 (TSC-22) is a leucine zipper protein expressed in many tissues and possessing various transcription-modulating activities. However, its function in the heart remains unknown. Methods: The aim of the present study was to characterize cardiac TSC-22 expression in vivo in cardiac remodelling and in myocytes in vitro. In addition, we used TSC-22 gene transfer in order to examine the effects of TSC-22 on cardiac gene expression and function. Results: We found that TSC-22 is rapidly up-regulated by multiple hypertrophic stimuli, and in post-MI remodelling both TSC-22 mRNA and protein levels were up-regulated (4.1-fold, P <0.001 and 3.0-fold, P <0.05, respectively) already on day 1. We observed that both losartan and metoprolol treatments reduced left ventricular TSC-22 gene expression. Finally, TSC-22 overexpression by local intramyocardial adenovirus-mediated gene delivery showed that TSC-22 appears to have a role in regulating collagen type III alpha 1 gene expression in the heart. Conclusions: These results demonstrate that TSC-22 expression is induced in response to cardiac overload. Moreover, our data suggests that, by regulating collagen expression in the heart in vivo, TSC-22 could be a potential target for fibrosis-preventing therapies.Peer reviewe

Income and outcomes of patients with incident atrial fibrillation

Background Socioeconomic disparities can be associated with adverse outcomes in patients with cardiovascular diseases. The impact of personal income on the outcomes of patients with atrial fibrillation (AF) is unclear. Methods Nationwide observational registry-based study on patients with incident AF in Finland during 2007-2018. Results 203 154 patients (mean age 73.0 +/- 13.5; females 49.0%) were diagnosed with incident AF during the study period. Overall, 16 272 (8.0%) patients experienced first-ever ischaemic stroke and 63 420 (31.2%) died (mean follow-up 4.3 +/- 3.3 years). After adjusting for confounding factors, low personal income was associated with increased risk of overall mortality in all age strata and the incidence of first--ever stroke in patients aged = 75 years. The magnitude of this effect was greatest in patients aged Conclusions Personal annual income has a significant impact on the incidence of first-ever ischaemic stroke and overall mortality among patients with incident AF, particularly among patients of working age. Low-income indicate the need for intervention strategies to improve outcomes of AF.Peer reviewe

Low incidence of clinically relevant bleeding complications after fast-track arthroplasty: a register study of 8,511 arthroplasties

Background and purpose: Fast-track total joint replacement (TJR) has become increasingly common. Routine thromboprophylaxis for pulmonary embolism and deep venous thrombosis prevention lasts from 2 to 5 weeks. This retrospective registry study focused on clinically relevant bleeding complications 90 days after fast-track primary TJR.Patients and methods: All primary fast-track total hip (THA) and knee arthroplasties (TKA) performed between 2015 and 2016 were extracted from the Finnish Arthroplasty Register and Finnish Hospital Discharge Register. Type of arthroplasty and indication for the operation were combined with diagnoses of clinically relevant bleeding complications within 90 days of surgery. The incidence of these bleedings was the primary outcome measure.Results: Of the total of 8,511 patients (mean age 67 years (SD 10); 60% female), 45% underwent unilateral THA, 52% unilateral TKA, and 3% bilateral TKA. The incidence of clinically relevant bleeding complications within 90 days was 1% (95% CI 0.8–1.3). No difference wasobserved in bleeding incidence between the groups. The 87 bleedings comprised 57 operative site bleedings, 17 gastrointestinalbleedings, 6 intracranial non-traumatic bleedings, 5 bleedings from the nose or another undetermined site, and 2 intraocular bleedings. 1 death due to intracranial bleeding was recorded, and hence clinically relevant bleeding-specific 90-day mortality was 0.01%.Interpretation: The incidence of clinically relevant bleeding complications was low. However, they cause patient discomfort, increase the use of healthcare services, and can be life-threatening and even fatal.</p

Mental health conditions and bleeding events in patients with incident atrial fibrillation : A Finnish nationwide cohort study

Peer reviewe

Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation : A Nationwide Cohort Study

BACKGROUND: Mental health conditions (MHCs) are associated with poor outcomes in patients with atrial fibrillation. However, persistence of oral anticoagulation therapy in patients with atrial fibrillation and MHCs is unknown. We aimed to evaluate the effect of MHCs on the persistence of direct oral anticoagulant (DOAC) use in patients with atrial fibrillation based on a nationwide cohort. METHODS AND RESULTS: The nationwide registry-based FinACAF (Finnish Anticoagulation in Atrial Fibrillation) cohort included 67 503 patients with incident atrial fibrillation and indication for permanent oral anticoagulation (CHA(2)DS(2)-VASc score >1 in men and >2 in women) starting DOAC therapy between 2011 and 2018. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophrenia, and composite of any MHC. The main outcome was nonpersistence of DOAC use, defined as the first 120-day period without DOAC purchases after drug initiation. The mean age of the patients was 75.3 +/- 8.9 years, 53.6% were women, and the prevalence of any MHC was 17.8%. Persistence after 1 year from DOAC initiation was 79.3% in patients without MHCs and 77.2% in patients with any MHC, and after 2 years were 64.4% and 60.6%, respectively (P CONCLUSIONS: MHCs are associated with nonpersistence of DOAC use.Peer reviewe

Socioeconomic factors and bleeding events in patients with incident atrial fibrillation : A Finnish nationwide cohort study

Background: Low socioeconomic status has been associated with higher risk of ischemic stroke and death in patients with atrial fibrillation (AF). However, whether socioeconomic status affects risk of bleeding events is unknown. We assessed the hypothesis that low income and educational attainment are associated with higher risk of bleeding in patients with AF.Methods: The registry-based FinACAF study covers all patients with AF in Finland during 2007-2018. Patients were divided into income quartiles and three categories based on their educational attainment. Outcomes of interest were the first-ever gastrointestinal (GI), intracranial (IC) and any bleeding.Results: We identified 205 019 patients (50.9 % female; mean age 72.3 (SD 13.4) years) with incident AF without prior bleeding. Mean follow-up time was 4.0 (SD 3.2) years, during which 25 013 (12.2 %) patients experienced first-ever any bleeding (incidence rate 3.07 (95 % CI 3.03-3.10) /100 patient-years). Low income was inde-pendently associated with hazard of any bleeding as well as GI and IC bleeding (adjusted hazard ratios (HRs) comparing lowest vs highest income quartile: 1.13 (1.08-1.17), 1.32 (1.23-1.41) and 1.15 (1.06-1.24), respectively). Income-related bleeding disparities were larger among younger patients under 65 years and among men. Education-related bleeding disparities were smaller than income related-disparities (adjusted HRs comparing lowest vs highest educational category: any bleeding 1.06 (1.02-1.11), GI bleeding 1.16 (1.08-1.24), IC bleeding 1.10 (0.93-1.09))Conclusions: Patients with AF and low income are at higher risk of bleeding, especially GI bleeding.Peer reviewe