Pancreatic Resection for Carcinoma of the Pancreas and the Periampullary Region. A Twenty-Year Experience

410 patients were treated for pancreatic and periampullary carcinoma in 1968–1987 of whom 89 (21.5%) underwent resection. Hospital mortality decreased from 33% in 1968–1972 to 0% in 1983–1987, but the morbidity rate remained unchanged. The trends were similar in patients ≥ 70 and < 70 years of age. The pylorus-saving technique did not increase mortality, morbidity, operative blood loss or the incidence of delayed gastric emptying, but it did reduce the operative time by one hour (p< 0.01). The real 5 year survival for periampullary cancer was 52%, but none of the patients with pancreatic carcinoma survived for 5 years

Integrative Approaches to the Undergraduate Public Health Major Curriculum: Strengths, Challenges, and Examples

Many “first generation” undergraduate public health degree programs were designed based on “siloed” course structures centered around subunits in the discipline (e.g., Introduction to Epidemiology, Introduction to Environmental Health) that may be meaningful primarily to experts in the field. An alternative to the siloed approach is an integrative curricular design, in which courses are designed around meaningful thematic units (e.g., explaining public health problems, asking and answering scientific questions in public health), with an emphasis on drawing connections between knowledge from different but complementary disciplinary areas as a means to improve student learning and retention. The integrative approach shifts the curriculum conversation to capitalize on the interdisciplinary roots of the public health profession. This approach is consistent with the learning outcome recommendations in the Framing the Future Task Force report and in the CEPH requirements for the undergraduate public health major. We explore integrative approaches to developing curricular models for undergraduate public health programs and discuss both pedagogical and career preparation arguments supporting an integrative curriculum approach. These include facilitating the often-challenging task for students of seeing how concepts interrelate, making transparent how “basic” knowledge in the discipline relates to “real world” applications of the content, and better mirroring how professionals in the discipline actually use knowledge in practice. Finally, we review examples of core concepts and features in an integrative curriculum approach to the undergraduate public health major as an effective educational program with high-quality, learner-centered educational experiences

Infektiotautien etiologia akuutisti sairailla lapsilla

Tiivistelmä. Tutkimus käsittelee infektiotautien etiologiaa ja taudinaiheuttajia lasten päivystykseen tulleilla lapsilla yhden vuoden ajanjaksolla Oulun yliopistollisessa sairaalassa. Kohorttitutkimukseen kuului 4647 lasta, joista 2559 (55%) todettiin kliinisesti infektio. Infektiopotilaista 1582 (62%) saatiin tarkka taudinaiheuttaja selville. Näiden joukosta rinovirus nousi yleisimmäksi etiologiseksi tekijäksi sekä lasten päivystyksessä että lasten teho-osastolla. Väestökohtainen ilmaantuvuus rinovirukseen liittyvillä päivystyskäynneillä alle 5-vuotiailla lapsilla oli 1796/100000/vuosi. Yleisin bakteeritaudinaiheuttaja oli Escherichia coli

Katsaus säätösähköteknologioihin

Tiivistelmä. Tulevaisuus asettaa monia haasteita sähköjärjestelmän toiminnalle niin Suomessa kuin muuallakin maailmassa. Yhteiskunnan kasvava sähkönkulutus lisää kuormitusta sähköntuotannolle, ja uusia tuotantolaitoksia tarvitaan koko ajan lisää. Tuotettavan sähkön tulisi kuitenkin olla mahdollisimman ympäristöystävällistä ja puhdasta, mikä lisää sähköjärjestelmän haasteita entisestään, sillä uusiutuvien energianlähteiden avulla tuotettava sähkö on altis säätilan muutoksille. Näin ollen sähkön tuotanto ei ole tasaista, ja tuotettavan sähkön määrää on vaikeampaa arvioida perinteisiin sähkön tuotantomuotoihin verrattuna. Sähköjärjestelmän toiminnan kannalta on kuitenkin hyvin tärkeää, että sähkön kysyntä ja tarjonta vastaisivat toisiaan mahdollisimman tarkasti. Ideaalitilanteessa sähköä tuotetaan täsmälleen saman verran kuin sitä kulutetaan, mutta todellisuudessa tällainen tilanne ei toteudu. Säätösähkön avulla pyritään reagoimaan sähkön tuotannon ja kulutuksen vaihteluihin ja ylläpitämään näiden välistä tasapainoa. Suomen sähköjärjestelmä käyttää erilaisia säätösähköteknologioita, joita käytetään sen mukaan, kuinka suuri tarve säädölle on. Työssä tarkastellaan Suomessa käytössä olevia säätösähköteknologioita. Suomen sähköverkko toimii osana yhteispohjoismaista synkronijärjestelmää, joka puolestaan liittyy muihin Euroopan alueella toimiviin vastaaviin järjestelmiin. Työssä tarkastellaan myös pohjoismaiden sähköntuotantoa ja tilannetta Euroopassa suurempana kokonaisuutena. Älykkäät energiajärjestelmät tulevat olemaan yhä suuremmassa roolissa yhteiskunnan eri teknisisissä infrastruktuureissa, joten työssä pohditaan myös tulevaisuuden älykkäiden sähkö- ja energiajärjestelmien vaikutusta säätösähköä silmällä pitäen. Sähköntuotannossa Suomessa ollaan menossa kohti puhtaampaa ja päästöttömämpää tulevaisuutta. Esimerkiksi tuulivoimaan tullaan investoimaan paljon, ja ydinvoimankin kapasiteetti kasvaa lähitulevaisuudessa. Ympäristön kannalta tämä on erinomainen asia, mutta varsinkin tuulivoiman lisääminen kasvattaa säätösähkön tarvetta. Vesivoima tulee olemaan jatkossakin käytetyin kotimainen säätösähköteknologia sen nopean säätökyvyn ansiosta. Suomessa on kuitenkin käytetty jo suurin osa vesivoimapotentiaalista, ja uusia, varsinkaan suuria voimalaitoksia tuskin tullaan rakentamaan, sillä vesivoimalaitoksen ympäristövaikutukset ovat mittavat. Niinpä vesivoiman lisäämiseksi olemassa olevia voimalaitoksia täytyy päivittää uudenpien ja tehokkaampien teknologioiden pariin. Myös pumppuvoimalaitokset voivat tulevaisuudessa tarjota ympäristöystävällistä ja puhdasta energiaa sähköjärjestelmän säätötarpeisiin. Vesivoiman lisäksi tarvitaan myös muita toimia, jotta sähköjärjestelmän säätökyky säilyy riittävänä. Älykkäät sähkö-ja energiajärjestelmät yhdessä kysyntäjouston kanssa tulevat mahdollistamaan sähköjärjestelmän tehokkaamman ja joustavamman käytön. Kun sähköjärjestelmän kysyntäpiikkejä voidaan siirtää tai pienentää, vähenee säätösähkön tarve. Myös pohjoismaiden välisten sähköyhteyksien merkitys korostuu, sillä Suomen lisäksi muita pohjoismaita ja Eurooppaa ajaa samat ilmastotavoitteet. Pohjoismaissa sähköntuotannon rakenne on maiden välillä hyvinkin erilainen, joten on tärkeää, että tarpeen vaatiessa säätömahdollisuuksia on saatavilla kotimaisten ratkaisujen lisäksi.Overview of balancing energy technologies. Abstract. The future poses many challenges to the operation of the power system in Finland, world-wide. Society’s growing power demand increases pressure on electricity production, and new production facilities are needed. However, the electricity produced should be as environmentally friendly and clean as possible, which increases the challenges of the power system even more, because the electricity produced with the aid of renewable energy sources is weather dependent. Consequently, electricity production is not uniform, and it is more difficult to estimate the amount of electricity produced compared to traditional forms of electricity production. In terms of the operation of the power system, it is very important that the demand and supply of electricity is matched as closely as possible. In an ideal situation, exactly the same amount of electricity should be produced, as it is consumed. In reality, such situation rarely happens due to the fluctuating nature of both consumption and variable energy generation. With the help of balancing power, the aim is to react to these fluctuations in electricity production and consumption and to maintain the balance between them. The Finnish power system uses different balancing power technologies, which are used depending on how great the need for control is and how short the reaction time must be. The thesis examines the balancing power technologies used in Finland. Finland’s electricity network operates as part of the Nordic synchronous system, which in turn is connected to other similar systems operating in Europe. The work also examines electricity production in the Nordic countries and the situation in Europe as a larger entity. Smart energy systems will play an increasingly important role in society’s various technical infrastructures, therefore the work also considers the impact of smart energy technologies of the future with regard to balancing power. Electricity production in Finland is heading towards a cleaner and emission-free future. For example, there will be a lot of investment in wind power, and the capacity of nuclear power will also increase in the near future. From an environmental point of view, this is excellent, however, especially higher share of wind power increases the need for balancing power. Hydropower will continue to be the most used domestic balancing power technology thanks to its fast control capability. However, most of the hydropower potential has already been used in Finland, and new, especially large, power plants will hardly be built, because the environmental impacts of a hydropower plant are considerable. Therefore, in order to increase hydropower, existing power plants must be updated with newer and more efficient technologies. In the future, pumped-storage-hydro-power plants can also offer environmentally friendly and clean energy for balancing the power system. In addition to hydropower, other measures are also needed to maintain sufficient controllability of the power system. Smart energy systems together with demand response will enable more efficient and flexible power use. During peak power, electricity consumption can be shifted or reduced, which will reduce the need for balancing power. The importance of electricity connections between the Nordic countries is also emphasized, because other Europeancountries are also driven by the same climate goals. In the Nordic countries, the composition of electricity production is varies between countries, so it is important that cross-border balancing possibilities are available in addition to domestic solutions

Effects of bright light treatment on psychomotor speed in athletes

Purpose: A recent study suggests that transcranial brain targeted light treatment via ear canals may have physiological effects on brain function studied by functional magnetic resonance imaging (fMRI) techniques in humans. We tested the hypothesis that bright light treatment could improve psychomotor speed in professional ice hockey players. Methods: Psychomotor speed tests with audio and visual warning signals were administered to a Finnish National Ice Hockey League team before and after 24 days of transcranial bright light or sham treatment. The treatments were given during seasonal darkness in the Oulu region (latitude 65 degrees north) when the strain on the players was also very high (10 matches during 24 days). A daily 12-min dose of bright light or sham (n = 11 for both) treatment was given every morning between 8–12 am at home with a transcranial bright light device. Mean reaction time and motor time were analyzed separately for both psychomotor tests. Analysis of variance for repeated measures adjusted for age was performed. Results: Time x group interaction for motor time with a visual warning signal was p = 0.024 after adjustment for age. In Bonferroni post-hoc analysis, motor time with a visual warning signal decreased in the bright light treatment group from 127 ± 43 to 94 ± 26 ms (p = 0.024) but did not change significantly in the sham group 121 ± 23 vs. 110 ± 32 ms (p = 0.308). Reaction time with a visual signal did not change in either group. Reaction or motor time with an audio warning signal did not change in either the treatment or sham group. Conclusion: Psychomotor speed, particularly motor time with a visual warning signal, improves after transcranial bright light treatment in professional ice-hockey players during the competition season in the dark time of the year

Effects of cognac on coronary flow reserve and plasma antioxidant status in healthy young men

<p>Abstract</p> <p>Background</p> <p>The cardioprotective effects of certain alcoholic beverages are partly related to their polyphenol content, which may improve the vasodilatory reactivity of arteries. Effect of cognac on coronary circulation, however, remains unknown. The purpose of this randomized controlled cross-over study was to determine whether moderate doses of cognac improve coronary reactivity as assessed with cold pressor testing (CPT) and coronary flow reserve (CFR) measument.</p> <p>Methods</p> <p>Study group consisted of 23 subjects. Coronary flow velocity and epicardial diameter was assessed using transthoracic echocardiography at rest, during CPT and adenosine infusion-derived CFR measurements before drinking, after a moderate (1.2 ± 0.1 dl) and an escalating high dose (total amount 2.4 ± 0.3 dl) of cognac. To explore the bioavailability of antioxidants, the antioxidant contents of cognac was measured and the absorption from the digestive tract was verified by plasma antioxidant capacity determination.</p> <p>Results</p> <p>Serum alcohol levels increased to 1.2 ± 0.2‰ and plasma antioxidant capacity from 301 ± 43.9 μmol/l to 320 ± 25.0 μmol/l by 7.6 ± 11.8%, (p = 0.01) after high doses of cognac. There was no significant change in flow velocity during CPT after cognac ingestion compared to control day. CFR was 4.4 ± 0.8, 4.1 ± 0.9 (p = NS), and 4.5 ± 1.2 (p = NS) before drinking and after moderate and high doses on cognac day, and 4.5 ± 1.4, and 4.0 ± 1.2 (p = NS) on control day.</p> <p>Conclusion</p> <p>Cognac increased plasma antioxidant capacity, but it had no effect on coronary circulation in healthy young men.</p> <p>Trial Registration</p> <p>NCT00330213</p

The Influence of Affect on HPV Vaccine Decision Making in an HPV Vaccine Naïve College Student Population

The HPV vaccine is recommended for all adolescents starting at age 11, but coverage is low, especially in the young adult population. The CDC is prioritizing catch-up vaccination and has expanded recommendations for all young adults to age 26. College students may be ideal targets for HPV vaccine interventions as they typically have on-site clinics that offer prevention services and students are in the position to make decisions about their own healthcare. We examined the risk perceptions of 101 HPV vaccine-naïve college students, both in terms of risk cognition (beliefs about susceptibility to HPV-related cancers and genital warts) and affect (worry and fear regarding HPV-related health outcomes) as they relate to HPV vaccine intentions. Participants completed an online survey, reporting absolute and comparative risk perceptions for HPV-related cancers/genital warts, fear and worry related to getting HPV-related cancer and/or genital warts, desire for positive emotions, affective associations with the HPV vaccine, and intentions to get the HPV vaccine. More fear/worry about vaccination was directly associated with increased vaccine intentions. The perceived risk to intentions relation included an indirect effect via fear/worry. Desire for positive affect strengthened this relation. Positive affective associations with the HPV vaccine were also related to increased vaccine intentions. Given the public health impact of increasing HPV vaccine coverage for young adults, educational strategies framing the HPV vaccine positively while decreasing fear/worry related to negative health outcomes might increase interest in on-campus catch-up vaccination

Cell cycle regulators p27 and pRb in lymphomas – correlation with histology and proliferative activity

The cell cycle is a complex event in which multiple regulator-proteins participate. The G 1/S checkpoint of the cell cycle is controlled by pRb protein, which functions in its hypophosphorylated form as a negative regulator of growth. p27 (Kip1), a member of CIP/KIP family of cyclin inhibitory proteins, participates in inhibition of forming complexes that allow pRb to phosphorylate and lead the cell into mitosis. The expression of these important cell cycle regulator proteins was studied in a total of 96 non-Hodgkin’s lymphoma (NHL) samples, which were classified according to the REAL classification. The expression of p27, pRb and the cell proliferation marker Ki-67 (MIB-1) was evaluated in lymphomas using immunohistochemistry. This study showed that there were coordinate changes in the expression of p27 and pRb in NHL. When compared to low-grade lymphomas, high-grade lymphomas showed significantly reduced expression of p27 and inversely pRb expression was increased (P < 0.001). Increase in expression of Ki-67 was parallel with pRb expression, and was mainly seen in cells that lacked p27 expression (P < 0.0001). This study suggests that changes in the control of the cell cycle closely relate to the pathobiology of NHL. © 2000 Cancer Research Campaig