Diagnostic and prognostic value of free PAPP-A in coronary artery disease – clinical studies with novel immunoassay

Complications of coronary artery disease are the number one cause of death worldwide, so identification of high-risk individuals is crucial. Pregnancy-associated plasma protein A (PAPP-A) is a candidate cardiac-risk related biomarker, which has been linked to poorer outcome in various cardiovascular patients. Especially, the free form of PAPP-A (fPAPP-A) is linked to cardiovascular events, but thus far no direct assay detecting fPAPP-A has been published. Most available assays measure total PAPP-A and are widely used in prenatal screening where high concentration changes occur. Thus, cardiac-related slight fPAPP-A changes might be undetectable with total PAPP-A assays. Also, PAPP-A is released to circulation after heparin treatment, which is a common anticoagulant used in dissolving thrombus. This might question the ability of PAPP-A to be used as a marker for haparinized patients. I n this thesis, first direct immunoassay targeting fPAPP-A was created and its analytical and clinical performance as cardiac-risk related biomarker was evaluated. The analytical performance of the fPAPP-A assay was evaluated against current guidelines. The risk of death or myocardial infarction in patients admitted to hospital due to chest pain was studied and compared to tPAPP-A and indirect fPAPP-A assays. The developed assay was also used in predicting obstructive CAD in suspected chronic CAD patients. The disease extent and severity was determined with hybrid computed tomography and positron emission tomography myocardial perfusion imaging. Correlation of heparin-induced release of fPAPP-A and atherosclerotic burden was studied in suspected chronic CAD patients. The developed assay sensitively measured fPAPP-A. The risk of death or myocardial infarction correlated with increasing circulating fPAPP-A concentration. Also, fPAPP-A in combination with contemporary cTnI further improved the riskpredictive capability. Accordingly, the fPAPP-A level was elevated in chronic CAD patients who were diagnosed with obstructive CAD. As a biomarker, fPAPP-A outperformed traditional risk factors and other evaluated biomarkers in predicting obstructive CAD. Heparin-induced release of fPAPP-A to circulation was not associated with clinical coronary atherosclerotic characteristristics observed with coronary computed tomography angiography.Suoralla menetelmällä mitattu vapaa PAPP-A diagnostisena ja ennustavana merkkiaineena sepelvaltimotaudissa Sepelvaltimotautiin liittyvät komplikaatiot ovat yleisin kuolinsyy maailmassa, jonka vuoksi korkean riskin potilaiden tunnistaminen ajoissa on tärkeää. Raskauteen liittyvä plasmaproteiini A (PAPP-A) on lupaava merkkiaine, joka on yhdistetty erilaisilla sydänpotilailla heikompaan selviytymiseen ilman sydäntapahtumia. Erityisesti PAPP-A:n vapaa muoto (fPAPP-A) on liitetty sydäntapahtumiin, mutta suoraa määritysmenetelmää fPAPP-A:lle ei ole vielä kehitetty. Useimmat määritykset mittaavat kaikkia PAPP-A:n muotoja ja niitä käytetään raskaudenaikaiseen seulontaan, jolloin pitoisuusmuutokset ovat suuria. Tällaisella määrityksellä mitattuna sydäntapahtumien yhteydessä tapahtuvat pienet fPAPP-A -muutokset saattavat jäädä huomioimatta. PAPP-A:ta vapautuu verenkiertoon myös verihyytymien liuottamiseen käytetyn hepariinilääkityksen vuoksi. Tämä saattaa kyseenalaistaa PAPP-A:n käytön merkkiaineena hepariinilääkityillä potilailla. Väitöskirjatyössä kehitettiin ensimmäinen suora fPAPP-A:ta mittaava immunomääritys. Määrityksen analyyttista toimivuutta evaluoitiin kliinisen kemian ohjeistusten mukaisesti. FPAPP-A:n käyttöä sydänkohtaukseen tai kuolemaan liitettynä merkkiaineena tutkittiin rintakivun vuoksi sairaalaan saapuneilta potilailta ja tuloksia verrattiin epäsuoralla menetelmällä mitattuun fPAPP-A:han sekä kaikkia PAPP-A:n muotoja mittaavaan määritykseen. Lisäksi, fPAPP-A:n yhteyttä ahtauttavaan sepelvaltimotautiin tarkasteltiin epäillyillä vakaaoireisilla sepelvaltimotautipotilailla. Sepelvaltimotaudin vakavuuden ja laajuuden määrittäimiseen käytettiin hybridikuvantamista, jossa hyödynnetään tietokonetomografiaa ja isotooppitutkimusta. Samoilla potilailla tutkittiin myös hepariinin vapauttaman fPAPPA:n yhteyttä sepelvaltimotaudin vaikeusasteeseen. Kehitetty määritys oli herkkä mittaamaan fPAPP-A:ta. Kohonnut fPAPP-A oli yhteydessä suurentuneeseen sydänkohtauksen tai kuoleman riskiin. Yhdistettynä sydänperäisen troponiini I:n kanssa, kyky ennustaa riskä parani entisestään. Lisäksi, ahtauttavaa sepelvaltimotautia sairastavilla potilailla oli kohonnut fPAPP-A - pitoisuus ja fPAPP-A toimi paremmin kuin perinteiset riskitekijät tai muut mitatut merkkiaineet. Hepariinin vuoksi verenkiertoon vapautunut fPAPP-A ei ollut yhteydessä selvaltimotaudin vakavuuteen tai laajuuteen

Constructivism: An Approach in Training Nursing Students in the Clinical Setting.

Abstract            Nurses are important in the society because of their soft and caring hands.  Because of the changing needs and increase in demand of care, today’s generation nurses are expected to be critically thinking of their own to be effective without depending too much from the other health care team.  Educators in the clinical setting have to utilize new teaching innovations that would create proficient nurses.  This paper aims to display that constructivist approach will enable nursing students to deal with complex situations in the hospital through analysis, application, evaluation, and creation; increase motivation and autonomy in nursing care with critical decision making; confirms active construction of knowledge among nursing students using language based on past experiences; enhance communication among students that provide real world examples and will provide them with experience-based learning opportunities to practice.            Student nurses are active learners in the clinical area because of their philosophy that their client’s health and well-being depends on their hands.  This paper concludes that constructivist approach will create globally competent nursing students and enable them to deal with complex situations in the hospital through analysis, application, evaluation and creation with motivation and autonomy.  It is the duty of the educators to enhance that skill by letting them actively construct knowledge using language based on past experiences, then context-rich.  This kind of learning strategy will provide learners with experience-based learning opportunities to practice skilled with appropriate decision making process.  Let us not waste what students know, instead, we save, preserve and add.  Educators need to let these students feel that as early as internship, they are capable and competent in providing quality care.  Therefore, guidance is needed and not directives

Discipline-Making and Organizational Permeability of the University : Discussing the Notion of Organizational Field

Peer reviewe

Advancing Understanding about the Relationship between Science, University and Society - An Introduction : [Guest Editorial]

Peer reviewe

CROWDSOURCING AS A MOBILE SERVICE - CASE STUDY: PUBLISHING PHOTOGRAPHY

Crowdsourcing- a method for companies to utilize the power of the crowd through internet-based platforms- is a relatively new phenomenon. When offered as a mobile service, crowdsourcing transcends the spatial, temporal and contextual barriers of traditional job requirements, offering an ubiquitous service and access, and providing a suite of both utilitarian and hedonic functions. IS literature indicates that users? extrinsic motivation is a stronger determinant to use utilitarian systems, while intrinsic motivation is a stronger determinant for hedonic systems. However, when the crowdsourced service, such as photography, is both hedonic and utilitarian by nature, users? perceptions of the service are unclear. Earlier research reports mixed results: while some studies suggest that tangible rewards can have an impact on the intrinsic motivation, other studies suggest the opposite. Hence, our study focuses on how the users perceive mobile crowdsourcing services, what motivates them to participate, and how the financial reward affects their intention to participate. In this paper, we outline an ongoing study of a company in Finnish publishing industry crowdsourcing photography. After interviews with the company executives, we will next conduct a series of interviews with the users, and finally, conduct a quasi-experiment to test the developed theoretical model

Advancing Understanding about the Relationship between Science, University and Society - An Introduction : [Guest Editorial]

Peer reviewe

Reinforcing Family Values with Web Design - Case Yle “P2” Children’s Website

This paper describes the findings of a redesign project of a children’s website, where social considerations have been providing the guidelines for design. The case company, Yle, is the national public service broadcasting company of Finland. The website redesigned is a cross-platform programming extension of Yle’s Pikkukakkonen (“The Little Channel Two”, P2), a TV show with media content that targets primarily pre-school age children. Our study utilizes action design research (ADR) as the research method, touchscreen game applications as the facilitating technology and theories on social values as theoretical lenses to formulate design principles. These design principles are used for redesigning the P2 website to enhance its contribution to the public service of Yle. Following the principles of ADR, our study demonstrates how the results can be used both for the benefit of the case company and to a class of similar problems. This study contributes to the knowledge on theories on social values and web design of public services, when also social considerations need to be taken into account

eBusiness in Apparel Retailing Industry - Critical Issues

The apparel industry has, like most other industries quickly started using the Internet to gain improvements in the efficiency and effectiveness of operations and marketing. In this report we briefly overview the developments of electronic commerce in apparel industry. We try to develop a framework for choosing the right technology and development options based on the business model and business orientation chosen. We illustrate the framework by four case companies, which have adapted different basic strategies and business models. The cases include companies with traditional operations with also physical retail outlets, as well as companies operating only on the Internet. There are still a number of unresolved problems related both to consumer-oriented e-commerce in general and to apparel industry in particular. Nevertheless, consumers are increasingly using the Internet to do extensive amount of research on products and fashion trends before purchasing through any media, also making more and more online purchase

Research Challenges in Electronic Commerce

In this paper we look at different research topics that will be interesting and important challenges in the area ofelectronic commerce (EC). These topics include benefits ofECfor different stakeholders, changing consumer behaviour, changing basis for services, restructuring of service processes and changing logic ofbusiness and industries in the global market space. We identify relevant topics for further investigation in all these topics. We believe that the Scandinavian environment together with the tradition ofhigh quality in-depth research, offers the Nordic countries a great opportunity to be in the frontline in developing services and business structures for the new order of economy and society coming together with the rapid diffusion ofelectronic commerce