The brain's ability to recognize different acoustic cues (e.g., frequency changes in rapid temporal succession) is important for speech perception and thus for successful language development. Here ...we report on distinct event-related potentials (ERPs) in 5–6-year-old children recorded in a passive oddball paradigm to repeated tone pair stimuli with a frequency change in the second tone in the pair, replicating earlier findings. An occasional insertion of a third tone within the tone pair generated a more merged pattern, which has not been reported previously in 5–6-year-old children. Both types of deviations elicited pre-attentive discriminative mismatch negativity (MMN) and late discriminative negativity (LDN) responses. Temporal principal component analysis (tPCA) showed a similar topographical pattern with fronto-central negativity for MMN and LDN. We also found a previously unreported discriminative response complex (P340–N440) at the temporal electrode sites at about 140ms and 240ms after the frequency deviance, which we suggest reflects a discriminative processing of frequency change. The P340 response was positive with a clear radial distribution preceding the fronto-central frequency MMN by about 30ms.
The results indicate that 5–6-year-old children can detect frequency change and the occasional insertion of an additional tone in sound pairs as reflected by MMN and LDN, even with quite short within-stimulus intervals (150ms and 50ms). Furthermore, MMN for these changes is preceded by another response to deviancy, temporal P340, which seems to reflect a parallel but earlier discriminatory process.
•Preschool-aged children detect sound frequency and temporal changes evident in ERPs.•Previously unreported discriminative P340–N440 complex at temporal channels•P340–N440 complex has radial distribution and precedes fronto-central MMN by 30ms.•P340–N440 reacts to stimulus change.•P340–N440 is a separate component from MMN.
The improvement of energy efficiency is seen as one of the most promising measures for reducing global CO sub(2 emissions. However, the emission reduction potential may seem different from the ...industrial plant and policy-maker's perspectives. This paper evaluates the influences of process heat conservation on CHP electricity production, primary energy consumption and CO) sub(2) emissions from both the mill site and national perspectives. The results indicate that heat conservation in an industrial process may lead to varying results in primary energy consumption and CO sub(2 emissions, depending on the form of marginal heat production used at the mill site. In the CHP process, reduction of the heat load lowers electricity production, and this reduction may have to be compensated for at the national level. Therefore, the energy conservation potential in industry has to be evaluated by taking into account the connections to the outside society, which means that a wider system boundary than a mill site has to be used. This study demonstrates by theoretical analysis and case mill studies the magnitude of the effects of system boundary definition when evaluating the contribution of an individual energy efficiency investment towards fulfilling the commitment to reduce CO) sub(2) emissions at the national level.
Suominen T, Koponen N, Mockiene V, Raid U, Istomina N, Vänskä M‐L, Blek‐Vehkaluoto M, Välimäki M. International Journal of Nursing Practice 2010; 16: 138–147 Nurses' knowledge and attitudes to ...HIV/AIDS—An international comparison between Finland, Estonia and Lithuania
This paper presents baseline data on nurses' knowledge of and attitudes to HIV/AIDS in three countries: Finland, Estonia and Lithuania. The prevalence of HIV/AIDS is steadily increasing in Finland, Estonia and Lithuania. At the same time, labour mobility and also nursing mobility between these countries increases. Previous international studies have shown that lack of knowledge and negative attitudes continue to exist. A total of 681 registered nurses from one Finnish (n = 322), one Estonian (n = 191) and one Lithuanian (n = 168) hospital were surveyed in spring 2006. The questionnaire was originally developed by Held in 1993 and modified for this study. The questionnaire has three scales: demographic and other background variable, nurses' knowledge related to HIV/AIDS, and nurses' attitudes towards people with HIV/AIDS and towards the disease itself. Across the whole sample respondents showed average levels of HIV/AIDS knowledge and attitudes towards people with HIV/AIDS. Years of work experience correlated negatively with the knowledge and attitude levels. A significant correlation was found between the level of knowledge and attitudes. Significant differences were found between countries, Finnish nurses showing the highest knowledge levels and most positive attitudes towards patients with HIV/AIDS. Factors positively influencing levels of knowledge and attitudes were education, previous experience of providing care to HIV/AIDS patient or knowing someone with the infection, and willingness to provide care to HIV/AIDS patients. Supplementary education is needed to strengthen nurses' knowledge. It is important to recognize that there might be differences in knowledge and attitudes between neighbour countries. This needs to be taken into account when planning education for degrees and for further nursing education.
The inhibitor of apoptosis protein BIRC-5/survivin plays roles in both apoptosis and the regulation of chromosome-segregation/cytokinesis during mitosis. As the population dynamics of male germ cells ...are regulated by both proliferation (mitosis and meiosis) and apoptotic culling, we hypothesized that BIRC-5/survivin could be central to the regulation of spermatogenesis.
We have analyzed BIRC-5/survivin expression throughout the seminiferous epithelial cycle of the rat. BIRC-5/survivin RNA and protein exhibit rhythms of expression throughout the seminiferous epithelial cycle. The highest levels of expression were found, by immunohistochemistry and in situ hybridization, to occur during the long first meiotic prophase of spermatocytes. Cytoplasmic abundance declined at metaphase and reappeared at anaphase. Some BIRC-5/survivin expression was also found to occur in interstitial Leydig cells.
BIRC-5/survivin protein levels were up-regulated in vitro by the paracrine, Stem-Cell Factor, that is known to regulate both proliferation and apoptosis of germ cells and Leydig cells.
The improvement of energy efficiency is seen as one of the most promising measures for reducing global CO
2 emissions. However, the emission reduction potential may seem different from the industrial ...plant and policy-maker’s perspectives. This paper evaluates the influences of process heat conservation on CHP electricity production, primary energy consumption and CO
2 emissions from both the mill site and national perspectives. The results indicate that heat conservation in an industrial process may lead to varying results in primary energy consumption and CO
2 emissions, depending on the form of marginal heat production used at the mill site. In the CHP process, reduction of the heat load lowers electricity production, and this reduction may have to be compensated for at the national level. Therefore, the energy conservation potential in industry has to be evaluated by taking into account the connections to the outside society, which means that a wider system boundary than a mill site has to be used. This study demonstrates by theoretical analysis and case mill studies the magnitude of the effects of system boundary definition when evaluating the contribution of an individual energy efficiency investment towards fulfilling the commitment to reduce CO
2 emissions at the national level.
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Introduction
Autologous stem cell transplantation (ASCT) is the standard treatment in multiple myeloma (MM) for eligible patients below 70 years of age. The main mobilization treatment in Europe ...consists of combination of cyclophosphamide (CY) and G-CSF. It is questionable if CY is useful in mobilization. CY as an alkylating agent might also have some negative long-term effects. Bortezomib seems not to have negative impact on autologous stem cell harvesting, but prolonged use of lenalidomide might hamper mobilization. There are only a few studies regarding autologous stem cell mobilization after RVD induction. We designed this randomized study as a substudy of the Finnish Myeloma Group Study (NCT01790737) to compare the results of CY+G-CSF versus G-CSF mobilization in autologous stem cell harvesting. The primary endpoint is the percentage of patients reaching ≥ 3 x 106/kg CD34+ cells (or ≥ 6 x 106/kg for two transplants), with ≤ 2 apheresis after low-dose CY+G-CSF vs. G-CSF mobilization. Secondary endpoints are need for plerixafor, graft cellular composition and engraftment after ASCT.
Patients and methods
This phase 2 study will include 80 patients below 70 years of age with symptomatic MM and eligible for ASCT. At registration the patients are randomized equally to arm A) CY 2 g/m2 + G-CSF 5 μg/kg or arm B) G-CSF 10 μg/kg. Before mobilization three RVD induction cycles are given. Each 3-week RVD cycle includes lenalidomide 25 mg daily on days 1−14, bortezomib 1.3 mg/m2 subcutaneously on days 1, 4, 8, 11, and dexamethasone 160 mg/cycle. By this schedule the first harvest is estimated to be on day +10 in CY + G-CSF and on day +5 in G-CSF group. Apheresis will start with blood CD34+ level >10 x 106/l. The target cell yields for one and two grafts are ≥ 3 and ≥ 6 x 106 CD34+ cells/kg, respectively, and the minimum for one graft ≥ 2 x 106/kg. Plerixafor is given if B-CD34+ cell count is less than 10 x 106/l on days +10 or +5, respectively, or if the first apheresis product contains < 1 x 106/kg CD34+ cells. G-CSF support is used after ASCT if the number of CD34+ cells in the graft is less than 3 x 106/kg. Engraftment will be assessed by blood neutrophil count > 0.5 x 109/l, and unsupported platelets > 20 x 109/l.
Results
Fifty-six patients have been included, and the mobilization data for the first 37 patients are available for analysis. The primary endpoint was reached in 90% of the patients (18/20) in arm A and in 82% (14/17) in arm B (p=NS). The median number of apheresis to reach the goal in arms A and B is one (1-3) and two (1−3), respectively (p=0.03). The median number of harvested cells in the two arms is 6.2 (2.2−12.1) and 4.8 (2.9−7.6) x 106/kg, respectively (p<0.01). All patients achieved the minimum collection target of ≥ 2 x 106/kg CD34+ cells in both arms, and the target yield of ≥ 3 x 106/kg was reached in 95% (19/20) in arm A and in 94% (16/17) in arm B. Plerixafor was used in two (12%) patients in arm B. The median blood CD34+ cell count on the first apheresis day was 55.9 (13.0−118.6) and 35 (16.0−148.5) x 106/l for arms A and B, respectively (p=0.44). The median time from mobilization day 1 to the first apheresis day was 10 (10−13) days in arm A and 5 (5−6) in arm B.
The median number of CD34+ cells transplanted, was 4.1 (2.2−7.3) and 3.2 (2.3−4.7) x 106/kg in arms A and B, respectively (p=0.01). In arm A the median neutrophil engraftment was on day +14 (9−28) (16 patients) and in arm B on day +15 (11−25) (15 patients) (p=0.68). The median platelet engraftment days were +13 (8−22) and +11 (8−21) in arms A and B, respectively (p=0.67). At ASCT the response rates in arm A were ≥ VGPR 65% (13/20), PR 25% (5/20), and 10% (2/20) were progressing, and the respective rates for arm B were 70% (12/17), 18% (3/17),and 12 % (2/17).
Conclusions
Preliminary results of this randomized mobilization substudy with a limited number of patients show no clinically significant differences between the number of harvested CD34+ autologous stem cells. However, in CY+G-CSF group the CD34+ cell target was reached by less aphereses. After short induction course of RVD it seems possible to harvest also for two autografts with G-CSF only mobilization. However, when compared to historical data the CD34+ cell counts in blood and grafts were lower than after bortezomib + dexamethasone induction, and also neutrophil engraftment seemed to be slower after lenalidomide-based induction therapy. We conclude that CY can be omitted in the mobilization regimen for MM patients who have responded to short course of RVD.
Silvennoinen:Janssen-Cilag: Research Funding; Celgene: Research Funding; Janssen-Cilag: Honoraria; Sanofi: Honoraria; Celgene: Honoraria. Porkka:BMS: Honoraria; BMS: Research Funding; Novartis: Honoraria; Novartis: Research Funding; Pfizer: Research Funding.
The purpose of this study was to describe the opportunities to participate and participation in HIV testing among men who have sex with men (MSM). The data (N = 2,072) reported was collected in 2010 ...in Finland. The respondents' age, size of the place of residence, province and employment status were statistically significantly related to perceived opportunities for HIV testing. Additionally, the size of the respondent's place of residence and province were connected to the expressed satisfaction with testing of HIV-positive MSM. We conclude that more attention should be paid to counseling in the testing situation and in how to ensure equal opportunities for testing throughout the country for MSM.
This article presents results on nursing and midwife students’ willingness to care for patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). An international ...cross-sectional survey design was used and the data were collected from educational institutions in Finland (
N
=
169), Estonia (
N
=
132) and Lithuania (
N
=
170) between autumn 2005 and spring 2006. Participants (
N
=
471) were nursing and midwife students training to be RN, public health nurses or midwives. A modified version of a scale developed by Duppert et al. (1994) was applied to measure willingness to care for patients with HIV/AIDS. The study found a general willingness on the part of students to provide care for patients with HIV/AIDS. However, nursing and midwife students willingness varied between countries and was also related to specific nursing interventions. Factors associated with students willingness also varied within each country, depending on nurses’ age, nursing experience (Finland), positive attitudes to treating patients with HIV/AIDS in general (Finland, Estonia), and previous experience in taking care of a patient with HIV/AIDS (Lithuania). It is important to develop strategies for nursing vulnerable patient populations and international nursing curricula to identify prejudicial thinking and intolerance towards patients with HIV/AIDS.
Swallowing and intraoral sensation outcome were investigated prospectively after microvascular free-flap reconstruction. Forty-one patients with a large oral or oropharyngeal carcinoma underwent ...free-flap surgery usually combined with radiotherapy. The patients completed modified barium swallow, self-rating of swallowing, and 2-point moving discrimination preoperatively and at four time points during the 12-month follow-up period, and a plain chest X-ray one year after operation. Swallowing was impaired with respect to an objective and subjective measure after therapy. Rates for nonsilent and silent aspiration increased during the follow-up. Intraoral sensation deteriorated. Swallowing outcome was not related to sensation. One year after surgery, 86% of the patients ate regular masticated or soft food. Microvascular transfers offer a reasonable option for oral reconstruction. This study does not support the need for sensate flaps. Swallowing problems should be routinely sought and patients rehabilitated during a sufficiently long follow-up with videofluorography regardless of the patient’s perception of swallowing.
