Intelligent digital tools for screening of brain connectivity and dementia risk estimation in people affected by mild cognitive impairment: the AI-Mind clinical study protocol

More than 10 million Europeans show signs of mild cognitive impairment (MCI), a transitional stage between normal brain aging and dementia stage memory disorder. The path MCI takes can be divergent; while some maintain stability or even revert to cognitive norms, alarmingly, up to half of the cases progress to dementia within 5 years. Current diagnostic practice lacks the necessary screening tools to identify those at risk of progression. The European patient experience often involves a long journey from the initial signs of MCI to the eventual diagnosis of dementia. The trajectory is far from ideal. Here, we introduce the AI-Mind project, a pioneering initiative with an innovative approach to early risk assessment through the implementation of advanced artificial intelligence (AI) on multimodal data. The cutting-edge AI-based tools developed in the project aim not only to accelerate the diagnostic process but also to deliver highly accurate predictions regarding an individual's risk of developing dementia when prevention and intervention may still be possible. AI-Mind is a European Research and Innovation Action (RIA H2020-SC1-BHC-06-2020, No. 964220) financed between 2021 and 2026. First, the AI-Mind Connector identifies dysfunctional brain networks based on high-density magneto- and electroencephalography (M/EEG) recordings. Second, the AI-Mind Predictor predicts dementia risk using data from the Connector, enriched with computerized cognitive tests, genetic and protein biomarkers, as well as sociodemographic and clinical variables. AI-Mind is integrated within a network of major European initiatives, including The Virtual Brain, The Virtual Epileptic Patient, and EBRAINS AISBL service for sensitive data, HealthDataCloud, where big patient data are generated for advancing digital and virtual twin technology development. AI-Mind's innovation lies not only in its early prediction of dementia risk, but it also enables a virtual laboratory scenario for hypothesis-driven personalized intervention research. This article introduces the background of the AI-Mind project and its clinical study protocol, setting the stage for future scientific contributions.

Sediment profile dating and reconstructing nuclear events from annually laminated lake sediments in northern Finland

The sediments deposited in Lake Kevojärvi (69°45N, 27°00'E) in northernmost Finland were investigated for radioactivity. Freeze cores recovered from the 35-m deep basin has preserved a distinct succession of annual laminations deposited between 1909 and 2015. The basic varve structure is composed of a detrital snowmelt layer and an organic-rich post-snowmelt layer lying on top of the snowmelt layer. The past nuclear events have been preserved in the lake sediment. In order to study these, sediment freeze with annual sediment laminations were recovered from the lake bottom and measured for gamma emitting radionuclides. A total of 53 sediment subsamples, each incorporating sediment from one to two varves i.e. sediment deposited during one to two years, were taken for gamma spectroscopy measurements using low-background HPGe detector system. The measurements showed large variations in ¹³⁷Cs and ²⁴¹Am concentrations between different laminae marking different nuclear events in history. This highly resolved profile revealed a detailed record of anthropogenic radioactive fallout from atmospheric nuclear weapons testing during 1950s and 1960s and the Chernobyl accident in 1986. The measured ¹³⁷Cs concentrations varied between 0.6 and 229 Bq/kg dry weight (dw) while the measured ²⁴¹Am concentrations varied between 0.6 and 6.4 Bq/kg dw. The ¹³⁷Cs showed downward migration in the sediment column since ¹³⁷Cs was also found in varves dating before 1945. The first clear increase in ¹³⁷Cs concentration was observed in 1956 varve and the ¹³⁷Cs concentrations were found to peak in the 1964, 1970 and 1986 varves. The ²⁴¹Am was first observed in 1957 varve and the concentrations peaked in 1960-1962, 1964 and 1970 varves. This demonstrated that ²⁴¹Am can be a complementary chronostratigraphic marker to ¹³⁷Cs in sediment. A time delay of one to two years was observed between the years of intensive atmospheric nuclear weapons testing and the increased ¹³⁷Cs and ²⁴¹Am concentrations in the sediment varves. In the ²¹⁰Pb concentrations long-time periods of low (~1930-1950 and ~1990-2000) and high concentrations (~1950-1980) were observed. The reason for large variation was the amount of sediment input. The Constant rate of supply (CRS) model results showed good agreement with the varve counting. The model results showed that the ²¹⁰Pb deposition has been constant over the last 80 years and no effect of climate change to the ²¹⁰Pb deposition was observed.

Sub-Arctic alpine Vaccinium vitis-idaea exhibits resistance to strong variation in snowmelt timing and frost exposure, suggesting high resilience under climatic change

In tundra ecosystems, snow cover protects plants from low temperatures in winter and buffers temperature fluctuations in spring. Climate change may lead to reduced snowfall and earlier snowmelt, potentially exposing plants to more frequent and more severe frosts in the future. Frost can cause cell damage and, in combination with high solar irradiance, reduce the photochemical yield of photosystem II (ΦPSII). Little is known about the natural variation in frost exposure within individual habitats of tundra plant populations and the populations’ resilience to this climatic variation. Here, we assessed how natural differences in snowmelt timing affect microclimatic variability of frost exposure in habitats of the evergreen Vaccinium vitis-idaea in sub-Arctic alpine Finland and whether this variability affects the extent of cell damage and reduction in ΦPSII. Plants in early melting plots were exposed to more frequent and more severe frost events, and exhibited a more pronounced decrease in ΦPSII, during winter and spring compared to plants in late-melting plots. Snowmelt timing did not have a clear effect on the degree of cell damage as assessed by relative electrolyte leakage. Our results show that sub-Arctic alpine V. vitis-idaea is currently exposed to strong climatic variation on a small spatial scale, similar to that projected to be caused by climate change, without significant resultant damage. We conclude that V. vitis-idaea is effective in mitigating the effects of large variations in frost exposure caused by differences in snowmelt timing. This suggests that V. vitis-idaea will be resilient to the ongoing climate change.

Task-Modulated Corticocortical Synchrony in the Cognitive-Motor Network Supporting Handwriting

Both motor and cognitive aspects of behavior depend on dynamic, accurately timed neural processes in large-scale brain networks. Here, we studied synchronous interplay between cortical regions during production of cognitive-motor sequences in humans. Specifically, variants of handwriting that differed in motor variability, linguistic content, and memorization of movement cues were contrasted to unveil functional sensitivity of corticocortical connections. Data-driven magnetoencephalography mapping (n = 10) uncovered modulation of mostly left-hemispheric corticocortical interactions, as quantified by relative changes in phase synchronization. At low frequencies (~2–13 Hz), enhanced frontoparietal synchrony was related to regular handwriting, whereas premotor cortical regions synchronized for simple loop production and temporo-occipital areas for a writing task substituting normal script with loop patterns. At the beta-to-gamma band (~13–45 Hz), enhanced synchrony was observed for regular handwriting in the central and frontoparietal regions, including connections between the sensorimotor and supplementary motor cortices and between the parietal and dorsal premotor/precentral cortices. Interpreted within a modular framework, these modulations of synchrony mainly highlighted interactions of the putative pericentral subsystem of hand coordination and the frontoparietal subsystem mediating working memory operations. As part of cortical dynamics, interregional phase synchrony varies depending on task demands in production of cognitive-motor sequences.

Beyond rest and quiescence (endodormancy and ecodormancy): A novel model for quantifying plant-environment interaction in bud dormancy release

Bud dormancy of plants has traditionally been explained either by physiological growth arresting conditions in the bud or by unfavourable environmental conditions, such as non-growth-promoting low air temperatures. This conceptual dichotomy has provided the framework also for developing process-based plant phenology models. Here, we propose a novel model that in addition to covering the classical dichotomy as a special case also allows the quantification of an interaction of physiological and environmental factors. According to this plant-environment interaction suggested conceptually decades ago, rather than being unambiguous, the concept of "non-growth-promoting low air temperature" depends on the dormancy status of the plant. We parameterized the model with experimental results of growth onset for seven boreal plant species and found that based on the strength of the interaction, the species can be classified into three dormancy types, only one of which represents the traditional dichotomy. We also tested the model with four species in an independent experiment. Our study suggests that interaction of environmental and physiological factors may be involved in many such phenomena that have until now been considered simply as plant traits without any considerations of effects of the environmental factors.

Cortical Tracking of Global and Local Variations of Speech Rhythm during Connected Natural Speech Perception

During natural speech perception, listeners must track the global speaking rate, that is, the overall rate of incoming linguistic information, as well as transient, local speaking rate variations occurring within the global speaking rate. Here, we address the hypothesis that this tracking mechanism is achieved through coupling of cortical signals to the amplitude envelope of the perceived acoustic speech signals. Cortical signals were recorded with magnetoencephalography (MEG) while participants perceived spontaneously produced speech stimuli at three global speaking rates (slow, normal/habitual, and fast). Inherently to spontaneously produced speech, these stimuli also featured local variations in speaking rate. The coupling between cortical and acoustic speech signals was evaluated using audio-MEG coherence. Modulations in audio-MEG coherence spatially differentiated between tracking of global speaking rate, highlighting the temporal cortex bilaterally and the right parietal cortex, and sensitivity to local speaking rate variations, emphasizing the left parietal cortex. Cortical tuning to the temporal structure of natural connected speech thus seems to require the joint contribution of both auditory and parietal regions. These findings suggest that cortical tuning to speech rhythm operates on two functionally distinct levels: one encoding the global rhythmic structure of speech and the other associated with online, rapidly evolving temporal predictions. Thus, it may be proposed that speech perception is shaped by evolutionary tuning, a preference for certain speaking rates, and predictive tuning, associated with cortical tracking of the constantly changing-rate of linguistic information in a speech stream.

ROS signalling in a destabilised world: A molecular understanding of climate change

Climate change results in increased intensity and frequency of extreme abiotic and biotic stress events. In plants, reactive oxygen species (ROS) accumulate in proportion to the level of stress and are major signalling and regulatory metabolites coordinating growth, defence, acclimation and cell death. Our knowledge of ROS homeostasis, sensing, and signalling is therefore key to understanding the impacts of climate change at the molecular level. Current research is uncovering new insights into temporal-spatial, cell-to-cell and systemic ROS signalling pathways, particularly how these affect plant growth, defence, and more recently acclimation mechanisms behind stress priming and long term stress memory. Understanding the stabilising and destabilising factors of ROS homeostasis and signalling in plants exposed to extreme and fluctuating stress will concomitantly reveal how to address future climate change challenges in global food security and biodiversity management.

A multimodal spectral approach to characterize rhythm in natural speech

Human utterances demonstrate temporal patterning, also referred to as rhythm. While simple oromotor behaviors (e.g., chewing) feature a salient periodical structure, conversational speech displays a time-varying quasi-rhythmic pattern. Quantification of periodicity in speech is challenging. Unimodal spectral approaches have highlighted rhythmic aspects of speech. However, speech is a complex multimodal phenomenon that arises from the interplay of articulatory, respiratory, and vocal systems. The present study addressed the question of whether a multimodal spectral approach, in the form of coherence analysis between electromyographic (EMG) and acoustic signals, would allow one to characterize rhythm in natural speech more efficiently than a unimodal analysis. The main experimental task consisted of speech production at three speaking rates; a simple oromotor task served as control. The EMG-acoustic coherence emerged as a sensitive means of tracking speech rhythm, whereas spectral analysis of either EMG or acoustic amplitude envelope alone was less informative. Coherence metrics seem to distinguish and highlight rhythmic structure in natural speech.

Task-sensitive reconfiguration of corticocortical 6-20 Hz oscillatory coherence in naturalistic human performance

Electrophysiological oscillatory coherence between brain regions has been proposed to facilitate functional long‐range connectivity within neurocognitive networks. This notion is supported by intracortical recordings of coherence in singled‐out corticocortical connections in the primate cortex. However, the manner in which this operational principle manifests in the task‐sensitive connectivity that supports human naturalistic performance remains undercharacterized. Here, we demonstrate task‐sensitive reconfiguration of global patterns of coherent connectivity in association with a set of easier and more demanding naturalistic tasks, ranging from picture comparison to speech comprehension and object manipulation. Based on whole‐cortex neuromagnetic recording in healthy behaving individuals, the task‐sensitive component of long‐range corticocortical coherence was mapped at spectrally narrow‐band oscillatory frequencies between 6 and 20 Hz (theta to alpha and low‐beta bands). This data‐driven cortical mapping unveiled markedly distinct and topologically task‐relevant spatiospectral connectivity patterns for the different tasks. The results demonstrate semistable oscillatory states relevant for neurocognitive processing. The present findings decisively link human behavior to corticocortical coherence at oscillatory frequencies that are widely thought to convey long‐range, feedback‐type neural interaction in cortical functional networks. Hum Brain Mapp 36:2455–2469, 2015. © 2015 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc..

Modeling fallout of anthropogenic 129I

Despite the relatively well-recognized emission rates of the anthropogenic 129I, there is little knowledge about the temporal fallout patterns and magnitude of fluxes since the start of the atomic era atthe early 1940s. We here present measurements of annual 129I concentrations in sediment archives from Sweden and Finland covering the period 1942-2006. The results revealed impression of 129I emissions from the nuclear reprocessing facility at Sellafield and La Hague and a clear Chernobyl fallout enhancement during 1986. In order to estimate relative contributions from the different sources, a numerical model approach was used taking into accountthe emission rates/estimated fallout, transport pathways, and the sediment system. The model outcomes suggest a relatively dominating marine source of 129I to north Europe compared to direct gaseous releases. A transfer rate of 129I from sea to atmosphere is derived for pertinent sea areas (English Channel, Irish Sea, and North Sea), which is estimated at 0.04 to 0.21 y(-1).

Motor cortex dynamics in visuomotor production of speech and non-speech mouth movements

We investigated timing and hemispheric balance of motor cortex activation when kinetically similar speech and non-speech mouth movements and sequences of such movements were triggered by visually presented letter- and symbol-strings. As an index of motor cortex activation, we used magnetoencephalographic recording of task-related change of precentral 20 Hz (16-24 Hz) activity. Suppression of the 20 Hz rhythm revealed pre-movement activation in the face representation areas that was tied to visual instruction, not movement onset. The 20 Hz rhythm remained suppressed throughout the preparation and execution of mouth movements and was followed by post-movement rebound. Left hemisphere preceded the right at the onset and offset of the suppression, similarly for isolated and sequential speech and non-speech movements. Pattern of task-related change in 20 Hz activity was otherwise symmetrical. In the face areas, the overall modulation of 20 Hz activity increased with sequence length and motor demands. Hand representation areas showed also weak reactivity, with systematically larger modulation of 20 Hz activity for non-speech than speech movements. Our results suggest an active role for the motor cortex in cognitive control of visually triggered mouth movements, not limited to movement execution.

Effect of Diabetes on Outcome and Changes in Quality of Life After Coronary Artery Bypass Grafting

BACKGROUND

An increasing proportion of patients undergoing coronary artery bypass grafting are diabetics who are known to carry a higher mortality and morbidity in association with operation, but data on whether health-related quality of life improves similarly after coronary artery bypass grafting in diabetic and nondiabetic patients are limited. We assessed in detail changes in health-related quality of life (RAND-36 Health Survey) during the first year after coronary artery bypass grafting.

METHODS

Seventy-four of the 508 patients (14.6%) operated on in a single institution had a history of diabetes and were compared to nondiabetics. The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 12 months later.

RESULTS

Thirty-day mortality was 2.7% versus 1.6% (p = 0.511) and one-year survival was 94.6% versus 97.0% (p = 0.287) in the diabetics and nondiabetics, respectively. Diabetics improved significantly (p < 0.005) in seven, nondiabetics (p < 0.001) in all eight RAND-36 dimensions. Physical component summary and mental component summary scores on the RAND-36 improved significantly (p < 0.001) in diabetics as well as in nondiabetics. Both groups experienced closely similar freedom from anginal symptoms at one year (86.2% vs 90.5%, p = 0.280).

CONCLUSIONS

Although diabetic patients differ from nondiabetics having slightly inferior quality of life before and one year after coronary artery bypass grafting, they gain similar improvement of quality of life in one year after surgery when compared to nondiabetics.

Perioperative myocardial infarction has negative impact on health-related quality of life following coronary artery bypass graft surgery

OBJECTIVE

Perioperative myocardial infarction (PMI) is a well-described complication of coronary artery bypass grafting (CABG). Data on its effect on patients' subsequent health-related quality of life (QOL) and on other related consequences is deficient. The aim here was to evaluate in a prospective follow-up design the risk factors for and consequences of PMI and especially its possible impact on health-related QOL.

METHODS

Comprehensive data, including preoperative risk profile, perioperative variables and postoperative morbidity up to discharge were collected of 501 CABG patients in the Heart Center of Tampere University Hospital and in all eighteen postoperative care hospitals. Eighty patients (16%) fulfilled ECG or cardiac enzyme criteria for PMI and they were compared to patients with no PMI. The RAND-36 Health Survey (RAND-36) was used as an indicator of QOL. The primary outcomes were change in physical component summary (PCS), mental component summary (MCS) and the eight dimensions of health-related QOL from the RAND-36. Symptomatic status was estimated according to New York Heart Association (NYHA) class. Assessments were made preoperatively and repeated 12 months later.

RESULTS

Multivariate logistic regression analysis identified long cardiopulmonary bypass time (P=0.006) and high age (P=0.049) as independent predictors for PMI. Thirty-day mortality was adversely affected by PMI (6.3 vs 1.0%, P=0.001). In discharged patients, the occurrence of PMI did not affect 1-year survival adversely (98.7 vs 98.6%). The PMI patients showed significant (P<0.05) improvements in six of the eight dimensions of RAND-36, but they presented with a negative change in their 'general health' scores at the follow-up. All QOL scores improved significantly (P<0.001) among the patients without PMI. A highly significant (P<0.001) pattern of change was seen in the RAND-36 PCS and MCS scores in both groups although PMI patients showed significantly (P=0.002) smaller change in their PCS scores. Both groups showed similar freedom from anginal symptoms at 1 year (89.6 vs 90.1%) but in the PMI group later readmissions due to cardiac-related causes were more common (23 vs 10%, P=0.002).

CONCLUSIONS

PMI increases 30-day mortality and affects also adversely on later health-related QOL following CABG.

Improved Health-related Quality of Life after Coronary Artery Bypass Grafting Is Unrelated to Use of Cardiopulmonary Bypass

This prospective study was instituted to assess whether the use of the on-pump method or the off-pump method affects changes in health-related quality of life (QOL) as evaluated a year after coronary artery bypass graft (CABG) surgery. Data including preoperative risk factors and postoperative morbidity up to discharge were collected from 508 CABG patients operated in the Heart Center of a university hospital and further treated in secondary referral hospitals. Four hundred and fifty-two (89.0%) patients underwent operation with the on-pump method and 56 (11.0%) with the off-pump method, i.e., without cardiopulmonary bypass (CPB). The RAND-36 Health Survey (RAND-36) was used as indicator of QOL. The primary outcome measure was a change in the physical component summary (PCS) and mental component summary (MCS) from the RAND-36. Symptomatic status was estimated according to New York Heart Association (NYHA) class. Assessments were made preoperatively and repeated 12 months later. The majority of patients operated on-pump (85.6%) and off-pump (92.9%) had a favorable outcome without major complications (p = 0.136). The present data showed significant improvement (p < 0.001) in all eight domains of QOL following on-pump CABG. Likewise, off-pump patients improved in all eight aspects, and the change was statistically significant in six dimensions. A highly significant (p < 0.001) pattern of change was seen in the RAND-36 MCS and PCS scores in both operative groups. Differences between the groups were nonsignificant. We conclude that most patients experience significant improvement in health-related QOL during the first year after CABG, and that cardiopulmonary bypass has no effect on patients' subsequent health-related QOL, but its use depends on specific indications.

Learning new names for new objects: cortical effects as measured by magnetoencephalography

We tracked the evolvement of naming-related cortical dynamics with magnetoencephalography when five normal adults successfully learned names and/or meanings of unfamiliar objects. In all subjects, the learning of new names was associated with pronounced cortical effects. The learning effect was of long latency and emerged as a change of activation in the same cortical network that was active during naming of familiar items. In four out of five subjects, the cortical learning effect occurred in the inferior parietal lobe. In three of these subjects, the cortical effect was left-sided. These results suggest that the inferior parietal lobe plays an important role in the acquisition of novel words, presumably as a part of working memory systems.

Changes in health-related quality of life and functional capacity following coronary artery bypass graft surgery

OBJECTIVE

Improvement in survival and quality of life are the primary indications for coronary artery bypass graft (CABG) operations. Among elderly patients the main goal of surgery is not necessarily to prolong life, but to improve the health-related quality of life. Factors associated with mortality and morbidity following CABG surgery have been well defined, but the quality of life and functional capacity in elderly patients undergoing CABG are poorly documented. The aim here was to investigate changes in health-related quality of life, overall performance status and symptomatic status during 1 year after CABG surgery.

METHODS

Comprehensive data on 508 CABG patients were prospectively collected, including preoperative risk factors and postoperative morbidity in a surgical center and in all eighteen secondary referral hospitals up to discharge. The RAND-36 Health Survey (RAND-36) was used as indicator of quality of life. The primary outcome was change in the physical component summary, mental component summary and General Health summary scores from the RAND-36. Karnofsky dependency category was used to assess overall performance status, and symptomatic status was estimated according to New York Heart Association (NYHA) class. All assessments were made preoperatively and repeated 12 months later. Analysis was based on three age groups: 64 years or less (282 patients), 65-74 years (175 patients), and 75 or more years (51 patients).

RESULTS

Thirty-day and 1-year survival rates were 98.2 and 96.7%, respectively. A great majority (86.4%) of the patients recovered without major complication. In all, the present data showed significant improvement in all eight domains of QOL as well as in functional capacity and NYHA class during the 1st year after CABG. However, the mean change in RAND-36 Mental Component Summary scores among patients aged 75 years or more did not reach a statistically significant level (P=0.097) and they had significantly minor improvement as compared to younger patients (P<0.05). Moreover, their General Health score improvement was poorer and statistically insignificant (P=0.817).

CONCLUSIONS

Elderly patients not only have higher mortality and morbidity but also derive less benefit from CABG regarding certain aspects of QOL.

Changes in eating and weight control habits after myocardial infarction

The focus of this study was to describe changes the patients make in eating and weight control habits 3--4 months after diagnosis of myocardial infarction, and to identify difficulties associated with the reported changes 1 month later. Subjects were 50 male patients (mean age 48 years, mean body mass index 27.9kg/m(2)) participating in an in-patient cardiac rehabilitation programme. The changes were assessed with a questionnaire (46 items) at the beginning of the rehabilitation programme and 4 days food diaries were used to assess the diet at home. Difficulties were assessed with a questionnaire (34 items) 1 month later. Nearly all patients (96%) had changed their habits after myocardial infarction. The majority of the patients (76%) reported that they had consumed foods containing less fat and many of them anticipated difficulties to eat healthily at workplace. More attention could be paid to self-change without the assistance of formal treatment among patients with cardiac disease.

Spatial and temporal performance of the miniface (free air CO2 enrichment) system on Bog Ecosystems in northern and Central Europe

The Bog Ecosystem Research Initiative (BERI) project was initiated to investigate, at five climatically different sites across Europe, the effects of elevated CO2 and N deposition on the net exchange of CO2 and CH4 between bogs and the atmosphere, and to study the effects of elevated CO2 and N deposition on the plant biodiversity of bog communities. A major challenge to investigate the effects of elevated CO2 on vegetation and ecosystems is to apply elevated CO2 concentrations to growing vegetation without changing the physical conditions like climate and radiation. Most available CO2 enrichment methods disturb the natural conditions to some degree, for instance closed chambers or open top chambers. Free Air CO2 Enrichment (FACE) systems have proven to be suitable to expose plants to elevated CO2 concentrations with minimal disturbance of their natural environment. The size and spatial scale of the vegetation studied within the BERI project allowed the use of a modified version of a small FACE system called MiniFACE. This paper describes the BERI MiniFACE design as well as its temporal and spatial performance at the five BERI field locations. The temporal performance of the MiniFACE system largely met the quality criteria defined by the FACE Protocol. One minute average CO2 concentrations measured at the centre of the ring stayed within 20% of the pre-set target for more than 95% of the time. Increased wind speeds were found to improve the MiniFACE system's temporal performance. Spatial analyses showed no apparent CO2 gradients across a ring during a 4 day period and the mean differences between each sampling point and the centre of the ring did not exceed 10%. Observations made during a windy day, causing a CO2 concentration gradient, and observations made during a calm day indicated that short term gradients tend to average out over longer periods of time. On a day with unidirectional strong winds, CO2 concentrations at the upwind side of the ring centre were higher than those made at the centre and at the downwind side of the ring centre, but the bell-shaped distribution was found basically the same for the centre and the four surrounding measurement points, implying that the short term (1 sec) variability of CO2 concentrations across the MiniFACE ring is almost the same at any point in the ring. Based on gas dispersion simulations and measured CO2 concentration profiles, the possible interference between CO2-enriched and control rings was found to be negligible beyond a centre-to-centre ring distance of 6 m.

Measuring Delivery Process Performance

The focus on reengineering in the early 1990s, and the more recent emphasis on process management and change management have increased both practitioners and researchers interest in the issues of measuring processes. The contradictory results of process change projects reported in the literature and our observations from research suggest conflicting requirements for measurement systems. In this article, we review process measurement schemes with particular emphasis on the measures of time, quality, costs and efficiency. With five case studies, we illustrate process structures and related measurements for both customized and standardized deliveries. A framework for setting objectives for different process types is proposed. The result is a normative scheme for different processes that suggests ways to set meaningful objectives for time, quality, costs and efficiency. Finally, conclusions and implications are presented.

Difficulties in changing the diet in relation to dietary fat intake among patients with coronary heart disease

OBJECTIVE

To study barriers in following nutritional advice among coronary heart disease patients in relation to dietary fat intake.

DESIGN

A cross-sectional study using 4-day food records and a questionnaire with regard to barriers to or difficulties in following dietary advice.

SUBJECTS

Altogether, 362 male subjects with coronary heart disease from two separate patient populations (91 + 271) were included in the study, with the mean age of 50 years and 60 years, respectively. The patients were classified into low (< or = 30 E%) or high (> 30 E%) fat intake groups. The patients with low dietary fat intake obtained on an average 10 E% less energy from fat as compared to the high dietary fat intake group.

RESULTS

Overall, most patients with coronary heart disease reported difficulties in following nutritional advice when eating in social situations. Patients with high dietary fat intake reported more frequently than patients with low fat intake that they eat like other people without thinking about what they eat. On the other hand, there were no differences between the high and low fat intake groups in the barriers: eating at work, food price, shopping, taste or knowledge of nutrition.

CONCLUSIONS

Our results suggest that the sensitivity to social influence is an important factor explaining noncompliance with dietary advice among patients with high dietary fat intake.

Diagnosis of Mycoplasma pneumoniae pneumonia in children

We evaluated a commercial immunoglobulin M (IgM)-capture immunoassay for the detection of Mycoplasma pneumoniae infections in 278 pediatric patients with community-acquired, radiographically defined pneumonia. Acute- and convalescent-phase serum samples were collected from all patients and were tested for M. pneumoniae-specific IgM and IgG antibodies by Platelia enzyme immunoassays (Sanofi Diagnostica Pasteur, Marnes la Coquette, France). Nasopharyngeal aspirates (NPAs) were collected at the time of admission to the hospital. A total of 227 NPAs were subjected to the detection of M. pneumoniae DNA by PCR, and 191 NPAs were cultured by using the Pneumofast kit (International Mycoplasma, Signeswere, France). Southern hybridization of PCR products and the IgM test with solid-phase antigen (Serion Immunodiagnostica, Würzburg, Germany) were used for additional confirmation of a positive result, which required agreement of at least two different methods. A total of 24 (9%) confirmed diagnoses of mycoplasma infection were made, 5 (21%) of which were in children <5 years of age. Of the positive children, 24 of 24 (sensitivity, 100%) were positive by the IgM-capture test with convalescent-phase serum, 19 of 24 (79%) were positive by the IgM-capture test with acute-phase serum, 19 of 24 (79%) were positive by IgG serology, 10 of 20 (50%) were positive by PCR, and 8 of 17 (47%) were positive by culture. An additional 5 (of 254) children were positive by the Platelia IgM test alone (specificity, 98%). When the PCR with Southern hybridization result was combined with the IgM-capture test result with the acute-phase sera, the sensitivity of rapid laboratory diagnosis increased to 95%. In conclusion, the IgM serology test was the single most valuable tool for the diagnosis of M. pneumoniae pneumonia in children of any age.

Internal C:N balance and biomass partitioning of Carex rostrata grown at three levels of nitrogen supply

The long-term effects of high nitrogen supply on the growth and partitioning of biomass in a common sedge species, Carex rostrata Stokes, were studied in a greenhouse experiment. Special attention was paid to free amino acids and soluble sugars, representing biochemically available fractions of nitrogen and carbon, respectively, in the tissues of Carex. Plants were grown in peat in buckets, and nitrogen was added as ammonium nitrate (2, 5, and 10 g N m-2 year-1) five times during two growing seasons. Changes in biomass allocation patterns became evident towards the end of the second growing season. The biomass of shoots was highest in the high-N treatment, resulting in a high ratio of aboveground to belowground biomass. The high biomass of shoots was due to both the high density of current-year shoots and later senescence in the high-N treatment. No differences were observed in the belowground biomasses. Changes in allocation patterns were accompanied by changes in the soluble fractions of carbon and nitrogen. The concentration of free amino acids (FAA) was significantly higher (both shoots and roots) and the concentration of total nonstructural carbohydrates (TNC) lower (roots only) in the high-N treatment. The concentration of total nitrogen also increased with increasing supply of nitrogen. The results indicate that a high long-term supply of nitrogen may shift the internal carbon to nitrogen balance of Carex towards higher availability of nitrogen. Compared with the carbon to nitrogen ratio, the TNC:FAA ratio seems to be a better indicator of the internal carbon to nitrogen balance. A low TNC:FAA ratio may enhance the allocation of biomass to shoots and also increase the density of shoots.Key words: amino acids, biomass partitioning, carbon, Carex, nitrogen, sugars.

Is Outsourcing Practices in the Usa, Japan and Finland: A Comparative Study

With increasing cost-reduction pressures, outsourcing of information systems (IS) functions has emerged as an important option for managers in companies around the world. In this paper we present the results of our exploratory, empirical research comparing practices of domestic and global IS outsourcing in the USA, Japan and Finland. The research methodology of a mail survey with similar questionnaires was used in all three countries. The paper provides new empirical evidence comparing these countries on the types of functions being commonly outsourced, the extent to which these functions are outsourced, views of Chief Information Officers (CIOs) on the desired cost savings and the comparative ratings of the advantages and disadvantages of IS outsourcing. Also compared are the roles played by different executives in making outsourcing decisions. The implications of these results for IS managers and directions for future research are presented in the conclusions.

Biomass and production of two vascular plants in a boreal mesotrophic fen

The vertical distribution of biomass and production was measured using indirect 14C isotope techniques in a boreal mesotrophic fen dominated by Carex rostrata and Potentilla palustris. The biomass of C. rostrata was high (2290 g∙m−2), 78% of which was fine-root biomass. Even with a low turnover rate (0.59 yr−1), fine roots also accounted for 74% of the total production of 1424 g∙m−2∙yr−1. The majority of the belowground biomass was found in the uppermost 30 cm. However, living roots of C. rostrata were found down to a depth of 230 cm. In fen ecosystems, the direct input of carbon through deep-penetrating roots to slowly decomposing layers may considerably affect the accumulation of peat. Keywords: biomass, Carex rostrata, fen, peat, production, roots.

Components of Type A behavior and the first-year prognosis of a myocardial infarction

This study examined prospectively the role of Type A behavior and its subcomponents in the first-year prognosis of myocardial infarction (MI). Anger expression, irritability, and cynicism were assessed as traits related to the hostility component of the construct. The sample comprised 92 patients, less than 65 yr old, who survived the acute phase of their first MI. Psychological data was collected by self-report questionnaires during the initial hospital stay. Type A behavior was measured by the Jenkins Activity Survey and by the Finnish Type A Scale. Factors were controlled for age, sex, social status, and the MI severity. The results showed that patient who had a reinfarction or died during the first year reported more irritability and experienced anger more often than patients surviving without any complications. From the standard subcomponents only the Speed-Impatience factor of the JAS predicted poor prognosis. Our results indicated that the global Type A scores were not associated with the prognosis of MI.