University of Helsinki

Introduction The prognosis of acute heart failure (AHF) remains poor. Studies focusing on the time‐sensitivity of early AHF management have reported controversial results. Thus, our aim is to review current studies focusing on AHF patients using emergency medical services (EMS), their early management, and patient outcomes. Methods We searched the recent literature in PubMed and Scopus for studies comparing AHF patients arriving at the hospital by EMS to those self‐presenting (non‐EMS) at ED (emergency department) from database inception until November 2022. Results The literature search found five studies fulfilling our inclusion criteria. The percentage of AHF patients using EMS varied in these studies: 11.5% (100/873) in Finnish FINN‐AKVA II, 22.1% (236/1068) in Canadian ASCEND‐HF, 35.5% (5129/14454) in a Pakistan Heart Failure‐registry study, 52.8% (3224/6106) in Spanish SEMICA, and 61.8% (309/500) in the European EURODEM study. The pre‐hospital management differed across the reviewed studies. The use of NIV was rare, ranging from zero to four percent. Vasodilators and diuretics were more commonly used. Although, the differences in the use were obvious (range from 7.1% to 22.0%, and 0.0% to 29.0% accordingly). Three of the studies reported significantly higher 30‐day mortality among EMS patients compared to non‐EMS patients: ranging from 5.6% versus 3.5%, p < 0.001% to 15.0% versus 6.9%, p < 0.001. Conclusion The use of EMS, as well as pre‐hospital management, varies between the international cohorts and registries. The pre‐hospital AHF management is generally limited. Moreover, EMS patients tend to have worse outcomes compared to non‐EMS patients.

There are numerous seasonal ice‐covered lakes on the Qinghai‐Tibet Plateau (QTP), which significantly influence local climate and lake ecosystems through thermal processes. Two QTP lakes, Ngoring (NL) and BLH‐A (BL), have similar latitudes, altitudes and climatic conditions. However, observed water temperature when freezing is lower in NL (about 0.5°C) and higher in BL (about 4°C). According to the novel lake thermal classification method proposed by Yang et al. (2021, https://doi.org/10.1029/2020gl091374) (Yang's method), NL and BL should be classified as cryomictic and cryostratified, respectively. However, the results calculated using both the original and improved Yang's method classified both lakes as cryomictic. Clearly, Yang's method was applicable to NL but not suitable for BL. This was probably because the method only considered lake area, depth, and wind speed, but neglected energy dissipation caused by bottom friction. Additionally, the LAKE model was employed to investigate the bottom friction effect. Results indicated that the extent of bottom friction effect on the two lakes was different and jointly influenced by small surface area and shallow depth.

Plain Language Summary Earth's magnetic field extends into space and forms a magnetic shield, the magnetosphere, which protects our planet from particles originating from the Sun. This stream of particles, the solar wind, carries with it the solar magnetic field and fills the entire solar system. Abrupt turns in the solar magnetic field can lead to particles accumulating in a small region of space, creating transient structures which rapidly grow, in a few minutes, to sizes comparable to Earth or even larger. When they impact Earth's magnetosphere, these structures cause disturbances such as oscillations of the Earth's magnetic field lines or brightening of the aurora. Here, we use a supercomputer model to better understand how these structures are formed. We show that several of them can grow when a single solar wind magnetic field turning reaches near‐Earth space because the first structure modifies its environment, enabling more particles to accumulate. As they travel toward Earth, these structures reach the bow shock, which slows down the solar wind before it hits the magnetosphere. The part of the shock impacted by the structures deforms and weakens.

The placenta is a very common, but often underappreciated, surgical pathology specimen. Gross examination of the placenta should be organized and routine, in order to efficiently identify abnormalities; only a proper gross examination will allow appropriate diagnosis. Gross findings and lesions discussed here include those of the umbilical cord (length, knots, coiling, insertion), membranes (discoloration, plaques, insertion), and disc (size, infarcts, abnormal shapes). The histologic findings are also discussed by site: cord (inflammation, thrombosis, remnants), membranes (pigment, lesions, chorionicity of twins, maternal arteriopathy), and disc (villous maturity, infarcts, hydropic change, villitis, specific infections). Finally, there is a discussion of the unifying diagnoses: maternal vascular malperfusion, fetal vascular malperfusion, and the amniotic fluid infection sequence.

Mugger crocodiles are the apex predator species of the wetland ecosystem in Nepal, and their conservation could safeguard the entire ecosystem. However, studies on their population status and habitat characteristics are limited, with no scientific research conducted on their nesting ecology to date. Therefore, we selected muggers as a representative species to better understand their daytime sightings, nesting characteristics, and the fine‐scale anthropogenic and environmental factors influencing their occurrence in five lakes of the Beeshazari Lake complex (BLC; Beeshazar Lake, Kumal Lake, Tikauli Lake, Kingfisher Lake, and Batuli Pokhari) of Chitwan National Park, Nepal. We conducted a preliminary survey, followed by a daytime sightings survey, a nesting site survey, and a habitat assessment survey in March 2023. A generalised linear model under binary logistic regression was used to analyse the factors influencing the habitat characteristics of muggers. During the research period, 50 detections of muggers were recorded, 66% of which were observed basking and 34% were submerged in the lakes. The Relative Abundance Index of the muggers in the BLC was 3.29 km⁻¹. Nesting sites (two from Tikauli Lake and three from Beeshazar Lake) were recorded during the study period. The probability of sighting a mugger was significantly influenced by the slope (moderate slope), substrate type (clay, grass, and sand), mid‐lake depth, presence of anthropogenic threats, and presence of invasive species. We recommend that future researchers employ more robust models, such as N‐mixture models, to provide up‐to‐date information on the population abundance of muggers in the BLC. Furthermore, a comprehensive multi‐seasonal study focusing on ecological and behavioural aspects of nesting sites alongside environmental aspects influencing nest success rates is critical. Such research will be crucial in guiding the development of targeted conservation strategies aimed at protecting and preserving essential nesting sites. Moreover, we recommend conducting robust studies on the carrying capacity of wetlands in Nepal to provide insights into the sustainable population size that a wetland can support.

Background Congenital myopathies are a group of neuromuscular disorders that typically present at birth or early childhood with hypotonia and non-progressive or slowly progressive muscle weakness. They are classically subclassified by characteristic structural changes and histopathological findings in skeletal muscle. Variants in over 40 genes have been described to date in patients with various forms of congenital myopathy with overlapping phenotypic and histological features, which poses a challenge for laboratories and clinicians in interpreting genetic findings. Objective The purpose of this study was to evaluate the evidence supporting each gene-disease relationship and provide an expert-reviewed classification for the clinical validity of genes involved in congenital myopathies. Methods The ClinGen Neurological Disorders Clinical Domain Working Group assembled the Congenital Myopathies Gene Curation Expert Panel (CongenMyopathy-GCEP), a group of clinicians and geneticists with expertise in congenital myopathies tasked to perform evidence-based curation of 50 gene-disease relationships using the ClinGen semiquantitative framework to assign clinical validity. Results Our curation effort resulted in 35 (70%) Definitive, eight (16%) Moderate, six (12%) Limited, and one (2%) Disputed disease relationship classifications. The summary of each curation is made publicly available on the ClinGen website. Conclusions Expert-reviewed assignment of gene-disease relationships by the CongenMyopathy-GCEP facilitates accurate molecular diagnoses for congenital myopathies and can allow genetic testing to focus on genes with a validated role in disease.

The global diffusion of participatory budgeting (PB) has attracted scholarly attention, particularly regarding how PB is institutionalised across different contexts. This article argues that institutionalisation requires both top-down and bottom-up efforts to introduce and promote PB, with media framing playing a crucial role in shaping how it is presented to the public. Using South Korea as a case study, this article analysed 28,480 news articles mentioning PB from 1991 to 2022, sourced from a digital news archive. A structural topic model was employed to identify major frames and trends in the extensive textual data. The analysis revealed 17 topics, with PB framed as a tool for regeneration and decentralisation strategies, distinct from the original Porto Alegre model. The findings also showed that media frames shifted after PB became mandatory in 2011 and varied between national and local newspapers, reflecting its dynamic nature. This study demonstrates the application of the media framing approach for both single and comparative contexts, offering a valuable framework for advancing research on the global diffusion of PB.

Isolated populations of postglacial relicts are known from many regions and are typically found on mountains for terrestrial species and in lakes for aquatic species. Among the few aquatic mammalian relicts, the Saimaa ringed seal ( Pusa hispida saimensis ) has been landlocked in Lake Saimaa, Finland, for the last 10,000 y. Saimaa ringed seals show genetic, behavioral, and morphological differences from the other ringed seal subspecies, but the extent these differences stem from the end of the last glacial period remains unclear. Here, we demonstrate with comprehensive sampling and state-of-the-art genomic methods that the Saimaa ringed seals are much older than the lake they inhabit, having formed a separate evolutionary branch for at least 60,000 y. This deep evolutionary origin of the Saimaa ringed seals is further underscored by anatomical differences, including our ecomorphological analyses revealing adaptively distinct features in their dentition and tongue. Overall, glacial relicts may harbor a richer selection of evolutionary history than might be expected from their recent isolation history alone.

Objectives The study analyzes how nursing home professionals communicate palliative hope in care plan meetings with family members of residents with late-stage dementia. Methods Eleven care plan meetings between nursing home professionals and residents’ family members at Finnish nursing homes were video- or audio-recorded and analyzed with inductive thematic analysis. Data were collected in 2020–2021 using convenience sampling: All nursing homes within one region in Finland were contacted with the help of the local Memory Association, and all volunteers were accepted as study participants. Results We identified three main themes of palliative hope in late-stage dementia: 1) Life is good and there is still time, 2) Agency and identity are not lost, and 3) Death will be good and professional support is available. Discussion As overarching goals of hope work, we identified acceptance and appreciation. Nursing home professionals have an important role in constructing and maintaining hope and thus supporting families. They can remind families that residents are not lost as people, they are in good care, and that there are still time and opportunities for a good life, meaningful moments, and connection, which families can appreciate despite the progressive illness. By highlighting the possibility of a peaceful death for the resident and willingness to support families in the end-of-life phase, nursing home professionals can help families accept the inevitable. Combined with good-quality palliative care, palliative hope work can support families’ social relationships and foster meaningful experiences at the end-of-life stage.

This systematic review evaluated the association between lower respiratory tract infections (LRTI) in infancy with respiratory syncytial virus (RSV), rhinovirus (RV) or infestation with helminths and the risk of developing asthma and allergic diseases. The risk of bias was assessed with ROBINS‐E, and the certainty of evidence (CoE) with GRADE. Meta‐analysis applied a random‐effects model. RSV LRTI is likely associated with an increased risk of developing asthma by age 7 (OR 3.02, 95% CI 2.23–4.09; I² = 98%; moderate CoE). The impact on wheezing, atopic dermatitis (AD), and allergic rhinitis is uncertain. RV LRTI may be associated with increased risk of developing asthma (OR 8.40, 95% CI 2.56–27.55; I² = 43%; low CoE). The impact on wheezing and AD is uncertain. Trichuris trichiura infestation might be associated with reduced risk of new‐onset wheezing (OR 0.57, 95% CI 0.35–0.94; very low CoE) or AD (HR: 0.35, 95% CI 0.18–0.67; very low CoE). The association between Ascaris lumbricoides and hookworm infestation and the risk of developing asthma or AD is uncertain. Infestation with any helminths might be associated with reduced risk of new‐onset asthma by age 5 (OR: 0.60, 95% CI 0.38–0.95; very low CoE) and wheezing (OR 0.70, 95% CI 0.51–0.95; very low CoE). More high‐quality studies are needed to confirm these findings.

Plant‐associated yeasts modulate host immunity to promote or prevent disease. Mechanisms of yeast perception by the plant innate immune system remain unknown, with progress hindered by lack of a model system with the model plant Arabidopsis thaliana (Arabidopsis). A yeast strain of Taphrina tormentillae, named M11, was previously isolated from wild Arabidopsis. Taphrina have been found on many non‐host plants, and their complex ecology remains understudied. Here, the interaction of M11 with Arabidopsis was characterised. Infection of Arabidopsis with the birch pathogen T. betulina, used as a non‐host control, triggered typical defence activation features but did not multiply, demonstrating Arabidopsis had immunity against a non‐adapted yeast. M11 triggered attenuated defence activation features, grew in planta, and caused subtle but clear leaf deformation symptoms, demonstrating it is pathogenic. M11 was widely distributed in environmental sequencing data and found on multiple non‐host plants, suggesting Taphrina play previously unrecognised ecological roles on multiple plant species. M11 genome features involved in host interaction were analysed, and potential immune stimulatory molecules in chitin‐free cell walls were identified. A pilot screen demonstrated the utility of reverse genetics with Arabidopsis and identified that the BAK1 co‐receptor is involved in the perception of M11 Taphrina cell walls.

Introduction The age at the onset of juvenile idiopathic arthritis (JIA) can influence the trajectory of the disease. We aimed to clarify how age at the visit 6 months after the onset as a continuous variable affects long-term remission of JIA. Methods This study investigated 358 patients from the Nordic JIA cohort study. Age at diagnosis was analysed continuously. Three age groups were studied: under 3 years, 3–5 years and over 6 years of age. JIA was categorised as oligoarthritis, seronegative polyarthritis and others (enthesitis-related, psoriatic and undifferentiated arthritis). Clinical data, collected at 6 months after the onset of symptoms, included information about disease activity, uveitis, laboratory test values and medication. The outcomes assessed 17.5 years after diagnosis included remission, health-related quality of life (HRQoL), and functional ability. Results The majority of patients with oligoarthritis and polyarthritis were diagnosed before age six, compared with 29% in the group of others. In the oligoarthritis group, predictors of remission included age at diagnosis, male gender, the Juvenile Arthritis Disease Activity Score-71 (JADAS71) and the absence of uveitis. In seronegative polyarthritis, predictors of remission were age at diagnosis and JADAS71 score. In the oligoarthritis group, remission rates were highest in both genders when diagnosed <3 years of age. In the seronegative polyarthritis group, this was not true for female patients. Age at diagnosis had no significant effect on HRQoL or functional ability. Conclusions Age at diagnosis in the oligoarthritis was inversely and in the seronegative polyarthritis positively associated with long-term remission in JIA, primarily in females.

Introduction Cardiac surgery in infants often triggers a severe inflammatory response. The role of biomarkers in predicting clinical outcomes in this group of patients has been debated in the literature. This study aimed to investigate the predictive value of 20 inflammatory biomarkers, in combination with clinical data, for acute kidney injury, ventilator support duration, and inotropic score following infant cardiac surgery by developing and comparing three models: Clinical‐Data‐Only, Biomarker‐Only, and Combined. Methods This secondary analysis of the MiLe‐1 study included infants undergoing surgery with cardiopulmonary bypass. Biomarkers were measured before and after CPB. Using BIC‐guided logistic regression, we developed and compared three multivariable models—Clinical‐Data‐Only, Biomarker‐Only, and Combined—for each outcome. Model performance was assessed using c‐statistics and p‐contrast tests. Results Regarding AKI risk prediction, the c‐statistics for Biomarker‐Only, Clinical‐Data‐Only, and Combined Model were 0.79, 0.60, and 0.78 respectively. The difference in performance between the Combined and Clinical‐Data‐Only Models was statistically significant ( p < 0.001). Concerning ventilator support time prediction, the c‐statistics were 0.80, 0.72, and 0.77 for the models respectively ( p ‐contrast = 0.10). As for inotropic score prediction, the c‐statistics were 0.83, 0.77, and 0.85 for the models ( p ‐contrast = 0.007). Conclusion Inflammatory biomarkers may enhance risk stratification for postoperative outcomes in infant cardiac surgery. However, given the exploratory nature of this study, further validation in larger and more diverse cohorts is needed.

This paper aims to introduce a novel approach to spatial blind source separation (SBSS) that addresses the limitations of existing methods. Current SBSS techniques rely on the joint diagonalization of multiple local covariance functions, all of which assume isotropy. To overcome this constraint, anisotropic local covariance matrices that relax the isotropy assumption are proposed. A simulation study and an application on real-world data demonstrate the performance improvement obtained by incorporating these anisotropic covariance matrices into the SBSS framework and highlight the potential of this new approach for more accurate and flexible source separation in spatial data analysis.

Individual sensitivity to environmental exposures may be genetically influenced. This genotype-by-environment interplay implies differences in phenotypic variance across genotypes, but these variants have proven challenging to detect. Genome-wide association studies of monozygotic twin differences are conducted through family-based variance analyses, which are more robust to the systemic biases that impact population-based methods. We combined data from 21,792 monozygotic twins (10,896 pairs) from 11 studies to conduct one of the largest genome-wide association study meta-analyses of monozygotic phenotypic differences, in children, adolescents and adults separately, for seven psychiatric and neurodevelopmental phenotypes: attention deficit hyperactivity disorder symptoms, autistic traits, anxiety and depression symptoms, psychotic-like experiences, neuroticism and wellbeing. The proportions of phenotypic variance explained by single-nucleotide polymorphisms in these phenotypes were estimated ( h ² = 0–18%), but were imprecise. We identified 13 genome-wide significant associations (single-nucleotide polymorphisms, genes and gene sets), including genes related to stress reactivity for depression, growth factor-related genes for autistic traits and catecholamine uptake-related genes for psychotic-like experiences. This is the largest genetic study of monozygotic twins to date by an order of magnitude, evidencing an alternative method to study the genetic architecture of environmental sensitivity. The statistical power was limited for some analyses, calling for better-powered future studies.

Epinephrine and norepinephrine are widely used to treat cardiovascular collapse during resuscitation with lipid emulsions in the treatment of drug toxicity including local or non‐local anesthetics. The effect of the lipid emulsion Intralipid on the vasoconstriction induced by epinephrine or norepinephrine is, however, still unknown. In this study, the interaction of epinephrine and norepinephrine with the intravenous Intralipid emulsion was investigated by capillary electromigration techniques. Capillary electrokinetic chromatography was performed to determine the distribution coefficients by running the analytes under different experimental conditions (temperature, ionic strength, and pH) through a capillary filled with the background electrolyte containing Intralipid emulsion. In addition, the binding constants of the epinephrine and norepinephrine complexes with Intralipid emulsion were determined based on the effective electrophoretic mobility data obtained by electrokinetic chromatography at a wide concentration range of Intralipid emulsion. The obtained binding constants, as well as the distribution coefficients determined by electrokinetic chromatography, confirm that epinephrine and norepinephrine are hydrophilic compounds and that they are minimally distributed into the Intralipid emulsion. Therefore, their application as drugs for vasoconstriction upon Intralipid emulsion treatment is well motivated.

Image classification with deep neural networks has reached state-of-the-art with high accuracy. The unreasonable effectiveness of deep neural networks is credited to the manifold hypothesis that states natural data lies on a low-dimensional manifold embedded in the high-dimensional space. The machine learning models learn patterns on these low-rank representations, which gives the learning algorithms robustness. We test the robustness of learning algorithms using the paradigm of “perturb and learn”. This paper proposes a novel technique called Low-Rank Perturbation Adjustment (LoPA), an implicit regularization method used by machine learning models for resisting external perturbations. LoPA exploits the dependencies in model weights that lie in high-dimensional space and projects to low-dimensional while resisting perturbation. We validate LoPA through singular value decomposition (SVD) theory and empirical experiments, showing the statistical distribution of trained model weights of zero mean and small variance. We inject perturbations into our model by hot-swapping the activation functions and interchanging loss functions during the training. An InceptionV3 Neural Network is trained on common FruitFly Drosophila images for binary classification tasks of cancer cells. The Drosophila cancer images are prepared in our lab through immunostaining protocol.

Cervical cancer is a preventable disease for which vaccines are available to provide long-term protection against human papillomavirus (HPV) infection. This systematic literature review (SLR) was performed to summarize the efficacy, effectiveness, impact, duration of protection, and safety profile of four licensed HPV vaccines against infection, precursor lesions, and cervical cancer. Data was extracted from published reports. The search resulted in 1,136 studies, of which 54 were selected for this review. A substantial decrease in the prevalence of oncogenic HPV types, high-grade cervical lesions, and cervical cancer was found in countries with high vaccine coverage and routine vaccination programs. Post-licensure studies of HPV vaccines have reported high efficacy, effectiveness, and health impact across settings and age groups. Studies emphasize vaccination in younger age groups. These findings may inform future discussions about HPV vaccination strategies.