Tampere University Research Articles

Collaborative Creativity with a Purpose: Understanding the Translation Reviser's Task

Lectio praecursoria, Tampere University, 15 March 2024

Integrative public leadership: a systematic review

PurposePublic leadership literature has recognised the need for specific integrative leadership style in boundary-crossing collaborations, and it has been proposed as a new umbrella term for describing such leadership in boundary-crossing settings. The article reviews the research literature on integrative leadership and describes and analyses its contents by answering the following question: What are the characteristics of integrative public leadership?Design/methodology/approachTo review the integrative leadership literature, a systematic literature review was conducted. The databases and search services included Web of Science, Andor provided by Tampere University, Scopus, Emerald, Business Source Ultimate (Ebsco) and ScienceDirect (Elsevier). The search terms were accordingly chosen as integrative leadership, integrative public leadership and public integrative leadership. From the hundreds of search hits 25 research articles were selected in the reviewing process to be further analysed through qualitative content analysis. Crosby and Bryson’s (2010) framework for understanding leadership and the creation and maintenance of cross-sector collaborations was used as a starting point for the categorisation.FindingsThe article presents an improved integrative leadership framework that helps to identify the factors shaping integrative leadership and visualises better the interconnection of structures, processes and participants, through which leadership is enacted in the collaborative network.Originality/valueThe article extends the knowledge on integrative public leadership and helps to direct future research.

Mortality and causes of death of traumatic spinal cord injury in Finland.

Prospective cohort study. To study the mortality rates of TSCI patients compared to matched controls and to examine possible TSCI-related mortality risk factors and causes of death. Oulu and Tampere University Hospital, Finland. All consecutive patients with a new TSCI were included in a prospective study (n = 344, 2012-16). All patients were followed until death or the end of 2019. Patients were compared to a control group formed by randomly choosing gender, age, municipality, and calendar time-matched controls (5 controls/TSCI patient). Standardized mortality ratios (SMR) were calculated using general population mortality rates. Mortality information was extracted from the Statistics of Finland (Helsinki, Finland). TSCI patients had an increased mortality (SMR = 2.9) compared with the Finnish population. During the observation period, 26% of TSCI patients and 12% of the matched controls died. Of the TSCI patient deaths, 51% occurred within the first two years postinjury. Increased age, severity of TSCI (as per International SCI Core Data Set) and fall were related to mortality (p < 0.05). The two most common etiologies of death were: circulatory (30%), and pulmonary diseases (28%). Pneumonia was the single most frequent disease leading to death among TSCI patients. During the first years after injury, the mortality of the patients with TSCI is double compared to the controls. Most deaths occur within two years postinjury. Elderly patients with more severe fall-related injury have the highest mortality risk. Circulatory diseases and pulmonary diseases, especially pneumonia, are the foremost causes of death after TSCI.

11.L. Round table: Fiscal measures for building resilient European health systems

Abstract Currently, over 100 million European citizens are affected by obesity and non-communicable diseases. These health conditions impact individuals and society economically as well as socially. Therefore, an increasing number of Member States has introduced taxes on foods high in fat, sugar, or salt. However, divergent national fiscal health measures can lead to market distortion or fraudulent activities, revealing that, although the responsibility for implementing fiscal measures lies with national governments, health systems of different Member States are much interlinked. The increasing health risks for European citizens and its broader impact underline the importance of resilience in European health systems more than ever before, calling for early response and effective concrete actions from both EU institutions and national governments. Additionally, the topic of resilient health systems currently ranks high on the European agenda, with the Belgian Presidency promoting health system preparedness and early response and health care strengthening as one of their six priorities. The European Commission will also continue its work on this issue for the next five years. The EU has already taken steps in this matter, such as the launch of the European Health Union and the creation of HERA. However, in order to preserve a healthy society, the EU must further develop in this regard. Therefore, this round table discussion will focus on the question of how fiscal measures in Member States can contribute to resilient health systems. It aims to generate ideas on how Ministries of Health can contribute to resilient health systems via fiscal measures compatible with European Community law that promote health and prevent disease. Panellists from the WHO Regional Office for Europe, the Hungarian Ministry of Health and Ecorys, a research-based consultancy, will provide diverse perspectives on the topic. The added value of the round table is laying out possible ways of how both the EU and Member States can contribute to enhancing the resilience of European health systems. In the discussion, knowledge is derived from various research projects, such as Ecorys’ study for DG TAXUD on health taxes, their study for the Dutch Ministry of Finance on sugar taxes, and their literature study on sugar taxation and VAT reduction on fruits and vegetables. Furthermore, as an example of alternative funding mechanisms for resilient health systems, the Hungarian approach to health taxes will be reviewed, since a portion of the tax revenue from their public health tax is used to finance public health initiatives. From a policy perspective, the round table will aid in formulating recommendations for improving the resilience of EU health systems for the next five years. Key messages • Unhealthy foods and drinks consumption poses significant health risks, impacting economy and society, and requiring evidence-based fiscal measures as part of comprehensive measures. • The round table provides public health stakeholders the opportunity to generate recommendations for improving the resilience of EU health systems for the next five years. Speakers/Panelists Kremlin Wickramasinghe Division of Country Health Programs, WHO/Europe, Denmark Krisztina Biró Ministry of Interior, State Secretariat for Health, Budapest, Hungary Soila Karreinen Tampere University, Tampere, Finland Rana Orhan Pees Ecorys, Rotterdam, Netherlands Sara Cerdas Former Member of the European Parliament, Brussels, Belgium

Magnetic Resonance Imaging - Derived Psoas Muscle Area and Survival in Patients Treated Invasively for Peripheral Arterial Disease.

Psoas muscle parameters estimated from computed tomography images, as surrogates for sarcopenia, have been found to be associated with post-interventional outcomes after a wide range of cardiovascular procedures. The pre-interventional assessment in patients undergoing invasive treatment for peripheral arterial disease is increasingly often carried out with magnetic resonance imaging (MRI), and we therefore sought to investigate the predictive potential of MRI-derived psoas muscle area in this cohort. A total of 899 patients with available sufficient quality pre-interventional MRI conducted within 6 months prior to treatment undergoing open, endovascular, or hybrid revascularization procedures for claudication and/or limb-threatening ischemia at Tampere University hospital between 2010 and 2020 were retrospectively studied in this single-center cohort study. The follow-up lasted until 17 June 2021. Psoas muscle areas were measured from the magnetic resonance images at the L4 level, and the reliability of muscle parameter measurements was tested with intraclass correlation coefficient analysis. The average psoas muscle area values (mean of left and right psoas surface areas) were z-scored and analyzed separately for men and women. The median follow-up time was 5.9 years (interquartile range (IQR) = 2.7-7.8), and the overall mortality count was 259 (28.8%) (29.5% n = 168/569 for men and 27.6% n = 91/330 for women). The intraclass correlation coefficient analysis showed excellent interrater reliability for psoas muscle measurements. The muscle surface areas were larger in men (mean = 7.58 cm2) compared to women (mean = 5.27 cm2) (p < 0.001). Higher psoas muscle area was associated with better survival in women (p = 0.003, hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.6-0.9 per 1 SD), whereas in men, an independent association of the muscle parameter with mortality was not found. MRI-derived psoas muscle area may be a prognostic factor for clinical use.

Medical and Paramedical Students' Positive Experiences With Interprofessional Simulation: A Questionnaire Study.

Simulation is a common and beneficial learning method in healthcare education. Interprofessional simulation combines both interprofessional collaboration and simulation, and it has been found to improve teamwork, interprofessional collaboration, and patient safety. This study aimed to evaluate medical and paramedical students' attitudes toward interprofessional simulation and their competence to act in acute situations. High-fidelity interprofessional acute simulations focused on internal medicine emergencies and both child and adult resuscitation are part of medical and paramedical curricula at Tampere University and Tampere University of Applied Sciences. A total of 120 final-year medical students and 34 third-year paramedical students participated in these simulations in spring 2021 and were asked to answer pre- and post-questionnaires. The response rates were 91% (n=140) for the pre-questionnaire and 86% (n=132) for the post-questionnaire. A mixed method was used for analysis. The students' attitudes toward interprofessional simulations were positive, and interprofessional simulation was considered an effective and safe learning method. Students experienced interprofessional simulations as an excellent learning method. Before the interprofessional simulations, 66% of the students rated their skills to act in acute situations as good or very good, and after the interprofessional simulations, 95% of the students rated their skills to act in acute situations as good or very good. Effective debriefing and positive feedback were considered important for learning. Interprofessional simulations promoted understanding of other professions and interprofessional communication. When the students self-evaluated their skills to act in acute situations, improvement was detected. Medical and paramedical students appreciated interprofessional collaboration. The students considered interprofessional simulation as an effective learning method and promoting the understanding of other professions. Results confirm that interprofessional simulation is also a good way to teach non-technical skills such as communication and teamwork.

Vegetarian diet and pregnancy outcome

ObjectiveVegetarian diets are becoming increasingly popular. Our aim was to evaluate the association of a vegetarian diet with pregnancy, labor, and newborn’s outcome. Study designThis retrospective case-control study included 150 women on a vegetarian diet and 300 omnivores. The data were collected from Tampere University Hospital pregnancy database from January 2015 to April 2021. Diet was a self-reported variable. Outcomes of interest were compared between the groups. The frequency of small-for-gestational age (SGA) newborns and low birth weight were primary outcomes. Other parameters concerning pregnancy, labor, and newborn served as secondary outcomes. ResultsThe rate of SGA at the 10 % cutoff was lower in the vegetarian group. Based on a definition of two standard deviations, SGA did not differ between the vegetarian diet group and the control group. The median birthweight was significantly higher in the vegetarian group. Gestational diabetes (GDM) was more common in the vegetarian group, however the numbers of large for gestational age (LGA) newborns were comparable between the study groups. Labor induction was more common, and the second stage of labor was longer in the vegetarian group. Preterm births (< 32+0 and < 37+0 gestational weeks) were more common in the control group. No differences were found in the mean umbilical artery pH value, 1- and 5- minutes Apgar scores or the number of newborns transferred to the neonatal intensive care unit and neonatal ward. The proportions of hypertensive disorders in pregnancy did not differ between the groups. ConclusionAccording to our results, a vegetarian diet may be considered safe during pregnancy. It was not associated with an increased risk of pregnancy- or neonatal complications.

COVID-19 pandemic impact on gynecologic cancer treatment pathways in a Finnish tertiary center.

COVID-19 and new guidelines during the pandemic affected the gynecologic cancer treatment pathways, resulting in recorded delays and modifications in the treatment protocols. The aim of this study was to determine the impact of the COVID-19 pandemic in one of the major gynecologic cancer care centers in Finland, Tampere University Hospital. Our retrospective register study included 909 patients that were new gynecologic cancer cases (uterine, cervical, vulvar, vaginal, or ovarian) referred to the Tampere University Hospital Gynecologic Oncology Outpatient Clinic between March 17th, 2018, and March 15th, 2022. The patients were divided into two separate groups depending on their time of referral: time before COVID (March 17th, 2018, to March 15th, 2020), and during COVID (March 16th, 2020, to March 15th, 2022). These groups were compared in terms of patient characteristics, different cancer types and stages, symptoms, and treatment methods. During the COVID-19 pandemic, patients generally suffered from cancer symptoms longer (p < 0.003) and were more likely to be overweight (p = 0.035). The improved multidisciplinary team meeting gave the patients a faster route to their first intervention during COVID (p < 0.05). An insignificant shift toward nonsurgical first interventions and non-curative intent was seen during COVID, but the multidisciplinary team treatment plans were mostly implemented accordingly on both eras. No decrease was seen in the number of new gynecologic cancer cases, and the one-year overall survival remained the same in both groups. Overall, the COVID-19 pandemic did not significantly alter treatment pathways in gynecologic cancer care at Tampere University Hospital. The number of new patients and given treatments remained relatively stable. During COVID, access from referral to cancer treatment was significantly accelerated, which is likely confounded by changes to the multidisciplinary team protocol made in early 2021.

Interplay of atherosclerosis and medial degeneration in human ascending aorta

The previous understanding has been that atherosclerosis tends to increase distally from the ascending aorta, but recent studies and practical experience have indicated that atherosclerosis occurs in the ascending aorta more than previously thought. Medial degeneration is linked to aortic aneurysms, dissection and dilatation and has been related to increased mortality. There is a lack of data on the coexistence of atherosclerosis and medial degeneration in the ascending aorta and its outcome to clinical morbidity and mortality. Earlier studies have shown coexisting atherosclerosis and medial degeneration as significant risk indicators for coronary and cerebrovascular events. We aimed to analyze aortic specimens classified according to the consensus documents of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology particularly the comparison of variable morphological features with the atherosclerotic grade to gain more data about the coexistence of atherosclerosis and medial degeneration. We evaluated 217 specimens of human ascending aorta resected at Tampere University Heart Hospital because of aortic aneurysm, dissection or dilatation. None of the samples contained normal aortic morphology; atherosclerosis was found in a total of 75.8% of the samples and medial degeneration in all the samples. The present study is mostly in agreement with earlier research regarding the prevalence of different histological findings, even though a higher prevalence of atherosclerosis was found compared with most studies. There was no statistically significant association between atherosclerosis and medial degeneration, but a higher atherosclerotic grade was significantly associated with the presence of smooth muscle cell nuclei loss, smooth muscle cell disorganisation, elastic fibre thinning and medial fibrosis. Our study reinforces the perception that atherosclerotic lesions significantly occur in the ascending aorta and coexist with individual components of the medial degeneration.

National retrospective registry survey on the epidemiology of sarcoidosis in Finland 2002−2022

BackgroundThe prevalence of sarcoidosis is known to be high in the Nordic countries. There are no recent research data on the incidence or prevalence of sarcoidosis in Finland. Our aim...

Genetic testing and new variants in diagnosis of congenital ichthyoses.

The aim of this study was to evaluate how diagnostic practice in congenital ichthyoses has evolved during the years 2000-2020 and what kind of gene variants of congenital ichthyosis have been found. The study cohort of this register-based research consisted of a total of 88 patients, whose diagnostic testing was conducted, and ichthyosis diagnoses set at the Department of Dermatology and the Department of Clinical Genetics at Tampere University Hospital during the years 2000-2020. Diagnosis of ichthyosis was confirmed with genetic testing in 33 cases, and with conventional diagnostic methods, such as clinical findings, skin biopsy and family history of ichthyoses, in 55 cases. We observed four novel variants in patients with the clinical diagnoses of congenital ichthyoses. When genetic testing became available, it was offered primarily to patients with severe forms of ichthyosis. During the study period next-generation sequencing became the genetic testing method of choice providing new opportunities in diagnostics.

Robotic-assisted versus conventional laparoscopic surgery for endometrial cancer: long-term results of a randomized controlled trial

BackgroundRobotic-assisted laparoscopic surgery (RALS) has become a widely and increasingly used modality of minimally invasive surgery in the treatment of endometrial cancer (EC). Due to its technical advantages, RALS offers benefits, such as a lower rate of conversions compared to conventional laparoscopy (CLS). Yet, data on long-term oncological outcomes after RALS is scarce and based on retrospective cohort studies only. ObjectivesThis study aimed to assess overall survival (OS), progression-free survival (PFS), and long-term surgical complications in EC patients randomly assigned to RALS or CLS. Study DesignThis randomized controlled trial was conducted at the Department of Gynecology and Obstetrics of Tampere University Hospital, Finland. Between 2010 and 2013, 101 patients with low-grade EC scheduled for minimally invasive surgery were randomized preoperatively 1:1 either to RALS or CLS. All patients underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. A total of 97 patients (49 in the RALS group and 48 in the CLS group) were followed up for a minimum of 10 years. Survival was analyzed using Kaplan-Meier curves, log-rank test, and Cox proportional hazard models. Binary logistic regression analysis was used to analyze risk factors for trocar site hernia. ResultsIn the multivariable regression analysis, OS was favorable in the RALS group (HR 0.39; 95% CI, 0.15–0.99, p=.047) compared to the CLS group. There was no difference in PFS (log-rank test, p=.598). The three-, 5- and 10-year OS were 98.0% (95% CI, 94.0–100) vs. 97.9% (93.8–100), 91.8% (84.2–99.4) vs. 93.7% (86.8–100), and 75.5% (64.5–87.5) vs. 85.4% (75.4–95.4) in the CLS and the RALS group, respectively. Trocar site hernia developed more often in the RALS group compared to the CLS group 18.2% vs. 4.1% (OR 5.42, 95% CI, 1.11–26.59, p=.028). The incidence of lymphocele, lymphedema, or other long-term complications did not differ between the groups. ConclusionsThe results of this RCT suggest a minor OS benefit in EC after RALS compared to CLS. Hence, the use of RALS in the treatment of EC seems safe, but larger RCTs are needed to confirm the potential survival benefit of RALS. No alarming safety signals were detected in the RALS group since the rate of long-term complications differed only in the incidence of trocar site hernia.

The proximal extension of acute type A aortic dissection is associated with ascending aortic wall degeneration.

Aortic root involvement during acute type A aortic dissection (ATAAD) may depend on ascending aortic wall degeneration. Surgical decision-making for extended resection of the aortic root is clinically made without histopathology. The aim of the study was to investigate whether the degree of degeneration of the ascending aortic wall found in patients with ATAAD is associated with the aortic root involvement. Collectively, 141 consecutive patients undergoing ATAAD surgery at Tampere University Heart Hospital were investigated. The ascending aortic wall resected in surgery was processed for 11 different variables that describe medial and adventitial degeneration. In addition, atherosclerosis and inflammation were separately evaluated. Patients undergoing aortic root replacement were compared with those with supracoronary reconstruction of the ascending aorta with/without aortic valve surgery (root-sparing surgery) during a mean 4.9-year follow-up. Aortic root replacement together with the ascending aortic replacement was performed in 39% of the patients (n=55). The mean age for all patients was 65 years [standard deviation (SD 13)]. Many patients with aortic root replacement had moderate to severe aortic valve regurgitation (85.5%). Most of the patients with aortic root-sparing surgery included a supracoronary tube prosthesis (89.5%), while nine patients also had aortic valve replacement. The degree of mucoid extracellular matrix accumulation was more prominent in patients with aortic root replacement compared to patients with root-sparing surgery (2.1 SD 0.4 vs. 1.9 SD 0.4, P=0.04, respectively). During follow-up, there were 52 deaths among patients (log rank P=0.79). Histopathology of the ascending aorta during ATAAD reveals distinctive aortic wall degeneration in patients with aortic root involvement vs. not. The degree of mucoid extracellular matrix accumulation assessed postoperatively is associated with the choice of surgical procedure in many patients.

Correlation of cerebral small vessel disease burden with outcome after lower extremity amputation

AimsThis study assessed whether changes associated with cerebral small vessel disease (CSVD) evaluated from head computed tomography (CT) images captured for non-related clinical purposes predict overall survival (OS), leg salvage (LS), and amputation-free survival (AFS) after lower extremity amputation (LEA). MethodsWe retrospectively included a cohort of 240 patients who had undergone a lower extremity amputation in Tampere University Hospital between the years 2007 and 2020 and had a head CT scan (within one year before amputation). A neuroradiologist graded the white matter lesions (WMLs) and reported infarcts, and the latter's effects on OS, LS, and AFS were evaluated. ResultsAltogether, 162 (67.5 %) and 91 (38.1 %) patients had WMLs and infarcts, respectively. Mild/moderate (HR 1.985, CI 95 % 1.317–2.992) and severe (HR 2.259, CI 95 % 1.501–3.399) WMLs and infarcts (HR 1.413, CI 95 % 1.029–1.940) were associated with inferior OS. After a minor amputation, mild/moderate (HR 2.012, CI 95 % 1.054–3.843) and severe (HR 3.879, CI 95 % 2.096–7.180) WMLs were similarly associated with inferior AFS. ConclusionsOverall, WML and infarcts detected on head CT scans were associated with impaired OS after LEA and AFS after minor LEA. Evaluation of CSVD could provide useful prognostic information for clinicians.

Information and Lived Religion in Inquisition Records from Medieval Languedoc (15.12.2023, Tampere University)

Information and Lived Religion in Inquisition Records from Medieval Languedoc (15.12.2023, Tampere University)

Enhancing left ventricular segmentation in echocardiography with a modified mixed attention mechanism in SegFormer architecture

Echocardiography is a key tool for the diagnosis of cardiac diseases, and accurate left ventricular (LV) segmentation in echocardiographic videos is crucial for the assessment of cardiac function. However, since semantic segmentation of video needs to take into account the temporal correlation between frames, this makes the task very challenging. This article introduces an innovative method that incorporates a modified mixed attention mechanism into the SegFormer architecture, enabling it to effectively grasp the temporal correlation present in video data. The proposed method processes each time series by encoding the image input into the encoder to obtain the current time feature map. This map, along with the historical time feature map, is then fed into a time-sensitive mixed attention mechanism type of convolution block attention module (TCBAM). Its output can serve as the historical time feature map for the subsequent sequence, and a combination of the current time feature map and historical time feature map for the current sequence. The processed feature map is then input into the Multilayer Perceptron (MLP) and subsequent networks to generate the final segmented image. Through extensive experiments conducted on two different datasets: Hamad Medical Corporation, Tampere University, and Qatar University (HMC-QU), Cardiac Acquisitions for Multi-structure Ultrasound Segmentation (CAMUS) and Sunnybrook Cardiac Data (SCD), achieving a Dice coefficient of 97.92 % on the SCD dataset and an F1 score of 0.9263 on the CAMUS dataset, outperforming all other models. This research provides a promising solution to the temporal modeling challenge in video semantic segmentation tasks using transformer-based models and points out a promising direction for future research in this field.

A Case Study on the Operational Performance Evaluation of a Manufacturing Process and System (MaPS) Sustainability Analysis Tool for Engineering Education

As the future product and process design decision-makers, students in engineering should have knowledge of sustainability and its application in industry. However, educators are challenged in training students in these concepts. Existing analysis tools are deficient in supporting sustainability assessment by nonexperts. To address this gap, the Manufacturing Process and System (MaPS) Sustainability Analysis tool was developed under the Constructionism in Learning: Sustainable Life Cycle Engineering (CooL:SLiCE) project. The technical aspects of developing a framework and its associated proof-of-concept MaPS Sustainability Analysis tool are reported in a separate study. Herein, the educational aspects of the MaPS Sustainability Analysis tool and its operational performance in terms of ease of use and usefulness to assess its suitability for the classroom are investigated. Undergraduate and graduate engineering students at Tampere University and Oregon State University were recruited to use and evaluate the tool. Through application of the Technology Acceptance Model (TAM), it was determined that the 24 study participants found the tool easy to use and useful in analyzing product design, manufacturing process, and supply chain sustainability performance. To move this proof of concept toward general use, key software operational characteristics and a GUI should be investigated to improve efficiency, effectiveness, satisfaction, and learnability of the MaPS Sustainability Analysis tool.

Risk factors for uveitis in a Finnish sarcoid population.

To evaluate possible risk factors for uveitis among Finnish sarcoidosis patients. Patient charts of patients with sarcoidosis, with (n = 97) or without (n = 255) uveitis, and with a comprehensive eye examination from January 2014 to January 2021 at Tays Eye Centre, Tampere University Hospital, Finland were studied. Sarcoidosis patients with uveitis had higher rate of lymphocytopenia (43% vs. 29%, p = 0.041) and lower serum lysozyme levels (2.0 mg/L vs. 2.3 mg/L, p = 0.049; 95% CI, -0.692 to -0.002). Lysozyme level or lymphocytopenia did not have a statistically significant effect on the probability of uveitis in a binary logistic regression analysis. No other differences in the potential risk factors with p-values ≤0.05 were found, including bilateral hilar lymphadenopathy, serum angiotensin-converting enzyme (ACE) levels, sex, age and history of smoking. Lymphocytopenia and lower serum lysozyme levels present as possible risk factors for uveitis among patients with sarcoidosis. Systematic measurement of lymphocyte and lysozyme levels in sarcoidosis is needed to further understand their role as potential risk factors.

Factors associated with hospital revisitation within 7 days among patients discharged at triage: a case-control study.

Existing data are limited for determining the medical conditions best suited for an emergency department (ED) redirection strategy in a heterogeneous, nonurgent patient population. The aim was to establish factors associated with hospital revisits within 7 days among patients discharged or redirected by a triage team. An observational single-center case-control study was conducted at the Tampere University Hospital ED for the full calendar year of 2019. The cases comprised unplanned hospital revisits within 7 days of being discharged or redirected by triage, while the controls were discharged or redirected but did not revisit. The primary outcome was an unplanned hospital revisit within 7 days. A subgroup analysis was conducted for revisits leading to hospitalization. Basic demographics, comorbidities before triage, and triage visit characteristics were considered as predictive factors for the revisit. A backward stepwise conditional logistic regression analysis was performed. During the calendar year of 2019, there were a total of 92 406 ED visits. Of these, 7216 (7.8%) visits were discharged or redirected by triage, and 6.5% (n = 467) of all these patients revisited. Of the revisiting patients, 25% (n = 117) were hospitalized. In multivariable analysis, higher age was associated with both revisitation [odds ratio (OR): 1.01, 95% confidence interval (CI): 1.00-1.02] and hospitalization (OR: 1.02, 95% CI: 1.00-1.04). Furthermore, using other visits as a reference, abdominal pain was associated with revisitation and hospitalization (OR: 3.70, 95% CI: 2.24-6.11 and OR: 5.28, 95% CI: 2.08-13.4, respectively). Higher age and abdominal pain were associated with hospital revisitation and hospitalization within 7 days among patients directly discharged or redirected by the triage team. Regardless of the triage system in use, there might be patient groups that should be evaluated more cautiously if a triage-based discharge or redirection strategy is to be considered.

Unemployed Biotechnology Graduates: Need of Modernization of Education and Training in Tunisia

Biotechnology is a priority higher education and economical sector for Tunisia. However, there is an ever-increasing unemployment rate of the biotechnology graduates in the country. Indeed, this huge problem warrants immediate attention and necessary actions from various stakeholders. This study presents the results of a benchmarking visit, which was arranged by Tampere University of Applied Sciences (TAMK) in Finland, as part of 'BiotechTunisia' Erasmus+ project entitled ‘Modernization of Biotechnology training for better employability of graduates in Tunisia’. There are four Tunisian and three European partners in this project that leads to modernization of skills of teachers, researchers, and students to improve employment and opportunities for entrepreneurship of young graduates in Tunisia. The project aims to modernize the education and the scientific research in the biotechnology field. During this benchmarking visit, Tunisian partners attended seminars, workshops, visited advanced learning facilities, participated to many group discussions, learned about teacher tutoring concept, and student counselling method. Delegation learned about new learning methodologies, pedagogy, and soft skills of students, which could be replicated in their home country education system. The benchmarking visit is seen as an opportunity for Tunisian partners to transfer the good practices from Finland to their home country. Tunisian delegates agree that the learnings could have a positive impact in their education system in coming years towards modernization of education and training of biotechnology students.