Room temperature photon-counting lidar at 3 µm.

A midinfrared single-photon-counting lidar at 3 µm is presented. The 3 µm photons were upconverted to 790 nm in a periodically poled rubidium-doped KTiOPO4 crystal through intracavity mixing inside a 1064 nm Nd:YVO4 laser and detected using a conventional silicon single-photon avalanche detector (SPAD). The lidar system could distinguish 1 mm deep features on a diffusely reflecting target, limited by the SPAD and time-tagging electronics. This technique could easily be extended to longer wavelengths within the transparency of the nonlinear crystal.

Bandwidth and stability of the stochastic parallel gradient descent algorithm for phase control in coherent beam combination.

The bandwidth and stability limits of the stochastic parallel gradient descent (SPGD) algorithm used for coherent beam combination is investigated by deriving an analytical model for the phase control loop. The analytical model is compared to experiments and numerical simulations using a laboratory tiled coherent beam combination setup. The setup consisted of four sub-beams from fiber-optic collimators and used a backreflected signal as feedback. A rotating phase plate was used to induce phase disturbances into the system. The analytical model compared favorably to numerical simulations and experiments as well as to other studies found in the literature. The results can be used to provide an estimate of the achievable phase control bandwidth of coherent beam combination systems using SPGD as a control algorithm.

High resolution and sensitivity up-conversion mid-infrared photon-counting LIDAR.

A single-photon-counting mid-infrared LIDAR is presented. 2.4 µm mid-infrared photons were up-converted to 737 nm by intra-cavity mixing in a periodically poled rubidium-doped KTiOPO4 crystal inside a Nd:YVO4 laser. The up-converted photons were detected by a Si single-photon avalanche photodiode (SPAD). A temporal resolution of 42 ps and a dark count rate of 500 Hz were achieved, limited by the SPAD and ambient light leakage. It allowed for detection of two targets separated by only a few millimeters. This technique is easily extendable to longer wavelengths, limited primarily by the nonlinear crystal transparency.

Cognitive ability in young adulthood predicts risk of early-onset dementia in Finnish men.

OBJECTIVE: To test if the Finnish Defence Forces Basic Intellectual Ability Test scores at 20.1 years predicted risk of organic dementia or Alzheimer disease (AD). METHODS: Dementia was defined as inpatient or outpatient diagnosis of organic dementia or AD risk derived from Hospital Discharge or Causes of Death Registers in 2,785 men from the Helsinki Birth Cohort Study, divided based on age at first diagnosis into early onset (<65 years) or late onset (≥65 years). The Finnish Defence Forces Basic Intellectual Ability Test comprises verbal, arithmetic, and visuospatial subtests and a total score (scores transformed into a mean of 100 and SD of 15). We used Cox proportional hazard models and adjusted for age at testing, childhood socioeconomic status, mother's age at delivery, parity, participant's birthweight, education, and stroke or coronary heart disease diagnosis. RESULTS: Lower cognitive ability total and verbal ability (hazard ratio [HR] per 1 SD disadvantage >1.69, 95% confidence interval [CI] 1.01-2.63) scores predicted higher early-onset any dementia risk across the statistical models; arithmetic and visuospatial ability scores were similarly associated with early-onset any dementia risk, but these associations weakened after covariate adjustments (HR per 1 SD disadvantage >1.57, 95% CI 0.96-2.57). All associations were rendered nonsignificant when we adjusted for participant's education. Cognitive ability did not predict late-onset dementia risk. CONCLUSION: These findings reinforce previous suggestions that lower cognitive ability in early life is a risk factor for early-onset dementia.

APOE and aging-related cognitive change in a longitudinal cohort of men.

We examined associations between APOE major isoforms, rs405509 promoter and rs440446 intron-1 polymorphisms, and nonpathologic cognitive aging. Men from the Helsinki Birth Cohort Study took the Finnish Defence Forces Basic Intellectual Ability Test twice, at age 20.1 (n = 404) and 67.6 years (n = 247). APOE major isoforms did not associate with cognitive ability. In the APOE major isoform-adjusted analyses, the number of rs405509 minor alleles was associated with a higher cognitive ability total and verbal, arithmetic, and visuospatial subtest scores at 67.6 years (p-values < 0.004). In the analyses of cognitive change, the visuospatial subtest score increased across time in rs440446 minor allele carriers but decreased in noncarriers (p = 0.007). Associations in the APOE major isoform-stratified analyses were significant in the APOE ε3/3 homozygotes only. The APOE locus harbors additional modifying alleles, independent of APOE major isoforms that are associated with better preserved general cognitive ability in nondemented elderly men and change in visuospatial ability across 5 decades. These results suggest that at least 2 distinct mechanisms link the APOE locus with cognitive ability.

Sexual function in male long-term survivors of childhood acute lymphoblastic leukemia.

BACKGROUND: Infertility, poor semen quality, and gonadal dysfunction are well recognized long-term sequelae in male survivors of childhood acute lymphoblastic leukemia (ALL). However, few studies have investigated adult sexual functioning in these survivors. METHODS: The authors studied 52 male survivors of childhood ALL at a median age of 28.5 years (range, 25-38 years) ≥ 10 years after diagnosis. In addition, 56 men without a history of cancer were recruited for an age-matched control group. The participants completed the Derogatis Interview for Sexual Functioning self-report. To analyze predictive factors for sexual dysfunction, variables assessing sociodemographic background, antileukemia treatment, testicular size, laboratory variables from current serum and semen samples, self-reported depressive symptoms, and self-reported physical functioning were included in multiple regression analyses. RESULTS: ALL survivors had significantly poorer sexual functioning, as measured by the Derogatis Interview for Sexual Functioning self-report, compared with the control group. Survivors had a similar frequency of sexual fantasies, autoerotic acts, and full erection during these activities as the control group, but they had less frequent sexual activity with a sexual partner, poorer self-rated orgasms, and lower satisfaction with their sex life. Predictive factors for poorer sexual functioning were depressive symptoms, the absence of a relationship, and, to a lesser extent, testicular size as an indication of gonadal damage from childhood antileukemia therapy. Older survivors experienced a deeper decline in sexual functioning compared with men in the control group. CONCLUSIONS: Decline in sexual functioning at an early adult age can be regarded as 1 of the late effects of childhood cancer. Monitoring these survivors' sexual health is indicated. Cancer 2016;122:2268-76. © 2016 American Cancer Society.

[Update on Current Care Guidelines: Post-traumatic Stress Disorder]. / Kaypa Hoite-Suosituksen Paivitystiivistelma. Traumaperäinen stressihäiriö.

The updated Current Care Guidelines for ASD and PTSD recommend psychosocial support and careful monitoring for acute stress reaction (ASR) and acute stress disorder (ASD). If symptoms require, short focused cognitive-behavioral psychotherapy can be used for ASD. Medication is rarely necessary. Trauma-focused psychotherapeutic interventions are the first-line treatment for post-traumatic stress disorder (PTSD). Antidepressant medication is an effective second-line treatment. Psychotherapeutic interventions and medication should often be combined. Specific groups, such as children, the elderly, and military and peacekeeping personnel need tailored interventions.

Increased Body Adiposity and Serum Leptin Concentrations in Very Long-Term Adult Male Survivors of Childhood Acute Lymphoblastic Leukemia.

BACKGROUND: We evaluated the body composition and its association with hypogonadism in adult male long-term acute lymphoblastic leukemia (ALL) survivors. METHODS: The cohort included 49 long-term male ALL survivors and 55 age-matched healthy controls. Fat and lean mass was assessed by dual-energy X-ray absorptiometry; blood biochemistry was obtained for adipokines and testicular endocrine markers. RESULTS: As compared with controls, the ALL survivors (median age 29 years, range 25-38), assessed 10-28 years after ALL diagnosis, had higher percentages of body (p < 0.05) and trunk fat mass (p < 0.05), and a lower body lean mass (p < 0.001). Survivors had significantly higher levels of leptin and adiponectin and lower levels of insulin-like growth factor-binding protein 3. Body fat mass and percent fat mass correlated with serum leptin and sex hormone-binding globulin (SHBG) levels. Altogether, 15% of the ALL survivors and 9% of age-matched controls were obese (BMI ≥ 30). Obese survivors more often had hypogonadism, had received testicular irradiation, and needed testosterone replacement therapy compared to nonobese survivors. CONCLUSION: At young adulthood, long-term male ALL survivors have significantly increased body adiposity despite normal weight and BMI. Potential indicators of increased adiposity included high leptin and low SHBG levels. Serum testicular endocrine markers did not correlate with body adiposity.

Long-term psychosocial outcomes after intraoperative awareness with recall.

BACKGROUND: Posttraumatic stress disorder, a common psychiatric disorder in the general population, may follow a traumatic experience of awareness with recall during general anesthesia. METHODS: We conducted a matched cohort design with 9 subjects after intraoperative awareness with recall during general anesthesia. A psychiatric diagnostic interview and questionnaire were performed on 9 matched controls and 9 subjects, a median of 17.2 years from their documented awareness episode. The subjects and the matched controls completed a battery of questionnaires related to psychosocial well-being, after which they participated in a diagnostic Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders. RESULTS: Patients with awareness did not seem to differ from their matched controls in subsequent psychosocial outcome, psychiatric morbidity, or quality of life. CONCLUSIONS: We found no indication that intraoperative awareness with recall had any deleterious long-term effects on patients' psychosocial outcome.

Suicides among military conscripts between 1991-2007 in Finland--a descriptive replication study.

BACKGROUND: Suicide mortality in Finland particularly among young people remains high, compared with other European countries. Suicide is one of the leading causes of death among military conscripts in Finland. AIMS: In this record-based study, we investigated characteristics of all 48 suicides among Finnish conscripts during the period 1991-2007. METHODS: We collected and analyzed healthcare records during military service and medicolegal investigations (medicolegal autopsy) of suicide victims. RESULTS: Of the 48 suicides, 36 (75%) were completed during leave days. Shooting, hanging and jumping were the most common methods used; a service gun was used in four (14%) of the 29 shooting cases. One-third of the victims had been in contact with military healthcare during the week preceding their suicide, and two-thirds during the preceding month. CONCLUSIONS: When conscripts use healthcare services, suicidal thoughts should be actively asked of those conscripts with history of any risk factors for suicidal behavior.

Otorhinolaryngological patient injuries in Finland.

OBJECTIVES/HYPOTHESIS: Otorhinolaryngology (ORL) is considered a specialty associated with few serious patient injuries. Research data that support this belief are, however, scarce. We analyzed claims associated with ORL to determine the number of Finnish cases and the possible common denominators. STUDY DESIGN: Register study of ORL cases in the Patient Insurance Centre (PIC), the Regional State Administrative Agencies (RSAA), and the National Supervisory Authority for Welfare and Care (Valvira) during the years 2004 to 2008. METHODS: These three agencies are the main actors in the field of patient injury in Finland. We analyzed compensated ORL patient injury cases from the PIC and cases associated with the ORL specialty for Valvira and RSAA from 2004 to 2008 and surveyed patient treatment files, statements from specialists, and compensation decisions. RESULTS: Injuries were usually associated with operations; three patients who experienced injuries during these procedures died. Common ORL operations such as tonsillectomy, septoplasty, and paranasal sinus surgery were most often associated with compensated injuries. Serious injuries were few, with a total of 110 out of 422 (26.1%) claims compensated by the PIC. Of the 110 compensated cases, 30 (27.3%) were related to tumor surgery. The most usual compensated case had iatrogenic nerve injury affecting the facial or trigeminal nerves. Of the compensated cases, 79 (71.8%) were treated by specialists, 15 (13.6%) by residents, and the rest by other medical professionals. CONCLUSIONS: Patient injuries in ORL are seldom severe and are strongly associated with surgery. A typical compensated injury was one that occurred in a central hospital during working hours. LEVEL OF EVIDENCE: N/A.

Predictors of completing compulsory military service among men who have received a temporary exemption from service.

Military or alternative civilian service is obligatory for all Finnish male citizens. About 70% of each annual age cohort carry out this service. The rest are given either a permanent or temporary exemption from military or civil service. The aim of this study was to investigate predictors associated with completing military service after having once been given a temporary exemption from service. The study sample consisted of 245 men who were exempted temporarily from service. The data were collected through questionnaires and register data. During the 5-year follow-up, only 21 men had completed the service following a previous temporary exemption. Completing military service was associated with an exemption based on a somatic diagnosis, having no suicidal ideation in the past, no history of parental divorce, and having physical exercise at least once a week. The results of this study support the idea of preferring to give a permanent exemption instead of a temporary exemption. However, this trend runs the risk of discharging men who could be capable of later completing the service successfully.

Potential gonadotoxicity of treatment in relation to quality of life and mental well-being of male survivors of childhood acute lymphoblastic leukemia.

PURPOSE: Results of earlier studies concerning quality of life (QOL) and psychosocial coping of childhood acute lymphoblastic leukemia (ALL) survivors have been inconsistent. Some treatments for ALL affect testicular function and we hypothesized that this may influence the QOL and psychosocial coping of male survivors. Our aims were to assess the QOL and psychosocial coping of male long-term ALL survivors and to evaluate the effect of both testosterone level and the potential gonadotoxicity of various treatment modalities on them. METHODS: Fifty-two male long-term survivors treated for childhood ALL at Helsinki University Hospital between 1970 and 1995, and 56 age- and gender-matched controls were studied. The participants completed a self-report questionnaire including questions on sociodemographics, RAND-36 to assess QOL, General Health Questionnaire and Beck Depression Inventory to assess mental well-being, and CAGE to assess alcohol abuse/dependence. Testosterone levels were measured, and treatment details were reviewed. RESULTS: ALL survivors in general had QOL close to that of controls or population norms. Decreased QOL was seen in physical health-related subscales, and vitality and emotional well-being were lowered in survivors with more gonadotoxic treatment modalities. No single independent factor in the treatment or the level of testosterone could, however, be found to clearly explain the variation in QOL scores of the survivors. Mental well-being of most of the survivors was good, but a subgroup with previous cyclophosphamide treatment or testicular irradiation showed increased risk of psychiatric morbidity. CONCLUSIONS: The male ALL survivors generally cope well, but increased focus on specific risk groups seems to be necessary. Further studies using patient interviews would probably point out issues concerning the QOL and psychosocial coping of ALL survivors, which may not emerge in these screening studies. IMPLICATIONS FOR CANCER SURVIVORS: In general, more attention should be paid for physical functioning of childhood ALL survivors. Increased focus should also be on QOL and mental well-being of survivors with more gonadotoxic treatment modalities and those whose diagnosis was made in their adolescence.

Early life origins cognitive decline: findings in elderly men in the Helsinki Birth Cohort Study.

OBJECTIVES: To examine whether the adverse effects of slow prenatal and postnatal growth on cognitive function persist to old age and predict age related cognitive decline. DESIGN AND SETTING: A longitudinal birth cohort study of men born in Helsinki, Finland 1934-44. PARTICIPANTS: Nine-hundred-thirty-one men of the Helsinki Birth Cohort Study, with detailed data on growth from birth to adulthood, aged 20.1 (SD = 1.4) at the first and 67.9 (SD = 2.5) years at the second cognitive testing. MAIN OUTCOME MEASURES: The Finnish Defense Forces Basic Intellectual Ability Test assessed twice over nearly five decades apart. RESULTS: Lower weight, length and head circumference at birth were associated with lower cognitive ability at 67.9 years (1.04-1.55 points lower ability per each standard deviation [SD] unit decrease in body size, 95% Confidence Interval [95%CI]: 0.05 to 2.72) and with cognitive decline after 20.1 years (0.07-0.11 SD decline over time per each SD decrease in body size, 95%CI:0.00 to 0.19). Men who were born larger were more likely to perform better in the cognitive ability test over time (1.22-1.43 increase in odds to remain in the top relative to the lower two thirds in ability over time per each SD increase in body size, 95%CI:1.04 to 1.79) and were more resilient to cognitive decline after 20.1 years (0.69 to 0.76 decrease in odds to decline from than remain in the top third of ability over time per each SD increase in body size, 95%CI:0.49 to 0.99). Slower growth between birth and two years in weight, height and body mass index was associated with lower cognitive ability at 67.9 years, but not with cognitive decline. CONCLUSIONS: Poorer lifetime cognitive ability is predicted by slower growth before and after birth. In predicting resilience to age related cognitive decline, the period before birth seems to be more critical.

Cognitive ability and decline after early life stress exposure.

We examined the effects of early life stress on cognitive ability and decline among men of the Helsinki Birth Cohort Study, 10% of whom were separated temporarily (mean age at separation = 4.1 years) from their parent(s) during World War II. The men underwent the Finnish Defense Forces Basic Intellectual Ability Test twice, at 20 years and retest at 70 years. Compared with the men without childhood separation and matched for year of birth (n = 186), men separated from their parents (n = 93) scored lower by 5.5 (95% confidence interval [CI], -9.2 to -1.7), 4.2 (95% CI, -8.1 to -0.3), 3.1 (95% CI, -7.0 to 0.8), and 4.5 (95% CI, -10.5 to -1.4) standardized points (SD = 15) on verbal, visuospatial, arithmetic, and general cognitive ability, respectively, at 70 years. Longer duration of separation was associated with lower test scores. Though early life stress was also associated significantly with weaker cognitive performance at the ages 20 and 70 years, it was not associated with cognitive decline over the 50-year period within this sample.

Stroke is predicted by low visuospatial in relation to other intellectual abilities and coronary heart disease by low general intelligence.

BACKGROUND: Low intellectual ability is associated with an increased risk of coronary heart disease and stroke. Most studies have used a general intelligence score. We studied whether three different subscores of intellectual ability predict these disorders. METHODS: We studied 2,786 men, born between 1934 and 1944 in Helsinki, Finland, who as conscripts at age 20 underwent an intellectual ability test comprising verbal, visuospatial (analogous to Raven's progressive matrices) and arithmetic reasoning subtests. We ascertained the later occurrence of coronary heart disease and stroke from validated national hospital discharge and death registers. RESULTS: 281 men (10.1%) had experienced a coronary heart disease event and 131 (4.7%) a stroke event. Coronary heart disease was predicted by low scores in all subtests, hazard ratios for each standard deviation (SD) lower score ranging from 1.21 to 1.30 (confidence intervals 1.08 to 1.46). Stroke was predicted by a low visuospatial reasoning score, the corresponding hazard ratio being 1.23 (95% confidence interval 1.04 to 1.46), adjusted for year and age at testing. Adjusted in addition for the two other scores, the hazard ratio was 1.40 (1.10 to 1.79). This hazard ratio was little affected by adjustment for socioeconomic status in childhood and adult life, whereas the same adjustments attenuated the associations between intellectual ability and coronary heart disease. The associations with stroke were also unchanged when adjusted for systolic blood pressure at 20 years and reimbursement for adult antihypertensive medication. CONCLUSIONS: Stroke is predicted by low visuospatial reasoning scores in relation to scores in the two other subtests. This association may be mediated by common underlying causes such as impaired brain development, rather than by mechanisms associated with risk factors shared by stroke and coronary heart disease, such as socio-economic status, hypertension and atherosclerosis.

Hypertensive disorders in pregnancy and cognitive decline in the offspring up to old age.

OBJECTIVE: We tested whether maternal hypertensive disorders in pregnancy predict age-related change in cognitive ability in the offspring up to old age. METHODS: Using mothers' blood pressure and urinary protein measurements from the maternity clinics and birth hospitals, we defined normotensive or hypertensive pregnancies in mothers of 398 men, who participated in the Helsinki Birth Cohort 1934-1944 Study. The men underwent the Finnish Defence Forces basic ability test twice: first during compulsory military service at age 20.1 (SD = 1.4) years and then in a retest at age 68.5 (SD = 2.9) years. The test yields a total score and subscores for tests measuring verbal, arithmetic, and visuospatial reasoning. RESULTS: Men born after pregnancies complicated by a hypertensive disorder, compared with men born after normotensive pregnancies, scored 4.36 (95% confidence interval, 1.17-7.55) points lower on total cognitive ability at 68.5 years and displayed a greater decline in total cognitive ability (2.88; 95% confidence interval, 0.07-5.06) after 20.1 years. Of the subscores, associations were strongest for arithmetic reasoning. CONCLUSION: Maternal hypertensive disorders in pregnancy predict lower cognitive ability and greater cognitive decline up to old age. A propensity to lower cognitive ability and decline up to old age may have prenatal origins.

Laser guiding of Tesla coil high voltage discharges.

We have investigated the guiding and triggering of discharges from a Tesla coil type 280 kHz AC high voltage source using filaments created by a femtosecond Terawatt laser pulse. Without the laser the discharges were maximum 30 cm long. With the laser straight, guided discharges up to 110 cm length were detected. The discharge length was limited by the voltage amplitude of the Tesla coil.

Hypertensive disorders in pregnancy and intellectual abilities in the offspring in young adulthood: the Helsinki Birth Cohort Study.

BACKGROUND: Hypertensive disorders may affect the fetal developmental milieu and thus hint at mechanisms by which prenatal adversity associates with poorer intellectual ability in subsequent life. AIM: We tested if hypertensive disorders in pregnancy are associated with intellectual ability in the offspring in young adulthood and if any potential associations between hypertensive disorders and intellectual abilities differ according to length of gestation, birth-weight, parity, and childhood socio-economic background. METHODS: Using mothers' blood pressure and urinary protein measurements at maternity clinics and birth hospitals, we defined normotensive or hypertensive pregnancies in mothers of 1,196 men who participated in the Helsinki Birth Cohort 1934-1944 Study. At age 20 years the men completed a test on intellectual abilities during compulsory military service. RESULTS: Participants born after pregnancies complicated by hypertensive disorders scored lower on intellectual abilities compared to those born after normotensive pregnancies. The effects of hypertensive disorders were most obvious in men born preterm or after a primiparous pregnancy and in men of higher childhood socio-economic background. CONCLUSION: Hypertensive disorders in pregnancy are, albeit weakly, associated with lower intellectual abilities in the offspring. These findings are compatible with the concept of adverse fetal 'programming' by a suboptimal prenatal environment.

Psychosocial factors associated with suicidal ideation among young men exempted from compulsory military or civil service.

AIMS: The aim of this study was to identify factors associated with suicidal ideation among young men exempted from compulsory military or civil service in Finland. METHODS: The study involved a total of 356 men exempted from military or civil service. The research data were collected using questionnaires and register data. RESULTS: One third of the young men exempted from compulsory military or civil service reported serious suicidal ideation. Of the men with serious suicidal ideation, one third had attempted suicide. Various childhood adversities and current stressful life events and problems were associated with suicidal ideation. Multivariate logistic regression analysis showed that the following factors were independently associated with suicidal ideation: maternal alcohol-related problems, changes in the family, discord with the boss over the past 12 months, and lack of social support. Accumulation of problems predicted suicidal ideation. CONCLUSIONS: Men exempted from compulsory military or civil service comprise an important target group in the prevention of suicide. In order to prevent suicidal behaviour among young men at risk, it is important to address the significance of social support and relationships, and likewise to be aware of early risk indicators such as maternal alcohol-related problems.