Maritime transportation in the Gulf of Finland in 2007 and in 2015

The Gulf of Finland is said to be one of the densest operated sea areas in the world. It is a shallow and economically vulnerable sea area with dense passenger and cargo traffic of which petroleum transports have a share of over 50 %. The winter conditions add to the risks of maritime traffic in the Gulf of Finland. It is widely believed that the growth of maritime transportation will continue also in the future. The Gulf of Finland is surrounded by three very different national economies with, different maritime transportation structures. Finland is a country of high GDP/per capita with a diversified economic structure. The number of ports is large and the maritime transportation consists of many types of cargoes: raw materials, industrial products, consumer goods, coal and petroleum products, and the Russian transit traffic of e.g. new cars and consumer goods. Russia is a large country with huge growth potential; in recent years, the expansion of petroleum exports has lead to a strong economic growth, which is also apparent in the growth of maritime transports. Russia has been expanding its port activities in the Gulf of Finland and it is officially aiming to transport its own imports and exports through the Russian ports in the future; now they are being transported to great extend through the Finnish, Estonian and other Baltic ports. Russia has five ports in the Gulf of Finland. Estonia has also experienced fast economic growth, but the growth has been slowing down already during the past couples of years. The size of its economy is small compared to Russia, which means the transported tonnes cannot be very massive. However, relatively large amounts of the Russian petroleum exports have been transported through the Estonian ports. The future of the Russian transit traffic in Estonia looks nevertheless uncertain and it remains to be seen how it will develop and if Estonia is able to find replacing cargoes if the Russian transit traffic will come to an end in the Estonian ports. Estonia’s own import and export consists of forestry products, metals or other raw materials and consumer goods. Estonia has many ports on the shores of the Gulf of Finland, but the port of Tallinn dominates the cargo volumes. In 2007, 263 M tonnes of cargoes were transported in the maritime traffic in the Gulf of Finland, of which the share of petroleum products was 56 %. 23 % of the cargoes were loaded or unloaded in the Finnish ports, 60 % in the Russian ports and 17 % in the Estonian ports. The largest ports were Primorsk (74.2 M tonnes) St. Petersburg (59.5 M tonnes), Tallinn (35.9 M tonnes), Sköldvik (19.8 M tonnes), Vysotsk (16.5 M tonnes) and Helsinki (13.4 M) tonnes. Approximately 53 600 ship calls were made in the ports of the Gulf of Finland. The densest traffic was found in the ports of St. Petersburg (14 651 ship calls), Helsinki (11 727 ship calls) and Tallinn (10 614 ship calls) in 2007. The transportation scenarios are usually based on the assumption that the amount of transports follows the development of the economy, although also other factors influence the development of transportation, e.g. government policy, environmental aspects, and social and behavioural trends. The relationship between the development of transportation and the economy is usually analyzed in terms of the development of GDP and trade. When the GDP grows to a certain level, especially the international transports increase because countries of high GDP produce, consume and thus transport more. An effective transportation system is also a precondition for the economic development. In this study, the following factors were taken into consideration when formulating the future scenarios: maritime transportation in the Gulf of Finland 2007, economic development, development of key industries, development of infrastructure and environmental aspects in relation to maritime transportation. The basic starting points for the three alternative scenarios were: • the slow growth scenario: economic recession • the average growth scenario: economy will recover quickly from current instability • the strong growth scenario: the most optimistic views on development will realize According to the slow growth scenario, the total tonnes for the maritime transportation in the Gulf of Finland would be 322.4 M tonnes in 2015, which would mean a growth of 23 % compared to 2007. In the average growth scenario, the total tonnes were estimated to be 431.6 M tonnes – a growth of 64 %, and in the strong growth scenario 507.2 M tonnes – a growth of 93%. These tonnes were further divided into petroleum products and other cargoes by country, into export, import and domestic traffic by country, and between the ports. For petroleum products, the share of crude oil and oil products was estimated and the number of tanker calls in 2015 was calculated for each scenario. However, the future development of maritime transportation in the GoF is dependent on so many societal and economic variables that it is not realistic to predict one exact point estimate value for the cargo tonnes for a certain scenario. Plenty of uncertainty is related both to the degree in which the scenario will come true as well as to the cause-effect relations between the different variables. For these reasons, probability distributions for each scenario were formulated by an expert group. As a result, a range for the total tonnes of each scenario was formulated and they are as follows: the slow growth scenario: 280.8 – 363 M tonnes (expectation value 322.4 M tonnes)

Governmental Measures to Enhance the Finnish Innovation System to Respond to the Challenge of Mitigating Climate Change

Climate innovations, that cover both technological applications and process and service innovations, play a key role in climate change mitigation. The purpose of this study was to examine how the Finnish innovation system could be enhanced with governmental measures so that the diffusion of climate innovations could be speeded up. During the study, it became evident that the governmental measures need to support the whole innovation chain, which comprises of research, development, demonstration and deployment. Only this can lead to the successful birth and diffusion of low carbon innovations. The study found that the strengths of the Finnish innovation system are research and development, and the current national innovation policies strongly support these activities. However, these have been emphasised at the expense of the demonstration and deployment. Consequently, the biggest bottlenecks in the Finnish innovation landscape are the lack of pilot and demonstration projects and slow commercialisation, thus the high price of the innovation. To meet with the challenge, the government should firstly promote strict greenhouse gas emission reduction targets. This would boost up the innovation activities, which would also lower the prices of the innovations. To speed up the commercialisation process, measures that stimulate the domestic market, such as feed-in-tariffs and public procurements, are needed. Special attention should also be paid to the measures that could shift the traditional closed innovation chain towards open innovation. This means that the product development should involve experts from several fields such as the user and marketing experts to speed up the commercialisation. In addition, efficient innovation co-operation between both private and public sector is essential. Finally, as the domestic resources are not adequate for producing all the innovations needed, the domestic innovation activities should be focused on a few sectors, and at the same time promote efficient import policies.

The contributions of netnography in new product development

Netnography has been studying in various aspects (e.g. definitions of netnography, application of netngoraphy, conducting procedure…) within different industrial contexts. Besides, there are many studies and researches about new product development in various perspectives, such as new product development models, management of new product development project, or interaction between customers and new product design, and so on. However, the connection and the interaction between netnography and new product development have not been studied recently. This opens opportunities for the writer to study and explore unrevealed issues regarding to applying netnography in new product development. In term of the relation between netnography and new product development, there are numerous of matters need to be explored; for instance, the process of applying netnography in order to benefit to new product development, the involvement degree of netnography in new product development process, or eliminating useless information from netnography so that only crucial data is utilized, and so on. In this thesis, writer focuses on exploring how netnography is applied in new product development process, and what benefits netnography can contribute to the succeed of the project. The aims of this study are to understand how netnography is conducted for new product development purpose, and to analyse the contributions of netnography in the new product development process. To do so, a case-study strategy will be conducted with triple case studies. The case studies are chosen bases on many different criteria in order to select the most relevant cases. Eventually, the writer selected three case studies, which are Sunless tanning product project (HYVE), Listerine (NetBase), and Nivea co-creation and netnography in black and white deodorant. The case study strategy applied in this thesis includes four steps e.g. case selection, data collection, case study analysis, and generating the research outcomes from the analysis. This study of the contributions of netnography in the new product development process may be useful for the readers in many ways. It offers the fundamental knowledge of netnography market research method and basic understanding of new product development process. Additionally, it emphasizes the differences between netnography and other market research methods in order to explain the reasons why many companies and market research agents recently utilized netnography in their market research projects. Furthermore, it highlights the contributions of netnography in the new product development process in order to indicate the importance of netnography in developing new product. Thus, the potential readers of the study can be students, marketers, researchers, product developers, or business managers.

The effects of congestion in the daily management of a trauma hospital

Today’s healthcare organizations are under constant pressure for change, as hospitals should be able to offer their patients the best possible medical care with limited resources and, at the same time, to retain steady efficiency level in their operation. This is challenging, especially in trauma hospitals, in which the variation in the patient cases and volumes is relatively high. Furthermore, the trauma patient's care requires plenty of resources as most the patients have to be treated as single cases. Occasionally, the sudden increases in demand causes congestion in the operations of the hospital, which in Töölö hospital appears as an increase in the surgery waiting times within the yellow urgency class patients. An increase in the surgery waiting times may cause the diminution of the patient's condition, which also raises the surgery risks. The congestion itself causes overloading of the hospital capacity and staff. The aim of this master’s thesis is to introduce the factors contributing to the trauma process, and to examine the correlation between the different variables and the lengthened surgery waiting times. The results of this study are based on a three-year patient data and different quantitative analysis. Based on the analysis, a daily usable indicator was created in order to support the decision making in the operations management. By using the selected indicator, the effects of congestion can be acknowledged and the corrective action can also be taken more proactively.

New threats - old routines : bureaucratic adaptability in the security policy environment

Within the framework of state security policy, the focus of this dissertation are the relations between how new security threats are perceived and the policy planning and bureaucratic implementation that are designed to address them. In addition, this thesis explores and studies some of the inertias that might exist in the core of the state apparatus as it addresses new threats and how these could be better managed. The dissertation is built on five thematic and interrelated articles highlighting different aspects of when new significant national security threats are detected by different governments until the threats on the policy planning side translate into protective measures within the society. The timeline differs widely between different countries and some key aspects of this process are also studied. One focus concerns mechanisms for adaptability within the Intelligence Community, another on the policy planning process within the Cabinet Offices/National Security Councils and the third focus is on the planning process and how policy is implemented within the bureaucracy. The issue of policy transfer is also analysed, revealing that there is some imitation of innovation within governmental structures and policies, for example within the field of cyber defence. The main findings of the dissertation are that this context has built-in inertias and bureaucratic seams found in most government bureaucratic machineries. As much of the information and planning measures imply security classification of the transparency and internal debate on these issues, alternative assessments become limited. To remedy this situation, the thesis recommends ways to improve the decision-making system in order to streamline the processes involved in making these decisions. Another special focus of the thesis concerns the role of the public policy think tanks in the United States as an instrument of change in the country’s national security decision-making environment, which is viewed from the perspective as being a possible source of new ideas and innovation. The findings in this part are based on unique interviews data on how think tanks become successful and influence the policy debate in a country such as the United States. It appears clearly that in countries such as the United States think tanks smooth the decision making processes, and that this model with some adaptations also might be transferrable to other democratic countries.

Characterization of the filter media used in the dual media filter

The removal of organics from copper electrolyte solutions after solvent extraction by dual media filtration is one of the most efficient ways to ensure the clean electrolyte flow into the electrowinning. The clean electrolyte will ensure the good quality cathode plate production. Dual media filtration uses two layers of filter media for filtration as anthracite and garnet respectively. The anthracite layer will help the coalescing of the entrained organic droplets which will then float to the top of the filter, and back to the solvent extraction process. The garnet layer will catch any solids left in the electrolyte traveling through the filter media. This thesis will concentrate on characterization of five different anthracites in order to find some differences using specific surface area analysis, particle size analysis, and morphology analysis. These results are compared to the pressure loss values obtained from lab column tests and bed expansion behavior. The goal of the thesis was to find out if there were any differences in the anthracite which would make the one perform better than the other. There were no big differences found on any aspect of the particle characterization, but some found differences should be further studied in order to confirm the meaning of the porosity, surface area, intensity mean and intensity SD (Standard Deviation) on anthracites and their use in dual media filtration. The thesis work analyzed anthracite samples the way that is not found on any public literature sources, and further studies on the issue would bring more knowledge to the electrolyte process.

Business Intelligence -järjestelmä päätöksentekijöiden tukena asiantuntijayrityksessä

Työn tarkoituksena oli kartoittaa ja tehdä esiselvitys Business Intelligencen(BI) mahdollisuuksista tiedon hallinnassa. Tavoitteena oli selvittää, kuinka yritys voi tietotekniikan avulla paremmin hyödyntää operatiivisten järjestelmien tuottamia tietoja päätöksenteon tukena. Työssä sovellettiin konstruktiivista tutkimusotetta. Business Intelligence -teknologiaan tutustuttiin aluksi kirjallisuuden avulla. Ongelmaa lähestyttiin selvittämällä kohdeyrityksen tiedonhallinnan nykytila ja siihen liittyvät ongelmat. Käyttäjävaatimukset selvitettiin strukturoidulla kyselytutkimuksella. Lisäksi työn empiriaosuudessa tutustuttiin kahteen Business Intelligence -toteutukseen ja arvioitiin teknologian kypsyyttä suhteessa asiakasvaatimuksiin. Tiedonhallinnalta toivottiin joustavuutta ja helppokäyttöisyyttä.Erityisesti tutkimuksessa esiin nousi se, että tiedon jakeluun tarvitaan monipuolisempia vaihtoehtoja. Käyttäjät olivat valmiita hyödyntämään uusia BI-ominaisuuksia varsin laajalti. Haastavinta tutkimuksessa oli liiketoiminnan ymmärtäminen. Suurimmat BI-teknologian puutteet havaittiin loppukäyttäjän sovelluksissa. Tietovarastointiprosessiin liittyvä teknologia todettiin toimivaksi.

Järjestelmäintegraattorin strategisten kasvumahdollisuuksien analyysi

Tämän pro gradu -tutkielman tarkoituksena oli selvittää, mikä on sopivin kasvustrategia omia ohjelmistoja tuottavalle tietojärjestelmäintegraattorille. Tavoitteena oli, että tutkimustuloksia voidaan käyttää konkreettisesti toimeksiantajan, Informa Oy:n, strategisen suunnittelun tukena. Yrityksen strateginen analyysi käsitellään ulkoisten ja sisäisten tekijöiden suhteen. Samalla vertaillaan eri strategiatutkimuksen koulukuntia ja luodaan synteesiä näiden välille. Kolmas teoreettinen kokonaisuus on kasvustrategioiden tarkastelu sekä suuntaus-, että kilpailustrategioiden näkökulmasta. Empiirisen osan aineisto kerättiin kvalitatiivisen haastattelututkimuksen avulla, jossa selvitettiin toimeksiantajayrityksessä eri tehtävissä työskentelevien henkilöiden näkemyksiä. Lisäksi analysoitiinyrityksen teettämiä asiakaskyselyitä ja toimialan kehitystä käsitteleviä lehtiartikkeleita. Toimialan merkittävimmiksi kehitystrendeiksi todettiin kansainvälistyminen, verkostoituminen, keskittyminen, tuotteiden vakioituminen ja ohjelmistorajapintojen avoimuuden lisääntyminen. Informa Oy:lle esitetyistä toimenpide-ehdotuksista tärkeimmät liittyvät resurssien panostamiseen entistä enemmän ydinosaamisen ja ydintuotteiden kehittämiseen. Toimialan keskittyminen tarkoittaa sitä, että pienen lattiatason tietojärjestelmiä toimittavan yrityksen on päästävä mukaan kilpailusta voittajana selviäviin arvoketjuihin. Asiakassegmenteistä potentiaalisimmaksi kasvualueeksi todettiin pk-yritykset, sekä julkinen- ja palvelusektori.

Sairaanhoitajan opiskelijaohjaustaidot sekä ohjaajakoulutuksen tarve ja hyöty hoitotyön ohjatun harjoittelun oppimisympäristössä

A Nurse's Preceptorship Skills of Guiding Students and the Need for and Benefit from Preceptorship Education Guided practical training in units of health services is an essential part of the education of nurses. Nurses take care of a student's preceptorship during these periods, and their role in supporting a student's learning has been shown to be the most important factor in the learning environment of guided practical training. Education for preceptors in various educational units has been organized to develop their skills of guiding students. The aim of this study was both to investigate preceptors' skills of guiding students, the differences in the student guiding skills of those who have and who have not received preceptorship education and to describe their experiences of their own need for preceptorship education and of the benefit of such education. Any activities that promote a student's learning were included in nurses' preceptorship skills. On the basis of research knowledge, the preceptorship skills were divided into the following subdomains: proficiency in nursing; creation of a preceptorship relationship; planning of preceptorship; implementation of preceptorship; combination of theory and practice; and evaluation. The target group comprised all those nurses (n=128) in a hospital in southern Finland who guided future nurses. The material was gathered by means of a questionnaire with structural and open questions. Preceptorship skills were studied with the structured questions and the need for and benefit from preceptorship education with the open questions. The material was interpreted by means of a statistical SAS programme and qualitative content analysis. The preceptorship skills in all domains of guiding skills proved good. Those who had received preceptorship education had better skills than those who had not received such education in all domains but “creation of a preceptorship relationship”. However, the differences were not statistically significant. The need for preceptorship education was highest in evaluation and in setting goals for a student. To support these, the preceptors wanted information on education and students' requirements. Most of all, preceptorship education had benefited the creation of a preceptorship relationship and the implementation of evaluation. The preceptors were of the opinion that their skills of guiding students were good. However, education is needed, which makes the results inconsistent in this respect. The results can be used in developing preceptorship skills and in planning preceptorship education.

Strategic groups and performance: an empirical analysis of strategic groups in the wind energy industry in Europe

The strategic group theory provides an intermediate level of analysis between a single company and the whole industry for identifying issues about the company's competitive position and strategic choices. Strategic groups are companies within an industry with similar strategic characteristics or competing on similar bases. Strategic choices are aligned with the firms’ resources. The purpose of this study was to identify the strategic groups in the wind energy industry in Europe, and study, whether a certain group membership results in financial performance differences. Altogether 80 European wind energy companies were included in the study, which were clustered into four strategic groups according to their age and growth rate. Each group corresponds to a different strategy. The results show that the wind energy companies can be clustered according to the chosen strategic characteristics. Strategic decisions were investigated with characteristic variables. Performance variables were used in the analysis measuring profitability, liquidity and solvency of the groups. These strategic choices of the companies did not have a significant influence on the firms’ performance. The more mature and slower growing group proved to be the most successful. However, the differences between groups were generally not statistically significant. The only statistically significant difference found was in the solvency ratio between Mature Slow and Young Rapid groups. Measured with these variables, more mature and slower growing companies performed better. Therefore, a certain strategic group membership results in performance differences.

The Role of Preannouncing In Innovation Launch Strategy

The objective of this master’s thesis was to examine the role of preannouncing in innovation launch strategy. Preannouncing was studied from three different angles that were preannouncement usage, preannouncement timing and preannouncement goals and from two different perspectives that were the firm’s internal strategy and the external circumstances. The firm’s internal strategy encompassed the product strategy the firm had chosen. The external circumstances consisted of the industry, the nature of competition and the nature of market. Additionally, the product’s performance in the short term was studied in order to be able to speak out whether it is advantageous to preannounce. The empirical study was conducted as a partial replication study. The data for the empirical part was collected with a wide mailing and Internet enquiry in October 2008 – June 2009. Sample (N = 713) consisted of Finnish firms representing different industries and innovation activities. The data collection produced 272 answers and thus, the final response rate of the study was 38.15 %. The data was analyzed by using Microsoft Excel and statistical analysis program SAS Enterprise Guide. As a conclusion, the major results indicate that even if the firms use preannouncing quite often (54.8 % of the respondents), preannouncing behavior cannot be explained by industry. However, out of other external circumstances, the customer related turbulence affects on preannouncing usage. It was also revealed that the product type has an effect on preannouncing behavior. Additionally, preannouncement timing was noticed to differ according to audiences (distributors and end users).

Developing the measurement and management of knowledge: applying the constructive research approach in a knowledge intensive service environment

Intellectual assets have attained continuous attention in the academic field, as they are vital sources of competitive advantage and organizational performance in the contemporary knowledge intensive business environment. Intellectual capital measurement is quite thoroughly addressed in the accounting literature. However, the purpose of the measurement is to support the management of intellectual assets, but the reciprocal relationship between measurement and management has not been comprehensively considered in the literature. The theoretical motivation for this study rose from this paradox, as in order to maximise the effectiveness of knowledge management the two initiatives need to be closely integrated. The research approach of this interventionist case study is constructive. The objective is to develop the case organization’s knowledge management and intellectual capital measurement in a way that they would be closely integrated and the measurement would support the management of intellectual assets. The case analysis provides valuable practical considerations about the integration and related issues as the case company is a knowledge intensive organization in which the know-how of the employees is the central competitive asset and therefore, the management and measurement of knowledge are essential for its future success. The results suggest that the case organization is confronting challenges in managing knowledge. In order to appropriately manage knowledge processes and control the related risks, support from intellectual capital measurement is required. However, challenges in measuring intellectual capital, especially knowledge, could be recognized in the organization. By reflecting the knowledge management situation and the constructed strategy map, a new intellectual measurement system was developed for the case organization. The construction of the system as well as its indicators can be perceived to contribute to the literature, emphasizing of the importance of properly considering the organization’s knowledge situation in developing an intellectual capital measurement system.

State of logistics and transport in the Baltic Sea region in 2025

The world’s pace of change is accelerating and new innovations, inventions and technologies come about every day. Change is unavoidable. It is difficult to keep up and even more difficult to prepare for the future. Even though it is not possible to know exactly what will happen in the future, by studying futures people can better anticipate what might lie ahead. By making decisions and realizing the consequences of their choices today, people and governments are able to actively decide how they will act in the future. Both opportunities and pitfalls lie ahead, which encourages actors to make more farsighted decisions. The Baltic Sea region is an interesting area for futures studies. It comprises 11 nations and more than 100 million inhabitants and entails countries with advanced, high-income economies, like Finland, Germany and Denmark, and developing economies, like Russia, Latvia and Lithuania. The western, eastern, northern and southern parts of the region are separated by the Baltic Sea, which at the same time represents a barrier and a facility for trade and travel between the countries belonging to the region The purpose of this study was to uncover the most probable future of transport and logistics in the Baltic Sea region in 2025 by using the Delphi method. Altogether 109 responses were collected in two separate instances from experts in all the Baltic Sea region countries, 56 of whom were defined as academic respondents and 53 of whom business respondents. Only minor differences in the opinions of academic and business experts were discovered, and the larger differences lie between eastern and western response groups. The Baltic Sea region is a very heterogeneous region and the division is clearest between East and West, which differ in political, economic, social, technological and environmental aspects. The probable future of the Baltic Sea region presented in this study is coherent with previous studies on the same subject. The future of the Baltic Sea region in terms of logistics and transport looks quite bright according to the experts who participated in the study. Trade volumes will grow and the importance of logistics and transport to the competitiveness of the region will increase. Respondents from eastern countries seemed to be more optimistic about the future in general. Most differences between opinions could be explained by the gap in technological and infrastructural development between the East and West. As eastern countries are less-developed in some parts of their economies, it is easier for them to improve the technical condition of infrastructure by merely catching up with the western countries.

The Role of Oxidative Stress in Environmental Responses of Fennoscandian Animals

All aerobic organisms have to deal with the toxicity of oxygen. Oxygen enables more efficient energy production compared to anaerobic respiration or fermentation, but at the same time reactive oxygen species (ROS) are being formed. ROS can also be produced by external factors such as UV-radiation and contamination. ROS can cause damage to biomolecules such as DNA, lipids and proteins and organisms try to keep the damage as small as possible by repairing biomolecules and metabolizing ROS. All ROS are not harmful, because they are used as signaling molecules. To cope against ROS organism have an antioxidant (AOX) system which consists both enzymatic and non-enzymatic AOX defense. Some AOX are produced by the organism itself and some are gained via diet. In this thesis I studied environmentally caused changes in the redox regulation of different wild vertebrate animals to gain knowledge on the temporal, spatial and pollution-derived-effects on the AOX systems. As study species I used barn swallow, ringed seal and the Baltic salmon. For the barn swallow the main interest was the seasonal fluctuation in the redox regulation and its connection to migration and breeding. The more contaminated ringed seals of the Baltic Sea were compared to seals from cleaner Svalbard to investigate whether they suffered from contaminant induced oxidative stress. The regional and temporal variation in redox regulation and regional variation in mRNA and protein expressions of Baltic salmon were studied to gain knowledge if the salmon from different areas are equally stressed. As a comparative aspect the redox responses of these different species were investigated to see which parts of the AOX system are substantial in which species. Certain parts of AOX system were connected to breeding and others to migration in barn swallows, there was also differences in biotransformation between birds caught from Africa and Finland. The Baltic ringed seal did not differ much from the seals from Svalbard, despite the difference in contaminant load. A possible explanation to this could be the enhanced AOX mechanisms against dive-associated oxidative stress in diving air-breathing animals, which also helps to cope with ROS derived from other sourses. The Baltic salmon from Gulf of Finland (GoF) showed higher activities in their AOX defense enzymes and more oxidative damage than fish from other areas. Also on mRNA and proteomic level, stress related metabolic changes were most profound in in the fish from GoF. Mainly my findings on species related differences followed the pattern of mammals showing highest activities and least damage and birds showing lower activities and most damage, fish being intermediate. In general, the glutathione recycling-related enzymes and the ratio of oxidized and reduced glutathione seemed to be the most affected parameters in all of the species.

Quantitative Magnetic Resonance Imaging of the Liver and Heart In Iron Overload

Systemic iron overload (IO) is considered a principal determinant in the clinical outcome of different forms of IO and in allogeneic hematopoietic stem cell transplantation (alloSCT). However, indirect markers for iron do not provide exact quantification of iron burden, and the evidence of iron-induced adverse effects in hematological diseases has not been established. Hepatic iron concentration (HIC) has been found to represent systemic IO, which can be quantified safely with magnetic resonance imaging (MRI), based on enhanced transverse relaxation. The iron measurement methods by MRI are evolving. The aims of this study were to implement and optimise the methodology of non-invasive iron measurement with MRI to assess the degree and the role of IO in the patients. An MRI-based HIC method (M-HIC) and a transverse relaxation rate (R2*) from M-HIC images were validated. Thereafter, a transverse relaxation rate (R2) from spin-echo imaging was calibrated for IO assessment. Two analysis methods, visual grading and rSI, for a rapid IO grading from in-phase and out-of-phase images were introduced. Additionally, clinical iron indicators were evaluated. The degree of hepatic and cardiac iron in our study patients and IO as a prognostic factor in patients undergoing alloSCT were explored. In vivo and in vitro validations indicated that M-HIC and R2* are both accurate in the quantification of liver iron. R2 was a reliable method for HIC quantification and covered a wider HIC range than M-HIC and R2*. The grading of IO was able to be performed rapidly with the visual grading and rSI methods. Transfusion load was more accurate than plasma ferritin in predicting transfusional IO. In patients with hematological disorders, the prevalence of hepatic IO was frequent, opposite to cardiac IO. Patients with myelodysplastic syndrome were found to be the most susceptible to IO. Pre-transplant IO predicted severe infections during the early post-transplant period, in contrast to the reduced risk of graft-versus-host disease. Iron-induced, poor transplantation results are most likely to be mediated by severe infections.