Measurement of the tree root growth using electrical impedance spectroscopy

Abstract

Observations on the Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clinical Studies on Healthy Volunteers and Intensive Care Patients

Patients treated in intensive care units require sedation and analgesia. However, sedative drugs also have potential adverse effects, and there is no single ideal sedativeanalgesic drug for these patients. Dexmedetomidine is an apha2-adrenoceptor agonist licenced for sedation of intensive care patients and patients undergoing surgery and other invasive procedures. Several routes of parenteral administration (intravenous, intramuscular, subcutaneous and intranasal) have been utilized. In the present series of studies, the pharmacokinetics and pharmacodynamics of intranasally administered dexmedetomidine as well as the gastrointestinal effects of intravenous dexmedetomidine were determined in healthy volunteers. Pharmacokinetics of dexmedetomidine during long lasting, high-dose infusions were characterized in intensive care patients. The bioavailability of intranasal dexmedetomidine was relatively good (65%), but interindividual variation was large. Dexmedetomidine significantly inhibited gastric emptying and gastrointestinal transit. In intensive care patients, the elimination half-life of dexmedetomidine was somewhat longer than reported for infusions of shorter duration and in less ill patients or healthy volunteers. Dexmedetomidine appeared to have linear pharmacokinetics up to the studied dose rate of 2.5 μg/kg/h. Dexmedetomidine clearance was decreasing with age and its volume of distribution was increased in hypoalbuminaemic patients, resulting in a longer elimination half-life and context-sensitive half-time. Intranasally administered dexmedetomidine was efficacious and well tolerated, making it appropriate for clinical situations requiring light sedation. The clinical significance of the gastrointestinal inhibitory effects of dexmedetomidine should be further evaluated in intensive care patients. The possibility of potentially altered potency and effect duration should be taken into account when administering dexmedetomidine to elderly or hypoalbuminaemic patients.

Immediate Decision-Making and Information Needs in Intensive Care Coordination

The aim of this study was to develop a theoretical model for information integration to support the deci¬sion making of intensive care charge nurses, and physicians in charge – that is, ICU shift leaders. The study focused on the ad hoc decision-making and immediate information needs of shift leaders during the management of an intensive care unit’s (ICU) daily activities. The term ‘ad hoc decision-making’ was defined as critical judgements that are needed for a specific purpose at a precise moment with the goal of ensuring instant and adequate patient care and a fluent flow of ICU activities. Data collection and research analysis methods were tested in the identification of ICU shift leaders’ ad hoc decision-making. Decision-making of ICU charge nurses (n = 12) and physicians in charge (n = 8) was observed using a think-aloud technique in two university-affiliated Finnish ICUs for adults. The ad hoc decisions of ICU shift leaders were identified using an application of protocol analysis. In the next phase, a structured online question¬naire was developed to evaluate the immediate information needs of ICU shift leaders. A national survey was conducted in all Finnish, university-affiliated hospital ICUs for adults (n = 17). The questionnaire was sent to all charge nurses (n = 515) and physicians in charge (n = 223). Altogether, 257 charge nurses (50%) and 96 physicians in charge (43%) responded to the survey. The survey was also tested internationally in 16 Greek ICUs. From Greece, 50 charge nurses out of 240 (21%) responded to the survey. A think-aloud technique and protocol analysis were found to be applicable for the identification of the ad hoc decision-making of ICU shift leaders. During one day shift leaders made over 200 ad hoc decisions. Ad hoc decisions were made horizontally, related to the whole intensive care process, and vertically, concerning single intensive care incidents. Most of the ICU shift leaders’ ad hoc decisions were related to human resources and know-how, patient information and vital signs, and special treatments. Commonly, this ad hoc decision-making involved several multiprofessional decisions that constituted a bundle of immediate decisions and various information needs. Some of these immediate information needs were shared between the charge nurses and the physicians in charge. The majority of which concerned patient admission, the organisation and management of work, and staff allocation. In general, the information needs of charge nurses were more varied than those of physicians. It was found that many ad hoc deci-sions made by the physicians in charge produced several information needs for ICU charge nurses. This meant that before the task at hand was completed, various kinds of information was sought by the charge nurses to support the decision-making process. Most of the immediate information needs of charge nurses were related to the organisation and management of work and human resources, whereas the information needs of the physicians in charge mainly concerned direct patient care. Thus, information needs differ between professionals even if the goal of decision-making is the same. The results of the international survey confirmed these study results for charge nurses. Both in Finland and in Greece the information needs of charge nurses focused on the organisation and management of work and human resources. Many of the most crucial information needs of Finnish and Greek ICU charge nurses were common. In conclusion, it was found that ICU shift leaders make hundreds of ad hoc decisions during the course of a day related to the allocation of resources and organisation of patient care. The ad hoc decision-making of ICU shift leaders is a complex multi-professional process, which requires a lot of immediate information. Real-time support for information related to patient admission, the organisation and man¬agement of work, and allocation of staff resources is especially needed. The preliminary information integration model can be applied when real-time enterprise resource planning systems are developed for intensive care daily management

Intuboidun hengityslaitehoitoa saavan aikuisen tehohoitopotilaan suunhoidon kirjaaminen

Tutkimuksen tarkoituksena oli tutkia potilastietojärjestelmien suunhoitosivut kaikilla suomalaisilla teho-osastoilla, joissa oli käytössä Clinisoft® -potilastietojärjestelmä ja, joilla hoidettiin intuboituja, hengityslaitehoitoa saavia aikuisia tehohoitopotilaita. Lisäksi tutkimuksessa analysoitiin yhden yliopistosairaalan teho-osaston hoitajien suunhoidon kirjauksia potilastietojärjestelmän vuorohuomioraporteista. Tutkimusosion 1 aineisto koostui aikuispotilaita hoitavien teho-osastojen (N=15) Clinisoft® -potilastietojärjestelmien suunhoitosivuista. Tutkimusosion 2 aineisto koostui yhden yliopistosairaalan teho-osaston intuboitujen, hengityslaitehoitoa saaneiden aikuisen tehohoitopotilaiden suunhoidon kirjauksista (n=97). Vuonna 2008–2009 hoidetuista intuboiduista, hengityslaitehoitoa saaneista tehohoitopotilaista (N=1180) valittiin satunnaisotannalla 100 potilasta, joiden suunhoitoon liittyvät potilasasiakirjat otettiin mukaan analyysiin. Aineistot analysoitiin sisällön erittelyllä. Suunhoitosivujen aihesisällöistä muodostettiin 14 sisältöluokkaa. Vuorohuomiokirjaukset oli kirjattu yleensä hengitys tai happeutuminen otsakkeiden alle, josta löytyi yhteensä 589 alkuperäislausumaa. Hoitajat kirjasivat ensin potilaan hengityslaitehoidosta ja happeutumisesta. Alkuperäislausumista tehohoitopotilaan suunhoitoon liittyviä lausumia oli 61 % (n=357). Vuorohuomiokirjauksista muodostettiin 11 sisältöluokkaa. Potilastietojärjestelmän suunhoitosivujen rakenne ei ohjannut VAP:a ehkäisevään suunhoitoon ja tehohoitopotilaan suunhoitoa kirjattiin usealle sivulle. Kaikkien tehohoito-osastojen suunhoitosivupohjissa oli kohdat suun kunnon arvioinnille ja suunhoidolle, mutta sivuilta ei aina selvinnyt tehohoito-osaston suunhoitoon käytättämiä välineitä. Sivuissa oli nähtävissä yksittäisiä VAP:n ehkäisyyn liittyviä interventioita. Vuorohuomioraportteihin kirjaaminen oli päällekkäistä suunhoitosivuun kirjattavien tietojen kanssa. Hoitajat kirjasivat tehohoitopotilaan hengityslaitehoidosta ja potilaan happeutumisesta. Suunhoidosta hoitajat kirjasivat eniten eritteiden määrää ja laatua ja vähiten suunhoidossa käytetyistä välineistä sekä suunhoitoon liittyvästä arvioinnista. Tehohoitopotilaan suuta hoidettiin keskimäärin 2.93 kertaa vuorokaudessa, eniten aamuvuoroissa. Suun kuntoa arvioitiin 1.12 kertaa vuorokaudessa. Pro gradu -tutkielma tuo uutta tietoa intuboidun, hengityslaitehoidossa olevan aikuisen tehohoitopotilaan näyttöön perustuvasta suunhoidosta, potilastietojärjestelmien suunhoitosivujen rakenteesta ja tehohoitopotilaan suunhoidon kirjaamisesta Suomessa. Tutkimustulosten ja kansainvälisten suositusten avulla kehitettiin Clinisoft® -potilastietojärjestelmän mallisivu tehohoitopotilaan suunhoidon tarpeen määrittämisen, suunnittelun, toteutuksen ja arvioinnin tueksi.

Modelling of changes in electricity end-use and their impacts on electricity distribution

The electricity distribution sector will face significant changes in the future. Increasing reliability demands will call for major network investments. At the same time, electricity end-use is undergoing profound changes. The changes include future energy technologies and other advances in the field. New technologies such as microgeneration and electric vehicles will have different kinds of impacts on electricity distribution network loads. In addition, smart metering provides more accurate electricity consumption data and opportunities to develop sophisticated load modelling and forecasting approaches. Thus, there are both demands and opportunities to develop a new type of long-term forecasting methodology for electricity distribution. The work concentrates on the technical and economic perspectives of electricity distribution. The doctoral dissertation proposes a methodology to forecast electricity consumption in the distribution networks. The forecasting process consists of a spatial analysis, clustering, end-use modelling, scenarios and simulation methods, and the load forecasts are based on the application of automatic meter reading (AMR) data. The developed long-term forecasting process produces power-based load forecasts. By applying these results, it is possible to forecast the impacts of changes on electrical energy in the network, and further, on the distribution system operator’s revenue. These results are applicable to distribution network and business planning. This doctoral dissertation includes a case study, which tests the forecasting process in practice. For the case study, the most prominent future energy technologies are chosen, and their impacts on the electrical energy and power on the network are analysed. The most relevant topics related to changes in the operating environment, namely energy efficiency, microgeneration, electric vehicles, energy storages and demand response, are discussed in more detail. The study shows that changes in electricity end-use may have radical impacts both on electrical energy and power in the distribution networks and on the distribution revenue. These changes will probably pose challenges for distribution system operators. The study suggests solutions for the distribution system operators on how they can prepare for the changing conditions. It is concluded that a new type of load forecasting methodology is needed, because the previous methods are no longer able to produce adequate forecasts.

Responses of silver birch saplings to low soil temperature

Abstract

Pyörivän magneettivuon aiheuttamien tehohäviöiden mittaus sähköteräslevystä.

Kiertomagnetoinnin, eli pyörivän magneettivuon, on havaittu aiheuttavan sähkökoneiden rautapiireissä käytetyissä sähköteräslevyissä merkittävästi vaihtovuota suuremman tehohäviön. Sähkökoneet suunnitellaan käyttäen vaihtovuomittaukseen perustuvia levymateriaalin tehohäviöarvoja, vaikka pyörivien sähkökoneiden rautapiireissä on alueita, joissa esiintyy pyörivä vuontiheysjakauma. Tämän johdosta rautahäviöiden tarkka laskeminen on vaikeaa. Työssä käsitellään rautaa magneettisena materiaalina, siinä muodostuvia tehohäviöitä vaihtovuolla sekä pyörivällä magneettivuolla sekä esitetään pyörivän magneettivuon aiheuttamien tehohäviöiden mittaukseen soveltuvat mittalaitteet ja laitteiden toiminnan perusta. Pyörivän magneettivuon aiheuttamat tehohäviöt määritetään sähkö- ja magneettikentänvoimakkuuden mittaukseen perustuvalla laitteistolla, joka suunniteltiin ja valmistettiin työn yhteydessä. Mittaukset suoritettiin kidesuuntaamattomille sähköteräksille M350-50A, M600-50A ja M800-50A. Mittaustulosten perusteella laitteistoa voidaan pitää toimivana.