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.

Jälkikäsitellyn jätevesikirkasteen uusiokäyttö Anjalan paperitehtailla

Työssä tarkasteltiin aktiivilietelaitoksen jätevesikirkasteen uusiokäyttöä Anjalan paperitehtailla. Tavoitteena oli löytää keino jätevesimäärän vähentämiseksi, kierrättämällä jatkokäsiteltyä jätevesikirkastetta. Työssä tehtiin prosessisuunnitelma kirkasteen kierrättämiseksi; suunnitelman vaikutuksia arvioitiin kirjallisuuden, simuloinnin ja arkkikokeiden avulla. Lisäksi arvioitiin kierrätyksen taloudellisia näkökohtia. Prosessisuunnittelussa päädyttiin vaihtoehtoon, jossa tehtaan nykyinen tehdasvesijae korvataan jälkikäsitellyllä jätevesikirkasteella. Esitetty prosessimuutos vähentäisi jokeen laskettavan kirkasteen määrää 20 %. Haitta-ainetason muutoksia selvitettiin simuloimalla prosessisuunnitelman mukainen suolatase. Simuloinnin kohteena oli haitta-ainetason muutokset PK3:lla. Tuloksista pääteltiin, että PK3:lla tapahtuu normaalissa ajotilanteessa suurempia muutoksia suolatasoissa kuin prosessimuutoksen aiheuttama suolatason muutos. Arkkikokeilla selvitettiin kirkasteen ja tehdasveden vaikutuksia PK3:n massan vaaleuteen ja vaaleuden pysyvyyteen. Kirkasteen vaikutus massan vaaleuteen oli suurempi kuin tehdasvedellä, kun kirkastetta oli käsitelty tehdasmittakaavan flotaatiolla ja hiekkasuodatuksella. Pilot-mittakaavan hiekkasuodatuksella ja laboratoriomittakaavassa laskeutetulla kirkasteella oli pienempi vaikutus arkkien vaaleuteen kuin tehdasvedellä. Vaaleuden pysyvyydessä ei havaittu eroa kirkasteen ja tehdasveden välillä. Kirkasteella oli voimakas vaikutus arkkien keltaisuuteen. Tehdasvesi ei vaikuttanut arkkien keltaisuuteen. Mikäli prosessisuunnitelman mukainen kirkastevirtaus jatkokäsiteltäisiin hiekkasuodatuksella, arvioitiin päälaitteista kerroinmenetelmällä tehdasinvestoinniksi 5.20 milj. euroa. Vuosittaisiksi kemikaalikustannuksiksi arvioitiin 0.21 milj. euroa ja teoreettiseksi energiasäästöksi 0.87 milj. euroa.

Blue sticky traps are more efficient for the monitoring of Lygus rugulipennis (Heteroptera, Miridae) than yellow sticky traps

Selostus: Siniset liimapyydykset ovat keltaisia liimapyydyksiä tehokkaampia peltoluteen tarkkailussa

Theorica Pantegni . Facsimile and Transcription of the Helsinki manuscript (Codex EÖ.II.14)

The Theorica Pantegni is a medieval medical textbook written in Latin. The author was Constantine the African (Constantinus Africanus), a monk of Tunisian origin. He compiled the work in the latter half of the eleventh century at the Benedictine monastery of Monte Cassino in Italy. - Manuscript Eö.II.14, containing the Theorica Pantegni published here, belongs today to the National Library of Finland. It can be dated to the third quarter of the twelfth century, which makes it one of the earliest surviving exemplars of the Theorica Pantegni: over seventy manuscripts of the work survive, of which about fifteen can be dated to the twelfth century. Manuscript Eö.II.14 is written in black ink on 210 parchment leaves (recto and verso), amounting to 420 pages, in pre-Gothic script. - The present text is a transcription of Ms Eö.II.14. The goal is to provide the reader with an accessible text that is faithful to the original.

JNK regulates dendrite and spine architecture in the central nervous system influencing spatial learning and motor tasks

JNK1 is a MAP-kinase that has proven a significant player in the central nervous system. It regulates brain development and the maintenance of dendrites and axons. Several novel phosphorylation targets of JNK1 were identified in a screen performed in the Coffey lab. These proteins were mainly involved in the regulation of neuronal cytoskeleton, influencing the dynamics and stability of microtubules and actin. These structural proteins form the dynamic backbone for the elaborate architecture of the dendritic tree of a neuron. The initiation and branching of the dendrites requires a dynamic interplay between the cytoskeletal building blocks. Both microtubules and actin are decorated by associated proteins which regulate their dynamics. The dendrite-specific, high molecular weight microtubule associated protein 2 (MAP2) is an abundant protein in the brain, the binding of which stabilizes microtubules and influences their bundling. Its expression in non-neuronal cells induces the formation of neurite-like processes from the cell body, and its function is highly regulated by phosphorylation. JNK1 was shown to phosphorylate the proline-rich domain of MAP2 in vivo in a previous study performed in the group. Here we verify three threonine residues (T1619, T1622 and T1625) as JNK1 targets, the phosphorylation of which increases the binding of MAP2 to microtubules. This binding stabilizes the microtubules and increases process formation in non-neuronal cells. Phosphorylation-site mutants were engineered in the lab. The non-phosphorylatable mutant of MAP2 (MAP2- T1619A, T1622A, T1625A) in these residues fails to bind microtubules, while the pseudo-phosphorylated form, MAP2- T1619D, T1622D, Thr1625D, efficiently binds and induces process formation even without the presence of active JNK1. Ectopic expression of the MAP2- T1619D, T1622D, Thr1625D in vivo in mouse brain led to a striking increase in the branching of cortical layer 2/3 (L2/3) pyramidal neurons, compared to MAP2-WT. The dendritic complexity defines the receptive field of a neuron and dictates the output to the postsynaptic cells. Previous studies in the group indicated altered dendrite architecture of the pyramidal neurons in the Jnk1-/- mouse motor cortex. Here, we used Lucifer Yellow loading and Sholl analysis of neurons in order to study the dendritic branching in more detail. We report a striking, opposing effect in the absence of Jnk1 in the cortical layers 2/3 and 5 of the primary motor cortex. The basal dendrites of pyramidal neurons close to the pial surface at L2/3 show a reduced complexity. In contrast, the L5 neurons, which receive massive input from the L2/3 neurons, show greatly increased branching. Another novel substrate identified for JNK1 was MARCKSL1, a protein that regulates actin dynamics. It is highly expressed in neurons, but also in various cancer tissues. Three phosphorylation target residues for JNK1 were identified, and it was demonstrated that their phosphorylation reduces actin turnover and retards migration of these cells. Actin is the main cytoskeletal component in dendritic spines, the site of most excitatory synapses in pyramidal neurons. The density and gross morphology of the Lucifer Yellow filled dendrites were characterized and we show reduced density and altered morphology of spines in the motor cortex and in the hippocampal area CA3. The dynamic dendritic spines are widely considered to function as the cellular correlate during learning. We used a Morris water maze to test spatial memory. Here, the wild-type mice outperformed the knock-out mice during the acquisition phase of the experiment indicating impaired special memory. The L5 pyramidal neurons of the motor cortex project to the spinal cord and regulate the movement of distinct muscle groups. Thus the altered dendrite morphology in the motor cortex was expected to have an effect on the input-output balance in the signaling from the cortex to the lower motor circuits. A battery of behavioral tests were conducted for the wild-type and Jnk1-/- mice, and the knock-outs performed poorly compared to wild-type mice in tests assessing balance and fine motor movements. This study expands our knowledge of JNK1 as an important regulator of the dendritic fields of neurons and their manifestations in behavior.