Congenital upper limb defects in Finland 1993-2005

Background: Interest in limb defects has grown after the thalidomide tragedy in the 1960s. As a result, congenital malformation registries, monitoring changes in birthprevalence and defect patterns, have been established in several countries. However, there are only a few true population based studies on birth prevalence of upper limb defects. The burden of hospital care among these children, specifically in terms of the number of admissions and total time spent in hospital, is also unknown. Aims and Methods: This study is based on information gathered from the Finnish Register of Congenital malformations (FRM) and the Finnish Hospital Discharge Register (FHDR). A total of 417 children born between 1993 and 2005 with an upper limb defect were gathered from the FRM. The upper limb defects were classified using the International Federation of Societies for Surgery of the Hand -classification that enables comparison with previous and future studies. Birth and live birth prevalence, sex and side distribution, frequency of associated anomalies as well as the proportion of perinatal and infant deaths according to the different subtypes were calculated. The number of hospital admissions, days spent in hospital, number and type of surgical operations were collected from the FHDR. Special features of two subgroups, radial ray defects (RRD) and constriction band syndrome (CBS), were explored. Results: Upper limb defects were observed in 417 of 753 342 consecutive births and in 392 of 750 461 live births. Birth prevalence was 5.5 per 10 000 births and 5.2 per 10 000 live births. Multiple anomalies or a known syndrome was found in 250 cases (60%). Perinatal mortality was 139 per 1000 births and infant mortality 135 per 1000 live births (overall Finnish perinatal mortality <5 per 1000 births and infant mortality 3.7 per 1000 live births). Altogether, 138 infants had RRD and 120 (87%) of these had either a known syndrome or multiple major anomalies. The proportion of perinatal deaths in RRD group was 29% (40/138) and infant deaths 35% (43/123). Fifty-one children had CBS in upper limbs. Fifteen of these (29%) had other major anomalies associated with constriction rings. The number of hospital admissions per year of children with congenital upper limb defects was 11-fold and the time spent in hospital 13-fold as compared with the general paediatric population. Conclusions: Birth prevalence of congenital upper limb defects was 5.5 per 10 000 births and 5.2 per 10 000 live births. RRD was especially associated with other major anomalies and high mortality. Nearly one third of the children with CBS also had other major anomalies suggesting different aetiologies inside the group. The annual burden of hospital care of children with congenital upper limb defects was at least 11-fold as compared with the general paediatric population.

Uusintamurtumien ehkäisy kaatumisen aiheuttaman yläraajamurtuman kokeneilla yli 50-vuotiailla henkilöillä

Tarkoitus: Tarkoituksena oli selvittää murtumien tehostetun ehkäisyohjelman vaikutuksia yläraajamurtuman saaneiden yli 50-vuotiaiden henkilöiden elämäntapoihin, murtumien riskitekijöihin, kaatumisiin, kaatumisvammoihin ja elämänlaatuun. Aineisto: 219 yli 50-vuotiasta kotona asuvaa, kaatumisen seurauksena yläraajamurtuman saanutta henkilöä satunnaistettiin koe- (n = 105) ja kontrolliryhmiin (n = 114). Menetelmä: Koeohjelma sisälsi yksilöllisen, yhdessä lääkärin, terveydenhoitajan ja tutkittavan kanssa laaditun hoito- ja kuntoutussuunnitelman sekä kutsun murtumien ehkäisyn koulutusohjelmaan. Kontrolliryhmän tutkittavat saivat kehotuksen hakeutua murtumahoitajan ohjaukseen. Seuranta-aika oli 14 kuukautta. Tulokset analysoitiin ryhmissä tapahtuneina muutoksina alkuja loppumittausten välillä sekä ryhmien välisenä erona muutoksissa. Tulokset: Keskimääräinen luun tiheys lannerangassa lisääntyi koeryhmässä (p<0,001) ja kontrolliryhmässä (p = 0,038), ryhmien välinen ero ei ollut tilastollisesti merkitsevä (p = 0,134). Reisiluun kaulassa luun tiheys ei muuttunut kummassakaan ryhmässä. Päivittäinen kalsiumin saanti lisääntyi koeryhmässä keskimäärin 167 mg (p<0,001) ja kontrolliryhmässä 30 mg (p = 0,475), ryhmien välinen ero oli tilastollisesti merkitsevä (p = 0,031). Kala-ateriat ja päivittäinen D-vitamiinilisä sekä kenkien liukuesteiden säännöllinen käyttö liukkaalla lisääntyivät molemmissa ryhmissä, mutta ryhmien välillä ei ollut eroa. Viiteen tuolilta nousukertaan käytetty aika vähentyi koeryhmässä keskimäärin 0,49 sekuntia (p = 0,185) ja lisääntyi kontrolliryhmässä 0,39 (p = 0,475), ero ryhmien välillä oli tilastollisesti merkitsevä (p = 0,02). Kymmenen metrin kävelyssä ei tapahtunut tulosten keskiarvossa muutoksia kummassakaan ryhmässä. Ortostatismi vähentyi kontrolliryhmässä (p = 0,049), ja masentuneisuus vähentyi koeryhmässä (p = 0,041), mutta ryhmien välillä ei näissä ollut merkitsevää eroa. Osteoporoosilääkkeiden käyttö lisääntyi molemmissa ryhmissä, ryhmien välillä ei ollut eroa. Alkoholin käytössä oli vähäisiä mutta ei merkittäviä muutoksia. Muissa testatuissa muuttujissa, kuten liikunnan viikoittainen määrä, tupakointi, näkökyky, tasapaino ja elämänlaatu, ei ollut merkitseviä muutoksia ryhmissä tai ryhmien välillä. Kaatumisten (koeryhmä 33, kontrolliryhmä 35) ja murtumien (koeryhmä 5 ja kontrolliryhmä 3) määrissä ei myöskään ollut merkitseviä eroja ryhmien välillä. Johtopäätökset: Noin neljällä viidestä kaatumisen seurauksena yläraajamurtuman saaneista, yli 50 vuotta täyttäneistä henkilöistä oli alentunut luun tiheys, ja noin joka toisella oli lisääntynyt kaatumisriski. Kaatumisen riskitekijöiden kliiniset mittaukset olivat nopeita toteuttaa ja auttoivat ehkäisytoimenpiteiden suunnittelussa. Murtuman saaneet olivat motivoituneita murtumien riskitekijöiden selvittämiseen ja myös toteuttamaan annettua lääkehoitoa. Elämäntavoissa helpoimmin toteutuivat muutokset ruokailutottumuksissa. Liikuntatottumuksien muuttaminen sen sijaan onnistui melko huonosti. Ryhmien välillä oli merkitsevä ero ainoastaan kalsiumin päivittäisessä käytössä ja tuolilta nousutestissä. Murtumariskien tunnistaminen, niiden syiden selvittäminen ja toimenpiteiden käynnistäminen riskien vähentämiseksi tulisi kuulua jokaisen pienienergisen murtuman saaneen potilaan kokonaisvaltaiseen hyvään hoitoon.

Neck Muscle Function and Adolescent Headache

Muscular function of the neck region may be of importance for the etiology of headache, especially of tension-type headache. However, very few data exist on the association of neck muscle function with different types of headache in adolescents. The main aim of the study was to examine the association of neck muscle function with adolescent headache. The associations between leisure time activities, endurance strength of the upper extremities (UE endurance) and mobility of the neck-shoulder region and adolescent headache were studied. In addition, the associations of force production, EMG/force ratio, co-activation and fatigue characteristics, and cross-sectional area (CSA) of neck muscles with adolescent headache were studied. The study is part of a population-based cohort study of 12-year-old children with and without headache. The study had five phases (years 1998-2003). At the age of 13 years, a sample of 183 adolescents (183/311) participated in endurance strength and mobility measurements of the neck-shoulder region. In addition, the type and level of physical and other leisure activity were elicited with open and structured questions. At the age of 17 years, a random sample of 89 adolescents (89/202) participated in force and EMG measurements of the neck-shoulder muscles. In addition, at the age of 17 years, a sample of 65 adolescents (65/89) participated in CSA measurements of the neck muscles. At the age of 13 years, intensive participation in overall sports activity was associated with migraine. Frequent computer use was associated both with migraine and tension-type headache. The type of sports or other leisure activity classified them on the basis of body loading was not associated with headache type. In girls, low UE endurance of both sides, and low cervical rotation of the dominant side, were associated with tension-type headache, and low UE endurance of non-dominant side with migraine. In boys, no associations occurred between UE endurance and mobility variables and headache types. At the age of 17 years, in girls, high EMG/force ratios between the EMG of the left agonist sternocleidomastoid muscle (SCM) and maximal neck flexion and neck rotation force to the right side as well as high co-activation of right antagonist cervical erector spinae (CES) muscles during maximal neck flexion force were associated with migraine-type headache. In girls, neck force production was not associated with headache types but low left shoulder flexion force was associated with tension-type headache. In boys, no associations were found between EMG and force variables and headache. Increased SCM muscles fatigue of both sides was associated with tension-type headache. In boys, the small CSA of the right SCM muscle and, in girls, of combined right SCM and scalenus muscles was associated with tension-type headache. Similarly, in boys, the large CSA of the right SCM muscle, of the combined right SCM and scalenus muscles, of the left semispinalis capitis muscle, of the combined left semispinalis and splenius muscles was associated with migraine. No other differences in the CSA of neck flexion or extension muscles were found. Differences in the neuromucular function of the neck-shoulder muscles were associated with adolescent headache, especially in girls. Differences in the cross-sectional area of unilateral neck muscles were associated with headache, especially in boys. Differences in the neuromuscular function and in the cross-sectional area of the neck muscles also occurred between different types of headache. It remains to be established whether the findings are primary or secondary to adolescent migraine and tension headache. Keywords: adolescent, cross-sectional area, electromyography, endurance strength, fatigue, force, headache, leisure time activity, migraine, mobility, neck muscles, tension-type headache

Neck Pain in Adolescent Headache Sufferers. A Cohort Study of Schoolchildren

Although neck pain (NP) and headache (HA) are often concomitant in adolescents, few data exist on the association of NP with HA in this age group. The aim of the study was to examine the association of concomitant NP with adolescent HA and with the outcome of HA. The associations of self-reported NP, physical findings of the neck and disc degeneration of the cervical spine with adolescent HA were studied. This study is part of a population-based follow-up study of 12-year-old children (N 1135/1409) with and without HA. A sample of adolescents (N = 304) was followed to the age of 16 years. At the age of 17 years, 69 of them participated in a magnetic resonance imaging (MRI) study of the cervical spine. During the follow-up from 13 to 16 years of age, changes in both HA type and frequency were common. A poor outcome of HA was associated with NP interfering with daily activities at the age of 13 years. The changes in HA type were not predictable by NP. At the age of 16 years, local and referred palpation pain of the neck muscles, self-reported NP and NP intensity were associated with HA, and especially with disturbing HA unresponsive to analgesics. The association of NP with HA was not determined by HA type. Mild degenerative changes of the cervical spine were common but did not contribute to headache. HA in adolescence is often episodic, and prevention and treatment of NP could be important in the prevention of future chronic adult HA.

Targeting Adenoviral Gene Therapy Vectors to Head and Neck Squamous Cell Carcinoma and Heart

Gene therapy aims to treat diseases by introducing genetic material to the diseased tissue. For cancer treatment it is important to destroy cancerous cells; this can be achieved by introducing a gene, which induces cell death or by allowing viral vectors to replicate, which also results in destruction of cancerous cells. For cardiac diseases the approach is more like the former, except the gene produces beneficial effects, like angiogenesis. Adenoviruses have many beneficial qualities, which make the virus an interesting gene therapy vector; it can be produced relatively easily, its manipulation is quite easy and it has naturally broad tropism. By removing or replacing certain genes in the adenoviral genome, it can be made non-replicative. In this study, adenoviral receptor expression patterns were characterized in both head and neck squamous cell carcinoma and the human heart. Adenovirus serotype 5 receptor expression in head and neck cancer cell lines was found to be highly variable between cell lines and overall at lower levels, while Ad35 receptor expression was more uniform and at higher levels in all analyzed cell lines. It was also shown that a hybrid virus Ad5/35 is able to infect cells refractory to Ad5, which correlates with receptor expression in these cells. Furthermore, this difference in infection properties extends to cell killing efficiency in case of conditionally replicative viruses. Expression levels of adenoviral receptors CAR, CD46, CD86 and αv-integrins were found to be high both in normal and dilated cardiomyopathy heart tissue. The receptor levels also correlate with transduction efficiency after intracardiac injection. Ad5 showed superior transduction ability compared with Ad5/35, but evoked also a more profound immune reaction when administered this way. Adenoviral gene therapy vectors are the most used delivery vehicles in clinical trials to date. These vectors have proven to be well tolerated and positive results have been obtained when combined with traditional treatments, although poor transduction efficiency has often been reported due to low-level expression of viral receptors on target cells. In spite of this, the results are encouraging and merit for further research.

Airway surgery for obstructive sleep apnea and partial upper airway obstruction during sleep

This study analyzed the feasibility and efficacy of surgical therapies in patients with sleep-disordered breathing ranging from partial upper airway obstruction during sleep to severe obstructive sleep apnea syndrome. The surgical procedures evaluated were tracheostomy, laser-assisted uvulopalatoplasty (LUPP) and uvulopalatopharyngoplasty (UPPP) with laser or ultrasound scalpel. Obstructive sleep apnea and partial upper airway obstruction during sleep were measured with the static charge-sensitive bed (SCSB) and pulse oximeter. The patients with severe obstructive sleep apnea syndrome were treated with tracheostomy. Palatal surgery was performed only if the upper airway narrowing occurred exclusively at the soft palate level in patients with partial upper airway obstruction during sleep. The ultrasound scalpel technique was compared to laser-assisted UPPP. The efficacy of LUPP to reduce partial upper airway obstruction during sleep was assessed and histology of uvulopalatal specimen was compared to body fat distributional parameters and sleep study findings. Tracheostomy was effective therapy in severe obstructive sleep apnea. Partial upper airway obstruction and arterial oxyhemoglobin desaturation index during sleep decreased significantly after LUPP. The minimal retropalatal airway dimension increased and soft palate collapsibility decreased at the level where the velopharyngeal obstruction had occurred before the surgery. Ultrasound scalpel did not offer any significant benefits over the laser-assisted technique, except fewer postoperative haemorrhage events. The loose connective tissue as a manifestation of edema was the only histological finding showing correlation with partial upper airway obstruction parameters of SCSB. Tracheostomy remains a life-saving therapy and also long-term option when adherence to CPAP fails in patients with obstructive sleep apnea syndrome. LUPP effectively reduces partial upper airway obstruction during sleep provided that obstruction at the other levels than the soft palate and uvula were preoperatively excluded. Technically the ultrasound scalpel or laser surgeries are equal. In patients with partial upper airway obstruction the loose connective tissue is more important than fat accumulation in the soft palate. This supports the hypothesis that edema is a primary trigger for aggravation of upper airway narrowing during sleep at the soft palate level and evolution towards partial or complete upper airway obstruction during sleep.

Pragmatic competence of Finnish learners of English: Meaning in interaction in secondary and upper secondary schools

Tutkin pro gradu -tutkielmassani englannin kielen oppijoiden pragmaattista kompetenssia. Tarkoitukseni oli selvittää, miten suomalaiset yläkoululaiset ja lukiolaiset osaavat käyttää englannin kieltä erilaisissa kommunikaatiotilanteissa. Tutkielmani voidaan sijoittaa välikielen pragmatiikan tutkimukseen. Halusin selvittää, millä tasolla suomalaisten oppijoiden pragmaattinen kompetenssi on ja kehittyykö se yläkoulun ja lukion välillä. Lisäksi tutkin, vaikuttavatko oppimisympäristö ja oppimismahdollisuudet oppijoiden kykyyn käyttää englannin kieltä. Toisin sanoen vertasin englantipainotteisilla luokilla olevia oppilaita formaalin opetuksen oppijoihin sekä tutkin, vaikuttavatko englanninkieliset vapaa-ajan aktiviteetit ja oppijoiden mahdolliset oleskelut englanninkielisissä maissa heidän pragmaattiseen kompetenssiinsa. Tutkimukseni kohderyhmä koostui yläkoulun kahdeksasluokkalaisista ja lukion toisen vuosikurssin opiskelijoista. Testasin neljä eri ryhmää, joissa oli sekä formaalissa opetuksessa olevia oppijoita (yksi ryhmä kahdeksasluokkalaisia ja yksi ryhmä toisen vuosikurssin opiskelijoita) että kielipainotteisten luokkien oppijoita (yksi ryhmä kahdeksasluokkalaisia ja yksi ryhmä toisen vuosikurssin opiskelijoita). Arvioin kohderyhmäni pragmaattista kompetenssia monivalintatestillä, jossa testattiin oppijoiden kykyä käyttää ja ymmärtää implikaatioita, tilannekohtaisia rutiineja sekä puheakteja. Taustakysymysten avulla selvitin, kuinka usein oppijat käyttivät englantia vapaa-aikanaan ja olivatko he vierailleet englanninkielisissä maissa. Tutkimustulokseni osoittavat, että suomalaisten yläkoululaisten ja lukiolaisten pragmaattinen kompetenssi oli korkea. Pragmaattinen kompetenssi kehittyi kahdeksasluokkalaisten ja lukion toisen vuosikurssin välillä. Kehitys oli suurempaa formaalissa opetuksessa kuin kielipainotteisilla luokilla. Englantipainotteisilla luokilla olevat oppilaat suoriutuivat testistä paremmin kuin formaalin opetuksen oppilaat. Tosin erot olivat tilastollisesti merkitseviä vain yläkoulussa. Tutkimuksessani siis päättelin, että vieraskielinen opetus vaikutti enemmän nuorempiin oppijoihin. Eri oppimismahdollisuudet osoittautuivat haastaviksi analysoida. Tulokset osoittivat, että vain englanninkielisessä maassa oleskelulla oli vaikutusta oppijoiden pragmaattiseen kompetenssiin. Kysyttäessä vapaa-ajan aktiviteettien merkitystä oppijat kuitenkin kertoivat, että ne auttoivat heitä testiin vastaamisessa enemmän kuin englanninopetuksessa käydyt asiat. Kouluissa tulisikin jatkossa painottaa yhä enemmän vuorovaikutteista kieltenopetusta.

The Sedimentology, Ichnology and Hydrogeochemistry of the Late Miocene, Marginal Marine, Upper Pebas and Nauta Formations, Amazonian Foreland Basin, Peru

This thesis includes detailed sedimentological and ichnological studies on two geological units: the Pebas Formation, with a special focus in its informal upper member, and the Nauta Formation. Both formations were deposited during the Miocene in Northeastern Peruvian Amazonia, in the Amazon retroarc foreland basin. The Pebas and Nauta successions mainly consist of non-consolidated, clastic sedimentary deposits arranged into sand- to mud-dominated heterolithic successions, which can be upward-coarsening to upward-fining. Sediments in both the Pebas and Nauta successions range from mud to fine- to medium-grained sand. The main facies observed were 1) mud-dominated horizontal heterolithic couplets; 2) rooted brownish mud; 3) lenticular, mud-draped, cross-stratified sand; 4) mud- to sand-dominated, inclined heterolithic stratification; 5) sand-dominated horizontal heterolithic couplets; and 6) mud-draped, trough cross-stratified sand. Locally, tidal rhythmites were documented. The facies are interpreted as: 1) muddy, shallow, subaqueous flats/shoals; 2) palaeosols; 3) secondary tidal channels or run-off creeks; 4) tidally influenced point bars; 5) shoreface deposits; and 6) subtidal compound dunes. Thalassinoides-dominated Glossifungites ichnofacies, low-diversity expressions of the Skolithos ichnofacies and depauperate suites consisting of elements common to the Cruziana ichnofacies strongly indicate brackish-water conditions. However, continental trace fossil assemblages, with possible elements common to the Scoyenia ichnofacies, have also been identified. In addition to the palaeoenvironmental study, a local hydrogeochemical characterisation of the Pebas and Nauta formations was also conducted. The geochemistry of the groundwaters reflects the characteristics and the soil geochemistry of the geological formations studied. The Pebas formation has low hardness, acid to neutral waters, whereas the upper Pebas has high hardness, acid to neutral waters. In both units, the arsenic content is locally high. The Nauta formation has low hardness acid groundwaters. A regional review of the Pebas and Nauta formations placed the local observations into a continental perspective and suggests that the whole Pebas-Nauta system was a probably shallow (some tens of metres at maximum), brackish- to freshwater, tidally-influenced epicontinental embayment with a probable semi-diurnal to mixed tidal regime and a microtidal range, surrounded by continental environments such as forest floors, lagoons, rivers and their flood plains, and lakes.

Differentiation of Metabolically Distinct Areas within Head and Neck Region using Dynamic 18F-FDG Positron Emission Tomography Imaging

Positron Emission Tomography (PET) using ¹⁸F-FDG is playing a vital role in the diagnosis and treatment planning of cancer. However, the most widely used radiotracer, ¹⁸F-FDG, is not specific for tumours and can also accumulate in inflammatory lesions as well as normal physiologically active tissues making diagnosis and treatment planning complicated for the physicians. Malignant, inflammatory and normal tissues are known to have different pathways for glucose metabolism which could possibly be evident from different characteristics of the time activity curves from a dynamic PET acquisition protocol. Therefore, we aimed to develop new image analysis methods, for PET scans of the head and neck region, which could differentiate between inflammation, tumour and normal tissues using this functional information within these radiotracer uptake areas. We developed different dynamic features from the time activity curves of voxels in these areas and compared them with the widely used static parameter, SUV, using Gaussian Mixture Model algorithm as well as K-means algorithm in order to assess their effectiveness in discriminating metabolically different areas. Moreover, we also correlated dynamic features with other clinical metrics obtained independently of PET imaging. The results show that some of the developed features can prove to be useful in differentiating tumour tissues from inflammatory regions and some dynamic features also provide positive correlations with clinical metrics. If these proposed methods are further explored then they can prove to be useful in reducing false positive tumour detections and developing real world applications for tumour diagnosis and contouring.

Upper Sambesi

Soitinnus: saksofonit (2), piano, rummut.

Entrepreneurship Education in Basic and Upper Secondary Education – Measurement and Empirical Evidence

The starting point of this study is to direct more attention to the teacher and those entrepreneurship education practices taking place in formal school to find out solutions for more effective promotion of entrepreneurship education. For this objective, the strategy-level aims of entrepreneurship education need to be operationalised into measurable and understandable teacher-level practices. Furthermore, to enable the effective development of entrepreneurship education in basic and upper secondary level education, more knowledge is needed of the state of affairs of entrepreneurship education in teaching. The purpose of the study is to increase the level of understanding of teachers’ entrepreneurship education practices, and through this to develop entrepreneurship education. This study builds on the literature on entrepreneurship education and especially those elements referring to the aims, resources, benefits, methods, and practises of entrepreneurship education. The study comprises five articles highlighting teachers’ role in entrepreneurship education. In the first article the concept of entrepreneurship and the teachers role in reflection upon his/hers approaches to entrepreneurship education are considered. The second article provides a detailed analysis of the process of developing a measurement tool to depict the teachers’ activities in entrepreneurship education. The next three articles highlight the teachers’ role in directing the entrepreneurship education in basic and upper secondary level education. Furthermore, they analyse the relationship between the entrepreneurship education practises and the teachers’ background characteristics. The results of the study suggest a wide range of conclusions and implications. First, in spite of many outspoken aims connected to entrepreneurship education, teachers have not set any aims for themselves. Additionally, aims and results seem to mix. However, it is possible to develop teachers’ target orientation by supporting their reflection skills, and through measurement and evaluation increase their understanding of their own practices. Second, applying a participatory action process it is possible to operationalise teachers’entrepreneurship education practices. It is central to include the practitioners’ perspective in the development of measures to make sure that the concepts and aims of entrepreneurship education are understood. Third, teachers’ demographic or tenure-related background characteristics do not affect their entrepreneurship education practices, but their training related to entrepreneurship education, participation in different school-level or regional planning, and their own capabilities support entrepreneurship education. Fourth, a large number of methods are applied to entrepreneurship education, and the most often used methods were different kinds of discussions, which seem to be an easy, low-threshold way for teachers to include entrepreneurship education regularly in their teaching. Field trips to business enterprises or inviting entrepreneurs to present their work in schools are used fairly seldom. Interestingly, visits outside the school are more common than visitors invited to the school. In line, most of the entrepreneurship education practices take place in a classroom. Therefore it seems to be useful to create and encourage teachers towards more in-depth cooperation with companies (e.g. via joint projects) and to network systematically. Finally, there are plenty of resources available for entrepreneurship education, such as ready-made materials, external stakeholders, support organisations, and learning games, but teachers have utilized them only marginally.

Montana and Wyoming territories : embracing most of the country drained by the Madison, Gallatin and upper Yellowstone rivers

Kartta kuuluu A. E. Nordenskiöldin kokoelmaan

Map of the Lower Geyser Basin of the Upper Madison River

Kartta kuuluu A. E. Nordenskiöldin kokoelmaan

Map of the Upper Geyser Basin on the Upper Madison River, Montana Terr.

Kartta kuuluu A. E. Nordenskiöldin kokoelmaan