Armon järjestys länsiruotsalaisen pietismin punaisena lankana

Kirjallisuusarvostelu

Uudenmaan vesienhoidon toimenpideohjelma vuosille 2016 – 2021

Uudenmaan vesienhoidon toimenpideohjelma sisältää tiedot vesien tilasta sekä tarvittavat toimenpiteet pinta- ja pohjavesien tilan parantamiseksi ja ylläpitämiseksi vesienhoitokaudella 2016 – 2021. Pintavesien ekologinen tila on heikko erityisesti peltovaltaisilla valuma-alueilla ja Suomenlahden rannikkovesissä. Jokien tilaa heikentää erityisesti hajakuormituksen aiheuttama rehevöityminen, mutta myös jokien rakentaminen, säännöstely ja patoaminen. Uudenmaan pintavesien kemiallinen tila on arvioitu suurelta osin hyväksi. Hyvää huonompi kemiallinen tila johtuu pääasiassa ym-päristölaatunormin ylittävistä elohopeapitoisuuksista ahvenessa. Uudellamaalla on 21 pohjavesialuetta, jotka on määritelty kemiallisesti huonoon tilaan. Yleisimpiä syitä kemiallisen tilan heikkenemiseen ovat pohjaveden kloridipitoisuus, liuottimet, torjunta-aineet sekä bensiinin lisäaine MTBE. Toimenpideohjelmassa esitettyjen toimenpiteiden kokonaiskustannukset ovat 372 milj. euroa vuodessa. Tästä 351 milj. euroa on muun lainsäädännön perusteella toteutettavia perus- ja muita perustoimenpiteitä ja 20 milj. euroa vesienhoidon täydentäviä toimen-piteitä. Toimenpiteiden toteutusta edistämään on esitetty lainsäädännöllisiä, taloudellisia, hallinnollisia ja tiedollisia ohjauskeinoja, joille on määritelty toteutusvastuut ja yhteistyötahot.

Åtgärdsprogram för vattenvården i Nyland för åren 2016 – 2021

Åtgärdsprogrammet för vattenvården i Nyland innehåller uppgifter om vattnens status samt om de åtgärder som krävs för att förbättra och upprätthålla yt- och grundvattnens status under förvaltningsperioden 2016 – 2021. Ytvattnens ekologiska status i är svag i synnerhet på de åkerdominerade avrinningsområdena och i Finska vikens kustvatten. Åarnas och älvarnas status försämras särskilt av eutrofiering till följd av diffus belastning, men också av byggande, reglering och uppdämning. Ytvattnens kemiska status i Nyland har till stor del bedömts vara god. Den sämre än goda kemiska statusen beror i huvudsak på de kvicksilverhalter i abborre som överstiger miljökvalitetsnormen. I Nyland finns 21 grundvattenområden som fastställts ha dålig kemisk status. De vanligaste orsakerna till att den kemiska statu-sen försämrats är grundvattnets kloridhalt, lösningsmedel, bekämpningsmedel samt bensintillsatsen MTBE. De sammanlagda kostnaderna för de åtgärder som föreslås i åtgärdsprogrammet är 372 miljoner euro per år. Härav är 351 mil-joner euro grund- och andra åtgärder som ska vidtas med stöd av annan lagstiftning och 20 miljoner euro åtgärder som kom-pletterar vattenvården. Lagstiftningsbaserade, ekonomiska, förvaltningsmässiga och informationsmässiga styrmetoder har presenterats för att främja genomförandet av åtgärderna. Ansvarsområdena och samarbetsparterna för genomförandet av styr-metoderna har fastställts.

Improving purchasing process for small purchases at a manufacturing company in chemical industry

This thesis was conducted on assignment by a multinational chemical corporation as a case study. The purpose of this study is to find ways to improve the purchasing process for small purchases at the case company. The improvements looked after are mainly cost and time savings. Purchasing process is the process that starts from the requisition of goods or services and ends when the invoice is paid. In this thesis the purchases with value less than 1000€ are considered to be small. The theoretical framework of the thesis consists of general theoretical view of costs and performance of the purchasing process, different types of purchasing processes and a model for improving purchasing processes. The categorization to small and large purchases is the most important followed by the division between direct and indirect purchases. Also models that provide more strategic perspective for categorization were found to be useful. Auditing and managerial control are important parts of the purchasing process. When considering the transaction costs of purchasing from the costs–benefits perspective large and small purchases should not have the same processes. Purchasing cards, e-procurement and vendor managed inventory are seen as an alternative to the traditional purchasing process. The empirical data collection was done by interviewing the company employees that take part of the purchasing process in their daily work. The interviews had open-ended questions and the answers were coded and analyzed. The results consist of process description and assessment as well as suggestions for potential improvements. At the case company the basic purchasing process was similar to the traditional purchasing process that is entirely done with computers and online. For some categories there was already more sophisticated e-procurement solutions in use. To improve the current e-procurement based solutions elimination of authorization workflow and better information exchange can be seen as potential improvements for most of the case purchases. Purchasing cards and a lightweight form of vendor managed inventory can be seen as potential improvements for some categories. Implementing the changes incurs at least some cost and the benefits might be hard to measure. This thesis has revealed that the small purchases have potential for significant cost and time savings at the case company.

Non-invasive measurement of trigeminal nerve somatosensory evoked potentials

Whiplash injuries are common yet enigmatic to substantiate clinically. Trigeminal somatosensory evoked potentials (TSEPs) were posited as an indicator of trigeminal nerve conduction damage resulting from whiplash. Alternating polarity square-wave current stimuli were applied transcutaneously in the facial region. 379 recorded pilot trials from 27 participants (8 male and 19 female) were utilized to develop a non-invasive recording capability for TSEPs. Stimulus intensity and artifact, cortical recording sites, stimulation electrode design and placement were explored. Statistically significant differences in amplitude of TSEP waveform components at 13, 19 and 27 ms between uninjured and whiplashed participants were noted. Increased stimulus intensity in whiplashed participants was observed to increase TSEP amplitude. The present methodology and hardware are discussed and directions for future advancement of the current process are outlined.

Búsqueda de selección en el polimorfismo 677C>T (c.665C>T) del gen de la metilentetrahidrofolato reductasa (MTHFR) en una población Colombiana

Se realizó un estudio genético – poblacional en dos grupos etarios de población colombiana con la finalidad de evaluar las diferencias genéticas relacionadas con el polimorfismo MTHFR 677CT en busca de eventos genéticos que soporten la persistencia de este polimorfismo en la especie humana debido que este ha sido asociado con múltiples enfermedades. De esta manera se genotipificaron los individuos, se analizaron los genotipos, frecuencias alélicas y se realizaron diferentes pruebas genéticas-poblacionales. Contrario a lo observado en poblaciones Colombianas revisadas se identificó la ausencia del Equilibrio Hardy-Weinberg en el grupo de los niños y estructuras poblacionales entre los adultos lo que sugiere diferentes historias demográficas y culturales entre estos dos grupos poblacionales al tiempo, lo que soporta la hipótesis de un evento de selección sobre el polimorfismo en nuestra población. De igual manera nuestros datos fueron analizados junto con estudios previos a nivel nacional y mundial lo cual sustenta que el posible evento selectivo es debido a que el aporte de ácido fólico se ha incrementado durante las últimas dos décadas como consecuencia de las campañas de fortificación de las harinas y suplementación a las embarazadas con ácido fólico, por lo tanto aquí se propone un modelo de selección que se ajusta a los datos encontrados en este trabajo se establece una relación entre los patrones nutricionales de la especie humana a través de la historia que explica las diferencias en frecuencias de este polimorfismo a nivel espacial y temporal.  

Defining the role of common variation in the genomic and biological architecture of adult human height

Using genome-wide data from 253,288 individuals, we identified 697 variants at genome-wide significance that together explained one-fifth of the heritability for adult height. By testing different numbers of variants in independent studies, we show that the most strongly associated ∼2,000, ∼3,700 and ∼9,500 SNPs explained ∼21%, ∼24% and ∼29% of phenotypic variance. Furthermore, all common variants together captured 60% of heritability. The 697 variants clustered in 423 loci were enriched for genes, pathways and tissue types known to be involved in growth and together implicated genes and pathways not highlighted in earlier efforts, such as signaling by fibroblast growth factors, WNT/β-catenin and chondroitin sulfate-related genes. We identified several genes and pathways not previously connected with human skeletal growth, including mTOR, osteoglycin and binding of hyaluronic acid. Our results indicate a genetic architecture for human height that is characterized by a very large but finite number (thousands) of causal variants.2014

Ten years of NO2 comparisons between ground-based SAOZ and satellite instruments (GOME, SCIAMACHY, OMI)

SAOZ (Systeme d'Analyse par Observations Zenithales) is a ground-based UV-Visible zenith-sky spectrometer installed between 1988 and 1995 at a number of NDSC stations at various latitudes on the globe. The instrument is providing ozone and NO2 vertical columns at sunrise and sunset using the Differential Optical Absorption Spectroscopy (DOAS) technique in the visible spectral range. The ERS-2 GOME Ozone Monitoring Experiment (GOME) in 1995 was the first satellite mission to provide a global picture of atmospheric NO 2 with reasonable spatial and temporal resolution. It was then followed by SCanning ImAging spectroMeter for Atmospheric ChartographY (SCIAMACHY) onboard ENVISAT in 2002, and Ozone Monitoring Instrument (OMI) onboard EOS-AURA in 2004, with a similar capacity to monitor total NO 2. All these instruments are nadir viewing mapping spectrometers, applying the DOAS technique in the visible for deriving the NO2 total column. Here we present the results of NO2 long-term comparisons between GOME and SAOZ for the whole period of GOME operation since 1995 at all latitudes - tropics, mid-latitudes and polar regions - in both hemispheres. Comparisons are also shown with the most recently available SCIAMACHY and OMI data in 2004-2005. Overall, the daytime satellite measurements (around noon) are found consistent with sunrise ground-based data, with an average smaller difference at the tropics and mid-latitudes than in the polar areas in the summer. The agreement is even improved after correcting for the NO2 photochemical change between sunrise and the satellite overpass using a box model. However, some seasonal dependence of the difference between ground-based and satellite total NO2 still remains, related to the accuracy of photochemical simulations and the set of NO2 air mass factors used in the retrievals of both systems.

Current approach to the haemodynamic management of septic shock patients in European intensive care units: a cross-sectional, self-reported questionnaire-based survey

The aim of this survey was to investigate clinicians' current approach to the haemodynamic management and resuscitation endpoints in septic shock.

Early non-invasive cardiac output monitoring in hemodynamically unstable intensive care patients: A multi-center randomized controlled trial

Introduction Acute hemodynamic instability increases morbidity and mortality. We investigated whether early non-invasive cardiac output monitoring enhances hemodynamic stabilization and improves outcome. Methods A multicenter, randomized controlled trial was conducted in three European university hospital intensive care units in 2006 and 2007. A total of 388 hemodynamically unstable patients identified during their first six hours in the intensive care unit (ICU) were randomized to receive either non-invasive cardiac output monitoring for 24 hrs (minimally invasive cardiac output/MICO group; n = 201) or usual care (control group; n = 187). The main outcome measure was the proportion of patients achieving hemodynamic stability within six hours of starting the study. Results The number of hemodynamic instability criteria at baseline (MICO group mean 2.0 (SD 1.0), control group 1.8 (1.0); P = .06) and severity of illness (SAPS II score; MICO group 48 (18), control group 48 (15); P = .86)) were similar. At 6 hrs, 45 patients (22%) in the MICO group and 52 patients (28%) in the control group were hemodynamically stable (mean difference 5%; 95% confidence interval of the difference -3 to 14%; P = .24). Hemodynamic support with fluids and vasoactive drugs, and pulmonary artery catheter use (MICO group: 19%, control group: 26%; P = .11) were similar in the two groups. The median length of ICU stay was 2.0 (interquartile range 1.2 to 4.6) days in the MICO group and 2.5 (1.1 to 5.0) days in the control group (P = .38). The hospital mortality was 26% in the MICO group and 21% in the control group (P = .34). Conclusions Minimally-invasive cardiac output monitoring added to usual care does not facilitate early hemodynamic stabilization in the ICU, nor does it alter the hemodynamic support or outcome. Our results emphasize the need to evaluate technologies used to measure stroke volume and cardiac output--especially their impact on the process of care--before any large-scale outcome studies are attempted.

Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials

Long-term sedation with midazolam or propofol in intensive care units (ICUs) has serious adverse effects. Dexmedetomidine, an α(2)-agonist available for ICU sedation, may reduce the duration of mechanical ventilation and enhance patient comfort.

TONOMETRY REVISITED: PERFUSION-RELATED, METABOLIC, AND RESPIRATORY COMPONENTS OF GASTRIC MUCOSAL ACIDOSIS IN ACUTE CARDIORESPIRATORY FAILURE

Mucosal pH (pHi) is influenced by local perfusion and metabolism (mucosal-arterial Pco2 gradient, DeltaPco2), systemic metabolic acidosis (arterial bicarbonate), and respiration (arterial Pco2). We determined these components of pHi and their relation to outcome during the first 24 h of intensive care. We studied 103 patients with acute respiratory or circulatory failure (age, 63 +/- 2 [mean +/- SEM]; Acute Physiology and Chronic Health Evaluation II score, 20 +/- 1; Sequential Organ Failure Assessment score, 8 +/- 0). pHi, and the effects of bicarbonate and arterial and mucosal Pco2 on pHi, were assessed at admission, 6, and 24 h. pHi was reduced (at admission, 7.27 +/- 0.01) due to low arterial bicarbonate and increased DeltaPco2. Low pHi (<7.32) at admission (n = 58; mortality, 29% vs. 13% in those with pHi >/=7.32 at admission; P = 0.061) was associated with an increased DeltaPco2 in 59% of patients (mortality, 47% vs. 4% for patients with low pHi and normal DeltaPco2; P = 0.0003). An increased versus normal DeltaPco2, regardless of pHi, was associated with increased mortality at admission (51% vs. 5%; P < 0.0001; n = 39) and at 6 h (34% vs. 13%; P = 0.016; n = 45). A delayed normalization or persistently low pHi (n = 47) or high DeltaPco2 (n = 25) was associated with high mortality (low pHi [34%] vs. high DeltaPco2 [60%]; P = 0.046). In nonsurvivors, hypocapnia increased pHi at baseline, 6, and 24 h (all P

Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation

PURPOSE: To compare dexmedetomidine (DEX) with standard care (SC, either propofol or midazolam) for long-term sedation in terms of maintaining target sedation and length of intensive care unit (ICU) stay. METHODS: A pilot, phase III, double-blind multicenter study in randomized medical and surgical patients (n = 85) within the first 72 h of ICU stay with an expected ICU stay of >or=48 h and sedation need for >or=24 h after randomization. Patients were assigned to either DEX (

Development and simultaneous application of multiple care protocols in critical care: a multicenter feasibility study

OBJECTIVE: To test the feasibility of and interactions among three software-driven critical care protocols. DESIGN: Prospective cohort study. SETTING: Intensive care units in six European and American university hospitals. PATIENTS: 174 cardiac surgery and 41 septic patients. INTERVENTIONS: Application of software-driven protocols for cardiovascular management, sedation, and weaning during the first 7 days of intensive care. MEASUREMENTS AND RESULTS: All protocols were used simultaneously in 85% of the cardiac surgery and 44% of the septic patients, and any one of the protocols was used for 73 and 44% of study duration, respectively. Protocol use was discontinued in 12% of patients by the treating clinician and in 6% for technical/administrative reasons. The number of protocol steps per unit of time was similar in the two diagnostic groups (n.s. for all protocols). Initial hemodynamic stability (a protocol target) was achieved in 26+/-18 min (mean+/-SD) in cardiac surgery and in 24+/-18 min in septic patients. Sedation targets were reached in 2.4+/-0.2h in cardiac surgery and in 3.6 +/-0.2h in septic patients. Weaning protocol was started in 164 (94%; 154 extubated) cardiac surgery and in 25 (60%; 9 extubated) septic patients. The median (interquartile range) time from starting weaning to extubation (a protocol target) was 89 min (range 44-154 min) for the cardiac surgery patients and 96 min (range 56-205 min) for the septic patients. CONCLUSIONS: Multiple software-driven treatment protocols can be simultaneously applied with high acceptance and rapid achievement of primary treatment goals. Time to reach these primary goals may provide a performance indicator.

Association of arterial blood pressure and vasopressor load with septic shock mortality: a post hoc analysis of a multicenter trial

INTRODUCTION: It is unclear to which level mean arterial blood pressure (MAP) should be increased during septic shock in order to improve outcome. In this study we investigated the association between MAP values of 70 mmHg or higher, vasopressor load, 28-day mortality and disease-related events in septic shock. METHODS: This is a post hoc analysis of data of the control group of a multicenter trial and includes 290 septic shock patients in whom a mean MAP > or = 70 mmHg could be maintained during shock. Demographic and clinical data, MAP, vasopressor requirements during the shock period, disease-related events and 28-day mortality were documented. Logistic regression models adjusted for the geographic region of the study center, age, presence of chronic arterial hypertension, simplified acute physiology score (SAPS) II and the mean vasopressor load during the shock period was calculated to investigate the association between MAP or MAP quartiles > or = 70 mmHg and mortality or the frequency and occurrence of disease-related events. RESULTS: There was no association between MAP or MAP quartiles and mortality or the occurrence of disease-related events. These associations were not influenced by age or pre-existent arterial hypertension (all P > 0.05). The mean vasopressor load was associated with mortality (relative risk (RR), 1.83; confidence interval (CI) 95%, 1.4-2.38; P < 0.001), the number of disease-related events (P < 0.001) and the occurrence of acute circulatory failure (RR, 1.64; CI 95%, 1.28-2.11; P < 0.001), metabolic acidosis (RR, 1.79; CI 95%, 1.38-2.32; P < 0.001), renal failure (RR, 1.49; CI 95%, 1.17-1.89; P = 0.001) and thrombocytopenia (RR, 1.33; CI 95%, 1.06-1.68; P = 0.01). CONCLUSIONS: MAP levels of 70 mmHg or higher do not appear to be associated with improved survival in septic shock. Elevating MAP >70 mmHg by augmenting vasopressor dosages may increase mortality. Future trials are needed to identify the lowest acceptable MAP level to ensure tissue perfusion and avoid unnecessary high catecholamine infusions.