Huoltoasemakiinteistöjen arviointiprosessi ja arviointimenetelmät: Case-huoltamokiinteistön arvonmääritys

The purpose of this research is to examine the appraisal of service station real estate. This is a case research and the case service station is located in Kanta-Häme region in Finland. In the empirical part data consisted of national land survey of Finland’s data, Case corporations financial statements and Haahtela-Kehitys Oy: real estate appraisal 2013 instructions. The aim of this research was to find out whether there is a most suitable method for the appraisal of service station real estate. In this research it was not possible to conclude that one of the appraisal methods was more suitable than the other for service station real estate appraisal. It can be pointed out that selection of the appraisal method depends on several factors such as purpose of the appraisal, available information and the evaluator’s point of view.

Reduction of nitrogen oxide emissions in lime kiln

Different nitrogen oxide removal technologies for rotary lime kiln are studied in this thesis, the main focus being in commercial technologies. Post-combustion methods are investigated in more detail as potential possible NOx removal with combustion methods in rotary lime kiln is more limited or primary methods are already in use. However, secondary methods as NOx scrubber, SNCR or SCR technologies are not listed as the Best Available Technologies defined by European Union. BAT technologies for NOx removal in lime kiln are (1) Optimised combustion and combustion control, (2) Good mixing of fuel and air, (3) Low-NOx burner and (4) Fuel selection/low-N fuel. SNCR method is the most suitable technique for NOx removal in lime kiln when NOx removal from 50 % to 70 % is required in case primary methods are already in use or cannot be applied. In higher removal cases ammonia slip is an issue in SNCR. By using SCR better NOx reduction can be achieved but issues with catalyst materials are expected to arise because of the dust and sulphur dioxide which leads to catalyst poison formation in lower flue gas temperatures. NOx scrubbing has potential when simultaneous NOx and SO2 removal is required. The challenge is that NO cannot be scrubbed directly, but once it is oxidized to NO2 or further scrubbing can be performed as the solubility of NO2 is higher. Commercial installations have not been made regarding SNCR, SCR or NOx scrubbing regarding rotary lime kiln. For SNCR and SCR the closest references come from cement industry.

Bariatric and Post-Bariatric Surgery: from Metabolic Surgery to Plastic Surgery Indications

Background: Controversy exists concerning indications and outcomes of major bariatric surgery procedures. Massive weight loss after bariatric surgery leads to excess skin with functional and aesthetic impairments. The aim of this study was to investigate the major bariatric surgery procedures and their outcomes in two specific subgroups of morbidly obese patients, ≥55-year-olds and the superobese. Further aims were to evaluate whether the preoperative weight loss correlates with laparoscopic gastric bypass complications. The prevalence and impact of excess skin and the desire for body contouring after bariatric surgery were also studied. Patients and Methods: Data from patients who underwent Laparoscopic Adjustable Gastric Banding (LAGB) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) at Vaasa Central Hospital were collected and postoperative outcomes were evaluated according to the BMI, age and preoperative weight loss. Patients who had undergone bariatric surgery procedures were asked to complete a questionnaire to estimate any impairment due to redundant skin and to analyse each patient’s desire for body contouring by area. Results: No significant difference was found in operative time, hospital stay, or overall early postoperative morbidity between LAGB and LRYGB. Mean excess weight loss percents (EWL%) at 6 and 12 months after LRYGB were significantly higher. A significant difference was found in operative time favouring patients <55 years. Intraoperative complications were significantly more frequent in the group aged >55 years. No significant difference was detected in overall postoperative morbidity rates. A significant difference was found in operative time and hospital stay favouring all patients who lost weight preoperatively. Most patients reported problems with redundant skin, especially on the abdomen, upper arms and rear/buttocks, which impaired daily physical activity in half of them. Excess skin was significantly associated with female gender, weight loss and ΔBMI. Patients with a WL >20 kg, ΔBMI ≥10 kg/m2 and an EWL % > 50 showed a significantly surplus skin discomfort (p < 0.001). Most patients desired body contouring surgery, with high or very high desire for waist/abdomen (62.2%), upper arm (37.6%), chest/breast (28.3%), and rear/buttock (35.6%) contouring. Conclusions: LRYGB is effective and safe in superobese (BMI >50) and elderly (>55 years) patients. A preoperative weight loss >5% is recommended to improve the outcomes and reduce complications. A WL >20 kg, ΔBMI ≥10 kg/m2 and an EWL % > 50 are associated with a higher functional discomfort due to redundant skin and to a stronger desire for body contouring plastic surgery.

Pharao - lisäpotkua Sfinxiin

Lääkehoidon arvioinnin sähköiset työkalut ja niiden hyödyntäminen potilastyössä.

SALKO : lääkityksen tarkistustyökalu apteekeille

Lääkehoidon arvioinnin sähköiset työkalut ja niiden hyödyntäminen potilastyössä.

Natiivin Android-pelin käyttöliittymän skaalautuminen ja suorituskyvyn optimointi

Tässä työssä esiteltiin Android laitteisto- ja sovellusalustana sekä kuvattiin, kuinka Android-pelisovelluksen käyttöliittymä voidaan pitää yhtenäisenä eri näyttölaitteilla skaalauskertoimien ja ankkuroinnin avulla. Toisena osiona työtä käsiteltiin yksinkertaisia tapoja, joilla pelisovelluksien suorituskykyä voidaan parantaa. Näistä tarkempiin mittauksiin valittiin matalatarkkuuksinen piirtopuskuri ja näkymättömissä olevien kappaleiden piilotus. Mittauksissa valitut menetelmät vaikuttivat demosovelluksen suorituskykyyn huomattavasti. Tässä työssä rajauduttiin Android-ohjelmointiin Java-kielellä ilman ulkoisia kirjastoja, jolloin työn tuloksia voi helposti hyödyntää mahdollisimman monessa eri käyttökohteessa.

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.

Nurse Competence of Graduating Nursing Students

The competence of graduating nursing students is an important issue in health care as it is related to professional standards, patient safety and the quality of nursing care. Many changes in health care lead to increased demand with respect to nurses’ competence as well the number of nurses. The purpose of this empirical study was to i) describe the nurse competence areas of nursing students in Europe, ii) evaluate the nurse competence of graduating nursing students, iii) identify factors related to the nurse competence, and to iv) assess the congruence between graduating nursing students’ self-assessments and their mentors’ assessments of students’ nurse competence. The study was carried out in two phases: descriptive phase and evaluation phase. The descriptive phase focused on describing the nurse competence areas of nursing students in Europe with the help of a literature review (n=10 empirical studies and n=4 additional documents). Thematic analysis was used as the analysis method. In the evaluation phase, the nurse competence with particular focus on nursing skills of graduating nursing students (n=154) was assessed. In addition, factors related to the nurse competence were examined. Also, the congruence between graduating nursing students’ self-assessments and their mentors’ assessments of students’ nurse competence was evaluated by comparing graduating nursing students’ self-assessments with the assessments by their mentors (n=42) in the final clinical placement in four university hospitals. Descriptive statistics and inferential statistics were used to analyse the data. Based on the results, the nurse competence of nursing students in Europe consists of nine main competence areas: (1) professional/ethical values and practice, (2) nursing skills and interventions, (3) communication and interpersonal skills, (4) knowledge and cognitive ability, (5) assessment and improving quality in nursing, (6) professional development, (7) leadership, management and teamwork, (8) teaching and supervision, and (9) research utilization. Graduating nursing students self-assessed their nurse competence as good. However, when graduating nursing students’ nurse competence was assessed by their mentors, the results were poorer. Readiness for practice based on nurse education, pedagogical atmosphere on the ward, supervisory relationship between student and mentor and being in paid work in health care at the moment of the study were the most significant factors related to the nurse competence. Conclusions: Nurse competence can be evaluated with a scale based on self-assessment, but other evaluation methods could be used alongside to ensure that nurse competence can be completed and evaluated critically. Practical implications are presented for nurse education and nursing practice. In future, longitudinal research is needed in order to understand the development of nurse competence during nurse education and the transition process from a nursing student to a professional nurse.

Evaluating land-use related environmental impacts of biomass value chains for decision-support : Comparison and testing of methodologies proposed for environmental life cycle assessment

Life cycle assessment (LCA) is one of the most established quantitative tools for environmental impact assessment of products. To be able to provide support to environmentally-aware decision makers on environmental impacts of biomass value-chains, the scope of LCA methodology needs to be augmented to cover landuse related environmental impacts. This dissertation focuses on analysing and discussing potential impact assessment methods, conceptual models and environmental indicators that have been proposed to be implemented into the LCA framework for impacts of land use. The applicability of proposed indicators and impact assessment frameworks is tested from practitioners' perspective, especially focusing on forest biomass value chains. The impacts of land use on biodiversity, resource depletion, climate change and other ecosystem services is analysed and discussed and the interplay in between value choices in LCA modelling and the decision-making situations to be supported is critically discussed. It was found out that land use impact indicators are necessary in LCA in highlighting differences in impacts from distinct land use classes. However, many open questions remain on certainty of highlighting actual impacts of land use, especially regarding impacts of managed forest land use on biodiversity and ecosystem services such as water regulation and purification. The climate impact of energy use of boreal stemwood was found to be higher in the short term and lower in the long-term in comparison with fossil fuels that emit identical amount of CO2 in combustion, due to changes implied to forest C stocks. The climate impacts of energy use of boreal stemwood were found to be higher than the previous estimates suggest on forest residues and stumps. The product lifetime was found to have much higher influence on the climate impacts of woodbased value chains than the origin of stemwood either from thinnings or final fellings. Climate neutrality seems to be likely only in the case when almost all the carbon of harvested wood is stored in long-lived wooden products. In the current form, the land use impacts cannot be modelled with a high degree of certainty nor communicated with adequate level of clarity to decision makers. The academia needs to keep on improving the modelling framework, and more importantly, clearly communicate to decision-makers the limited certainty on whether land-use intensive activities can help in meeting the strict mitigation targets we are globally facing.

Ympäristön tilan seurantaohjelma 2015

Ympäristön tilan seurannan tavoitteena on tuottaa tietoa ympäristön tilasta, sen muutoksista ja muutosten syistä. Seurannasta saatavia tietoja käytetään päätöksenteon sekä ympäristönsuojelutoimien kohdentamisen ja niiden tuloksellisuuden arvioinnin tukena. Tietoja hyödynnetään maankäytön suunnittelussa ja sen ohjauksessa sekä ympäristövaikutusten arvioinnissa. Seurantatietoja tarvitaan kansainvälisten sopimusten edellyttämiin selvityksiin ja niitä hyödynnetään tutkimuksissa. Hämeen ELY-keskuksen seurantaohjelma vuodelle 2015 perustuu ympäristöhallinnon seurantaohjelmaan vuosille 2014–2016. Se sisältää pintavesien ohella pohjavesien ja maaympäristön seurantaa. Osa seurannassa olevista vesistöistä on vaihtunut toisiin, sillä useimmista vesistöistä ei enää oteta näytteitä vuosittain, vaan muutaman vuoden välein. Lähes kaikkien vesistöjen seurannassa on mukana jokin biologisen seurannan osa (kasviplankton, vesikasvit, pohjaeläimet, kalat) vesienhoitolain ja -asetuksen (vesipuitedirektiivin) mukaisesti. Pohjavesien seuranta jatkuu kolmella pohjavesiasemalla ja hydrologinen seuranta sisältää mm. vesistöjen vedenkorkeuksien, virtaamien, lämpötilojen, jäänpaksuuden sekä lumipeitteen paksuuden, haihdunnan ja roudan seurantaa. Maaympäristön seurantaan kuuluu myös useita eri seurantahankkeita.

Fosforin talteenotto eri saostus- ja kiteytysmenetelmillä

Fosfori on elintärkeä alkuaine ravinteena ja haasteena on, että fosforivarannot ovat yleismaailmallisesti ehtymässä. Sen kiertokulussa merkittävä osa päätyy vesistöihin aiheuttaen rehevöitymistä. Ongelmaan etsittiin ratkaisua fosforin saostus- ja kiteytysmenetelmistä. Kandityössä esitettiin eri periaatteet erottaa fosfori jätevedestä. Prosesseihin vaikuttavat tekijät määritettiin kiteytysteorian ja kirjallisuudesta löytyvien tutkimusten pohjalta, joiden avulla voitiin määrittää lupaavimmat menetelmät talteenottaa fosfori. Lupaavimmiksi yhdisteiksi saostaa fosfori osoittautuivat magnesiumammoniumfosfaatti- tai hydroksiapatiitti saostusprosessi.

Framework for Regional Heating Energy Efficiency Assessment

The aim of this project was to develop general framework for systematic assessment of energy efficiency of heating on regional level in Russia. The framework created during this project includes two main instruments, namely: general regional heating energy efficiency assessment model (REEMod) and general regional heating energy efficiency assessment criteria for housing areas (REECrit). Framework pays extreme attention to realization of energy saving, overall cost efficiency and comfortable indoor climate. Life-cycle ideology was applied during creation of the framework. Application of the framework can provide decision-making process with systematically collected and processed information on current state of areas energy efficiency. Such information will help decision makers to evaluate current situation of the whole energy chain, to compare different development scenarios and to identify the most efficient improvement methods, thus supporting realization of regions efficient energy management. Simultaneous pursuit of energy savings, cost efficiency and indoor air quality can contribute to development of sustainable community. Presented instruments should be continuously developed further as an iterative process based on knew experience, development of technology and overall understanding of energy efficiency issues.

Starting Insulin Treatment in Type 2 Diabetes

Type 2 diabetes is a disorder of glucose metabolism characterized by chronic hyperglycemia. Initially type 2 diabetes is characterized by insulin resistance and impaired function of beta cells, leading progressively to insulin deficiency. Type 2 diabetes is treated with diet and other lifestyle changes, and with medication modulating e.g. insulin resistance, liver glucose production and insulin secretion. Injectable insulin is added to the treatment when lifestyle changes and other medication are insufficient to maintain adequate control of hyperglycemia. The aim of the treatment is to remove the symptoms of diabetes and to prevent late complications of diabetes. Insulin was traditionally started at hospital wards, but from the early 1990’s also in outpatient care. The first substudy of this thesis examined retrospectively initiation practices and how successfully insulin treatment was introduced in 1990 – 1996 in Southwestern Finland. This study aimed also at identifying the best methods of controlling plasma glucose. It showed that in the 1990’s the incidence of insulin treatment increased and was initiated more often in outpatient care than previously. The use of combination treatment also increased, first with sulfonylureas and later with metformin as the oral drug. In combination therapy the insulin dose was smaller than with insulin monotherapy. HbA1c improved similarly in middle-aged and older age groups. Weight increase associated with insulin initiation was smaller when combined with oral agents. A prospective insulin initiation study (1994 – 1998) tested the hypothesis that hyperglycemia (fasting and postprandial hyperglycemia) may affect the outcome of insulin initiation. The type of hyperglycemia was determined by the relation of fasting plasma glucose to HbA1c. Treatment was initiated with insulin Lente or human NPH insulin. In patients treated with insulin monotherapy twice daily the decline in HbA1c was markedly greater for postprandial than fasting hyperglycemia patients suggesting that hyperglycemia type has significance in the selection of the insulin regimen. Another insulin initiation study showed that patients with fasting hyperglycemia starting on insulin (2004-2005) were significantly more prone to overweight than patients with postprandial hyperglycemia. Irrespective of the insulin preparation (insulin NPH or insulin glargine), patients with fasting hyperglycemia had a greater weight increase compared to patients with postprandial hyperglycemia. Special attention should be paid to prevention of weight increase in these patients.

Käsityön osaamisen jäljillä. Tutkimus käsityön oppiaineen osaamisen ja oppilaan käsityönopetuksellisen taustan yhteydestä neljän yläkoulun 7.luokilla Satakunnan ja Varsinais-Suomen alueella

Käsityön oppiaineen tulevaisuus on viimeaikoina puhuttanut niin opetusalan kehittäjiä, opetushenkilöstöä, opettajankouluttajia kuin opettajaopiskelijoitakin. Käsityön oppiainetta toteutetaan edelleen valtakunnallisesti kahteen eri sisältöön painottuneena tai enemmän molemmat käsityön sisällöt, tekninen työ ja tekstiilityö, huomioiden. Tulevat Perusopetuksen opetussuunnitelman perusteet (2016) eivät enää mahdollista oppilaalle painottumiseen perustuvaa valintaa teknisen työn tai tekstiilityön sisältöjen välillä, mikä on lisännyt keskustelua entisestään. Tämän tutkielman tavoitteena oli selvittää onko käsityön oppiaineen toteuttamistavalla samansisältöisenä tai painottuneena yhteyttä oppilaan käsityön osaamiseen. Lisäksi selvitettiin onko oppilaan sukupuolella tai harrastuneisuudella yhteyttä oppilaan osaamiseen. Osaamista tutkittiin myös käsityön eri osa-alueilla, joita olivat työvälineet ja materiaalit, tuotteen suunnittelu, tuotteen valmistus ja menetelmät, kestävä kehitys, työturvallisuus ja teknologia. Tutkimus toteutettiin Opetushallituksen (Koulutuksen seurantaraportti 2011:1) käsityön osaamista arvioivan tutkimuksen syventävän tehtäväsarjan mittaria käyttäen. Tutkimus suoritettiin neljässä yläkoulussa Satakunnan ja Varsinais-Suomen alueella huhti- ja toukokuun 2014 aikana. Tutkimukseen osallistui yhteensä 229 7. luokan oppilasta. Tutkimusaineisto analysoitiin vertailemalla keskeisiä tunnuslukuja, keskihajontoja ja korrelaatioita. Analysoinnissa käytettiin epäparametrisiä menetelmiä ja päätestit tehtiin käyttäen Mann Withneyn U- ja Kruskal-Wallisin testiä. Tuloksista voidaan tulkita, että käsityön oppiaineen toteuttaminen monipuolisesti, molemmat käsityön sisällöt huomioivana opetuksena, ei heikennä oppilaiden käsityön osaamista. Heikoiten mittauksessa menestyivät erittäin painottuneessa käsityönopetuksessa olleet oppilaat. Tuloksista voitiin tulkita, että sukupuolella on tilastollisesti merkittävä yhteys käsityön osaamiseen. Tytöt menestyivät poikia paremmin käsityön osaamisen kokonaisarvioinnissa sekä tekstiilityön kysymyksissä. Pojat menestyivät paremmin vain teknisen työn kysymyksissä. Harrastuneisuudella ei ollut tilastollisesti merkittävää yhteyttä osaamiseen, mutta harrastajat menestyivät keskiarvovertailussa ei-harrastajia paremmin. Eri osa-alueiden keskiarvovertailuissa neljällä osa-alueella parhaiten menestyivät oppilaat, jotka olivat osallistuneet molempisisältöiseen käsityönopetukseen koko tähänastisen käsityönopetuksensa ajan.

Balancing the quotation process by LEAN methods

This thesis studies the possibility to use lean tools and methods in a quotation process which is carried out in an office environment. The aim of the study was to find out and test the relevant lean tools and methods which can help to balance and standardize the quotation process, and reduce the variance in quotation lead times and in quality. Seminal works, researches and guide books related to the topic were used as the basis for the theory development. Based on the literature review and the case company’s own lean experience, the applicable lean tools and methods were selected to be tested by a sales support team. Leveling production, by product categorization and value stream mapping, was a key method to be used to balance the quotation process. 5S method was started concurrently for standardizing the work. Results of the testing period showed that lean tools and methods are applicable in office process and selected tools and methods helped to balance and standardize the quotation process. Case company’s sales support team decided to implement new lean based quotation process model.