Aggression and its Management in Adolescent Forensic Psychiatric Care

The overall goal of this study was to explore and identify good aggression management methods and on that basis to produce recommendations for aggression management in the adolescent forensic setting. The study was conducted in three phases. In Phase I, staff’s (n = 58) perception of adolescent aggressive behaviour and methods to manage it was examined. In Phase II, staff’s (n = 30) perception of treatment settings and treatment interventions available were studied. In Phase III, the effectiveness of an aggression management programme was evaluated. The data were collected during the period 2004-2007. Participants perceived adolescent aggressive behaviour in a similar way and described aggressive behaviour as being a comprehensible phenomenon. Management methods used to control aggressive situations were alike, although the practical solutions varied between the study units, especially regarding coercive methods. Staff members proposed more time and better opportunities to discuss and evaluate the aggression situation in order to improve the methods used. The treatment settings were similar in studied forensic units and interventions were primarily focused on psychological aspects, including management of aggressive behavior. A comprehensive aggression management programme proved to be effective in decreasing incidents of violence. The use of coercive methods in aggression situations decreased and injuries to the staff became less frequent. If staff members intend to apply high quality management methods in aggression situations they have to share a consistent understanding of aggressive behaviour and need to be aware of the various methods available. In addition, they should learn more about assessment methods in order to improve aggression management. International comparison of aggression, methods for managing it and service provision creates a starting point for developing equal care provision and realization within and between European countries.

Containment Measures in Adolescent Psychiatric Care - Focus on Mechanical Restrain

Rajoitetoimet, erityisesti sitominen, nuorisopsykiatrisessa hoitotyössä Tutkimuksen tavoitteena oli kuvata ja syventää tietoa rajoitetoimien, erityisesti sitomisen, käytöstä nuorisopsykiatrisessa vastentahtoisessa osastohoidossa. Tutkimuksen tavoitteena oli kuvata hoitajien, lääkäreiden ja potilaiden asenteita eri rajoittamiskeinoja kohtaan nuorisopsykiatrisessa osastohoidossa, kerätä tietoa yhden vuoden aikana tapahtuneiden sitomisten määrästä ja luonteesta sekä kuvata potilaiden kokemuksia sitomisesta nuorisopsykiatrisen osastohoidon aikana. Tutkimus tuottaa arvokasta tietoa korkeatasoisten sitomiskäytäntöjen kehittämiseen nuorisopsykiatrisessa osastohoidossa, sekä sitomisten määrää vähentämällä että sitomistapoja kehittämällä. Tavoitteena on parantaa sidottujen potilaiden kliinistä hoitoa. Tutkimusaineisto kerättiin suomalaisilla, pääkaupunkiseudulle sijoittuvilla, nuorisopsykiatrisilla osastoilla neljässä vaiheessa lokakuun 2009 ja huhtikuun 2012 välisenä aikana. Helsingin ja Uudenmaan sairaanhoitopiirin (HUS) nuorisopsykiatrian erikoisalan seitsemän suljetun osaston hoitohenkilökunta sekä lääkärit suhtautuivat myönteisesti rajoittamistoimenpiteisiin. Nuorisopsykiatriset potilaat suhtautuivat rajoittamistoimenpiteisiin kriittisemmin kuin henkilökunta. Nuoret suhtautuivat myönteisimmin tarvittaessa annettavaan lääkitykseen, ajoittaiseen tarkkailuun ja kulun rajoittamiseen. Vähiten hyväksytty menetelmä oli verkkosänky. Nuoret arvioivat sitomisen kolmen vähiten hyväksytyn menetelmän joukkoon. Sitomisen esiintyvyys ja pitkien sitomisten määrä olivat korkeita tutkimukseen valituissa yksiköissä. Useimmat sidotut nuoret tiesivät syyn sitomiseensa, suhtautuivat siihen ambivalentisti nähden siinä sekä hyötyä että haittaa, pitäen sitä kuitenkin rangaistuksena. Huolimatta tästä, suurin osa haastatelluista nuorista koki, että joissain tilanteissa sitomista tarvitaan nuorisopsykiatrisessa osastohoidossa. Nuorilla oli monia ehdotuksia, kuinka parantaa sitomista käytännön osastohoidossa. Tämä väitöskirja tuottaa uutta tietoa eri rajoittamistoimenpiteiden ja sitomisen toteuttamisesta nuorisopsykiatrisessa osastohoidossa. Käytännön hoitotyön parantamiseksi nuorisopsykiatrisilla osastoilla tarvitaan laaja-alaista ja syvälle luotaavaa koulutusta, jotta rajoittamis-toimenpiteiden määrää voidaan vähentää. Myös kriisitilanteiden hallintaan tarvitaan uusia keinoja. Tietoa, kuvausta toimenpiteistä ja tilanteiden käsittelyä jälkikäteen tulee tarjota ala-ikäiselle potilaalle hänen kehitystasonsa huomioiden. Sitomisten määrää tulee vähentää ja niiden kestoa lyhentää. Nuorten tulee olla aktiivisesti mukana kehittämässä aggression hallintamenetelmiä suomalaisessa nuorisopsykiatrisessa osastohoidossa.

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

Consistency of UML based designs using ontology reasoners

Software plays an important role in our society and economy. Software development is an intricate process, and it comprises many different tasks: gathering requirements, designing new solutions that fulfill these requirements, as well as implementing these designs using a programming language into a working system. As a consequence, the development of high quality software is a core problem in software engineering. This thesis focuses on the validation of software designs. The issue of the analysis of designs is of great importance, since errors originating from designs may appear in the final system. It is considered economical to rectify the problems as early in the software development process as possible. Practitioners often create and visualize designs using modeling languages, one of the more popular being the Uni ed Modeling Language (UML). The analysis of the designs can be done manually, but in case of large systems, the need of mechanisms that automatically analyze these designs arises. In this thesis, we propose an automatic approach to analyze UML based designs using logic reasoners. This approach firstly proposes the translations of the UML based designs into a language understandable by reasoners in the form of logic facts, and secondly shows how to use the logic reasoners to infer the logical consequences of these logic facts. We have implemented the proposed translations in the form of a tool that can be used with any standard compliant UML modeling tool. Moreover, we authenticate the proposed approach by automatically validating hundreds of UML based designs that consist of thousands of model elements available in an online model repository. The proposed approach is limited in scope, but is fully automatic and does not require any expertise of logic languages from the user. We exemplify the proposed approach with two applications, which include the validation of domain specific languages and the validation of web service interfaces.

Mobile clinics in public health care: Integrated service offerings for rural elderly

This research is an analysis of the value and content of local service offerings that enable longer periods of living at home for elderly people. Mobile health care and new distribution services have provided an interesting solution in this context. The research aim to shed light on the research question, ‘How do we bundle services based on different customer needs?’ A research process consisting of three main phases was applied for this purpose. During this process, elderly customers were segmented, the importance of services was rated and service offerings were defined. Value creation and service offering provides theoretical framework for the research. The target group is South Karelia’s 60 to 90-year old individuals and the data has been acquired via a postal questionnaire. Research has been conducted as exploratory research utilizing the methods of quantitative and social network analysis. The main results of the report are identified customer segments and service packages that fits to the segments’ needs. The results indicate the needs of customers and the results are additionally analysed from the producer’s point of view. In addition to the empirical results, the used theory framework has been developed further in order for the service-related theories to be seen from the customer’s point of view and not just from the producer’s point of view.

m-Equine : IS support for the horse industry

The horse industry is in many ways still operating the same way as it did in the beginning of the 20th century. At the same time the role of the horse has changed dramatically, from a beast of burden to a top athlete, a production animal or a beloved pet. A racehorse or an equestrian sport horse is trained and taken care of like any other athlete, but unlike its human counterpart, it might end up on our plate. According to European and many other countries’ laws, a horse is a production animal. The medical data of a horse should be known if it is to be slaughtered, to ensure that the meat is safe for human consumption. Today this vital medical information should be noted in the horse’s passport, but this paperbased system is not reliable. If a horse gets sold, depending on the country’s laws, the medical records might not be transferred to the new owner, the horse’s passport might get lost etc. Thus the system is not fool proof. It is not only the horse owners who have to struggle with paperwork; veterinarians as well as other officials often use much time on redundant paperwork. The main research question of this thesis is if IS could be used to help the different stakeholders within the horse industry? Veterinarians in particular who travel to stables to treat horses cannot always take with them their computers, since the somewhat unsanitary environment is not suitable for a sensitive technological device. Currently there is no common medical database developed for horses, although such a database with a support system could help with many problems. These include vaccination and disease control, food-safety, as well as export and import problems. The main stakeholders within the horse industry, including equine veterinarians and horse owners, were studied to find out their daily routines and needs for a possible support system. The research showed that there are different aspects within the horse industry where IS could be used to support the stakeholders daily routines. Thus a support system including web and mobile accessibility for the main stakeholders is under development. Since veterinarians will be the main users of this support system, it is very important to make sure that they find it useful and beneficial in their daily work. To ensure a desired result, the research and development of the system has been done iteratively with the stakeholders following the Action Design Research methodology.

Scenario-based traffic forecasts for the routes between the PENTA ports in 2020

Maritime transport is the foundation for trade in the Baltic Sea area. It represents over 15% of the world’s cargo traffic and it is predicted to increase by over 100% in the future. There are currently over 2,000 ships sailing on the Baltic Sea and both the number and the size of ships have been growing in recent years. Due to the importance of maritime traffic in the Baltic Sea Region, ports have to be ready to face future challenges and adapt to the changing operational environment. The companies within the transportation industry – in this context ports, shipowners and logistics companies – compete continuously and although the number of companies in the business is not particularly substantial because the products offered are very similar, other motives for managing the supply chain arise. The factors creating competitive advantage are often financial and related to cost efficiency, but geographical location, road infrastructure in the hinterland and vessel connections are among the most important factors. The PENTA project focuses on adding openness, transparency and sharing knowledge and information, so that the challenges of the future can be better addressed with regard to cooperation. This report presents three scenario-based traffic forecasts for routes between the PENTA ports in 2020. The chosen methodology is PESTE, in which the focus in on economic factors affecting future traffic flows. The report further analyses the findings and results of the first PENTA WP2 report “Drivers of demand in cargo and passenger traffic between PENTA ports” and utilises the same material, which was obtained through interviews and mail surveys.

Coercion, Perceived Care and Quality of Life Among Patients in Psychiatric Hospitals

The goals of the study were to describe patients’ perceptions of care after experiencing seclusion/restraint and their quality of life. The goal was moreover to identify methodological challenges related to studies from the perspective of coerced patients. The study was conducted in three phases between September 2008 and April 2012. In the first phase, the instrument Secluded/ Restrained Patients’ Perception of their Treatment (SR-PPT) was developed and validated in Japan in cooperation with a Finnish research group (n = 56). Additional data were collected over one year from secluded/restrained patients using the instrument (n = 90). In the second phase, data were collected during the discharge process (n = 264). In the third phase, data were collected from electronic databases. Methodological and ethical issues were reviewed (n = 32) using systematic review method. Patients perceived that co-operation with the staff was poor; patients’ opinions were not taken into account, treatment targets collated and treatment methods were seen in different ways. Patients also felt that their concerns were not well enough understood. However, patients received getting nurses’ time. In particular, seclusion/restraint was considered unnecessary. The patients felt that they benefited from the isolation in treating their problems more than they needed it, even if the benefit was seen to be minor. Patients treated on forensic wards rated their treatment and care significantly lower than in general units. During hospitalization secluded/restrained patients evaluated their quality of life, however, better than did non-secluded/restrained patients. However, no conclusion is drawn to the effect that the better quality of life assessment is attributable to the seclusion/restraint because patients’ treatment period after the isolation was long and because of many other factors, as rehabilitation, medication, diagnostic differences, and adaptation. According to the systematic mixed studies review variation between study designs was found to be a methodological challenge. This makes comparison of the results more difficult. A research ethical weakness is conceded as regards descriptions of the ethical review process (44 %) and informed consent (32 %). It can be concluded that patients in psychiatric hospital care and having a voice as an equal expert require special attention to clinical nursing, decision-making and service planning. Patients and their family members will be consulted in plans of preventive and alternative methods for seclusion and restraint. The study supports the theory that in ethical decision-making situations account should be taken of medical indications, in addition to the patients’ preferences, the effect of treatment on quality of life, and this depends on other factors. The connection between treatment decisions and a patient’s quality of life should be evaluated more structurally in practice. Changing treatment culture towards patients’ involvement will support daily life in nursing and service planning taking into account improvements in patients’ quality of life.

Suunnittelulla ja ruo´on hyötykäytöllä tehokkuutta rantojen hoitoon : Tuloksia ja kokemuksia VELHO-hankkeesta

Varsinais-Suomen ELY-keskuksen toteuttamassa VELHO-hankkeessa kehitettiin kustannustehokkaita ratkaisuja ranta-alueiden umpeenkasvun aiheuttamiin ongelmiin luomalla uusi konsepti ranta-alueiden monikäyttösuunnitteluun, edistämällä järviruo’on hyötykäyttöä ja valmistelemalla esityksiä uuteen maaseudun kehittämisohjelmaan. Tässä julkaisussa esitellään työn tulokset ja johtopäätökset. Hankkeessa laadittiin kolme ranta-alueiden monikäyttösuunnitelmaa: Mynälahden Sarsalanaukko ja Musta-aukko, Oukkulanlahti – Naantalinaukko ja Eurajoen - Luvian rannikko. Suunnitelmissa sovitettiin yhteen ranta-alueiden eri käyttömuotoja ja pyrittiin löytämään optimaalinen verkosto hyötykäyttöön leikattavien ruovikoiden, avoimena pidettävien merenrantaniittyjen ja säilytettävien ruovikoiden välille. Kustannustehokkuuteen pyrittiin kohdentamalla hoitotoimet laajoihin kokonaisuuksiin sekä järviruo’on hyötykäytöllä. Suunnitelmat laadittiin laajassa osallistavassa prosessissa. Hankkeessa laadituissa ranta-alueiden monikäyttösuunnitelmissa esitettiin erilaisia maankäyttötavoitteita ja hoitosuosituksia yli 2000 hehtaarille. Ruovikoiden ja rantaniittyjen lisäksi suunnittelun kohteena olivat myös rantojen läheiset peltoalueet, reunavyöhykkeet ja muut perinnebiotoopit. Hoitotoimilla tavoitellaan alueiden luonnon monimuotoisuuden ja vesien tilan paranemista, maiseman avartumista ja virkistyskäytön helpottumista. Ruovikoiden erilaisia leikkuumenetelmiä (talvileikkuut, vesileikkuut, maaleikkuut) testattiin 90 hehtaarin alalla. Rantaniittyjen kunnostuksessa testattiin maaleikkuun lisäksi ruovikon niittomurskausta. Ruokomassan hyötykäyttökokeissa testattiin kahden eri ruokolaadun eli tuoreen kesäruo’on ja kuivan talviruo’on esikäsittelyä ja hyötykäyttöä energiantuotannossa (poltto, biokaasutus) ja maataloudessa (maanparannusaine, viherlannoite, kuivike, katemateriaali). Maaseudun kehittämisohjelmaan tehtiin esityksiä tukimuotojen kehittämiseksi: rantaniittyjen kunnostuksen lisääminen ja hoidon laadun parantaminen, ruovikoiden vesileikkuut ravinteiden poistajina sekä ruokomassojen käyttö maan orgaanisen aineen lisääjänä. Hankkeen kokemusten mukaan yksi kustannustehokkaimmista hoito- ja käyttöketjuista on ruovikon leikkuu loppukesällä ja siitä kertyvän massan käyttö ranta-alueiden läheisillä pelloilla viherlannoitteena ja maanparannusaineena. Yhden hehtaarin ruovikon kesäleikkuulla poistetaan keskimäärin 80 kg typpeä ja 7 kg fosforia. Vesiensuojelullisten hyötyjen lisäksi leikkuulla parannetaan umpeenkasvusta kärsivien lajien elinoloja, lisätään rantojen vetovoimaisuutta ja edistetään luonnonhoitoyrittäjyyden edellytyksiä. Peltokäytössä käsittelyketju on lyhyt eikä se vaadi pitkiä kuljetusmatkoja. Ruokomassa kierrättää ravinteita takaisin pelloille ja parantaa maan rakennetta. Järviruo’on hyötykäytöllä ei pystytä kattamaan koko leikkuu- ja käyttöketjun kustannuksia. Leikkuusta ja hyötykäytöstä saatavien monien eri aineellisten ja aineettomien ekosysteemipalveluhyötyjen vuoksi toimintaan on tarpeen suunnata yhteiskunnan tukea ja luoda käytännön toteutusta edistäviä tukimuotoja. Kustannustehokkuutta voidaan edelleen parantaa laitteita ja menetelmiä kehittämällä.

International Advanced Water Technologies Centre, IAWTC/LADEC and LUT 2013 : Questionnaire Responses from Russian Drinking Water and Wastewater Treatment Plants

In this report, information is published concerning Russian water and wastewater treatment plants. The information is based on a questionnaire sent to 70 water and wastewater treatment plants in 2012-2013. The questionnaire was prepared by the International Advanced Water Technologies Centre (IAWTC) and Lahti Development Company (LADEC). The questions dealt with an assessment of the present state, the need for changes, renovation, investments, and how to improve the efficiency of the operation by training and investments. A significant need to renew the old pipelines, constructions, and processes was clearly evident. The aggregated answers can be utilized in Russia as internal benchmarking in order to arrange training and plant visits, which were requested in many of the answers. Sharing this open report with the respondents can aid networking and awareness of HELCOM requirements which relate to waste water treatment plants discharging their waste water directly or indirectly into the Baltic Sea. The aim of this report is to provide information for Finnish small and medium size companies (SMEs) as regards possible water related exportation to different parts of Russia.

Distribution channel plan for wound care products: Case 3M Finland Ltd.

The aim of this master’s thesis was to make a qualitative marketing research and on the basis of this to develop a distribution plan for the case company Finnish 3M Ltd.’s wound care products. The literature review includes three important parts: distribution channel planning, the buying behavior of seniors, and special characteristics of health care products’ marketing. The empirical part of this thesis comprises two different parts. The first part is a marketing research, in which the buying behavior of wound care products is studied in Espoo. The research aim was to examine, in which distribution channels the wound care patients under home care would most preferably buy wound care products during the time period, when municipalities will not yet provide the products for free. The data was collected through semi-structured phone interviews and regular interviews, and was treated qualitatively and anonymously. The study revealed that the recommendations of nurses and doctors influenced most the buying behavior of wound care customers. In the second part of the thesis a distribution channel plan for wound care products was made for the case company 3M Finland Ltd. based on the results. 3M Finland Ltd. should focus on pharmacies, online-stores and municipal health centers as their main distributors.

Quality of radiotherapy care by development of e-feedback knowledge

The aim of this three phase study was to develop quality of radiotherapy care by the e-Feedback knowledge of radiotherapy -intervention (e-Re-Know). In Phase I, the purpose was to describe the quality of radiotherapy care and its deficits experienced by cancer patients. Based on the deficits in patient education in Phase II, the purpose was to describe cancer patients’ e-knowledge expectations in radiotherapy. In Phase III, the purpose was to develop and evaluate the outcomes of the e-Re-Know among breast cancer patients. The ultimate aim was to develop radiotherapy care to support patients’ empowerment with patient e-education. In Phase I (2004-2005), the descriptive design was used, and 134 radiotherapy patients evaluated their experiences by Good Nursing Care Scale for Patients (GNCS-P) in the middle of RT period. In Phase II (2006-2008), the descriptive longitudinal design was used and 100 radiotherapy patients’ e-knowledge expectations of RT were evaluated using open-ended questionnaire developed for this study before commencing first RT, in the middle of the treatment, and concluding RT period. In Phase III, firstly (2009-2010), the e-Re-Know intervention, i.e. knowledge test and feedback, was developed in terms of empowering knowledge and implemented with e-feedback approach based on literature and expert reviews. Secondly (2011-2014), the randomized controlled study was used to evaluate the e-Re-Know. Breast cancer patients randomized to either the intervention group (n=65) receiving the e-Re-Know by e-mail before commencing first RT and standard education or the control group (n=63) receiving standard education. The data were collected before commencing first RT, concluding last RT and 3 months after last RT using RT Knowledge Test, Spielberger’s State Trait Inventory (STAI) and Functional Assessment of Cancer Therapy - Breast (FACT-B) –instruments. Data were analyzed using statistical methods and content analysis. The study showed radiotherapy patients experienced quality of care high. However, there were deficits in patient education. Furthermore, radiotherapy patients’ multidimensional e-knowledge expectations through Internet covered mainly bio-physiological and functional knowledge. Thus, the e-Re-Know was developed and evaluated. The study showed when breast cancer patients’ carried out the e-Re-Know their knowledge of side effects self-care was significantly increased and quality of life (QOL) significantly improved in line with decrease in anxiety from time before radiotherapy period to three months after. In addition, the e-Re-Know has potential to have positive effects on anxiety and QOL, regardless of patient characteristics or knowledge level. The results support the theory of empowering patient education suggesting that empowerment can be supported by confirming patients’ understanding of own knowledge level. In summary, the e-Feedback knowledge of radiotherapy (e-Re-Know) intervention can be recommended in development of quality of radiotherapy care experienced by breast cancer patients. Further research is needed to assess and develop patient-centred quality of care by patient education among cancer patients.

PCR-based ribotyping of Staphylococcus aureus

Genotyping techniques are valuable tools for the epidemiologic study of Staphylococcus aureus infections in the hospital setting. Pulsed-field gel electrophoresis (PFGE) is the current method of choice for S. aureus strain typing. However, the method is laborious and requires expensive equipment. In the present study, we evaluated the natural polymorphism of the genomic 16S-23S rRNA region for genotyping purpose, by PCR-based ribotyping. Three primer pairs were tested to determine the size of amplicons produced and to obtain better discrimination with agar gel electrophoresis and ethidium bromide staining. The resolution of the typing system was determined using sets of bacteria obtained from clinical specimens from a large tertiary care hospital. These included DNA from three samples obtained from a bacteremic patient, six strains with known and diverse PGFE patterns, and 88 strains collected over a 3-month period in the same hospital. Amplification patterns obtained from samples from the same patient were identical, and PFGE from samples known to be different produced three genotypes. Amplification of DNA from 61 methicillin-resistant isolates produced only one pattern. Methicillin-sensitive strains yielded a diversity of patterns, pointing to a true polyclonal distribution throughout the hospital (22 unique patterns from 27 strains). Computer-based software can be used to differentiate among identifiable strains, given the low number of bands and good characterization of PCR products. PCR-based ribotyping can be a useful technique for genotyping methicillin-sensitive S. aureus strains, but is of limited value for methicillin-resistant strains.

Nanoparticle-Assisted Immunoassays for Point-of-Care Testing - With Specific Interest in Minimally Interference-Prone Assays for Cardiac Troponin I

Cardiac troponins (cTn) I and T are the current golden standard biochemical markers in the diagnosis and risk stratification of patients with suspected acute coronary syndrome. During the past few years, novel assays capable of detecting cTn‐concentrations in >50% of apparently healthy individuals have become readily available. With the emerging of these high sensitivity cTn assays, reductions in the assay specificity have caused elevations in the measured cTn levels that do not correlate with the clinical picture of the patient. The increased assay sensitivity may reveal that various analytical interference mechanisms exist. This doctoral thesis focused on developing nanoparticle‐assisted immunometric assays that could possibly be applied to an automated point‐of‐care system. The main objective was to develop minimally interference‐prone assays for cTnI by employing recombinant antibody fragments. Fast 5‐ and 15‐minute assays for cTnI and D‐dimer, a degradation product of fibrin, based on intrinsically fluorescent nanoparticles were introduced, thus highlighting the versatility of nanoparticles as universally applicable labels. The utilization of antibody fragments in different versions of the developed cTnI‐assay enabled decreases in the used antibody amounts without sacrificing assay sensitivity. In addition, the utilization of recombinant antibody fragments was shown to significantly decrease the measured cTnI concentrations in an apparently healthy population, as well as in samples containing known amounts of potentially interfering factors: triglycerides, bilirubin, rheumatoid factors, or human anti‐mouse antibodies. When determining the specificity of four commercially available antibodies for cTnI, two out of the four cross‐reacted with skeletal troponin I, but caused crossreactivity issues in patient samples only when paired together. In conclusion, the results of this thesis emphasize the importance of careful antibody selection when developing cTnI assays. The results with different recombinant antibody fragments suggest that the utilization of antibody fragments should strongly be encouraged in the immunoassay field, especially with analytes such as cTnI that require highly sensitive assay approaches.