Current Care Guidelines for Cardiopulmonary Resuscitation : Implementation, skills and attitudes

Background: The national resuscitation guidelines were published in Finland in 2002 and are based on international guidelines published in 2000. The main goal of the national guidelines, available on the Internet free of charge, is early defibrillation by nurses in an institutional setting. Aim: To study possible changes in cardiopulmonary resuscitation (CPR) practices, especially concerning early defibrillation, nurses and students attitudes of guideline implementation and nurses and students ability to implement the guideline recommendations in clinical practices after publication of the Current Care (CC) guidelines for CPR 2002. Material and methods: CPR practices in Finnish health centres; especially concerning rapid defibrillation programmes, as well as the implementation of CC guidelines for CPR was studied in a mail survey to chief physicians of every health centre in Finland (Study I). The CPR skills using an automated external defibrillator (AED) were compared in a study including Objective stuctured clinical examination (OSCE) of resuscitation skills of nurses and nursing students in Finnish and Swedish hospital and institution (Studies II, III). Attitudes towards CPR-D and CPR guidelines among medical and nursing students and secondary hospital nurses were studied in surveys (Studies IV, V). The nurses receiving different CPR training were compared in a randomized trial including OSCE of CPR skills of nurses in Finnish Hospital (Study VI). Results: Two years after the publication, 40.7% of Finnish health centres used national resuscitation guidelines. The proportion of health centres having at least one AED (66%) and principle of nurse-performed defibrillation without the presence of a physician (42%) had increased. The CPR-D training was estimated to be insufficient regarding basic life support and advanced life support in the majority of health centres (Study I). CPR-D skills of nurses and nursing students in two specific Swedish and Finnish hospitals and institutions (Study II and III) were generally inadequate. The nurses performed better than the students and the Swedish nurses surpassed the Finnish ones. Geriatric nurses receiving traditional CPR-D training performed better than those receiving an Internet-based course but both groups failed to defibrillate within 60 s. Thus, the performance was not satisfactory even two weeks after traditional training (Study VI). Unlike the medical students, the nursing students did not feel competent to perform procedures recommended in the cardiopulmonary resuscitation guidelines including the defibrillation. However, the majority of nursing students felt confident about their ability to perform basic life support. The perceived ability to defibrillate correlated significantly with a positive attitude towards nurse-performed defibrillation and negatively with fear of damaging the patient s heart by defibrillation (Study IV). After the educational intervention, the nurses found their level of CPR-D capability more sufficient than before and felt more confident about their ability to perform defibrillation themselves. A negative attitude toward defibrillation correlated with perceived negative organisational attitudes toward cardiopulmonary resuscitation guidelines. After CPR-D education in the hospital, the majority (64%) of nurses hesitated to perform defibrillation because of anxiety and 27 % hesitated because of fear of injuring the patient. Also a negative personal attitude towards guidelines increased markedly after education (Study V). Conclusions: Although a significant change had occurred in resuscitation practices in primary health care after publication of national cardiopulmonary resuscitation guidelines the participants CPR-D skills were not adequate according to the CPR guidelines. The current way of teaching is unlikely to result in participants being able to perform adequate and rapid CPR-D. More information and more frequent training are needed to diminish anxiety concerning defibrillation. Negative beliefs and attitudes toward defibrillation affect the nursing students and nurses attitudes toward cardiopulmonary resuscitation guidelines. CPR-D education increased the participants self-confidence concerning CPR-D skills but it did not reduce their anxiety. AEDs have replaced the manual defibrillators in most institutions, but in spite of the modern devices the anxiety still exists. Basic education does not provide nursing students with adequate CPR-D skills. Thus, frequent training in the workplace has vital importance. This multi-professional program supported by the administration might provide better CPR-D skills. Distance learning alone cannot substitute for traditional small-group learning, tutored hands-on training is needed to learn practical CPR-D skills. Standardized testing would probably help controlling the quality of learning. Training of group-working skills might improve CPR performance.

Keskiluokkainen kulutuseetos 1920–1950-luvuilla syntyneiden suomalaisten kulutuskerronnassa

Tutkielmassa tarkastellaan suomalaista kulutuskulttuuria ja sen muuttumista kulutuskerronnan kautta. Aineisto koostuu 39 iäkkään, 1920–1950-luvuilla syntyneen, suomalaisen kuluttajaelämäkerroista, jotka kerättiin kirjoituskilpailulla. Tutkielmassa analysoidaan informanttien kulutukseen ja rahankäyttöön liittämiä hyveitä sekä sitä, millaisista kulutuseetoksista hyveet kertovat. Elämäkertojen erittelyyn ja tulkintaan on sovellettu lähiluentaa. Analyysin avulla on rakennettu tulkinta keskiluokkaisesta kulutuseetoksesta. Tutkimuksen teoreettinen viitekehys pohjautuu kulutuksen normatiivisia merkityksiä, kulutuseetoksia ja keskiluokkaisuutta käsitteleviin tutkimuksiin. Tulkintaa ohjaa lisäksi ymmärrys tutkittavan sukupolven elämänkulusta suomalaisen kulutusyhteiskunnan kehityksen näkökulmasta. Tutkittavan sukupolven elämän aikana kotitalous on kehittynyt agraarisen yhteiskunnan omavaraisesta tuotantoyksiköstä vauraan yhteiskunnan kulutukseen ja sosiaaliseen uusintamiseen keskittyväksi instituutioksi. Palkkatyöläisyys, vapaa-aika ja kulutusmahdollisuudet ovat lisääntyneet, ja yhteiskuntaa leimaa keskiluokkaistuminen. Elämäkerroista löytyvät säästäväisyyden ja vaatimattomuuden hyveet kertovat talonpoikaisen kulutueetoksen olevan edelleen keskeinen kulutuseetos, mutta niukkuuden hyveellistämisen lisäksi kulutuskerronnasta löytyy myös modernimpia tapoja suhtautua kulutukseen. Tulkitsen kuluttajaelämäkerroista löytyvien järkevyyden, tavallisuuden ja työnteon hyveiden kertovan keskiluokkaisuudesta. Hyveellinen kuluttaminen on keskiluokkaisessa kulutuseetoksessa talonpoikaista kulutuseetosta sallivampaa. Se määrittyy niukan kuluttamisen sijaan kohtuullisen ja tavallisen kuluttamisen hyveellistämiseksi. Keskiluokkaisessa kulutuseetoksessa on hyväksyttävää nauttia kohtuudella ja järkevästi omalla työllä ansaitusta vaurastumisesta. Talonpoikaisesta kulutuseetoksesta poiketen keskiluokkainen kulutuseetos hyväksyy kulutuksesta saatavan nautinnon. Sanonta ”ensin työ, sitten huvi” kuvaa keskiluokkaisen kulutuseetoksen tapaa suhtautua vaurastumisen mukanaan tuomaan kulutuskulttuuriin ja sen nautintoihin.

HALLINNONTASOJEN VÄLINEN DIALOGI JA ERITYISOPETUKSEN MUUTOS BYROKRAATTISENA INSTITUUTIONA : - Kymppikuntien loppuraportin ja Erityisopetuksen strategian sisällönanalyyttinen vertailu

The rise of Special education numbers in Finland has caused a situation where Finland s ten largest LEA s so called kymppikunnat (ten communes) have expressed their growing concern of organizing the special education in the current institutional settings. The LEA s started the conversation of redefining special education system in 2004. Their aim was to target the governments attention to the problematics of special education. By the request of the Ministry of Education the LEA s prepared a final report concerning the central questions in the Finnish special education system. On the basis of the LEA s survey it became even clearer that the legislation, funding system and curriculum are tightly linked together. The following LEA s took part into the writing process Espoo, Helsinki, Jyväskylä, Kuopio, Lahti, Lappeenranta, Tampere, Turku and Vantaa. The report was hand over to the Ministry of Education at 18.8.2006. After the delivery the Ministry organized special education development group meetings 17 times in the year 2007. The result of the LEA s report and the development meetings was a new Special Education Strategy 2007. I am observing the dialogue between administrational levels in governmental institutions change process. The research is a content analysis where I compare the Erityistä tukea tarvitsevan oppilaan opetuksen järjestämisen uudistaminen osana yhtenäistä perusopetusta- kohti laatua ja joustavuutta (The renewal of the organization of teaching for student with special educational needs as part of unified education for all - towards quality and flexibility) document to Erityisopetuksen strategia (Special education strategy) document. My aim was to find out how much of their own interests have the LEA s been able to integrate into the official governmental documentation. The data has been organized and analyzed quantitatively with Macros created as additional parts in Microsoft Excel software. The document material has also been arranged manually on sentence based categorization into an Excel matrix. The results have been theoretically viewed from the special education reform dialogue perspective, and from the angle of the change process of a bureaucratic institution. My target has been to provide a new viewpoint to the change of special education system as a bureaucratic institution. The education system has traditionally been understood as a machine bureaucracy. By the review provided in my pro gradu analysis it seems however that the administrational system in special education is more of a postmodern network bureaucracy than machine bureaucracy. The system appears to be constructed by overlapping, crossing and complex networks where things are been decided. These kinds of networks are called "governance networks . It seems that the governmental administrational - and politic levels, the third sector actors and other society s operators are mixed in decision making.

Supistamista, rationalisointia vai kehittämistä? : Valtiovarainministeriön järjestelyosaston järjestämän henkilöstökoulutus- ja tutkimustoiminnan rakentuminen osaksi valtionhallintoa vuosina 1943-1971

The study examines the personnel training and research activities carried out by the Organization and Methods Division of the Ministry of Finance and their becoming a part and parcel of the state administration in 1943-1971. The study is a combination of institutional and ideological historical research in recent history on adult education, using a constructionist approach. Material salient to the study comes from the files of the Organization and Methods Division in the National Archives, parliamentary documents, committee reports, and the magazines. The concentrated training and research activities arranged by the Organization and Methods Division, became a part and parcel of the state administration in the midst of controversial challenges and opportunities. They served to solve social problems which beset the state administration as well as contextual challenges besetting rationalization measures, and organizational challenges. The activities were also affected by a dependence on decision-makers, administrative units, and civil servants organizations, by different views on rationalization and the holistic nature of reforms, as well as by the formal theories that served as resources. It chose long-term projects which extended to the political decision-makers and administrative units turf, and which were intended to reform the structures of the state administration and to rationalize the practices of the administrative units. The crucial questions emerged in opposite pairs (a constitutional state vs. the ideology of an administratively governed state, a system of national boards vs. a system of government through ministries, efficiency of work vs. pleasantness of work, centralized vs. decentralized rationalization activities) which were not solvable problems but impossible questions with no ultimate answers. The aim and intent of the rationalization of the state administration (the reform of the central, provincial, and local governments) was to facilitate integrated management and to render a greater amount of work by approaching management procedures scientifically and by clarifying administrative instances and their respon-sibilities in regards to each other. The means resorted to were organizational studies and committee work. In the rationalization of office work and finance control, the idea was to effect savings in administrative costs and to pare down those costs as well as to rationalize and heighten those functions by developing the institution of work study practitioners in order to coordinate employer and employee relationships and benefits (the training of work study practitioners, work study, and a two-tier work study practitioner organization). A major part of the training meant teaching and implementing leadership skills in practice, which, in turn, meant that the learning environment was the genuine work community and efforts to change it. In office rationalization, the solution to regulate the relations between the employer and the employees was the co-existence of the technical and biological rationalization and the human resource administration and the accounting and planning systems at the turn of the 1960s and 1970s. The former were based on the school of scientific management and human relations, the latter on system thinking, which was a combination of the former two. In the rationalization of the state administration, efforts were made to find solutions to stabilize management ideologies and to arrange the relationships of administrative systems in administrative science - among other things, in the Hoover Committee and the Simon decision making theory, and, in the 1960s, in system thinking. Despite the development-related vocabulary, the practical work was advanced rationalization. It was said that the practical activities of both the state administration and the administrative units depended on professional managers who saw to production results and human relations. The pedagogic experts hired to develop training came up with a training system, based on the training-technological model where the training was made a function of its own. The State Training Center was established and the training office of the Organization and Methods Division became the leader and coordinator of personnel training.

Mass Spectrometry Informatics in Systems Biology

Mass spectrometry (MS) became a standard tool for identifying metabolites in biological tissues, and metabolomics is slowly acknowledged as a legitimate research discipline for characterizing biological conditions. The computational analyses of metabolomics, however, lag behind compared with the rapid advances in analytical aspects for two reasons. First is the lack of standardized data repository for mass spectra: each research institution is flooded with gigabytes of mass-spectral data from its own analytical groups and cannot host a world-class repository for mass spectra. The second reason is the lack of informatics experts that are fully experienced with spectral analyses. The two barriers must be overcome to establish a publicly free data server for MS analysis in metabolomics as does GenBank in genomics and UniProt in proteomics. The workshop brought together bioinformaticians working on mass spectral analyses in Finland and Japan with the goal to establish a consortium to freely exchange and publicize mass spectra of metabolites measured on various platforms computational tools to analyze spectra spectral knowledge that are computationally predicted from standardized data. This book contains the abstracts of the presentations given in the workshop. The programme of the workshop consisted of oral presentations from Japan and Finland, invited lectures from Steffen Neumann (Leibniz Institute of Plant Biochemistry), Matej Oresic (VTT), Merja Penttila (VTT) and Nicola Zamboni (ETH Zurich) as well as free form discussion among the participants. The event was funded by Academy of Finland (grants 139203 and 118653), Japan Society for the Promotion of Science (JSPS Japan-Finland Bilateral Semi- nar Program 2010) and Department of Computer Science University of Helsinki. We would like to thank all the people contributing to the technical pro- gramme and the sponsors for making the workshop possible. Helsinki, October 2010 Masanori Arita, Markus Heinonen and Juho Rousu

Eläke- ja vammaisetuuksien, maahanmuuttajan erityistuen ja eläkkeensaajan asumistuen muutokset 1.1.2011

Kansaneläkeindeksi 1 508, elinkustannusindeksi 1 749 (pistelukujen keskiarvo heinäsyyskuulta 2010) Vuoden 2011 alusta kansaneläkkeisiin, perhe-eläkkeisiin, lapsikorotuksiin, rintamalisiin, vammaisetuuksiin (pl. ruokavaliokorvaukset) ja maahanmuuttajan erityistukiin tehtiin 0,4 prosentin indeksitarkistus. Eläke-etuusmenot kasvoivat 9,7 milj. euroa (0,4 %), vammaisetuusmenot 1,9 milj. euroa (0,4 %) ja maahanmuuttajan erityistukimenot 0,1 milj. euroa (0,3 %). Laskelmat perustuvat joulukuun 2010 etuuskantaan.

Investigations of a two-stage pulse tube cryocooler operating down to 2.5K

A two-stage pulse tube cryocooler (PTC) which produces a no-load temperature of similar to 2.5 K in its second stage at an operating frequency of 1.6 Hz has been designed and fabricated. The second stage of the system provides a refrigeration power of similar to 250 mW at 5.0 K. The system uses stainless steel meshes (mesh size 200) along with lead (Pb) granules and combinations of Pb, Er3Ni, and HoCu2 as the first and second stage regenerator materials, respectively. Experimental studies have been carried out on different pulse tube configurations by varying the dimensions of the pulse tubes and regenerators to arrive at the best one, which leads to the lowest no-load second stage cold head temperature. Using this configuration, detailed experimental studies have been conducted by varying the volume percentage ratios of the second stage regenerator materials such as HoCu2, Er3Ni, and Pb (with an average grain size of similar to 250 mu m). This article presents the results of our experimental studies on cryocoolers with the regenerator material arranged in layered structures. Comparative studies have also been presented for specific cases where the regenerator materials are arranged as a homogeneous mixture in the second stage. The experimental results clearly indicate that the design of PTCs should use only layered structures of regenerator materials and not homogenous mixtures.

Kelan opintoetuustilasto 2009/10

Kelan opintoetuustilasto 2009/10 -julkaisu sisältää keskeiset tiedot Kelan maksamista opintotuista ja koulumatkatuista sekä Kelan myöntämästä aikuiskoulutustukeen liittyvästä opintolainan valtiontakauksesta. Julkaisu tarjoaa tilastoja näiden etuuksien saajista ja maksetuista euromääristä. Opintotuesta esitetään myös opintolainoja, korkeakouluopiskelijoiden ateriatukea ja opintolainavähennystä koskevia tietoja.

Managing in the “Golden Cage” An Ethnographic Study of Work, Management and Gender in Parliamentary Administration

Parliaments are political institutions, but they are also places where people work; the MPs and the people who are employed there work, albeit in rather different ways. In this research the focus is on those in a Parliament who work there as employees and managers, and thereby, in some senses, run the organisation. Accordingly, this involves seeing the Parliament as a working environment, for MPs and employees, for men and women. The institution of Parliament is thus here examined by looking at it from a different and new angle. Instead of the usual focus on politicians the focus is on the administration of this institution. The aim is, amongst other things, to increase knowledge and offer different perspectives on democracy and democratic institutions. Unpacking the nearly mythical institution into smaller, more digestible, graspable realities should at the very least help to remind the wider society that although nations, to a certain extent, do need national institutions they should not become mystified or seen as larger than life. Institutions should work on behalf of people and thus be accountable to these same people. The main contribution of this work is to explore and problematise how managing and working is done inside an institution that both largely fulfils the characteristics of a bureaucracy and yet also has added special features that seem to be rather far removed from clear bureaucratic structures. This research offers a new kind of information on working life inside this elite institution. The joys and the struggles of working and managing in this particular public sector organisation are illustrated here and offer a view, a glimpse, into the experiences of managing and working in this House.

Being in between: An Ethnographic Study of Opera and Dialogical Identity Construction

The paradoxical co-existence of conflicting logics governs practices in cultural organizations. This requires ‘balancing acts’ between artistic and managerial efforts, which are often subjects to struggle among the organizational members. This ethnographic study aims to go beyond either-or thinking on the paradoxical organizational context by examining how the organizational members of an opera house construct views on their organization in dialogical meaning-making processes. Various professional groups, dozens of upcoming productions, increased international cooperation, and global competition combined with scarce financial resources make opera houses a complex though interesting context for organization studies. In order to provide a deeper knowledge of the internal dynamics of an opera organization this thesis takes an interpretative view to examine the ways organizational members construct and make sense of their organization. How is the opera organization constructed by the organizational members? How do the members draw on different logics when relating to their organization? Or what are the elements that characterize the relational processes of organizational identity construction in an opera organization? The thesis aims to answer these questions by providing a detailed description of the everyday life of an opera organization and a particular focus put on organizational identity construction. The processes of organizational identity construction are approached from a relational point of view. This may involve various relations between multiple positions, different professional groups, other organizations in the cultural field or between past and present understandings of an organization. The study shows that the construction of an opera organization involves not only the two conflicting logics of art and economy, but also the logic of a national institution. The study suggests also that organizational identities are constructed through processes related to the dialogics of positions, work and management practices. The dialogics involve various struggles through which the organizational members find themselves between the different organizational aspects such as visiting ‘stars’ and an ensemble or between ‘Finnishness’ of opera productions and internationalization. In addition, the study argues that a struggle between different elements is a general mode of relation in cultural organizations and therefore an inherent and enduring aspect in the organizational identity construction. However, the space of ‘being in between’ involves both the enabling and constraining elements in the dialogical identity construction in the context of cultural organizations, which present the struggle in a more generative light.

Health-related quality of life, symptoms and comorbidity in inflammatory bowel disease

Health-related quality of life (HRQoL) measurement has become an important outcome in treatment trials and in health policy decisions. HRQoL can be measured by using generic or disease-specific tools. Generic instruments can be used for comparing health status among patients in different health states and conditions but they do not focus specifically on the issues relevant in a particular disease. Disease-specific tools may be more responsive to changes within a specific condition. In earlier studies, impairment of HRQoL has been evident in patients with inflammatory bowel disease (IBD), especially when the disease is active. Data about the impact of comorbidity or demographic characteristics of the patients on HRQoL are partly controversial. This study, which comprised 2913 adult IBD patients, examined HRQoL using the disease-specific IBDQ and the general 15D instruments. The 15D scores of IBD patients were compared with scores of a gender and age matched general population sample. Frequency of IBD symptoms and arrangement of therapy were studied and compared with those of IBD patients in an earlier European study. Furthermore, data of other chronic diseases of the patients were obtained from the Social Insurance Institution s reimbursement register and comorbidity of IBD patients was compared with that of age and gender matched controls. --- Of the respondents, 37% reported that they suffered from disturbing IBD symptoms weekly. In 17% of the patients, the symptoms greatly affected the ability to enjoy leisure activities, and 14% stated that these symptoms greatly affected their capacity to work. Despite that, the great majority (93%) of patients expressed satisfaction with their current treatment, which exceeded the rate observed in the other European patients. The mean IBDQ score was 163, as the possible range is 32-224, and disease activity was strongly correlated with HRQoL. Older age, comorbid diseases, and female gender were also related to impairment of HRQoL. Lower HRQoL scores were seen also in newly-diagnosed patients and in those with a history of surgery, especially after stoma or ileal pouch-anal anastomosis (IPAA) operation. The range of 15D scores was 0.30-1.00, with mean of 0.87. As with the IBDQ, disease activity, older age and history of surgery were correlated with the score. Both the newly-diagnosed patients and patients with a long-lasting disease had lower scores than average even after adjusting for age. The 15D scores of IBD patients were significantly lower than those of the control group. A strong correlation was seen between the 15D and the IBDQ scores. Comorbidity with other chronic diseases was observed in 29% of IBD patients. Connective tissue diseases, chronic obstructive pulmonary diseases, pernicious anaemia, and coronary heart disease (CHD) were significantly increased in patients with IBD. Especially female IBD patients appeared to be at increased risk for CHD, and patients who reported weekly IBD symptoms had a higher risk for having other chronic diseases in addition to IBD. Comorbidity impaired HRQoL, as measured with both generic and disease-specific tools. In conclusion, HRQoL is impaired in IBD patients. An understanding of predictors of HRQoL will help to recognise patients who will need special support.

Slip line field analysis of a simple plane strain closed‐die forging

A slip line field is proposed for symmetrical single‐cavity closed‐die forging by rough dies. A compatible velocity field is shown to exist. Experiments were conducted using lead workpiece and rough dies. Experimentally observed flow and load were used to validate the proposed slip line field. The slip line field was used to simulate the process in the computer with the objective of studying the influence of flash geometry on cavity filling.

Asumistuensaajien vuokranylityksiin toimeentulotukea

Kela maksoi asumistukia 1 214,5 milj. euroa vuoden 2010 aikana. Kasvua edelliseen vuoteen oli 7 %. Taloustilanteen aiheuttaman työllisyyden huononemisen seurauksena asumistukien maksatus on kahtena peräkkäisenä vuotena kasvanut reilusti. Asumistukea saaneita perheitä tai ruokakuntia oli vuoden lopussa 498 000.