Carotid Surgery : A posse ad esse non valet consequentia

According to a large body of evidence, carotid endarterectomy (CEA) can prevent strokes, provided that appropriate inclusion criteria and high-quality perioperative treatment methods are utilised with low complication rates. From the patient s perspective, it is of paramount importance that the operation is as safe and effective as possible. From the community s point of view, it is important that CEA provision prevents as many strokes as possible. In order to define the stroke preventing potential of CEA in different communities, a comparison between eight European countries and Australia was performed including 53 077 carotid interventions. A more detailed evaluation was performed in Finland, the United Kingdom and Egypt. It could be estimated that many potentially preventable strokes occur due to insufficient diagnostics and CEA provision. The number of CEAs should be at least doubled in the Helsinki region. The theoretical power of CEA provision in stroke prevention varied significantly between the countries. Delay from symptom to surgery has been identified as one of the most important factors influencing the effectiveness of CEA. In 2008 only 11% of CEAs in Helsinki university central hospital (HUCH) were performed within the recommended14 days. Registered data of 673 CEAs in HUCH during 2000-2005 was analyzed. There was no systematic error that would have changed the outcome analysis. However it is important that registers are audited regularly and cross matching of different registries is possible. A previously unpublished method of combining medial mandibulotomy, neck incision and carotid artery interposition was carried out as a collaboration of maxillofacial, ear, nose and throat and vascular surgeons. Five patients were operated on with a technique that was feasible and possible to perform with little morbidity, but due to the significant risks involved, this technique should be reserved for carefully selected cases. In stroke prevention, organisational decisions seem far more important than details in interventional procedures when CEA is performed with low complication rates, as was the case in the present study. A TIA clinic approach with close co-operation between the on-call vascular surgeons, neurologists and radiologists should be available at all centres treating these patients. Patients should have a direct and fast admission to the hospital performing CEA.

Desorptio/fotoionisaatio ilmanpaineessa takavarikoitujen huumausaineiden, steroidien ja räjähdysaineiden tutkimuksessa

Tutkimuksen tarkoituksena oli selvittää desorptio/fotoionisaatio ilmanpaineessa tekniikan (engl. desorption atmospheric pressure photoionization, DAPPI) soveltuvuutta rikosteknisen laboratorion näytteiden analysointiin. DAPPI on nopea massaspektrometrinen ionisaatiotekniikka, jolla voidaan tutkia yhdisteitä suoraan erilaisilta pinnoilta. DAPPI:ssa käytetään lämmitettyä mikrosirua, joka suihkuttaa höyrystynyttä liuotin- ja kaasuvirtausta kohti näytettä. Näytteen pinnan komponentit desorboituvat lämmön vaikutuksesta, jonka jälkeen ionisoituminen tapahtuu VUV-lampun emittoimien fotonien avulla.DAPPI:lla tutkittiin takavarikoituja huumausaineita, anabolisia steroideja ja räjähdysaineita sekä niiden jäämiä erilaisilta pinnoilta. Lisäksi kartoitettiin DAPPI:n mahdollisuuksia ja rajoituksia erilaisille näytematriiseille ilman näytteiden esikäsittelyä. Takavarikoitujen huumausaineiden tutkimuksessa analysoitiin erilaisia tabletteja, jauheita, kasvirouheita, huumekasveja (khat, oopium, kannabis) ja sieniä. Anabolisia steroideja tunnistettiin tableteista sekä ampulleista, jotka sisälsivät öljymäistä nestettä. Jauheet ripoteltiin kaksipuoliselle teipille ja analysoitiin siltä. Muut näytteet analysoitiin sellaisenaan ilman minkäänlaista esikäsittelyä, paitsi nestemäisten näytteiden kohdalla näyte pipetoitiin talouspaperille, joka analysoitiin DAPPI:lla. DAPPI osoittautui nopeaksi ja yksinkertaiseksi menetelmäksi takavarikoitujen huumausaineiden ja steroidien analysoimisessa. Se soveltui hyvin rikoslaboratorion erityyppisten näytteiden rutiiniseulontaan ja helpotti erityisesti huumekasvien ja öljymäisten steroidiliuosten tutkimusta. Massaspektrometrin likaantuminen pystyttiin ehkäisemään säätämällä näytteen etäisyyttä sen suuaukosta. Likaantumista ei havaittu huolimatta näytteiden korkeista konsentraatioista ja useita kuukausia jatkuneista mittauksista. Räjähdysaineiden tutkimuksessa keskityttiin seitsemän eri räjähdysaineen DAPPI-MS-menetelmän kehitykseen; trinitrotolueeni (TNT), nitroglykoli (NK), nitroglyseriini (NG), pentriitti (PETN), heksogeeni (RDX), oktogeeni (HMX) ja pikriinihappoä Nämä orgaaniset räjähteet ovat nitraattiyhdisteitä, jotka voidaan jakaa rakenteen puolesta nitroamiineihin (RDX ja HMX), nitroaromaatteihin (TNT ja pikriinihappo) sekä nitraattiestereihin (PETN, NG ja NK). Menetelmäkehityksessä räjähdysainelaimennokset pipetoitiin polymetyylimetakrylaatin (PMMA) päälle ja analysoitiin siitä. DAPPI:lla tutkittiin myäs autenttisia räjähdysainejäämiä erilaisista matriiseista. DAPPI:lla optimoitiin jokaiselle räjähdysaineelle sopiva menetelmä ja yhdisteet saatiin näkymään puhdasaineina. Räjähdysainejäämien analysoiminen erilaisista rikospaikkamateriaaleista osoittautui haastavammaksi tehtäväksi, koska matriisit aiheuttivat itsessään korkean taustan spektriin, josta räjähdysaineiden piikit eivät useimmiten erottuneet tarpeeksi. Muut desorptioionisaatiotekniikat saattavat soveltua paremmin haastavien räjähdysainejäämien havaitsemiseksi.

Molecular methods for the epidemiological analysis of methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae

Methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae are major health problems worldwide, both found in symptomless carriage but also causing even life-threatening infections. The aim of this thesis was to characterise MRSA and S. pneumoniae in detail by using several molecular typing methods for various epidemiological purposes: clonality analysis, epidemiological surveillance, outbreak investigation, and virulence factor analysis. The characteristics of MRSA isolates from the strain collection of the Finnish National Infectious Disease Register (NIDR) and pneumococcal isolates collected from military recruits and children with acute otitis media (AOM) were analysed using various typing techniques. Antimicrobial susceptibility testing, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), spa typing, staphylococcal cassette chromosome mec (SCCmec) typing, and the detection of Panton-Valentine leukocidin (PVL) genes were performed for MRSA isolates. Pneumococcal isolates were analysed using antimicrobial susceptibility testing, serotyping, MLST, and by detecting pilus islet 1 (PI-1) and 2 (PI-2) genes. Several international community- and hospital-associated MRSA clones were recognised in Finland. The genetic diversity among MRSA FIN-4 isolates and among FIN-16 isolates was low. Overall, MRSA blood isolates from 1997 to 2006 were genetically diverse. spa typing was found to be a highly discriminatory, rapid and accurate typing method and it also qualifies as the primary typing method in countries with a long history of PFGE-based MRSA strain nomenclature. However, additional typing by another method, e.g. PFGE, is needed in certain situations to be able to provide adequate discrimination for epidemiological surveillance and outbreak investigation. An outbreak of pneumonia was associated with one pneumococcal strain among military recruits, previously healthy young men living in a crowded setting. The pneumococcal carriage rate after the outbreak was found to be exceptionally high. PI-1 genes were detected at a rather low prevalence among pneumococcal isolates from children with AOM. However, the study demonstrated that PI-1 has existed among pneumococcal isolates prior to pneumococcal conjugate vaccine and the increased antimicrobial resistance era. Moreover, PI-1 was found to associate with the serotype rather than the genotype. This study adds to our understanding of the molecular epidemiology of MRSA strains in Finland and the importance of an appropriate genotyping method to be able to perform high-level laboratory-based surveillance of MRSA. Epidemiological and molecular analyses of S. pneumoniae add to our knowledge of the characteristics of pneumococcal strains in Finland.

Reynolds stress and heat flux in spherical shell convection

Context. Turbulent fluxes of angular momentum and heat due to rotationally affected convection play a key role in determining differential rotation of stars. Aims. We compute turbulent angular momentum and heat transport as functions of the rotation rate from stratified convection. We compare results from spherical and Cartesian models in the same parameter regime in order to study whether restricted geometry introduces artefacts into the results. Methods. We employ direct numerical simulations of turbulent convection in spherical and Cartesian geometries. In order to alleviate the computational cost in the spherical runs and to reach as high spatial resolution as possible, we model only parts of the latitude and longitude. The rotational influence, measured by the Coriolis number or inverse Rossby number, is varied from zero to roughly seven, which is the regime that is likely to be realised in the solar convection zone. Cartesian simulations are performed in overlapping parameter regimes. Results. For slow rotation we find that the radial and latitudinal turbulent angular momentum fluxes are directed inward and equatorward, respectively. In the rapid rotation regime the radial flux changes sign in accordance with earlier numerical results, but in contradiction with theory. The latitudinal flux remains mostly equatorward and develops a maximum close to the equator. In Cartesian simulations this peak can be explained by the strong 'banana cells'. Their effect in the spherical case does not appear to be as large. The latitudinal heat flux is mostly equatorward for slow rotation but changes sign for rapid rotation. Longitudinal heat flux is always in the retrograde direction. The rotation profiles vary from anti-solar (slow equator) for slow and intermediate rotation to solar-like (fast equator) for rapid rotation. The solar-like profiles are dominated by the Taylor-Proudman balance.

Pelastustoimi alueellisessa kehittämisessä : Länsi-Uudenmaan pelastuslaitoksen saavutettavuus

By law, rescue services must anticipate and plan future rescue situations so that the emergency measures taken in the event of an accident can be accomplished quickly and effectively. To reach this goal, rescue services planning must be up to date. The development of rescue services is di-rected by the Rescue Act, and guidelines such as the readiness program, based on that law. The guidelines give the basic principles for organizing rescue services. This paper studies the ability of rescuers to reach different locations now, and in the future, and whether this happens within the time constraints required by the readiness program. The time per-spective of the study includes both the current time and the future. Predictions of possible future situations are based on zoning information. The goal of the study is to find out whether there are any gaps in the network of fire stations or if gaps will develop in the near future. The strong growth and increase in the population of the greater Helsinki area, and of surrounding towns, creates many challenges for city planning, including rescue services. This study targets the two towns of Espoo and Kirkkonummi, where fast growth specifically into new housing areas, makes planning of rescue services challenging. Many new options are available for planning due to technological developments. The combined methods of planning and geo-informatics used in this study help to determine the need for new resources in rescue services. By using these methods, the planning of rescue services could be done at least 10 years into the future.

NDDO-based CI methods for the prediction of electronic spectra and sum-over-states molecular hyperpolarization

NDDO-based (AM1) configuration interaction (CI) calculations have been used to calculate the wavelength and oscillator strengths of electronic absorptions in organic molecules and the results used in a sum-over-states treatment to calculate second-order-hyperpolarizabilities. The results for both spectra and hyperpolarizabilities are of acceptable quality as long as a suitable CI-expansion is used. We have found that using an active space of eight electrons in eight orbitals and including all single and pair-double excitations in the CI leads to results that agree well with experiment and that do not change significantly with increasing active space for most organic molecules. Calculated second-order hyperpolarizabilities using this type of CI within a sum-over-states calculation appear to be of useful accuracy.