Vanhusten hyvä kotona asuminen: tutkimusta kuntatuottavuudesta, älykodeista ja apuvälinepalveluprosesseista

The purpose of the research was to investigate operational processes related to home care of the elderly as well as use of assistive devices in smart home environments, and operational processes that are generally related to use of assistive devices – from the point of view of productivity improvement. The themes were looked into from the points of view of both the elderly and care personnel. In addition, perspectives of near relatives of the elderly, of the larger service system as well as of companies that provided assistive devices to the smart homes were taken into consideration. In the study of home care processes, 32 customer interviews and 17 employee interviews were carried out. This report contains a summary that is based on a separate report of the home care study. The study of home care was conducted in 2006. The use of technological and mechanical assistive devices and the related operational processes were investigated with the help of the smart home pilot in 2007–2008. The study is described in this report. The smart home pilot was implemented in four different housing service units for elderly people at Lahti, Nastola and Hollola. They were in use during short-term housing periods related to, for instance, end of hospitalisation, holidays of caring relatives and assessment of living and housing conditions. More than 60 different assistive devices and technologies were brought to the smart homes. During the pilot period, experiences of customers and personnel as well as processes related to the use of assistive devices were investigated. The research material consisted of 20 survey questionnaires of personnel and customers, four interviews with customers, five interviews with personnel, feedback survey responses from 14 companies, and other data that were collected, for instance, in orientation events. The research results highlighted the need for tailored services based on an elderly person’s needs and wishes, while taking advantage of innovative and technological solutions. As in the earlier home care study, also assistive device-related operational processes were looked into with the help of concepts of ‘resource focus’, ‘lost motion’ and ‘intermediate landing’. The following were identified as central operational processes in assistive device-related services (regardless of the service provider): (1) acquisition process of technologies and assistive devices as well as of rearrangement and rebuilding works in the home, (2) introduction and orientation process (of the elderly, their relatives and care personnel), (3) information and communication process, and (4) service and monitoring process. In addition, the research focused on design and desirability of assistive devices as well as their costs, such as opportunity costs. The process-based points of view gave new knowledge that may be used in the future to develop service processes and clarify their ownership so that separately managed cross-functional processes could be built with participants from different sectors to operate alongside organisations of elderly care. Development of functionality of assistive device-related services is a societally significant issue.

Effect of Smoking on Blood Pressure and Resting Heart Rate: A Mendelian Randomization Meta-Analysis in the CARTA Consortium.

BACKGROUND: Smoking is an important cardiovascular disease risk factor, but the mechanisms linking smoking to blood pressure are poorly understood. METHODS AND RESULTS: Data on 141 317 participants (62 666 never, 40 669 former, 37 982 current smokers) from 23 population-based studies were included in observational and Mendelian randomization meta-analyses of the associations of smoking status and smoking heaviness with systolic and diastolic blood pressure, hypertension, and resting heart rate. For the Mendelian randomization analyses, a genetic variant rs16969968/rs1051730 was used as a proxy for smoking heaviness in current smokers. In observational analyses, current as compared with never smoking was associated with lower systolic blood pressure and diastolic blood pressure and lower hypertension risk, but with higher resting heart rate. In observational analyses among current smokers, 1 cigarette/day higher level of smoking heaviness was associated with higher (0.21 bpm; 95% confidence interval 0.19; 0.24) resting heart rate and slightly higher diastolic blood pressure (0.05 mm Hg; 95% confidence interval 0.02; 0.08) and systolic blood pressure (0.08 mm Hg; 95% confidence interval 0.03; 0.13). However, in Mendelian randomization analyses among current smokers, although each smoking increasing allele of rs16969968/rs1051730 was associated with higher resting heart rate (0.36 bpm/allele; 95% confidence interval 0.18; 0.54), there was no strong association with diastolic blood pressure, systolic blood pressure, or hypertension. This would suggest a 7 bpm higher heart rate in those who smoke 20 cigarettes/day. CONCLUSIONS: This Mendelian randomization meta-analysis supports a causal association of smoking heaviness with higher level of resting heart rate, but not with blood pressure. These findings suggest that part of the cardiovascular risk of smoking may operate through increasing resting heart rate.

The Changing Face of Psychiatric Nursing –Care or Control?

This report has been written as part of the project “Toward improved quality – developing nurse’s continuing vocational training in hospitals and inpatient units”. Its overall goal is to ensure high quality, ethically appropriate and therapeutically effective interventions to enable nurses to manage distressed and disturbed patients in European psychiatric hospitals and inpatient units. In this large-scale, multinational projects there are all together six European countries involved: Finland, Ireland, England, Portugal, Italy and Lithuania. The project work plan were during autumn 2006 and spring 2007. The content of this publication was produced in the first stage of the project aiming to collect the preliminary source material for the project. The literature review was carried out in the project stage, providing the groundwork for the next steps for the project. This project aims to develop an interactive multinational portal with training material. Therefore, it is important to share an understanding of basic information, psychiatric nurse’s continuing vocational education, laws and ethical codes and patient restriction used in mental health care. In this publication, the purpose of the material produced here is to understand nurses’ educational need related to vocational continuing education and to be used in further project stages as an empirical data collection. The data were collected as a preliminary source material for latter phases where nurse’s perceptions of the current practice, nurse’s attitudes to mental illness, prevalence of use of seclusion room and existing and desired vocational training provision will be collected in six different European countries. The following organisations are involved in this project: University of Turku, Dublin City University, St. Vincent Hospital, National Council for the Professional Development of Nursing and Midwifery, University of Padova, Klaipeda College - Health Faculty, Klaipeda Psychiatric Hospital, Escola Superior de Enfermagem de Lisboa, Centro Hospitalar Psiquiátrico de Lisboa, Omnia Vocational Institution the Espoo Region, Kellokoski psychiatric hospital, Hyvinkää hospital area, Pirkanmaa Hospital District, Kingston University & St. George’s Medical School and South West London & St. George’s Mental Health NHS Trust. A wide variety of different countries, organisations and individuals in this project give us a strong confidence that theoretical, practical, ethical and political issues around the topic of interest will be taken account during this project lifetime. We are aware the content of this book will be partially outdated almost as soon as it has been published. We still hope that this publication will encourage nurses and different professions working in mental health care field to have a basic understanding of similarities and differences between different European countries related in mental health care. We also hope that this publication will inspirate and motivate nurses in maintaining and developing the quality of psychiatric care in Europe.

Genome-wide meta-analysis uncovers novel loci influencing circulating leptin levels.

Leptin is an adipocyte-secreted hormone, the circulating levels of which correlate closely with overall adiposity. Although rare mutations in the leptin (LEP) gene are well known to cause leptin deficiency and severe obesity, no common loci regulating circulating leptin levels have been uncovered. Therefore, we performed a genome-wide association study (GWAS) of circulating leptin levels from 32,161 individuals and followed up loci reaching P<10(-6) in 19,979 additional individuals. We identify five loci robustly associated (P<5 × 10(-8)) with leptin levels in/near LEP, SLC32A1, GCKR, CCNL1 and FTO. Although the association of the FTO obesity locus with leptin levels is abolished by adjustment for BMI, associations of the four other loci are independent of adiposity. The GCKR locus was found associated with multiple metabolic traits in previous GWAS and the CCNL1 locus with birth weight. Knockdown experiments in mouse adipose tissue explants show convincing evidence for adipogenin, a regulator of adipocyte differentiation, as the novel causal gene in the SLC32A1 locus influencing leptin levels. Our findings provide novel insights into the regulation of leptin production by adipose tissue and open new avenues for examining the influence of variation in leptin levels on adiposity and metabolic health.

Childhood community-acquired pneumonia

Background: Community-acquired pneumonia is a leading cause of morbidity and mortality in children worldwide. New, rapid methods are needed to improve the microbiologic diagnosis of pneumonia in clinical practice. The increasing incidence of parapneumonic empyema in children accentuates the importance of the identification of the causative agent and clinical predictors of empyema. Aims and methods: Two prospective studies were conducted to find feasible diagnostic methods for the detection of causative agents of pneumonia. The usefulness of pneumolysin-targeted real-time PCR in the diagnosis of pneumococcal disease was studied in children with pneumonia and empyema, and the clinical utility of induced sputum analysis in the microbiologic diagnosis of pneumonia was investigated in children with pneumonia. In addition, two retrospective clinical studies were performed to describe the frequency and clinical profile of influenza pneumonia in children and the frequency, clinical profile and clinical predictors of empyema in children. Results: Pneumolysin-PCR in pleural fluid significantly improved the microbiologic diagnosis of empyema by increasing the detection rate of pneumococcus almost tenfold to that of pleural fluid culture (75 % vs. 8 %). In whole blood samples, PCR detected pneumococcus in only one child with pneumonia and one child with pneumococcal empyema. Sputum induction provided good-quality sputum specimens with high microbiologic yield. Streptococcus pneumoniae (46 %) and rhinovirus (29 %) were the most common microbes detected. The quantification results of the paired sputum and nasopharyngeal aspirate specimens provided support that the majority of the bacteria (79 %) and viruses (55 %) found in sputum originated from the lower airways. Pneumonia was detected in 14 % of children with influenza infection. A history of prolonged duration of fever, tachypnea, and pain on abdominal palpation were found to be independently significant predictors of empyema. Conclusions: Pneumolysin-targeted real-time PCR is a useful and rapid method for the diagnosis of pneumococcal empyema in children. Induced sputum analysis with paired nasopharyngeal aspirate analysis can be of clinical value in the microbiologic diagnosis of pneumonia. Influenza pneumonia is an infrequent and generally benign disease in children with rare fatalities. Repeat chest radiograph and ultrasound imaging are recommended in children with pneumonia presenting with clinical predictors of empyema and in children with persistent fever and high CRP levels during hospitalization.

Draaman ja teatterin sovelluksia nuorten työpajaympäristössä : kuvaus Dynamo-hankkeen draamapajan toiminnan muotoutumisesta

Opinnäytetyö on kuvaus Lahden kaupungin nuorisopalveluiden Dynamo-hankkeen draamapajan toiminnasta. Kirjoittaja on työskennellyt draamapajan työvalmentajana Dynamon ensimmäisellä projektikaudella vuosina 2006-2008. Nuorten seudullinen työllisyyshanke Dynamo on Lahden nuorisopalveluiden hallinnoima ESR-rahoitteinen projekti. Dynamo tarjoaa tuettua työharjoittelua Lahden kaupunkiseudun 17-24-vuotiaille työttömille nuorille. Työharjoittelu kestää viisi kuukautta draama-, media-, sisustus- tai remonttipajassa. Opinnäytetyö on hankkeistettu Lahden kaupungin nuorisopalveluille. Draamapajassa nuoret tutustuvat taiteen ja kulttuurin tekemiseen. Opinnäytetyössä avataan ja tutkitaan draamapajan tavoitteita ja toiminnan muotoja. Draamapajan toimintaa lähestytään kolmesta teoreettisesta näkökulmasta, jotka ovat sosiokulttuurinen innostaminen, draamakasvatus ja soveltava teatteri. Draamapajan työskentely on luonteeltaan prosessinomaista. Opinnäytetyössä esitellään tapausesimerkkinä yksi draamapajan loppuprojekteista; devising-esitys Delirium tremensis eli kuinka jokerit sinä meiltä pimität. Esityksen syntyprosessin kuvauksessa havainnoillistetaan työtapoja käytännössä. Opinnäytetyön luvussa seitsemän tarkastellaan, millaisia välineitä teatteri-ilmaisun ohjaajan koulutus tarjoaa työvalmentajana toimimiseen. Kirjoituksessa pohditaan työvalmennuksen pedagogisia haasteita esittävän taiteen koulutuksen näkökulmasta. Loppupäätelmissä draamapaja nähdään soveltavan teatterin, draamakasvatuksen ja sosiokulttuurisen innostamisen sulatusuunina, jossa draaman eri lajityyppien väliset rajat ovat häilyviä. Toiminnassa sovelletaan erilaisia draamallisia ja toiminnallisia menetelmiä. Työskentelyn tavoitteena on mahdollistaa taiteeseen ja kulttuuriin tutustuminen sekä työharjoittelijan omien tavoitteiden saavuttaminen. Työvalmentajan tehtävä työskentelyssä on luoda tilaa osallistujien omalle merkityksenannolle. Parhaimmillaan merkityksenanto draamatyöskentelyssä voi saada aikaan uudelleenrakentumista nuoren ajattelussa ja toiminnassa.

Osake- ja henkilöyhtiöiden sulautuminen vero-oikeudessa, yhtiöoikeudessa ja kirjanpidossa

Sulautuminen on yksi yleisimmistä yritysjärjestelyvaihtoehdoista. Sulautumisessa on otettava huomioon vero- ja yhtiöoikeudelliset sekä kirjanpidolliset seikat. Ne ohjaavat sulautumisen toteuttamista ja säätelevät sallittuja menettelytapoja. Tutkimuksen päätavoitteena on analysoida osakeyhtiön, avoimen ja kommandiittiyhtiön vero-oikeudellisen, yhtiöoikeudellisen ja kirjanpidollisen sulautumisen käsittelyn eroja. Tutkimuksessa on aluksi selvitetty syitä yritysjärjestelyihin ja sulautumista yritysjärjestelyvaihtoehtona. Sulautumisen käsittely aloitetaan osakeyhtiön sulautumisen yhtiöoikeudellisen sääntelyn käsittelemisellä. Seuraavaksi tutkittiin kirjanpidollista sääntelyä sulautumisen yhteydessä. Tämän jälkeen määritettiin verotuksen sääntelyä sulautumisen yhteydessä. Viimeisessä teoriakappaleessa käsitellään henkilöyhtiöiden sulautumista. Tutkimuksessa selvitettiin sulautumisen oikeudellinen sääntely ja havaittiin säännöksissä olevan ristiriitaisuuksia, jotka vaikuttavat sulautumisessa tehtäviin päätöksiin.

The use of future-oriented knowledge in regional innovation processes: Research on knowledge generation, transfer and conversion

The importance of the regional level in research has risen in the last few decades and a vast literature in the fields of, for instance, evolutionary and institutional economics, network theories, innovations and learning systems, as well as sociology, has focused on regional level questions. Recently the policy makers and regional actors have also began to pay increasing attention to the knowledge economy and its needs, in general, and the connectivity and support structures of regional clusters in particular. Nowadays knowledge is generally considered as the most important source of competitive advantage, but even the most specialised forms of knowledge are becoming a short-lived resource for example due to the accelerating pace of technological change. This emphasizes the need of foresight activities in national, regional and organizational levels and the integration of foresight and innovation activities. In regional setting this development sets great challenges especially in those regions having no university and thus usually very limited resources for research activities. Also the research problem of this dissertation is related to the need to better incorporate the information produced by foresight process to facilitate and to be used in regional practice-based innovation processes. This dissertation is a constructive case study the case being Lahti region and a network facilitating innovation policy adopted in that region. Dissertation consists of a summary and five articles and during the research process a construct or a conceptual model for solving this real life problem has been developed. It is also being implemented as part of the network facilitating innovation policy in the Lahti region.

Nanosuodatuskalvojen alkalikestävyys

Tässä diplomityössä tutkittiin nanosuodatuskalvojen puhdistusta ja kestävyyttä alkalipesuissa. Työn kirjallisuusosassa käsitellään kalvojen likaantumista ja eri puhdistusmenetelmiä, sekä vertaillaan kolmen nanosuodatuskalvon erotusominaisuuksia. Kokeellisessa osassa tutkittiin emäksisten pesukemikaalien vaikutusta kirjallisuusosassa esitettyihin kalvoihin. Käytetyt suodatuskalvot olivat Dow FilmTecTM NF-270, GE Osmonics Desal-5 DL ja Trisep XN45. Kalvojen puhdistukseen käytettiin Ecolabin P3-ultasil 110 ja 112 alkalipesukemikaaleja. Suodatuskokeet tehtiin laboratoriomittakaavan tasokalvojen suodatinlaitteistolla. Alkalikäsittelyitä tehtiin sekä liottamalla kalvoja säilytysastiassa että altistamalla näitä virtauksen ja paineen alaisuudessa. Vaihdettuja muuttujia oliat: pesuainekonsentraatio, lämpötila ja vaikutusaika. Kalvoissa tapahtuneita muutoksia arvioitiin mittaamalla permeabiliteettia sekä magnesiumsulfaatti- ja glukoosiretentioita. Suodatuslämpötilan nostaminen kasvatti lineaarisesti permeabiliteettia ja vastaavasti laski lineaarisesti retentiota. Kalvojen välillä ei ollut eroja permeabiliteettien lämpötilariippuvuuksissa. DL:n retentio laski vähiten lämpötilaa nostettaessa. Liotuskokeiden perusteella kestävät DL- ja NF-270-kalvot noin 1 % P3-ultrasil 110 liuoksia, sekä XN-kalvo 1,2–1,5 %:sia liuoksia, kun lämpötilana on 44 ºC ja vaikutusaikana 50 vrk. Käytettyjen pesukemikaalien välillä ei havaittu eroja. Pienen paineen ja virtauksen alla suoritetuissa käsittelyissä havaittiin alkalihajoamisen noudattavan likimain ensimmäisen kertaluvun reaktiokinetiikkaa ja käyttäytyvän likimain Arrheniuksen yhtälön ennustamalla tavalla. Myös näissä kokeissa XN45 osoittautui kestävimmäksi. Retentioiden heikkenemistä ei pystytty luotettavasti ennustamaan permeabiliteetin perusteella. Työssä osoitettiin että kalvojen muutoksia alkalipesuissa ajan funktiona voidaan ennustaa ja näin teollisuudessa voidaan ennakoida kalvojen vaihtotarvetta.

Matalakompleksisen palvelupyyntömallin kehittäminen palveluväylää hyödyntäviin järjestelmäintegraatioihin

Tässä työssä kehitetään yleiskäyttöinen palvelupyyntömalli, jonka avulla Lahden kaupungin Lahti Fenix –projektin Kuntalaistilijärjestelmän palveluväylän kautta voidaan kutsua järjestelmän tietokantatasoa tai muita palveluväylän avulla integroituja järjestelmiä. Työn tavoitteena oli suoraviivaistaa järjestelmäintegraatioihin liittyvien palveluiden kehittämistä suunnittelemalla sellainen palvelupyyntömuodostin, joka ei sisällä staattisia viittauksia jossakin tietyssä palvelussa käytettäviin luokkiin tai muihin ominaisuuksiin. Työssä hyödynnettiin Java-kielen kehittyneitä ominaisuuksia; reflektiivistä ohjelmointia, geneeristä ohjelmointia ja Java-virtuaalikoneen metodipinon lukemista. Tavoitteen saavuttamista mitattiin käyttäen avuksi McCaben syklomaattista kompleksisuutta ja metodeissa käytettyä rivimäärää. Työ aloitettiin joulukuussa 2008 ja saatiin valmiiksi helmikuussa 2009. Työn tuloksena syntyi toimiva, syklomaattiselta kompleksisuudeltaan matala ja helppokäyttöinen palvelukutsumuodostin.