Measures to prevent microembolization in cardiac surgery and during angiography with special reference to carbon dioxide

Background: Cardiovascular interventions including open heart surgery using cardiopulmonary bypass (CPB) and coronary angiography may introduce air and particulate arterial embolism that may lead to tissue lesions of the brain and other organs. Aims: To assess: if CO2-insufflation of an empty CPB circuit decreases number of gaseous emboli in the prime compared with a conventional CPB circuit, which holds air before fluid priming (Study I); the efficacy of a new mini-diffuser device for CO2 de-airing in a minimally invasive open cardiothoracic wound cavity model and in patients undergoing minimally invasive open aortic valve surgery (Study II); if an extra separate venous reservoir abolishes CO2-insufflation induced hypercapnia and retains sweep gas flow of the oxygenator constant during open heart surgery (Study III); if there is a difference in the incidence of cerebral microemboli when using either the femoral or the radial approach during coronary angiography (Study IV). Methods: Study I-II were experimental. Study I: Number of gaseous microemboli in the arterial line were counted after randomization to insufflation with CO2-gas or not prior to priming in 20 CPB-circuits. Study II: Air displacement efficacy of a mini-diffuser and of an open-ended tube was measured during CO2-insufflation in a minimally invasive open cardiothoracic wound cavity model and in patients undergoing minimally invasive open aortic valve surgery. Study III: A separate reservoir was used during CPB in addition to a standard venous reservoir. The separate reservoir received drained blood and CO2-gas continuously via a suction drain (1 L/min) and handheld suction devices from the surgical wound. CO2-gas was insufflated via a gas-diffuser in the open wound at 10 L/min. In a crossover design for each patient, gas and blood were either uninterruptedly drained from the separate to the standard venous reservoir or not. PaCO2 was determined after tuning of sweep-gas flow as necessary and following steady state of PaCO2 with an online monitor. Study IV: We randomized 51 patients to either right femoral or right radial arterial approach and documented with transcranial Doppler the number of particulate microemboli circulating through the middle cerebral arteries. Results: Study I. Throughout the experiment, the median microembolic count per minute in the CO2 group stayed lower than in the control group (p≤0.004). Study II. The air content was <1% and 10-75% in the open wound model during CO2 inflow of 2–10 L/min with the mini diffuser and the open-ended tube, respectively. In 6 patients air content in the open surgical wound stayed <1% during CO2 flows of 5 and 8 L/min via the mini-diffuser. Study III. Median PaCO2 did not vary between setups (5.41; 5.29-5.57, interquartile range [IQR] vs. 5.41; 5.24-5.58, p=0.92), while sweep-gas flow (L/min) was lower (2.58; 2.50-3.16 vs. 4.42; 4.00-5.40, p=0.002) when CO2-gas was not drained from the separate to the standard reservoir. Study IV. The median (range) number of particulate emboli was significantly higher with radial 10 (1–120) than with femoral 6 (1–19) approach. Also, with the radial approach more particulate microemboli circulated through the right sided middle cerebral artery compared with the femoral approach. Conclusions: CO2-insufflation of an empty CPB circuit reduces the number of gaseous emboli in the prime compared with conventional CPB circuit priming (Study I); CO2 deairing with the mini-diffuser was effective in a minimally invasive open cardiothoracic wound cavity model and in patients (Study II); A separate venous reservoir, with a clamped connecting tube to the standard venous reservoir for evacuation of gas and blood from the open surgical wound, prevents CO2-insufflation induced hypercapnia in open heart surgery, keeping PaCO2 and sweep gas flow constant (Study III); When performing coronary angiography, the radial access produces a higher number of particulate cerebral microemboli than the femoral alternative (Study IV). This approach is hence advocated in this aspect

Pienyrityksien näkökulmia ihmisen roolista ulkoistetuissa talouspalveluissa

Laskentatoimen tutkimuksissa on keskusteltu paljon tekoälyn sekä automaation tuomista vaikutuksista laskentatoimen ammattilaisten työnkuviin sekä -paikkoihin. Tutkimuksissa on esitetty, että laskentatoimen työpaikkojen määrä tulisi jopa vähenemään ja muuttumaan automaation ja tekoälyn seurauksena. Aihetta on tutkittu talouspalveluja tarjoavien yrityksien näkökulmasta, mutta palveluita ostavien yrityksien näkökulma on jäänyt puuttumaan, eikä tutkimuksissa ei ole otettu mukaan huomioon ihmisen roolin merkitystä. Tämän tutkimuksen tarkoituksena on lisätä ymmärrystä siitä, minkälaisena pienyritykset käsittävät ihmisen roolin ostamissaan ulkoistetuissa talouspalveluissa ja mitä pienyritykset tavoittelevat ostamaltaan ulkoistetulta talouspalvelulta. Aiemmankirjallisuuden sekä tieteellisten artikkeleiden perusteella muodostettiin viitekehys, jonka tarkoituksena oli luoda käsitys ulkoistettujen talouspalvelujen ja ihmisen roolin merkityksestä sekä tekoälyn ja automaation merkityksestä laskentatoimen ammattilaisten työnkuvaan. Teoreettisen viitekehyksen avulla muodostettiin myös etukäteen tutkimuksen haastattelujen kysymysrunko. Tutkimuksen empiirinen aineisto koostuu kolmelta suomalaiselta pienyritykseltä saadulta haastattelusta. Aineiston analyysi toteutettiin teoriaohjaavan sisällönanalyysin keinoin. Tutkimuksen tulosten perusteella pienyritykset käsittävät ihmisen roolin ostamissaan talouspalveluissa hyvin tärkeänä ja merkittävänä. Tekoälyä ja automaatiota ei nähty suorana uhkana, sillä niissä nähtiin inhimillisyyden, ymmärtämisen sekä päättelykyvyn puute. Tekoälyn ja automaation kasvun seurauksena haastatteluissa tuotiin kuitenkin esiin mahdollinen ongelma ihmiskontaktin vähenemisessä, joka saattaisi aiheuttaa haasteita nopeaa reagointia vaativiin tilanteisiin. Lisäksi ihmisen roolissa korostettiin riskienhallintaa sekä tietyn toimialan asiantuntemusta, jota tekoälyllä ei uskottu olevan. Tutkimuksen johtopäätöksenä voidaan todeta, että pienyritykset eivät ole valmiita luopumaan ihmiskontaktista ostamissaan talouspalveluissa. Kirjallisuuden sekä empirian perusteella voidaan nähdä, että pienyrityksille asiantuntijuus on ostetussa palvelussa tärkeämpää kuin palvelun hinta. Ihmisen roolin voidaan päätellä edesauttavan talouspalvelua ostaneen pienyrityksien liiketoimintaa tuomalla siihen varmuutta sekä riskienhallintaa taloustietojen näkökulmasta

Unfolding principles for student peer feedback:A comparative analysis across higher education contexts

In this paper we conceptualize formative peer feedback principles by analyzing and comparing six empirical examples of formative peer feedback in a set of international STEM (science, technology, engineering, and mathematics) contexts. By discussing how these different approaches to peer feedback unfold in practice, we aim to facilitate the bridging of the gap between theory and practice in implementing peer feedback in Higher Education. As a group of researchers and teaching practitioners from six Higher Education institutions, we discussed, analyzed, and synthesized practical examples of peer feedback in STEM that cover a breadth of settings, aims, and forms. The analysis and comparison of these examples illustrate how principles in peer feedback emerge in practice. We discuss how the context in peer feedback influences its practical implementation, particularly with regard to its purpose and aims, the development and use of assessment criteria, and embedding and supporting the initiatives into the teaching and learning activities.peerReviewe

Cardiac steatosis associates with visceral obesity in nondiabetic obese men.

Background: Liver fat and visceral adiposity are involved in the development of the metabolic syndrome (MetS). Ectopic fat accumulation within and around the heart has been related to increased risk of heart disease. The aim of this study was to explore components of cardiac steatosis and their relationship to intra-abdominal ectopic fat deposits and cardiometabolic risk factors in nondiabetic obese men. Methods: Myocardial and hepatic triglyceride (TG) contents were measured with 1.5 T magnetic resonance spectroscopy, and visceral adipose (VAT), abdominal subcutaneous tissue (SAT), epicardial and pericardial fat by magnetic resonance imaging in 37 men with the MetS and in 40 men without the MetS. Results: Myocardial and hepatic TG contents, VAT, SAT, epicardial fat volumes, and pericardial fat volumes were higher in men with the MetS compared with subjects without the MetS (P < .001). All components of cardiac steatosis correlated with SAT, VAT, and hepatic TG content and the correlations seemed to be strongest with VAT. Myocardial TG content, epicardial fat, pericardial fat, VAT, and hepatic TG content correlated with waist circumference, body mass index, high-density lipoprotein cholesterol TGs, very low-density lipoprotein-1 TGs, and the insulin-resistance homeostasis model assessment index. VAT was a predictor of TGs, high-density lipoprotein cholesterol, and measures of glucose metabolism, whereas age and SAT were determinants of blood pressure parameters. Conclusions: We suggest that visceral obesity is the best predictor of epicardial and pericardial fat in abdominally obese subjects. Myocardial TG content may present a separate entity that is influenced by factors beyond visceral adiposity

Cardiac steatosis and left ventricular function in men with metabolic syndrome

Peer reviewe

Characterization of different fat depots in NAFLD using inflammation-associated proteome, lipidome and metabolome

Non-alcoholic fatty liver disease (NAFLD) is recognized as a liver manifestation of metabolic syndrome, accompanied with excessive fat accumulation in the liver and other vital organs. Ectopic fat accumulation was previously associated with negative effects at the systemic and local level in the human body. Thus, we aimed to identify and assess the predictive capability of novel potential metabolic biomarkers for ectopic fat depots in non-diabetic men with NAFLD, using the inflammation-associated proteome, lipidome and metabolome. Myocardial and hepatic triglycerides were measured with magnetic spectroscopy while function of left ventricle, pericardial and epicardial fat, subcutaneous and visceral adipose tissue were measured with magnetic resonance imaging. Measured ectopic fat depots were profiled and predicted using a Random Forest algorithm, and by estimating the Area Under the Receiver Operating Characteristic curves. We have identified distinct metabolic signatures of fat depots in the liver (TAG50:1, glutamate, diSM18:0 and CE20:3), pericardium (N-palmitoyl-sphinganine, HGF, diSM18:0, glutamate, and TNFSF14), epicardium (sphingomyelin, CE20:3, PC38:3 and TNFSF14), and myocardium (CE20:3, LAPTGF-beta 1, glutamate and glucose). Our analyses highlighted non-invasive biomarkers that accurately predict ectopic fat depots, and reflect their distinct metabolic signatures in subjects with NAFLD.Peer reviewe

Hårda och mjuka former i gränsvattnets förvaltningsrum : Ett perspektiv på utvecklingen av internationell vattenförvaltning i Sverige

Vattenförvaltning innebär upprättandet av förvaltningsplaner för hur vattenförekomster ämnas hanteras. I samband med att hela avrinningsområden är den vedertagna skalan att genomföra vattenförvaltning på uppstår det problem när avrinningsområden överskrider administrativa gränser, särskilt nationella sådana. Denna studie ämnar att utreda hur formerna för internationellt gränsöverskridande vattenförvaltning kan se ut genom att undersöka Torneälvens avrinning – ett internationellt avrinningsdistrikt. Studien frågar sig hur den nationella kontexten påverkar en internationell vattenförvaltning. Det är även av intresse för studien hur samarbetsorganisationer kan verka i denna förvaltningsform, samt vilken uppföljning som går att se i projekt- och plandokument. Genom en kvalitativt analyserande fallstudie appliceras ett “soft space”-perspektiv på den internationella vattenförvaltningen i Torneälven. Analysen visar på en informalitet i plandokument trots etablerade förvaltningsformer. Den nationella kontexten beror dels på institutionaliseringen av den allmänna vattenförvaltningen samt på mellanstatliga relationer. Studien finner även potential i samarbetsorganisationer och konstruktiv uppföljning

Hårda och mjuka former i gränsvattnets förvaltningsrum : Ett perspektiv på utvecklingen av internationell vattenförvaltning i Sverige

Vattenförvaltning innebär upprättandet av förvaltningsplaner för hur vattenförekomster ämnas hanteras. I samband med att hela avrinningsområden är den vedertagna skalan att genomföra vattenförvaltning på uppstår det problem när avrinningsområden överskrider administrativa gränser, särskilt nationella sådana. Denna studie ämnar att utreda hur formerna för internationellt gränsöverskridande vattenförvaltning kan se ut genom att undersöka Torneälvens avrinning – ett internationellt avrinningsdistrikt. Studien frågar sig hur den nationella kontexten påverkar en internationell vattenförvaltning. Det är även av intresse för studien hur samarbetsorganisationer kan verka i denna förvaltningsform, samt vilken uppföljning som går att se i projekt- och plandokument. Genom en kvalitativt analyserande fallstudie appliceras ett “soft space”-perspektiv på den internationella vattenförvaltningen i Torneälven. Analysen visar på en informalitet i plandokument trots etablerade förvaltningsformer. Den nationella kontexten beror dels på institutionaliseringen av den allmänna vattenförvaltningen samt på mellanstatliga relationer. Studien finner även potential i samarbetsorganisationer och konstruktiv uppföljning

Machine learning approaches for detection of urinary tract infections

Urinary tract infections (UTI) are a common bacterial infection. Diagnosing UTI can be done through urine culturing. While precise, culturing is both time and money consuming. Flow cytometry analysis (FCA) is a different technique that can calculate different attributes in a urine sample. This is both faster and cheaper. Though, the problem with FCA is that it cannot reliably diagnose patients. The aim of this thesis is to investigate how different screening methods perform when applied before culturing. The screening methods uses FCA and some general characteristics to predict UTI. Using machine learning algorithms, different screening methods were compared. The methods were altered using a sensitivity correction such that the sensitivity exceeded 95%. The performance was measured using obtained real life data consisting of 1316 samples and cross validation. The best savings achieved was obtained using random forest. It managed to save up to 46% of the load on the culturing process while keeping a sensitivity of 95.15%. The specificity were 72%. Even though the data set obtained was too small to reliable declare the real performance, the savings looks really promising