Is Brain-Dead Donor Fluid Therapy With Colloids Associated With Better Kidney Grafts?

Objectives: Fluid therapy is required to maintain perfusion to donor organs. Recent reviews on the choices of fluids have emphasized the safety of using crystalloids, as opposed to fluid therapy with colloids, which has been reported to be either unequivocally or potentially harmful in a number of studies on various patient populations. We aimed to analyze whether the type of fluid administered to donors is connected with kidney transplant outcomes. Materials and Methods: A total of 100 consecutive brain-dead multiorgan donors and their respective 181 kidney recipients were studied retrospectively. Data concerning donor fluid therapy, the characteristics of the donors and the recipients, and outcomes after kidney transplant were extracted from organ retrieval and patient records. Cases with early graft function were compared with cases with delayed graft function. Results: Donors had received both crystalloids and colloids in most cases (84%). Fluid therapy with crystalloids alone was more common among the 40 recipients with delayed (30%) than in the 103 recipients with early graft function (11%) (P = .005). Donor age, time on renal replacement therapy before transplant, and donor fluid therapy with crystalloids alone were independent risk factors for delayed graft function in multivariate analysis. Conclusions: Our results suggest that donor fluid therapy including colloids could be beneficial instead of harmful compared with treatment with crystalloids alone. This finding needs to be evaluated in prospective studies.Peer reviewe

Raskaudenkeskeytysten ehkäisy ja keskeytyksiin johtavat riskitekijät : Katsaus kirjallisuuteen

Opinnäytetyön tarkoituksena on kuvata ja jäsentää raskaudenkeskeytyksiin johtavia riskitekijöitä sekä niiden ehkäisemistä. Tavoitteena oli löytää uusia keinoja ja toimintamalleja raskaudenkeskeytysten ehkäisemiseen terveydenhuollossa, erityisesti terveydenhoitajan työssä. Opinnäytetyö tehtiin kirjallisuuskatsauksena. Tutkimusaineisto kerättiin tiedonhaulla kolmesta eri tietokannasta, jotka olivat Medic, CINAHL ja PubMed. Aineistoksi valittiin yhteensä kymmenen tieteellistä tutkimusartikkelia, joista yksi oli suomenkielinen ja loput yhdeksän englanninkielisiä. Rajasimme haussa aineiston vuosien 2000–2015 välille. Analysoimme tutkimusaineiston käyttämällä sisällönanalyysiä työmenetelmänä. Tutkimustuloksista kävi ilmi, että raskaudenkeskeytyksiin johtavat riskitekijät koostuvat osa-alueista, joita ovat väkivallan kokeminen, demografiset ja kulttuurilliset tekijät sekä syntyvyyden säännöstelyn epäonnistuminen. Raskaudenkeskeytysten ehkäisemisessä pääteemoiksi nousivat tehokkaiden ehkäisymenetelmien saatavuuden turvaaminen sekä ehkäisyneuvonnan tarjoaminen. Tämän opinnäytetyön perusteella riskitekijät osataan jo tunnistaa melko hyvin, mutta ehkäisymenetelmien löytämiseksi tarvitaan vielä lisää tutkimusta. Opinnäytetyön tuloksia voidaan hyödyntää osittain sellaisenaan terveydenhoitajan työssä sekä yhteiskunnallisella tasolla terveydenhuollossa, kuten tarjoamalla ilmaista ehkäisyä varsinkin alle 25-vuotiaille nuorille naisille. Opinnäytetyön toivotaan auttavan terveydenhoitajia ja muita terveydenhuollon ammattilaisia tunnistamaan nuoret naiset, joilla on suurentunut riski päätyä raskaudenkeskeytykseen. Riskitekijät tunnistamalla voidaan tarjota oikeanlaista tukea ja palveluita raskaudenkeskeytysten ehkäisemiseksi ja niiden määrän vähentämiseksi.The purpose of this thesis was to identify and discern factors that lead to induced abortion. The purpose was also to search ways to prevent abortions. The aim of this thesis was to find new tools and models to prevent induced abortions in Finnish public health care especially in public health nursing. The thesis was implemented as a review of literature. The used data was searched from three different medical databases, Medic, CINAHL and Finnish database called PubMed. Ten studies were selected, one of them in Finnish and other nine in English. The studies were published between years 2000–2015. The data was analyzed by using methods of content analysis. The results showed that factors leading to induced abortions were history of violence and domestic violence, demographic and cultural factors and failure of birth control. Main themes of preventing induced abortions were securing availability of effective contraception methods and contraceptive advice in public health care. Based to this thesis, the risk factors can be identified quite well but further research of prevention of induced abortions needs to be done. The results of this thesis can be used as a part of public health nurses’ daily work and in public health care for example providing free contraception especially to women under 25 years. Hopefully this thesis will help medical professionals to identify women having high risk to induced abortion. By identifying the risk factors, induced abortions can be reduced and prevented. This can be done by offering suitable support and services from the public health care system

Eila Hiltunen, poeta della materia: Solo la lealtà verso l’arte è importante. L’esperienza individuale dell’artista nella realizzazione del Monumento a Sibelius e il tempo di recupero in Italia

Obiettivo dello studio è riflettere sulla situazione alla nascita e al completamento di un monumento pubblico, il monumento a Sibelius, dal punto di vista della scultrice che lo realizzò, ma anche di comprendere la mentalità del tempo per spiegare gli eventi che generarono una fiera opposizione al progetto. Un altro obiettivo è mettere in evidenza l’esperienza individuale dell’artista nel processo di creazione del monumento, poi durante il tempo di recupero in Italia. Con questa tesi, si è presentata l’occasione di delineare un profilo biografico di Eila Hiltunen e della “sua Italia” così come per analizzare la vulnerabilità e la verità personale, dietro la “facciata pubblica” di Eila Hiltunen. Il corpus della ricerca è costituito dai seguenti testi: Ihmisen ääni: Eila Hiltunen, (WSOY 1979), le memorie inedite di Piia Virtanen, figlia della Hiltunen, intitolate Torni Toscanassa (Una torre in Toscana, 2005); la biografia, opera di Markku Pietinen, dei suoi genitori, Tulivuori ja Marttyyri, Perhekuvassa Eila Hiltunen ja Otso Pietinen (Otava 2012); Eila Hiltunen, Scritti e sculture, (Elemond 1992). Questa tesi di laurea ci offre anche l’opportunità di approfondire l’importante questione della tradizione dell’arte monumentale e in particolare la svolta nelle convenzioni relative alla scultura pubblica in Finlandia negli anni ’60 del Novecento, analizzando la storia del monumento a Sibelius, che fece scaturire un dibattito particolarmente intenso, perché il pubblico voleva che nei monumenti commemorativi dedicati ai grandi uomini finlandesi si rispettassero le forme tradizionali. Una delle ragioni per cui l’espressione dell’opera si guadagnò tante critiche negative, fu probabilmente il fatto che metteva in primo piano l’artista e la sua tecnica personale, non si concentrava unicamente sulla commemorazione del grande musicista finlandese. La nuova corrente artistica al centro della questione è l’arte informale: tutta l’attenzione è rivolta ai materiali e alla superficie delle opere, invece che alla loro forma – in primo piano la tecnologia e la materia – e nella realizzazione del monumento a Sibelius, la tecnica innovativa della Hiltunen, ovvero la saldatura. Gli anni d’intenso lavoro influirono pesantemente sull’artista. Nell’estate del 1967, poco prima dell‘inaugurazione di Passio Musicae, l’artista acquistò una torre medievale a Monticchiello, dove decise di trasferirsi a vivere e lavorare. L’Italia rappresentò per lei una nuova vita: a suo parere l’amore, la gioia e altre emozioni positive, sarebbero in Italia più forti che altrove

Toiminnan jatkuvuuden ja menettelytapojen jatkuvuuden periaatteet tilinpäätöksessä ja tilintarkastuksessa

Siirretty Doriast

Engineering Privacy And Trust In Social Devices Environments

As the concept of smart devices is to make our lives both more efficient and effective, the real opportunities and more importantly the dangers come in consideration. However, there will be a trade-off between privacy and trust depending on the use of a selected device. For the time being all the approaches for asserting trust revolves around propagation of known values of trust which are either users / peers in a trusted networks providing measures for asserting that particular trust value being assessed or the assumption that all social-based applications share the same levels of trust. This triggers the illusion and the effect that users using these platforms have difficulties differentiating the trusted users thus making their own decisions based solely on their limited knowledge of the potentially wide user base or relying on recommendations set by either other users or possibly the application itself. This Thesis’ purpose is to evaluate the projections of trust and privacy issues that have risen with new implementations to Social Devices concept. With devices gathering proximity information about other nearby devices, the platform’s requirements for privacy varies depending on the level of advisable protection. The client itself has a basic functionality of autonomously and asynchronously accepting requests and desirably forming connections to other devices

Laatutekijöiden merkitys ohjelmistotyössä

Työn keskeisin tarkoitus on mallintaa laatutekijöitä, niiden mittaamista ja soveltamista ohjelmistomaailmassa. Työ on kaksiosainen. Se alkaa laadun määrittelemisellä ja mallintaa käytettävien standardien perustoiminnallisuutta ja laadun elinkaarta edeten laadun vaatimusten kehykseen, ominaisuuksiin ja dokumentointiin. Työn toinen osa on opitun tiedon hyödyntämistä projektin omaisena tuotantokäytössä olevassa tietojärjestelmässä käytettävyyden näkökulmasta. Työn loppuosa tehtiin raporttina

Information technology investment processes in schools

Suomi sijoittuu vuosi toisensa jälkeen PISA-arvioinneissa maailman kärkeen, mutta koulujen tietotekniikkavertailuissa on Suomen sijoitus laskenut jo useita vuosia perättäin. Koulujen tietotekniikkainvestoinnit eivät siis ole täyttäneet niille asetettuja odotuksia. Yhtenä syynä tähän ovat tehottomat hankintaprosessit, jotka eivät johda toivottuihin tuloksiin ja laskevat entisestään opettajien motivaatiota tietotekniikkainvestointien käyttöönottoon. Ongelman ratkaisemiseksi tässä diplomityössä tutkitaan Suomen kuntien hankintaprosesseja ja etsitään tehokkaampaan tietotekniikkainvestointien käyttöönottoon johtavia menetelmiä. Työn teoreettinen osuus keskittyy tietotekniikkainvestointeja käsitteleviin aineistoihin ja hankintaprosessien vaiheita ja mallintamista tutkivaan kirjallisuuteen. Koulujen tietotekniikkainvestointien hankintaprosesseista ei ole Suomessa suoritettu aiempaa tutkimusta, joten aineistoa haettiin ulkomaisista lähteistä ja muiden sektoreiden hankintaprosessien tutkimuksesta. Materiaalin pohjalta muodostettiin tietotekniikkainvestointien hankintaprosessille kehysmalli. Tutkimuksen empiirisessä osuudessa toteutettiin haastattelututkimus, jossa tiedonkeräysmenetelmänä käytettiin puolistrukturoitua teemahaastattelua. Haastattelut suoritettiin yhdeksässä Suomen kunnassa, joista jokaisessa kunnassa haastateltiin peruskoulun ja lukion tietotekniikkainvestointien hankintaorganisaatioon kuuluvia henkilöitä. Kerätystä haastattelumateriaalista pyrittiin tunnistamaan teoriaosassa luodun kehysmallin mukaisia vaiheita ja sijoittamaan ne erilaisiksi hankintaprosessipoluiksi kuntakohtaisesti. Tutkimuksessa luotiin hankintaprosessimallit kaikille tutkimukseen osallistuneille kunnille, sekä verrattiin löydöksiä teoriaosuudessa käsiteltyyn materiaaliin. Tuloksena saaduista malleista myös tutkimuksen ulkopuolelle jääneet kunnat voivat kehittää omia hankintaprosessejaan ja löytää vaihtoehtoisia hankintaprosessimalleja ja toimintatapoj

Building solids inside nano-space: from confined amorphous through confined solvate to confined ‘metastable’ polymorph

The nanocrystallisation of complex molecules inside mesoporous hosts and control over the resulting structure is a significant challenge. To date the largest organic molecule crystallised inside the nano-pores is a known pharmaceutical intermediate – ROY (259.3 g mol1). In this work we demonstrate smart manipulation of the phase of a larger confined pharmaceutical – indomethacin (IMC, 357.8 g mol1), a substance with known conformational flexibility and complex polymorphic behaviour. We show the detailed structural analysis and the control of solid state transformations of encapsulated molecules inside the pores of mesoscopic cellular foam (MCF, pore size ca. 29 nm) and controlled pore glass (CPG, pore size ca. 55 nm). Starting from confined amorphous IMC we drive crystallisation into a confined methanol solvate, which upon vacuum drying leads to the stabilised rare form V of IMC inside the MCF host. In contrast to the pure form, encapsulated form V does not transform into a more stable polymorph upon heating. The size of the constraining pores and the drug concentration within the pores determine whether the amorphous state of the drug is stabilised or it recrystallises into confined nanocrystals. The work presents, in a critical manner, an application of complementary techniques (DSC, PXRD, solid-state NMR, N2 adsorption) to confirm unambiguously the phase transitions under confinement and offers a comprehensive strategy towards the formation and control of nano-crystalline encapsulated organic solids

Enhancing the dissolution of phenylbutazone using Syloid® based mesoporous silicas for oral equine applications

Three mesoporous silica excipients (Syloid® silicas AL-1 FP, XDP 3050 and XDP 3150) were formulated with a model drug known for its poor aqueous solubility, namely phenylbutazone, in an attempt to enhance the extent and rate of drug dissolution. Although other forms of mesoporous silica have been investigated in previous studies, the effect of inclusion with these specific Syloid® silica based excipients and more interestingly, with phenylbutazone, is unknown. This work reports a significant enhancement for both the extent, and rate, of drug release for all three forms of Syloid® silica at a 1:1 drug:silica ratio over a period of 30 minutes. An explanation for this increase was determined to be conversion to the amorphous form and an enhanced drug loading ability within the pores. Differences between the release profiles of the three silicas was concluded to be a consequence of the physicochemical differences between the three forms. Overall, this study confirms that Syloid® silica based excipients can be used to enhance dissolution, and potentially therefore bioavailability, for compounds with poor aqueous solubility, such as phenylbutazone. In addition, it has been confirmed that drug release can be carefully tailored based on the choice of Syloid® silica and desired release profile