The Barents area changes – How will Finland adapt? (Barentsin alue muuttuu – miten Suomi sopeutuu?)

The cumulative impacts of environmental, climatic and societal changes and their consequences will affect the development of the Arctic region in the coming decades. Adaptation to these changes will require measures of all the actors in the region. Finland, part of the Euro-Arctic region, will adapt to these changes in a variety of ways. The Barents area is unique in the Arctic in being a multicultural, relatively densely populated area with well-developed industries and infrastructure. This report examines adaptation to changes and their consequences in the Barents area in terms of governance and Finland’s capacities to adapt. The aim has been to produce comprehensive information from the Finnish perspective for local and national decision-makers about long-term changes in the region, their expected impacts and adaptation options, and to support decision-making that will advance adaptation. The report includes recommendations. This report is based on the contribution of Finnish experts to an Arctic Council and Arctic Monitoring and Assessment Programme (AMAP) project titled ”Adaptation Actions for a Changing Arctic” (AACA). The project has prepared a pilot report by Nordic and Russian experts on the Barents area in English on changes, their impacts and adaptation options. The report will be published in 2017 (AMAP 2017)

Systematic reviews of observational studies of Risk of Thrombosis and Bleeding in General and Gynecologic Surgery (ROTBIGGS) : introduction and methodology

Funding Information: The Risk of Thrombosis and Bleeding in General and Gynecologic Surgery (ROTBIGGS) project was conducted by the Clinical Urology and Epidemiology (CLUE) Working Group and supported by the Academy of Finland (309387, 340957), Sigrid Jusélius Foundation and Competitive Research Funding of the Helsinki University Hospital (TYH2019321; TYH2020248). The sponsors had no role in the analysis and interpretation of the data or the manuscript preparation, review, or approval. Funding Information: KMA received a research grant from Astra Zeneca, and is consultant for Gedeon Richter, and received reimbursement for attending a scientific meeting from GSK (Tesaro Bio). RMT received reimbursement for attending a scientific meeting from Olympus. LIL, GHG, YL, RC, ALL, VJS, IEJK, PJK, RJC, RLA, KA, KMA, IB-L, MHB, JLC, SC, PJG, HAG-P, FZG, HAG, LH, MLI-K, KMJ, PKK, NK, TPK, AJK, TK, HL, AKM, BTN, TPN, CN, SMO, SP, NP, CBBR, ARR, TS, RMT, RWMV, YW, YX, LY, JH, and KAOT have no financial conflicts of interest. GHG and RC were panel members of the European Association of Urology (EAU) ad hoc Guideline on Thromboprophylaxis in Urological Surgery. KAOT was chair of the European Association of Urology (EAU) ad hoc Guideline on Thromboprophylaxis in Urological Surgery and panel member of the American Society of Hematology (ASH) Guideline Panel on Prevention of Venous Thromboembolism (VTE) in Surgical Hospitalized Patients. Publisher Copyright: © 2021, The Author(s).Background Venous thromboembolism (VTE) and bleeding are serious and potentially fatal complications of surgical procedures. Pharmacological thromboprophylaxis decreases the risk of VTE but increases the risk of major post-operative bleeding. The decision to use pharmacologic prophylaxis therefore represents a trade-off that critically depends on the incidence of VTE and bleeding in the absence of prophylaxis. These baseline risks vary widely between procedures, but their magnitude is uncertain. Systematic reviews addressing baseline risks are scarce, needed, and require innovations in methodology. Indeed, systematic summaries of these baseline risk estimates exist neither in general nor gynecologic surgery. We will fill this knowledge gap by performing a series of systematic reviews and meta-analyses of the procedure-specific and patient risk factor stratified risk estimates in general and gynecologic surgeries. Methods We will perform comprehensive literature searches for observational studies in general and gynecologic surgery reporting symptomatic VTE or bleeding estimates. Pairs of methodologically trained reviewers will independently assess the studies for eligibility, evaluate the risk of bias by using an instrument developed for this review, and extract data. We will perform meta-analyses and modeling studies to adjust the reported risk estimates for the use of thromboprophylaxis and length of follow up. We will derive the estimates of risk from the median estimates of studies rated at the lowest risk of bias. The primary outcomes are the risk estimates of symptomatic VTE and major bleeding at 4 weeks post-operatively for each procedure stratified by patient risk factors. We will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate evidence certainty. Discussion This series of systematic reviews, modeling studies, and meta-analyses will inform clinicians and patients regarding the trade-off between VTE prevention and bleeding in general and gynecologic surgeries. Our work advances the standards in systematic reviews of surgical complications, including assessment of risk of bias, criteria for arriving at the best estimates of risk (including modeling of the timing of events and dealing with suboptimal data reporting), dealing with subgroups at higher and lower risk of bias, and use of the GRADE approach. Systematic review registration PROSPERO CRD42021234119Peer reviewe

Systematic reviews of observational studies of Risk of Thrombosis and Bleeding in General and Gynecologic Surgery (ROTBIGGS): introduction and methodology

Background: Venous thromboembolism (VTE) and bleeding are serious and potentially fatal complications of surgical procedures. Pharmacological thromboprophylaxis decreases the risk of VTE but increases the risk of major post-operative bleeding. The decision to use pharmacologic prophylaxis therefore represents a trade-off that critically depends on the incidence of VTE and bleeding in the absence of prophylaxis. These baseline risks vary widely between procedures, but their magnitude is uncertain. Systematic reviews addressing baseline risks are scarce, needed, and require innovations in methodology. Indeed, systematic summaries of these baseline risk estimates exist neither in general nor gynecologic surgery. We will fill this knowledge gap by performing a series of systematic reviews and meta-analyses of the procedure-specific and patient risk factor stratified risk estimates in general and gynecologic surgeries.Methods: We will perform comprehensive literature searches for observational studies in general and gynecologic surgery reporting symptomatic VTE or bleeding estimates. Pairs of methodologically trained reviewers will independently assess the studies for eligibility, evaluate the risk of bias by using an instrument developed for this review, and extract data. We will perform meta-analyses and modeling studies to adjust the reported risk estimates for the use of thromboprophylaxis and length of follow up. We will derive the estimates of risk from the median estimates of studies rated at the lowest risk of bias. The primary outcomes are the risk estimates of symptomatic VTE and major bleeding at 4 weeks post-operatively for each procedure stratified by patient risk factors. We will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate evidence certainty.Discussion: This series of systematic reviews, modeling studies, and meta-analyses will inform clinicians and patients regarding the trade-off between VTE prevention and bleeding in general and gynecologic surgeries. Our work advances the standards in systematic reviews of surgical complications, including assessment of risk of bias, criteria for arriving at the best estimates of risk (including modeling of the timing of events and dealing with suboptimal data reporting), dealing with subgroups at higher and lower risk of bias, and use of the GRADE approach.Systematic review registration: PROSPERO CRD42021234119</p

Evaluation of North Eurasian snow-off dates in the ECHAM5.4 atmospheric general circulation model

The timing of springtime end of snowmelt (snow-off date) in northern Eurasia in version 5.4 of the ECHAM5 atmospheric general circulation model (GCM) is evaluated through comparison with a snow-off date data set based on space-borne microwave radiometer measurements and with Russian snow course data. ECHAM5 reproduces well the observed gross geographical pattern of snow-off dates, with earliest snow-off (in March) in the Baltic region and latest snow-off (in June) in the Taymyr Peninsula and in northeastern parts of the Russian Far East. The primary biases are (1) a delayed snow-off in southeastern Siberia (associated with too low springtime temperature and too high surface albedo, in part due to insufficient shielding by canopy); and (2) an early bias in the western and northern parts of northern Eurasia. Several sensitivity experiments were conducted, where biases in simulated atmospheric circulation were corrected through nudging and/or the treatment of surface albedo was modified. While this alleviated some of the model biases in snow-off dates, 2 m temperature and surface albedo, especially the early bias in snow-off in the western parts of northern Eurasia proved very robust and was actually larger in the nudged runs. <br><br> A key issue underlying the snow-off biases in ECHAM5 is that snowmelt occurs at too low temperatures. Very likely, this is related to the treatment of the surface energy budget. On one hand, the surface temperature <i>T</i>_s is not computed separately for the snow-covered and snow-free parts of the grid cells, which prevents <i>T</i>_s from rising above 0 °C before all snow has vanished. Consequently, too much of the surface net radiation is consumed in melting snow and too little in heating the air. On the other hand, ECHAM5 does not include a canopy layer. Thus, while the albedo reduction due to canopy is accounted for, the shielding of snow on ground by the overlying canopy is not considered, which leaves too much solar radiation available for melting snow