Asuminen kielialueittain Helsingissä - Harjoitustyö

Peer reviewe

Common Inflammation-Related Candidate Gene Variants and Acute Kidney Injury in 2647 Critically Ill Finnish Patients

Acute kidney injury (AKI) is a syndrome with high incidence among the critically ill. Because the clinical variables and currently used biomarkers have failed to predict the individual susceptibility to AKI, candidate gene variants for the trait have been studied. Studies about genetic predisposition to AKI have been mainly underpowered and of moderate quality. We report the association study of 27 genetic variants in a cohort of Finnish critically ill patients, focusing on the replication of associations detected with variants in genes related to inflammation, cell survival, or circulation. In this prospective, observational Finnish Acute Kidney Injury (FINNAKI) study, 2647 patients without chronic kidney disease were genotyped. We defined AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared severe AKI (Stages 2 and 3, n = 625) to controls (Stage 0, n = 1582). For genotyping we used iPLEX(TM) Assay (Agena Bioscience). We performed the association analyses with PLINK software, using an additive genetic model in logistic regression. Despite the numerous, although contradictory, studies about association between polymorphisms rs1800629 in TNFA and rs1800896 in IL10 and AKI, we found no association (odds ratios 1.06 (95% CI 0.89-1.28, p = 0.51) and 0.92 (95% CI 0.80-1.05, p = 0.20), respectively). Adjusting for confounders did not change the results. To conclude, we could not confirm the associations reported in previous studies in a cohort of critically ill patients.Peer reviewe

Heme oxygenase-1 repeat polymorphism in septic acute kidney injury

Acute kidney injury (AKI) is a syndrome that frequently affects the critically ill. Recently, an increased number of dinucleotide repeats in the HMOX1 gene were reported to associate with development of AKI in cardiac surgery. We aimed to test the replicability of this finding in a Finnish cohort of critically ill septic patients. This multicenter study was part of the national FINNAKI study. We genotyped 300 patients with severe AKI (KDIGO 2 or 3) and 353 controls without AKI (KDIGO 0) for the guanine-thymine (GTn) repeat in the promoter region of the HMOX1 gene. The allele calling was based on the number of repeats, the cut off being 27 repeats in the S-L (short to long) classification, and 27 and 34 repeats for the S-M-L2 (short to medium to very long) classification. The plasma concentrations of heme oxygenase-1 (HO-1) enzyme were measured on admission. The allele distribution in our patients was similar to that published previously, with peaks at 23 and 30 repeats. The S-allele increases AKI risk. An adjusted OR was 1.30 for each S-allele in an additive genetic model (95% CI 1.01-1.66; p = 0.041). Alleles with a repeat number greater than 34 were significantly associated with lower HO-1 concentration (p<0.001). In septic patients, we report an association between a short repeat in HMOX1 and AKI risk

Operational periods of Finnish public–private partnerships

Tässä diplomityössä tarkastellaan Suomen elinkaarihankkeiden palvelujaksoja. Aiempi tutkimus on esittänyt elinkaarihankkeilla olevan useita teoreettisia hyötyjä ja haasteita, joten on tarpeellista tutkia, miten elinkaarihankkeet ovat sujuneet käytännössä ja soveltuuko elinkaarimalli kunnallisten koulu- ja päiväkotihankkeiden toteuttamiseen. Palvelujaksojen tutkimus on ollut vielä vähäistä, vaikka palvelujakso on kaikista elinkaarihankkeen vaiheista pitkäkestoisin. Palvelujaksojen tutkimiselle on siten tarvetta ja tähän tarpeeseen vastataan osaltaan tässä diplomityössä. Suomessa ensimmäinen elinkaarihankkeena toteutettu rakennus valmistui vuonna 2003 ja seuraavat 2010-luvulla. Elinkaarihankkeet ovat pääasiassa vielä alkupuolella 20–25 vuotta kestävää palvelujaksoaan. Tämän tutkimuksen tavoitteena on selvittää, mitkä tekijät vaikuttavat elinkaarihankkeen palvelujaksoon, miten palvelujaksot ovat sujuneet tähän mennessä ja minkälaisena niiden tulevaisuus nähdään. Tutkimusmenetelminä käytetään kirjallisuuskatsausta sekä puolistrukturoituja haastatteluita. Puolistrukturoiduilla haastatteluilla kerättiin tietoa tapaustutkimukseen valittujen uudiskohteiden palvelujaksoista. Tapaustutkimuksessa oli mukana Espoossa, Jyväskylässä, Kuopiossa, Oulussa ja Porvoossa elinkaarihankkeina toteutetut koulut ja päiväkodit. Palvelujaksolla olevia hankkeita oli yhteensä 18. Tutkimuksen perusteella julkisen sektorin tilaajat ja yksityiset palveluntuottajat ovat olleet kokonaisuudessaan tyytyväisiä palvelujaksoihin. Kohteissa on esiintynyt muutamia puutteita ja virheitä, mutta ne on selvitetty hankkeille ominaisessa kumppanuushengessä. Kumppanuushengen lisäksi selkeä vastuunjako, palveluntuottajan laaja vastuu, pitkä sopimuskausi, ankarat sanktiot, yhdessä sovitut tavoitteet ja jatkuva tiedonvaihto ovat edistäneet palvelujakson toimivuutta ja sopimusehtojen toteuttamista. Palvelujaksojen odotetaan etenevän ilman suuria haasteita sopimuskauden loppuun asti, sillä palveluntuottajiin luotetaan eikä palvelujaksoihin oleteta kohdistuvan merkittäviä muutoksia sopimuskauden aikana. Tilaajat eivät ole vielä suunnitelleet, miten kohteiden palvelut tullaan järjestämään sopimuksen päättymisen jälkeen.In this Master’s thesis, the operational periods of Finnish public–private partnerships (PPPs) are studied. The previous research has proposed PPPs to have several theoretical advantages and challenges. Therefore, it is necessary to study how PPPs have progressed in practice and whether PPP is a suitable model for managing public school and kindergarten projects. The research on operational periods has been scant despite the operational period is the longest of all phases of a PPP. Thus, there is a need to study operational periods, and this Master’s thesis responds to the observed research gap. The first building was completed under a contract of public–private partnership in Finland in 2003 and the following ones in the 2010s. These PPPs are mainly on the first half of their 20–25-year-long operational periods. The aim of this study is to find out which factors affect the operational periods, how the operational periods have progressed so far, and how they are expected to progress in the future. The research methods consist of a literature review and semi-structured interviews. The semi-structured interviews were used to collect information on the operational periods of the PPPs selected in this case study. These PPPs were schools and kindergartens in Espoo, Jyväskylä, Kuopio, Oulu, and Porvoo. The operational period was ongoing altogether in 18 projects. This study indicates that the public parties and the private service providers have, in general, been satisfied with the operational periods. A few flaws have occurred in the projects, but they have been solved in a good collaboration manner that is characteristic for PPPs. In addition to the good collaboration manner, a clear division of responsibilities, a broad responsibility of the private service providers, a long agreement period, strict sanctions, mutually agreed goals, and continuous communication have contributed to the feasibility of the operational periods and the fulfillment of the contractual terms. The operational periods are expected to proceed without any major challenges till the end of the contract period since the trust in the private service providers is high and no significant changes are expected to affect the operational periods during the contract period. The public parties have not planned yet how services will be arranged for PPPs during the post-contractual period