Hoitajiin kohdistuva väkivalta ja uhkailu Kuusankosken aluesairaalan ensiapupoliklinikalla

TIIVISTELMÄ KYMENLAAKSON AMMATTIKORKEAKOULU Hoitotyön koulutusohjelma HELLSTEN, SUSANNA Hoitajiin kohdistuva väkivalta ja uhkailu Kuusankosken aluesairaalan ensiapupoliklinikalla NAHKURI, ELISE Opinnäytetyö 41 sivua + 7 liitesivua Työn ohjaajat lehtori Merja Laitoniemi lehtori Kristiina Mettälä Toimeksiantaja Kuusankosken aluesairaala ensiapupoliklinikka Syyskuu 2009 Avainsanat väkivalta, uhkailu, selviytyminen Tämän opinnäytetyön tarkoituksena oli tutkia, kuinka paljon hoitajiin kohdistuvaa väkivaltaa ja uhkailua esiintyy Kuusankosken aluesairaalan ensiapupoliklinikalla. Tavoitteena oli myös selvittää, minkä tyyppistä väkivalta on ja miten väkivaltatilanteita käsitellään jälkeenpäin. Lisäksi selvitettiin, minkälaiset valmiudet hoitajilla on kohdata väkivaltaa ja uhkailua sekä joutuvatko he kokemaan väkivaltaa ja uhkailua myös vapaa-aikanaan johtuen työstään. Lopuksi tavoitteena oli selvittää käytössä olevat turvallisuusjärjestelmät ja niiden tärkeys. Kohderyhmänä oli ensiapupoliklinikan 19 hoitajaa. Kohderyhmä rajattiin kuukauden tai sen yli työskennelleisiin perus-, lähi- ja sairaanhoitajiin. Tutkimus oli kvantitatiivinen ja se suoritettiin strukturoidun kyselylomakkeen avulla. Tutkimustulokset analysoitiin Excel-taulukkolaskentaohjelmaa käyttäen. Vastausprosentiksi muodostui 73,1. Jokainen hoitaja oli kokenut töissä väkivaltaa ja uhkailua. Yleisimpiä väkivallan muotoja olivat haukkuminen ja nimittely sekä epäasiallinen arvostelu. Tärkeimmäksi väkivaltatilanteiden käsittelykeinoksi osoittautui työkavereiden kanssa keskustelu. Suurin osa hoitajista koki valmiutensa toimia väkivalta- ja uhkailutilanteissa huonoiksi, ja turvallisuusjärjestelmät koettiin tärkeiksi.ABSTRACT KYMENLAAKSON AMMATTIKORKEAKOULU University of Applied Sciences Health Care HELLSTEN, SUSANNA Threatening and Violence Towards Nursing Staff of Casualty and Emergency Department at Kuusankoski District Hospital NAHKURI, ELISE Bachelor’s Thesis 41 pages + 7 pages of appendices Supervisors Merja Laitoniemi, MNSc, senior lecturer Kristiina Mettälä, MNSc, senior lecturer Commissioned by Kuusankoski District Hospital, Casualty and Emergency Department September 2009 Keywords violence, threatening, surviving The purpose of this study was to examine how much threatening and violence there was towards the nursing staff of the casualty and emergency department at Kuusankoski district hospital as well as the type of violence the nursing staff had to suffer, and how they dealt with violence situations afterwards. The purpose was also to examine what kind of readiness the nurses had to meet with threatening and violence, and if they also had to meet with threatening and violence due to their occupation in their free time. Finally the aim was also to find out about the security systems and their importance. The target group was 19 nurses of the casualty and emergency department and it was limited to practical nurses, practical nurses in social and health care and registered nurses, who had worked for one month or over. The study was a quantitative one and the questionnaires were structured. The results were analyzed using Excel –spreadsheet. The response rate was 73.1 per cent. Every nurse had suffered threatening and violence. The most common forms of violence were verbal abuse, namecalling and irrelevant criticism. The most important way to handle violence was discussion with workmates. Most of the nurses regarded their preparedness to deal with threatening and violence situations as poor and found the security systems important

Topological Data Analysis of Task-Based fMRI Data from Experiments on Schizophrenia

We use methods from computational algebraic topology to study functional brain networks, in which nodes represent brain regions and weighted edges encode the similarity of fMRI time series from each region. With these tools, which allow one to characterize topological invariants such as loops in high-dimensional data, we are able to gain understanding into low-dimensional structures in networks in a way that complements traditional approaches that are based on pairwise interactions. In the present paper, we use persistent homology to analyze networks that we construct from task-based fMRI data from schizophrenia patients, healthy controls, and healthy siblings of schizophrenia patients. We thereby explore the persistence of topological structures such as loops at different scales in these networks. We use persistence landscapes and persistence images to create output summaries from our persistent-homology calculations, and we study the persistence landscapes and images using $k$-means clustering and community detection. Based on our analysis of persistence landscapes, we find that the members of the sibling cohort have topological features (specifically, their 1-dimensional loops) that are distinct from the other two cohorts. From the persistence images, we are able to distinguish all three subject groups and to determine the brain regions in the loops (with four or more edges) that allow us to make these distinctions

Moment Is now

Taiteen maisterin opinnäytetyö Hetki on nyt koostuu kahdesta taiteellisesta osasta ja kirjallisesta osasta, jotka käsittelevät hetkellisyyttä ja ajan kuvaamisen problematiikkaa. Taiteellinen osa I koostuu kahdesta itsenäisestä teoksesta, jotka on esitetty Suomen valokuvataiteen museolla osana Unfold-näyttelyä 17.1.-22.3.2020. Taiteellinen osa II koostuu luonnoksista, jotka esitetään kirjallisen osan yhteydessä. Kaikki taiteellisen osan teokset ovat aika- ja paikkakohtaisia tulkintoja hetkellisyydestä, visuaalisia ajan kuvaajia, jotka ovat rakennettu kameran ja ennalta määritellyn systeemin avulla. Kirjallinen osa on esseemuotoinen teksti, joka käsittelee hetkellisyyden teemoja: aikaa, sattumaa ja ainutlaatuisuutta. Kirjallinen osa käsittelee metodeja, joilla tekijä pyrkii tekemään näkyväksi subjektiivisen kokemuksen ajasta. Kirjallinen osa pohdiskelee näitä asioita suhteessa sekä tekijän omiin teoksiin että muiden taiteilijoiden työskentelyyn ja ajatuksiin. Tutkimus peilaa myös tekijän teoksia ja ajattelua systeemiteoriaan ja ajan eri määritelmiin. Essee etenee kronologisesti suhteessa tekijän työskentelyn kehittymiseen ja oivalluksiin prosessin varrelta. Hetki on nyt on tutkielma vapaudesta määrittää säännöt, joilla jokainen voi tulkita ympäröiviä ilmiöitä itselleen sopivalla tavalla. Samalla työ on henkilökohtainen kuvaus prosessista, jossa tekijä etsii omaa tapaansa jäsentää kokemustaan ajan kulusta.Moment Is Now is a Master’s thesis consisting of two artistic parts and a literal part, which explore momentariness and problematics of presenting time. The Artistic Part I presents two independent art pieces exhibited as part of the Unfold exhibition 17.1.-22.3.2020 in The Finnish Museum of Photography. The Artistic Part II presents sketches which are included in the literal part. The art pieces are time and place bound interpretations of momentariness and transition. Works are visual indicators of time which are constructed by using a camera and pre-defined system. The literal part is a chronological essay form research about themes of momentariness: time, chance and uniqueness. Essay describes the methods that the artist has used to upfront his subjective experience of duration. The literal part discusses the artist's discoverings compared to other artists and artworks as well as systems theory and conceptions of time. Moment Is Now is a thesis about the freedom of defining individualistic rules for interpreting phenomenas and existence. This research is also a personal portrayal of a process for discovering one's distinctive way of perceiving the passage of time

Aikuisten uniapneapotilaiden nielurisaleikkausten hoitotulokset Varsinais-Suomen sairaanhoitopiirin alueella 16 vuoden aikana

Nielurisaleikkausta käytetään uniapneataudin hoidossa valikoiduilla potilailla. Toimenpiteen tavoitteena on avartaa suunielua obstruktion vähentämiseksi nukkuessa. Nielurisaleikkausta voidaan käyttää uniapneataudin hoidossa potilailla, joilla on hypertrofiset nielurisat. Tämän retrospektiivisen tutkimuksen tavoitteena on selvittää nielurisojen poiston vaikutusta uniapneataudin hoidossa aikuisilla Varsinais-Suomen sairaanhoitopiirissä. Tutkimuksessa aineistona käytettiin Varsinais-Suomen sairaanhoitopiirin alueella 2004–2019 nielurisaleikkauksessa olleita potilaita. Tietohaku on toteutettu Auria Tietopalveluiden avustuksella. Tutkimukseen valittiin potilaat, joiden päätoimenpiteenä oli nielurisaleikkaus tai nielurisa- ja kitarisaleikkaus ja toimenpideindikaationa uniapneatauti (G47.3) tai kuorsaus (R06.5). Potilaista kerättiin tiedot yöpolygrafioista, nielurisojen koosta ja muut tietohaulla saadut tiedot. Sisäänottokriteerit täyttäviä potilaita löytyi 151. Potilaita, joilla oli sekä preoperatiivinen ja postoperatiivinen yöpolygrafia valikoitui tarkempaan analyysiin 27. Preoperatiivinen AHI oli käytettävissä 81 potilaista ja tämän keskiarvo oli 20,6 (95 % CI 16,1-25,1). Postoperatiivinen AHI oli mitattu 49 potilaalta ja tämän keskiarvo oli 12,3 (95 % CI 8,4-16,3). Tarkemman analyysin ryhmässä preoperatiivinen AHI keskiarvo oli 22,3 (95 % CI 16,8-27,7). Postoperatiivinen AHI-keskiarvo oli 10,8 (95 % CI 5,7-16,0). Preoperatiivinen BMI-keskiarvo oli 28,0 (95 % CI 26,3-29,8) ja postoperatiivinen keskiarvo 29,5 (95 % CI 26,9-32,2). Hoito oli onnistunut 15 potilaalla (55,6 %) ja hoito oli kuratiivinen 10 potilaalla eli 37 %:lla. Tutkimuksen tulokset viittaavat tonsillektomian olevan tehokas hoitomuoto obstruktiiviseen uniapneaan aikuisilla, joilla on tonsillojen hypertrofia

Treatment of sleep apnoea with tonsillectomy : a retrospective analysis using long-term follow-up data

Purpose This single-group, retrospective, pre-test-post-test study was performed to examine clinical outcomes in treating obstructive sleep apnoea (OSA) with tonsillectomy alone and had the longest follow-up periods to date. Methods We analysed 151 tonsillectomies in our district between the years 2004 and 2018 that had either sleep apnoea or snoring listed as a diagnosis. Twenty-one patients met our criteria and were included. Patient records were analysed for home sleep apnoea test and Epworth Sleepiness Scale (ESS) scores. Results We defined success as a > 50% reduction of the Apnoea-Hypopnea Index (AHI) and a total AHI of < 20 post-surgery. The averages before surgery were an AHI of 22.3 and an ESS of 7.22. The success rate was 47.6% after tonsillectomy as the sole treatment for obstructive sleep apnoea in our adult population. Eleven patients were non-responders. The average ESS score reduction was 0.69 and did not reach statistical significance. With follow-up times ranging from 1.8 to 171 months, this study had the longest follow-up period compared to other existing studies. No patient with a follow-up longer than one year was a responder. Conclusion Our results support that tonsillectomy is an effective treatment for obstructive sleep apnoea in adults with tonsillar hypertrophy. With less severe OSA than those reported on previously, our patients also had less severe daytime sleepiness before surgery, and daytime sleepiness score reductions did not reach statistical significance. In the future, long-term results should be further analysed.Peer reviewe

A mega-analysis of expression quantitative trait loci (eQTL) provides insight into the regulatory architecture of gene expression variation in liver

TS was an awardee of the Roche Internships for Scientific Exchange (RiSE) Programme. The work has been supported in part by institutional funds (TG77) of the Institute of Human Genetics Regensburg and by a grant from the Helmut Ecker Foundation (Ingolstadt, Germany) to BHFW (No. 05/17).Peer reviewedPublisher PD

Treatment of sleep apnoea with tonsillectomy: a retrospective analysis using long-term follow-up data

Purpose: This single-group, retrospective, pre-test-post-test study was performed to examine clinical outcomes in treating obstructive sleep apnoea (OSA) with tonsillectomy alone and had the longest follow-up periods to date.Methods: We analysed 151 tonsillectomies in our district between the years 2004 and 2018 that had either sleep apnoea or snoring listed as a diagnosis. Twenty-one patients met our criteria and were included. Patient records were analysed for home sleep apnoea test and Epworth Sleepiness Scale (ESS) scores.Results: We defined success as a > 50% reduction of the Apnoea-Hypopnea Index (AHI) and a total AHI of Conclusion: Our results support that tonsillectomy is an effective treatment for obstructive sleep apnoea in adults with tonsillar hypertrophy. With less severe OSA than those reported on previously, our patients also had less severe daytime sleepiness before surgery, and daytime sleepiness score reductions did not reach statistical significance. In the future, long-term results should be further analysed.</p

Complex exon-intron marking by histone modifications is not determined solely by nucleosome distribution

It has recently been shown that nucleosome distribution, histone modifications and RNA polymerase II (Pol II) occupancy show preferential association with exons (“exon-intron marking”), linking chromatin structure and function to co-transcriptional splicing in a variety of eukaryotes. Previous ChIP-sequencing studies suggested that these marking patterns reflect the nucleosomal landscape. By analyzing ChIP-chip datasets across the human genome in three cell types, we have found that this marking system is far more complex than previously observed. We show here that a range of histone modifications and Pol II are preferentially associated with exons. However, there is noticeable cell-type specificity in the degree of exon marking by histone modifications and, surprisingly, this is also reflected in some histone modifications patterns showing biases towards introns. Exon-intron marking is laid down in the absence of transcription on silent genes, with some marking biases changing or becoming reversed for genes expressed at different levels. Furthermore, the relationship of this marking system with splicing is not simple, with only some histone modifications reflecting exon usage/inclusion, while others mirror patterns of exon exclusion. By examining nucleosomal distributions in all three cell types, we demonstrate that these histone modification patterns cannot solely be accounted for by differences in nucleosome levels between exons and introns. In addition, because of inherent differences between ChIP-chip array and ChIP-sequencing approaches, these platforms report different nucleosome distribution patterns across the human genome. Our findings confound existing views and point to active cellular mechanisms which dynamically regulate histone modification levels and account for exon-intron marking. We believe that these histone modification patterns provide links between chromatin accessibility, Pol II movement and co-transcriptional splicing

Evolutionarily Stable Association of Intronic snoRNAs and microRNAs with Their Host Genes

Small nucleolar RNAs (snoRNAs) and microRNAs (miRNAs) are integral to a range of processes, including ribosome biogenesis and gene regulation. Some are intron encoded, and this organization may facilitate coordinated coexpression of host gene and RNA. However, snoRNAs and miRNAs are known to be mobile, so intron-RNA associations may not be evolutionarily stable. We have used genome alignments across 11 mammals plus chicken to examine positional orthology of snoRNAs and miRNAs and report that 21% of annotated snoRNAs and 11% of miRNAs are positionally conserved across mammals. Among RNAs traceable to the bird–mammal common ancestor, 98% of snoRNAs and 76% of miRNAs are intronic. Comparison of the most evolutionarily stable mammalian intronic snoRNAs with those positionally conserved among primates reveals that the former are more overrepresented among host genes involved in translation or ribosome biogenesis and are more broadly and highly expressed. This stability is likely attributable to a requirement for overlap between host gene and intronic snoRNA expression profiles, consistent with an ancestral role in ribosome biogenesis. In contrast, whereas miRNA positional conservation is comparable to that observed for snoRNAs, intronic miRNAs show no obvious association with host genes of a particular functional category, and no statistically significant differences in host gene expression are found between those traceable to mammalian or primate ancestors. Our results indicate evolutionarily stable associations of numerous intronic snoRNAs and miRNAs and their host genes, with probable continued diversification of snoRNA function from an ancestral role in ribosome biogenesis

A High-Resolution Whole-Genome Map of Key Chromatin Modifications in the Adult Drosophila melanogaster

Epigenetic research has been focused on cell-type-specific regulation; less is known about common features of epigenetic programming shared by diverse cell types within an organism. Here, we report a modified method for chromatin immunoprecipitation and deep sequencing (ChIP–Seq) and its use to construct a high-resolution map of the Drosophila melanogaster key histone marks, heterochromatin protein 1a (HP1a) and RNA polymerase II (polII). These factors are mapped at 50-bp resolution genome-wide and at 5-bp resolution for regulatory sequences of genes, which reveals fundamental features of chromatin modification landscape shared by major adult Drosophila cell types: the enrichment of both heterochromatic and euchromatic marks in transposons and repetitive sequences, the accumulation of HP1a at transcription start sites with stalled polII, the signatures of histone code and polII level/position around the transcriptional start sites that predict both the mRNA level and functionality of genes, and the enrichment of elongating polII within exons at splicing junctions. These features, likely conserved among diverse epigenomes, reveal general strategies for chromatin modifications