Monivammapotilaan tietokonetomografia - miten kuvaan?

Vertaisarvioitu. Näin tutkin.Monivammapotilaan keskeiseen tutkimusvalikoimaan kuuluva tietokonetomografia, trauma-TT, voidaan suorittaa monin eri tavoin. Protokolliin liittyy eroja tutkimuksen keston, diagnostisen osuvuuden ja säderasituksen osalta, ja näiden tunteminen on edellytys parhaan mahdollisen vaihtoehdon valitsemiselle. Tylpät kaulavaltimovammat ja niihin liittyvät iskeemiset aivotapahtumat eivät ole harvinaisia, ja kaulavaltimoiden kuvantaminen trauma-TT:n yhteydessä tulisi ottaa huomioon. Lävistävien vammojen kuvauksessa voidaan harkita suolistovarjoainetta, joka ei tylppien vammojen yhteydessä ole tarpeen. Monienergia-TT tuo diagnostisia lisämahdollisuuksia muun muassa verenvuodon ja iskeemisten vaurioiden havaitsemiseen. Vakavasti loukkaantuneiden ja lävistäviä vartalovammoja saaneiden kuvauksen tulee kattaa myös kaulavaltimot sekä vatsan ja lantion alue niin valtimo- kuin laskimovaiheessakin

Punnitukseen perustuva kotitalouksien jätemaksujärjestelmä : Toteuttajan tietopaketti

Euroopan unionin jätedirektiivi edellyttää jäsenmailta yhdyskuntajätteen 50 prosentin kierrätystavoitteen saavuttamista vuoteen 2020 mennessä. Tavoitteet tiukentuivat kesällä 2018 voimaantulleen uuden jätedirektiivin myötä. Euroopan unionin uutena tavoitteena on, että yhdyskuntajätteestä kierrätettäisiin 55 prosenttia vuonna 2025, 60 prosenttia vuonna 2030 ja 65 prosenttia vuonna 2035. Lajittelua tehostavat käytännöt -hanke (LAJITEHO) käynnistyi vuonna 2017 ympäristöministeriön yhdyskuntajätteen kierrätystä edistävällä kokeilurahoituksella. Hankkeen toteuttivat ympäristöministeriö, Suomen ympäristökeskus SYKE, Suomen Kiertovoima ry KIVO ja Pirkanmaan Jätehuolto Oy. LAJITEHO-hankkeen tavoitteena on ollut yhdyskuntajätteen kierrätysasteen noston kannalta soveltuvien painoperusteisten PAYT ’Pay As You Throw’ -menetelmien tutkiminen, PAYT-järjestelmän kehittäminen asiakaslähtöiseksi, lajitteluun kannustavaksi järjestelmäksi sekä löytää Suomen olosuhteisiin soveltuvia ratkaisuja. Hankkeessa on koottu tietoa ja laadittu työkaluja jätelaitoksille painoperusteisen järjestelmän käyttöönoton tueksi. Tähän raporttiin on koottu selvitykset koskien painoperusteisen PAYT-järjestelmän juridisia ja hallinnollisia reunaehtoja, kolmen painoperusteisen PAYT-järjestelmän esimerkkitapausta Euroopasta, SWOT-analyysia, tietoa punnitustekniikan käytöstä keräysvälineiden tyhjennyksessä, selvityksen järjestelmän ympäristövaikutuksista, viestinnän tukiaineiston, sekä jätemaksujen hinnoittelumallin

High-intensity endurance training increases nocturnal heart rate variability in sedentary participants

The effects of endurance training on endurance performance characteristics and cardiac autonomic modulation during night sleep were investigated during two 4-week training periods. After the first 4-week training period (3 x 40 min per week, at 75% of HRR) the subjects were divided into HIGH group (n = 7), who performed three high-intensity endurance training sessions per week; and CONTROL group (n = 8) who did not change their training. An incremental treadmill test was performed before and after the two 4-week training periods. Furthermore, nocturnal RR-intervals were recorded after each training day. In the second 4-week training period HIGH group increased their VO2max (P = 0.005) more than CONTROL group. At the same time, nocturnal HR decreased (P = 0.039) and high-frequency power (HFP) increased (P = 0.003) in HIGH group while no changes were observed in CONTROL group. Furthermore, a correlation was observed between the changes in nocturnal HFP and changes in VO2max during the second 4-week training period (r = 0.90, P < 0.001). The present study showed that the increased HFP is related to improved VO2max in sedentary subjects suggesting that nocturnal HFP can provide a useful method in monitoring individual responses to endurance training.peerReviewe

Prevention of storage aging in dried raw blue fox skins

VokTU

Relationships between Heart Rate Variability, Sleep Duration, Cortisol and Physical Training in Young Athletes

The aims of the current study were to examine the relationships between heart rate variability (HRV), salivary cortisol, sleep duration and training in young athletes. Eight athletes (16 ± 1 years) were monitored for 7 weeks during training and competition seasons. Subjects were training for endurance-based winter sports (cross-country skiing and biathlon). Training was divided into two zones (K1, easy training and K2, hard training). Heart rate and blood lactate during submaximal running tests (SRT), as well as cortisol, sleep duration and nocturnal HRV (RMSSD), were determined every other week. HRV and cortisol levels were correlated throughout the 7-week period (r = -0.552, P = 0.01), with the strongest correlation during week 7 (r = -0.879, P = 0.01). The relative changes in K1 and HRV showed a positive correlation from weeks 1-3 (r = 0.863, P = 0.006) and a negative correlation during weeks 3-5 (r = -0.760, P = 0.029). The relative change in sleep during weeks 1-3 were negatively correlated with cortisol (r = -0.762, P = 0.028) and K2 (r = -0.762, P = 0.028). In conclusion, HRV appears to reflect the recovery of young athletes during high loads of physical and/or physiological stress. Cortisol levels also reflected this recovery, but significant change required a longer period than HRV, suggesting that cortisol may be less sensitive to stress than HRV. Moreover, our results indicated that during the competition season, recovery for young endurance athletes increased in duration and additional sleep may be beneficial.peerReviewe

Evaluation of nocturnal vs. morning measures of heart rate indices in young athletes

Purpose The purpose of this study was to compare heart rate (HR) and heart rate variability in young endurance athletes during nocturnal sleep and in the morning; and to assess whether changes in these values are associated with changes in submaximal running (SRT) and counter-movement jump (CMJ) performance. Methods During a three-week period of similar training, eleven athletes (16 ± 1 years) determined daily HR and heart rate variability (RMSSD) during sleep utilizing a ballistocardiographic device (Emfit QS), as well as in the morning with a HR monitor (Polar V800). Aerobic fitness and power production were assessed employing SRT and CMJ test. Results Comparison of the average values for week 1 and week 3 revealed no significant differences with respect to nocturnal RMSSD (6.8%, P = 0.344), morning RMSSD (13.4%, P = 0.151), morning HR (-3.9 bpm, P = 0.063), SRT HR (-0.7 bpm, P = 0.447), SRT blood lactate (4.9%, P = 0.781), CMJ (-4.2%, P = 0.122) or training volume (16%, P = 0.499). There was a strong correlation between morning and nocturnal HRs during week 1 (r = 0.800, P = 0.003) and week 3 (r = 0.815, P = 0.002), as well as between morning and nocturnal RMSSD values (for week 1, r = 0.895, P<0.001 and week 3, r = 0.878, P = 0.001). Conclusion This study concluded that HR and RMSSD obtained during nocturnal sleep and in the morning did not differ significantly. In addition, weekly changes in training and performance were small indicating that fitness was similar throughout the 3-week period of observation. Consequently, daily measurement of HR indices during nocturnal sleep provide a potential tool for long-term monitoring of young endurance athletes.peerReviewe

Monitoring Training Adaptation With a Submaximal Running Test in Field Conditions

Regular monitoring of adaptation to training is important for optimizing training load and recovery, which is the main factor in successful training. Purpose: To investigate the usefulness of a novel submaximal running test (SRT) in field conditions in predicting and tracking changes of endurance performance. Methods: Thirty-five endurance-trained men and women (age 20–55 y) completed the 18-wk endurance-training program. A maximal incremental running test was performed at weeks 0, 9, and 18 for determination of maximal oxygen consumption (VO2max) and running speed (RS) at exhaustion (RSpeak) and lactate thresholds (LTs). In addition, the subjects performed weekly a 3-stage SRT including a postexercise heart-rate-recovery (HRR) measurement. The subjects were retrospectively grouped into 4 clusters according to changes in SRT results. Results: Large correlations (r = .60–.89) were observed between RS during all stages of SRT and all endurance-performance variables (VO2max, RSpeak, RS at LT2, and RS at LT1). HRR correlated only with VO2max (r = .46). Large relationships were also found between changes in RS during 80% and 90% HRmax stages of SRT and a change of RSpeak (r = .57, r = .79). In addition, the cluster analysis revealed the different trends in RS during 80% and 90% stages during the training between the clusters, which showed different improvements in VO2max and RSpeak. Conclusions: The current SRT showed great potential as a practical tool for regular monitoring of individual adaptation to endurance training without time-consuming and expensive laboratory tests.peerReviewe

Individual Endurance Training Prescription with Heart Rate Variability

Introduction: Measures of HR variability (HRV) have shown potential to be of use in training prescription. Purpose: The aim of this study was to investigate the effectiveness of using HRV in endurance training prescription. Methods: Forty recreational endurance runners were divided into the HRV-guided experimental training group (EXP) and traditional predefined training group (TRAD). After a 4-wk preparation training period, TRAD trained according to a predefined training program including two to three moderate- (MOD) and high-intensity training (HIT) sessions per week during an 8-wk intensive training period. The timing of MOD and HIT sessions in EXP was based on HRV, measured every morning. The MOD/HIT session was programmed if HRV was within an individually determined smallest worthwhile change. Otherwise, low-intensity training was performed. Maximal oxygen consumption (V˙O2max) and 3000-m running performance (RS3000m) were measured before and after both training periods. Results: The number of MOD and HIT sessions was significantly lower (P = 0.021, effect size = 0.98) in EXP (13.2 ± 6.0 sessions) compared with TRAD (17.7 ± 2.5 sessions). No other differences in training were found between the groups. RS3000m improved in EXP (2.1% ± 2.0%, P = 0.004) but not in TRAD (1.1% ± 2.7%, P = 0.118) during the intensive training period. A small between-group difference (effect size = 0.42) was found in the change in RS3000m. V˙O2max improved in both groups (EXP: 3.7% ± 4.6%, P = 0.027; TRAD: 5.0% ± 5.2%, P = 0.002). Conclusion: The results of the present study suggest the potential of resting HRV to prescribe endurance training by individualizing the timing of vigorous training sessions.peerReviewe

A Submaximal Running Test With Post-Exercise Cardiac Autonomic And Neuromuscular Function In Monitoring Endurance Training Adaptation

The aim of this study was to investigate whether a submaximal running test (SRT) with postexercise heart rate recovery (HRR), heart rate variability (HRV), and countermovement jump (CMJ) measurements could be used to monitor endurance training adaptation. Thirty-five endurance-trained men and women completed an 18-week endurance training. Maximal endurance performance and maximal oxygen uptake were measured every 8 weeks. In addition, SRTs with postexercise HRR, HRV, and CMJ measurements were carried out every 4 weeks. Submaximal running test consisted of two 6-minute stages at 70 and 80% of maximum heart rate (HRmax) and a 3-minute stage at 90% HRmax, followed by a 2-minute recovery stage for measuring postexercise HRR, HRV, and CMJ test. The highest responders according to the change of maximal endurance performance showed a significant improvement in running speeds during stages 2 and 3 in SRT, whereas no changes were observed in the lowest responders. The strongest correlation was found between the change of maximal endurance performance and running speed during stage 3, whereas no significant relationships were found between the change of maximal endurance performance and the changes of postexercise HRR, HRV, and CMJ. Running speed at 90% HRmax intensity was the most sensitive variable to monitor adaptation to endurance training. The present submaximal test showed potential to monitor endurance training adaptation. Furthermore, it may serve as a practical tool for athletes and coaches to evaluate weekly the effectiveness of training program without interfering in the normal training habits.peerReviewe