Kohti kestävää pienvenesatamaa - veneilijöiden ja satamatoimijoiden näkökulmista

Involving stakeholders in the context of both business planning and environmental management is important to ensure joint understanding of prevailing or potential problems and risks, the objectives of different parties, and the best ways to attain them. This report presents a study concerning the sustainable development of small ports in the Eastern Gulf of Finland. Ten stakeholders, involving boaters and port actors, from two countries, Finland and Estonia, were interviewed to analyze how stakeholders communicate and think about the concept of sustainability and its materialization in the planning and development of small ports. The report also compares how the definition of sustainability, or thoughts concerning sustainable development, differ between boaters and port actors. Theoretically speaking, the concept of sustainable development should consist of a balance between three aspects: environment, economic and social. Following an explanation of the three-aspect concept, the interviewed stakeholders accepted the idea of sustainable development being based on these three aspects; however, the weighting of aspects varied between the interviewee groups. Although the environmental perspective was important for both boaters and port actors, boaters valued the environment more socio-ecologically than port actors, who had a more economically-oriented perspective. The interviewed boaters valued safety the highest, acknowledging many things should be improved in small ports. Port actors, instead, seemed quite unaware of the challenges boaters face regarding both safety and maintaining sewage-holding-tank pumpout stations. These differences indicate the potential need for more active communication between the two groups. The analysis concretely shows that practical management actions and investments made in small ports are typically related to more than one of the three elements of sustainability. Consequently, evaluation of various decisions’ cost-effectiveness requires holistic planning. Sustainability as an objective is incompatible with short-term thinking, requiring a longer-time perspective. Observed short contracts of port actors remarkably hindered sustainability. Interviewees mutually agreed on the high potential of small ports to bring added value both economically and socially to their surrounding areas. Thus, one important question is: who should fund the investments to develop the long-term sustainability of ports? This report consists of a description of the interviewing method and a thorough analysis of the results. The results lead from recommendations and ideas for the future development of sustainable small ports

Noninvasive quantification of airway inflammation following segmental allergen challenge with functional MR imaging: A proof of concept study

Purpose To evaluate oxygen-enhanced T1-mapping magnetic resonance (MR) imaging as a noninvasive method for visualization and quantification of regional inflammation after segmental allergen challenge in asthmatic patients compared with control subjects. Materials and Methods After institutional review board approval, nine asthmatic and four healthy individuals gave written informed consent. MR imaging (1.5 T) was performed by using an inversion-recovery snapshot fast low-angle shot sequence before (0 hours) and 6 hours and 24 hours after segmental allergen challenge by using either normal- or low-dose allergen or saline. The volume of lung tissue with increased relaxation times was determined by using a threshold-based method. As a biomarker for oxygen transfer from the lungs into the blood, the oxygen transfer function (OTF) was calculated. After the third MR imaging examination, eosinophils in bronchoalveolar lavage fluid were counted. Differences between times and segments were analyzed with nonparametric Wilcoxon matched-pairs test and Spearman correlation. Results In lung segments treated with the standard dose of allergen, the OTF was decreased at 6 hours in asthmatic patients, compared with saline-treated segments (P = .0078). In asthmatic patients at 24 hours, the volume over threshold was significantly increased in normal allergen dose–treated segments compared with saline-treated segments (P = .004). In corresponding lung segments, the volume over threshold at 24 hours in the asthmatic group showed a positive correlation (r = 0.65, P = .0001) and the OTF at 6 hours showed an inverse correlation (r = -0.67, P = .0001) with the percentage of eosinophils in the bronchoalveolar lavage fluid. Conclusion OTF and volume over threshold are noninvasive MR imaging-derived parameters to visualize and quantify the regional allergic reaction after segmental endobronchial allergen challenge

Multiparametric MRI for organ quality assessment in a porcine Ex-Vivo lung perfusion system.

IntroductionEx-vivo lung perfusion (EVLP) is an emerging technique promising an expansion of the donor pool and improvements in the outcome after lung transplantation. Reliable biomarkers for local assessment of organ function in the EVLP system are intensely sought after. This study aims to evaluate the feasibility of multiparametric functional magnetic resonance imaging (fMRI) in an EVLP system in a porcine aspiration model.Material and methodsSeven female pigs were anesthetized and gastric juice was instilled in the right lower lobe bronchus to simulate aspiration. Left lungs served as control. Lungs were removed and installed in a modified EVLP system. In the 12-hour EVLP run three sequential MRI scans were performed. Oxygen-washout time, Fourier Decomposition derived ventilation and perfusion, and dynamic contrast enhanced imaging derived perfusion were calculated. PaO2:FiO2 ratio was determined and correlated. End-point histology and computed tomography served as control.ResultsAll animals completed the protocol. MRI structural images showed infiltrates in lungs after aspiration comparable to CT scans. Ventilation was significantly (p = 0.016) reduced while perfusion was increased (p = 0.016) in lungs after aspiration. Non-contrast dependent Fourier decomposition perfusion showed good correlation (R2 = 0.67) to dynamic contrast enhanced derived perfusion. Oxygen washout time was significantly increased (p = 0.016) in lungs after aspiration and showed a correlation with the PaO2:FiO2 ratio (R2 = 0.54).ConclusionMultiparametric fMRI for local assessment of organ function is feasible in EVLP and detects alterations in lung function following aspiration with correlation to clinical parameters. fMRI may improve organ assessment in ex-vivo perfusion systems, leading to a better selection of segments suitable for transplant

Indacaterol/Glycopyrronium improves pulmonary ventilation and ventilation inhomogeneity in the CLAIM Study

Background: Ventilation of the lungs is disturbed in COPD. Bronchodilator treatment reduces airway obstruction and improves airflow in the lung. Analysis of lung ventilation might help to further characterize COPD patients and assess treatment effects. Objectives: The objective was to analyze treatment effects of indacaterol/glycopyrronium (IND/GLY) on regional lung ventilation. Methods: CLAIM was a randomized, double-blind, single-center, placebo-controlled, 2 period cross-over trial. 62 hyperinflated COPD patients were enrolled to receive IND/GLY (110/50 μg q.d.) for 14 days followed by placebo or vice versa. Regional lung ventilation was measured under free breathing conditions in three coronal slices and in left and right sagittal slices using phase-resolved functional lung (PREFUL)-MRI. Results: Analysis of coronal lung slices showed that treatment with IND/GLY increased total fractional ventilation (FV) in the lung by 12.4% vs. placebo (relative LS Mean difference, p=0.0114) at day 14. Increase in total FV was associated with a reduction of hypoventilated areas (volume defect percentage) by 16.6% (p=0.0002) and an increase in homogeneity of lung ventilation by 12.4% (p<0.0001) vs. placebo, measured as reduction of the variation coefficient of FV. Similar results were obtained for sagittal slices, thereby supporting the validity of these results for the entire lung. Conclusion: IND/GLY improved lung ventilation in hyperinflated COPD patients. Importantly, this was associated with a reduction of hypoventilated areas and increased homogeneity. Improved regional lung ventilation might contribute to the reduction in dyspnea reported earlier for the CLAIM study

Patient characteristics.

<p>Patient characteristics.</p

Flowchart of patients included in the study.

<p>LTx  =  lung transplantation, DLTx  =  double lung transplantation, BOS  =  bronchiolitis obliterans syndrome, m  =  male, f  = female, y  =  years; median and 25; 75 interquartile range for age distribution.</p

Functional lung MRI for regional monitoring of patients with cystic fibrosis

<div><p>Purpose</p><p>To test quantitative functional lung MRI techniques in young adults with cystic fibrosis (CF) compared to healthy volunteers and to monitor immediate treatment effects of a single inhalation of hypertonic saline in comparison to clinical routine pulmonary function tests.</p><p>Materials and methods</p><p>Sixteen clinically stable CF patients and 12 healthy volunteers prospectively underwent two functional lung MRI scans and pulmonary function tests before and 2h after a single treatment of inhaled hypertonic saline or without any treatment. MRI-derived oxygen enhanced T₁ relaxation measurements, fractional ventilation, first-pass perfusion parameters and a morpho-functional CF-MRI score were acquired.</p><p>Results</p><p>Compared to healthy controls functional lung MRI detected and quantified significantly increased ventilation heterogeneity in CF patients. Regional functional lung MRI measures of ventilation and perfusion as well as the CF-MRI score and pulmonary function tests could not detect a significant treatment effect two hours after a single treatment with hypertonic saline in young adults with CF (p>0.05).</p><p>Conclusion</p><p>This study shows the feasibility of functional lung MRI as a non-invasive, radiation-free tool for monitoring patients with CF.</p></div

Patient cohort (CONSORT flow chart).

<p>Please note: For the control group a second visit of 4 patients of the treatment group were included resulting in 20 visits of 16 patients.</p

Subject demographics.

<p>Subject demographics.</p

Comparison of CF patients to healthy volunteers.

<p>Comparison of CF patients to healthy volunteers.</p