Tiesuolalogistiikka

Tämän opinnäytetyön tilaajana toimii YIT Rakennus Oy. Opinnäytetyö on kehittämisprojekti, jonka tavoitteena on tuottaa tilaajalle visuaalinen hallintajärjestelmä tiesuolan materiaalivirtojen seuraamiseen. Työn lähteenä on käytetty Liikenneviraston julkaisemaa materiaalia teiden kunnossapidosta sekä YIT:n eri työmaiden tuottama dataa teiden kunnossapidosta. Kehittämisprojektin lähtötietoina käytetään olemassa olevaa dataa tiesuolasta, lisäksi projektissa kartoitetaan uusia tapoja hyödyntää olemassa olevaa dataa, yhdenmukaistetaan eri työmaiden käytäntöjä kerätä dataa sekä tuodaan mahdollisuus koko organisaatiolle hyödyntää kerättyä dataa. Työssä kerrotaan myös yleisten teiden kunnossapidosta, teiden hoitoluokista, liukkaudentorjunnasta suolaamalla sekä tiesuolan varastoinnista, kuljetuksesta sekä materiaalivirtojen hallinnasta yleisesti. Työn tuloksena on syntynyt uusi hallintajärjestelmä tiesuolan materiaalivirtojen hallintaan sekä uusia toimintatapaehdotuksia liukkaudentorjuntamateriaalien hallinnasta kerättävään dataan.This Bachelor´s thesis was commissioned by YIT Construction Ltd. The purpose of the thesis was to develop a visual control system to follow the materials flow of the ice-control salt. Another aim was to explore new ways to utilize the existing data, standardize the practice of different construction sites to collect data and provide the organization with the possibility to utilize the collected data. The sources used in the thesis were the existing data and studies on the topic including the material published by Finnish Transport Agency and the data provided by YIT´s various construction sites on road maintenance. This thesis also discusses general road maintenance, road maintenance classes, antiskid treatment through ice-control salt, storage of ice-control salt, transportation and general material flow management. As a result of the thesis a new management system for the management of road salt material flows was produced. The thesis also includes suggestions for the control of ice-control salt material

Prospective Study of the Quality of Colonoscopies Performed by Primary Care Physicians: The Alberta Primary Care Endoscopy (APC-Endo) Study

<div><p>Background</p><p>The quality of colonoscopies performed by primary care physicians (PCPs) is unknown.</p><p>Objective</p><p>To determine whether PCP colonoscopists achieve colonoscopy quality benchmarks, and patient satisfaction with having their colonoscopy performed by a primary care physician.</p><p>Design</p><p>Prospective multi-center, multi-physician observational study. Colonoscopic quality data collection occurred via completion of case report forms and pathological confirmation of lesions. Patient satisfaction was captured by a telephone survey.</p><p>Setting</p><p>Thirteen rural and suburban hospitals in Alberta, Canada.</p><p>Measurements</p><p>Proportion of successful cecal intubations, average number of adenomas detected per colonoscopy, proportion of patients with at least one adenoma, and serious adverse event rates; patient satisfaction with their wait time and procedure, as well as willingness to have a repeat colonoscopy performed by their primary care endoscopist.</p><p>Results</p><p>In the two-month study period, 10 study physicians performed 577 colonoscopies. The overall adjusted proportion of successful cecal intubations was 96.5% (95% CI 94.6–97.8), and all physicians achieved the adjusted cecal intubation target of ≥90%. The average number of ademonas detected per colonoscopy was 0.62 (95% CI 0.5–0.74). 46.4% (95% CI 38.5–54.3) of males and 30.2% (95% CI 22.3–38.2) of females ≥50 years of age having their first colonoscopy, had at least one adenoma. Four serious adverse events occurred (three post polypectomy bleeds and one perforation) and 99.3% of patients were willing to have a repeat colonoscopy performed by their primary care colonoscopist.</p><p>Limitations</p><p>Two-month study length and non-universal participation by Alberta primary care endoscopists.</p><p>Conclusions</p><p>Primary care physician colonoscopists can achieve quality benchmarks in colonoscopy. Training additional primary care physicians in endoscopy may improve patient access and decrease endoscopic wait times, especially in rural settings.</p></div

Quality Outcomes of the Alberta Primary Care Endoscopy Study.

a<p>USMSTF adjusted proportion of successful cecal intubations excludes incomplete colonoscopies due to poor bowel preparation and severe colitis.</p>b<p>Number of pathologically confirmed adenomas/number of colonoscopies ^c,d Proportion of males^c or females^d ≥50 years old, first time colonoscopy with pathologically confirmed adenoma</p>e<p>Average withdrawal time of procedures where no lesions were detected</p>f<p>Only 2 colonoscopies performed on this patient cohort;</p>g<p>Only 3 colonoscopies performed on this patient cohort.</p><p>% = percent; min = minutes; # = number, serious adverse events (SAEs) reported as totals.</p>*<p>Overall means reported with 95% confidence intervals except age reported with standard deviations.</p

Participating physician and practice characteristics for the Alberta Primary Care Endoscopy study.

<p>M = male; F = female.</p><p>FM = Family Medicine; GIM = General Internal Medicine.</p>a<p>General practice – Anaesthetists (Gp-A).</p

Alberta Primary Care Endoscopy Study Participation Results.

<p>Alberta Primary Care Endoscopy Study Participation Results.</p

Patient characteristics for the Alberta Primary Care Endoscopy study.

<p>% = percentage; SD = standard deviation.</p><p>Overall totals/means : reported with 95% confidence intervals except age reported with standard deviations.</p><p>Screening includes : family history of colorectal cancer, Lynch syndrome or familial adenomatous polyposis; positive FOBT; and average risk screening.</p

Weight loss and fecal occult blood in stool in response to DSS.

<p>n = 6 for Ct and Sh groups; n = 9 for ICR groups. Values are given as Mean ± SEM. Experiments were performed 2x with n = 3 in each of the control and sham groups, and 3x with an n = 3 for the ICR groups. (A) Animal weight from day of surgery (Day 0) to DSS treatment (Day 9–13). Mice in the ICR-D group showed significant weight loss by day 15. *p<0.05 compared with Ct, Ct-D, Sh, and Sh-D. (B) Animal weight from day of surgery (Day 0) to DSS treatment (Day 24–28). There were no significant changes in body weight over the course of the experiment. (C,D) Kaplan-Meier curves demonstrating time to occult blood positive stools. Significance was determined using the log-rank test for equality in survivor analysis. ICR mice showed a significantly earlier onset of occult blood positive stools compared with Ct-D and Sh-D groups in both the early DSS group (C) and in the late DSS group (D).</p

Timeline of experiments in two separate cohorts of ICR mice.

<p>All mice were placed on a liquid diet one day prior to surgery. Following ICR, mice remained on a liquid diet for 2 days, and then were placed back on chow diet. In Group 1, DSS was administered between days 9 and 13 post-op, followed by water for 2 days. Mice were sacrificed on Day 16 and tissues removed for analysis. In Group 2, DSS was administered between days 24 and 28 post-op, followed by water for 2 days. Mice were then scarified on day 31 and tissues removed for analysis.</p

Weight loss and fecal occult blood in stool in response to DSS.

<p>n = 6 for Ct and Sh groups; n = 9 for ICR groups. Values are given as Mean ± SEM. Experiments were performed 2x with n = 3 in each of the control and sham groups, and 3x with an n = 3 for the ICR groups. (A) Animal weight from day of surgery (Day 0) to DSS treatment (Day 9–13). Mice in the ICR-D group showed significant weight loss by day 15. *p<0.05 compared with Ct, Ct-D, Sh, and Sh-D. (B) Animal weight from day of surgery (Day 0) to DSS treatment (Day 24–28). There were no significant changes in body weight over the course of the experiment. (C,D) Kaplan-Meier curves demonstrating time to occult blood positive stools. Significance was determined using the log-rank test for equality in survivor analysis. ICR mice showed a significantly earlier onset of occult blood positive stools compared with Ct-D and Sh-D groups in both the early DSS group (C) and in the late DSS group (D).</p

Cell counts from immunofluorescence stained colonic tissue sections.

<p>(A) Cells labelled with CD11c and CD11b. In controls, DSS treatment decreased numbers of CD11c+ cells and increased numbers of CD11b+ cells. At day 16, ICR mice had decreased CD11c+ cells and increased CD11b+ cells. DSS treatment in ICR mice eliminated the rise in CD11b+ cells. At day 31, CD11c+ cells remained decreased in the ICR and ICR-D groups, but CD11b+ cells had increased in both groups. Data is shown as Mean ± SEM. Counts were performed on 6 representative photomicrographs from n = 3/group. * p ≤ 0.05 relative to Ct. (B) Cells labelled with CD11c and CD103. ICR and ICR-D mice had increased numbers of CD11c+CD103+ cells at day 16 and at day 31. Data is shown as Mean ± SEM. Counts were performed on 6 representative photomicrographs from n = 3/group. * p ≤ 0.05 relative to Ct and Ct-D. (C) Cells labelled with F4/80 and NOS2/F4/80. At day 16 and 31, ICR and ICR-D mice had increased levels of F4/80+ cells. Data is shown as Mean ± SEM. Counts were performed on 6 representative photomicrographs from n = 3/group. * p ≤ 0.05 relative to Ct and Ct-D; # p ≤ 0.05 with Ct; +p<0.05 compared with Day 16 ICR and ICR-D.</p