Diabetes Care for Patients with Peripheral Arterial Disease

The number of diabetics will increase almost 70% in developed countries during the next 20 years: peripheral arterial disease is a common and costly complication. The incidence of cardiovascular disease (mortality and morbidity) due to atherosclerosis, is higher among patients with diabetes than in those without diabetes. Intensive management of diabetes, including glycaemic control, treatment of hypertension and dyslipidemia, as well as nonpharmacological interventions, decreases both micro- and macrovascular complications. Aspirin and clopidogrel have less antiplatelet effect in patients with diabetes. Metformin therapy is considered a risk factor for lactic acidosis if not withdrawn 2 days before angiography, but this risk is extremely low in patients with normal renal function. Peri-operative hyperglycaemia and large fluctuations in plasma glucose increase postoperative mortality and morbidity and careful measures are required to minimise these effects

Yhdyskuntajätteen koostumustiedon laadun parantaminen

Yhdyskuntajätteen koostumus tunnetaan vain osittain. Eri alkulähteillä syntyneiden sekalaisten jätteiden, kuten seka- ja energiajätteiden, koostumus vaihtelee. Kotitalousjätteiden sekajätekoostumusta on selvitetty eri alueilla, mutta hallinto-, palvelu- ja elinkeinotoiminnan sekalaisten jätevirtojen koostumuksesta ei ole julkaistua tietoa. Yhdyskuntajätteen koostumustietoja tarvitaan uudistuneen jätedirektiivin edellyttämässä raportoinnissa sekä jätehuollon suunnittelun ja ohjauskeinojen tukena. Tässä raportissa on tarkasteltu erilaisia tapoja muodostaa yhdyskuntajätteen koostumus. Tehdyn selvityksen keskiössä ovat erityisesti hallinto-, palvelu- ja elinkeinotoiminnan jätteet sekä seka-, energia- ja biojätteiden koostumus. Lisäksi selvitettiin Ruotsin ja Irlannin käyttämiä tiedonkeruumenetelmiä ja kokemuksia kotitalouksien sekajätetutkimuksissa käytetystä ohjeistuksesta sekä laajan toimijahaastattelun pohjalta muodostettiin vaihtoehtoiset tavat muodostaa vankempi tietopohja yhdyskuntajätekoostumuksesta. Lopuksi tarkasteltiin mahdollisia ohjauskeinoja tiedonkeruun vahvistamiseksi. Selvityksessä päädyttiin suosittelemaan alakohtaisia koostumusselvityksiä yhdistettynä alakohtaisiin ominaisjätemäärätietoihin kokonaiskuvan muodostamisessa. Menetelmän käyttöönoton vahvistamiseksi ehdotettiin vapaaehtoista sopimista. Koostumustiedolle tarvitaan myös oma tietojärjestelmä

Preoperative and perioperative use of levosimendan in cardiac surgery: European expert opinion

In cardiac surgery, postoperative low cardiac output has been shown to correlate with increased rates of organ failure and mortality. Catecholamines have been the standard therapy for many years, although they carry substantial risk for adverse cardiac and systemic effects, and have been reported to be associated with increased mortality. On the other hand, the calcium sensitiser and potassium channel opener levosimendan has been shown to improve cardiac function with no imbalance in oxygen consumption, and to have protective effects in other organs. Numerous clinical trials have indicated favourable cardiac and non-cardiac effects of preoperative and perioperative administration of levosimendan. A panel of 27 experts from 18 countries has now reviewed the literature on the use of levosimendan in on-pump and off-pump coronary artery bypass grafting and in heart valve surgery. This panel discussed the published evidence in these various settings, and agreed to vote on a set of questions related to the cardioprotective effects of levosimendan when administered preoperatively, with the purpose of reaching a consensus on which patients could benefit from the preoperative use of levosimendan and in which kind of procedures, and at which doses and timing should levosimendan be administered. Here, we present a systematic review of the literature to report on the completed and ongoing studies on levosimendan, including the newly commenced LEVO-CTS phase III study (NCT02025621), and on the consensus reached on the recommendations proposed for the use of preoperative levosimendan

Epileptogenesis after prolonged febrile seizures: mechanisms, biomarkers and therapeutic opportunities.

Epidemiological and recent prospective analyses of long febrile seizures (FS) and febrile status epilepticus (FSE) support the idea that in some children, such seizures can provoke temporal lobe epilepsy (TLE). Because of the high prevalence of these seizures, if epilepsy was to arise as their direct consequence, this would constitute a significant clinical problem. Here we discuss these issues, and describe the use of animal models of prolonged FS and of FSE to address the following questions: Are long FS epileptogenic? What governs this epileptogenesis? What are the mechanisms? Are there any predictive biomarkers of the epileptogenic process, and can these be utilized, together with information about the mechanisms of epileptogenesis, for eventual prevention of the TLE that results from long FS and FSE

Executing circular economy strategies in practice in Finland. Results and experiences from Circwaste project

A Europe-wide circular economy policy was launched in 2014 when the European Commission published the first strategic policy programme for circular economy. It was compiled to provide very comprehensive impacts and dimensions of sustainable development: sustainable growth and a climate neutral, resource efficient and competitive economy. The targets of a circular economy are that the value of products, materials and resources is maintained in the economy for as long as possible, economic growth is decoupled from resource use, generation of waste and environmental loads are minimised, and pressure on the Earth’s resources and biodiversity is minimised. The European Union is supporting the sustainability transition with research and development funding. In Finland, Circwaste – Towards Circular Economy is one of the biggest development projects accelerating the transition to a circular economy. During the period 2016–2020, the project has produced monitoring data on the development of circular economy and the sustainability of waste management, highlighted the circular economy concept, promoted stakeholder collaboration, supported strategic national processes, strengthened know-how and mainstreamed and concretised circular economy thinking. This interim report presents all the relevant results so far. It is crucial that data is produced from different angles on implementing the circular economy. More information is needed both to support decision making and on connections between and reflections on different factors. The key figures for Finland show quite clear coupling of the use of natural resources, waste amounts and economic growth. The circular material use rate is ca. 7%, which can be considered quite modest. Quantitative national targets for decreasing the use of natural resources are needed. Instead of country comparisons, the focus should be on trends in order to learn from the past and to identify the policy instruments needed to achieve the level aspired to. One of the key findings is the need for regional indicators and data for decisionmaking. The work done within Circwaste is the first effort towards a systematic monitoring scheme for monitoring circular economy regionally. The study showed that the production of regional waste data is challenging, that the estimated recycling rates have not increased adequately to reach the EU targets and that there could therefore be a need for municipallevel recycling targets. The transition to a circular economy also causes fundamental social changes in society. In the project, new indicators were developed for measuring social impacts: circular economy employment, education and employment for vulnerable groups, publicly shared resources, accessibility of recycling services and sustainable vehicle fuels. The first baseline data show advances towards the circular economy: the accessibility of waste management services has improved, the Finnish educational system has been able to respond quickly to the need for circular economy education, circular economy activities have potential for the employment of vulnerable groups and economic activities related to recycling, repair and reuse have grown. The regions and municipalities emerge as key actors in facilitating a socially just transition towards a circular economy. The study on innovative material processing technologies gathered data on technologies for elemental recycling, especially for plastic waste but also for making new fibres from textiles waste. Financial issues are key to the survival of these technologies and there is a need for governmental financial support. Public procurers can be considered key players in the circular economy, creating demand for more sustainable products and services. Implementing circular economy in municipalities requires commitment, financial planning, interaction with regional actors and inclusion of circular economy in financial rules. The construction sector is a major consumer of natural resources, but the municipalities can make construction more sustainable through public procurements and planning. As buyers, they can require the use of recycled raw materials and soils in construction projects. Obligations for ecological compensation and goals of no net loss of biodiversity would decrease the pressure on natural resources. To support municipalities in their work, a national organisation for providing municipal auditing, development, education and business support services could be established. Employing circular economy experts in each municipality to work as crossadministrative coordinators could enhance the transition. The project has created a lot of political, theoretical and practical content on the concept and field of circular economy. The next steps are to further develop and widen, as well as deepen, the results and to provide national support in searching for answers and solutions for decreasing the use of natural resources, achieving the MSW recycling targets and creating a more sustainable society

Taxonomy of the family Arenaviridae and the order Bunyavirales: update 2018

In 2018, the family Arenaviridae was expanded by inclusion of 1 new genus and 5 novel species. At the same time, the recently established order Bunyavirales was expanded by 3 species. This article presents the updated taxonomy of the family Arenaviridae and the order Bunyavirales as now accepted by the International Committee on Taxonomy of Viruses (ICTV) and summarizes additional taxonomic proposals that may affect the order in the near future

Päivittäistavarakaupan jätteet

Yhdyskuntajätteitä syntyy kotitalouksissa sekä hallinnossa, elinkeinotoiminnassa ja palveluissa kuten esimerkiksi päivittäistavarakaupassa. Tarkempi tieto yhdyskuntajätteiden määristä toiminnoittain puuttuu. Jos jätteen määrää ja laatua pystyttäisiin seuraamaan tarkemmin, toiminnan kehittäminen olisi tehokkaampaa. Valtakunnallisesti seurantaan pohjaavalla ohjaamisella voitaisiin parantaa yhdyskuntajätteen kierrätysastetta. Myös sekalaisten jätevirtojen koostumustietoa puuttuu hallinto-, palvelu- ja elinkeinotoiminnoista. Tarkempaa jätetietoa valtakunnallisen ohjaamisen lisäksi tarvitaan Euroopan unionin (EU:n) edellyttämään jäteraportointiin. Tässä raportissa esitellään tuloksia päivittäistavarakaupan alan jätemäärien laskennasta sekä seka- ja energiajätteiden koostumustutkimuksesta. Esitetyt jätemäärätiedot koskevat vuotta 2021 ja koostumustiedot vuotta 2022. Tulosten mukaan päivittäistavarakaupan kokonaisjätemäärä edustaa 4 % koko Suomen yhdyskuntajätteen massasta. Päivittäistavarakauppa on siten tärkeä yksittäinen toimiala jätemäärien näkökulmasta. Päivittäistavarakaupan seka- ja energiajäte sisältää kierrätyskelpoisia materiaaleja ja kierrätyspotentiaalia on vielä merkittävästi. Erityisesti muovin, paperin, kartongin ja pahvin sekä biojätteen lajittelua voitaisiin tehostaa päivittäistavarakaupassa. Tämä raportti antaa myös käytännönläheisiä ohjeita hallinto-, palvelu- ja elinkeinotoiminnan jätekoostumustutkimuksen tekoon. Ohjeet pohjautuvat Suomen Kiertovoiman kotitalouksien sekajätteelle laatimaan ohjeistukseen: Opas sekajätteen koostumustutkimuksiin.Avfall inom dagligvaruhandel Kommunalt avfall genereras i hushållen och inom administration, näringsverksamhet och tjänster såsom dagligvaruhandel. Mer detaljerad information om mängden av kommunalt avfall för olika verksamheter saknas. Om mängden och kvaliteten av avfallet kunde följas upp noggrannare skulle verksamheten kunna utvecklas effektivare. Rikstäckande anvisningar baserade på uppföljning skulle kunna förbättra återvinningsgraden för kommunalt avfall. Det saknas också information om sammansättningen av blandade avfallsströmmar inom administrativ, service och näringsverksamhet. Mer detaljerad information om avfall behövs också för avfallsrapportering som krävs av Europeiska unionen (EU). I denna rapport redovisas resultaten av beräkningen av avfallsmängder inom dagligvaruhandeln och en plockanalys av blandat och energiavfall. De presenterade avfallsmängderna är från år 2021 och sammansättningen inklusive år 2022. Enligt resultaten utgör den totala mängden avfall från dagligvaruhandeln 4 % av massan av allt kommunalt avfall i Finland. Dagligvaruhandeln är således en viktig enskild sektor ur avfallsmängdssynpunkt. Blandat och energiavfall från dagligvaruhandeln innehåller återvinningsbart material och det finns fortfarande en betydande återvinningspotential. Framför allt skulle sorteringen av plast, papper, kartong samt bioavfall kunna effektiviseras i mataffären. Denna rapport ger också praktiska råd till genomförande av forskning av sammansättningen av avfallet inom administration, service och affärsverksamhet. Råden grundar sig på de riktlinjer som utarbetats av Suomen Kiertovoima för blandat hushållsavfall: Opas sekajätteen koostumustutkimuksiin.Municipal solid waste from grocery trade Municipal solid waste (MSW) is generated in households as well as in administration, business activities and services. Grocery trade waste is also included in MSW. There is a lack of information on the amounts of MSW generated in different branches in Finland, which makes it difficult to raise the recycling rate. There is also a lack of information on the composition of mixed waste streams in administrative, service, and economic activities. In addition, more detailed waste information is needed for waste reporting required by the European Union. This report presents the results of the calculation of the amount of waste in the grocery trade and the mixed and energy waste composition study. The presented waste data apply to the years 2021 and 2022, respectively. According to the results, the total amount of waste from the grocery trade sector represents 4% of the entire MSW stream in Finland. Therefore, the grocery trade is an important individual sector from the point of view of MSW quantities. Mixed and energy waste from grocery stores contains recyclable materials and there is still significant recycling potential according to the study results. In particular, the sorting of plastic, paper, cardboard, as well as bio-waste could be enhanced. This report also gives practical instructions for conducting a waste composition study of administration, service, and business activities. The instructions are based on the” Guidelines for composition studies” prepared by Suomen Kiertovoima for mixed household waste