Varsinais-Suomen aluepelastuslaitoksen sopimuspalokuntien ensiauttajien kokemus osaamisestaan

Tämän opinnäytetyön tarkoituksena oli selvittää Varsinais-Suomen aluepelastuslaitoksen sopimuspalokuntien ensivasteessa toimivien henkilöiden kokemuksia osaamisestaan ja saadusta koulutuksesta sekä koulutuksen tarpeesta. Tutkimus oli kvantitatiivinen ja se toteutettiin strukturoidulla kyselylomakkeella kesällä 2009. Kyselylomakkeita lähetettiin 190 ja niistä palautui vastattuna 51. Vastausprosentiksi muodostui siis 27. Tulokset analysoitiin Exel- taulukkolaskentaohjelmalla ja vastauksista laadittiin frekvenssi- sekä prosenttijakaumat jotka esitetään opinnäytetyössä graafisten kuvaajien avulla. Ensiauttajat kokivat osaamisensa tilanteissa melko usein epävarmaksi, mutta keskeisillä osa-alueilla peruselintoimintojen häiriötilanteissa osattiin toimia. Ensivasteyksikön välineiden käytön vastaajat kokivat yleisesti osaavansa. Tulosten mukaan ensiauttajat kokivat saaneensa koulutusta liian vähän. Valtaosa ensiauttajista toivoi lisäkoulutusta lähes jokaisesta kysytystä aihealueesta. Ensiauttajien testausta järjestetään alueella vaihtelevasti. Suurin osa ensiauttajista vastasi, että testausta järjestetään harvemmin kuin kolmen vuoden välein tai ei ollenkaan. Opinnäytetyön tuloksia voidaan hyödyntää suunniteltaessa tulevia ensivastekoulutuksia. Alueen sairaankuljetuksessa työskentelevät saavat tuloksista kuvan ensiauttajien tämänhetkisestä tieto- taitotasosta.The purpose of this thesis was to study the voluntary fire department first responders' conception of their professional skills and knowledge, the amount of training they have received and whether the first responders, in their own opinion, required more training in order to successfully perform their duties. Study was quantitative and it was conducted with a structured questionnaire in the summer of 2009. Altogether 190 questionnaires were sent and 51 of them were returned completed. Thus, the response rate was 27 per cent. Results were first analyzed with an Exel- spreadsheet program and the frequency and per cent distributions were then illustrated by graphic representations. First responders were quite often insecure of their own skills in different situations, but in the most essential areas of their professional skills, such as in recognizing and evaluating the malfunctions related to vital signs, they knew clearly how to act. First responders felt that they generally knew how to use the equipment in their first response unit. According to the results the first responders felt that the amount of train-ing that they had received was not sufficient. Moreover, most of them felt that there was a need for further training in all subject areas. The results show that there are considerable regional differences in the testing of first responders' skills. Most of the first responders answered that testing was arranged less frequently than every three years, or not at all. In the future the results of this thesis can be used when planning first response- training. Furthermore, these results will provide an overall picture of the current level of competence and knowledge among first responders for the ambulance staff as well as paramedics employed in this region

Ulkomaisen työvoiman käytön riskejä rakennusteollisuudessa

Tämä toiminnallinen opinnäytetyö on työelämälähtöinen kehityshanke. Opinnäytetyön tarkoituksena on luoda kokonaan puuttuva riskikortti ja tarkistuslista aiheesta ulkomaisen työvoiman käytön riskejä rakennusteollisuudessa. Työ on toiminnallinen opinnäytetyö, sillä tilaus työlle on tullut työelämästä ja se tehdään työelämän tarpeita mukaillen. Työn tilaajana on PK-RH-foorumi, joka on wwwsivujensa muodossa erikoistunut pienten- ja keskisuurten yritysten riskienhallinnan kehittämiseen. Työssä käsitellään alan keskeistä tilannetta ulkomaisen työvoiman käytön osalta sekä tulevaisuudenennusteita. Ulkomaisen työvoiman määrä on viimeisessä viidessä vuodessa kaksinkertaistunut ja varovaistenkin arvioiden mukaan se tulee yhä kasvamaan tulevaisuudessa. Suurten ikäluokkien eläköityminen luo tarpeen ulkomaiselle työvoimalle myös tulevaisuudessa. Harmaa talous ja muut ulkomaiseen työvoimaan usein liitetyt epäkohdat muodostavat riskejä työmaille, joita tässä työssä kartoitetaan. Työn lopputuotoksena muodostuneen riskikortin avulla yritykset pystyvät hallitsemaan ja tunnistamaan näitä riskejä paremmin. Tarkastuskortit selvittävät yrityksille käytännön tasolla, mitä asioita tulee huomioida toimittaessa joko ulkomaisten yritysten tai yksittäisten ulkomaisten työntekijöiden kanssa. Opinnäytetyöstä löytyy myös uusien lakimuutosten perehdytys(tilaajavastuulaki sekä käännetty ALV). Johtopäätöksinä mainitsen muun muassa alan suuren valvonnan puutteen. Haastattelujen perusteella niin kotimaiset kuin ulkomaiset työntekijät ja yritykset käyttävät valvonnan puutetta suuresti hyväkseen. Jyrkkien arvioiden mukaan 30 000:sta Suomessa työskentelevästä ulkomaisesta työntekijästä vain murto-osa maksaa veroja Suomeen.The idea for this functional thesis arises from actual working life. This thesis was commissioned by PK-RH-Forum, and it was completed in order to develop the Forum’s processes. The main purpose of the thesis was to produce a yet missing risk assessment card and a check list for the use of PK-RH’s customers. This thesis is functional due to the actual needs of the organization. PK-RH-Forum is a risk assessment- forum for small and medium sized construction companies. They work mainly trough their website. This thesis reviews the current situation concerning foreign labor and discusses the future of foreign labor working on Finnish building sites. In the past five years the number of foreign employees in Finland has doubled. Even the most careful estimates predict the number will only increase further in the future. Also, as the baby boom generations retire, a further number of positions will need to be filled with new employees. The black economy and other drawbacks associated with foreign labor create risks to construction yards and this thesis will map those risks. With the risk assessment card, created as the result of the thesis, companies will be able to recognize and control these risks. The attached checklist will help companies to observe the process of recruiting foreign employees or subcontractors by decreasing he risks involved. The thesis also includes a short introduction to the new laws concerning the issue (Act on the contractor’s obligations and liability when work is contracted out and reverse charge of value added tax). The conclusions mention the huge problem of the lack of control in the industry. Based on the conducted interviews, the domestic and international companies seem to take advantage of this lack of control. By even the strictest of estimates, only a few hundred of the 30 000 foreigners working in Finland pay Finnish taxes

Multi-echelon Inventory Control with Integrated Shipment Decisions

Rising fuel prices and increasing environmental awareness emphasizes the importance of the transportation aspect in logistics. This calls for new improved inventory control methods that consider the effects of shipment strategies in a more realistic manner. This thesis, consisting of an introduction and three scientific papers, studies how shipment decisions can be included in the inventory control of distribution systems. The systems studied in the papers consist of a central warehouse that supplies goods to a number of retailers that face stochastic customer demand. The first two papers consider a system where shipments from the central warehouse are consolidated to groups of retailers periodically. This means that replenishment orders of one or several items from different retailers are consolidated and dispatched at certain time intervals. By doing so, transportation cost savings can be realized and emissions can be reduced. This is achieved by filling the vehicles or load carriers to a higher extent and by using cheaper and more environmentally friendly, transportation modes. The first paper explicitly focuses on how to include more realistic transportation costs and emissions. This is done by obtaining the distribution of the size of an arbitrary shipment leaving the central warehouse (directly affected by the shipment frequency). It is thereby easy to evaluate any system where the transportation costs and emissions are dependent on the size of the shipment. The paper also provides a detailed analysis of a system where there is an opportunity to reserve shipment capacity on an intermodal truck-train-truck solution to at least one of the retailer groups. For this system it is shown how to jointly optimize the shipment intervals, the reserved capacities on the intermodal transportation modes and the reorder points in the system. The presented optimization procedure is applicable in three scenarios; (i) the emissions are not considered, (ii) there is a fixed cost per unit of emission, and (iii) there is a constraint on the maximum emissions per time unit. The second paper extends the analysis of a similar time-based shipment consolidation system to handle compound Poisson demand (instead of pure Poisson demand). This system has a simpler transportation cost structure, but the more general demand structure makes the model applicable for a broader array of products. The paper also extends the model to handle fill rate constraints, which further improves the practical applicability. The cost analysis is performed with a new methodology, based on the nominal inventory position. This variable is a helpful tool for analyzing the dynamics of distribution systems. Another system where this tool can be used is studied in the third paper. In this paper all stock points use installation stock (R,Q) ordering policies (batch ordering). This implies that situations can occur when only part of a requested retailer order is available at the central warehouse. The existing literature predominantly assumes that the available units are shipped immediately and the remaining units are shipped as soon as they arrive to the central warehouse, referred to as partial delivery. An alternative is to wait until the entire order is available before dispatching, referred to as complete delivery. The paper introduces a cost for splitting the order and evaluates three delivery policies; the PD policy (only partial deliveries are used), the CD policy (only complete deliveries are used), and the state-dependent MSD policy (an optimization between a partial and a complete delivery is performed for each delivery). The MSD policy is proven to perform better than both the PD and the CD policy. In a numerical study it is shown that significant savings can be made by using the MSD policy

Exact Methods for Multi-echelon Inventory Control : Incorporating Shipment Decisions and Detailed Demand Information

Recent advances in information technologies and an increased environmental awareness have altered the prerequisites for successful logistics. For companies operating on a global market, inventory control of distribution systems is often an essential part of their logistics planning. In this context, the research objective of this thesis is: To develop exact methods for stochastic inventory control of multi-echelon distribution systems incorporating shipment decisions and/or detailed demand information.The thesis consists of five scientific papers (Paper I, II, III, IV and V) preceded by a summarizing introduction. All papers study systems with a central warehouse supplying a number of non-identical local warehouses (retailers) facing stochastic demand. For given replenishment policies, the papers provide exact expressions for evaluating the expected long-run system behavior (e.g., distributions of backorders, inventory levels, shipment sizes and expected costs) and present optimization procedures for the control variables. Paper I and II consider systems where shipments from the central warehouse are consolidated to groups of retailers and dispatched periodically. By doing so, economies of scale for the transports can be reached, reducing both transportation costs and emissions. Paper I assumes Poisson customer demand and considers volume-dependent transportation costs and emissions. The model involves the possibility to reserve intermodal (train) capacity in combination with truck transports available on demand. For this system, the expected inventory costs, the expected transportation costs and the expected transport emissions are determined. Joint optimization procedures for the shipment intervals, the capacity reservation quantities, the reorder points and order-up-to levels in the system are provided, with or without emission considerations. Paper II analyses the expected costs of the same system for compound Poisson demand (where customer demand sizes may vary), but with only one transportation mode and fixed transportation costs per shipment. It also shows how to handle fill rate constraints. Paper III studies a system where all stock points use installation stock (R,Q) ordering policies (batch ordering). This implies that situations can occur when only part of a requested retailer order is available at the central warehouse. In these situations, the models in existing literature predominantly assume that available units are shipped immediately (partial delivery). An alternative is to wait until the entire order is available before dispatching (complete delivery). The paper introduces a cost for splitting the order and evaluates a system where optimal choices between partial and complete deliveries are made for all orders. In a numerical study it is shown that significant savings can be made by using this policy compared to systems which exclusively use either partial or complete deliveries. Paper IV shows how companies can benefit from detailed information about their customer demand. In a continuous review base stock system, the customer demand is modeled with independent compound renewal processes at the retailers. This means that the customer inter-arrival times may follow any continuous distribution and the demand sizes may follow any discrete distribution. A numerical study shows that this model can achieve substantial savings compared to models using the common assumption of exponential customer inter-arrival times. Paper V is a short technical note that extends the scope of analysis for several existing stochastic multi-echelon inventory models. These models analyze the expected costs without first determining the inventory level distribution. By showing how these distributions can be obtained from the expected cost functions, this note facilitates the analysis of several service measures, including the ready rate and the fill rate

Helsinkiläisten asunnottomien terveys, myöhempi asumistilanne ja terveyspalvelujen käyttö

Being homeless is a stressful life-situation that complicates everyday life in many ways. Previous studies from other countries have shown that homelessness is associated with increased morbidity and mortality, as well as increased use of hospital and emergency department services. Yet, the health situation of the homeless in Finland has not been extensively studied before. The aim of this study was to examine the housing situation, morbidity, mortality and healthcare service use of the homeless shelter population in Helsinki, Finland. By combining data from both local and national registers three cohorts of shelter users (in total 1458 persons) were followed for up to ten years. The housing situation, morbidity and overall as well as cause-specific mortality and health care service use were assessed and compared with an age-matched control group from the general population. The results show that homeless shelter users had high morbidity compared with the control group, and that especially psychiatric morbidity was high. During the ten-year follow-up period about half of those who had stayed in shelter died, which means a fivefold risk of death for the homeless compared with the controls. The risk of death from diseases and medical conditions was more than threefold compared with the control group, and the risk of death from external causes was over tenfold. The large majority of those still alive at the end of the ten year follow-up were staying in supported housing, with only a small group being still or again homeless. Six per cent of the homeless were independently housed. Compared with controls, the homeless had over 40 times more hospital days in psychiatric hospitals, 10 times more hospital emergency department visits and over six times more medical/surgical hospital days. Also those who had stayed only temporarily in shelter had a high use of emergency department and hospital services. Mental disorders were strongly associated with primary healthcare service use. The homeless visited primary care for mental health- and substance use-related problems, traumas and infections, but undertreatment of chronic conditions such as hypertension and diabetes was detected. This study shows that, also in the Finnish setting, having experienced homelessness is strongly associated with adverse health outcomes and that the prognosis for the homeless in shelters is poor both in terms of being independently housed and mortality. The high use of hospital and emergency services and relatively low use of outpatient care, as well as undertreatment of chronic conditions, indicate that access to timely and appropriate care is insufficient, leading to high use of specialized care. Better, targeted healthcare services are needed to prevent avoidable hospitalizations, ill health and premature death.Asunnottoman henkilön arki on monella tapaa hankalaa ja stressaavaa. Aiempi kansainvälinen tutkimus on osoittanut, että asunnottomuuteen liittyy kohonnut sairastavuuden ja kuolleisuuden riski, sekä lisääntynyttä päivystys- ja sairaalapalvelujen käyttöä. Asunnottomien terveydentilaa ei ole Suomessa aiemmin selvitetty perusteellisesti. Tämän väitöstutkimuksen tavoitteena oli tuottaa tietoa pääkaupunkiseudun ensisuojissa yöpyneiden asunnottomiensairastavuudesta, kuolleisuudesta, terveyspalvelujen käytöstä ja myöhemmästä asumistilanteesta. Yhdistelemällä rekisteritietoja monesta eri rekisteritietokannasta tutkimuksessa seurattiin kolmea ensisuojassa yöpyneiden ryhmää (yhteensä 1458 henkilöä) pisimmillään kymmenen vuoden ajan. Heidän asumistilannettaan, sairastavuuttaan, kuolleisuuttaan ja terveyspalvelujen käyttöään verrattiin ikävakioituun verrokkiryhmään. Tutkimuksen tulokset osoittivat, että asunnottomat olivat verrokkeja selvästi sairaampia, koskien erityisesti mielenterveyshäiriöitä. Kymmenen vuoden seurannan aikana noin puolet ensisuojassa yöpyneistä asunnottomista kuoli, mikä tarkoittaa noin viisinkertaista kuolemanriskiä verrokkiryhmään nähden. Seurannan lopussa elossa olleista tutkittavista valtaosa asui tuetun asumisen piirissä ja vain pieni joukko oli yhä tai jälleen asunnottomina. Kuusi prosenttia alkuperäisestä asunnottomien ryhmästä asui itsenäisesti. Verrokkiryhmään nähden asunnottomilla oli yli nelikymmenkertaisesti sairaalapäiviä psykiatrisessa sairaalahoidossa, kymmenkertaisesti sairaalapäivystyskäyntejä ja yli kuusinkertaisesti sairaalapäiviä somaattisessa erikoissairaanhoidossa. Myös he, joiden ensisuojassa yöpyminen oli tilapäistä ja lyhytaikaista, käyttivät paljon sairaala- ja päivystyspalveluja. Mielenterveysongelmista kärsiminen oli vahvasti yhteydessä perusterveydenhuollon käyttöön. Asunnottomat henkilöt kävivät perusterveydenhuollon lääkärin vastaanotolla mielenterveys- ja päihdeongelmien, traumojen sekä infektioiden takia, sen sijaan krooniset taudit olivat alihoidettuja. Tämä tutkimus osoittaa, että myös Suomessa asunnottomuuteen liittyy hyvin usein terveysongelmia ja selvästi kohonnut kuolemanriski. Runsas sairaala- ja päivystyspalvelujen käyttö sekä suhteellisen pieni polikliinisten palvelujen käyttö viittaavat siihen, että oikea-aikaisen ja asianmukaisen hoidon saatavuus on asunnottomilla riittämätöntä, mikä johtaa suureen erikoissairaanhoitopalvelujen käyttöön. Tarvittaisiinkin parempia, erityisesti asunnottomille kohdistettuja terveyspalveluja vähentämään ennaltaehkäistävissä olevia sairaalajaksoja, huonoa terveyttä ja kohonnutta ennenaikaisen kuoleman riskiä

Nordic Narratives of the Second World War : National Historiographies Revisited

How have the dramatic events of the Second World War been viewed in the Nordic countries? In Nordic Narratives of the Second World War, leading Nordic historians analyse post-war memory and historiography. They explore the relationship between scholarly and public understandings of the war. How have national interpretations been shaped by official security-policy doctrines? And in what way has the end of the Cold War affected the Nordic narratives? The authors not only present the overarching themes that set the Nordic experience of the Second World War apart from other European narratives, but also describe the distinctive postwar characteristics of Denmark, Norway, Finland, Iceland, and Sweden. Key concepts such as national identity, memory culture, and the moral turn are placed in their Nordic context. Bringing new nuance to the post-war history of Europe, this is the first work to focus on Nordic narratives of the war, and is valuable reading for students, academics, and all who have an interest in the historiography of the Second World War or modern European history

The Water Extract of Juniperus communis L. Induces Cell Death and Sensitizes Cancer Cells to Cytostatic Drugs through p53 and PI3K/Akt Pathways

Juniper (Juniperus communis L.) is a northern coniferous plant generally used as a spice and for nutritional purposes in foods and drinks. It was previously reported that juniper extract (JE) affects p53 activity, cellular stress, and gene expression induced cell death in human neuroblastoma cells. Therefore, the effects of juniper on p53 and Akt signaling was examined further in A549 lung, 22RV1 and DU145 prostate, and HepG2 liver cancer cells using Western blot, confocal microscopy, and MTT analysis. We found that juniper simultaneously decreased cell viability, activated the p53 pathway, and inactivated the PI3K/Akt pathway. The p53 activation was associated with increased nuclear p53 level. Akt was dephosphorylated, and its inactivation was associated with increased levels of PHLPP1 and PHLPP2 phosphatases. Parallel increases of PARP suggest that JE decreased cell viability by activating cell death. In addition, JE potentiated the effects of gemcitabine and 5-fluorouracil anticancer drugs. Thus, JE can activate cell death in different cancer cell lines through p53 and Akt pathways

Young Children’s Humour in Play and Moments of Everyday Life in ECEC Centres

The aim of our study is to identify elements of young children’s shared humour by observing children’s own expressions in the everyday life of early childhood education and care (ECEC) centres aged 1–6 in three Finnish ECEC centres. Our analysis shows that young children’s humour plays an important role in routine transitions and play situations. Children’s shared humour is often seen as momentary twinkles, as a flowing current, as carnivalism or what we term “hyperfun.” The article highlights why humour should be more utilised as a pedagogical tool. This study attempts to enrich the discussion on young children’s shared humour in order to gain a deeper understanding of its nature and application in early childhood education and care.Peer reviewe

The first step in the development of Text Mining technology for Cancer Risk Assessment: identifying and organizing scientific evidence in risk assessment literature.

BACKGROUND: One of the most neglected areas of biomedical Text Mining (TM) is the development of systems based on carefully assessed user needs. We have recently investigated the user needs of an important task yet to be tackled by TM -- Cancer Risk Assessment (CRA). Here we take the first step towards the development of TM technology for the task: identifying and organizing the scientific evidence required for CRA in a taxonomy which is capable of supporting extensive data gathering from biomedical literature. RESULTS: The taxonomy is based on expert annotation of 1297 abstracts downloaded from relevant PubMed journals. It classifies 1742 unique keywords found in the corpus to 48 classes which specify core evidence required for CRA. We report promising results with inter-annotator agreement tests and automatic classification of PubMed abstracts to taxonomy classes. A simple user test is also reported in a near real-world CRA scenario which demonstrates along with other evaluation that the resources we have built are well-defined, accurate, and applicable in practice. CONCLUSION: We present our annotation guidelines and a tool which we have designed for expert annotation of PubMed abstracts. A corpus annotated for keywords and document relevance is also presented, along with the taxonomy which organizes the keywords into classes defining core evidence for CRA. As demonstrated by the evaluation, the materials we have constructed provide a good basis for classification of CRA literature along multiple dimensions. They can support current manual CRA as well as facilitate the development of an approach based on TM. We discuss extending the taxonomy further via manual and machine learning approaches and the subsequent steps required to develop TM technology for the needs of CRA.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are