Lihan kypsentäminen portfolio

Opinnäytetyön aiheena on lihan valmistuksen kokeellinen toiminta. Työssäni tuon esiin Haaga- Helian opiskelun aikana tekemiäni kokeellisia valmistus toimintoja. Opinnäyte työni lähtökohtana on ollut ensimmäisen vuoden opiskelujen aikana tehty projekti lihan kypsentämisestä eri metodeilla. Tästä työstä olen saanut pohjustuksen muille töilleni ja vertailu kohtia. Työni on pitkälti työpaikka painotteinen, kun lopputuloksia mietitään. Myös aihe valikoitui tätä kautta sopivaksi. Työelämän arjessa käytetään eri metodeja kypsennyksessä, mutta niiden vaikutusta harvemmin pohditaan tutkivalta kannalta. Työssäni olen käyttänyt seuraavia töitä apuna ja runkona. 1. Lihan kypsennys uunissa 2. Vanhasta uutta 3. Aistinvarainen arvio Töiden lähtökohtina on ollut työelämän haasteet ja kolmas projekti yhdisti opinnäyte ja ensimmäisen projektityön yhteen. Projektityöt on toteutettu itsenäisesti, pois lukien ensimmäinen joka oli parityö. Toiseen projektin sain vertailukohtaa vaihto-opiskelun aikana ja siellä tein siihen liittyen kokeen koti keittiöön tarkoitetulla laitteella. Työ on ollut mielenkiintoinen prosessi ja oman oppimisen sekä osaamisen kautta antoisa, työelämän haasteisiin olen saanut paljon apua ja osaaminen eri tapojen hallintaan on parantunut. Työn avut ovat myös tulleet laadun, hävikin ja työ tehokkuuden parantamiseen. Nämä kolme edellä mainittua asiaa ovatkin seurannassa työelämässä. Työnjatkumoa oli tarkoitus toteuttaa illallisruokailulla, mutta tämä projekti jäi aikataulujen alle, mutta kyseinen työ voidaan toteuttaa jatkumona seuraavassa opintopolussa. Laaja mittainen työ itselle ja sen avulla olen huomannut, samat asiat ovat monen ravintola ammattilaisen mietteissä. Työn ohessa olen päässyt tutustumaan laitteisiin ja miettimään, kuinka ne vaikuttavat keittiösuunnitteluun arjessa

Tutkimustiedosta käytäntöön : mini-ASA pre-eklampsian ehkäisyssä

publishedVersio

Obstetric early warning system to predict maternal morbidity of pre-eclampsia, postpartum hemorrhage and infection after birth in high-risk women : a prospective cohort study

Objective: The purpose of early warning systems is to detect deterioration of the patient and to enable timely intervention to prevent possible severe illness. The most common causes of maternal morbidity and mortality after birth are worsening pre-eclampsia, postpartum haemorrhage and puerperal infection. Our aim was to validate the accuracy of the obstetric early warning system and different physiological triggers to predict morbidity on the postnatal ward in high-risk women. Design: A prospective cohort study. Setting: A tertiary referral hospital in Finland. Participants: High-risk women (n= 828) (body mass index > 35 kg/m(2), postpartum haemorrhage > 1,500 g, preeclampsia, chorioamnionitis during birth, type 1 diabetes or anxiety over the maternal condition based on clinical judgement) were studied on the postnatal ward in the first 24 hours after giving birth. In this study population the women without any morbidity served as a control group. The study was conducted between 1.11.2016 - 30.4. 2018 covering a period of 18 months. Measurements and findings: The accuracy of the obstetric early warning system and its five physiological parameters-respiratory rate, oxygen saturation, blood pressure, heart rate and body temperature-and a pain score to predict worsening pre-eclampsia, complications related to postpartum haemorrhage and puerperal infection were determined. A red trigger is as a single, markedly abnormal observation, and a yellow trigger is a combination of two mildly abnormal observations. The sensitivity of obstetric early warning system at its best was 72% for pre-eclampsia, 52% for infection and 25% for postpartum haemorrhage. The red triggers were significantly associated with morbidity in each outcome studied. The red triggers of systolic blood pressure (OR 25.7, 95% CI 13.2-50.1) and diastolic blood pressure (OR 22.1, 95% CI 11.3-43.0) were independently associated with pre-eclampsia, systolic blood pressure (OR 2.7, 95% CI 1.4-5.6) and heart rate (OR 3.6, 95% CI 1.7-7.6) with postpartum haemorrhage and heart rate (OR 3.3, 1.0-10.3) with infection.Keyconclusions: The sensitivity of obstetric early warning system varied depending on the type of morbidity. The highest sensitivity and positive predictive value were in pre-eclampsia. Systolic and diastolic blood pressure and heart rate were the strongest physiological parameters to predict morbidity. Implications for practice: The systematic use of obstetric early warning system helps to improve maternal safety after birth in high-risk women. Blood pressure and pulse are the most important measurements.Peer reviewe

Severe birth injuries in neonates and associated risk factors for injury in mothers with different types of diabetes in Finland

Objective To examine severe birth-related injuries in neonates among mothers with different types of diabetes. Methods Retrospective cohort study based on Finnish Medical Birth Register data from 2004 to 2017. The study included singleton neonates born vaginally with cephalic presentation (n = 623 649) after 35(+0) weeks of gestation. The primary outcome variable was severe birth injury. Incidences, crude and adjusted odds ratios, and probabilities in regression analysis were calculated for different types of diabetes. Results There were 1952/623 649 (0.3%) severe birth injuries of which brachial plexus injury occurred most frequently. The injury incidence was highest in neonates of women with type 1 or type 2 diabetes, 42/1659 (2.5%) and 10/548 (1.8%), respectively. For gestational diabetes, the injury incidence was comparable to non-diabetic women: 422/77 810 (0.5%) and 1478/543 632 (0.3%), respectively. Shoulder dystocia, high birthweight, and vacuum-assisted delivery were associated with the highest probability for injury. Birthweight and obesity had a stronger impact on injury risk in women with pregestational diabetes compared to other pregnancies. Conclusion Neonates of women with pregestational diabetes have a higher risk for severe birth injury than other neonates. The injury risk in neonates delivered by women with gestational diabetes or non-diabetic women is generally low.Peer reviewe

Akuutti paksusuolen pseudo-obstruktio - keisarileikkauksen harvinainen komplikaatio

English summar

Tutkimustiedosta käytäntöön : mini-ASA pre-eklampsian ehkäisyssä

publishedVersio

Äidin verestä otettavan sikiötestin (NIPT) vaikutus jatkotutkimuksiin osallistumiseen ja löydöksiin seulontapositiivisissa raskauksissa

VertaisarvioituPeer reviewe

Association of dietary fiber, liquid intake and lifestyle characteristics with gastrointestinal symptoms and pregnancy outcome

Objectives: Heartburn and constipation are common gastrointestinal symptoms during pregnancy. High fiber and liquid intake have beneficial effects on these symptoms in non- pregnant population. Our aim was to evaluate the association of dietary fiber, fluid intake and lifestyle characteristics with constipation, heartburn, and pregnancy outcome. Study design: Two hundred pregnant women were enrolled in this prospective cohort study during the 1st trimester of pregnancy. Participants completed a self- administered questionnaire concerning bowel symptoms, dietary fiber, liquid intake, and lifestyle characteristics before pregnancy, during pregnancy and post-partum. After exclusions 173 pregnant women participated the study and 173, 173, 136, 109 and 91 completed pre-pregnancy, and 1st, 2nd, and 3rd trimester, and post-partum questionnaires, respectively. Data on deliveries and perinatal outcome (n = 173) were collected from hospital records. In trajectory analysis, the women were clustered in groups based on the intake of fiber and liquids. Generalized linear mixed models and logistic regression analyses were used to find associations of fiber and fluid intake with constipation, heartburn and pregnancy outcome. Results and conclusions: Heartburn increased significantly during pregnancy and the highest prevalence (33%) was during the third trimester. A combination of low fiber and low fluid intake increased the risk of constipation during pregnancy (OR 5.9, 95% CI 2.00–17.4). Low fiber intake increased the risk of combined adverse outcome (cesarean section, premature delivery and/or small for gestational age; OR 3.4, 95% CI 1.2–9.6). Sufficient fiber and liquid intake may be protective against pregnancy-associated constipation and may be associated with improved pregnancy outcome.publishedVersionPeer reviewe

Longitudinal study to assess changes in arterial stiffness and cardiac output parameters among low-risk pregnant women.

AIM: A single-centre, prospective longitudinal study to assess changes in maternal arterial stiffness and cardiac output parameters among low-risk healthy pregnant women. METHODOLOGY: Thirty low-risk, healthy, pregnant women attending their routine antenatal dating ultrasound scan were recruited. Non-invasive assessment of arterial stiffness and cardiac output was undertaken at five gestational windows from 11 to 40 weeks of pregnancy. Data were analysed using a linear mixed model incorporating time and other relevant predictors as fixed effects, and patient as a random effect. RESULTS: Gestational age had a significant effect on all arterial stiffness parameters, including brachial augmentation index (AIx) (p = .001), aortic AIx (p = .002) and aortic pulse wave velocity (p = .002). The aortic AIx (%) reduced during pregnancy: the lowest mean (standard error, SE) was 4.07 (1.01) at 28 weeks before it increased to 7.04 (SE 1.64) at 40 weeks. Similarly, non-invasive assessments of cardiac output (p < .001), stroke volume (p = .014), heart rate (p < .001) and total peripheral resistance (p < .001) demonstrated significant changes with gestational age. Mean cardiac output (l/m) increased during pregnancy reaching a peak at 28 weeks gestation 6.66 (SE 0.28), but dropped thereafter to reach 5.71 (SE 0.25) around term. CONCLUSION: The current study provides pregnancy normograms for gestational changes in arterial stiffness and cardiac output parameters among low-risk, healthy pregnant women. Further work will be required to assess the risk of placental mediated diseases and pregnancy outcome among pregnant women with parameters outside the normal range

Tafoxiparin, a novel drug candidate for cervical ripening and labor augmentation : results from 2 randomized, placebo-controlled studies

Background: Slow progression of labor is a common obstetrical problem with multiple associated complications. Tafoxiparin is a depolymerized form of heparin with a molecular structure that eliminates the anticoagulant effects of heparin. We report on 2 phase II clinical studies of tafoxiparin in primiparas. Study 1 was an exploratory, first-in-pregnant-women study and study 2 was a dose-finding study. Objective: Study 1 was performed to explore the effects on labor time of subcutaneous administration of tafoxiparin before onset of labor. Study 2 was performed to test the hypothesis that intravenous treatment with tafoxiparin reduces the risk for prolonged labor after spontaneous labor onset in situations requiring oxytocin stimulation because of dystocia. Study Design: Both studies were randomized, double-blind, and placebo-controlled. Participants were healthy, nulliparous females aged 18 to 45 years with a normal singleton pregnancy and gestational age confirmed by ultrasound. The primary endpoints were time from onset of established labor (cervical dilation of 4 cm) until delivery (study 1) and time from start of study treatment infusion until delivery (study 2). In study 1, patients at 38 to 40 weeks of gestation received 60 mg tafoxiparin or placebo daily as 0.4 mL subcutaneous injections until labor onset (maximum 28 days). In study 2, patients experiencing slow progression of labor, a prolonged latent phase, or labor arrest received a placebo or 1 of 3 short-term tafoxiparin regimens (initial bolus 7, 21, or 35 mg followed by continuous infusion at 5, 15, or 25 mg/hour until delivery; maximum duration, 36 hours) in conjunction with oxytocin. Results: The number of participants randomized in study 1 was 263, and 361 were randomized in study 2. There were no statistically significant differences in the primary endpoints between those receiving tafoxiparin and those receiving the placebo in both studies. However, in study 1, the risk for having a labor time exceeding 12 hours was significantly reduced by tafoxiparin (tafoxiparin 6/114 [5%] vs placebo 18/101 [18%]; P=.0045). Post hoc analyses showed that women who underwent labor induction had a median (range) labor time of 4.44 (1.2–8.5) hours with tafoxiparin and 7.03 (1.5–14.3) hours with the placebo (P=.0041) and that co-administration of tafoxiparin potentiates the effect of oxytocin and facilitates a shorter labor time among women with a labor time exceeding 6 to 8 hours (P=.016). Among women induced into labor, tafoxiparin had a positive effect on cervical ripening in 11 of 13 cases (85%) compared with 3 of 13 participants (23%) who received the placebo (P=.004). For women requiring oxytocin because of slow progression of labor, the corresponding results were 34 of 51 participants (66%) vs 16 of 40 participants (40%) (P=.004). In study 2, tafoxiparin had no positive effects on the secondary endpoints when compared with the placebo. Except for injection-site reactions in study 1, adverse events were no more common for tafoxiparin than for the placebo among either mothers or infants. There were few serious or treatment-related adverse events. Conclusion: Subcutaneous treatment with tafoxiparin before labor onset (study 1) may be effective in reducing the labor time among women undergoing labor induction and among those requiring oxytocin for slow progression of labor. Moreover, tafoxiparin may have a positive effect on cervical ripening. Short-term, intravenous treatment with tafoxiparin as an adjunct to oxytocin in patients with labor arrest (study 2) did not affect labor time or other endpoints. Both studies suggest that tafoxiparin has a favorable safety profile in mothers and their infants.Peer reviewe