Olympiatulen poltteessa - Suomalaisten Kiinan-kirjeenvaihtajien työ ja sen muutos 2000-luvulla olympialaisiin valmistautuneessa Kiinassa

Tämän tutkielman aiheena on suomalaisten Kiinan-kirjeenvaihtajien työ ja sen muutos olympialaisiin valmistautuneessa Kiinassa. Selvitän, vaikuttiko Kiinan olympialaisiin valmistautuminen suomalaiskirjeenvaihtajien työn arkeen ja millä tavalla 2000-luvun ensimmäinen vuosikymmen erosi Kiinan-kirjeenvaihtajien aiemmista vuosikymmenistä. Näitä eroja hahmottelen vertaamalla oman aineistoni antia aikaisempaan Kiinan-kirjeenvaihtajista tehtyyn tutkimukseen. Tutkimusaiheeni ponnistaa Kiinan kommunistihallinnon lupauksesta parantaa kirjeenvaihtajien toimintavapauksia, kun maalle myönnettiin vuoden 2008 kesäolympialaiset. Vastaan tutkimuskysymyksiini kymmenen suomalaisen Kiinan-kirjeenvaihtajan haastatteluiden ja kirjekyselymateriaalin pohjalta. Kirjeenvaihtajat asuivat ja työskentelivät Kiinassa tutkimusjaksoni aikana eli vuosina 2000-2008. Haastateltavien joukossa on kirjoittavia toimittajia ja televisiotoimittajia. Osa heistä oli vakituisessa työsuhteessa, osa freelancereita. Työni tutkimuksellinen viitekehys rakentuu kahdesta osasta. Ensimmäinen koostu aiemmasta kirjeenvaihtajatutkimuksesta, jonka perusteella hahmottelen yleiskuvan kirjeenvaihtajan työstä ja työskentelystä sananvapautta rajoittavissa oloissa. Toisessa osassa teen historiallisen katsauksen Kiinan-kirjeenvaihtajien työhön ja työoloihin. Tutkimuksen empiirinen aineisto on kerätty teemahaastatteluilla ja kirjekyselyllä. Teemoja on neljä: Kiinan-kirjeenvaihtajuuden alkutaival, työrupeama, sanavapaustilanne ja työn rajoitukset sekä erityiskysymykset eli olympialaisten vaikutus työhön ja arvio suomalaisesta Kiina-journalismista. Nämä teemat jakautuvat alateemoihin, joissa käsitellään kirjeenvaihtajien lähtökohtia, alkuunpääsyä työssä, päivärutiineita, aiheita ja ideoita, lähdekäytäntöjä, matkustamista ja liikkumista, tiedonhankinnan esteitä, sananvapaustilannetta, arkoja juttuaiheita ja työn teknisiä esteitä. Vastaan tutkimuskysymyksiini yhdistämällä teoriaohjaavaa ja aineistolähtöistä sisällönanalyysia. Tämän tutkielman keskeinen tulos on, että kirjeenvaihtajien perustyöarki Kiinassa muistutti niin sanottua klassista kirjeenvaihtajuutta, mutta arkea reunustivat vaativat työolot. Työolojen hankaluuden voi tiivistää kahteen osaan: Työskentely oli haastavaa, koska Kiinan toimintakulttuuri ja kieli olivat kirjeenvaihtajille vieraita, eikä niihin sisälle pääsy ollut helppoa. Toiseksi työskentelyä vaikeuttivat Kiinan valtion kirjeenvaihtajille asettamat säännöt sekä kirjeenvaihtajiin kohdistunut valvonta ja vaikutusyritykset. Kiinan olympialaisiin valmistautuminen ja kirjeenvaihtajien työn sääntöuudistukset kehittivät suomalaisten Kiinan-kirjeenvaihtajien työoloja parempaan suuntaan. Täydellisestä median vapaudesta oltiin vielä kaukana. Työolojen vapautumista voi kutsua aaltoilevaksi. Kirjeenvaihtajien työn kontrollointi jatkui edelleen, mutta sen muodot muuttuivat. Vaikutusyritysten kohteeksi joutuivat kirjeenvaihtajan sijaan entistä useammin haastateltavat ja avustajat

Routine Inferior Mesenteric Artery Embolisation is Unnecessary Before Endovascular Aneurysm Repair

Peer reviewe

Long-term outcomes of endovascular aneurysm repair according to instructions for use adherence status

Objective: Endovascular aneurysm repair (EVAR) has become the standard treatment for abdominal aortic aneurysms (AAAs). Endovascular device manufacturers have defined specific anatomic criteria for the aneurysm characteristics that should be observed as instructions for use (IFU) for specific grafts. In clinical practice, the prevalence of performing EVAR outside the IFU has been high. In the present study, we aimed to determine the effects of nonadherence to the IFU on the outcomes. Methods: Patients who had undergone EVAR for an infrarenal AAA between 2005 and 2013 were included. IFU nonadherence was defined as any violation of device-specific IFU criteria and was compared with IFU adherence. The primary outcomes were all-cause mortality, aneurysm-related mortality, AAA rupture, graft-related adverse events (GRAEs), including limb-related adverse events, and type Ia endoleaks. A second aim was to study whether the prevalence of EVAR performed outside the IFU has increased over time. Results: A total of 258 patients were included, 144 (55.8%) of whom had been treated according to the IFU and 114 (44.2%) outside the IFU. In the IFU nonadherence group, all-cause mortality (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.02-1.89; P = .037) and aneurysm-related mortality (HR, 5.1; 95% CI, 1.4-18.6; P = .015), and the incidence of AAA rupture (HR, 5.4; 95% CI, 1.1-26.6; P = .036) and GRAEs (HR, 1.7; 95% CI, 1.1-2.8; P = .025). No significant association was found between the incidence of type Ia endoleaks and neck-related IFU or limb-related adverse events and iliac-related IFU. However, neck length was a risk factor for type Ia endoleaks (HR, 18.2, 95% CI, 6.3-52.2; P < .001), aneurysm-related mortality (HR, 8.7; 95% CI, 1.8-41.6; P = .007), AAA rupture (HR, 21.7; 95% CI, 2.8-166; P = .003), and GRAEs (HR, 4.4; 95% CI, 2.0-9.7; P < .001). An IFU violation regarding neck angulation was also a risk factor for all-cause mortality (HR, 2.0; 95% CI, 1.1-3.7; P = .032), aneurysm-related mortality (HR, 7.6; 95% CI, 1.4-42.8; P = .021), AAA rupture (HR, 79.4; 95% CI, 6.3-999; P = .001), and GRAEs (HR, 4.3; 95% CI, 1.9-9.5; P < .001). The prevalence of EVAR performed outside the IFU did not increase over time. Conclusions: Performing EVAR outside the IFU had a negative effect on outcomes, including all-cause mortality, aneurysm-related mortality, AAA rupture, and GRAEs. Neck angulation and neck length seemed to be the most crucial aneurysm characteristics.publishedVersionPeer reviewe

Endovascular Repair of Abdominal Aortic Aneurysms is a Valid Alternative to Open Repair also in Patients Treated Outside of Instructions for Use Criteria

Purpose: It remains unclear whether endovascular aneurysm repair, in the long term, is less effective than open surgery due to need for reinterventions and close monitoring. We aimed to evaluate this matter in a real-life cohort. Methods: We collected consecutive patients treated with EVAR or OSR between January 2005 and December 2013. Primary outcomes were 30-day, 90-day and long-term all-cause mortality. Secondary outcomes were 30-day reintervention rate and reintervention-free survival. We evaluated also a subpopulation who did not adhere to IFU. Results: The inclusion criteria were met by 416 patients. 258 (62%) received EVAR, while 158 (38%) underwent OSR. The 30- or 90-day mortality was similar between groups (p = 0.272 and p = 0.346), as ARM (p = 0.652). The 30-day reintervention rate was higher in the OSR group (p < 0.001), but during follow-up, it was significantly higher in the EVAR group (log-rank: 0.026). There were 114 (44.2%) non-IFU patients in the EVAR group, and we compared them with OSR group. There was no significant difference in all-cause mortality at 30 or 90 days, nor in the long term (p = 1; p = 1 and p = 0.062). ARM was not affected by the procedure technique (p = 0.136). The short-term reintervention rate was higher in the OSR group (p = 0.003), while in the long-term EVAR, patients experienced more reinterventions (log-rank = 0.0.43). Conclusion: No significant difference in survival was found between EVAR and OSR, independent of adherence to IFU. EVAR may be considered for surgical candidates.publishedVersionPeer reviewe

Routine Inferior Mesenteric Artery Embolisation is Unnecessary Before Endovascular Aneurysm Repair

Objective: A type II endoleak is the most common complication during surveillance after endovascular aneurysm repair (EVAR), and a patent inferior mesenteric artery (IMA) is a known risk factor for an endoleak. The effect of routine IMA embolisation prior to EVAR on overall outcome is unknown. The aim of the study was to compare two strategies: routine attempted IMA embolisation prior to EVAR (strategy in centre A) and leaving the IMA untouched (strategy in centre B). Methods: Patients were treated with EVAR in two centres during the period 2005 – 2015, and the data were reviewed retrospectively. The primary endpoints were re-intervention rate due to type II endoleaks and the late IMA embolisation rate. Secondary endpoints included EVAR related re-intervention, sac enlargement, aneurysm rupture, and open conversion rates. Results: Strategy A was used to treat 395 patients. The IMA was patent in 268 (67.8%) patients, and embolisation was performed in 164 (41.5%). The corresponding figures for strategy B were 337 patients with 279 (82.8%) patent IMAs, two (0.6%) of which were embolised. The mean duration of follow up was 70 months for strategy A and 68.2 months for strategy B. The re-intervention rates due to a type II endoleak were 12.9% and 10.4%, respectively (p = .29), with no significant difference in the rate of re-interventions to occlude a patent IMA (2.0% and 4.7%, respectively; p = .039). The EVAR related re-intervention rate was similar, regardless of strategy (24.1% and 24.6%, respectively; p = .93). Significant sac enlargement was seen in 20.3% of cases treated with strategy A and in 19.6% treated with strategy B (p = .82). The rupture and conversion rates were 2.5% and 2.1% (p = .69) and 1.0% and 1.5% (p = .40), respectively. Conclusion: The strategy of routinely embolising the IMA does not seem to yield any significant clinical benefit and should therefore be abandoned.publishedVersionPeer reviewe

Various vascular malformations are prevalent in Finnish pseudoxanthoma elasticum (PXE) patients : a national registry study

BACKGROUND: Pseudoxanthoma elasticum (PXE, OMIM# 264800) is an inborn error of metabolism causing ectopic soft tissue calcification due to low plasma pyrophosphate concentration. We aimed to assess the prevalence of PXE in Finland and to characterize the Finnish PXE population. A nationwide registry search was performed to identify patients with ICD-10 code Q82.84. Information was gathered from available medical records which were requisitioned from hospitals and health centers. Misdiagnosed patients and patients with insufficient records were excluded. RESULTS: The prevalence of PXE in Finland was 1:260,000 with equal sex distribution. Patients with high conventional cardiovascular risk had more visual and vascular complications than patients with low risk. Four patients (19%) had at least one vascular malformation. A high proportion (33%) of ABCC6 genotypes were of the common homozygous c.3421C > T, p.Arg1141Ter variant. Nine other homozygous or compound heterozygous allelic variants were found. CONCLUSIONS: The prevalence of diagnosed PXE appears to be lower in Finland than in estimates from other countries. Decreased visual acuity is the most prevalent complication. We suggest that various vascular malformations may be an unrecognized feature of PXE.publishedVersionPeer reviewe

Next generation networks, mobility management and appliances in intelligent transport systems

For quite some time there has been discussion regarding convergence of networks. Access technologies of different characteristics are converging into one heterogeneous, but ubiquitous access network, where different access technologies with different parameters complement each other. To enable such a convergence, many challenges regarding network interworking must be solved. One of the major challenges is the mobility management across heterogeneous networks. This dissertation discusses mobility management in heterogeneous network environments. Mobility management is studied from the user point of view and a proposal of the mobility management system is suggested. The benefits of an introduced system are identified from both user and operator point of view. Currently, the major challenges for the introduced mobility management system are related to robust link information collecting. Thus integration with a standardized solution is researched. There are promising opportunities for such an implementation, but a strong consensus among the standardization organizations is required to achieve a common solution. The mobility management policies that define how the mobile node behaves between different networks are a part of this discussion. Intelligent Transport Systems are taken as an example of the environment where the multi-access networking provides significant advantages compared to single access connectivity. The benefits are discussed by both technology and business perspectives. The latter is supported by the techno-economic analysis that shows the strong potential of the solutions studied. The corresponding service and technology frameworks are researched and suggested as well

Perehdytyskansio Järvi-Pohjanmaan jätevedenpuhdistamoille

Järvi-Pohjanmaan jätevedenpuhdistamoilla, joihin kuuluvat Alajärven, Vimpelin, Soinin ja Lehtimäen jätevedenpuhdistamot, työtehtävät ovat vaihtelevia ja niihin liittyy monenlaisia riskitekijöitä. Tämä opinnäytetyö on laadittu erityisesti Järvi-Pohjanmaan jätevedenpuhdistamoiden uusia työntekijöitä varten, jotta heillä olisi kirjallisessa muodossa ohjeet turvallisesta työskentelystä puhdistamoilla ja siellä esiintyvien riskien minimoimisesta. Perehdytyskansio on varsinaisen opinnäytetyön liitteenä, joka kattaa opinnäytetyön suurimman osuuden. Perehdytyskansion sisältö on laadittu pitkälti yhteistyössä työn tilaajan kanssa. Suurena apuna on ollut myös Järvi-Pohjanmaan puhdistamoiden henkilökunta, joilla on työkokemuksen kautta paljon tietoa puhdistamoilla työskentelystä, jota on edelleen hyödynnetty perehdytyskansiota laadittaessa. Myös omat kysymykset uudessa työpaikassa ovat olleet tärkeitä, sillä samat kysymykset pyörivät varmasti myös muiden uusien työntekijöiden mielissä. Perehdytyskansioon saatiin tietoa myös Suomen laista, alan kirjallisuudesta ja työn tilaajan omista materiaaleista, joista oli suuresti apua. Perehdytyskansiossa on turvallinen työskentely pyritty ottamaan tärkeimmäksi asia kokonaisuudeksi, mutta sieltä löytyy myös muita hyödyllisiä tietoja. Monet puhdistamoilla ja puhdistamoiden ulkopuolella tapahtuvat työtapaturmat olisivat helppo välttää, jos vain turvallisuuteen kiinnitettäisiin enemmän huomiota. Pereh-dytyskansio tullaan sijoittamaan Järvi-Pohjanmaan jokaiselle puhdistamolle, josta vanhat työntekijät voivat hyödyntää sitä uuden työntekijän perehdyttämisessä. Uuden työntekijän on myös itsenäisesti hyvä lukea perehdytyskansiota, sillä sen avulla hän pystyy tutustumaan paremmin uuteen työpaikkaan ja sen toimintaan.This thesis has been conducted on Järvi-Pohjanmaa wastewater treatment plants. In this work the biggest part is the orientation guidebook what is also by attach-ment. The orientation guidebook has been made co-operation with work subscriber. Jär-vi-Pohjanmaa treatment plants staff has been great help during this work, their working experience has been benefitted in the orientation guidebook. Also mine questions was important, because all new workers may wonder same question than I was. To the orientation guidebook were got information to Finland’s legislation, old publications and work subscriber’s own material, which were very valuables. Safe work was taken to be the most important thing in the orientation guidebook, but it also includes a lot of other useful information’s. Many occupational accident inside or outside of treatment plants would be easy to avoid if we would just mind work safety requirements. The orientation guidebook will be placed in all the waste water treatment plants in Järvi-Pohjanmaa