Höstrapsens lönsamhet i södra Finland

Syftet med avhandlingen var att utreda höstrapsens lönsamhet i södra Finland samt belysa risker och hot som höstrapsodling medför. I undersökningen utreddes också lönsamheten för en vårrapssort som användes som referensvärde för att utreda skillnaden i lönsamhet mellan höst-och vårraps. Lönsamheten utreddes med hjälp av täckningsbidragskalkyler. Undersökningsmaterialet bestod av data från försöksodlingar utförda av NSL på Västankvarn gård i Ingå och K-lantbruk på Kaupan Maataloussäätiös gård i Hauho. Materialet bestod av odlingsförsök utförda under åren 2011–2014 där medelskörden, samt högsta och lägsta uppmätta skörd framgick. Tre olika höstrapssorter jämfördes sinsemellan och dessa jämfördes ytterligare med en vårrapssort. Odlare och experter inom höstrapsodling intervjuades för att belysa problem och risker som höstrapsodling medför i praktiken. I undersökningen jämfördes höstrapssorterna; Apanaci (populationssort), Banjo(hybridsort) och DK Imistar CL(Clearfield). DK Imistar CL, som var den lönsammaste höstrapssorten, hade ett täckningsbidrag som var dryga 80 € per hektar högre än Apanacis och Banjos. I jämförelsen mellan höst- och vårraps var DK Imistar CL fortfarande den mest lönsamma sorten. Täckningsbidraget var knappa 130 € högre än vårrapsen Campinos. Alla tre höstrapssorter hade ett högre täckningsbidrag än vårrapsen. I undersökningen presenterades scenarier över möjliga utfall av produktionen i syfte att beskriva variationen i skördenivån och sannolikheten för att så skulle ske. Scenarierna bestod av låg skörd, medelskörd och hög skörd och sannolikheten för att dessa skulle ske var 25 procent, 50 procent och 25 procent. Odlingsalternativen bestod av odling av en populations-, hybrid- och Clearfield höstrapssort och vårrapssorten Campino. Då de möjliga utfallen är medräknade var lönsamheten för odling av en Clearfield höstrapssort högst. Enligt tidigare undersökningar är övervintringen den största risken för höstrapsskörden. Av undersökningsmaterialet framgick att övervintringen misslyckats en gång av fyra. Av intervjuerna framgick också att övervintringen var det största hotet för en lyckad skörd. Val av rätt odlingsfält samt fungerande dränering på fältet, sniglar, nederbördsmängd, tidig såningstidpunkt samt val av förväxt var andra faktorer som ansågs problematiska inom höstrapsodling. Höstrapsen ansågs vara en tålig gröda med en mycket hög skördepotential och därför ett beaktansvärt alternativ till våroljeväxter. Odlingen innebär dock risker, övervintringen som den främsta, och kräver ett intresse och risktagande av odlaren. Antalet observationer i undersökningen var inte tillräckligt för att kunna beskriva höstrapsens lönsamhet mer allmänt. Men resultaten understöds av tidigare undersökningar där samma risker och hot kommer fram. Höstrapsen är ett beaktansvärt alternativ till våroljeväxter och ekonomiskt sett mer lönsamt. I dagsläget finns det ringa praktisk erfarenhet av odlingen i södra Finland, men resultat från odlingar i Sverige som ligger på samma breddgrader som Finlands sydkust stöder uppfattningen att höstraps är ett lönsamt alternativ till våroljeväxter

Control groups in recent septic shock trials : a systematic review

The interpretation of septic shock trial data is profoundly affected by patients, control intervention, co-interventions and selected outcome measures. We evaluated the reporting of control groups in recent septic shock trials. We searched for original articles presenting randomized clinical trials (RCTs) in adult septic shock patients from 2006 to 2016. We included RCTs focusing on septic shock patients with at least two parallel groups and at least 50 patients in the control group. We selected and evaluated data items regarding patients, control group characteristics, and mortality outcomes, and calculated a data completeness score to provide an overall view of quality of reporting. A total of 24 RCTs were included (mean n = 287 patients and 71 % of eligible patients were randomized). Of the 24 studies, 14 (58 %) presented baseline data on vasopressors and 58 % the proportion of patients with elevated lactate values. Five studies (21 %) provided data to estimate the proportion of septic shock patients fulfilling the Sepsis-3 definition. The mean data completeness score was 19 out of 36 (range 8-32). Of 18 predefined control group characteristics, a mean of 8 (range 2-17) were reported. Only 2 (8 %) trials provided adequate data to confirm that their control group treatment represented usual care. Recent trials in septic shock provide inadequate data on the control group treatment and hemodynamic values. We propose a standardized trial dataset to be created and validated, comprising characteristics of patient population, interventions administered, hemodynamic values achieved, surrogate organ dysfunction, and mortality outcomes, to allow better analysis and interpretation of future trial results.Peer reviewe

Cerebrovascular autoregulation following cardiac arrest : Protocol for a post hoc analysis of the randomised COMACARE pilot trial

Background Approximately two-thirds of the mortality following out of hospital cardiac arrest is related to devastating neurological injury. Previous small cohort studies have reported an impaired cerebrovascular autoregulation following cardiac arrest, but no studies have assessed the impact of differences in oxygen and carbon dioxide tensions in addition to mean arterial pressure management. Methods This is a protocol and statistical analysis plan to assess the correlation between changes in cerebral tissue oxygenation and arterial pressure as measure of cerebrovascular autoregulation, the tissue oxygenation index, in patients following out of hospital cardiac arrest and in healthy volunteers. The COMACARE study included 120 comatose survivors of out of hospital cardiac arrest admitted to ICU and managed with low-normal or high-normal targets for mean arterial pressure, arterial oxygen and carbon dioxide partial pressures. In addition, 102 healthy volunteers have been investigated as a reference group for the tissue oxygenation index. In both cohorts, the cerebral tissue oxygenation was measured by near infrared spectroscopy. Conclusions Cerebrovascular autoregulation is critical to maintain homoeostatic brain perfusion. This study of changes in autoregulation following out of hospital cardiac arrest over the first 48 hours, as compared to data from healthy volunteers, will generate important physiological information that may guide the rationale and design of interventional studies.Peer reviewe

New-onset atrial fibrillation in the intensive care unit : Protocol for an international inception cohort study (AFIB-ICU)

Introduction New-onset atrial fibrillation (NOAF) is frequently observed in critically ill patients and may be associated with prolonged hospital stay and increased mortality. Considerable variation exists in the reported frequencies of NOAF due to the lack of a standardised definition and detection method. Importantly, there are limited data on NOAF in the intensive care unit (ICU). Thus, we aim to provide contemporary epidemiological data on NOAF in the ICU. Methods and Analysis We have designed an international inception cohort study including at least 1,000 consecutive adult patients acutely admitted to the ICU without prior history of persistent or permanent AF. We will present data on the incidence, risk factors, used management strategies and outcomes of NOAF. We will register data daily during stay in the ICU for a maximum of 90 days after admission. The incidence of NOAF and management strategies used will be presented descriptively, and we will use Cox regression analyses including competing risk analyses to assess risk factors for NOAF and any association with 90-day mortality. Conclusion The outlined international AFIB-ICU inception cohort study will provide contemporary data on the incidence, risk factors, used management strategies and outcomes of NOAF in adult ICU patients. Ethics and dissemination This observational study poses no risk to the included patients. All participating sites will obtain relevant approvals according to national laws before patient enrollment. Funding sources will have no influence on data handling, analyses or writing of the manuscript. The study report(s) will be submitted to an international peer-reviewed journal.Peer reviewe

Targeted tissue perfusion versus macrocirculation-guided standard care in patients with septic shock (TARTARE-2S) : study protocol and statistical analysis plan for a randomized controlled trial

Background: Septic shock has a 90-day mortality risk of up to 50 %. The hemodynamic targets, including mean arterial pressure (MAP) are not based on robust clinical data. Both severe hypotension and high doses of vasopressors may be harmful. Hence, re-evaluation of hemodynamic targets in septic shock is relevant. Methods/design: The targeted tissue perfusion versus macrocirculation-guided standard care in patients with septic shock (TARTARE-2S) trial is a prospective, two-parallel-group, randomized, open-label, multicenter trial with assessor-blinded outcome evaluation. We will randomize at least 200 patients with septic shock in four European intensive care units (ICUs) to test whether a tissue perfusion-guided treatment strategy based on capillary refill time, peripheral temperature, arterial lactate concentrations, and accepting lower MAP levels, leads to a faster resolution of shock than macrocirculation target-guided standard care. The primary outcome measure is days alive in 30 days with normal arterial blood lactate (first value of Discussion: The TARTARE-2S trial will provide important clinical data on treatment targets in septic shock, evaluating the impact of clinical tissue perfusion-guided hemodynamic treatment on a surrogate outcome combining resolution of shock (hyperlactatemia and vasopressors/inotropes), and 30-day mortality.Peer reviewe

Defining the characteristics and expectations of fluid bolus therapy : A worldwide perspective

Purpose: The purpose of the study is to understand what clinicians believe defines fluid bolus therapy (FBT) and the expected response to such intervention. Methods: We asked intensive care specialists in 30 countries to participate in an electronic questionnaire of their practice, definition, and expectations of FBT. Results: We obtained 3138 responses. Despite much variation, more than 80% of respondents felt that more than 250 mL of either colloid or crystalloid fluid given over less than 30 minutes defined FBT, with crystalloids most acceptable. The most acceptable crystalloid and colloid for use as FBT were 0.9% saline and 4% albumin solution, respectively. Most respondents believed that one or more of the following physiological changes indicates a response to FBT: a mean arterial pressure increase greater than 10 mm Hg, a heart rate decrease greater than 10 beats per minute, an increase in urinary output by more than 10 mL/h, an increase in central venous oxygen saturation greater than 4%, or a lactate decrease greater than 1 mmol/L. Conclusions: Despite wide variability between individuals and countries, clear majority views emerged to describe practice, define FBT, and identify a response to it. Further investigation is now required to describe actual FBT practice and to identify the magnitude and duration of the physiological response to FBT and its relationship to patient-centered outcomes. (C) 2016 Elsevier Inc. All rights reserved.Peer reviewe

Defining the characteristics and expectations of fluid bolus therapy: a worldwide perspective

Purpose: The purpose of the study is to understand what clinicians believe defines fluid bolus therapy (FBT) and the expected response to such intervention. Methods: We asked intensive care specialists in 30 countries to participate in an electronic questionnaire of their practice, definition, and expectations of FBT. Results: We obtained 3138 responses. Despite much variation, more than 80% of respondents felt that more than 250 mL of either colloid or crystalloid fluid given over less than 30 minutes defined FBT, with crystalloids most acceptable. The most acceptable crystalloid and colloid for use as FBT were 0.9% saline and 4% albumin solution, respectively. Most respondents believed that one or more of the following physiological changes indicates a response to FBT: a mean arterial pressure increase greater than 10 mm Hg, a heart rate decrease greater than 10 beats per minute, an increase in urinary output by more than 10 mL/h, an increase in central venous oxygen saturation greater than 4%, or a lactate decrease greater than 1 mmol/L. Conclusions: Despite wide variability between individuals and countries, clear majority views emerged to describe practice, define FBT, and identify a response to it. Further investigation is now required to describe actual FBT practice and to identify the magnitude and duration of the physiological response to FBT and its relationship to patient-centered outcomes.Facultad de Ciencias Médica

Lekmäns återupplivning, upplevelser vid hjärt - och lungräddning

Syfte med denna studie var att utreda lekmäns upplevelser vid hjärt- och lungräddning (HLR). Arbetet har gjorts i samarbete med uppdragsgivaren samt en medicine studerande vid Helsingfors Universitet. Medicine studeranden har utfört en kvantitativ forskning an-gående lekmäns utförande av hjärt- och lungräddning. Hans forskningsresultat presente-ras inte i detta arbete. Studiens centrala frågeställningar: 1) Vilka svårigheter upplevde lekmännen vid HLR och HLR+D? 2) Upplever lekmännen att det behöver mera kunskap för att kunna agera vid en riktig återupplivning? I denna studie deltog 28 lekmän, förstaårsstuderanden inom vårdsektionen vid yrkeshög-skolan Arcada. Alla deltagarna deltog i ett prehospitalt återupplivningsscenario under hösten 2014. Simuleringen skedde parvis. Dryga hälften av informanterna fick instrukt-ioner av nödcentralen att använda en defibrillator i samband med hjärt- och lungräddning. Resten av lekmännen fick instruktioner att endast utföra hjärt- och lungräddning. Infor-manterna svarade genast efter simuleringen på en webbenkät samt deltog i en kort struk-turerad intervju. Deltagarna avgränsades på basis av att de inte hade tidigare utbildning inom vård. Lekmännen hade endast blivit lärda hjärt- och lungräddning men inte defi-brillering. Undersökningen utfördes med en kombination av kvantitativa och kvalitativa forskningsmetoder. Tidigare forskningar har avgränsats till lekmannaåterupplivning. Som teoretisk bakgrund till examensarbete beskrivs hjärt- och lungräddning samt hur man kan mäta återupplivningens kvalitet. Resultatet påvisar att igenkännande av en livlös människa, agerande vid hjärtstillestånd samt användningen av hjärtstartare upplevdes svårt. Majoriteten tvekar på att de klarar av en riktig återupplivning men har en positiv inställning till att öva hjärt- och lungräddning. Därmed konstateras att mera kunskap behövs samt regelbundet övande för att kunna hantera en återupplivning

Energieffektivitet för industrifastigheter : case NMC Termonova Oy, Ingå

Energieffektivitet är ett ständigt aktuellt och behandlas ofta också i massmedier. Det här arbetet handlar om fabrikers energieffektivitet. Arbetets beställare är NMC Termonova OY. Syftet med arbetet är att presentera modeller för hur man kan gå till väga för att kontrollera och effektivisera industrianläggningars energianvändning, det vill säga energihantering. Ökad energieffektivitet är kostnadseffektivt, minskar utsläppen av växthusgaser och hjälper tryggandet av energiförsörjningen vilket har en positiv effekt på miljön. I arbetet presenteras 2 olika modeller som företag kan använda då de vill bli mera energieffektiva. Den ena modellen består av energieffektivitetsavtal och Motiva Oy:s energianalys. Energieffektivitetsavtalen sluts mellan företaget, branschorganisationer och ministerier. Med avtalet förbinder sig företaget att minska sin energiförbrukning med 9 % till år 2016 jämfört med medelförbrukningen under åren 2001-2005. För att uppnå målet görs en energianalys som bygger på en av Motiva Oy utformad modell. Företag som utför en energianalys och företag som investerar i energieffektivitet är berättigade till energistöd. Den andra modellen för energieffektivering som presenteras i arbetet baserar sig på Energimyndighetens råd för energieffektivisering. I båda modellerna är de centrala delarna att man bör kartlägga och analysera energianvändningen och sedan utföra energieffektiviserande åtgärder. Det är dessutom viktigt att kontinuerligt granska sin energianvändning för att bibehålla en hög energieffektivitet.Energy efficiency is a current topic that is often also dealt with in the media. This work is all about factories' energy efficiency. This thesis is ordered by NMC Termonova OY. The purpose of this thesis is to highlight the question of how to proceed in order to control and increase the efficiency of industrial energy use. Energy efficiency is a cost effective way to reduce greenhouse gas emissions. In addition to increased energy efficiency it reduces greenhouse gas emissions and helps to secure the energy supply, which has a positive effect on the environment in general. This thesis presents two different models that companies can use when they want to become more energy efficient. One model consists of an energy efficiency agreement (Energiatehokkuussopimus) and an energy analysis by Motiva Oy. Energy contracts are made between the company, industrial associations and government departments. The agreement commits the company to reduce its energy consumption by 9% by 2016 compared to the average consumption during the period 2001-2005. To achieve this goal an energy analysis is made. The energy analysis is based on a model designed by Motiva Oy. Companies that perform an energy analysis and companies investing in energy efficiency are eligible for energy subsidies. The second model for energy efficiency, as presented in this thesis, is based on the advice on energy efficiency by Energimyndigheten. The key elements in both models are to identify and analyze energy use and then carry out measures for increased energy efficiency. It is also important to continually examine energy use to maintain high energy efficiency

Association of deranged cerebrovascular reactivity with brain injury following cardiac arrest : a post-hoc analysis of the COMACARE trial

Background: Impaired cerebrovascular reactivity (CVR) is one feature of post cardiac arrest encephalopathy. We studied the incidence and features of CVR by near infrared spectroscopy (NIRS) and associations with outcome and biomarkers of brain injury. Methods: A post-hoc analysis of 120 comatose OHCA patients continuously monitored with NIRS and randomised to low- or high-normal oxygen, carbon dioxide and mean arterial blood pressure (MAP) targets for 48 h. The tissue oximetry index-(TOx) generated by the moving correlation coefficient between cerebral tissue oxygenation measured by NIRS and MAP was used as a dynamic index of CVR with-TOx > 0 indicating impaired reactivity and TOx > 0.3 used to delineate the lower and upper MAP bounds for disrupted CVR. TOx was analysed in the 0-12, 12-24, 24-48 h timeperiods and integrated over 0-48 h. The primary outcome was the association between TOx and six-month functional outcome dichotomised by the cerebral performance category (CPC1-2 good vs. 3-5 poor). Secondary outcomes included associations with MAP bounds for CVR and biomarkers of brain injury. Results: In 108 patients with sufficient data to calculate TOx, 76 patients (70%) had impaired CVR and among these, chronic hypertension was more common (58% vs. 31%, p = 0.002). Integrated TOx for 0-48 h was higher in patients with poor outcome than in patients with good outcome (0.89 95% CI [- 1.17 to 2.94] vs. - 2.71 95% CI [- 4.16 to - 1.26], p = 0.05). Patients with poor outcomes had a decreased upper MAP bound of CVR over time (p = 0.001), including the high-normal oxygen (p = 0.002), carbon dioxide (p = 0.012) and MAP (p = 0.001) groups. The MAP range of maintained CVR was narrower in all time intervals and intervention groups (p < 0.05). NfL concentrations were higher in patients with impaired CVR compared to those with intact CVR (43 IQR [15-650] vs 20 IQR [13-199] pg/ml, p = 0.042). Conclusion: Impaired CVR over 48 h was more common in patients with chronic hypertension and associated with poor outcome. Decreased upper MAP bound and a narrower MAP range for maintained CVR were associated with poor outcome and more severe brain injury assessed with NfL.Peer reviewe