AKSU 2012

Alueidenkäytön suunnittelujärjestelmän toimivuus -selvitys (AKSU 2012) on osa laajempaa maankäyttö- ja rakennuslain toimivuuden arviointia. Selvitys perustuu kolmeen kyselyyn, jotka suunnattiin alueidenkäytön suunnittelun ja ohjauksen asiantuntijoille, kansalaisjärjestöille sekä elinkeinoelämän toimijoille. Kyselyt on toteutettu siten, että niiden tuloksia on mahdollista verrata vuonna 2004 toteutettuihin vastaavanlaisiin suunnittelun ja ohjauksen asiantuntijoille sekä kansalaisjärjestöille suunnattuihin kyselyihin. Elinkeinoelämän toimijoille suunnattu kysely toteutettiin tässä muodossa nyt ensimmäistä kertaa. AKSU 2012 selvityksessä painopisteet alueidenkäytön suunnittelun ja ohjauksen asiantuntijoille kohdistetussa kyselyssä olivat: - Kaavojen työnjaon kehittyminen, ohjaussuhteen toimivuus sekä kaavoituksen sujuvuus - Kaavajärjestelmän käyttö eri tilanteissa - Valtakunnallisten alueidenkäyttötavoitteiden toteutuminen ja niiden soveltaminen - Osallistuminen eri kaavatasoilla Kansalaisjärjestöille suunnatussa kyselyssä vastaajilta tiedusteltiin kaavoituksen tiedonsaannista, osallistumisesta, vaikutuskeinoista sekä näkemyksiä siitä, miten näkemyksiä oli otettu huomioon. Lisäksi vastaajilta kysyttiin kaavoitukseen liittyvistä toimintatapojen muutoksista viime vuosien aikana. Elinkeinoelämän toimijoilta kysyttiin vastaavia asioita kuin kansalaisjärjestökyselyssä sekä niiden lisäksi kokemuksia kaavoitusprosessin kestosta ja ennakoitavuudesta sekä kaavoituksen vaikutuksista kilpailuun. Tutkimusmenetelmänä käytettiin laajaa kyselytutkimusta kuntien kaavoittajille, konsulteille, maakuntakaavoittajille, valtion ympäristöhallinnolle ja eri sektoriviranomaisille. Kansalaisjärjestökyselyssä vastaajia olivat erilaiset harraste-, nais- ja perhejärjestöt, luontojärjestöt sekä Suomen Kotiseutuliitto, Suomen Kylätoiminta ja Suomen Omakotiliitto. Elinkeinoelämän toimijoilta vastauksia saatiin yrityksisltä ja järjestöiltä energia-alalta, rakentamisesta ja kiinteistöalalta, kaupasta, teollisuudesta, kaivostoiminnasta, logistiikasta ja kuljetusalalta, muusta palvelutoiminnasta, maa- ja metsätalousalalta sekä joiltakin monialaisilta toimijoilta. Raporttiin on koottu kyselyjen tulokset ja niistä esitettyjä arvioita. AKSU 2012 selvityksen teki FCG Suunnittelu ja tekniikka Oy suunnittelupäällikkö, arkkitehti SAFA Helena Ylisen johdolla. Raportoinnin toteuttamiseen osallistuivat myös suunnittelija FM Olli Hokkanen,tutkimuspäällikkö FK Heikki Miettinen sekä projektipäällikkö FM Katariina Pahkasalo

Prediction of renal outcome in Henoch-Schonlein nephritis based on biopsy findings

Background In Henoch-Schonlein nephritis (HSN), a risk factor for unfavorable outcome is prolonged proteinuria, but the value of renal biopsies in prognosis assessment is debatable. Methods We evaluated serial renal biopsies from 26 HSN patients. Follow-up biopsy occurred at median 2.1 years after diagnostic biopsy. Patients formed two groups at the follow-up biopsy: patients without proteinuria (group I; n = 11) and with proteinuria (group II; n = 15). Biopsies underwent evaluation according to three classifications: International Study of Kidney Disease in Children (ISKDC), Oxford (MEST-C), and semiquantitative classification (SQC) including an activity and chronicity score. Analysis also included expression of pro-fibrotic (alpha-smooth muscle actin and vimentin) and inflammatory (P-selectin glycoprotein ligand-1) molecules in the diagnostic biopsy specimens. Definition of unfavorable outcome was active renal disease or reduced renal function at last follow-up. Results Between the biopsies, SQC chronicity score increased in 22 (85%) patients, whereas activity score and ISKDC grade decreased in 21 (81%) and 17 (65%), respectively. Of the MEST-C parameters, endocapillary proliferation (from 83 to 13%; p <0.001) and crescents (from 63 to 25%; p = 0.022) showed significant reduction, and segmental glomerulosclerosis (from 38 to 79%; p = 0.006) significant increment. These changes occurred similarly in groups I and II. Expression of the pro-fibrotic and inflammatory molecules showed no clinically significant differences between groups I and II. None in group I and five (33%) patients in group II had unfavorable outcome (p = 0.053). Conclusions Our results suggest that follow-up biopsies provide limited additional information to clinical symptoms in HSN outcome prediction.Peer reviewe

The ISKDC classification and a new semiquantitative classification for predicting outcomes of Henoch-Schonlein purpura nephritis

Histological findings from primary kidney biopsies were correlated with patient outcomes in a national cohort of paediatric Henoch-Schonlein nephritis (HSN) patients. Primary kidney biopsies from 53 HSN patients were re-evaluated using the ISKDC (International Study of Kidney Disease in Children) classification and a modified semiquantitative classification (SQC) that scores renal findings and also takes into account activity, chronicity and tubulointerstitial indices. The ISKDC and SQC classifications were evaluated comparatively in four outcome groups: no signs of renal disease (outcome A, n = 27), minor urinary abnormalities (outcome B, n = 18), active renal disease (outcome C, n = 3) and renal insufficiency, end-stage renal disease or succumbed due to HSN (outcome D, n = 5). For the receiver operating characteristic and logistic regression analyses, outcomes A and B were considered to be favourable and outcomes C and D to be unfavourable. The median follow-up time was 7.3 years. The patients with an unfavourable outcome (C and D), considered together due to low patient numbers, had significantly higher total biopsy SQC scores and activity indices than those who had a favourable one (groups A and B). The chronicity and tubulointerstitial indices differed significantly only between group C + D and group A. The difference in areas under the curve between the total biopsy SQC scores and ISKDC findings was 0.15 [p = 0.04, normal-based 95% confidence interval (CI) 0.007-0.29, bias-controlled 95% CI -0.004 to 0.28]. Our results suggest that the modified SQC is more sensitive than ISKDC classification for predicting the outcome in HSN cases.Peer reviewe

Common Inflammation-Related Candidate Gene Variants and Acute Kidney Injury in 2647 Critically Ill Finnish Patients

Acute kidney injury (AKI) is a syndrome with high incidence among the critically ill. Because the clinical variables and currently used biomarkers have failed to predict the individual susceptibility to AKI, candidate gene variants for the trait have been studied. Studies about genetic predisposition to AKI have been mainly underpowered and of moderate quality. We report the association study of 27 genetic variants in a cohort of Finnish critically ill patients, focusing on the replication of associations detected with variants in genes related to inflammation, cell survival, or circulation. In this prospective, observational Finnish Acute Kidney Injury (FINNAKI) study, 2647 patients without chronic kidney disease were genotyped. We defined AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared severe AKI (Stages 2 and 3, n = 625) to controls (Stage 0, n = 1582). For genotyping we used iPLEX(TM) Assay (Agena Bioscience). We performed the association analyses with PLINK software, using an additive genetic model in logistic regression. Despite the numerous, although contradictory, studies about association between polymorphisms rs1800629 in TNFA and rs1800896 in IL10 and AKI, we found no association (odds ratios 1.06 (95% CI 0.89-1.28, p = 0.51) and 0.92 (95% CI 0.80-1.05, p = 0.20), respectively). Adjusting for confounders did not change the results. To conclude, we could not confirm the associations reported in previous studies in a cohort of critically ill patients.Peer reviewe

Heme oxygenase-1 repeat polymorphism in septic acute kidney injury

Acute kidney injury (AKI) is a syndrome that frequently affects the critically ill. Recently, an increased number of dinucleotide repeats in the HMOX1 gene were reported to associate with development of AKI in cardiac surgery. We aimed to test the replicability of this finding in a Finnish cohort of critically ill septic patients. This multicenter study was part of the national FINNAKI study. We genotyped 300 patients with severe AKI (KDIGO 2 or 3) and 353 controls without AKI (KDIGO 0) for the guanine-thymine (GTn) repeat in the promoter region of the HMOX1 gene. The allele calling was based on the number of repeats, the cut off being 27 repeats in the S-L (short to long) classification, and 27 and 34 repeats for the S-M-L2 (short to medium to very long) classification. The plasma concentrations of heme oxygenase-1 (HO-1) enzyme were measured on admission. The allele distribution in our patients was similar to that published previously, with peaks at 23 and 30 repeats. The S-allele increases AKI risk. An adjusted OR was 1.30 for each S-allele in an additive genetic model (95% CI 1.01-1.66; p = 0.041). Alleles with a repeat number greater than 34 were significantly associated with lower HO-1 concentration (p<0.001). In septic patients, we report an association between a short repeat in HMOX1 and AKI risk

Mutta kun ei ole tilaa : Yhteistilat sisällä ja ulkona Espoon Kivenlahdessa

Palvelurakenteen ympäristöt -projekt

Virtsa-avannesidoksen vaihto : ohjausvideo virtsa-avannesidoksen vaihdosta

Opinnäytetyön toimeksiantajalla, Pirkanmaan sairaanhoitopiirillä, oli tarve yhtenäistää sairaalan oma video-ohjauksen tarjontansa niille potilaille, jotka tarvitsevat tukea avannesidosten vaihdon oppimiseen. Suolistoavannepotilaille oli jo olemassa ohjausvideot, mutta virtsa-avannepotilaille ei. Tarkoituksena oli tehdä sairaanhoitopiirille helposti käytettävä video virtsa-avannepotilaan saaman ohjauksen monipuolistamiseksi. Hoitojakso sairaalassa on usein vain noin viikon pituinen, joten erilaisia ohjaustapoja on hyvä olla tarjolla, jotta potilas pystyisi hyödyntämään yksilöllisesti parhaalta vaikuttavan tavan saada tietoa ja taitoja arjessa pärjäämiseen. Tarkoituksena oli toiminnallisen opinnäytetyön keinoin vastata kysymyksiin, mikä on virtsa-avanne ja mitkä ovat sen tekemisen indikaatiot, miten virtsa-avannesidos vaihdetaan ja millainen on hyvä ohjausvideo. Tavoitteena oli videoiden avulla tukea potilaan omahoitoa virtsa-avannesidoksen vaihdossa sekä ammattilaisten suorittamaa potilasohjausta sairaalassa ennen kotiutumista. Normaali virtsaneritysjärjestelmä koostuu munuaisista, virtsanjohtimista, virtsarakosta sekä virtsaputkesta. Kun virtsarakko joudutaan poistamaan, potilaan ohutsuolesta leikataan irti pala, johon virtsanjohtimet liitetään. Toinen pää poistetusta ohutsuolen palasta tuodaan vatsanpeitteiden läpi. Tätä kutsutaan virtsa-avanteeksi, ja sitä kautta virtsa pääsee poistumaan elimistöstä. Virtsaa erittyy avanteen kautta jatkuvasti, joten potilas tarvitsee avannesidoksen ympärivuorokautiseen käyttöön. Sairaanhoitopiirin oma audiovisuaalinen työryhmä toteutti videoiden kuvakset. Videoiden käsikirjoitus on opinnäytetyön liitteenä. Videoilla esiintyi vapaaehtoinen henkilö, jolla oli virtsa-avanne. Sekä raportista että videoilta on rajattu pois avannetta ympäröivän ihon hoito sekä erillisen yöpussin vaihto. Kehittämisehdotuksina esitetään ohjausvideoiden vaikuttavuuden ja hyödyllisyyden arviointia sekä tutkimusta virtsa-avanteen kanssa elämisestä ja virtsa-avanteen perushoidosta.The idea to for the thesis came from working life – Pirkanmaa Hospital District. There was a need to unify the provision to the patients who need support with their stoma. There were already educational videos for the intestinal patients, but not for patients who have an urostomy pouch. The aim in the thesis was to create easily useful videos to the Hospital District when there is a need to offer guidance to patients with an urostomy pouch. These patients are usually in the hospital only for a week. It is good that there are many types of guidance to offer, and the patient can benefit from the method that works best for them. The study was done as a functional method and a volunteer, who had an urostomy pouch, appeared in the videos. The study includes a report and two educational videos. The thesis contains the most-recent theoretical data on urostomy pouches. The main research questions were: what is urostomy and what are the indications for doing it, how to change a urinary pouch, and what is a good patient educational video. The aim of the videos was to support the patients’ self-care in the replacement of the urostomy pouch, as well as for the professionals to perform patient guidance in the hospital before discharge. Development proposals include an evaluation of the effectiveness and usefulness of the videos, as well as research on living with urostomy and basic treatment of urostomy

Solutions for control of nitrogen discharges at mines and quarries

The growth of Finnish extractive industry increases the need to study and monitor different environmental impacts and to integrate the environmental issues more tightly into the overall framework of the activities. Nitrogen released from explosives or from mining processes and ending up in the water system can have negative environmental effects. The MINIMAN project, financed by the Tekes Green Mining Programme and the industry aimed at comprehensive understanding on the nitrogen issue in the extractive industry. The project collected essential data on nitrogen compounds present in the environments of mines and quarries, and developed technologies for the treatment of nitrogen containing mine water. Based on a technology review, selective sorption, electrochemically assisted membrane separation and biological treatment were selected to be studied and developed in the project. Denitrification and nitrification studies on synthetic mine wastewater in laboratory scale revealed that denitrification was possible at low pH (2.5) and temperatures as low as 7°C. Nitrification was more pH sensitive. Both processes tolerated metals (Fe, Ni, Co and As). In the adsorption tests with zeolite, complete ammonium removal from real mine wastewater was achieved with a hydraulic retention time of 2 minutes, with complete regeneration. In addition, a novel electropervaporative nitrogen capture technology was developed. Further larger scale testing and development of all technologies is required to ensure their feasibility in a real mining site. A follow-up period in lysimeters showed that the explosives originated nitrogen content of left over stones from natural stone quarrying is relatively low and ca. half of the nitrogen is leached within the first weeks after detonation. The main sources of nitrogen are process and dewatering waters, irrespective of the scale of extractive activity. The total potential nitrogen load to the environment depends on the scale and type of the activity as well as the type of explosives used. In addition to factors related to the activity itself, the overall nitrogen management should take into account the background concentrations and sensitivity of the local ecosystem