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Definition and developmental goals for Nordic emergency medicine
No full textAlthough Emergency Medicine is now globally an established specialty, the Nordic countries have been relatively slow to implement it into their health care systems. To facilitate the development of EM in the Nordic area, a working group was formed with representation from all national EM societies; DASEM (Danish Society for Emergency Medicine), FiSEM (Finnish Society of Emergency Medicine), ISEM (Icelandic Society for Emergency Medicine), NCEM (Norwegian College of Emergency Medicine), and SWESEM (Swedish Society for Emergency Medicine). This group was tasked with creating a Nordic EM manifesto-to create a definition and developmental goals for Nordic Emergency Medicine. The commentary provides an overview of the current status and challenges facing EM in the Nordic countries.Non peer reviewe
Comprehensive neuropsychological assessment and predictors of cognitive functioning at six months after COVID-19 in patients treated in the ICU, regular hospital ward, or isolated at home
No full textCognitive impairment in patients with COVID-19 has been reported, but findings are inconsistent. This study assessed cognitive functioning 6 months post-infection across three COVID-19 severity groups compared to non-COVID controls. Seventy-two ICU-treated, 49 ward-treated, and 44 home-isolated patients with COVID-19, along with 48 controls, underwent neuropsychological evaluation and assessment of subjective cognitive symptoms, depressive symptoms, and fatigue. Cognitive test scores were compared using ANCOVA. Associations between cognitive functioning and variables including demographics, illness severity, comorbidities, depressive symptoms, fatigue, and ICU-related factors were examined with hierarchical linear regression models. Results showed no significant differences in cognitive test performance of impairment frequencies between COVID-19 groups and controls. However, patients with COVID-19 reported higher levels of subjective cognitive symptoms, depressive symptoms, and fatigue compared to controls. Predictors of cognitive functioning included age, education, and, to a lesser extent, comorbidities. COVID-19 severity, depression, fatigue, or ICU-related variables did not significantly impact performance. These findings suggest that while individual cognitive impairments may exist, overall cognitive functioning in patients with COVID-19 was comparable to controls.Peer reviewe
Cancer risk due to ingestion of naturally occurring radionuclides through drinking water: A systematic review
No full textNaturally occurring radionuclides can, in rare cases, reach high levels in drinking water of specific areas, leading to meaningful radiation exposures upon ingestion. Increased cancer risk is the only well-established health impact of exposure to low-dose radiation. Multiple ecological studies have shown conflicting results about cancer risk in areas of high levels of radionuclides in water. However, such studies have methodological limitations and are generally not highly informative. Studies with individual-level data are scarce and have not established a clear association either. To further investigate this issue, we conducted a systematic review of the literature on cancer risk associated with radionuclide ingestion through drinking water, aiming to summarize and evaluate the current epidemiological evidence. Published studies have examined the effects of uranium, radium, and radon, while potential risks of polonium, radioactive lead, and thorium remain unknown. Existing research is heterogeneous regarding the cancer types assessed and faces methodological challenges, including limitations in exposure assessment, dosimetric uncertainties, low statistical power, and inadequate control of confounding factors. Due to lack of high-quality evidence, it is not possible to confirm or rule out an increased cancer risk among highly exposed populations. While risk assessment based on extrapolation from high dose studies does not suggest an excess cancer risk beyond background variation, such assessment involves considerable uncertainties. Future studies should focus on populations with high radionuclide exposure to provide sufficient exposure contrast, prioritizing radionuclides with high-dose coefficients and cancers in tissues with the highest radionuclide deposition.Peer reviewe
The effects of increased thermal insulation in timbre-framed external walls with a thin gypsum board as a wind barrier
No full textClimate change and the need for energy savings challenge the hygrothermal performance of timbre-framed wall structures in cold climates. The future climate conditions will be more suitable for mould growth than the present, and the attempts to save heating energy involve the use of very effective thermal insulation. Hence, the hygrothermal performance of the outer parts of exterior walls must be studied and effective measures must be introduced to prevent mould growth. In this study, four timbre-framed exterior wall constructions were studied. All the walls were equipped with a gypsum board wind barrier having a minimal thermal resistance. Insulation thicknesses of 150 and 300 mm, demonstrating a moderate and a very effective levels of thermal insulation, were compared. Wooden cladding and brick veneer were compared as façade materials. Thickness of thermal insulation was the dominant parameter in this study. Although even the walls with 300 mm thermal insulation performed decently in the study, they might become problematic in the future. A wind barrier with a noticeable thermal resistance or the use of a thermal insulation layer outside the gypsum board wind barrier would obviously improve the performance of the studied walls.Peer reviewe
Robust Visual Perception and Decision Making for Autonomous Systems
Get PDFAutonomous systems, embodying a synthesis of visual perception and decision-making capabilities, are poised to revolutionize a wide array of sectors, from transportation and manufacturing to healthcare. Visual perception, the ability to comprehend and interpret visual data to discern the environment, lays the bedrock for these systems to function effectively in diverse real-world scenarios. Decision making complements this by equipping these systems with the ability to select optimal actions based on visually perceived information.
The first part of this thesis concentrates on visual perception, specifically through the lens of video object segmentation. As a crucial facet of computer vision, video object segmentation empowers autonomous systems to distinguish and track objects within dynamic video streams. Despite considerable advancements in the field, certain challenges endure, particularly when it comes to robust and coherent segmentation of objects in complex, real-world scenarios. This work introduces three key innovations to address these challenges. We present an efficient graph transduction learning approach for improved primary video object segmentation. A semi-supervised adaptation technique is put forth to harness the power of pretrained deep convolutional neural networks in semantic video object segmentation. Lastly, we introduce a hierarchical graphical model, fusing both bottom-up and top-down cues with long-term object relations and spatiotemporal contexts for superior performance in semantic video object segmentation.
The latter half of this thesis shifts the spotlight to decision making, specifically delving into hierarchical reinforcement learning (HRL). Reinforcement learning, a fundamental paradigm in decision making, facilitates autonomous systems to learn from their interactions with the environment. However, its efficacy can be obstructed by issues such as non-stationarity in off-policy training. This non-stationarity can be attributed to the continuous adjustments in the policies at different levels of the hierarchy throughout the learning phase. To counter this, we propose a novel adversarially guided subgoal generation framework within the realm of HRL. This adversarial learning technique effectively alleviates shifts in data distribution from relabeled experiences to the current high-level policy behavior, resulting in enhanced learning efficiency and stability.
In sum, this thesis endeavors to push the frontiers of visual perception and decision making capabilities for autonomous systems. Through contributions in video object segmentation and hierarchical reinforcement learning, it sets the stage for the development of more robust and dependable autonomous systems, thereby paving the way for their wider and safer application in society
Assessment of improvement in functional outcomes between a novel knee replacement design and conventional designs in 240 patients: a randomized controlled trial
No full textBackground and purpose — The introduction and development of new total knee arthroplasty (TKA) implant designs are industry driven. To date, an adequately powered randomized controlled trial (RCT) to provide evidence of the superiority of novel implant designs over conventional ones is often lacking. The aim of our RCT was to investigate the functional outcomes of a novel TKA implant design compared with 2 conventional TKA designs. Primary outcome was difference in the change in Oxford Knee Score (OKS) at 2 years. Secondary outcomes were Forgotten Joint Score, 15D quality of life questionnaire, UCLA activity score, and complications. Methods —We compared functional outcomes between a novel TKA implant design (Persona CR) and 2 conventional designs (NexGen CR, PFC CR). 240 patients with severe knee osteoarthritis were recruited to a pragmatic, single-center, prospective, parallel-group RCT between September 2015 and August 2018. The duration of follow-up was 2 years. Results — Of 240 randomized patients, 225 were included in the intention-to-treat analysis (mean age 61.8 years; 67.5% females). The OKS exceeded minimal clinical important difference (MCID) from baseline to 2 years in all 3 treatment groups (Persona CR: 18.9 points, PFC CR: 20.3 points, NexGen CR: 19.4 points). At 2 years the difference between Persona CR and PFC CR in the change score was –1.0 (95% confidence interval [CI] –3.6 to 1.7). Similarly, the difference between Persona CR and NexGen CR was –0.9 (CI –3.6 to 1.9). At the time of final follow-up evalu-ation, OKS was equivalent between groups, as CI excluded between-group differences larger than 4 points. Conclusion — We showed no clinically relevant differences in functional outcomes measured with OKS, 15D, or FJS between the 2 conventional implant designs and the novel implant design at 2-year follow-up.Peer reviewe
A large-scale risk assessment and classification model for pneumococcus using Finnish national health data
No full textStreptococcus pneumoniae, or pneumococcus, poses a significant health risk, particularly to infants, the elderly, and individuals with underlying medical conditions. In Finland, pneumococcal vaccination is part of the national immunization program, with vaccination provided to young children and only selected at-risk adult populations included. This study aims to leverage the Finnish national electronic health record system, Kanta, to analyze treatment histories and identify individuals at increased risk for disease to improve vaccination strategies. Kanta provides a comprehensive, nationwide database of patient treatment histories, which can be utilized to track individual risk factors and disease episodes. We analyzed health data from 96,200 Finnish residents with risk factors for pneumococcal disease following guidelines from the Finnish Institute for Health and Welfare and the World Health Organization. We prioritize vaccination for those at the greatest risk by categorizing individuals based on their identified risk factors. This study demonstrates the potential for using national health record data to conduct large-scale risk analyses, allowing for more targeted and efficient vaccination strategies. The novelty of our approach lies in the automatic identification of high-risk individuals, which can inform public health initiatives and enhance the monitoring of pneumococcal disease risk at a population level.Peer reviewe
Using GTFS-data to calculate the roadwork caused delays on public transport network
No full textThe reliability of public transport is a significant reason whether people choose it over other transport modes. Roadworks, i.e., mandatory road maintenance, can cause delays on vehicle journeys in parts of the network, thus generating missed transport connections. To sustain the reliability of the public transport system, it is important to understand effects these delays cause. This study explains a method that allows to model delay effects to the network using GTFS-data. The developed method allows a simple workflow to calculate how different delays on different locations affect the reachability of the areas. The method is tested in two case areas in Finland. Based on the case areas in this study, the results indicate that a 3-minute delay occurring for the departures from city centre only seldomly appears as a total travel time delay longer than the calculated delay. However, for some parts of the city that rely on transfer connections, even a 2-minute delay will result in missed connections, and thus, longer travel times.Peer reviewe
Lampaanvillan käsittely kutistumisen vähentämiseksi
Get PDFNyky-yhteiskunnassa tekstiileiltä vaaditaan konepesun kestoa. Tämä koskee myös villasta valmistettuja tuotteita. Villavaatteet kutistuvat pesussa ja se lyhentää niiden käyttöikää ja vähentää käyttömukavuutta. Tässä työssä tarkastellaan villakuitua, sen kutistumista ja eri menetelmiä kutistumisen vähentämiseksi.
Villakuidun pinnan suomurakenne aiheuttaa kuituun kitkakerroineron. Pestessä villasta valmistettua vaatetekstiiliä pesukoneessa, villa joutuu märkänä mekaanisen työn kohteeksi, jolloin se kutistuu. Kutistumista tapahtuu, kun kuidut jäävät kitkakerroineron vuoksi kiinni toisiinsa muodostaen solmuja. Kun kuituihin kohdistuu voimaa, ne pääsevät liikkumaan vain tiettyyn suuntaan. Kuitujen pituus lyhenee, ja isommassa mittakaavassa vaatetekstiilin pinta-ala pienenee, eli se kutistuu.
Kutistumista voidaan ehkäistä monilla eri keinoilla. Kaikkien keinojen tavoitteena on pienentää kitkakerroineron vaikutusta ja joko helpottaa kuituja liikkumaan toistensa lomitse tai estää liikettä tapahtumasta. Menetelmät voidaan jakaa kemiallisiin ja fysikaalisiin menetelmiin. Kemiallisissa menetelmissä jokin kemiallinen aine reagoi kuidun pinnan kanssa. Fysikaalisilla menetelmillä aiheutetaan kuidun pinnan kemialliseen rakenteeseen muutoksia esimerkiksi ultraviolettisäteillä tai plasmalla.
Tällä hetkellä käytetyin kutistumisen estokeino on kloori-Hercosett-menetelmä, jossa kloorilla kuidun pinta esikäsitellään hapettamalla sidoksia rikki, jonka jälkeen pinta päällystetään polymeerillä. Menetelmä on tehokas, mutta klooriyhdisteet ovat ympäristölle haitallisia. Menetelmälle pyritään kehittämään ympäristöystävällisempiä vaihtoehtoja.
Tämän kirjallisuuskatsauksen perusteella mahdollisia tulevaisuuden menetelmiä ovat erilaiset esikäsittelyt yhdistettynä polymeeripäällystykseen. Erityisesti plasma ja entsyymit ovat ympäristön kannalta hyviä esikäsittelyitä. Lisäksi ultraviolettisäteilyn ja silkin valmistuksesta sivutuotteena saatavan serisiini-polymeerin yhdistämistä on tutkittu. Vaihtoehtoiset keinot ovat kalliita toteuttaa ja prosessin teho ei yllä kloori-Hercosett-käsittelyn tasolle
Determining products for Assemble-to-Order inventory: Development of a calculation model and an implementation process
No full textDetermining which items and materials to stock is an essential aspect of inventory management. In this study, ATO (Assemble-to-Order) offering management refers to defining which materials are stocked to enable short lead times for end products. A calculated ATO offering is a computationally defined set of materials and components that ensure sufficient availability of end products while minimizing inventory costs. Defining a calculated ATO offering is important across the organization, as it impacts manufacturing, operations, inventory costs, customer satisfaction, and overall business performance.
The objective of this study was to identify the key criteria for determining which items and materials should be stocked in an ATO environment, and how these criteria can be formed into a calculation logic for a computational model. The study also examines how computational suggestions of materials to be added to or removed from stock should be implemented in practice. For the case company, the goal of this study was to create a way to challenge and evaluate the current ATO offering, by developing and implementing a historical demand-based calculation model. This model is used to evaluate and suggest changes to the ATO offering on an annual basis within the case company. Optimizing the ATO offering improves availability for high-demand items and reduces unnecessary inventory to free up inventory-tied capital. This systematic approach to reviewing the ATO offering enables holistic management, allowing adjustments to be made before issues such as low availability or low warehouse consumption become apparent.
The study includes a literature review and industry expert interviews which provide a foundation for the quantitative analysis. The quantitative section utilizes the Action Design Research framework for developing the calculation model, where iterative versions are produced, evaluated, and modified according to practical considerations of the case organization. The aim is to produce a solution that solves a real-life challenge of evaluating the current ATO offering, calculating suggested changes, and implementing these suggestions in practice. Results of the calculation model were evaluated by industry experts in workshops, to highlight challenges in the implementation phase.
The key findings of this study are both theoretical and practical. The theoretical findings highlight the parameters to be considered when defining a calculated offering and the importance of defining the key parameters that are used to determine which items to stock. The practical findings highlight the many factors which need to be considered when implementing such a tool in practice. These include tacit knowledge, data reliability, the workload of manual reviews, as well as the ease of using and understanding the final solution and its results in practice.
A key outcome of this study is the practical calculation model and its implementation process for the case company. The calculation model is a comprehensive tool for ATO offering management: Calculated suggestions are manually reviewed to ensure changes implemented are feasible. From the academic perspective, the conclusions of this study underscore the combination of theoretical and practical considerations for ATO offering management: To successfully develop and implement a solution to manage the ATO offering in a practical context, theoretical ideas need to be applied, practically tested, evaluated, and developed iteratively