Browsing by Subject "RECOVERY"

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  • Jokelainen, Jarno; Belozerskikh, Anna; Mustonen, Harri; Udd, Marianne; Kylänpää, Leena; Lindström, Outi; Mazanikov, Maxim; Pöyhiä, R. (2020)
    Background Endoscopic retrograde cholangiopancreatography (ERCP) requires moderate to deep sedation, usually with propofol. Adverse effects of propofol sedation are relatively common, such as respiratory and cardiovascular depression. This study was conducted to determine if doxapram, a respiratory stimulant, could be used to reduce the incidence of respiratory depression. Methods This is a single-center, prospective randomized double-blind study performed in the endoscopy unit of Helsinki University Central Hospital. 56 patients were randomized in a 1:1 ratio to either receive doxapram as an initial 1 mg/kg bolus and an infusion of 1 mg/kg/h (group DOX) or placebo (group P) during propofol sedation for ERCP. Main outcome measures were apneic episodes and hypoxemia (SpO(2) <90%). Mann-Whitney test for continuous variables and Fisher's exact test for discrete variables were used and mixed effects modeling to take into account repeated measurements on the same subject and comparing both changes within a group as a function of time and between the groups. Results There were no statistically significant differences in apneic episodes (p = 0.18) or hypoxemia (p = 0.53) between the groups. There was a statistically significant rise in etCO(2) levels in both groups, but the rise was smaller in group P. There was a statistically significant rise in Bispectral Index (p = 0.002) but not modified Observer's Assessment of Agitation/Sedation (p = 0.21) in group P. There were no statistically significant differences in any other measured parameters. Conclusions Doxapram was not effective in reducing respiratory depression caused by deep propofol sedation during ERCP. Further studies are warranted using different sedation protocols and dosing regimens.
  • Salo, Karita S.-T.; Mutanen, Tuomas P.; Vaalto, Selja M. I.; Ilmoniemi, Risto J. (2020)
    The combination of transcranial magnetic stimulation (TMS) and electroencephalography (EEG) is commonly applied for studying the effective connectivity of neuronal circuits. The stimulation excites neurons, and the resulting TMS-evoked potentials (TEPs) are recorded with EEG. A serious obstacle in this method is the generation of large muscle artifacts from scalp muscles, especially when frontolateral and temporoparietal, such as speech, areas are stimulated. Here, TMS–EEG data were processed with the signal-space projection and source-informed reconstruction (SSP–SIR) artifact-removal methods to suppress these artifacts. SSP–SIR suppressed muscle artifacts according to the difference in frequency contents of neuronal signals and muscle activity. The effectiveness of SSP–SIR in rejecting muscle artifacts and the degree of excessive attenuation of brain EEG signals were investigated by comparing the processed versions of the recorded TMS–EEG data with simulated data. The calculated individual lead-field matrix describing how the brain signals spread on the cortex were used as simulated data. We conclude that SSP–SIR was effective in suppressing artifacts also when frontolateral and temporoparietal cortical sites were stimulated, but it may have suppressed also the brain signals near the stimulation site. Effective connectivity originating from the speech-related areas may be studied even when speech areas are stimulated at least on the contralateral hemisphere where the signals were not suppressed that much.
  • Cooke, Marie; Ritmala-Castren, Marita; Dwan, Toni; Mitchell, Marion (2020)
    Background Pharmacological interventions for sleep (analgesic, sedative and hypnotic agents) can both disrupt and induce sleep and have many negative side effects within the intensive care population. The use of complementary and alternative medicine therapies to assist with sleep has been studied but given the variety of modalities and methodological limitations no reliable conclusions have been drawn. Objective To synthesise research findings regarding the effectiveness of using complementary and alternative medicine interventions within the domains of mind and body practices (relaxation techniques, acupuncture) and natural biologically based products (herbs, vitamins, minerals, probiotics) on sleep quality and quantity in adult intensive care patients. Review method used Systematic review Data sources Five databases were searched in August 2018 and updated in February 2019 and 2020. Review methods: Searches were limited to peer reviewed randomised controlled trials, published in English involving adult populations in intensive care units. Interventions were related to the complementary and alternative medicine domains of mind and body practices and natural products. Included studies were assessed using Cochrane's risk of bias tool. Results Seventeen studies were included. The interventions used varied: 4 investigated melatonin; 4 music +/- another therapy; 3 acupressure; 2 aromatherapy and 1 each for relaxation and imagery, reflexology, bright light exposure and inspiratory muscle training. Measurement of sleep quantity and quality was also varied: 5 studies used objective measures such as Polysomnography and Bispectral index with the remaining using subjective patient or clinician assessment (for example, Richards-Campbell Sleep Questionnaire, Pittsburgh Sleep Quality Index, observation). Given the different interventions, outcomes and measures used in the studies a meta-analysis was not possible. Generally, the results support the use of complementary and alternative medicine for assisting with sleep with 11 out of 17 trials reporting significant results for the interventions examined. Conclusions Complementary and alternative medicine interventions, in particular, melatonin and music, have shown promise for improving sleep in adults with critically conditions; however, further research that addresses the limitations of small sample sizes and improved techniques for measuring sleep is needed.
  • Soukkio, Paula K.; Suikkanen, Sara A.; Kukkonen-Harjula, Katriina T.; Kautiainen, Hannu; Hupli, Markku T.; Aartolahti, Eeva M.; Kääriä, Sanna M.; Pitkälä, Kaisu H.; Sipilä, Sarianna (2022)
    Background Long-term functional limitations are common after hip fractures. Exercise may alleviate these negative consequences but there is no consensus on an optimal training program. The objective was to study the effects of a 12-month home-based supervised, progressive exercise program on functioning, physical performance, and physical activity. Methods Secondary analysis of a randomized controlled trial targeting patients with surgical repair of a hip fracture, aged >= 60 years, Mini-Mental State Examination (MMSE) score of >= 12. The participants were randomized into Exercise (n = 61) or Usual care (n = 60). Assessments at baseline, 3, 6, and 12 months included Lawton's Instrumental Activities of Daily Living (IADL), Short Physical Performance Battery (SPPB), handgrip strength, and self-reported frequency of sessions of leisure-time physical activity. Analyzed using mixed-effects models. Results Participants' (n = 121) mean age was 81 years (SD 7), and 75% were women. The mean IADL score at baseline was 17.1 (SD 4.5) in the exercise group, and 17.4 (5.1) in the usual care group. The mean SPPB scores were 3.9 (1.6) and 4.2 (1.8), and handgrip strength was 17.7 (8.9) kg and 20.8 (8.0) kg, respectively. The age- and sex-adjusted mean changes in IADL over 12 months were 3.7 (95% CI 2.8-4.7) in the exercise and 2.0 (1.0-3.0) in the usual care group (between-group difference, p = 0.016); changes in SPPB 4.3 (3.6-4.9) and 2.1 (1.5-2.7) (p < 0.001); and changes in handgrip strength 1.2 kg (0.3-2.0) and 1.0 kg (-1.9 to -0.2) (p < 0.001), respectively. We found no between-group differences in changes in the frequency of leisure-time activity sessions. Conclusion A 12-month home-based supervised, progressive exercise program improved functioning and physical performance more than usual care among patients with hip fractures. However, the training did not increase leisure-time physical activity.
  • Rodionov, Andrei; Savolainen, Sarianna; Kirveskari, Erika; Mäkelä, Jyrki P.; Shulga, Anastasia (2020)
    Recovery of lower-limb function after spinal cord injury (SCI) is dependent on the extent of remaining neural transmission in the corticospinal pathway. The aim of this proof-of-concept pilot study was to explore the effects of long-term paired associative stimulation (PAS) on leg muscle strength and walking in people with SCI. Five individuals with traumatic incomplete chronic tetraplegia (>34 months post-injury, motor incomplete, 3 females, mean age 60 years) with no contraindications to transcranial magnetic stimulation (TMS) received PAS to one or both legs for 2 months (28 sessions in total, 5 times a week for the first 2 weeks and 3 times a week thereafter). The participants were evaluated with the Manual Muscle Test (MMT), AIS motor and sensory examination, Modified Asworth Scale (MAS), and the Spinal Cord Independence Measure (SCIM) prior to the intervention, after 1 and 2 months of PAS, and after a 1-month follow-up. The study was registered at (NCT03459885). During the intervention, MMT scores and AIS motor scores increased significantly (p = 0.014 and p = 0.033, respectively). Improvements were stable in follow-up. AIS sensory scores, MAS, and SCIM were not modified significantly. MMT score prior to intervention was a good predictor of changes in walking speed (Radj2 = 0.962). The results of this proof-of-concept pilot study justify a larger trial on the effect of long-term PAS on leg muscle strength and walking in people with chronic incomplete SCI.
  • Hagner, Marleena Maaria; Hyvönen, Terho; Mikola, Juha; Kemppainen, Riitta; Lindqvist, Bengt; Suojala-Ahlfors, Terhi; Tiilikkala, Kari (2020)
    Agrochemicals and plastics represent a burden on natural ecosystems and there is an urgent need to introduce alternative plant protection measures that have fewer negative impacts on the environment. Replacement of plastic mulches and synthetic pesticides with their biodegradable alternatives offers a way to decrease chemical residues. Pyrolysis liquids (PL) have been suggested as easily degradable and residue-free herbicides for agriculture. We tested the efficiency of PL (1%-10% of volume) containing peat mulch (PLM) in weed control under glasshouse and field conditions. We also estimated the length of the withdrawal period needed between PLM spreading and sowing/planting for crops and examined the light permeability and effects of PLM on soil temperature. In the glasshouse, the mulch amended with 5%-10% PL inhibited weed germination entirely. In the agricultural field, the number of weeds remained 44%-60% lower under PLM than under the control mulch. In a study performed in a city park, weed cover around the base of trees remained 64%-85% lower under PLM than without a mulch. However, a 7-21 d withdrawal period, depending on crop plant species, is needed to avoid injuring the crops. PLM inhibited sunlight effectively and the effects on soil heat sum across the growing season remained small. The weed-inhibiting effect of PLM is probably a result of both the PL compounds and the solid cover, formed by the sticky PL and peat fibres, which acts as a mechanical barrier. We conclude that the PLM is a promising alternative to plastic mulches.
  • Vanttola, Päivi; Puttonen, Sampsa; Karhula, Kati; Oksanen, Tuula; Härmä, Mikko (2020)
    A considerable proportion of shift workers have work schedule-related insomnia and/or excessive sleepiness, a phenomenon described as shift work disorder (SWD). There is yet a lack of evidence on whether or not employees recover from symptoms of SWD between work shifts. We studied whether SWD and its subtypes are associated with insomnia and excessive sleepiness during weekly non-work days and with 24-h sleep time. Hospital employees answered a survey on SWD, insomnia and excessive sleepiness on weekly non-work day s, and 24-h sleep. To identify shift workers with night shifts (n=2,900, 18% with SWD) and SWD, we linked survey responses to employers' register on NI orking hours. SWD included three subtypes: insomnia only (SWD-I, 4%, n=102), excessive sleepiness only (SWD-Es, 8%, n=244), and both insomnia and excessive sleepiness (SWD-IEs, 6%, n=183). Based on regression analy ses, SWD was associated with excessive sleepiness on non-work days (OR: 1.42, 95% CI: 1.07-1.88) and with insomnia on non-work days (0.53, 0.31-0.91). SWD-I was associated with excessive sleepiness on non-work days (2.25, 1.31-3.87) and with shorter sleep (7-7.5 h: 1.96, 1.06-3.63; = 8 h). The results suggest that especially employees with SWD-I may need longer time to overcome excessive sleepiness than allowed by their roster.
  • Milardi, Marco; Gavioli, Anna; Soininen, Janne; Castaldelli, Giuseppe (2019)
    Exotic species invasions often result in native biodiversity loss, i.e. a lower taxonomic diversity, but current knowledge on invasions effects underlined a potential increase of functional diversity. We thus explored the connections between functional diversity and exotic species invasions, while accounting for their environmental drivers, using a fine-resolution large dataset of Mediterranean stream fish communities. While functional diversity of native and exotic species responded similarly to most environmental constraints, we found significant differences in the effects of altitude and in the different ranking of constraints. These differences suggest that invasion dynamics could play a role in overriding some major environmental drivers. Our results also showed that a lower diversity of ecological traits in communities (about half of less disturbed communities) corresponded to a high invasion degree, and that the exotic component of communities had typically less diverse ecological traits than the native one, even when accounting for stream order and species richness. Overall, our results suggest that possible outcomes of severe exotic species invasions could include a reduced functional diversity of invaded communities, but analyzing data with finer ecological, temporal and spatial resolutions would be needed to pinpoint the causal relationship between invasions and functional diversity.
  • Olafsdottir, Steinunn A.; Jonsdottir, Helga; Bjartmarz, Ingibjorg; Magnusson, Charlotte; Caltenco, Hector; Kyto, Mikko; Maye, Laura; McGookin, David; Arnadottir, Solveig Asa; Hjaltadottir, Ingibjorg; Hafsteinsdottir, Thora B. (2020)
    BackgroundTechnical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors. Caregivers are often able and willing to assist with home-based exercise and physical activity but lack the knowledge and resources to do so. ActivABLES was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. The aim of our study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality.MethodsA convergent design of mixed methods research in which quantitative results were combined with personal experiences of a four-week use of ActivABLES by community-dwelling stroke survivors with support from their caregivers. Data collection before, during and after the four-week period included the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG) and Five Times Sit to Stand Test (5xSST) and data from motion detectors. Semi-structured interviews were conducted with stroke survivors and caregivers after the four-week period. Descriptive statistics were used for quantitative data. Qualitative data was analysed with direct content analysis. Themes were identified related to the domains of feasibility: acceptability, demand, implementation and practicality. Data was integrated by examining any (dis)congruence in the quantitative and qualitative findings.ResultsTen stroke survivors aged 55-79years participated with their informal caregivers. Functional improvements were shown in BBS (+2.5), ABC (+0.9), TUG (-4.2) and 5xSST (-2.7). More physical activity was detected with motion detectors (stand up/sit down +2, number of steps +227, standing +0.3h, hours sitting/lying -0.3h). The qualitative interviews identified themes for each feasibility domain: (i) acceptability: appreciation, functional improvements, self-initiated activities and expressed potential for future stroke survivors; (2) demand: reported use, interest in further use and need for follow-up; (3) implementation: importance of feedback, variety of exercises and progression of exercises and (4) practicality: need for support and technical problems. The quantitative and qualitative findings converged well with each other and supported the feasibility of ActivABLES.ConclusionsActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes. Further studies are needed with larger samples.
  • Inkinen, Nina; Jukarainen, Sakari; Wiersema, Renske E.; Poukkanen, Meri; Pettilä, Ville; Vaara, Suvi T. (2021)
    Purpose: Whether positive fluid balance among patients with acute kidney injury (AKI) stems from decreased urine output, overzealous fluid administration, or both is poorly characterized. Materials and methods: This was a post hoc analysis of the prospective multicenter observational Finnish Acute Kidney Injury study including 824 AKI and 1162 non-AKI critically ill patients. Results: We matched 616 AKI (diagnosed during the three first intensive care unit (ICU) days) and non-AKI patients using propensity score. During the three first ICU days, AKI patients received median [IQR] of 11.4 L [8.0-15.2]L fluids and non-AKI patients 10.2 L [7.5-13.7]L, p < 0.001 while the fluid output among AKI patients was 4.7 L [3.0-7.2]L and among non-AKI patients 5.8 L [4.1-8.0]L, p < 0.001. In AKI patients, the median [IQR] cumulative fluid balance was 2.5 L [-0.2-6.0]L compared to 0.9 L [-1.4-3.6]L among non-AKI patients, p < 0.001. Among the 824 AKI patients, smaller volumes of fluid input with a multivariable OR of 0.90 (0.88-0.93) and better fluid output (multivariable OR 1.12 (1.07-1.18)) associated with enhanced change of resolution of AKI. Conclusions: AKI patients received more fluids albeit having lower fluid output compared to matched critically ill non-AKI patients. Smaller volumes of fluid input and higher fluid output were associated with better AKI recovery. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://
  • Bauer, Barbara; Gustafsson, Bo; Hyytiäinen, Kari; Meier, Markus; Muller-Karulis, Bärber; Saraiva, Sofia; Tomczak, Maciej (2019)
    We developed numerical simulations of potential future ecological states of the Baltic Sea ecosystem at the end of century under five scenarios. We used a spatial food web (Ecospace) model, forced by a physical-biogeochemical model. The scenarios are built on consistent storylines that describe plausible developments of climatic and socioeconomic factors in the Baltic Sea region. Modelled species diversity and fish catches are driven by climate- and nutrient load-related changes in habitat quality and by fisheries management strategies. Our results suggest that a scenario including low greenhouse gas concentrations and nutrient pollution and ecologically focused fisheries management results in high biodiversity and catch value. On the other hand, scenarios envisioning increasing societal inequality or economic growth based on fossil fuels, high greenhouse gas emissions and high nutrient loads result in decreased habitat quality and diminished biodiversity. Under the latter scenarios catches are high but they predominantly consist of lower-valued fish.
  • CTR-TBI Participants Investigators; Andelic, Nada; Roe, Cecilie; Brunborg, Cathrine; von Steinbuechel, Nicole; Palotie, Aarno; Piippo-Karjalainen, Anna; Pirinen, Matti; Raj, Rahul; Ripatti, Samuli (2021)
    Background Fatigue is one of the most commonly reported subjective symptoms following traumatic brain injury (TBI). The aims were to assess frequency of fatigue over the first 6 months after TBI, and examine whether fatigue changes could be predicted by demographic characteristics, injury severity and comorbidities. Methods Patients with acute TBI admitted to 65 trauma centers were enrolled in the study Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI). Subjective fatigue was measured by single item on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), administered at baseline, three and 6 months postinjury. Patients were categorized by clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU). Injury severity, preinjury somatic- and psychiatric conditions, depressive and sleep problems were registered at baseline. For prediction of fatigue changes, descriptive statistics and mixed effect logistic regression analysis are reported. Results Fatigue was experienced by 47% of patients at baseline, 48% at 3 months and 46% at 6 months. Patients admitted to ICU had a higher probability of experiencing fatigue than those in ER and ADM strata. Females and individuals with lower age, higher education, more severe intracranial injury, preinjury somatic and psychiatric conditions, sleep disturbance and feeling depressed postinjury had a higher probability of fatigue. Conclusion A high and stable frequency of fatigue was found during the first 6 months after TBI. Specific socio-demographic factors, comorbidities and injury severity characteristics were predictors of fatigue in this study.
  • Int Stroke Genetics Consortium; NINDS-SiGN Consortium; Genetics Ischaemic Stroke Funct; Söderholm, Martin; Pedersen, Annie; Strbian, Daniel; Tatlisumak, Turgut (2019)
    Objective To discover common genetic variants associated with poststroke outcomes using a genome-wide association (GWA) study. Methods The study comprised 6,165 patients with ischemic stroke from 12 studies in Europe, the United States, and Australia included in the GISCOME (Genetics of Ischaemic Stroke Functional Outcome) network. The primary outcome was modified Rankin Scale score after 60 to 190 days, evaluated as 2 dichotomous variables (0-2 vs 3-6 and 0-1 vs 2-6) and subsequently as an ordinal variable. GWA analyses were performed in each study independently and results were meta-analyzed. Analyses were adjusted for age, sex, stroke severity (baseline NIH Stroke Scale score), and ancestry. The significance level was p <5 x 10(-8). Results We identified one genetic variant associated with functional outcome with genome-wide significance (modified Rankin Scale scores 0-2 vs 3-6, p = 5.3 x 10(-9)). This intronic variant (rs1842681) in the LOC105372028 gene is a previously reported trans-expression quantitative trait locus for PPP1R21, which encodes a regulatory subunit of protein phosphatase 1. This ubiquitous phosphatase is implicated in brain functions such as brain plasticity. Several variants detected in this study demonstrated suggestive association with outcome (p <10(-5)), some of which are within or near genes with experimental evidence of influence on ischemic stroke volume and/or brain recovery (e.g., NTN4, TEK, and PTCH1). Conclusions In this large GWA study on functional outcome after ischemic stroke, we report one significant variant and several variants with suggestive association to outcome 3 months after stroke onset with plausible mechanistic links to poststroke recovery. Future replication studies and exploration of potential functional mechanisms for identified genetic variants are warranted.
  • Int Stroke Genetics Consortium; NINDS-SiGN Consortium; Maguire, Jane M.; Bevan, Steve; Stanne, Tara M.; Strbian, Daniel; Tatlisumak, Turgut; Lindgren, Arne (2017)
    Introduction: Genome-wide association studies have identified several novel genetic loci associated with stroke risk, but how genetic factors influence stroke outcome is less studied. The Genetics of Ischaemic Stroke Functional outcome network aims at performing genetic studies of stroke outcome. We here describe the study protocol and methods basis of Genetics of Ischaemic Stroke Functional outcome. Methods: The Genetics of Ischaemic Stroke Functional outcome network has assembled patients from 12 ischaemic stroke projects with genome-wide genotypic and outcome data from the International Stroke Genetics Consortium and the National Institute of Neurological Diseases Stroke Genetics Network initiatives. We have assessed the availability of baseline variables, outcome metrics and time-points for collection of outcome data. Results: We have collected 8831 ischaemic stroke cases with genotypic and outcome data. Modified Rankin score was the outcome metric most readily available. We detected heterogeneity between cohorts for age and initial stroke severity (according to the NIH Stroke Scale), and will take this into account in analyses. We intend to conduct a first phase genome-wide association outcome study on ischaemic stroke cases with data on initial stroke severity and modified Rankin score within 60-190 days. To date, we have assembled 5762 such cases and are currently seeking additional cases meeting these criteria for second phase analyses. Conclusion: Genetics of Ischaemic Stroke Functional outcome is a unique collection of ischaemic stroke cases with detailed genetic and outcome data providing an opportunity for discovery of genetic loci influencing functional outcome. Genetics of Ischaemic Stroke Functional outcome will serve as an exploratory study where the results as well as the methodological observations will provide a basis for future studies on functional outcome. Genetics of Ischaemic Stroke Functional outcome can also be used for candidate gene replication or assessing stroke outcome non-genetic association hypotheses.
  • Mattila, Kristiina; Lahtela, Merja; Hynynen, Markku (2012)
  • Kulesskaya, Natalia; Molotkov, Dmitry; Sliepen, Sonny; Mugantseva, Ekaterina; Garcia Horsman, Arturo; Paveliev, Mikhail; Rauvala, Heikki (2021)
    Heparin-binding growth-associated molecule (pleiotrophin) is a neurite outgrowth-promoting secretory protein that lines developing fiber tracts in juvenile CNS (central nervous system). Previously, we have shown that heparin-binding growth-associated molecule (HB-GAM) reverses the CSPG (chondroitin sulfate proteoglycan) inhibition on neurite outgrowth in the culture medium of primary CNS neurons and enhances axon growth through the injured spinal cord in mice demonstrated by two-photon imaging. In this study, we have started studies on the possible role of HB-GAM in enhancing functional recovery after incomplete spinal cord injury (SCI) using cervical lateral hemisection and hemicontusion mouse models. In vivo imaging of blood-oxygen-level-dependent (BOLD) signals associated with functional activity in the somatosensory cortex was used to assess the sensory functions during vibrotactile hind paw stimulation. The signal displays an exaggerated response in animals with lateral hemisection that recovers to the level seen in the sham-operated mice by injection of HB-GAM to the trauma site. The effect of HB-GAM treatment on sensory-motor functions was assessed by performance in demanding behavioral tests requiring integration of afferent and efferent signaling with central coordination. Administration of HB-GAM either by direct injection into the trauma site or by intrathecal injection improves the climbing abilities in animals with cervical hemisection and in addition enhances the grip strength in animals with lateral hemicontusion without affecting the spontaneous locomotor activity. Recovery of sensory signaling in the sensorimotor cortex by HB-GAM to the level of sham-operated mice may contribute to the improvement of skilled locomotion requiring integration of spatiotemporal signals in the somatosensory cortex.
  • Salminen, Sarianna; Tammelin, Mira; Jilbert, Tom; Fukumoto, Yu; Saarni, Saija (2021)
    The influence of lake restoration efforts on lake bottom-water conditions and varve preservation is not well known. We studied varved sediments deposited during the last 80 years along a water-depth transect in the Enonsaari Deep, a deep-water area of the southernmost Enonselka Basin, Lake Vesijarvi, southern Finland. For the last few decades, the Enonselka Basin has been subject to ongoing restoration efforts. Varve, elemental, and diatom analyses were undertaken to explore how these actions and other human activities affected varve preservation in the Enonsaari Deep. In contrast to most varved Finnish lakes, whose water columns have a natural tendency to stratify, and possess varve records that span thousands of years, varve formation and preservation in Lake Vesijarvi was triggered by relatively recent anthropogenic stressors. The multi-core varve analysis revealed that sediment in the Enonsaari Deep was initially non-varved, but became fully varved in the late 1930s, a time of increasing anthropogenic influence on the lake. The largest spatial extent of varves occurred in the 1970s, which was followed by a period of less distinguishable varves, which coincided with diversion of sewage from the lake. Varve preservation weakened during subsequent decades and was terminated completely by lake aeration in the 2010s. Despite improvements in water quality, hypolimnetic oxygen depletion and varve preservation persisted beyond the reduction in sewage loading, initial aeration, and biomanipulation. These restoration efforts, however, along with other human actions such as harbor construction and dredging, did influence varve characteristics. Varves were also influenced by diatom responses to anthropogenic forcing, because diatoms form a substantial part of the varve structure. Of all the restoration efforts, a second episode of aeration seems to have had the single most dramatic impact on profundal conditions in the basin, resulting in replacement of a sediment accumulation zone by a transport or erosional zone in the Enonsaari Deep. We conclude that human activities in a lake and its catchment can alter lake hypolimnetic conditions, leading to shifts in lake bottom dynamics and changes in varve preservation.
  • Parviainen, Tuuli; Goerlandt, Floris; Helle, Inari; Haapasaari, Päivi; Kuikka, Sakari (2021)
    The risk of a large-scale oil spill remains significant in marine environments as international maritime transport continues to grow. The environmental as well as the socio-economic impacts of a large-scale oil spill could be substantial. Oil spill models and modeling tools for Pollution Preparedness and Response (PPR) can support effective risk management. However, there is a lack of integrated approaches that consider oil spill risks comprehensively, learn from all information sources, and treat the system uncertainties in an explicit manner. Recently, the use of the international ISO 31000:2018 risk management framework has been suggested as a suitable basis for supporting oil spill PPR risk management. Bayesian networks (BNs) are graphical models that express uncertainty in a probabilistic form and can thus support decision-making processes when risks are complex and data are scarce. While BNs have increasingly been used for oil spill risk assessment (OSRA) for PPR, no link between the BNs literature and the ISO 31000:2018 framework has previously been made. This study explores how Bayesian risk models can be aligned with the ISO 31000:2018 framework by offering a flexible approach to integrate various sources of probabilistic knowledge. In order to gain insight in the current utilization of BNs for oil spill risk assessment and management (OSRA-BNs) for maritime oil spill preparedness and response, a literature review was performed. The review focused on articles presenting BN models that analyze the occurrence of oil spills, consequence mitigation in terms of offshore and shoreline oil spill response, and impacts of spills on the variables of interest. Based on the results, the study discusses the benefits of applying BNs to the ISO 31000:2018 framework as well as the challenges and further research needs.
  • Repo, Jussi P.; Häkkinen, Arja H.; Porkka, Tuukka; Häkkinen, Keijo; Kautiainen, Hannu; Kyrölä, Kati; Neva, Marko H. (2019)
    Purpose: Interleukin 6 (IL-6) and the acute phase C-reactive protein (CRP) blood concentrations after lumbar spine fusion may be affected by age. The purpose of this prospective observational study was to assess postoperative serum levels of pro-inflammatory IL-6 and CRP after instrumented lumbar spine fusion surgery. We hypothesized that older patients would have increased levels of IL-6 and CRP after surgery. Methods: IL-6 and high-sensitive CRP biochemical marker levels were measured before instrumented spinal fusion, and postoperatively at 1 and 3 days, 6 weeks, and 3 months. The 49 patients in this sample were divided into two groups: age 60 years (n = 26). Results: Acute changes in IL-6 high-sensitivity and CRP from preoperative levels to postoperative day (POD) 1 increased with age. Mean (95% CI) difference between the age-groups in changes of IL-6 at PODs 1 and 3 was 45 pg/ml (10-83, p = 0.014) and 20 pg/ml (5-36, p = 0.021), respectively. Mean (95% CI) difference between groups in changes of CRP at PODs 1 and 3 was 9.6 mg/l (-3.5 to 22.7, p = 0.47) and 24.8 mg/l (-17 to 67, p = 0.33), respectively. Both groups had decreased IL-6 and CRP levels at 6 weeks after surgery compared to the preoperative level. Conclusions: Elevation of IL-6 and CRP is stronger in patients over 60 years old after instrumented lumbar spinal fusion. The CRP and IL-6 are sensitive markers for acute postoperative inflammation. Even high acute CRP values do not necessarily indicate postoperative infection.
  • Broman, Jenna; Aarnio, Karoliina; But, Anna; Marinkovic, Ivan; Rodríguez-Pardo, Jorge; Kaste, Markku; Tatlisumak, Turgut; Putaala, Jukka (2022)
    Objective Data on post-stroke use of antidepressants in young individuals are scarce. We examined pattern and factors associated with initiating post-stroke antidepressants (PSAD) after ischemic stroke (IS) in young adults. Methods Helsinki Young Stroke Registry includes patients aged 15-49 years with first-ever IS, 1994-2007. Data on prescriptions, hospitalizations and death came from nationwide registers. We defined time of initiating PSAD as time of the first filled prescription for antidepressants within 1 year from IS. We assessed factors associated with initiating PSAD with multivariable Cox regression models, allowing for time-varying effects when appropriate. Results We followed 888 patients, of which 206 (23.2%) initiated PSAD. Higher hazard of starting PSAD within the first 100 days appeared among patients with mild versus no limb paresis 2.53 (95% confidence interval 1.48-4.31) and during later follow-up among those with silent infarcts (2.04; 1.27-3.28), prior use of antidepressants (2.09; 1.26-3.46) and moderate versus mild stroke (2.06; 1.18-3.58). The relative difference in the hazard rate for moderate-severe limb paresis persisted both within the first 100 days (3.84, 2.12-6.97) and during later follow-up (4.54; 2.51-8.23). The hazard rate was higher throughout the follow-up among smokers (1.48; 1.11-1.97) as well as lower (1.78; 1.25-2.54) and upper white-collar workers (2.00; 1.24-3.23) compared to blue-collar workers. Conclusion One-fourth of young adults started PSADs within 1 year from IS. We identified several specific clinical characteristics associated with PSAD initiation, highlighting their utility in assessing the risk of post-stroke depression during follow-up.