"Kun ette nyt kuitenkaan kaatuisi" : potilasohje ikääntyneen kaatumisen ennaltaehkäisyyn

Ikääntyneiden kaatumiset ovat suuri kansantaloudellinen ja -terveydellinen ongelma. Joka kolmas kotona asuvista 65-vuotiaista kaatuu kerran vuodessa, laitoksissa asuvista jopa yli puolet. Kaatuminen heikentää iäkkään elämänlaatua kokonaisvaltaisesti, ja aiheuttaa paljon turhaa kipua ja kärsimystä. Ohjaus on hoitotyön auttamismenetelmä, joka määritellään asiakkaan ja hoitajan tavoitteelliseksi toiminnaksi. Ohjauksen tavoitteena on vahvistaa iäkkään selviytymistä kotona hoitosuhteen jälkeen. Tämän opinnäytetyön tarkoituksena oli tuottaa selkeä ikääntyneiden kaatumista ennaltaehkäisevä potilasohje. Opinnäytetyön tavoitteena oli, että potilasohjetta voitaisiin hyödyntää hoitotyön ohjaamistilanteissa. Tavoitteena oli saada luotua potilasohjeesta sellainen, joka toimisi ikääntyneen ja omaisen työvälineenä ikääntyneen arjessa. Tämä opinnäytetyö on luonteeltaan toiminnallinen. Opinnäytetyö oli osa NÄYTKÖ-projektia, joka toteutui Turun hyvinvointitoimialan ja Turun ammattikorkeakoulun yhteistyöhankkeena. Opinnäytetyössä selvitettiin ikääntyneiden kaatumisia ja niiden ennaltaehkäisyä, potilasohjausta sekä luotiin kirjallinen potilasohje. Opinnäytetyön aineisto hankittiin tekemällä kattava kirjallisuuskatsaus sekä haastattelemalla sairaanhoitajia, jotka työskentelivät ikääntyneiden parissa (n=5). Haastattelut toteutuivat kahtena erillisenä fokusryhmähaastatteluna toukokuussa 2013. Aineisto analysoitiin sisällönanalyysia soveltaen. Saatujen tulosten mukaan ikääntyneiden kaatumisia ennaltaehkäistiin puutteellisesti. Kaatumisten ennaltaehkäisyssä avainasemassa ovat toimintakyvyn ja fyysisen kunnon ylläpitäminen, osteoporoosin esto ja hoito, apuvälineiden oikeanlainen käyttö ja ympäristön vaaratekijöiden poisto. Haastatelluiden hoitajien mielestä potilasohjeeseen kuuluu edellisten lisäksi myös tietoa kengistä, lääkkeistä, ravitsemuksesta ja nesteytyksestä, avunpyyntöön soveltuvista välineistä ja tiheävirtsaisuudesta. Ikääntyneet tarvitsevat kirjallisia potilasohjeita tukemaan muistia suullisen ohjauksen lisäksi. Omaiset tulisi ottaa paremmin huomioon ikääntyneitä ohjatessa ja järjestää heille mahdollisuus osallistua ikääntyneen kanssa ohjaustilanteisiin.Elderly falls are a major public health and economic problem. One in three people living in the home of 65-year-old crashes once a year, people living in institutions even more than half. The downfall to reduce the overall quality of life of the elderly, and causes a lot of unnecessary pain and suffering. Control is nursing interventions, which is defined as the client and the caregiver as a purposeful activity. The aim of instruction is to strengthen the survival of elderly home care after a therapeutic relationship. The purpose of this thesis was to produce fall prevention instructions for older patients. The goal was that the instruction could be used in nursing-guidance. The goal was create patient instruction that would work as a tool for the elderly and their relatives in everyday life. This thesis was functional. Thesis is a part of the NÄYTKÖ project, which was implemented with Welfare Division of the City of Turku and the Turku University of Applied Sciences in a collaborative project. The focus of this thesis was clear the elderly falls and prevention, patient education and to create written patient guidance. The material was obtained through a literature review and by interviewing nurses who worked with older people (n=5). Interviews were carried out in two separate focus group interviews in May 2013. The data were analyzed using content analysis. The results show that older people fall prevention has done incomplete. A key roles in falls prevention are functional capacity and physical condition, osteoporosis prevention and treatment, proper use of assistive devices and removal of environmental risk factors. Interviewed nurses think that in written instruction should also contain information about shoes, medicines, nutrition and hydration, appropriate instruments application for assistance and urinary frequency. The elderly need written instructions to support their memory. Relatives should take better account when giving patient guidance to elderly and provide them to have opportunity to participate in elderly guidance situations

A revision of the Ceratopsia or horned dinosaurs.

3 pt.

Inimeseks saamine

Becoming a HumanThis philosophical reflection, written for the Yearbook, looks into the relations between written words, human beings and the humanistic spirit

Convex neural networks and finite element approximation of non-newtonian fluids

LAUREA MAGISTRALENegli ultimi anni, le potenzialità del machine learning sono diventate sempre più evidenti, consolidando la sua presenza in diversi campi scientifici. Questa tesi studia la sostituzione del termine viscoso nell'equazione di Stokes per i fluidi non newtoniani con una Input Convex Neural Network (ICNN), una specifica architettura di rete neurale che mantiene una relazione di convessità tra input e output. La ragione di questa scelta è quella di sfruttare i vantaggi delle reti neurali artificiali rispetto al più tradizionale approccio modellistico per la descrizione della viscosità di un fluido, assicurando al contempo che siano soddisfatte le assunzioni necessarie sul termine viscoso affinché l'equazione di Stokes ammetta una soluzione unica. Per convalidare questo approccio, viene fatto un confronto diretto tra le soluzioni ottenute considerando la tradizionale legge di Carreau (una equazione constitutiva molto usata per modellare fluidi non newtoniani) come legge di viscosità e le soluzioni derivate da un'equazione di Stokes modificata, dove il termine di viscosità è sostituito da una ICNN addestrata su dati campionati dalla stessa legge di Carreau. Questa ricerca contribuisce al crescente corpus di conoscenze che esplora l'intersezione tra machine learning e fluidodinamica e fornisce le basi per ulteriori esplorazioni e sviluppi nell'impiego delle ICNN per la modellazione di fluidi non newtoniani.Over the last few years, the power of machine learning has become increasingly evident, consolidating its presence in various scientific fields. This thesis investigates the substitution of the viscosity term in the Stokes equation for non-Newtonian fluids by employing an Input Convex Neural Network (ICNN): a specific neural network architecture that maintains a convex relationship between input and output. The reason behind this choice is to leverage the advantages of artificial neural networks over the more traditional model-approach for describing the viscosity of a fluid, while ensuring that the necessary assumptions on the viscous term for the Stokes equation to admit a unique solution are met. To validate this method, a direct comparison is made between the solutions obtained by considering the traditional Carreau law (a widely used non-Newtonian constitutive equation) as the viscous law and the solutions derived from a modified Stokes equation, where the viscosity term is replaced by an ICNN trained on data sampled from the Carreau law itself. This research contributes to the growing body of knowledge exploring the intersection of machine learning and fluid dynamics and it provides a foundation for further investigation and development, in employing ICNNs for non-Newtonian fluid modelling

An Overview of the Anticoagulant Drugs Used in Routine Clinical Practice

Anticoagulant drugs directly or indirectly influence coagulation factors preventing fibrin formation thus preventing blot clotting. They are classified into two groups according to the mode of application, namely parenteral and oral drugs. Among the latter, vitamin K antagonists (most often warfarin) were the only available oral drugs and were widely used for almost a century. In the recent years, new oral anticoagulant drugs became available that directly target either factor IIa or Xa. This chapter provides an overview of both parenteral and oral anticoagulant drugs used in clinical practice with description of the mode of action and management of therapy in different clinical settings

The effects of cultural distance and international experience on CEO departure in cross border acquisitions

LAUREA MAGISTRALEIn meno di venti anni, il numero di acquisizioni cross-border, ossia acquisizioni tra imprese i cui rispettivi quartier generali hanno sede in diversi paesi, è più che triplicato. Questa tesi cerca di capire l’impatto che la distanza culturale e l’esperienza internazionale degli amministratori delegati hanno in queste acquisizioni e, in particolare, i loro effetti sulla decisione dell’impresa acquirente di mantenere o meno l'amministratore delegato dell’impresa acquisita. Abbiamo studiato 197 acquisizioni di piccole imprese operanti in settori ad alta tecnologia in cui le conoscenze tacite, le caratteristiche e le capacità del management e dei dirigenti sono un’importante fonte di vantaggio competitivo e in cui il fatto che l’amministratore delegato dell’impresa acquisita lasci il suo incarico può portare al fallimento dell’acquisizione. Basandoci sulla letteratura sul tema, discutiamo teoricamente e mostriamo empiricamente che, maggiore è la distanza culturale tra il paese dell’impresa acquirente e quello dell’impresa acquisita, più alta è la probabilità che l’amministratore delegato dell’impresa acquisita lasci il suo incarico, mentre l'esperienza internazionale di tali amministratori delegati è negativamente correlata alla loro partenza. In particolare, abbiamo diviso l'esperienza internazionale degli amministratori in generale e specifica al paese dell’acquirente (country-specific). L’esperienza generale è calcolata come la somma delle esperienze lavorative maturate in un paese straniero, mentre quella specifica è l'esperienza che l’amministratore delegato dell’impresa acquisita ha maturato in imprese il cui quartier generale ha sede nel paese dell'acquirente. Inoltre, la tesi discute e mostra che questi due tipi di esperienza internazionale possono indebolire l'effetto positivo della distanza culturale sulla probabilità che l’amministratore delegato dell’impresa acquisita lasci il suo incarico in seguito a una operazione di acquisizione cross-border.In less than twenty years, the number of cross-border acquisitions, i.e. acquisitions between firms whose respective headquarters are based in different countries, has more than tripled. This thesis tries to understand the impact of cultural distance and international experience of CEOs have in these acquisitions and, in particular, their effects on the decision of the acquiring company to whether maintain or not the CEO of the acquired one. We studied 197 acquisitions of small high tech firms in which the tacit knowledge, the characteristics and capabilities of management and managers are an important source of competitive advantage and where the departure of the CEO of the acquired company can lead to the failure of the acquisition. Based on the literature on the topic, we discuss theoretically and empirically show that the greater the cultural distance between the country of the acquiring and the acquired firm, the higher is the probability that the CEO of the acquired company leaves the company, while the international experience of these CEOs is negatively related to their departure. In particular, we have divided the international experience of the CEOs in general and specific to the buyer's country (country-specific). The general experience is computed as the sum of work experiences gained in a foreign country, while the specific is the experience that the CEO of the acquired company has gained in companies whose headquarters is based in the buyer's country. In addition, the thesis discusses and shows that these two types of international experience may weaken the positive effect of cultural distance on the probability that the CEO of the acquired company will leave his role following a cross-border acquisition

Noorte organisatsiooniline kuuluvus siirdeaja Eestis: motiivid ja eesmärgid individualiseerumisteooria kontekstis

My master thesis is titled “Organizational Membership of Young People in Transitional Estonia: Purposes and Motives in the Context of Individualization Theory”. The central focus of my study is the influence of individualization and globalization processes on the collective action of young people. It is based on the theoretical paradigm of individualization and risk society which claims that in late modern societies self- determined individuals are in the centre of the society. Several empirical researches and analyses conducted by sociologists indicate to the changes in social sphere and value systems of young people. It is also believed that participation in different collective activities is decreasing among young people in whole Europe. As societal and ethical decisions are individualized, young people must – even though they may not be so inclined – take an individual stand and take responsibility for society’s value decisions, problems and risks. I have set two goals for the master thesis: theoretical and practical. The theoretical goal of this study is to provide a theoretical context for analyzing the perspectives of organizational membership, collective action, the societal coherence of young people and the development of the third sector in Estonia. My aim is to raise the problem and the hypothesis of the research by the individualization and risk theory. The practical purpose of my thesis is to give some tips for the leaders of different organizations about how to reach the members of their organization and motivate young people to take action. While discussing the theoretical and practical issues of my research I wish to find out why young people are becoming less interested in community work. My study is based on 5 focus-group interviews and 4 in-depth interviews. As the thesis is written in a comparative perspective, the data has been gathered from five different types of organizations. All the five organizations are youth organizations that are, according to my presumptions, dependent on global and societal processes. In the first chapter I give a theoretical and an empirical overview of the analyzed field, focusing on the main thesis and empirical data of individualization. My own empirical material comes from different organizations - opinions of the leaders and active members. In the concluding part I answer the questions set in the research. In the discussion section I link my research results with the theoretical and empirical parts presented at the beginning of the thesis. My results indicate to the fact that individualization has in some ways affected the mindset and values of young generation in Estonia, regarding collective action and organizational membership. The main motives for joining any organization are very closely related to people’s personal pragmatic reasons. On the other hand my results show that individualization does not lead organizational and collective work into collapse. Although the values and motives of the younger generation differ from the previous generation, collective action is not disappearing from the society. However, it changes according to the values and priorities of a modern society generation.http://www.ester.ee/record=b3784178*es

Anxiety during pregnancy

Uvod: Anksioznost je običajen odziv, ki nas pripravi na beg pred nevarno situacijo. Z anksioznimi motnjami se v Evropski uniji sooča približno 14 % prebivalstva, pogostejše pa so pri ženskah. Namen: Namen diplomskega dela je bil s pomočjo pregleda literature ugotoviti, kolikšna je razširjenost anksioznosti med nosečnicami in kateri so dejavniki tveganja za nastanek anskioznosti, kakšen vpliv ima na nosečnost, njen izid ter porod in katere meritvene lestvice se uporabljajo v raziskavah za merjenje anksioznosti. Metode dela: Uporabljena je bila opisna oziroma deskriptivna metoda raziskovanja s sistematičnim pregledom strokovne in znanstvene literature. Literatura je bila poiskana s pomočjo slovenskih podatkovnih baz: COBISS in DiKUL, ostala literatura je bila poiskana s pomočjo angleških podatkovnih baz: Google Scholar in Science Direct. Vključeni so bili dostopni članki in literatura v angleškem in slovenskem jeziku od leta 2000 do 2018. Rezultati: Pri približno 6 % nosečnic se razvije anksioznost. Nosečnice, ki se soočajo z anksioznostjo, so nenehno zaskrbljene in imajo občutek, da se jim bo zgodilo nekaj slabega. Visoke ravni anksiozno-depresivnih simptomov pri nosečnicah so povezane z neugodnimi porodnimi rezultati. Rezultati študij, ki so bile vključene v pregled literature, so pokazali, da je anksioznost pogosta duševna motnja v nosečnosti, ki prizadane predvsem nosečnice v zadnjem trimesečju. Na anksioznost v nosečnosti vplivajo slabša izobrazba in ekonomski status nosečnice, starost, medicinski zapleti v prejšnjih nosečnostih, pomanjkanje partnerjeve ter socialne podpore in nasilje. Anksioznost vpliva na duševno zdravje ženske in njeno dobro počutje. Raziskovalci so anksioznost povezali z razvojem preeklampsije, tokofobije, prolongiranim porodom, prezgodnjim porodom in nenačrtovanim carskim rezom. Pri vseh raziskavah, vključenih v pregled literature, so bile uporabljene meritvene lestvice za ugotavljanje anksioznosti. Najpogosteje uporabljeni lestvici sta bili STAI in CES-D. Razprava in zaključek: Zadnje trimesečje v nosečnosti je za žensko še posebej zahtevno obdobje. Spremembe povzročajo, da se v tem obdobju nosečnice pogosto soočajo s strahovi. Pri nezdravljenih duševnih stiskah je povečano tveganje za slabši izid nosečnosti. Z zagotavljanjem rednega izobraževanja zdravstvenih strokovnjakov, ki so pristojni za skrb žensk v rodni dobi, bi lahko bistveno izboljšali način prepoznavanja duševnih stisk, kakršni sta anksioznost in depresija.Introduction: Anxiety is a common response that prepares us to escape from a dangerous situation. Approximately 14 % of the population in the European union confront with anxiety disorders, that are more common in women. Purpose: The purpose of the diploma work is to determine the prevalence of anxiety among pregnant women, risk factors for the onset of anxiety, the impact on pregnancy, its outcome and labour and what measurements are used in reasearch for measuring anxiety. Methods: Descriptive method of research was used with a systematic review of professional and scientific literature. Literature was searched using Slovenian databases: COBISS and DiKUL, and other literature was found using foreign databases: Science Direct and Google Scholar. Accessible articles and literature in the English and Slovenian languages, from 2000 to 2018 were included. Results: About 6 % of pregnant women develop anxiety. Pregnant women with anxiety disorders are constantly worried and have the feeling that something bad will happen. High levels of anxiety-depressive symptoms in pregnant women are associated with unpleasant maternal outcomes. The results of studies that were included in the literature review have showed that anxiety is a common mental disorder in pregnancy and that affects mainly pregnant women in the last trimester. Anxiety in pregnancy is affected by poorer education and economic status of pregnant women, age, medical complications in previous pregnancies, lack of partner, social support and violence. Anxiety affects the mental health of a woman and her well-being. The researchers associated anxiety with the development of preeclampsia, tocophobia, prolonged birth, premature birth and unplanned caesarean section. In all of the studies included in the literature review, measurement scales were used to determine anxiety. The most commonly used scales were STAI and CES-D. Discussion and conclusion: The last trimester of pregnancy is a particularly demanding period for a woman. Changes cause that during this period, pregnant women often face fears. In untreated mental disorders, the risk of a worse outcome of pregnancy is increased. By ensuring the regular education of health professionals who are responsible for the care of women of childbearing age, the way of recognizing mental disorders, such as anxiety and depression, would be significantly improved