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Acute kidney injury is a common sequela after major burn injury, but only a small proportion of patients need renal replacement therapy. In the majority of patients, need for renal replacement therapy subsides before discharge from the burn center but limited literature exists on long-term outcomes. A few studies report an increased risk for chronic renal failure after burn injury. We investigated the long-term outcome of severely burned patients receiving renal replacement therapy during acute burn injury treatment. Data on 68 severely burned patients who received renal replacement therapy in Helsinki Burn Centre between November 1988 and December 2015 were collected retrospectively. Thirty-two patients survived and remained for follow-up after the primary hospital stay until December 31, 2016. About 56.3% of discharged patients were alive at the end of follow-up. In 81.3% of discharged patients, need for renal replacement therapy subsided before discharge. Two patients received renal replacement therapy for longer than 3 months; however, need for renal replacement therapy subsided in both patients. One patient required dialysis several years later on after the need for renal replacement therapy had subsided. This study showed that long-term need for renal replacement therapy is rare after severe burn injury. In the vast majority of patients, need for renal replacement therapy subsided before discharge from primary care. Acute kidney injury in association with burns is a potential but small risk factor for later worsening of kidney function in fragile individuals. [ABSTRACT FROM AUTHOR]

Introduction: Three migrant population studies conducted in Finland over this decade (Migrant Health and Wellbeing Study, Survey on work and well-being among people of foreign origin and Asylum Seekers Health and Wellbeing Survey) has shown that immigrants, especially those who come to Finland as refugees or from similar conditions, experience a higher level of psychological load than general population. Objectives: The aim is to explain how Finland builds the mental health services for refugees. Methods: The PALOMA project (Developing National Mental Health Policies for Refugees) was launched in 2016 to tackle this wellbeing cap in the population. One outcome of the project was PALOMA handbook. The handbook includes recommendations and tools for promoting refugees' mental health and to enhance the services. During the project the need for the regional centers of expertise on refugees mental health work was recognized. To fulfill this need the PALOMA2 project (National support system for refugee mental health work and the knowhow dissemination) started in February 2019. The tasks of the Centre are to coordinate the refugees' mental health work, build networks and organize training. It also provides clinical guidance and consultation and develops the services by implementing best practices. The tasks are assigned to all five university hospitals. Therefore the Centre of Expertise covers the whole country. Results: As a result of the PALOMA work the mental health work with the refugees will be systematically organized as a part of the service system. Conclusions: The PALOMA work has systematically improved the mental health services of the refugees in Finland. [ABSTRACT FROM AUTHOR]

Background: Swine flu might serve as a model for challenges that primary care faces during pandemics. This study examined changes in the numbers and diagnoses of general practitioner (GP) visits during and after the Swine flu pandemic in Vantaa, a Finnish city, and how GP activities recovered after the pandemic. Putative sex and age group differences were also evaluated., Methods: The study was an observational retrospective study. The monthly number of patient visits to primary care GPs by women and men in age groups 0-19, 20-64 and 65 + years was recorded before, during and two years after the Swine flu pandemic. The recorded diagnoses were also examined. The investigation period was from 2008 to 2012., Results: The numbers of monthly visits to primary care decreased from 12 324 (mean) to 10 817 in women and from 8563 to 7612 in men during the first six months of the Swine flu, returning to the original level afterwards. This decrease was thus slightly more prominent in women. However, as the size of the population increased during the follow-up period, the actual number of GP visits adjusted for the size of population remained at a decreased level for two years after the Swine flu. This decrease was observed especially in office-hours visits of men (from 3692 to 3260) and women (from 6301 to 5428) of 20-64 years. Swine flu did not alter the number of visits to the primary care Emergency Department. The proportion of visits with diagnostic recordings of common infectious diseases mostly decreased during the Swine flu. Only a minor impact on the distribution of recordings of chronic diagnoses was found., Conclusion: A pandemic, such as Swine flu, may decrease office-hours visits to primary care GPs. This in turn may lead to activities of primary care being adjusted downward for a long time following the pandemic. Especially the age group 20-64 years may be affected. This risk should be considered when recovery from the COVID-19 pandemic begins. Swine flu did not affect the proportion of consultations of chronic diseases, but the number of diagnoses of common infectious diseases had diminished., (© 2024. The Author(s).)

Fabricating dispersed single atoms and size-controlled metal nanoclusters remains a difficult challenge due to sintering. Here, we demonstrate that atoms and clusters can be immobilized using atomically clean defect-engineered graphene as the matrix. The graphene is first cleaned of surface contamination with laser heating, after which low-energy Ar irradiation is used to create spatially well-separated vacancies into it. Metal atoms are then evaporated either via thermal or ebeam evaporation onto graphene, where they diffuse until being trapped into a vacancy. The density of embedded structures can be controlled through irradiation dose, and the size of the structures through evaporation time. The resulting structures are confirmed through atomic-resolution scanning transmission electron microscopy and electron energy loss spectroscopy. We demonstrate here incorporation of Al, Ti, Fe, Ag and Au single atoms or nanoclusters, but the method should work equally well for other elements., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jani Kotakoski reports financial support was provided by Austrian Science Fund. Harriet Ahlgren reports financial support was provided by Austrian Science Fund. Kimmo Mustonen reports financial support was provided by Austrian Science Fund. Toma Susi reports financial support was provided by European Research Council. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The van der Waals atomic solids of noble gases on metals at cryogenic temperatures were the first experimental examples of two-dimensional systems. Recently, such structures have also been created on surfaces under encapsulation by graphene, allowing studies at elevated temperatures through scanning tunnelling microscopy. However, for this technique, the encapsulation layer often obscures the arrangement of the noble gas atoms. Here we create Kr and Xe clusters in between two suspended graphene layers, and uncover their atomic structure through transmission electron microscopy. We show that small crystals (N < 9) arrange on the basis of the simple non-directional van der Waals interaction. Larger crystals show some deviations, possibly enabled by deformations in the encapsulating graphene lattice. We further discuss the dynamics of the clusters within the graphene sandwich, and show that although all the Xe clusters with up to N ≈ 100 remain solid, Kr clusters with already N ≈ 16 turn occasionally fluid under our experimental conditions (under a pressure of ~0.3 GPa). This study opens a way for the so-far unexplored frontier of encapsulated two-dimensional van der Waals solids with exciting possibilities for fundamental condensed-matter physics research and possible applications in quantum information technology., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Previous electroencephalography (EEG) studies have indicated altered brain oscillatory α-band activity in schizophrenia, and treatment with repetitive transcranial magnetic stimulation (rTMS) using individualized α-frequency has shown therapeutic effects. Magnetic resonance imaging-based neuronavigation methods allow stimulation of a specific cortical region and improve targeting of rTMS; therefore, we sought to study the efficacy of navigated, individual α-peak-frequency-guided rTMS (αTMS) on treatment-refractory schizophrenia., Methods: We recruited medication-refractory male patients with schizophrenia or schizoaffective disorder in this doubleblind, sham-controlled study. We randomized patients to a 3-week course of either active αTMS or sham stimulation applied to the left dorsolateral prefrontal cortex (DLPFC). We assessed participants with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale (CGI) at baseline and after treatment. We conducted a follow-up assessment with the PANSS 3 months after intervention., Results: We included 44 patients. After treatment, we observed a significantly higher PANSS total score ( p = 0.029), PANSS general psychopathology score ( p = 0.027) and PANSS 5-factor model cognitive-disorganized factor score ( p = 0.011) in the αTMS group than the sham group. In addition, the CGI-Improvement score was significantly higher among those who received αTMS compared with sham stimulation ( p = 0.048)., Limitations: The limited number of study participants included only male patients. Depression was not formally evaluated., Conclusion: Navigated αTMS to the left DLPFC reduced total, general psychopathological, and cognitive-disorganized symptoms of schizophrenia. These results provide evidence for the therapeutic efficacy of individual α-peak-frequency-guided rTMS in treatment-refractory schizophrenia., Clinical Trial Registration: NCT01941251; ClinicalTrials.gov., Competing Interests: Competing interests:: Sara Määttä is vice president of the Finnish Society of Clinical Neurophysiology. Petro Julkunen reports unrelated consulting fees and a patent with Nexstim Plc. No other competing interests were declared., (© 2024 CMA Impact Inc. or its licensors.)

Background: Laparoscopic ventral hernia repair (LVHR) may be associated with chronic pain, seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence and poor quality of life (QoL). Our study evaluates whether robotic-assisted ventral hernia repair (rVHR) diminishes these complications compared to LVHR with primary closure of the defect (hybrid)., Methods: Thirty-eight consecutive patients undergoing incisional ventral hernia operation with fascial defect size from 3 to 6 cm were recruited between November 2019 and October 2020. Nineteen patients underwent rVHR and nineteen underwent hybrid operation. The main outcome measure was postoperative pain, evaluated with a visual analogue scale (VAS: 0-10) at 1-month and at 1-year. Hernia recurrence was evaluated with ultrasound examination and QoL using the generic SF-36 short form questionnaire., Results: At the 1-month control visit, VAS scores were significantly lower in the rVHR group; 2.5 in the hybrid group and 0.3 in the rVHR group ( p  < 0.001). At the 1-year control, the difference in VAS scores was still significant, 2.8 vs 0.1 ( p  = 0.023). There was one hernia recurrence in the hybrid group ( p  = 0.331). QoL did not differ significantly between the study groups when compared to preoperative physical status at 1-year follow-up ( p  = 0.121). However, emotional status ( p  = 0.049) and social functioning ( p  = 0.039) improved significantly in the rVHR group., Conclusions: Robotic-assisted ventral hernia repair (rVHR) was less painful compared to hybrid repair at 1-month and at 1-year follow-up. In addition, improvement in social functioning status was reported with rVHR., Trial Registration Id: 5200658.

This study, conducted in a Finnish city, examined whether a long-lasting observed trend in Finnish primary health care, namely, a decreasing rate of office-hour visits to general practitioners (GPs), would lead to reduced services for specific gender, diagnosis or age groups. This was an observational retrospective follow-up study. The annual number of visits to office-hour primary care GPs in different gender, diagnosis and age groups was recorded during a 13-year follow-up period. The effect of the decreasing visit rate on the annual mortality rate in different age and gender groups was also studied. The total number of monthly visits to office-hour GPs decreased slowly over the whole study period. This decrease was stronger in women and older people. The proportion of recorded infectious diseases (Groups A and J and especially diagnoses related to infections of respiratory airways) decreased. Proportions of recorded chronic diseases increased (Group I, cardiovascular diseases, diabetes and osteoarthrosis) during the follow-up. The annual rate of visits to office-hour GP/per GP decreased. There was a decrease in the mortality in two of the age groups (20-64, 65+ years) and no change in the youngest population (0-19 years). The decrease in the office-hours GP activity does not seem to increase mortality either.

Substituting heteroatoms into graphene can tune its properties for applications ranging from catalysis to spintronics. The further recent discovery that covalent impurities in graphene can be manipulated at atomic precision using a focused electron beam may open avenues towards sub-nanometer device architectures. However, the preparation of clean samples with a high density of dopants is still very challenging. Here, we report vacancy-mediated substitution of aluminium into laser-cleaned graphene, and without removal from our ultra-high vacuum apparatus, study their dynamics under 60 keV electron irradiation using aberration-corrected scanning transmission electron microscopy and spectroscopy. Three- and four-coordinated Al sites are identified, showing excellent agreement with ab initio predictions including binding energies and electron energy-loss spectrum simulations. We show that the direct exchange of carbon and aluminium atoms predicted earlier occurs under electron irradiation, although unexpectedly it is less probable than the same process for silicon. We also observe a previously unknown nitrogen-aluminium exchange that occurs at Al─N double-dopant sites at graphene divacancies created by our plasma treatment., Competing Interests: Conflict of interest The authors declare no conflicts of interest.

Background: This study, conducted in a Finnish city, examined whether decreasing emergency department (ED) services in an overcrowded primary care ED and corresponding direction to office-hours primary care would modify service usage for specific gender, age or diagnosis groups., Methods: This was an observational retrospective study carried out by gradually decreasing ED services in primary care. The interventions aimed at decreasing use of EDs were a) application of ABCDE-triage combined with public guidance on the proper use of EDs, b) closure of a minor supplementary ED, and finally, c) application of "reverse triage" with enhanced direction of the public to office-hours services and away from the remaining ED The annual number of visits to office-hours primary care GPs in different gender, age and diagnosis groups (International Classification of Diseases (ICD - 10) were recorded during a 13-year follow-up period., Results: The total number of monthly visits to EDs decreased slowly over the whole study period. This decrease was similar in women and men. The decrease was stronger in the youngest age groups (0-19 years). GPs treated decreasing proportions of ICD-10 groups. Recorded infectious diseases (Groups A and J, and especially diagnoses related to infections of respiratory airways) tended to decrease. However, visits due to injuries and symptomatic diagnoses increased., Conclusion: Decreasing services in a primary health care ED with the described interventions seemed to reduce the use of services by young people. The three interventions mentioned above had the effect of making the primary care ED under study appear to function more like a standard ED driven by specialized health care., (© 2022. The Author(s).)

Heterostructures composed of 2D materials are already opening many new possibilities in such fields of technology as electronics and magnonics, but far more could be achieved if the number and diversity of 2D materials were increased. So far, only a few dozen 2D crystals have been extracted from materials that exhibit a layered phase in ambient conditions, omitting entirely the large number of layered materials that may exist at other temperatures and pressures. This work demonstrates how such structures can be stabilized in 2D van der Waals (vdw) stacks under room temperature via growing them directly in graphene encapsulation by using graphene oxide as the template material. Specifically, an ambient stable 2D structure of copper and iodine, a material that normally only occurs in layered form at elevated temperatures between 645 and 675 K, is produced. The results establish a simple route to the production of more exotic phases of materials that would otherwise be difficult or impossible to stabilize for experiments in ambient., (© 2022 The Authors. Advanced Materials published by Wiley-VCH GmbH.)

Proactive and coordinated action to mitigate and adapt to climate change will be essential for achieving the healthy, resilient, safe, sustainably harvested and biodiverse ocean that the UN Decade of Ocean Science and sustainable development goals (SDGs) seek. Ocean-based mitigation actions could contribute 12% of the emissions reductions required by 2030 to keep warming to less than 1.5 ºC but, because substantial warming is already locked in, extensive adaptation action is also needed. Here, as part of the Future Seas project, we use a "foresighting/hindcasting" technique to describe two scenarios for 2030 in the context of climate change mitigation and adaptation for ocean systems. The "business-as-usual" future is expected if current trends continue, while an alternative future could be realised if society were to effectively use available data and knowledge to push as far as possible towards achieving the UN SDGs. We identify three drivers that differentiate between these alternative futures: (i) appetite for climate action, (ii) handling extreme events, and (iii) climate interventions. Actions that could navigate towards the optimistic, sustainable and technically achievable future include:(i)proactive creation and enhancement of economic incentives for mitigation and adaptation;(ii)supporting the proliferation of local initiatives to spur a global transformation;(iii)enhancing proactive coastal adaptation management;(iv)investing in research to support adaptation to emerging risks;(v)deploying marine-based renewable energy;(vi)deploying marine-based negative emissions technologies;(vii)developing and assessing solar radiation management approaches; and(viii)deploying appropriate solar radiation management approaches to help safeguard critical ecosystems., Supplementary Information: The online version contains supplementary material available at 10.1007/s11160-021-09678-4., Competing Interests: Conflict of interestThe authors declared that they have no conflict of interest., (© Crown 2021.)

One of the most pronounced effects of climate change on the world's oceans is the (generally) poleward movement of species and fishery stocks in response to increasing water temperatures. In some regions, such redistributions are already causing dramatic shifts in marine socioecological systems, profoundly altering ecosystem structure and function, challenging domestic and international fisheries, and impacting on human communities. Such effects are expected to become increasingly widespread as waters continue to warm and species ranges continue to shift. Actions taken over the coming decade (2021-2030) can help us adapt to species redistributions and minimise negative impacts on ecosystems and human communities, achieving a more sustainable future in the face of ecosystem change. We describe key drivers related to climate-driven species redistributions that are likely to have a high impact and influence on whether a sustainable future is achievable by 2030. We posit two different futures-a 'business as usual' future and a technically achievable and more sustainable future, aligned with the Sustainable Development Goals. We then identify concrete actions that provide a pathway towards the more sustainable 2030 and that acknowledge and include Indigenous perspectives. Achieving this sustainable future will depend on improved monitoring and detection, and on adaptive, cooperative management to proactively respond to the challenge of species redistribution. We synthesise examples of such actions as the basis of a strategic approach to tackle this global-scale challenge for the benefit of humanity and ecosystems., Supplementary Information: The online version contains supplementary material available at 10.1007/s11160-021-09641-3., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Crown 2021.)