PLOS ONE

RESEARCH ARTICLE

Emergency department visits due to hand

trauma and subsequent emergency hand
surgery in three Finnish hospitals during the
first and second waves of COVID-19 pandemic
Ilari Kuitunen ID1,2*, Jarkko Jokihaara3,4, Ville Ponkilainen5, Aleksi Reito5,
Juha Paloneva1,6, Ville M. Mattila4,5, Antti P. Launonen ID5

1 School of Medicine, University of Eastern Finland, Kuopio, Finland, 2 Mikkeli Central Hospital, Mikkeli,
a1111111111
Finland, 3 Department of Hand- and Microsurgery, Tampere University Hospital, Tampere, Finland,
a1111111111 4 Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland, 5 Department of
a1111111111 Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland, 6 Central Finland Hospital,
a1111111111 Jyväskylä, Finland
a1111111111
* ilari.kuitunen@uef.fi

Abstract
OPEN ACCESS

Citation: Kuitunen I, Jokihaara J, Ponkilainen V,

Reito A, Paloneva J, Mattila VM, et al. (2022)
Emergency department visits due to hand trauma Introductions
and subsequent emergency hand surgery in three
Finnish hospitals during the first and second waves The rate of acute hand trauma visits to emergency departments (ED) and surgeries
of COVID-19 pandemic. PLoS ONE 17(2): decreased during the COVID-19 lockdown. Our aim was to analyze the influence of national
e0263435. https://doi.org/10.1371/journal. lockdown during the first wave and the regional restrictions during the second wave on the
pone.0263435
rate of visits to the ED and urgent hand surgeries in Finland.
Editor: Gabriel de Araújo, Universidade Federal
Fluminense, BRAZIL

Received: March 29, 2021 Methods

Accepted: January 19, 2022 Material for this retrospective study was gathered from three Finnish hospitals All ED visits
Published: February 2, 2022 and urgent or emergency surgeries from January 2017 to December 2020 were included.
Peer Review History: PLOS recognizes the Incidences per 100 000 persons with 95% confidence intervals (CI) were calculated and
benefits of transparency in the peer review compared by incidence rate ratios (IRR).
process; therefore, we enable the publication of
all of the content of peer review and author
responses alongside final, published articles. The
editorial history of this article is available here:
Results
https://doi.org/10.1371/journal.pone.0263435 The incidence of hand injury was lower after the beginning of the lockdown in March 2020
Copyright: © 2022 Kuitunen et al. This is an open (IRR 0.70 CI 0.63–0.78). After lockdown ended in May, the monthly incidences of ED visits
access article distributed under the terms of the returned to the reference level. During the lockdown, the incidence of fractures and disloca-
Creative Commons Attribution License, which
tions was 42% lower in March (IRR 0.58 CI 0.50–0.68) and 33% lower in April 2020 (IRR
permits unrestricted use, distribution, and
reproduction in any medium, provided the original 0.67 CI 0.57–0.80). The incidence of fracture repair surgeries was 43% lower in March 2020
author and source are credited. (IRR 0.57 CI 0.35–0.93) and 41% lower in July 2020 (IRR 0.59 CI 0.36–0.98). Incidence of
Data Availability Statement: Data cannot be replantation was 49% higher in March 2020 (IRR 1.49 CI 0.53–4.20) and 200% higher in
shared publicly because of Finnish register July 2020 (IRR 3.00 CI 0.68–13.2) but these increases had high uncertainty.

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PLOS ONE Hand trauma visits and emergency hand surgery during the first and second waves of COVID-19 pandemic

legislation. Data are available from the participating Conclusions

hospitals Institutional Data Access Committee for
researchers who meet the criteria for access to The rate of ED visits due to hand injuries decreased while the rate of emergency hand oper-
confidential data as this data contains sensitive ations remained unchanged during the national COVID-19 lockdown in spring. After the
information. Research permission requests to lockdown, the incidences returned to reference level and were unaffected by regional
obtain the access to data can be submitted to satu.
yla-mononen@pshp.fi in Tampere University
restrictions during the second wave of pandemic.
Hospital, paivi.lampinen@ksshp.fi in Central
Finland Hospital and pirkko.tikkanen@essote.fi in
Mikkeli Central Hospital.

Funding: The authors received no specific funding

for this work.
Introduction
Competing interests: The authors have declared
On March 12, 2020, the World Health Organization declared COVID-19 a global pandemic
that no competing interests exist.
[1]. In Finland, the Government declared a state of emergency and nationwide lockdown and
implemented several measures to enforce social distancing on March 16. These measures
included a ban on social gatherings of more than 10 persons, the closure of external borders,
and Finnish citizens returning from abroad were ordered to stay in quarantine at home for
two weeks. In addition, public institutions, including primary schools, were closed and work-
ing remotely from home, where possible, was encouraged. These restrictions remained in
force until the end of May 2020 [2]. As the second wave began in September 2020 in Finland,
were regional stepwise restrictions used instead of nationwide lockdown.
Although surgical societies have provided guidelines on how to treat and operate surgical
patients with COVID-19 [3,4], the effects of social restrictions on the demand for surgical care
is not well understood. Following the start of the nationwide lockdown in the UK in March
2020, the rate of hand traumas referred to the Hand Trauma Clinic in London decreased by
75%, after which rates slowly returned to normal during April [5]. Another recent French
study from Paris reported that although the overall rate of hand injuries decreased during the
lockdown, domestic hand injuries increased when compared to the rate in 2019, whereas
work-related injuries decreased. Moreover, a larger proportion of the patients admitted with
hand injuries in Paris required operative treatment in 2020 (52%) compared to the corre-
sponding dates in 2019 (37%) [6]. Trauma operations decreased by 30% in Finnish children
during the first wave of the pandemic, but the decrease was mainly due to reduced rates of
lower limb injuries, whereas the rate of upper limb operations remained nearly unchanged
compared to pre-pandemic era [7]. The association between lockdown and change in the risk
for hand injury is not straightforward because the majority of hand injuries occur in domestic
or other everyday situations, and therefore the rate did not slow down during the lockdown
[8].
The aim of our study was to describe the influence of the national lockdown, social distanc-
ing, regional restrictions and remote working on the number of visits to emergency depart-
ments and emergency or urgent hand surgeries performed during the first and second waves
COVID-19 pandemic in Finland. The identification of changes in injury patterns and the sub-
sequent demand for surgical care are important factors in the planning of the optimal use of
resources during a national state of emergency.

Materials and methods

The data for this multicenter, retrospective study were collected from three Finnish hospitals
that provide primary, secondary and tertiary care. These hospitals cover a total catchment area
of 900 000 residents, which accounts for 1/6th of the Finnish population [9]. Moreover, the
catchment area for replantation and revascularization surgery at these hospitals comprises a

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PLOS ONE Hand trauma visits and emergency hand surgery during the first and second waves of COVID-19 pandemic

population of over three million residents (more than half of the population). Thus, the three
hospitals are representative of the Finnish population as a whole. Data on all visits to the emer-
gency department (ED) due to hand injuries and all emergency or urgent (operated within 7
days after referral) hand operations were collected from 1.1.2017 to 31.12.2020. We included
patients 16 years of age and more at the time of the injury.
Hand injury was defined as an injury to the distal forearm, wrist, or hand. The Finnish ver-
sion of the Nomesco surgical procedural codes 10 [10], ICD-10 diagnosis codes, and patient
characteristics were collected from the electronic patient information systems of the participat-
ing hospitals using data management software. (Table 1) Hand injuries were further classified
as minor injuries (skin wounds, sprains, bruises), fractures and dislocations, tendon injuries
(flexor or extensor), or major injuries (injuries requiring emergency vascular repair or replan-
tation). The healthcare system in Finland is publicly funded and accessible for all emergency
patients. All emergency patients requiring hand surgery have access to operative treatment in
public hospitals. We retrieved daily number of positive COVID-19 cases from the open access
data of the Finnish Institute of Health and Welfare, available online from ww.thl.fi/en.
Clinical and demographic data have been presented as means and standard deviations (SD)
or as counts and percentages. Monthly incidences with 95% confidence intervals (CI) per 100
000 persons were calculated by using the Poisson exact method. Data from the year 2020 were
compared with reference years 2017–2019 by using incidence rate ratios (IRR). The analyses
were performed using R version 4.0.4 (R Foundation for Statistical Computing, Vienna,
Austria).

Table 1. Included operations based on the Nomesco surgical procedure classification and included diagnoses
based on the international classification of diseases-10.
Procedure code Explanation
NDP10 Replantation of hand
NDP12 Replantation of a digit
NDP18 Replantation of several digits
NDP30 Repair of wrist or hand by transplant of tissue
NDP32 Repair of finger or fingers by transplant of tissue
NDL30 Suture or reinsertion of tendon of wrist or hand, flexor tendon
NDL32 Suture or reinsertion of tendon of wrist or hand, extensor tendon
NDL34 Suture or reinsertion of tendon of wrist or hand, other tendon
NDJ60 Internal fixation of fracture of wrist or hand with screw
NDJ62 Internal fixation of fracture of wrist or hand using plate and screws, scaphoid
NDJ64 Internal fixation of fracture of wrist or hand wire, rod, cerclage or pin
Diagnose code
S52.5 Fracture of lower end of radius
S52.6 Fracture of lower end of both ulna and radius
S60.0 –S60.9 Superficial injury of wrist and hand
S61.0 –S61.8 Open wound of wrist and hand
S62.0 –S62.8 Fracture at wrist and hand level
S63.0 –S63.9 Dislocation, sprain and strain of joints and ligaments at wrist and hand level
S64.0 –S64.9 Injury of nerves at wrist and hand level
S65.0 –S65.9 Injury of blood vessels at wrist and hand level
S66.0 –S66.9 Injury of muscle and tendon at wrist and hand level
S67 Crushing injury of wrist and hand
S68.0 –S68.9 Traumatic amputation of wrist and hand
S69 Other and unspecified injuries of wrist and hand
https://doi.org/10.1371/journal.pone.0263435.t001

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PLOS ONE Hand trauma visits and emergency hand surgery during the first and second waves of COVID-19 pandemic

Ethics
According to the Finnish research legislation and The Finnish National Board on Research
Integrity, appointed by the Ministry of Education and Culture: "The review of the ethics com-
mittee is not required for the research of public and published data, registry and documentary
data and archive data.". https://tenk.fi/en/advice-and-materials/guidelines-ethical-review-
human-sciences. The Ethics Committee of Tampere University Hospital has waived ethical
evaluation of all register-based studies, in which the participants are not contacted. https://
www.tays.fi/en-US/Research_and_development/Ethics_Committee. Institutional permissions
were obtained from Chief doctors of each of the participating hospitals to access the hospital
discharge register data. Informed consent from patients are not needed when retrospective
register data is handled and the participants are not contacted.

Results
During the four-year study period, a total of 32 506 hand injuries were treated in the ED of the
participating hospitals, and 2 474 emergency or urgent hand operations were performed. Of
these, 6 477 (19.9%) ED visits and 509 (20.5%) surgeries occurred during the pandemic period
(from March 2020 to December 2020). The incidence of hand injury was lower before the start
of the lockdown in February 2020 when compared with reference years (IRR 0.88 CI 0.78–
0.98; Fig 1A), and after the beginning of the lockdown in March 2020 the incidence of ED vis-
its decreased (IRR 0.70 CI 0.63–0.78; Fig 1A). Correspondingly, after the end of May and lock-
down, the incidence increased and the monthly incidence peaked and the highest monthly
incidence within the study period was reported in June 2020, 98 ED visits per 100 000 person-
months (IRR 1.12 CI 1.02–1.24; Fig 1A). After June 2020, the monthly incidences of ED visits
due to hand injuries remained at the reference level (Fig 1A). The age and gender distribution
of ED patients remained unchanged in year 2020 (Table 1).
The most common reasons for ED visit were minor hand injuries followed by fractures and
dislocations of the hand or wrist. The incidences of minor injuries were 16% lower in March
during the lockdown (IRR 0.84 CI 0.71–0.99; Fig 1B). The most prominent change during the
lockdown was seen in the incidence of fractures and dislocations which was 42% lower in
March (IRR 0.58 CI 0.50–0.68) and 33% lower in April 2020 (IRR 0.67 CI 0.57–0.80) than in
the reference years (Fig 1B). After the lockdown both minor and major injuries shifted back to
the level of reference years (Fig 1B).
The overall incidence trend of emergent and urgent hand operations in 2020 was similar to
reference years Fig 2A. Men were more likely to sustain hand injury requiring operative treat-
ment (Table 2). The lockdown did not increase the proportion of patients waiting for opera-
tion over 48 hours after the referral (Table 2). During the lockdown the rate of replantation
was 49% higher in March 2020 than in the reference years (IRR 1.49 CI 0.53–4.20; Fig 2B), and
in July 2020, the rate of replantation was 200% higher (IRR 3.00 CI 0.68–13.2; Fig 2B), but
these findings have high uncertainty. On the contrary, the incidence of fracture repair was
43% lower in March 2020 (IRR 0.57 CI 0.35–0.93; Fig 2B) and 41% lower in July 2020 (IRR
0.59 CI 0.36–0.98; Fig 2B). The incidences of tendon repairs in 2020 were similar to reference
years (Fig 2B).
The daily number of positive COVID-19 findings is presented in Fig 3. During the first wave
the testing capacity was limited, but during the second way testing capacity was in full use.

Discussion
The national COVID-19 lockdown seemed to have a clear decreasing impact on the rate of vis-
its to the ED due to hand injuries during the first wave of COVID-19. The decrease was mainly

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PLOS ONE Hand trauma visits and emergency hand surgery during the first and second waves of COVID-19 pandemic

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PLOS ONE Hand trauma visits and emergency hand surgery during the first and second waves of COVID-19 pandemic

Fig 1. A Monthly incidences of emergency department visits due hand injuries. Blue line with 95% confidence
intervals (light blue) presents year 2020 and black line presents the average incidence for reference years 2017–2019. B
Monthly incidences of emergency department visits due hand injuries stratified by the diagnose of the visit. Blue line
with 95% confidence intervals (light blue) present year 2020 and black line presents the average incidence for reference
years 2017–2019.
https://doi.org/10.1371/journal.pone.0263435.g001

due the reduced number of fractures and dislocations during the lockdown as the other injury
types remained unchanged. The overall rate of emergency or urgent hand operations remained
unchanged during the lockdown in Finland, despite the clear decrease in the rate of fracture
repairs. A high, but uncertain, increase was seen in the number of replantation or revasculari-
zation operations after the start of the lockdown. However, this increase may be a non-specific
change, and a similar temporal variation was also observed in the data from the reference
years. The rate of revascularizations was again higher after the lockdown during the summer,
when restrictions were lifted, but also this finding had high uncertainty. When compared to
the major decreases seen in the rate of referrals to hand trauma units after the start of the lock-
down in London (75% decrease) and Paris (67% decrease), our results were less dramatic; the
maximum monthly decrease in the referral rate during the lockdown was 30%, which was
mainly due the reduced rate of fractures [5,6]. It must be noted that the first wave of COVID-
19 was much milder in Finland. Our results in adults reflects the previous report over Finnish
children, which demonstrated that the rate of operatively treated upper limb traumas
remained nearly unchanged during the first wave of the pandemic [7].
The profile and etiology of hand and wrist trauma is likely to vary between countries and
demonstrates that country-specific characteristics exist. For example, in Finland the trauma
profile varies by the season. The Finnish winter is slippery due to ice and snow, which can be
seen in the increase in wrist and hand fractures [11,12]. However, more hand fractures occur
among children during warm summer days [13,14]. In recent years, there has been increasing
rates of falls from roofs due to snow clearing and a specific type of thumb avulsion injury
caused by motorized ice drill accidents in Finland [15,16].
The COVID-19 lockdown was introduced introduced in mid-March. At the time of the
lockdown beginning the winter holiday period was over in Southern Finland. The country is
relatively large with changing weather and the winter season ends over a month earlier in
Southern part than in the Northern. In early April many families start the summer cabin sea-
son in the south parts of the Finland and begin do-it-yourself renovations and wood chopping
preparings for the next winter [17]. There is no information on the specific incidence of inju-
ries caused by chopping firewood in Finland, but a total of 67 amputation or crush injuries
caused by powered log splitters were operated during a two-year period in the TAUH region
[18]. In Germany, 80% of saw injuries take place outside of work and half of the injuries are
related to cutting firewood [19]. Powered cutting tools are more likely to cause injuries than
an axe, which has been reported to relate to only 10% of the hospitalized wood chopping inju-
ries [20].
Although, the overall incidence of hand injuries decreased during the lockdown, the overall
rate of emergent and urgent hand operations remained constant during lockdown. Small
decrease was seen in February before the lockdown and in March during the lockdown in the
incidence of fracture operation, which may be explained by the weather in addition to the
lockdown. The possible decrease in the rate of traffic and work-related hand injuries may have
been augmented by an increase in the rate of domestic hand injuries and thus explain the
unchanged incidence of severe hand injuries. According to a previous Nordic study, 36% of
hand injuries occur at home, 36% during leisure activities, and 26% at work [8]. In Finland,
however, work-related injuries are rare. According to the Finnish Workers’ Compensation

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PLOS ONE Hand trauma visits and emergency hand surgery during the first and second waves of COVID-19 pandemic

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PLOS ONE Hand trauma visits and emergency hand surgery during the first and second waves of COVID-19 pandemic

Fig 2. A Monthly incidences of emergency and urgent hand operations. Blue line with 95% confidence intervals (light blue) present
year 2020 and black line presents the average incidence for reference years 2017–2019. B Monthly incidences of emergency and
urgent hand operations stratified by the operation type. Blue line with 95% confidence intervals (light blue) present year 2020 and
black line presents the average incidence for reference years 2017–2019.
https://doi.org/10.1371/journal.pone.0263435.g002

Center, the incidence of work-related traumas in Finland was 29 per million working hours in
2019. Moreover, nearly 80% of injuries leading to absence from work occur outside the work-
place, typically at home. In 2020, the incidence of traumatic injuries at work seemed to be
lower during the lockdown period in comparison with 2019, which may be explained by the
decrease in traffic and other activities with an increased risk of injury [21]. The decrease in
traffic also led to a decrease in traffic accidents and traffic deaths from April through to May
2020 compared to the ten previous years [22].
When the lockdown restrictions were lifted in June 2020, the injury patterns returned to
normal. People returned to workplaces instead of remote working from home, and restrictions
on public institutions and social gathering were eased during the summer due to low pan-
demic phase. When the second wave began in September 2020 regional restrictions came into
effect. The difference, when compared with lockdown, was that regional restrictions were
aimed towards the adult population. Operation of restaurants and bars was restricted, remote
working was recommended, and hobbies and activities were not banned but some restrictions
were enforced. These applied regional restrictions had no observable impact on the incidences
of ED visits due hand injuries or emergency hand operations.
The strength of the study was the public and practically free healthcare system in Finland
that allows patients to seek medical assistance whenever needed and thus the data reflects most
likely true incidences. A minor limitation is the lack of information on private health care facil-
ities, in which a small proportion of minor hand traumas have been treated. However, practi-
cally all major traumas and traumas needing acute surgery are treated in public hospitals.

Table 2. Demographic data of the ED visits due hand injuries and subsequent hand operations, 2020 compared with mean of reference years 2017–2019. Time strat-
ified by the national lockdown and regional restrictions in effect during the first and second waves of COVID-19 pandemic in Finland.
Before Lockdown January to Lockdown March to May After lockdown June to Regional restrictions
February August September to December
2020 2017–2019 2020 2017–2019 2020 2017–2019 2020 2017–2019
N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%)
Total ED visits 1 238 (100) 1 302 (100) 1 747 (100) 2 178 (100) 2 399 (100) 2 297 (100) 2 331 (100) 1 921 (100)
Gender male 615 (49.7) 635 (48.7) 950 (54.4) 1 099 (50.5) 1 373 (57.2) 1 337 (58.2) 1 233 (52.9) 1 307 (52.7)
Age, mean (SD) 41.1 (23) 41.8 (23) 42.5 (23) 42.2 (23) 41.5 (24) 40.5 (24) 40.4 (24) 40.8 (23)
ED visit diagnose
Minor injury 550 (44.4) 558 (42.8) 904 (51.7) 972 (44.5) 1 257 (52.4) 1 193 (52.0) 1 210 (51.9) 1 255 (50.6)
Fractures and dislocations 637 (51.5) 695 (53.3) 752 (43.0) 1 100 (50.5) 1 029 (42.9) 983 (42.8) 1 000 (42.9) 1 115 (45.8)
Tendon injury 26 (2.1) 27 (2.1) 41 (2.3) 53 (2.4) 46 (1.9) 64 (2.8) 49 (2.1) 62 (2.5)
Major injury 25 (2.0) 23 (1.8) 50 (2.9) 58 (2.7) 67 (2.8) 57 (2.4) 72 (3.1) 48 (1.9)
Total operations 83 (6.7) 93 (7.2) 155 (8.9) 169 (7.8) 160 (6.7) 183 (8.0) 194 (8.3) 182 (9.5)
Gender male 62 (74.7) 58 (62.4) 110 (71.0) 117 (69.2) 129 (80.6) 137 (74.9) 135 (69.6) 129 (70.9)
Age, mean (SD) 37.9 (19) 42.9 (21) 45.5 (19) 44.6 (20) 41.1 (19) 40.6 (20) 40.7 (19) 41.0 (19)
Operation
Fracture repair 57 (68.7) 65 (69.9) 92 (59.4) 112 (66.2) 105 (65.6) 125 (68.3) 134 (69.1) 116 (63.8)
Replantation 4 (4.8) 4 (4.3) 16 (10.3) 15 (8.9) 13 (8.2) 9 (4.9) 11 (5.7) 10 (5.5)
Tendon repair 22 (26.5) 24 (25.8) 47 (30.3) 42 (24.9) 42 (26.2) 49 (26.8) 49 (25.2) 56 (30.7)
Waiting time from ED to OR <48h 44 (53.1) 63 (67.7) 111 (71.6) 116 (68.6) 102 (63.8) 125 (68.3) 105 (54.1) 126 (69.2)
https://doi.org/10.1371/journal.pone.0263435.t002

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PLOS ONE Hand trauma visits and emergency hand surgery during the first and second waves of COVID-19 pandemic

Fig 3. Daily number of PCR test-positive COVID-19 findings in Finland in 2020.

https://doi.org/10.1371/journal.pone.0263435.g003

Another limitation of our study was that we only had information on the diagnoses and exter-
nal causes of the visits to the ED or operation, and we were thus unable to classify the injuries
by specific etiology and occurring site.
The nationwide COVID-19 lockdown decreased the rate of visits to the ED due to hand
injuries in three Finnish hospitals, but the rate of emergency and urgent hand operations
remained unchanged during the lockdown. As the restrictions were eased, the visit rates
returned to the level of reference years. Enforcing a variety of regional restrictions had no
observable impact on the hand injuries during the second wave of COVID-19 in Finland.
Most likely this was due to less strict restrictions and therefore, for example, many employers
were back to workplaces, sports facilities were mainly open, and domestic traveling was more
accepted, whereas during the lockdown all of these were recommended against. Compared to
other countries Finland had one of the lowest daily numbers of positive cases in 2020 and this
is most likely a contributing factor to these results, as the daily numbers most likely reflect to
behavior and risk taking, and Finland did not need a curfew, which most likely would have
reduced the trauma rates.

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PLOS ONE Hand trauma visits and emergency hand surgery during the first and second waves of COVID-19 pandemic

The identification of regional changes in injury patterns and the subsequent demand for
surgical care are important factors in ensuring the effective treatment of hand injuries in the
ED and operation room. The findings of this study will therefore provide better tools for the
planning of the optimal and sustainable use of resources during a future national state of
emergency.

Acknowledgments
We would like to thank Mr Peter Heath for language corrections.

Author Contributions
Conceptualization: Jarkko Jokihaara, Aleksi Reito, Ville M. Mattila, Antti P. Launonen.
Data curation: Ilari Kuitunen, Ville Ponkilainen, Aleksi Reito.
Formal analysis: Ilari Kuitunen, Ville Ponkilainen, Antti P. Launonen.
Funding acquisition: Juha Paloneva, Ville M. Mattila.
Investigation: Ilari Kuitunen, Jarkko Jokihaara, Aleksi Reito, Juha Paloneva, Ville M. Mattila,
Antti P. Launonen.
Methodology: Ilari Kuitunen, Ville Ponkilainen, Aleksi Reito, Ville M. Mattila.
Project administration: Jarkko Jokihaara, Juha Paloneva, Ville M. Mattila, Antti P. Launonen.
Resources: Juha Paloneva, Ville M. Mattila, Antti P. Launonen.
Software: Ville Ponkilainen, Aleksi Reito, Ville M. Mattila.
Supervision: Jarkko Jokihaara, Juha Paloneva, Ville M. Mattila, Antti P. Launonen.
Validation: Ville Ponkilainen, Aleksi Reito, Juha Paloneva, Ville M. Mattila, Antti P.
Launonen.
Visualization: Ville Ponkilainen.
Writing – original draft: Ilari Kuitunen.
Writing – review & editing: Ilari Kuitunen, Jarkko Jokihaara, Ville Ponkilainen, Aleksi Reito,
Juha Paloneva, Ville M. Mattila, Antti P. Launonen.

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