The Influence of Network Competence on Internationalization of SMEs

This study focuses on the relationship between organizational network competence and the internationalization process of small- and medium sized enterprises (SMEs). Over recent decades, the global business environment has become increasingly conducive to internationalization of small firms. A central facilitating factor in the process has been the emergence of networked business relationships between internationalizing firms. Research on SME internationalization has found that certain types of structures and dynamics of business networks allow SMEs access to the resources they need to enter foreign markets. This consequently means that their internationalization often becomes to depend on the networks they are embedded in. However, research so far has mostly ignored the possibility that the organizational ability to develop and manage business network relationships, network competence, may be a major underlying factor in determining how well SMEs can leverage their network relationships to enter foreign markets and consequently may determine in large part how successful their internationalization process turns out to be. This study aims to respond to those gaps, by empirically examining how the development of network competence in internationalizing SMEs influences the internationalization outcomes that they can expect, and how such network competence is conceptualized and developed. Using a mixed methods approach, survey data collected from 298 Finnish SMEs across five industry sectors is first used to examine how levels of network competence are related to internationalization propensity of SMEs and their subsequent international performance, growth and profitability as internationally operating firms. In order to illustrate in more detail the ways in which network competence is conceptualized and how it develops during the internationalization process of an SME, qualitative data from internationally operating Finnish SMEs are used. Longitudinal interview data of an internationalizing Finnish SME is accompanied by data gathered through a series of semistructured interviews of Finnish and Russian managers involved in mutual business relationship dyads. Structurally, this thesis examines the research issue as an article-based dissertation, consisting of five journal and conference publications. Three of these publications are based on the quantitative data, and the remaining two apply the qualitative interview data. The results find several aspects where network competence has a positive influence on the success of internationalizing SMEs, how it develops and what it entails conceptually in this context. Quantitatively, the level of network competence is found to have a positive relationship to various internationalization outcomes, including the propensity of SMEs to enter foreign markets and on their subsequent international performance, their growth and their profitability. Additionally, the positive relationship is divided between the relationship-specific and cross-relational dimension of network competence, in that the influence of the former is relevant for the propensity to internationalize, while the latter is for the growth and profitability of the already internationalized SMEs. Qualitatively, the results suggest, firstly, that the development process of network competence does not necessarily precede the start of the internationalization process, but may occur through a gradual learning process alongside it. And secondly, the results also imply that the conceptualization of network competence by Finnish managers of internationally operating Finnish SMEs is structurally distinct from that of their culturally distinct partner managers in Russia. This study contributes to the literature on SME internationalization in several ways. Firstly, it introduces operationalized organizational competencies to the literature on internationalization of SMEs, which has so far mainly examined the influence of business networking on the internationalization process without having such an organizational viewpoint. Furthermore, this study provides a multi-level analysis of the determinants of successful SME internationalization, by examining various strategic and performance outcomes across the process. These results also contribute to the literature on organizational strategy of internationalizing SMEs, by clarifying how different dimensions of business networking may be optimal in different phases of the internationalization process. Conceptually, the results of this study contribute to the literature on competence development and SME internationalization, by illustrating how the development process of network competence may occur during internationalization process. Thus, they also contribute to the discussion on how SMEs are able to influence the dynamics and structures of their business networks over time. Finally, this study contributes to the literature on the role of culture in the internationalization process, by implying that the cultural background of the manager of the SME may determine whether business networking and network competence is seen as an organizational-level or an individual level capability. The study also includes some additional contributions to the literature on dynamic capabilities in strategic management, and on that of strategic business networks. These include further clarifying the exact nature and tangibility of dynamic capabilities, and being one of the first studies to introduce constructs from both dynamic capabilities and business network literature to the field of international entrepreneurship. And finally, the study also has some contribution on the two streams of literature, in illustrating how both dyadic and network-level capabilities may be relevant, depending on the current strategic goals and market position of the firm. Keywords: network competence, internationalizatio

"Tässä on nyt todellakin meidän panos!" Tapaustutkimus kolmen nuoren kasvuhakuisen yrittäjätiimin minä, minun, me ja meidän -diskursseista

Tässä tutkimuksessa yhdistän tiimiyrittäjyyden, sosiaalisen identiteetin ja kollektiivisen psykologisen omistajuuden akateemisia keskusteluja. Tavoitteenani on kuvailla millaisia minä, minun, me ja meidän -diskursseja yrittäjätiimien jäsenet puhuvat kuvatessaan yrittäjyyttään. Tutkimuksen aineistona on nuorten, kasvuhakuisten yrittäjätiimien jäsenten puolistrukturoidut teemahaastattelut. Näkökulmana hyödynnän sosiaalista konstruktionismia ja analysoin aineiston diskurssianalyysillä. Tulkitsen neljä erilaista diskurssia, jotka liittyvät eri tavoin yrittäjätiimien me-identiteettiin. Ensimmäisessä diskurssissa yrittäjät puhuvat omasta roolistaan suhteessa tiimiin. Toisessa diskurssissa yrittäjät luovat oikeudenmukaisuuden ja yhteisvastuullisuuden normeja, joilla rakennetaan me-orientoitumista. Kolmannessa diskurssissa he puhuvat me-muodossa. Puheessa me on kokija, toimija, kollektiivinen psykologinen omistaja ja merkityksen antaja. Neljännessä diskurssissa me-identiteettiä rakentavat yrittäjyyden representaatiot ja toiminta. Meidän -puhetta liitetään asioihin, joihin tiiminä on yhdessä panostettu. Meidän -kokemukset näyttäytyvät puheessa voimallisena yrittäjyyden toiminnan merkityksellistämisen tapana.

State of logistics and transport in the Baltic Sea region in 2025

The world’s pace of change is accelerating and new innovations, inventions and technologies come about every day. Change is unavoidable. It is difficult to keep up and even more difficult to prepare for the future. Even though it is not possible to know exactly what will happen in the future, by studying futures people can better anticipate what might lie ahead. By making decisions and realizing the consequences of their choices today, people and governments are able to actively decide how they will act in the future. Both opportunities and pitfalls lie ahead, which encourages actors to make more farsighted decisions. The Baltic Sea region is an interesting area for futures studies. It comprises 11 nations and more than 100 million inhabitants and entails countries with advanced, high-income economies, like Finland, Germany and Denmark, and developing economies, like Russia, Latvia and Lithuania. The western, eastern, northern and southern parts of the region are separated by the Baltic Sea, which at the same time represents a barrier and a facility for trade and travel between the countries belonging to the region The purpose of this study was to uncover the most probable future of transport and logistics in the Baltic Sea region in 2025 by using the Delphi method. Altogether 109 responses were collected in two separate instances from experts in all the Baltic Sea region countries, 56 of whom were defined as academic respondents and 53 of whom business respondents. Only minor differences in the opinions of academic and business experts were discovered, and the larger differences lie between eastern and western response groups. The Baltic Sea region is a very heterogeneous region and the division is clearest between East and West, which differ in political, economic, social, technological and environmental aspects. The probable future of the Baltic Sea region presented in this study is coherent with previous studies on the same subject. The future of the Baltic Sea region in terms of logistics and transport looks quite bright according to the experts who participated in the study. Trade volumes will grow and the importance of logistics and transport to the competitiveness of the region will increase. Respondents from eastern countries seemed to be more optimistic about the future in general. Most differences between opinions could be explained by the gap in technological and infrastructural development between the East and West. As eastern countries are less-developed in some parts of their economies, it is easier for them to improve the technical condition of infrastructure by merely catching up with the western countries.

Esimiestyön haasteet liikelaitoksen yhtiöittämisessä

Tämän työn tarkoituksena on tutkia esimiestoiminnan haasteita, joita syntyy liikelaitoksen yhtiöittämisessä. Yhtiöittämisen perusteet kumpuavat juridisesta toimintakentästä, joka muodostaa pakon muutokselle. Työn teoriaosassa käydään läpi lyhyesti liikkeen luovutuksen merkitys työsuhteen sääntelyn kannalta ja perehdytään johtamiseen, esimiestyöhön sekä muutoksen aiheuttamien tunteiden huomioimiseen. Tätä teoriaviitekehystä tutkitaan konkreettisen case-yrityksen avulla. Case-yrityksenä on Helsingin Satama, jonka esimiehiä on haastateltu empiirisen aineiston saamiseksi. Tutkimuskysymyksenä tässä työssä on, miten suurta muutosta tulisi johtaa yksilön tunteet huomioiden. Työssä havaittiin, että vaikka viestintävälineet ovat kunnossa ja vaikka niiden käyttö on vähintäänkin kohtalaisella tasolla, ei viestin omaksuminen silti ole niin helppoa. Syitä tähän löydettiin mm. viestimiskulttuurin epämääräisyydestä ja työntekijätason haluttomuudesta käsitellä muutosta. Muutosvastarinta on yrityksessä erittäin vahvaa, mikä kielii epäonnistumisesta edellisen muutoksen johtamisessa. Onnistuneen muutoksen johtaminen tapahtuu vuorovaikutuksessa henkilöstön kanssa. Yhtiöittämismuutos on pyritty viestimään paremmin kuin edellinen suuri muutos. Yhtiöittämisen koettiin tuovan pääasiassa positiivisia asioita, kuten byrokratian vähenemistä. Positiivisiin asioihin keskittyminen parantaa muutoksen onnistumista.

Negotiating home and belonging. Young Kurds in Finland

This study looks at negotiation of belonging and understandings of home among a generation of young Kurdish adults who were born in Iraq, Iran, and Turkey and who reached adulthood in Finland. The young Kurds taking part in the study belong to the generation of migrants who moved to Finland in their childhood and early teenage years from the region of Kurdistan and elsewhere in the Middle East, then grew to adulthood in Finland. In theoretical terms, the study draws broadly from three approaches: transnationalism, intersectionality, and narrativity. Transnationalism refers to individuals’ cross-border ties and interaction extending beyond nationstates’ borders. Young people of migrant background, it has been suggested, are raised in a transnational space that entails cross-border contacts, ties, and visits to the societies of departure. How identities and feelings of belonging become formed in relation to the transnational space is approached with an intersectional frame, for examination of individuals’ positionings in terms of their intersecting attributes of gender, age/generation, and ethnicity, among others. Focus on the narrative approach allows untangling how individuals make sense of their place in the social world and how they narrate their belonging in terms of various mechanisms of inclusion and exclusion, including institutional arrangements and discursive categorisation schemes. The empirical data for this qualitative study come from 25 semi-structured thematic interviews that were conducted with 23 young Kurdish adults living in Turku and Helsinki between 2009 and 2011. The interviewees were aged between 19 and 28 years at the time of interviewing. Interview themes involved topics such as school and working life, family relations and language-learning, political activism and citizenship, transnational ties and attachments, belonging and identification, and plans for the future and aspirations. Furthermore, data were collected from observations during political demonstrations and meetings, along with cultural get-togethers. The data were analysed via thematic analysis. The findings from the study suggest that young Kurds express a strong sense of ‘Kurdishness’ that is based partially on knowing the Kurdish language and is informed by a sense of cultural continuity in the diaspora setting. Collective Kurdish identity narratives, particularly related to the consciousness of being a marginalised ‘other’ in the context of the Middle East, are resonant in young interviewees’ narrations of ‘Kurdishness’. Thus, a sense of ‘Kurdishness’ is drawn from lived experiences indexed to a particular politico-historical context of the Kurdish diaspora movements but also from the current situation of Kurdish minorities in the Middle East. On the other hand, young Kurds construct a sense of belonging in terms of the discursive constructions of ‘Finnishness’ and ‘otherness’ in the Finnish context. The racialised boundaries of ‘Finnishness’ are echoed in young Kurds’ narrations and position them as the ‘other’ – namely, the ‘immigrant’, ‘refugee’, or ‘foreigner’ – on the basis of embodied signifiers (specifically, their darker complexions). This study also indicates that young Kurds navigate between gendered expectations and norms at home and outside the home environment. They negotiate their positionings through linguistic repertoires – for instance, through mastery of the Finnish language – and by adjusting their behaviour in light of the context. This suggests that young Kurds adopt various forms of agency to display and enact their belonging in a transnational diaspora space. Young Kurds’ narrations display both territorially-bounded and non-territorially-bounded elements with regard to the relationship between identity and locality. ‘Home’ is located in Finland, and the future and aspirations are planned in relation to it. In contrast, the region of Kurdistan is viewed as ‘homeland’ and as the place of origins and roots, where temporary stays and visits are a possibility. The emotional attachments are forged in relation to the country (Finland) and not so much relative to ‘Finnishness’, which the interviewees considered an exclusionary identity category. Furthermore, identification with one’s immediate place of residence (city) or, in some cases, with a religious identity as ‘Muslim’ provides a more flexible venue for identification than does identifying oneself with the (Finnish) nation.

Kjærlighet i forbundethet : en kraft i gamle menneskers åndelighet og verdighet

The thesis is rooted in caring science and the notion that the human being is an indivisible unity of body, soul and spirit. The purpose is to search for new, or expanded knowledge and understanding of the substance of the human’s spiritual space, as well as aspects that may constitute a foundation for the safeguard of human dignity. The clinical research study concerns the importance of spirituality and dignity in the care for older people. The thesis consists of three substudies with four articles, and the methodology is based on Gadamer’s philosophical hermeneutics. Through a metasynthesis of 17 research articles, sub-study I searched for understanding of the concept of spirituality as it may appear in reality (deduction). 17 older people were interviewed in sub-study II. This sub-study sought understanding for spirituality and dignity in the specific reality (induction). Sub-study III searched for theory development regarding spirituality, through a literature review of 20 research articles and a text by Tillich (abduction). The findings imply that spirituality entails human beings’ connectedness with one’s inner space and connectedness beyond oneself. Love in connectedness appears as a force in both spirituality and dignity. Themes portrayed include understanding of the spiritual space, religiousness, dignity, and spiritual care. The relationship between dignity and spirituality can be seen in the confirmation of human worth and care for the whole human being, including the spiritual dimension, and this is understood as a prerequisite for perceived dignity. It seems to be important that older people feel valued, loved, not abandoned, and alive. The theoretical model portrays love as a reunifying and connecting force that may foster confirmation, serving, longing and holiness. The movement towards connectedness may create room for the human being’s perception of dignity and holiness, and as such, it may be a force in the search for wholeness and becoming in health.

Urvilja : när livet är människans hem

This caring science study explores ‘Will’ as an ontological concept. The aim is to deepen the understanding of the essence of Will, and to highlight the manifestations of Will and how Will becomes evident in clinical caring. Will is ontological and universal. Will is connected with the essence of the human being, and manifests in the human being as will. The approach is inspired by Gadamer’s philosophical hermeneutics. The study’s horizon of understanding consists of Eriksson’s caritative theory and the caring science-tradition. The study’s research questions are as follows: What is the essence of Will? What are its manifestations? How does Will become evident in clinical caring? The hermeneutic interpretative movement is initiated by the material, which consists of the philosopher Arthur Schopenhauer’s texts, letters from experts and dictionaries. Meaning-bearing substance fragments in the material are intertwined with the original horizon of understanding through hermeneutical reading, hermeneutical interpretation and concept analysis in an oscillating interpretive movement. An abstraction occurs when the new substance is illuminated by the caring science ontology. The oscillating interpretive movement results in a reinterpreted horizon of understanding, which in turn provides the findings of the study. The reinterpreted horizon of understanding is presented in the form of a theoretical model and abductive theses. The essence of Will is represented in the theoretical model as the lifeaffirming and the loving force. Life and love are Will’s origin and destination. Will’s manifestations (its diversity) hold conditions and chance occurrences that obstruct Will. Hence the will of the human being does not necessarily appear in a way that is in tune with ontological Will. Will represents the lifeblood of ethos, and in this lifeblood love flows. Will acts by virtue of itself, and gives ethos its force. Will manifests in a way that ethos can affirm. When Will is affected by caring its force is active in the service of life and love. Being a caregiver entails acting as a world-eye, which means recognizing Will in diversity. For caregivers, being a world-eye means observing fragments of Will as it manifests in its original form in the real reality, and acting as the mirror of life. The human being who is able to perceive the fundamental values of life and to live according to these has understood the laws of life and entered upon the human calling. The human being then lives according to the fundamental order and has found a home in life.

Semantic and fuzzy modelling for human behaviour recognition in smart spaces : a case study on ambient assisted living.

Human activity recognition in everyday environments is a critical, but challenging task in Ambient Intelligence applications to achieve proper Ambient Assisted Living, and key challenges still remain to be dealt with to realize robust methods. One of the major limitations of the Ambient Intelligence systems today is the lack of semantic models of those activities on the environment, so that the system can recognize the speci c activity being performed by the user(s) and act accordingly. In this context, this thesis addresses the general problem of knowledge representation in Smart Spaces. The main objective is to develop knowledge-based models, equipped with semantics to learn, infer and monitor human behaviours in Smart Spaces. Moreover, it is easy to recognize that some aspects of this problem have a high degree of uncertainty, and therefore, the developed models must be equipped with mechanisms to manage this type of information. A fuzzy ontology and a semantic hybrid system are presented to allow modelling and recognition of a set of complex real-life scenarios where vagueness and uncertainty are inherent to the human nature of the users that perform it. The handling of uncertain, incomplete and vague data (i.e., missing sensor readings and activity execution variations, since human behaviour is non-deterministic) is approached for the rst time through a fuzzy ontology validated on real-time settings within a hybrid data-driven and knowledgebased architecture. The semantics of activities, sub-activities and real-time object interaction are taken into consideration. The proposed framework consists of two main modules: the low-level sub-activity recognizer and the high-level activity recognizer. The rst module detects sub-activities (i.e., actions or basic activities) that take input data directly from a depth sensor (Kinect). The main contribution of this thesis tackles the second component of the hybrid system, which lays on top of the previous one, in a superior level of abstraction, and acquires the input data from the rst module's output, and executes ontological inference to provide users, activities and their in uence in the environment, with semantics. This component is thus knowledge-based, and a fuzzy ontology was designed to model the high-level activities. Since activity recognition requires context-awareness and the ability to discriminate among activities in di erent environments, the semantic framework allows for modelling common-sense knowledge in the form of a rule-based system that supports expressions close to natural language in the form of fuzzy linguistic labels. The framework advantages have been evaluated with a challenging and new public dataset, CAD-120, achieving an accuracy of 90.1% and 91.1% respectively for low and high-level activities. This entails an improvement over both, entirely data-driven approaches, and merely ontology-based approaches. As an added value, for the system to be su ciently simple and exible to be managed by non-expert users, and thus, facilitate the transfer of research to industry, a development framework composed by a programming toolbox, a hybrid crisp and fuzzy architecture, and graphical models to represent and con gure human behaviour in Smart Spaces, were developed in order to provide the framework with more usability in the nal application. As a result, human behaviour recognition can help assisting people with special needs such as in healthcare, independent elderly living, in remote rehabilitation monitoring, industrial process guideline control, and many other cases. This thesis shows use cases in these areas.

Livets källa kärleken : hälsans urkraft

This basic research focuses on the ethos of health and the human being's becoming in health. The theoretical perspective consists of the caring tradition within caring science developed at Åbo Akademy University. The aim of the present doctoral thesis is to uncover a new understanding as well as to deepen and attain a more nuanced understanding of the ethos of health, the essence of health, by penetrating to the core of what gives the human being the strength for experiencing a becoming in health. The research questions are as follows: l) What is the human being's source of strength? and 2) What reveals the source of strength so that the human being can perceive it and dedicate its strength in order to experience a becoming in health? The primary methodology used in the dissertation is hermeneutical. The material consists of the work Kärlekens gerningar by Kierkegaard, texts from focused interviews with respondents who have lived through severe personal suffering, as well as the book Det bländande mörkret by Wikström. These texts are interpreted through hermeneutical reading. The new horizon of understanding that emerges is reflected towards Eriksson's caritative theory, towards prior research within the tradition of caring science at Åbo Akademy University and towards previous national and international studies within this field. The new understanding shows that the human being's source of strength is love, the essence and origin of life. The substance of health is love, which, through the trinity of faith, hope and love, also makes possible the existence of the source of strength. Love has a deeper dignity than faith and hope, is connected with eternity and is the uniting link between temporality and eternity. The human being's inner longing entails an ontological attraction towards the source of strength. This source of strength is hidden, which provides and maintains its force, like a mystery connected with the darkness of suffering that hides the secret representing the source of strength, life's mystery, bu t w hi ch is revealed in both the darkness of suffering and in the light of joy. The dedication of strength requires freedom, willingness and courage to see the light, despite awareness of shame and guilt. Creative acts liberate the human being for the dedication of strength, which is preceded by a holy presence where, in solitude, the human being makes sacrifices for the sake of his or her human smallness and weakness, and allows himself or herself to be enclosed by the darkness of suffering to discover the light from the source. This entails being enraptured in a quiet "doing" in order to experience the beauty that bears witness to the holy which creates unity. The source of strength is revealed through beauty. The ethos of the human being and the ethos of health have the same fundamental substance, whilst the ethos of life possesses the deepest dimension and concerns the mysterious and infinite eternity. The ethos of life, eternity, which is a wellspring of strength, is not in itself strength-giving unless it is allied with love. Health can be understood in the light of life, of which death is an inevitable part. Life itself constitutes and creates the source which, through its alliance with eternity' s primordial wellspring of strength, generates strength from which the human being's source of strength, love, receives its eternal fervour. The human being is fundamentally interconnected with an abstract other, the first love, a universal wellspring of strength. Through Communion with this abstract other a dedication of the strength to experience a becoming in health becomes possible. Love for one's neighbour is the fundamental substance in the movement of becoming in health. Becoming in health presupposes a simultaneous movement in which the human being practices the human calling through ethos. As one loves one's neighbour through actions the still forces of eternity are in motion. When life emerges in the foreground and becomes the home of the human being, a dedication of the power of love is possible. Life itself determines the human being's becoming in health. A humble fundamental attitude towards life constitutes the basis for a continuous dedication of vitality from this source.

Trilling race : the political economy of racialised visual-aural encounters

This thesis investigates the matter of race in the context of Finnish language acquisition among adult migrants in Finland. Here matter denotes both the materiality of race and how race comes to matter. Drawing primarily on an auto/ethno/graphic account of learning the Finnish language as a participant in the Finnish for foreigners classes, this thesis problematises the ontology and epistemology of race, i.e., what race is, how it is known, and what an engagement with race entails. Taking cues from the bodily practices of learning the Finnish trill or the rolling r, this study proposes a notion of “trilling race” and argues for an onto-epistemological dis/continuity that marks race’s arrival. The notion of dis/continuity reworks the distinction between continuity and discontinuity, and asks about the how of the arrival of any identity, the where, and the when. In so doing, an analysis of “trilling race” engages with one of the major problematics that has exercised much critical attention, namely: how to read race differently. That is, to rethink the conundrum of the need to counter “representational weight” (Puar 2007, 191) of race on the one hand, and to account for the racialised lived realities on the other. The link between a study of the phenomenon of host country language acquisition and an examination of the question of race is not as obvious as it might seem. For example, what does the argument that the process of language learning is racialised actually imply? Does it mean that race, as a process of racialisation or an ongoing configuration of sets of power relations, exerts force from an outside on the otherwise neutral process of learning the host country language? Or does it mean that race, as an identity category, presents as among the analytical perspectives, along with gender and class for instance, of the phenomenon of host country language acquisition? With these questions in mind, and to foreground the examination of the question of race in the context of Finnish language acquisition among adult migrants, this thesis opens with a discussion of the art installation Finnexia by Lisa Erdman. Finnexia is a fictitious drug said to facilitate Finnish language learning through accelerating the cognitive learning process and reducing the anxiety of speaking the Finnish language. Not only does the Finnexia installation make visible the ways in which the lack of skill in Finnish is fgured as the threshold – a border that separates the inside from the outside – to integration, but also, and importantly, it raises questions about the nature of difference, and the process of differentiation that separates the individual from the social, fact from fiction, nature from culture. These puzzles animate much of the analysis in this dissertation. These concerns continue to be addressed in the rest of part one. Whereas chapter two offers a reconsideration of the ambiguities of ethnisme/ethnicity and race, chapter three dilates on the methodological implications of a conception of the dis/continuity of race. Part two focuses on the matter of race and examines the political economy of visual-aural encounters, whereas part three shifts the focus and rethinks the possibilities and limitations of transforming racialised and normative constraints. Taking up these particular problematics, this thesis as a whole argues that race trills itself: its identity/difference is simultaneously made possible and impossible.

Hälsa i vårdande gemenskap : gemenskapens betydelse för äldre

The aim of the study and research questions: The aim of this study is to illuminate how caring communion can aid in promoting health as becoming in elderly people in the context of natural caring. The target group of the study consists of elderly citizens living at home. The focus of this thesis is on the concept of communion and how caring communion can affect the inner health resources in a patient’s inner health domain, as well as how caring communion can support health as becoming and inner health resources in the elderly. The main research questions of this study are the following: 1) what does communion mean? 2) what does caring communion mean? 3) what is the connection between caring communion and health? Theoretical perspective: The theoretical perspective of this qualitative study relies on the caritative caring theory as developed by scholars of caring sciences at the Åbo Academi University’s Vasa unit. The caritas motive is based on an ethos built on a consideration of togetherness, i.e. caring communion, a place where one feels at home and where one can be the person one was meant to be. Methodology: A hermeneutic research approach based on Gadamer (1997) permeates the study. This entails that understanding and interpretation become central. The study conducted in the thesis is divided into three sub-studies. Sub-study one and two are based on ontological determination whereas the third sub-study is carried out by contextual determination. The first sub-study is conducted by etymological and semantic analysis of the concept of communion (gemenskap) based on Koort (1975) and the second sub-study by determining the basic epistemological category of the concept based on Eriksson (2010b). Sub-study three is conducted through content analysis of 18 multidisciplinary and 13 caring science articles and dissertations based on Kvale (2009). The aim in the third sub-study is to define caring communions in various contexts of meaning based on Eriksson´s model of conceptual determination (2010b). All studies are interpreted through hermeneutic interpretation where the continuous movement from a part of a whole, to the whole, to part again, leads to new understanding. Finally, the findings from all the three sub-studies are compared to the concepts of pre-understanding and the inner-health-domain model of Wärnås (2002). Results: The results of the study offer a description of the dimensions of caring communion and a model that illuminates how caring communion can further health as becoming. The fundamentals of caring communion rest on the idea of a human being’s absolute right to dignity as a base for communion. The concept of communion contains a moral, an ethical, and a spiritual component. In communion, there exists a moral and ethical responsibility and a willingness to commit oneself. The individual is part of a connection or relation and knows the aim and course for the communion. A caring connection, a caring culture, a caring atmosphere and caring listening are characteristics of caring communion. In caring communion, the elderly feel trusting and see themselves as unique, powerful, and valuable. The model demonstrates that when the elderly are able to rest in caring communion, the virtues of courage and faith become strong and desire for life awaken within the elderly and health as becoming becomes possible. Conclusions: The outcome of the study is that all communion is not necessarily caring communion. In order for communion to be caring and for the elderly to achieve health as becoming, there are certain criteria that must be met. This is especially important when designing activities for the elderly in the context of natural caring.

Safety and outcome of coronary interventions with special reference to anticoagulation and stent type

University of Turku, Faculty of Medicine, Department of Cardiology and Cardiovascular Medicine, Doctoral Programme of Clinical Investigation, Heart Center, Turku University Hospital, Turku, Finland Division of Internal Medicine, Department of Cardiology, Seinäjoki Central Hospital, Seinäjoki, Finland Heart Center, Satakunta Central Hospital, Pori, Finland Annales Universitatis Turkuensis Painosalama Oy, Turku, Finland 2015 Antithrombotic therapy during and after coronary procedures always entails the challenging establishment of a balance between bleeding and thrombotic complications. It has been generally recommended to patients on long-term warfarin therapy to discontinue warfarin a few days prior to elective coronary angiography or intervention to prevent bleeding complications. Bridging therapy with heparin is recommended for patients at an increased risk of thromboembolism who require the interruption of anticoagulation for elective surgery or an invasive procedure. In study I, consecutive patients on warfarin therapy referred for diagnostic coronary angiography were compared to control patients with a similar disease presentation without warfarin. The strategy of performing coronary angiography during uninterrupted therapeutic warfarin anticoagulation appeared to be a relatively safe alternative to bridging therapy, if the international normalized ratio level was not on a supratherapeutic level. In-stent restenosis remains an important reason for failure of long-term success after a percutaneous coronary intervention (PCI). Drug-eluting stents (DES) reduce the problem of restenosis inherent to bare metal stents (BMS). However, a longer delay in arterial healing may extend the risk of stent thrombosis (ST) far beyond 30 days after the DES implantation. Early discontinuation of antiplatelet therapy has been the most important predisposing factor for ST. In study II, patients on long-term oral anticoagulant (OAC) underwent DES or BMS stenting with a median of 3.5 years’follow-up. The selective use of DESs with a short triple therapy seemed to be safe in OAC patients, since late STs were rare even without long clopidogrel treatment. Major bleeding and cardiac events were common in this patient group irrespective of stent type. In order to help to predict the bleeding risk in patients on OAC, several different bleeding risk scorings have been developed. Risk scoring systems have also been used also in the setting of patients undergoing a PCI. In study III, the predictive value of an outpatient bleeding risk index (OBRI) to identify patients at high risk of bleeding was analysed. The bleeding risk seemed not to modify periprocedural or long-term treatment choices in patients on OAC after a percutaneous coronary intervention. Patients with a high OBRI often had major bleeding episodes, and the OBRI may be suitable for risk evaluation in this patient group. Optical coherence tomography (OCT) is a novel technology for imaging intravascular coronary arteries. OCT is a light-based imaging modality that enables a 12–18 µm tissue axial resolution to visualize plaques in the vessel, possible dissections and thrombi as well as, stent strut appositions and coverage, and to measure the vessel lumen and lesions. In study IV, 30 days after titanium-nitride-oxide (TITANOX)-coated stent implantation, the binary stent strut coverage was satisfactory and the prevalence of malapposed struts was low as evaluated by OCT. Long-term clinical events in patients treated with (TITANOX)-coated bio-active stents (BAS) and paclitaxel-eluting stents (PES) in routine clinical practice were examined in study V. At the 3-year follow-up, BAS resulted in better long-term outcome when compared with PES with an infrequent need for target vessel revascularization. Keywords: anticoagulation, restenosis, thrombosis, bleeding, optical coherence tomography, titanium