From statin efficacy to everyday effectiveness: Studying the gap in between.

Statins are indicated for preventing cardiovascular disease events. Patients with diabetes have a risk of major cardiovascular events double the risk of their peers without diabetes. Thus, clinical treatment guidelines recommend statins for the management of diabetic dyslipidemia. The evidence base for statin use in cardiovascular disease derives from the randomized controlled statin trials designed to prove statin efficacy under ideal conditions, among a homogenous study population meeting strict trial eligibility criteria. This thesis was implemented as four pharmacoepidemiological statin studies using register data on realworld statin users. The overall purpose was to evaluate the trends, patterns and effectiveness of statin use in everyday life. More specifically, nationwide secular trends in statin use in Finland were analysed, especially among patient groups which had been underrepresented in the statin trials. Furthermore, the benchmarking statin trials in diabetes, the Heart Protection Study and the Collaborative Atorvastatin Diabetes Study, were evaluated for their representativeness for real-world diabetes care with the emphasis placed on adherence to statin use. The association between good adherence and the incidence of major cardiovascular events in the real-world was further investigated in diabetes. These studies demonstrate that statin initiations increased from 1995 to 2005 in Finland. The increase was most pronounced among those aged at least 75 years and was observed already before the publication of rigorous trial data conducted in elderly subjects. Thus, statins seem to have been initiated in clinical practice also going beyond the strict trial eligibility criteria. Nonetheless, low adherence to statin use among the real-world patients with diabetes was found not only to limit the representativeness of the trials for clinical care but also to attenuate in all likelihood their benefits in the real-world. In fact, good adherence to statin use was found to associate with a decreased risk for major cardiovascular events in patients with diabetes. In conclusion, these studies highlight the importance of good adherence to statin use in clinical practice in order to obtain the full therapeutic value demonstrated in the statin trials. Simply increasing the number of statin users will not alone suffice in sharing our common resources appropriately.

Fundraising and investor relations in social enterprise: Marketing your way out of the pioneer gap in African off-grid renewable energy

Social enterprises apply the best of business for the pursuit of social or environmental mission while also generating revenues. Globally, nearly 1,3 billion people lack access to electricity, as well as another billion having access to only low quality and infrequent electricity. Off-grid renewable energy, like solar, will increasingly have a key role in the solution of the energy access issue. The pioneer gap in off-grid renewable energy consists of financing (or funding) gaps and capacity gaps, to do with both the early stage of the enterprises in question, as well as the early stage of the whole industry. The gaps are emphasised by specific characteristics of off-grid renewable energy business models and the requirements of operating in bottom-of-the-pyramid markets. The marketing perspective to fundraising is chosen to uncover the possible role enterprises themselves have in bridging the pioneer gap. The purpose of this thesis is to study how social enterprises operating in off-grid renewable energy in Africa utilise marketing activities in their investor relations in bridging the pioneer gap. This main research question is divided into the following sub-questions:  How does the pioneer gap affect fundraising for these enterprises?  How are the funding needs for these enterprises characterised?  How do these enterprises build trust in their investor relations? The theoretic framework is built on relationship marketing and investor relations, with an emphasis on creation of trust. The research is conducted as a thematical case study. Primary data is gathered via semi-structured interviews with six solar energy companies and two accelerators. According to the findings, the main components affecting trust-creation are diminished information asymmetry and perceived risk, mission alignment as well as a personal fit or relationship with the investor. Therefore, an enterprise can utilise e.g. the following marketing activities in their investor relations to bridge the pioneer gap: ensuring investor material, the enterprise story and presenting of them is clear, concise and complete to “package” the enterprise as an investment; taking investor needs and motivations into account as well as utilising existing investors as ambassadors.

Narrow Gap flux-cored arc welding of high strength shipbuilding steels

This thesis is part of the Arctic Materials Technologies Development –project. The research of the thesis was done in cooperation with Arctech Helsinki Shipyard, Lappeenranta University of Technology and Kemppi Oy. Focus of the thesis was to study narrow gap flux-cored arc welding of two high strength steels with three different groove angles of 20°, 10° and 5°. Welding of the 25 mm thick E500 TMCP and 10 mm thick EH36 steels was mechanized and Kemppi WisePenetration and WiseFusion processes were tested with E500 TMCP steel. EH36 steel test pieces were welded without Wise processes. Shielding gases chosen were carbon dioxide and a mixture of argon and carbon dioxide. Welds were tested with non-destructive and destructive testing methods. Radiographic, visual, magnetic particle and liquid penetrant testing proved that welds were free from imperfections. After non-destructive testing, welds were tested with various destructive testing methods. Impact strength, bending, tensile strength and hardess tests proved that mechanized welding and Wise processes produced quality welds with narrower gap. More inconsistent results were achieved with test pieces welded without Wise processes. Impact test results of E500 TMCP exceeded the 50 J limit on weld, set by Russian Maritime Register of Shipping. EH36 impact test results were much closer to the limiting values of 34 J on weld and 47 on HAZ. Hardness values of all test specimens were below the limiting values. Bend testing and tensile testing results fulfilled the the Register requirements. No cracking or failing occurred on bend test specimens and tensile test results exceeded the Register limits of 610 MPa for E500 TMCP and 490 MPa for EH36.

Legitimacy Building in Public Disclosures on Strategic Energy Investments

Renewable energy investments play a key role in energy transition. While studies have suggested that social acceptance may form a barrier for renewable energy investments, the ways in which companies perceive and attempt to gain the acceptance have received little attention. This study aims to fill the gap by exploring how large electric utilities justify their strategic investments in their press releases and how do the justifications differ between renewable and non-renewable energy investments. The study bases on legitimacy theory and aims at contributing to the research on legitimation in institutional change. As its research method, the study employs an inductive mixed method content analysis. The study has two parts: a qualitative content analysis that explores and identifies the themes and legitimation strategies of the press releases and a quantitative computer-aided analysis that compares renewable and non-renewable energy investments. The sample of the study consists of 396 press releases representing the strategic energy investments of 34 electric utilities from the list of the world’s 250 largest and financially most successful energy companies. The data is collected from the period of 2010–2014. The study reveals that most important justifications for strategic energy investments are fit with the strategy and environmental and social benefits. Justifications address especially the expectations of market. Investments into non-renewable energy are justified more and they use more arguments addressing the proprieties and performance of power plants whereas renewable energy investments are legitimized by references to past actions and commonly accepted morals and norms. The findings support the notion that validity-addressing and propriety-addressing legitimation strategies are used differently in stable and unstable institutional settings.

Sosioteknisen kuilun kaventaminen toiminnanohjausjärjestelmän ja käyttäjien välillä

Pro Gradu- tutkimuksen keskeisin tavoite on ollut selvittää, kuinka sosioteknistä kuilua kohdeyrityksen toiminnanohjausjärjestelmän ja käyttäjien välillä voitaisiin pienentää. Teo-reettisena viitekehyksenä on käytetty sosioteknistä systeemiteoriaa sekä teorioita liittyen tietoteknisen järjestelmän hyväksyntään. Toiminnanohjausjärjestelmät ovat tunnetusti välttämätön osa nykypäivää lähes kaikille yrityksille. Niiden käyttöönoton onnistumista ja käytön tehokkuutta voidaan parantaa huomioimalla sekä sosiaalinen että tekninen systeemi organisaatiossa. Sosiotekninen kuilu rakentuu kahden välttämättömän ja toisistaan riippuvaisen systeemin välille: sekä sosiaalinen systeemi eli henkilöstö ja heidän työtapansa että tekninen systeemi eli tekno-logia ja tieto on huomioitava ja aidosti sosioteknisessä muutoksessa molempia systeeme-jä muokattava. Organisaatio voi parantaa omilla toimillaan käyttäjien asennetta ja haluk-kuutta ja siten kaventaa kuilua sosiaalisen systeemin puolelta. Lisäksi teknistä systeemiä tulisi muokata paremmin vastaamaan käyttäjien toiveita, jotta kuilu kapenisi myös tekni-sen systeemin suunnasta. Tutkimus toteutettiin laadullisena ja aineistonkeräystapana käytettiin puolistrukturoituja haastatteluja kohdeyrityksessä.

Evaluation of novel programs in health counseling – their effectiveness in the oral health of young children, and their acceptance by parents and professionals in public dental service.

Aim and design: To evaluate family-based health counseling for young children, and to study the significance of adding parental self-care or the training of professionals to the programs. The effectiveness and acceptability of the programs were evaluated by comparing two new programs with an earlier one. Subjects and methods: The study was carried out in Vantaa, which was divided into three study areas. The subjects consisted of children born in 2008, particularly fi rstborn children, while children born in 2006 formed the historical control. The fi rst of the new programs emphasized oral hygiene and use of fl uoride, and the second program focused on proper diet and use of xylitol. The main outcome measure was mutansstreptococci (MS) in the dental biofi lm of two-year-olds, and the opinions of parents and dental professionals were evaluated using questionnaires. Results: The programs found wide acceptance among dental professionals. There were no group-related differences found in the MS scores of the two-year-olds. However, all groups combined, father’s advanced level of education and child’s proper use of xylitol were associated with negative MS scores. In the opinion of parents, the oral healthcare guidance at least somewhat met their expectations. Conclusions: The present fi ndings suggest that providing training and support for professionals in health education is important. The addition of parental self-care to supplement programs aimed at young children does not improve the program, although it may improve parental readiness to change their own health habits. Counseling for families might be best carried out through a routine patient-centered program.