Anaesthesia and Pain Management for Use in Orthopaedic Day Surgery

Day surgery has gained a large popularity during the last decades. In Finland, 57% of the elective procedures, and 50% at Turku University Hospital, were already conducted on day basis during 2012. The steady growth of day surgery is mostly due to an increased safety in perioperative care and cost-effectiveness. The development of surgical techniques and anaesthetic methods has advanced the modern day surgery and extended the repertory of the procedures for use in day surgery operations. Day surgery also offers certain benefits like reduced risk for hospital-related infections, stress and confusion. Patient satisfaction, regarding several issues, is high. Most concerns and complaints are related to postoperative pain, nausea and vomiting pain and nausea. Pain can hamper recovery and pain management is a crucial factor for hospital discharge. Appropriate pain treatment is effective, safe, easy and economical. A procedure-specific approach and an individually planned, multimodal analgesia should be the basis of modern pain management. The main aim of this thesis was to evaluate the effectiveness and safety of anaesthetic technique and methods in pain treatment of orthopaedic day case surgery, and following conclusions were made. Unilateral spinal block was achieved using hyperbaric bupivacaine with a small dose of clonidine but clonidine prolonged the block. Continuous subacromial bupivacaine was found to be safe but conferring only moderate efficacy in pain care after shoulder arthroscopy. Transdermal fentanyl, 12 g/h, as part of multimodal analgesia, offered a safe and easy option to pain management in this patient group. However, after forefoot surgery, it did not reduce pain any further. In general, pain scores in all patient groups were low and the need for rescue opioid moderate.

Foreign Direct Investment, Clean Development Mechanism, and Environmental Management: A case of Sub-Saharan Africa

This doctoral dissertation explores the contribution of environmental management practices, the so-called clean development mechanism (CDM) projects, and foreign direct investment (FDI) in achieving sustainable development in developing countries, particularly in Sub- Saharan Africa. Because the climate change caused by greenhouse gas emissions is one of the most serious global environmental challenges, the main focus is on the causal links between carbon dioxide (CO2) emissions, energy consumption, and economic development in Sub-Saharan Africa. In addition, the dissertation investigates the factors that have affected the distribution of CDM projects in developing countries and the relationships between FDI and other macroeconomic variables of interest. The main contribution of the dissertation is empirical. One of the publications uses crosssectional data and Tobit and Poisson regressions. Three of the studies use time-series data and vector autoregressive and vector error correction models, while two publications use panel data and panel data estimation methods. One of the publications uses thus both timeseries and panel data. The concept of Granger causality is utilized in four of the publications. The results indicate that there are significant differences in the Granger causality relationships between CO2 emissions, energy consumption, economic growth, and FDI in different countries. It appears also that the causality relationships change over time. Furthermore, the results support the environmental Kuznets curve hypothesis but only for some of the countries. As to CDM activities, past emission levels, institutional quality, and the size of the host country appear to be among the significant determinants of the distribution of CDM projects. FDI and exports are also found to be significant determinants of economic growth.

Competence foresight: linking the identification of HR competences and competence management alignment with business strategy

The objective of this study was to increase understanding of the link between the identification of required HR competences and competence management alignment with business strategy in a Finnish, global company employing over 8,000 people and about 100 HR professionals. This aim was approached by analyzing the data collected in focus group interviews using a grounded theory method and in parallel reviewing the literature of strategic human resource management, competence-based strategic management, strategy and foresight. The literature on competence management in different contexts dismisses in-depth discussions on the foresight process and individuals are often forgotten in strategic frameworks. However, corporate foresight helps in the detection of emerging opportunities for innovations and in the implementation of strategy. The empirical findings indicate a lack of strategic leadership and an alignment with HR and business. Accordingly, the most important HR competence areas identified were the need for increasing business understanding and enabling change. As a result, the study provided a holistic model for competence foresight, which introduces HR professionals as strategic change agents in the role of organizational futurists at the heart of the company: facilitating competence foresight and competence development on individual as well as organizational levels, resulting in an agile organization with increased business understanding, sensitive sensors and adaptive actions to enable change.

Project Charter, Scope, and Time Management In the Movie Industry

This thesis explores how the project charter development, project scope management, and project time management are executed in a Finnish movie production. The deviations and analogies between a case movie production and best practices suggested in PMBOK are presented. Empirical material from the case is gathered with two semi-structured interviews with a producer and a line producer. The interview data is categorized according to PMBOK knowledge areas. The analysis is complemented with movie industry specific norms found in popular movie production guides. The described and observed methods are linked together and the relationship between them is discussed. The project charter development, which is referred as a green light process in the movie industry, is mostly analogous between all areas. The deviations are in the level of formality. The green lighting in the case movie was accomplished without bureaucratic reports described in movie production guides. The empirical material shows that project management conventions and movie industry employ similar methods especially in scope management. Project management practices introduce a work breakdown structure (WBS) method, and movie production accomplishes the same task by developing a shooting script. Time management of the case movie deviates on most parts from the methods suggested in PMBOK. The major deviation is resource management. PMBOK suggests creating a resource breakdown structure. The case movie production accomplished this through budgeting process. Furthermore the popular movie production guides also disregard resource management as sovereign process. However the activity listing is quite analogous between the case movie and PMBOK. The final key observation is that although there is a broad set of effective and detailed movie industry specific methods, a comprehensive methodology that would cover the whole production process, such as Prince2 or Scrum, seems to be missing from the movie industry.

Project charter, scope, and time management in the movie industry

This thesis explores how the project charter development, project scope management, and project time management are executed in a Finnish movie production. The deviations and analogies between a case movie production and best practices suggested in PMBOK are presented. Empirical material from the case is gathered with two semi-structured interviews with a producer and a line producer. The interview data is categorized according to PMBOK knowledge areas. The analysis is complemented with movie industry specific norms found in popular movie production guides. The described and observed methods are linked together and the relationship between them is discussed. The project charter development, which is referred as a green light process in the movie industry, is mostly analogous between all areas. The deviations are in the level of formality. The green lighting in the case movie was accomplished without bureaucratic reports described in movie production guides. The empirical material shows that project management conventions and movie industry employ similar methods especially in scope management. Project management practices introduce a work breakdown structure (WBS) method, and movie production accomplishes the same task by developing a shooting script. Time management of the case movie deviates on most parts from the methods suggested in PMBOK. The major deviation is resource management. PMBOK suggests creating a resource breakdown structure. The case movie production accomplished this through budgeting process. Furthermore the popular movie production guides also disregard resource management as sovereign process. However the activity listing is quite analogous between the case movie and PMBOK. The final key observation is that although there is a broad set of effective and detailed movie industry specific methods, a comprehensive methodology that would cover the whole production process, such as Prince2 or Scrum, seems to be missing from the movie industry.

Modelling the simultaneous effects of intellectual capital and knowledge management on the organisational performance of Finnish companies

The aim of this study was to contribute to the current knowledge-based theory by focusing on a research gap that exists in the empirically proven determination of the simultaneous but differentiable effects of intellectual capital (IC) assets and knowledge management (KM) practices on organisational performance (OP). The analysis was built on the past research and theoreticised interactions between the latent constructs specified using the survey-based items that were measured from a sample of Finnish companies for IC and KM and the dependent construct for OP determined using information available from financial databases. Two widely used and commonly recommended measures in the literature on management science, i.e. the return on total assets (ROA) and the return on equity (ROE), were calculated for OP. Thus the investigation of the relationship between IC and KM impacting OP in relation to the hypotheses founded was possible to conduct using objectively derived performance indicators. Using financial OP measures also strengthened the dynamic features of data needed in analysing simultaneous and causal dependences between the modelled constructs specified using structural path models. The estimates were obtained for the parameters of structural path models using a partial least squares-based regression estimator. Results showed that the path dependencies between IC and OP or KM and OP were always insignificant when analysed separate to any other interactions or indirect effects caused by simultaneous modelling and regardless of the OP measure used that was either ROA or ROE. The dependency between the constructs for KM and IC appeared to be very strong and was always significant when modelled simultaneously with other possible interactions between the constructs and using either ROA or ROE to define OP. This study, however, did not find statistically unambiguous evidence for proving the hypothesised causal mediation effects suggesting, for instance, that the effects of KM practices on OP are mediated by the IC assets. Due to the fact that some indication about the fluctuations of causal effects was assessed, it was concluded that further studies are needed for verifying the fundamental and likely hidden causal effects between the constructs of interest. Therefore, it was also recommended that complementary modelling and data processing measures be conducted for elucidating whether the mediation effects occur between IC, KM and OP, the verification of which requires further investigations of measured items and can be build on the findings of this study.

Social-business tensions and their management in social enterprise: evidence from Finland.

This thesis aims to provide insight into the social-business tensions the social enterprises face in their operation and how they manage them. The social-business tensions are examined from four theoretical perspectives using triangulation approach. The theoretical lenses chosen are organizational identity, stakeholder theory, paradox theory and institutional theory. The theories aim to clarify, how the tensions are formed, how they appear and how they are managed in social enterprises. One viewpoint of this thesis is to examine the competence of these theories in explaining the social-business tensions in practise. The qualitative data was collected by interviewing persons from the management of two social enterprises. The empirical evidence of this thesis suggests that the appearing of social-business tensions varies between the social enterprises and they can be seen both as an advantage and as a challenge. Most of the social-business tensions arise from the enterprise’s multiple incoherent objectives, their stakeholders’ various demands and the differing understanding of the company’s central operation among the members of the organization. According to this thesis, the theories of organizational identity, stakeholder, paradox and institution are all able to provide unique insight into the identification and management of the social-business tensions. However, the paradox theory turned out to be the most abstract of the theories and thus being the farthest from the practise.

Power and Performance Management Strategies on NoC-Based Multicore Platforms, Using DVFS, Adaptive Algorithm and Task Parallelism

This work presents synopsis of efficient strategies used in power managements for achieving the most economical power and energy consumption in multicore systems, FPGA and NoC Platforms. In this work, a practical approach was taken, in an effort to validate the significance of the proposed Adaptive Power Management Algorithm (APMA), proposed for system developed, for this thesis project. This system comprise arithmetic and logic unit, up and down counters, adder, state machine and multiplexer. The essence of carrying this project firstly, is to develop a system that will be used for this power management project. Secondly, to perform area and power synopsis of the system on these various scalable technology platforms, UMC 90nm nanotechnology 1.2v, UMC 90nm nanotechnology 1.32v and UMC 0.18 μmNanotechnology 1.80v, in order to examine the difference in area and power consumption of the system on the platforms. Thirdly, to explore various strategies that can be used to reducing system’s power consumption and to propose an adaptive power management algorithm that can be used to reduce the power consumption of the system. The strategies introduced in this work comprise Dynamic Voltage Frequency Scaling (DVFS) and task parallelism. After the system development, it was run on FPGA board, basically NoC Platforms and on these various technology platforms UMC 90nm nanotechnology1.2v, UMC 90nm nanotechnology 1.32v and UMC180 nm nanotechnology 1.80v, the system synthesis was successfully accomplished, the simulated result analysis shows that the system meets all functional requirements, the power consumption and the area utilization were recorded and analyzed in chapter 7 of this work. This work extensively reviewed various strategies for managing power consumption which were quantitative research works by many researchers and companies, it's a mixture of study analysis and experimented lab works, it condensed and presents the whole basic concepts of power management strategy from quality technical papers.