Primary and Revision Hip Replacement. A University Hospital Database and Registry Study

Large-headed total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) with metal-on-metal (MoM) bearings became popular during the last decade. Recently, it has become evident that the large-head MoM hip implants are associated with increased revision rates despite their theoretical advantages. The purpose of this study was to evaluate the early results of primary MoM hip replacements and of acetabular revisions. I analyzed retrospectively the results of four MoM implant designs and the survival rate of acetabular revisions with impaction bone grafting, as documented in the Turku University Hospital database. Further, I evaluated the correlation between femoral head size and dislocation rate, and used the Finnish Arthroplasty Register data to compare the survival of three large-head MoM THAs to analogous HRAs. The early results for the Magnum M2A–ReCap THA were good. A larger head size decreased the risk of dislocation. Articular surface replacement (ASR) THA yielded inferior results compared to analogous HRA. For two other designs the results were similar. The R3–Synergy THA yielded inferior results compared to the reference implants. The survival of acetabular reconstructions with impaction bone grafting was inferior compared to previous reports. In conclusion, the early results of the Biomet ReCap–Magnum design were promising, and large head sizes decreased the dislocation rate. The survival of different MoM hip implant designs varied. The survival of new designs and techniques may be inferior to those reported by the clinics where implants are developed. An important caveat is that early promising results of new devices may rapidly worsen. New implants need to be introduced in a controlled fashion to the market; here, arthroplasty registers are a valuable tool that needs to be used.

Strategic narratives and competitive advantage : do winners speak differently?

Concepts, models, or theories that end up shaping practices, whether those practices fall in the domains of science, technology, social movements, or business, always emerge through a change in language use. First, communities begin to talk differently, incorporating new vocabularies (Rorty, 1989), in their narratives. Whether the community’s new narratives respond to perceived anomalies or failures of the existing ones (Kuhn, 1962) or actually reveal inadequacies by addressing previously unrecognized practices (Fleck, 1979; Rorty, 1989) is less important here than the very phenomena that they introduce differences. Then, if the new language proves to be useful, for example, because it helps the community solve a problem or create a possibility that existing narratives do not, the new narrative will begin circulating more broadly throughout the community. If other communities learn of the usefulness of these new narratives, and find them sufficiently persuasive, they may be compelled to test, modify, and eventually adopt them. Of primary importance is the idea that a new concept or narrative perceived as useful is more likely to be adopted. We can expect that business concepts emerge through a similar pattern. Concepts such as “competitive advantage,” “disruption,” and the “resource based view,” now broadly known and accepted, were each at some point first introduced by a community. This community experimented with the concepts they introduced and found them useful. The concept “competitive advantage,” for example, helped researchers better explain why some firm’s outperformed others and helped practitioners more clearly understand what choices to make to improve the profit and growth prospects of their firms. The benefits of using these terms compelled other communities to consider, apply, and eventually adopt them as well. Were these terms not viewed as useful, they would not likely have been adopted. This thesis attempts to observe and anticipate new business concepts that may be emerging. It does so by seeking to observe a community of business practitioners that are using different language and appear to be more successful than a similar community of practitioners that are have not yet begun using this different language as extensively. It argues that if the community that is adopting new types of narratives is perceived as being more successful, their success will attract the attention of other communities who may then seek to adopt the same narratives. Specifically, this thesis compares the narratives used by a set of firms that are considered to be performing well (called Winners) with those of set of less-successful peers (called Losers). It does so with the aim of addressing two questions: - How do the strategic narratives that circulate within “winning” companies and their leaders differ from those circulating within “losing” companies and their leaders? - Given the answer to the first question: what new business strategy concepts are likely to emerge in the business community at large? I expected to observe “winning” companies shifting their language, abandoning an older set of narratives for newer ones. However the analysis indicates a more interesting dynamic: “winning” companies adopt the same core narratives as their “losing” peers with equal frequency yet they go beyond these. Both “winners” and “losers” seem to pursue economies of scale, customer captivity, best practices, and securing preferential access to resources with similar vigor. But “winners” seem to go further, applying three additional narratives in their pursuits of competitive advantage. They speak of coordinating what is uncoordinated, adopting what this thesis calls “exchanging the role of guest for that of host,” and “forcing a two-front battle” more frequently than their “loser” peers. Since these “winning” companies are likely perceived as being more successful, the unique narratives they use are more likely to be emulated and adopted. Understanding in what ways winners speak differently, therefore, gives us a glimpse into the possible future evolution of business concepts.

Competitive advantage through proprietary erp implementation: analysis of the project Väinämö

In the market where companies similar in size and resources are competing, it is challenging to have any advantage over others. In order to stay afloat company needs to have capability to perform with fewer resources and yet provide better service. Hence development of efficient processes which can cut costs and improve performance is crucial. As business expands, processes become complicated and large amount of data needs to be managed and available on request. Different tools are used in companies to store and manage data, which facilitates better production and transactions. In the modern business world the most utilized tool for that purpose is ERP - Enterprise Resource Planning system. The focus of this research is to study how competitive advantage can be achieved by implementing proprietary ERP system in the company; ERP system that is in-house created, tailor made to match and align business needs and processes. Market is full of ERP software, but choosing the right one is a big challenge. Identifying the key features that need improvement in processes and data management, choosing the right ERP, implementing it and the follow-up is a long and expensive journey companies undergo. Some companies prefer to invest in a ready-made package bought from vendor and adjust it according to own business needs, while others focus on creating own system with in-house IT capabilities. In this research a case company is used and author tries to identify and analyze why organization in question decided to pursue the development of proprietary ERP system, how it has been implemented and whether it has been successful. Main conclusion and recommendation of this research is for companies to know core capabilities and constraints before choosing and implementing ERP system. Knowledge of factors that affect system change outcome is important, to make the right decisions on strategic level and implement on operational level. Duration of the project in the case company has lasted longer than anticipated. It has been reported that in cases of buying ready product from vendor, projects are delayed and completed over budget as well. In general, in case company implementation of proprietary ERP has been successful both from business performance figures and usability of system by employees. In terms of future research, conducting a study to calculate statistically ROI of both approaches; of buying ready product and creating own ERP will be beneficial.

Achieving competitive e-commerce in Finnish B2C retail business

E-commerce is one of the most fast growing business areas today and an extremely important channel in retail. In order for companies to succeed in this business environment, it is highly important to understand consumers and how they perceive and select webstores. The objective of the study is to investigate how to achieve competitive e-commerce by investigating consumers and the factors based on which they select a webstore. In addition, the study also seeks to explore whether sex or consumers’ buying experience have an effect on consumer’s webstore selection. Managerial implications are viewed from case company’s perspective. In order to answer the research questions a quantitative marketing survey was conducted. The data was collected by online questionnaire using the case company’s customers as respondents. A total of 1613 responses were obtained from Finnish consumers. Responses were analyzed using ANOVA, factor analysis and t-test. The results show that the most important factors in consumer’s webstore selection are usability, reliability and vendor related information. The biggest difference between heavy and light shoppers is trust formation. Light shoppers value physical stores and familiar vendors, whereas heavy shoppers judge vendor based on the information and usability. Women perceive higher risk than men. The winning strategy requires a hybrid of cost leadership and differentiation.

Competitive Effects of Non-Controlling Minority Acquisitions – Sufficient to merit further EU merger regulation?

Partial ownership interests are a widespread phenomenon in modern corporate environment. Unless minority shareholding affords the target to exercise control over the target, they do currently not have to be notified to the European Commission under EU merger regime. However, economic research has long suggested that when linking competing or non-horizontally positioned undertakings particularly in industries with few competitors, minority shareholdings even far below the majority of shares or voting rights could lead to higher prices or lower output volumes to the detriment of consumers. The Commission has recognized this issue and proceeded to suggest an extension of the merger regime to catch also certain non-controlling minority acquisitions. Horizontal non-controlling minority shareholdings create a positive correlation between the sales revenues of the partial acquirer and target. Through the equity interest the acquirer will internalise a fraction, proportional to the financial rights attached to the shareholding, of the profit of the target. This will incentivise the acquirer to contribute to increasing the target’s business profits by increasing its own sales price (horizontal unilateral effects). When a minority stake is held in a vertically related or a conglomerate company, the minority acquirer could be allowed to hamper or eliminate the target’s rivals’ access either to inputs (input foreclosure) or customers (customer foreclosure), depending on which level of the supply chain the parties are (vertical unilateral effects). Under certain circumstances minority share acquisitions could also lessen competition because they facilitate collusion between companies active in the market (coordinated effects). Economic theory confirms that non-controlling minority shareholdings may under certain circumstances create anti-competitive effects that are unlikely to be remedies by pro-competitive effects. However, they are likely to be of less significant nature than anticompetitive effects created by full mergers. This derives fore mostly from the fact that a minority share acquirer carries all the costs associated with its unilateral action but will internalise only a fraction of the lost profits. This is likely to limit the acquirer’s incentive to raise price and the profitability of such behavior. Having in mind that the number of potentially problematic cases is expected to be next to negligible, the limited potential competitive effects of non-controlling minority share acquisitions cannot be seen to clearly merit extension of the scope of the EUMR. The system suggested by the Commission is particularly ill-fitted for such purpose given the clear lack of legal certainty and considerable administrative burden associated with it.

The Competitive Analysis of Selected Biorefineries in Finland

Biorefineries is a perspective field of study that covers many opportunities of a successful business unit with respect to sustainability. The thesis focuses on the following key objective: identification of a competitive biorefineries production process in small and medium segments of the chemical and forest industries in Finland. The scope of the research relates to the selected biorefineries operations in Finland and the use of hemicellulose, as a raw material. The identification of the types of biorefineries and the important technical and process characteristics opens the advantage in the company’s competitive analysis. The study concentrates on the practical approach to the scientific methods of the market and companies research with the help of Quality Function Deployment and House of Quality tool. The thesis’s findings provide mindset version of the expert’s House of Quality application, identification of crucial biorefineries technical and design characteristics’ correlation and their effect on the competitive behavior of a company. The theoretical background helps to build the picture of the problematic issues within the field and provides scientific possible solutions. The analysis of the biorefineries’ market and companies operations bring the practical-oriented aptitude of the research. The results of the research can be used for the following investigations in a field and may be applied as a company’s management analytic and strategic application.

Marketing a Mobile Application in a Highly Competitive Global Marketplace

The purpose of this research was to study the marketing of mobile applications. The main objective was to find out what are the most efficient ways of marketing to increase the sales for a mobile application within a highly competitive marketplace. The marketplaces, app stores, are studied from the perspective of size, ease of entry, competition and customers and their purchasing process. The study also includes research on what are some of the main marketing methods used in mobile app marketing in general. The study consists of two parts, theoretical and empirical research. Theoretical research was done by studying past scientific research on the chosen subjects. As the subject is very new, the research was also extended to other publications from the field of mobile technology. The empirical part was done through interviews and empirical experiments with a case-company, which were used to answer the main objective of this study. These experiments showed that the chosen methods of mobile app marketing, app store optimization, localization and selected social media marketing activities, created the most sales when used together. Positive results were seen also when the activities were conducted by themselves, but together they were able to push the case company to their all time best results. However the key to succeeding and hitting high positions in the app store rankings would most likely require creating a solid marketing strategy, trying out other marketing activities alongside the ones used here, without forgetting to stay on top of mobile technology trends.