Observations on the Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clinical Studies on Healthy Volunteers and Intensive Care Patients

Patients treated in intensive care units require sedation and analgesia. However, sedative drugs also have potential adverse effects, and there is no single ideal sedativeanalgesic drug for these patients. Dexmedetomidine is an apha2-adrenoceptor agonist licenced for sedation of intensive care patients and patients undergoing surgery and other invasive procedures. Several routes of parenteral administration (intravenous, intramuscular, subcutaneous and intranasal) have been utilized. In the present series of studies, the pharmacokinetics and pharmacodynamics of intranasally administered dexmedetomidine as well as the gastrointestinal effects of intravenous dexmedetomidine were determined in healthy volunteers. Pharmacokinetics of dexmedetomidine during long lasting, high-dose infusions were characterized in intensive care patients. The bioavailability of intranasal dexmedetomidine was relatively good (65%), but interindividual variation was large. Dexmedetomidine significantly inhibited gastric emptying and gastrointestinal transit. In intensive care patients, the elimination half-life of dexmedetomidine was somewhat longer than reported for infusions of shorter duration and in less ill patients or healthy volunteers. Dexmedetomidine appeared to have linear pharmacokinetics up to the studied dose rate of 2.5 μg/kg/h. Dexmedetomidine clearance was decreasing with age and its volume of distribution was increased in hypoalbuminaemic patients, resulting in a longer elimination half-life and context-sensitive half-time. Intranasally administered dexmedetomidine was efficacious and well tolerated, making it appropriate for clinical situations requiring light sedation. The clinical significance of the gastrointestinal inhibitory effects of dexmedetomidine should be further evaluated in intensive care patients. The possibility of potentially altered potency and effect duration should be taken into account when administering dexmedetomidine to elderly or hypoalbuminaemic patients.

Corporate Social Responsibility in the Oil and Gas Industry: Environmental Management Systems as a Source of Sustainable Development

The environmental aspect of corporate social responsibility (CSR) expressed through the process of the EMS implementation in the oil and gas companies is identified as the main subject of this research. In the theoretical part, the basic attention is paid to justification of a link between CSR and environmental management. The achievement of sustainable competitive advantage as a result of environmental capital growth and inclusion of the socially responsible activities in the corporate strategy is another issue that is of special significance here. Besides, two basic forms of environmental management systems (environmental decision support systems and environmental information management systems) are explored and their role in effective stakeholder interaction is tackled. The most crucial benefits of EMS are also analyzed to underline its importance as a source of sustainable development. Further research is based on the survey of 51 sampled oil and gas companies (both publicly owned and state owned ones) originated from different countries all over the world and providing reports on sustainability issues in the open access. To analyze their approach to sustainable development, a specifically designed evaluation matrix with 37 indicators developed in accordance with the General Reporting Initiative (GRI) guidelines for non-financial reporting was prepared. Additionally, the quality of environmental information disclosure was measured on the basis of a quality – quantity matrix. According to results of research, oil and gas companies prefer implementing reactive measures to the costly and knowledge-intensive proactive techniques for elimination of the negative environmental impacts. Besides, it was identified that the environmental performance disclosure is mostly rather limited, so that the quality of non-financial reporting can be judged as quite insufficient. In spite of the fact that most of the oil and gas companies in the sample claim the EMS to be embedded currently in their structure, they often do not provide any details for the process of their implementation. As a potential for the further development of EMS, author mentions possible integration of their different forms in a single entity, extension of existing structure on the basis of consolidation of the structural and strategic precautions as well as development of a unified certification standard instead of several ones that exist today in order to enhance control on the EMS implementation.

Identification and application of bile metabolites to assess the exposure of fish to pharmaceuticals in the environment

Thousands of tons of pharmaceuticals are consumed yearly worldwide. Due to the continuous and increasing consumption and their incomplete elimination in wastewater treatment plants (WWTP), pharmaceuticals and their metabolites can be detected in receiving waters, although at low concentrations (ng to low μg/L). As bioactive molecules the presence of pharmaceuticals in the aquatic environment must be considered potentially hazardous for the aquatic organisms. In this thesis, the biotransformation and excretion of pharmaceuticals in fish was studied. The main biotransformation pathways of three anti‐inflammatory drugs, diclofenac, naproxen and ibuprofen, in rainbow trout were glucuronidation and taurine conjugation of the parent compounds and their phase I metabolites. The same metabolites were present in fish bile in aquatic exposures as in fish dosed with intraperitoneal injection. Higher bioconcentration factor in bile (BCFbile) was found for ibuprofen when compared to diclofenac and naproxen. Laboratory exposure studies were followed by a study of uptake of pharmaceuticals in a wild fish population living in lake contaminated with WWTP effluents. Of the analyzed 17 pharmaceuticals and six phase I metabolites, only diclofenac, naproxen and ibuprofen was present in bream and roach bile. It was shown, that diclofenac, naproxen and ibuprofen excreted by the liver can be found in rainbow trout and in two native fish species living in the receiving waters. In the bream and roach bile, the concentrations of diclofenac, naproxen and ibuprofen were roughly 1000 times higher than those found in the lake water, while in the laboratory exposures, the bioconcentration of the compounds and their metabolites in rainbow trout bile were at the same level as in wild fish or an order of magnitude higher. Thus, the parent compounds and their metabolites in fish bile can be used as a reliable biomarker to monitor the exposure of fish to environmental pharmaceuticals present in water receiving discharges from WWTPs.

Luminescent Lanthanide Reporters: New Concepts for Use in Bioanalytical Applications

Lanthanides represent the chemical elements from lanthanum to lutetium. They intrinsically exhibit some very exciting photophysical properties, which can be further enhanced by incorporating the lanthanide ion into organic or inorganic sensitizing structures. A very popular approach is to conjugate the lanthanide ion to an organic chromophore structure forming lanthanide chelates. Another approach, which has quickly gained interest, is to incorporate the lanthanide ions into nanoparticle structures, thus attaining improved specific activity and binding capacity. The lanthanide-based reporters usually express strong luminescence emission, multiple narrow emission lines covering a wide wavelength range, and exceptionally long excited state lifetimes enabling timeresolved detection. Because of these properties, the lanthanide-based reporters have found widespread applications in various fields of life. This study focuses on the field of bioanalytical applications. The aim of the study was to demonstrate the utility of different lanthanide-based reporters in homogeneous Förster resonance energy transfer (FRET)-based bioaffinity assays. Several different model assays were constructed. One was a competitive bioaffinity assay that utilized energy transfer from lanthanide chelate donors to fluorescent protein acceptors. In addition to the conventional FRET phenomenon, a recently discovered non-overlapping FRET (nFRET) phenomenon was demonstrated for the first time for fluorescent proteins. The lack of spectral overlap in the nFRET mechanism provides sensitivity and versatility to energy transfer-based assays. The distance and temperature dependence of these phenomena were further studied in a DNA-hybridization assay. The distance dependence of nFRET deviated from that of FRET, and unlike FRET, nFRET demonstrated clear temperature dependence. Based on these results, a possible excitation mechanism operating in nFRET was proposed. In the study, two enzyme activity assays for caspase-3 were also constructed. One of these was a fluorescence quenching-based enzyme activity assay that utilized novel inorganic particulate reporters called upconverting phosphors (UCPs) as donors. The use of UCPs enabled the construction of a simple, rather inexpensive, and easily automated assay format that had a high throughput rate. The other enzyme activity assay took advantage of another novel reporter class, the lanthanidebinding peptides (LBPs). In this assay, energy was transferred from a LBP to a green fluorescent protein (GFP). Using the LBPs it was possible to avoid the rather laborious, often poorly repeatable, and randomly positioned chemical labeling. In most of the constructed assays, time-resolved detection was used to eliminate the interfering background signal caused by autofluorescence. The improved signal-to-background ratios resulted in increased assay sensitivity, often unobtainable in homogeneous assay formats using conventional organic fluorophores. The anti-Stokes luminescence of the UCPs, however, enabled the elimination of autofluorescence even without time-gating, thus simplifying the instrument setup. Together, the studied reporters and assay formats pave the way for increasingly sensitive, simple, and easily automated bioanalytical applications.

Determinants of credit risk in secured loans – Evidence from the auto loan industry

The purpose of this study is to examine attributes which have explanation power to the probability of default or serious overdue in secured auto loans. Another goal is to find out differences between defaulted loans and loans which have had payment difficulties but survived without defaulting. 19 independent variables used in this study reflect information available at the time of credit decision. These variables were tested with logistic regression and backward elimination procedure. The data includes 8931 auto loans from a Finnish finance company. 1118 of the contracts were taken by company customers and 7813 by private customers. 130 of the loans defaulted and 584 had serious payment problems but did not default. The maturities of those loans were from one month to 60 months and they have ended during year 2011. The LTV (loan-to-value) variable was ranked as the most significant explainer because of its strong positive relationship with probability of payment difficulties. Another important explainer in this study was the credit rating variable which got a negative relationship with payment problems. Also maturity and car age performed well having both a positive relationship with the probability of payment problems. When compared default and serious overdue situations, the most significant differences were found in the roles of LTV, Maturity and Gender variables.

Infant Colic Crying and Gastrointestinal Tract – Causes, Consequences and Cure

Despite over 50 years of investigation, the precise cause of infant colic crying remains unresolved and the long-term consequences unrevealed, and an effective treatment is lacking. Indeed, a more profound understanding of the complex nature of infants’ excessive crying is needed. The purpose of this series of studies was to investigate the association between gut microbiota composition and infant crying, to evaluate the impact of colic crying on children’s later health and to study the possibilities of treating and preventing excessive crying with pro- and prebiotics. The material comprised three on-going, prospective randomized controlled trials of the probiotic Lactobacillus rhamnosus GG (ATCC 53103, LGG) or a mixture of prebiotics administered in early infancy. The study populations consisted of term infants (n=89), preterm infants (n=94) and term colic infants (n=30). Early crying was found to be inversely associated with the number of Bifidobacterium and Lactobacillus. Furthermore, at the age of 13 years functional gastrointestinal disorders (FGID) were manifested more frequently among children with previous colic crying than in those without. In preterm infants pro- and prebiotic supplementation during the first months of life reduced the frequency of excessive crying when compared to placebo. In parallel, probiotic LGG in tandem with a cow’s milk elimination diet and behavioral counseling reduced the daily crying amount among term colic infants when compared to placebo. In conclusion, the composition of the gut microbiota is associated with infant crying and colic, and probiotic LGG might provide a safe and effective treatment or preventive option to alleviate excessive crying in early infancy in term and preterm infants. Furthermore, early colic crying might be associated with the later development of FGID.

Mathematical modeling and optimal control of malaria

Malaria continues to infect millions and kill hundreds of thousands of people worldwide each year, despite over a century of research and attempts to control and eliminate this infectious disease. Challenges such as the development and spread of drug resistant malaria parasites, insecticide resistance to mosquitoes, climate change, the presence of individuals with subpatent malaria infections which normally are asymptomatic and behavioral plasticity in the mosquito hinder the prospects of malaria control and elimination. In this thesis, mathematical models of malaria transmission and control that address the role of drug resistance, immunity, iron supplementation and anemia, immigration and visitation, and the presence of asymptomatic carriers in malaria transmission are developed. A within-host mathematical model of severe Plasmodium falciparum malaria is also developed. First, a deterministic mathematical model for transmission of antimalarial drug resistance parasites with superinfection is developed and analyzed. The possibility of increase in the risk of superinfection due to iron supplementation and fortification in malaria endemic areas is discussed. The model results calls upon stakeholders to weigh the pros and cons of iron supplementation to individuals living in malaria endemic regions. Second, a deterministic model of transmission of drug resistant malaria parasites, including the inflow of infective immigrants, is presented and analyzed. The optimal control theory is applied to this model to study the impact of various malaria and vector control strategies, such as screening of immigrants, treatment of drug-sensitive infections, treatment of drug-resistant infections, and the use of insecticide-treated bed nets and indoor spraying of mosquitoes. The results of the model emphasize the importance of using a combination of all four controls tools for effective malaria intervention. Next, a two-age-class mathematical model for malaria transmission with asymptomatic carriers is developed and analyzed. In development of this model, four possible control measures are analyzed: the use of long-lasting treated mosquito nets, indoor residual spraying, screening and treatment of symptomatic, and screening and treatment of asymptomatic individuals. The numerical results show that a disease-free equilibrium can be attained if all four control measures are used. A common pitfall for most epidemiological models is the absence of real data; model-based conclusions have to be drawn based on uncertain parameter values. In this thesis, an approach to study the robustness of optimal control solutions under such parameter uncertainty is presented. Numerical analysis of the optimal control problem in the presence of parameter uncertainty demonstrate the robustness of the optimal control approach that: when a comprehensive control strategy is used the main conclusions of the optimal control remain unchanged, even if inevitable variability remains in the control profiles. The results provide a promising framework for the design of cost-effective strategies for disease control with multiple interventions, even under considerable uncertainty of model parameters. Finally, a separate work modeling the within-host Plasmodium falciparum infection in humans is presented. The developed model allows re-infection of already-infected red blood cells. The model hypothesizes that in severe malaria due to parasite quest for survival and rapid multiplication, the Plasmodium falciparum can be absorbed in the already-infected red blood cells which accelerates the rupture rate and consequently cause anemia. Analysis of the model and parameter identifiability using Markov chain Monte Carlo methods is presented.

Tuoteportfolion hallinnointiprosessin erityispiirteet lääketeollisuusyrityksessä – tapaustutkimus

Tämän pro gradu -tutkielman tarkoituksena oli selvittää, miten lääketeollisuusyritys toteuttaa tuoteportfolioidensa hallinnointia ja miten tämän caseyrityksen portfolioprosessi vastaa kirjallisuuden näkemystä tuoteportfolion hallinnoinnista. Tutkimusongelmaa lähestyttiin tapaustutkimuksella caseyrityksen portfolioprosessista, ja tätä prosessia verrattiin kirjallisuuden näkemykseen aiheesta. Empiiristä aineistoa kerättiin pääosin teema- ja lomakehaastatteluilla caseyrityksen projektin avainhenkilöiltä. Tutkimuksessa havaittiin portfolioprosessin olevan vaiheittainen toimintamalli, jonka tavoitteena on hankkia mahdollisimman kannattava tuotevalikoima. Caseyrityksen portfolioprosessi vastasi pääosin aiheen teorian kuvaamaa mallia, mutta prosessia ja etenkin karsintakriteereitä monipuolistamalla voidaan tulevaisuudessa saavuttaa parempia tuloksia. Lääketeollisuudella toimialana on tiettyjä ominaispiirteitä, mutta nämä eivät suoraan näy varsinaisessa portfolioprosessissa. Kuitenkin esimerkiksi erityyppisten liiketoimintayksiköiden tarpeet olisi syytä huomioida tuoteportfolion hallinnointiprosessissa.

Sisälogististen materiaalivirtojen -ja materiaalitoimintojen kehittäminen eräässä kokoonpanoyrityksessä

Toimintaympäristön muutokset ja kysynnän monipuolistuminen haastavat useat teollisuuden alan yritykset kehittämään toimintaansa. Varastointi ja sisälogistiikka sisältävät useita yrityksen sisäisen tehokkuuden kehityskohteita. Logististen toimintojen ajankäytöllisen hukan eliminointi ja sisälogistinen selkeys parantavat liiketoiminnan kannattavuutta. Työssä käsitellään yrityksen sisälogistisia materiaalivirtoja, jotka muodostuvat materiaalitoimintojen suorittamista komponenttien ja lopputuotteiden siirroista. Tavoitteina oli lyhentää tuotannon pääkokoonpanon komponenttien keräilyyn kuluvaa aikaa ja selkeyttää sisälogistista systeemiä kehittämällä kokoonpanotuotannon ja sitä palvelevan varastoinnin layoutia, sekä komponenttien varastopaikkoja. Tutkimus perustuu kvantitatiiviseen ja kvalitatiiviseen tutkimusmenetelmään. Sisälogististen osa-alueiden analysointiin käytettiin osallistuvaa havainnointia, haastatteluita, vertailevaa tutkimusta ja datapohjaista aineistoa. Työn tuloksena syntyi kehitysehdotus materiaalivirtojen ja varastoinnin uudeksi rakenteeksi, sekä toimintamalli nimikkeiden varastopaikkojen määrittämiseksi ja työpisteiden järjestyksen ylläpitoon.

Analyzing the Effects of the New Renewable Energy Policy in Russia on Investments into Wind, Solar and Small Hydro Power

This thesis presents an analysis of recently enacted Russian renewable energy policy based on capacity mechanism. Considering its novelty and poor coverage by academic literature, the aim of the thesis is to analyze capacity mechanism influence on investors’ decision-making process. The current research introduces a number of approaches to investment analysis. Firstly, classical financial model was built with Microsoft Excel® and crisp efficiency indicators such as net present value were determined. Secondly, sensitivity analysis was performed to understand different factors influence on project profitability. Thirdly, Datar-Mathews method was applied that by means of Monte Carlo simulation realized with Matlab Simulink®, disclosed all possible outcomes of investment project and enabled real option thinking. Fourthly, previous analysis was duplicated by fuzzy pay-off method with Microsoft Excel®. Finally, decision-making process under capacity mechanism was illustrated with decision tree. Capacity remuneration paid within 15 years is calculated individually for each RE project as variable annuity that guarantees a particular return on investment adjusted on changes in national interest rates. Analysis results indicate that capacity mechanism creates a real option to invest in renewable energy project by ensuring project profitability regardless of market conditions if project-internal factors are managed properly. The latter includes keeping capital expenditures within set limits, production performance higher than 75% of target indicators, and fulfilling localization requirement, implying producing equipment and services within the country. Occurrence of real option shapes decision-making process in the following way. Initially, investor should define appropriate location for a planned power plant where high production performance can be achieved, and lock in this location in case of competition. After, investor should wait until capital cost limit and localization requirement can be met, after that decision to invest can be made without any risk to project profitability. With respect to technology kind, investment into solar PV power plant is more attractive than into wind or small hydro power, since it has higher weighted net present value and lower standard deviation. However, it does not change decision-making strategy that remains the same for each technology type. Fuzzy pay-method proved its ability to disclose the same patterns of information as Monte Carlo simulation. Being effective in investment analysis under uncertainty and easy in use, it can be recommended as sufficient analytical tool to investors and researchers. Apart from described results, this thesis contributes to the academic literature by detailed description of capacity price calculation for renewable energy that was not available in English before. With respect to methodology novelty, such advanced approaches as Datar-Mathews method and fuzzy pay-off method are applied on the top of investment profitability model that incorporates capacity remuneration calculation as well. Comparison of effects of two different RE supporting schemes, namely Russian capacity mechanism and feed-in premium, contributes to policy comparative studies and exhibits useful inferences for researchers and policymakers. Limitations of this research are simplification of assumptions to country-average level that restricts our ability to analyze renewable energy investment region wise and existing limitation of the studying policy to the wholesale power market that leaves retail markets and remote areas without our attention, taking away medium and small investment into renewable energy from the research focus. Elimination of these limitations would allow creating the full picture of Russian renewable energy investment profile.

Unequal Teeth Widths for Torque Ripple Reduction in Permanent Magnet Synchronous Machines With Fractional-Slot Non-Overlapping Windings

Permanent magnet synchronous machines with fractional-slot non-overlapping windings (FSPMSM), also known as tooth-coil winding permanent magnet synchronous machines (TCW PMSM), have been under intensive research during the latest decade. There are many optimization routines explained and implemented in the literature in order to improve the characteristics of this machine type. This paper introduces a new technique for torque ripple minimization in TCW PMSM. The source of torque harmonics is also described. The low order torque harmonics can be harmful for a variety of applications, such as direct drive wind generators, direct drive light vehicle electrical motors, and for some high precision servo applications. The reduction of the torque ripple harmonics with the lowest orders (6th and 12th) is realized by machine geometry optimization technique using finite element analysis (FEA). The presented optimization technique includes the stator geometry adjustment in TCW PMSMs with rotor surface permanent magnets and with rotor embedded permanent magnets. Influence of the permanent magnet skewing on the torque ripple reduction and cogging torque elimination was also investigated. It was implemented separately and together with the stator optimization technique. As a result, the reduction of some torque ripple harmonics was attained.

Lean Methods and Digital Technologies in Healtchare

The experiences of several healthcare organizations were considered to distinguish the most frequently used lean tools, the success and failure factors, and the obstacles that may appear while implementing lean. As a result, two approaches to “go lean” were defined, and analyzed from the prospective of the applicability to healthcare processes. Industrialization of healthcare was studied, and the most promising digital technology tools to improve healthcare process were highlighted. Finally, the analysis of healthcare challenges and feasible ways to address them was conducted and presented as the main result of this work. The possible ways of implementation of the findings and limitations were described in the conclusion.

Control of multi-actuator system by an electrically driven hydraulic pump-motor

The awareness and concern of our environment together with legislation have set more and more tightening demands for energy efficiency of non-road mobile machinery (NRMM). Integrated electro-hydraulic energy converter (IEHEC) has been developed in Lappeenranta University of Technology (LUT). The elimination of resistance flow, and the recuperation of energy makes it very efficient alternative. The difficulties of IEHEC machine to step to the market has been the requirement of one IEHEC machine per one actuator. The idea is to switch IEHEC between two actuators of log crane using fast on/off valves. The control system architecture is introduced. The system has been simulated in co-simulation using two different software. The simulated responses of pump-controlled system is compared to the responses of the conventional valve-controlled system.

Juridisen kaksinkertaisen verotuksen problematiikka kansainvälisessä yritystoiminnassa

Tässä tutkielmassa tarkastellaan kansainvälisessä yritystoiminnassa esiintyviä juridisen kaksinkertaisen verotuksen ongelmatilanteita suomalaisten yritysten näkökulmasta. Tutkielmassa pohditaan lisäksi yritysten omaa roolia osana kaksinkertaisen verotuksen tilanteita. Juridista kaksinkertaista verotusta muodostuu, kun sama yhtiö maksaa samasta tulosta veroa kahteen valtioon. Teoriaosio etenee verotusoikeuden määrittämisestä kaksinkertaisen verotuksen muodostumiseen. Kaksinkertainen verotus pyritään poistamaan poistomenetelmällä, joka on Suomessa tavallisesti hyvitysmenetelmä. Ongelmatilanne muodostuu, kun kaksinkertaista verotusta ei saada tehokkaasti poistettua tulon lähdevaltion ja yhtiön asuinvaltion välillä. Tämä tutkielma on laadullinen tutkimus ja tutkimusmenetelmänä on käytetty teemahaastattelua. Tutkimustulokset osoittavat, että kvalifikaatiokonflikteissa juridisen kaksinkertaisen verotuksen ongelmatilanne esiintyy pääsääntöisesti rojalti-liiketulo -luokitteluristiriidan seurauksena. Kiinteän toimipaikan kvalifikaatio on harvinaisempi ongelmatilanne. Hyvitysmenetelmän suurimmat ongelmat esiintyvät puolestaan pääliikkeen tappiollisen liiketoiminnan johdosta. Toinen hyvitysmenetelmän ongelmakohta esiintyy, kun lähdeveron alainen tulo huomioidaan bruttotulosta, mutta ulkomaisen tulon hyvitys suoritetaan nettotulosta. Haastatteluiden perusteella on selvää, että yritysten oma rooli kaksinkertaisen verotuksen ehkäisyssä on merkittävä. Yrityksen omia vaikutusmahdollisuuksia ovat muun muassa riittävä ennakointikyky, dokumentointi, selkeät sopimukset ja asiantuntijuus.

Improving purchasing process for small purchases at a manufacturing company in chemical industry

This thesis was conducted on assignment by a multinational chemical corporation as a case study. The purpose of this study is to find ways to improve the purchasing process for small purchases at the case company. The improvements looked after are mainly cost and time savings. Purchasing process is the process that starts from the requisition of goods or services and ends when the invoice is paid. In this thesis the purchases with value less than 1000€ are considered to be small. The theoretical framework of the thesis consists of general theoretical view of costs and performance of the purchasing process, different types of purchasing processes and a model for improving purchasing processes. The categorization to small and large purchases is the most important followed by the division between direct and indirect purchases. Also models that provide more strategic perspective for categorization were found to be useful. Auditing and managerial control are important parts of the purchasing process. When considering the transaction costs of purchasing from the costs–benefits perspective large and small purchases should not have the same processes. Purchasing cards, e-procurement and vendor managed inventory are seen as an alternative to the traditional purchasing process. The empirical data collection was done by interviewing the company employees that take part of the purchasing process in their daily work. The interviews had open-ended questions and the answers were coded and analyzed. The results consist of process description and assessment as well as suggestions for potential improvements. At the case company the basic purchasing process was similar to the traditional purchasing process that is entirely done with computers and online. For some categories there was already more sophisticated e-procurement solutions in use. To improve the current e-procurement based solutions elimination of authorization workflow and better information exchange can be seen as potential improvements for most of the case purchases. Purchasing cards and a lightweight form of vendor managed inventory can be seen as potential improvements for some categories. Implementing the changes incurs at least some cost and the benefits might be hard to measure. This thesis has revealed that the small purchases have potential for significant cost and time savings at the case company.