Libyan breast cancer: Health services and biology. Diagnosis delay and prognostic value of DNA pploidy, S-phase fraction, and Ki-67 and Bcl-2 immunohistochemistry

The aim of this study was to investigate the diagnosis delay and its impact on the stage of disease. The study also evaluated a nuclear DNA content, immunohistochemical expression of Ki-67 and bcl-2, and the correlation of these biological features with the clinicopathological features and patient outcome. 200 Libyan women, diagnosed during 2008–2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. Also retrospective preclinical and clinical data were collected from medical records on a form (questionnaire) in association with the interview. Tumor material of the patients was collected and nuclear DNA content analysed using DNA image cytometry. The expression of Ki-67 and bcl-2 were assessed using immunohistochemistry (IHC). The studies described in this thesis show that the median of diagnosis time for women with breast cancer was 7.5 months and 56% of patients were diagnosed within a period longer than 6 months. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was also associated with initial breast symptom(s) that did not include a lump, old age, illiteracy, and history of benign fibrocystic disease. The patients who showed diagnosis delay had bigger tumour size (p<0.0001), positive lymph nodes (p<0.0001), and high incidence of late clinical stages (p<0.0001). Biologically, 82.7% of tumors were aneuploid and 17.3% were diploid. The median SPF of tumors was 11% while the median positivity of Ki-67 was 27.5%. High Ki-67 expression was found in 76% of patients, and high SPF values in 56% of patients. Positive bcl-2 expression was found in 62.4% of tumors. 72.2% of the bcl-2 positive samples were ER-positive. Patients who had tumor with DNA aneuploidy, high proliferative activity and negative bcl-2 expression were associated with a high grade of malignancy and short survival. The SPF value is useful cell proliferation marker in assessing prognosis, and the decision cut point of 11% for SPF in the Libyan material was clearly significant (p<0.0001). Bcl-2 is a powerful prognosticator and an independent predictor of breast cancer outcome in the Libyan material (p<0.0001). Libyan breast cancer was investigated in these studies from two different aspects: health services and biology. The results show that diagnosis delay is a very serious problem in Libya and is associated with complex interactions between many factors leading to advanced stages, and potentially to high mortality. Cytometric DNA variables, proliferative markers (Ki-67 and SPF), and oncoprotein bcl-2 negativity reflect the aggressive behavior of Libyan breast cancer and could be used with traditional factors to predict the outcome of individual patients, and to select appropriate therapy.

Using Moodle to provide added value in the teaching of a software development course

The rate of adoption and use of learning management systems to support teaching and learning processes in academic institutions is growing rapidly. Universities are acquiring systems with functionalities that can match with their specific needs and requirements. Moodle is one of the most popular and widely deployed learning management systems in academic institutions today. However, apart from the system, universities tend to maintain other applications for the purpose of supplementing their teaching and learning processes. This situation is similar to Lappeenranta University of Technology (LUT), which is our case study in this project. Apart from Moodle, the university also maintains other systems such as Oodi, Noppa and Uni portal for the purpose of supporting its educational activities. This thesis has two main goals. The first goal is to understand the specific role of Moodle at LUT. This information is fundamental in assessing whether Moodle is needed in the university’s current teaching and learning environment. The second aim is to provide insights to teachers and other departmental stakeholders on how Moodle can provide added value in the teaching of a software development course. In response to this, a Moodle module for a software development course is created and the underlying features are tested. Results of the constructive work proposed some improvements through (i) the use of Moodle for in-class surveys, (ii) transfer of grades from Moodle to Oodi, (iii) use of Moodle in self-study courses and MOOCs, (iv) online examinations, and (v) Moodle integrations with third party applications. The proposed items were then evaluated for their utility through interviews of five expert interviews. The final results of this work are considered useful to LUT administration and management specifically on ways that Moodle can bring changes to the university at managerial, economical and technical level. It also poses some challenges on platform innovations and research.

Mapping the Value Network Potential in Cross-sector Collaboration: Case welfare Services for Elderly in Finland

Value network has been studied greatly in the academic research, but a tool for value network mapping is missing. The objective of this study was to design a tool (process) for value network mapping in cross-sector collaboration. Furthermore, the study addressed a future perspective of collaboration, aiming to map the value network potential. During the study was investigated and pondered how to get the full potential of collaboration, by creating new value in collaboration process. These actions are parts of mapping process proposed in the study. The implementation and testing of the mapping process were realized through a case study of cross-sector collaboration in welfare services for elderly in the Eastern Finland. Key representatives in elderly care from public, private and third sectors were interviewed and a workshop with experts from every sector was also conducted in this regard. The value network mapping process designed in this study consists of specific steps that help managers and experts to understand how to get a complex value network map and how to enhance it. Furthermore, it make easier the understanding of how new value can be created in collaboration process. The map can be used in order to motivate participants to be engaged with responsibility in collaboration and to be fully committed in their interactions. It can be also used as a motivator tool for those organizations that intend to engage in collaboration process. Additionally, value network map is a starting point in many value network analyses. Furthermore, the enhanced value network map can be used as a performance measurement tool in cross-sector collaboration.

The effects of the service process on satisfaction, trust and value as creators of customer loyalty in a daily deals concept

This study aims at applying the customer behaviour studies of satisfaction, trust, perceived value and loyalty to a daily deals concept. The goal is to find out whether the relationships are the same in this specific context when compared to previous e-commerce studies. The study examines how the daily deals service process affects customer satisfaction, trust and value, and how these in turn impact customer loyalty and each other. The data was collected via e-mail survey from case company customers, and research was conducted on a quantitative basis by using multivariate methods as tools. The results suggest that daily deals service process and service quality do have a direct and positive effect on customer satisfac-tion, trust and value. Additionally, positive correlations between the latter variables and customer loyalty were found. The results imply that the daily deals concept does not differ from other e-services when considering the studied factors. The results also emphasize the importance of recognizing what determinants have the greatest impact on customer loyalty in this specific context.

Energiatehokkaille ratkaisuille perustuva investointipotentiaali sairaalan saneeraushankkeessa

Tämän diplomityön tavoitteena oli tutkia ympäristömyönteisiä energiatehokkaita ratkaisuja, joita voitaisiin hyödyntää Kymenlaakson keskussairaalan rakennus- ja saneeraushankkeessa. Energiatehokkaiden ratkaisujen mahdollistamista vuotuisista käyttökustannussäästöistä laskettiin investointipotentiaali, jota voidaan hyödyntää saneerausinvestoinnin rahoituksessa. Työ jakautuu teoreettiseen kirjallisuusselvitykseen ja empiiriseen osuuteen, joka on toiminta-analyyttinen case-tutkimus. Investointipotentiaalin määrittämiseksi muodostettiin kolme skenaariota eritasoisisten energiankulutusta vähentävien toimenpiteiden ja tutkimustulosten sekä toteutusvaiheessa olevan saneeraushankeen pohjalta. Skenaariot muodostuivat erilaisista lämmön- ja sähkönkulutuksen vähentämisen yhdistelmistä. Investointipotentiaali saatiin laskemalla nykyarvo vuotuisista tulevaisuuden energiankulutuksen käyttökustannussäästöistä. Työn tuloksina esitettiin energiatehokkuutta parantavia ratkaisuja sekä kolme erisuuruisten energiankulutuksen vähennysyhdistelmien aikaansaamaa käyttökustannus-säästöistä syntyvää investointipotentiaaliratkaisua. Tutkimustietoa voidaan hyödyntää alkavassa sairaalan rakennus- ja saneerausinvestoinnin suunnittelutyössä.

Adsorptiojäähdyttimen käytön kannattavuus kaukolämpöjärjestelmässä

Vantaa Energy has decided to find out the district cooling business opportunities in Vantaa. One reason for starting up the cooling business is Vantaa Energy's waste-to-energy power plant which is under construction. In the future, especially in the summer time there is an oversupply of district heating because of the new power plant. The cooling using the district heat could be one way to increase the consumption of district heat in the summer. This thesis examines the use of adsorption cooling profitability. Adsorption refrigerator is a machine which uses heat as the driving energy. At Vantaa Energy's case, district heat produced at cogeneration plants would be used. The literature section of this thesis includes descriptions of district cooling, building cooling demand, as well as different ways to produce cooling energy. A tool for profitability calculations was made. It shows the payback period, internal rate of return and net present value of different projects. Based on the calculations adsorption refrigeration is not profitable. This is primarily due to the high price of the adsorption refrigerator. Payback periods become long even when the used heat energy is free. In addition, the lack of availability of the refrigerators and operating experience could become a partial barrier to the use of technology even if the investment would become profitable.

Value engineering of InnoTrackTM

Middle section module of InnoTrackTM moving walk was re-engineered according to value analysis process. Self-supporting steel structure for moving walk was created as a result of this process. Designed structure was verified and validated by prototype tests and finite element method calculations. Self-supporting steel structure replaces the original design of middle section module in InnoTrackTM. Designed structure provides higher satisfaction to customers’ needs and at the same time, it uses less resources. The redesigned middle section module provides higher value to the customer.

Creating an open-books implementation framework for a maintenance-related value-based life-cycle model

This study is a qualitative action research by its nature with elements of personal design in the form of a tangible model implementation framework construction. Utilized empirical data has been gathered via two questionnaires in relation to the arranged four workshop events with twelve individual participants. Five of them represented maintenance customers, three maintenance service providers and four equipment providers respectively. Further, there are two main research objectives in proportion to the two complementary focusing areas of this thesis. Firstly, the value-based life-cycle model, which first version has already been developed prior to this thesis, requires updating in order to increase its real-life applicability as an inter-firm decision-making tool in industrial maintenance. This first research objective is fulfilled by improving appearance, intelligibility and usability of the above-mentioned model. In addition, certain new features are also added. The workshop participants from the collaborating companies were reasonably pleased with made changes, although further attention will be required in future on the model’s intelligibility in particular as main results, charts and values were all reckoned as slightly hard to understand. Moreover, upgraded model’s appearance and added new features satisfied them the most. Secondly and more importantly, the premises of the model’s possible inter-firm implementation process need to be considered. This second research objective is delivered in two consecutive steps. At first, a bipartite open-books supported implementation framework is created and its different characteristics discussed in theory. Afterwards, the prerequisites and the pitfalls of increasing inter-organizational information transparency are studied in empirical context. One of the main findings was that the organizations are not yet prepared for network-wide information disclosure as dyadic collaboration was favored instead. However, they would be willing to share information bilaterally at least. Another major result was that the present state of companies’ cost accounting systems will definitely need implementation-wise enhancing in future since accurate and sufficiently detailed maintenance data is not available. Further, it will also be crucial to create supporting and mutually agreed network infrastructure. There are hardly any collaborative models, methods or tools currently in usage. Lastly, the essential questions about mutual trust and predominant purchasing strategies are cooperation-wise important. If inter-organizational activities are expanded, a more relational approach should be favored in this regard. Mutual trust was also recognized as a significant cooperation factor, but it is hard to measure in reality.

Kaukolämmön hinnoittelumallien optimointi ja kehittäminen muuttuvassa toimintaympäristössä

Kaukolämpöliiketoiminnan kehittämistarve korostuu jatkuvasti alan rakennemuutosten ja markkinoiden muutoksien seurauksena. Turku Energian tavoitteena on uudistaa ja kehittää kaukolämmön hinnoitteluaan vastaamaan energian tuotannon, jakelun, loppukäytön ja muihin alan muutoksiin. Tässä opinnäytetyössä tutkitaan kaukolämmön hinnoittelun optimointi ja kehittämistä nykyisessä sekä tulevaisuuden markkina- ja tuotantorakenteessa. Nykyisen hinnoittelumallin lisäksi tutkitaan vaihtoehtoisia tapoja hinnoitella myytävä kaukolämpöenergia, kuten vuodenaikojen mukaan määriteltävä muuttuva energianhinta. Työn kirjallisuusosassa esitellään kaukolämmön tuotanto, siirto ja jakelu sekä liiketoiminta Suomessa ja Turun seudulla. Tutkittavat hinnoittelumallit perustuvat todellisiin ja arvioituihin liiketoiminnan kustannuksiin, sekä esitettyihin laskentaperiaatteisiin. Turku Energian nykyistä perusmaksun hintatasoa tulee korottaa, jotta se vastaa lämmönhankinnan kiinteitä kustannuksia tarkemmin ja minimoi liiketoiminnan markkinariskiä. Nykyisen hinnoittelun verokomponentin kehittämisellä lisätään hinnoittelun läpinäkyvyyttä. Kausihinnoittelun avulla energianhinta noudattaa tuotannon kustannuksia vuoden aikana ja ohjaa asiakkaiden lämmönkulutusta nykyistä tarkemmin. Uusiutuvilla energianlähteillä tuotettua kaukolämpöä voidaan myydä erillisillä tuotteilla, joiden avulla liiketoiminnalle saadaan lisäarvoa.

In search of information systems value : a case study of the EHR benefits realisation efforts of three Swedish hospitals.

The Swedish public health care organisation could very well be undergoing its most significant change since its specialisation during the late 19th and early 20th century. At the heart of this change is a move from using manual patient journals to electronic health records (EHR). EHR are complex integrated organisational wide information systems (IS) that promise great benefits and value as well as presenting great challenges to the organisation. The Swedish public health care is not the first organisation to implement integrated IS, and by no means alone in their quest for realising the potential benefits and value that it has to offer. As organisations invest in IS they embark on a journey of value-creation and capture. A journey where a costbased approach towards their IS-investments is replaced with a value-centric focus, and where the main challenges lie in the practical day-to-day task of finding ways to intertwine technology, people and business processes. This has however proven to be a problematic task. The problematic situation arises from a shift of perspective regarding how to manage IS in order to gain value. This is a shift from technology delivery to benefits delivery; from an ISimplementation plan to a change management plan. The shift gives rise to challenges related to the inability of IS and the elusiveness of value. As a response to these challenges the field of IS-benefits management has emerged offering a framework and a process in order to better understand and formalise benefits realisation activities. In this thesis the benefits realisation efforts of three Swedish hospitals within the same county council are studied. The thesis focuses on the participants of benefits analysis projects; their perceptions, judgments, negotiations and descriptions of potential benefits. The purpose is to address the process where organisations seek to identify which potential IS-benefits to pursue and realise, this in order to better understand what affects the process, so that realisation actions of potential IS-benefits could be supported. A qualitative case study research design is adopted and provides a framework for sample selection, data collection, and data analysis. It also provides a framework for discussions of validity, reliability and generalizability. Findings displayed a benefits fluctuation, which showed that participants’ perception of what constituted potential benefits and value changed throughout the formal benefits management process. Issues like structure, knowledge, expectation and experience affected perception differently, and this in the end changed the amount and composition of potential benefits and value. Five dimensions of benefits judgment were identified and used by participants when finding accommodations of potential benefits and value to pursue. Identified dimensions affected participants’ perceptions, which in turn affected the amount and composition of potential benefits. During the formal benefits management process participants shifted between judgment dimensions. These movements emerged through debates and interactions between participants. Judgments based on what was perceived as expected due to one’s role and perceived best for the organisation as a whole were the two dominant benefits judgment dimensions. A benefits negotiation was identified. Negotiations were divided into two main categories, rational and irrational, depending on participants’ drive when initiating and participating in negotiations. In each category three different types of negotiations were identified having different characteristics and generating different outcomes. There was also a benefits negotiation process identified that displayed management challenges corresponding to its five phases. A discrepancy was also found between how IS-benefits are spoken of and how actions of IS benefits realisation are understood. This was a discrepancy between an evaluation and a realisation focus towards IS value creation. An evaluation focus described IS-benefits as well-defined and measurable effects and a realisation focus spoke of establishing and managing an on-going place of value creation. The notion of valuescape was introduced in order to describe and support the understanding of IS value creation. Valuescape corresponded to a realisation focus and outlined a value configuration consisting of activities, logic, structure, drivers and role of IS.

Working Capital Management Model in value chains

The objective of this Master’s thesis is to create a calculation model for working capital management in value chains. The study has been executed using literature review and constructive research methods. Constructive research methods were mainly modeling. The theory in this thesis is founded in research articles and management literature. The model is developed for students and researchers. They can use the model for working capital management and comparing firms to each other. The model can also be used to cash management. The model tells who benefits and who suffers most in the value chain. Companies and value chains cash flows can be seen. By using the model can be seen are the set targets really achieved. The amount of operational working capital can be observed. The model enables user to simulate the amount of working capital. The created model is based on cash conversion cycle, return on investment and cash flow forecasting. The model is tested with carefully considered figures which seem to be though realistic. The modeled value chain is literally a chain. Implementing this model requires from the user that he/she have some kind of understanding about working capital management and some figures from balance sheet and income statement. By using this model users can improve their knowledge about working capital management in value chains.

Information and appearance - design creating value for wearable technology items in B2C markets

The objective of the thesis is to study the role of design in adding value for wearable technology (WT) items in B2C markets by applying previous value creation literature to the subject. The thesis investigates value creation through types of value perceived by the customer being functional/instrumental, experiential/hedonic, symbolic/expressive and cost/sacrifice. The data was collected in face-to-face interviews with both consumers and industry experts. The results suggest that value perceived by both experts and consumers in every end-user category was elementarily functional, however, design was considered to bring most added value to WT in the categories of health and medicine, infotainment, and fashion. Also, WT ought to have same characteristics as regular clothing in order to attract mass markets. The results of the study suggest that companies should invest in design in order to gain long-term user engagement.