Free Flap Monitoring. Using Tissue Oxygen Measurement and Positron Emission Tomography

Aims:This study was carried out to evaluate the feasibility of two different methods to determine free flap perfusion in cancer patients undergoing major reconstructive surgery. The hypotheses was that low perfusion in the flap is associated with flap complications. Patients and methods: Between August 2002 and June 2008 at the Department of Otorhinolaryngology – Head and Neck Surgery, Department of Surgery, and at the PET Centre, Turku, 30 consecutive patients with 32 free flaps were included in this study. The perfusion of the free microvascular flaps was assessed with positron emission tomography (PET) and radioactive water ([¹⁵O] H₂O) in 40 radiowater injections in 33 PET studies. Furthermore, 24 free flaps were monitored with a continuous tissue oxygen measurement using flexible polarographic catheters for an average of three postoperative days. Results: Of the 17 patients operated on for head and neck (HN) cancer and reconstructed with 18 free flaps, three re-operations were carried out due to poor tissue oxygenation as indicated by p_tiO₂ monitoring results and three other patients were reoperated on for postoperative hematomas in the operated area. Blood perfusion assessed with PET (BF_PET) was above 2.0 mL / min / 100 g in all flaps and a low flap-to-muscle BFPET ratio appeared to correlate with poor survival of the flap. Survival in this group of HN cancer patients was 9.0 months (median, range 2.4-34.2) after a median follow-up of 11.9 months (range 1.0-61.0 months). Seven HN patients of this group are alive without any sign of recurrence and one patient has died of other causes. All of the 13 breast reconstruction patients included in the study are alive and free of disease at a median follow-up time of 27.4 months (range 13.9-35.7 months). Re-explorations were carried out in three patients due data provided by p_tiO₂ monitoring and one re-exploration was avoided on the basis of adequate blood perfusion assessed with PET. Two patients had donorsite morbidity and 3 patients had partial flap necrosis or fat necrosis. There were no total flap losses. Conclusions: P_tiO₂ monitoring is a feasible method of free flap monitoring when flap temperature is monitored and maintained close to the core temperature. When other monitoring methods give controversial results or are unavailable, [₁₅O] H₂O PET technique is feasible in the evaluation of the perfusion of the newly reconstructed free flaps.

Concentrated Winding Multiphase Permanent Magnet Machine Design and Electromagnetic Properties – Case Axial Flux Machine

Concentrated winding permanent magnet machines and their electromagnetic properties are studied in this doctoral thesis. The thesis includes a number of main tasks related to the application of permanent magnets in concentrated winding open slot machines. Suitable analytical methods are required for the first design calculations of a new machine. Concentrated winding machines differ from conventional integral slot winding machines in such a way that adapted analytical calculation methods are needed. A simple analytical model for calculating the concentrated winding axial flux machines is provided. The next three main design tasks are discussed in more detail in the thesis. The magnetic length of the rotor surface magnet machines is studied, and it is shown that the traditional methods have to be modified also in this respect. An important topic in this study has been to evaluate and minimize the rotor permanent magnet Joule losses by using segmented magnets in the calculations and experiments. Determination of the magnetizing and leakage inductances for a concentrated winding machine and the torque production capability of concentrated winding machines with different pole pair numbers are studied, and the results are compared with the corresponding properties of integral slot winding machines. The thesis introduces a new practical permanent magnet motor type for industrial use. The special features of the machine are based on the option of using concentrated winding open slot constructions of permanent magnet synchronous machines in the normal speed ranges of industrial motors, for instance up to 3000 min-1, without excessive rotor losses. By applying the analytical equations and methods introduced in the thesis, a 37 kW 2400 min-1 12-slot 10-pole axial flux machine with rotor-surfacemounted magnets is designed. The performance of the designed motor is determined by experimental measurements and finite element calculations.

De inclutis montibus Ararat

Painovuosi nimekkeestä.

Miniatures

Soitinnus: piano.

Effects of Country of Origin on Consumer Product Evaluations: Finnish clothing products in the minds of Russian tourists

Companies operating in today’s highly internationalized markets consider product differentiation the key priority in pursue to attain a constant competitive advantage in challenging global environment (Baker and Ballington 2002, 158). The main driver affecting companies’ differentiation actions was described as early as 1912 by one of the marketing pioneers A. W. Shaw (1912, 710) as meeting human wants more accurate than the competition, and thus increasing customers’ perceived value and satisfaction. Dickson and Ginter (1987, 2) point out in their study based on earlier research by Chamberlin (1965) and Porter (1976) that differentiation can be based on either tangible characteristics of a product such as design or intangible characteristics such as a brand name and country of origin (hereafter referred to as COO). The concept of COO and its impact on consumers’ evaluation of a product as an extrinsic product cue has been one of the most noteworthy topics in international marketing, having been voluminously examined by over 780 authors in more than 750 academic publications in the past 40 years (Papadopoulos and Heslop 2002, 294). Many of these studies accentuate the significant effect the COO has on consumers’ product attribute evaluations. People routinely associate country images with products and services in order to judge and categorize them based on perceived quality and risk levels; thereby COO can influence the likelihood of a purchase (Peterson and Jolibert 1995, 883-884; Verlegh and Steenkamp 1999, 523). Based on the vast research related to COO in the field of international business, it is widely recognized that the country associated with a product can act in a similar way as the name of a brand and even become a part of product’s total image. Thereby depending on customer’s values and perceptions, the product-country image can either increase or decrease perceived value.

Luomukysely 2013 : Varsinais-Suomen luomutuottajat liputtavat laadun ja yhteistyön puolesta

MTK – Varsinais-Suomi, Varsinais-Suomen ELY- keskuksen maaseutupalvelut - yksikkö sekä ProAgria Länsi-Suomi toteuttivat vuonna 2013 alussa alueen maataloustuottajille suunnatun luonnonmukaista tuotantoa koskevan kyselyn, jolla selvitettiin luomutuottajien näkemyksiä neuvonta- ja viranomaismenettelystä luomutuotannon toimintaedellytysten edelleen kehittämiseksi. Kysely osoittautui tarpeelliseksi, sillä parannusmahdollisuuksia ja yhteistoimintamuotojen kehittämistä esitettiin aktiivisesti. Palautetta asiakaspalvelun ja viranomaismenettelyn laadusta annettiin runsaasti. Luomutuotannon kehittämisedellytysten painopisteet ovat tämän kyselyn perusteella erityisesti tiedon ja vertaistiedon jakamisessa, markkinoinnissa ja neuvontapalveluissa sekä viranomaismenettelyjen selkeyttämisessä. Luomuyhteistyöverkostossa suuri merkitys on luottamuksella, joka luo myönteisiä ja rahanarvoisia sosiaalisia pääomaresursseja ja hyödyttää luonnonmukaisen tuotannon kehitystä yleisesti ja eri luomutoimijoiden välistä yhteistyötä. Luomutuottajien keskeinen pyrkimys on toimia suomalaisen maatalouden parhaaksi yhdessä asiantuntijoiden ja viranomaisten kanssa, sekä tuottaa kuluttajille mahdollisimman laadukkaita ja puhtaita elintarvikkeita, luoda kestävää maataloutta sekä edistää kuluttajien ruokatietoisuutta.

Item-level life-cycle model for maintenance network – from cost to additional value

The importance of industrial maintenance has been emphasized during the last decades; it is no longer a mere cost item, but one of the mainstays of business. Market conditions have worsened lately, investments in production assets have decreased, and at the same time competition has changed from taking place between companies to competition between networks. Companies have focused on their core functions and outsourced support services, like maintenance, above all to decrease costs. This new phenomenon has led to increasing formation of business networks. As a result, a growing need for new kinds of tools for managing these networks effectively has arisen. Maintenance costs are usually a notable part of the life-cycle costs of an item, and it is important to be able to plan the future maintenance operations for the strategic period of the company or for the whole life-cycle period of the item. This thesis introduces an itemlevel life-cycle model (LCM) for industrial maintenance networks. The term item is used as a common definition for a part, a component, a piece of equipment etc. The constructed LCM is a working tool for a maintenance network (consisting of customer companies that buy maintenance services and various supplier companies). Each network member is able to input their own cost and profit data related to the maintenance services of one item. As a result, the model calculates the net present values of maintenance costs and profits and presents them from the points of view of all the network members. The thesis indicates that previous LCMs for calculating maintenance costs have often been very case-specific, suitable only for the item in question, and they have also been constructed for the needs of a single company, without the network perspective. The developed LCM is a proper tool for the decision making of maintenance services in the network environment; it enables analysing the past and making scenarios for the future, and offers choices between alternative maintenance operations. The LCM is also suitable for small companies in building active networks to offer outsourcing services for large companies. The research introduces also a five-step constructing process for designing a life-cycle costing model in the network environment. This five-step designing process defines model components and structure throughout the iteration and exploitation of user feedback. The same method can be followed to develop other models. The thesis contributes to the literature of value and value elements of maintenance services. It examines the value of maintenance services from the perspective of different maintenance network members and presents established value element lists for the customer and the service provider. These value element lists enable making value visible in the maintenance operations of a networked business. The LCM added with value thinking promotes the notion of maintenance from a “cost maker” towards a “value creator”.

EU-kansalaisen oikeus toimeentulotukeen

Euroopan unioni on vuosikymmenien saatossa muotoutunut markkinataloudesta myös sosiaaliseksi toimijaksi. EU-kansalaisten vapaa liikkuvuus on yksi EU:n toiminnan kulmakivistä. Tämän tutkielman tavoitteena on selvittää, miten EU-kansalaisen oikeus toimeentulotukeen määräytyy. Oikeus saada toimeentulotukea perustuu lakiin toimeentulotuesta (1412/1997), mutta oikeutta ei voida määritellä puhtaasti kansallisen lain perusteella tilanteessa, jossa EU-oikeuden määräykset on otettava huomioon. Tutkielmassa luodaankin kokonaiskuva siitä, mitkä määräykset vaikuttavat EU-kansalaisen oikeuteen saada toimeentulotukea. Tämän lisäksi tutkielmassa tehdään katsaus ajankohtaisiin muutoksiin perusturvan kentässä, nimittäin toimeentulotuen perusosan siirtoon Kelan toimeenpantavaksi sekä perustulokokeiluun. EU-kansalaisen oikeus saada sosiaalietuuksia toisessa jäsenvaltiossa perustuu sosiaaliturvan koordinoinnin määräyksiin. Toimeentulotuki ei kuitenkaan kuulu sosiaaliturvan koordinoinnin piiriin, koska se on osa sosiaalihuoltoa. Tutkielmassa tutkitaankin käytännöllisen lainopin keinoin toimeentulotukioikeuden kannalta relevanttia EU- ja kansallista normistoa. Tutkielman lähdeaineiston muodostavat sosiaaliturvajärjestelmien yhteensovittamista koskeva asetus 883/2004 sekä vapaan liikkuvuuden direktiivi 2004/38/EY, ja työntekijöiden vapaata liikkuvuutta koskeva asetus 492/2011. EU-oikeuden dynaamisen luonteen vuoksi käydään läpi myös EU-tuomioistuimen viimeaikaisia ratkaisuja liittyen oikeuteen saada sosiaalihuoltoetuuksia. EU-oikeuden lisäksi syvennytään toimeentulotukeen ja ulkomaalaislakiin liittyvään kotimaiseen lainsäädäntöön ja niiden valmistelutöihin, sekä viranomaisen antamiin ohjeisiin. Tutkielmassa myös luodaan vertaileva katsaus Ruotsissa voimassaoleviin toimeentulotuen myöntämiskäytäntöihin. Tutkielman johtopäätöksenä voidaan todeta, että EU-kansalaisen oikeus toimeentulotukeen on kytköksissä oikeuteen oleskella jäsenvaltiossa. Myös EU-kansalaisen asemalla on merkitystä; taloudellisesti aktiivinen EU-kansalainen on paremmassa asemassa kuin ei-aktiivinen EU-kansalainen. Viranomaisen ohjeissa ei kuitenkaan ole täysin otettu huomioon EU-oikeuden määräyksiä. Lisäksi toimeentulotuen perusoikeudellisen luonteen vuoksi hakijan yksilöllinen tilanne tulisi aina ottaa huomioon. Perustoimeentulotuen toimeenpanon siirtyessä Kelaan on mahdollista laatia ohjeet, jotka koskevat yhdenvertaisesti kaikkia Suomessa oleskelevia, ja toisaalta huomioivat EU-oikeuden velvoitteet. Myös perustulokokeilun suunnittelussa EU-oikeuden määräykset on hyvä huomioida, koska perustulon merkitys suomalaisen sosiaaliturvan kenttään on merkittävä.