Infective Endocarditis in a Finnish Teaching Hospital. 25 Years of Experience of Adult Patients

Infektiivinen endokardiitti yliopistollisessa keskussairaalassa vuosina 1980-2004 hoidetuilla aikuispotilailla Tausta: Infektiivinen endokardiitti on edelleen vakava sairaus. Huolimatta siitä, että taudin diagnostiikka ja hoito ovat kehittyneet, siihen liittyy edelleen merkittävää sairastuvuutta ja kuolleisuutta. Endokardiitin taudinkuvassa on viime vuosina tapahtunut muutoksia monissa maissa. Tavoitteet: Tutkia endokardiitin kliinista kuvaa ja ennustetta suomalaisessa yliopistosairaalassa vuosina 1980-2004 endokardiitin vuoksi hoidetuilla aikuispotilailla. Aineisto: Osatyössä I endokardiitin todennäköisyyttä analysoitiin 222:lla vuosina 1980-1995 endokardiittiepäilyn vuoksi hoidetulla potilaalla käyttäen apuna sekä Duken että von Reyn diagnostisia kriteereitä. Osatyössä II tutkittiin endokardiittiin liittyviä neurologisia komplikaatioita 218 varmassa tai mahdollisessa endokardiittiepisodissa. Osatyössä III tutkittiin seerumin C-reaktiivisen proteiinin (CRP) käyttökelpoisuutta hoitovasteen arvioinnissa 134:ssä varmaksi luokitellussa endokardiittiepisodissa. Osatyössä IV tutkittiin yleisbakteeri-PCRmenetelmän käyttökelpoisuutta etiologisessa diagnostiikassa 56:lla endokardiittiepäilyn vuoksi leikatulla potilaalla. Osatöissä V ja VI analysoitiin kaikki vuosina 1980-2004 hoidetut 303 endokardiittipotilasta lyhytaikais- ja 1-vuotisennusteen suhteen sekä tutkittiin endokardiitin taudinkuvassa tapahtuneita muutoksia sairaalassamme. Tulokset: Duken kriteerit osoittautuivat von Reyn kriteereitä herkemmiksi endokardiitin diagnostiikassa: 243 tutkitusta episodista 114 luokiteltiin varmoiksi endokardiiteiksi Duken kriteereillä, kun vastaavasti ainoastaan 64 luoteltiin varmoiksi von Reyn kriteereillä (p<0.001). Lisäksi peräti 115 episodissa endokardiitin diagnoosi hylättiin von Reyn kriteereillä, kun diagnoosi hylättiin Duken kriteereillä ainoastaan 37 episodissa (p<0.001). Neurologinen komplikaatio ilmeni ennen mikrobilääkehoidon aloittamista 76 %:ssa episodeja ollen ensimmäinen oire 47 %:ssa. Kuolema oli merkitsevästi yhteydessä neurologisiin komplikaatioihin. Hoitovastetta seurattaessa seerumin CRP:n lasku oli merkitsevästi nopeampaa komplikaatioitta toipuvilla potilailla kuin niillä, joille kehittyi komplikaatioita tai jotka menehtyivät tautiinsa. PCR-tutkimus poistetusta läpästä antoi ainoana menetelmänä etiologisen diagnoosin neljässä tapauksessa (2 stafylokokkilajia, 1 Streptococcus bovis,1 Bartonella quintana), joissa kaikissa mikrobilääkehoito oli ollut käytössä ennen näytteiden ottamista. Koko aineistossa kahden läpän infektio tai neurologisten komplikaatioiden, perifeeristen embolioiden tai sydämen vajaatoiminnan kehittyminen ennustivat sekä sairaalakuolleisuutta että 1-vuotiskuolleisuutta, kun taas ≥65 vuoden ikä ja sydämen ultraäänitutkimuksessa todettu vegetaatio tai Duken luokittelun mukainen pääkriteeri ennustivat kuolemaa vuoden sisällä. Korkea CRP-taso sairaalaan tullessa ennusti sekä sairaalakuolleisuutta että 1-vuotiskuolleisuutta. Huumeiden käyttäjien endokardiitit lisääntyivät tutkimusaikana merkitsevästi (p<0.001). Päätelmät: Tässä työssä vahvistetaan Duken kriteerien käyttökelpoisuus endokardiitin diagnostiikassa. Lisäksi vahvistui käsitys, että nopea diagnoosi ja mikrobilääkehoidon aloittaminen ovat parhaat keinot ehkäistä neurologisia komplikaatioita ja parantaa endokardiittipotilaiden ennustetta. CRP:n normalisoituminen on endokardiittipotilailla hyvän ennusteen merkki. Suoraan läppäkudoksesta tehty PCR-tutkimus on hyödyllinen, kun taudin aiheuttaja on kasvuominaisuuksiltaan vaativa tai potilas on saanut mikrobilääkehoitoa ennen viljelynäytteiden ottamista. Muutamat aiemmissa tutkimuksissa todetut huonon ennusteen merkit ennustavat huonoa ennustetta myös tämän tutkimuksen potilailla. Uutena löydöksenä ilmeni, että korkea CRP-arvo sairaalaan tullessa merkitsee sekä huonoa lyhyt- että pitkäaikaisennustetta. Huumeiden käyttäjien endokardiittien ilmaantuminen on tärkein epidemiologinen muutos 25 vuoden tutkimusaikana.

The role of trust and its evolution in distributed teams in a multinational organisation

Tutkimuksen päätavoitteena on ollut selvittää miten kansallinen ja organisaatiokulttuuri, niihin liittyvät normit ja arvot edesauttavat tai vaikeuttavat luottamuksen kehittymistä monikulttuurisissa tiimeissä maailmanlaajuisessa organisaatiossa. Tutkimuksen avulla haluttiin myös selvittää miten luottamus kehittyy hajautetuissa monikansallisissa tiimeissä WorldCom Internationalissa. Empiirinen tutkimusmenetelmä perustuu kvalitatiivisiin teemahaastatteluihin, jotka tehtiin WorldComin työntekijöille. Tutkimuksessa havaittiin, ettei yhteisten sosiaalisten normien merkitys luottamuksen syntymiselle ole niin merkittävä, koska WorldComin yhtenäiset toimintatavat sekä hallitseva amerikkalaisen emoyhtiön "kotikulttuuri" muodostavat yhtenäiset toimintalinjat tiimeissä. Tietokonevälitteisen kommunikoinnin jatkuva käyttö on edesauttanut työntekijöiden ns. sosiaalisen älyn kehittymistä, sillä henkilökohtaisen tapaamisen puuttuminen kehittää vastaavasti taitoja aistia ja tulkita sähköpostien tai puhelinneuvotteluiden aikana välittyviä vastapuolen "näkymättömiä" vihjeitä.

Communication challenges in virtual teams – a case study of implementing computer-mediated communication technologies in inter-organisational virtual teams

This thesis seeks to answer, if communication challenges in virtual teams can be overcome with the help of computer-mediated communication. Virtual teams are becoming more common work method in many global companies. In order for virtual teams to reach their maximum potential, effective asynchronous and synchronous methods for communication are needed. The thesis covers communication in virtual teams, as well as leadership and trust building in virtual environments with the help of CMC. First, the communication challenges in virtual teams are identified by using a framework of knowledge sharing barriers in virtual teams by Rosen et al. (2007) Secondly, the leadership and trust in virtual teams are defined in the context of CMC. The performance of virtual teams is evaluated in the case study by exploiting these three dimensions. With the help of a case study of two virtual teams, the practical issues related to selecting and implementing communication technologies as well as overcoming knowledge sharing barriers is being discussed. The case studies involve a complex inter-organisational setting, where four companies are working together in order to maintain a new IT system. The communication difficulties are related to inadequate communication technologies, lack of trust and the undefined relationships of the stakeholders and the team members. As a result, it is suggested that communication technologies are needed in order to improve the virtual team performance, but are not however solely capable of solving the communication challenges in virtual teams. In addition, suitable leadership and trust between team members are required in order to improve the knowledge sharing and communication in virtual teams.

Managing virtual project teams

The purpose of the Master’s Thesis is to study the best practices to virtual project management from the project manager’ point of view. The best practices are divided according to a five-phase virtual project life cycle model. Each phase include concrete suggestions for actions. Research’s theoretical background is wide because of the broad subject matter. In the theoretical part topics such as virtual working, virtual project management challenges are examined and some concrete actions to tackle these challenges are introduced. Thesis’ approach is constructive, where a known problem is solved piece by piece after creating a pre-understanding of the topic. Existing research work is utilized when creating a model for virtual project team management. The basis of the model comes from various best practices read from literature and from the interviews conducted on experienced virtual project managers in the case organization. As a result the model combines both previous research and the organizations empirical experience. As an output of the thesis a model for virtual project team management is developed, which can be used as a guideline by the virtual project managers in their work. The model includes actions and practices what can be used to overcome the challenges of virtual project management.

The relationship between a virtual leader’s communication practices and a virtual team’s performance

A lot of research has been carried out into virtual teams and virtual leadership, yet there is hardly any research available on the communication behaviour of virtual leaders within a real business context. This research assessed the communication practices of virtual leaders and analysed the relationship between these practices and the performance of virtual teams. The objective of this research was to examine the distinctions of virtual teams, to study the leader’s role in a virtual team and its performance, and to examine the leader’s communication practices within virtual teams. The research involves a case study in which interviews have been carried out within an international technology company headquartered in Finland. Qualitative research methods were applied in the research. Based on the results of the study it can be said that there is a strong relationship between a virtual leader’s communication practices and a virtual team member’s job satisfaction. Through their communication practices, activities and message contents, leaders can affect the job satisfaction of virtual team members. In virtual leadership the focus is not in virtual but in leadership. It does not matter if the context is virtual or face-to-face; similar communication practices are good in both cases. As the global economic crisis strongly affected the sales results of the between a leader’s communication practices and a virtual team’s objective performance cannot be made.

Teaching mathematics and programming : new approaches with empirical evaluation

Programming and mathematics are core areas of computer science (CS) and consequently also important parts of CS education. Introductory instruction in these two topics is, however, not without problems. Studies show that CS students find programming difficult to learn and that teaching mathematical topics to CS novices is challenging. One reason for the latter is the disconnection between mathematics and programming found in many CS curricula, which results in students not seeing the relevance of the subject for their studies. In addition, reports indicate that students' mathematical capability and maturity levels are dropping. The challenges faced when teaching mathematics and programming at CS departments can also be traced back to gaps in students' prior education. In Finland the high school curriculum does not include CS as a subject; instead, focus is on learning to use the computer and its applications as tools. Similarly, many of the mathematics courses emphasize application of formulas, while logic, formalisms and proofs, which are important in CS, are avoided. Consequently, high school graduates are not well prepared for studies in CS. Motivated by these challenges, the goal of the present work is to describe new approaches to teaching mathematics and programming aimed at addressing these issues: Structured derivations is a logic-based approach to teaching mathematics, where formalisms and justifications are made explicit. The aim is to help students become better at communicating their reasoning using mathematical language and logical notation at the same time as they become more confident with formalisms. The Python programming language was originally designed with education in mind, and has a simple syntax compared to many other popular languages. The aim of using it in instruction is to address algorithms and their implementation in a way that allows focus to be put on learning algorithmic thinking and programming instead of on learning a complex syntax. Invariant based programming is a diagrammatic approach to developing programs that are correct by construction. The approach is based on elementary propositional and predicate logic, and makes explicit the underlying mathematical foundations of programming. The aim is also to show how mathematics in general, and logic in particular, can be used to create better programs.

In pursuit of an intercultural dimension in EFL-teaching : exploring cognitions among Finland-Swedish comprehensive school teachers

This thesis is about the educational purpose of foreign language teaching (FLT) in an increasingly internationalised world.The past 20-30 years have witnessed a fundamental rethinking of the aims of FLT, entailing a shift in emphasis from linguistic competence over communicative competence to intercultural competence. The growing emphasis on cultural issues, called for by research and international curricular documents, places new demandson language teachers. The overall aim of this study is to deepen the knowledge about the attitudes of teachers at the upper level of the Finland-Swedish comprehensive school towards the treatment of culture in English foreign language (EFL) teaching. The questions in focus are: 1) How do teachers interpret the concept"culture" in EFL-teaching?, 2) How do they specify the cultural objectives of their teaching? and 3) What do they do to attain these objectives? The thesis strives to reveal whether or not language teaching today can be describedas intercultural, in the sense that culture is taught with the aim of promotingintercultural understanding, tolerance and empathy. This abductive and largely exploratory study is placed within a constructivist and sociocultural framework,and is inspired by both phenomenography and hermeneutics. It takes its starting-point in language didactics, and can also be regarded as a contribution to teacher cognition research. The empirical data consists of verbatim transcribed interviews with 13 Finland-Swedish teachers of English at grades 7-9. The findings are presented according to three orientations and reviewed with reference to the 2004 Finnish National Framework Curriculum. Within the cognitive orientation, "culture" is perceived as factual knowledge, and the teaching of cultureis defined in terms of the transmission of knowledge, especially about Britain and the USA (Pedagogy of Information). Within the action-related orientation, "culture" is seen as skills of a social and socio-linguistic nature, andthe teaching aims at preparing the students for contacts with people from the target language areas (Pedagogy of Preparation). Within the affective orientation, which takes a more holistic approach, "culture" is seen as a bi-directional perspective. Students are encouraged to look at their own familiar culture from another perspective, and learn to empathise with and show respect for otherness in general, not just concerning representatives of English-speaking countries (Pedagogy of Encounter). Very few of the interviewed teachers represent the third approach, which is the one that can be characterised as truly intercultural. The study indicates that many teachers feel unsure about how to teach culture in an appropriate and up-to-date manner. This is attributed to, among other things, lack of teacher insights as well as lack of time and adequate material. The thesis ends with a set of recommendations as to how EFL could be developed ina more intercultural direction.