National oral history - Time of change project

Reviews

The effect of the birth hospital and the time of birth on the outcome of Finnish very preterm infants

The purpose of this study was to evaluate the effect of the birth hospital and the time of birth on mortality and the long-term outcome of Finnish very low birth weight (VLBW) or very low gestational age (VLGA) infants. This study included all Finnish VLBW/VLGA infants born at <32 gestational weeks or with a birth weight of ≤1500g, and controls born full-term and healthy. In the first part of the study, the mortality of VLBW/VLGA infants born in 2000–2003 was studied. The second part of the study consisted of a five-year follow-up of VLBW/VLGA infants born in 2001–2002. The study was performed using data from parental questionnaires and several registers. The one-year mortality rate was 11% for live-born VLBW/VLGA infants, 22% for live-born and stillborn VLBW/VLGA infants, and 0% for the controls. In live-born and in all (including stillbirths) VLBW/VLGA infants, the adjusted mortality was lower among those born in level III hospitals compared with level II hospitals. Mortality rates of live-born VLBW/VLGA infants differed according to the university hospital district where the birth hospital was located, but there were no differences in mortality between the districts when stillborn infants were included. There was a trend towards lower mortality rates in VLBW/VLGA infants born during office hours compared with those born outside office hours (night time, weekends, and public holidays). When stillborn infants were included, this difference according to the time of birth was significant. Among five-year-old VLBW/VLGA children, morbidity, use of health care resources, and problems in behaviour and development were more common in comparison with the controls. The health-related quality of life of the surviving VLBW/VLGA children was good but, statistically, it was significantly lower than among the controls. The median and the mean number of quality-adjusted life-years were 4.6 and 3.6 out of a maximum five years for all VLBW/VLGA children. For the controls, the median was 4.8 and the mean was 4.9. Morbidity rates, the use of health care resources, and the mean quality-adjusted life-years differed for VLBW/VLGA children according to the university hospital district of birth. However, the time of birth, the birth hospital level or university hospital district were not associated with the health-related quality of life, nor with behavioural and developmental scores of the survivors at the age of five years. In conclusion, the decreased mortality in level III hospitals was not gained at the expense of long-term problems. The results indicate that VLBW/VLGA deliveries should be centralized to level III hospitals and the regional differences in the treatment practices should further be clarified. A long-term follow-up on the outcome of VLBW/VLGA infants is important in order to recognize the critical periods of care and to optimise the care. In the future, quality-adjusted life-years can be used as a uniform measure for comparing the effectiveness of care between VLBW/VLGA infants and different patient groups

The Roman Empire as it was in the time of Julius Caesar and it is described in his Commentaries, and in Silius Italicus

Julkaisussa: Geographia classica : the geography of the ancients

“Who is steering the ship and which constellation guides the way? Exploring transparency in the European Central Bank during the time of crisis”

This paper explores transparency in the decision-making of the European Central Bank (ECB). According to ECB´s definition, transparency means that the central bank provides the general public with all relevant information on its strategy, assessments and policy decisions as well as its procedures in an open, clear and timely manner. In this paper, however, the interpretation of transparency is somewhat broader: Information is freely available and directly accessible to those who will be affected by the decisions. Moreover, the individuals shall be able to master this material. ECB´s negative attitude towards publication of documents has demonstrated central bank´s reluctance to strive towards more extensive transparency. By virtue of the definition adopted by the ECB the bank itself is responsible for determining what is considered as relevant information. On the grounds of EU treaties, this paper assesses ECB`s accountability concentrating especially on transparency by employing principal-agent theory and constitutional approach. Traditionally, the definite mandate and the tenet of central bank independence have been used to justify the limited accountability. The de facto competence of the ECB has, however, considerably expanded as the central bank has decisively resorted to non-standard measures in order to combat the economic turbulences facing Europe. It is alleged that non-standard monetary policy constitutes a grey zone occasionally resembling economic policy or fiscal policy. Notwithstanding, the European Court of Justice has repeatedly approved these measures. This dynamic interpretation of the treaties seems to allow temporarily exceptions from the central bank´s primary objective during extraordinary times. Regardless, the paper suggests that the accountability nexus defined in the treaties is not sufficient in order to guarantee the accountability of the ECB after the adoption of the new, more active role. Enhanced transparency would help the ECB to maintain its credibility. Investing in the quality of monetary dialogue between the Parliament and the ECB appears to constitute the most adequate and practicable method to accomplish this intention. As a result of upgraded transparency the legitimacy of the central bank would not solely rest on its policy outputs.

The Effect of Operational Disturbances on Reliability and Operation Time Distribution of NCmachine Tools in FMS

This thesis concentrates on studying the operational disturbance behavior of machine tools integrated into FMS. Operational disturbances are short term failures of machine tools which are especially disruptive to unattended or unmanned operation of FMS. The main objective was to examine the effect of operational disturbances on reliability and operation time distribution for machine tools. The theoretical part of the thesis covers the fimdamentals of FMS relating to the subject of this study. The concept of FMS, its benefits and operator's role in FMS operation are reviewed. The importance of reliability is presented. The terms describing the operation time of machine tools are formed by adopting standards and references. The concept of failure and indicators describing reliability and operational performance for machine tools in FMSs are presented. The empirical part of the thesis describes the research methodology which is a combination of automated (ADC) and manual data collection. By using this methodology it is possible to have a complete view of the operation time distribution for studied machine tools. Data collection was carried out in four FMSs consisting of a total of 17 machine tools. Each FMS's basic features and the signals of ADC are described. The indicators describing the reliability and operation time distribution of machine tools were calculated according to collected data. The results showed that operational disturbances have a significant influence on machine tool reliability and operational performance. On average, an operational disturbance occurs every 8,6 hours of operation time and has a down time of 0,53 hours. Operational disturbances cause a 9,4% loss in operation time which is twice the amount of losses caused by technical failures (4,3%). Operational disturbances have a decreasing influence on the utilization rate. A poor operational disturbance behavior decreases the utilization rate. It was found that the features of a part family to be machined and the method technology related to it are defining the operational disturbance behavior of the machine tool. Main causes for operational disturbances were related to material quality variations, tool maintenance, NC program errors, ATC and machine tool control. Operator's role was emphasized. It was found that failure recording activity of the operators correlates with the utilization rate. The more precisely the operators record the failure, the higher is the utilization rate. Also the FMS organizations which record failures more precisely have fewer operational disturbances.