Differentiation of Metabolically Distinct Areas within Head and Neck Region using Dynamic 18F-FDG Positron Emission Tomography Imaging

Positron Emission Tomography (PET) using ¹⁸F-FDG is playing a vital role in the diagnosis and treatment planning of cancer. However, the most widely used radiotracer, ¹⁸F-FDG, is not specific for tumours and can also accumulate in inflammatory lesions as well as normal physiologically active tissues making diagnosis and treatment planning complicated for the physicians. Malignant, inflammatory and normal tissues are known to have different pathways for glucose metabolism which could possibly be evident from different characteristics of the time activity curves from a dynamic PET acquisition protocol. Therefore, we aimed to develop new image analysis methods, for PET scans of the head and neck region, which could differentiate between inflammation, tumour and normal tissues using this functional information within these radiotracer uptake areas. We developed different dynamic features from the time activity curves of voxels in these areas and compared them with the widely used static parameter, SUV, using Gaussian Mixture Model algorithm as well as K-means algorithm in order to assess their effectiveness in discriminating metabolically different areas. Moreover, we also correlated dynamic features with other clinical metrics obtained independently of PET imaging. The results show that some of the developed features can prove to be useful in differentiating tumour tissues from inflammatory regions and some dynamic features also provide positive correlations with clinical metrics. If these proposed methods are further explored then they can prove to be useful in reducing false positive tumour detections and developing real world applications for tumour diagnosis and contouring.

Secondary Aural Symptoms in Relation to Cranio-Cervical and General Disorders

The present thesis comprises two study populations. The first study sample (SS1) consisted of 411 adults examined and interviewed at three annual visits. The second study sample (SS2) consisted of 1720 adults who filled in a mailed questionnaire about secondary otalgia, tinnitus and fullness of ears. In the second phase of the SS2, 100 subjects with otalgia were examined and interviewed by specialist in stomatognathic physiology and otorhinolaryngology. In the third phase, 36 subjects participated in a randomized, controlled and blinded trial of effectiveness of occlusal appliance on secondary otalgia, facial pain, headache and treatment need of temporomandibular disorders (TMD). The standardized prevalence of recurrent secondary otalgia was 6%, tinnitus 15% and fullness of ears 8%. Aural symptoms were more frequent among young than old subjects. They were associated with other, simultaneous aural symptoms, TMD pain, head and neck region pain, and visits to a physician. The subjects with aural symptoms more often had tenderness on palpation of masticatory muscles and clinical signs of temporomandibular joint than the subjects without. 85% of the subjects reporting secondary otalgia had cervical spine or temporomandibular disorder or both. In SS1, the final model of secondary otalgia included active need treatment for TMD, elevated level of stress symptoms, and bruxism. In SS2, the final models of aural symptoms included associated aural symptoms, young age, TMD pain, headache and shoulder ache. Stabilization splint more effectively alleviated secondary otalgia and active treatment need for TMD than a palatal control splint. In patients with aural pain, tinnitus or fullness of ears, it is important to first rule out otologic and nasopharyngeal diseases that may cause the symptoms. If no explanation for aural symptoms is found, temporomandibular and cervical spine disorders should be rouled out to minimize unnecessary visits to a physician.

Regional innovation strategies and sustainability in selected EU countries

This study focuses on regional innovation strategy (RIS) and sustainability aspects in selected regions of European Union (EU) countries. It is known that RIS helps a region to innovate locally and to compete globally and it is considered as one of the main policy tools of the EU for innovation support at a regional level. This study is conducted to explore the existence and adoption of RIS in different regions of selected EU countries, and to highlight and compare regional RIS characteristics. The study is also aimed at identifying the factors that characterise the formulation and implementation of RIS as well as the problems associated thereof. In this study, six regions of EU countries are considered: Päijät-Häme Region (Finland); London Region (United Kingdom); Mid-West Region (Ireland); Veneto Region (Italy); Eastern Region (Poland); and West Region (Romania). Data and information are collected by sending questionnaires to the respective regional authorities of these selected regions. Based on the gathered information and analysis, RIS or equivalent strategy document serves as a blueprint for forwarding innovative programmes towards regional sustainability. The objectives of RIS in these regions are found to be dependent on the priority sectors and state of the region’s development. The current environmental sustainability aspects are focused on eco-design, eco-products, and eco-innovation, although each region also has its own specific aspects supported by RIS. Likewise, regional policies typically follow the RIS yet translated in various sectoral focus or priority areas. The main enhancing factors supporting RIS among selected regions have some similarities and variations; among others, some regions are strongly supported by EU while others have support from own regional agencies, organisations and professional networks. RIS implementation is not without challenges and despite the differences in challenges, almost all of reviewed regions consider financial resource as a common problem. Generally, it is learned from this study that RIS and regional sustainability are reinforcing each other mutually. In this study, the strong focus is given towards environmental sustainability in the regions although regional sustainability also includes economic and social aspects. A well-focused and prioritised RIS is beneficial for regional sustainable development.

Genetically Determined Hypometabolism in Alzheimer’s Disease and Midlife Risk Factors for Cognitive Impairment

The role of genetic factors in the pathogenesis of Alzheimer’s disease (AD) is not completely understood. In order to improve this understanding, the cerebral glucose metabolism of seven monozygotic and nine dizygotic twin pairs discordant for AD was compared to that of 13 unrelated controls using positron emission tomography (PET). Traditional region of interest analysis revealed no differences between the non-demented dizygotic co-twins and controls. In contrast, in voxel-level and automated region of interest analyses, the non-demented monozygotic co-twins displayed a lower metabolic rate in temporal and parietal cortices as well as in subcortical grey matter structures when compared to controls. Again, no reductions were seen in the non-demented dizygotic co-twins. The reductions seen in the non-demented monozygotic co-twins may indicate a higher genetically mediated risk of AD or genetically mediated hypometabolism possibly rendering them more vulnerable to AD pathogenesis. With no disease modifying treatment available for AD, prevention of dementia is of the utmost importance. A total of 2 165 at least 65 years old twins of the Finnish Twin Cohort with questionnaire data from 1981 participated in a validated telephone interview assessing cognitive function between 1999 and 2007. Those subjects reporting heavy alcohol drinking in 1981 had an elevated cognitive impairment risk over 20 years later compared to light drinkers. In addition, binge drinking was associated with an increased risk even when total alcohol consumption was controlled for, suggesting that binge drinking is an independent risk factor for cognitive impairment. When compared to light drinkers, also non-drinkers had an increased risk of cognitive impairment. Midlife hypertension, obesity and low leisure time physical activity but not hypercholesterolemia were significant risk factors for cognitive impairment. The accumulation of risk factors increased cognitive impairment risk in an additive manner. A previously postulated dementia risk score based on midlife demographic and cardiovascular factors was validated. The risk score was found to well predict cognitive impairment risk, and cognitive impairment risk increased significantly as the score became higher. However, the risk score is not accurate enough for use in the clinic without further testing.

Drivers and barriers of mobile travel and tourism service adoption : a study of individual perceptions and business model development in a travel and tourism context

The Travel and Tourism field is undergoing changes due to the rapid development of information technology and digital services. Online travel has profoundly changed the way travel and tourism organizations interact with their customers. Mobile technology such as mobile services for pocket devices (e.g. mobile phones) has the potential to take this development even further. Nevertheless, many issues have been highlighted since the early days of mobile services development (e.g. the lack of relevance, ease of use of many services). However, the wide adoption of smartphones and the mobile Internet in many countries as well as the formation of so-called ecosystems between vendors of mobile technology indicate that many of these issues have been overcome. Also when looking at the numbers of downloaded applications related to travel in application stores like Google Play, it seems obvious that mobile travel and tourism services are adopted and used by many individuals. However, as business is expected to start booming in the mobile era, many issues have a tendency to be overlooked. Travelers are generally on the go and thus services that work effectively in mobile settings (e.g. during a trip) are essential. Hence, the individuals’ perceived drivers and barriers to use mobile travel and tourism services in on-site or during trip settings seem particularly valuable to understand; thus this is one primary aim of the thesis. We are, however, also interested in understanding different types of mobile travel service users. Individuals may indeed be very different in their propensity to adopt and use technology based innovations (services). Research is also switching more from investigating issues of mobile service development to understanding individuals’ usage patterns of mobile services. But designing new mobile services may be a complex matter from a service provider perspective. Hence, our secondary aim is to provide insights into drivers and barriers of mobile travel and tourism service development from a holistic business model perspective. To accomplish the research objectives seven different studies have been conducted over a time period from 2002 – 2013. The studies are founded on and contribute to theories within diffusion of innovations, technology acceptance, value creation, user experience and business model development. Several different research methods are utilized: surveys, field and laboratory experiments and action research. The findings suggest that a successful mobile travel and tourism service is a service which supports one or several mobile motives (needs) of individuals such as spontaneous needs, time-critical arrangements, efficiency ambitions, mobility related needs (location features) and entertainment needs. The service could be customized to support travelers’ style of traveling (e.g. organized travel or independent travel) and should be easy to use, especially easy to take into use (access, install and learn) during a trip, without causing security concerns and/or financial risks for the user. In fact, the findings suggest that the most prominent barrier to the use of mobile travel and tourism services during a trip is an individual’s perceived financial cost (entry costs and usage costs). It should, however, be noted that regulations are put in place in the EU regarding data roaming prices between European countries and national telecom operators are starting to see ‘international data subscriptions’ as a sales advantage (e.g. Finnish Sonera provides a data subscription in the Baltic and Nordic region at the same price as in Finland), which will enhance the adoption of mobile travel and tourism services also in international contexts. In order to speed up the adoption rate travel service providers could consider e.g. more local initiatives of free Wi-Fi networks, development of services that can be used, at least to some extent, in an offline mode (do not require costly network access during a trip) and cooperation with telecom operators (e.g. lower usage costs for travelers who use specific mobile services or travel with specific vendors). Furthermore, based on a developed framework for user experience of mobile trip arrangements, the results show that a well-designed mobile site and/or native application, which preferably supports integration with other mobile services, is a must for true mobile presence. In fact, travel service providers who want to build a relationship with their customers need to consider a downloadable native application, but in order to be found through the mobile channel and make contact with potential new customers, a mobile website should be available. Moreover, we have made a first attempt with cluster analysis to identify user categories of mobile services in a travel and tourism context. The following four categories were identified: info-seekers, checkers, bookers and all-rounders. For example “all-rounders”, represented primarily by individuals who use their pocket device for almost any of the investigated mobile travel services, constituted primarily of 23 to 50 year old males with high travel frequency and great online experience. The results also indicate that travel service providers will increasingly become multi-channel providers. To manage multiple online channels, closely integrated and hybrid online platforms for different devices, supporting all steps in a traveler process should be considered. It could be useful for travel service providers to focus more on developing browser-based mobile services (HTML5-solutions) than native applications that work only with specific operating systems and for specific devices. Based on an action research study and utilizing a holistic business model framework called STOF we found that HTML5 as an emerging platform, at least for now, has some limitations regarding the development of the user experience and monetizing the application. In fact, a native application store (e.g. Google Play) may be a key mediator in the adoption of mobile travel and tourism services both from a traveler and a service provider perspective. Moreover, it must be remembered that many device and mobile operating system developers want service providers to specifically create services for their platforms and see native applications as a strategic advantage to sell more devices of a certain kind. The mobile telecom industry has moved into a battle of ecosystems where device makers, developers of operating systems and service developers are to some extent forced to choose their development platforms.

Prenatal and perinatal risk factors for bipolar disorder

Bipolar disorder (BPD) is a severe mental disorder associated with considerable morbidity and mortality. Prenatal insults have been shown to be associated with later development of mental disorders and there is a growing interest in the potential role of prenatal and perinatal risk factors in the development of BPD. The aims of this thesis were to describe the overall study design of the Finnish Prenatal Study of Bipolar Disorders (FIPS-B) and demographic characteristics of the sample. Furthermore, it was aimed to examine the association of parental age, parental age difference, perinatal complications and maternal smoking during pregnancy with BPD. This thesis is based on FIPS-B, a nested case-control study using several nationwide registers. The cases included all people born in Finland between January 1st 1983 and December 31st 1998 and diagnosed with BPD according to the Finnish Hospital Discharge Register (FHDR) before December 31st 2008. Controls for this study were people who were without BPD, schizophrenia or diagnoses related to these disorders, identified from the Population Register Centre (PRC), and matched two-fold to the cases on sex, date of birth (+/- 30 days), and residence in Finland on the first day of diagnosis of the matched case. Conditional logistic regression models were used to examine the association between risk factors and BPD. This study included 1887 BPD cases and 3774 matched controls. The mean age at diagnosis was 19.3 years and females accounted for 68% of the cases. Mothers with the lowest educational level had the highest odds of having BPD in offspring. Being born in Eastern and Southern region of Finland increased the odds of having BPD later in life. A U-shaped distribution of odds ratio was observed between paternal age and BPD in the unadjusted analysis. Maternal age and parental age difference was not associated with BPD. Birth by planned caesarean section was associated with increased odd of BPD. Smoking during pregnancy was not associated with BPD in the adjusted analyses. Region of birth and maternal educational level were associated with BPD. Both young and old father’s age was associated with BPD. Most perinatal complications and maternal smoking during pregnancy were not associated with BPD. The findings of this thesis, considered together with previous literature, suggest that the pre- and perinatal risk factor profile varies among different psychiatric disorders.

The role of network competence and international business competence in multinational corporations: Subsidiary perspective

On-going process of globalization makes companies all over the world to go beyond the national markets and internationalize. Organizational form of multinational corporation (MNC) has capabilities for establishing the affiliate companies in several countries. Thus, the relocation of resources occurs and particularly, the cross-border transfer of knowledge which possesses the competitive advantage. However, differences in countries` business environments and cultures may constrain this capability. The research aim of this thesis is to investigate the role of subsidiary’s network competence (ability to build and manage the relationships with other local business units) and international business competence in relation to the benefits that MNC receives from a subsidiary. Additionally, subsidiary’s business adaptation, partnerships and knowledge transfer mechanism with parent company and external partners are investigated. This research, conducted in the Finnish-Russian context, consists of theoretical and empirical parts. The qualitative approach in the form of multiple case studies is employed. The empirical data incorporated primary and secondary data in the form of interviews collected in 2013 and 2015 years. Interviews were collected from four Finnish case companies in Saint-Petersburg and Kaluga region and five Russian partner companies. Results are drawn from two cases from Saint-Petersburg. The abductive research approach for the results analysis is adopted. The results indicate that both competencies lead to the subsidiary’s local embeddedness in the form of mutual business activities with local business partners and product adaptation for the local market needs. In addition to the monetary benefits in form of payments or turnover share, local embeddedness brings the knowledge of the local environment which is utilized by an MNC in the long-term planning. Another found tacit benefit is the access to the national market. This is strategically useful benefit not only for parent MNC but also for the subsidiary’s partners, i.e. international suppliers.

Yrityksen sijaintipaikkapäätökseen vaikuttavat tekijät ja alueiden kilpailukyky Suomessa

Tämän diplomityön tavoite on luoda viitekehys kahdesta työn pääteorioista, jotka ovat: "liiketoiminnan ulkoiset menestystekijät" ja "alueiden kilpailukyky". Kummatkin teoriat sisältävät tekijöitä, joilla on vaikutusta yrityksen sijaintipaikkapäätökseen. Viitekehyksen pohjalta tarkastellaan kahta tutkimusaluetta: Landen seutua ja Kuuma-aluetta. Työn tuloksena syntyy kuva kummastakin tutkimusalueesta ja analyysi viitekehyksestä. Työn ensimmäisessä osassa käydään läpi aihealueen tutkimuksen taustaa ja mitä ongelmia tutkimuksissa on tullut esille. Senjälkeen esitellään kaikki liiketoiminnan ulkoiset menestystekijät. Alueiden kilpailukyvyn teoriaosuus täydentää viitekehyksen tekijät. Työn jälkimmäinen empiirinen osa perustuu lähdemateriaaliin, joka on kerätty haastatteluista, lehtiartikkeleista ja seminaareista koskien tutkimusalueita. Tutkimustuloksista selviää, että kummatkin tutkimusalueet ovat erilaisia ja niillä on omat avainklusterinsa ja menestyvät toimialansa. Viitekehys luotiin melko onnistuneesti. Lopulta selvisi, että se sopii hyvin aihealueen tutkimuksen laajentamiseen, mutta heikosti yksittäisenyrityksen sijaintipaikkapäätökseen.

Etelä-Karjala asuin- ja elinympäristönä: Korkeasti koulutettujen nuorten näkökulma

Tämän tutkimuksen keskeisenä tarkoituksena on tutkia Etelä-karjalaa asuin- ja työpaikkana. Tutkimuksen päätavoitteena on selvittää asuin- ja elinympäristön laadun merkitystä alueella viihtymiseen. Tutkimus luokitellaan kaupunkitutkimukseksi, jossa tarkastelun kohteena on asuin- ja elinympäristön laatu. Tutkimuksessa hyödynnetään survey-tutkimusmenetelmää. Tutkimuksen teoriaoosassa tarkastellaan globalisaation alueellisia vaikutuksia, alueiden kilpailukyvyn ja kilpailuedun muodostumista sekä alueen imagon merkitystä kilpailussa. Tutkimukseen liittyvä tutkimusaineisto kerättiin kirjekyselyllä Lappeenrannan teknillisestä yliopistosta vuosina 1997-2000 valmistuneiden diblomi-insinöörien ja kauppatieteiden maistereiden keskuudesta. Tutkimuksen empiirisessä osassa mitataan tekijöitä, jotka vaikuttavat asuinpaikkakunnan valintaan. Lisäksi mitataan Etelä-Karjalan asuin- ja elinympäristön laatua. Aineiston perusteella voidaan todeta, että Etelä-Karjalan asuin- ja elinympäristön laadun fyysiset, toiminnalliset ja sosiaaliset ominaisuudet edesaauttavat yliopistoststa valmistuneita jäämään alueelle. Ongelmatekijäksi nousi alueen kyky tarjota korkeasti koulutetuille nuorille työpaikkoja

Etelä-Karjalan energiaselvitys ja maakunnan energiatalouden tulevaisuus

Diplomityössä on selvitetty Etelä-Karjalan maakunnan energian käyttöä nyt ja tulevaisuudessa. Tavoitteena on selvittää eri energialähteiden hankintavaihtoehtoja, sekä eri energialähteiden käytön kehittymissuunnat seuraavan 10 - 20 vuoden kuluessa. Diplomityö on tehty Etelä-Karjalan liiton toimeksiannosta ja sitä tullaan käyttämään taustaselvityksenä maakuntakaavan laadinnassa sekä maakunnan aluevarauksia määriteltäessä. Tarkoituksena on arvioida miten energiahuollon rakenne tulee muuttumaan tulevaisuudessa ja mikä merkitys tulevaisuuden energiaratkaisuilla on alueiden käyttöön ja aluerakenteeseen liittyen. Etelä-Karjala on osa Euroopan suurinta metsäteollisuuskeskittymää ja maakunta on Suomen suurimpia teollisuuden energian- ja sähkönkäyttäjiä. Etelä-Karjalan vahva metsäteollisuus ja sen käyttämät puupolttoaineet sekä sijainti Venäjän maakaasuvarojen läheisyydessä ja kattava maakaasuverkko vaikuttavat merkittävästi maakunnan energiataseeseen. Vuonna 2007 Etelä-Karjalan primäärienergiankäyttö oli 24,3 TWh, tästä uusiutuvien energialähteiden osuus oli 68 % ja fossiilisten energialähteiden osuus 22 %. Etelä-Karjalan energiatalouden tulevaisuuteen vaikuttaa merkittävästi maakunnan metsäteollisuuden tulevaisuus. Tiukentuvan energia- ja ilmastopolitiikan ja ympäristömääräysten myötä maakunnan energiatehokkuutta on parannettava kaikilla sektoreilla. Maakunnan energiankulutusta voidaan vähentää tehostamalla energiantuotantoa, tiivistämällä yhdyskuntarakennetta ja lisäämällä bioenergian käyttöä energiantuotannossa. Etelä-Karjalassa on myös potentiaalia lisätä vaihtoehtoisten energialähteiden osuutta maakunnan energiatalouden tulevaisuudessa.

The Determinants of Financial Leverage of Large Publicly Listed Companies - Evidence from Nordic Telecom Sector

This thesis examines the determinants of financial leverage ratio of large publicly listed companies within Nordic Telecom sector. The study is done as a case study and it covers 5 case companies headquartered in Nordic countries during period of 2002 - 2014 and by using restated values of quarterly observations from each case company’s interim reports. The chosen hypotheses are tested with multiple linear regressions firm by firm. The Findings of the study showed that uniqueness of Telecom sector and the region of our sample could not provide us unequivocal determinants of leverage ratio within the sector. However, e.g. Pecking order theory’s statement of Liquidity was widely confirmed by 3 out of 5 case companies which is worth to be taken into account in the big picture. The findings also showed that theories and earlier empirical evidence are confirmed by our case companies individually and non-systematically. Though Telecom sector is considered as quite unique industry and we did not discover absolute common relationships that would have held through all the Nordic case companies, we got unique and valuable evidence to conduct the research of this sector in future.