E-portfoliojärjestelmien vertailu rajapintojen näkökulmasta

Työssä tutustutaan erilaisiin e-portfoliojärjestelmiin, niiden ominaisuuksiin ja toiminnallisuuksiin sekä vertaillaan valittuja e-portfoliojärjestelmiä keskenään yhteensopivuuden ja -toimivuuden näkökulmasta yliopistomaailmassa. Tavoitteena on valita e-portfoliojärjestelmistä monipuolisin ja opiskelijaystävällisin järjestelmä. Järjestelmän tulee tukea opiskelijan elinikäistä oppimista. E-portfolio on sähköisessä muodossa oleva omien töiden kokoelma ja sitä hallitaan e-portfoliojärjestelmällä. E-portfoliojärjestelmissä tärkeässä roolissa ovat portfoliospesifikaatiot, jotka mahdollistavat e-portfolion siirtämisen sellaisenaan toiseen järjestelmään rajapintojen kautta. Työssä ei keskitytä henkilökohtaiseen oppimisympäristöön, joka on käsitteenä laajempi kuin e-portfolio. Työssä vertailtiin avoimeen lähdekoodiin perustuvia, web-pohjaisia e-portfoliojärjestelmiä ja tutkittiin niiden tarjoamaa mahdollisuutta portfolioiden siirtoon ja tuomiseen. Lisäksi tarkasteltiin järjestelmien integroituvuutta muihin järjestelmiin, kuten virtuaalisiin oppimisympäristöihin. Vertailun tuloksena monipuolisin ja opiskelijaystävällisin e-portfoliojärjestelmä on Mahara ja yleisin portfoliospesifikaatio Leap2A.

Uraohjaus ja urasuunnittelu ammattikorkeakoulussa

Tutkimuksen tarkoituksena oli selvittää, millaista uraohjausta ammattikorkeakoulun tuutoriopettajat antavat ja millaista uraohjausta opiskelijat haluavat. Lisäksi tavoitteena oli selvittää, löytyykö opiskelijoiden koulutusalavalinnan perusteista yhteyttä uran suunnittelutaitoihin ja ohjauksen tarpeeseen, ja tunnistavatko tuutoriopettajat opiskelijoiden erilaiset uraohjauksen tarpeet. Tutkimuksen teoreettisissa rakenteissa hyödynnettiin kolmea postmodernia urateoriaa, jotka olivat Hodkinsonin ja Sparkesin (1997) uranvalinnan päätöksentekoteoria, Mitchellin, Lewinin ja Krumbolzin (1999) suunnitellun sattuman teoria ja Savickasin (2005) uran rakentamisteoria. Tutkimusympäristönä oli Satakunnan ammattikorkeakoulu. Tutkimus oli kaksivaiheinen. Ensimmäisessä vaiheessa kerättiin harkinnanvaraisesti valituilta tuutoriopettajilta (n=14) ja opintojensa eri vaiheissa olevilta opiskelijoilta (n=65) kirjoitettu aineisto. Kvalitatiivinen aineisto analysoitiin sisällönanalyysillä. Aineiston perusteella löydettiin kolmenlaisia urasuunnittelijoita: epävarmat, uteliaat ja tietoiset. Aineiston perusteella laadittiin kyselylomake tutkimuksen toisen vaiheen tiedonkeruuta varten. Tutkimuksen toisessa vaiheessa kerättiin opintojen eri vaiheissa olevilta opiskelijoilta kyselylomakekyselynä kvantitatiivinen aineisto (n=903), joka analysoitiin tilastollisin menetelmin. Koulutusalavalinnan perusteista elämäntilanne, alan mahdollisuudet, oma toive, kutsumus, aktiivinen tiedonhaku ja halu opiskella ammattikorkeakoulussa olivat yhteydessä opiskelijan hyvään urasuunnittelukykyyn. Näillä perusteilla koulutusalansa valinneita tietoisiksi luokiteltuja urasuunnittelijoita oli 72 % vastanneista. Alavalinnan perusteista sattuman, kavereiden, sukulaisten, lukion opinto-ohjauksen ja paikkakunnan perusteella koulutusalansa valinneet luokiteltiin epävarmoiksi urasuunnittelijoiksi, ja heitä oli 28 % vastanneista. Tulokset antavat ohjaajille tukea epävarman ja muita enemmän uraohjausta tarvitsevan opiskelijan tunnistamiseen ja heidän hops-prosessinsa tehostamiseen opintojen alusta asti. Lisäksi tulosten perusteella esitetään seuraavia suosituksia: tuutoriopettajille tulisi asettaa pätevyysvaatimukseksi ohjausalan opintojen suorittaminen; opiskelijoita tulisi ohjata tunnistamaan erilaisia satunnaisesti avautuvia mahdollisuuksia ja tietoisesti hyödyntämään niitä elämässään; uraohjaukseen tulisi kytkeä mukaan työelämäyhteistyö; ohjaajien tulisi tiivistää yhteistyötä toisen asteen ohjaajien kanssa, jotta opiskelijoiden koulutusalavalinnat onnistuisivat paremmin; uraohjausta tulisi antaa tulevaisuuden kvalifikaatioiden ennakoinnin ja elinikäisten oppimisvalmiuksien näkökulmasta.

Monitoimityöstökeskuksen kokonaistehokkuuden parantaminen kokonaisvaltaisella tuottavalla kunnossapidolla

Tämän diplomityön tavoitteena oli tutustua kokonaisvaltaisen tuottavan kunnossapidon teoriaan ja soveltaa sitä Abloy Oy Joensuun tehtaalla pilottikohteeksi valittuun koneeseen. Pilottikohteeksi oli valittu uusi Sveitsiläinen Hydromat-monitoimityöstökeskus, jonka kokonaistehokkuutta (OEE) pyrittiin parantamaan kokonaisvaltaisella tuottavalla kunnossapidolla (TPM). Työn kirjallisuusosuudessa tarkastellaan teoriatietoja, jotka liittyvät yleisesti kunnossapitoon ja tarkemmin TPM-toimintaan. Lisäksi käsitellään kunnossapidon mittareita ja tietojärjestelmiä. Työn empiirisessä osassa selvitetään, kuinka TPM-toiminta otettiin käyttöön Hydromat-monitoimityöstökeskuksen osalta. Eniten resursseja käytettiin koneen asetusaikojen lyhentämiseen. Lisäksi koneen käyttäjien itsenäiseen kunnossapitoon siirtyminen kuului työn sisältöön. Työssä on selvitetty myös uuden tuotannon seurantataulun käyttöönotto. Seurantataulusta nähdään useita tuotantotietoja kuten kokonaistehokkuus. Työn merkittävimmät tulokset osoittavat, että asetusajat ovat tällä hekellä hyvin pitkiä tavoitteisiin nähden. Asetusaikojen lyhentyminen halutulle tasolle vaatii koneen käyttäjien pitkän oppimisprosessin sekä optimaaliset toimintaolosuhteet. Lisäksi havaittiin, että uuden toimintamallin esitteleminen ja sen käyttöönotto valmistavassa teollisuudessa on vaativa prosessi.

Identification and characterization of new genes and pathways regulating spermatogonial cell fate

Spermatogenesis, i.e sperm production in the seminiferous tubules of the testis, is a complex process that takes over one month to complete. Life-long ability of sperm production ultimately lies in a small population of undifferentiated cells, called spermatogonial stem cells (SSCs). These cells give rise to differentiating spermatogonia, which are committed to mature into spermatozoa. SSCs represent a heterogeneous population of cells and many aspects of their basic biology are still unknown. Understanding the mechanisms behind the cell fate decision of these cells is important to gain more insights into the causes of infertility and testis cancer. In addition, an interesting new aspect is the use of testis-derived stem cells in regenerative medicine. Our data demonstrated that adult mouse testis houses a population of Nanog-expressing spermatogonia. Based on mRNA and protein analysis these cells are enriched in stage XII of the mouse seminiferous epithelial cycle. The cells derived from this stage have the highest capacity to give rise to ES cell-like cells which express Oct4 and Nanog. These cells are under tight non- GDNF regulation but their fate can be dictated by activating p21 signalling. Comparative studies suggested that these cells are regulated like ES cells. Taken together these data imply that pluripotent cells are present in the adult mammalian testis. CIP2A (cancerous inhibitor of PP2A) has been associated with tumour aggressiveness and poor prognosis. In the testis it is expressed by the descendants of stem cells, i.e. the spermatogonial progenitor cells. Our data suggest that CIP2A acts upstream of PLZF and is needed for quantitatively normal spermatogenesis. Classification of CIP2A as a cancer/testis gene makes it an attractive target for cancer therapy. Study on the CIP2A deficient mouse model demonstrates that systemic inhibition of CIP2A does not severely interfere with growth and development or tissue or organ function, except for the spermatogenic output. These data demonstrate that CIP2A is required for quantitatively normal spermatogenesis. Hedgehog (Hh) signalling is involved in the development and maintenance of many different tissues and organs. According to our data, Hh signalling is active at many different levels during rat spermatogenesis: in spermatogonia, spermatocytes and late elongating spermatids. Localization of Suppressor of Fused (SuFu), the negative regulator of the pathway, specifically in early elongating spermatids suggests that Hh signalling needs to be shut down in these cells. Introduction of Hh signalling inhibitor resulted in an increase in germ cell apoptosis. Follicle-stimulating hormone (FSH) and inhibition of receptor tyrosine kinases resulted in down-regulation of Hh signalling. These data show that Hh signalling is under endocrine and paracrine control and it promotes germ cell survival.

Detection of the Vulnerable Atherosclerotic Plaque. Pre-Clinical Evaluation of Novel PET Imaging Probes With Experimental Models

Atherosclerosis is a life-long vascular inflammatory disease and the leading cause of death in Finland and in other western societies. The development of atherosclerotic plaques is progressive and they form when lipids begin to accumulate in the vessel wall. This accumulation triggers the migration of inflammatory cells that is a hallmark of vascular inflammation. Often, this plaque will become unstable and form vulnerable plaque which may rupture causing thrombosis and in the worst case, causing myocardial infarction or stroke. Identification of these vulnerable plaques before they rupture could save lives. At present, in the clinic, there exists no appropriated, non-invasive method for their identification. The aim of this thesis was to evaluate novel positron emission tomography (PET) probes for the detection of vulnerable atherosclerotic plaques and to characterize, two mouse models of atherosclerosis. These studies were performed by using ex vivo and in vivo imaging modalities. The vulnerability of atherosclerotic plaques was evaluated as expression of active inflammatory cells, namely macrophages. Age and the duration of high-fat diet had a drastic impact on the development of atherosclerotic plaques in mice. In imaging of atherosclerosis, 6-month-old mice, kept on high-fat diet for 4 months, showed matured, metabolically active, atherosclerotic plaques. [18F]FDG and 68Ga were accumulated in the areas representative of vulnerable plaques. However, the slow clearance of 68Ga limits its use for the plaque imaging. The novel synthesized [68Ga]DOTA-RGD and [18F]EF5 tracers demonstrated efficient uptake in plaques as compared to the healthy vessel wall, but the pharmacokinetic properties of these tracers were not optimal in used models. In conclusion, these studies resulted in the identification of new strategies for the assessment of plaque stability and mouse models of atherosclerosis which could be used for plaque imaging. In the used probe panel, [18F]FDG was the best tracer for plaque imaging. However, further studies are warranted to clarify the applicability of [18F]EF5 and [68Ga]DOTA-RGD for imaging of atherosclerosis with other experimental models.

Sotilaslentäjän fyysinen suorituskyky sekä työperäiset tuki- ja liikuntaelinoireet

Kirjallisuudesta välittyy useitten vuosikymmenten ajalta tietämys sotilaslentämisen fyysisestä kuormittavuudesta. G-voimista aiheutuva kuormittuminen näyttää johtavan joko akuutisti tai pitkäaikaisesti lentäjän tuki- ja liikuntaelimistön toimintakykyä alentaviin ongelmiin. Erityisesti on selvitetty niskan alueen työperäisten ongelmien syntyä, jolloin on havaittu lentotoiminnan fyysisen kuormittavuuden johtavan ennenaikaiseen rakenteelliseen rappeumaan, haittaa aiheuttavan oireen lisäksi. Kansainvälisen kirjallisuuden mukaan ammatista johtuvista eli työperäisistä oireista kärsii vähintään 2/3 kaikista sotilaslentäjistä. Tietyin edellytyksin lentäjien kaularangan alueen rappeuma on Suomessa hyväksytty ammattitaudiksi vuodesta 1995 alkaen. On arveltu, että hyvästä fyysisestä suorituskyvystä olisi apua tuki- ja liikuntaelin (TULE)-oireilun ennaltaehkäisemisessä ja toimintakyvyn ylläpitämisessä. Tutkimusnäyttö tästä on lentäjien osalta ollut toistaiseksi erittäin niukkaa. Tämän tutkimuksen tavoitteena oli selvittää suomalaisten sotilaslentäjien työperäisen TULE-oireilun esiintyvyyttä, oireista koetun haitan tasoa, lentäjien fyysisen kunnon tasoja virkauran aikana ja näitten kaikkien välisiä yhteyksiä sekä työperäisen TULE-oireen merkitystä sotilaan toimintakykyyn. Tutkimus jakautui kahteen osaan. Poikkileikkauksena lentotoimintaperäisiä TULE-oireita kartoitettiin kyselytutkimuksella, johon vastasi vuositarkastuksen yhteydessä 267 lentäjää vuosina 2004-2005. Joukosta poimittiin ne 195 lentäjää, jotka olivat suorittaneet yleissotilaalliset kuntotestit puolen vuoden sisällä kyselyyn vastaamisesta, ja mitatut testitulokset yhdistettiin kyselytutkimusaineistoon. Tässä aineistossa toteutettiin fyysisesti erilailla kuormittuvien lentäjäryhmien välisiä vertailuja fyysisen kunnon, TULE-esiintyvyyden ja koetun haitan suhteen. Poikkileikkausosassa tutkittiin myös lentäjien virkauran aikaisia tasoeroja yleissotilaallisissa kuntotesteissä (n=195) verrattuna muihin suomalaisiin sotilaisiin. Lisäksi (N=289) selvitettiin ilmailulääketieteellisen tarkastuksen yhteydessä mitattuja, ns. ammatillisia fyysisiä erityisominaisuuksia eri ikäluokissa. Pitkittäisosassa seurattiin 67:n Hawk-suihkuharjoituskoneella aloittaneen Ilmavoimien sotilaslentäjien lentouran aikaista lentotoimintaperäisten TULE-oireitten esiintyvyyttä vuosien 1996 ja 2008 välillä. Lisäksi tutkittiin lentäjien kontakteja työterveyshuoltoon, oireen aiheuttamaa lentokelvottomuusaikaa, työn kuormituksen kumulatiivista kertymää lentotuntien lisääntyessä ja TULE-oireiden esiintyvyyden kannalta kriittisiä ajankohtia lentouran aikana. Tulokset osoittivat, että kaikki seurannassa olleet suomalaiset sotilaslentäjät kokivat jonkinasteisen lentotoimintaperäisen TULE-oireen uransa aikana. Niskan ammattitautiluokituksen tasoisen ongelman esiintyvyys oli 4 % koko lentäjäpopulaatiosta ja 10 % suihkuharjoituskonevaiheen jo läpäisseistä, mutta vastaavanlaisia TULE-ongelmia, ilman riittävää näyttöä ammattitaudista, esiintyi lähes joka kolmannella sotilaslentäjällä. Alaselän osalta lentäjät oireilivat lähes samassa määrin, mutta näitä oireita ei toistaiseksi ole mahdollista määrittää ammattitaudiksi. Lentäjät kävivät varsin vähän valittamassa oireistaan työterveyshuoltoon, jossa käytäneen vasta silloin, kun oire jo selvästi heikentää työtehtävissä vaadittavaa toimintakykyä. Merkittävin lentotoimintaperäisten oireitten esiintymisen kasvu ajoittui 200 Hawk-lentotunnin kohdalle, jolloin koneella saavutetaan eräänlainen optimaalinen G-indeksi eli taktisen liikehtelyn G-tasoylitysten vaihtelu. Tämän jälkeen lentäjät ovat erityisen alttiina akuuteille lennonaikaisille TULE-ongelmille. Oireitten esiintyminen kasvoi eksponentiaalisesti noin 600 lentotuntiin asti. Monimuuttujamallien mukaan työperäisen TULE-oireen esiintyvyysriskiä vähensivät alaraajojen hyvä motoriikka, korkeat valintapisteet ja korkea kaulan fleksion voimataso maksimaalisessa isometrisessä testissä. Yleissotilaallisilla kuntotasoilla ei ollut yhteyttä oireiluun, mutta lihaskunnoltaan voimakkaimmat lentäjät kärsivät tilastollisesti merkittävästi vähemmän haittaa lentotoimintaperäisistä TULE-oireistaan. Yleissotilaallisissa kuntotesteissä lentäjät olivat parempia kuin muut suomalaiset sotilaat. Aktiivisimman lentouran aikana, 30-40-vuotiaina, lentäjien fyysinen suorituskyky oli normaaliväestöön nähden vain keskimääräinen ja urheilijoihin nähden keskimääräistä heikompi. Käytännössä lentäjät eivät kyenneet ylläpitämään valintavaiheen fyysistä suorituskykyään edes kadettivaiheen loppuun asti. Huomattavaa oli lisäksi, että aktiivisen lentouran päätyttyä fyysinen kunto näytti jossain määrin palautuvan kohti lähtötasoa lentäjien ikääntymisestä huolimatta. Lentäjien valintavaiheen aikana mitatun fyysisen suorituskyvyn tason säilyminen aktiivisen lentopalveluksen loppuun asti vaatisi lentäjien fyysisen toimintakyvyn ylläpidon ja kehittämisen tehostamista koulutuksen ja työuran eri vaihessa. Tähän tavoitteeseen nähden Ilmavoimien fyysisen kasvatuksen järjestelyt vaikuttivat alimitoitetuilta. Operatiivisesti huolestuttavaa oli Ilmavoimien ohjaajien fyysisen suorituskyvyn heikentyminen silloin, kun heidän taitojensa puolesta olisi pitänyt olla suorituskykyisimpiä taistelutehtäviinsä. Myös lentäjän terveyttä ja toimintakykyä pitäisi pystyä reaaliaikaisemmin seuraamaan koko lentouran aikana. Ilmavoimille suositellaan moniammatillista lähestymistä sotilaslentäjien toimintakyvyn ylläpitämiseen ja terveysriskien hallintaan yhdessä liikunnan, työterveyshuollon, lentoturvallisuusalan ja operatiivisen suunnittelun asiantuntijoitten kanssa. Lisäksi suositellaan avoimempaa ja eettisesti kestävämpää suhtautumista ammattiin liittyvien terveysongelmien kuvaamiseen sekä fyysisen kunnon kysymyksiin jo lentäjien rekrytointivaiheessa.

Neural correlates of language learning in adults

The human language-learning ability persists throughout life, indicating considerable flexibility at the cognitive and neural level. This ability spans from expanding the vocabulary in the mother tongue to acquisition of a new language with its lexicon and grammar. The present thesis consists of five studies that tap both of these aspects of adult language learning by using magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) during language processing and language learning tasks. The thesis shows that learning novel phonological word forms, either in the native tongue or when exposed to a foreign phonology, activates the brain in similar ways. The results also show that novel native words readily become integrated in the mental lexicon. Several studies in the thesis highlight the left temporal cortex as an important brain region in learning and accessing phonological forms. Incidental learning of foreign phonological word forms was reflected in functionally distinct temporal lobe areas that, respectively, reflected short-term memory processes and more stable learning that persisted to the next day. In a study where explicitly trained items were tracked for ten months, it was found that enhanced naming-related temporal and frontal activation one week after learning was predictive of good long-term memory. The results suggest that memory maintenance is an active process that depends on mechanisms of reconsolidation, and that these process vary considerably between individuals. The thesis put special emphasis on studying language learning in the context of language production. The neural foundation of language production has been studied considerably less than that of perceptive language, especially on the sentence level. A well-known paradigm in language production studies is picture naming, also used as a clinical tool in neuropsychology. This thesis shows that accessing the meaning and phonological form of a depicted object are subserved by different neural implementations. Moreover, a comparison between action and object naming from identical images indicated that the grammatical class of the retrieved word (verb, noun) is less important than the visual content of the image. In the present thesis, the picture naming was further modified into a novel paradigm in order to probe sentence-level speech production in a newly learned miniature language. Neural activity related to grammatical processing did not differ between the novel language and the mother tongue, but stronger neural activation for the novel language was observed during the planning of the upcoming output, likely related to more demanding lexical retrieval and short-term memory. In sum, the thesis aimed at examining language learning by combining different linguistic domains, such as phonology, semantics, and grammar, in a dynamic description of language processing in the human brain.

Employees’ continuous learning and job satisfaction - effects on productivity

In today’s knowledge intense economy the human capital is a source for competitive advantage for organizations. Continuous learning and sharing the knowledge within the organization are important to enhance and utilize this human capital in order to maximize the productivity. The new generation with different views and expectations of work is coming to work life giving its own characteristics on learning and sharing. Work should offer satisfaction so that the new generation employees would commit to organizations. At the same time organizations have to be able to focus on productivity to survive in the competitive market. The objective of this thesis is to construct a theory based framework of productivity, continuous learning and job satisfaction and further examine this framework and its applications in a global organization operating in process industry. Suggestions for future actions are presented for this case organization. The research is a qualitative case study and the empiric material was gathered by personal interviews concluding 15 employee and one supervisor interview. Results showed that more face to face interaction is needed between employees for learning because much of the knowledge of the process is tacit and so difficult to share in other ways. Offering these sharing possibilities can also impact positively to job satisfaction because they will increase the sense of community among employees which was found to be lacking. New employees demand more feedback to improve their learning and confidence. According to the literature continuous learning and job satisfaction have a relative strong relationship on productivity. The employee’s job description in the case organization has moved towards knowledge work due to continuous automation and expansion of the production process. This emphasizes the importance of continuous learning and means that productivity can be seen also from quality perspective. The normal productivity output in the case organization is stable and by focusing on the quality of work by improving continuous learning and job satisfaction the upsets in production can be handled and prevented more effectively. Continuous learning increases also the free human capital input and utilization of it and this can breed output increasing innovations that can increase productivity in long term. Also job satisfaction can increase productivity output in the end because employees will work more efficiently, not doing only the minimum tasks required. Satisfied employees are also found participating more in learning activities.

Patient-perceived health-related quality of life during recovery after total hip arthroplasty – a 6-month follow-up study

Potilaiden käsitys terveyteen liittyvästä elämänlaadusta lonkan tekonivelleikkauksen jälkeisenä toipumisaikana – kuuden kuukauden seurantatutkimus Tässä kaksivaiheisessa seurantatutkimuksessa tarkasteltiin potilaiden käsitystä terveyteen liittyvästä elämänlaadusta lonkan tekonivelleikkauksen jälkeisenä toipumisaikana. Tutkimuksen ensimmäisessä vaiheessa tarkoituksena oli sekä kuvailla potilaiden kokemuksia potilaana olosta, saamastaan hoidosta ja terveyspalveluorganisaatiosta että analysoida aikaisempien tutkimusten perusteella leikkauksen tuloksia potilaan kannalta. Toisessa vaiheessa tarkoituksena oli arvioida potilaiden kokemaa elämänlaatua leikkauksen jälkeen, ja sitä vaikuttivatko primaaritulokset (fyysinen toimintakyky, kipu, ahdistus) tai taloudelliset seuraukset (potilaiden itsensämaksamat kustannukset, palvelujen käyttö) terveyteen liittyvään elämänlaatuun. Tutkimuksen tavoitteena oli löytää mahdolliset kriittiset ajankohdat tai tekijät, jotka saattavat hidastaa toipumista ja siten huonontaa potilaiden elämänlaatua. Tätä tietoa voidaan käyttää hoitotyössä kun suunnitellaan sopivaa hoitoa ja tukea toipumisajalle. Tutkimuksen ensimmäisessä vaiheessa primaarileikkaukseen tulevat potilaat (n = 17) kuvailivat teemahaastatteluissa kokemuksiaan kahdesti leikkauksen jälkeen. Haastatteluaineisto analysoitiin induktiivisella sisällönanalyysilla. Lisäksi 17 tutkimusartikkelista analysoitiin deduktiivisella sisällönanalyysilla leikkauksen tuloksia potilaalle, tuloksiin vaikuttavia tekijöitä ja käytetyt tutkimusmetodit. Toisessa vaiheessa primaari- tai revisioleikkaukseen tulevat potilaat (n = 100) arvioivat leikkauksen tuloksia kuuden kuukauden ajan leikkauksen jälkeen: terveyteen liittyvää elämänlaatua, primaarituloksia ja taloudellisia seurauksia. Aineisto kerättiin erilaisilla mittareilla: Sickness Impact Profile, Finnish Version, Stait-Trait Anxiety Inventory, ja Numeric Rating Scale. Lisäksi käytettiin tätä tutkimusta varten tehtyjä kyselylomakkeita: Fyysinen toimintakyky-mittari, Palvelujen käyttö-mittari ja Kustannusmittari. Tutkimuksen toiseen vaiheen tulokset analysoitiin tilastollisilla menetelmillä. Potilaiden terveyteen liittyvä elämänlaatu parani ja kipu lievittyi leikkauksen jälkeen ja fyysinen toimintakyky lisääntyi toipumisaikana. Positiivisista muutoksista huolimatta potilaat kokivat ahdistusta samassa määrin kuin ennen leikkaustakin. Palvelujen käyttö vaihteli toipumisajan kuluessa ja potilaiden maksamissa kustannuksissa oli suuria vaihteluita. Fyysisen toimintakyvyn lisääntyminen ja kivun lieveneminen paransivat terveyteen liittyvää elämänlaatua. Sen sijaan huonompi elämänlaatu toipumisaikana oli yhteydessä suurempaan palvelujen käyttöön, kun taas kustannuksilla ei ollut yhteyttä elämänlaatuun. Potilaiden ominaispiirteet tulisi ottaa enemmän huomioon suunniteltaessa sopivaa leikkauksenjälkeistä hoitoa ja tukea. Potilaat tarvitsevat yksilöllisiä ohjeita, sillä monet taustatekijät (esim. ikä, sukupuoli, preoperatiivinen kipu, siviilisääty, ja leikkaustyyppi) vaikuttavat toipumiseen.

Luottamuksen ilmeneminen alueellisissa yhteistyöverkostoissa

Appearance of trust in regional, co-operative networks In our times, the value of social networks has been widely acknowledged. One can say that it is important for private persons to get networked, whilst it is even a must for companies and organizations in business life. This doctor's thesis examines three co-operative regional networks. Networks are located in Western Uusimaa (Länsi-Uusimaa) region in southernmost Finland, and they had both public organizations and private companies as participants (later called ‘players’). Initially, all of them were co-financed from public funds, and two of them are still operational while writing this. The main target of these networks has been to act as learning networks. The learning network stands for an ensemble of research and development units and workplaces constituting a common forum for learning. The main focus in this study has been on qualitative and structural characteristics of the networks, and how they are relating with intrinsic trust. In addition to the development of trust, it has been studied, at what level organizational learning within the networks takes place, and lastly, what kind of factors facilitate the development of social capital. The theoretical framework for the study is built on analysing trust and social capital. It is a 'mission impossible' to find single definitions for such major concepts. In this study, from the research questions' point of view it has been more relevant to concentrate on the aspects of networking and the relationships between the participating organizations. The total view in this study is very network-centric, and therefore those theories which have similar point of view have been prioritized. Such is the theory about structural holes by Ronald S. Burt (1992). It has been widely applied; especially his views on constraints affecting players in networks. The purpose of this study has not been to create new theories or to analyse and compare thoroughly the existing theoretical trends. Instead, the existing theories have provided the study with conceptual tools, which have been utilized for supporting the empirical results. The aim has been to create an explanatory case study consisting relevant discussion on the relationship between the network characteristics and the appearance of trust. The conceptual categorization for confidence vs. trust created by Niklas Luhmann (1979) is another important theoretical building block. In most cases, co-operation in networks is initiated by people already trusting in each other and willing to work together. However, personal trust is not sufficient in the long run to sustain the co-operation within the network: more abstract systemic trust described by Luhmann must also emerge. In the networks with different structures and at different development phases, these forms of trust appear at different levels. In this study, Luhmann’s systemic trust as a term has been replaced by the concept of 'trust in network as a system'. Structural characteristics of a network (density, centrality, structural holes etc.) have been selected to explain the creation of social capital and trust. The ability to adapt new information is essential for the development of social capital. Qualitative analysis for development phase has been used, and the Learning Network Maturity Test by Leenamaija Otala (2000) and her work have been applied. Thus, the qualitative characteristics and the structural characteristics of the networks are utilized together, when the creation of social capital and appearance of trust are assessed. Social Network Analysis, questionnaires and interviews have been the research methods. Quantitative and qualitative data have been combined. There is a similarity in viewpoints to research data with Extensive Case Study method, in which different cases are searched by exploring various cases and comparing certain common features between them and generic models. Development of trust, social capital and organizational learning has been explained in the study by comparing the networks in hand. Being a case study, it doesn't have targets to provide with general results and findings like conventional surveys. However, in this work phenomena and mechanisms related to them are interpreted from the empirical data. Key finding of this study is that the networks with high structural equality and clear target setting enable building trust to the network as a system. When systemic trust is present, e.g. changes in personnel involved in the co-operation won't hinder the network from remaining operational. On the other hand, if the players are not well motivated to co-operate, if the network is extremely centralized structurally, or if the network has players holding very much more beneficial position compared to the others, systemic trust won't develop: trust tends to remain at the personal level, and is directed to some players only. Such networks won't generate results and benefits to its players, and most probably they won’t live very long. In other words, learning networks cannot solely be based on willingness to learn, but also on willingness to co-operate.

Very preterm infants in Finland - Use of health care services and economic consequences during the first five years of life

The aim of this thesis was to study the health, the hospitalisations, and the use of communal health care services in very preterm children during the first five years of life. In addition, the effect of very preterm birth and prematurity-related morbidities on the costs of hospitalisations, other health care services and the cost per quality adjusted life years (QALY) were studied. This population-based study included all very preterm children (gestational age (GA) <32 weeks or birth weight<1501g, N=2 064) and full-term controls (GA 37+0−41+6, N=200 609) born in Finland during 2000-2003. The data sources included national register data, costing data from the participating hospitals and parental questionnaires. This study showed that most very preterm infants born in Finland survived without prematurity-related morbidities diagnosed during the first years of life. They required relatively little hospital care after the initial discharge, which accounted for the vast majority of the total four-year hospitalisation costs. However, a minority of children born very preterm later developing morbidities had a long initial length of stay and more re-admissions and outpatient visits during the five-year follow-up period. In particular, the number and costs of non-emergency outpatient visits were considerable in individuals with prematurity-related morbidities. The need and costs of hospitalisations decreased clearly with each follow-up year, even in individuals with morbidities. The health-care related costs during the fifth year of life in children born very preterm without prematurity-related morbidities were close to the costs in infants born healthy at term. The cost per QALY of 19,245 € was at an acceptable level already by four years of age in the very preterm population as a whole. Prematurity-related later morbidities and decreasing GA increased the costs per QALY. As the initial hospital stay accounted for a great majority of the total four-year costs, and the costs of hospitalisation decreased with each follow-up year, the cost per QALY is likely to decrease with age. In conclusion, the majority of costs arising after the initial hospitalisation were associated with morbidities related to prematurity. Therefore offering high-quality neonatal care to prevent later morbidities in very preterm survivors has a long-term impact on the cost per QALY. In addition, this study indicates that when estimating the costs of prematurity after the first year of life, one should calculate not only the hospitalisation costs, but also other costs for social welfare services, primary care, and therapies, as these exceed the hospitalisation costs in very preterm infants during the fifth year of life.

Survival and Quality of Life among Patients with Severe Lower Extremity Peripheral Arterial Disease

Lower extremity peripheral arterial disease (PAD) is associated with decreased functional status, diminished quality of life (QoL), amputation, myocardial infarction, stroke, and death. Nevertheless, public awareness of PAD as a morbid and mortal disease is low. The aim of this study was to assess the incidence of major lower extremity amputation due to PAD, the extent of reamputations, and survival after major lower extremity amputation (LEA) in a population based PAD patient cohort. Furthermore, the aim was to assess the functional capacity in patients with LEA, and the QoL after lower extremity revascularization and major amputation. All 210 amputees due to PAD in 1998–2002 and all 519 revascularized patients in 1998–2003 were explored. 59 amputees alive in 2004 were interviewed using a structured questionnaire of QoL. Two of each amputee age-, gender- and domicile-matched controls filled in and returned postal self-administered QoL questionnaire as well as 231 revascularized PAD patients (the amount of these patients who engaged themselves to the study), and one control person for each patient completed postal self-administered QoL questionnaire. The incidence rate of major LEA was 24.1/100 000 person-years and it was considerably high during the years studied. The one-month mortality rate was 21%, 52% at one-year, and the overall mortality rate was 80%. When comparing the one-year mortality risk of amputees, LEAs were associated with a 7.4-fold annual mortality risk compared with the reference population in Turku. Twenty-two patients (10%) had ipsilateral transversions from BK to AK amputation. Fifty patients (24%) ended up with a contralateral major LEA within two to four amputation operations. Three bilateral amputations were performed at the first major LEA operation. Of the 51 survivors returning home after their first major LEA, 36 (71%) received a prosthesis; (16/36, 44%) and were able to walk both in- and outdoors. Of the 68 patients who were discharged to institutional care, three (4%) had a prosthesis one year after LEA. Both amputees and revascularized patients had poor physical functioning and significantly more depressive symptoms than their controls. Depressive symptoms were more common in the institutionalized amputees than the home-dwelling amputees. The surviving amputees and their controls had similar life satisfaction. The amputees felt themselves satisfied and contented, whether or not they lived in long-term care or at home. PAD patients who had undergone revascularizations had poorer QoL than their controls. The revascularized patients’ responses on their perceived physical functioning gave an impression that these patients are in a declining life cycle and that revascularizations, even when successful, may not be sufficient to improve the overall function. It is possible that addressing rehabilitation issues earlier in the care may produce a more positive functional outcome. Depressive symptoms should be recognized and thoroughly considered at the same time the patients are recovering from their revascularization operation. Also primary care should develop proper follow-up, and community organizations should have exercise groups for those who are able to return home, since they very often live alone. In rehabilitation programs we should consider not only physical disability assessment but also QoL.

Learning Robot Motions from Visual Sensing

Learning from demonstration becomes increasingly popular as an efficient way of robot programming. Not only a scientific interest acts as an inspiration in this case but also the possibility of producing the machines that would find application in different areas of life: robots helping with daily routine at home, high performance automata in industries or friendly toys for children. One way to teach a robot to fulfill complex tasks is to start with simple training exercises, combining them to form more difficult behavior. The objective of the Master’s thesis work was to study robot programming with visual input. Dynamic movement primitives (DMPs) were chosen as a tool for motion learning and generation. Assuming a movement to be a spring system influenced by an external force, making this system move, DMPs represent the motion as a set of non-linear differential equations. During the experiments the properties of DMP, such as temporal and spacial invariance, were examined. The effect of the DMP parameters, including spring coefficient, damping factor, temporal scaling, on the trajectory generated were studied.

Verbal learning in mild cognitive impairment and alzheimer's disease : behavioural and neural approaches

The main focus of the present thesis was at verbal episodic memory processes that are particularly vulnerable to preclinical and clinical Alzheimer’s disease (AD). Here these processes were studied by a word learning paradigm, cutting across the domains of memory and language learning studies. Moreover, the differentiation between normal aging, mild cognitive impairment (MCI) and AD was studied by the cognitive screening test CERAD. In study I, the aim was to examine how patients with amnestic MCI differ from healthy controls in the different CERAD subtests. Also, the sensitivity and specificity of the CERAD screening test to MCI and AD was examined, as previous studies on the sensitivity and specificity of the CERAD have not included MCI patients. The results indicated that MCI is characterized by an encoding deficit, as shown by the overall worse performance on the CERAD Wordlist learning test compared with controls. As a screening test, CERAD was not very sensitive to MCI. In study II, verbal learning and forgetting in amnestic MCI, AD and healthy elderly controls was investigated with an experimental word learning paradigm, where names of 40 unfamiliar objects (mainly archaic tools) were trained with or without semantic support. The object names were trained during a 4-day long period and a follow-up was conducted one week, 4 weeks and 8 weeks after the training period. Manipulation of semantic support was included in the paradigm because it was hypothesized that semantic support might have some beneficial effects in the present learning task especially for the MCI group, as semantic memory is quite well preserved in MCI in contrast to episodic memory. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, indicating that the MCI patients’ preserved semantic memory abilities compensated for their impaired episodic memory. The MCI group performed equally well as the controls in the tasks tapping incidental learning and recognition memory, whereas the AD group showed impairment. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that acquisition is compromised in both MCI and AD, whereas long13 term retention is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI. In studies III and IV, the neural correlates of naming newly learned objects were examined in healthy elderly subjects and in amnestic MCI patients by means of positron emission tomography (PET) right after the training period. The naming of newly learned objects by healthy elderly subjects recruited a left-lateralized network, including frontotemporal regions and the cerebellum, which was more extensive than the one related to the naming of familiar objects (study III). Semantic support showed no effects on the PET results for the healthy subjects. The observed activation increases may reflect lexicalsemantic and lexical-phonological retrieval, as well as more general associative memory mechanisms. In study IV, compared to the controls, the MCI patients showed increased anterior cingulate activation when naming newly learned objects that had been learned without semantic support. This suggests a recruitment of additional executive and attentional resources in the MCI group.