Operative Treatment of Ovarian Cancer and Borderline Tumors in Different Hospital Categories in Finland

Surgery is the cornerstone of ovarian cancer treatment and maximal cytoreduction is important. In the early 1980’s primary surgical treatment of ovarian cancer was performed in over 80 hospitals in Finland. The significance of the operative volume of the hospital, of the training of the surgeons and of centralization of surgical treatment has been widely discussed. The aim of the present study was to evaluate the outcome of surgical treatment of ovarian cancer in different hospital categories retrospectively and prospectively, and to analyze if any differences are reflected in survival. The retrospective study included 3851 ovarian cancer patients operated between 1983 and 1994 in Finland. The data was analyzed according to hospital category (university, central, and other) and by quartiles of the hospital operative volume. The results showed that patients operated in the highest operative volume hospitals had the best relative survival. When stratifying the analysis by the period of diagnosis (1983-1988 and 1989-1994), the university hospitals improved their performance the most. The prospective part of the thesis was initiated in 1999 and included 307 patients with invasive ovarian cancer and 65 patients with an ovarian borderline tumor. The baseline and 5-year surveys used a questionnaire that was filled in by the operating surgeons. For analysis of the 5-year followup data, the hospitals were divided into three categories (<10, 10-20, or >20 patients operated in 1999). The effect of the surgical volume was analyzed also as a continuous variable (1-47 operations per year). In university hospitals, pelvic lymphadenectomy was performed in 88 %, and para-aortic lymphadenectomy in 73 %, of the patients with stage I disease. The corresponding figures ranged from 11 % to 21 % in the other hospitals. For stage III ovarian cancer patients operated by gynecological oncologists, the estimated odds ratio for no macroscopic residual tumor was 3.0 times higher (95 % CI 1.2-7.5) than for those operated by general gynecologists. In the university and other hospitals 82% of the patients received platinum-based chemotherapy. Platinum + taxane combination was given to 63 % of the patients in the university and in 49 % in the other hospitals (p = 0.0763). Only a minority of the patients with tumors of borderline malignancy were staged according to recommendations, most often multiple peritoneal biopsies and omentectomy were neglected. FIGO stage, patient age, and residual tumor were independent prognostic factors of cancer-specific 5-year survival. A higher hospital operative volume was also a significant prognostic factor for better cancer-specific survival (p = 0.036) and disease-free survival (p = 0.048). In conclusion, ovarian cancer patients operated in high-volume university hospitals were more often optimally debulked and had a significantly better cancer-specific survival than patients operated in other hospitals. These results favor centralization of primary surgical treatment of ovarian cancer.

Investments and value creation Case pulp and paper industry

Tämä tutkimus analysoi 49 sellu- ja paperiteollisuusyrityksen investointistrategioiden ja yrityksen arvon välistä yhteyttä vuosien 1996 ja 2005 välillä. Teoriaosa luo katsauksen arvonmääritysmenetelmiin ja investointien vaikutuksesta yrityksen arvoon ja arvonluontiin. Empiirinen osa on sekä kuvaileva, että selittävä. Yrityksen arvon kehittyminen mitataan vuosittain lisäarvomallilla (EVA®). Toteutetussa analyysissa yritykset on ryhmiteltyjoko liiketoimintaorientaation tai maantieteellisen alueen mukaan. Yritysten investointistrategiat jaoteltiin kasvumallin mukaisesti T&K:hon käyttöomaisuusinvestointeihin ja yritysostoihin. Kasvumallin tulokset ovat raportoitu yritystasolla. Tulokset osoittavat, että harvat sellu- ja paperiteollisuusyritykset ovetpystyneet arvonluontiin. Arvonluonti riippuu merkittävästi talouden suhdanteista. Yritysten investointistrategiat ovat olleet hyvin identtisiä tarkastelujaksonaikana ja alan suurimpien yritysten investointistrategiat kuvaavat hyvin koko toimialan kehitystä. Pienempien yritysten investointistrategiat eroavat valtavirran toimista. Jatkoanalyysi osoitti, että investoinnit käyttöomaisuuteen parantavat kannattavuutta, mitattuna EBITDA-%:lla ja yritysostot heikentävät sitä. Mitattaessa arvonluontia EVA®:lla käyttöomaisuusinvestoinneilla on positiivinen vaikutus arvonluontiin, kun taas yritysostot tuhoavat arvoa. Havainnot tukevat aikaisempia empiirisiä tutkimustuloksia.

Gold investments and short- and long-run price determinants of the price of gold

Tämän tutkielman tavoitteena on tutkia tekijöitä jotkavaikuttavat lyhyellä ja pitkällä aikavälillä kullan hintaan. Toiseksi tutkielmassa selvitetään mitä eri sijoitusmahdollisuuksia löytyy kultaan sijoitettaessa. Aineistona käytetään kuukausitasoista dataa Yhdysvaltain ja maailman hintaindekseistä, Yhdysvaltain ja maailman inflaatiosta ja inflaation volatiliteetista, kullan beetasta, kullan lainahinnasta, luottoriskistä ja Yhdysvaltojen ja maailman valuuttakurssi indeksistä joulukuulta 1972 elokuulle 2006. Yhteisintegraatio regressiotekniikoita käytettiin muodostamaan malli jonka avullatutkittiin päätekijöitä jotka vaikuttavat kullan hintaan. Kirjallisuutta tutkimalla selvitettiin miten kultaan voidaan sijoittaa. Empiirisettulokset ovat yhteneväisiä edellisten tutkimusten kanssa. Tukea löytyi sille, että kulta on pitkän ajan suoja inflaatiota vastaan ja kulta ja Yhdysvaltojen inflaatio liikkuvat pitkällä aikavälillä yhdessä. Kullan hintaan vaikuttavat kuitenkin lyhyen ajan tekijät pitkän ajan tekijöitä enemmän. Kulta on myös sijoittajalle helppo sijoituskohde, koska se on hyvin saatavilla markkinoilla ja eri instrumentteja on lukuisia.

Assessing Strategic IT Investments of Forest Industry by Means of the Real Options Approach, Case: Stora Enso

Tutkimuksen päämääränä oli tutkia miten reaalioptiomenetelmä soveltuu metsäteollisuuden strategisten informaatioteknologiainvestointien arvioimiseen. Tässä tutkimuksessa muodostettiin mukautettu reaalioptiosovelluskehys, esiteltyjen reaalioptiosovelluskehyksien perusteella. Valitut investointiehdotukset arvioitiin muodostetun sovelluskehyksen avulla. Tutkimus oli luonteeltaan kvalitatiivinen. Pääasiallisia tiedonlähteitä olivat lehtiartikkelit, GDSS -istunnot ja haastattelut. Tutkimuksen tuloksena selvisi, että reaalioptiomenetelmä sopii metsäteollisuudenstrategisten informaatioteknologiainvestointien arvioimiseen. On kuitenkin huomioitava, että investoinnin suunnitteluprosessin kypsyysaste vaikuttaa reaalioptiomenetelmän soveltamiseen. Tutkimuksessa arvioidut investoinnit ovat investoinnin suunnitteluvaiheen varhaisessa vaiheessa.

LAAJENNUS- JA KORVAUSINVESTOINTIEN JÄLKI TARKKAILU PÄÄOMAVALTAISESSA TEOLLISUUDESSA

Työn tavoitteena on selvittää pääomavaltaisen teollisuudenalan yritysten käyttämiä investointien suunnittelu- ja jälkitarkkailumenetelmiä. Työn keskeisintä aluetta ovat operatiiviset tuottavuusinvestoinnit, kuten laajennus- ja korvausinvestoinnit. Tutkimuksen teoriaosassa käsitellään investointiprosessia ja siihen kiinteästi liittyviä käsitteitä ja toimintoja. Myös käytetyimpien investointilaskentamenetelmien laskentakaavat esitetään. Muita työssä käsiteltäviä aiheita ovat mm. laskentakorkokannan määrittäminen, riskin huomioiminen investointihankkeissa ja reaalioption käsite. Työssä keskitytään eri laskentamenetelmien tulosten antaman informaation tulkintaan. Työssä selvitetään mm. pääoman tuottoasteen (ROI), hyötykustannussuhteen, nykyarvomenetelmän (NPV) ja sisäisen koron menetelmän (IRR) tulosten tulkitsemista. Työssä selvitetään myös käsitteet: taloudellinen lisäarvo (EVA) ja jäännöskate (RI). Työssä tutkitaan investointiprosessia investoinnin jälkitarkkailun kannalta, eli miten mahdollistetaan luotettava ja systemaattinen investoinnin jälkitarkkailu. Myös jälkitarkkailulla saavutettavan tiedon hyödyntämiseen otetaan kantaa. Yhden haasteen työhön asettaa tutkittavan teollisuudenalan konsernien suuri koko. Investointilaskentamenetelmiä on osattava käyttää monipuolisesti. Investointien jälkitarkkailu on huomioitava jo suunnitteluvaiheessa. Yleisesti ottaen yritysten tulisi lisätä nykyarvomenetelmän käyttöä. Jälkitarkkailussa havaittuihin poikkeamiin täytyy reagoida mahdollisimman aikaisessa vaiheessa. Suunnittelun ja jälkitarkkailun apuna voidaan käyttää asiantuntijoista koottua arviointiryhmää. Suuren konsernin on tärkeää kiinnittää huomiota investointien suunnittelu- ja jälkitarkkailutoimintojen yhtenäistämiseen eri tuotantoyksikköjen sisällä. Työn ensisijainen kohdeyritys, UPM-Kymmene Oyj, on yksi maailman suurimmista metsäteollisuusyrityksistä. Tutkimuksen empiirisen osan teossa oli mukana UPM-Kymmenen lisäksi kolme muuta suurta suomalaista pääomavaltaisella teollisuudenalalla toimivaa yritystä: M-Real, Outokumpu ja Stora Enso. Tutkimukseen osallistuneiden yritysten investointiprosessin läpivientiin liittyviä ajatuksia ja toimintamalleja selvitettiin haastattelemalla investointisuunnittelun parissa toimivia henkilöitä.

Operative level purchasing in pharmaceutical wholesale trade

Tämän tutkintotyön tavoitteena on selvittää operatiivista ostotoimintaa, joka sisältää oikea-aikaisen tilausrytmin ja tasapainoisen tilausmäärän määrityksen sekä saapuvan tavaravirran mukauttamisen myyntiin tai kulutukseen kokonaisuutena. Tässä tutkimuksessa tarkastellaan myös varastojen merkitystä ja ostotoiminnan kannalta keskeisimpiä tehokkaaseen varastonohjaukseen liittyviä tunnuslukuja. Tutkimus sisältää lääkkeiden toimitusketjun kuvauksen, koska se poikkeaa merkittävästi muista toimialoista. Tämä tutkintotyö on syntetisoiva kirjallisuustutkimus. Tutkintotyön empiirisessä osassa analysoidaan aluksi case-yrityksen vaihto-omaisuusvaraston ohjausta ostotoiminnan näkökulmasta ABC analyysiin pohjautuen. Tämän jälkeen ostotoimintaa analysoidaan tarkemmin tiettyjen toimittajien osalta. Lopuksi laaditaan optimaalinen tilausrytmi ja tilausmäärät sekä ostobudjetti yhden toimittajan tuotteille. ABC analyysia voidaan hyödyntää työkaluna määriteltäessä miten erilaisten tuotteiden materiaalivirtoja tulisi ostotoiminnan kannalta ohjata. Analyysi perustuu resurssien keskittämiseen sinne missä tuotto on suurin.

Managing through measurement : A framework for successful operative level performance measurement

The research around performance measurement and management has focused mainly on the design, implementation and use of performance measurement systems. However, there is little evidence about the actual impacts of performance measurement on the different levels of business and operations of organisations, as well as the underlying factors that lead to a positive impact of performance measurement. The study thus focuses on this research gap, which can be considered both important and challenging to cover. The first objective of the study was to examine the impacts of performance measurement on different aspects of management, leadership and the quality of working life, after which the factors that facilitate and improve performance and performance measurement at the operative level of an organisation were examined. The second objective was to study how these factors operate in practice. The third objective focused on the construction of a framework for successful operative level performance measurement and the utilisation of the factors in the organisations. The research objectives have been studied through six research papers utilising empirical data from three separate studies, including two sets of interview data and one of quantitative data. The study applies mainly the hermeneutical research approach. As a contribution of the study, a framework for successful operative level performance measurement was formed by matching the findings of the current study and performance measurement theory. The study extents the prior research regarding the impacts of performance measurement and the factors that have a positive effect on operative level performance and performance measurement. The results indicate that under suitable circumstances, performance measurement has positive impacts on different aspects of management, leadership, and the quality of working life. The results reveal that for example the perception of the employees and the management of the impacts of performance measurement on leadership style differ considerably. Furthermore, the fragmented literature has been reorganised into six factors that facilitate and improve the performance of the operations and employees, and the use of performance measurement at the operative level of an organisation. Regarding the managerial implications of the study, managers who operate around performance measurement can utilise the framework for example by putting the different phases of the framework into practice.

Analysis of electricity distribution network operation business models and capitalization of control room functions with DMS

Electricity distribution network operation (NO) models are challenged as they are expected to continue to undergo changes during the coming decades in the fairly developed and regulated Nordic electricity market. Network asset managers are to adapt to competitive technoeconomical business models regarding the operation of increasingly intelligent distribution networks. Factors driving the changes for new business models within network operation include: increased investments in distributed automation (DA), regulative frameworks for annual profit limits and quality through outage cost, increasing end-customer demands, climatic changes and increasing use of data system tools, such as Distribution Management System (DMS). The doctoral thesis addresses the questions a) whether there exist conditions and qualifications for competitive markets within electricity distribution network operation and b) if so, identification of limitations and required business mechanisms. This doctoral thesis aims to provide an analytical business framework, primarily for electric utilities, for evaluation and development purposes of dedicated network operation models to meet future market dynamics within network operation. In the thesis, the generic build-up of a business model has been addressed through the use of the strategicbusiness hierarchy levels of mission, vision and strategy for definition of the strategic direction of the business followed by the planning, management and process execution levels of enterprisestrategy execution. Research questions within electricity distribution network operation are addressed at the specified hierarchy levels. The results of the research represent interdisciplinary findings in the areas of electrical engineering and production economics. The main scientific contributions include further development of the extended transaction cost economics (TCE) for government decisions within electricity networks and validation of the usability of the methodology for the electricity distribution industry. Moreover, DMS benefit evaluations in the thesis based on the outage cost calculations propose theoretical maximum benefits of DMS applications equalling roughly 25% of the annual outage costs and 10% of the respective operative costs in the case electric utility. Hence, the annual measurable theoretical benefits from the use of DMS applications are considerable. The theoretical results in the thesis are generally validated by surveys and questionnaires.

The Process of Greening Cycle as Method of Operative Environmental

The structural change of society from product-based business to service- and further to need-based business has caused the fact that work for environmental issues has spread from conventional factories and environmentally harmful production to concern services and offices as well. Almost every company has an office, so a relatively small environmental burden caused by an individual office grows remarkable already at the state level and globally even more. Motivation to work for environmental issues in an individual office could be challenging even without the fact that wasted environmental impacts bound also wasted costs. Besides cost savings, a concretely greener image of a company has its value in the B2Cas well as in the B2B-field. Consumers and clients are more and more conscious of environmental issues and demand concrete actions instead of speeches, good thoughts and meaningless certifications. Internal work for environmental issues at a strategy level is not sufficient, so operational environmental management is needed for changing old practices. This research is about the effects of operative environmental management on the greening process of an office-based business. The research is outlined to concern the operative work in the office including field sales. Target was to concretely lower the environmental impacts of Lyreco Finland and to find cost savings directly by changing the operative practices in the office and also indirectly by affecting the level of environmental knowledge of the personnel. During the greening process, the aim was also to create concrete arguments for marketing as well. The circle of greening process, which was especially created for this diploma work, was used as a method. The circle divides a year to themes and sections separated by factors of environmental impacts. Separation is based on Brett Wills’ thoughts of seven green wastes (Wills, Brett. The Green Intensions. 2009) and follows it uneasily. The circle aimed at ensuring evolutionary growth of knowledge instead of being revolutionary in the changing process. Committing personnel to the process from its start by asking ideas from them and giving them clear directions was an important part of the research of operative management. Because of working from distance, communication with personnel was operated by frequent training days and weekly greening notes via emails and intranet. Also availability for communication was an important task because of the telecommuting. Research results of this work show that operative environmental management in an officebased business today is mostly management of change. When the strategic environmental friendliness is taken into a concrete level, the most important individual factor is motivating the operating personnel. Research shows that evolutionary change is found being an efficient way to make a change. Also understanding one´s own impact on the environmental burden and on the whole greening process clearly motivates the personnel. Results show that in the operative realization of the greening process, clear directions of new working practices, being as concrete as possible, and committing personnel to follow them make the process more effective. The operative environmental management and the cycle of the greening process decrease the environmental burden and save costs. The concrete results could be used as believable arguments in marketing and therefore exploited in communication with interest groups. Commitment of the management is also one of the key factors of success in the greening process. In this research, changes in the business field by a company trade took the focus of the management away from the greening process and made the process more inefficient by decreasing the amount of training days. The circle of greening process will be used as a tool in the future, as well, and therefore it will help observe environmental impacts of a company and increase sustainable development. Commitment of management to the evolutionary environmental work helps the operating personnel lower environmental impacts, decrease costs and build a concretely greener image.

Harmonization of Environmental Costs and Investments Reporting

The objective of this Master’s Thesis is to examine the current state of environmental costs and investments reporting at Stora Enso in the Business Area of Printing and Reading. Differences and the factors causing the differences in environmental costs and investments reporting are examined in order to further harmonize the reporting between the mills. Research method is a case study, which comprises 11 paper mills. Environmental costs are studied from year 2012 and environmental investments from year 2011 or from 2012 depending on the mill. The results show that there are two types of differences such as actual and harmonisable affecting to environmental costs reporting. Actual differences result from factors such as location and technical features of the mill. Harmonisable differences represent differences, which distort the actual differences. Factors that cause harmonisable differences are identification and traceability of environmental costs as well as interpretation of the instructions. Estimation of the environmental share of indirect environmental investments causes differences between the mills in environmental investments reporting, as it has to be done case-by-case judgments. A further research could consider a detailed examination of the data registering process in order to further improve traceability of environmental costs. Furthermore, identification and reporting of potential savings could be studied from environmental point of view as resource efficiency is an increasing interest.

ERP Systems as Investments: Analysing Costs vs. Benefits

An ERP system investment analysis method using a Fuzzy Pay-Off approach for Real Option valuation is examined. It is studied, how the investment can be incrementally adopted and analyzed as a compounding Real Option model. The modeling allows follow-up. IS system development model COCOMO is presented as an example for investment analysis. The thesis presents the usage of Real Options as an alternative for the valuation of an investment. An idea is presented to use a continuous investment follow-up during the investment. This analysis can be performed using Real Options. As a tool for the analysis, the Fuzzy Pay-Off method is presented as an alternative for investment valuation.

The Pay-Off Method as a Tool for Evaluating the Risk and Profitability of Public Real Estate Investments

Real option valuation, in particular the fuzzy pay-off method, has proven to be useful in defining risk and visualizing imprecision of investments in various industry applications. This study examines whether the evaluation of risk and profitability for public real estate investments can be improved by using real option methodology. Firstly, the context of real option valuation in the real estate industry is examined. Further, an empirical case study is performed on 30 real estate investments of a Finnish government enterprise in order to determine whether the presently used investment analysis system can be complemented by the pay-off method. Despite challenges in the application of the pay-off method to the case company’s large investment base, real option valuation is found to create additional value and facilitate more robust risk analysis in public real estate applications.