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Kirjallisuusarvostelu

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Kirjallisuusarvostelu

Modularity in Health and Social Services: Perspectives on Organization and Management

Organizations that provide health and social services operate in a complex and constantly changing environment. Changes occur, for example, in ageing, technology and biotechnology, and customers’ expectations, as well as the global economic situation. Organizations typically aim to adapt the changes by introducing new organizational structures and managerial practices, such as process and lean management. Only recently has there been an interest in evaluating whether organizations providing health and social services could apply modularity in order to respond to some of the changes. The concept of modularity originates from manufacturing, but is applied in many other disciplines, such as information technology and logistics. However, thus far, the literature concerning modularity in health and social services is scarce. Therefore the purpose of this thesis is to increase understanding concerning modularity and the possibilities to apply modularity in the health and social services context. In addition, the purpose is to shed light on the viewpoints that are worth taking into account when considering the application of modularity in the health and social services context. The aim of the thesis is to analyze the way in which the modular structures are applied in the health and social services context and to analyze what advantages and possible barriers, as well as managerial concerns, might occur if modularity is applied in the health and social services context. The thesis is conducted by using multiple methods in order to provide a broad aspect to the topic. A systematic literature review provided solid ground for pre-understanding the topic and supported the formulation of the research questions. Theoretical reasoning provided a general overview of the special characteristics of the health and social services context and their effect on application of modularity. Empirical studies concentrated on managerial concerns of modularity particularly from the perspective of health and social services for the elderly. Results of the thesis reveal that structures in products, services, processes, and organizations are rather modular in health and social services. They can be decomposed in small independent units, while the challenges seem to occur especially in the compatibility of the services. It seems that health and social services managers have recognized this problem and they are increasingly paying attention to this challenge in order to enhance the flexible compatibility of services. Advantages and possible barriers of modularity are explored in this thesis, and from the theoretical perspective it could be argued that modularity seems to be beneficial in the context of health and social services. In fact, it has the potential to alleviate several of the challenges that the health and social services context is confronting. For example, modular structures could support organizations in their challenging task to respond to customers’ increasing demand for heterogeneous services. However, special characteristics of the health and social services context create barriers and provide significant challenges in application of modularity. For example, asymmetry of information, negative externalities, uncertainty of demand, and rigid regulation prevent managers from extensively drawing benefits from modularity. Results also reveal that modularity has managerial implications in health and social service. Modularity has the potential to promote and support new service development and outsourcing. Results also provide insights into network management and increases managerial understanding of different network management strategies. Standardization in health and social services is extensive due to legislation and recommendations. Modularity provides alternative paths to take an advantage of standardization while still ensuring the quality of the services. Based on this thesis, it can be concluded, both from a theoretical perspective and from empirical results concerning modularity in health and social services, that modularity might fit well and be beneficial. However, the special characteristics of the health and social services context prevent some of the benefits of modularity and complicate its application. This thesis contributes to the academic literature on the organization and management of health and social services by describing modularity as an alternative way for organizing and managing health and social services. In addition, it contributes to the literature of modularity by exploring the applicability of modularity in the context of health and social services. It also provides practical contribution to health and social services managers by evaluating the pros and cons of modularity when applied to health and social services.

Bioinformatical and in vitro approaches to essential oil-induced matrix metalloproteinase inhibition

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Seasonal home ranges and fidelity to breeding sites among ringed seals

Population structure and patterns of habitat use among ringed seals (Phoca hispida) are poorly known, in part because seasonal movements have not been adequately documented. We monitored the movements of 98 ringed seals in the Beaufort and Chukchi seas between 1990 and 2006 using three forms of telemetry. In the winter—spring period (when the seals were occupying shorefast ice), we used radio and ultra-sonic tags to track movements above and below the ice, respectively. We used satellite-linked transmitters in summer and fall (when the seals ranged away from their winter sites) to track at-sea movements. In the shorefast ice habitat, the home ranges of 27 adult males ranged from\1 to 13.9 km2 (median = 0.628) while the home ranges of 28 adult females ranged from \1 to 27.9 km2 (median = 0.652). The 3-dimensional volumes used by 9 seals tracked acoustically under the ice averaged 0.07 (SD = 0.04) km3 for subadults and adult males and 0.13 (SD = 0.04) km3 for adult females. Three of the radio-tracked seals and 9 tracked by satellite ranged up to 1,800 km from their winter/spring home ranges in summer but returned to the same small (1–2 km2) sites during the ice-bound months in the following year. The restricted movements of ringed seals during the ice-bound season— including the breeding season—limits their foraging activities for most of the year and may minimize gene flow within the species.

Postoperative evaluation of surgery for craniosynostosis based on image registration techniques

Craniosynostosis consists of a premature fusion of the sutures in an infant skull, which restricts the skull and brain growth. During the last decades there has been a rapid increase of fundamentally diverse surgical treatment methods. At present, the surgical outcome has been assessed using global variables such as cephalic index, head circumerence and intracranial volume. However, the variables have failed in describing the local deformations and morphological changes, which are proposed to more likely induce neurological disorders.

Feature-invariant image registration method for quantification of surgical outcomes in patients with craniosynostosis: a preliminary study

Craniosynostosis consists of a premature fusion of the sutures in an infant skull that restricts skull and brain growth. During the last decades, there has been a rapid increase of fundamentally diverse surgical treatment methods. At present, the surgical outcome has been assessed using global variables such as cephalic index, head circumference, and intracranial volume. However, these variables have failed in describing the local deformations and morphological changes that may have a role in the neurologic disorders observed in the patients. This report describes a rigid image registration-based method to evaluate outcomes of craniosynostosis surgical treatments, local quantification of head growth, and indirect intracranial volume change measurements. The developed semiautomatic analysis method was applied to computed tomography data sets of a 5-month-old boy with sagittal craniosynostosis who underwent expansion of the posterior skull with cranioplasty. Quantification of the local changes between pre- and postoperative images was quantified by mapping the minimum distance of individual points from the preoperative to the postoperative surface meshes, and indirect intracranial volume changes were estimated. The proposed methodology can provide the surgeon a tool for the quantitative evaluation of surgical procedures and detection of abnormalities of the infant skull and its development.

Comprehensive copy number and gene expression profiling of the 17q23 amplicon in human breast cancer

The biological significance of DNA amplification in cancer is thought to be due to the selection of increased expression of a single or few important genes. However, systematic surveys of the copy number and expression of all genes within an amplified region of the genome have not been performed. Here we have used a combination of molecular, genomic, and microarray technologies to identify target genes for 17q23, a common region of amplification in breast cancers with poor prognosis. Construction of a 4-Mb genomic contig made it possible to define two common regions of amplification in breast cancer cell lines. Analysis of 184 primary breast tumors by fluorescence in situ hybridization on tissue microarrays validated these results with the highest amplification frequency (12.5%) observed for the distal region. Based on GeneMap'99 information, 17 known genes and 26 expressed sequence tags were localized to the contig. Analysis of genomic sequence identified 77 additional transcripts. A comprehensive analysis of expression levels of these transcripts in six breast cancer cell lines was carried out by using complementary DNA microarrays. The expression patterns varied from one cell line to another, and several overexpressed genes were identified. Of these, RPS6KB1, MUL, APPBP2, and TRAP240 as well as one uncharacterized expressed sequence tag were located in the two common amplified regions. In summary, comprehensive analysis of the 17q23 amplicon revealed a limited number of highly expressed genes that may contribute to the more aggressive clinical course observed in breast cancer patients with 17q23-amplified tumors.

Varareittisuunnitelma kantateille 78 ja 81 sekä valtatielle 4 Kemin kohdalla

Pääteillä esiintyvien häiriöiden, kuten onnettomuuksien, tietöiden, tapahtumien ja poikkeuksellisten ruuhkatilanteiden varalle tarvitaan varareittejä, joille liikenne voidaan häiriön sattuessa ohjata joko kokonaan tai osittain. Varareitit ja niiden opastus tulee olla ennalta suunniteltuja, jolloin niiden käyttöönotto sujuu häiriötilanteessa mahdollisimman vaivattomasti eri viranomaisten yhteistyönä. Häiriötilanteiden hallinnassa paitsi suunnitellut varareitit ja niiden liikenteen ohjaus, myös tiivis yhteistyö eri viranomaisten välillä on oleellista tilanteen sujuvan hoitamisen kannalta. Tässä raportissa on esitetty kantateille 78 ja 81 sekä valtatielle 4 Kemin kohdalla liikenteen häiriötilanteissa käytettävät varareitit, häiriöpaikalla tapahtuvan liikenteenohjauksen periaatekuva sekä varareittien liikenteenohjaussuunnitelmat. Suunnittelualueella on, kuten pääsääntöisesti koko Suomen tieverkolla, varsin vähän lyhyitä ja aina kaikelle liikenteelle soveltuvia varareittejä. Tämän vuoksi suunnitelmassa määritettiin varsinkin raskaan liikenteen tarpeita ajatellen myös pidempiä varareittejä. Pidemmille varareiteille liikennettä ohjattaessa korostuu tiedotuksen ja liikenteenohjauskaluston tärkeys. Varareitin aktivoinnissa ja liikenteenohjauksen järjestämisessä korostuu yhteistyö liikenneviraston tieliikennekeskuksen kanssa. ELYkeskus vastaa kustannuksista, urakoitsijan kanssa tehdyn sopimuksen mukaisesti, jotka syntyvät urakoitsijan toiminnasta häiriöhallintatilanteen purkamisessa.

Luokanopettaja liikunnanopettajana – merkityssuhteita luomassa

Tämän tutkimuksen tarkoituksena on selvittää mitä merkityksiä luokanopettajat pitävät tärkeinä liikunnanopetuksessa ja verrata niitä oppilaille tehtyyn tutkimukseen. Liikunnan moninaiset merkitykset vaikuttavat oppilaiden liikuntasuhteen muodostumiseen. Liikunnassa merkitykset konkretisoituvat havainnoinnin ja fyysisen tekemisen tuomien elämysten kautta. Liikuntaa opettavalla opettajalla voi olla merkittävä rooli oppilaan liikuntasuhteen muodostumiseen sekä siihen, minkälaisia merkityksiä oppilaan on mahdollista kohdata ja löytää liikunnasta. Merkitysten tiedostamisella voidaan tukea liikunnallisen elämäntavan syntymistä ja harrastuneisuutta. Liikunnassa asiat koetaan usein fyysisesti, mutta yhtä tärkeää on se, mitä tapahtuu kognitiivisella tasolla. Tutkimuksen aineisto (n=164) kerättiin joulukuussa 2015 sosiaalisen median kautta toteutettuna kyselynä. Kysely oli suunnattu luokanopettajille, jotka ohjattiin Facebook- keskusteluryhmien välityksellä Webropol-kyselyyn. Kyselyn määrällisessä osiossa käytettiin pohjana merkitysosioa, joka oli Lasten ja nuorten liikuntakäyttäytymisen tutkimuksessa. Laadullista aineistoa kerättiin lomakkeeseen lisätyillä avoimilla kysymyksillä liikunnanopetukseen liittyen. Aineistoa analysoitiin SPSS 23.0 tilasto-ohjelmalla. Liikunnanopetuksessa koettuja merkityksiä vertailtiin tärkeäksi ja erittäin tärkeäksi kokemisen lisäksi muun muassa keskiarvoilla. Tutkimuksen tulokset antoivat kuvan opettajien liikunnanopetuksessa tärkeänä pitämistä merkityksistä, joita olivat ilo, parhaansa yrittäminen, onnistumisen elämykset, hyvän olon saaminen ja liikunnan terveellisyys. Vanhimmat vastaajat pitivät muita ikäryhmiä tärkeämpänä lihasvoiman kasvattamista ja notkeuden parantamista. Miehet pitivät naisia yleisemmin tärkeänä menestyksen voittamisen tavoittelua. Oppilaiden ja opettajien tärkeimmiksi ja vähiten tärkeiksi kokemien merkitysten joukosta löytyi samoja merkityksiä.