Impact of simultaneous pancreas-kidney transplantation: patients' perspectives

Background: Few qualitative studies of simultaneous pancreas-kidney transplantation (SPK Tx) have been published. The aims of this study were to explore from the perspective of patients, the experience of living with diabetes mellitus type 1 (T1DM), suffering from complications, and undergoing SPK Tx with good outcome; and to determine the impact of SPK Tx on patients and their social and cultural environment. Methods: We performed a focused ethnographic study. Twenty patients were interviewed. Data were analyzed using content analysis and constant comparison following the method proposed by Miles and Huberman. Results: A functioning SPK Tx allowed renal replacement therapy and insulin to be discontinued. To describe their new situation, patients used words and phrases such as"miracle","being reborn" or"coming back to life". Although the complications of T1DM, its surgery and treatment, and associated psychological problems did not disappear after SPK Tx, these were minimized when compared with the pretransplantation situation. Conclusion: For patients, SPK Tx represents a recovery of their health and autonomy despite remaining problems associated with the complications of T1DM and SPK Tx. The understanding of patients" existential framework and their experience of disease are key factors for planning new intervention and improvement strategies.

Impact of simultaneous pancreas-kidney transplantation: patients' perspectives

Background: Few qualitative studies of simultaneous pancreas-kidney transplantation (SPK Tx) have been published. The aims of this study were to explore from the perspective of patients, the experience of living with diabetes mellitus type 1 (T1DM), suffering from complications, and undergoing SPK Tx with good outcome; and to determine the impact of SPK Tx on patients and their social and cultural environment. Methods: We performed a focused ethnographic study. Twenty patients were interviewed. Data were analyzed using content analysis and constant comparison following the method proposed by Miles and Huberman. Results: A functioning SPK Tx allowed renal replacement therapy and insulin to be discontinued. To describe their new situation, patients used words and phrases such as"miracle","being reborn" or"coming back to life". Although the complications of T1DM, its surgery and treatment, and associated psychological problems did not disappear after SPK Tx, these were minimized when compared with the pretransplantation situation. Conclusion: For patients, SPK Tx represents a recovery of their health and autonomy despite remaining problems associated with the complications of T1DM and SPK Tx. The understanding of patients" existential framework and their experience of disease are key factors for planning new intervention and improvement strategies.

A Social Network Analysis of Twitter: Mapping the Digital Humanities Community

Defining digital humanities might be an endless debate if we stick to the discussion about the boundaries of this concept as an academic "discipline". In an attempt to concretely identify this field and its actors, this paper shows that it is possible to analyse them through Twitter, a social media widely used by this "community of practice". Based on a network analysis of 2,500 users identified as members of this movement, the visualisation of the "who's following who?" graph allows us to highlight the structure of the network's relationships, and identify users whose position is particular. Specifically, we show that linguistic groups are key factors to explain clustering within a network whose characteristics look similar to a small world.

Outsourcing Challenges in Russia

The study focuses on the key factors in outsourcing from the viewpoint of manufacturing companies operating in Russia. The goal has been to give an overview of the different kinds of challenges companies might face in the case of outsourcing. Of particular interest are the possible risks which might originate from the subcontract relationship, as well as managing these risks. The empirical material for this qualitative interview study was collected from three large-scale manufacturing companies operating in food industry in Russia. Two of the interviewed companies were local Russian actors, and one was an international firm. According to the respondents, a big challenge is to find a suitable supplier in the Russian markets. If there are suppliers available, they may often not be capable of operating as outsourcing partners. The most common problems faced with suppliers are unstable quality and arbitrary pricing. Whether the suppliers are capable to offer activities which satisfy the company’s own and the end customers’ requirements, seems to be the biggest concern in the interviewed companies. This quality risk is managed by the strategy of multiple sourcing. Single sourcing is seen as an impossible option. The interviewed companies have no organised risk management with their external suppliers.

Ydinvoimalaitoksen elinkaaren ympäristönäkökohdat ja rakentamisvaiheen ympäristöjohtaminen

Ympäristöasiat ovat nousseet merkittävän tarkastelun kohteeksi yhteiskunnan kaikissa toiminnoissa. Yritysten ympäristöjohtamisen välineeksi on kehitetty ympäristöjärjestelmiä, joiden lähtökohtana on toiminnan ympäristönäkökohtien ja -vaikutusten tunnistaminen. Työn tavoitteena on luoda perusta Fennovoiman ympäristöjärjestelmää varten ja löytää keinoja ydinvoimalaitoksen rakennustyömaan ympäristönäkökohtien ja -vaikutusten hallitsemiseksi. Työn teoriaosassa keskitytään tarkastelemaan ISO 14001 -standardin mukaisen ympäristöjärjestelmän toteuttamiseen ja ylläpitoon liittyviä perusasioita, kuten ympäristönäkökohtien ja -vaikutusten tunnistamista, päämääriä ja tavoitteita sekä jatkuvan parantamisen periaatetta. Työn tutkimusosassa tarkastellaan ydinvoimalaitoshankkeen elinkaaren ympäristönäkökohtia ja -vaikutuksia sekä kartoitetaan keinoja rakentamisvaiheen ympäristöjohtamiseksi kahden eri rakentamisvaiheen toteutusmallin tapauksessa. Avainasemassa ovat määritellyt tavoitteet, tiedonkulku ja yhteistyö eri osapuolten välillä

Assessment of facilitators' design thinking

Meeting design is one of the most critical prerequisites of the success of facilitated meetings but how to achieve the success is not yet fully understood. This study presents a descriptive model of the design of technology supported meetings based on literature findings about the key factors contributing to the success of collaborative meetings, and linking these factors to the meeting design steps by exploring how facilitators consider the factors in practice in their design process. The empirical part includes a multiple-case study conducted among 12 facilitators. The case concentrates on the GSS laboratory at LUT, which has been working on facilitation and GSS for the last fifteen years. The study also includes ‘control’ cases from two comparable institutions. The results of this study highlight both the variances and commonalities among facilitators in how they design collaboration processes. The design thinking of facilitators of all levels of experience is found to be largely consistent wherefore the key design factors as well as their role across the design process can be outlined. Session goals, group composition, supporting technology, motivational aspects, physical constraints, and correct design practices were found to outline the key factors in design thinking. These factors are further categorized into three factor types of controllable, constraining, and guiding design factors, because the study findings indicate the factor type to have an effect on the factor’s importance in design. Furthermore, the order of considering these factors in the design process is outlined.

Electrical machine in a Hybrid Electrical Vehicle

Hybrid electric vehicles (HEV) have attracted very much attention during the latest years. Increasing environmental concern and an increase in fuel prices are key factors for the growing interest towards the HEV. In a hybrid electric vehicle the power train consists of both a mechanical power system and an electric power transmission system. The major subsystems in the mechanical power system are the internal combustion engine which powers the vehicle; electric power transmission including an energy storage, power electronic inverter, hybrid control system; the electric motor drive that runs either in the generating mode or in the motoring mode to process the power flow between the energy storage and the electrical machine. This research includes two advanced electric motors for a parallel hybrid: induction machine and permanent magnets synchronous machine. In the thesis an induction motor and a permanent magnet motor are compared as propulsion motors. Electric energy storages are also studied.

Asiakkaan luottamuksen kokemus terveydenhuollon palveluntarjoajaa kohtaan : case tutkimus terveydenhuollon yksityiseltä sektorilta

Tutkimuksen tavoite on selvittää mitkä tekijät vaikuttavat asiakkaan luottamuksen kokemukseen palveluntarjoajaa kohtaan ei kasvokkain tarjottavissa terveyspalveluissa. Tutkimusongelman käsittelyssä kiinnitetään erityisesti huomiota luottamuksen rakentumisen dynamiikkaan ja aikaulottuvuuteen sekä yksityisen palveluntarjoajan maineeseen yhtenä luottamuksen kokemusta selittavänä tekijänä. Kirjailisuuskatsauksessa on määritelty paääkäsitteet maine ja luottamus sekä niiden alakasitteita. Lähteinä on käytetty luottamusta käsittelevää kirjallisuutta useilta eri tieteenaloilta. Case tutkimus on suoritettu laadullisin menetelmin kirjallisuuskatsauksessa esitetyn viitekehyksen ja aikaisemman tutkimuksen pohjalta. Primaariaineisto on kerätty fokusryhmäkeskusteluilia. Aineistoa on pyritty anatysoimaan mahdollisimman yksityiskohtaisesti tutkimuskysymyksen kontekstissa. Analyysin pohjalta tehtyjä tulkintoja on verrattu aikaisempaan tutkimukseen. Case tutkimus osoitti, etta positiivisten odotusten ja suomalaista terveydenhuollon järjestelmää kohtaan tunnetun luottamuksen ansiosta suhtautuminen terveydenhuollon palveluntarjoajaa kohtaan on lähtokohtaisesti luottavainen. Luottamuksen rakentumisen ensivaiheessa nopea luottamus perustuu aikaisemmista kokemuksista siirrettyyn luottamukseen ja stereotypioihin. Seuraavassa vaiheessa luottamus henkilöityy hoitajaan. Luottamus syvenee positiivisten kokemusten ja odotusten täyttymyksen myötä koskemaan myös palveluntarjoajaa. Luottamuksen rakentumisen tärkeimmiksi tekijöiksi nousivat yrityksen maine sosiaalisessa mediassa, suosittelijat, yrityksen asema terveydenhuollon järjestelmässä sekä hoitajien kyvykkyys, kompetenssi, empatiakyky ja potilaan ymmärtäminen.

La inclusión laboral de personas con trastorno mental grave mediante Empleo con Apoyo : elementos clave a partir de los professionals

Supported Employment (SE) is a clear alternative to the work inclusion of people with severe mental disorder (SMD). This article has two purposes: first, to show the possibilities of application of the SE with people with SMD, secondly, to establish the main lines that are configured as elements favoring the inclusion processes of this group work by SE. A piece of research has been carried out based on interviews of professionals with experience in supporting the work inclusion of people with SMD, focusing on the key factors that these professionals perceive as key elements for successful work inclusion processes. The awareness of the disease by the worker with SMD, the organization of the support processes throughout the insertion process, the relationship with the company as well as with the family and the characteristics of the health network are among the factors that, according to the research results, appear to be key factors for successful and less successful work inclusion processes. The information obtained provides insight into how people with SMD develop work inclusion processes with supported employment and help us to suggest some strategies to improve these processes

Conversioni al cattolicesimo a Roma tra Sei e Settecento. La presenza degli scandinavi nell’Ospizio dei Convertendi.

In my PhD dissertation, I have examined a group of people of Scandinavian origin received by Ospizio dei Convertendi. This group has been hitherto largely unknown to historical research. The Ospizio was an institute founded by the Oratorian Congregation in Rome in 1673 to provide religious instruction and material aid to both recent and aspirant converts to Roman Catholicism. My research traces the profile of converts and a typology of motives, examining different factors which influenced the conversion process. I show that the key factors were often of a social rather than a religious nature. Moreover, I have analyzed the hospice in the context of Counter-Reformation charity as well. In terms of numbers, the Scandinavians formed a somewhat marginal yet not insignificant group within the Roman hospice. Out of a total of 2203 guests received between 1673 and 1706, 4.6 % were Scandinavians: 74 Swedes (including Finland and Livonia) and 27 Danes (including Norway). They came from a rigorously Protestant region which reacted to Catholicism with severe legislative measures. Converts to Catholicism risked confiscation of their goods, expulsion or even capital punishment. Since both Sweden and Denmark were practically impenetrable to Catholicism at the time and clandestine missionary attempts often failed before they had even properly started, the Roman Catholic Church shifted its interest towards Northerners arriving in Rome, a preferred destination for young noblemen, artists and migrant craftsmen. The material related to Ospizio dei Convertendi, conserved in the Vatican archives, is a scarcely known yet unusually rich source, not only for the religious history of our continent, but also for social history and the study of migration in early modern Europe. It contains a wealth of information about members of the subordinate classes, of their travels and lives in Europe. The profile delineated in these documents is of individuals who had a wide range of different professions and different aspirations. These documents encompass a vast social spectrum that was highly mobile on a continent which by that time had become pluriconfessional. Therefore, these migrants faced the complex religious reality in their everyday life. The principal corpus of my research consists of two types of manuscript sources created for administrative and in a way also for apologetic purposes of the Roman Catholic Church. My starting point is the Primo registro generale of Ospizio dei Convertendi. This is a volume in which the following information about each guest was registered: name, nationality, city of origin, age, sex, profession, confession professed before converting, date of arrival, departure, abjuration and baptism. Typically, the convert was male, originating from Stockholm or Copenhagen, from 21 to 30 years of age. The biggest occupational groups in descending order were soldiers, noblemen, craftsmen and sailors. Thus the data reflects a multiform reality of interurban and long distance migration, ideals regarding the education of young noblemen and gentry as well as the need of European armies to hire foreign mercenaries in their various campaigns. Against this background the almost total absence of women is hardly surprising: there is only one woman in the material I have studied. The second main source, Nota degl’ospiti ricevuti e spese fatte per essi, sheds more light on the choices of the converts, their motivations and their lives outside Scandinavia before reaching Rome. This narrative material permits an analysis which completes but also goes far beyond the columns of the Institute’s general register. This material consists of reports written by Catholic priests based on an interview conducted upon each guest’s arrival. The material frequently includes information on what the converts would do following their departure from the Institute as well. These sources have a specific narrative form and contain short biographies, list reasons for converting and information about the journey from the North to the Mediterranean - a journey which in many cases took several years. Moreover, they show that certain unorthodox practices such as calling on the saints and pleading for help from them were not uncommon in the Protestant popular religion. The recording of information on conversions from Protestantism to Catholicism reflects both religious and social interest on the part of the receiving institute. The information obtained was used for the purposes of religious teaching, for finding adequate ways of inserting the convert into Italian society so that he could earn a living, and to find effective methods to convert others with a similar cultural and geographical background. The stories recorded were based on interviews with the newly-arrived, information obtained from a travel companion or fellow countrymen, or from written documents the aspirant converts carried with them. These sources illustrate, although sometimes in rather simplified ways, the circumstances and motivations which were relevant to the choice of changing one’s confession. In addition, I have examined petitions addressed to the hospice and other Roman authorities in order to get financial aid. These petitions were written by Italian scrittori, and they contain certain conventions and topoi of presenting the conversion with the purpose of improving the chances of obtaining financial aid. It is through these filters, which may seem initially almost invisible, that the remote voice of the converts reaches us. The results of the analysis are particularly interesting because they disagree with some of the principal conclusions of previous work on the subject. First, earlier research has focused almost exclusively on the conversions of noblemen, and has argued, second, that the Queen Christina of Sweden was the driving force behind their change of confession. The sources examined for this dissertation present a profile of long-distance migrants, many of them members of the subordinate classes, who were looking for ways to make their living in Europe. These people had in many cases left their country of origin several years earlier and not for religious reasons, so, crucially, we are not dealing with confessional migration in these cases. Rather, conversion was a complex process, intricately tied up with strategies of survival, integration and upward social mobility. At the same time, while these components are significant on their own right, they do not necessarily point to the absence of motivations of a more clearly religious nature.

Segmental Durations of Speech

This dissertation considers the segmental durations of speech from the viewpoint of speech technology, especially speech synthesis. The idea is that better models of segmental durations lead to higher naturalness and better intelligibility. These features are the key factors for better usability and generality of synthesized speech technology. Even though the studies are based on a Finnish corpus the approaches apply to all other languages as well. This is possibly due to the fact that most of the studies included in this dissertation are about universal effects taking place on utterance boundaries. Also the methods invented and used here are suitable for any other study of another language. This study is based on two corpora of news reading speech and sentences read aloud. The other corpus is read aloud by a 39-year-old male, whilst the other consists of several speakers in various situations. The use of two corpora is twofold: it involves a comparison of the corpora and a broader view on the matters of interest. The dissertation begins with an overview to the phonemes and the quantity system in the Finnish language. Especially, we are covering the intrinsic durations of phonemes and phoneme categories, as well as the difference of duration between short and long phonemes. The phoneme categories are presented to facilitate the problem of variability of speech segments. In this dissertation we cover the boundary-adjacent effects on segmental durations. In initial positions of utterances we find that there seems to be initial shortening in Finnish, but the result depends on the level of detail and on the individual phoneme. On the phoneme level we find that the shortening or lengthening only affects the very first ones at the beginning of an utterance. However, on average, the effect seems to shorten the whole first word on the word level. We establish the effect of final lengthening in Finnish. The effect in Finnish has been an open question for a long time, whilst Finnish has been the last missing piece for it to be a universal phenomenon. Final lengthening is studied from various angles and it is also shown that it is not a mere effect of prominence or an effect of speech corpus with high inter- and intra-speaker variation. The effect of final lengthening seems to extend from the final to the penultimate word. On a phoneme level it reaches a much wider area than the initial effect. We also present a normalization method suitable for corpus studies on segmental durations. The method uses an utterance-level normalization approach to capture the pattern of segmental durations within each utterance. This prevents the impact of various problematic variations within the corpora. The normalization is used in a study on final lengthening to show that the results on the effect are not caused by variation in the material. The dissertation shows an implementation and prowess of speech synthesis on a mobile platform. We find that the rule-based method of speech synthesis is a real-time software solution, but the signal generation process slows down the system beyond real time. Future aspects of speech synthesis on limited platforms are discussed. The dissertation considers ethical issues on the development of speech technology. The main focus is on the development of speech synthesis with high naturalness, but the problems and solutions are applicable to any other speech technology approaches.

Puolustusteollisuusalan yrityksen strategisen verkoston hallinta ja tuloksellisuus vastakauppatoiminnan näkökulmasta

Valtiot soveltavat yleisesti puolustusvälinehankintojensa yhteydessä vastakauppamenettelyä, jota kutsutaan offsetiksi. Tämän laadullisen tapaustutkimuksen tavoitteena on selvittää minkälaista verkottumista suora offset edellyttää myyjäyritykseltä ja mitä vaikutuksia verkottumisella on myyjäyritykseen. Offsetvaatimusten ja paikallisyhteistyön vuoksi tapahtuvalla verkottumisella on monia vaikutuksia myyjäyritykseen, joista pääosan voidaan sanoa olevan liiketaloudellisessa mielessä negatiivisia. Huomioitavaa kuitenkin on, että ilman offsetia ei voida voittaa hankkeita ja näin generoida liiketoimintaa. Suoran offsetin verkostoituminen perustuu ratkaisuliiketoiminnan eli arvopajan kautta tuotettuun lisäarvoon loppuasiakkaalle. Tällaista verkostotoimintaa harjoittavaa yritystä voidaan kutsua asiakaskeskeisen verkoston ansaitsijaksi joka kasvattaa ansaintaansa tuottamansa korkeamman lisäarvon kautta. Offsetin luonteesta johtuen erilaisten mittausjärjestelmien rakentaminen voi nousta haasteeksi.

New mechanisms regulating human Th1 and Th2 cell differentiation

Selective development of human T helper (Th) cells into functionally distinct Th1 and Th2 subtypes plays an essential role in the host immune response towards pathogens. However, abnormal function or differentiation of these cells can lead to development of various autoimmune diseases as well as asthma and allergy. Therefore, identification of key factors and the molecular mechanisms mediating Th1 and Th2 cell differentiation is important for understanding the molecular mechanisms of these diseases. The goal of this study was to identify novel factors involved in the regulation of Th1 and Th2 differentiation processes. A new method was optimized for enrichment of transiently transfected resting human primary T lymphocytes, that allowed the study of the influence of genes of interest in human Th1/Th2 cell differentiation and other primary Th cell functions. Functional characterization of PRELI, a novel activation-induced protein in human Th cells, identified it as a mitochondrial protein involved in the regulation of Th cell differentiation and apoptosis. By influencing the intracellular redox state, PRELI induces mitochondrial apoptosis pathway and downregulates STAT6 and Th2 differentiation. The data suggested that Calpain, an oxidative stress induced cysteine protease, is involved as a mediator in PRELI-induced downregulation of STAT6. PIM serine/threonine-specific kinases were identified as new regulators of human Th1 cell differentiation. PIM1 and PIM2 kinases were shown to be preferentially expressed in Th1 cells as compared to Th2 cells. RNA interference studies showed that PIM kinases enhance the production of IFN, the hallmark cytokine produced by Th1 cells. They also induce the expression of the key Th1-driving factor T-bet and the IL-12 signaling pathway during early phases of Th1 cell differentiation. Taken together, new regulators of human T helper cell differentiation were identified in this study, which provides new insights into the signaling mechanisms controlling the selective activation of human Th cell subsets.

Outsourcing process in pharmaceutical product development

The aim of this study was to create an outsourcing process for pharmaceutical product development. This study focuses on two main questions. The first question is “What is the outsourcing process model?” In the second phase key success factors of the outsourcing process are identified. As a result of the literature reviews, a general outsourcing process was created. Transaction cost economics and resource based view were used to derived a theoretical framework to the process by combining the existing processes presented in the literature. The model of process is considered used to the outsourcing broadly. The general outsourcing process was then developed further with the key factors that affect the success of pharmaceutical product development and the interviews of pharmaceutical outsourcing experts. The result of the research was the process consists of seven phases with key activities and expected outputs for each of the phases. In addition, the strategic decision-making framework for outsourcing decision in pharmaceutical product development is giving as well as the tools for selecting supplier and preparing structured contract. This study also gives some recommendations for managing the outsourcing process.

The role of power relations in strategic supply management – A value net approach

Supplier relationships are key elements of supply management and thus have attracted substantial research interest among academics and practitioners. The collaborative nature of relationships has been the focus of the mainstream research, and limited interest has been channelled towards power in buyer–supplier relationships. However, power is one of the key factors determining the outcomes in many business relations. Hence, one of the main objectives of this dissertation is to clarify how power may influence the nature of buyer–supplier relationships and, moreover, the depth of collaboration. Another main objective is to clarify the role of power relations in strategic supply management. Given the different nature of relationships, the firm needs divergent strategies in its supply management in order to handle them efficiently. Power has been identified as one of the factors that affect the nature of buyer–supplier relationships, and firms should thus develop strategies for handling power relations. Three research questions are addressed in pursuit of these objectives, the aim being to clarify the sources of power, the influence of power on collaboration, and the role of buyer–supplier relationships in the firm’s supply strategy. This dissertation has two parts. The first part provides a synthesis of the overall dissertation, and the second part comprises five complementary research papers. The qualitative research method is applied in an empirical case study from the Finnish food industry. The main contribution of this dissertation is that it clarifies the role of power relations in strategic supply management in value nets, and discloses the nature of power as an influencing factor in supplier relationships. It extends the discussion on power in buyer– supplier relationships in highlighting the context of networks and raising the question of network effects on power relations. It also illustrates how power positions and power relations in value nets can be determined based on the sources of power of the network actors, and shows their influence on collaboration.