Predictors and consequences of adherence to the treatment of pediatric patients with attention-deficit/hyperactivity disorder in Central Europe and East Asia.

PURPOSE: To assess baseline predictors and consequences of medication non-adherence in the treatment of pediatric patients with attention-deficit/hyperactivity disorder (ADHD) from Central Europe and East Asia. PATIENTS AND METHODS: Data for this post-hoc analysis were taken from a 1-year prospective, observational study that included a total of 1,068 newly-diagnosed pediatric patients with ADHD symptoms from Central Europe and East Asia. Medication adherence during the week prior to each visit was assessed by treating physicians using a 5-point Likert scale, and then dichotomized into either adherent or non-adherent. Clinical severity was measured by the Clinical Global Impressions-ADHD-Severity (CGI-ADHD) scale and the Child Symptom Inventory-4 (CSI-4) Checklist. Health-Related Quality of Life (HRQoL) was measured using the Child Health and Illness Profile-Child Edition (CHIP-CE). Regression analyses were used to assess baseline predictors of overall adherence during follow-up, and the impact of time-varying adherence on subsequent outcomes: response (defined as a decrease of at least 1 point in CGI), changes in CGI-ADHD, CSI-4, and the five dimensions of CHIP-CE. RESULTS: Of the 860 patients analyzed, 64.5% (71.6% in Central Europe and 55.5% in East Asia) were rated as adherent and 35.5% as non-adherent during follow-up. Being from East Asia was found to be a strong predictor of non-adherence. In East Asia, a family history of ADHD and parental emotional distress were associated with non-adherence, while having no other children living at home was associated with non-adherence in Central Europe as well as in the overall sample. Non-adherence was associated with poorer response and less improvement on CGI-ADHD and CSI-4, but not on CHIP-CE. CONCLUSION: Non-adherence to medication is common in the treatment of ADHD, particularly in East Asia. Non-adherence was associated with poorer response and less improvement in clinical severity. A limitation of this study is that medication adherence was assessed by the treating clinician using a single item question.

Pienen ja keskisuuren osakeyhtiön pääoma uudessa osakeyhtiölaissa

Tämä Pro Gradu tutkielman tavoitteena on selvittää, miten 1.9.2007 voimaan tullut uusi osakeyhtiölaki vaikuttaa pienten ja keskisuurten osakeyhtiöiden pääomanhallintaan. Vastausta etsitään myös siihen, toteutuivatko lakimuutoksessa asetetut tavoitteet pienen ja keskisuuren yrityksen näkökulmasta. Tutkimusmetodologiana käytetään käsiteanalyyttistä lähestymistapaa. Tutkielma on havainnoiva ja selittävä. Tutkimuksen analyysin lähteenä käytettävät yritystilanteet ovat kirjoittajan tilitoimistotyössä esiin tulleita. Lain kokonaisuudistuksessa eräs tavoite oli tehdä laista pienille osakeyhtiöille selkeä ja toimintaa helpottava. Lain teksti on helppolukuisempaa ja lain rakenne on selkeä. Etua monelle perustettavalle pienelle osakeyhtiölle on siitä, että perustaminen on yksinkertaistunut ja minimipääoma pienentynyt. Velkojien aseman parantamiseksi lakiin otetun maksukykyisyystestin ja joustavan rahoitusratkaisun tarjoavan sijoitetun vapaan pääoman rahaston voidaan myös katsoa auttavan pientä ja keskisuurta osakeyhtiötä toiminnassaan. Maksukykyisyystesti on hyödyllinen muistutus varovaisesta varojen jaosta ja SVOP rahasto on vaihtoehto pääomalainalle. Verolakien uudistamatta jääminen osakeyhtiölain muuttuessa on vaikeuttanut joidenkin OYL:n mahdollistamien uusien menettelytapojen käyttöönottoa.

Counselling on limited preoperative fasting in paediatric ambulatory tonsillectomy

Rajoitetun preoperatiivisen paaston ohjaus lasten päiväkirurgisessa nielurisaleikkauksessa Tutkimuksen tarkoituksena oli selvittää, onko sairaanhoitajan toteuttama, vanhempien interaktiivinen preoperatiivinen ohjaus lapsen rajoitettuun preoperatiiviseen paastoon ja aktiiviseen nesteyttämiseen turvallista, kuinka vanhemmat omaksuvat kyseistä tietoa ja edistääkö se turvallisesti lapsen postoperatiivista toipumista päiväkirurgisen nielurisaleikkauksen jälkeen. Aineisto koostui sadastakuudestatoista perheestä, joiden lapsi, iältään 4 – 10 vuotta, oli kutsuttu päiväkirurgiseen nielurisaleikkaukseen. Koeryhmä (n= 58) ohjattiin interaktiivisesti lapsen preoperatiiviseen paastoon ja aktiiviseen preoperatiiviseen nesteyttämiseen. Lapsen suositellut preoperatiiviset paastoajat olivat: 4t syömättä ja 2t juomatta. Leikkauspäivän aamuna vanhemmat rohkaisivat lapsia juomaan annokset kirkkaita nesteitä kahteen otteeseen; jälkimmäinen annos 2t ennen leikkausta. Kontrolliryhmä (n= 58) sai preoperatiivisen ohjauksen kirjallisena ilman interaktiivista ohjausta; paastoajat olivat samat kuin koeryhmässä: 4t syömättä ja 2t juomatta. Vanhempien tiedontasoa lapsen leikkaukseen liittyvästä paastosta mitattiin tietotestillä, joka sisälsi myös preoperatiivista tiedontarvetta ja ahdistusta mittaavan mittarin (The Amsterdam Preoperative Anxiety and Information scale, APAIS). Mittaukset suoritettiin ennen preoperatiivista ohjausta tai kirjallisten ohjeiden lähettämistä sekä lapsen leikkausta seuraavana päivänä. Lapsen leikkauksen jälkeen vanhemmat arvioivat myös heille välitetyn informaation tasoa. Lapsen postoperatiivista kipua, pahoinvointia, janoa ja nälkää lapset itse arvioivat VAS- asteikolla (10cm), ja vanhemmat ja sairaanhoitajat numeerisella 0 – 10 asteikolla. Mittaukset suoritettiin 2t, 4t, 8t, ja 24t lapsen leikkauksen jälkeen. Vanhemmat pitivät päiväkirjaa lapsen ravinnosta ja kipulääkityksestä. Aineisto analysoitiin sekä tilastollisesti että sisällön analyysilla. Vanhempien tiedontaso lapsen leikkauksen jälkeen oli molemmissa ryhmissä merkitsevästi parantunut, mutta kontrolliryhmän vanhempien ahdistus ei ollut helpottanut verrattuna heidän ahdistukseensa ennen lapsen leikkausta. Mitä korkeammat pisteet vanhemmat saivat tietotestistä lapsen leikkauksen jälkeen sitä vähemmän he tunsivat tiedontarvetta ja ahdistusta. Merkitsevästi alhaisemmat pisteet tietotestistä oli vanhemmilla, joilla oli alempi peruskoulutus. Kontrolliryhmän lapset paastosivat preoperatiivisesti merkitsevästi pitempään kuin koeryhmän lapset. Perioperatiivisesti lapset paastosivat kiinteästä ruuasta yhtä kauan, mutta nesteistä kontrolliryhmä merkitsevästi pitempään. Postoperatiivisen toipumisen alussa koeryhmän lapset olivat merkitsevästi kivuttomampia. Molemmissa ryhmissä lapset olivat kipeimpiä kahdeksan tuntia leikkauksesta ja pahoinvointisimpia neljä tuntia leikkauksesta. Ensimmäisen kahdeksan tunnin aikana leikkauksen jälkeen lapset eivät olleet janoisia tai nälkäisiä, mutta VAS- arvot koeryhmässä jäivät alhaisemmalle tasolle kuin kontrolliryhmässä 24 postoperatiivisen tunnin ajan. Leikkausta seuraavana aamuna kontrolliryhmän lapset olivat merkitsevästi janoisempia ja nälkäisempiä kuin interventioryhmän lapset. Sairaanhoitajan toteuttama vanhempien interaktiivinen preoperatiivinen ohjaus lapsen rajoitettuun preoperatiiviseen paastoon lisää vanhempien tiedontasoa ja vähentää preoperatiivista tiedontarvettaan ja ahdistusta, ja turvallisesti parantaa lapsen kokemusta leikkausprosessin ja postoperatiivisen toipumisen aikana nielurisaleikkauksen jälkeen. Kaikkien leikkaukseen tulevien lasten nesteyttäminen kaksi tuntia ennen päivän ensimmäistä leikkausta voi olla ratkaisu lasten kohtuuttomien perioperatiivisten paastoaikojen estämiseksi. Aina ei kuitenkaan ole mahdollisuuksia vanhempien henkilökohtaiseen kohtaamiseen, mikä haastaa hoitotieteellisen tutkimuksen kartoittamaan muita mahdollisuuksia vanhempien interaktiiviseen ohjaukseen.

Yritysmuodon vaikutus verotuksen edullisuuteen, case Lahden Betonilattiat Oy / Tmi MR-Rakennus & Remontti

Suomessa verotuksen tarkoituksena ei ole vaikuttaa yritysmuodon valintaan. Yritystä perustettaessa kiinnitetään kuitenkin usein erityistä huomiota verotukseen. Yrityksen ja omistajayrittäjän verotukseen vaikuttavat monet eri tekijät. Yleispäteviä saantoja yritysmuodon vaikutuksesta verotuksen edullisuuteen on mahdoton antaa ja siksi harkinta täytyy tehdä aina tilannekohtaisesti. Tärkeintä verotuksen edullisuuslaskelmissa on kokonaisrasituksen mittaaminen. Tutkimuksessa on vertailtu kahden samalla toimialalla toimivan pienyrityksen yritysmuodon vaikutusta verotuksen edullisuuteen. Tutkimuksen tavoitteena on ollut selvittää omistajayrittäjille jäävän nettotulon määrä. Tutkimuksen kohteena olevat yritykset ovat Lahden Betonilattiat Oy ja Tmi MR-Rakennus & Remontti, joista ensimmäinen on yritysmuodoltaan osakeyhtiö ja toinen yksityisliike. Tutkimusongelman ratkaisemiseksi tutkimuksessa on perehdytty yritysten kirjanpitoon ja tilinpaatostietoihin. Niiden avulla on laskettu yritysten nettovarallisuus, tulonmuodostus ja verot. Siten on saatu konkreettinen tulos siitä, kuinka paljon on ollut omistajayrittäjien kokonaisverorasitus ja käteen jäävän nettotulon määrä. Tutkimuksessa on oletettu tilikauden voiton otetun kokonaisuudessaan osakkaan käyttöön. Lisäksi on tutkittu miten tilanne muuttuu voiton ja nettovarallisuuden kasvaessa. Tutkimuksen tulosten perusteella todetaan yksityisliikkeen olevan verotuksen kannalta osakeyhtiötä edullisempi vaihtoehto. Yritysten voiton ja nettovarallisuuden kasvaessa havaitaan yksityisliikkeen lähes aina olevan osakeyhtiötä edullisempi yritysmuoto. Osakeyhtiö on yksityisliikettä edullisempi vaihtoehto ainoastaan silloin, kun sen nettovarallisuus on huomattavan suuri ja paljon yksityisliikkeen nettovarallisuutta suurempi.

Cultural aspects of globalizing university-industry knowledge interaction in China

Previous studies of the local involvement of multinational corporation (MNC) subsidiaries focus on host-country firms and local business partners such as suppliers and customers. The role of host-country universities in the same context of innovation networks is neglected. Furthermore, there are many organizational culture- and knowledge-related differences between universities and companies, and this is likely to pose additional challenges for successful collaboration. Early university-industry (U-I) studies have primarily been limited within a national boundary, being concerned with a single level of culture (i.e., at an organizational level) and one-way knowledge transfer from university to industry. Research on more dynamic knowledge interaction in multinational settings is lacking. This is particularly true in the business context of China. In today’s globalizing and rapidly changing organizations, addressing cultural differences and clashes is an everyday reality, and inter-cultural U-I collaboration is becoming a key asset for gaining global competitiveness. This study deals with Finnish MNC subsidiaries’ research collaboration with Chinese universities. It aims to explore the essence of such U-I collaboration and knowledge interaction, uncovering the deep functioning mechanisms of culture underlying effective collaborative knowledge creation and innovation. The study reviews critically different bodies of literature including knowledge management theories and studies, U-I collaboration and knowledge interaction, and cross-cultural research in terms of organizational knowledge generation and utilization. It adopts a case study strategy with qualitative research methods, and data is collected through in-depth interviews and participant observation. The study presents the following major findings: 1. In the light of a comprehensive analysis of U-I collaboration, an effective matching strategy is proposed, in the assumption that good alignment of knowledge interaction strategies and approaches with their corresponding knowledge type, capability development and research task may greatly enhance the effectiveness of cross-cultural U-I collaboration and knowledge interaction. 2. It is proposed that in the Chinese MNC context more dynamic types of knowledge interaction like knowledge co-creation should be of key concern particularly when dealing simultaneously with multi-disciplinary applied research of human factors and technologies. U-I knowledge interaction, otherwise, pays attention only to the study of one-way technology and knowledge transfer. 3. It is posited that the influence of culture on collaborative knowledge interaction can be studied in a valuable way when knowledge-related variables are simultaneously taken into account. A systematic analysis of the role of knowledge in cross-cultural knowledge interaction could best be approached from multi-aspects of knowledge including not only nature, characteristics and types of knowledge but also the process of knowledge (e.g., intensifications of knowledge interaction). 4. The study demonstrates the significant role of aspects of the host-country culture (e.g., Chinese guanxi) in U-I collaboration and knowledge interaction. This is evident, for instance, in issues related to interpersonal relationships and trust, true interest and the relatedness of the research, mutual commitment and learning, communication intensity and interaction, and awareness of cultural and knowledge-related differences between collaboration partners. Theoretical and practical implications of the findings are suggested and discussed.

Phase voltage control and filtering in a converter-fed single-phase customer-end system of the LVDC distribution network

In recent years, the network vulnerability to natural hazards has been noticed. Moreover, operating on the limits of the network transmission capabilities have resulted in major outages during the past decade. One of the reasons for operating on these limits is that the network has become outdated. Therefore, new technical solutions are studied that could provide more reliable and more energy efficient power distributionand also a better profitability for the network owner. It is the development and price of power electronics that have made the DC distribution an attractive alternative again. In this doctoral thesis, one type of a low-voltage DC distribution system is investigated. Morespecifically, it is studied which current technological solutions, used at the customer-end, could provide better power quality for the customer when compared with the current system. To study the effect of a DC network on the customer-end power quality, a bipolar DC network model is derived. The model can also be used to identify the supply parameters when the V/kW ratio is approximately known. Although the model provides knowledge of the average behavior, it is shown that the instantaneous DC voltage ripple should be limited. The guidelines to choose an appropriate capacitance value for the capacitor located at the input DC terminals of the customer-end are given. Also the structure of the customer-end is considered. A comparison between the most common solutions is made based on their cost, energy efficiency, and reliability. In the comparison, special attention is paid to the passive filtering solutions since the filter is considered a crucial element when the lifetime expenses are determined. It is found out that the filter topology most commonly used today, namely the LC filter, does not provide economical advantage over the hybrid filter structure. Finally, some of the typical control system solutions are introduced and their shortcomings are presented. As a solution to the customer-end voltage regulation problem, an observer-based control scheme is proposed. It is shown how different control system structures affect the performance. The performance meeting the requirements is achieved by using only one output measurement, when operating in a rigid network. Similar performance can be achieved in a weak grid by DC voltage measurement. An additional improvement can be achieved when an adaptive gain scheduling-based control is introduced. As a conclusion, the final power quality is determined by a sum of various factors, and the thesis provides the guidelines for designing the system that improves the power quality experienced by the customer.

Finnish Critical Industries, Maritime Transport Vulnerabilities and societal Implications

Maritime transports are very essential for Finland as over 80% of the foreign trade in the country is seaborne and possibilities to carry out these transports by are limited. Any disruption in maritime transports has negative consequences to many sectors in the Finnish economy. Maritime transport thus represents critical infrastructure for Finland. This report focuses on the importance of maritime transports on security of supply in Finland and for the so called critical industries in particular. The report summarizes the results of the Work Package 2 of the research project STOCA – “Study of cargo flows in the Gulf of Finland in emergency situations”. The aim of the research was to analyze the cargo flows and infrastructure that are vital for maintaining security of supply in Finland, as well as the consequences of disruptions in the maritime traffic for the Finnish critical industries and for the Finnish society. In the report we give a presentation of the infrastructure and transport routes which are critical for maintaining security of supply in Finland. We discuss import dependency of the critical industries, and the importance of the Gulf of Finland ports for Finland. We assess vulnerabilities associated with the critical material flows of the critical industries, and possibilities for alternative routings in case either one or several of the ports in Finland would be closed. As a concrete example of a transport disruption we analyze the consequences of the Finnish stevedore strike at public ports (4.3.–19.3.2010). The strike stopped approximately 80% of the Finnish foreign trade. As a result of the strike Finnish companies could not export their products and/or import raw materials, components and spare parts, or other essential supplies. We carried out personal interviews with representatives of the companies in Finnish critical industries to find out about the problems caused by the strike, how companies carried out they transports and how they managed to continue their operations during the strike. Discussions with the representatives of the companies gave us very practical insights about companies’ preparedness towards transport disruptions in general. Companies in the modern world are very vulnerable to transport disruptions because companies regardless of industries have tried to improve their performance by optimizing their resources and e.g. by reducing their inventory levels. At the same time they have become more and more dependent on continuous transports. Most companies involved in foreign trade have global operations and global supply chains, so any disruption anywhere in the world can have an impact on the operations of the company causing considerable financial loss. The volcanic eruption in Iceland in April 2010 stopping air traffic in the whole Northern Europe and most recently the earth quake causing a tsunami in Japan in March 2011 are examples of severe disruptions causing considerable negative impacts to companies’ supply chains. Even though the Finnish stevedore strike was a minor disruption compared to the natural catastrophes mentioned above, it showed the companies’ vulnerability to transport disruptions very concretely. The Finnish stevedore strike gave a concrete learning experience of the importance of preventive planning for all Finnish companies: it made them re-think their practical preparedness towards transport risks and how they can continue with their daily operations despite the problems. Many companies realized they need to adapt their long-term countermeasures against transport disruptions. During the strike companies did various actions to secure their supply chains. The companies raised their inventory levels before the strike began, they re-scheduled or postponed their deliveries, shifted customer orders between production plants among their company’s production network or in the extreme case bought finished products from their competitor to fulfil their customers’ order. Our results also show that possibilities to prepare against transport disruptions differ between industries. The Finnish society as a whole is very dependent on imports of energy, various raw materials and other supplies needed by the different industries. For many of the Finnish companies in the export industries and e.g. in energy production maritime transport is the only transport mode the companies can use due to large volumes of materials transported or due to other characteristics of the goods. Therefore maritime transport cannot be replaced by any other transport mode. In addition, a significant amount of transports are concentrated in certain ports. From a security of supply perspective attention should be paid to finding ways to decrease import dependency and ensuring that companies in the critical industries can ensure the continuity of their operations.

Combustion properties of biomass residues rich in phosphorus

Tillgången på traditionella biobränslen är begränsad och därför behöver man ta fram nya, tidigare outnyttjade biobränslen för att möta de uppställda CO2 emissionsmålen av EU och det ständigt ökande energibehovet. Under de senare åren har intresset riktats mot termisk energiutvinning ur olika restfraktioner och avfall. Vid produktion av fordonsbränsle ur biomassa är den fasta restprodukten ofta den största procesströmmen i produktionsanläggningen. En riktig hantering av restprodukterna skulle göra produktionen mera lönsam och mer ekologiskt hållbar. Ett alternativ är att genom förbränning producera elektricitet och/eller värme eftersom dessa restprodukter anses som CO2-neutrala. Målsättningen med den här avhandlingen var att studera förbränningsegenskaperna hos några fasta restprodukter som uppstår vid framställning av förnybara fordonsbränslen. De fyra undersökta materialen är rapskaka, palmkärnskaka, torkad drank och stabiliserat rötslam. I studien används ett stort urval av undersökningsmetoder, från laboratorieskala till fullskalig förbränning, för att identifiera de huvudsakliga utmaningarna förknippade med förbränning av restprodukterna i pannor med fluidiserad bäddteknik. Med hjälp av detaljerad bränslekarakterisering kunde restprodukterna konstateras vara en värdefull källa för värme- och elproduktion. Den kemiska sammansättningen av restprodukterna varierar stort jämfört med mera traditionellt använda biobränslen. En gemensam faktor för alla de studerade restprodukterna är en hög fosforhalt. På grund av de låga fosforkoncentrationerna i de traditionella biobränslena har grundämnet hittills inte ansetts spela någon större roll i askkemin. Experimenten visade nu att fosfor inte mera kan försummas då man studerar kemin i förbränningsprocesser, då allt flera fosforrika bränslen tränger in på energimarknaden.

Sukupolvenvaihdoksen toteuttaminen henkilöyhtiössä

Tutkielma on kvalitatiivinen tutkimus, jossa pääpaino perustuu kirjallisuus- ja oikeustapaustutkimukseen. Tutkielman tavoitteena on selvittää henkilöyhtiön sukupolvenvaihdoksen toteuttamisen vaihtoehdot sekä henkilöyhtiön yhtiöosuuksien luovutuksena että yhtiömuodon muutoksella, jolloin henkilöyhtiö muutetaan ensin osakeyhtiöksi ja sen jälkeen osakeyhtiö voi jakautua. Perheyrityksen sukupolvenvaihdoksen ja siihen liittyvien veroseuraamusten optimointi edellyttää suunnitelmallista prosessia, missä otetaan huomioon eri toteutusvaihtoehtojen verotuksellinen kohtelu sekä luopujien että jatkajien kannalta. Perheen sisällä tapahtuvat sukupolvenvaihdokset tapahtuvat useimmiten lahjana tai lahjanluonteisena kauppana, jolloin perintö- ja lahjaverotus on tarpeen ottaa huomioon jo suunnitteluvaiheessa. Yritysvarallisuuden arvostaminen perintö- ja lahjaverotuksessa sekä sukupolvenvaihdoksen yhteydessä saatavat verohuojennukset ja niiden huomioon ottaminen ovat tärkeitä tekijöitä. Tutkielman case- yrityksessä luopujien ja jatkajien tarpeet huomioiden yhtiömuodon muutos ja jakautuminen voitiin todeta kannattavimmaksi vaihtoehdoksi.

Corporate Social Responsibility in the Oil and Gas Industry: Environmental Management Systems as a Source of Sustainable Development

The environmental aspect of corporate social responsibility (CSR) expressed through the process of the EMS implementation in the oil and gas companies is identified as the main subject of this research. In the theoretical part, the basic attention is paid to justification of a link between CSR and environmental management. The achievement of sustainable competitive advantage as a result of environmental capital growth and inclusion of the socially responsible activities in the corporate strategy is another issue that is of special significance here. Besides, two basic forms of environmental management systems (environmental decision support systems and environmental information management systems) are explored and their role in effective stakeholder interaction is tackled. The most crucial benefits of EMS are also analyzed to underline its importance as a source of sustainable development. Further research is based on the survey of 51 sampled oil and gas companies (both publicly owned and state owned ones) originated from different countries all over the world and providing reports on sustainability issues in the open access. To analyze their approach to sustainable development, a specifically designed evaluation matrix with 37 indicators developed in accordance with the General Reporting Initiative (GRI) guidelines for non-financial reporting was prepared. Additionally, the quality of environmental information disclosure was measured on the basis of a quality – quantity matrix. According to results of research, oil and gas companies prefer implementing reactive measures to the costly and knowledge-intensive proactive techniques for elimination of the negative environmental impacts. Besides, it was identified that the environmental performance disclosure is mostly rather limited, so that the quality of non-financial reporting can be judged as quite insufficient. In spite of the fact that most of the oil and gas companies in the sample claim the EMS to be embedded currently in their structure, they often do not provide any details for the process of their implementation. As a potential for the further development of EMS, author mentions possible integration of their different forms in a single entity, extension of existing structure on the basis of consolidation of the structural and strategic precautions as well as development of a unified certification standard instead of several ones that exist today in order to enhance control on the EMS implementation.

Pneumatose intestinal

Pneumatosis Intestinalis (PI) is the presence of gas-filled cysts within the wall of the gastrointestinal tract (GIT). It is a clinical and/or radiological sign associated with a wide spectrum of diseases, so that it has a variable clinical significance. Probably, its prevalence is increasing. The nature of the diseases causing PI is been modifying in last decades. Peptic ulcers were its main cause in the past. Nowadays, probably, immunosuppressive conditions and states of increased permeability of the GIT mucosa (AIDS, transplanted patients or in chemotherapy, etc) are more common causes. PI can be shown on simple abdominal roentgenograms and computed tomographic scans obtained with lung windows. Its diagnosis include definition of the cause in addition to its presence. The treatment should be directed to the cause of the PI, fluctuating from expectant to emergency laparotomy. The present report is a contribution to the limited literature experience in this topic and calls attention to the importance of recognizing PI and its clinical significance in order to define the right conduct.

Osakeyhtiömuotoisen perheyrityksen edullinen ja onnistunut sukupolvenvaihdos: Case-tutkimus

Tutkielman tarkoituksena oli selvittää yksityisen osakeyhtiömuotoisen perheyrityksen sukupolvenvaihdoksenprosessin edullisuuteen ja onnistumiseen liittyviä tekijöitä. Tavoitteena oli selvittää, kuinka sukupolvenvaihdos tulee toteuttaa, jotta se olisi sekä luopujalle että jatkajalle mahdollisimman edullinen. Täten huomio kiinnittyi lahjaveroon, varainsiirtoveroon, luovutusvoittoveroon sekä mahdollisiin verohuojennuksiin. Lisäksi tutkielmassa kiinnitettiin huomiota sukupolvenvaihdoksen onnistumisen kannalta tärkeisiin pehmeisiin tekijöihin, joita ovat muun muassa luopumisen vaikeus ja vaihdoksen haasteet. Tutkielma toteutettiin laadullisena tapaustutkimuksena. Tutkimusaineistona toimivat case-yrityksen tilinpäätös sekä haastattelututkimuksen tulokset. Case-yrityksen sukupolvenvaihdoksen toteutustapojen edullisuutta mallinnettiin lahjanluonteisilla kaupoilla sekä lahjalla. Tulokset osoittivat, että case-yrityksen tapauksessa sukupolvenvaihdos tapahtuu edullisimmin lahjan avulla tai maksamalla 10 prosenttia yrityksen käyvästä arvosta. Tutkimus osoitti myös, että sukupolvenvaihdos on haastava ja aikaa vievä prosessi.

Strategic alliances as an international entry strategy: Finnish cleantech SMEs and the Indian market

The demand for environmental technologies, also called cleantech, is growing globally but the need is especially high in emerging markets such as India where the rising economy and rapid industrialisation have led to increasing energy needs and environmental degradation. The market is of great potential also for the Finnish cleantech cluster that represents advanced expertise in several fields of environmental technologies. However, most of the Finnish companies in the field are SMEs that face challenges in their internationalisation due to their limited resources. The objective of this study was to estimate, whether strategic alliances could be an efficient entry strategy for Finnish cleantech SMEs entering the Indian market. This was done by studying what are the key factors influencing the international entry mode decision of Finnish cleantech SMEs, what are the major factors affecting the entry of Finnish cleantech SMEs to the Indian market and how do Finnish cleantech SMEs use strategic alliances in their internationalisation process. The study was realised as a qualitative multi-case study through theme interviews of Finnish cleantech SME representatives. The results indicated that Finnish cleantech SMEs prefer to enter international markets through non-equity and collaborative modes of entry. These entry modes are chosen because of the small size and limited resources of companies, but also because they want to protect their innovative technologies from property rights violations. India is an attracting market for Finnish cleantech SMEs mainly because of its size and growth, but insufficient environmental regulation and high import tariffs have hindered entry to the market. Finnish cleantech SMEs commonly use strategic alliances in their internationalisation process but the use is rather one-sided. Most of the formed strategic alliances are low-commitment, international contractual agreement in sales and distribution. Alliance partner selection receives less attention. In the future, providing Finnish cleantech SMEs with international experience and training could help in diversifying the use of strategic alliances and increase their benefits to SME internationalisation.

Vauhtikausi. Autoilun sukupuoli 1920-luvun Suomessa

The Age of Speed:Automobility’s Gender in the 1920s Finland The aim of this study is to analyze the connections between automobility and gender in Finland in the 1920s. In this study it is argued that the 1920s was the significant era in the Finnish history of automobility when many of the long-lasting gendered notions and cultural understandings were constructed. This study combines cultural history of technology with gender analysis. As the previous research on gender and technology has recognized, technology is a significant site of gender negotiations. Both from the cultural historical perspective and a gender perspective it is important to understand both technology and gender as cultural constructions. They were linked together and constructed each other. In other words: technology shapes gender and gender shapes technology. Historians of technology like Nina Lerman, Ruth Oldenziel and Arwen Mohun have argued that both gender and technology are about power: social, cultural, economic and political. In this study automobility means technology that can be analyzed in layers of identity, structures, institutions and representations. The source material consists of various types of historical sources, magazines and journals, advertisements, archival material together with films and literature. In the previous studies of the history of automobility gender has often been neglected. The term “gender” has also quite often been misunderstood. Some studies in the field have only focused on the early female drivers. However, far too little attention has been paid to the question, why automobility was considered as masculine sphere only. This study aims to give new insights to the previous interpretations of the history of automobility. As in various other countries also in Finland, the decade of the 1920s is characterized as a period of “modern times.” It was also the era of the automobiles. Although the number of cars in Finland was still low compared to the other European countries and the USA, in press, films and literature, images of automobiles and new women – and men – on the wheel became as an emblem of a new era. The thesis consists of three main chapters. The first main chapter focuses on the conflicts between drivers and non-drivers. The study shows how in the debate of the automobility “a driver” was constantly referred as a man and “a pedestrian” accordingly a woman, even though in the reality there were as much men and women walking on the streets and the roads. Thus, the public debate constructed and reconstructed the gendered traffic system where men were playing the key role. The second main chapter of the study analyses the automobile clubs and the cultural representations. The chapter answers the question how the concept of a driver was gendered. The Automobile clubs and the organizations of professional drivers were in a significant role in developing the early history of traffic in Finland. The Finnish Automobile Club (Suomen Automobiili Klubi, founded in 1919) was the oldest and the most powerful of all automobile organizations. The Finnish Automobile Club accepted women as members from the very beginning. The membership was strictly limited to the upper class and the very first female members were wives and daughters of the male members. However, Doctor of medicine and surgery 316 Karolina Eskelin (1867-1936) the founding member of the Club was an exception to that convention. The male members of the Finnish Automobile Club attended official international meetings and consulted Finnish authorities in traffic and road questions, whereas, female members joined car trips, picnics and social gatherings arranged by the club. Few young female members of the club drove in races and gross-country-tours. The cultural representations of drivers in the Finnish media in the 1920s both deconstructed and reconstructed the concept of gender. In Finnish press in general, motoring was seen as male dominated area. Men were represented as the experts of the automobility. The drivers’ uniforms and the automobile clubs underlined professionalism and expertise which, thus, got masculine meaning. Women were beautiful accessories in the car ads, but they were also becoming a new consumer group in the market. The representations of the female and the male drivers influenced and shaped actively the understandings of femininity and masculinity. In the third main chapter the analysis focuses on the automobile as an artifact.The automobile was considered as an artifact that primarily belonged to the masculine domain. However, the representations of the automobiles were ambivalent. The automobile was both masculine and feminine depending on the context. The representations of the automobile were also used to construct the discourse of heteronormativity.

Overview on the Cost-effectiveness of Maritime Safety Policy Instruments

Maritime safety is an issue that has gained a lot of attention in the Baltic Sea area due to the dense maritime traffic and transportation of oil in the area. Lots of effort has been paid to enhance maritime safety in the area. The risk exists that excessive legislation and other requirements mean more costs for limited benefit. In order to utilize both public and private resources efficiently, awareness is required of what kind of costs maritime safety policy instruments cause and whether the costs are in relation to benefits. The aim of this report is to present an overview of the cost-effectiveness of maritime safety policy instruments focusing on the cost aspect: what kind of costs maritime safety policy causes, to whom, what affects the cost-effectiveness and how cost-effectiveness is studied. The study is based on a literature review and on the interviews of Finnish maritime experts. The results of this study imply that cost-effectiveness is a complicated issue to evaluate. There are no uniform practices for which costs and benefits should be included in the evaluation and how they should be valued. One of the challenges is how to measure costs and benefits during the course of a longer time period. Often a lack of data erodes the reliability of evaluation. In the prevention of maritime accidents, costs typically include investments in ship structures or equipment, as well as maintenance and labor costs. Also large investments may be justifiable if they respectively provide significant improvements to maritime safety. Measures are cost-effective only if they are implemented properly. Costeffectiveness is decreased if a measure causes overlapping or repetitious work. Costeffectiveness is also decreased if the technology isn’t user-friendly or if it is soon replaced with a new technology or another new appliance. In future studies on the cost-effectiveness of maritime safety policy, it is important to acknowledge the dependency between different policy instruments and the uncertainty of the factors affecting cost-effectiveness. The costs of a single measure are rarely relatively significant and the effect of each measure on safety tends to be positive. The challenge is to rank the measures and to find the most effective combination of different policy instruments. The greatest potential offered for the analysis of cost-effectiveness of individual measures is their implementation in clearly defined risk situations, in which different measures are truly alternative to each other. Overall, maritime safety measures do not seem to be considered burdening for the shipping industry in Finland at the moment. Generally actors in the Finnish shipping industry seem to find maintaining a high safety level important and act accordingly.