Parents as Pain Killers in the Pain Management of Preterm Infants

Vanhemmat keskoslasten kivun lievittäjinä Tutkimuksen tarkoituksena oli kehittää uusi kivunlievitysmenetelmä, Vanhempien käsikapalo, keskoslasten kivunhoitoon vastasyntyneiden teho-osastolla. Vanhempien käsikapalon tehokkuutta verrattiin kahdessa satunnaistetussa kontrolloidussa crossover-tutkimusasetelmassa ei-lääkkeelliseen näyttöön perustuvaan hoitoon (P.O. glukoosiliuos), lääkkeelliseen menetelmään (I.V. oksikodoni) ja lumeeseen (P.O. vesi) tai kontrolli hoitoon kantapääpiston ja hengitysteiden imemisen aikana. Lisäksi mitattiin kivunhoidon lyhytaikaisia sivuvaikutuksia (hapetuksen- ja pulssinlasku) ja pidempiaikaisia vaikutuksia uneen. Tutkittujen lasten ikä oli 28 raskausviikkoa (n = 20) ja 28 1/7 (n = 20). Toimenpidekipua arvioitiin Premature Infant Pain Profile (PIPP) -kipumittarilla. Interventioiden jälkeen unen rakenne analysoitiin 13 tunnin polysomnografia-rekisteröinneistä. Viimeisessä vaiheessa haastateltiin äitejä (n = 23), jotka olivat käyttäneet vanhempien käsikapaloa 2–4 viikkoa vastasyntyneiden teho-osastolla, strukturoidulla the Clinical Interview for Parents of High-Risk Infants -haastattelulla, johon oli lisätty kysymyksiä lapsen kivunhoidosta. Kantapääpiston aikana PIPP–pisteet olivat merkitsevästi matalampia P.O. glukoosiliuoksella (ka 4,85 ± 1,73, p ≤ 0,001) ja vanhempien käsikapalolla (ka 5,20 ± 1,70, p = 0,004) verrattuna lumeeseen (ka 7,05 ± 2,16). Hengitysteiden imemisen yhteydessä PIPP–pisteet olivat matalampia P.O. glukoosiliuoksella (ka 11,05 ± 2,31, p = 0,014) ja vanhempien käsikapalolla (ka 11,25 ± 2,47, p = 0,034) verrattuna lumeeseen (ka 12,40 ± 2,06). Oksikodonin teho oli verrattavissa lumeeseen kummankin toimenpiteen aikana. P.O. glukoosiliuoksen (21,3 %) ja lumeen (12,5 %) annosteluun liittyi merkittävästi enemmän lyhytaikaisia sivuvaikutuksia verrattuna oksikodoniin (5 %) tai vanhempien käsikapaloon (5 %). Oksikodoni muutti keskoslasten unen rakennetta vähentämällä merkittävästi aktiivisen unen määrää verrattuna muihin hoitoihin. Vanhemmat suhtautuivat positiivisesti käsikapalon käyttöön. Äitien osallistuminen kivunhoitoon voitiin jaotella kolmeen eri tyylin, jotka selittyivät äidin kiintymyksen tunteilla ja lapsen tehohoitoon liittyvällä stressillä. Vanhempien käsikapalo on suositeltavampi lyhyen toimenpidekivun lievittäjä kuin P.O. glukoosiliuos tai I.V. oksikodoni, kun tehokkuus, turvallisuus ja perhe otetaan huomioon.

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.

Effect of hydrodynamics on modelling, monitoring and control of crystallization

Crystallization is a purification method used to obtain crystalline product of a certain crystal size. It is one of the oldest industrial unit processes and commonly used in modern industry due to its good purification capability from rather impure solutions with reasonably low energy consumption. However, the process is extremely challenging to model and control because it involves inhomogeneous mixing and many simultaneous phenomena such as nucleation, crystal growth and agglomeration. All these phenomena are dependent on supersaturation, i.e. the difference between actual liquid phase concentration and solubility. Homogeneous mass and heat transfer in the crystallizer would greatly simplify modelling and control of crystallization processes, such conditions are, however, not the reality, especially in industrial scale processes. Consequently, the hydrodynamics of crystallizers, i.e. the combination of mixing, feed and product removal flows, and recycling of the suspension, needs to be thoroughly investigated. Understanding of hydrodynamics is important in crystallization, especially inlargerscale equipment where uniform flow conditions are difficult to attain. It is also important to understand different size scales of mixing; micro-, meso- and macromixing. Fast processes, like nucleation and chemical reactions, are typically highly dependent on micro- and mesomixing but macromixing, which equalizes the concentrations of all the species within the entire crystallizer, cannot be disregarded. This study investigates the influence of hydrodynamics on crystallization processes. Modelling of crystallizers with the mixed suspension mixed product removal (MSMPR) theory (ideal mixing), computational fluid dynamics (CFD), and a compartmental multiblock model is compared. The importance of proper verification of CFD and multiblock models is demonstrated. In addition, the influence of different hydrodynamic conditions on reactive crystallization process control is studied. Finally, the effect of extreme local supersaturation is studied using power ultrasound to initiate nucleation. The present work shows that mixing and chemical feeding conditions clearly affect induction time and cluster formation, nucleation, growth kinetics, and agglomeration. Consequently, the properties of crystalline end products, e.g. crystal size and crystal habit, can be influenced by management of mixing and feeding conditions. Impurities may have varying impacts on crystallization processes. As an example, manganese ions were shown to replace magnesium ions in the crystal lattice of magnesium sulphate heptahydrate, increasing the crystal growth rate significantly, whereas sodium ions showed no interaction at all. Modelling of continuous crystallization based on MSMPR theory showed that the model is feasible in a small laboratoryscale crystallizer, whereas in larger pilot- and industrial-scale crystallizers hydrodynamic effects should be taken into account. For that reason, CFD and multiblock modelling are shown to be effective tools for modelling crystallization with inhomogeneous mixing. The present work shows also that selection of the measurement point, or points in the case of multiprobe systems, is crucial when process analytical technology (PAT) is used to control larger scale crystallization. The thesis concludes by describing how control of local supersaturation by highly localized ultrasound was successfully applied to induce nucleation and to control polymorphism in reactive crystallization of L-glutamic acid.

Impact of anthracnose on the yield of soybean subjected to chemical control in the north region of Brazil

ABSTRACT Losses due to soybean anthracnose, caused by Colletotrichum truncatum, have not been systematically quantified in the field, and the efficacy of chemical control of this disease is not known. This study shows an estimate of losses associated with the disease in soybean crops in the north of the country. Two trials with cv. M9144 RR were carried out in commercial fields in Tocantins State in the 2010/2011 and 2011/2012 growing seasons, in randomized blocks, with four replicates. Foliar applications were performed on plants at R1/R2 and R5.2 stages, employing CO2-pressurized equipment and application volume of 200 L ha-1. Nine fungicides and one untreated control were compared, and the disease gradients in the two seasons were obtained. The percentage of infected pods was calculated at the R6 stage. Grain yield ranged from 3,288 to 3,708 kg/ha in the untreated plots in 2010/2011 and 2011/2012, respectively, and from 3,282 to 4,110 kg/ha in the treated plots. In the 2010/2011 season, only azoxystrobin + cyproconazole significantly reduced the disease incidence, compared to untreated control plots, not differing from the remaining treatments. In the 2011/2012 season, there were no significant differences between treated and untreated plots. Highly significant correlations (p < 0.01) were found between yield and soybean anthracnose incidence on pods in both years (r = -0.85). For each 1% increment in the disease incidence, c. 90 kg/ha of soybean grain were lost. The current study determined that significant losses due to anthracnose occur in commercial crops in the north of the country and highlighted the limitation of chemical control as anthracnose management method.

Challenges in transferring the hydropower control centre

Euroopan sähkömarkkinat ovat viime vuosikymmeninä olleet suurien muutoksien kohteena näiden yhtenäistämisprojektin seurauksena. Fortum, yksi Euroopan johtavista energia-alan yrityksistä valmistautuu tähän muutokseen toteuttamalla omia yrityksen sisäisiä muutoksia, tavoitteenaan yksinkertaistaa organisaatiorakennettaan ja parantaa tehokkuuttaan. Yksi suuri muutos tähän liittyen on vesivoimavalvomojen lokalisaatioprojekti. Vesivoimavalvomojen uudelleenlokalisaation ja vesivoiman käytönvalvojien ikääntymisen myötä nähtiin tarpeelliseksi tehdä tutkimus käytönvalvojien hiljaisesta tiedosta. Näin ollen, tässä diplomityössä perehdyttiin Fortumin vesivoiman käytönvalvojien kompetensseihin ja näiden hiljaiseen tietoon. Tutkimusaiheena oli selvittää minkälaista hiljaista tietoa käytönvalvojat omaavat, ja mikä osa tästä tiedosta muodostaa sen kriittisen osaamisen, jota halutaan säilyttää ja kehittää. Tutkimustyypiksi muodostui kvalitatiivinen, jonka päämetodi oli puoli-avoin haastattelu. Tutkimus koostui seuraavista vaiheista: tarkkailu, tekstianalyysi, haastattelu, transkriptio ja data analyysi. Haastatteluja tehtiin kahdeksan, joista kerääntyi yli 24 tuntia haastattelumateriaalia. Tästä materiaalista muodostettiin analyysien avulla taulukko, jonka avulla tunnistettiin ne osa-alueet, joihin käytönvalvojan tärkeimmät kompetenssit liittyvät. Tuloksilla saatiin myös kerättyä lista korjaus- ja kehityskohteista, sekä tarkemmat määritykset jatkotutkimukselle.

Requirement management in nuclear power projects

Diplomityön tarkoituksena oli tutkia vaatimusten hallintaa suunnittelu- ja konsultointiyrityksen kannalta Suomen ydinvoimaprojekteissa keskittyen ydinturvallisuus- ja laatuvaatimuksiin. Ydinvoimaprojekteissa toimiminen on edellyttänyt menettelyohjeiden ja laatujärjestelmän uudelleen organisointia yrityksessä ja esiin on noussut haasteita liittyen muun muassa vaatimusten tunnistamiseen ja todentamiseen erityyppisissä ja erilaajuisissa projekteissa. Työ toteutettiin perehtymällä ydinvoimaan liittyvään lainsäädäntöön Suomessa, ohjeisiin ja standardeihin sekä haastattelemalla yrityksen omia asiantuntijoita. Viimeaikaisista sekä meneillään olevista projekteista kerättiin kokemuksia sekä arvioitiin ydinvoima projekteja varten laaditun projektin toteutusohjeen toimivuutta ja käytettävyyttä esimerkkiprojektin avulla. Suurimmiksi haasteiksi tunnistettiin lainsäädännöllisten vaatimusten, kuten ydinvoima- laitosohjeiden (YVL) muuttuminen ja tulkinnanvaraisuus sekä asiakkaiden perehtymät- tömyys Suomen lainsäädäntöön ja vaatimustasoon liittyen ydinturvallisuuteen. Työn tuloksena tunnistettiin hyviä vaatimusten hallintaan liittyviä projektinhallintaa ja ydin- turvallisuutta edistäviä asioita, kuten vaatimusten täsmentäminen jo sopimustasolla sekä niiden täyttymisen seuranta projektin aikana. Erillisen vaatimustietokannan luomista ydinvoimaprojekteja varten tutkittiin, mutta siitä luovuttiin teknisten vaatimusten osalta kannattamattomana, sillä standardien ja vaatimusten määrä kasvoi niin suureksi, että niiden hallitseminen vaatisi enemmän työtä kuin mitä projektien taso yleensä sallisi.

Configuring Health Care Services - Service Control Improvement

The costs of health care are increasing, and at the same time, population is aging. This leads health care organizations to focus more on home based care services. This thesis focuses on the home care organization of the South Karelian District of Social and Health Services (Eksote), which was established in 2010; how its operation is organized and managed, and which problem types are faced in the daily operation of home care. This thesis examines home care services through an extensive interview study, process mapping and statistical data analysis. To be able to understand the nature of services and special environment theory models, such as service management and performance measurement, service processes and service design are introduced. This study is conducted from an external researcher‟s point of view and should be used as a discussion opener. The outcome of this thesis is an upper level development path for Eksote home care. The organization should evaluate and build a service offering, then productize home care services and modularize the products and identify similarities. Service processes should be mapped to generate efficiency for repeating tasks. Units should be reasonably sized and geographically located to facilitate management and operation. All this can be done by recognizing the different types of service products: runners repeaters and strangers. Furthermore, the organization should not hide behind medical issues and should understand the legislative, medical and operational frameworks in health care.

Irrigation management in pruned coffee tree crop

It was evaluated the effect of irrigation management on the production characteristics of coffee cultivar Acaiá MG-1474, planted in spacing of 3.00 m x 0.60 m, pruned in 2004, and irrigated by drip since the planting, in 1997. The experimental designed used was of randomized blocks with five treatments and four replications. The treatments consisted of irrigation management strategies, applying or not applying controlled moisture deficit in layer of 0 to 0.4m, in dry seasons of the year: A = no irrigation (control), B = irrigation during all year considering the factor of water availability in the soil (f) equal to 0.75, C = irrigation during all year considering f = 0.25, D = irrigation during all year, but in January /February /March /July /October /November /December with f = 0.25 and April /May /June /August /September with f = 0.75, E = irrigation only during April /May /June /August /September with f = 0.25. From July /2005 to June /2007 the applied water depth was defined based on Class A pan evaporation (ECA) and the period from July/2007 to June/2008 based on readings of matric potential of soil obtained from Watermark® sensors. Each plot consisted of three rows with ten plants per row, considering as useful plot five plants of center line. The results indicated that the E irrigation management was the most suitable for technical reasons.

Control of ammonia emissions in naturally ventilated dairy cattle facilities in Portugal

We conducted a study of the processes associated to NH3 emission in naturally ventilated dairy cattle facilities, having described factors that regulate NH3 emission, as well as methodologies for measuring these emissions at these facilities. Appropriate techniques to mitigate NH3 emission in facilities located in regions with warm climates were also identified. The most effective mitigation techniques with simple implementation include strategies associated to: (i) installation design and flooring, which lead to reduced emissions, (ii) excreta pre-excretion, namely the use of diets with optimized crude protein content and increased milk production at farm level; and (iii) excreta post-excretion, particularly by changing the conditions of environmental monitoring within the premises, practice introduction or additive application in the management of excreta deposited on floors.

Management strategies of saline water on morphometric characteristics of melon cultivars

It was to aimed it to investigate effects of various saline water use strategies on melon production and quality of two cultivars (Cucumis melo L., Sancho - C1 and Medellín - C2. The plants were irrigated with water of low (S1 = 0.61 dS m-1) and high (S2 = 4.78 dS m-1) salinity levels, during each crop stage: S1S1S2S2 - T1; S2S1S2S2 - T2; S2S2S1S2 - T3. The 1st, 2nd, 3rd and 4th terms of these sequences correspond to initial growth, flowering, fruit ripening and harvest phenological stages, respectively. Additionally, there was irrigation rotation during all cycle, with water S1 during two days followed by S2 for one day (S1 2 dias + S2 1 dia - T4) and irrigation with non-salt water S2 during all cycle - T5. Moreover, we used as control, the irrigation water at 3.2 dS m-1 resulting from water mixture of S1 and S2 - T6 (farm used irrigation management). The experiment was carried out in Pedra Preta Farm, in Mossoró, RN, using an entire randomized block statistical design in a 6x2 subdivided plot scheme with four replications. Saline water irrigation at initial growth stage reduces leaf area and shoot dry phytomass of Sancho and Medellín melon cultivars. The irrigation by T4 provided the highest phytomass production of fruits at 48 DAS, reducing in 33% of good quality water in irrigation.

Process approach in quality management - Case: ECO process development in EMS industry

The aim of the thesis was to study quality management with process approach and to find out how to utilize process management to improve quality. The operating environment of organizations has changed. Organizations are focusing on their core competences and networking with suppliers and customers to ensure more effective and efficient value creation for the end customer. Quality management is moving from inspection of the output to prevention of problems from occurring in the first place and management thinking is changing from functional approach to process approach. In the theoretical part of the thesis, it is studied how to define quality, how to achieve good quality, how to improve quality, and how to make sure the improvement goes on as never ending cycle. A selection of quality tools is introduced. Process approach to quality management is described and compared to functional approach, which is the traditional way to manage operations and quality. The customer focus is also studied, and it is presented, that to ensure long term customer commitment, organization needs to react to changing customer requirements and wishes by constantly improving the processes. In the experimental part the theories are tested in a process improvement business case. It is shown how to execute a process improvement project starting from defining the customer requirements, continuing to defining the process ownership, roles and responsibilities, boundaries, interfaces and the actual process activities. The control points and measures are determined for the process, as well as the feedback and corrective action process, to ensure continual improvement can be achieved and to enable verification that customer requirements are fulfilled.

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.

Development of a project control procedure

The aim of this study is to develop a suitable project control procedure for a target company that can be used in engineering, procurement, and construction or con-struction management contracts. This procedure contains suitable project control software and a model for the use of the software in practice. This study is divided into two main sections. Theoretical part deals with project management, focusing on cost and time dimensions in projects. Empirical part deals with the development of the project control procedure for the target compa-ny. This development takes place in two parts. In the first part, semi-structured interviews are used to find out the company’s employees’ demands and desires for the project control software which will then be used in the developed procedure. These demands and desires are compared to available software in the market and the most suitable one will be chosen. Interview results show that important factors are cost tracking, integration with other software, English language availability, references, helpdesk, and no need for regular updates. The most suitable one is CMPro5 cost control software. The chosen software is used in a pilot project, where its functions and use are analyzed. Project control procedure which will be used in the future is developed based on these procedures. The five steps in developed procedure include employment of a cost engineer, whose task is to maintain the procedure in the target company.

Hazard Risk Management in Large Nordic Companies' Operations in Russia

The objective of this research was to describe how Nordic companies manage hazard risks in their operations in Russia and how the local business environment is considered to affect the hazard risks. Research methods used in this research were literature review and expert interviews. Twelve Nordic industrial companies operating in different fields of industry were interviewed. Large Nordic companies typically guide risk management centralized from the parent company on behalf of the whole company group and the risk management standards and policies are integrated in all subsidiaries. Parent companies typically control hazard risk management in Russia by regular risk management reporting, auditing the Russian sites and by training local managers and employees to risk management work. Many companies have experienced several losses in the first years of operating in Russia before the risk management policies have been implemented in Russian subsidiaries. The companies have learned to take local characteristics better into account by experience and most companies are quite satisfied with their current risk management standards in Russia. The interviews indicate that companies experience especially the poor quality of infrastructure, some features in Russian organizational culture and high level of criminality to increase hazard risks in Russia. However, understanding these features and risks in the business environment makes the management of these risks possible. Risks related to infrastructure can be managed in advance by decreasing dependencies of infrastructure and considering the infrastructure quality already when planning the business operations. Also good local network is often considered critical in order to overcome the complications related to infrastructure. Russian personnel has typically different attitude towards risk management than Nordic personnel and neglecting safety and maintenance and concealing losses is more typical in Russia. By training and guiding the local personnel risk management and safety work and desired ways of actions these risks can be decreased. Criminality risks are often managed to certain extent by investing in security, increasing supervising and paying attention to reliability of the employees and other interest groups of the company.

Improving product profitability control in continuous IT-services

The target of the thesis is to improve product profitability control in continuous IT-services. Accurate product cost accounting and correctly allocated revenues are a necessity for good product profitability control. The focus of the study is on costs and revenues that are not traced directly to services. The thesis is focused on revenue allocations as revenue allocation methods have not been used in the case company before. In order to achieve the target revenue allocation methods, which improve the product profitability accounting and control, are presented. The research methods used in the thesis are literature review and empirical case study. The research approach is constructive. The theoretical part is composed of literature and articles that create a base for the empirical part. Internal interviews describe the current situation in the company and based on it development actions are planned. The part of the empirical case study is seen mostly in the limitations as the research is limited to concern only one department in the company. Problems in the revenue tracing are caused by customer specific services and lack of service definitions because of which the revenues are not traced correctly. Methods to allocate revenues are presented in the thesis and stand-alone revenue allocation method is the most suitable one because it is fair and it can be modified. Approximate product profitability analysis is done in the thesis and the results of it indicate that some services are profitable and some unprofitable.