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Anesthetics can affect the structure and biological function of tissues and systems differentially. The aim of the present study was to compare three injectable anesthetics generally used in experiments with animals in terms of the degree of hemolysis and glycogenolysis occurring after profound anesthesia. Twenty-four male Wistar rats (330-440 g) were divided into three groups (N = 8): chloral hydrate (CH), ketamine + xylazine (KX), Zoletil 50® (zolazepam and tiletamine) + xylazine (ZTX). After deep anesthesia, total blood was collected. The liver and white (WG) and red gastrocnemius (RG) muscles were also immediately removed. The degree of serum hemolysis was quantified on the basis of hemoglobin concentration (g/L). Hepatic and muscular glycogen concentrations (mmol/kg wet tissue) were quantified by the phenol-sulfuric method. The CH and KX groups exhibited serum hemolysis (4.0 ± 2.2 and 1.9 ± 0.9 g/L, respectively; P < 0.05) compared to the ZTX group, which presented none. Only KX induced elevated glycogenolysis (mmol/kg wet tissue) in the liver (86.9 ± 63.2) and in WG (18.7 ± 9.0) and RG (15.2 ± 7.2; P < 0.05). The CH and ZTX groups exhibited no glycogenolysis in the liver (164.4 ± 41.1 and 176.8 ± 54.4, respectively), WG (28.8 ± 4.4, 32.0 ± 6.5, respectively) or RG (29.0 ± 4.9; 25.3 ± 8.6, respectively). Our data indicate that ZTX seems to be an appropriate general anesthetic for studies that seek to simultaneously quantify the concentration of glycogen and serum biochemical markers without interferences. ZTX is reasonably priced, found easily at veterinary markets, quickly induces deep anesthesia, and presents a low mortality rate.

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Inclusion or Exclusion? Trade Union Strategies and Labor Migration This research identified and analyzed immigration-related strategies of the Finnish Construction Trade Union (FCTU) and the Service Union United (SUU); e.g. how the unions react to labor immigration, whether unions seek to include migrants in the unions, and what is migrants’ position in the unions. The two unions were chosen as the focus of the research because the workforce in the sectors they represent is migrant-dense. The study also analyzed the experiences that migrants who work in these sectors have with trade unions. The Estonian labor market situation –including the role of Estonian trade unions– was also examined as it has a considerable impact on the operating environment of the FCTU. The results of the study indicate that immigration is a contradictory issue for both unions. On the one hand, they strive to include migrants as trade union members and to defend migrants’ labor rights. On the other hand, they, together with their umbrella organization the Central Organisation of Finnish Trade Unions (SAK), seek to prevent labor immigration from outside the EU and EEA countries. They actively defend current labor immigration restrictions by drawing atten- tion to high unemployment figures and to the breaches of working conditions migrants encounter. In contrast, the employer organizations promote a more liberal state policy on labor immigration because they see it as a boost for business. Both the unions and the employer organizations ground their arguments on national interest. However, the position of the trade union movement is not uniform: unions belonging to the Confederation of Unions for Professionals and Managerial Staff in Finland (Akava) embrace more liberal labor immigration stances than the SAK. A key trade union strategy is to try to guarantee that migrants’ working condi- tions do not differ from those of the natives. The FCTU and the SUU inform migrants about Finnish collective agreements and trade union membership in the most common migrant languages. This is important for the unions because it is not in their interest that migrants’ working conditions are undercut. The interviewed migrants said that natives had more negotiating power with employers, which is often negatively portrayed in migrants’ working conditions. Migrants perceive that trade unions have an important role in protecting their working conditions. However, they stressed that migrants’ knowledge of unions is often very limited. The number of migrants in both two unions studied here is increasing. Espe- cially in the SUU, a considerable proportion of the new members are migrants. The FCTU is in a more challenging situation than the SUU because migrant construc- tion workers often work only for short periods in Finland and are consequently not interested in becoming union members. The unions’ strategies partly differ: the FCTU was the first Finnish trade union to establish a trade union branch/lo- cal for migrant members. The goal is to facilitate migrants’ inclusion in the union and to highlight the specific problems they face. The SUU, for its part, insists that such a special strategy would exclude migrants within the union organization. Despite the unions’ strategies, migrants are still underrepresented as union members and officials, which some of the interviewed migrants saw as a problem. Immigrants’ perception of trade unions was pragmatic: they had joined unions when membership yielded concrete benefits. In spite of the unions’ strategies, migrants –and temporary migrants– encoun- ter specific problems in terms of working conditions. Both unions demand more state intervention to protect migrants’ labor rights because overseeing working conditions consumes union resources. However, without the unions’ intervention, these problems would be more common than is currently the case. For instance, some of the interviewed migrants had received trade union assistance in claim- ing unpaid wages. The study demonstrated with the help of building on Walter Korpi’s power resources theory, that immigration is a power resource issue for the unions: suc- cessful immigration-related strategies strengthen unions –and vice versa. The research also showed how the unions’ operating environments constrain and enable their immigration-related strategies. This study has illuminated a previously ignored dimension: the immigrant- inclusive strategies of the Finnish trade unions. The research material consists of 78 qualitative interviews, observation in trade union events, and trade unions’ and employer organizations’ public state- ments.

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Imagine the potential implications of an organization whose business and IT processes are well aligned and are capable of reactively and proactively responding to the external and internal changes. The Philips IT Infrastructure and Operations department (I&O) is undergoing a series of transformation activities to help Philips business keeping up with the changes. I&O would serve a critical function in any business sectors; given that the I&O’s strategy switched from “design, build and run” to “specify, acquire and performance manage”, that function is amplified. In 2013, I&O’s biggest transforming programme I&O Futures engaged multiple interdisciplinary departments and programs on decommissioning legacy processes and restructuring new processes with respect to the Information Technology Internet Library (ITIL), helping I&O to achieve a common infrastructure and operating platform (CI&OP). The author joined I&O Futures in the early 2014 and contributed to the CI&OP release 1, during which a designed model Bing Box and its evaluations were conducted through the lens of six sigma’s structured define-measure-analyze-improve-control (DMAIC) improvement approach. This Bing Box model was intended to firstly combine business and IT principles, namely Lean IT, Agile, ITIL best practices, and Aspect-oriented programming (AOP) into a framework. Secondly, the author implemented the modularized optimization cycles according to the defined framework into Philips’ ITIL-based processes and, subsequently, to enhance business process performance as well as to increase efficiency of the optimization cycles. The unique of this thesis is that the Bing Box model not only provided comprehensive optimization approaches and principles for business process performance, but also integrated and standardized optimization modules for the optimization process itself. The research followed a design research guideline that seek to extend the boundaries of human and organizational capabilities by creating new and innovative artifacts. The Chapter 2 firstly reviewed the current research on Lean Six Sigma, Agile, AOP and ITIL, aiming at identifying the broad conceptual bases for this study. In Chapter 3, we included the process of constructing the Bing Box model. The Chapter 4 described the adoption of Bing Box model: two-implementation case validated by stakeholders through observations and interviews. Chapter 5 contained the concluding remarks, the limitation of this research work and the future research areas. Chapter 6 provided the references used in this thesis.

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Food industry has been developing products to meet the demands of increasing number of consumers who are concerned with their health and who seek food products that satisfy their needs. Therefore, the development of processed foods that contain functional components has become important for this industry. Microencapsulation can be used to reduce the effects of processing on functional components and preserve their bioactivity. The present study investigated the production of lipid microparticles containing phytosterols by spray chilling. The matrices comprised mixtures of stearic acid and hydrogenated vegetable fat, and the ratio of the matrix components to phytosterols was defined by an experimental design using the mean diameters of the microparticles as the response variable. The melting point of the matrices ranged from 44.5 and 53.4 ºC. The process yield was melting point dependent; the particles that exhibited lower melting point had greater losses than those with higher melting point. The microparticles' mean diameters ranged from 13.8 and 32.2 µm and were influenced by the amount of phytosterols and stearic acid. The microparticles exhibited spherical shape and typical polydispersity of atomized products. From a technological and practical (handling, yield, and agglomeration) points of view, lipid microparticles with higher melting point proved promising as phytosterol carriers.

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Fats and oils are very important raw materials and functional ingredients for several food products such as confectionery, bakery, ice creams, emulsions, and sauces, shortenings, margarines, and other specially tailored products. Formulated products are made with just about every part of chemistry, but they are not simple chemicals. In general, they consist of several, and often many, components. Each of these components has a purpose. Most formulated products have a micro- or nano-structure that is important for their function, but obtaining this structure is often the big challenge. Due to a rise in overweight or obesity, health concerns have increased. This fact has led to the need to the develop products with low fat content, which have become a market trend. In addition, the development of new products using fat substitutes can be a good option for companies that are always trying to reduce costs or substitute trans fat or saturated fat. However, the successful development of these products is still a challenge because fat plays multiple roles in determining the desirable physicochemical and sensory attributes, and because the consumers who want or need to replace these ingredients, seek products with similar characteristics to those of the original product. Important attributes such as smooth, creamy and rich texture; milky and creamy appearance; desirable flavor; and satiating effects are influenced by the droplets of fat, and these characteristics are paramount to the consumer and consequently crucial to the success of the product in the market. Therefore, it is important to identify commercially viable strategies that are capable of removing or reducing fat content of food products without altering their sensory and nutritional characteristics. This paper intended to provide an overview about the role of fat in different food systems such as chocolate, ice cream, bakery products like biscuits, breads, and cakes considering the major trends of the food industry to meet the demands of modern society.

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Building Information Modeling – BIM is widely spreading in the Architecture, Engineering, and Construction (AEC) industries. Manufacturers of building elements are also starting to provide more and more objects of their products. The ideal availability and distribution for these models is not yet stabilized. Usual goal of a manufacturer is to get their model into design as early as possible. Finding the ways to satisfy customer needs with a superior service would help to achieve this goal. This study aims to seek what case company’s customers want out of the model and what they think is the ideal way to obtain these models and what are the desired functionalities for this service. This master’s thesis uses a modified version of lead user method to gain understanding of what the needs are in a longer term. In this framework also benchmarking of current solutions and their common model functions is done. Empirical data is collected with survey and interviews. As a result this thesis provides understanding that what is the information customer uses when obtaining a model, what kind of model is expected to be achieved and how is should the process optimally function. Based on these results ideal service is pointed out.

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Corporations practice company acquisitions in order to create shareholder’s value. During the last few decades, the companies in emerging markets have become active in the acquisition business. During the last decade, large and significant acquisitions have occurred especially in automotive industry. While domestic markets have become too competitive and companies are lacking required capabilities, they seek possibilities to expand into Western markets by attaining valuable assets through acquisitions of developed country corporations. This study discusses the issues and characteristics of these acquisitions through case studies. The purpose of this study was to identify the acquisition motives and strategies for post-transaction brand and product integration as well as analyze the effect of the motives to the integration strategy. The cases chosen for the research were Chinese Geely acquiring Swedish Volvo in 2010 and Indian Tata Motors buying British Jaguar Land Rover in 2008. The main topics were chosen according to their significance for companies in automotive industry as well as those are most visible parts for consumers. The study is based on qualitative case study methods, analyzing secondary data from academic papers and news articles as well as companies’ own announcements e.g. stock exchange and press releases. The study finds that the companies in the cases mainly possessed asset-seeking and market-seeking motives. In addition, the findings refer to rather minimal post-acquisition brand and product integration strategies. Mainly the parent companies left the target company autonomous to make their own business strategies and decisions. The most noticeable integrations were in the product development and production processes. Through restructuring the product architectures, the companies were able to share components and technology between product families and brands, which results in cutting down costs and in increase of profitability and efficiency. In the Geely- Volvo case, the strategy focused more on component sharing and product development know-how, whereas in Tata Motors-Jaguar Land Rover case, the main actions were to cut down costs through component sharing and combine production and distribution networks especially in Asian markets. However, it was evident that in both cases the integration and technology sharing were executed cautiously to prevent on harming the valuable image of the luxury brand. This study has concluded that the asset-seeking motives have significant influence on the posttransaction brand and model line-up integration strategies. By taking a cautious approach in acquiring assets, such as luxury brand, the companies in the cases have implemented a successful post-acquisition strategy and managed to create value for the shareholders at least in short-term. Yritykset harjoittavat yritysostoja luodakseen osakkeenomistajille lisäarvoa. Viimeisten muutamien vuosikymmenien aikana yritykset kehittyvissä maissa ovat myös aktivoituneet yritysostoissa. Viimeisen vuosikymmenen aikana erityisesti autoteollisuudessa on esiintynyt suuria ja merkittäviä yritysostoja. Koska kilpailu kotimaan markkinoilla on kiristynyt ja yritykset ovat vailla vaadittavia valmiuksia, ne etsivät mahdollisuuksiaan laajentaa länsimaisiin markkinoihin hankkimalla arvokkaita etuja kehittyneiden maiden yrityksistä yritysostojen avulla. Tämä tutkimus pohtii näiden yritysostojen olennaisia kysymyksiä ja ominaisuuksia casetutkimuksien kautta. Tutkimuksen tarkoitus oli tunnistaa sekä yritysostojen motiiveja ja brändi- ja mallisto-integraation strategioita että analysoida kyseisten motiivien vaikutusta integraatiostrategiaan. Tapaus-tutkimuksiksi valittiin kiinalaisen Geelyn yritysosto ruotsalaisesta Volvosta vuonna 2010 ja intialaisen Tata Motorsin yritysosto englantilaisesta Jaguar Land Roverista vuonna 2008. Tutkimus on kvalitatiivinen case-tutkimus ja siinä analysoidaan toissijaista tietoa sekä akateemisten ja uutisartikkeleiden että yritysten omien ilmoitusten, kuten pörssi- ja lehdistötiedotteiden, kautta. Tutkimuksen tulokset osoittavat, että tutkittujen yritysten toiminnat perustuivat motiiveihin, joita ajoivat etujen and uusien markkinoiden tarve. Sen lisäksi tutkimustulokset osoittivat, että yritysoston jälkeinen brändi- ja mallisto-integraatio pidettiin minimaalisena. Pääasiallisesti kohdeyrityksille jätettiin autonomia tehdä omat liikkeenjohdolliset päätökset yritysstrategioihin liittyen. Huomattavimmat integraatiot koskivat tuotekehityksellisiä ja tuotannollisia prosesseja. Kehittämällä uudelleen tuotearkkitehtuureja, yritykset pystyivät jakamaan komponentteja ja teknologiaa tuoteperheiden ja brändien välillä. Tämä mahdollisti kustannusleikkauksia sekä kannattavuuden ja tehokkuuden parantamista. Geely-Volvo –tapauksessa integraatiostrategia keskittyi komponenttien jakamiseen yhteisten tuotearkkitehtuurien avulla ja tuotekehityksen ammattitaitoon, kun taas Tata Motors-JLR –tapauksessa päätoiminnat olivat kustannuksien leikkaus sekä tuotannon ja jakeluverkoston yhdistäminen erityisesti Aasian maissa. Yhteistä yrityskaupoissa oli, että brändi- ja mallisto-integraatio sekä teknologian jakaminen suoritettiin varoen ehkäistäkseen arvokkaiden luksus-brändien tuotekuvan vahingoittamista. Tutkimuksen lopputulokset osoittavat, että yrityskaupan motiiveilla on huomattava vaikutus brändija mallisto-integraation strategiaan. Toteuttamalla varovaista lähestymistapaa luksus-brändin hankinnassa ja integraatiossa, yritykset ovat onnistuneet luomaan lisäarvoa osakkeenomistajille vähintään lyhyellä aikavälillä.

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Introduction: The treatment offered to chronic kidney disease (CKD) patients before starting hemodialysis (HD) impacts prognosis. Objective: We seek differences among incident HD patients according to the distance between home and the dialysis center. Methods: We included 179 CKD patients undergoing HD. Patients were stratified in two groups: "living near the dialysis center" (patients whose hometown was in cities up to 100 km from the dialysis center) or as "living far from the dialysis center" (patients whose hometown was more than 100 km from the dialysis center). Socioeconomic status, laboratory results, awareness of CKD before starting HD, consultation with nephrologist before the first HD session, and type of vascular access when starting HD were compared between the two groups. Comparisons of continuous and categorical variables were performed using Student's t-test and the Chi-square test, respectively. Results: Ninety (50.3%) patients were classified as "living near the dialysis center" and 89 (49.7%) as "living far from the dialysis center". Patients living near the dialysis center were more likely to know about their condition of CKD than those living far from the dialysis center, respectively 46.6% versus 28.0% (p = 0.015). Although without statistical significance, patients living near the dialysis center had more frequent previous consultation with nephrologists (55.5% versus 42.6%; p = 0.116) and first HD by fistula (30.0% versus 19.1%; p = 0.128) than those living far from the dialysis center. Conclusion: There are potential advantages of CKD awareness, referral to nephrologists and starting HD through fistula among patients living near the dialysis center.

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The purpose of this study is to analyze supplier’s value creation ability in project business in order to enhance customer’s business. In addition, the aim is to identify the role of business relationships in value creation and analyze the applicability of key account management in project business. The study considers value from the customer’s point of view. The concepts of value and value creation are widely discussed in marketing literature. Theory emphasizes the importance of value creation and business relationships in business markets. The empirical part of the study is conducted as a case study research. The empirical evidence is collected by interviewing one supplier organization and their three customer organizations. These companies operate in Finnish and global industrial markets. Data is collected through semi-structured interviews and analyzed by using qualitative content analysis. The study identifies several customer value drivers influencing on the value creation, which can be divided into product, service and relationship elements. One of the recognized value drivers is customer-supplier relationship. The findings show that a closer relationship enhances value creation possibilities and the key account management program allows effective managing of business relationships. As managerial implications, suppliers should seek to create continuous and conversational relationships with the key account customers.

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Diplomityön tavoitteena on tutkia yrityskaupan vaikutuksia liiketoimintaan. Kuinka se muuttui yrityskaupan jälkeen ja kuinka se vastasi ennalta suunniteltua strategiaa. Työ tehtiin haastattelututkimuksena, jossa tutkittavina kohdeyhtiöinä oli kuusi yritystä, jotka olivat laajentuneet ostamalla yrityksen tai yrityksiä. Yhtiöiden tavoitteena oli hakea kasvua ostamalla valmis yritys tai liiketoiminta. Tutkimuksen teoreettisen viitekehityksen mukaisesti, jos yrityksen kasvustrategiana on kasvaa yrityskaupan avulla, sillä on vaikutus liiketoimintaan yrityskaupan jälkeen. Työn tuloksena saatiin arvio siitä, kuinka alkuperäinen strateginen tavoite saavutettiin ja mitä muita hyötyjä ja haittoja liiketoiminnan yhdistämisellä oli. Työn keskeisimmät tulokset olivat, että yrityskaupalla on aina vaikutus yrityksen liike- toimintaan. Paras hyöty saadaan, jos ostettavan yrityksen liiketointa on täydentävää, ei päällekkäistä liiketoimintaa. Yhdistymisestä saadaan hyötyjä jos yritykset voivat hyödyn- tää toinen toisensa osaamista. Etuina saadaan myös synergiahyötyjä, erityisesti yrityksen hallinnossa ja toiminnanohjausjärjestelmissä. Ostettavan yrityksen haltuunotto tulisi olla hallittu ja nopea.

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Tässä työssä tarkastellaan Start-up & Spin-off Factory -projektissa, pääsääntöisesti Kymenlaaksossa toimiville, yrittäjille suunnattua ja toteutettua yritysvalmennusohjelmaa. Työssä selvitetään ja käsitellään Start-up & Spin-off -projektin yritysvalmennuksen onnistumisia ja kehittämiskohteita sähköisen kyselyn sekä teemahaastatteluiden pohjalta. Start-up & Spin-off Factory -projektissa tuettiin innovatiivisten yritysten (21 yritystä) kasvua kiihdytysohjelmalla, jossa kokeneet sarjayrittäjät valmensivat uutta yritystä perustavia tai jo yritystoiminnan aloittaneita yrittäjiä, joiden tuotteille/palveluille haluttiin saada kasvua. Projektin tavoitteena oli edistää erityisesti kiihdytettävien yritysten nopeaa kansainvälistymistä auttamalla yrittäjiä pilottien, asiakkaiden, partnerien ja rahoituksen hankinnassa. Valmennettavat kokivat saaneensa lisäarvoa valmennuksesta omaksumalla uusia näkökulmia. He kokivat koulutuksen tuoneen yrityksen toimintaan lisää nöyrää asennetta ja lujaa uskoa tulevaisuuteen. Vertaistuen osuutta sekä verkostojen lisääntymisen mukana tullutta uusien kontaktien määrää pidettiin myönteisenä asiana. Vastausten perusteella valmennus selkeytti valmennettavien ymmärrystä liiketoiminnan kehittämisestä. Hissipuheen teko ja harjoittelu koettiin tärkeäksi ja jännittäväksi. Valmennus vahvisti luottamusta omaan tuotteeseen ja palveluun. Valmennuksen painottuminen ICT-alan firmoihin merkitsi valmennuksessa sitä, että teoriat ja esimerkit tulivat useasti tältä alalta. Toimialojen eroavaisuus tulisi huomioida valmennuksessa opetussisältöjen ja esimerkkien osalta. Kyselyn ja haastatteluiden mukaan valmentajien asiantuntemukseen oltiin tyytyväisiä. Lisäksi onnistuneena osa-alueena koettiin valmennuksen käytännön järjestelyjä. Kehitettävää puolestaan oli opetusmateriaalien, opetusmenetelmien ja koulutuksen keston suhteen. Kysyttäessä valmennuksen hyvistä ja huonoista puolista olivat vastaajat sitä mieltä, että valmennuksessa oli hyvä ilmapiiri ja valmennus oli käytännönläheistä. Pienryhmävalmennusta pidettiin hyvänä asiana, samoin kuin henkilökohtaistamista.

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Tässä tutkimuksessa tutkittiin neljän suomalaisen pörssilistatun kansainvälisesti toimivan B2B-yrityksen maineenhallintaa sosiaalisessa mediassa. Tutkimuksen tavoitteena oli selvittää miksi, mistä lähtökohdista ja miten suomalaiset B2B-yritykset hallitsevat mainettaan sosiaalisessa mediassa. Yritysten maineenhallinta rajattiin koskemaan yrityksen ulkoisen viestinnän keinoja, joilla yritykset pyrkivät vaikuttamaan maineeseensa. Tutkimus toteutettiin kvalitatiivisena, vertailevana tapaustutkimuksena. Tutkimuksen empiirinen aineisto kerättiin puolistrukturoiduilla teemahaastatteluilla tapausyritysten viestinnän johto- ja asiantuntijatehtävissä työskenteleviltä henkilöiltä. Tutkimus osoitti, että hyvä maine on yrityksille tärkeää aineetonta pääomaa ja sitä voi ja tulee johtaa sekä hallita sosiaalisessa mediassa. B2B-yritykset hallitsevat mainettaan sosiaalisessa mediassa monitoroimalla sosiaalisen media keskusteluja tavoitteenaan suojella yritystä mainekriiseiltä ja tuottamalla tavoitemainekuvansa mukaista sisältöä rakentaakseen itsestään kuvaa vastuullisena ja innovatiivisena yrityksenä sekä hyvänä kumppanina. B2B-yritysten maineenhallinnan käytänteiksi tutkimuksessa tunnistettiin sosiaalisen median monitorointi, keskusteleminen ja sisällöntuotanto, mittaaminen, kriisinhallinta sekä yhteistyönhallinta.

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Answers to a marxist critic of the rhetorical and pragmatic perspectives in economics. Based on recent discussions regarding the rhetorical perspective in economics, this paper presents an interpretation of the philosophical approach of Habermas which attempts to rescue the so called 'modern spirit', forgotten in the annals of the 19th century, similar to that presented by Marshall Berman in 1982. Following the reconstructive approach of Habermas's project of modernity, we attempt to show how a 'rhetorical approach' could be applied in the field of economics, and yet still be clearly modern by taking into account intersubjectivities, given the expanded sphere of human communication (as defended in the theory of communicative action of Habermas). In this sense, we will seek to demonstrate the philosophical limits of the anti-rhetorical critiques of, for example, Paulani (1996, 2003, 2005, 2006), which seem to underestimate the linguistic and intersubjective aspect of Habermas's philosophical project that can also be found in McCloskey’s methodological approach.

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The healthcare sector is currently in the verge of a reform and thus, the medical game research provide an interesting area of research. The aim of this study is to explore the critical elements underpinning the emergence of the medical game ecosystem with three sub-objectives: (1) to seek who are the key actors involved in the medical game ecosystem and identify their needs, (2) to scrutinise what types of resources are required in medical game development and what types of relationships are needed to secure those resources, and (3) to identify the existing institutions (‘the rules of the game’) affecting the emergence of the medical game ecosystem. The theoretical background consists of service ecosystems literature. The empirical study conducted is based on the semi-structured theme interviews of 25 experts in three relevant fields: games and technology, health and funding. The data was analysed through a theoretical framework that was designed based upon service ecosystems literature. The study proposes that the key actors are divided into five groups: medical game companies, customers, funders, regulatory parties and complementors. Their needs are linked to improving patient motivation and enhancing the healthcare processes resulting in lower costs. Several types of resources, especially skills and knowledge, are required to create a medical game. To gain access to those resources, medical game companies need to build complex networks of relationships. Proficiency in managing those value networks is crucial. In addition, the company should take into account the underlying institutions in the healthcare sector affecting the medical game ecosystem. Three crucial institutions were identified: validation, lack of innovation supporting structures in healthcare and the rising consumerisation. Based on the findings, medical games cannot be made in isolation. A developmental trajectory model of the emerging medical game ecosystem was created based on the empirical data. The relevancy of relationships and resources is dependent on the trajectory that the medical game company at that time resides. Furthermore, creating an official and documented database for clinically valdated medical games was proposed to establish the medical game market and ensure an adequate status for the effective medical games. Finally, ecosystems approach provides interesting future opportunities for research on medical game ecosystems.

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This article invites to a reflection on the ontological and axiological foundations of the concept 'international economic order'. We argue that the notion of 'order' implies, at first, identifying a sort of social arrangement or pattern. However, as we intend to demonstrate, this pattern is hardly present in contemporary international economic relations. Besides, the adjectives 'economic' and 'international' instill doubt not only in regard to the nature of the 'international', but also in what concerns the feasibility of spotting a working pattern in international economy nowadays. Thus, it seems, on heuristical terms, an appropriate methodological option to revisit some of the main canonical contributions to the theme of international (economic) order, and to submit it to academic scrutiny. Additionally, we seek to evaluate how plausible it is to think of a 'multilateral' economic international order.