What are the opportunities and challenges of cloud computing technology in the healthcare information systems

This thesis discusses the opportunities and challenges of the cloud computing technology in healthcare information systems by reviewing the existing literature on cloud computing and healthcare information system and the impact of cloud computing technology to healthcare industry. The review shows that if problems related to security of data are solved then cloud computing will positively transform the healthcare institutions by giving advantage to the healthcare IT infrastructure as well as improving and giving benefit to healthcare services. Therefore, this thesis will explore the opportunities and challenges that are associated with cloud computing in the context of Finland in order to help the healthcare organizations and stakeholders to determine its direction when it decides to adopt cloud technology on their information systems.

Serva ad ministrare : tjänandets ethos i vårdledarskap

Avhandlingen syftar till att ur ett vårdvetenskapligt perspektiv beskriva och upptäcka tjänandets meningsinnehåll samt fördjupa förståelsekunskap om tjänandets ethos i förhållande till vårdledarskap med en inriktning på det vårdadministrativa. Syftet är även att skapa en idealmodell som öppnar för en ny eller annorlunda förståelsehorisont för tjänandets ethos i vårdledarskap. Kunskapssökandet sker genom följande delstudier: (1) I begreppsbestämningen genomförs begreppsanalyser av tjäna och tjänst med avsikt att öppna för en grundförståelse och tankestruktur i forskningsuppgiften. (2) I det idéhistoriska spåras tjänandets ontologiska arv och idémönster fram genom tolkning av historiska källornas texter från 1900-talets första hälft i ljuset av sjuksköterskeledarskap utgående från Sophie Mannerheims, Bertha Wellins och Bergljot Larssons idéer och tankeströmningar. (3) Sökandet fortsätter i dagens kliniska kontextbas genom kvalitativa djupintervjuer med 30 deltagare (vårdledare och vårdare) från Finland, Sverige och Norge. Förförståelsen och forskningens teoretiska perspektiv har rötter i Erikssons caring science-tradition och vårdvetenskapens ontologiska grundantaganden som utvecklats vid Åbo Akademi, Enheten för vårdvetenskap i Vasa. Forskningsansatsen är inspirerad av H-G Gadamers filosofiska hermeneutik. Designen är explorativ-deskriptiv, idiografisk och implicerar ett hypotetisk-deduktivt tillvägagångssätt. Tjänandet och vårdledarskapets ethos upptäcks och tolkas genom det metodologiska närmandet: Erikssons hermeneutiska begreppsbestämningsmodell, idéhistoriska läsakt och hermeneutiska läsakt. Materialet bildar förståelsehorisonter genom den hermeneutiska dialogens successiva och oändliga rörelse. Horisonterna reflekteras mot teorikärnan för att öppna för ny förståelse av tjänandets meningsinnehåll, vårdledarskap och vårdadministration. I slutandet sker en horisontsammansmältning och en reflektiv anslutning till vårdvetenskapens teorikärna som visar hur tjänandets ethos blir evident i vårdledarskap. Resultatet visar att vårdledarskap som är tjänande för patienten och vårdkulturen synliggörs i vårdadministrationens kontext genom huvudets skärpa, handens gärningar och hjärtats visdom. Tjänandets sanna, goda och sköna tidlösa rörelse är riktad mot hälsa och helande. I dag sammankopplas tjänande inom vårdorganisationer med hälsoekonomiska förhållanden, effektivitet, produktivitet och rationalitet, vilket strider mot tjänandets värdegrund, människans värdighet och respekt för livet. Vårdorganisationernas etiska ansvar är att fungera som samhälleliga förebilder, tillrättalägga för vårdadministrationernas tjänande och stå i patientens tjänst. Gestaltningen av tjänandets ethos i vårdledarskap öppnar för nya diskurser, riktningar, visioner och handlingar i den vårdadministrativa verkligheten. Avhandlingen ger vårdvetenskapens systematiska grundforskning ett teoritillskott av fördjupad förståelse av tjänandets och vårdledarskapets historiska och samtida ontologiska evidens och ethos med applikationen på klinisk vårdvetenskap.

Public and private sector cooperative opportunities in the Finnish healthcare internationalization : views from the public sector’s perspective

Traditionally mostly publicly provided Finnish healthcare services are confronted today by the evident challenge of rising healthcare costs as the expenditure on health and social case has exceeded Finland’s national GDP growth significantly since the new millennium. While the opening of the traditional barriers through the EU’s new patient directive resulting in increasing international competition and the free flow of patients within the EU present opportunities for the Finnish healthcare services industry there are also several challenges for the existing healthcare system as proposed by the Ministry of Employment and the Economy in 2011. Due to the structure and nature of the current Finnish healthcare service system the greatest potential for internationalization is seen from a joint cooperation of the public and private sectors in an internationalization network for Finnish healthcare services. As its formation has recently also taken as a strategic initiative to be completed by the Ministry of Employment and the Economy and no earlier research exists on how this is seen in practice by the network actors, the purpose of this study is to examine the proposed solution of forming an internationalization network between the public and private sector actors in Finland in practice from the viewpoint of public sector actors. The research relied heavily on the reports by the Finnish Ministries in understanding the current situation of the Finnish healthcare services internationalization and its potential. Suitable theories were also used to build a more comprehensive view of the matter. The study applied a qualitative research approach on the explorative research problem. The data collection was achieved through expert interviews in two of the largest Finnish public healthcare service providers; the Turku and Helsinki Central University Hospitals. Expert interviews were considered as the most suitable method for data collection in order to create an in-depth understanding of the topic within the limitations of this thesis. In turn, two different public healthcare service providers were chosen to give a broader view of the field instead of focusing on a specific unit and also to allow a possible comparison between the two different organizations. The latter however was shown not to be suitable for the purposes of this study as the opinions of the respondents varied largely also within their own organizations. The conclusion is that while the actors agree on the evident internationalization of Finnish healthcare services, there are several large-scale structural challenges effectively preventing such activities while at the same time the opportunities within Finland vary, as there are several niches but no real large-scale advantages in the highly competitive industry. Interest towards cooperation between the sectors are seen especially in exploiting the advantages offered by the private sector in commercialization and marketization, yet however no clear views exist on how these activities should be governed or structured in the short-term as a larger reform of the entire Finnish healthcare service sector is needed in the long-term.

Analysis of trophic responses in lesioned brain: focus on basic fibroblast growth factor mechanisms

The actions of fibroblast growth factors (FGFs), particularly the basic form (bFGF), have been described in a large number of cells and include mitogenicity, angiogenicity and wound repair. The present review discusses the presence of the bFGF protein and messenger RNA as well as the presence of the FGF receptor messenger RNA in the rodent brain by means of semiquantitative radioactive in situ hybridization in combination with immunohistochemistry. Chemical and mechanical injuries to the brain trigger a reduction in neurotransmitter synthesis and neuronal death which are accompanied by astroglial reaction. The altered synthesis of bFGF following brain lesions or stimulation was analyzed. Lesions of the central nervous system trigger bFGF gene expression by neurons and/or activated astrocytes, depending on the type of lesion and time post-manipulation. The changes in bFGF messenger RNA are frequently accompanied by a subsequent increase of bFGF immunoreactivity in astrocytes in the lesioned pathway. The reactive astrocytes and injured neurons synthesize increased amount of bFGF, which may act as a paracrine/autocrine factor, protecting neurons from death and also stimulating neuronal plasticity and tissue repair

Entrepreneurship Education in Basic and Upper Secondary Education – Measurement and Empirical Evidence

The starting point of this study is to direct more attention to the teacher and those entrepreneurship education practices taking place in formal school to find out solutions for more effective promotion of entrepreneurship education. For this objective, the strategy-level aims of entrepreneurship education need to be operationalised into measurable and understandable teacher-level practices. Furthermore, to enable the effective development of entrepreneurship education in basic and upper secondary level education, more knowledge is needed of the state of affairs of entrepreneurship education in teaching. The purpose of the study is to increase the level of understanding of teachers’ entrepreneurship education practices, and through this to develop entrepreneurship education. This study builds on the literature on entrepreneurship education and especially those elements referring to the aims, resources, benefits, methods, and practises of entrepreneurship education. The study comprises five articles highlighting teachers’ role in entrepreneurship education. In the first article the concept of entrepreneurship and the teachers role in reflection upon his/hers approaches to entrepreneurship education are considered. The second article provides a detailed analysis of the process of developing a measurement tool to depict the teachers’ activities in entrepreneurship education. The next three articles highlight the teachers’ role in directing the entrepreneurship education in basic and upper secondary level education. Furthermore, they analyse the relationship between the entrepreneurship education practises and the teachers’ background characteristics. The results of the study suggest a wide range of conclusions and implications. First, in spite of many outspoken aims connected to entrepreneurship education, teachers have not set any aims for themselves. Additionally, aims and results seem to mix. However, it is possible to develop teachers’ target orientation by supporting their reflection skills, and through measurement and evaluation increase their understanding of their own practices. Second, applying a participatory action process it is possible to operationalise teachers’entrepreneurship education practices. It is central to include the practitioners’ perspective in the development of measures to make sure that the concepts and aims of entrepreneurship education are understood. Third, teachers’ demographic or tenure-related background characteristics do not affect their entrepreneurship education practices, but their training related to entrepreneurship education, participation in different school-level or regional planning, and their own capabilities support entrepreneurship education. Fourth, a large number of methods are applied to entrepreneurship education, and the most often used methods were different kinds of discussions, which seem to be an easy, low-threshold way for teachers to include entrepreneurship education regularly in their teaching. Field trips to business enterprises or inviting entrepreneurs to present their work in schools are used fairly seldom. Interestingly, visits outside the school are more common than visitors invited to the school. In line, most of the entrepreneurship education practices take place in a classroom. Therefore it seems to be useful to create and encourage teachers towards more in-depth cooperation with companies (e.g. via joint projects) and to network systematically. Finally, there are plenty of resources available for entrepreneurship education, such as ready-made materials, external stakeholders, support organisations, and learning games, but teachers have utilized them only marginally.

Effect of a Brazilian regional basic diet on the prevalence of caries in rats

The aim of the present study was to determine the effect of a regional basic diet (RBD) on the prevalence of caries in the molar teeth of rats of both sexes aged 23 days. The animals were divided into six groups of 10 rats each receiving the following diets for 30 and 60 days after weaning: RBD, a cariogenic diet, and a commercial diet. The prevalence and penetration of caries in the molar teeth of the rats was then analyzed. The RBD produced caries in 37.5% of the teeth of animals fed 30 days, and in 83.4% of animals fed 60 days, while the cariogenic diet produced caries in 72.5% and 77.5% of the teeth of animals fed 30 and 60 days, respectively. Rats fed the RBD for 30 days had caries in the enamel in 38% of their teeth, 48% had superficial dentin caries, and 7.5% moderate dentin caries. The effect of the RBD did not differ significantly from that of the cariogenic diet in terms of the presence of caries in rats fed 60 days. The penetration depth of the caries produced by the RBD was the same as that produced by the cariogenic diet. Our results show that the RBD has the same cariogenic potential as the cariogenic diet. Since the RBD is the only option for the low-income population, there should be a study of how to compensate for the cariogenicity of this diet.

Palvelusetelien prosessit ja hallinnolliset kustannukset Helsingin kaupungin sosiaali- ja terveysvirastossa

Diplomityö käsittelee Helsingin sosiaali- ja terveysviraston palvelusetelitoimintaa eräänä ostopalvelun järjestämistapana. Vakinaistettuja palveluseteleitä on kaksi-toista, joista työhön on valittu viisi kustannuksiltaan ja lukumääriltään suurinta palveluseteliä. Tutkimuksessa mallinnetaan kahden keskenään erilaisimman palve-lusetelin prosessikuvaukset, vanhusten palveluasumisen (sosh) ja suun terveyden-huollon (tervh) palveluseteleille ja kuvataan niiden hallinnolliset työvaiheet ja toi-minnot. Empiirinen aineisto koostuu aiemmin kerätystä hallinnollisen työajan da-tasta, jonka avulla eri toimintoihin sitoutuneiden hallinnollisten kustannuksien las-kenta on suoritettu hyödyntäen aikaperusteista toimintolaskentaa. Aikaperusteisen toimintolaskennan avulla saadaan esille kirjanpidon ulkopuolelle jääviä piileviä prosessikustannuksia. Lisäksi diplomityössä tehdään edullisuusvertailua oman vas-taavan palvelutoiminnan ja palvelusetelien välillä. Terveydenhuollon palvelusetelien hallinnolliset prosessit osoittautuvat hallinnolli-sesti ja kustannuksien osalta kuormittavammaksi kuin sosiaalihuollon vastaavat prosessit. Terveydenhuollon palveluseteliprosessit ovat luonteeltaan monivaihei-sempia, ne ovat toimenpiteellisiä ja kertaluonteisia, joka lisää asiakasvolyymia ja tiedon välittämisen tarvetta sosiaali- ja terveysviraston ja palveluntuottajan välillä. Hallinnollinen kustannuslisä on vuoden 2013 palvelusetelitoiminnan volyymeillä suun terveydenhuollossa +24%, kolonoskopiassa +9%, ikäihmisten päivätoimin-nassa +8%, vammaisten henkilökohtaisessa avussa +5% ja vanhusten palveluasu-misessa +1%. Hallinnollisten kustannusten esiin tuomiseksi tulee terveydenhuollon palvelusetelien kirjanpidon kustannuksissa käyttää kerrointa 1,167 ja sosiaalihuol-lon palvelusetelien kustannuksissa kerrointa 1,046. Edullisuusvertailussa suun terveydenhuollon ja kolonoskopian palvelusetelit osoittautuvat omaa toimintaa kalliimmiksi, vanhusten palveluasuminen, ikäihmisten päivätoiminta ja vammais-ten henkilökohtainen apu on edullisempaa tuottaa palvelusetelillä. Palveluseteli-toiminnan kustannushyöty ei ole ainoa tekijä toimintaa suunnitelleessa. Hoitota-kuuseen vastaaminen, asiakasorientaation ja vapaavalintaisuuden lisääntyminen, sekä palvelun sujuvuus vaikuttavat myös palvelusetelitoiminnan kehittämisessä.

Semantic and fuzzy modelling for human behaviour recognition in smart spaces : a case study on ambient assisted living.

Human activity recognition in everyday environments is a critical, but challenging task in Ambient Intelligence applications to achieve proper Ambient Assisted Living, and key challenges still remain to be dealt with to realize robust methods. One of the major limitations of the Ambient Intelligence systems today is the lack of semantic models of those activities on the environment, so that the system can recognize the speci c activity being performed by the user(s) and act accordingly. In this context, this thesis addresses the general problem of knowledge representation in Smart Spaces. The main objective is to develop knowledge-based models, equipped with semantics to learn, infer and monitor human behaviours in Smart Spaces. Moreover, it is easy to recognize that some aspects of this problem have a high degree of uncertainty, and therefore, the developed models must be equipped with mechanisms to manage this type of information. A fuzzy ontology and a semantic hybrid system are presented to allow modelling and recognition of a set of complex real-life scenarios where vagueness and uncertainty are inherent to the human nature of the users that perform it. The handling of uncertain, incomplete and vague data (i.e., missing sensor readings and activity execution variations, since human behaviour is non-deterministic) is approached for the rst time through a fuzzy ontology validated on real-time settings within a hybrid data-driven and knowledgebased architecture. The semantics of activities, sub-activities and real-time object interaction are taken into consideration. The proposed framework consists of two main modules: the low-level sub-activity recognizer and the high-level activity recognizer. The rst module detects sub-activities (i.e., actions or basic activities) that take input data directly from a depth sensor (Kinect). The main contribution of this thesis tackles the second component of the hybrid system, which lays on top of the previous one, in a superior level of abstraction, and acquires the input data from the rst module's output, and executes ontological inference to provide users, activities and their in uence in the environment, with semantics. This component is thus knowledge-based, and a fuzzy ontology was designed to model the high-level activities. Since activity recognition requires context-awareness and the ability to discriminate among activities in di erent environments, the semantic framework allows for modelling common-sense knowledge in the form of a rule-based system that supports expressions close to natural language in the form of fuzzy linguistic labels. The framework advantages have been evaluated with a challenging and new public dataset, CAD-120, achieving an accuracy of 90.1% and 91.1% respectively for low and high-level activities. This entails an improvement over both, entirely data-driven approaches, and merely ontology-based approaches. As an added value, for the system to be su ciently simple and exible to be managed by non-expert users, and thus, facilitate the transfer of research to industry, a development framework composed by a programming toolbox, a hybrid crisp and fuzzy architecture, and graphical models to represent and con gure human behaviour in Smart Spaces, were developed in order to provide the framework with more usability in the nal application. As a result, human behaviour recognition can help assisting people with special needs such as in healthcare, independent elderly living, in remote rehabilitation monitoring, industrial process guideline control, and many other cases. This thesis shows use cases in these areas.

A conceptual and practical overview of cDNA microarray technology: implications for basic and clinical sciences

cDNA microarray is an innovative technology that facilitates the analysis of the expression of thousands of genes simultaneously. The utilization of this methodology, which is rapidly evolving, requires a combination of expertise from the biological, mathematical and statistical sciences. In this review, we attempt to provide an overview of the principles of cDNA microarray technology, the practical concerns of the analytical processing of the data obtained, the correlation of this methodology with other data analysis methods such as immunohistochemistry in tissue microarrays, and the cDNA microarray application in distinct areas of the basic and clinical sciences.

Usability metric design for prenatal healthcare information system

This work goes through the concept of usability in general and healthcare, especially prenatal healthcare, context. Different frameworks and guidelines used to measure it are considered. A collection of metrics is suggested to be used at a prenatal unit of one Finnish healthcare district. The metrics consist of a set of 12 general measures and a supplementary System Usability Scale questionnaire including a Fun Toolkit Smileyometer. The metrics are tested in real life work situations by observing meetings with patients and presenting the questionnaire for the focus group personnel. A total of 6 focus group patient meetings were observed. This work suggests that in order to get more conclusive data from the metrics the focus groups need to be more involved and observation situations need to be more controlled. Revised metrics consist of the 12 general measures.

cDNA and deduced primary structure of basic phospholipase A2 with neurotoxic activity from the venom secretion of the Crotalus durissus collilineatus rattlesnake

To illustrate the construction of precursor complementary DNAs, we isolated mRNAs from whole venom samples. After reverse transcription polymerase chain reaction (RT-PCR), we amplified the cDNA coding for a neurotoxic protein, phospholipase A2 D49 (PLA2 D49), from the venom of Crotalus durissus collilineatus (Cdc PLA2). The cDNA encoding Cdc PLA2 from whole venom was sequenced. The deduced amino acid sequence of this cDNA has high overall sequence identity with the group II PLA2 protein family. Cdc PLA2 has 14 cysteine residues capable of forming seven disulfide bonds that characterize this group of PLA2 enzymes. Cdc PLA2 was isolated using conventional Sephadex G75 column chromatography and reverse-phase high performance liquid chromatography (RP-HPLC). The molecular mass was estimated using matrix-assisted laser desorption ionization-time-of-flight (MALDI-TOF) mass spectrometry. We tested the neuromuscular blocking activities on chick biventer cervicis neuromuscular tissue. Phylogenetic analysis of Cdc PLA2 showed the existence of two lines of N6-PLA2, denominated F24 and S24. Apparently, the sequences of the New World’s N6-F24-PLA2 are similar to those of the agkistrodotoxin from the Asian genus Gloydius. The sequences of N6-S24-PLA2 are similar to the sequence of trimucrotoxin from the genus Protobothrops, found in the Old World.

Normal skin and hypertrophic scar fibroblasts differentially regulate collagen and fibronectin expression as well as mitochondrial membrane potential in response to basic fibroblast growth factor

Basic fibroblast growth factor (bFGF) regulates skin wound healing; however, the underlying mechanism remains to be defined. In the present study, we determined the effects of bFGF on the regulation of cell growth as well as collagen and fibronectin expression in fibroblasts from normal human skin and from hypertrophic scars. We then explored the involvement of mitochondria in mediating bFGF-inducedeffects on the fibroblasts. We isolated and cultivated normal and hypertrophic scar fibroblasts from tissue biopsies of patients who underwent plastic surgery for repairing hypertrophic scars. The fibroblasts were then treated with different concentrations of bFGF (ranging from 0.1 to 1000 ng/mL). The growth of hypertrophic scar fibroblasts became slower with selective inhibition of type I collagen production after exposure to bFGF. However, type III collagen expression was affected in both normal and hypertrophic scar fibroblasts. Moreover, fibronectin expression in the normal fibroblasts was up-regulated after bFGF treatment. bFGF (1000 ng/mL) also induced mitochondrial depolarization in hypertrophic scar fibroblasts (P < 0.01). The cellular ATP level decreased in hypertrophic scar fibroblasts (P < 0.05), while it increased in the normal fibroblasts following treatment with bFGF (P < 0.01). These data suggest that bFGF has differential effects and mechanisms on fibroblasts of the normal skin and hypertrophic scars, indicating that bFGF may play a role in the early phase of skin wound healing and post-burn scar formation.

Osteogenesis induced in goat bone marrow progenitor cells by recombinant adenovirus coexpressing bone morphogenetic protein 2 and basic fibroblast growth factor

Bone morphogenetic protein 2 (BMP2) and basic fibroblast growth factor (bFGF) have been shown to exhibit a synergistic effect to promote bone repair and healing. In this study, we constructed a novel adenovirus with high coexpression of BMP2 and bFGF and evaluated its effect on osteogenic differentiation of goat bone marrow progenitor cells (BMPCs). Recombinant adenovirus Ad-BMP2-bFGF was constructed by using the T2A sequence. BMPCs were isolated from goats by density gradient centrifugation and adherent cell culture, and were then infected with Ad-BMP2-bFGF or Ad-BMP2. Expression of BMP2 and bFGF was detected by ELISA, and alkaline phosphatase (ALP) activity was detected by an ALP assay kit. In addition, von Kossa staining and immunocytochemical staining of collagen II were performed on BMPCs 21 days after infection. There was a high coexpression of BMP2 and bFGF in BMPCs infected with Ad-BMP2-bFGF. Twenty-one days after infection, ALP activity was significantly higher in BMPCs infected with Ad-BMP2-bFGF than in those infected with Ad-BMP2. Larger and more mineralized calcium nodules, as well as stronger collagen II staining, were observed in BMPCs infected with Ad-BMP2-bFGF than in those infected with Ad-BMP2. In summary, we developed a novel adenovirus vector Ad-BMP2-bFGF for simultaneous high coexpression of BMP2 and bFGF, which could induce BMPCs to differentiate efficiently into osteoblasts.

Bone marrow mesenchymal stem cells overexpressing human basic fibroblast growth factor increase vasculogenesis in ischemic rats

Administration or expression of growth factors, as well as implantation of autologous bone marrow cells, promote in vivo angiogenesis. This study investigated the angiogenic potential of combining both approaches through the allogenic transplantation of bone marrow-derived mesenchymal stem cells (MSCs) expressing human basic fibroblast growth factor (hbFGF). After establishing a hind limb ischemia model in Sprague Dawley rats, the animals were randomly divided into four treatment groups: MSCs expressing green fluorescent protein (GFP-MSC), MSCs expressing hbFGF (hbFGF-MSC), MSC controls, and phosphate-buffered saline (PBS) controls. After 2 weeks, MSC survival and differentiation, hbFGF and vascular endothelial growth factor (VEGF) expression, and microvessel density of ischemic muscles were determined. Stable hbFGF expression was observed in the hbFGF-MSC group after 2 weeks. More hbFGF-MSCs than GFP-MSCs survived and differentiated into vascular endothelial cells (P<0.001); however, their differentiation rates were similar. Moreover, allogenic transplantation of hbFGF-MSCs increased VEGF expression (P=0.008) and microvessel density (P<0.001). Transplantation of hbFGF-expressing MSCs promoted angiogenesis in an in vivo hind limb ischemia model by increasing the survival of transplanted cells that subsequently differentiated into vascular endothelial cells. This study showed the therapeutic potential of combining cell-based therapy with gene therapy to treat ischemic disease.