Retirada de fasciola hepatica da via biliar principal por coledocoscopia

The authors present a rare case of hepatic fascioliasis in a female patient 53-years-old, coming from the rural zone of Rio Grande do Sul, a southern State from Brazil. She has presented with biliary colic, fluctuant jaundice and eosinophilia. Abdominal ultrasound has shown a dilated biliary tree with inside heterogeneous images. At surgery we have found inside the biliary tree several Fasciola hepatica, which have been pulled out with the choledocoscope. We have proceeded with biliodigestive anastomosis using the small intestine. The patient remains asymptomatic six months after surgical procedure. Small intestine. The patient remains asymptomatic six months after surgical procedure.

Variação anatômica da artéria torácica interna lateral: relato de caso

The objective of this report was to describe a variation in the origin of the lateral internal thoracic artery (LITA), a variable large-caliber artery in the thoracic wall. This report presents a case in which a trunk coming from the subclavian artery (SCA) bifurcates and gives origin to the LITA and internal thoracic artery (ITA). This case demonstrates an unusual bilateral origin for the LITA, which emerges together with the ITA rather than directly from the SCA, as could be expected. Although such presentation is uncommon, the possibility that it could be damaged during surgical interventions such as thoracotomy and pleural drainage justifies our report .

Leda förändring genom relationer, processer och kultur

Forskningens syfte var att bidra med en ny kunskapssyntes om vad det innebär att leda förändring ur ett vårdvetenskapligt perspektiv. Vårdledaren har, speciellt vid större förändringar inom organisationen, en stor betydelse för hur vårdandet förvaltas genom att hålla den vårdande traditionen levande och genom formningen av den vårdande kulturen och vårdgemenskapen. Den övergripande hermeneutiska forskningsansatsen med tillämpning av metodologisk triangulering har influerats av Gadamers, Ricoeurs och Ödmans syn på hermeneutik med förståelse och förklaring som kompletterar varandra. Forskningens övergripande frågeställning ”Vad innebär det att leda förändring ur ett vårdvetenskapligt perspektiv?” förankrades i de fyra underliggande frågeställningarna. Den första frågeställningen berörde meningsinnehållet i begreppet förändring samt dess gestaltning. Metoden var en hermeneutisk begreppsbestämning på en ontologisk och kontextuell nivå enligt Koorts metod för begreppsbestämning. Genom en personalenkät undersöktes personalens åsikter (totalt 597 personer) om den kommande fusionen och förändringen samt deras förväntningar på ledarna under förändringsprocessen för att få svar på vad förutsättningarna var för en förändring eller förändringsprocess med avsedda mål och effekter. Svaret på hur vårdledaren och dennes uppgifter gestaltades vid en förändring samt hur vårdledarna uppfattade förändring och den kommande förändringsprocessen erhölls genom djupintervjuer med vårdledare (17). Av resultatet framgår att vårdledaren leder förändring genom att leda relationer, processer och kultur och genom ett stödjande, reflekterande och kulturbärande ledarskap med syftet att åstadkomma en verklig och hållbar förändring. För att åstadkomma en verklig och hållbar förändring, dvs. en inre omgestaltning och omdaning som vardande, förutsätts dock att både tankemönster och handlanden förändras. Riktningen och insatserna för förändringen skall ha sin grund i en tydlig och meningsfull målsättning och vision utgående från en gemensam värdegrund. En arena för dialog borde utvecklas så att förändringens liksom även vårdandets vision och mission förankras och utvecklas till handling och förändring. Vårdledarens primära uppgift eller mission var att tillhandahålla varje individuell patient en god vård. Den primära missionen var med andra ord att med ansvarsfullhet tjäna vårdandet sak utgående från ett etiskt förhållningssätt. I tjänande av vårdandets sak fanns dock en tillit till att förändringen gagnar patienten och hans eller hennes vård, men vårdledarnas anpassning till förändringen var utan djupare engagemang. Vårdledarna kände även en oro för sitt uppdrag som vårdledare, vårdarbetets ställning och mandatet som patientens advokat. Vårdledaren är också en kulturbärare, vilket innebär att även kulturen har betydelse under en förändringsprocess. Genom att leda kulturen skapar vårdledaren en öppen, bekräftande och evidensbaserad atmosfär med centrala värderingar som ger uttryck för den rådande andan och kulturen.

Monte Carlo Hypothesis Testing with The Sharpe Ratio

The purpose of this master thesis was to perform simulations that involve use of random number while testing hypotheses especially on two samples populations being compared weather by their means, variances or Sharpe ratios. Specifically, we simulated some well known distributions by Matlab and check out the accuracy of an hypothesis testing. Furthermore, we went deeper and check what could happen once the bootstrapping method as described by Effrons is applied on the simulated data. In addition to that, one well known RobustSharpe hypothesis testing stated in the paper of Ledoit and Wolf was applied to measure the statistical significance performance between two investment founds basing on testing weather there is a statistically significant difference between their Sharpe Ratios or not. We collected many literatures about our topic and perform by Matlab many simulated random numbers as possible to put out our purpose; As results we come out with a good understanding that testing are not always accurate; for instance while testing weather two normal distributed random vectors come from the same normal distribution. The Jacque-Berra test for normality showed that for the normal random vector r1 and r2, only 94,7% and 95,7% respectively are coming from normal distribution in contrast 5,3% and 4,3% failed to shown the truth already known; but when we introduce the bootstrapping methods by Effrons while estimating pvalues where the hypothesis decision is based, the accuracy of the test was 100% successful. From the above results the reports showed that bootstrapping methods while testing or estimating some statistics should always considered because at most cases the outcome are accurate and errors are minimized in the computation. Also the RobustSharpe test which is known to use one of the bootstrapping methods, studentised one, were applied first on different simulated data including distribution of many kind and different shape secondly, on real data, Hedge and Mutual funds. The test performed quite well to agree with the existence of statistical significance difference between their Sharpe ratios as described in the paper of Ledoit andWolf.

Suomen metsäteollisuuden päästökehitys vuoteen 2020

Metsäteollisuudessa on käynnissä rakennemuutos, joka tuo haasteita toimialan ympäristöasioiden hallintaan sekä ympäristölupia myöntävän ja valvovan viranomaisen toimintaan. Lähivuosina tulee myös runsaasti voimaan uutta lainsäädäntöä, joka vaikuttaa metsäteollisuuden ympäristöasioiden hallintaan. Tämän työn tarkoituksena oli arvioida Suomen kemiallisen metsäteollisuuden päästökehitystä vuoteen 2020 huomioiden metsäteollisuuden uusi tuotanto sekä lähivuosina voimaan tuleva ympäristölainsäädäntö, erityisesti päivitettävänä oleva massa- ja paperiteollisuuden BREF-asiakirja. Päästökehitystä arvioitiin viiden skenaarion avulla. Vesistöpäästöjen osalta tarkasteltiin COD- ja AOX-päästöjä sekä typpi- ja fosforipäästöjä, ja ilmapäästöjen osalta sellun tuotannon rikki- ja typpioksidi- sekä hiukkaspäästöjä. Massan- ja paperintuotannon oletettiin pysyvän muutaman prosentin nykyistä tasoa korkeammalla tasolla. Uuden tuotannon osalta kahdessa skenaariossa huomioitiin nestemäisten biopolttoaineiden tuotanto kolmella laitoksella, yhteensä 600 000 t/a. Päästölaskennassa käytettiin päivitettävänä olevan massa- ja paperiteollisuuden BREF-asiakirjan BAT-päätelmissä annettuja luonnoksia uusista päästötasoista. Skenaarioiden pohjalta havaittiin, että massa- ja paperiteollisuuden BAT-päätelmien mukaiset päästötasot eivät tuo merkittäviä muutoksia metsäteollisuuden vesistöpäästöihin vuoteen 2020 mennessä. Biojalosteiden tuotannon vaikutus vesistöpäästöihin todettiin myös hyvin vähäiseksi. Sen sijaan ilmaan johdettavat päästöt pienenevät huomattavasti: hiukkaspäästöt vähenivät 42–50 prosenttia uusien päästötasojen myötä. Biojalosteiden tuotannon vaikutus oli myös merkittävämpi kuin ilmapäästöihin kuin vesistöpäästöihin. Prosentuaalisesti eniten biojalostus lisäsi rikkidioksidipäästöjä.

Sparrows (Passer domesticus L.) as intermediary hosts of Toxoplasma gondii in poultry farms from the "agreste" region of Pernambuco, Brazil

This paper aimed to identify Toxoplasma gondii infection in house sparrows (Passer domesticus, Linneaus 1758) coming from poultry farms in the "agreste" region of the Brazilian state of Pernambuco. 151 sparrows (Passer domesticus) captured in eight broiler, egg layer and commercial laying poultry farms, were used. Indirect hemagglutination test was used to research anti-T. gondii antibodies. Animals that presented titration of 1:16 were destined to DNA research through Polymerase Chain Reaction (PCR) technique, followed by Nested-PCR. It was observed that, from 151 analyzed samples. 91 (60.3%) were reagents and 60 (39.7%) were not reagents. It was verified, through analysis of the distribution of infected animals frequency per farm, that in only one farm (12.5%) no animal reagent to T. gondii was captured. It was also observed that three (30.00%) of the ten samples destined to DNA research for T. gondii were positive to PCR and four (40.00%) were positive to Nested-PCR. Anti-T gondii antibodies occurrence and the molecular identification of the agent confirmed natural T. gondii infection in sparrows from poultry farms in Brazil. Other studies must be carried out to highlight the real importance of these animals in the epidemiological chain and their efficiency in the transmission of the parasite to felines. Therefore, researches that use parasite isolation and molecular techniques to determine genomic profile of the agent present in these poultry farms are needed.

Konversiosähköauton mitoitussuunnitelma

Sähköautojen tulemista on odotettu jo pitkään ja ne ovat potentiaalisia fossiilisilla polttoaineilla toimivien polttomoottoreiden korvaajia. Hybridiautoja on tullut markkinoille entistä enemmän ja ne osaltaan auttavat vähentämään fossiilisten polttoaineiden käyttöä. Sähköautot ovat toistaiseksi jääneet taka-alalle. Tässä työssä on tehty konversiosähköauton mitoitussuunnitelma museoikäiseen autoon. Työssä on mitoitettu kolme sähköisen voimansiirron pääkomponenttia sähkömoottori, taajuudenmuuttaja ja akusto. Mitoitussuunnitelma toimii hyvänä pohjana, jonka avulla konversiota voidaan alkaa rakentamaan.

Professional sports and gambling regulation in Finland - Examining the institutional factors of gambling affecting professional sport clubs in Finland

This study examines how to institutional environment of gambling is currently in motion both in Europe and Finland. Furthermore, it examines the criticism by Finnish professional sport clubs directed towards the national gambling monopolies, especially Veikkaus Oy. This criticism addresses the acclaimed issue of low or non-existing sponsorship funds coming to the clubs despite the clubs’ duties to promote Veikkaus Oy in their stadiums etc. In essence the main research objective was to examine the interaction and institutional environments of both Finnish professional sport clubs and gambling regulation. This was done through three sub-objectives: 1) to analyze professional sport as business and its institutional environment 2) to analyze the institutions of gambling in their current state and their potential future 3) to evaluate the potential impact of an institutional change in gambling legislation to the professional sport clubs The findings from Finland were then compared to those of Denmark where an institutional change had occurred in gambling regulation. Empirical data was collected through multiple interviews. Interviewees represented sport clubs (7), sport association (1), sport league (1), Finnish monopoly representatives (2), commercial gambling providers (1), Danish monopoly system representatives (1), Danish sport club (1). In addition a vast amount of secondary data (e.g. Green and white books by EU, court decisions, a variety of studies etc.). Theoretically this study combines the aspects of institutional theory with the theory of professional sports as business. This proved to be a rather new approach and no published literature was found to have done specifically this. The findings of this study are twofold, on the European level it is clear that the momentum if towards a more liberated gambling market while Finland is at the moment trying to go the opposite direction and uphold its monopoly. From the sport club’s level the findings suggest that currently sport clubs do not directly benefit from the funds originated from Veikkaus Oy as these funds are more or less used on the association/league levels. However, the clubs themselves are also lacking in self-criticism as they are lacking in clear sponsorship packages/programs which Veikkaus Oy might be interested in participating. If liberation of the gambling market would occur it is highly possible that that the largest clubs in football and ice-hockey would be the main beneficiaries while smaller clubs and sports could possibly be worse off than currently. These interpretations were well supported by the findings from Denmark.

Lean, Six Sigma ja Total Welding Management hitsaavassa verkostossa

Diplomityössä tarkastellaan hitsaavan verkoston laadunhallintaa ja siinä ilmeneviä erilaisia ongelmakohtia. Tämän lisäksi työssä tarkastellaan kolmen eri laatutyökalun Lean, Six Sigma ja Total Welding Management soveltamista hitsaavan verkoston laadunhallinnassa. Teoriaosassa käsitellään sekä yleisesti että hitsauksen osalta laatua ja laadunhallintaa, sekä edellä mainittuja laatutyökaluja. Tutkimusosaan tietoja hitsaavista verkostoista kerättiin kaikkiaan kolmesta eri verkostosta. Näiden kerättyjen tietojen pohjalta tarkasteltiin valittujen laatutyökalujen soveltuvuutta verkostomaiseen käyttöön. Verkostoitunut toiminta aiheuttaa monia uusia haasteita yritysten laadunhallinnalle verrattuna yksittäisiin hitsaaviin yrityksiin. Suurimpia tutkimuksessa havaittuja ongelmakohtia ovat suunnittelun ja valmistuksen yhteistyön erilaiset puutteet, laatutasoon ja sen varmistukseen liittyvät asiat, sekä verkoston sisälle syntyvä niin sanottu hiljainen tieto ja sen häviäminen. Tutkimuksen tarkastelujen perusteella havaittiin, että kaikkien tutkimukseen valitun kolmen laatutyökalun soveltaminen myös verkostomaisessa toiminnassa on mahdollista, mutta se vaatii huomattavasti suurempaa työpanosta kuin soveltaminen yksittäisessä yrityksessä. Myös näiden kaikkien kolmen työkalun yhtä aikainen käyttö on mahdollista. Juuri oikean työkalun valitseminen kullekin hitsaavalle verkostolle vaatii tarkkaa perehtymistä verkostoon ja sen tilanteeseen.

Historia sovittelun forumina

Kirjallisuusarvostelu

Deregulation’s Impact on the Railway Freight Transport Sector’s Future in the Baltic Sea Region

The European transport market has confronted several changes during the last decade. Due to European Union legislative mandates, the railway freight market was deregulated in 2007. The market followed the trend started by other transport modes as well as other previously regulated industries such as banking, telecommunications and energy. Globally, the first country to deregulate the railway freight market was the United States, with the introduction of the Staggers Rail Act in 1980. Some European countries decided to follow suit already before regulation was mandated; among the forerunners were the United Kingdom, Sweden and Germany. The previous research has concentrated only on these countries, which has provided an interesting research gap for this thesis. The Baltic Sea Region consists of countries with different kinds of liberalization paths, including Sweden and Germany, which have been on the frontline, whereas Lithuania and Finland have only one active railway undertaking, the incumbent. The transport market of the European Union is facing further challenges in the near future, due to the Sulphur Directive, oil dependency and the changing structure of European rail networks. In order to improve the accessibility of this peripheral area, further action is required. This research focuses on topics such as the progression of deregulation, barriers to entry, country-specific features, cooperation and internationalization. Based on the research results, it can be stated that the Baltic Sea Region’s railway freight market is expected to change in the future. Further private railway undertakings are anticipated, and these would change the market structure. The realization of European Union’s plans to increase the improved rail network to cover the Baltic States is strongly hoped for, and railway freight market counterparts inside and among countries are starting to enhance their level of cooperation. The Baltic Sea Region countries have several special national characteristics which influence the market and should be taken into account when companies evaluate possible market entry actions. According to thesis interviews, the Swedish market has a strong level of cooperation in the form of an old-boy network, and is supported by a positive attitude of the incumbent towards the private railway undertakings. This has facilitated the entry process of newcomers, and currently the market has numerous operating railway undertakings. A contrary example was found from Poland, where the incumbent sent old rolling stock to the scrap yard rather than sell it to private railway undertakings. The importance of personal relations is highlighted in Russia, followed by the railway market’s strong political bond with politics. Nonetheless, some barriers to entry are shared by the Baltic Sea Region, the main ones being acquisition of rolling stock, bureaucracy and needed investments. The railway freight market is internationalizing, which is perceived via several alliances as well as the increased number of mergers and acquisitions. After deregulation, markets seem to increase the number of railway undertakings at a rather fast pace, but with the passage of time, the larger operators tend to acquire smaller ones. Therefore, it is expected that in a decade’s time, the number of railway undertakings will start to decrease in the deregulation pioneer countries, while the ones coming from behind might still experience an increase. The Russian market is expected to be totally liberalized, and further alliances between the Russian Railways and European railway undertakings are expected to occur. The Baltic Sea Region’s railway freight market is anticipated to improve, and, based on the interviewees’ comments, attract more cargoes from road to rail.

Excelling in procurement : IT Contract Management with Lean and Six Sigma. Case study on legacy contract management at Philips Global IT.

Few people see both opportunities and threats coming from IT legacy in current world. On one hand, effective legacy management can bring substantial hard savings and smooth transition to the desired future state. On the other hand, its mismanagement contributes to serious operational business risks, as old systems are not as reliable as it is required by the business users. This thesis offers one perspective of dealing with IT legacy – through effective contract management, as a component towards achieving Procurement Excellence in IT, thus bridging IT delivery departments, IT procurement, business units, and suppliers. It developed a model for assessing the impact of improvements on contract management process and set of tools and advices with regards to analysis and improvement actions. The thesis conducted case study to present and justify the implementation of Lean Six Sigma in IT legacy contract management environment. Lean Six Sigma proved to be successful and this thesis presents and discusses all the steps necessary, and pitfalls to avoid, to achieve breakthrough improvement in IT contract management process performance. For the IT legacy contract management process two improvements require special attention and can be easily copied to any organization. First is the issue of diluted contract ownership that stops all the improvements, as people do not know who is responsible for performing those actions. Second is the contract management performance evaluation tool, which can be used for monitoring, identifying outlying contracts and opportunities for improvements in the process. The study resulted in a valuable insight on the benefits of applying Lean Six Sigma to improve IT legacy contract management, as well as on how Lean Six Sigma can be applied in IT environment. Managerial implications are discussed. It is concluded that the use of data-driven Lean Six Sigma methodology for improving the existing IT contract management processes is a significant addition to the existing best practices in contract management.

Verkostoinvestointien optimointi uuden sähkömarkkinalain ympäristössä

Vuonna 2013 uudistunut sähkömarkkinalaki toi sähköverkkoyhtiöille velvoitteen parantaa sähkönjakeluverkkojensa toimintavarmuutta suurhäiriötilanteissa. Toimenpiteet tämän velvoitteen täyttämiseksi näkyvät merkittävinä verkostoinvestointeina. Diplomityössä tarkastellaan uudistuneen sähkömarkkinalain tuomia vaikutuksia Imatran Seudun Sähkön jakeluverkkoa koskeviin verkostoinvestointeihin. Päätavoitteena on selvittää, millaisia toimenpiteitä uuden sähköntoimitusvarmuustason vaatimusten täyttämiseksi tarvitaan ja mitkä ovat optimaaliset ratkaisut näiden toimenpiteiden toteuttamiseksi. Uudella sähköntoimitusvarmuustasolla on vaikutusta jakeluverkon rakennemuutoksiin tulevien 15 vuoden aikana, mutta näiden rakennemuutosten vaikutukset kantavat useiden kymmenien vuosien päähän.

Tuulivoimalan lapojen huolto ja tarkastukset

Uusiutuva energia elää voimakasta kasvukautta ja hallituksen tekemien tukipäätösten vuoksi tuulivoimaa tullaan rakentamaan huomattavasti lisää tulevien vuosien aikana. Tuuligeneraattorin siipien huolto- ja tarkastustoiminta on uusi ja kehittyvä toimiala. Tämä diplomityö onkin tehty oppaaksi helpottamaan tuulivoimaa omistavien, rakentavien, tai tuulivoimapuiston perustamista harkitsevien tahojen huoltosuunnitelmien tekemistä varten. Diplomityössä käydään läpi yleisimmät tuulivoimaloiden lapojen vikaantu-miset, sekä työskentelytavat ja käytettävät laitteistot voimaloiden lapojen huoltoja ja tarkastuksia tehtäessä.

The role of potassium in the corrosion of superheater materials in boilers firing biomass

Inhibition of global warming has become one of the major goals for the coming decades. A key strategy is to replace fossil fuels with more sustainable fuels, which has generated growing interest in the use of waste-derived fuels and of biomass fuels. However, from the chemical point of view, biomass is an inhomogeneous fuel, usually with a high concentration of water and considerable amounts of potassium and chlorine, all of which are known to affect the durability of superheater tubes. To slow down or reduce corrosion, power plants using biomass as fuel have been forced to operate at lower steam temperatures as compared to fossil fuel power plants. This reduces power production efficiency: every 10°C rise in the steam temperature results in an approximate increase of 2% in power production efficiency. More efficient ways to prevent corrosion are needed so that power plants using biomass and waste-derived fuels can operate at higher steam temperatures. The aim of this work was to shed more light on the alkali-induced corrosion of superheater steels at elevated temperatures, focusing on potassium chloride, the alkali salt most frequently encountered in biomass combustion, and on potassium carbonate, another potassium salt occasionally found in fly ash. The mechanisms of the reactions between various corrosive compounds and steels were investigated. Based on the results, the potassium-induced accelerated oxidation of chromia protected steels appears to occur in two consecutive stages. In the first, the protective chromium oxide layer is destroyed through a reaction with potassium leading to the formation of intermediates such as potassium chromate (K2CrO4) and depleting the chromium in the protective oxide layer. As the chromium is depleted, chromium from the bulk steel diffuses into the oxide layer to replenish it. In this stage, the ability of the material to withstand corrosion depends on the chromium content (which affects how long it takes the chromium in the oxide layer to be depleted) and on external factors such as temperature (which affects how fast the chromium diffuses into the protective oxide from the bulk steel). For accelerated oxidation to continue, the presence of chloride appears to be essential.