Infecção urinária na gravidez: análise dos métodos para diagnóstico e do tratamento

Objetivos: avaliar os aspectos diagnósticos, terapêuticos e as complicações dos casos de infecção do trato urinário (ITU) sintomática durante a gestação, que necessitaram de internação hospitalar. Métodos: foram incluídas 136 grávidas com diagnóstico clínico de pielonefrite. Foram avaliados: a idade e paridade da paciente, idade gestacional em que foi feito o diagnóstico, antecedentes de importância epidemiológica, propedêutica laboratorial para avaliação da infecção urinária, tratamento e evolução clínica, antimicrobianoprofilaxia e complicações. Resultados: pielonefrite foi diagnosticada, nas mesmas proporções, em todas as idades gestacionais. Houve maior incidência de ITU entre as primigestas. Apenas 29,3% das gestantes apresentaram história prévia de ITU. Observou-se que 57,0% das pacientes apresentaram anemia e 93,0% mostraram análise urinária alterada. A Escherichia coli foi o uropatógeno mais prevalente (75,8% dos casos), com baixos percentuais de sensibilidade à ampicilina (60,6%) e à cefalotina (63,6%) e altos percentuais de sensibilidade à cefuroxima (95,5%). A maior taxa de melhora clínica foi obtida entre as gestantes tratadas com cefuroxima (95,7%). A antimicrobianoprofilaxia foi necessária em 11,0% das pacientes. O trabalho de parto pré-termo ocorreu em 33,3% das gestantes que deram à luz em nosso serviço, e o parto pré-termo em 18,9%. Conclusões: esses resultados reforçam a necessidade do diagnóstico precoce e tratamento efetivo da ITU em gestantes, a fim de evitar a ocorrência freqüente de complicações perinatais, como o trabalho de parto e o parto pré-termo. Destaca-se a necessidade de avaliação periódica do padrão de sensibilidade dos agentes etiológicos prevalentes aos antimicrobianos de uso permitido durante a gestação, adotando-se a cefuroxima como o antimicrobiano de escolha para o tratamento das ITU na gestação.

Infecção urinária na gravidez

Vários fatores tornam a infecção do trato urinário (ITU) uma relevante complicação do período gestacional, agravando tanto o prognóstico materno quanto o prognóstico perinatal. Durante muitos anos, a gravidez foi vista como fator predisponente a todas as formas de ITU. Hoje, sabe-se que ela, como evento isolado, não é responsável por maior incidência de ITU; as mudanças anatômicas e fisiológicas impostas ao trato urinário pela gravidez predispõem à transformação de mulheres bacteriúricas assintomáticas (BA) em gestantes com ITU sintomáticas. A BA acomete entre 2 e 10% de todas as gestantes, das quais aproximadamente 30% desenvolverão pielonefrite, se não tratadas adequadamente. No entanto, observa-se incompreensível resistência dos pré-natalistas à identificação da BA neste período. Seu diagnóstico é microbiológico e baseia-se em duas uroculturas apresentando mais que 10(5) colônias/mL de urina, identificando-se o mesmo germe. Seu tratamento é facilitado, visto que pode ser baseado no antibiograma, não havendo fundamentação científica de que o pré-estabelecimento de esquemas terapêuticos seja uma medida adequada. Para o tratamento da pielonefrite, não é possível aguardar o resultado da cultura e o conhecimento prévio do perfil de resistência dos antibacterianos disponíveis para uso em gestantes seria a melhor medida. Outra variável importante é utilizar um antibiótico bactericida, endovenoso na fase aguda da infecção e com possibilidades de ser administrado via oral após a melhora clínica da paciente, em seu domicílio. Em nosso meio, a droga que melhor atende a todas estas demandas é a cefuroxima, utilizada por um período de 10-14 dias. As cefalosporinas de terceira geração não existem na forma oral, carreando o inconveniente de tratamento parenteral em sua totalidade. Em decorrência dos efeitos colaterais, considera-se inadequado o uso de aminoglicosídeos em gestantes. Apesar das inconsistentes insinuações de contra-indicações das quinolonas monofluoradas, havendo indicação, acredita-se que a norfloxacina possa ser uma boa opção à cefuroxima. Para os casos em que a profilaxia da ITU está indicada, preferem-se os quimioterápicos, entre eles a nitrofurantoína, com o cuidado de evitar seu uso no final da gravidez pelo risco de kernicterus no neonato.

Measuring the performance of corporate events : an empirical study of measuring practices in Finnish companies

Corporate events as an effective part of marketing communications strategy seem to be underestimated in Finnish companies. In the rest of the Europe and the USA, investments in events are increasing, and their share of the marketing budget is significant. The growth of the industry may be explained by the numerous advantages and opportunities that events provide for attendees, such as face-to-face marketing, enhancing corporate image, building relationships, increasing sales, and gathering information. In order to maximize these benefits and return on investment, specific measurement strategies are required, yet there seems to exist a lack of understanding of how event performance should be perceived or evaluated. To address this research gap, this research attempts to describe the perceptions of and strategies for evaluating corporate event performance in the Finnish events industry. First, corporate events are discussed in terms of definitions and characteristics, typologies, and their role in marketing communications. Second, different theories on evaluating corporate event performance are presented and analyzed. Third, a conceptual model is presented based on the literature review, which serves as a basis for the empirical research conducted as an online questionnaire. The empirical findings are to a great extent in line with the existing literature, suggesting that there remains a lack of understanding corporate event performance evaluation, and challenges arise in determining appropriate measurement procedures for it. Setting clear objectives for events is a significant aspect of the evaluation process, since the outcomes of events are usually evaluated against the preset objectives. The respondent companies utilize many of the individual techniques that were recognized in theory, such as calculating the number of sales leads and delegates. However, some of the measurement tools may require further investments and resources, thus restricting their application especially in smaller companies. In addition, there seems to be a lack of knowledge of the most appropriate methods in different contexts, which take into account the characteristics of the organizing party as well as the size and nature of the event. The lack of inhouse expertise enhances the need for third-party service-providers in solving problems of corporate event measurement.

Käytäntölähtöinen innovaatiotoiminta – Kaakkois-Suomen peliteollisuus

Tiede innovaatioiden synnyttäjänä on nykyisin ennemminkin oletus kuin totuus, ja monet innovaatiot syntyvät käytäntölähtöisten toimintojen kautta. Diplomityön päätavoitteena on määrittää käytäntölähtöinen innovaatiotoiminta. Tutkimus on toteutettu laadullisena case-tutkimuksena. Tutkimuksessa on haastateltu seitsemää pelinkehitysyritystä liittyen yritysten innovaatioprosesseihin ja käytäntölähtöiseen innovaatiotoimintaan. Lisäksi tutkimuksessa on haastateltu neljää voittoa tavoittelemattoman organisaation edustajaa Kymenlaakson innovaatiojärjestelmän nykytilasta. Teoriaosassa käydään läpi käytäntölähtöisen innovaation nykyisiä määritelmiä ja niihin liittyviä käsitteitä. Empiriaosassa esitetään haastatteluilla kerätyn aineiston analyysin perusteella tehdyt johtopäätökset. Teoria- ja empiriaosien avulla määritetään käytäntölähtöinen innovaatiotoiminta. Johtopäätöksissä määritetään käytäntölähtöisten innovaatioiden syntymekanismit ja lähteet. Lisäksi esitetään alueellisen innovaatiojärjestelmän asema käytäntölähtöisten innovaatioiden edistämisessä.

Hitsauksen lämpökäsittelyn vaikutus CrMo - terästen mekaanisiin ominaisuuksiin

Diplomityössä selvitettiin lujuusomaisuuksien muuttumista toimitustilassa olevilla ja hitsatuilla The American Society of Mechanical Engineering (ASME) SA335 P22 ja P5 teräksillä, kun hitsauksen lämpökäsittelylämpötila oli suurempi kuin materiaalin valmistuksen aikainen päästölämpötila. Diplomityön perusteella ei pystytä yksiselitteisesti todentamaan tai kumoamaan standardeissa ASME SA335: 2008a, ASME B31.3: 2010 ja SFS-EN 13445: 2009 esitettyjä varoituksia materiaalien mekaanisten ominaisuuksien huononemisesta, jos hitsien jälkilämpökäsittely ylittää materiaalien päästölämpötilan. Veto-, kovuus- ja iskukoetestitulosten perusteella todennettiin kuitenkin, ettei lämpökäsittely lämpötila-alueella 710–760 oC vaikuta suuresti materiaalien mekaanisiin ominaisuuksiin. Tuloksien perusteella todettiin myös, että koemateriaalivalikoima ja tehdyt testisarjat olivat suppeahkoja tarkkojen hankinta- ja valmistuskriteerien määrittämiseksi.

DEVELOPING A CROWDSOURCED VIDEOGRAPHIC RESEARCH METHOD FOR CONSUMER CULTURE RESEARCH

The purpose of this study is to develop a crowdsourced videographic research method for consumer culture research. Videography provides opportunities for expressing contextual and culturally embedded relations. Thus, developing new ways to conduct videographic research is meaningful. This study develops the crowdsourced videographic method based on a literature review and evaluation of a focal study. The literature review follows a qualitative systematic review process. Through the literature review, based on different methodological, crowdsourcing and consumer research related literature, this study defines the method, its application process and evaluation criteria. Furthermore, the evaluation of the focal study, where the method was applied, completes the study. This study applies professional review with self-evaluation as a form of evaluation, drawing from secondary data including research task description, screenshots of the mobile application used in the focal study, videos collected from the participants, and self-evaluation by the author. The focal study is analyzed according to its suitability to consumer culture research, research process and quality. Definitions and descriptions of the research method, its process and quality criteria form the theoretical contribution of this study. Evaluating the focal study using these definitions underlines some best practices of this type of research, generating the practical contribution of this study. Finally, this study provides ideas for future research. First, defining the boundaries of the use of crowdsourcing in various parts of conducting research. Second, improving the method by applying it to new research contexts. Third, testing how changes in one dimension of the crowdsourcing models interact with other dimension. Fourth, comparing the quality criteria applied in this study to various other quality criteria to improve the method’s usefulness. Overall, this study represents a starting point for further development of the crowdsourced videographic research method.

Kiinteistönvälittäjän tiedonantovelvollisuus käytetyn asunnon kaupassa

Tutkielman tarkoituksena on selvittää kiinteistövälittäjän tiedonantovelvollisuuden laajuus käytetyn asunnon kaupassa. Tutkielma noudattaa lainopillista tutkimusmenetelmää ja sen perustan muodostaa kiinteistönvälitystä ja asuntokauppaa sääntelevä lainsäädäntö ja sen tulkinta. Tarkemmat rajaukset kiinteistönvälittäjän tiedonantovelvollisuudelle sekä tukea lain tulkinnalle haetaan aihetta käsittelevistä korkeimman oikeuden ennakkopäätöksistä ja oikeuskirjallisuudesta. Ennakkopäätösten sekä kuluttajariitalautakunnan ratkaisujen läpikäynti ja tulkinta muodostavat tutkimuksen ytimen. Tutkimus osoittaa, että kiinteistönvälittäjän tiedonantovelvollisuuteen vaikuttaa monta tekijää kussakin yksittäisessä asuntokaupassa, jolloin tiedonantovelvollisuuden täyttäminen on monisyinen ja tulkinnanvarainen seikka. Laki ei siis anna tyhjentävää vastausta kiinteistönvälittäjän tiedonantovelvollisuudesta, vaan se on kokonaisuus, joka täytyy arvioida voimassa olevan lain sekä ennakkopäätösten linjausten valossa.

Precisão da tira reagente e do exame microscópico da urina no diagnóstico de infecções do trato urinário em porcas

O diagnóstico de infecção do trato urinário (ITU) em porcas geralmente é feito com o auxílio de tiras reagentes, por ser um método rápido, prático e passível de ser realizado na própria granja. O exame microscópico da urina raramente é utilizado em granjas por ser uma técnica mais demorada e trabalhosa. No entanto, não existem estudos sobre a precisão destas duas técnicas no diagnóstico de ITU nesta espécie. O objetivo deste estudo foi avaliar a precisão da tira reagente e do exame microscópico da urina no diagnóstico de ITU em porcas, comparando-os com o exame bacteriológico da urina. Para selecionar as porcas que iriam compor o estudo foi realizado um exame químico prévio com tira reagente, do qual foram selecionadas 139 porcas, 66 positivas para nitrito na tira reagente e 73 negativas. No dia seguinte foi realizada uma nova coleta de urina destas 139 porcas para realização da urinálise completa, que incluiu os exames físico, químico, microscópico e microbiológico destas amostras de urina. Os resultados demonstraram que a prova de nitrito da tira reagente apresentou 100% de especificidade e 93% de sensibilidade. A especificidade do exame microscópico para bacteriúria foi de 82% e a sensibilidade de 100%. O diagnóstico de ITU com o uso de tiras reagentes e/ou com exame microscópico da urina é confiável, quando comparado com o exame bacteriológico da urina, o que torna possível o diagnóstico rápido de ITU em porcas na granja.

Estimating Attractor Dimension on the Nonlinear Pendulum Time Series

Chaotic dynamical systems exhibit trajectories in their phase space that converges to a strange attractor. The strangeness of the chaotic attractor is associated with its dimension in which instance it is described by a noninteger dimension. This contribution presents an overview of the main definitions of dimension discussing their evaluation from time series employing the correlation and the generalized dimension. The investigation is applied to the nonlinear pendulum where signals are generated by numerical integration of the mathematical model, selecting a single variable of the system as a time series. In order to simulate experimental data sets, a random noise is introduced in the time series. State space reconstruction and the determination of attractor dimensions are carried out regarding periodic and chaotic signals. Results obtained from time series analyses are compared with a reference value obtained from the analysis of mathematical model, estimating noise sensitivity. This procedure allows one to identify the best techniques to be applied in the analysis of experimental data.

Liiketoimintamallit huonekalujen uudelleenkäytön edistämiseksi

Tässä kandidaatintyössä tutustutaan eri liiketoimintamallien määritelmiin sekä huonekalukaupan malleihin ja näiden kautta kehitellään mahdollisia ratkaisuja sille, voisiko kierrätysmateriaaleista valmistettuja designhuonekaluja myydä Suomessa.

Osaamisen johtaminen ja kehittäminen asiantuntijaorganisaatiossa - case Itä-Suomen yliopiston opinto- ja opetuspalvelut

Tutkielman tavoitteena on luoda kokonaisvaltainen kuvaus osaamisen johtamisesta ja kehittämisestä tutkielman kohdeorganisaatiossa. Lisäksi halutaan selvittää, millaista osaamista kohdeorganisaatiosta löytyy ja mikä motivoi asiantuntijoita oman osaamisen kehittämiseen. Teoreettinen tarkastelu pohjautuu kolmeen keskeiseen käsitteeseen: osaamiseen, osaamisen johtamiseen ja osaamisen kehittämiseen. Kirjallisuuskatsauksessa pyritään myös selkeyttämään näiden käsitteiden määritelmien kirjavaa kenttää. Tutkimus toteutettiin kvalitatiivisena tapaustutkimuksena. Empiirinen aineisto kerättiin sähköisten kyselylomakkeiden avulla. Tutkielman kohdeorganisaatio on kokenut muutama vuosi sitten suuren organisaatiorakenteen muutoksen, mikä on tuonut omat haasteensa osaamisen johtamiseen ja toisaalta korostanut sen tärkeyttä. Tutkimuksen tulokset osoittavat, että kohdeorganisaatiossa on vahvaa monialaista osaamista ja oman osaamisen kehittämiseen motivoituneita työntekijöitä. Kuitenkin useimmilla osaamisen kehittäminen jää päivittäisten työtehtävien varjoon, joten kouluttautumiselle ja työssä oppimiselle toivottiin lisää mahdollisuuksia.

Productivity and Services – Safety Telephone Services for the Elderly

Previous research on productivity is often associated with manufacturing or uses manufacturing definitions of productivity. Marketing research on services has not been satisfied with the manufacturing definitions. No universal definition for service productivity exists. The lack of a universal definition highlights the complexity entailed in the concept of productivity. The objective of this study was to investigate service productivity in situations, where traditional ways are in some cases even not possible or are not enough. In one definition of the productivity of service organisations there is the efficiency of the organisation on the input side and on the output side the customers’ perceived quality or value-in-use. To learn about value-in-use, many methods have been developed. A common practice is to make customer opinion surveys in the form of customer questionnaires and interviews. However, customers cannot always be asked directly, for example, because of impaired cognitive abilities. Such cases include the elderly and children. Furthermore, customer opinion surveys are time consuming. In addition, customers do not always know what kind of services they would benefit from. For the empirical part of the study, a business area was identified where traditional ways of measuring value-in-use are difficult or in some cases even not possible. This business area is safety telephone services. These services are most often used by the elderly. The way to define value-in-use here was to assess how well the services offered met customer expectations. Comparing the services customers asked for and the services provided to them indicated whether customer expectations were met. This study showed that customers had their ideas concerning the contents of the services but many times the services provided did not meet these expectations. Organisational efficiency aspirations can decrease customers’ value-in-use. This study found a solution, in which increasing organisational efficiency would go hand-in-hand with increasing customers’ value-in-use; the result being that the organisations’ needs and the service users’ expectations were in line. Value creation for customers produced organisational efficiency and thus increased productivity. In this study, customer expectations were observed by means of wellness technology. With the help of modern technology, customer expectations can be followed quickly and easily and customers can co-create with the organisation. This type of an approach could be useful even in the development of other services for other ages and in different contexts. If a service organisation decreases the number of personnel and, at the same time, tries to offer services to the same or a larger clientele, customers easily notice the change, which is often negative. To avoid harmful decrease in value-in-use, limitations to the aspiration of efficiency should be implemented – one of such is that the organisation is required to meet certain quality standards defined by experts. The aim is to secure that, as a result of efficiency aspirations in the organisation, the quality of the service offerings does not diminish below mutually agreed standards. Traditionally, when productivity in services has been estimated, organisational efficiency has not been combined with both customer expectations and an expert assessment of quality. This study contributes with novel thinking entitled ‘Relationship Management of the Elderly’. This study handles productivity, expert defined quality and value-in-use in an organisational context, which is practically untouched in previous research studies.

Modelling flexible asset management in industrial maintenance companies and networks

The tightening competition and increasing dynamism have created an emerging need for flexible asset management. This means that the changes of market demand should be responded to with adjustments in the amount of assets tied to the balance sheets of companies. On the other hand, industrial maintenance has recently experienced drastic changes, which have led to an increase in the number of maintenance networks (consisting of customer companies that buy maintenance services, as well as various supplier companies) and inter-organizational partnerships. However, the research on maintenance networks has not followed the changes in the industry. Instead, there is a growing need for new ways of collaboration between partnering companies to enhance the competitiveness of the whole maintenance network. In addition, it is more and more common for companies to pursue lean operations in their businesses. This thesis shows how flexible asset management can increase the profitability of maintenance companies and networks under dynamic operating conditions, and how the additional value can then be shared between the network partners. Firstly, I have conducted a systematic literature review to identify what kind of requirements for asset management models are set by the increasing dynamism. Then I have responded to these requirements by constructing an analytical model for flexible asset management, linking asset management to the profitability and financial state of a company. The thesis uses the model to show how flexible asset management can increase profitability in maintenance companies and networks, and how the created value can be shared in the networks to reach a win-win situation. The research indicates that the existing models for asset management are heterogeneous by nature due to the various definitions of ‘asset management’. I conclude that there is a need for practical asset management models which address assets comprehensively with an inter-organizational, strategic view. The comprehensive perspective, taking all kinds of asset types into account, is needed to integrate the research on asset management with the strategic management of companies and networks. I will show that maintenance companies can improve their profitability by increasing the flexibility of their assets. In maintenance networks, reorganizing the ownership of the assets among the different network partners can create additional value. Finally, I will introduce flexible asset management contracts for maintenance networks. These contracts address the value sharing related to reorganizing the ownership of assets according to the principles of win-win situations.

Enseigner l'interculturel dans le supérieur: quels discours et approches d'un concept ambigu à l'heure de l'internationalisation? Le cas de la Finlande

L‘interculturel est un concept souvent partagé mais rarement défini dans la recherche alors que ses compréhensions, interprétations et applications sont variées, ce qui mène à des malentendus et des positionnements épistémologiques et méthodologiques ambigus. En parallèle, de nombreuses critiques et propositions de réorientations de la notion voient le jour. Nous entendons faire le point sur la notion et son intégration potentielle dans l‘enseignement de la communication interculturelle (ECI). Notre étude se base sur l‘analyse de six groupes focalisés d‘enseignants (-chercheurs) impliqués dans l‘enseignement de l‘interculturel du niveau supérieur en Finlande, pays du nord de l‘Europe. Nous avons recours aux paradigmes postmodernes et aux sciences du langage (analyse du discours inspirée d‘auteurs français, et plus particulièrement de l‘école française de la deuxième génération (les théories de l‘énonciation (Kerbrat-Orecchioni, 2002 ; Marnette, 2005) et une approche du dialogisme inspirée par Bakhtine (1977))). Ces méthodes permettent de mettre en avant la complexité identitaire en posant l‘hétérogénéité du discours comme principe, c‘est-à-dire qu‘elles considèrent que tout discours inclut la « voix » de l‘autre. Repérer la présence de ces voix dans les discours des enseignants/chercheurs nous a permis de démontrer comment celles-ci participaient à la construction de leur identité pendant l‘interaction. Nous avons pu observer comment les relations entre ces interactions verbales donnaient lieu à des instabilités (contradictions, omissions), dont l‘étude nous a aidée à déduire leur(s) façon(s) de concevoir l‘interculturel. Les discours analysés révèlent a) que la définition de l‘interculturel est partagée sans être perçue de la même manière et b) que les différentes représentations du concept peuvent varier dans le discours d‘un même enseignant, mettant en évidences des contradictions qui posent problème s‘il s‘agit de communiquer un savoir-être aux apprenants. Nous nous sommes efforcée de trouver la place d‘un interculturel renouvelé parmi ces discours et de dissocier l‘image de l‘éducation interculturelle qui est promue en Finlande de ce qui est proposé en réalité : les changements actuels semblent avoir un minimum d‘impact sur la façon dont les enseignants traitent l‘interculturel. Nous nous demandons alors comment l‘Etat finlandais peut promouvoir un enseignement interculturel cohérent sans proposer aux enseignants/chercheurs une formation qui leur permettrait de reconnaitre les diverses diversités impliquées par l‘interculturel. Mots clés : Communication interculturelle, diversité, culture, enseignement supérieur finlandais.

Ristikkorakenteisen hihnakuljetinsillan mitoitustyökalun kehittäminen

Hihnakuljettimia käytetään muun muassa voimalaitos- ja sellutehdasympäristöissä kuljettamaan kiinteää polttoainetta tai haketta pitkiä matkoja. Pitkät hihnakuljettimet asennetaan yleensä teräsristikoista rakennettujen kuljetinsiltojen sisään. Kuljetinsilta toimii siis hihnakuljettimen ja hoitokäytävän runkona sekä suojaa kuljetinta ja kuljetettavaa materiaalia säältä. Tässä diplomityössä on laadittu mitoitustyökalu, jolla voidaan nopeasti mitoittaa ristikkorakenteisen hihnakuljetinsillan sauvat sekä määrittää rakenteen massa. Laskentaohjelma on toteutettu Microsoft Excel -taulukkolaskentana. Sillan poikkileikkaus voi olla suljettu symmetrinen umpirakenne tai avorakenne, jossa on ulokkeellinen hoitotaso. Ristikon sauvat ovat RHS-putkia. Rakenteeseen voi vaikuttaa jatkuvia kuormia, pistekuormia sekä näistä johdetut, ekvivalenttiin staattiseen voimaan perustuvat maanjäristyskuormat. Diplomityössä on perehdytty mitoitustyökalussa sovellettuihin teorioihin. Voimasuureiden laskenta perustuu 2-tukisina palkkeina käsiteltävien siltalohkojen ratkaisuun ja palkkianalogiaan, jossa ristikon sauvavoimat ratkaistaan käsittelemällä ristikkoa palkkina. Sauvojen kestävyyden laskenta perustuu SFS-EN 1993-1-1 -normiin, joka on osa Eurocode -rakennesuunnittelunormistoa. Lisäksi työssä on käsitelty ristikkoliitosten mitoitusta SFS-EN 1993-1-8 mukaan. Mitoitusohjelman toimivuutta on testattu tarkastelemalla esimerkkisiltaa laaditulla mitoituspohjalla ja Autodesk Robot Professional 2013 -FE-analyysiohjelmisuolla. Tulosten perusteella mitoitustyökalua voidaan käyttää ainakin tarjousvaiheen nopeisiin tarkasteluihin ja omamassan määritykseen, mutta myös lopulliseen mitoitukseen, mikäli hyväksytään konservatiivinen mitoitus.