Rare adverse events associated with oral poliovirus vaccine in Brazil

Oral poliovirus vaccine (OPV) developed by A. Sabin has been effectively used to control poliomyelitis in Brazil, and the last case with the isolation of a wild poliovirus strain occurred in March 1989. Although the vaccine controlled the circulation of wild strains and poliomyelitis cases associated with these strains were not detected during the last eight years, rare cases classified as vaccine-associated paralytic poliomyelitis (VAPP) have been detected. Molecular characterization studies of poliovirus strains isolated from VAPP cases and from healthy contacts have confirmed that the isolates are derived from the Sabin vaccine strains and also detected genomic modifications known or suspected to increase neurovirulence such as mutations and recombination. The molecular characterization of polioviruses isolated during the last eight years from paralysis cases classified as Guillain-Barré (GBS) syndrome and transverse myelitits (TM), and from facial paralysis (FP) cases also confirmed the vaccine origin of the strains and demonstrated mutations known to increase neurovirulence. Analysis of the epidemiologic data of these GBS, TM and FP cases demonstrated that in most of them the last OPV dose was given months or years before the onset of the disease and the isolation of the polioviruses. The temporal association between the isolation of these strains and the GBS, TM and FP suggested that the Sabin vaccine-derived poliovirus strains could also rarely trigger the diseases.

In vitro radioautographic studies of the biodistribution of radiopharmaceuticals on blood elements

In the present study we evaluated the binding of the radiopharmaceuticals sodium pertechnetate (Na 99mTcO4), methylenediphosphonic acid (99mTc-MDP) and glucoheptonate acid (99mTc-GHA) to blood elements using centrifugation and radioautographic techniques. Heparinized blood was incubated with the labelled compounds for 0, 1, 2, 3, 4, 6 and 24 h. Plasma (P) and blood cells (BC) were isolated and precipitated with 5% trichloroacetic acid (TCA), and soluble (SF) and insoluble fractions (IF) were separated. Blood samples were prepared (0 and 24 h) and coated with LM-1 radioautographic emulsions and percent radioactivity (%rad) in P and BC was determined. The binding of Na 99mTcO4 (%rad) to P was 61.2% (0 h) and 46.0% (24 h), and radioautography showed 63.7% (0 h) and 43.3% (24 h). The binding to BC was 38.8% (0 h) and 54.0% (24 h), and radioautography showed 36.3% (0 h) and 56.7% (24 h). 99mTc-MDP study presented 91.1% (0 h) to P and 87.2% (24 h), and radioautography showed 67.9% (0 h) and 67.4% (24 h). The binding to BC was 8.9% (0 h) and 12.8% (24 h), and radioautography showed 32.1% (0 h) and 32.6% (24 h). 99mTc-GHA study was 90.1% (0 h) to P and 79.9% (24 h), and radioautography showed 67.2% (0 h) and 60.1% (24 h). The binding to BC was 9.9% (0 h) and 20.1% (24 h), and radioautography showed 32.8% (0 h) and 39.9% (24 h). The comparison of the obtained results suggests that the binding to plasma and blood cells in the two techniques used (radioautography and centrifugation) is qualitatively in accordance

Development of finite elements for analysis of biomechanical structures using flexible multibody formulations

The absolute nodal coordinate formulation was originally developed for the analysis of structures undergoing large rotations and deformations. This dissertation proposes several enhancements to the absolute nodal coordinate formulation based finite beam and plate elements. The main scientific contribution of this thesis relies on the development of elements based on the absolute nodal coordinate formulation that do not suffer from commonly known numerical locking phenomena. These elements can be used in the future in a number of practical applications, for example, analysis of biomechanical soft tissues. This study presents several higher-order Euler–Bernoulli beam elements, a simple method to alleviate Poisson’s and transverse shear locking in gradient deficient plate elements, and a nearly locking free gradient deficient plate element. The absolute nodal coordinate formulation based gradient deficient plate elements developed in this dissertation describe most of the common numerical locking phenomena encountered in the formulation of a continuum mechanics based description of elastic energy. Thus, with these fairly straightforwardly formulated elements that are comprised only of the position and transverse direction gradient degrees of freedom, the pathologies and remedies for the numerical locking phenomena are presented in a clear and understandable manner. The analysis of the Euler–Bernoulli beam elements developed in this study show that the choice of higher gradient degrees of freedom as nodal degrees of freedom leads to a smoother strain field. This improves the rate of convergence.

Protection of plasmid DNA by a Ginkgo biloba extract from the effects of stannous chloride and the action on the labeling of blood elements with technetium-99m

Ginkgo biloba extract (EGb) is a phytotherapeutic agent used for the treatment of ischemic and neurological disorders. Because the action of this important extract is not fully known, assays using different biological systems need to be performed. Red blood cells (RBC) are labeled with technetium-99m (Tc-99m) and used in nuclear medicine. The labeling depends on a reducing agent, usually stannous chloride (SnCl2). We assessed the effect of different concentrations of EGb on the labeling of blood constituents with Tc-99m, as sodium pertechnetate (3.7 MBq), and on the mobility of a plasmid DNA treated with SnCl2 (1.2 µg/ml) at room temperature. Blood was incubated with EGb before the addition of SnCl2 and Tc-99m. Plasma (P) and RBC were separated and precipitated with trichloroacetic acid, and soluble (SF-P and SF-RBC) and insoluble (IF-P and IF-RBC) fractions were isolated. The plasmid was incubated with Egb, SnCl2 or EGb plus SnCl2 and agarose gel electrophoresis was performed. The gel was stained with ethidium bromide and the DNA bands were visualized by fluorescence in an ultraviolet transilluminator system. EGb decreased the labeling of RBC, IF-P and IF-RBC. The supercoiled form of the plasmid was modified by treatment with SnCl2 and protected by 40 mg/ml EGb. The effect of EGb on the tested systems may be due to its chelating action with the stannous ions and/or pertechnetate or to the capability to generate reactive oxygen species that could oxidize the stannous ion.

The importance of package design to Japanese consumers: The role of visual and informational elements of package design in decision making

The importance of package design as a marketing tool is growing as the competition in retail environment increases. However, there is a lack of studies on how each element of package design affects consumer decisions in different countries. The objective of this thesis is to study the role of package design to Japanese consumers. The research was conducted through an experiment with a sample of 37 Japanese female participants. They were divided into two groups and were given different tasks: one group had to choose a chocolate for themselves, and the other for a group of friends. The participants were presented with 15 different Finnish chocolate boxes to choose from. The qualitative data was gathered through observation and semi-structured interviews. In addition, data from questionnaires was quantified and all the data was triangulated. The empirical results suggest that visual elements strongly affect the decision making of Japanese consumers. Image was the most important element which acted as both, a visual and an informational aspect in the experiment. Informational elements on the other hand have little effect, especially when the context is written in a foreign language. However, informational elements affected participants who were choosing chocolates for a group of friends. A unique finding was the importance of kawaii (cuteness) to Japanese consumers.

Essential regulatory elements for NHE3 gene transcription in renal proximal tubule cells

The objectives of the present study were to identify the cis-elements of the promoter absolutely required for the efficient rat NHE3 gene transcription and to locate positive and negative regulatory elements in the 5’-flanking sequence (5’FS), which might modulate the gene expression in proximal tubules, and to compare this result to those reported for intestinal cell lines. We analyzed the promoter activity of different 5’FS segments of the rat NHE3 gene, in the OKP renal proximal tubule cell line by measuring the activity of the reporter gene luciferase. Because the segment spanning the first 157 bp of 5’FS was the most active it was studied in more detail by sequential deletions, point mutations, and gel shift assays. The essential elements for gene transcription are in the region -85 to -33, where we can identify consensual binding sites for Sp1 and EGR-1, which are relevant to NHE3 gene basal transcription. Although a low level of transcription is still possible when the first 25 bp of the 5’FS are used as promoter, efficient transcription only occurs with 44 bp of 5’FS. There are negative regulatory elements in the segments spanning -1196 to -889 and -467 to -152, and positive enhancers between -889 and -479 bp of 5’FS. Transcription factors in the OKP cell nuclear extract efficiently bound to DNA elements of rat NHE3 promoter as demonstrated by gel shift assays, suggesting a high level of similarity between transcription factors of both species, including Sp1 and EGR-1.

Effect of blanching time on selective mineral elements extraction from the spinach substitute (Tetragonia expansa) commonly used in Brazil

The true spinach (Spinacia oleracea) does not grow well in warm climates and for that reason is not commercialized in Brazil. Instead, a spinach substitute (Tetragonia expansa), originally from New Zealand, is widely used in the country. There is scant information on the mineral profile and none on the soluble mineral fraction of this vegetable. The solubility of a mineral is one of the important factors for its absorption. For this reason, the calcium, magnesium, iron, manganese, copper, zinc, potassium, and sodium soluble fractions in the raw spinach substitute were determined and the effect of blanching times on the solubility of these minerals was investigated. Blanching times of 1, 5, and 15 minutes were employed. The magnesium, manganese, potassium, and sodium soluble fractions increased sizably with shorter blanching time. Longer blanching time (15 minutes) caused large losses of minerals. The soluble mineral fractions can contribute poorly to diet in terms of potassium, magnesium, manganese, and zinc. The spinach substitute cannot be considered a dietary source of calcium, iron and copper due to the insolubility of these minerals in the vegetable, possibly caused by the large oxalate content.

Measuring Effectiveness of Marketing Message: The Role of Verbal, Visual and Brand Elements

The aim of this paper is to study the role of verbal, visual and brand elements while meas-uring effectiveness of marketing message. The thesis is written in the context of mobile gaming industry. The object of the study is marketing message. To achieve the aim, the main research question was formulated: How do the elements of marketing message, such as verbal, visual and brand, affect the consumer’s attitude toward the ad, emotional response and attention capture? The theory development chapter lays on three corner stones – analysis of previous litera-ture on marketing message and its elements, namely verbal, visual and brand; overview of literature on attitude formation and particularly attitude toward the ad. In addition, investiga-tion of key points of emotional response and attention capture literature finalizes the chap-ter. The empirical part consists of experiment, conducted with 27 participants. Experiment includes the self-report semantically anchored scale, measuring the attitude toward the ad, as well as autonomic measures – eye tracking (attention capture) and facial expressions (emotional response). The results of the experiment showed that the size of the brand element – the logo – has an effect on the attention capture and the overall attitude toward the ad. The bigger the logo, the more time people spend viewing it, and they realise the message is more educa-tional and factual. The measure related to the visual element – the visual complexity – in-creases the intensity of participant’s facial expression. While the measure of verbal ele-ment – the contrast between text and background colours – leads to a better attitude to-ward the ad. The higher the contrast between text and background, the more known the message appears to the viewer.

Lauseen aspektin ilmaiseminen suomen kielessä. Tutkimus olla-, tehdä- ja tulla-verbillisistä tekstilauseista käyttökonteksteissaan

Tutkimuksessa tarkastellaan lauseen aspektin ilmaisemista suomen kielessä. Aspektia käsitellään merkityskategoriana, joka osoittaa lauseen kuvaaman asiaintilan ajallisen keston, ja perustavanlaatuisena aspektuaalisena erontekona pidetään rajattuuden ja rajaamattomuuden vastakohtaisuutta. Tutkimuksessa selvitetään, millä perusteella lauseet saavat joko rajatun tai rajaamattoman aspektitulkinnan ja miten konteksti vaikuttaa tähän tulkintaan. Lauseen kontekstina käsitellään kielellistä kontekstia eli tekstiä. Työ on aineistopohjainen tutkimus kirjoitetusta nykysuomesta, ja tarkastelun kohteena on sanomalehtiteksteistä koottu lauseaineisto. Lauseiden pääverbit ovat olla, tehdä ja tulla. Aineistosta on mahdollista esittää sekä kvalitatiivisia että kvantitatiivisia huomioita. Tutkimuksen teoreettisen ja metodologisen taustan muodostavat eräiden kognitiivisen kielitieteen suuntausten kuvauskäsitteet ja -metodit sekä fennistinen aspektin kuvaamisen perinne. Tutkimuksessa tarkastellaan kahta fennistiikassa esitettyä tapaa määritellä lauseen aspektimerkitys ja osoitetaan, että ne ovat toisiaan täydentäviä. Molemmat lähestymistavat huomioon ottamalla on siis mahdollista kuvata lauseen aspektimerkityksen määräytyminen täsmällisemmin kuin vain yhteen kuvaustapaan keskittymällä. Lisäksi osoitetaan, että keskeisinä aspektin ilmaisemisen keinoina pidetyt keston ja toistuvuuden adverbiaalit jäävät aineistossa marginaalisiksi. Ajankohdan adverbiaaleja puolestaan käsitellään aiemmasta tutkimuksesta poiketen rajattuina tarkastelunäkökulmina kuvattuun asiaintilaan, ja ne toimivat tässä tehtävässä liittyessään aspektiltaan rajaamattomiin lauseisiin. Lisäksi tutkimus osoittaa, että aspektin ilmaisemisen kerroksellisuutta voidaan aspektin ilmaisemiseen osallistuvien lauseenjäsenten kerrostumisen ohella tarkastella lausekokonaisuuden eri semanttisten tasojen kerrostumisena. Lausetta laajemman kontekstin vaikutusta aspektitulkintaan ei ole aiemmin tutkittu suomen kielessä. Tutkimus osoittaa, että aspektiltaan monitulkintaisten lauseiden konteksti voi selventää tulkinnan tai mahdollistaa samanaikaisesti vaihtoehtoiset tulkinnat. Lisäksi erilaisten lauseenulkoisten rajan ilmausten avulla on mahdollista osoittaa lauseen aspektin rajattuutta siinä tapauksessa, että lause muutoin ymmärrettäisiin aspektiltaan rajaamattomaksi.

Lipoprotein glomerulopathy: a case report of a rare disease in a brazilian child

Lipoprotein glomerulopathy (LPG) is a rare autosomal recessive glomerulopathy associated with the deposition of lipoprotein thrombi in the capillary lumina due to apoE gene mutations. Abnormal plasma lipoprotein profile and marked increase in serum apoliprotein E (apoE) are characteristic clinical data. The compromised patients can present nephrotic syndrome, hematuria, and progressive renal failure. Herein, the authors present the first described case of LPG in a Brazilian male patient, 11 years, who presented with a steroid-resistant nephrotic syndrome. Renal function was normal. Kidney biopsy showed markedly enlarged glomerulus, with dilated capillary loops and weak eosinophilic lipoprotein thrombi in the capillary lumina. Interstitium, tubules, arteries, and veins showed normal histologic aspect. Genotypic study for the apoE gene showed the presence of the alleles E3 and E4. The diagnosis of LPG was then performed. The patient received lipid-lowering treatment. After 2 years of follow-up, renal function is gradually decreasing, with persisting heavy proteinuria, despite a marked decrease in serum cholesterol and triglycerides levels.

Cat Scratch Disease in kidney transplant receptors: is it a rare or underdiagnosed pathology?

Cat Scratch Disease (CSD) is an infectious disorder which appears after cat scratching particularly in children and adolescents. Bartonella henselae is the etiologic agent more frequently involved. There are only a few recent reports demonstrating the disease after transplantation, although the illness is not infrequent in immunologically competent people. Indeed CSD in transplant receptors has only been recently emphasized in the literature and it was concluded that fever and lymphadenopathy in patients who had been exposed to cats should prompt clinicians to maintain a suspicion for the infection. In this report CSD infecting a renal transplanted adolescent complaining of headache, blurred vision and fever, presenting a cat scratching lesion in the right arm, with a bilateral painful cervical lymphadenopathy was related. He also presented indirect immunofluorescency identifying that the two subtype's titles of Bartonella-henselae and quintana- were elevated. Treatment with doxicicline e rifampicin was introduced and the patient became asymptomatic in about 3 weeks.

Toisen jäte on toisen raaka-aine – Kierrätys ja uudelleenvalmistus taloudellisesti ja ekologisesti kestävänä liiketoimintamahdollisuutena

Toisen jäte on toisen raaka-aine – Kierrätys ja uudelleenvalmistus taloudellisesti ja ekologisesti kestävänä liiketoimintamahdollisuutena Väitöskirjatutkimus tarkastelee kierrätystä ja uudelleenvalmistusta sekä siihen perustuvaa kierrätysliiketoimintaa taloudellisesti ja ekologisesti kestävänä liiketoimintamahdollisuutena. Tässä kestävyys tarkoittaa jätekysymysten ratkaisemista tavalla, joka mahdollistaa kestävän kehityksen periaatteiden mukaisen yhteiskunnan kehittymisen. Jätteisiin liittyvät taloudelliset ja ekolo- giset kysymykset ovat merkittävä yhteiskunnallinen haaste. Tämä luo tarpeen tutkimukselle, jonka lähtökohtana on jätekysymysten moniulotteinen tarkas- telu ja yksittäisen yrityksen toiminnan suhteuttaminen osaksi laajempaa kokonaisuutta. Tässä tutkimuksessa jätteen hyödyntämistä materiaalina lähestytään sekä empiirisesti yrityksen näkökulmasta että teoreettisesti systeemiajattelun tarjoamasta laajemmasta perspektiivistä. Tutkimuksen tavoitteena on ymmär- tää kierrätystä ja uudelleenvalmistusta liiketoimintamahdollisuutena, niiden merkitystä yrityksessä, alueella ja kierrätystaloudessa sekä näiden vuorovai- kutteista suhdetta taloudelliseen ja ekologiseen kestävyyteen nähden. Tutki- muskysymys on tärkeä, koska siihen vastaamalla syvennetään ymmärrystä yrityksissä tapahtuvan kierrätyksen ja uudelleenvalmistuksen merkityksestä kestävämmän yhteiskunnan rakentumisessa. Tutkimuksen teoriaperusta pohjautuu teollisen ekologian kirjallisuuteen ja ekoteollisen kehityksen tutkimukseen. Kierrätysliiketoiminnan kestävyyden tarkastelu rakentuu tutkimuksessa teollisen ekologian ja ekoteollisen kehityk- sen lähtökohtana olevaan win-win-ajatteluun, jonka mukaan hyvä ympäristö- suorituskyky ja hyvä taloudellinen suorituskyky voivat vahvistaa toisiaan. Kierrätysliiketoiminnan teoreettisessa tarkastelussa keskeisiä elementtejä ovat kierrätystalouden malli, teollisen ekologian alueelliset systeemit, ekoteolliset verkostot ja yrityksen rooli teollista ekologiaa soveltavana toimijana. Tutki- muksen keskeisenä kontribuutiona on yritysnäkökulman integroiminen aiem- paa vahvemmin osaksi teollisen ekologian diskursseja. Kierrätysliiketoiminnan taloudelliseen ja ekologiseen kannattavuuteen ja sen myötä kestävyyteen liittyviä kysymyksiä on lähestytty tekemällä yritys- haastatteluja ja hyödyntämällä valmista haastatteluaineistoa. Tutkimusta varten haastattelin 10 kierrätysliiketoimintaa harjoittavaa yritystä vuosina 2007 ja 2008. Tämän lisäksi tutkimuksessa on hyödynnetty Turun ammatti- korkeakoulun ja Turku Science Parkin toteuttamassa RESU-hankkeessa (Kierrätysliiketoiminta ja resurssitehokkuus Varsinais-Suomen vahvuudeksi – RESU) vuosina 2013 ja 2014 kerättyä aineistoa. Hankkeessa haastateltiin yhteensä 25 jätemateriaalia hyödyntävää ja/tai tuottavaa yritystä. Aineistojen analysointimenetelmänä on sisällönanalyysi. Analyysin tulok- sena muodostettiin yhteensä viisi pääteemaa ja 12 alateemaa. Teemat kuvaavat kierrätysliiketoimintaa aiempaa moniulotteisemmin ja näin syventävät ymmär- rystä ilmiön merkityksestä kestävämmän yhteiskunnan rakentumisessa. Teolli- sen ekologian alaan kuuluvat kvalitatiiviset tutkimukset ovat melko harvinai- sia, joten tämän väitöstutkimuksen ilmeisenä vahvuutena on laadullisen tutkimusmenetelmän hyödyntäminen. Tutkimuksen tuloksena voidaan todeta, että kierrätystalouden kehittymistä edistävä kierrätysliiketoiminta on monimuotoista ja sisältää erilaisia liiketoi- mintamahdollisuuksia sekä arvoketjuja. Paikallistuntemus ja keskeinen sijainti jätemateriaalien tuottajien suhteen on tärkeä kriteeri kierrätysliiketoiminnassa, mutta jätemateriaaleja myös kuljetetaan pitkiä matkoja. Paikallisia tai alueelli- sia jätevirtoja hyödyntävä kierrätysliiketoiminta voi tukea alueellista kestä- vyyttä, mutta toisinaan myös keskitetty hyödyntäminen voi olla kestävä vaih- toehto. Yhteistyöverkostot ovat tärkeitä jätemateriaalin laadun ja saatavuuden näkökulmasta. Tutkimus osoittaa, että kierrätysliiketoimintaa harjoittavat yritykset ovat samalla sekä kierrätystalouden käytännön toimeenpanijoita että uuden toimintakulttuurin luojia. Tutkimuksen tulosten perusteella voidaan esittää johtopäätös, että kierrä- tysliiketoiminta on taloudellisesti ja ekologisesti kannattava liiketoimintamah- dollisuus. Win-win-ratkaisut eivät kuitenkaan takaa kierrätysliiketoiminnan kestävyyttä. Kierrätysliiketoiminnan kestävyyden arvioiminen edellyttää laajaa perspektiiviä ja toiminnan vaikutusten suhteuttamista mittakaavaan, ajalliseen ulottuvuuteen, interventioon ja sosiaalisiin kysymyksiin. Teolliseen ekologiaan perustuva kierrätysliiketoiminta luo mahdollisuuksia edistää kestävyyttä, joten tällä perusteella kierrätystä ja uudelleenvalmistusta voidaan pitää kestävänä liiketoimintamahdollisuutena. Avainsanat: kierrätysliiketoiminta, kierrätys, uudelleenvalmistus, systeemiajattelu, teollinen ekologia, ekoteollinen kehitys, kierrätystalous, win-win-ajattelu, kestävyys One company's waste is another's raw material –Recycling and remanufacturing as an economically and environmentally sustainable business opportunity The thesis investigates whether product recycling and remanufacturing can serve as a business opportunity that is economically and ecologically sustaina- ble. In this effort, my idea is to contribute to solving the waste issue in a manner that makes it possible to strive toward sustainable societal develop- ment. The economic and ecological questions associated with waste flows are a significant challenge. The complexity of the issue requires a multidimen- sional approach in which the operation of an individual company is viewed in the context of the larger societal system. In this thesis waste utilization as a resource with value is considered both from an empirical perspective on the firm as well as from a more general viewpoint offered by systems analysis. The objective of the thesis is to under- stand recycling and remanufacturing as a business opportunity. The thesis considers the meaning of recycling and remanufacturing for a single company, for the region the company is located and for the recycling economy. The objective of this study is important for it enhances the understanding of the product recycling and remanufacturing processes that take place within busi- ness organizations and how these processes affect societal sustainable development. The theoretical basis arises from industrial ecology and from the literature on eco-industrial development. The business-economic win-win situation and this vision serve as the basic position from which recycling business is inves- tigated in the thesis. In the theoretical discussion, key elements are recycling economy model, regional and local industrial ecosystems, eco-industrial networks and the role of a company as an actor that applies industrial ecology in practice. The main contribution of this study lies in integrating the company perspective more strongly into the industrial ecology discourses. The recycling business has been studied by conducting interviews in companies and by secondary analysis of an existing interview material. During 2007 and 2008 I made 10 interviews in companies that are active in recycling business. In addition, I used interview material gathered for the project “Recycling business and resource efficiency as the strength of Southwest Finland” (RESU) by Turku University of Applied Sciences and Turku Science Park during the period 2013–2014. This data covers altogether 25 businesses that either utilize and/or produce waste materials. The data has been analyzed using the content analysis method. This process led to the development of 5 main themes and 12 sub-themes. These themes describe the recycling business multi-dimensionally and thus understanding of the phenomenon and its role in building a sustainable society are substantially deepened in this research. In the field of industrial ecology qualitative studies are relatively rare and therefore the qualitative research approach is an evident strength of the thesis. The results show that the recycling business activity supporting recycling economy has diverse dimensions including various business opportunities and diverse value chains. The results show that for waste producers it is important to know the local situational factors and to have a central geographical location. Waste materials are, however, transported over long distances as well. The study indicates that local waste flow utilization can support regional sustainability, while occasionally a more centralized utilization can be sustain- able. Collaboration networks are important to secure the quality and availabil- ity of utilizable waste materials. The thesis demonstrates that the companies practicing recycling business serve simultaneously as actors that implement recycling economy and enhance a new operation culture within the business community. The overall conclusion of the thesis argues that recycling business is a business opportunity that can support both an economically and environmen- tally viable business operation. However, win-win solutions do not secure the sustainability of recycling business. The sustainability evaluation of recycling business requires a holistic systems perspective. The actions undertaken need to be considered with changing spatial and temporal system boundaries, societal intervention and placed in the context of relevant societal issues. Industrial ecology -based recycling business creates opportunities for sustain- ability and thus recycling and remanufacturing present an opportunity for sustainable business. Keywords: Recycling business; Recycling; Remanufacturing, Systems thinking; Industrial ecology; Eco-industrial development; Recycling Economy; Win-Win thinking; Sustainability

Critical elements underpinning the emergence of the medical game ecosystem: gamifying traumatic brain injury rehabilitation in Finland

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.

Viable Health Games: Elements for Success

The main purpose of this study is to identify the elements of children's health games that have a positive impact on children’s health. The investigation is done by evaluating previous health game studies concentrating on children and five health affairs (such as asthma, cancer, diabetes, nutrition and obesity). In order to do so, firstly the topic of children’s health games is explained through its roots, as it is an interdisciplinary topic pertinent with many other fields. For this reason, the topics regarding the children’s health games as games, video games, children’s gameplay, and serious games along with health, relevant health affairs, and health promotion were covered. Secondly, the meta-study was conducted with the 56 articles on children’s health games. These 56 articles were analyzed with the coding technique defined by Charmaz’s Grounded Theory Method (Charmaz, 2006) for finding out which elements of children’s health games have a positive impact on children’s health promotion. The main result suggests that, although there are 24 different elements found and listed which all positive in their nature, their positive impact is a matter of how they are used or implemented through the consumption cycle of children’s health games and how all these elements interact with each other. In addition to this, a pragmatic proposal is formulated for possibly better or more successful health games. The study concludes with the declaration of the limitations encountered through the research and the recommendations for future research.