Trombose mesentérica como complicação da colecistectomia videolaparoscópica

Intestinal complications after laparoscopic cholecystectomy are rare and usually caused by direct injury sustained on trocar insertion. However, intestinal ischaemia has been reported as an unusual complication of the pneumoperitoneum. We describe a 55-years-old patient who underwent an uneventful laparoscopic cholecystectomy after an episode of acute cholecystitis. Initial recovery was complicated by development of increasing abdominal pain which led to open laparotomy on day 2. Gangrene of the distal ileum and right-sided colon was detected and small bowel resection with right colectomy and primary anastomosis was performed. Histological examination of the resected ileum showed features of venous hemorragic infarction and trombosis. In view of the proximity of the operation it is assumed that ileal ischaemia was precipitated by carbon dioxide pneumoperitoneum. Some studies have been demonstrated that, within 30 minutes of establishing a pneumoperitoneum at an intraabdominal pressure of 16 mmHg, cardiac output, blood flow in the superior mesenteric artery and portal vein decrease progressively. Carbon dioxide pneumoperitoneum may lead to mechanical compression of the splanchnic veins and mesenteric vasoconstriction as a result of carbon dioxide absortion. The distribution of the ischaemic segment of intestine is also unusual as the most precarious blood supply is traditionally at the splenic flexure of the colon. It has been suggested that intermittent decompression of the abdomen reduces the risk of mesenteric ischaemia during penumoperitoneum especially in patients with predisposing clinical features for arteriosclerosis intestinal. In present patient was observed intestinal venous infarction what remains unclear but we think the carbon dioxide pneumoperitoneum have been related to it.

Leiomiossarcoma de jejuno

We describe a case of leiomyosarcoma of the jejunum in which abdominal computed tomography showed an intestinal tumor with a "sui generis" metalic artefact inside, which made us think of a benign disease (foreign body granuloma), because the patient lived in the rural area and he had a manioc flour mill, which is one the basic foods of the majority of the population of the north in Brazil. Because of the aspect of the tumor, we decided on a large scale resection, considering the possibility of a malignant tumor since we don't have frozen sections. This assured us of an adequate treatment for the tumor. This type of pathology should be remembered even though it only accounts for 0,2-2% of the intestinal tract tumors.

Ympäristö säätelee ja muokkaa nuorten etnisiä asenteita

Tuuli Anna Mähösen väitöskirja What should I think, how should I feel? : the balancing of personal experiences and social norms in the outgroup attitude formation of youth (Helsingin yliopisto 2011).

Fraud detection in the banking sector : a multi-agent approach

Fraud is an increasing phenomenon as shown in many surveys carried out by leading international consulting companies in the last years. Despite the evolution of electronic payments and hacking techniques there is still a strong human component in fraud schemes. Conflict of interest in particular is the main contributing factor to the success of internal fraud. In such cases anomaly detection tools are not always the best instruments, since the fraud schemes are based on faking documents in a context dominated by lack of controls, and the perpetrators are those ones who should control possible irregularities. In the banking sector audit team experts can count only on their experience, whistle blowing and the reports sent by their inspectors. The Fraud Interactive Decision Expert System (FIDES), which is the core of this research, is a multi-agent system built to support auditors in evaluating suspicious behaviours and to speed up the evaluation process in order to detect or prevent fraud schemes. The system combines Think-map, Delphi method and Attack trees and it has been built around audit team experts and their needs. The output of FIDES is an attack tree, a tree-based diagram to ”systematically categorize the different ways in which a system can be attacked”. Once the attack tree is built, auditors can choose the path they perceive as more suitable and decide whether or not to start the investigation. The system is meant for use in the future to retrieve old cases in order to match them with new ones and find similarities. The retrieving features of the system will be useful to simplify the risk management phase, since similar countermeasures adopted for past cases might be useful for present ones. Even though FIDES has been built with the banking sector in mind, it can be applied in all those organisations, like insurance companies or public organizations, where anti-fraud activity is based on a central anti-fraud unit and a reporting system.

Nuorten kokemien elämysten yksilölliset ja yhteisölliset merkitykset

Tutkimuksessa tarkastellaan nuorten antamia merkityksiä elämykseksi nimetylle kokemukselle ja tunteelle. Tavoitteena on ollut selvittää elämysten kokemista nuorten näkökulmasta ja suhteuttaa nuorten kokemuksilleen antamia merkityksiä laajemmin nuoruutta ja elämyksien kokemista käsittelevään yhteiskunnalliseen keskusteluun. Elämysten merkityksellistämistä analysoidaan suhteessa identiteetin muodostukseen. Yksilöllisesti koetut elämykset saavat merkityksensä diskursiivisesti rakentuneen todellisuuden ympäröimänä. Tutkimus paikantuu sosiologisen nuorisotutkimuksen ja tunteiden tutkimuksen alaan sekä metodologisesti fenomenologis-konstruktivistisen tutkimuksen alaan. Tutkimuksen taustalla on elämyshakuisuutta käsittelevä teoria. Elämyshakuisuuden tulkinta fenomenologisesta viitekehyksestä tuo käsitteen ymmärtämiseen uuden ulottuvuuden. Elämyshakuisuus kuvaa asennoitumistapaa eli sitä, miten yksilö orientoituu ympäröivään maailmaan. Tällöin ei edellytetä intentionaalisten tekojen tietoista luonnetta. Toiminnalliset prosessit muovautuvat vuorovaikutuksen myötä samaan tapaan kuin ihminen ruumiillisena subjektina muovautuu. Tutkimuksen aineisto koostuu lukion ensimmäisen luokan oppilaiden kirjoituksista (519 kpl), lastensuojeluinstituutioissa ja kuntoutuskeskuksissa asuvien nuorten yksilöteemahaastatteluista (16 nuorta) sekä seikkailualan asiantuntijoiden teemahaastatteluista (20 aikuista). Nuorten kirjoitukset on kerätty vuosina 1996–1997 ja 2002–2003. Aineiston analyysi on aineistolähtöinen. Erilaiset osa-aineistot työssäni avaavat erilaisia näkökulmia elämysten kokemiseen. Aineistojen analyysi ja tutkimukset teoreettiset lähtökohdat ovat rakentuneet analyysin edetessä ja vuorovaikutussuhteessa toisiinsa. Nuorten elämyksiä käsittelevä kerronta on moninaista ja elämyksiä koetaan erilaisissa tilanteissa. Elämykselle ei ole yhtä määritelmää, kokemisen paikkaan tai kokemisen syytä vaan kokemuksen merkitys rakentuu tilanteisesti. Elämys kuitenkin erottuu muista kokemuksista sen muistettavuuden, ainutlaatuisuuden, uutuuden ja intensiivisyyden perusteella. Nuorten elämyksellisissä hetkissä korostuvat harrastusten yhteydessä koetut uudet, erilaiset, yhteisöllisesti jaetut, mutta myös maailmaa nuorille avaavat itsenäisyyden tunnetta ja hallintaa tuottavat kokemukset. Yksi merkittävä uusia elämyksiä ja tietoa tuottava asia nuorten elämässä on seurustelu. Myös matkailu, erilaiset retket ja leirit olivat nuorille elämyksiä tuottavia tilanteita. Kaikilla nuorilla ei kuitenkaan ole sellaisia harrastuksia, joihin he olisivat sitoutuneita tai joissa he pääsisivät ilmaisemaan itseään ja kokemaan onnistumista. Nuorten elämyksiä käsittelevissä hetkissä nuorten vapaa-ajan toiminta, ympäristö ja sosiaaliset suhteet ovat keskeisessä asemassa. Nuoret eivät ensisijaisesti ajatelleet itse etsivänsä tai toisten nuorten etsivän elämyksiä viihdeteollisuuden tuottamista asioista. Elämyksissä arvostettiin aitoutta ja koettu tunne määritti sitä, oliko jokin koettu elämyksenä vai ei. Toisaalta erilaisten päihteiden todettiin mahdollisesti tuottavan elämyksiä, mutta niidenkin yhteydessä korostettiin usein muita asioita kokemusta rakentavina. Nuorten elämyskokemuksissa toisten nuorten merkitys, luottamus, läheisyyteen ja hyväksyntään liittyvät kokemukset korostuvat. Myös aikuisten asiantuntijoiden omaa nuoruutta käsittelevät elämykset olivat emotionaaliselta merkitykseltään hyvin samanlaisia kuin tämän päivän nuorten esittämät. Elämyksiksi miellettyjä kokemuksia pidettiin arvokkaina. Niiden uskottiin suuntaavan yksilön toimintaa.

The Effects of Service Quality, Customer Satisfaction and Customer Perceived Value on Behavioral Intentions

The intent of this research was to develop a model that describes the extent to which customer behavioral intentions are influenced by service quality, customer satisfaction and customer perceived value in the business-to-business service context. Research on customer behavioral intentions is quite fragmented and no generalized model has been presented. Thus, there was need for empirical testing. This study builds on the services marketing theory and assesses the relationships between the identified constructs. The data for the empirical analysis was collected via a quantitative online survey and a total of 226 usable responses were obtained for further analysis. The model was tested in an employment agency service setting. The measures used in this survey were first assessed by using confirmatory factor analysis (CFA) after which the hypothesized relationships were further verified using structural equation modeling (SEM) in LISREL 8.80. The analysis identified that customer satisfaction played a pivotal role in the model as it was the only direct antecedent of customer behavioral intentions, however, customer perceived value showed a strong indirect impact on buying intentions via customer satisfaction. In contrast to what was hypothesized, service quality and customer perceived value did not have a direct positive effect on behavioral intentions. Also, a contradicting finding with current literature was that sacrifice was argued to have a direct but positive impact on customer perceived value. Based on the findings in this study, managers should carefully think of their service strategies that lead to their customers’ favorable behavioral intentions.

Riskienhallinnan huomioiminen tilintarkastusasiakkaan hyväksymisprosessissa - kokemuksia suurista tilintarkastusyhteisöistä

Tämän tutkimuksen tarkoituksena on selvittää, miten riskienhallinnan näkökulma on huomioitu Suomessa toimivien suurten tilintarkastusyhteisöjen asiakashyväksyntäprosesseissa. Asiakashyväksyntä on tilintarkastusprosessin ensimmäinen vaihe. Tutkimuksen tiedonhankinnan strategiana käytettiin teemahaastattelua ja tutkimuksessa haastateltiin kolmea asiakashyväksynnän näkökulmasta eri rooleissa toimivaa tilintarkastajaa. Kirjallisuuskatsauksessa perehdytään sekä tilintarkastusprosessiin että riskienhallintaan liittyvään kirjallisuuteen. Tutkimuksen tuloksena todettiin, että tutkitut tilintarkastusyhteisöt ovat kehittäneet ja formalisoineet asiakashyväksyntäprosessejaan jatkuvasti riskienhallintanäkökulman huomioiden. Automatisoidut tietojärjestelmät ovat nousseet yhä merkittävämpään rooliin ja myös asiakashyväksyntään liittyvää päätöksentekopolkua on mietitty ja uudistettu. Tutkimuksen tuloksena vahvistui näkemys siitä, että aiemmissa tutkimuksissa esitetty toimeksiantoriskin käsite kuvaa myös suomalaisten tilintarkastajien asiakashyväksyntävaiheessa tekemiä riskiarvioita. Merkittävimpinä pidettiin erilaisia tilintarkastusyhteisön maineeseen vaikuttavia riskitekijöitä sekä asiakkaan henkilökysymyksiin liittyviä seikkoja. Tilintarkastajien todettiin tarkastelevan sekä riskin negatiivisia puolia että myös siihen liittyviä positiivisia mahdollisuuksia. Varsinaisia aktiivisia riskienhallinnan toimenpiteitä tärkeämmäksi koettiin se, että asiakkaaseen liittyvät riskit kartoitetaan ja arvioidaan asianmukaisesti. Asiakashyväksynnän merkityksestä riskienhallinnassa voidaan todeta, että sitä pidettiin niin sanottuna ensimmäisenä suojamuurina, jonka avulla voidaan pyrkiä suojautumaan erityisesti sellaisia riskejä vastaan, joihin ei enää myöhemmässä vaiheessa voida tilintarkastustoimenpiteillä vaikuttaa. Tällöin liian korkeariskiset asiakkaat jätetään hyväksymättä - ei niinkään pyritä suunnittelemaan riskiä alentavia toimenpiteitä, joiden avulla asiakas voitaisiin hyväksyä.

Litteratur och livskunskap : modersmålslärarens berättelse om undervisningen i årkurs 7-9

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The consequences of e-HRM on line managers

The purpose of this research was to provide a deeper insight into the consequences of electronic human resource management (e-HRM) for line managers. The consequences are viewed as used information system (IS) potentials pertaining to the moderate voluntaristic category of consequences. Due to the need to contextualize the research and draw on line managers’ personal experiences, a qualitative approach in a case study setting was selected. The empirical part of the research is loosely based on literature on HRM and e-HRM and it was conducted in an industrial private sector company. In this thesis, method triangulation was utilized, as nine semi-structured interviews, conducted in a European setting, created the main method for data collection and analysis. Other complementary data such as HRM documentation and statistics of e-HRM system usage were utilized as background information to help to put the results into context. E-HRM has partly been taken into use in the case study company. Line managers tend to use e-HRM when a particular task requires it, but they are not familiar with all the features and possibilities which e-HRM has to offer. The advantages of e-HRM are in line with the company’s goals. The advantages are e.g. an transparency of data, process consistency, and having an efficient and easy-to-use tool at one’s disposal. However, several unintended, even contradictory, and mainly negative outcomes can also be identified, such as over-complicated processes, in-security in use of the tool, and the lack of co-operation with HR professionals. The use of e-HRM and managers’ perceptions regarding e-HRM affect the way in which managers perceive the consequences of e-HRM on their work. Overall, the consequences of e-HRM are divergent, even contradictory. The managers who considered e-HRM mostly beneficial to their work found that e-HRM affects their work by providing information and increasing efficiency. Those managers who mostly perceived challenges in e-HRM did not think that e-HRM had affected their role or their work. Even though the perceptions regarding e-HRM and its consequences might reflect the strategies, the distribution of work, and the ways of working in all HRM in general and can’t be generalized as such, this research contributed to the field of e-HRM and it provides new perspectives to e-HRM in the case study organization and in the academic field in general.

Accounting for competition, governance and accountability during institutional change in not-for-profit and public sector organisations

Purpose The aim of this thesis1 is to analyse theoretically how institutionalisation of competitive tendering2, governance and budgetary policies cannot be taken for granted to lead to accountability among institutional actors3. The nature of an institutionalised management accounting policy, its relevance as a source of power in organisational decision making, and in negotiating inter-organisational relationships, are also analysed. Practical motivation The practical motivation of the thesis is to show how practitioners and policy makers can institutionalise changes which improve the power of management accounting and control systems4 as a mechanism of accountability among institutional actors and in negotiating relationships with other organisations. Theoretical motivation and conceptual approach The theoretical motivation of the thesis is to extend the institutional framework of management accounting change proposed by Burns and Scapens (2000) by using the theories of critical realism, communicative action, negotiated order and the framework of circuits of power. The Burns and Scapens framework needs further theorisation to analyse the relationship between the institutionalisation of management accounting and accountability; and the relevance of management accounting information in negotiating in inter-organisational relationships. Methodology and field studies Field research took place in public and not-for-profit health care organisations and a municipality in Finland from 2008 to 2013. Data were gathered by document analysis, interviews, participation in meetings and observations. Findings The findings are explained in four different essays that show that institutionalisation of competitive tendering, governance and budgetary policies cannot be taken for granted to lead to accountability among institutional actors. The ways by which institutional actors think and act can be influenced by other institutional mechanisms, such as inter-organisational circuits of power and intraorganisational governance policies, independent of the institutional change process. The relevance of institutionalised management accounting policies in negotiating relationships between two or more organisations depends on processes and contexts through which institutional actors use management accounting information as a tool of communication, mutual understanding and power. Research limitations / implications The theoretical framework used can be applied validly in other studies. The empirical findings cannot be generalised directly to other organisations than the organisations analysed. Practical implications Competitive tendering and budgetary policies can be institutionalised to shape actions of institutional actors within an organisation. To lead to accountability, practitioners and policy makers should implement governance policies that increase the use of management accounting information in institutional actors’ thinking, actions and responsibility for their actions. To reach a negotiated order between organisations, institutionalised management accounting policies should be used as one of the tools of communication aiming to reach mutual agreement among institutional actors.

Improving internal performance of a company - Introducing employee empowerment via job redesign in Finnish small and medium sized enterprises

This bachelor's thesis is about to find out to what extent Finnish managers and small and medium sized organizations are willing and able to put employee empowerment into practice and what experiences they have got from employee empowerment as an approach towards job redesign. Some of the top enterprises in the world are known for their empowered employees as a single most important factor for their success and this thesis focuses on introducing the subject to Finnish managers and organizations to find out what benefits, barriers and other thoughts they have about the whole idea of empowered employees in Finnish organization culture. Most notable findings in this thesis are that Finnish managers do think that their organization's employees are capable to work efficiently if their job is extended and the organizations would perform better when right person's job is enriched and he/she is given more power to solve problems.

The Invisible Institutional Repository: Missing a Trick (and Missing Fulltext)?

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

A repository is NOT a digital archive

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

The board of directors as a part of family business governance – multilevel participation and board development

In this study, I examine the board of directors as a part of family business governance. Both boards and governance have increased their attractiveness as a research topic lately. Research on boards has concentrated mostly on the study of different board attributes, like composition, and the relationship of these attributes to the firm’s performance. Family business governance studies are criticized for ignoring the multifaceted needs of companies. More research observing the context and contingencies affecting the governance and board of directors is needed. The objective of this study is to clarify: 1) how the board participates in family business governance, and 2) how the board develops along with the firm’s and family’s development. The study is implemented as qualitative research, and the longitudinal process approach has been used as it provides the opportunity to examine development in context. Selection criteria for the two cases selected for this study are: active board of directors, at least one implemented succession, and interviewees available from two generations and from different positions in the firm. The data consists of interviews and secondary data, and it is collected from different data sources. The analysis was done selecting first some critical events from both cases to closer examination, and analysing them by using content analysis technique. Several conclusions were drawn basing on the findings. First, the family business board participates in the firm’s activities much more widely than it is customary to think. Second, the family business board is not a static part of the business, but it develops and it has to develop for different reasons. Third, ownership is not only the basis for the board’s activities or existence, but the relationship between the board and ownership is two-way. The board contributes to a large extent to the ownership decisions, and in this way to the management of ownership. Fourth, according to the cases, the board has many unrecognized possibilities to facilitate succession in family firms.