Designing a new type of support for rotary kilns

Lime kiln is used as a part of the modern kraft pulp process in order to produce burnt lime from lime mud. This rotating kiln is supported by support rollers, which are traditionally supported by journal bearings. Since the continuous growth in the production of pulp mills requires larger lime kilns, the traditional bearing construction has become unreliable. The main problem especially involves the running-in phase of the bearings. In the present thesis, a new type of support roller was developed by using the systematic approach of machine design. Structural analysis was conducted on the critical parts of the selected structure by the finite element method. The operation of hydrodynamic bearings was examined by analytical methods. As a result of this work, a new type of support for rotating kilns was designed, which is more reliable and easier to service. A new support roller geometry is described, which pro¬vides for significant cost savings.

Creating customer relationship management concept for engineering and service business

Customer relationship management has been one essential part of marketing for over 20 years. Today’s business environment is fast changing, international and highly competitive, and that is why the most important factor for long-term profitability is one-to-one customer relationships. However, managing relationships and serving customers that are profitable has been always challenging. In this thesis the objective was to define the main obstacles that the case company must overcome to succeed in CRM. Possible solutions have also been defined. The main elements of the implementation i.e. people, processes and technologies, can clearly be found behind these matters and solutions. This thesis also presents theoretical information about CRM and it is meant to act as a guide book inside the organisation to spread information about CRM for those who are not so familiar with the topic.

Customer-Related Internal Communication in a Global Matrix Organization

The objective of the thesis was to explore the nature and characteristics of customer-related internal communication in a global industrial matrix organization during a specific customer relationship, and how it could be improved. The theoretical part of the study views the field of the concepts of intra-organizational information and knowledge sharing. The theoretical part also views the internal communications influences to customer relationships, its problematic, and the suggestions to improve internal communication in literature. The empirical part of the study was conducted with the Content Analysis and the Social Network Analysis as research methods. The data was collected by interviews and a questionnaire. Internal communication was observed first generally within the organization from the point of view of a certain business, and secondly, during a specific customer relationship at personal level and at departmental level. The results of the study describe the nature and characteristics of internal communication in the organization. The results give 13 suggestions for improving internal communication in the organization. Although the study has been done in one specific organization, it also offers insights for other organizations as well as managers to improve their internal communication.

Customer driven business model – connecting customer value to firm resources in ICT value networks

The objective of this thesis is to provide a business model framework that connects customer value to firm resources and explains the change logic of the business model. Strategic supply management and especially dynamic value network management as its scope, the dissertation is based on basic economic theories, transaction cost economics and the resource-based view. The main research question is how the changing customer values should be taken into account when planning business in a networked environment. The main question is divided into questions that form the basic research problems for the separate case studies presented in the five Publications. This research adopts the case study strategy, and the constructive research approach within it. The material consists of data from several Delphi panels and expert workshops, software pilot documents, company financial statements and information on investor relations on the companies’ web sites. The cases used in this study are a mobile multi-player game value network, smart phone and “Skype mobile” services, the business models of AOL, eBay, Google, Amazon and a telecom operator, a virtual city portal business system and a multi-play offering. The main contribution of this dissertation is bridging the gap between firm resources and customer value. This has been done by theorizing the business model concept and connecting it to both the resource-based view and customer value. This thesis contributes to the resource-based view, which deals with customer value and firm resources needed to deliver the value but has a gap in explaining how the customer value changes should be connected to the changes in key resources. This dissertation also provides tools and processes for analyzing the customer value preferences of ICT services, constructing and analyzing business models and business concept innovation and conducting resource analysis.

L'insatisfaction des besoins en soins de support chez les patients atteints d'un cancer du poumon en fonction du genre, de l'âge et du tabagisme : étude descriptive corrélationnelle transversale

Les patients atteints d'un cancer du poumon souffrent de différents troubles physiques et psychosociaux sévères causés par la maladie et son traitement. Ces troubles engendrent plusieurs besoins en soins de support chez les patients. Afin de satisfaire leurs besoins et de leur offrir la meilleure qualité de soins possible, l'identification des besoins en soins de support des patients devient primordiale. But : Le but de l'étude est, dans un premier temps, d'identifier et de décrire les besoins insatisfaits en soins de support pour les patients souffrant d'un cancer du poumon pendant la phase de chimiothérapie dans un Centre Hospitalier Universitaire en Suisse (CHU). Dans un second temps, le but de l'étude est également d'explorer l'éventuelle existence de différences quant au degré d'insatisfaction, tel qu'exprimé par les patients, notamment en fonction de l'âge, du genre et du tabagisme des patients. Cadre théorique : La présente étude se base sur la théorie du déficit d'auto-soin de Dorothea Orem. Méthode : Le travail de recherche s'est basé sur un devis descriptif corrélationnel transversal. L'échantillon, composé de 26 patients atteints d'un cancer du poumon, a été recruté selon la méthode non probabiliste accidentelle dans le service d'oncologie ambulatoire du CHU. Le recueil des données a été effectué à travers deux questionnaires auto-administrés aux patients (Supportive Care Needs Survey Short Form 34 et un questionnaire socio-démographique). Les données médicales ont été recueillies par l'étudiant chercheur à travers la consultation des dossiers médicaux. Résultats : Les résultats montrent que les besoins les plus insatisfaits chez les patients se regroupent surtout autour des besoins liés aux aspects psychologiques et physiques/vie quotidienne. Les patients expriment aussi un degré d'insatisfaction par rapport aux besoins en information ainsi qu'aux soins et au soutien prodigués par les soignants. Les deux besoins le plus fréquemment (65,38 %) exprimés comme insatisfaits par les patients ont été : « être informé de ce que vous pouvez faire vous-même pour aller mieux » et « l'incertitude face à l'avenir ». Les différences des degrés d'insatisfaction, tel qu'exprimés par les patients, en fonction de l'âge, du genre du tabagisme ont permis de poser des hypothèses quant aux relations entre ces variables et le degré d'insatisfaction : les femmes seraient plus insatisfaites de toutes les dimensions liées aux besoins en soins de support ; les patients d'âge égal ou supérieur à 65 ans seraient plus insatisfaits quant aux besoins physiques/vie quotidienne, psychologiques et de soutien; les patients d'âge inférieur à 65 ans seraient plus insatisfaits quant aux besoins liés à la sexualité; les non-fumeurs avant le diagnostic seraient plus insatisfaits quant aux besoins physiques/vie quotidienne, d'information et sexuels ; les patients qui arrêtent de fumer après le diagnostic seraient plus insatisfaits quant aux besoins physique/vie quotidienne, psychologique et de soutien. Conclusion : Cette étude met en évidence le fait que, pendant la phase de chimiothérapie, les patients atteints d'un cancer du poumon expriment de l'insatisfaction par rapport à plusieurs besoins en soins de support. Afin d'améliorer la qualité des soins et de mieux répondre aux besoins des patients, les infirmières et les équipes interdisciplinaires présentes au sein des services d'oncologie du CHU sont appelés à prendre en considération l'insatisfaction exprimée par les patients.

Social Support, Social and Temporal Comparisons Protect Well-Being and Health between 45 and 70 Years Old in Four Urban Communities

This study examined the impact of social support and of temporal and social comparisons on well-being and selfreported health in four capital cities: Paris, Berlin, Moscow and Beijing. Based on the lifespan control theory, an integrative model investigating the influence of these coping strategies, especially on the psychological regulation of health losses, was tested on 1141 respondents aged 45 to 70 years by using structural equation modelling with multigroup comparisons. Results indicated a good fit of the model to participants' responses. In all contexts, physical weaknesses favoured the use of social and temporal comparison strategies rather than social support. Moreover, across the cities, coping strategies were oriented more toward protecting self-evaluation of health than toward enhancement of well-being. Social comparison decreased the impact of physical weaknesses on health evaluation and on well-being in the four cities, but to a lesser extent in China. Results are discussed regarding the normative cross-cultural aspects that intervene during ageing in the four urban contexts.

Extracorporeal liver support in severe alcoholic hepatitis

The severity of alcoholic hepatitis (AH) which may coexist with cirrhosis varies greatly, from asymptomatic forms which are detected in alcoholic patients without any sign of liver disease, except laboratory abnormalities, to severe forms characterised by deep jaundice, ascites, hepatic encephalopathy and low prothrombin index. In hospitalized patients the mortality could be as high as 75%. The elevated number of therapeutic proposals reported for more than forty years reveals the lack of efficacy of a particular modality. Even in the most favorable trials, the survival is already very poor and in some cases related to the development of renal failure or hepatorenal syndrome. There are some motivating reports concerning albumin dialysis as a support treatment in patients with severe AH, either alone or in combination with other pharmacological therapies. The favorable effects of albumin dialysis in patients with severe AH suggest that the procedure used alone or in combination with other therapies may have a role in this clinical condition. This will be particularly relevant to offer an alternative therapy in these patients, thus being a potential bridge to recovery or to be listed for liver transplantation.

Metabolic and nutritional support of critically ill patients: consensus and controversies.

The results of recent large-scale clinical trials have led us to review our understanding of the metabolic response to stress and the most appropriate means of managing nutrition in critically ill patients. This review presents an update in this field, identifying and discussing a number of areas for which consensus has been reached and others where controversy remains and presenting areas for future research. We discuss optimal calorie and protein intake, the incidence and management of re-feeding syndrome, the role of gastric residual volume monitoring, the place of supplemental parenteral nutrition when enteral feeding is deemed insufficient, the role of indirect calorimetry, and potential indications for several pharmaconutrients.

Improving coronary artery bypass graft durability: use of the external saphenous vein graft support.

Coronary bypass grafting remains the best option for patients suffering from multivessel coronary artery disease, and the saphenous vein is used as an additional conduit for multiple complete revascularizations. However, the long-term vein graft durability is poor, with almost 75% of occluded grafts after 10 years. To improve the durability, the concept of an external supportive structure was successfully developed during the last years: the eSVS Mesh device (Kips Bay Medical) is an external support for vein graft made of weft-knitted nitinol wire into a tubular form with an approximate length of 24 cm and available in three diameters (3.5, 4.0 and 4.5 mm). The device is placed over the outer wall of the vein and carefully deployed to cover the full length of the graft. The mesh is flexible for full adaptability to the heart anatomy and is intended to prevent kinking and dilatation of the vein in addition to suppressing the intima hyperplasia induced by the systemic blood pressure. The device is designed to reduce the vein diameter of about 15-20% at most to prevent the vein radial expansion induced by the arterial blood pressure, and the intima hyperplasia leading to the graft failure. We describe the surgical technique for preparing the vein graft with the external saphenous vein graft support (eSVS Mesh) and we share our preliminary clinical results.

Mechanical circulatory support for destination therapy.

Patients with chronic heart failure who are not eligible for heart transplant and whose life expectancy depends mainly on the heart disease may benefit from mechanical circulatory support. Mechanical circulatory support restores adequate cardiac output and organ perfusion and eventually improves patients' clinical condition, quality of life and life expectancy. This treatment is called destination therapy (DT) and we estimate that in Switzerland more than 120 patients per year could benefit from it. In the last 10 years, design of the devices, implantation techniques and prognoses have changed dramatically. The key to successful therapy with a left ventricular assist device is appropriate patient selection, although we are still working on the definition of reliable inclusion and exclusion criteria and optimal timing for surgical implantation. Devices providing best long-term results are continuous flow, rotary or axial blood pumps implanted using minimally invasive techniques on a beating heart. These new devices (Thoratec HeartMate II and HeartWare HVAD) have only a single moving part, and have improved durability with virtually 10 years freedom from mechanical failure. In selected patients, the overall actuarial survival of DT patients is 75% at 1 year and 62% at 2 years, with a clear improvement in quality of life compared with medical management only. Complications include bleeding and infections; their overall incidence is significantly lower than with previous devices and their management is well defined. DT is evolving into an effective and reasonably cost-effective treatment option for a growing population of patients not eligible for heart transplant, showing encouraging survival rates at 2 years and providing clear improvement in quality of life. The future is bright for people suffering from chronic heart failure.

Identification and ethnic diversity underlie support for multicultural rights : a multilevel analysis in Bulgaria

Bulgaria is historically a multicultural society, composed of the Bulgarian (ethnic) majority and a number of ethnic minorities among which Bulgarian Turks and Roma are the largest. Both minority communities are stigmatized in contemporary Bulgaria, though to different degrees and for different reasons. Ethnic minorities' rights to preserve their culture, customs, and language are a topic of contentious debate. The purpose of this study was to examine individual- and context-level antecedents of the ethnic Bulgarian majority's support for multicultural rights of ethnic minorities. Multilevel regression analyses were conducted with International Social Survey Programme ISSP 2003 data (N = 920 in 28 Bulgarian districts). At the individual-level, an ethnic conception of the nation and anti-Roma symbolic prejudice were negatively related to support for multicultural rights, whereas national identification was positively related to the support of these rights. Over and above individual-level effects, and in line with recent extensions of intergroup contact theory, thepercentage ofBulgarianTurks withindistricts was positively related to support for multicultural rights. Importantly, support for multicultural rights was particularly high in districts characterized by ethnic diversity, that is, in districts with high proportions of both Bulgarian Turks and Roma. The beneficial effects of ethnic diversity and theoretical implications of findings are discussed.