Community-acquired pneumonia in adult patients with special reference to rapid methods for etiological diagnosis

Aikuispotilaan kotisyntyisen keuhkokuumeen etiologinen diagnostiikka mikrobiologisilla pikamenetelmillä Tausta. Keuhkokuume on vakava sairaus, johon sairastuu Suomessa vuosittain n. 60 000 aikuista. Huolimatta siitä, että taudin hoito on kehittynyt, siihen liittyy yhä merkittävä, 6-15%:n kuolleisuus. Alahengitystieinfektion aiheuttajamikrobien tunnistaminen on myös edelleen haasteellista. Tavoitteet. Tämän työn tavoitteena oli tutkia Turun yliopistollisessa keskussairaalassa hoidettujen aikuispotilaiden keuhkokuumeen etiologiaa sekä selvittää uusien mikrobiologisten pikamenetelmi¬en hyödyllisyyttä taudinaiheuttajan toteamisessa. Aineisto. Osatöiden I ja III aineisto koostui 384 Turun yliopistollisen keskussairaalaan infektio-osastolla hoidetusta keuhkokuumepotilaasta. Osatyössä I tutkittiin keuhkokuumeen aiheuttaja¬mikrobeja käyttämällä perinteisten menetelmien lisäksi antigeeniosoitukseen ja PCR-tekniikkaan perustuvia pikamenetelmiä. Osatyö II käsitti 231 potilaasta koostuvan alaryhmän, jossa tutkittiin potilaiden nielun limanäytteestä rinovirusten ja enterovirusten esiintyvyyttä. Osatyössä III potilailta tutkittiin plasman C-reaktiivisen proteiinin (CRP) pitoisuus ensimmäisten viiden sairaalahoitopäi¬vän aikana. Laajoja tilastotieteellisiä analyysejä käyttämällä selvitettiin CRP:n käyttökelpoisuutta sairauden vaikeusasteen arvioinnissa ja komplikaatioiden kehittymisen ennustamisessa. Osatyössä IV 68 keuhkokuumepotilaan sairaalaan tulovaiheessa otetuista näytteistä määritettiin neutrofiilien pintareseptorien ekspressio. Osatyössä V analysoitiin sisätautien vuodeosastoilla vuosina 1996-2000 keuhkokuumepotilaille tehtyjen keuhkohuuhtelunäytteiden laboratoriotutkimustulokset. Tulokset. Keuhkokuumeen aiheuttaja löytyi 209 potilaalta, aiheuttajamikrobeja löydettiin kaikkiaan 230. Näistä aiheuttajista 135 (58.7%) löydettiin antigeenin osoituksella tai PCR-menetelmillä. Suu¬rin osa, 95 (70.4%), todettiin pelkästään kyseisillä pikamenetelmillä. Respiratorinen virus todettiin antigeeniosoituksella 11.1% keuhkokuumepotilaalla. Eniten respiratorisia viruksia löytyi vakavaa keuhkokuumetta sairastavilta potilailta (20.3%). 231 keuhkokuumepotilaan alaryhmässä todettiin PCR-menetelmällä picornavirus 19 (8.2%) potilaalla. Respiratorinen virus löytyi tässä potilasryh¬mässä kaiken kaikkiaan 47 (20%) potilaalta. Näistä 17:llä (36%) löytyi samanaikaisesti bakteerin aiheuttama infektio. CRP-tasot olivat sairaalaan tulovaiheessa merkitsevästi korkeammat vakavaa keuhkokuumetta (PSI-luokat III-V) sairastavilla potilailla kuin lievää keuhkokuumetta (PSI-luokat I-II) sairastavilla potilailla (p <0.001). Yli 100 mg/l oleva CRP-taso neljän päivän kuluttua sairaa¬laan tulosta ennusti keuhkokuumeen komplikaatiota tai huonoa hoitovastetta. Neutrofiilien komple¬menttireseptorin ekspressio oli pneumokokin aiheuttamaa keuhkokuumetta sairastavilla merkitse¬västi korkeampi kuin influenssan aiheuttamaa keuhkokuumetta sairastavilla. BAL-näytteistä vain yhdessä 71:stä (1.3%) todettiin diagnostinen bakteerikasvu kvantitatiivisessa viljelyssä. Uusilla menetelmilläkin keuhkokuumeen aiheuttaja löytyi vain 9.8% BAL-näytteistä. Päätelmät. Uusilla antigeeniosoitus- ja PCR-menetelmillä keuhkokuumeen etiologia voidaan saada selvitettyä nopeasti. Lisäksi näitä menetelmiä käyttämällä taudin aiheuttajamikrobi löytyi huomattavasti suuremmalta osalta potilaista kuin pelkästään tavanomaisia menetelmiä käyttämällä. Pikamenetelmien hyödyllisyys vaihteli taudin vaikeusasteen mukaan. Respiratorinen virus löytyi huomattavan usein keuhkokuumetta sairastavilta potilailta, ja näiden potilaiden taudinkuva oli usein vaikea. Tulovaiheen korkeaa CRP-tasoa voidaan käyttää lisäkeinona arvioitaessa keuhkokuumeen vaikeutta. CRP on erityisen hyödyllinen arvioitaessa hoitovastetta ja riskiä komplikaatioiden ke¬hittymiseen. Neutrofiilien komplementtireseptorin ekspression tutkiminen näyttää lupaavalta pi¬kamenetelmältä erottamaan bakteerien ja virusten aiheuttamat taudit toisistaan. Antimikrobihoitoa saavilla potilailla BAL-tutkimuksen löydökset olivat vähäiset ja vaikuttivat hoitoon vain harvoin.

The economic value of reciprocal bilingualism

Some bilingual societies exhibit a distribution of language skills that can- not be explained by economic theories that portray languages as pure commu- nication devices. Such distribution of skills are typically the result of public policies that promote bilingualism among members of both speech commu- nities (reciprocal bilingualism). In this paper I argue that these policies are likely to increase social welfare by diminishing economic and social segmenta- tion between the two communities. However, these gains tend to be unequally distributed over the two communities. As a result, in a large range of circum- stances these policies might not draw su¢ cient support. The model is built upon the communicative value of languages, but also emphasizes the role of linguistic preferences in the behavior of bilingual individuals.

Osakeindeksiobligaation fair value Case: SHB Paras Kolmesta 5010

Tutkielmassa selvitetään monimutkaisen indeksiobligaation arvon määritystä obligaation juoksuaikana. Tutkittava indeksiobligaatio sijoittaa osakkeisiin, korkoon ja raaka aineisiin. Kyseisessä indeksi-obligaatiossa sijoitetaan korioptioihin ja ne ovat lisäksi niiltä osin kvantto optioita, kun positio on ollut tarpeen suojata valuutta kurssimuutoksia vastaan. Tämän lisäksi indeksiobligaatio sijoittaa nolla kuponkilainaan. Sijoittajalle on haastavaa ymmärtää oikein ja läpinäkyvästi monimutkaisen osakeindeksiobligaation arvonmääritystä sen juoksuaikana. Tässä tutkielmassa avataan monimutkaisen osakeindeksiobligaation arvonmäärityksen perusteet. Tutkielmassa huomataan, että sijoittajalla voi helposti olla vaara mielikuva siitä, miten arvo määrittyy. Tämä johtuu siitä, että arvonmääritys eroaa huomattavasti siitä mikä käy ilmi velkakirjan ehdoissa. Tutkielman keskeisin anti on se, että kyseinen osakeindeksiobligaatio antaa heikkoa tuottoa kesken juoksuajan, mikäli joko osakkeet, raaka-aineet tai korot kehittyvät negatiivisesti. Lisaksi raaka aineoptioiden hinnan määritys eroaa siitä, mitä sijoittaja olettaa sen olevan velkakirjan ehtoja lukiessaan. Raaka-aineiden hinnat määritellään forward hinnoista

On Value Creation at an Industrial Intersection – Bioenergy in the Forest and Energy Sectors

The traditional forest industry is a good example of the changing nature of the competitive environment in many industries. Faced with drastic challenges forestindustry companies are forced to search for new value-creating strategies in order to create competitive advantage. The emerging bioenergy business is now offering promising avenues for value creation for both the forest and energy sectors because of their complementary resources and knowledge with respect to bioenergy production from forest-based biomass. The key objective of this dissertation is to examine the sources of sustainable competitive advantage and the value-creation opportunities that are emerging at the intersection between the forest and energy industries. The research topic is considered from different perspectives in order to provide a comprehensive view of the phenomenon. The study discusses the business opportunities that are related to producing bioenergy from forest-based biomass, and sheds light on the greatest challenges and threats influencing the success of collaboration between the forest and energy sectors. In addition, it identifies existing and potential bioenergy actors, and considers the resources and capabilities needed in order to prosper in the bioenergy field. The value-creation perspective is founded on strategic management accounting, the theoretical frameworks are adopted from the field of strategic management, and the future aspect is taken into account through the application of futures studies research methodology. This thesis consists of two parts. The first part provides a synthesis of the overall dissertation, and the second part comprises four complementary research papers. There search setting is explorative in nature, and both qualitative and quantitative research methods are used. As a result, the thesis lays the foundation for non-technological studies on bioenergy. It gives an example of how to study new value-creation opportunities at an industrial intersection, and discusses the main determinants affecting the value-creation process. In order to accomplish these objectives the phenomenon of value creation at the intersection between the forest and energy industries is theorized and connected with the dynamic resource-based view of the firm.

Coopetitive advantage – How firms create and appropriate value by collaborating with their competitors

Collaboration between competing firms (coopetition) has emerged as an important issue forn business practice in many industries. Extant literature has examined coopetition on many levels of analysis, but lacks clarity in distinguishing it explicitly from cooperation between noncompeting organizations. Because of this, the performance implications of coopetition from the perspective of an individual firm are still ambiguous – some research suggests positive results whereas other studies suggest detrimental outcomes. The aim in this dissertation is to narrow these gaps by exploring how firms create and appropriate value through collaboration with their competitors. The dissertation is divided into two parts. The first part comprises an overview of the relevant literature, as well as the conclusions of the whole study, and the second part includes six research publications. Both qualitative and quantitative methodologies are utilized. The results suggest that coopetition embodies the distinctive logic of value creation and appropriation from the perspective of an individual firm, and thus differs in terms of performance implications from cooperation between non-competitors. The distinction comes from the fact that competitors have somewhat similar understanding, capabilities and interest related to certain markets, which is potentially both challenging and beneficial in terms of the individual firm’s competitiveness. It appears from the findings that there are distinctive firm-external and firm-specific factors affecting the success of a coopetition strategy. This study makes three main contributions. First, on the conceptual level it shows the distinction between coopetition and cooperation between non-rivals as a collaborative inter-organizational relationship. Secondly, it sets out a framework and propositions that enhance understanding of how value is created and appropriated in coopetition from the perspective of an individual firm. Thirdly, it offers empirical evidence of how coopetition affects firms’ innovation and market performance, and identifies the focal internal and external factors involved. In general terms, the thesis adds to our knowledge of how a firm can successfully utilize a coopetition strategy in its pursuit of improved performance.

Usability Centered Implementation of a Web Based Value Added Module

Customer specific functionalities are a challenging part of procurement and invoice automation environments. In Basware Enterprise Purchase to Payment product family the customer specific reports are supported only in a basic level without any seamless interface between all EPP products. Also other customer specific functionalities are not supported as there is no customizable interface between the applications and only the most common features are implemented to the products themselves. In this thesis foundations are created for a new web based value added module where it is possible to create seamless customer specific functionalities throughout the whole EPP product family. The work is implemented in a Proof of Concept type of piloting. The system is created in user centered way where the users are able to explain their requests and determine their needs. The result is an excellent foundation for a module that can be developed further.

The role of power relations in strategic supply management – A value net approach

Supplier relationships are key elements of supply management and thus have attracted substantial research interest among academics and practitioners. The collaborative nature of relationships has been the focus of the mainstream research, and limited interest has been channelled towards power in buyer–supplier relationships. However, power is one of the key factors determining the outcomes in many business relations. Hence, one of the main objectives of this dissertation is to clarify how power may influence the nature of buyer–supplier relationships and, moreover, the depth of collaboration. Another main objective is to clarify the role of power relations in strategic supply management. Given the different nature of relationships, the firm needs divergent strategies in its supply management in order to handle them efficiently. Power has been identified as one of the factors that affect the nature of buyer–supplier relationships, and firms should thus develop strategies for handling power relations. Three research questions are addressed in pursuit of these objectives, the aim being to clarify the sources of power, the influence of power on collaboration, and the role of buyer–supplier relationships in the firm’s supply strategy. This dissertation has two parts. The first part provides a synthesis of the overall dissertation, and the second part comprises five complementary research papers. The qualitative research method is applied in an empirical case study from the Finnish food industry. The main contribution of this dissertation is that it clarifies the role of power relations in strategic supply management in value nets, and discloses the nature of power as an influencing factor in supplier relationships. It extends the discussion on power in buyer– supplier relationships in highlighting the context of networks and raising the question of network effects on power relations. It also illustrates how power positions and power relations in value nets can be determined based on the sources of power of the network actors, and shows their influence on collaboration.

Virtual Professional Network as a Value Creator in the Dental Business

The research of virtual professional networks has been enormous but the lack of research in the dental field was obvious. This study focuses on those uses and gratifications, and motives of participants that a virtual pro-fessional network should fulfil. The aim of this study is to understand the factors behind the successful virtual professional network, and motives of participants that support a particular business network’s building up for contributing its further success. In this study the focus is on particular mo-tives, needs and benefits of participants that are significant for the net-work’s further development. The study will explore relevant scientific research and theory that is char-acteristic in networking, and theories of user’s needs and motives. Empiri-cal data was collected from dental professionals by net based question-naire that was sent by e-mail. Data analysis was done by quantitative fac-tor analysis. The findings of this study were obvious that virtual knowledge of implantology is inadequate and knowledge is rather difficult to find in the Internet. Sharing of virtual knowledge, net-learning and communication were seen to improve the quality of impolantological professionalism and also the development of these areas was experienced essential. On the grounds of this study a host of a virtual professional network can focus on those aspects that serve the users at best, can develop professionalism in implantology and can profit in its own business operations.

Value co-creation in industrial buyer-seller partnerships - creating and exploiting interdependencies : an empirical case study

In summary the main findings of the study are that there seems to be is no universal definition of value in the context of industrial relationships, but a notion that it is context-, time-, and actor dependent. Value co-creation is a suitable concept in the context of buyerseller relationships. The evolution of a relationship from a transactional to a partnership is long and eventful - a process where the outcome is impossible to estimate in advance. The process is filled with differenttypes of events and also conflicts, which as a matter of fact can be seen as constructive forces in relationship development. The perceived value of a relationship is an antecedent to pursuing a high-involvement strategy; once a partnership exists, the value co-creation potential is realizable through exploiting interdependencies. Those interdependencies are the trigger for value co-creation potential. The value cocreation potential is realized though different processes of value co-creation either to achieve efficiency in exchange or effective use of resources. The logic of buyer-seller partnerships is to create and exploit interdependencies in order to create both efficiency and effective use of resources. (Summary of main findings p. 176)

Vaihtosuuntaajan reaaliaikainen lämpömalli

Vaihtosuuntaajan IGBT-moduulin liitosten lämpötiloja ei voida suoraan mitata, joten niiden arviointiin tarvitaan reaaliaikainen lämpömalli. Tässä työssä on tavoitteena kehittää tähän tarkoitukseen C-kielellä implementoitu ratkaisu, joka on riittävän tarkka ja samalla mahdollisimman laskennallisesti tehokas. Ohjelmallisen toteutuksen täytyy myös sopia erilaisille moduulityypeille ja sen on tarvittaessa otettava huomioon saman moduulin muiden sirujen lämmittävä vaikutus toisiinsa. Kirjallisuuskatsauksen perusteella valitaan olemassa olevista lämpömalleista käytännön toteutuksen pohjaksi lämpöimpedanssimatriisiin perustuva malli. Lämpöimpedanssimatriisista tehdään Simulink-ohjelmalla s-tason simulointimalli, jota käytetään referenssinä muun muassa implementoinnin tarkkuuden verifiointiin. Lämpömalli tarvitsee tiedon vaihtosuuntaajan häviöistä, joten työssä on selvitetty eri vaihtoehtoja häviölaskentaan. Lämpömallin kehittäminen s-tason mallista valmiiksi C-kieliseksi koodiksi on kuvattu tarkasti. Ensin s-tason malli diskretoidaan z-tasoon. Z-tason siirtofunktiot muutetaan puolestaan ensimmäisen kertaluvun differenssiyhtälöiksi. Työssä kehitetty monen aikatason lämpömalli saadaan jakamalla ensimmäisen kertaluvun differenssiyhtälöt eri aikatasoille suoritettavaksi sen mukaan, mikä niiden kuvaileman termin vaatima päivitysnopeus on. Tällainen toteutus voi parhaimmillaan kuluttaa alle viidesosan kellojaksoja verrattuna suoraviivaiseen yhden aikatason toteutukseen. Implementoinnin tarkkuus on hyvä. Implementoinnin vaatimia suoritusaikoja testattiin Texas Instrumentsin TMS320C6727- prosessorilla (300 MHz). Esimerkkimallin laskemisen määritettiin kuluttavan vaihtosuuntaajan toimiessa 5 kHz kytkentätaajuudella vain 0,4 % prosessorin kellojaksoista. Toteutuksen tarkkuus ja laskentakapasiteetin vähäinen vaatimus mahdollistavat lämpömallin käyttämisen lämpösuojaukseen ja lisäämisen osaksi muuta jo prosessorilla olemassa olevaa systeemiä.

Components of customer value in nurse call solutions

This study aimed to identify the value components of nurse call solutions. The value creation of such systems was analyzed by using a framework that was created based on the existing customer value literature. The empirical part of the study was conducted as a multiple-case study by using qualitative research methods. The data for the analysis was gathered through structured interviews in ten Finnish eldercare centers. The results indicate that a nurse call solution creates value for eldercare centers by increasing the safety of the residents, and by improving the efficiency of the staff while also providing cost savings.

Working capital management in the value chain of automotive industry

The objective of this Master’s thesis is to examine working capital management in the automotive industry in years 2006-2008. The study is conducted by the analysis of financial statements. The sample consists of 65 companies that represent different stages in the value chain of automotive industry beginning from raw material suppliers and ending to car dealers. Working capital management is studied by the cash conversion cycle (CCC). The results show that the average CCC of the value chain is 67 days. Car manufacturers had the longest CCC, 106 days, whereas the CCC of oil companies was the shortest, 22 days. The findings suggest that the cycle time of working capital usually follows the cycle time of inventories, since the changes in cycle times of accounts receivable and payable compensate each other. Improvements in working capital management could be achieved by sharing more accurate information in the chain for example about inventory levels and order points of customer. It could also be discussed within the automotive industry, if the long credit periods, which tie up working capital, are really needed. New technologies enable faster payments, which would reduce the cash conversion cycles, improve the profitability of companies, and increase the competitiveness of the value chain. Working capital should not be reduced at the expense of value chain partners, because nowadays the competition is rather between the value chains than between the companies. Similar research design is applied earlier to study working capital management in the value chain of pulp and paper industry. Even if the industries and the structures of the chains differ from each other, results were surprisingly similar. In future research, working capital management in other industries’ value chains could still be studied and compared to previous studies. ICT industry, for example, could be an interesting object.