Comparison between open and laparoscopic elective cholecystectomy in elderly, in a teaching hospital

Objective: to analyze the differences in mortality rates, length of hospital stay, time of surgery and the conversion rate between elective open cholecystectomies (OC) and laparoscopic ones (LC) in elderly patients. Methods : we evaluated medical records of patients 65 years of age or older undergoing open or laparoscopic cholecystectomy at the Hospital Regional de Mato Grosso do Sul between January 2008 and December 2011. We excluded individuals operated in non-elective scenarios or who underwent intraoperative cholangiography. Results : we studied 113 patients, of whom 38.1% were submitted to the OC and 61.9%, to LC. Women accounted for 69% of patients and men, for 31%. The conversion rate was 2.9%. The mean age and duration of the procudure was 70.1 and 84 minutes, respectively, with no significant difference between OC and LC. Patients undergoing LC had shorter hospital stays (2.01 versus 2.95 days, p=0.0001). We identified operative complications in sixpatients (14%) after OC and in nine (12%) after LC, with no statistical difference. Conclusion : there was no difference in morbidity and mortality when comparing OC with LC. The laparoscopic approach led to shorter hospital stay. Operative time did not differ between the two access routes. The conversion rate was similar to other studies.

Professional development among educators pursuing a B.Ed. program in special education in Tanzania : a study of motives and perceived outcomes

Implementation of different policies and plans aiming at providing education for all is a challenge in Tanzania. The need for educators and professionals with relevant knowledge and qualifications in special education is substantial. Teacher education does not equip educators with sufficient knowledge and skills in special education and professional development programs in special education are few in number. Up to 2005 no degree programs in special education at university level were available in Tanzania. The B.Ed. Special Education program offered by the Open University of Tanzania in collaboration with Åbo Akademi University in Finland was one of the efforts aimed at addressing the big national need for teachers and other professionals with degree qualifications in special education. This pilot program offered unique possibilities to study professional development in Tanzania. The research group in this study consisted of the group of students who participated in the degree program 2005-2007. The study is guided by three theoretical perspectives: individual, social and societal. The individual perspective emphasizes psychological factors as motives, motivation, achievement, self-directed behavior and personal growth. Within social perspective, professional development is viewed as situated within the social and cultural context. The third perspective, the societal, focuses on change, reforms, innovations and transformation of school systems and societies. Accordingly, professional development is viewed as an individual, social and societal phenomenon. The overall aim of the study is to explore the participants’ motives for participating in a B.Ed. Special Education program and the perceived outcomes of the program in terms of professional development. In order to achieve the objectives of the study, a case study approach was adopted. Questionnaires and semi-structured interviews were administered in three waves between January 2007 and February 2009 to the 35 educators participating in the B.Ed. Special Education program. The findings of the study reveal that the participants expressed motives which were related to job performance, knowledge, skills, academic degree and career. Also altruistic motives were expressed by the participants in terms of helping and supporting students with special needs and their communities. The perceived outcomes of the program were in line with the expressed motives. However, the results indicate that the participants also learned new skills, as interaction skills and guidance and counseling skills. Increased self-confidence was also mentioned as an outcome. The participants also got deepened understanding of disability issues. In addition, they learned strategies for creating awareness of persons with disability in the communities. Thus the findings of the study indicate positive outcomes of the program in terms of professional development. The conclusion of the study is that individual, social and societal factors interact when it comes to explaining why Tanzanian educators in special education choose to pursue a degree program in special education. The individual motives, as increased knowledge and better prospects of career development interact with the social and societal motives to help and support vulnerable student groups. The study contributes to increased understanding of the complexity of professional development and of the realities educators meet when educational reforms are implemented in a developing country.

Enhanced muscle strength with carbohydrate supplement two hours before open cholecystectomy: a randomized, double-blind study

Objective: to investigate the effects of preoperative fasting abbreviation with oral supplementation with carbohydrate in the evolution of grip strength in patients undergoing cholecystectomy by laparotomy. Methods : we conducted a clinical, randomizeddouble blind study with adult female patients, aged 18-60 years. Patients were divided into two groups: Control Group, with fasting prescription 6-8h until the time of operation; and Intervention Group, which received prescription of fasting for solids 6-8h before surgery, but ingested an oral supplement containing 12.5% carbohydrate, six (400ml) and two (200ml) hours before theprocedure. The handgrip strength was measured in both hands in both groups, at patient's admission (6h before surgery), the immediate pre-operative time (1h before surgery) and 12-18h postoperatively. Results : we analyzed 27 patients, 14 in the intervention group and 13 in the control group. There was no mortality. The handgrip strength (mean [standard deviation]) was significantly higher in the intervention group in the three periods studied, in at least one hand: preoperatively in the dominant hand (27.8 [2.6] vs 24.1 [3.7] kg; p=0.04), in the immediate preoperative in both hands, and postoperatively in the non-dominant hand (28.5 [3.0] vs 21.3 [5.9] kg; p=0.01). Conclusion : the abbreviation of preoperative fasting to two hours with drink containing carbohydrate improves muscle function in the perioperative period.

The demand for global student talent: Capitalizing on the value of university-industry collaboration

The university sector in Europe has invested money and effort into the internationalization of higher education. The benefits of internationalizing higher education are fuelled by changing global values, choices and practices. However, arguments that serve the internationalization of higher education tend to stress either local organizational or individual interests; seldom do they emphasize the societal benefits. This dissertation investigates how collaboration between university and industry facilitates a shift in thinking about attracting and retaining global student talent, in terms of co-creating solutions to benefit the development of our knowledge society. The macro-structures of the higher education sector have the tendency to overemphasize quantitative goals to improve performance verifiability. Recruitment of international student talent is thereby turned into a mere supply issue. A mind shift is needed to rethink the efficacy of the higher education sector with regard to retaining foreign student talent as a means of contributing to society’s stock of knowledge and through that to economic growth. This thesis argues that academic as well as industrial understanding of the value of university-industry collaboration might then move beyond the current narrow expectations and perceptions of the university’s contribution to society’s innovation systems. This mind shift is needed to encourage and generate creative opportunities for university-industry partnerships to develop sustainable solutions for successful recruitment of foreign student talent, and thereby to maximize the wealth-creating potential of global student talent recruitment. This thesis demonstrates through the use of interpretive and participatory methods, how it is possible to reveal new and important insights into university-industry partnering for enhancing attraction and retention of global student talent. It accomplishes this by expressly pointing out the central role of human collaborative experiencing and learning. The narratives presented take the reader into a Finnish and Dutch universityindustry partnering environment to reflect on the relationship between the local universities of technology and their operational surroundings, a relationship that is set in a context of local and global entanglements and challenges.

Open Door International Summer School at Mlada Boleslav, Czechoslovakia, July 31st – August 4th, 1933

19 x 32 cm

Open-book accounting - hyödyt ja haasteet erityyppisissä liiketoimintasuhteissa

Tutkimuksessa tarkastellaan OBA:n soveltamisen hyötyjä ja haasteita erityyppisissä yritysten välisissä suhteissa.Tutkimuksen tavoitteena on vastata kysymykseen, mitä erilaisia tavoitteita liiketoimintasuhteiden taustalla esiintyy, tyypitellä liiketoimintasuhteet tavoitteiden ja yritysten välisten toimintojen näkökulmasta ja arvioida miten OBA voi auttaa erityyppisien suhteiden johtamista tukevan informaation tuottamisessa ja hyödyntämisessä. Markkinaperustaisissa suhteissa vaihdannan avulla tavoitellaan tehokkuutta jonka perustana on markkinoilla vallitsevan kilpailun tehokkuus. Neuvotteluvoimaan perustuvissa suhteissa tavoitteena on hankkia resursseja sisäisiä tuotantokustannuksia edullisemmin markkinavoimaa hyväksikäyttämällä. Yhteistyösuhteissa toimittajan kyky tuottaa resurssi sisäisiin tuotantokustannuksiin nähden kilpailukykyisellä hinnalla perustuu vallitseviin mittakaavaetuihin tai erikoistumisen tuomaan osaamiseen ja niissä pyritään saavuttamaan kilpailuetua yritysten osaamista ja resursseja yhdistämällä. Yhteistyösuhteet voidaan jakaa operatiivisiin, taktisiin ja strategisiin yritysten välisten toimintojen integroituneisuuden ja strategisen merkityksen perusteella. Tutkimus antaa viitteitä siitä että OBA:n soveltamisen suurin potentiaali liittyy taktisiin ja strategisiin yhteistyösuhteisiin, koska niissä yritysten välisten toimintojen määrä on merkittävä ja yhteiset tavoitteet lisäävät yritysten välistä luottamusta.

Open access Suomessa 2013?

Esitys Avoin tiede -keskustelutilaisuudessa 4.3.2013.

Conceptions of mathematics teacher education : thoughts among teacher educators in Tanzania

This study addresses the question of teacher educators’ conceptions of mathematics teacher education (MTE) in teacher colleges in Tanzania, and their thoughts on how to further develop it. The tension between exponents of content as opposed to pedagogy has continued to cause challenging conceptual differences, which also influences what teacher educators conceive as desirable in the development of this domain. This tension is connected to the dissatisfaction of parents and teachers with the failure of school mathematics. From this point of view, the overall aim was to identify and describe teacher educators’ various conceptions of MTE. Inspired by the debate among teacher educators about what the balance should be between subject matter and pedagogical knowledge, it was important to look at the theoretical faces of MTE. The theoretical background involved the review of what is visible in MTE, what is yet to be known and the challenges within the practice. This task revealed meanings, perspectives in MTE, professional development and assessment. To do this, two questions were asked, to which no clear solutions satisfactorily existed. The questions to guide the investigation were, firstly, what are teacher educators’ conceptions of MTE, and secondly, what are teacher educators’ thoughts on the development of MTE? The two questions led to the choice of phenomenography as the methodological approach. Against the guiding questions, 27 mathematics teacher educators were interviewed in relation to the first question, while 32 responded to an open-ended questionnaire regarding question two. The interview statements as well as the questionnaire responses were coded and analysed (classified). The process of classification generated patterns of qualitatively different ways of seeing MTE. The results indicate that MTE is conceived as a process of learning through investigation, fostering inspiration, an approach to learning with an emphasis on problem solving, and a focus on pedagogical knowledge and skills in the process of teaching and learning. In addition, the teaching and learning of mathematics is seen as subject didactics with a focus on subject matter and as an organized integration of subject matter, pedagogical knowledge and some school practice; and also as academic content knowledge in which assessment is inherent. The respondents also saw the need to build learner-educator relationships. Finally, they emphasized taking advantage of teacher educators’ neighbourhood learning groups, networking and collaboration as sustainable knowledge and skills sharing strategies in professional development. Regarding desirable development, teacher educators’ thoughts emphasised enhancing pedagogical knowledge and subject matter, and to be determined by them as opposed to conventional top-down seminars and workshops. This study has revealed various conceptions and thoughts about MTE based on teacher educators´ diverse history of professional development in mathematics. It has been reasonably substantiated that some teacher educators teach school mathematics in the name of MTE, hardly distinguishing between the role and purpose of the two in developing a mathematics teacher. What teacher educators conceive as MTE and what they do regarding the education of teachers of mathematics revealed variations in terms of seeing the phenomenon of interest. Within limits, desirable thoughts shed light on solutions to phobias, and in the same way low self-esteem and stigmatization call for the building of teacher educator-student teacher relationships.

The Finnish National Digital Library: a national service is developed in collaboration with a network of libraries, archives and museums

Insight-lehden numerossa 26 (Maaliskuu 2013) julkaistu artikkeli.

Research framework for the connection between environmental collaboration and firm performance

This thesis focuses on collaborative activities with regard to environmental issues both within the firm and outside the firm with the key suppliers and customers, i.e. internal and external environmental collaboration. Integrating environmental thinking into supply chain management has received increasing interest in recent years. The relational view and the natural resource-based-view together suggest that environmental capabilities can be built jointly with supply chain partners and used to gain sustained competitive advantage. Several studies have been undertaken to analyse the connection between environmental activities and firm performance but most studies have taken only economic performance into account. This study pays attention also to two other dimensions of firm performance, intra-firm supply chain performance and environmental performance, and aims at presenting the linkages between them and environmental collaboration. This thesis creates a research framework for the connections between environmental collaboration and firm performance and suggests approaches to analyse these. In order to find out the key concepts and their relationship, an extensive literature review is conducted. The research framework proposes a positive connection between internal and external environmental collaboration and all three dimensions of firm performance. In addition, environmental performance and intra-firm supply chain performance are expected to contribute positively to economic performance. Hence, firms are suggested to benefit from environmental collaboration both within the firm and outside the firm. Empirical testing of the developed research framework is out of the scope of this study. However, this thesis proposes using a mixed methods research approach, including survey research and multiple case studies. Finland State of Logistics 2012 survey commissioned by the Finnish Ministry of Transport and Communications and conducted by Turku School of Economics is used as an example of data for the quantitative phase. The applicability of these two methods is discussed at a general level and with regard to analysing the research framework developed in the thesis. Future research will aim at the development of the research framework and the methods in order to confirm the connection between environmental collaboration and firm performance.

Laparoscopic versus open splenectomy in dogs

In the last few years, the use of laparoscopy in veterinary medicine has expanded and consequently so was the need for studies that establish the advantages, disadvantages and possible complications of each procedure. The purpose of the current study was to describe a laparoscopic splenectomy technique and the alterations due to this access, and compare it to the open procedure in dogs. A total of 15 healthy female mongrel dogs were used, with mean weight of 17.4±2.5kg. The animals were distributed into three groups: Group IA of open splenectomy (laparotomy) using double ligation of the vessels of the splenic hilum with poliglicolic acid, Group IB of open splenectomy (laparotomy) with bipolar electrocoagulation of the splenic hilum, and Group II of laparoscopic access with bipolar electrocoagulation of the splenic hilum. Operative time, blood loss, size of incisions, complications during and after surgery were evaluated. Other parameters included pain scores, white blood cell (WBC) counts and postoperative serum concentrations of alanine aminotransferase (ALT), alkaline phosphatase (ALP), creatine kinase (CK), C-reactive protein (CRP), glucose and cortisol. No differences were found in the evaluation of parameters between both open splenectomy techniques employed. Laparoscopic access presented significant differences (p<0,05) when compared with open surgery: Longer operative time, smaller abdominal access, decrease in blood loss, lower concentrations of CRP, higher levels of CK and ALP, and lower scores in the pain scale. Laparoscopic surgery showed fewer complications of the surgical wound. No significant differences were observed between groups in the postoperative temperature, WBC, ALT, cortisol and glucose concentrations. In conclusion, the laparoscopic technique is useful for splenectomy in dogs, being advantageous in terms of blood loss, surgical stress and surgical wounds. However, it expends more operative time and causes transitory increase in hepatic and muscular enzymes.

Situational awareness concept in a multinational collaboration environment : challenges in the information sharing framework

Technological capabilities are built to support different types of collaboration, and this gives the justification to widely observe, how activity environments are influenced by technology. Technology as an enabler can be addressed from different perspectives, other than merely technological. Dynamic, evolving environment is at the same time interesting but also challenging. As a multinational collaboration environment, the maritime surveillance is an good example of time critical and evolving environment, where technological solutions enable new ways of collaboration. Justification for the inspiration to use maritime environment as the baseline for understanding the challenges in creating and maintaining adequate level of situational awareness, derives from the complexity of the collaboration and information sharing environment elements, needed to be taken into account, when analyzing criticalities related to decision making. Situational awareness is an important element supporting decision making, and challenges related to it can also be observed in the maritime environment. This dissertation describes the structures and factors involved in this complex setting, found from the case studies that should be taken into account when trying to understand, how these elements affect the activities. This dissertation focuses on the gray area that is between a life threatening situation and normal everyday activities. From the multinational experimentation series case studies, MNE5 and MNE6 it was possible to observe situations that were not life threatening for the participants themselves, but not also basic every day activities. These case studies provided a unique possibility to see situations, where gaining of situational awareness and decision making are challenged with time critical crisis situations. Unfortunately organizations do not normally take the benefit from the everyday work to prepare themselves for possible emerging crisis situations. This dissertation focuses on creating a conceptual model and a concept that supports organizations – also outside the maritime community – to improve their ability to support gaining of situational awareness from the individual training level, all the way to changes in organizational structures in aiming for better support for decision making from the individual level to the highest decision making level. Quick changes and unpredictability are reality in organizations and organizations do not have the possibility to control all the factors that affect their functioning. Since we cannot be prepared for everything, and predict every crisis, individual activities inside teams and as a part of organizations, need to be supported with guidance, tools and training in order to support acting in challenging situations. In fact the ideology of the conceptual model created, lies especially in the aim of not controlling everything in beforehand, but supporting organizations with concrete procedures to help individuals to react in different, unpredictable situations, instead of focusing on traditional risk prevention and management. Technological capabilities are not automatically solutions for functional challenges; this is why it is justified to broaden the problem area observation from the technological perspective. This dissertation demonstrates that it is possible to support collaboration in a multinational environment with technological solutions, but it requires the recognition of technological limitations and accepting the possible restrictions related to technological innovations. Technology should not be considered value per se, the value of technology should be defined according to the support of activities, including strategic and operational environment evaluation, identification of organizational elements, and taking into account also the social factors and their challenges. Then we are one step closer to providing technological solutions that support the actual activities by taking into account the variables of the activity environment in question. The multidisciplinary view to approach the information sharing and collaboration framework, is derived especially from the complexity of decision making and building of situational awareness, since they are not build or created in vacuity, but in the organizational framework by the people doing it with the technological capabilities, enabled by the organizational structures. Introduced case studies were related to maritime environment, but according to the research results, it is valid to argue, that based on the lessons learned it is possible to create and further develop conceptual model and to create a general concept to support a wider range of organizations in their attempt to gain better level of situational awareness (SA) and to support decision making. To proof the versatile usage of the developed concept, I have introduced the case study findings to the health care environment and reflected the identified elements from the trauma center to the created concept. The main contribution to complete this adventure is the presented situational awareness concept created in the respect to NATO concept structure. This has been done to tackle the challenge of collaboration by focusing on situational awareness in the information sharing context by providing a theoretical ground and understanding, of how these issues should be approached, and how these elements can be generalized and used to support activities in other environments as well. This dissertation research has been a several year evolving process reflecting and affecting presented case studies and this learning experience from the case studies has also affected the goals and research questions of this dissertation. This venture has been written from a retro perspective according to ideology of process modeling and design rationale to present to the reader how this entire journey took place and what where the critical milestones that affected the end result, conceptual model. Support in a challenging information sharing framework can be provided with the right type of combination of tools, procedures and individual effort. This dissertation will provide insights to those with a new approach to war technology for the organizations to gain a better level of awareness and to improve the capabilities in decision making. This dissertation will present, from the war technology starting point, a new approach and possibility for the organizations to create a better level of awareness and support for decision making with the right combination of tools, procedures and individual effort.

Memory Effects in the Dynamics of Open Quantum Systems

In this Thesis various aspects of memory effects in the dynamics of open quantum systems are studied. We develop a general theoretical framework for open quantum systems beyond the Markov approximation which allows us to investigate different sources of memory effects and to develop methods for harnessing them in order to realise controllable open quantum systems. In the first part of the Thesis a characterisation of non-Markovian dynamics in terms of information flow is developed and applied to study different sources of memory effects. Namely, we study nonlocal memory effects which arise due to initial correlations between two local environments and further the memory effects induced by initial correlations between the open system and the environment. The last part focuses on describing two all-optical experiment in which through selective preparation of the initial environment states the information flow between the system and the environment can be controlled. In the first experiment the system is driven from the Markovian to the non- Markovian regime and the degree of non-Markovianity is determined. In the second experiment we observe the nonlocal nature of the memory effects and provide a novel method to experimentally quantify frequency correlations in photonic environments via polarisation measurements.

Implementing an open data system and showing its benefits

Open data refers to publishing data on the web in machine-readable formats for public access. Using open data, innovative applications can be developed to facilitate people‟s lives. In this thesis, based on the open data cases (discussed in the literature review), Open Data Lappeenranta is suggested, which publishes open data related to opening hours of shops and stores in Lappeenranta City. To prove the possibility of creating Open Data Lappeenranta, the implementation of an open data system is presented in this thesis, which publishes specific data related to shops and stores (including their opening hours) on the web in standard format (JSON). The published open data is used to develop web and mobile applications to demonstrate the benefits of open data in practice. Also, the open data system provides manual and automatic interfaces which make it possible for shops and stores to maintain their own data in the system. Finally in this thesis, the completed version of Open Data Lappeenranta is proposed, which publishes open data related to other fields and businesses in Lappeenranta beyond only stores‟ data.