Do induced twin pregnancies influence the obstetric and neonatal results of multiple births born before 32 weeks? Comparison to spontaneous gestation

PURPOSE: To compare obstetric outcomes of induced preterm twin births (under 32 weeks gestation) with those spontaneously conceived. METHODS: Prospective study of twin pregnancies (25 induced and 157 spontaneously conceived) developed over a period of 16 years in a tertiary obstetric center. Demographic factors, obstetric complications, gestational age at delivery, mode of delivery, birth weight and immediate newborn outcome were compared. RESULTS: The analysis of obstetrical complications concerning urinary or other infections, hypertensive disorders of pregnancy, gestational diabetes, fetal malformations, intrauterine fetal death, intrauterine growth restriction and intrauterine discordant growth reveal no significant statistical differences between the two groups. First trimester bleeding was higher in the induced group (24 versus 8.3%, p=0.029). The cesarean delivery rate was 52.2% in spontaneous gestations and 64% in induced gestations. Gestational age at delivery, birth weight, Apgar scores at first and fifth minutes, admissions to Neonatal Intensive Care Unit and puerperal complications show no statistically significant differences between the two groups. These results were independent of chorionicity and induction method. CONCLUSION: The mode of conception did not influence obstetric and neonatal outcomes. Although induced pregnancies have higher risk of first trimester bleeding, significant differences were not observed regarding other obstetric and puerperal complications and neonatal results.

Magnetic Resocance Imaging Methods in the Follow-up of Multiple Sclerosis and in Farby Disease

Multiple sclerosis (MS) is a chronic immune-mediated inflammatory disorder of the central nervous system. MS is the most common disabling central nervous system (CNS) disease of young adults in the Western world. In Finland, the prevalence of MS ranges between 1/1000 and 2/1000 in different areas. Fabry disease (FD) is a rare hereditary metabolic disease due to mutation in a single gene coding α-galactosidase A (alpha-gal A) enzyme. It leads to multi-organ pathology, including cerebrovascular disease. Currently there are 44 patients with diagnosed FD in Finland. Magnetic resonance imaging (MRI) is commonly used in the diagnostics and follow-up of these diseases. The disease activity can be demonstrated by occurrence of new or Gadolinium (Gd)-enhancing lesions in routine studies. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are advanced MR sequences which can reveal pathologies in brain regions which appear normal on conventional MR images in several CNS diseases. The main focus in this study was to reveal whether whole brain apparent diffusion coefficient (ADC) analysis can be used to demonstrate MS disease activity. MS patients were investigated before and after delivery and before and after initiation of diseasemodifying treatment (DMT). In FD, DTI was used to reveal possible microstructural alterations at early timepoints when excessive signs of cerebrovascular disease are not yet visible in conventional MR sequences. Our clinical and MRI findings at 1.5T indicated that post-partum activation of the disease is an early and common phenomenon amongst mothers with MS. MRI seems to be a more sensitive method for assessing MS disease activity than the recording of relapses. However, whole brain ADC histogram analysis is of limited value in the follow-up of inflammatory conditions in a pregnancy-related setting because the pregnancy-related physiological effects on ADC overwhelm the alterations in ADC associated with MS pathology in brain tissue areas which appear normal on conventional MRI sequences. DTI reveals signs of microstructural damage in brain white matter of FD patients before excessive white matter lesion load can be observed on conventional MR scans. DTI could offer a valuable tool for monitoring the possible effects of enzyme replacement therapy in FD.

Product placement on personal blogs: a multiple case study from companies’ perspective

As traditional advertising is losing its value in corporations’ marketing, new and growing social media marketing channels are increasing their importance. The growing interest in the media and the lack of research on the subject create a clear need for this study. The objectives are to increase understanding about product placement in personal blogs and examine the benefits as well as the downsides created by this marketing channel and present the requirements for success. The study also takes a stand on what kind of things a successful product placement strategy in personal blogs includes and what points should be considered when creating a strategy. The study’s empirical part consists of seven thematic interviews with case companies’ representatives and one agent. The study’s personal blogs were delimited to consist only lifestyle and fashion blogs. The results show that product placement on personal lifestyle and fashion blogs is a strongly growing marketing channel and it is best suited to reach young women. It is also a very good channel to change and improve brand image. Via personal blogs it is possible to reach a large number of consumers with a very cost-efficient manner. Thus utilizing the channel is suitable for all companies regardless of the size of the marketing budget. Of course, companies have to consider the suitability of their product to the themes of blogs. Executing a successful campaign in this media requires good relationship management skills and understanding of this particular media as the final content is not in advertiser’s hands. As a marketing channel, personal blogs differ highly from traditional marketing channels because of their constantly changing nature and multidirectional quality where several parties are in interaction.

Hezbollah and Taliban - hybrid adversaries in contemporary conflicts? : views on an adversary from the United States Armed Forces perspective

The experiences of the United States Armed Forces of the wars in Iraq and Afghanistan and Israel Defense Forces in the Second Lebanon War resulted a new term to surface called “hybrid warfare”. It was to describe the complexity of today’s battlefield. The term “hy-brid warfare” was never officially defined nor is it today. The updated version of the US ARMY Field Manual 3-0: Operations (Change 1) from February 22, 2011, introduced and defined “hybrid threat” and thus opened the discussion for hybrid adversary. In this thesis a model is introduced according to which any organization, group or an ad-versary can be examined and evaluated to see whether it qualifies as a hybrid adversary. It is demonstrated by the example of Hezbollah, which is recognized as the best example of an organization utilizing “hybrid warfare” and subsequently categorizing as a hybrid adver-sary. The model will be tested with Afghan Taliban to see whether both the model works and Taliban qualifies as a hybrid adversary or not. According to the model used in this thesis, it is concluded that Taliban does not meet the standards of a hybrid adversary, but with acquisition of standoff weapons it would quickly qualify as one. The model proved to work, and it could be used as a tool by intelligence of-ficers for estimating the threat levels of any group or identifying those groups that are al-ready or are about to develop into a hybrid adversary.

Multiple scales analysis of nonlinear oscillations of a portal frame foundation for several machines

An analytical study of the nonlinear vibrations of a multiple machines portal frame foundation is presented. Two unbalanced rotating machines are considered, none of them resonant with the lower natural frequencies of the supporting structure. Their combined frequencies is set in such a way as to excite, due to nonlinear behavior of the frame, either the first anti-symmetrical mode (sway) or the first symmetrical mode. The physical and geometrical characteristics of the frame are chosen to tune the natural frequencies of these two modes into a 1:2 internal resonance. The problem is reduced to a two degrees of freedom model and its nonlinear equations of motions are derived via a Lagrangian approach. Asymptotic perturbation solutions of these equations are obtained via the Multiple Scales Method.

ERP implementation in SMEs : Consultant – Client Views On Critical Success Factors

ERP system is now attracting the SMEs, as it is now economical and affordable for them. The current research emphasizes on “how to make ERP successful for SMEs”. The researchers have identified various critical success factors in implementation of ERP. The research gap noticed by author is the missing point of view of ERP consultant. This thesis investigates the answer of research question “What are the critical success factors in implementation of ERP system in SMEs in opinion of ERP consultants and acquiring organizations”. The purpose of this study is to identify the highly important and less important factors. The study results will suggest the ERP managers where they have to concentrate more in order to achieve success. Literature is reviewed in order to setup a base for empirical study. Aplenty of work is found related to CSFs, SMEs and ERP. The authors and factors are organized in form of a table that tells which author is agreed upon which factor. Final result of literature review is a list of 14 CSFs. The qualitative research methodology is used to investigate the ERP in Pakistani SMEs. A case study approach is selected because of unified nature of SMEs in Pakistan. A rice mill is selected as a case because it contains maximum SME attributes. The opinion of a Microsoft certified consultant is obtained by a semi-structured interview. Similarly a semi-structured interview is conducted with CIO of SME that acquired ERP. Both the interviewees are asked about all 14 factors, whether they are agree or not and why. The collected evidences then analyzed by tabulation. The factors upon which both the participants found agreed, taken as highly important. Similarly the factors upon which both participants found disagree, taken as less important. Study results present a grid with four quadrants, the CSFs highly important in opinion of both, the CSFs less important in opinion of both, CSFs important in opinion of consultant but not client, CSFs important in opinion of client but not consultant. In discussion part, the significance of each factor is discussed individually. It is discussed that why some factors are high/less important for SMEs in Pakistan. The study output communicates a message that the success of ERP system in SMEs is linked with careful management of five important factors, the project management, top management support, user training and education, consultant participation and ERP teamwork and composition. The ERP consultants and managers can divert their concentration from less important factors such as user involvement, culture readiness and ERP package selection, toward the highly important factors. The limitations of the study are small number of interviews and less people involved, provide an opportunity for future research in this field of information system.

Pk-yrityksen menestystekijät kansainvälistymisprosessissa

Tutkielman tarkoitus oli selvittää, mitkä tekijät määrittelevät kansainvälistymisprosessin potentiaalista menestyjää. Aihetta on tutkittu paljon, mutta laajempi kokonaiskuva kansainvälistymisen menestystekijöistä puuttui. Tutkielman näkökulma on holistinen: Siinä yhdistettiin useampi linssi eri näkökulmia menestymiseen kansainvälistymisessä ja eri tutkimusmetodeja kvalitatiivisista kvantitatiivisiin. Tutkimuksessa käytettiin teoriasidonnaista lähestymistapaa ja konstruktiivista tutkimusotetta, jonka avulla Finpro ry:lle rakennettiin usean tutkimusvaiheen aikana potentiaalisia menestystapauksia tunnistava työkalu. Tutkimus toteutettiin neljässä vaiheessa, joissa rakennettiin kunkin vaiheen testituloksien mukainen konstruktio. Ensimmäisessä vaiheessa teemahaastattelulla selvitettiin konstruktion tarvepohja sekä rajaehdot. Konstruktion pohjaksi taulukoitiin 2001–2012 vuosien tutkimuksien tutkituimmat menestystekijät ja siihen lisättiin kansainvälistymisprosessin asiantuntijoiden korostamat menestystekijät. Tulokset yhdistettiin rakentamalla Konstruktio1. Toisessa vaiheessa Konstruktio1:sta kyselyn ja eksploratiivisen faktorianalyysin avulla faktoroitiin tärkeimmät menestymisen taustalla olevat ilmiöt, joista rakennettiin Konstruktio2. Kolmannessa vaiheessa kahden riippumattomien otosten ttestin avulla selvitettiin, mitkä Konstruktio2:n menestysfaktorit ovat tärkeimpiä ICT- ja life science -toimialoilla toimiville yrityksille ja mitä ilmiöitä yrityksen johto tai sijoittajat pitävät tärkeinä. Tuloksien pohjalta Konstruktio2 kehitettiin Konstruktio3:ksi. Neljännessä vaiheessa Konstruktio3:n pätevyyttä testattiin peilaamalla sen menestysfaktoreita kuuteen menestyjiksi todettuun tapaukseen, ja sen toimivuus selvitettiin kuuden avoimen haastattelun avulla. Tuloksien avulla Konstruktio3:sta rakennettiin Konstruktio4. Tutkimukset osoittivat, että menestystekijät vaihtelevat yrityksen kansainvälistymispolun ja eri näkökulmien mukaan. Tutkimus loi vahvan teoreettisen ja liiketoiminnallisen kontribuution. Tutkimusvaiheiden avulla hahmotettiin kansainvälistymisessä menestymisen kokonaisuus ja luottiin uusi näkemys pk-yrityksen menestymisestä. Toisaalta päästiin myös heti käyttövalmiiseen lopputulokseen, joka auttaa Finpron konsultteja ja myyjiä ymmärtämään menestymistä kansainvälistymisprosessissa ja löytämään potentiaalisia menestyjiä.

Corporate Social Responsibility and Shipping Views of Baltic Sea Shipping Companies on the Benefits of Responsibility

The safety of shipping operations in the Baltic Sea is an extensively studied issue due to the density of traffic and the ecological sensitivity of the area. The focus has, however, mainly been on ship technology or on traffic control measures and the operative safety aspect of shipping is in a minor position in maritime safety studies and is lacking in terms of solutions. Self-regulatory and voluntary measures could be effective ways to improve the operational safety of shipping. Corporate social responsibility, or CSR, is one example of a voluntary measure that the shipping companies can take. CSR can enhance maritime safety and improve the shipping companies’ competitiveness. The aim of this study is to increase the knowledge of CSR in the maritime sector and study its applicability and benefits to the shipping companies. The research comprises of a theory part and a questionnaire study, which examine the significance of corporate social responsibility in shipping companies’ maritime safety and competitiveness. The aim of the questionnaire study is to find out how corporate social responsibility is implemented in the shipping companies. According to the literature review, responsible actions can produce financial and time costs, but due to these actions cost savings in the form of learning and increased efficiency can be achieved. Responsible actions can also produce concrete improvements and a reputation of responsibility that can lead to both cost savings and increase in the company’s income. CSR is recognised as having real business benefits in terms of attracting customers and high-quality employees. In shipping, CSR usually focuses on environmental issues. Environmental social responsibility in shipping is mainly motivated by the need to comply with existing and forthcoming regulation. Shipping companies engage in CSR to gain competitive advantage and to increase maritime safety. The social aspects of CSR take into account the well-being and skills of the employees, corporation and other stakeholders of the company. The questionnaire study revealed that the most common CSR measures in shipping companies are environmental measures, and that environmental concerns are considered to be the most important reason to engage in CSR. From the preliminary question about the concept of CSR it can also be seen that safety issues are commonly considered to be a part of CSR and safety gains are the second most important reason to engage in CSR. From the questionnaire, it can also be extrapolated that gaining a better reputation is one of the most important reasons to engage in CSR in the first place. For example, the main economic benefit was seen to be the increase of customer numbers as a result of a better reputation. Based on the study, it would seem that companies are starting to realise that they might gain competitive advantage and be favoured as shippers if they engage in sustainable, responsible operations and present themselves as “green”.

Issuant views of hell in contemporary Anglo-American theology

This problem of hell is a specific form of the problem of evil that can be expressed in terms of a set of putatively incompatible statements: 1. An omnipotent God could create a world in which all moral agents freely choose life with God. 2. An omnibenevolent God would not create a world with the foreknowledge that some (perhaps a significant proportion) of God’s creatures would end up in hell. 3. An omniscient God would know which people will end up in hell. 4. Some people will end up forever in hell. Since the late twentieth century, a number of British and North American philosophical theologians, inspired by C.S. Lewis, have developed a new approach to answering the problem of hell. Very little work has been done to systematize this category of perspectives on the duration, quality, purpose and finality of hell. Indeed, there is no consensus among scholars as to what such an approach should be called. In this work, however, I call this perspective issuantism. Starting from the works of a wide range of issuantist scholars, I distill what I believe to be the essence of issuantist perspectives on hell: hell is a state that does not result in universal salvation and is characterized by the insistance that both heaven and hell must issue from the love of God, an affirmation of libertarian human freedom and a rejection of retributive interpretations of hell. These sine qua non characteristics form what I have labeled basic issuantism. I proceed to show that basic issuantism by itself does not provide an adequate answer to the problem of hell. The issuantist scholars themselves, however, recognize this weakness and add a wide range of possible supplements to their basic issuantism. Some of these supplemented versions of issuantism succeed in presenting reasonable answers to the problem of hell. One of the key reasons for the development of issuantist views of hell is a perceived failure on the part of conditionalists, universalists and defenders of hell as eternal conscious torment to give adequate answers to the problem of hell. It is my conclusion, however, that with the addition of some of the same supplements, versions of conditionalism and hell as eternal conscious torment can be advanced that succeed just as well in presenting answers to the problem of hell as those advanced by issuantists, thus rendering some of the issuantist critique of non-issuantist perspectives on hell unfounded.

Insiders´ views as a predictor of stock performance : can insider trading be used to predict stock performance on the United States stock market?

This thesis studies the possibility of using information on insiders’ transactions to forecast future stock returns after the implementation of Sarbanes Oxley Act in July 2003. Insider transactions between July 2003 and August 2009 are analysed with regression tests to identify the relationships between insiders’ transactions and future stock returns. This analysis is complemented with rudimentary bootstrapping procedures to verify the robustness of the findings. The underlying assumption of the thesis is that insiders constantly receive pieces of information that indicate future performance of the company. They may not be allowed to trade on large and tangible pieces of information but they can trade on accumulation of smaller, intangible pieces of information. Based on the analysis in the thesis insiders’ profits were found not to differ from the returns from broad stock index. However, their individual transactions were found to be linked to future stock returns. The initial model was found to be unstable but some of the predictive power could be sacrificed to achieve greater stability. Even after sacrificing some predictive power the relationship was significant enough to allow external investors to achieve abnormal profits after transaction costs and taxes. The thesis does not go into great detail about timing of transactions. Delay in publishing insiders’ transactions is not taken into account in the calculations and the closed windows are not studied in detail. The potential effects of these phenomena are looked into and they do not cause great changes in the findings. Additionally the remuneration policy of an insider or a company is not taken into account even though it most likely affects the trading patterns of insiders. Even with the limitations the findings offer promising opportunities for investors to improve their investment processes by incorporating additional information from insiders’ transaction into their decisions. The findings also raise questions on how insider trading should be regulated. Insiders achieve greater returns than other investors based on superior information. On the other hand, more efficient information transfer could warrant more lenient regulation. The fact that insiders’ returns are dominated by the large investment stake they maintain all the time in their own companies also speaks for more leniency. As Sarbanes Oxley Act considerably modified the insider trading landscape, this analysis provides information that has not been available before. The thesis also constitutes a thorough analysis of insider trading phenomenon which has previously been somewhat separated into several studies.

Public and private sector cooperative opportunities in the Finnish healthcare internationalization : views from the public sector’s perspective

Traditionally mostly publicly provided Finnish healthcare services are confronted today by the evident challenge of rising healthcare costs as the expenditure on health and social case has exceeded Finland’s national GDP growth significantly since the new millennium. While the opening of the traditional barriers through the EU’s new patient directive resulting in increasing international competition and the free flow of patients within the EU present opportunities for the Finnish healthcare services industry there are also several challenges for the existing healthcare system as proposed by the Ministry of Employment and the Economy in 2011. Due to the structure and nature of the current Finnish healthcare service system the greatest potential for internationalization is seen from a joint cooperation of the public and private sectors in an internationalization network for Finnish healthcare services. As its formation has recently also taken as a strategic initiative to be completed by the Ministry of Employment and the Economy and no earlier research exists on how this is seen in practice by the network actors, the purpose of this study is to examine the proposed solution of forming an internationalization network between the public and private sector actors in Finland in practice from the viewpoint of public sector actors. The research relied heavily on the reports by the Finnish Ministries in understanding the current situation of the Finnish healthcare services internationalization and its potential. Suitable theories were also used to build a more comprehensive view of the matter. The study applied a qualitative research approach on the explorative research problem. The data collection was achieved through expert interviews in two of the largest Finnish public healthcare service providers; the Turku and Helsinki Central University Hospitals. Expert interviews were considered as the most suitable method for data collection in order to create an in-depth understanding of the topic within the limitations of this thesis. In turn, two different public healthcare service providers were chosen to give a broader view of the field instead of focusing on a specific unit and also to allow a possible comparison between the two different organizations. The latter however was shown not to be suitable for the purposes of this study as the opinions of the respondents varied largely also within their own organizations. The conclusion is that while the actors agree on the evident internationalization of Finnish healthcare services, there are several large-scale structural challenges effectively preventing such activities while at the same time the opportunities within Finland vary, as there are several niches but no real large-scale advantages in the highly competitive industry. Interest towards cooperation between the sectors are seen especially in exploiting the advantages offered by the private sector in commercialization and marketization, yet however no clear views exist on how these activities should be governed or structured in the short-term as a larger reform of the entire Finnish healthcare service sector is needed in the long-term.

Multiple resistance of Conyza sumatrensis to Chlorimuron­ethyl and to Glyphosate

Weed resistance to herbicides has been a major issue in Brazil, mainly due to the inefficiency of the herbicides used in no-till areas and to the high cost of these herbicide treatments. Failures in controlling the weed Conyza have been reported in Western and Northern grain crop areas in Paraná (Brazil). This work aimed to evaluate the potential occurrence of C. sumatrensis biotypes resistant to the herbicides chlorimuron-ethyl and glyphosate. Experiments were carried out under greenhouse conditions with four biotypes (Cascavel-2, Toledo-4, Tupãssi-6, and Assis Chateaubriand-7) possibly resistant to, as well as a population considered susceptible to chlorimuron-ethyl and glyphosate. To obtain dose-response curves, eight herbicide doses of chlorimuron-ethyl (0, 2.5, 5, 10, 20, 40, 80 and 160 g ha-1) and glyphosate (0, 90, 180, 360, 720, 1,440, 2,880 and 5,760 g e.a. ha-1) were applied and weed control and shoot biomass evaluations were made. Results provided evidence that two biotypes (Cascavel-2 and Tupãssi-6) were resistant to glyphosate and four biotypes (Cascavel-2, Toledo-4, Tupãssi-6 and Assis Chateaubriand-7) were resistant to chlorimuron­ethyl. Multiple resistance to glyphosate and chlorimuron was confirmed for biotypes Cascavel­2 and Tupãssi 6. This is the first report on multiple resistance in Conyza sumatrensis, worldwide.