954 resultados para Intention de quitter


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

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The overall goal of the study was to describe nurses’ acceptance of an Internet-based support system in the care of adolescents with depression. The data were collected in four phases during the period 2006 – 2010 from nurses working in adolescent psychiatric outpatient clinics and from professionals working with adolescents in basic public services. In the first phase, the nurses’ anticipated perceptions of the usefulness of the Internet-based support system before its implementation was explored. In the second phase, the nurses’ perceived ease of computer and Internet use and attitudes toward it were explored. In the third phase, the features of the support system and its implementation process were described. In the fourth phase, the nurses’ experiences of behavioural intention and actual system use of the Internet-based support were described in psychiatric out-patient care after one year use. The Technology Acceptance Model (TAM) was used to structure the various research phases. Several benefits were identified from the nurses’ perspective in using the Internet-based support system in the care of adolescents with depression. The nurses’ technology skills were good and their attitudes towards computer use were positive. The support system was developed in various phases to meet the adolescents’ needs. Before the implementation of the information technology (IT)-based support system, it is important to pay attention to the nurses’ IT-training, technology support, resources, and safety as well as ethical issues related to the support system. After one year of using the system, the nurses perceived the Internet-based support system to be useful in the care of adolescents with depression. The adolescents’ independent work with the support system at home and the program’s systematic character were experienced as conducive from the point of view of the treatment. However, the Internet-based support system was integrated only partly into the nurseadolescent interaction even though the nurses’ perceptions of it were positive. The use of the IT-based system as part of the adolescents’ depression care was seen positively and its benefits were recognized. This serves as a good basis for future IT-based techniques. Successful implementations of IT-based support systems need a systematic implementation plan and commitment from the part of the organization and its managers. Supporting and evaluating the implementation of an IT-based system should pay attention to changing the nurses’ work styles. Health care organizations should be offered more flexible opportunities to utilize IT-based systems in direct patient care in the future.

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Retaining players and re-attracting switching players has long been a central topic for SNG providers with regard to the post-adoption stage of playing an online game. However, there has not been much research which has explored players’ post-adoption behavior by incorporating the continuance intention and the switching intention. In addition, traditional IS continuance theories were mainly developed to investigate users’ continued use of utilitarian IS, and thus they may fall short when trying to explain the continued use of hedonic IS. Furthermore, compared to the richer literature on IS continuance, far too little attention has been paid to IS switching, leading to a dearth of knowledge on the subject, despite the increased incidence of the switching phenomenon in the IS field. By addressing the limitations of prior literature, this study seeks to examine the determinants of SNG players’ two different post-adoption behaviors, including the continuance intention and the switching intention. This study takes a positivist approach and uses survey research method to test five proposed research models based on Unified Theory of Acceptance and Use of Technology 2; Use and Gratification Theory; Push-Pull-Mooring model; Cognitive Dissonance Theory; and a self-developed model respectively with empirical data collected from the SNG players of one of the biggest SNG providers in China. A total of 3919 valid responses and 541 valid responses were used to examine the continuance intention and the switching intention, respectively. SEM is utilized as the data analysis method. The proposed research models are supported by the empirical data. The continuance intention is determined by enjoyment, fantasy, escapism, social interaction, social presence, social influence, achievement and habit. The switching intention is determined by enjoyment, satisfaction, subjective norms, descriptive norms, alternative attractiveness, the need for variety, change experience, and adaptation cost. This study contributes to IS theories in three important ways. Firstly, it shows IS switching should be included in IS post-adoption research together with IS continuance. Secondly, a modern IS is usually multi-functional and SNG players have multiple reasons for using a SNG, thus a player’s beliefs about the hedonic, social and utilitarian perceptions of their continued use of the SNG exert significant effects on the continuance intention. Thirdly, the determinants of the switch ing intention mainly exert push, pull, and mooring effects. Players’ beliefs about their current SNG and the available alternatives, as well as their individual characteristics are all significant determinants of the switching intention. SNG players combine these effects in order to formulate the switching intention. Finally, this study presents limitations and suggestions for future research.

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Diplomityössä tarkastellaan raskaita teräsrakenteita valmistavan tilauskonepajan tuotannon kehittämiskohteita. Tuotannon kehittämisellä halutaan nopeuttaa tuotannon läpimenoaikoja, vähentää laatukustannuksia ja parantaa yrityksen tiedonkulkua. Näillä toimenpiteillä pyritään vaikuttamaan yrityksen kilpailukykyyn, jolloin se voi nousta suomalaisessa toimittajaverkostossa korkeammalle portaalle. Työn teoriaosassa paneudutaan tuottavuus- ja laatuajatteluun hitsaavassa konepajassa. Samalla esitellään eräitä konepajoissa tyypillisimmin käytettyjä laatustandardeja, joita ovat: SFS-EN ISO 9001, SFS-EN ISO 3834 ja SFS-EN 1090. Lisäksi teoriaosiossa on kerrottu erilaisista tuotannonohjausjärjestelmistä ja layout-teorioista. Tämän diplomityön kohdeyritys on Karjalan Konepaja Oy. Yrityksen nykytilanteen kartoittamiseksi suoritettiin useita haastatteluita sekä laadittiin koko organisaatiota koskeva kysely. Tilauskonepajan haasteena ovat alati muuttuvat tilaukset. Tilauskonepajan tuotannon kehittäminen tulee aloittaa sopivien tuotannontehokkuutta mittaavien mittareiden määrittämisellä. Usein kapasiteetti ja tuottavuus kuvastavat parhaiten työvaiheiden tehokkuutta. Mittareiden tarkoitus on auttaa konepajaa löytämään ne tuotannon pullonkaulat, joista yrityksen kehittäminen tulisi aloittaa. Lean-filosofian avulla tulee kehittää tuotannosta hitaimmin suoriutuvia työvaiheita. Tarkoituksena on poistaa valmistusketjusta sellaiset työvaiheet, jotka eivät anna tuotteelle lisäarvoa. Lisäksi työpisteiden layout kannattaa kyseenalaistaa aika ajoin, sillä jo pienilläkin muutoksilla voidaan saada parannuksia työpisteiden tuottavuuteen ja kapasiteettiin.

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The Pasvik monitoring programme was created in 2006 as a result of the trilateral cooperation and with the intention of following changes in the environment under variable pollution levels. Water quality is one of the basic elements of the programme when assessing the effects of the emissions from the Pechenganikel mining end metallurgical industry (Kola GMK). In this report temporal trends of the water chemistry during 2000–2013 are examined on the basis of the data gathered from lake Inari, River Pasvik and directly connected lakes, Lake Kuetsjarvi and 25 small lakes in three areas: Pechenganikel (Russia), Jarfjord (Norway) and Vätsäri (Finland). The lower parts of the Pasvik watercourse are impacted by both atmospheric pollution and direct wastewater discharge from the Pechenganikel smelter and the settlement of Nikel. The upper section of the watercourse and the small lakes and streams which are not directly linked to the Pasvik Watercourse only receive atmospheric pollution. Lake Inari is free of direct emissions from the Pechenganikel and the water quality is excellent. In River Pasvik and the directly connected lakes copper, nickel, and sulphates are the main pollutants. The most polluted water body is the Kolosjoki River as well as the stream connecting the Lakes Salmijarvi and Kuetsjarvi. The concentration of metals and sulphates in the water notably increases downstream the river lower Lake Kuetsjarvi. In Lake Kuetsjarvi copper and nickel concentrations are clearly elevated and have changed insignificantly in the last years of the research period. In the small border area lakes recovery from acidification in Vätsäri and Jarfjord is evident. Nickel and copper oncentrations have fluctuated but remained on clearly elevated level in Jarfjord and Pechenga. Copper concentrations have been slightly rising in the recent years. In Pechenga area nickel concentrations during the last four monitoring years are decreasing in some places but the regional trend through whole time series is still positive.

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Trials have demonstrated that high-dose escalation followed by autologous transplantation can promote better long-term survival as salvage treatment in malignant lymphomas. The aim of the present nonrandomized clinical trial was to demonstrate the role of high-dose cyclophosphamide (HDCY) in reducing tumor burden and also to determine the effectiveness of HDCY followed by etoposide (VP-16) and methotrexate (MTX) in Hodgkin's disease plus high-dose therapy with peripheral blood progenitor cell (PBPC) transplantation as salvage treatment. From 1998 to 2000, 33 patients with a median age of 33 years (13-65) affected by aggressive non-Hodgkin's lymphoma (NHL) (60.6%) or persistent or relapsed Hodgkin's disease (39.4%) were enrolled and treated using high dose escalation (HDCY + HDVP-16 plus HDMTX in Hodgkin's disease) followed by autologous PBPC transplantation. On an "intention to treat" basis, 33 patients with malignant lymphomas were evaluated. The overall median follow-up was 400 days (40-1233). Thirty-one patients underwent autografting and received a median of 6.19 x 10(6)/kg (1.07-29.3) CD34+ cells. Patients who were chemosensitive to HDCY (N = 22) and patients who were chemoresistant (N = 11) presented an overall survival of 96 and 15%, respectively (P<0.0001). Overall survival was 92% for chemosensitive patients and 0% for patients who were still chemoresistant before transplantation (P<0.0001). Toxicity-related mortality was 12% (four patients), related to HDCY in two cases and to transplant in the other two. HDCY + HDVP-16 plus HDMTX in only Hodgkin's disease followed by autologous PBPC proved to be effective and safe as salvage treatment for chemosensitive patients affected by aggressive NHL and Hodgkin's disease, with acceptable mortality rates related to sequential treatment.

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The purpose of this thesis was to discover whether the common financial concept has created benefits for the franchisees as well as to find out how the financial con-cept should be developed. Services play an important role in franchising supporting the core competence and releasing the franchisee to do what he knows best. So they don’t need to use their time and energy on something that a working service function does for them. This thesis has been implemented by using a qualitative research. A survey to fran-chisees and semi-structured thematic interviews formed the research material used in this study. A theoretical framework was created through value chain, core compe-tence, customer-perceived value, creating value to the customer and together with the customer and noticing the difficulties in individual decision-making. The thesis is based on practical and investigational needs. On the practical level, the research is intended to support the development process of the financial ser-vices. The purpose of the financial service concept is to support the core business. Furthermore the intention was to find through the theoretical basis the background to support the practical work specifically in a service-dominant business.

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This thesis in caring science didactics is based on a thinking, where the fundamental basis for the didactic is science-based, i.e. it does not emanate from the nursing profession but brings forward a didactic that grows out of caring science and its core substance and ethos. This view on didactics arises from the caritative theory developed by Eriksson. The overall aim of the study is to clarify the meaning and essence of understanding, as well as to explore and deepen the understanding of student nurses' processes of understanding and becoming with the intention of developing a theory model for caring didactics. The overarching research questions are: What is the essence of understanding (of caring science knowledge)? What are the possibilities and importance of understanding in the appropriation of caring science? What characterizes and impels the process of becoming? The thesis consists of four sub studies and a summary section. The overall methodological approach is hermeneutic involving quantitative as well as qualitative methods. The data for the study has been collected through a longitudinal research project that followed student nurses at three universities during their entire education. The empirical sub studies form the basis for the interpreted knowledge that is formulated in the new understanding. This new understanding have, through additional theory-charging with the theory fragments from Gadamer, generated the heuristic synthesis which is illustrated in the theory model. The findings shows that understanding can be described as something unlimited, as an endless movement, which can be illustrated as a lying eighth, a lemniscate. The lemiscate of understanding is characterized by seeing, knowing and becoming and consists of seven differently named phases; the acquired horizon of understanding, the encounter of horizons, the dialogue of horizons, the fusion of horizons, application, reflection and shaping a new horizon of understanding. Bildung (formation), is the ultimate imprint of the endless spiral movement of understanding. Ethos and arête constitute the hubs around which the lemniscate of understanding circles. These include the spirit and driving force that the student carries within. The caring culture encloses the lemniscate of understanding. The caring culture provides the life space of understanding and the prevailing basic values are evinced in the culture.

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The objective of this study was to increase understanding of the link between the identification of required HR competences and competence management alignment with business strategy in a Finnish, global company employing over 8,000 people and about 100 HR professionals. This aim was approached by analyzing the data collected in focus group interviews using a grounded theory method and in parallel reviewing the literature of strategic human resource management, competence-based strategic management, strategy and foresight. The literature on competence management in different contexts dismisses in-depth discussions on the foresight process and individuals are often forgotten in strategic frameworks. However, corporate foresight helps in the detection of emerging opportunities for innovations and in the implementation of strategy. The empirical findings indicate a lack of strategic leadership and an alignment with HR and business. Accordingly, the most important HR competence areas identified were the need for increasing business understanding and enabling change. As a result, the study provided a holistic model for competence foresight, which introduces HR professionals as strategic change agents in the role of organizational futurists at the heart of the company: facilitating competence foresight and competence development on individual as well as organizational levels, resulting in an agile organization with increased business understanding, sensitive sensors and adaptive actions to enable change.

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Since there are some concerns about the effectiveness of highly active antiretroviral therapy in developing countries, we compared the initial combination antiretroviral therapy with zidovudine and lamivudine plus either nelfinavir or efavirenz at a university-based outpatient service in Brazil. This was a retrospective comparative cohort study carried out in a tertiary level hospital. A total of 194 patients receiving either nelfinavir or efavirenz were identified through our electronic database search, but only 126 patients met the inclusion criteria. Patients were included if they were older than 18 years old, naive for antiretroviral therapy, and had at least 1 follow-up visit after starting the antiretroviral regimen. Fifty-one of the included patients were receiving a nelfinavir-based regimen and 75 an efavirenz-based regimen as outpatients. Antiretroviral therapy was prescribed to all patients according to current guidelines. By intention-to-treat (missing/switch = failure), after a 12-month period, 65% of the patients in the efavirenz group reached a viral load <400 copies/mL compared to 41% of the patients in the nelfinavir group (P = 0.01). The mean CD4 cell count increase after a 12-month period was also greater in the efavirenz group (195 x 10(6) cells/L) than in the nelfinavir group (119 x 10(6) cells/L; P = 0.002). The efavirenz-based regimen was superior compared to the nelfinavir-based regimen. The low response rate in the nelfinavir group might be partially explained by the difficulty of using a regimen requiring a higher patient compliance (12 vs 3 pills a day) in a developing country.

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A 7.4% vaginal extract of the Brazilian pepper tree (Schinus terebinthifolius Raddi) was compared with 0.75% vaginal metronidazole, both manufactured by the Hebron Laboratory, for the treatment of bacterial vaginosis, used at bedtime for 7 nights. The condition was diagnosed using the combined criteria of Amsel and Nugent in two groups of 140 and 137 women, aged between 18 and 40 years. Intention-to-treat analysis was performed. Women were excluded from the study if they presented delayed menstruation, were pregnant, were using or had used any topical or systemic medication, presented any other vaginal infections, presented hymen integrity, or if they reported any history suggestive of acute pelvic inflammatory disease. According to Amsel’s criteria separately, 29 patients (21.2%) treated with the extract and 87 (62.1%) treated with metronidazole were considered to be cured (P < 0.001). According to Nugent’s score separately, 19 women (13.9%) treated with the extract and 79 (56.4%) treated with metronidazole were considered to be cured (P < 0.001). Using the two criteria together, the so-called total cure was observed in 17 women (12.4%) treated with the extract and in 79 women (56.4%) treated with metronidazole (P < 0.001). In conclusion, the cure rate for bacterial vaginosis using a vaginal gel from a pepper tree extract was lower than the rate obtained with metronidazole gel, while side effects were infrequent and non-severe in both groups.

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Recent evidence shows that moxifloxacin could exert an antimicrobial effect against Helicobacter pylori in both in vitroand in vivo models. To systematically evaluate whether moxifloxacin-containing triple therapy could improve eradication rates and reduce side effects in first-line or second-line anti-H. pyloritreatment, eligible articles were identified by searches of electronic databases. We included all randomized trials comparing moxifloxacin-based triple therapy with standard triple or quadruple therapy during H. pylori eradication treatment. Statistical analysis was performed with Review Manager 5.0.10. Subanalysis/sensitivity analysis was also performed. We identified seven randomized trials (n=1263). Pooled H. pylori eradication rates were 79.03% (95%CI: 75.73-82.07) and 68.33% (95%CI: 64.44-72.04) for patients with moxifloxacin-based triple therapy or with standard triple or quadruple therapy, respectively (intention-to-treat analysis). The odds ratio (OR) was 1.82 (95%CI: 1.17-2.81), the occurrence of total side effects was 15.23% (95%CI: 12.58-18.20) and 27.17% (95%CI: 23.64-30.92) for groups with or without moxifloxacin, and the summary OR was 0.45 (95%CI: 0.26-0.77). In subgroup analyses, we noted that the second-line eradication rate in the moxifloxacin group was significantly higher than that in the quadruple therapy group (73.33 vs 60.17%, OR: 1.78, 95%CI: 1.16-2.73, P<0.001). However, there was no difference in first-line eradication treatment. Findings from this meta-analysis suggest that moxifloxacin-based triple therapy is more effective and better tolerated than standard triple or quadruple therapy. Therefore, a moxifloxacin-based triple regimen should be used in the second-line treatment of H. pylori infection.

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We aimed to evaluate the effectiveness and safety of bismuth-containing quadruple therapy plus postural change after dosing for Helicobacter pylori eradication in gastrectomized patients. We compared 76 gastric stump patients with H. pylori infection (GS group) with 50 non-gastrectomized H. pylori-positive patients who met the treatment indication (controls). The GS group was divided into GS group 1 and GS group 2. All groups were administered bismuth potassium citrate (220 mg), esomeprazole (20 mg), amoxicillin (1.0 g), and furazolidone (100 mg) twice daily for 14 days. GS group 1 maintained a left lateral horizontal position for 30 min after dosing. H. pylori was detected using rapid urease testing and histologic examination of gastric mucosa before and 3 months after therapy. Mucosal histologic manifestations were evaluated using visual analog scales of the updated Sydney System. GS group 1 had a higher prevalence of eradication than the GS group 2 (intention-to-treat [ITT]: P=0.025; per-protocol [PP]: P=0.030), and the control group had a similar prevalence. GS group 2 had a lower prevalence of eradication than controls (ITT: P=0.006; PP: P=0.626). Scores for chronic inflammation and activity declined significantly (P<0.001) 3 months after treatment, whereas those for atrophy and intestinal metaplasia showed no significant change. Prevalence of adverse reactions was similar among groups during therapy (P=0.939). A bismuth-containing quadruple therapy regimen plus postural change after dosing appears to be a relatively safe, effective, economical, and practical method for H. pylori eradication in gastrectomized patients.

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Poly-L-lactide (PLLA) is a widely used sustainable and biodegradable alternative to replace synthetic non-degradable plastic materials in the packaging industry. Conversely, its processing properties are not always optimal, e.g. insufficient melt strength at higher temperatures (necessary in extrusion coating processes). This thesis reports on research to improve properties of commercial PLLA grade (3051D from NatureWorks), to satisfy and extend end-use applications, such as food packaging by blending with modified PLLA. Adjustment of the processability by chain branching of commercial poly-L-lactide initiated by peroxide was evaluated. Several well-defined branched structures with four arms (sPLLA) were synthesized using pentaerythritol as a tetra-functional initiator. Finally, several block copolymers consisting of polyethylene glycol and PLLA (i.e. PEGLA) were produced to obtain a well extruded material with improved heat sealing properties. Reactive extrusion of poly-L-lactide was carried out in the presence of 0.1, 0.3 and 0.5 wt% of various peroxides [tert-butyl-peroxybenzoate (TBPB), 2,5-dimethyl-2,5-(tert-butylperoxy)-hexane (Lupersol 101; LOL1) and benzoyl peroxide (BPO)] at 190C. The peroxide-treated PLLAs showed increased complex viscosity and storage modulus at lower frequencies, indicating the formation of branched/cross linked architectures. The material property changes were dependent on the peroxide, and the used peroxide concentration. Gel fraction analysis showed that the peroxides, afforded different gel contents, and especially 0.5 wt% peroxide, produced both an extremely high molar mass, and a cross linked structure, not perhaps well suited for e.g. further use in a blending step. The thermal behavior was somewhat unexpected as the materials prepared with 0.5 wt% peroxide showed the highest ability for crystallization and cold crystallization, despite substantial cross linking. The peroxide-modified PLLA, i.e. PLLA melt extruded with 0.3 wt% of TBPB and LOL1 and 0.5 wt% BPO was added to linear PLLA in ratios of 5, 15 and 30 wt%. All blends showed increased zero shear viscosity, elastic nature (storage modulus) and shear sensitivity. All blends remained amorphous, though the ability of annealing was improved slightly. Extrusion coating on paperboard was conducted with PLLA, and peroxide-modified PLLA blends (90:10). All blends were processable, but only PLLA with 0.3 wt% of LOL1 afforded a smooth high quality surface with improved line speed. Adhesion levels between fiber and plastic, as well as heat seal performance were marginally reduced compared with pure 3051D. The water vapor transmission measurements (WVTR) of the blends containing LOL1 showed acceptable levels, only slightly lower than for comparable PLLA 3051D. A series of four-arm star-shaped poly-L-lactide (sPLLA) with different branch length was synthesized by ring opening polymerization (ROP) of L-lactide using pentaerythritol as initiator and stannous octoate as catalyst. The star-shaped polymers were further blended with its linear resin and studied for their melt flow and thermal properties. Blends containing 30 wt% of sPLLA with low molecular weight (30 wt%; Mwtotal: 2500 g mol-1 and 15000 g mol-1) showed lower zero shear viscosity and significantly increased shear thinning, while at the same time slightly increased crystallization of the blend. However, the amount of crystallization increased significantly with the higher molecular weight sPLLA, therefore the star-shaped structure may play a role as nucleating agent. PLLA-polyethylene glycol–PLLA triblock copolymers (PEGLA) with different PLLA block length were synthesized and their applicability as blends with linear PLLA (3051D NatureWorks) was investigated with the intention of improving heat-seal and adhesion properties of extrusion-coated paperboard. PLLA-PEG-PLLA was obtained by ring opening polymerization (ROP) of L-lactide using PEG (molecular weight 6000 g mol-1) as an initiator, and stannous octoate as catalyst. The structures of the PEGLAs were characterized by proton nuclear magnetic resonance spectroscopy (1H-NMR). The melt flow and thermal properties of all PEGLAs and their blends were evaluated using dynamic rheology, and differential scanning calorimeter (DSC). All blends containing 30 wt% of PEGLAs showed slightly higher zero shear viscosity, higher shear thinning and increased melt elasticity (based on tan delta). Nevertheless, no significant changes in thermal properties were distinguished. High molecular weight PEGLAs were used in extrusion coating line with 3051D without problems.

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China’s phenomenal economic growth and social development have brought along interesting opportunities for Finnish companies. One intriguing sector offering significant growth potential is the food industry. Due to the local food safety issues, rising disposable income level and changing consumer habits, the demand for foreign food is increasing. Finnish food companies have much to offer in terms of high quality, food safety in production, technological development and innovation. The purpose of this study is to examine how the Finnish food enterprises choose their entry modes in the Chinese market. This study increases understanding of entry modes the Finnish companies can use to successfully enter the unpredictable market of China in the food industry context. The study examines the industry specific challenges and the possible solutions to them. Qualitative research is selected as research methodology for this study because the intention is to understand the reasons behind the Finnish food enterprises’ entry mode choices in the Chinese market. The study is conducted as a qualitative case analysis. Six Finnish case companies operating in the food industry were interviewed. The results of the research indicate that most of the food industry companies use exporting as their entry mode to China; only one case company used an investment mode. This study illustrates the significance of the factors related to company’s background, mode concerns and Chinese market influences in the entry mode choice.