In search of information systems value : a case study of the EHR benefits realisation efforts of three Swedish hospitals.

The Swedish public health care organisation could very well be undergoing its most significant change since its specialisation during the late 19th and early 20th century. At the heart of this change is a move from using manual patient journals to electronic health records (EHR). EHR are complex integrated organisational wide information systems (IS) that promise great benefits and value as well as presenting great challenges to the organisation. The Swedish public health care is not the first organisation to implement integrated IS, and by no means alone in their quest for realising the potential benefits and value that it has to offer. As organisations invest in IS they embark on a journey of value-creation and capture. A journey where a costbased approach towards their IS-investments is replaced with a value-centric focus, and where the main challenges lie in the practical day-to-day task of finding ways to intertwine technology, people and business processes. This has however proven to be a problematic task. The problematic situation arises from a shift of perspective regarding how to manage IS in order to gain value. This is a shift from technology delivery to benefits delivery; from an ISimplementation plan to a change management plan. The shift gives rise to challenges related to the inability of IS and the elusiveness of value. As a response to these challenges the field of IS-benefits management has emerged offering a framework and a process in order to better understand and formalise benefits realisation activities. In this thesis the benefits realisation efforts of three Swedish hospitals within the same county council are studied. The thesis focuses on the participants of benefits analysis projects; their perceptions, judgments, negotiations and descriptions of potential benefits. The purpose is to address the process where organisations seek to identify which potential IS-benefits to pursue and realise, this in order to better understand what affects the process, so that realisation actions of potential IS-benefits could be supported. A qualitative case study research design is adopted and provides a framework for sample selection, data collection, and data analysis. It also provides a framework for discussions of validity, reliability and generalizability. Findings displayed a benefits fluctuation, which showed that participants’ perception of what constituted potential benefits and value changed throughout the formal benefits management process. Issues like structure, knowledge, expectation and experience affected perception differently, and this in the end changed the amount and composition of potential benefits and value. Five dimensions of benefits judgment were identified and used by participants when finding accommodations of potential benefits and value to pursue. Identified dimensions affected participants’ perceptions, which in turn affected the amount and composition of potential benefits. During the formal benefits management process participants shifted between judgment dimensions. These movements emerged through debates and interactions between participants. Judgments based on what was perceived as expected due to one’s role and perceived best for the organisation as a whole were the two dominant benefits judgment dimensions. A benefits negotiation was identified. Negotiations were divided into two main categories, rational and irrational, depending on participants’ drive when initiating and participating in negotiations. In each category three different types of negotiations were identified having different characteristics and generating different outcomes. There was also a benefits negotiation process identified that displayed management challenges corresponding to its five phases. A discrepancy was also found between how IS-benefits are spoken of and how actions of IS benefits realisation are understood. This was a discrepancy between an evaluation and a realisation focus towards IS value creation. An evaluation focus described IS-benefits as well-defined and measurable effects and a realisation focus spoke of establishing and managing an on-going place of value creation. The notion of valuescape was introduced in order to describe and support the understanding of IS value creation. Valuescape corresponded to a realisation focus and outlined a value configuration consisting of activities, logic, structure, drivers and role of IS.

Growth inhibitors in turfgrass

Well-maintained lawns are comfortable and safe places for leisure activities and sports practice, and they also bring environmental benefits; for example, they reduce soil exposure to erosion and releases atmospheric CO2, thus reducing the greenhouse effect. However, regardless of the purpose of use or the choice of the plant species to form the lawn, the highest costs involve cutting that is needed to keep the turfgrass at its appropriate height. Successive lawn cutting operations are necessary basically because of the vegetative and reproductive growth of turfgrass which, in Brazil, occurs mainly from October to March. Expenditures with successive mechanical cuttings have fostered the search of alternative procedures to keep lawn plants at appropriate height, such as the use of plant growth inhibitors, an increasingly interesting procedure. Since the use of this technology in Brazil is still at its early stage, the aim of this literature review is to examine aspects associated with lawn management by using growth inhibitors. Another alternative is to increase the knowledge of the classification and rational application of the different compounds currently available in the market.

Weed mapping using techniques of precision agriculture

The aim of this study was to identify and map the weed population in a no-tillage area. Geostatistical techniques were used in the mapping in order to assess this information as a tool for the localized application of herbicides. The area of study is 58.08 hectares wide and was sampled in a fixed square grid (which point spaced 50 m, 232 points) using a GPS receiver. In each point the weeds species and population were analyzed in a square with a 0.25 m2 fixed area. The species Ipomoea grandifolia, Gnaphalium spicatum, Richardia spp. and Emilia sonchifolia have presented no spatial dependence. However, the species Conyza spp., C. echinatus and E. indica have shown a spatial correlation. Among the models tested, the spherical model has shown had a better fit for Conyza spp. and Eleusine indica and the Gaussian model for Cenchrus echinatus. The three species have a clumped spatial distribution. The mapping of weeds can be a tool for localized control, making herbicide use more rational, effective and economical.

Helluntailaiset luokkakuvassa. uskontokulttuuri ja yksikön luokka-asema Turun Helluntaiseurakunnassa

Tässä tutkimuksessa analysoin sitä, miten helluntailainen uskontokulttuuri vaikuttaa yksilön valintoihin ja sen kautta siihen, mihin luokka-asemiin seurakuntalaiset ovat päätyneet Turun Helluntaiseurakunnassa. Tutkimus on uskontoantropologinen ja kuuluu uskontotieteen alaan. Siinä yhdistetään sosiologista luokkatutkimusta sekä rationaalisen valinnan ja toiminnan teorioita uskontoantropologisessa viitekehyksessä. Pääasialliseksi aineistoksi keräsin laajan etnografisen aineiston, joka koostuu systemaattisesta havainnoinnista, kyselyistä ja haastatteluista. Lisäksi olen tutkinut seurakunnan ja helluntailaisuutta koskevia arkistoja sekä kirjallisuutta. Tutkimuksen kohde on Turun helluntaiseurakunta, joka muodostaa tutkimusongelman kannalta mielekkään tutkimusasetelman. Tutkimus kertoo olennaista tietoa siitä, miten uskonto vaikuttaa yksilön valintoihin ja hänen yhteiskunnalliseen asemaansa. Tutkimusaineiston pohjalta laadin selittävän mallin kuvaamaan sitä prosessia, miten yksilöt tekevät valintojaan rationaalisina toimijoina eri kulttuurien vaikutuspiireissä. Antropologisena pohjana selitykselle toimii uskonnon rajojen rakentumisen, muuttamisen ja ylittämisen logiikka. Pyhän kategorisoinnin jäsentämä uskontokulttuuri ohjaa yksilöä suosimaan toisia kulttuureja, luokkakulttuureja ja tyylejä sekä vierastamaan toisia. Jos yksilö haluaa tehdä valinnan, joka nähdään arveluttavana, täytyy hänen oikeuttaa se kulttuurinsa sisäisillä symboleilla ja rituaaleilla. Turun Helluntaiseurakunnassa korostuvat auttamisen ja sivistämisen ammatit, kuten lääkäri, sairaanhoitaja ja opettaja. Nämä voidaan edelleen jäljittää seurakunnan opetuksiin sekä seurakuntalaisten käyttämiin diskursseihin ja oletuksiin hyväksytyistä elämäntyyleistä. Lisäksi diskursseissa korostuvat näkemykset ammatista kutsumuksena, koulutuksen itsestäänselvyys sekä asemaan liittyvän radikalismin välttäminen. Seurakunnan uskontokulttuurin keskiluokkaistava vaikutus näkyy ennen kaikkea toisen ja useamman polven helluntailaisissa, jotka sijoittuvat korkeampiin asemiin kuin ulkopuolelta kääntyneet. Seurakunnan uskontokulttuuri vähentää luokkatietoisuuden syntyä ja voi osaltaan ylläpitää yhteiskunnan luokkarakennetta, koska uskonnon ensisijaiset päämäärät eivät kohdistu yhteiskunnan rakenteen muuttamiseen Suomessa. Tutkimuksen mukaan yksilön omat ja häneen kohdistetut oletukset ja arvot, jotka hän kulttuurissa omaksuu, ohjaavat häntä myös kulttuurinsa näkökulmasta suosiollisiin asemiin.

Att tala om det osägbara : Nicolaus Cusanus cirkulära filosofi i verket De coniecturis med särskild hänsyn till Nelson Pikes tankar om unio mystica

In my dissertation called Speaking of the unsayable: The circular philosophy of Nicholas of Cusa in his work De coniecturis, I presuppose an internal (conceptual) relation between the personal experience of God of Nicholas of Cusa (1401-64) in 1438 and, on the other hand, his philosophy. I hence try to describe the precise character of this relation. Referring to the Norwegian scholars Egil Wyller and Viggo Rossvær, I assume that there is a circularity in Cusanus’ philosophy which appears as self-references (= a sentence refers to itself: A is explained by B and B is explained by A). Wyller finds three phases in the thought of Cusanus (1. De docta ignorantia I-III, 2. De coniecturis I-II, 3. all subsequent works). Rossvær finds it impossible to presuppose certain phases, as the philosophy of Cusanus continuously proceeds and remains open to new ideas. As Cusanus however treats his experience of God far more consciously in his second work De coniecturis than in De docta ignorantia, I find it possible to distinguish between the earlier Cusanus (De docta ignorantia including his earlier works) and the later Cusanus (De coniecturis, about 1444, as well as the following works). Cusanus creates a philosophy of language in outline expressed in De coniecturis, in which he presents two concepts of necessity, i.e. absolute necessity and logical, or reasonable, necessity. These are interrelated in the sense that the mind, or the self, logically affirms the absolute, or unsayable, necessity, which shows itself in the mind and which the mind affirms conjecturally. The endeavour conceptually to understand absolute necessity implies intuitive (or intellectual) contemplation, or vision (investigatio symbolica), in which the four mental unities (the absolute, the intellectual, the rational and the sensuous) work together according to the rules described in De coniecturis. In De coniecturis Cusanus obviously turns from a negative concept of the unsayable to a paradigmatic, which implies that he looks for principles of speaking of the unsayable and presents the idea of a divine language (divinaliter). However, he leaves this idea behind after De coniecturis, although he continues to create new concepts of the unsayable and incomprehensible. The intellectual language of absolute seeing is expressed in the subjunctive, i.e. conditionally. In order to describe the unsayable, Cusanus uses tautologies, the primary one of which is a concept of God, i.e. non aliud est non aliud quam non aliud (the non-other is non-other than the nonother). Wyller considers this the crucial point of the philosophy of Cusanus (De non aliud), described by the latter as the definition of definitions, i.e. the absolute definition. However, this definition is empty regarding its content. It demonstrates that God surpasses the coincidence of opposites (coincidentia oppositorum) and that he is “superunsayable” (superineffabilis), i.e. he is beyond what can be conceived or said. Nothing hence prevents us from speaking of him, provided that he is described as unsayable (= the paradigmatic concept of the unsayable). Here the mode of seeing is decisive. Cusanus in this context (and especially in his later literary production) uses modalities which concern possibility and necessity. His aim is to conduct any willing reader ahead on the way of life (philosophia mentalis). In De coniecturis II he describes the notion of human self-consciousness as the basis of spiritual mutuality in accordance with the humanistic tradition of his time. I mainly oppose the negatively determined concept of Christian mysticism presented by the German philosopher Kurt Flasch and prefer the presentation of Burkhard Mojsisch of the translogical and conjectural use of language in De coniecturis. In particular, I take account of the Scandinavian research, basically that of Johannes Sløk, Birgit H. Helander, Egil Wyller and Viggo Rossvær, who all consider the personal experience of God described by Cusanus a tacit precondition of his philosophy.

Polysulfidiprosessi sulfaattisellutehtaassa

Kandidaatintyön tavoitteena on kartoittaa merkittävimmät muutokset sellutehtaalla siirryttäessä sulfaattimassan valmistuksesta polysulfidiselluprosessiin. Työssä esitellään sulfaattisellun valmistusprosessi ja polysulfidin vaatimat muutokset selluprosessissa erityisesti höyrynkulutuksen kannalta. Sellutehtaan höyrynkulutusta ja sen mahdollisia muutoksia tarkastellaan suhteessa tehtaan selluntuotantoon. Tutkimus tehdään tutustuen dokumenttilähteisiin sekä erityisesti hankkimalla lisätietoa ja käytännön näkemystä asiantuntijahaastatteluista. Työssä käytetään esimerkkinä tyypillistä modernia sellutehdasta, jonka perusteella tarkasteltavat osaprosessit ovat valikoituneet. Sulfaattiprosessiin tehtävät muutokset käsittävät keittolipeän muuttamisen polysulfidipitoiseksi, polysulfidin valmistusprosessin (MOXY) sekä keiton muuttamisen siten, että polysulfidin vaikutus voidaan maksimoida. Polysulfidiprosessi vaikuttaa merkittävästi lipeäkiertoon, keittämöön sekä kuivauskoneeseen. Muilla osastoilla ominaishöyrynkulutuksen odotetaan pysyvän tavanomaista sulfaattiprosessia vastaavalla tasolla. Höyrynkulutuksella on huomattava merkitys modernin sellutehtaan tuotanto- ja kustannustehokkuuteen, sillä säästetyllä ylijäämähöyryllä voidaan tuottaa myyntisähköä. Uusiutuvan energian tuottajana ja ympäristövastuullisena toimijana sellutehtaiden on järkevää pyrkiä vähentämään omaa höyrynkulutustaan ja lisäämään sitä kautta sähköntuotantoaan.

Human_Leishmaniasis@cytokines.bahia.br

The cell-mediated immune response is critical in the resistance to and recovery from leishmaniasis. Cytokines are central elements in mounting an immune response and have received a great deal of attention in both human and experimental leishmaniasis. IFN-g is responsible for macrophage activation leading to leishmanicidal mechanisms. Understanding the balance of cytokines that lead to enhanced production of or synergize with IFN-g, and those cytokines that counterbalance its effects is fundamental for developing rational immunotherapeutic or immunoprophylactic approaches to leishmaniasis. Here we focus on the cytokine balance in human leishmaniasis, particularly IL-10 as an IFN-g opposing cytokine, and IL-12 as an IFN-g inducer. The effects of these cytokines were evaluated in terms of several parameters of the human immune response. IL-10 reduced lymphocyte proliferation, IFN-g production and cytotoxic activity of responsive human peripheral blood mononuclear cells. Neutralization of IL-10 led to partial restoration of lymphoproliferation, IFN-g production and cytotoxic activity in unresponsive visceral leishmaniasis patients. IL-12 also restored the responses of peripheral blood mononuclear cells from visceral leishmaniasis patients. The responses obtained with IL-12 are higher than those obtained with anti-IL-10, even when anti-IL-10 is combined with anti-IL-4

Algorithmic Techniques in Gene Expression Processing. From Imputation to Visualization

The amount of biological data has grown exponentially in recent decades. Modern biotechnologies, such as microarrays and next-generation sequencing, are capable to produce massive amounts of biomedical data in a single experiment. As the amount of the data is rapidly growing there is an urgent need for reliable computational methods for analyzing and visualizing it. This thesis addresses this need by studying how to efficiently and reliably analyze and visualize high-dimensional data, especially that obtained from gene expression microarray experiments. First, we will study the ways to improve the quality of microarray data by replacing (imputing) the missing data entries with the estimated values for these entries. Missing value imputation is a method which is commonly used to make the original incomplete data complete, thus making it easier to be analyzed with statistical and computational methods. Our novel approach was to use curated external biological information as a guide for the missing value imputation. Secondly, we studied the effect of missing value imputation on the downstream data analysis methods like clustering. We compared multiple recent imputation algorithms against 8 publicly available microarray data sets. It was observed that the missing value imputation indeed is a rational way to improve the quality of biological data. The research revealed differences between the clustering results obtained with different imputation methods. On most data sets, the simple and fast k-NN imputation was good enough, but there were also needs for more advanced imputation methods, such as Bayesian Principal Component Algorithm (BPCA). Finally, we studied the visualization of biological network data. Biological interaction networks are examples of the outcome of multiple biological experiments such as using the gene microarray techniques. Such networks are typically very large and highly connected, thus there is a need for fast algorithms for producing visually pleasant layouts. A computationally efficient way to produce layouts of large biological interaction networks was developed. The algorithm uses multilevel optimization within the regular force directed graph layout algorithm.

Polysulfidiprosessin vaikutukset höyrynkulutukseen sulfaattisellutehtaassa

Diplomityön tavoitteena on kartoittaa höyrynkulutuksen merkittävimmät muutokset sellutehtaalla siirryttäessä sulfaattimassan valmistuksesta polysulfidiselluprosessiin. Työssä esitellään sulfaattisellun valmistusprosessi ja polysulfidin vaatimat muutokset selluprosessissa erityisesti höyrynkulutuksen kannalta. Sellutehtaan höyrynkulutusta ja sen mahdollisia sekä todennettuja muutoksia tarkastellaan suhteessa tehtaan selluntuotantoon. Diplomityössä analysoidaan muutoksiin johtaneita syitä ja erityisesti peilataan niitä ennalta odotettuihin muutoksiin, joita kandidaatintyö ”Polysulfidiprosessi sulfaattisellutehtaassa” (Szepaniak 2014) esitti kirjallisuuden pohjalta. Tutkimus tehdään tutustuen dokumenttilähteisiin sekä erityisesti hankkimalla lisätietoa ja käytännön näkemystä asiantuntijahaastatteluista. Työssä käytetään esimerkkinä tyypillistä modernia sellutehdasta, jonka perusteella tarkasteltavat osaprosessit ovat valikoituneet. Tutkimustulosten perusteella esitetään jatkotutkimus- ja kehityskohteita. Sulfaattiprosessiin tehtävät muutokset käsittävät keittolipeän muuttamisen polysulfidipitoiseksi, polysulfidin valmistusprosessin (MOXY) sekä keiton muuttamisen siten, että polysulfidin vaikutus voidaan maksimoida. Polysulfidiprosessi vaikuttaa merkittävästi lipeäkiertoon ja keittämöön. Keittämön höyrynkulutus kasvaa, haihduttamon kuorma vähenee ja soodakattilan lämmöntuotanto heikkenee. Muilla osastoilla ominaishöyrynkulutuksen muutokset ovat tilastollisesti merkityksettömiä. Höyrynkulutuksella on huomattava merkitys modernin sellutehtaan tuotanto- ja kustannustehokkuuteen, sillä säästetyllä ylijäämähöyryllä voidaan tuottaa myyntisähköä. Uusiutuvan energian tuottajana ja ympäristövastuullisena toimijana sellutehtaiden on järkevää pyrkiä vähentämään omaa höyrynkulutustaan ja lisäämään sitä kautta sähköntuotantoaan.

Poly-DL-lactide-co-glycolide microspheres as a controlled release antigen delivery system

Successful vaccine application means maximum protection with minimal number of administrations. A rational development of vaccines involves studies of the nature of the antigen as well as of the adjuvant to be used to improve the immune responses. This has provided the impetus for studies to design the degradable devices and for different approaches to antigen delivery by different routes of administration. The development of controlled release systems based on polymeric devices that permit a sustained or pulsed release of encapsulated antigens has attracted much interest. Polymeric delivery systems consist of polymers that release their content continuously in a controlled manner over a period of time. The development of a biocompatible delivery system for parenteral administration offers several advantages in terms of immunoadjuvanticity over other compounds. It was found that, in contrast to other carriers, microspheres are more stable, thus permitting administration by the oral or parenteral route. In the present study, we describe the main characteristics and potentialities of this new immunoadjuvant for oral and parenteral administration.

Decision making and decision support in service systems

This thesis is a literature study that develops a conceptual model of decision making and decision support in service systems. The study is related to the Ä-Logi, Intelligent Service Logic for Welfare Sector Services research project, and the objective of the study is to develop the necessary theoretical framework to enable further research based on the research project results and material. The study first examines the concepts of service and service systems, focusing on understanding the characteristics of service systems and their implications for decision making and decision support to provide the basis for the development of the conceptual model. Based on the identified service system characteristics, an integrated model of service systems is proposed that views service systems through a number of interrelated perspectives that each offer different, but complementary, implications on the nature of decision making and the requirements for decision support in service systems. Based on the model, it is proposed that different types of decision making contexts can be identified in service systems that may be dominated by different types of decision making processes and where different types of decision support may be required, depending on the characteristics of the decision making context and its decision making processes. The proposed conceptual model of decision making and decision support in service systems examines the characteristics of decision making contexts and processes in service systems, and their typical requirements for decision support. First, a characterization of different types of decision making contexts in service systems is proposed based on the Cynefin framework and the identified service system characteristics. Second, the nature of decision making processes in service systems is proposed to be dual, with both rational and naturalistic decision making processes existing in service systems, and having an important and complementary role in decision making in service systems. Finally, a characterization of typical requirements for decision support in service systems is proposed that examines the decision support requirements associated with different types of decision making processes in characteristically different types of decision making contexts. It is proposed that decision support for the decision making processes that are based on rational decision making can be based on organizational decision support models, while decision support for the decision making processes that are based on naturalistic decision making should be based on supporting the decision makers’ situation awareness and facilitating the development of their tacit knowledge of the system and its tasks. Based on the proposed conceptual model a further research process is proposed. The study additionally provides a number of new perspectives on the characteristics of service systems, and the nature of decision making and requirements for decision support in service systems that can potentially provide a basis for further discussion and research, and support the practice alike.

Do retail investors use technical analysis? Evidence from Stuttgart stock exchange.

Tutkielma käyttää automaattista kuviontunnistusalgoritmia ja yleisiä kahden liukuvan keskiarvon leikkauspiste –sääntöjä selittääkseen Stuttgartin pörssissä toimivien yksityissijoittajien myynti-osto –epätasapainoa ja siten vastatakseen kysymykseen ”käyttävätkö yksityissijoittajat teknisen analyysin menetelmiä kaupankäyntipäätöstensä perustana?” Perusolettama sijoittajien käyttäytymisestä ja teknisen analyysin tuottavuudesta tehtyjen tutkimusten perusteella oli, että yksityissijoittajat käyttäisivät teknisen analyysin metodeja. Empiirinen tutkimus, jonka aineistona on DAX30 yhtiöiden data vuosilta 2009 – 2013, ei tuottanut riittävän selkeää vastausta tutkimuskysymykseen. Heikko todistusaineisto näyttää kuitenkin osoittavan, että yksityissijoittajat muuttavat kaupankäyntikäyttäytymistänsä eräiden kuvioiden ja leikkauspistesääntöjen ohjastamaan suuntaan.

Kallet til livets embete : mødre i helse og lidelse

Mothers represent the natural caring. Natural caring is the object of caring science and of research interest because it establishes the central core of professional caring. In this study, we encounter patients who are mothers in need of care in a psychiatric context. Motherhood involves taking responsibility that extends beyond one's own life, because the child represents possibilities in a yet unknown future. Understanding and knowledge about the mothers' struggle in health and suffering are of crucial importance to enable clinical practice to make provisions for and adapt to the individual patient. The overall purpose of this dissertation is to illuminate how the innermost essence of caring emerges in health and suffering in patients who are mothers in psychiatric care. The purpose of the study in a clinical sense is to seek to understand and illuminate the patient's inner world in health and suffering in terms of contextual, existential, ontological and ethical dimensions. The dissertation is exploratory and descriptive in nature and encompasses induction, deduction and abduction as logics tools of reasoning. A theoretical model of natural caring and a universal theoretical model of the innermost essence of caring is developed as seen from the patient's world in a psychiatric context. The dissertation is anchored in human science's view of the human being and the world and in caring science's perspective. Caring science's view of the human being as a unity comprising body, soul and spirit is central in the study's concept of the patient. This multi-dimensional conception of the human being encompasses the dissertation's basic values and is decisive for choice of methodology. Hermeneutic epistemology guided the interpretation of the empirical data, the paradigmatic theses and assumptions. The dialectical movement in interpretation moves back and forth between empirical data, caring science theory and philosophical theory and reveals deeper insight into meaningful content in the clinical context. The interpretation process comprises four levels of abstraction: rational, contextual, existential and ontological. Hermeneutic philosophy guides the inductive and deductive approach to interpretation, as well as the movement between the clinical context and the caring science paradigm. In this encounter between the visible and invisible reality, the image of natural caring – motherliness emerged. The dissertation consists of four studies. The first study is a systematic review of nineteen research articles. The three other studies are hermeneutical interpretations based on text materials from open interviews. Fifteen participants were interviewed, all of whom are mothers of children between 0 and 18 years of age. All were outpatients in the psychiatric specialist health service. In the interpretation process, the mothers' struggle in health and suffering emerges as a struggle between the inner and outer world. Being a mother and patient in health and suffering in a psychiatric context means to struggle to be oneself, to create oneself, to live and realize one's good deeds as a mother and human being. To be oneself, to possess oneself as a mother is not only a question of tending, playing and learning in order to master a practical situation or to survive. It involves constituting a deep, inner desire to courageously create oneself so that the child is able to realize his or her potential in health and suffering. Motherliness manifests itself in caring as a call to ministering humanity and life. The voice of motherliness is understood as the voice of life—the eternal, inner call of love and freedom. The inner call craves fulfilment. Motherliness in natural caring does not retreat. Motherliness defines the Other as freedom and proceeds without regard for all other exterior requirements to realizing wellbeing. The inner essence of caring is attentive, aware and heeds the call of the heart. The innermost essence of caring is to be and to make oneself responsible for the Other. Responsibility cannot be relinquished; free choice consists in whether or not to follow the call. To renounce the inner call to responsibility is to deny oneself and one's dignity as a human being. The theoretical models provide clinical and systematic caring science with knowledge and understanding based on the natural caring spirit inherent in the human being. The study elucidates and strengthens the ontological basic assumptions about the human being as a unity of body, soul and spirit, the sanctity of the human being and the core of caring, ethos. The results of the dissertation will provide clinical practice with knowledge about the inner movements of the mothers' souls in relation to their responsibility as mothers and human beings. Being able to understand the basic conditions for responsibility is crucial for developing care that encompasses mother and child and the mutual relationship between them. This is basic knowledge for developing attitudes and actions that meet and provide for the needs of the patient as mother and as a whole, suffering human being.

Nasopharyngeal colonization by pathogenic bacteria: effect of polymorphisms in innate immune genes of young children

Nasopharyngeal bacteria can asymptomatically colonize the nasopharynx of infants and young children but are also associated with the development of respiratory infections and diseases. Such nasopharyngeal bacteria include Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae and Staphylococcus aureus. The host defense against invading pathogens is largely relies germline-encoded pattern recognition receptors (PRR), which are expressed on the cells of innate immunity, and different cytokines. These include toll-like receptors (TLR), mannose-binding lectin (MBL) and different cytokines such as IL-17A. Single nucleotide polymorphisms (SNP) in these receptors and cytokines have been reported. The aim of this study was to investigate genetic polymorphisms in the genes for TLR2, 3 and 4, MBL as well as for IL-17A and their associations with nasopharyngeal pathogenic bacterial colonization during a two-year follow-up. The study revealed that polymorphisms in TLRs, MBL2 and IL17A are associated with the nasopharyngeal bacterial colonization in young children. Healthy young (2.6 months of age) children with variant types of MBL2, TLR2 R753Q or TLR4 D299G had an increased risk to be colonized by S. pneumonia, S. aureus or M. catarrhalis, respectively. Moreover, variant types of MBL2 in healthy children with might facilitate human rhinovirus (HRV)-induced S. pneumoniae colonization at 2.6 months of age. The polymorphism of TLR4 D299G was shown to be associated with M. catarrhalis colonization throughout the whole two-year follow-up (2.6, 13 and 24 months of age) and also with the bacterial load of this pathogen. Also, the polymorphism of IL17A G152A was shown to be associated with increased risk to be colonized by S. pneumoniae at 13 and 24 months of age. Furthermore, the results suggest that IL17A G152A has an effect on production of serum IL-17A already at young age. In conclusion, the results of this study indicate that polymorphisms in the key PRRs and IL17A seem to play an important role to colonization of S. pneumoniae, M. catarrhalis, and S. aureus in healthy young Finnish children. The nasopharyngeal colonization by these pathogenic bacteria may further promote the development of respiratory infections and may be related to development of asthma and allergy in the later life of children. These findings offer a possible explanation why some children have more respiratory infections than other children and provide a rational basis for future studies in this field.

L1 sequence of a new human papillomavirus type-58 variant associated with cervical intraepithelial neoplasia

The present study on molecular characterization of a human papillomavirus (HPV) isolated in Central Brazil describes the L1 gene sequence from a new variant of HPV-58, the isolate Bsb-02. The sample was from a smear obtained from a woman with cervical intraepithelial neoplasia grade II. The whole L1 gene from isolate Bsb-02 was sequenced automatically, showing 99.1% nucleotide identity with the gene from the HPV-58 reference. The clustering between Bsb-02 and HPV-58 reference sequence was also supported by phylogenetic analysis. Fourteen nucleotide substitutions were observed: eight were synonymous and six were associated with amino acid substitutions. A10V and V144I have not been previously described. At GenBank, the only complete L1 sequence from HPV-58 in addition to the HPV-58 reference one is that of Bsb-02. These data provide information that may be relevant to HPV diagnosis and to rational vaccine strategies. HPV variants may also be associated with host immune responses and with the risk of cervical neoplasia.