Sustainable building envelope design by considering energy cost and occupant satisfaction

The built environment is a major contributor to the world’s carbon dioxide emissions, with a considerable amount of energy being consumed in buildings due to heating, ventilation and air-conditioning, space illumination, use of electrical appliances, etc., to facilitate various anthropogenic activities. The development of sustainable buildings seeks to ameliorate this situation mainly by reducing energy consumption. Sustainable building design, however, is a complicated process involving a large number of design variables, each with a range of feasible values. There are also multiple, often conflicting, objectives involved such as the life cycle costs and occupant satisfaction. One approach to dealing with this is through the use of optimization models. In this paper, a new multi-objective optimization model is developed for sustainable building design by considering the design objectives of cost and energy consumption minimization and occupant comfort level maximization. In a case study demonstration, it is shown that the model can derive a set of suitable design solutions in terms of life cycle cost, energy consumption and indoor environmental quality so as to help the client and design team gain a better understanding of the design space and trade-off patterns between different design objectives. The model can very useful in the conceptual design stages to determine appropriate operational settings to achieve the optimal building performance in terms of minimizing energy consumption and maximizing occupant comfort level.

Factors influencing hospital readmission and length of stay of Vietnamese patients with type 2 diabetes and cardiac disease

Background: Increased hospital readmission and longer stays in the hospital for patients with type 2 diabetes and cardiac disease can result in higher healthcare costs and heavier individual burden. Thus, knowledge of the characteristics and predictive factors for Vietnamese patients with type 2 diabetes and cardiac disease, at high risk of hospital readmission and longer stays in the hospital, could provide a better understanding on how to develop an effective care plan aimed at improving patient outcomes. However, information about factors influencing hospital readmission and length of stay of patients with type 2 diabetes and cardiac disease in Vietnam is limited. Aim: This study examined factors influencing hospital readmission and length of stay of Vietnamese patients with both type 2 diabetes and cardiac disease. Methods: An exploratory prospective study design was conducted on 209 patients with type 2 diabetes and cardiac disease in Vietnam. Data were collected from patient charts and patients' responses to self-administered questionnaires. Descriptive statistics, bivariate correlation, logistic and multiple regression were used to analyse the data. Results: The hospital readmission rate was 12.0% among patients with both type 2 diabetes and cardiac disease. The average length of stay in the hospital was 9.37 days. Older age (OR= 1.11, p< .05), increased duration of type 2 diabetes (OR= 1.22, p< .05), less engagement in stretching/strengthening exercise behaviours (OR= .93, p< .001) and in communication with physician (OR= .21, p< .001) were significant predictors of 30-dayhospital readmission. Increased number of additional co-morbidities (β= .33, p< .001) was a significant predictor of longer stays in the hospital. High levels of cognitive symptom management (β= .40, p< .001) significantly predicted longer stays in the hospital, indicating that the more patients practiced cognitive symptom management, the longer the stay in hospital. Conclusions: This study provides some evidence of factors influencing hospital readmission and length of stay and argues that this information may have significant implications for clinical practice in order to improve patients' health outcomes. However, the findings of this study related to the targeted hospital only. Additionally, the investigation of environmental factors is recommended for future research as these factors are important components contributing to the research model.

Political transition and structural politicisation : The long shadow of Taiwan's one-party legacy

Väitöskirjatutkimuksessa tarkastellaan Taiwanin politiikkaa ensimmäisen vaalien kautta tapahtuneen vallanvaihdon jälkeen (2000) yhteiskunnan rakenteellisen politisoitumisen näkökulmasta. Koska Taiwanilla siirryttiin verettömästi autoritaarisesta yksipuoluejärjestelmästä monipuoluejärjestelmään sitä on pidetty poliittisen muodonmuutoksen mallioppilaana. Aiempi optimismi Taiwanin demokratisoitumisen suhteen on sittemmin vaihtunut pessimismiin, pitkälti yhteiskunnan voimakkaasta politisoitumisesta johtuen. Tutkimuksessa haetaan selitystä tälle politisoitumiselle. Yhteiskunnan rakenteellisella politisoitumisella tarkoitetaan tilannetta, jossa ”poliittisen” alue kasvaa varsinaisia poliittisia instituutioita laajemmaksi. Rakenteellinen politisoituminen muuttuu helposti yhteiskunnalliseksi ongelmaksi, koska siitä usein seuraa normaalin poliittisen toiminnan (esim. lainsäädännän) jähmettyminen, yhteiskunnan jyrkkä jakautuminen, alhainen kynnys poliittisille konflikteille ja yleisen yhteiskunnallisen luottamuksen alentuminen. Toisin kuin esimerkiksi Itä-Euroopassa, Taiwanissa entinen valtapuolue ei romahtanut poliittisen avautumisen myötä vaan säilytti vahvan rakenteellisen asemansa. Kun valta vaihtui ensimmäisen kerran vaalien kautta, vanha valtapuolue ei ollut valmis luovuttamaan poliittisen järjestelmän ohjaksia käsistään. Alkoi vuosia kestänyt taistelu järjestelmän hallinnasta vanhan ja uuden valtapuolueen välillä, jossa yhteiskunta politisoitui voimakkaasti. Tutkimuksessa Taiwanin yhteiskunnan politisoituminen selitetään useiden rakenteellisten piirteiden yhteisvaikutuksen tuloksena. Tällaisia politisoitumista edistäviä rakentellisia piirteitä ovat hidas poliittinen muutos, joka säilytti vanhat poliittiset jakolinjat ja niihin liittyvät vahvat edut ja intressit; sopimaton perustuslaki; Taiwanin epäselvä kansainvälinen asema ja jakautunut identiteetti; sekä sosiaalinen rakenne, joka helpottaa ihmisten nopeaa mobilisointia poliittiisiin mielenilmauksiin. Tutkimuksessa kiinnitetään huomiota toistaiseksi vähän tutkittuun poliittiseen ilmiöön, joidenkin demokratisoituvien yhteiskuntien voimakkaaseen rakenteelliseen politisoitumiseen. Tutkimuksen pääasiallinen havainto on, että yksipuoluejärjestelmän demokratisoituminen kantaa sisällään rakenteellisen politisoitumisen siemenen, jos entinen valtapuolue ei romahda demokratisoitumisen myötä.

Participation or further exclusion? : Contestations over forest conservation and control in the East Usambara Mountains, Tanzania

This Ph.D. thesis Participation or Further Exclusion? Contestations over Forest Conservation and Control in the East Usambara Mountains, Tanzania describes and analyses the shift in the prevailing discourse of forest and biodiversity conservation policies and strategies towards more participatory approaches in Tanzania, and the changes in the practises of resource control. I explore the scope for and limits to the different actors and groups who are considered to form the community, to participate in resource control, in a specific historical and socio-economic context. I analyse whether, how and to which extent the targets of such participatory conservation interventions have been able to affect the formal rules and practices of resource control, and explore their different responses and discursive and other strategies in relation to conservation efforts. I approach the problematic through exploring certain participatory conservation interventions and related negotiations between the local farmers, government officials and the external actors in the case of two protected forest reserves in the southern part of the East Usambaras, Tanzania. The study area belongs to the Eastern Arc Mountains that are valued globally and nationally for their high level of biodiversity and number of endemic and near endemic species. The theoretical approach draws from theorising on power, participation and conservation in anthropology of development and post-structuralist political ecology. The material was collected in three stages between 2003 and 2008 by using an ethnographic approach. I interviewed and observed the actors and their resource use and control practices at the local level, including the representatives of the villagers living close to the protected forests and the conservation agency, but also followed the selected processes and engaged with the non-local agencies involved in the conservation efforts in the East Usambaras. In addition, the more recent processes of change and the actors strategies in resource control were contextualised against the social and environmental history of the study area and the evolvement of institutions of natural resource control. My findings indicate that the discourse of participation that has emerged in global conservation policy debate within the past three decades, and is being institutionalised in the national policies in many countries, including Tanzania, has shaped the practices of forest conservation in the East Usambaras, although in a fragmented and uneven way. Instrumental interpretation of participation, in which it is to serve the goals of improving the control of the forest and making it more acceptable and efficient, has prevailed among the governmental actors and conservation organisations. Yet, there is variation between the different projects and actors promoting participatory conservation regarding the goals and means of participation, e.g. to which extent the local people are to be involved in decision-making. The actors representing communities also have their diverse agendas, understandings and experiences regarding the rationality, outcomes and benefits of being involved in forest control, making the practices of control fluid. The elements of the exclusive conservation thinking and practices co-exist with the more recent participatory processes, and continue to shape the understandings and strategies of the actors involved in resource control. The ideas and narratives of the different discourses are reproduced and selectively used by the parties involved. The idea of forest conservation is not resisted as such by most of the actors at local level, quite the opposite. However, the strict regulations and rules governing access to resources, such as valuable timber species, continue to be disputed by many. Furthermore, the history of control, such as past injustices related to conservation and unfulfilled promises, undermines the participation of certain social groups in resource control and benefit sharing. This also creates controversies in the practices of conservation, and fuels conflicts regarding the establishment of new protected areas. In spite of this, the fact that the representatives of the communities have been invited to the arenas where information is shared, and principles and conditions of forest control and benefit sharing are discussed and partly decided upon, has created expectations among the participants, and opened up opportunities for some of the local actors to enhance their own, and sometimes wider interests in relation to resource control and the related benefits. The local actors experiences of the previous government and other interventions strongly affect how they position themselves in relation to conservation interventions, and their responses and strategies. However, my findings also suggest, in a similar way to research conducted in some other protected areas, that the benefits of participation in conservation and resource control tend to accrue unevenly between different groups of local people, e.g. due to unequal access to information and differences in their initial resources and social position.

Improved wound management at lower costs: A sensible goal for Australia

Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes.

Short- and long-term consequences of food resources on Ural owl Strix uralensis reproduction

Life-history theory states that although natural selection would favour a maximisation of both reproductive output and life-span, such a combination can not be achieved in any living organism. According to life-history theory the reason for the fact that not all traits can be maximised simultaneously is that different traits compete with each other for resources. These relationships between traits that constrain the simultaneous evolution of two or more traits are called trade-offs. Therefore, during different life-stages an individual needs to optimise its allocation of resources to life-history components such as growth, reproduction and survival. Resource limitation acts on these traits and therefore investment in one trait, e.g. reproduction, reduces the resources available for investment in another trait, e.g. residual reproduction or survival. In this thesis I study how food resources during different stages of the breeding event affect reproductive decisions in the Ural owl (Strix uralensis) and the consequences of these decisions on parents and offspring. The Ural owl is a suitable study species for such studies in natural populations since they are long-lived, site-tenacious, and feed on voles. The vole populations in Fennoscandia fluctuate in three- to four-year cycles, which create a variable food environment for the Ural owls to cope with. The thesis gives new insight in reproductive costs and their consequences in natural animal populations with emphasis on underlying physiological mechanisms. I found that supplementary fed Ural owl parents invest supplemented food resources during breeding in own self-maintenance instead of allocating those resources to offspring growth. This investment in own maintenance instead of improving current reproduction had carry-over effects to the following year in terms of increased reproductive output. Therefore, I found evidence that reduced reproductive costs improves future reproductive performance. Furthermore, I found evidence for the underlying mechanism behind this carry-over effect of supplementary food on fecundity. The supplementary-fed parents reduced their feeding investment in the offspring compared to controls, which enabled the fed female parents to invest the surplus resources in parasite resistance. Fed female parents had lower blood parasite loads than control females and this effect lasted until the following year when also reproductive output was increased. Hence, increased investment in parasite resistance when resources are plentiful has the potential to mediate positive carry-over effects on future reproduction. I further found that this carry-over effect was only present when potentials for future reproduction were good. The thesis also provides new knowledge on resource limitation on maternal effects. I found that increased resources prior to egg laying improve the condition and health of Ural owl females and enable them to allocate more resources to reproduction than control females. These additional resources are not allocated to increase the number of offspring, but instead to improve the quality of each offspring. Fed Ural owl females increased the size of their eggs and allocated more health improving immunological components into the eggs. Furthermore, the increased egg size had long-lasting effects on offspring growth, as offspring from larger eggs were heavier at fledging. Limiting resources can have different short- and long-term consequences on reproductive decisions that affect both offspring number and quality. In long-lived organisms, such as the Ural owl, it appears to be beneficial in terms of fitness to invest in long breeding life-span instead of additional investment in current reproduction. In Ural owls, females can influence the phenotypic quality of the offspring by transferring additional resources to the eggs that can have long-lasting effects on growth.

Barrett's Esophagus and Associated Adenocarcinoma : studies on pathogenesis, clinical staging and cost-utility of cancer treatment

Esophageal and gastroesophageal junction (GEJ) adenocarcinoma is rapidly increasing disease with a pathophysiology connected to oxidative stress. Exact pre-treatment clinical staging is essential for optimal care of this lethal malignancy. The cost-effectiviness of treatment is increasingly important. We measured oxidative metabolism in the distal and proximal esophagus by myeloperoxidase activity (MPA), glutathione content (GSH), and superoxide dismutase (SOD) in 20 patients operated on with Nissen fundoplication and 9 controls during a 4-year follow-up. Further, we assessed the oxidative damage of DNA by 8-hydroxydeoxyguanosine (8-OHdG) in esophageal samples of subjects (13 Barrett s metaplasia, 6 Barrett s esophagus with high-grade dysplasia, 18 adenocarcinoma of the distal esophagus/GEJ, and 14 normal controls). We estimated the accuracy (42 patients) and preoperative prognostic value (55 patients) of PET compared with computed tomography (CT) and endoscopic ultrasound (EUS) in patients with adenocarcinoma of the esophagus/GEJ. Finally, we clarified the specialty-related costs and the utility of either radical (30 patients) or palliative (23 patients) treatment of esophageal/GEJ carcinoma by the 15 D health-related quality-of-life (HRQoL) questionnaire and the survival rate. The cost-utility of radical treatment of esophageal/GEJ carcinoma was investigated using a decision tree analysis model comparing radical, palliative, and hypothetical new treatment. We found elevated oxidative stress ( measured by MPA) and decreased antioxidant defense (measured by GSH) after antireflux surgery. This indicates that antireflux surgery is not a perfect solution for oxidative stress of the esophageal mucosa. Elevated oxidative stress in turn may partly explain why adenocarcinoma of the distal esophagus is found even after successful fundoplication. In GERD patients, proximal esophageal mucosal anti-oxidative defense seems to be defective before and even years after successful antireflux surgery. In addition, antireflux surgery apparently does not change the level of oxidative stress in the proximal esophagus, suggesting that defective mucosal anti-oxidative capacity plays a role in development of oxidative damage to the esophageal mucosa in GERD. In the malignant transformation of Barrett s esophagus an important component appears to be oxidative stress. DNA damage may be mediated by 8-OHdG, which we found to be increased in Barrett s epithelium and in high-grade dysplasia as well as in adenocarcinoma of the esophagus/GEJ compared with controls. The entire esophagus of Barrett s patients suffers from increased oxidative stress ( measured by 8-OhdG). PET is a useful tool in the staging and prognostication of adenocarcinoma of the esophagus/GEJ detecting organ metastases better than CT, although its accuracy in staging of paratumoral and distant lymph nodes is limited. Radical surgery for esophageal/GEJ carcinoma provides the greatest benefit in terms of survival, and its cost-utility appears to be the best of currently available treatments.

Instagrammatics and digital methods: Studying visual social media, from selfies and GIFs to memes and emoji

Visual content is a critical component of everyday social media, on platforms explicitly framed around the visual (Instagram and Vine), on those offering a mix of text and images in myriad forms (Facebook, Twitter, and Tumblr), and in apps and profiles where visual presentation and provision of information are important considerations. However, despite being so prominent in forms such as selfies, looping media, infographics, memes, online videos, and more, sociocultural research into the visual as a central component of online communication has lagged behind the analysis of popular, predominantly text-driven social media. This paper underlines the increasing importance of visual elements to digital, social, and mobile media within everyday life, addressing the significant research gap in methods for tracking, analysing, and understanding visual social media as both image-based and intertextual content. In this paper, we build on our previous methodological considerations of Instagram in isolation to examine further questions, challenges, and benefits of studying visual social media more broadly, including methodological and ethical considerations. Our discussion is intended as a rallying cry and provocation for further research into visual (and textual and mixed) social media content, practices, and cultures, mindful of both the specificities of each form, but also, and importantly, the ongoing dialogues and interrelations between them as communication forms.

Fair values and audit fees: Evidence from asset revaluations in Australia

This paper examines the association between the level of audit fees paid and asset revaluations, one use of fair value accounting. This Australian study also investigates attributes of asset revaluations and the association with the level of audit fees paid. We find that firms choosing the revaluation model incur higher audit fees than those that chose the cost model; asset revaluations made by directors lead to the firm incurring higher audit fees than for those made by external independent appraisers; and revaluation of investment properties leads to lower audit fees. The findings suggest that asset revaluations can result in higher agency costs and audit fees vary with the reliability of the revaluations and the class of assets being revalued.

Supistamista, rationalisointia vai kehittämistä? : Valtiovarainministeriön järjestelyosaston järjestämän henkilöstökoulutus- ja tutkimustoiminnan rakentuminen osaksi valtionhallintoa vuosina 1943-1971

The study examines the personnel training and research activities carried out by the Organization and Methods Division of the Ministry of Finance and their becoming a part and parcel of the state administration in 1943-1971. The study is a combination of institutional and ideological historical research in recent history on adult education, using a constructionist approach. Material salient to the study comes from the files of the Organization and Methods Division in the National Archives, parliamentary documents, committee reports, and the magazines. The concentrated training and research activities arranged by the Organization and Methods Division, became a part and parcel of the state administration in the midst of controversial challenges and opportunities. They served to solve social problems which beset the state administration as well as contextual challenges besetting rationalization measures, and organizational challenges. The activities were also affected by a dependence on decision-makers, administrative units, and civil servants organizations, by different views on rationalization and the holistic nature of reforms, as well as by the formal theories that served as resources. It chose long-term projects which extended to the political decision-makers and administrative units turf, and which were intended to reform the structures of the state administration and to rationalize the practices of the administrative units. The crucial questions emerged in opposite pairs (a constitutional state vs. the ideology of an administratively governed state, a system of national boards vs. a system of government through ministries, efficiency of work vs. pleasantness of work, centralized vs. decentralized rationalization activities) which were not solvable problems but impossible questions with no ultimate answers. The aim and intent of the rationalization of the state administration (the reform of the central, provincial, and local governments) was to facilitate integrated management and to render a greater amount of work by approaching management procedures scientifically and by clarifying administrative instances and their respon-sibilities in regards to each other. The means resorted to were organizational studies and committee work. In the rationalization of office work and finance control, the idea was to effect savings in administrative costs and to pare down those costs as well as to rationalize and heighten those functions by developing the institution of work study practitioners in order to coordinate employer and employee relationships and benefits (the training of work study practitioners, work study, and a two-tier work study practitioner organization). A major part of the training meant teaching and implementing leadership skills in practice, which, in turn, meant that the learning environment was the genuine work community and efforts to change it. In office rationalization, the solution to regulate the relations between the employer and the employees was the co-existence of the technical and biological rationalization and the human resource administration and the accounting and planning systems at the turn of the 1960s and 1970s. The former were based on the school of scientific management and human relations, the latter on system thinking, which was a combination of the former two. In the rationalization of the state administration, efforts were made to find solutions to stabilize management ideologies and to arrange the relationships of administrative systems in administrative science - among other things, in the Hoover Committee and the Simon decision making theory, and, in the 1960s, in system thinking. Despite the development-related vocabulary, the practical work was advanced rationalization. It was said that the practical activities of both the state administration and the administrative units depended on professional managers who saw to production results and human relations. The pedagogic experts hired to develop training came up with a training system, based on the training-technological model where the training was made a function of its own. The State Training Center was established and the training office of the Organization and Methods Division became the leader and coordinator of personnel training.

Breathing, swallowing and voice in laryngeal disorsers

The aim of this work was to examine how breathing, swallowing and voicing are affected in different laryngeal disorders. For this purpose, we examined four different patient groups: patients who had undergone total laryngectomy, anterior cervical decompression (ACD), or injection laryngoplasty with autologous fascia (ILAF), and patients with dyspnea during exercise. We studied the problems and benefits related to the automatic speech valve used for the rehabilitation of speech in laryngectomized patients. The device was given to 14 total laryngectomized patients who used the traditional valve especially well. The usefulness of voice and intelligibility of speech were assessed by speech pathologists. The results demonstrated better performance with the traditional valve in both dimensions. Most of the patients considered the automatic valve a helpful additional device but because of heavier breathing and the greater work needed for speech production, it was not suitable as a sole device in speech rehabilitation. Dysphonia and dysphagia are known complications of ACD. These symptoms are caused due to the stretching of tissue needed during the surgery, but the extent and the recovery from them was not well known before our study. We studied two patient groups, an early group with 50 patients who were examined immediately before and after the surgery and a late group with 64 patients who were examined 3 9 months postoperatively. Altogether, 60% reported dysphonia and 69% dysphagia immediately after the operation. Even though dysphagia and dysphonia often appeared after surgery, permanent problems seldom occurred. Six (12 %) cases of transient and two (3 %) permanent vocal cord paresis were detected. In our third study, the long-term results of ILAF in 43 patients with unilateral vocal cord paralysis were examined. The mean follow-up was 5.8 years (range 3 10). Perceptual evaluation demonstrated improved results for voice quality, and videostroboscopy revealed complete or partial glottal closure in 83% of the patients. Fascia showed to be a stable injection material with good vocal results. In our final study we developed a new diagnostic method for exertional laryngeal dyspnea by combining a cardiovascular exercise test with simultaneous fiberoptic observation of the larynx. With this method, it is possible to visualize paradoxal closure of the vocal cords during inspiration, which is a diagnostic criterion for vocal cord dysfunction (VCD). We examined 30 patients referred to our hospital because of suspicion of exercise-induced vocal cord dysfunction (EIVCD). Twenty seven out of thirty patients were able to perform the test. Dyspnea was induced in 15 patients, and of them five had EIVCD and four high suspicion of EIVCD. With our test it is possible to set an accurate diagnosis for exertional laryngeal dyspnea. Moreover, the often seen unnecessary use of asthma drugs among these patients can be avoided.

Determinants and Consequences of Information Sharing with Key Suppliers

As companies become more efficient with respect to their internal processes, they begin to shift the focus beyond their corporate boundaries. Thus, the recent years have witnessed an increased interest by practitioners and researchers in interorganizational collaboration, which promises better firm performance through more effective supply chain management. It is no coincidence that this interest comes in parallel with the recent advancements in Information and Communication Technologies, which offer many new collaboration possibilities for companies. However, collaboration, or any other type of supply chain integration effort, relies heavily on information sharing. Hence, this study focuses on information sharing, in particular on the factors that determine it and on its value. The empirical evidence from Finnish and Swedish companies suggests that uncertainty (both demand and environmental) and dependency in terms of switching costs and asset specific investments are significant determinants of information sharing. Results also indicate that information sharing improves company performance regarding resource usage, output, and flexibility. However, companies share information more intensely at the operational rather than the strategic level. The use of supply chain practices and technologies is substantial but varies across the two countries. This study sheds light on a common trend in supply chains today. Whereas the results confirm the value of information sharing, the contingent factors help to explain why the intensity of information shared across companies differ. In the future, competitive pressures and uncertainty are likely to intensify. Therefore, companies may want to continue with their integration efforts by focusing on the determinants discussed in this study. However, at the same time, the possibility of opportunistic behavior by the exchange partner cannot be disregarded.