Comparação entre duas técnicas de genotipagem do HPV em mulheres com lesão intra-epitelial de alto grau

OBJETIVO: Comparar o desempenho de duas técnicas de genotipagem de papilomavírus humano (HPV), Linear Array e PapilloCheck, em mulheres com lesão intra-epitelial de alto grau (LIAG).MÉTODOS: Foram selecionadas 88 mulheres com diagnóstico citopatológico de LIAG em 2 centros de referência em patologia cervical em Salvador, Bahia, no período de julho de 2006 a janeiro de 2009. Após o diagnóstico citopatológico de LIAG, foram realizadas a coleta de células do colo uterino para a genotipagem do HPV e a biópsia sob visão colposcópica para análise histopatológica do fragmento retirado. Posteriormente à confirmação de NIC2+ pelo exame histopatológico, foi realizada a genotipagem do HPV em 41 mulheres pelas técnicas Linear Array e PapilloCheck.RESULTADOS: Os dois testes apresentaram taxa de concordância geral para detecção do vírus HPV de 97,2% (35/36). Das 36 amostras válidas, 35 (97,2%) foram consideradas positivas em ambos os testes e apenas uma amostra (2,8%) foi considerada discordante. Os genótipos do HPV mais prevalentes detectados através da técnica do Linear Array foram: HPV 16, HPV 56, HPV 35, HPV 45 e HPV 70; e pela técnica PapilloCheck foram: HPV 16, HPV 56, HPV 11, HPV 35 e HPV 42. Foi observado índice semelhante de infecção por múltiplos tipos do HPV nos dois testes analisados (72,5% no Linear Array e 75,0% no PapilloCheck).CONCLUSÕES: Os testes de genotipagem Linear Array e PapilloCheck apresentaram um desempenho equivalente na detecção dos tipos de HPV oncogênicos em mulheres com LIAG, tendo o PapilloCheck a vantagem de ser um método que evita a subjetividade da leitura dos genótipos de HPV.

Predictive Capability of HPV and Pap Tests in Screening for Cervical Cancer over a Three-Year Follow-up

Purpose To compare the predictive capability of HPV and Pap smear tests for screening pre-cancerous lesions of the cervix over a three-year follow-up, in a population of users of the Brazilian National Health System (SUS). Methods This is a retrospective cohort study of 2,032 women with satisfactory results for Pap smear and HPV tests using second-generation hybrid capture,made in a previous study. We followed them for 36 months with data obtained from medical records, the Cervix Cancer Information System (SISCOLO), and the Mortality Information System (SIM). The outcome was a histological diagnosis of cervical intraepithelial neoplasia grade 2 or more advanced lesions (CIN2ş). We constructed progression curves of the baseline test results for the period, using the Kaplan-Meier method, and estimated sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios for each test. Results A total of 1,440 women had at least one test during follow-up. Progression curves of the baseline test results indicated differences in capability to detect CIN2ş (p < 0.001) with significantly greater capability when both tests were abnormal, followed by only a positive HPV test. The HPV test was more sensitive than the Pap smear (88.7% and 73.6%, respectively; p < 0.05) and had a better negative likelihood ratio (0.13 and 0.30, respectively). Specificity and positive likelihood ratio of the tests were similar. Conclusions These findings corroborate the importance of HPV test as a primary cervical cancer screening.

From network pictures to network insight in solution business – the role of internal communication

Operating in business-to-business markets requires an in-depth understanding on business networks. Actions and reactions made to compete in markets are fundamentally based on managers‘ subjective perceptions of the network. However, an amalgamation of these individual perceptions, termed a network picture, to a common company level shared understanding on that network, known as network insight, is found to be a substantial challenge for companies. A company‘s capability to enhance common network insight is even argued to lead competitive advantage. Especially companies with value creating logics that require wide comprehension of and collaborating in networks, such as solution business, are necessitated to develop advanced network insight. According to the extant literature, dispersed pieces of atomized network pictures can be unified to a common network insight through a process of amalgamation that comprises barriers/drivers of multilateral exchange, manifold rationality, and recursive time. However, the extant body of literature appears to lack an understanding on the role of internal communication in the development of network insight. Nonetheless, the extant understanding on the amalgamation process indicates that internal communication plays a substantial role in the development of company level network insight. The purpose of the present thesis is to enhance understanding on internal communication in the amalgamation of network pictures to develop network insight in the solution business setting, which was chosen to represent business-to-business value creating logic that emphasizes the capability to understand and utilize networks. Thus, in solution business the role of succeeding in the amalgamation process is expected to emphasize. The study combines qualitative and quantitative research by means of various analytical methods including multiple case analysis, simulation, and social network analysis. Approaching the nascent research topic with differing perspectives and means provides a broader insight on the phenomenon. The study provides empirical evidence from Finnish business-to-business companies which operate globally. The empirical data comprise interviews (n=28) with managers of three case companies. In addition the data includes a questionnaire (n=23) collected mainly for the purpose of social network analysis. In addition, the thesis includes a simulation study more specifically achieved by means of agent based modeling. The findings of the thesis shed light on the role of internal communication in the amalgamation process, contributing to the emergent discussion of network insights and thus to the industrial marketing research. In addition, the thesis increases understanding on internal communication in the change process to solution business, a supplier‘s internal communication in its matrix organization structure during a project sales process, key barriers and drivers that influence internal communication in project sales networks, perceived power within industrial project sales, and the revisioning of network pictures. According to the findings, internal communication is found to play a substantial role in the amalgamation process. First, it is suggested that internal communication is a base of multilateral exchange. Second, it is suggested that internal communication intensifies and maintains manifold rationality. Third, internal communication is needed to explicate the usually differing time perspectives of others and thus it is suggested that internal communication has role as the explicator of recursive time. Furthermore, the role of an efficient amalgamation process is found to be emphasized in solutions business as it requires a more advanced network insight for cross-functional collaboration. Finally, the thesis offers several managerial implications for industrial suppliers to enhance the amalgamation process when operating in solution business.

Trust in inter-organisational dyadic relationships

Understanding the trust in organisations and the business relationships have been an emerging trend in past years. Researchers and executives and subject matter experts in companies have recognised the importance of managing the trust in inter-organisational relationships. Further, the interest both in academia and in business has raised an interest to under-stand dyadic relationships. The objective of this thesis was to examine trust in inter-organisational and inter-personal dyadic relationships. Trust and the dyadic relationships were analysed in information technolo-gy services and outsourcing industry. Dyads were established between the supplier company operating in the industry and its customers. The empiric part of the study was carried out by an email survey that was sent to 331 respondents resulting with effective response rate of 48.7 per cent. Statistical analyses were applied to analyse the data sample. In general, results indicated reputation, trustworthiness, capability and collaboration in dyadic trust relationships. Experience grown in duration of the relationship affected the trust positively. No drastic differences in trust were recognised when comparing supplier and customer responses.

Integration of existing military capability models into the Comprehensive Capability Meta-model

Abstract—This paper discusses existing military capability models and proposes a comprehensive capability meta-model (CCMM) which unites the existing capability models into an integrated and hierarchical whole. The Zachman Framework for Enterprise Architecture is used as a structure for the CCMM. The CCMM takes into account the abstraction level, the primary area of application, stakeholders, intrinsic process, and life cycle considerations of each existing capability model, and shows how the models relate to each other. The validity of the CCMM was verified through a survey of subject matter experts. The results suggest that the CCMM is of practical value to various capability stakeholders in many ways, such as helping to improve communication between the different capability communities.

The holistic military capability life cycle model

Abstract - This paper reviews existing military capability models and the capability life cycle. It proposes a holistic capability life-cycle model (HCLCM) that combines capability systems with related capability models. ISO 15288 standard is used as a framework to construct the HCLCM. The HCLCM also shows how capability models and systems relate to each other throughout the capability life cycle. The main contribution of this paper is conceptual in nature. The model complements the existing, but still evolving, understanding of the military capability life cycle in a holistic and systemic way. The model also increases understanding and facilitates communication among various military capability stakeholders.

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

Capital Structure and Firm Growth: R&D Intensive Companies

The purpose of this study is to examine and explain firm`s growth impact on capital structure decision-making in research and development intensive companies. Many studies claim that R&D has a pivotal impact on capital structure decisions, but corporate finance theories have often failed to explain these observed patterns. As sales growth is an important concept and objective for R&D firms, it is logical to assume that it plays a vital role in capital structure decisions. This study applies nomothetic research approach. The theoretical part employs a formal conceptual analysis in order to develop the propositions that are tested with empirical data. The empirical part consists of the analysis of three companies; the data is obtained from the annual reports over the period 2003 – 2008. The companies operate in IT- or ICT-industry and are publicly listed. The method for analyzing the case data is based on the financial indicators, which are obtained from the financials of the case companies. These economic indicators describe the capital structure and the financial decision-making of the firms. The method relates to the quantitative studies. Yet, this study extends the analysis beyond the indicators. Specifically, this study addresses the question of what is behind the economic indicators, therefore combining aspects of quantitative and qualitative analysis. The firms examined in this study seem to prefer internal finance during growth. However, external finance seems to be a catalyst for sales growth. Firms strongly prefer equity financing. In growth, the use of equity per capital either increases or stays in a constant level. Over the period 2003 – 2008, the firms were often associated to equity related transactions and short-term debt. Short-term debt was used as a substitute of long-term debt and equity. The case firms also adjusted their capital structure – these adjustments were carried out with short-term debt or equity. The case data also provides implications for the growth signal theory that was developed in this study. Based on the econometric indicators, arguments can be made that equity investors are `attracted` to growing R&D firms. This is because growth helps investors perceive the true type of firm. The findings of this study are best explained by the trade-off theory and the pecking order theory. These corporate finance theories are considered as mainstream. Little support can be found to the implications of the signaling theory and market timing theory.

Facoemulsificação em cães, com e sem implante de lente intra-ocular em piggyback: estudo clínico da inflamação pós-operatória

A uveíte peri e pós-operatória é o maior problema da cirurgia para extração de catarata no cão, sendo considerada o fator mais importante para o sucesso cirúrgico, imediato e tardio. Diversos protocolos pré e pós-operatórios utilizando agentes anti-inflamatórios esteroidais e não-esteroidais têm sido empregados na tentativa de controle da uveíte cirurgicamente induzida. O objetivo do presente estudo foi avaliar a reação inflamatória pós-operatória, clinicamente e por meio da pressão intraocular (PIO), após a cirurgia de facoemulsificação para extração de catarata em cães, com e sem implante de lente intraocular (LIO) em piggyback. Empregaram-se, 25 cães portadores de catarata, subdivididos em dois grupos: G1 (com implante de LIO), G2 (sem implante de LIO). A técnica cirúrgica adotada foi a facoemulsificação bimanual unilateral. Avaliações clínicas e mensurações da PIO foram aferidas antes do procedimento cirúrgico (0) e nos tempos 3, 7, 14, 21, 28 e 60 dias após o ato cirúrgico. Cães do grupo G1 apresentaram sinais clínicos de uveíte visivelmente mais intensos, relativamente aos do G2. Entretanto, a PIO não demonstrou diferença significativa entre os dois grupos analisados, nem entre os olhos operados e os contralaterais. A utilização de duas LIOs humanas em piggyback no cão é exequível, porém suscita mais inflamação e complicações no pós-operatório.

Pressão intra-abdominal em cães

Sob consenso recente em pacientes humanos, os valores basais da pressão intra-abdominal (PIA) e seus prováveis limiares em casos mórbidos, foram estipulados com intuito de favorecer a homogeneidade de estudos científicos, além de fornecer diretrizes para conduta diagnóstica e terapêutica destes pacientes. Valores basais e alterações na pressão intra-abdominal em animais não são ainda suficientemente conhecidos e cientificamente determinados. Médicos veterinários necessitam conhecer melhor os estados mórbidos que cursam com Hipertensão Intra-Abdominal (HIA) ou Síndrome de Compartimento Abdominal (SCA). O presente estudo objetivou testar em cães a técnica já descrita sob consenso na medicina como modelo de mensuração da pressão intra-abdominal, assim como determinar os valores normais para a espécie. Foram utilizados 15 cães hígidos, machos e fêmeas, homogêneos e todos sem raça definida. A mensuração da pressão intra-abdominal foi realizada por meio da técnica indireta de sondagem vesical e utilização de coluna de água com régua graduada em cm de H2O, sendo seu valor final convertido para a unidade de mm de Hg. Foi observado valor mínimo subatmosférico (abaixo de zero mm de Hg) até o valor máximo de 3,75 mmHg. Houve importante variação entre os valores encontrados individualmente em determinados cães, colocando sob discussão questões como massa corporal, freqüência/volume total de solução fisiológica a ser infundida e agitação destes pacientes no momento do exame. Os valores limítrofes encontrados são considerados fisiológicos, indicando confiabilidade da técnica e possibilidade do seu emprego clínico. A ausência de sedação e utilização de sonda uretral não inviabilizou a realização da mensuração, porém podendo culminar numa sub ou superestimativa dos valores encontrados.

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

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

Strategic Innovation Management Based on Three Dimensions

This thesis examines innovation development needs of firms in a remote rural region. The perspective of the study is in strategic innovation management and three dimensions of innovation development: innovation environment, value delivery and innovation capability. The framework is studied with a theoretical and methodological approach in the context of the development of a regional innovation system and the defining of innovation development needs. The thesis is based on existing innovation management literature, expanding it by examining the features of the three dimensions. The empirical data of the study comprise 50 purposefully selected firms within the region of Pielinen Karelia located in Eastern Finland. Most of the firms (70%) included in the study represent manufacturing firms, and over 90% are small and medium-sized enterprises. The research data consist of two questionnaires and an interview, which were done during 2011 in the connection of a regional development project. The point of view of the research is in regional development and harnessing the innovation capability of the firms within the region. The principal research approach applies soft systems methodology. The study explores the means to foster the innovativeness of firms from the viewpoints of innovation environment, innovation capability and value delivery. In closer detail, the study examines relations between the innovation capability factors, differences in innovation development needs within the value delivery system, between sectors and between firm size categories. The thesis offers three major contributions. First, the study extends earlier research on strategic innovation management by connecting the frameworks of innovation capability, innovation environment and value delivery process to the defining of innovation development needs at the regional level. The results deepen knowledge especially concerning practice-based innovation, peripheral regions and smaller firms. Second, the empirical work, based on a case study, confirms the existence of a structural connection integrating five factors of innovation capability. Statistical evidence is provided especially for the positive impacts of the improvement of absorption capability, marketing capability and networking capability, which are the main weaknesses of firms according to the study. Third, the research provides a methodological contribution by applying the innovation matrix in the defining of the innovation development needs of firms. The study demonstrates how the matrix improves possibility to target policy instruments and innovation services more efficiently through indicating significant differences between the innovation support needs regarding various time horizons and phases of innovation process.

Hankintatoimen osaamisen kehittäminen

Tutkimuksen tavoitteena oli kuvata sekä määrittää case-yrityksen hankintaosaamisen nykytila. Nykytila-analyysin tarkoituksena oli muodostaa lähtökohdat hankintatoimen kehittämiselle case-yrityksessä. Yksi tavoite oli myös tutkia hankinnan sähköisten työkalujen vaikutusta hankintaosaamiseen. Kirjallisuuden osalta tutkimuksessa hyödynnettiin resurssipohjaisen näkökulmaa sekä dynaamisten kyvykkyyksien lähestymistapaa kuvaamaan hankintaosaamisen sekä -kyvykkyyksien vaikutusta hankintatoimen suorituskykyyn. Empiirisen tutkimuksen aineisto on koottu hyödyntämällä kyselytutkimusta, ryhmähaastattelua sekä puolistrukturoitua haastattelua. Tutkimustulokset kuvaavat laaja-alaisesti case-yrityksen hankintaosaamisen nykytilan sekä hankintatoimen aseman yrityksessä yleisesti. Johtopäätöksissä on nostettu esiin keskeisten tutkimustuloksien lisäksi myös kehittämisen kannalta huomioitavia tekijöitä.