"Suurin vaikutuksemme maailman kestävään kehitykseen tapahtuu tuotteidemme kautta"- Kestävän kehityksen diskursiivinen legitimaatio yrityksen verkkosivuilla

This study aims to contribute to the discussion on how corporations legitimate their own existence through legitimation of sustainability engagement. More specifically, the research focused on the discourses and legitimation strategies corporations use in their own texts to assure their audience that they are a legitimate societal actor, and therefore should be supplied resources to. The research was executed as a discourse analysis on six Finnish production companies’ sustainability website texts. The data consisted of the sustainability websites’ front pages and descriptions of Approach to sustainability and Sustainability areas. Two opposing discourses were found to be used: Sustainability as an asset, which holds the idea of sustainability contributing to the organization’s operations positively and Sustainability as a liability, i.e. an obligation that has to be fulfilled. Six discursive themes under these were identified, which respectively from asset to liability were: Business core, Stakeholders, External valuation, Business impact, Moral obligation and Laws and regulations. The findings suggest that a stronger legitimacy can be achieved through strategic implications of sustainability, i.e. viewing it as an asset, where legitimacy can primarily be achieved through normalization and rationalization. Legitimacy increased through outsourcing the decision of important aspects to stakeholders through prospective normalization, as well as giving the authority to judge sustainability outside the company, through using authorization. Legitimation through the liability discourse seems to be in place especially if appealing to humanistic values when talking about employees or communities, with moralization primarily used to achieve legitimacy. Sustainability has been found to produce legitimacy to an organization’s existence, and therefore stronger stakeholder engagement. This study extends the knowledge of how corporations’ responsibilities today go beyond making profit, and especially how corporations seek to assure their audiences of their responsibility

Lead Time and Prognostic Role of Serum CEA, CA19-9, IL-6, CRP, and YKL-40 after Adjuvant Chemotherapy in Colorectal Cancer

Simple Summary Colorectal cancer is the third most common cancer worldwide. Recurrence risk after curative intent surgery combined with adjuvant chemotherapy is substantial. Unlike many other cancers, curative metastasectomy is possible upon recurrence, which raises the question of personalized surveillance strategies according to individual risk factors. We studied whether elevated biomarkers, such as gold standard CEA and experimental CA19-9, IL-6, CRP, and YKL-40 after adjuvant therapy, are associated with disease-free and/or overall survival, and whether the diagnostic time from the elevated biomarker to the diagnosis of metastases can be prolonged by combining these biomarkers. We show that elevated post-adjuvant CEA, IL-6, and CRP are associated with impaired survival and that elevated IL-6 finds recurrences in patients with normal CEA. Lead time is shorter with CEA than with experimental biomarkers. Our findings thus may impact the follow-up strategies after curative intent treatment aiming at finding operable relapses. These biomarkers are readily available and feasible in clinical practice. In colorectal cancer (CRC), 20-50% of patients relapse after curative-intent surgery with or without adjuvant therapy. We investigated the lead times and prognostic value of post-adjuvant (8 months from randomisation to adjuvant treatment) serum CEA, CA19-9, IL-6, CRP, and YKL-40. We included 147 radically resected stage II-IV CRC treated with 24 weeks of adjuvant 5-fluorouracil-based chemotherapy in the phase III LIPSYT-study (ISRCTN98405441). All 147 were included in lead time analysis, but 12 relapsing during adjuvant therapy were excluded from post-adjuvant analysis. Elevated post-adjuvant CEA, IL-6, and CRP were associated with impaired disease-free survival (DFS) with hazard ratio (HR) 5.21 (95% confidence interval 2.32-11.69); 3.72 (1.99-6.95); 2.58 (1.18-5.61), respectively, and elevated IL-6 and CRP with impaired overall survival (OS) HR 3.06 (1.64-5.73); 3.41 (1.55-7.49), respectively. Elevated post-adjuvant IL-6 in CEA-normal patients identified a subgroup with impaired DFS. HR 3.12 (1.38-7.04) and OS, HR 3.20 (1.39-7.37). The lead times between the elevated biomarker and radiological relapse were 7.8 months for CEA and 10.0-53.1 months for CA19-9, IL-6, CRP, and YKL-40, and the lead time for the five combined was 27.3 months. Elevated post-adjuvant CEA, IL-6, and CRP were associated with impaired DFS. The lead time was shortest for CEA.Peer reviewe

Resemetaforen i cancerspråket

Att studera språket och dess metaforer kan säga mycket om hur vi tänker kring en företeelse. I min undersökning tittar jag, dels genom en metaforanalys, dels genom en enkätundersökning, på hur resemetaforen framställer den som är sjuk i cancer, och hur den sjuke reagerar på denna framställning. Syftet med studien är att undersöka vilka konceptualiseringar av cancern som kommer till uttryck i informationsboken Den ofrivillige resenären, och hur ett antal utvalda metaforer därur tas emot av läsaren. Resultatet från metaforanalysen visar att metaforen något oftare används på ett sätt som tar ifrån den sjuke agens än som tilldelar den agens. Resultatet från enkätundersökningen pekar på att det inte, som tidigare forskning föreslår, är mer negativt att använda metaforer på ett sätt som tar ifrån den sjuke agens än som tilldelar den agens

Tjänster, ju fler desto bättre? : En kvantitativ studie om vilka tjänster inom e-handeln som påverkar konsumentens köpbeslut på internet.

Handeln utvecklas idag i en allt högre takt och e-handeln har etablerat sig som en stadig försäljningskanal som sakta men säkert tar marknadsandelar från fysiska “offline-marknaden”. Skor- och klädbranschen har haft en lite långsammare utveckling men även där har nu e-handeln satt fart. På internet har konsumenter tillgång till enorma mängder information och att byta leverantör kräver bara ett enda klick. Pris anses inte längre vara en konkurrensfaktor då konsumenter enkelt kan jämföra, utvärdera och rangordna olika alternativ innan köp.   Service anses vara den nya vägen till framgång och företag erbjuder allt fler tjänster för att locka konsumenter till deras e-handelsbutik och till köpbeslut. Idag erbjuds inte bara tjänster som fokuserar på att hjälpa konsumenten till köpbeslut vilket länge anses viktigt. Tjänster som påverkar konsumenten efter transaktionen och alternativa tjänster om fel uppstår i processen är också tjänster som företag använder för att konkurrera på marknaden idag. Vi frågade oss därför vilka tjänster som faktiskt påverkar konsumentens köpbeslut och hur.   Med en utgångspunkt ur en servicelogik undersöker vi service som marknadsföringsstrategi och försöker fastställa tjänsters särdrag. Konsumentbeteende på internet och hur konsumenter accepterar teknologi som hjälpmedel är en viktig del då detta tillsammans med tjänsteteori beskriver hur värde skapas på konsumenten på internet genom olika tjänster. Den forskning som finns på området har länge fokuserat på att undersöka tjänster som berör konsumentens interaktion med webbsidan och därmed inte lagt någon större vikt på tjänster som uppstår efter transaktionen.   Med hjälp av en enkätundersökning som utfördes på internet har vi undersökt vad konsumenter inom e-handeln anser om de tjänster som existerar på marknaden idag, och hur attityder till olika funktioner påverkar värderingen av dessa tjänster. De tjänster som studerats och undersökts, berör konsumenten både innan och efter ett köp.   Resultatet visar att säkerhet är en betydande faktor för konsumenter där tjänster som bidrar till en ökad säkerhet värderas högt. Vidare visar resultatet att tjänster som påverkar konsumenten både innan och efter köp, samt tjänster som konsumenten endast kommer i kontakt med vid ett eventuellt misstag värderas högt. Detta visar att konkurrensfördelar inte endast skapas genom att hjälpa konsumenten till ett köp, utan framgång nås genom att erbjuda konsumenter ett bredare utbud av tjänster.   Studien visar också en inkonsekvent resultat för attityden till bekvämlighet, där tjänster inom området värderas högt men konsumenter anser inte att detta är viktigt. Avslutningsvis visar studien att tjänster relaterade till hållbarhet inte påverkar konsumentens köpbeslut i någon större utsträckning.

A wound that has changed me : A literature review describing patients’ experiences of living with a chronic wound

Bakgrund: Svårläkta sår är ett växande problem då vi lever allt längre och de är vanligare hos äldre personer. Ett svårläkt sår är ett sår som inte läkt inom en sex veckors period. Det finns flera bakomliggande orsaker till uppkomsten av denna typ av sår, malignitet och venös insufficiens är två exempel. Sjuksköterskan bör ha evidensbaserad kunskap för att kunna ge en god omvårdnad till de patienter som lider av ett svårläkt sår. Syfte: Syftet med litteraturöversikten är att beskriva patienters upplevelser av att leva med maligna tumörsår eller venösa bensår. Metod: En litteraturöversikt har genomförts med hjälp av Fribergs metod. Samtliga tio vetenskapliga artiklar som använts i litteraturöversikten har använt sig av kvalitativ metod. Databaserna som använts vid datainsamlingen är Academic Search Complete, Cinahl Complete och PubMed. Resultat: Resultatet sammanfattas i fyra huvudteman: Upplevelsen av symtom, En förändrad identitet, Social isolering och Att leva med ett svårläkt sår. Det var vanligt bland deltagarna att såren hade en negativ inverkan på deras liv och orsakade dem en förändrad kroppsuppfattning. Symtomen upplevdes besvärande och orsakade dem oro, ångest och skam över den egna kroppen, som ledde till att de isolerade sig från omgivningen. Deltagarna använde sig av olika coping-strategier för att hantera sin situation och klara av det dagliga livet. Diskussion: Resultatet diskuterades utifrån Jocalyn Lawlers somologiska teori som beskriver hur en patient kan uppleva en omvårdnadssituation och hur sjuksköterskan kan främja ett vårdande möte genom att se hela patienten.Background: Chronic wounds are an increasing problem in society because we live longer, and the problem is more common when we get older. The criteria of a chronic wound are that it has not healed within six weeks. There are several underlying reasons for this type of wounds; malignancy and venous insufficiency are two examples. A nurse should have evidence based knowledge to be able to provide good care for patients suffering from this type of wounds. Aim: The aim of the study was to describe the patients’ experience of living with malignant wounds or venous leg ulcers. Method: A literature study has been carried out using Friberg’s method. Ten scientific articles used in the literature study were qualitative. The databases that were used in data collection were Academic Search Complete, Cinahl Complete and PubMed. Results: The results are summarized into four main themes: Perception of symptoms, A changed identity, Social isolation and Live with a chronic wound. The study showed that the wounds had a negative impact on the patients’ lives and caused them an altered body image. The symptoms were experienced as bothersome and caused anxiety, fear and shame. That led to social isolation. Participants used a variety of coping strategies to manage their situation to manage with their daily life. Discussion: The results were analyzed on the basis of Jocalyn Lawler’s somology theory that describes how a patient may experience a nursing situation and how the nurse can promote a caring encounter when seeing the whole patient

Can nudging promote sustainable premium pension savings?

The interest in sustainability has increased among private investors and a gradual increase in SRI is the result. However, there still seems to be a gap between people’s values and interest in sustainability and how individuals actually invest. Hence, this thesis aims to examine whether individuals tend to choose sustainable investments, specifically premium pension investments, to a larger extent when they are reminded of their values of sustainability and get the time to reflect upon them. The essay's overall question is formulated as follows: Can nudging promote sustainable premium pension investments? In order to answer the research question, data have been collected through a survey experiment, where the respondents obtained 100 000 SEK to distribute between four different premium pension funds. It can be concluded that the nudge had a significant effect on the investment decision, a result which mainly can be explained by the theory of cognitive dissonance. This implies that nudging can be used to promote sustainable premium pension investments, which is the main contribution of our studie

Diagnostic criteria for temporomandibular disorders : Diagnostic accuracy for general dentistry procedure without mandatory commands regarding myalgia, arthralgia and headache attributed to temporomandibular disorder

The clinical examination in diagnostic criteria for temporomandibular disorders (DC/TMD) is a strict procedure and comprises mandatory commands. However, learning and using these mandatory commands in general practice have proven to be difficult and their use of DC/TMD is minimal. To investigate whether reliability on a diagnostic level for DC/TMD diagnoses differs between examiners using the mandatory commands or not. Six examiners were divided into two groups: one using the mandatory commands in DC/TMD for the clinical examination and one who did not use the mandatory commands. A reliability assessment was performed twice, one occasion for each group of examiners. The assessment was performed according to the guidelines from the International Network for Orofacial Pain and Related Disorders Methodology. Each group of examiners thereby examined 16 subjects (11 TMD patients and 5 healthy individuals) each, and the diagnostic agreement (reliability) as compared to diagnoses derived by a reference standard examiner was calculated with Cohen' s kappa coefficient. The DC/TMD diagnoses myalgia, arthralgia and headache attributed to TMD were included in the reliability assessment. There was no significant difference regarding diagnostic agreement reliability between the examiners using or not using the mandatory DC/TMD commands. This study indicates that not using the mandatory commands in DC/TMD in general practice does not impair the diagnostic reliability regarding the diagnoses myalgia, arthralgia and headache attributed to TMD compared to including the commands

ESMO / ASCO Recommendations for a Global Curriculum in Medical Oncology Edition 2016

The European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) are publishing a new edition of the ESMO/ASCO Global Curriculum (GC) thanks to contribution of 64 ESMO-appointed and 32 ASCO-appointed authors. First published in 2004 and updated in 2010, the GC edition 2016 answers to the need for updated recommendations for the training of physicians in medical oncology by defining the standard to be fulfilled to qualify as medical oncologists. At times of internationalisation of healthcare and increased mobility of patients and physicians, the GC aims to provide state-of-the-art cancer care to all patients wherever they live. Recent progress in the field of cancer research has indeed resulted in diagnostic and therapeutic innovations such as targeted therapies as a standard therapeutic approach or personalised cancer medicine apart from the revival of immunotherapy, requiring specialised training for medical oncology trainees. Thus, several new chapters on technical contents such as molecular pathology, translational research or molecular imaging and on conceptual attitudes towards human principles like genetic counselling or survivorship have been integrated in the GC. The GC edition 2016 consists of 12 sections with 17 subsections, 44 chapters and 35 subchapters, respectively. Besides renewal in its contents, the GC underwent a principal formal change taking into consideration modern didactic principles. It is presented in a template-based format that subcategorises the detailed outcome requirements into learning objectives, awareness, knowledge and skills. Consecutive steps will be those of harmonising and implementing teaching and assessment strategies