Tietomallinnuksen haasteita: Näkemyksiä uraauurtavasta prosessinkehittämisen yhteistyöriihestä Suomessa

The purpose of this thesis was firstly, to find the challenges related to BIM process, and secondly to find the solutions to the challenges. The solutions were found from multi-party agreements (MPAs), where building construction and the contract is designed in collaboration between the architect, the other designers, main contractor, and the owner. The contract model is based on the fact that the profits and risks during the process are allocated between the participants, which will motivate the team to pursue as effective cooperation as possible, to share information also about incomplete work, and thus to enhance understanding about different discipline’s work, challenges and the whole design and construction process. The subject is relevant, as the industry evolves so slowly even though there are solutions for the challenges. Building information modeling (BIM) refers to the process in which different disciplines are designing 3-4D designs within a construction project. It provides development opportunities when there is competence to utilize them. The model can be used for visualization for the owner and the authorities, and as a tool for the site workers in the constructing phase. The as-built model can also be used in the maintenance phase, as all the materials and particles used in the building are in the final model. The challenges found during this study were especially related to collaboration, coordination, contractual interests, and the lack of competence in both using the models, as well as modeling it-self. The results show that these challenges are not only related to BIM, but construction processes in general. Thus, it is important to emphasize all of the most obvious solutions available. This thesis provides for a basis for future research concentrating on operational challenges related to construction process. It also serves the field work, especially in the planning phase, when struggling with the challenges presented in this thesis. The empirical part of this thesis was based on a focus-group workshop arranged for the Finnish pioneers in BIM, from which the qualitative material was collected by observations and recordings. In the research, an initial theoretical framework is constructed from the BIM related challenges and MPA related solutions found in the literature, which are tested with the collected empirical data. The result is an enhanced constructed framework, which shows that the BIM related challenges can in fact be solved with implementing MPAs as well as the so called Last Planner® System.Tämän työn tarkoituksena oli löytää tietomallintamisprosessiin, käytäntöihin ja teknologioihin liittyviin haasteisiin ratkaisuja monen osapuolen välisestä sopimusmallista (MPA), missä rakentaminen ja sopimus suunnitellaan yhdessä arkkitehdin, muiden suunnittelijoiden, rakennuttajan sekä omistajan kesken. Sopimusmalli perustuu siihen, että sekä rakentamisprosessin aikana säästetyt varat, että siihen liittyvät riskit jaetaan edellä mainittujen osapuolten kesken, mikä motivoi jokaista tavoittelemaan mahdollisimman tehokasta yhteistyötä, jakamaan tietoa keskeneräisistäkin suunnitelmista, ja parantamaan siten ymmärrystä eri osapuolten työstä, haasteista ja koko suunnittelu- ja rakennusprosessista. Tutkimuksen aihe on relevantti, koska teollisuudenala kehittyy hitaasti siihen nähden, että löytyneisiin haasteisiin on olemassa ratkaisuja. Tietomallinnus (BIM) tarkoittaa eri suunnittelualojen toimesta tehtävää 3-4D – suunnitteluprosessia samassa rakennusprojektissa. Tietomallia voidaan hyödyntää omistajalle ja viranomaisille visualisoinnissa, työmaan työntekijöiden oppaana, ja nk. to-be – mallina - mitä on loppujen lopuksi rakennettu. Mallia voidaan tällöin hyödyntää myös ylläpitovaiheessa, kun kaikki olennainen on siihen mallinnettu. Tämän tutkimuksen puitteissa havaittuja haasteita ovat erityisesti yhteistyön optimoiminen ja koordinoiminen, sopimustekniikka, tiedon yhteensopivuus, sekä mallintamisen ja mallien käytön osaamisen puute. Tutkimuksen tulokset osoittavat, että löydetyt haasteet eivät liity vain tietomallintamiseen, vaan rakennusprosesseihin yleensä. Niinpä on tärkeää korostaa kaikkia yleisimpiä, olemassa olevia ratkaisuja niihin. Tämä työ tarjoaa perustan tulevalle, rakennusalan operationaalisiin haasteisiin keskittyvälle tutkimukselle. Tämä palvelee myös kenttätyötä, erityisesti niissä suunnitteluvaiheen haasteissa, joita on esitelty tässä työssä. Työn empiirinen osa perustuu Suomen BIM pioneereille järjestettyyn fokusryhmä-workshoppiin, mistä laadullinen aineisto kerättiin havainnoimalla ja nauhoittamalla. Tutkimuksessa luodaan ensin teoreettinen viitekehys kirjallisuuskatsauksessa löydetyistä BIM:n haasteista ja ratkaisuista, jota testattiin empiriasta saamalla aineistolla. Työn tulos on testatusta aineistosta rakennettu paranneltu viitekehys, mistä nähdään, että tietomallinnukseen liittyviin haasteisiin voidaan löytää ratkaisu monen osapuolen välisestä sopimuksesta, sekä nk. Last Planner® Systeemistä, koordinaatiota optimoivasta työkalusta, mikä liitetään usein monen osapuolen väliseen sopimiseen

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Groin hernias and unmet need for surgery in Uganda : Epidemiology, mosquito nets and cost-effectiveness

Background Surgery has traditionally been considered more expensive than many other health care interventions and with little impact on the burden of disease in a global perspective. One of the reasons behind this misconception is that the effects of surgical conditions and their treatment have not been factored into the equation. Cost-effectiveness analyses of surgical interventions have largely been missing. An estimated 20 million herniorrhaphies are carried out annually but over 200 million people suffer from groin hernias. Herniorrhaphy is one of the most commonly performed surgical procedures also in Low and Middle Income Countries (LMIC). However, the surgical repair method is not the same due to financial constraints. In high income countries a synthetic mesh is used and has reduced the risk of recurrence. This 125 USD mesh is too costly for the majority in LMIC. Mosquito mesh, which is cheaper but very similar to commercial meshes, is used in several settings but outcomes need to be investigated more extensively before this practice can be recommended in routine surgical service. The Aims of this thesis were to define the prevalence of groin hernia, to relate it to the surgical capacity, outcomes and costs of surgery in eastern Uganda and to investigate the feasibility and difference in cost and cost-effectiveness of replacing a commercial mesh with a mosquito mesh in groin hernia surgery. Methods Three studies (1-3) were carried out in eastern Uganda. 1: A cross sectional study investigating the prevalence of groin hernia in adult males in the Health and Demographic Surveillance Site (HDSS) in Iganga and Mayuge districts. 2: A facility based study with prospective data collection of all surgeries undertaken in the two hospitals providing surgery for the HDSS population. 3: A double blinded, randomised controlled trial comparing the outcomes of using a mosquito mesh relative using a commercial mesh in groin hernia surgery. Results 1: the prevalence of untreated groin hernia among the study participants was 6.6%. 2: the rate of groin hernia surgery was 17 per 100 000 population. Thus, less than 1% of the estimated number of cases of groin hernia in the catchment area of the two hospitals are operated per year. A herniorrhaphy costs around 60 USD to perform. This corresponds to a third of the cost of TB treatment and a 15th of the cost of HIV/AIDS treatment per year in Uganda. 3: No significant differences in terms of recurrence rates, post operative and chronic complications and patient satisfaction were demonstrated between the patients operated using the mosquito mesh and the commercial mesh. Cost-effectiveness was very high for both materials but total cost in the mosquito mesh group was 124 USD lower per surgery than in the commercial mesh group. Conclusion There is a vast unmet need for groin hernia surgery. Cost of surgery compares favourably with other health care interventions prioritised by the international organisations and funders. A superior technique can be used in groin hernia surgery at low cost, with high cost-effectiveness in a Low Income Country.

Högtider och traditioner i förskolan : Ett examensarbete om förskollärares skildringar kring högtider och traditioner i förskolan.

Det har debatterats kring högtider och traditioner i såväl förskolan, samhället som runt om i världen. Forskningen lyfter att debatten till viss del handlar om hur stor plats högtider ska ta i samhället och därmed förskolan, då samhället numera är mångkulturellt. Traditioner och kulturarv är något som förskolan ska förhålla sig till och något som ska föras vidare till nästa generation. Den forskning som vi tog del av använde inte det interkulturella perspektivet i analysen av sitt resultat, det gjordes därmed i denna studie. Syftet är att bidra med den kunskap som konstrueras kring det kulturarv som förmedlas i förskolor ur ett interkulturellt perspektiv. Detta med utgångspunkt i socialkonstruktionism. De forskningsfrågor som ämnades att besvara var hur skildras uppmärksammandet av högtider och traditioner samt vad framträder i de reflektioner förskollärarna gör kring högtider och traditioner. Studien genomfördes genom intervjuer av nio förskollärare i olika områden där datamaterialet analyserades med en tematisk analys. Resultatet visade att de kristna högtider som förskollärarna hade erfarenhet av var de högtider och traditioner som fick störst utrymme i verksamheten. Vidare synliggjorde även resultatet att det fanns en strävan mot att inta ett interkulturellt perspektiv och att integrera flera högtider och traditioner i verksamheten. Det som dock påverkade möjligheten att integrera fler högtider och traditioner var att förskollärarna upplevde en kunskapsbrist och osäkerhet kring högtider och traditioner som de inte hade någon erfarenhet av. Förskollärarna uttryckte även att det skedde en exkludering av barn när högtider uppmärksammades och att det resulterade i att högtider reducerades och att det inte samtalades kring innebörden av högtiderna, utan fokus låg istället på estetiska uttrycksformer. Studiens slutsats är att det kulturarv som förmedlas är det som finns representerat hos förskollärarna. Det finns en strävan att föra vidare ett kulturarv som representeras av hela barngruppen

Brandbelastning i träbyggnader : Jämförande beräkning och kartläggning om hur branschen hanterar permanet brandbelastning

Wood is a renewable material, it is strong in relation to its weight, climate smart but also combustible. Owing to its many advantages and the easy access in Sweden, wood is motivated as a topical building material. However, the aspects related to the combustible nature need to be considered in the design of buildings with a wooden frame. Whether and in such cases how to take into account the increased permanent fire load is a problem of which there are shared opinions. Today's regulatory framework is unclear in some aspects in its formulation and thus leaves room for interpretation. The purpose of this work is to investigate the reasonableness of tabulated data for permanent fire load and the sharp boundary between a BR1 building and a BR0 building but also by surveying how the industry handles the issue. In order to assess the reasonableness for the tabulated data, the method has been calculations with two different methods; one that follows BBR's guidelines (method 1) and another where calculations of the charring depth (method 2) have been performed, as well as a survey and a literature study. The result from the calculations in method 1 shows that in order for the level of the total fire load not to exceed the standard value for a residence of 800 MJ/m2, a low coefficient is required, and thus in principle all wood is assumed to be protected. According to the calculations in method two, it is possible to read out how the permanent fire load is affected by different protective linings and carbonation rates. The survey shows that the most common way to dimension fire protection is through simplified sizing, which entails that one does not have to consider whether the permanent fire load increases due to a combustible frame. There are divided opinions about whether Boverket's rules are enough to achieve adequate protection and how to handle it. The literature study shows that for the timber frame to be counted as fully protected it needs to be three layers of fire gypsum board in the ceiling and that two layers on the walls. Several conclusions can be drawn; the calculations indicate that a permanent fire load of 200 MJ/m2 (2013:11) is unreasonable in a wooden frame building also that if the permanent fire load is considered it becomes costly both economically and in terms of space. Even that Boverket's rules need to be clarified and adapted further against tall wood buildings and that fire projectors work differently and the experience of working with tall wood buildings differs greatly

The stability of AM and FM screenings in different water conditions – with the mottle under consideration

This project was performed at Rochester Institute of Technology to get more understanding and knowledge about AM and FM screenings similarities and differences with considerations of the mottle. By designing a test form conformed to the specific measurements and printing it on Heidelberg's Sunday 2000 press, the project group has evaluated the questions that already existed and the ones that occurred during the project. Hence the first press run left some unexpected phenomenon therefore another press run was performed. Measurements were performed and graphs produced in Excel. The project group evaluated the results and from that able to establish facts and draw conclusions. It has been a great experience for the project group and they have learnt a lot

Global surgery for medical students - is it meaningful? : A mixed-method study

Introduction: There has been an increase in global health courses at medical universities in high-income countries. Their effect on students, however, is poorly understood. In 2016 an elective global surgery course was introduced for medical students at Karolinska Institutet in Sweden. The course includes a theoretical module in Sweden and a two-week clinical rotation in Uganda. The present study aimed to assess the format and determine its effect on students' knowledge of global surgery and approach towards patients of non-Swedish origin. Method: A mixed-methods design was used. Semi-structured case-based interviews were conducted individually with 18 students and analysed using qualitative content analysis. Examination scores and the course evaluation were analysed with Kruskal Wallis one-way analysis of variance, Pearson's Chi-square and a Wilcoxon signed-rank test as appropriate. Results: The course was appreciated and students reported gained insights and interest in global surgery. Students' ability to reason about global surgery issues was improved after the course. Students considered complicating aspects in the meeting with patients of non-Swedish origin. Students with abroad clinical experience felt less compelled to act on preconceptions. Discussion: The global surgery course at Karolinska Institutet is appreciated and students gained valuable knowledge. The case-based interviews acted as a catalyst for reflection and showed that students felt insecure as they lacked knowledge about globally common surgical conditions and struggled with generalized preconceptions of patients of non-Swedish origin. To further support students to integrate theoretical knowledge and professional development, we suggest the introduction of problem-based learning. Conclusion: The ability of the course to inspire students' commitment to global surgery is promising as this engagement is the key to reaching the goal of equitable health globally. Offering such courses is a step towards inspiring and recruiting the future clinicians and researchers needed for expanding the field of global surgery