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Making initiatives and having ownership over one's learning is a key for applying and creating knowledge, acquiring new abilities, actively steering one's life and the engaging in change in society. Understanding the preconditions for such learning should be in the core of designing learning environments and the primary interest of frontline learning research. This study focuses on exploring students' sense of their learning agency in studying and the role of teacher and peer support in cultivating it. We examined how primary (grades 1-6) and lower secondary school students (grades 7-9) perceive their learning agency (LA), its relationship with the experienced teacher and peer support in studying. Also, differences between the girls and boys, and schools located in low and high SES neighborhoods was examined. We assessed the structure and level of learning agency by using a new measurement and explorative structural equation modeling (ESEM). Results show that learning agency consists of interdependent elements of motivation to learn, self-efficacy beliefs about learning and strategies for learning in meaning making, problem solving and scaffolding in studying. The experienced learning agency was related to social support experienced in several ways. Also differences in learning agency and social support in terms of grade level, gender and SES were detected. Results indicate that meaning making especially calls for intentional support from teachers in lower secondary grades and that girls and boys have partly different support needs in terms of cultivating strong sense of learning agency.

Background: Extensive surgery on advanced-stage epithelial ovarian cancer is associated with increased postoperative morbidity, which may cause a delay in or omission of chemotherapy. We examined postoperative complications and their effects on adjuvant treatment in patients undergoing primary debulking surgery (PDS). Methods: Stage IIIC-IV epithelial ovarian cancer patients who underwent PDS between January 2013 and December 2020 were included. Patients were divided into two groups according to the radicality of the operation, i.e., extensive or standard surgery, and their outcomes were compared. Results: In total, 172 patients were included; 119 underwent extensive surgery, and 53 had standard surgery. Clavien–Dindo grade 3–5 (CDC 3+) complications were detected in 41.2% of patients after extensive operations and in 17% after standard surgery (p = 0.002). The most common CDC 3+ complication was pleural effusion. Despite the difference in the complication rates, the delay in chemotherapy did not differ between the extensive and standard groups (p = 0.98). Conclusions: Complications are common after PDS. Extensive surgery increases the complication rate, but most complications can be treated effectively; therefore, a delay in adjuvant treatment is rare.

Supervision is one of the most important determinants of a successful doctoral process. However, there have been few large-scale survey studies on the development of PhD supervisors. In this study, doctoral supervisors' perceptions of their supervisory competence, professional development activities and professional support from the research community are explored. A total of 561 doctoral supervisors from a large multi-field research-intensive university in Finland responded to the survey. The data were analysed with statistical methods. The results showed that the supervisors perceived their supervisory competence as being high. More experienced supervisors were more confident with their supervisory competence than less experienced ones. Support from the scholarly community was also related to positive perceptions of one's supervisory competencies. The results further showed that engaging in supervisory development activities was also related to perceived supervisory competence. Some gendered and disciplinary differences in supervisors' engagement in professional development activities were detected.

Purpose: Empirical evidence on how supervisors have perceived the changes and the implications of the COVID-19 pandemic on their supervision is scarce. This paper aims to examine how the changing landscape of doctoral education has affected supervision from the supervisors' perspective. Design/methodology/approach: This survey addressed change, challenges and impact in supervisory responsibilities due to COVID-19 pandemic. The survey was completed by 561 doctoral supervisors from a large multi-field research-intensive university in Finland. Findings: Results show that supervisors estimated that their supervision had been negatively affected by the pandemic, but to a lesser extent than their doctoral candidates' progress and well-being. In the changed landscape of supervision, the supervisors grappled with challenges related to recognising doctoral candidates' need of help. Supervisors' experiences of the challenges and the impact of changed circumstances varied depending on the field and the position of the supervisor, whether they supervised part- or full-time candidates, and the organisation of supervision. Practical implications: The slowed-down progression and diminishing well-being of doctoral candidates reported by supervisors is likely to influence supervision in a delayed way. Supervisors may be anticipating some issues with stalled studying and stress, but the question is the extent to which they are prepared to handle these as they emerge in supervision encounters. The fact that the experiences varied across field, position, organisation of supervision and the type of candidates (full or part time) suggests that support provided for supervisors to overcome challenges needs to be tailored and engineered. Originality/value: This study contributes to the literature on doctoral supervision by exploring the impact of transitioning to online supervision and the rapid changes in doctoral supervision as a consequence of the recent global pandemic.

Purpose: This study aims to advance the understanding on individual variations in PhD candidates' personal interest in their doctorate and supervisory and research community support, and several individual and structural attributes potentially having an impact on the profiles. Design/methodology/approach: The authors explored the interrelationship between personal interest-social support profiles, and nationality, gender, research group and study status and the risk of dropping out. A total of 768 PhD candidates from a research-intensive university in Finland responded to a modified version of the cross-cultural doctoral experience survey. Latent profile analysis was used to explore the individual variations in PhD candidates' interest and support from the supervisor and research community. Findings: Three distinctive PhD interest-social support profiles were detected; the high interest-high support profile (74.4%, n = 570), the high interest-moderate support profile (18.2%, n = 140) and the moderate interest-moderate support profile (7.4%, n = 56). The profiles exhibited high to moderate levels of research, development and instrumental interest. Individuals in the high interest--moderate support and in the moderate interest--moderate support profiles were more prone to consider dropping out from their PhD than in the high interest-high support profile. Originality/value: The results indicate that by cultivating PhD candidates' interest and providing sufficient supervisory and the research community offers a means for preventing candidates from discontinuing their doctorate. Hence, building a supportive learning environment that cultivates a PhD candidate's personal interest is likely to reduce high dropout rates among the candidates.

Supervisory relationship is a highly significant driver of doctoral experience. However, empirical studies exploring the alignment between supervisors' and supervisees' perceptions of good doctoral supervision is lacking. A total of 768 doctoral candidates and 561 doctoral supervisors from a multi-field research-intensive university participated in the study. Data were collected with the doctoral experience survey and the supervisory experience survey, and qualitatively and quantitatively analysed. The results showed that both doctoral candidates and the supervisors described informational, emotional, instrumental, and co-constructional support as the primary characteristics of high-quality supervision. However, some differences also existed. Perceptions regarding frequency of supervision are well aligned, although supervisors report supervising slightly more than candidates report receiving it. The results highlight the importance of promoting the alignment between doctoral candidates' and supervisors' perceptions of quality and quantity of supervision, as it fosters study progress, reduces the risk of candidates discontinuing their PhD and increases satisfaction.

Objective: To examine the relevance of questions on psychosocial working conditions and depressive symptoms, as used in a screening questionnaire in preventive occupational health care, to predict repetitive short or long sickness absences. Methods: The participants were 11,495 employees of various occupations in Finnish companies. The data were prospectively collected by one occupational healthcare service provider (Finla) and included register data of sickness absences and responses to a questionnaire used in pre-employment and periodic health examinations between 2011 and 2019. Long sickness absences of > 30 days and repetitive short sickness absences of one to ten days in a 24-month follow-up were used as outcome variables for multiple logistic regression analysis. Results: Strong associations were found between repetitive short and long sickness absences, and the questions on depressive symptoms “felt hopeless about the future”, “felt melancholic”, “felt everything was an effort”, and “feelings of worthlessness”. Among questions on psychosocial working conditions, strong associations were found between sickness absences and questions on decision authority, self-reformation opportunities, job versatility, and appreciation for their work. Conclusions: Questionnaires on depressive symptoms and psychosocial work environment can help identify patients with an increased risk of sickness absence. Data accumulating in occupational health care should be used more systematically to reduce the risk of work disability through targeted occupational health interventions.

Vaaratapahtumista ilmoittaminen on keskeinen osa asiakas- ja potilasturvallisuuden jatkuvaa kehitystyötä, mutta silti vaaratapahtumat ovat aliraportoituja. Yleisellä tasolla on tiedossa, että vaaratapahtumien ilmoitusjärjestelmät itsessään voivat olla yksi monista vaaratapahtumien ilmoittamisen esteistä. Tästä huolimatta käyttäjien näkemyksiä ilmoitusjärjestelmistä ja niiden ominaisuuksista, sekä käyttäjien omista tiedoista liittyen vaaratapahtumista ilmoittamiseen on tutkittu vähän. Tämän tutkimuksen tarkoituksena on kuvata käyttäjien näkemyksiä sähköisistä vaaratapahtumien ilmoitusjärjestelmistä ja tiedoistaan koskien potilasturvallisuuteen liittyvien vaaratapahtumien ilmoittamista. Tutkimustietoa voidaan hyödyntää suunniteltaessa ja kehitettäessä vaaratapahtumien ilmoitusprosesseja ja -järjestelmiä. Tutkimus toteutettiin poikkileikkaustutkimuksena. Aineisto kerättiin kahdelta hyvinvointialueelta Suomessa tammikuussa 2024 lähettämällä sähköinen kyselylomake kaikille potentiaalisille sähköisten vaaratapahtumien ilmoitusjärjestelmien käyttäjille. Aineistosta analysoitiin HaiPro tai Laatuportti ilmoitusjärjestelmää työssään käyttäneiden vastaajien (n=729) taustatiedot ja strukturoidut vastaukset. Tulokset esitettiin frekvensseinä, prosenttiosuuksina, vastausten keskiarvoina ja keskihajontoina, sekä selvittämällä eri ilmoitusjärjestelmiä käyttävien vastaajien vastausten välisiä eroja Mann-Whitney-U-testillä. Tulokset osoittivat vastaajien olevan tyytyväisiä tietoihinsa vaaratapahtumien ilmoittamisesta ja ilmoitusjärjestelmistä. Ilmoitusjärjestelmien ominaisuuksista vastaajat olivat tyytymättömimpiä ilmoitusten käsittelyyn liittyviin ominaisuuksiin. HaiPron ja Laatuportin käyttäjien vastauksissa ei ollut tilastollisesti merkitsevää eroa. Kuitenkin HaiProta käyttävät vastaajat antoivat usein paremman arvion järjestelmän ominaisuuksista kuin Laatuporttia käyttävät vastaajat. Kokonaisuudessaan vastaajat olivat tyytyväisiä ja tyytymättömiä hyvin samansuuntaisesti eri ilmoitusjärjestelmien ominaisuuksiin riippumatta käytetystä järjestelmästä. Asiakas- ja potilasturvallisuusstrategian ja toimeenpanosuunnitelman mukaisesti Suomessa suunnitellaan ilmoitusjärjestelmien sisällöllistä uudistusta. Tässä kehitystyössä ilmoitusjärjestelmien loppukäyttäjien näkökulmien huomioiminen on keskeistä uudistuneiden järjestelmien hyväksynnän ja tehokkaan implementoinnin saavuttamiseksi.

The study examines the benefits of digital tools in teaching and learning as experienced by university teachers in two different time periods: (1) during the controlled digital leap before the COVID-19 pandemic (2017-2019); and (2) during the emergency imposition of remote teaching in response to the lockdown aimed at containing the COVID-19 pandemic (2020). Teachers in different academic fields at a large multidisciplinary Finnish university (N1 = 303 and N2 = 265) responded to two open-ended questions as part of a broader questionnaire. The research identified four kinds of benefits related to digital teaching: (1) practical and administrative and (2) independence of time and place, implying practical and technical benefits; as well as (3) enhancing learning and (4) developing teaching, which are primarily pedagogical benefits, related to teaching and learning. Voluntary and forced digital leaps provided different kinds of consequences in teaching and learning. Digital tools generally provided practical and technological benefits for teaching and learning during the controlled digital leap, but they also had positive pedagogical effects. The forced digital leap, in turn, demonstrated the value of time-and-place-independent online teaching and learning. It also exposed differences among academic fields in how teachers experienced the benefits of using digital tools. Support of and training for university teachers should take into account the different needs of faculties and disciplines, and promote dialogue between pedagogical and technological interests.

Our aim with this study was to gain a better understanding of the emotional landscape of curriculum making by exploring the variety of emotions embedded in shared sense-making about the national curriculum reform implementation at the district level. Focus group interview data were collected from 12 curriculum reform steering groups around Finland, that were responsible for orchestrating curriculum reform work at the district level. The data were qualitatively content analysed. The results showed that the local steering group members experienced a wide range of emotions in shared sense-making. Positive emotions were described slightly more often than negative emotions. The emotional landscape of the sense-making strategies applied in curriculum reform work varied depending on the strategy applied.

Abstract Background Ensuring equal access to medicines and their appropriate and safe use at reasonable costs are core functions of health systems. Despite that, few descriptions of national medicines policies' development processes and implementation strategies have been published. This study aimed to describe the government program-based development of the Rational Pharmacotherapy Action Plan in Finland as a part of the undergoing major health and social service system reform, also covering the implementation of rational pharmacotherapy in the reformed system and processes. Methods The data of this qualitative study consisted of public reports and Steering Group meeting memos related to the development of the national Rational Pharmacotherapy Action Plan that the Ministry of Social Affairs and Health coordinated. Qualitative content analysis applying systems theory and the conceptual framework of integrated services as theoretical frameworks was used as an analysis method. Results The national Rational Pharmacotherapy Action Plan covering 2018–2022 was created in a bottom-up development process involving a wide range of stakeholders. Rational pharmacotherapy was redefined by adding equality as the fifth pillar to complement the previously defined pillars of being effective, safe, high-quality, and cost-effective. The Action Plan formed a normative framework for long-term development, with a vision and principles focusing on people-centeredness, better coordination and management of the medication use processes, the continuity of treatment paths and the flow of patient and medicines information through partnerships, and evidence-informed policies and practices. Conclusion Through intensive stakeholder participation, the bottom-up approach created a national vision and principles of rational pharmacotherapy along with strong commitment to implementing the goals and measures. The concern lies in ensuring the continuity of the Action Plan implementation and achieving a balanced long-term development aligned with the integrated and reformed national social and health services system. The development of the pharmaceutical system has several national and EU-level dependencies requiring political long-term commitment. While the Action Plan differs from the national medicines policy, it forms a good basis for long-term development covering important parts of medicine policy at the micro, meso, and macro levels of the service system.

Abstract Aapa mires are waterlogged northern peatland ecosystems characterized by a patterned surface structure where water‐filled depressions (‘flarks’) alternate with drier hummock strings. As one of the EU Habitat Directive priority habitats, aapa mires are important for biodiversity and carbon cycling, harbouring several red‐listed species and supporting unique species communities. Due to their sensitivity to hydrological disturbances, reliable, up‐to‐date and systematic information on the hydrological condition and responses of mires is crucial and required for multiple purposes ranging from carbon exchange modelling to EU Habitats Directive reporting and conservation and ecosystem restoration planning. Here, we demonstrate the usability of Sentinel‐2 satellite data in a semi‐automatic cloud‐based approach to retrieve large‐scale information on aapa mire hydrological variability. Two satellite‐derived metrics, soil moisture index and the extent of water‐saturated surfaces based on pixel‐wise classification, are used to quantify monthly and interannual wetness variation between 2017 and 2020 across Natura 2000 aapa mires in Finland, including responses to the extreme drought of 2018. The results revealed high temporal variability in wetness, particularly in the southern parts of the aapa mire zone and generally in the late summer months interannually. Observations from the drought summer showed that one third of usually year‐round wet flark surfaces may be exposed to drying during climatic extremes. Responses varied between sites and regions, implicating the significance of environmental factors for drought resistance: some sites maintained high levels of moisture, whereas others lost wet surfaces completely. Our study provides the first comprehensive national‐level representation of seasonal and interannual wetness variability and drought‐sensitivity of pristine aapa mire sites. The approach and methods used here can be directly upscaled outside protected areas and to other EU countries. Thus, they provide a means for harmonized, systematic large‐scale monitoring of this priority habitat, as well as valuable information for other applications supporting peatland conservation and research.

Hepsin, a type II transmembrane serine protease, is commonly overexpressed in prostate and breast cancer. The hepsin protein is stabilized by the Ras‐MAPK pathway, and, downstream, this protease regulates the degradation of extracellular matrix components and activates growth factor pathways, such as the hepatocyte growth factor (HGF) and transforming growth factor beta (TGFβ) pathway. However, how exactly active hepsin promotes cell proliferation machinery to sustain tumor growth is not fully understood. Here, we show that genetic deletion of the gene encoding hepsin (Hpn) in a WAP‐Myc model of aggressive MYC‐driven breast cancer inhibits tumor growth in the primary syngrafted sites and the growth of disseminated tumors in the lungs. The suppression of tumor growth upon loss of hepsin was accompanied by downregulation of TGFβ and EGFR signaling together with a reduction in epidermal growth factor receptor (EGFR) protein levels. We further demonstrate in 3D cultures of patient‐derived breast cancer explants that both basal TGFβ signaling and EGFR protein expression are inhibited by neutralizing antibodies or small‐molecule inhibitors of hepsin. The study demonstrates a role for hepsin as a regulator of cell proliferation and tumor growth through TGFβ and EGFR pathways, warranting consideration of hepsin as a potential indirect upstream target for therapeutic inhibition of TGFβ and EGFR pathways in cancer.

Abstract Background There is a need for better adoption of technology to meet the needs of home care professionals, older people, and informal caregivers. Methods Mixed methods were used to describe and analyse quantitative and qualitative data in a Finnish governmental programme called KATI. The study was three-fold: it 1) listed what kinds of technologies were piloted and deployed in a national study, 2) provided information from the perspectives of home care professionals about requirements to use technology by using focus-group interviews, and 3) assessed experiences of how the adoption of technology changes work and work processes over time by using repeated surveys. Informants in interviews (n = 25) and surveys (n = 90) were home care professionals, who also described the perspectives of older people and informal caregivers. The conceptual models framing the study were adapted from the Technology Acceptance Model and DirVA PROVE-IT. Results There were 80 technology pilots, in which variety of technologies were followed in home care. Familiarity with, commitment to and understanding of technology benefits were considered to be requirements for the technology to be used. The adoption of technology provided new skills and information about older people’s wellbeing, realisation of treatment and new possibilities in home care. It developed new procedures to focus on older people’s needs and motivated professionals by gained concrete aid. It enabled them to leave out some concrete procedures as unnecessary. On the other hand, there were also pessimistic and negative experiences when technology use provided nothing new or did not change anything. Conclusions The adoption of technology is dependent on the technology and its integration into the prevailing service practice. When they both work, it is possible to leave out unnecessary procedures in care, allocate resources and save time. It is possible to be aware of older people’s safety and how they cope at home, find new ways to get involved in older people’s lives, gain insight, and make changes at work. Continuous on-site training, modifications in service practices and communication throughout organisations is needed.

This article urges a reconsideration of professional responsibility in arts education, moving beyond an emphasis on narrow technical expertise and strict disciplinary boundaries in order to respond to the needs of complex late modern society. We reconsider 'professionalism' in arts education as a site of struggle that requires 'systems reflexivity' to engage in the transformation of wider society. By presenting three cases, conceptualised as social innovations in the arts education system in Finland, we illustrate how multi-professional collaboration and systems entrepreneurship, flexible institutional boundary-crossing, and performing social categories in professional education of artists help tackle exclusion and inequalities. We also argue that a degree of activism may be necessary for the field to expand its sense of professional responsibility beyond 'what is' towards 'what could be'.