Competence in intensive and critical care nursing - development of a basic assessment scale for graduating nursing students

Intensive and critical care nursing is a speciality in its own right and with its own nature within the nursing profession. This speciality poses its own demands for nursing competencies. Intensive and critical care nursing is focused on severely ill patients and their significant others. The patients are comprehensively cared for, constantly monitored and their vital functions are sustained artificially. The main goal is to win time to cure the cause of the patient’s situation or illness. The purpose of this empirical study was i) to describe and define competence and competence requirements in intensive and critical care nursing, ii) to develop a basic measurement scale for competence assessment in intensive and critical care nursing for graduating nursing students, and iii) to describe and evaluate graduating nursing students’ basic competence in intensive and critical care nursing by seeking the reference basis of self-evaluated basic competence in intensive and critical care nursing from ICU nurses. However, the main focus of this study was on the outcomes of nursing education in this nursing speciality. The study was carried out in different phases: basic exploration of competence (phase 1 and 2), instrumentation of competence (phase 3) and evaluation of competence (phase 4). Phase 1 (n=130) evaluated graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care with Basic Knowledge Assessment Tool version 5 (BKAT-5, Toth 2012). Phase 2 focused on defining competence in intensive and critical care nursing with the help of literature review (n=45 empirical studies) as well as competence requirements in intensive and critical care nursing with the help of experts (n=45 experts) in a Delphi study. In phase 3 the scale Intensive and Critical Care Nursing Competence Scale (ICCN-CS) was developed and tested twice (pilot test 1: n=18 students and n=12 nurses; pilot test 2: n=56 students and n=54 nurses). Finally, in phase 4, graduating nursing students’ competence was evaluated with ICCN-CS and BKAT version 7 (Toth 2012). In order to develop a valid assessment scale of competence for graduating nursing students and to evaluate and establish the competence of graduating nursing students, empirical data were retrieved at the same time from both graduating nursing students (n=139) and ICU nurses (n=431). Competence can be divided into clinical and general professional competence. It can be defined as a specific knowledge base, skill base, attitude and value base and experience base of nursing and the personal base of an intensive and critical care nurse. Personal base was excluded in this self-evaluation based scale. The ICCN-CS-1 consists of 144 items (6 sum variables). Finally, it became evident that the experience base of competence is not a suitable sum variable in holistic intensive and critical care competence scale for graduating nursing students because of their minor experience in this special nursing area. ICCN-CS-1 is a reliable and tolerably valid scale for use among graduating nursing students and ICU nurses Among students, basic competence of intensive and critical care nursing was self-rated as good by 69%, as excellent by 25% and as moderate by 6%. However, graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care were poor. The students rated their clinical and professional competence as good, and their knowledge base and skill base as moderate. They gave slightly higher ratings for their knowledge base than skill base. Differences in basic competence emerged between graduating nursing students and ICU nurses. The students’ self-ratings of both their basic competence and clinical and professional competence were significantly lower than the nurses’ ratings. The students’ self-ratings of their knowledge and skill base were also statistically significantly lower than nurses’ ratings. However, both groups reported the same attitude and value base, which was excellent. The strongest factor explaining students’ conception of their competence was their experience of autonomy in nursing. Conclusions: Competence in intensive and critical care nursing is a multidimensional concept. Basic competence in intensive and critical care nursing can be measured with self-evaluation based scale but alongside should be used an objective evaluation method. Graduating nursing students’ basic competence in intensive and critical care nursing is good but their knowledge and skill base are moderate. Especially the biological and physiological knowledge base is poor. Therefore in future in intensive and critical care nursing education should be focused on both strengthening students’ biological and physiological knowledge base and on strengthening their overall skill base. Practical implications are presented for nursing education, practice and administration. In future, research should focus on education methods and contents, mentoring of clinical practice and orientation programmes as well as further development of the scale.

Pragmatic competence of Finnish learners of English: Meaning in interaction in secondary and upper secondary schools

Tutkin pro gradu -tutkielmassani englannin kielen oppijoiden pragmaattista kompetenssia. Tarkoitukseni oli selvittää, miten suomalaiset yläkoululaiset ja lukiolaiset osaavat käyttää englannin kieltä erilaisissa kommunikaatiotilanteissa. Tutkielmani voidaan sijoittaa välikielen pragmatiikan tutkimukseen. Halusin selvittää, millä tasolla suomalaisten oppijoiden pragmaattinen kompetenssi on ja kehittyykö se yläkoulun ja lukion välillä. Lisäksi tutkin, vaikuttavatko oppimisympäristö ja oppimismahdollisuudet oppijoiden kykyyn käyttää englannin kieltä. Toisin sanoen vertasin englantipainotteisilla luokilla olevia oppilaita formaalin opetuksen oppijoihin sekä tutkin, vaikuttavatko englanninkieliset vapaa-ajan aktiviteetit ja oppijoiden mahdolliset oleskelut englanninkielisissä maissa heidän pragmaattiseen kompetenssiinsa. Tutkimukseni kohderyhmä koostui yläkoulun kahdeksasluokkalaisista ja lukion toisen vuosikurssin opiskelijoista. Testasin neljä eri ryhmää, joissa oli sekä formaalissa opetuksessa olevia oppijoita (yksi ryhmä kahdeksasluokkalaisia ja yksi ryhmä toisen vuosikurssin opiskelijoita) että kielipainotteisten luokkien oppijoita (yksi ryhmä kahdeksasluokkalaisia ja yksi ryhmä toisen vuosikurssin opiskelijoita). Arvioin kohderyhmäni pragmaattista kompetenssia monivalintatestillä, jossa testattiin oppijoiden kykyä käyttää ja ymmärtää implikaatioita, tilannekohtaisia rutiineja sekä puheakteja. Taustakysymysten avulla selvitin, kuinka usein oppijat käyttivät englantia vapaa-aikanaan ja olivatko he vierailleet englanninkielisissä maissa. Tutkimustulokseni osoittavat, että suomalaisten yläkoululaisten ja lukiolaisten pragmaattinen kompetenssi oli korkea. Pragmaattinen kompetenssi kehittyi kahdeksasluokkalaisten ja lukion toisen vuosikurssin välillä. Kehitys oli suurempaa formaalissa opetuksessa kuin kielipainotteisilla luokilla. Englantipainotteisilla luokilla olevat oppilaat suoriutuivat testistä paremmin kuin formaalin opetuksen oppilaat. Tosin erot olivat tilastollisesti merkitseviä vain yläkoulussa. Tutkimuksessani siis päättelin, että vieraskielinen opetus vaikutti enemmän nuorempiin oppijoihin. Eri oppimismahdollisuudet osoittautuivat haastaviksi analysoida. Tulokset osoittivat, että vain englanninkielisessä maassa oleskelulla oli vaikutusta oppijoiden pragmaattiseen kompetenssiin. Kysyttäessä vapaa-ajan aktiviteettien merkitystä oppijat kuitenkin kertoivat, että ne auttoivat heitä testiin vastaamisessa enemmän kuin englanninopetuksessa käydyt asiat. Kouluissa tulisikin jatkossa painottaa yhä enemmän vuorovaikutteista kieltenopetusta.

Assessing the Environmental Value of Water Treatment Solutions in the Mining Industry

Environmental accountability has become a major source of competitive advantage for industrial companies, because customers consider it as relevant buying criterion. However, in order to leverage their environmental responsibility, industrial suppliers have to be able to demonstrate the environmental value of their products and services, which is also the aim of Kemira, a global water chemistry company considered in this study. The aim of this thesis is to develop a tool which Kemira can use to assess the environmental value of their solutions for the customer companies in mining industry. This study answers to questions on what kinds of methods to assess environmental impacts exist, and what kind of tool could be used to assess the environmental value of Kemira’s water treatment solutions. The environmental impacts of mining activities vary greatly between different mines. Generally the major impacts include the water related issues and wastes. Energy consumption is also a significant environmental aspect. Water related issues include water consumption and impacts in water quality. There are several methods to assess environmental impacts, for example life cycle assessment, eco-efficiency tools, footprint calculations and process simulation. In addition the corresponding financial value may be estimated utilizing monetary assessment methods. Some of the industrial companies considered in the analysis of industry best practices use environmental and sustainability assessments. Based on the theoretical research and conducted interviews, an Excel based tool utilizing reference data on previous customer cases and customer specific test results was considered to be most suitable to assess the environmental value of Kemira’s solutions. The tool can be used to demonstrate the functionality of Kemira’s solutions in customers’ processes, their impacts in other process parameters and their environmental and financial aspects. In the future, the tool may be applied to fit also Kemira’s other segments, not only mining industry.

The Influence of Network Competence on Internationalization of SMEs

This study focuses on the relationship between organizational network competence and the internationalization process of small- and medium sized enterprises (SMEs). Over recent decades, the global business environment has become increasingly conducive to internationalization of small firms. A central facilitating factor in the process has been the emergence of networked business relationships between internationalizing firms. Research on SME internationalization has found that certain types of structures and dynamics of business networks allow SMEs access to the resources they need to enter foreign markets. This consequently means that their internationalization often becomes to depend on the networks they are embedded in. However, research so far has mostly ignored the possibility that the organizational ability to develop and manage business network relationships, network competence, may be a major underlying factor in determining how well SMEs can leverage their network relationships to enter foreign markets and consequently may determine in large part how successful their internationalization process turns out to be. This study aims to respond to those gaps, by empirically examining how the development of network competence in internationalizing SMEs influences the internationalization outcomes that they can expect, and how such network competence is conceptualized and developed. Using a mixed methods approach, survey data collected from 298 Finnish SMEs across five industry sectors is first used to examine how levels of network competence are related to internationalization propensity of SMEs and their subsequent international performance, growth and profitability as internationally operating firms. In order to illustrate in more detail the ways in which network competence is conceptualized and how it develops during the internationalization process of an SME, qualitative data from internationally operating Finnish SMEs are used. Longitudinal interview data of an internationalizing Finnish SME is accompanied by data gathered through a series of semistructured interviews of Finnish and Russian managers involved in mutual business relationship dyads. Structurally, this thesis examines the research issue as an article-based dissertation, consisting of five journal and conference publications. Three of these publications are based on the quantitative data, and the remaining two apply the qualitative interview data. The results find several aspects where network competence has a positive influence on the success of internationalizing SMEs, how it develops and what it entails conceptually in this context. Quantitatively, the level of network competence is found to have a positive relationship to various internationalization outcomes, including the propensity of SMEs to enter foreign markets and on their subsequent international performance, their growth and their profitability. Additionally, the positive relationship is divided between the relationship-specific and cross-relational dimension of network competence, in that the influence of the former is relevant for the propensity to internationalize, while the latter is for the growth and profitability of the already internationalized SMEs. Qualitatively, the results suggest, firstly, that the development process of network competence does not necessarily precede the start of the internationalization process, but may occur through a gradual learning process alongside it. And secondly, the results also imply that the conceptualization of network competence by Finnish managers of internationally operating Finnish SMEs is structurally distinct from that of their culturally distinct partner managers in Russia. This study contributes to the literature on SME internationalization in several ways. Firstly, it introduces operationalized organizational competencies to the literature on internationalization of SMEs, which has so far mainly examined the influence of business networking on the internationalization process without having such an organizational viewpoint. Furthermore, this study provides a multi-level analysis of the determinants of successful SME internationalization, by examining various strategic and performance outcomes across the process. These results also contribute to the literature on organizational strategy of internationalizing SMEs, by clarifying how different dimensions of business networking may be optimal in different phases of the internationalization process. Conceptually, the results of this study contribute to the literature on competence development and SME internationalization, by illustrating how the development process of network competence may occur during internationalization process. Thus, they also contribute to the discussion on how SMEs are able to influence the dynamics and structures of their business networks over time. Finally, this study contributes to the literature on the role of culture in the internationalization process, by implying that the cultural background of the manager of the SME may determine whether business networking and network competence is seen as an organizational-level or an individual level capability. The study also includes some additional contributions to the literature on dynamic capabilities in strategic management, and on that of strategic business networks. These include further clarifying the exact nature and tangibility of dynamic capabilities, and being one of the first studies to introduce constructs from both dynamic capabilities and business network literature to the field of international entrepreneurship. And finally, the study also has some contribution on the two streams of literature, in illustrating how both dyadic and network-level capabilities may be relevant, depending on the current strategic goals and market position of the firm. Keywords: network competence, internationalizatio

GIS assessing traditional and modern agricultural land use/land cover change. A case study 1959-2005: Rekijoki, Somero, SW-Finland

Finland’s rural landscape has gone through remarkable changes from the 1950’s, due to agricultural developments. Changed farming practices have influenced especially traditional landscape management, and modifications in the arable land structure and grasslands transitions are notable. The review of the previous studies reveal the importance of the rural landscape composition and structure to species and landscape diversity, whereas including the relevance in presence of the open ditches, size of the field and meadow patches, topology of the natural and agricultural landscape. This land-change study includes applying remote sensed data from two time series and empirical geospatial analysis in Geographic Information Systems (GIS). The aims of this retrospective research is to detect agricultural landscape use and land cover change (LULCC) dynamics and discuss the consequences of agricultural intensification to landscape structure covering from the aspects of landscape ecology. Measurements of LULC are derived directly from pre-processed aerial images by a variety of analytical procedures, including statistical methods and image interpretation. The methodological challenges are confronted in the process of landscape classification and combining change detection approaches with landscape indices. Particular importance is paid on detecting agricultural landscape features at a small scale, demanding comprehensive understanding of such agroecosystems. Topological properties of the classified arable land and valley are determined in order to provide insight and emphasize the aspect the field edges in the agricultural landscape as important habitat. Change detection dynamics are presented with change matrix and additional calculations of gain, loss, swap, net change, change rate and tendencies are made. Transition’s possibility is computed following Markov’s probability model and presented with matrix, as well. Thesis’s spatial aspect is revealed with illustrative maps providing knowledge of location of the classified landscape categories and location of the dynamics of the changes occurred. It was assured that in Rekijoki valley’s landscape, remarkable changes in landscape has occurred. Landscape diversity has been strongly influenced by modern agricultural landscape change, as NP of open ditches has decreased and the MPS of the arable plot has decreased. Overall change in the diversity of the landscape is determined with the decrease of SHDI. Valley landscape considered as traditional land use area has experienced major transitional changes, as meadows class has lost almost one third of the area due to afforestation. Also, remarkable transitions have occurred from forest to meadow and arable land to built area. Boundaries measurement between modern and traditional landscape has indicated noticeable proportional increase in arable land-forest edge type and decrease in arable land-meadow edge type. Probability calculations predict higher future changes for traditional landscape, but also for arable land turning into built area.

A platform for assessing the current state of data repositories in Korea, Japan and China

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Integrating Use of Customer Information Throughout Multiple Sales Channels to Create Customer Competence

Customer knowledge management (CKM) practices enable organizations to create customer competence with systematic use of customer information that is integrated throughout the organization. Nonetheless, organizations are not able to fully exploit the vast amount of data available. Previous research on use of customer information is limited especially in a multichannel environment. The aim of this study was to identify the main obstacles for utilizing customer information efficiently across multiple sales channels. The study was conducted as a single case study in order to gain deeper understanding of the research problem. The empirical findings indicate that lack of CKM practices and a common goal are major challenges obstructing effective utilization of customer information. Furthermore, decentralized organizational structure and insufficient analytical skills create obstacles for information sharing and capabilities to process information and create new knowledge. The implications of the study suggest that in order to create customer competence organizations should shift their focus from technology to the organizational factors affecting use of information and implement CKM practices throughout the organization.

Nurse Competence of Graduating Nursing Students

The competence of graduating nursing students is an important issue in health care as it is related to professional standards, patient safety and the quality of nursing care. Many changes in health care lead to increased demand with respect to nurses’ competence as well the number of nurses. The purpose of this empirical study was to i) describe the nurse competence areas of nursing students in Europe, ii) evaluate the nurse competence of graduating nursing students, iii) identify factors related to the nurse competence, and to iv) assess the congruence between graduating nursing students’ self-assessments and their mentors’ assessments of students’ nurse competence. The study was carried out in two phases: descriptive phase and evaluation phase. The descriptive phase focused on describing the nurse competence areas of nursing students in Europe with the help of a literature review (n=10 empirical studies and n=4 additional documents). Thematic analysis was used as the analysis method. In the evaluation phase, the nurse competence with particular focus on nursing skills of graduating nursing students (n=154) was assessed. In addition, factors related to the nurse competence were examined. Also, the congruence between graduating nursing students’ self-assessments and their mentors’ assessments of students’ nurse competence was evaluated by comparing graduating nursing students’ self-assessments with the assessments by their mentors (n=42) in the final clinical placement in four university hospitals. Descriptive statistics and inferential statistics were used to analyse the data. Based on the results, the nurse competence of nursing students in Europe consists of nine main competence areas: (1) professional/ethical values and practice, (2) nursing skills and interventions, (3) communication and interpersonal skills, (4) knowledge and cognitive ability, (5) assessment and improving quality in nursing, (6) professional development, (7) leadership, management and teamwork, (8) teaching and supervision, and (9) research utilization. Graduating nursing students self-assessed their nurse competence as good. However, when graduating nursing students’ nurse competence was assessed by their mentors, the results were poorer. Readiness for practice based on nurse education, pedagogical atmosphere on the ward, supervisory relationship between student and mentor and being in paid work in health care at the moment of the study were the most significant factors related to the nurse competence. Conclusions: Nurse competence can be evaluated with a scale based on self-assessment, but other evaluation methods could be used alongside to ensure that nurse competence can be completed and evaluated critically. Practical implications are presented for nurse education and nursing practice. In future, longitudinal research is needed in order to understand the development of nurse competence during nurse education and the transition process from a nursing student to a professional nurse.

Osaamiskartoitus osaamisen mittaamisen välineenä

Yrityksen aineeton pääoma ja etenkin osaaminen on arvokasta, mutta sen mittaaminen on vaikeaa. Osaaminen on ensin tunnistettava, jotta sitä voidaan kehittää. Tässä tutkimuksessa on tarkoitus luoda kaupan alalle osaamiselle lukuarvo, joka voidaan viedä ketjun tuloskorttiin. Tutkimusaineisto koostuu kuvailevasta ja tilastollisesta osasta. Case yrityksenä on Osuuskauppa Hämeenmaan Sale-ketju ja kartoitus kohdentuu päivittäistavarakaupan myyjän osaamistarpeisiin. Tutkimus toteutettiin kvalitatiivisena tutkimuksena, mutta yhteenvedossa on myös kvantitatiivisia piirteitä. Kuvaileva aineisto koostui ryhmähaastattelusta, joka tehtiin lomakkeen suunnitteluvaiheessa haastattelemalla Osuuskauppa Hämeenmaan Sale-ketjun esimiehiä tulevaisuuden osaamistarpeista. Tilastollinen aineisto koostui osaamistarpeiden kartoituksessa käytetystä kyselystä. Tutkimuksessa tulevaisuuden osaamisen tarve eroaa tutkijoiden esittämästä näkemyksestä ja painottuu asenne osaamiseen. Sale-ketjun asenne osaamisissa vahvuuksia ovat: sitoutuminen omaan työhön ja halu oppia. Ammattiosaamiset kuten hyllytys ja kassatyö ovat myös vahvuuksia. 2013 vuoden tutkimuksessa suurimmat kehitystarpeet olivat tilausjärjestelmien hallitsemisessa sekä kilpailuetuosaamisissa. Yksiköiden välissä tarkastelussa löytyi selkeitä eroja, mutta erot eivät olleet riippuvaisia yksikön koosta tai työryhmän keski-iästä. Tutkimuksen tuloksena jokaiselle yksikölle tuotettiin yhteenveto sen hetkisestä osaamisesta, selvittäen vahvuudet ja kehittämisalueet. Näiden pohjalta tehtiin yksiköille kehityssuunnitelmat sekä jokaiselle työntekijälle henkilökohtainen kehityssuunnitelma kehityskeskustelun yhteydessä. Tämän tutkimuksen mukaan osaaminen, työtyytyväisyys ja asiakastyytyväisyys korreloivat keskenään. Yksikössä, jossa on hyvä osaaminen, ovat myös työtyytyväisyys ja asiakaspalvelu kunnossa. Vaikuttava tekijä taustalla on johtaminen. Esimiehet, jotka jakavat vastuuta työryhmässään saavuttivat osaamisessa suurempaa kehitystä kuin ne esimiehet, jotka eivät vastuuta jakaneet. Päivittäistavarakauppa on murroksessa tällä hetkellä ja tulevaisuuden osaamistarpeet ovat muuttuneet jo tämän tutkimuksen aikana. Vuonna 2014 toteutettiin sama kartoitus kuin vuonna 2013 ja voitiin todeta osaamistarpeen muuttuneen. Kustannustietous ja kriisienhallinta ovat työryhmien arkea ja osaamisalueet kuten työssä jaksaminen, ripeys ja muutosvalmius ovat korostuneet vuoden aikana. Henkilöstöjohtamisen luonteessa on myös havaittavissa muutoksia, kauaskantoinen tekeminen on muuttunut ketteräksi ja joustavaksi strategiseksi kumppanuudeksi. Osaamista johdetaan edelleen hyvin perinteisin menetelmin, johtaminen on vain entistä kohdennetumpaa. Tutkimuksessa syntyi kuvaava malli henkilöstöjohtamisen luonteesta sekä kaupanalan osaamistarpeesta 2014.

Competence foresight: linking the identification of HR competences and competence management alignment with business strategy

The objective of this study was to increase understanding of the link between the identification of required HR competences and competence management alignment with business strategy in a Finnish, global company employing over 8,000 people and about 100 HR professionals. This aim was approached by analyzing the data collected in focus group interviews using a grounded theory method and in parallel reviewing the literature of strategic human resource management, competence-based strategic management, strategy and foresight. The literature on competence management in different contexts dismisses in-depth discussions on the foresight process and individuals are often forgotten in strategic frameworks. However, corporate foresight helps in the detection of emerging opportunities for innovations and in the implementation of strategy. The empirical findings indicate a lack of strategic leadership and an alignment with HR and business. Accordingly, the most important HR competence areas identified were the need for increasing business understanding and enabling change. As a result, the study provided a holistic model for competence foresight, which introduces HR professionals as strategic change agents in the role of organizational futurists at the heart of the company: facilitating competence foresight and competence development on individual as well as organizational levels, resulting in an agile organization with increased business understanding, sensitive sensors and adaptive actions to enable change.

Informal learning and competence development during a management trainee program

The purpose of this research was to study how management trainee program participants experienced the program with respect to their learning and competence development. Additionally, the purpose was also to examine what the trainees learned and how the learning occurred. Furthermore, factors affecting learning in the workplace were examined. The theoretical framework of this research was formed utilizing individual competence and informal learning frameworks. Research was conducted as a single case study and data was gathered by thematic interviews. The results of this research indicate that the trainees experienced the program as a good method for learning the overall picture of the organization and its business. Regarding competence development, especially knowledge- and cognitive competence categories were developed during the program. The best learning outcomes were achieved through learning by doing, in co-operation with others, and learning from others. The results indicate that the planning of the program and its structure have a significant effect on learning. Furthermore, a sufficient level of challenge was experienced as being important for the quality of the learning as well.

The role of network competence and international business competence in multinational corporations: Subsidiary perspective

On-going process of globalization makes companies all over the world to go beyond the national markets and internationalize. Organizational form of multinational corporation (MNC) has capabilities for establishing the affiliate companies in several countries. Thus, the relocation of resources occurs and particularly, the cross-border transfer of knowledge which possesses the competitive advantage. However, differences in countries` business environments and cultures may constrain this capability. The research aim of this thesis is to investigate the role of subsidiary’s network competence (ability to build and manage the relationships with other local business units) and international business competence in relation to the benefits that MNC receives from a subsidiary. Additionally, subsidiary’s business adaptation, partnerships and knowledge transfer mechanism with parent company and external partners are investigated. This research, conducted in the Finnish-Russian context, consists of theoretical and empirical parts. The qualitative approach in the form of multiple case studies is employed. The empirical data incorporated primary and secondary data in the form of interviews collected in 2013 and 2015 years. Interviews were collected from four Finnish case companies in Saint-Petersburg and Kaluga region and five Russian partner companies. Results are drawn from two cases from Saint-Petersburg. The abductive research approach for the results analysis is adopted. The results indicate that both competencies lead to the subsidiary’s local embeddedness in the form of mutual business activities with local business partners and product adaptation for the local market needs. In addition to the monetary benefits in form of payments or turnover share, local embeddedness brings the knowledge of the local environment which is utilized by an MNC in the long-term planning. Another found tacit benefit is the access to the national market. This is strategically useful benefit not only for parent MNC but also for the subsidiary’s partners, i.e. international suppliers.