Hematopoietic stem cell transplantation in Switzerland: a comprehensive quality control report on centre effect.

Interest groups advocate centre-specific outcome data as a useful tool for patients in choosing a hospital for their treatment and for decision-making by politicians and the insurance industry. Haematopoietic stem cell transplantation (HSCT) requires significant infrastructure and represents a cost-intensive procedure. It therefore qualifies as a prime target for such a policy. We made use of the comprehensive database of the Swiss Blood Stem Cells Transplant Group (SBST) to evaluate potential use of mortality rates. Nine institutions reported a total of 4717 HSCT - 1427 allogeneic (30.3%), 3290 autologous (69.7%) - in 3808 patients between the years 1997 and 2008. Data were analysed for survival- and transplantation-related mortality (TRM) at day 100 and at 5 years. The data showed marked and significant differences between centres in unadjusted analyses. These differences were absent or marginal when the results were adjusted for disease, year of transplant and the EBMT risk score (a score incorporating patient age, disease stage, time interval between diagnosis and transplantation, and, for allogeneic transplants, donor type and donor-recipient gender combination) in a multivariable analysis. These data indicate comparable quality among centres in Switzerland. They show that comparison of crude centre-specific outcome data without adjustment for the patient mix may be misleading. Mandatory data collection and systematic review of all cases within a comprehensive quality management system might, in contrast, serve as a model to ascertain the quality of other cost-intensive therapies in Switzerland.

Embankment Quality Phase IV: Application to Unsuitable Soils, TR-492, 2007

The Quality Management Earthwork (QM-E) special provision was implemented on a pilot project to evaluate quality control (QC) and quality assurance (QA) testing in predominately unsuitable soils. Control limits implemented on this pilot project included the following: 95% relative compaction, moisture content not exceeding +/- 2% of optimum moisture content, soil strength not exceeding a dynamic cone penetrometer (DCP) index of 70 mm/blow, vertical uniformity not exceeding a variation in DCP index of 40 mm/blow, and lift thickness not exceeding depth determined through construction of control strips. Four-point moving averages were used to allow for some variability in the measured parameter values. Management of the QC/QA data proved to be one of the most challenging aspects of the pilot project. Implementing use of the G-RAD data collection system has considerable potential to reduce the time required to develop and maintain QC/QA records for projects using the QM-E special provision. In many cases, results of a single Proctor test were used to establish control limits that were used for several months without retesting. While the data collected for the pilot project indicated that the DCP index control limits could be set more tightly, there is not enough evidence to support making a change. In situ borings, sampling, and testing in natural unsuitable cut material and compacted fill material revealed that the compacted fill had similar strength characteristics to that of the natural cut material after less than three months from the start of construction.

Embankment Quality: Phase III, TR-401, 2002

This report describes test results from a full-scale embankment pilot study conducted in Iowa. The intent of the pilot project was to field test and refine the proposed soil classification system and construction specifications developed in Phase II of this research and to evaluate the feasibility of implementing a contractor quality control (QC) and Iowa DOT quality assurance (QA) program for earthwork grading in the future. One of the primary questions for Phase III is “Was embankment quality improved?” The project involved a “quality conscious” contractor, well-qualified and experienced Iowa Department of Transportation field personnel, a good QC consultant technician, and some of our best soils in the state. If the answer to the above question is “yes” for this project, it would unquestionably be “yes” for other projects as well. The answer is yes, the quality was improved, even for this project, as evidenced by dynamic cone penetrometer test data and the amount of disking required to reduce the moisture content to within acceptable control limits (approximately 29% of soils by volume required disking). Perhaps as important is that we know what quality we have. Increased QC/QA field testing, however, increases construction costs, as expected. The quality management-earthwork program resulted in an additional $0.03 per cubic meter, or 1.6%, of the total construction costs. Disking added about $0.04 per cubic meter, or 1.7%, to the total project costs. In our opinion this is a nominal cost increase to improve quality. It is envisioned that future contractor innovations have the potential for negating this increase. The Phase III results show that the new soil classification system and the proposed field test methods worked well during the Iowa Department of Transportation soils design phase and during the construction phase. Recommendations are provided for future implementation of the results of this study by city, county, and state agencies.

Management Strategy for Iowa’s Water Resources, December 2007

In Iowa, the Department of Natural Resources (DNR)is responsible for regulating water allocation and use through the issuance of water use permits, but improvements are necessary in this process to assure sustainable supplies into the future. In recent years, there have not been resources dedicated at the state level to properly track and assess water quantity issues. Resources for water use and water quantity monitoring (groundwater level and surface gauges) have continued to decline and have resulted in data becoming outdated and in a format that is difficult to analyze in order to make good decisions.

Impact of quality and environmental investment on business competitiveness and profitability: The case of travel agencies

Few studies have examined the combined effect of implementing quality and environmental management within the service sector. This void is more evident if we focus on segments in which small businesses predominate and even more so if we look for highly competitive sectors that are very variable and that have high business mortality. After analysing 198 surveys of Spanish travel agency managers using structural equations, it can be concluded that practices of quality management have a significant direct impact on business competitiveness but not on this business's financial results, at least directly. However, there is a significant relationship between environmental management practices and economic benefits. This article suggests that commitment to quality and the environment can allow small businesses in the service sector to have a competitive advantage that will separate surviving and ceased operations, particularly in sectors that are rapidly evolving and highly competitive.

Estacions termals en zones rurals, serveis associats i titulacions oficials

El turisme rural, l’esport i la salut han adquirit de forma progressiva en els últims anys una importància cada vegada més gran. Una part creixent de la població ha anat incorporant de mica en mica dies de descans i repòs durant tot l’any. Aquesta realitat és deguda, parcialment, a l’augment del temps lliure i a la consideració del seu gaudi com un element per a la millora de la qualitat de vida. El turisme rural, a causa del canvi de valors experimentat en la societat contemporània, s’interrelaciona amb altres productes, com ara el turisme termal i les activitats esportives realitzades en contacte amb la natura, igual que amb altres serveis del sector del lleure, com ara l’espectacle, el joc, la cultura, etc. Aquesta situació determina la necessitat de plantejar sistemes de gestió professionals i aplicar estratègies que permetin de generar factors competitius i diferenciadors. Les empreses turístiques que han adoptat el paradigma empresarial de la gestió de qualitat total es caracteritzen per oferir qualitat de servei, i per assolir aquesta qualitat cal disposar d’un equip d’especialistes altament qualificats i experimentats. El propòsit d’aquest treball és analitzar les titulacions oficials relacionades amb les estacions termals en zones rurals i els serveis associats.

Estaciones termales en zonas rurales, servicios asociados y titulaciones oficiales

El turismo rural, el deporte y la salud han venido adquiriendo de forma progresiva en los últimos años una importancia cada vez mayor. Una parte creciente de la población ha ido incorporando paulatinamente días de descanso y reposo durante todo el año. Esta realidad es debida, en parte, al aumento del tiempo libre y a la consideración de su disfrute como un elemento para la mejora de la calidad de vida. El turismo rural, debido al cambio de valores sufrido en la sociedad contemporánea, se interrelaciona con otros productos como el turismo termal y las actividades deportivas realizadas en contacto con la naturaleza, al igual que con otros servicios del sector ocio, como pueden ser el espectáculo, el juego, la cultura, etc. Esta situación determina la necesidad de plantear sistemas de gestión profesionales y aplicar estrategias que permitan generar factores competitivos y diferenciadores. Las empresas turísticas que han adoptado el paradigma empresarial de la gestión de calidad total se caracterizan por ofrecer calidad de servicio, y para alcanzar dicha calidad es necesario disponer de un equipo de especialistas altamente cualificados y experimentados. El propósito de este trabajo es analizar las titulaciones oficiales relacionadas con las estaciones termales en zonas rurales y los servicios asociados.

Quality in services marketing in infocom sector in Finland

Tutkielman tavoitteena oli selvittää, mikä on palvelun laadun taso infocom sektorilla Suomessa, ja miten sitä voidaan parantaa. Teoriaosassa tavoitteeseen pyrittiin muodostamalla teoriakirjallisuuteen, tieteellisiin julkaisuihin sekä aikaisempaan aihealuetta sivuavaan tutkimukseen perustuva viitekehysmalli. Empiirisessä osassa tavoitetta lähestyttiin tutkimalla infocom sektorin kunkin toimialueen (telekommunikaatio, informaatio teknologia ja sisältötuotanto) palvelujen laatua case-kuvausten muodossa. Tutkielman empiirinen osuus toteutettiin kvalitatiivisena multiple case -tutkimuksena teemahaastattelu-menetelmää soveltaen. Case-analyysi suorittiin käyttäen ns. explanation- building -menetelmää. Teoreettiset ja empiiriset tutkimustulokset yhdistettiin erityisiksi infocom sektorille soveltuviksi toimenpidesuosituksiksi. Tutkielman empiirinen osuus antoi tukea teoreettisen osuuden pohjalta kehitetylle viitekehykselle. Tutkimuksen tavoitteena oli case-analyysi- menetelmän mukaisesti luoda perusta syvemmälle aihepiiriä käsittelevälle jatkotutkimukselle ja luoda kuva infocom sektorin tämän hetkisestä laadullisesta tilasta. Yhteenvetona voidaan sanoa, että laatu palvelujen markkinoinnissa infocom sektorilla on suhteellisen heikkoa, vaikka tutkimusaineiston mukaan laatu arvostetaan hyvin korkealle. Yritysten tämänhetkiset panostukset laatuun liittyvät lähinnä liiketoiminnan tukifunktioihin ja prosessien ohjausmenetelmiä koskeviin järjestelmiin. Tutkimuksen pohjalta tehtävät varsinaiset toimenpidesuositukset liittyvät laadun sisäistämiseen jo strategiaa luotaessa, asiakaslähtöisyyteen, laatujohtamiseen, laatukoulutukseen ja kokonaisvaltaisen laatukulttuurin luomiseen organisaatioissa. Turbulentissa, nopeasti kansainvälistyvässä ja erittäin voimakkaasti kilpaillussa liiketoimintaympäristössä nämä ovat elintärkeitä menestymisen kriteerejä.

EMQAL: Erasmus Mundus Master in Quality in Analytical Laboratories

The Erasmus Mundus Master in Quality in Analytical Laboratories (EMQAL) is a two-year Joint Master Degree. The course is funded by the European Commission through the Erasmus Mundus Programme, providing a number of attractive scholarships for European and non-European students. EMQAL prepares professionals for analytical laboratories, focusing on laboratory management and quality systems, along with complementing their technical knowledge. The EMQAL aims at training students in the most relevant issues concerning quality systems and management in analytical laboratories, and to become an expert in: Quality management, Analytical methods and Data Analysis. EMQAL promotes mobility. The students will attend one academic year of lectures in one of the European universities of the EMQAL consortium, and a 12 months master thesis at other European university, with the possibility to spend three-months in one of the non-EU partners. The language of instruction and examination is English. Further information is available at www.emqal.org.

Aggression and its Management in Adolescent Forensic Psychiatric Care

The overall goal of this study was to explore and identify good aggression management methods and on that basis to produce recommendations for aggression management in the adolescent forensic setting. The study was conducted in three phases. In Phase I, staff’s (n = 58) perception of adolescent aggressive behaviour and methods to manage it was examined. In Phase II, staff’s (n = 30) perception of treatment settings and treatment interventions available were studied. In Phase III, the effectiveness of an aggression management programme was evaluated. The data were collected during the period 2004-2007. Participants perceived adolescent aggressive behaviour in a similar way and described aggressive behaviour as being a comprehensible phenomenon. Management methods used to control aggressive situations were alike, although the practical solutions varied between the study units, especially regarding coercive methods. Staff members proposed more time and better opportunities to discuss and evaluate the aggression situation in order to improve the methods used. The treatment settings were similar in studied forensic units and interventions were primarily focused on psychological aspects, including management of aggressive behavior. A comprehensive aggression management programme proved to be effective in decreasing incidents of violence. The use of coercive methods in aggression situations decreased and injuries to the staff became less frequent. If staff members intend to apply high quality management methods in aggression situations they have to share a consistent understanding of aggressive behaviour and need to be aware of the various methods available. In addition, they should learn more about assessment methods in order to improve aggression management. International comparison of aggression, methods for managing it and service provision creates a starting point for developing equal care provision and realization within and between European countries.

Lean, Six Sigma ja Total Welding Management hitsaavassa verkostossa

Diplomityössä tarkastellaan hitsaavan verkoston laadunhallintaa ja siinä ilmeneviä erilaisia ongelmakohtia. Tämän lisäksi työssä tarkastellaan kolmen eri laatutyökalun Lean, Six Sigma ja Total Welding Management soveltamista hitsaavan verkoston laadunhallinnassa. Teoriaosassa käsitellään sekä yleisesti että hitsauksen osalta laatua ja laadunhallintaa, sekä edellä mainittuja laatutyökaluja. Tutkimusosaan tietoja hitsaavista verkostoista kerättiin kaikkiaan kolmesta eri verkostosta. Näiden kerättyjen tietojen pohjalta tarkasteltiin valittujen laatutyökalujen soveltuvuutta verkostomaiseen käyttöön. Verkostoitunut toiminta aiheuttaa monia uusia haasteita yritysten laadunhallinnalle verrattuna yksittäisiin hitsaaviin yrityksiin. Suurimpia tutkimuksessa havaittuja ongelmakohtia ovat suunnittelun ja valmistuksen yhteistyön erilaiset puutteet, laatutasoon ja sen varmistukseen liittyvät asiat, sekä verkoston sisälle syntyvä niin sanottu hiljainen tieto ja sen häviäminen. Tutkimuksen tarkastelujen perusteella havaittiin, että kaikkien tutkimukseen valitun kolmen laatutyökalun soveltaminen myös verkostomaisessa toiminnassa on mahdollista, mutta se vaatii huomattavasti suurempaa työpanosta kuin soveltaminen yksittäisessä yrityksessä. Myös näiden kaikkien kolmen työkalun yhtä aikainen käyttö on mahdollista. Juuri oikean työkalun valitseminen kullekin hitsaavalle verkostolle vaatii tarkkaa perehtymistä verkostoon ja sen tilanteeseen.

The application of Process Management for reliability enhancement of the Taguchi method

The concept of Process Management has been used by managers and consultants that search for the improvement of both operational or managerial industrial processes. Its strength is in focusing on the external client and on the optimization of the internal process in order to fulfill their needs. By the time the needs of internal clients are being sought, a set of improvements takes place. The Taguchi method, because of its claim for knowledge share between design engineers and people engaged in the process, is a candidate for process management implementation. The objective of this paper is to propose that kind of application aiming for improvements related with reliability of results revealed by the robust design of Taguchi method.

Long-term nutrient load management and lake restoration: Case of Säkylän Pyhäjärvi (SW Finland)

Eutrophication caused by anthropogenic nutrient pollution has become one of the most severe threats to water bodies. Nutrients enter water bodies from atmospheric precipitation, industrial and domestic wastewaters and surface runoff from agricultural and forest areas. As point pollution has been significantly reduced in developed countries in recent decades, agricultural non-point sources have been increasingly identified as the largest source of nutrient loading in water bodies. In this study, Lake Säkylän Pyhäjärvi and its catchment are studied as an example of a long-term, voluntary-based, co-operative model of lake and catchment management. Lake Pyhäjärvi is located in the centre of an intensive agricultural area in southwestern Finland. More than 20 professional fishermen operate in the lake area, and the lake is used as a drinking water source and for various recreational activities. Lake Pyhäjärvi is a good example of a large and shallow lake that suffers from eutrophication and is subject to measures to improve this undesired state under changing conditions. Climate change is one of the most important challenges faced by Lake Pyhäjärvi and other water bodies. The results show that climatic variation affects the amounts of runoff and nutrient loading and their timing during the year. The findings from the study area concerning warm winters and their influences on nutrient loading are in accordance with the IPCC scenarios of future climate change. In addition to nutrient reduction measures, the restoration of food chains (biomanipulation) is a key method in water quality management. The food-web structure in Lake Pyhäjärvi has, however, become disturbed due to mild winters, short ice cover and low fish catch. Ice cover that enables winter seining is extremely important to the water quality and ecosystem of Lake Pyhäjärvi, as the vendace stock is one of the key factors affecting the food web and the state of the lake. New methods for the reduction of nutrient loading and the treatment of runoff waters from agriculture, such as sand filters, were tested in field conditions. The results confirm that the filter technique is an applicable method for nutrient reduction, but further development is needed. The ability of sand filters to absorb nutrients can be improved with nutrient binding compounds, such as lime. Long-term hydrological, chemical and biological research and monitoring data on Lake Pyhäjärvi and its catchment provide a basis for water protection measures and improve our understanding of the complicated physical, chemical and biological interactions between the terrestrial and aquatic realms. In addition to measurements carried out in field conditions, Lake Pyhäjärvi and its catchment were studied using various modelling methods. In the calibration and validation of models, long-term and wide-ranging time series data proved to be valuable. Collaboration between researchers, modellers and local water managers further improves the reliability and usefulness of models. Lake Pyhäjärvi and its catchment can also be regarded as a good research laboratory from the point of view of the Baltic Sea. The main problem in both of them is eutrophication caused by excess nutrients, and nutrient loading has to be reduced – especially from agriculture. Mitigation measures are also similar in both cases.

Enabling Change in Universities: Enhancing Education for Sustainable Development with Tools for Quality Assurance

Enabling Change in Universities: Enhancing Education for Sustainable Development with Tools for Quality Assurance This thesis deals with enabling change in universities, more explicitly enhancing education for sustainable development with tools for quality assurance. Change management is a discipline within management that was developed in the 1980s because business changed from being predictable to unpredictable. The PEST mnemonic is a method to categorize factors enabling change; such as political, economic, socio-cultural and technological factors, which all affect higher education. A classification of a change, in either hard or soft, can help understanding the type of change that an organization is facing. Hard changes are more applied to problems that have clear objectives and indicators, with a known cause of the problem. Soft changes are applied to larger problems that affect the entire organization or beyond it. The basic definition for sustainable development is: the future generations should have similar opportunities as the previous. The UN has set as a global goal an integration of education for sustainable development (ESD) at all levels of education during 2005- 2014. The goal is set also in universities, the graduates of which are future leaders for all labor markets. The objective for ESD in higher education is that graduates obtain the competence to take economic, social and environmental costs and benefits into account when making decisions. Knowledge outcomes should aim for systematic and holistic thinking, which requires cross disciplinary education. So far, the development of ESD has not achieved its goals. The UN has identified a need for more transdisclipnary research in ESD. A joint global requirement for universities is quality assurance, the aim of which is to secure and improve teaching and learning. Quality, environmental and integrated management systems are used by some universities for filling the quality assurance requirements. The goal of this thesis is to open up new ways for enhancing ESD in universities, beyond the forerunners; by exploring how management systems could be used as tools for promoting ESD. The thesis is based on five studies. In the first study, I focus on if and how tools for quality assurance could be benefitted for promoting ESD. It is written from a new perspective, the memetic, for reaching a diversity of faculty. A meme is an idea that diffuses from brain to brain. It can be applied for cultural evolution. It is a theory that is based on the evolutionary theory by Darwin, applied for social sciences. In the second Paper, I present the results from the development of the pilot process model for enhancing ESD with management systems. The development of the model is based on a study that includes earlier studies, a survey in academia and an analysis of the practice in 11 universities in the Nordic countries. In the third study, I explore if the change depends on national culture or if it is global. It is a comparative study on both policy and implementation level, between the Nordic countries and China. The fourth study is a single case study based on change management. In this study, I identify what to consider in order to enable the change: enhancing ESD with tools for quality assurance in universities. In the fifth Paper, I present the results of the process model for enhancing ESD with management systems. The model was compared with identified drivers and barriers for enhancing ESD and for implementing management systems. Finally, the process model was piloted and applied for identifying sustainability aspects in curricula. Action research was chosen as methodology because there are not already implemented approaches using quality management for promoting ESD, why the only way to study this is to make it happen. Another reason for choosing action research is since it is essential to involve students and faculty for enhancing ESD. Action based research consists of the following phases: a) diagnosing, b) planning action, c) taking action and d) evaluating action. This research was made possible by a project called Education for Sustainable Development in Academia in the Nordic countries, ESDAN, in which activities were divided into these four phases. Each phase ended with an open seminar, where the results of the study were presented. The objective for the research project was to develop a process for including knowledge in sustainable development in curricula, which could be used in the quality assurance work. Eleven universities from the Nordic countries cooperated in the project. The aim was, by applying the process, to identify and publish examples of relevant sustainability aspects in different degree programs in universities in the Nordic countries. The project was partly financed by the Nordic Council of Ministers and partly by the participating pilot universities. Based on the results of my studies, I consider that quality, environmental and integrated management systems can be used for promoting ESD in universities. Relevant sustainability aspects have been identified in different fields of studies by applying the final process model. The final process model was compared with drivers and barriers for enhancing ESD and for implementing management systems in universities and with succeeding with management systems in industry. It corresponds with these, meaning that drivers are taken into account and barriers tackled. Both ESD and management systems in universities could be considered successful memes, which can reflect an effective way of communication among individuals. I have identified that management systems could be used as tools for hard changes and to support the soft change of enhancing ESD in universities with management system. Based on the change management study I have summarized recommendations on what to consider in order to enable the studied change. The main practical implications of the results are that the process model could be applied for assessment, benchmarking and communication of ESD, connected to quality assurance, when applied. This is possible because the information can be assembled in one picture, which facilitates comparison. The memetic approach can be applied for structuring. It is viable to make comparative studies between cultures, for getting insight in special characteristics of the own culture. Action based research is suitable for involving faculty. Change management can be applied for planning a change, which both enhancing ESD and developing management systems are identified to be.