Attitudes towards hastened death in ALS: A prospective study of patients and family caregivers.

Abstract Amyotrophic lateral sclerosis (ALS) may be associated with the wish to hasten death (WTHD). We aimed to determine the prevalence and stability of WTHD and end-of-life attitudes in ALS patients, identify predictive factors, and explore communication about WTHD. We conducted a prospective questionnaire study among patients and their primary caregivers attending ALS clinics in Germany and Switzerland. We enrolled 66 patients and 62 caregivers. Half of the patients could imagine asking for assisted suicide or euthanasia; 14% expressed a current WTHD at the baseline survey. While 75% were in favour of non-invasive ventilation, only 55% and 27% were in favour of percutaneous endoscopic gastrostomy and invasive ventilation, respectively. These attitudes were stable over 13 months. The WTHD was predicted by depression, anxiety, loneliness, perceiving to be a burden to others, and a low quality of life (all p < 0.05). Lower religiosity predicted whether patients could imagine assisted suicide or euthanasia. Two-thirds of patients had communicated their WTHD to relatives; no-one talked to the physician about it, yet half of them would like to do so. In conclusion, physicians should consider proactively asking for WTHD, and be sensitive towards neglected psychosocial problems and psychiatric comorbidity.

Firm's network capability and innovation performance: evidences from China hi-tech industry

ABSTRACT : A firm's competitive advantage can arise from internal resources as well as from an interfirm network. -This dissertation investigates the competitive advantage of a firm involved in an innovation network by integrating strategic management theory and social network theory. It develops theory and provides empirical evidence that illustrates how a networked firm enables the network value and appropriates this value in an optimal way according to its strategic purpose. The four inter-related essays in this dissertation provide a framework that sheds light on the extraction of value from an innovation network by managing and designing the network in a proactive manner. The first essay reviews research in social network theory and knowledge transfer management, and identifies the crucial factors of innovation network configuration for a firm's learning performance or innovation output. The findings suggest that network structure, network relationship, and network position all impact on a firm's performance. Although the previous literature indicates that there are disagreements about the impact of dense or spare structure, as well as strong or weak ties, case evidence from Chinese software companies reveals that dense and strong connections with partners are positively associated with firms' performance. The second essay is a theoretical essay that illustrates the limitations of social network theory for explaining the source of network value and offers a new theoretical model that applies resource-based view to network environments. It suggests that network configurations, such as network structure, network relationship and network position, can be considered important network resources. In addition, this essay introduces the concept of network capability, and suggests that four types of network capabilities play an important role in unlocking the potential value of network resources and determining the distribution of network rents between partners. This essay also highlights the contingent effects of network capability on a firm's innovation output, and explains how the different impacts of network capability depend on a firm's strategic choices. This new theoretical model has been pre-tested with a case study of China software industry, which enhances the internal validity of this theory. The third essay addresses the questions of what impact network capability has on firm innovation performance and what are the antecedent factors of network capability. This essay employs a structural equation modelling methodology that uses a sample of 211 Chinese Hi-tech firms. It develops a measurement of network capability and reveals that networked firms deal with cooperation between, and coordination with partners on different levels according to their levels of network capability. The empirical results also suggests that IT maturity, the openness of culture, management system involved, and experience with network activities are antecedents of network capabilities. Furthermore, the two-group analysis of the role of international partner(s) shows that when there is a culture and norm gap between foreign partners, a firm must mobilize more resources and effort to improve its performance with respect to its innovation network. The fourth essay addresses the way in which network capabilities influence firm innovation performance. By using hierarchical multiple regression with data from Chinese Hi-tech firms, the findings suggest that there is a significant partial mediating effect of knowledge transfer on the relationships between network capabilities and innovation performance. The findings also reveal that the impacts of network capabilities divert with the environment and strategic decision the firm has made: exploration or exploitation. Network constructing capability provides a greater positive impact on and yields more contributions to innovation performance than does network operating capability in an exploration network. Network operating capability is more important than network constructing capability for innovative firms in an exploitation network. Therefore, these findings highlight that the firm can shape the innovation network proactively for better benefits, but when it does so, it should adjust its focus and change its efforts in accordance with its innovation purposes or strategic orientation.

Multisensory Integration: Flexible Use of General Operations.

Research into the anatomical substrates and "principles" for integrating inputs from separate sensory surfaces has yielded divergent findings. This suggests that multisensory integration is flexible and context dependent and underlines the need for dynamically adaptive neuronal integration mechanisms. We propose that flexible multisensory integration can be explained by a combination of canonical, population-level integrative operations, such as oscillatory phase resetting and divisive normalization. These canonical operations subsume multisensory integration into a fundamental set of principles as to how the brain integrates all sorts of information, and they are being used proactively and adaptively. We illustrate this proposition by unifying recent findings from different research themes such as timing, behavioral goal, and experience-related differences in integration.

08025-015 Remsen Source Water Protection Final Report

The City of Remsen is proactively addressing an increase of nitrates in their public water supply before it becomes a financial catastrophe for them. An intensive assessment was conducted by the Iowa DNR Source Water Protection program as one of four pilot projects in the state. This assessment far surpassed standard desktop assessments and gathered monitoring information in-the-field led by a local watershed group. This was incorporated into a computer modeling program to help the local watershed group discuss alternatives. This comprehensive approach clearly identified the source of nitrate infiltration as a cropland area adjacent to the City well field. Many options were evaluated but only one option provided an economical, viable and secure answer to the water supply needs of Remsen for generations to come. The watershed planning group chose to seek the purchase of this critical area of cropland and convert it to a deep rooted mixture of native grasses. This WIRB funding is intended to be used to acquire a small area totaling 21.1 acres. It represents about 22% of the total local project effort. This will be added to the existing City well field of 40.2 acres and another piece of adjacent property, 35.34 acres, that the City recently acquired as part of an overall aggressive program to protect the community water supply. The City has a signed purchase agreement for 14.4 acres of the 21.1 and a strong verbal commitment to obtain the remaining 5.7 acres. This project has been very active for almost 2 years and is ready to implement immediately upon funding notification. The establishment of native grasses, funded by the local chapter of Pheasants Forever, will take approximately the next three years of operation & maintenance.

06014-007 Lower Coldwater-Palmer Creek Watershed Final Report

Lower Coldwater and Palmer Creeks in Butler and Floyd counties are subwatersheds of the Cedar River, which provides drinking water to Cedar Rapids, IA. The increasing concentration of nitrate+nitrate in the river is of concern to the Cedar Rapids water utility, and IDNR snapshot monitoring shows Coldwater and Palmer to be significant potential sources (above the 90th percentile for subwatersheds monitored). Both creeks are also on the Iowa Section 303(d) list of impaired waters (aquatic life). Citizens of these predominantly agricultural watersheds organized the Coldwater-Palmer Watershed Improvement Association to deal proactively with nonpoint source pollutants from crop and livestock operations through a performance-based environmental management program. The locally-adapted program implemented by the Coldwater-Palmer watershed council rewards participants for environmental accomplishments - soil quality improvement and nutrient source reduction as measured by accepted, scientifically-based tests and models. Most of the locally­appropriate BMPs used to improve performance are undertaken voluntarily at participants' initiative. WIRB funds will be combined with funding from the Iowa Com Growers Association and significant in-kind support from the Cedar River Watershed Monitoring Coalition, Iowa State University Extension and other partners. The project will result in sustainable reduction in nutrient loading achieved with voluntary participation of a majority of watershed farm operators.

Fenix-järjestelmän suorituskyvyn analysointi

Kasvavat käyttäjämäärät TietoEnatorin Fenix-tietojärjestelmässä ovat nostaneet suorituskyvyn tutkinnan tärkeään asemaan. Suorituskykymittausten tekeminen, analysoiminen ja ennen kaikkea säännöllinen seuranta ovat ensiarvioisen tärkeitätoimenpiteitä järjestelmän tehokkuuden proaktiiviseen kehittämiseen. Fenixin suorituskykymittausjärjestelmän tuottamaa aineistoa on runsaasti tarjolla. Tämän työn tavoitteena on edistää suorituskykymittausjärjestelmän tuottaman aineiston käyttöä erilaisissa raportointi- ja tutkimustilanteissa. Työssäperehdytään aineiston keräämiseen, häiriösuodatukseen ja tulosten visualisointiin. Työn tuloksena syntyy automaattinen raportointijärjestelmä, joka tuottaa palvelukohtaisia tilastollisia suorituskykyraportteja. Raporttien tarkoituksena on tuoda kehittäjien nähtäville palveluista kerätyt mittaustulokset ja osoittaa mahdollisia suorituskykyparannuskohteita.

The career engagement scale : Development and validation of a measure of proactive career behaviors

Careers today increasingly require engagement in proactive career behaviors; however, there is a lack of validated measures assessing the general degree to which somebody is engaged in such career behaviors. We describe the results of six studies with six independent samples of German university students (total N = 2,854), working professionals (total N = 561), and university graduates (N = 141) that report the development and validation of the Career Engagement Scale - a measure of the degree to which somebody is proactively developing her or his career as expressed by diverse career behaviors. The studies provide support for measurement invariance across gender and time. In support of convergent and discriminant validity, we find that career engagement is more prevalent among working professionals than among university students and that this scale has incremental validity above several specific career behaviors regarding its relation to vocational identity clarity and career self-efficacy beliefs among students and to job and career satisfaction among employees. In support of incremental predictive validity, beyond the effects of several more specific career behaviors, career engagement while at university predicts higher job and career satisfaction several months later after beginning work.

Inclusion and empowerment in public art and urban design

To involve citizens in developing the processes of city making is an objective that occupies part of the agenda of political parties in the context of the necessary renewal in representative democracy. This paper aims to provide some answers to the following questions: Is it possible to overcome the participatory processes based exclusively on the consultation? Is it possible to"train" residents to take an active role in decision-making? How can we manage, proactively, the relationship between public actors, technicians and politicians, in a participatory process? We analyse the process development for creating the Wall of Remembrance in the Barcelona neighbourhood of Baró de Viver, a work of public art, created and produced by its neighbours, in the context of a long participatory process focused on changing the image of the neighbourhood and the improvement of public space. This result and this process have been possible in a given context of cooperation among neighbours, local government and the research team (CR-Polis, Art, City, Society at the University of Barcelona). The development of a creative process of citizen participation between 2004 and 2011 made possible the direct management of decision making by the residents on the field of the design of public space in the neighbourhood. However, the material results of the process does not overshadow the great achievement of the project: the inclusion of a neighbourhood in taking informed decisions because of their empowerment in public space design and management of their remembrances.

Customer consciousness in the production process of a steel factory

The purpose of this thesis is to examine the level of customer consciousness of the production process employees in a steel factory and to investigate the methods of internal marketing in order to propose development practices to enhance the customer consciousness of the case company employees. The significance of the level of customer consciousness is discussed and practices already implemented affecting the level of customer consciousness in the company are examined. The literature review gives an insight to the role of customer consciousness in the CRM philosophy of a manufacturing company and examines the means of internal marketing in enhancing customer consciousness. In the empirical part of the study, the level and significance of customer consciousness is determined by conducting individual and focus group interviews. The interviews are also used to examine the practices that could function in enhancing the customer consciousness of the employees. Development suggestions to improve the level of customer consciousness in the production process are given based on the results. The level of customer consciousness is at a poor level in the production process and influences above all on work motivation and job satisfaction, but possibly on customer satisfaction as well. The enhancement of customer consciousness in the production process should be done e.g. by ensuring the distribution of right knowledge coherently to all of the employees, gathering large customer reference database to exploit in work and in training, using visual illustration in presenting the customer information, training proactively and letting the employees to participate in the customer oriented development activities. Customer satisfaction focused reward system can be considered.

Ammattikorkeakoulu innovatiivisena oppimisyhteisönä

Ammattikorkeakoulut ovat osa suomalaista innovaatiojärjestelmää. Niiden tärkeimpiä tuotteita ovat laadukkaat tutkinnot, joilla tuotetaan Suomen kilpailukyvyn kannalta olennaista osaavaa työvoimaa. Koulutusinnovaatioiden avulla ammattikorkeakoulut voivat parantaa opetuksen ja oppimisen laatua ja edistää opiskelijoiden parempaa osaamista. Tässä tutkimuksessa tarkasteltiin Kymenlaakson ammattikorkeakoulua innovatiivisena oppimisyhteisönä Hokkasen (2001) hahmotteleman innovatiivisen oppimisyhteisön profiilitekijöiden mukaisesti. Tutkimuksen tavoitteena oli selvittää, millainen innovatiivinen oppimisyhteisö KyAMK:ssa toteutuu opettajien kokemana, ja miten innovatiivisen oppimisyhteisön piirteitä voitaisiin edistää mainitussa organisaatiossa. Aineisto kerättiin haastattelemalla kymmentä KyAMK:n Tekniikan ja liikenteen toimialan opettajaa. Tulokset osoittivat Kymenlaakson ammattikorkeakoulun johdon sallivan innovatiiviset koulutuksen kehittämiseen tähtäävät toimet, mutta johto ei proaktiivisesti ohjannut ja kannustanut niihin. Ammattikorkeakouluopettajien pedagogisen autonomian todettiin olevan suurta. Tästä huolimatta kaivattiin yhteisöllisyyteen tukevia toimintamalleja, joiden avulla organisaatiossa oleva monialaisen työyhteisön innovaatiopotentiaali voitaisiin valjastaa opetuksen kehittämiseen ja organisaatiolta puuttuvan toiminnan kokonaiskuvan ja -ymmärryksen kehittämiseen. Osana yhteisöllisyyden kehittämistä aineistosta nousi esiin kehittämisehdotuksena pitkäjänteisemmän verkostoitumisen toteuttaminen niin organisaation sisällä kuin ulkopuolisten sidosryhmien kanssa.

The Role of a firm’s mindset in international success - case study of Finnish marine industry firms

This thesis investigates the influence of a firm’s mindset on international success in the context of the Finnish marine industry. The study draws theoretical wisdom from organisational behaviour and strategic management literatures. The research aim set for this study was to identify and categorise existing strategic types based on mindsets found in the marine industry SMEs, and to link the influence of mindsets with success by examining the role of mindsets in a firm’s performance. Mindsets of firms were conceptualised as aggregate collections of perceptions that influence how the surrounding environment is discerned by the members of the firm. Mindsets are idiosyncratic to firms and therefore important firm-specific resources which influence decision-making and can be observed through the strategic behaviour of firms. Qualitative case study method was applied which was further supported by quantitative data on the financial performance of the ten case firms. Taxonomy based on the dimension of mindsets and prediction was developed to demonstrate four ideal types of firms identified within the marine industry. It was found that all of the case firms emphasised adaptation in their strategy while planning was emphasised to a varying degree. Moreover, two different methods of adapting were found; proactive and reactive. Firms which plan in the long-term and adapt proactively constantly investigate whether their plans are synchronous with the realities of the market; by having an open mindset, a firm’s perception of the reality of the market is enabling the firm to develop value creating strategies which are superiorly informed.This finding was supported by the financial data and led to the proposition that having an open mindset and placing a high level of emphasis on prediction may have a positive influence on international success. Also, it was proposed that concentrating only on exploiting business opportunities in the present time and not exploring any addition opportunities can have a negative influence on the firm’s performance, even if the mindset of the firm is open.

ICT-varautumisen analyysi ja kehittäminen julkisen sektorin virastossa

Lainsäädäntö velvoittaa valtionhallintoa huolehtimaan riittävästä ICT-varautumisesta, jotta yhteiskunnan kriittiset toiminnot ovat turvattu normaaliolojen lisäksi normaaliolojen häiriötilanteissa ja poikkeusoloissa. ICT-varautumisen vaatimukset on määrätty VAHTI ICT-varautumisen vaatimukset - ohjeessa. ICT-varautuminen on riskienhallintaan perustuvaa toimintaa, joka liittyy keskeisesti organisaation kokonaisturvallisuuteen, tietohallintoon ja yleiseen varautumiseen. Tutkielman teoriakatsauksessa perehdytään riskienhallintaan ja kokonaisturvallisuuteen painottaen ICT-varautumisen kannalta tärkeitä osa-alueita tietoturvallisuutta ja IT-riskienhallintaa. Kohdeorganisaation ICT-varautumisen toimintajärjestelmää varten kartoitetaan ICT-varautumisen viitekehys. Empiirisessä osiossa toteutetaan tapaustutkimuksena kohdeorganisaation ICT-varautumisen nykytilan suppea analyysi ja laaditaan kehittämisehdotelmana toimintamalli ICT-varautumisen organisoimiseksi ja käyttöönottamiseksi. Tutkielman tuotoksena kohdeorganisaatiolla on systemaattinen organisaation eri tasot huomioiva toimintamalli ICT-varautumisen toteuttamiseksi.

The early activities of front end of innovation in oem companies using a new fei platform as a framework for renewal

The main goal of this study is to create a seamless chain of actions and more detailed structure to the front end of innovation to be able to increase the front end performance and finally to influence the renewal of companies. The main goal is achieved through by the new concept of an integrated model of early activities of FEI leading to a discovery of new elements of opportunities and the identification of new business and growth areas. The procedure offers one possible solution to a dynamic strategy formation process in innovation development cycle. In this study the front end of innovation is positioned between a strategy reviews and a concept creation with needed procedures, tools, and frameworks. The starting point of the study is that the origins of innovation are not well enough understood. The study focuses attention on the early activities of FEI. These first activities are conceptualized in order to find out successful innovation initiatives and strategic renewal agendas. A seamless chain of activities resulting in faster and more precise identification of opportunities and growth areas available on markets and inside companies is needed. Three case studies were conducted in order to study company views on available theory doctrine and to identify the first practical experiences and procedures in the beginning of the front end of innovation. Successful innovation requires focus on renewal in both internal and external directions and they should be carefully balanced for best results. Instead of inside-out mode of actions the studied companies have a strong outside-in thinking mode and they mainly co-develop their innovation initiatives in close proximity with customers i.e. successful companies are an integral part of customers business and success. Companies have tailor-made innovation processes combined their way of working linked to their business goals, and priorities of actual needs of transformation. The result of this study is a new modular FEI platform which can be configured by companies against their actual business needs and drivers. This platform includes new elements of FEI documenting an architecture presenting how the system components work together. The system is a conceptual approach from theories of emergent strategy formation, opportunity identification and creation, interpretation-analysis-experimentation triad and the present FEI theories. The platform includes new features compared to actual models of FEI. It allows managers to better understand the importance of FEI in the whole innovation development stage and FEI as a phase and procedure to discover and implement emergent strategy. An adaptable company rethinks and redirects strategy proactively from time to time. Different parts of the business model are changed to remove identified obstacles for growth and renewal which gives them avenues to find right reforms for renewal.

Future of Newspaper Business Models in Finland

The purpose of this Master’s thesis was to study the business model development in Finnish newspaper industry during the next then years through scenario planning. The objective was to see how will the business models develop amidst the many changes in the industry, what factors are affecting the change, what are the implications of these changes for the players in the industry and how should the Finnish newspaper companies evolve in order to succeed in the future. In this thesis the business model change is studied based on all the elements of business models, as it was discovered that the industry is too often focusing on changes in only few of those elements and a more broader view can provide valuable information for the companies. The results revealed that the industry is affected by many changes during the next ten years. Scenario planning provides a good tool for analyzing this change and for developing valuable options for businesses. After conducting series of interviews and discovering forces affecting the change, four different scenarios were developed centered on the role that newspaper will take and the level at which they are providing the content in the future. These scenarios indicated that there are varieties of options in the way the business models may develop and that companies should start making decisions proactively in order to succeed. As the business model elements are interdepended, changes made in the other elements will affect the whole model, making these decisions about the role and level of content important for the companies. In the future, it is likely that the Finnish newspaper industry will include many different kinds of business models, some of which can be drastically different from the current ones and some of which can still be similar, but take better into account the new kind of media environment.

The effects of congestion in the daily management of a trauma hospital

Today’s healthcare organizations are under constant pressure for change, as hospitals should be able to offer their patients the best possible medical care with limited resources and, at the same time, to retain steady efficiency level in their operation. This is challenging, especially in trauma hospitals, in which the variation in the patient cases and volumes is relatively high. Furthermore, the trauma patient's care requires plenty of resources as most the patients have to be treated as single cases. Occasionally, the sudden increases in demand causes congestion in the operations of the hospital, which in Töölö hospital appears as an increase in the surgery waiting times within the yellow urgency class patients. An increase in the surgery waiting times may cause the diminution of the patient's condition, which also raises the surgery risks. The congestion itself causes overloading of the hospital capacity and staff. The aim of this master’s thesis is to introduce the factors contributing to the trauma process, and to examine the correlation between the different variables and the lengthened surgery waiting times. The results of this study are based on a three-year patient data and different quantitative analysis. Based on the analysis, a daily usable indicator was created in order to support the decision making in the operations management. By using the selected indicator, the effects of congestion can be acknowledged and the corrective action can also be taken more proactively.