Quality of Disease Management and Risk of Mortality in English Primary Care Practices

OBJECTIVE: To investigate whether better management of chronic conditions by family practices reduces mortality risk. DATA: Two random samples of 5 million patients registered with over 8,000 English family practices followed up for 4 years (2004/5-2007/8). Measures of the quality of disease management for 10 conditions were constructed for each family practice for each year. The outcome measure was an indicator taking the value 1 if the patient died during a specified year, 0 otherwise. STUDY DESIGN: Cross-section and multilevel panel data multiple logistic regressions were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures. PRINCIPAL FINDINGS: Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression. CONCLUSIONS: The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 782 [95 percent CI: 423, 1140]. A longer study period may be necessary to detect any mortality impact of better management of other conditions.

Biotic interactions boost spatial models of species richness

Biotic interactions are known to affect the composition of species assemblages via several mechanisms, such as competition and facilitation. However, most spatial models of species richness do not explicitly consider inter-specific interactions. Here, we test whether incorporating biotic interactions into high-resolution models alters predictions of species richness as hypothesised. We included key biotic variables (cover of three dominant arctic-alpine plant species) into two methodologically divergent species richness modelling frameworks - stacked species distribution models (SSDM) and macroecological models (MEM) - for three ecologically and evolutionary distinct taxonomic groups (vascular plants, bryophytes and lichens). Predictions from models including biotic interactions were compared to the predictions of models based on climatic and abiotic data only. Including plant-plant interactions consistently and significantly lowered bias in species richness predictions and increased predictive power for independent evaluation data when compared to the conventional climatic and abiotic data based models. Improvements in predictions were constant irrespective of the modelling framework or taxonomic group used. The global biodiversity crisis necessitates accurate predictions of how changes in biotic and abiotic conditions will potentially affect species richness patterns. Here, we demonstrate that models of the spatial distribution of species richness can be improved by incorporating biotic interactions, and thus that these key predictor factors must be accounted for in biodiversity forecasts

The Business Models of Telecommunications Equipment Manufacturers. Case: Cisco Systems.

Tutkielman tavoitteena oli tarkastella telekommunikaatiolaitevalmistajien liiketoimintamalleja. Tutkielma jakaantuu teoreettiseen ja empiiriseen osaan. Teoreettinen osa keskittyy lähinnä liiketoimintamallin käsitteen määrittelyyn. Olemassa olevien määritelmien, sekä liiketoimintamallin käsitteeseen läheisesti liittyvien termien, pohjalta luotiin liiketoimintamallille uusi malli. Tutkielman empiirinen osa keskittyy case-yritys Cisco Systemsin liiketoimintamallin määrittelyyn ja kehityksen kuvaamiseen. Liiketoimintamallin kehitystä seurattiin kahden vuoden ajalta perehtymällä lähinnä yrityksen lehdistötiedotteisiin, artikkeleihin ja muuhun julkiseen materiaaliin. Ciscon lisäksi empiirisessä osassa tutkittiin kahdeksan muun laitevalmistajan liiketoimintamallien kehitystä. Empiirisen osan päätavoitteena oli selvittää, miten telekommunikaatiolaitevalmistajien liiketoimintamallit kehittyvät nyt ja tulevaisuudessa.

Representations of work and worker in the three generations of knowledge management. Critical Discourse Analysis of selected texts.

The thesis studies the representations of different elements of contemporary work as present in Knowledge Management (KM). KM is approached as management discourse that is seen to affect and influence managerial practices in organizations. As representatives of KM discourse four journal articles are analyzed, using the methodology of Critical Discourse Analysis and the framework of Critical Management Studies, with a special emphasis on the question of structure and agency. The results of the analysis reveal that structural elements such as information technology and organizational structures are strongly present in the most influential KM representations, making their improvement also a desirable course of action for managers. In contrast agentic properties are not in a central role, they are subjugated to structural constraints of varying kind and degree. The thesis claims that one such constraint is KM discourse itself, influencing managerial and organizational choices and decision making. The thesis concludes that the way human beings are represented, studied and treated in management studies such as KM needs to be re-examined. Pro gradu-tutkielmassa analysoidaan työhön ja sen tekijään liittyviä representaatioita Tietojohtamisen kirjallisuudessa. Tietojohtamista tarkastellaan liikkeenjohdollisena diskurssina, jolla nähdään olevan vaikutus organisaatioiden päätöksentekoon ja toimintaan. Tutkielmassa analysoidaan neljä Tietojohtamisen tieteellistä artikkelia, käyttäen metodina kriittistä diskurssianalyysiä. Tutkielman viitekehyksenä on kriittinen liikkeenjohdon tutkimus. Lisäksi työssä pohditaan kysymystä rakenteen ja toimijan välisestä vuorovaikutuksesta. Tutkielman analyysi paljastaa, että tietojohtamisen vaikutusvaltaisimmat representaatiot painottavat rakenteellisia tekijöitä, kuten informaatioteknologiaa ja organisaatiorakenteita. Tämän seurauksena mm. panostukset em. tekijöihin nähdään organisaatioissa toivottavana toimintana. Vastaavasti representaatiot jotka painottavat yksilöitä ja toimintaa ovat em. tekijöille alisteisessa asemassa. Tapaa, jolla yksilöitä kuvataan ja käsitellään Tietojohtamisen diskurssissa, tulisikin laajentaa ja monipuolistaa.

Generative models of the human connectome.

The human connectome represents a network map of the brain's wiring diagram and the pattern into which its connections are organized is thought to play an important role in cognitive function. The generative rules that shape the topology of the human connectome remain incompletely understood. Earlier work in model organisms has suggested that wiring rules based on geometric relationships (distance) can account for many but likely not all topological features. Here we systematically explore a family of generative models of the human connectome that yield synthetic networks designed according to different wiring rules combining geometric and a broad range of topological factors. We find that a combination of geometric constraints with a homophilic attachment mechanism can create synthetic networks that closely match many topological characteristics of individual human connectomes, including features that were not included in the optimization of the generative model itself. We use these models to investigate a lifespan dataset and show that, with age, the model parameters undergo progressive changes, suggesting a rebalancing of the generative factors underlying the connectome across the lifespan.

Business Models of Packaging Machinery Manufacturers – Case Study

The goal of the study was to find a proper frame to understand business models and study business models of the chosen companies in packaging machinery manufacturing. Good practices and tips are searched from business models which have helped companies to success. Packaging industry’s future is also examined in front of different kinds of changes and the influence which they have on machinery manufacturer’s business models. In the theory part business models’ history and the best frame suitable for this study are presented. The chosen case companies have been discussed according to the frame, and they have been compared to each other to point out the differences. The good practices noticed in companies and according to information from other sources, new business model has been constructed including things that should be noticed while constructing a new business model. The information sources of this study where interviews, annual reports, companies presentations and web pages. The type of study was an interpretative case study.

Ecosystem impacts of Alpine water intakes for hydropower: the challenge of sediment management

The natural flow hydrological characteristics (such as the magnitude, frequency, duration, timing, and rate of change of discharge) of Alpine streams, dominated by snowmelt and glacier melt, have been established for many years. More recently, the ecosystems that they sustain have been described and explained. However, natural Alpine flow regimes may be strongly modified by hydroelectric power production, which impacts upon both river discharge and sediment transfer, and hence on downstream flora and fauna. The impacts of barrages or dams have been well studied. However, there is a second type of flow regulation, associated with flow abstraction at intakes where the water is transferred laterally, either to another valley for storage, or at altitude within the same valley for eventual release downstream. Like barrages, such intakes also trap sediment, but because they are much smaller, they fill more frequently and so need to be flushed regularly. Downstream, while the flow regime is substantially modified, the delivery of sediment (notably coarser fractions) remains. The ecosystem impacts of such systems have been rarely considered. Through reviewing the state of our knowledge of Alpine ecosystems, we outline the key research questions that will need to be addressed in order to modify intake management so as to reduce downstream ecological impacts. Simply redesigning river flows to address sediment management will be ineffective because such redesign cannot restore a natural sediment regime and other approaches are likely to be required if stream ecology in such systems is to be improved.

In Vivo Longitudinal (1)H MRS Study of Transgenic Mouse Models of Prion Disease in the Hippocampus and Cerebellum at 14.1 T.

In vivo (1)H MR spectroscopy allows the non invasive characterization of brain metabolites and it has been used for studying brain metabolic changes in a wide range of neurodegenerative diseases. The prion diseases form a group of fatal neurodegenerative diseases, also described as transmissible spongiform encephalopathies. The mechanism by which prions elicit brain damage remains unclear and therefore different transgenic mouse models of prion disease were created. We performed an in vivo longitudinal (1)H MR spectroscopy study at 14.1 T with the aim to measure the neurochemical profile of Prnp -/- and PrPΔ32-121 mice in the hippocampus and cerebellum. Using high-field MR spectroscopy we were able to analyze in details the in vivo brain metabolites in Prnp -/- and PrPΔ32-121 mice. An increase of myo-inositol, glutamate and lactate concentrations with a decrease of N-acetylaspartate concentrations were observed providing additional information to the previous measurements.

Influence of process parameters on part quality and mechanical properties for DMLS and SLM with iron-based materials

Rapid manufacturing is an advanced manufacturing technology based on layer-by-layer manufacturing to produce a part. This paper presents experimental work carried out to investigate the effects of scan speed, layer thickness, and building direction on the following part features: dimensional error, surface roughness, and mechanical properties for DMLS with DS H20 powder and SLM with CL 20 powder (1.4404/AISI 316L). Findings were evaluated using ANOVA analysis. According to the experimental results, build direction has a significant effect on part quality, in terms of dimensional error and surface roughness. For the SLM process, the build direction has no influence on mechanical properties. Results of this research support industry estimating part quality and mechanical properties before the production of parts with additive manufacturing, using iron-based powders

Reciprocal Effects on Neurocognitive and Metabolic Phenotypes in Mouse Models of 16p11.2 Deletion and Duplication Syndromes.

The 16p11.2 600 kb BP4-BP5 deletion and duplication syndromes have been associated with developmental delay; autism spectrum disorders; and reciprocal effects on the body mass index, head circumference and brain volumes. Here, we explored these relationships using novel engineered mouse models carrying a deletion (Del/+) or a duplication (Dup/+) of the Sult1a1-Spn region homologous to the human 16p11.2 BP4-BP5 locus. On a C57BL/6N inbred genetic background, Del/+ mice exhibited reduced weight and impaired adipogenesis, hyperactivity, repetitive behaviors, and recognition memory deficits. In contrast, Dup/+ mice showed largely opposite phenotypes. On a F1 C57BL/6N × C3B hybrid genetic background, we also observed alterations in social interaction in the Del/+ and the Dup/+ animals, with other robust phenotypes affecting recognition memory and weight. To explore the dosage effect of the 16p11.2 genes on metabolism, Del/+ and Dup/+ models were challenged with high fat and high sugar diet, which revealed opposite energy imbalance. Transcriptomic analysis revealed that the majority of the genes located in the Sult1a1-Spn region were sensitive to dosage with a major effect on several pathways associated with neurocognitive and metabolic phenotypes. Whereas the behavioral consequence of the 16p11 region genetic dosage was similar in mice and humans with activity and memory alterations, the metabolic defects were opposite: adult Del/+ mice are lean in comparison to the human obese phenotype and the Dup/+ mice are overweight in comparison to the human underweight phenotype. Together, these data indicate that the dosage imbalance at the 16p11.2 locus perturbs the expression of modifiers outside the CNV that can modulate the penetrance, expressivity and direction of effects in both humans and mice.

Empirical analysis of solid management waste costs: Some evidence from Galicia, Spain

This paper analyses the factors that determine solid waste service costs. The empirical analysis is based on information derived from a survey conducted in a sample of Galician municipalities. The results reveal economies of scale in municipalities of fewer than 50,000 inhabitants, such that cooperation between these municipalities could lead to cost savings. It also appears that private delivery is not cheaper than public delivery. Finally, designating a larger proportion of the total waste volume to recycling does not imply greater costs.

Climate Change and the Cost of Carbon Sequestration: The Case of Forest Management

The Kyoto protocol allows Annex I countries to deduct carbon sequestered by land use, land-use change and forestry from their national carbon emissions. Thornley and Cannell (2000) demonstrated that the objectives of maximizing timber and carbon sequestration are not complementary. Based on this finding, this paper determines the optimal selective management regime taking into account the underlying biophysical and economic processes. The results show that the net benefits of carbon storage only compensate the decrease in net benefits of timber production once the carbon price has exceeded a certain threshold value. The sequestration costs are significantly lower than previous estimates

Lähiverkkotuotteen palveluprosessien kehittäminen, Case: Elisa

Diplomityön aiheena oli tutkia case-yrityksen prosessikehitystä, prosessijohtamista sekä lähiverkkopalveluketjua prosessinäkökulman kannalta. Tutkimuksen päätavoitteina oli selvittää, kuinka lähiverkkopalveluketjun toimintaa voisi tehostaa, ja minkälaisia kertakustannuksia yhdestä keskiverotoimituksesta syntyy. Tavoitteina oli myös selvittää yrityksen prosessikehittämisen tila sekä minkälaisia prosessijohtamismalleja yrityksessä käytetään ja millä tavoin sen pääprosesseja johdetaan. Tutkimus oli case-tyyppinen, eli siinä tutkittiin yhden yrityksen toimintaa ja prosesseja. Teoreettinen pohja tutkimukselle luotiin käsittelemällä liiketoimintaprosesseihin liittyviä ydinmääritelmiä, erilaisia prosessijohtamismalleja ja liiketoimintaprosessien mittaamista. Tutkimuksen peruselementit tiedon hankintaan olivat kirjallisuus ja haastattelut. Lisäksi tutkimus pohjasi vahvasti tutkijan tekemiin omiin havaintoihin yrityksessä ja sen toimintaympäristössä. Tutkimuksen ensimmäisessä vaiheessa kartoitettiin lähiverkkopalveluketjun senhetkinen tilanne, analysoitiin palveluketjun sisältämiä prosesseja ja kirjattiin ylös havaitut ongelmakohdat. Haastatteluista kerättyjen tietojen perusteella laskettiin yhdestä keskivertolähiverkkotoimituksesta case-yritykselle syntyvät kertakustannukset. Tämän lisäksi analysoitiin yrityksen senhetkistä prosessijohtamis- ja prosessikehitystasoa sekä peilattiin niitä yrityksen tulevaisuuden prosessikehittämistoimiin. Lopuksi johtopäätöksien kautta esitettiin kaksi toimintaehdotusta, joilla palveluketjun toimintaa voitaisiin parantaa. Ensimmäinen ehdotus oli radikaalimpi, ja siinä siirryttäisiin kokonaan pois palveluketjumallista tiimipohjaiseen malliin. Toisessa ehdotuksessa keskityttiin korjaamaan palveluketjun ongelmakohtia.

Cumulative Costs of Caries Prevention and Treatment in Children - with Special Reference to Work Division and Cohort Effect

Lapsen karieshoidon kustannuskertymän muutokset ja karieshoidon toimintakäytäntöjen yhteys kustannuksiin Tutkimuksen tavoitteena oli mitata terveyskeskuksessa hoidettavien lasten karieshoidon kumulatiivisia kustannuksia ja verrata niitä kahden erilaisen toimintatavan välillä. Lisäksi tarkasteltiin lasten hampaiden terveyttä. Tutkimus tehtiin julkisen palvelutuottajan näkökulmasta. Tutkimusaineisto kerättiin Kemin ja Tornion terveyskeskusten suun terveydenhuollon potilaskertomuksista. Kemin kohortit 1980, 1983 ja 1986 (n = 600) ja Tornion kohortit 1980 ja 1992 (n = 400) edustivat perinteistä ja Kemin kohortit 1989, 1992 ja 1995 (n = 600) uutta toimintatapaa työnjaon ja ehkäisyn ajoituksen suhteen. Kohortteja ja kaupunkeja verrattiin hampaiden terveyden (dmft/DMFT = 0 ja dmft ja DMFT keskiarvot 5 ja 12 vuoden iässä) ja voimavarojen käytön suhteen. Panoskäyttö johdettiin käyntimäärien avulla laskennallisen työajan kautta. Kustannuskertymät muodostettiin käyttämällä henkilöstömenoista laskettuja suorittajakohtaisia yksikkökustannuksia. Panoskäytön ja yksikkökustannusten kautta muodostettiin kustannuskertymät. Kustannusten ja terveysvaikutusten suhteita arvioitiin kustannus-vaikuttavuusanalyysissä. Suuhygienistien työpanosta hyödyntävällä varhaisen ehkäisyn toimintamallilla saavutettiin vähäisemmin kustannuksin alle kouluiässä parempi ja kouluiässä yhtä hyvä hammasterveys kuin perinteisellä, enemmän hammaslääkärien työpanokseen perustuvalla tavalla. Karieksen hoitoon liittyvien käyntien määrä oli nuorimmissa syntymävuosikohorteissa pienempi kuin vanhimmissa kohorteissa. Käynnit hammaslääkärissä vähenivät eniten. Toimintatavalla oli merkittävä vaikutus lapsen karieshoidon kokonaiskustannuksiin. Herkkyysanalyysin mukaan karieshoidon kustannukset olivat työnjakoa hyödyntämällä kolmanneksen pienemmät, kuin jos hoidon suorittajana olisi ollut ainoastaan hammaslääkäri-hoitaja työpari. Lasten karieshoidon kustannusvaikuttavuus kohentui molemmissa terveyskeskuksissa nuoremmissa kohorteissa vanhempiin verrattuna. Suun terveydenhuollon potilaskertomuksia olisi hyödynnettävä toiminnan kehittämisessä. Varhaisen ehkäisyn avulla voitaisiin kaikkien suun terveydenhuollon ammattihenkilöiden työpanos kohdentaa kustannustehokkaasti.