Tobacco control policies in hospitals before and after the implementation of a national smoking ban in Catalonia, Spain

Background: Diverse projects and guidelines to assist hospitals towards the attainment of comprehensive smoke-free policies have been developed. In 2006, Spain government passed a new smoking ban that reinforce tobacco control policies and banned completely smoking in hospitals. This study assesses the progression of tobacco control policies in the Catalan Network of Smokefree Hospitals before and after a comprehensive national smoking ban. Methods: We used the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals to score the compliance of 9 policy standards (global score = 102). We used two crosssectional surveys to evaluate tobacco control policies before (2005) and after the implementation of a national smoking ban (2007) in 32 hospitals of Catalonia, Spain. We compared the means of the overall score in 2005 and 2007 according to the type of hospital, the number of beds, the prevalence of tobacco consumption, and the number of years as a smoke-free hospital. Results: The mean of the implementation score of tobacco control policies was 52.4 (95% CI:45.4-59.5) in 2005 and 71.6 (95% CI: 67.0-76.2) in 2007 with an increase of 36.7% (p < 0.01). The hospitals with greater improvement were general hospitals (48% increase; p < 0.01), hospitals with > 300 beds (41.1% increase; p < 0.01), hospitals with employees' tobacco consumption prevalence 35-39% (72.2% increase; p < 0.05) and hospitals that had recently implemented smoke-free policies (74.2% increase; p < 0.01). Conclusion: The national smoking ban appears to increase tobacco control activities in hospitals combined with other non-bylaw initiatives such as the Smoke-free Hospital Network.

Tobacco control policies in hospitals before and after the implementation of a national smoking ban in Catalonia, Spain

Background: Diverse projects and guidelines to assist hospitals towards the attainment of comprehensive smoke-free policies have been developed. In 2006, Spain government passed a new smoking ban that reinforce tobacco control policies and banned completely smoking in hospitals. This study assesses the progression of tobacco control policies in the Catalan Network of Smokefree Hospitals before and after a comprehensive national smoking ban. Methods: We used the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals to score the compliance of 9 policy standards (global score = 102). We used two crosssectional surveys to evaluate tobacco control policies before (2005) and after the implementation of a national smoking ban (2007) in 32 hospitals of Catalonia, Spain. We compared the means of the overall score in 2005 and 2007 according to the type of hospital, the number of beds, the prevalence of tobacco consumption, and the number of years as a smoke-free hospital. Results: The mean of the implementation score of tobacco control policies was 52.4 (95% CI:45.4-59.5) in 2005 and 71.6 (95% CI: 67.0-76.2) in 2007 with an increase of 36.7% (p < 0.01). The hospitals with greater improvement were general hospitals (48% increase; p < 0.01), hospitals with > 300 beds (41.1% increase; p < 0.01), hospitals with employees' tobacco consumption prevalence 35-39% (72.2% increase; p < 0.05) and hospitals that had recently implemented smoke-free policies (74.2% increase; p < 0.01). Conclusion: The national smoking ban appears to increase tobacco control activities in hospitals combined with other non-bylaw initiatives such as the Smoke-free Hospital Network.

Implementation of Customer Relationship Management Strategy in Pulp Company

Työn tarkoituksena oli löytää Asiakkuuksienhallintastrategian käyttöönoton ongelmakohtia asiakkuuksienhallintaan erikoistuneen konsulttiyrityksen asiakasyrityksen taholta. Lisäksi työssä etsitään ratkaisuja asiakkuusteorian viemiseksi käytäntöön. Työn anti on asiakkuusstrategian käytäntöön panon ongelmakohtien paikallistaminen, prosessin vaiheiden kuvaaminen sekä asiakkuuksienhallinnan tutkiminen lähtökohtana asiakkaalle tuotettu arvo. Asiakkuusstrategian implementoinnin ongelmakohtien ja kriittisten menestystekijöiden kuvaus ja vertailu käsitellään empiirisessä osassa suhteuttaen teoriaosuuden materiaaliin. CRM Group:n kannalta työ mahdollistaa osaltaan asiakasprojektien kehitystyön.Kirjallisuusosan pohjalta implementoinnin kannalta kriittisiksi menestystekijöiksi nousivat tietoteknisten ratkaisujen sulauttaminen osaksi asiakkuusstrategiaa tukevia toimintoja, aidon synergian löytäminen asiakas – toimittaja –suhteeseen sekä asiakkuusstrategiaa kehittävän organisaation sisäinen resursointi ja henkilöstön sitouttaminen.

The design and implementation of a standards-based mobile messaging platform - case WAP Push Proxy Gateway

Tässä diplomityössä perehdytään WAP:in Push -viitekehykseen. WAP-standardit määrittelevät kuinka Internet-tyyppisiä palveluita, joita voidaan käyttää erilaisia mobiileja päätelaiteitteita käyttäen, toteutetaan tehokkaalla ja verkkoteknologiasta riippumattomalla tavalla. WAP pohjautuu Internet:iin, mutta huomioi pienten päätelaitteiden ja mobiiliverkkojen rajoitukset ja erikoisominaisuudet. WAP Push viitekehys määrittelee verkon aloittaman palvelusisällön toimittamisen. Työn teoriaosassa käydään läpi yleinen WAP-arkkitehtuuri ja WAP-protokollapino käyttäen vertailukohtina lanka-Internetin arkkitehtuuria ja protokollapinoa. Edellistä perustana käyttäen tutustaan WAP Push -viitekehykseen. Käytännönosassa kuvataan WAP Push -välityspalvelimen suunnittelu ja kehitystyö. WAP Push -välityspalvelin on keskeinen verkkoelementti WAP Push -viitekehyksessä. WAP Push -välityspalvelin yhdistää Internetin ja mobiiliverkon tavalla, joka piilottaa teknologiaeroavaisuudet Internetissä olevalta palveluntuottajalta.

The Design and Implementation of Loudspeaker Control Network Protocols

The networking and digitalization of audio equipment has created a need for control protocols. These protocols offer new services to customers and ensure that the equipment operates correctly. The control protocols used in the computer networks are not directly applicable since embedded systems have resource and cost limitations. In this master's thesis the design and implementation of new loudspeaker control network protocols are presented. The protocol stack was required to be reliable, have short response times, configure the network automatically and support the dynamic addition and removal of loudspeakers. The implemented protocol stack was also required to be as efficient and lightweight as possible because the network nodes are fairly simple and lack processing power. The protocol stack was thoroughly tested, validated and verified. The protocols were formally described using LOTOS (Language of Temporal Ordering Specifications) and verified using reachability analysis. A prototype of the loudspeaker network was built and used for testing the operation and the performance of the control protocols. The implemented control protocol stack met the design specifications and proved to be highly reliable and efficient.

Market Potential and Demand Drivers for a Special Laminating Paper: Implementation of Market Research

Tutkimuksen tavoitteena oli selvittää raaka-aineena käytettävän paloa hidastavan laminaattipaperin markkinapotentiaali sekä kysyntä Euroopassa. Näiden kehitystä arvioitiin analysoimalla kysyntään vaikuttavia tekijöitä. Tutkimusmetodologiassa yhdistyivät useat lähestymistavat, pääasiassa käytettiin kuvailevaa ja ennustavaa tutkimusotetta. Tutkimus perustui sekä primaari että sekundaaritietoon. Primaaritietoa hankittiin tuotteen käyttäjiltä, myyntiedustajilta sekä haastattelemalla tuottajayrityksen henkilökuntaa. Sekundaaritietoa kerättiin myös, mutta tutkimuksen tavoitteisiin liittyviä lähteitä ei ollut runsaasti saatavilla. Tästä syystä primaaritiedolla oli tutkimuksessa hieman tärkeämpi rooli kuin sekundaaritiedolla, mikä on yleistä teollisessa markkinatutkimuksessa. Tuotteen tulevaisuuden näkymät vaikuttavat melko hyviltä. Teoreettinen markkinapotentiaali on suuri verrattuna nykyiseen myyntimäärään, myyntimäärän kasvattaminen vaatii kuitenkin tiettyjä toimenpiteitä. Tulevaisuudessa huomiota tulisi kiinnittää tuotekuvaan, hinnoitteluun ja laadun kokonaisvaltaiseen maksimointiin. Tutkimuksessa havaittiin suuntauksia kysynnän kasvusta tulevien parin vuoden aikana. Myös teoreettinen markkinapotentiaali voisi kasvaa, koska paloa hidastavien laminaattien kysyntä vaikuttaa kasvavan Euroopassa erityisesti rakennusalalla.

Implementation of CORBA interface in a wireless device

CORBA (Common Object Request Broker Architecture) on laajalle levinnyt ja teollisuudessa yleisesti käytetty hajautetun tietojenkäsittelyn arkkitehtuuri. CORBA skaalautuu eri kokoisiin tarpeisiin ja sitä voidaan hyödynntää myös sulautetuissa langattomissa laitteissa. Oleellista sulautetussa ympäristössä on rakentaa rajapinnat kevytrakenteisiksi, pysyviksi ja helposti laajennettaviksi ilman että yhteensopivuus aikaisempiin rajapintoihin olisi vaarassa. Langattomissa laitteissa resurssit, kuten muistin määrä ja prosessointiteho, ovat hyvin rajalliset, joten rajapinta tulee suunnitella ja toteuttaa optimaalisesti. Palveluiden tulee ottaa huomioon myös langattomuuden rajoitukset, kuten hitaat tiedonsiirtonopeudet ja tiedonsiirron yhteydettömän luonteen. Työssä suunniteltiin ja toteutettiin CORBA-rajapinta GSM-päätelaitteeseen, jonka on todettu täyttävän sille asetetut tavoitteet. Rajapinta tarjoaa kaikki yleisimmät GSM-terminaalin ominaisuudet ja on laajennettavissa tulevia tuotteita ja verkkotekniikoita varten. Laajennettavuutta saavutetaan esimerkiksi kuvaamalla terminaalin ominaisuudet yleisellä kuvauskielellä, kuten XML:lla (Extensible Markup Language).

Implementation of bayesian therapeutic drug monitoring in modern patient care

The variability observed in drug exposure has a direct impact on the overall response to drug. The largest part of variability between dose and drug response resides in the pharmacokinetic phase, i.e. in the dose-concentration relationship. Among possibilities offered to clinicians, Therapeutic Drug Monitoring (TDM; Monitoring of drug concentration measurements) is one of the useful tool to guide pharmacotherapy. TDM aims at optimizing treatments by individualizing dosage regimens based on blood drug concentration measurement. Bayesian calculations, relying on population pharmacokinetic approach, currently represent the gold standard TDM strategy. However, it requires expertise and computational assistance, thus limiting its large implementation in routine patient care. The overall objective of this thesis was to implement robust tools to provide Bayesian TDM to clinician in modern routine patient care. To that endeavour, aims were (i) to elaborate an efficient and ergonomic computer tool for Bayesian TDM: EzeCHieL (ii) to provide algorithms for drug concentration Bayesian forecasting and software validation, relying on population pharmacokinetics (iii) to address some relevant issues encountered in clinical practice with a focus on neonates and drug adherence. First, the current stage of the existing software was reviewed and allows establishing specifications for the development of EzeCHieL. Then, in close collaboration with software engineers a fully integrated software, EzeCHieL, has been elaborated. EzeCHieL provides population-based predictions and Bayesian forecasting and an easy-to-use interface. It enables to assess the expectedness of an observed concentration in a patient compared to the whole population (via percentiles), to assess the suitability of the predicted concentration relative to the targeted concentration and to provide dosing adjustment. It allows thus a priori and a posteriori Bayesian drug dosing individualization. Implementation of Bayesian methods requires drug disposition characterisation and variability quantification trough population approach. Population pharmacokinetic analyses have been performed and Bayesian estimators have been provided for candidate drugs in population of interest: anti-infectious drugs administered to neonates (gentamicin and imipenem). Developed models were implemented in EzeCHieL and also served as validation tool in comparing EzeCHieL concentration predictions against predictions from the reference software (NONMEM®). Models used need to be adequate and reliable. For instance, extrapolation is not possible from adults or children to neonates. Therefore, this work proposes models for neonates based on the developmental pharmacokinetics concept. Patients' adherence is also an important concern for drug models development and for a successful outcome of the pharmacotherapy. A last study attempts to assess impact of routine patient adherence measurement on models definition and TDM interpretation. In conclusion, our results offer solutions to assist clinicians in interpreting blood drug concentrations and to improve the appropriateness of drug dosing in routine clinical practice.

Blind Inversion of Wiener System using a minimization-projection (MP) approach

In this paper, a new algorithm for blind inversion of Wiener systems is presented. The algorithm is based on minimization of mutual information of the output samples. This minimization is done through a Minimization-Projection (MP) approach, using a nonparametric “gradient” of mutual information.

A Gradient based algorithm for blind inversion of Wiener System using multi-variate score functions

A Wiener system is a linear time-invariant filter, followed by an invertible nonlinear distortion. Assuming that the input signal is an independent and identically distributed (iid) sequence, we propose an algorithm for estimating the input signal only by observing the output of the Wiener system. The algorithm is based on minimizing the mutual information of the output samples, by means of a steepest descent gradient approach.

Critical Success Factors in the Implementation of the Balanced Scorecard

Tutkielman tavoitteena on tunnistaa kriittiset menestystekijät balanced scorecardin käyttöönotossa. Tutkimus on luonteeltaan selittävä tapaustutkimus. Tutkimuksen haastatteluaineisto on kerätty suomalaisyrityksistä, jotka ovat ottaneet onnistuneesti balanced scorecardin käyttöön organisaatiossa. Yksi tapauksista osoittautui kuitenkin epäonnistuneeksi. Balanced scorecardin onnistuneeseen käyttöönottoon vaikuttaa usea eri tekijä. Tutkielmassa käyttöönottoon vaikuttavat menestystekijät on jaettu neljään eri ryhmään, jotka ovat tekijät liittyen organisaatioon, resursseihin, käyttöönottoprosessiin ja itse balanced scorecardiin. Viitekehys havainnollistaa kriittisten menestystekijöiden keskinäisiä suhteita. Johdon sitoutuminen, ajankäyttö sekä avoin kommunikaatio ovat eräitä keskeisiä menestystekijöitä balanced scorecardin käyttöönottoprosessissa. Lisäksi balanced scorecardin onnistuneeseen käyttöönottoon on kaksi perusedellytystä: organisaation strategian selkeys sekä ympäristön tuki prosessille.

A Legislator under Surveillance: The Creation and Implementation of Swiss Banking Legislation 1910-1934

This paper analyses how banking regulation was introduced in Switzerland - one of the world's most prominent financial centres - which remained in place until the beginning of the twenty-first century. It shows that the law adopted on 8 November 1934 is a perfect example of capture of the regulator by the regulated. Essentially a political response in the context of the economic crisis of the 1930s, it largely reflected the interests of banking circles by limiting the intervention of the State as much as possible. The introduction of the new legislation was facilitated by the temporary weakness of Swiss banking circles, as they depended on the State to delay or prevent the collapse of many major credit institutions. They did not manage to derail the law as they had two decades earlier when they scuppered the federal bill on banks drawn up between 1914 and 1916. But this time they were better organized and more united, and intervened all the more effectively in the legislative process itself. The 1934 law is thus distinctive in that it made no structural changes to the architecture of the financial centre but merely codified its practices through flexible legislation meant to reassure the public. The law was aimed less at controlling banking activity than at keeping - thanks to skilfully calibrated political concessions - the State from having to intervene more directly in the internal management of banks or in the fixing of interest rates and the export of capital.

Eligibility to treatment and economic effect of the implementation of the new U.S. or European Society of Hypertension/European Society of Cardiology hypertension guidelines.

OBJECTIVE: To evaluate the population and economic impact of implementing the new Joint National Committee (JNC) or European Society of Hypertension (ESH)/European Society of Cardiology (ESC) hypertension guidelines in the Swiss population. METHODS: Cross-sectional, population-based sample (6708 participants) collected between 2003 and 2006 in the city of Lausanne, Switzerland. Blood pressure categories were defined according to both the JNC (JNC-7 and JNC-8) and the ESH/ESC (2007 and 2013) guidelines. RESULTS: The proportion of participants aged 35-60 years eligible for drug treatment was 25.6% [95% confidence interval (CI) 24.4-26.9%] and 24.8% (95% CI 23.6-26.0%) for the JNC-7 and the JNC-8 guidelines, respectively; for participants aged 60-75 years, the values were 62.3% (95% CI 60.1-64.5%) and 46.8% (95% CI 44.5-49.0%), respectively. Shifting from the JNC-7 to the JNC-8 guidelines would lead to an annual saving of 163.6 million Swiss francs (187.7 million US dollars or 134.5 million European euro). The proportion of participants aged 35-75 years without chronic kidney disease, diabetes mellitus or reported history of cardiovascular disease and eligible for treatment was 30.2% (95% CI 29.0-31.4%) for the ESH/ESC 2007 and 2013 guidelines. For participants with chronic kidney disease, diabetes mellitus or reported history of cardiovascular disease, the values were 73.6% (95% CI 70.8-76.3%) and 55.6% (95% CI 52.5-58.8%), respectively. Shifting from the ESH/ESC 2007 to the ESH/ESC 2013 guidelines would lead to an annual saving of 86.9 million Swiss francs (99.5 million US dollars or 71.4 million European euro). CONCLUSION: In Switzerland, shifting from the JNC-7 to the JNC-8 guidelines or from the ESH/ESC 2007 to the ESH/ESC 2013 guidelines would decrease the prevalence of patients eligible for treatment and increase the percentage of treated patients within blood pressure goals. Both strategies lead to potential savings in antihypertensive drug treatment.

Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators.

OBJECTIVE: To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. DESIGN: A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. SETTING: International group of countries participating to OECD projects. PARTICIPANTS: Members of the OECD HCQI expert group. RESULTS: A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. CONCLUSIONS: The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies.