Abnormal nocturnal blood pressure fall in normotensive adolescents with insulin-dependent diabetes is ameliorated following glycemic improvement

Lack of the physiological nocturnal fall in blood pressure (BP) has been found in diabetics and it seems to be related to the presence of diabetic complications. The present study examined the changes in the nocturnal BP pattern of 8 normotensive insulin-dependent diabetic adolescents without nephropathy following improvement in glycemic control induced by an 8-day program of adequate diet and exercise. The same number of age- and sex-matched control subjects were studied. During the first and eighth nights of the program, BP was obtained by ambulatory BP monitoring. After a 10-min rest, 3 BP and heart rate (HR) recordings were taken and the mean values were considered to represent their awake values. The monitor was programmed to cuff insufflation every 20 min from 10:00 p.m. to 7:00 a.m. The glycemic control of diabetics improved since glycemia (212.0 ± 91.5 to 140.2 ± 69.1 mg/dl, P<0.03), urine glucose (12.7 ± 11.8 to 8.6 ± 6.4 g/24 h, P = 0.08) and insulin dose (31.1 ± 7.7 to 16.1 ± 9.7 U/day, P<0.01) were reduced on the last day. The mean BP of control subjects markedly decreased during the sleeping hours of night 1 (92.3 ± 6.4 to 78.1 ± 5.0 mmHg, P<0.001) and night 8 (87.3 ± 6.7 to 76.9 ± 3.6 mmHg, P<0.001). Diabetic patients showed a slight decrease in mean BP during the first night. However, the fall in BP during the nocturnal period increased significantly on the eighth night. The average awake-sleep BP variation was significantly higher at the end of the study (4.2 vs 10.3%, P<0.05) and this ratio turned out to be similar to that found in the control group (10.3 vs 16.3%). HR variation also increased on the eighth night in the diabetics. Following the metabolic improvement obtained at the end of the period, the nocturnal BP variation of diabetics was close to the normal pattern. We suggest that amelioration of glycemic control may influence the awake-sleep BP and HR differences. This effect may be due at least in part to an attenuated insulin stimulation of sympathetic activity

Osaamiskartoitus osaamisen mittaamisen välineenä

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

Managing Customer Co-creation: Empirical Evidence from Finnish High-tech SMEs

The purpose of this thesis is to find out how customer co-creation activities are managed in Finnish high-tech SMEs by understanding managers’ views on relevant issues. According to theory, issues such as firm size, customer knowledge implementation, lead customers, the fuzzy front-end of product/service development as well as the reluctance to engage in customer co-creation are some of the field’s focal issues. The views of 145 Finnish SME managers on these issues were gathered as empirical evidence through an online questionnaire and analyzed with SPSS statistics software. The results show, firstly, that Finnish SME managers are aware of the issues associated with customer co-creation and are able to actively manage them. Additionally, managers performed well in regards to collaborating with lead customers and implemented customer knowledge evenly in various stages of their new product and service development processes. Intellectual property rights emerged as an obstacle deterring managers from engaging in co-creation. The results suggest that in practice managers would do well by looking for more opportunities to implement customer knowledge in the early and late stages of new product and service development, as well as by actively searching for lead customers.

Customer Experience Management – How to Improve the Customer Experience Management and its Measurement

The main goal of this master’s thesis was to find out, how to improve customer experience management and measurement. This study is a qualitative case study, in which the data collection method has been interviews. In addition, some of the company’s customer experience measurement methods have been analyzed. The theoretical background is applied in practice by interviewing 5 representatives from the case company. In the case company, the management has launched a customer experience focused program, and given guidelines for customer experience improvement. In the case company, customer experience is measured with different methods, one example is asking the recommendation readiness from a customer. In order to improve the customer experience management, the case company should define, what the company means with customer experience and what kind of customer experience the company is aiming to create. After the encounter, the customer should be left with feelings of satisfaction, positivity and trust. The company should focus on easiness in its processes, on top of which the processes should work fluently. The customer experience management should be improved through systematic planning, and by combining and standardizing different measures. In addition, some channel-based measures should be used. The measurement conducted should be more customer focused, and the case company should form an understanding, which touch points are the most relevant to measure.

Continuity of patient care in day surgery

Continuity is a part of high-quality patient care. The purpose of this study was to analyse what factors are important in the continuity of patients’ care, and how well continuity is achieved in different stages of the care of day surgical patients. Day surgery has become significantly more prevalent in the past few decades, and in order for it to be carried out successfully, continuity in care is particularly essential. The study was carried out in two stages. In the first stage (2001–2005) of the study, continuity was examined through a review of literature from the perspective of critical pathways, naming the continuity categories of time flow, coordination flow, caring relationship flow, and information flow. The first stage also entailed an analysis of matters important to the patient and problems concerning the achievement of care continuity, carried out by interviewing 25 day surgical patients. In the second stage (2006–2015), the degree to which the continuity of day surgical patient care was achieved was analysed from the perspective of patients (n=203, 58%) and nurses working in day surgery units (n=83, 69%), and suggestions for developing the continuity of day surgery patient care were made. In this study continuity of care was examined through a review of literature from the perspective of critical pathways, naming the continuity categories of time flow, coordination flow, caring relationship flow, and information flow. Within these categories, several important factors for the patient were found. According to both patients and nurses, continuity of care is generally achieved to a high degree. Continuity of care is improved by patients being acquainted with and meeting the staff attending to them (nurse and surgeon) before and after the operation. From patients’ perspective, there is room for improvement especially in terms of being admitted to care and in the carer-patient relationship. From nurses’ perspective, there is room for improvement in terms of the smoothness of care. Nurses evaluated the continuity of care to be the least successful before and after the operation. An extensive social and health care reform is planned in Finland in the coming years, aiming to enhance social and health care services and to create smoothly functioning service and care. As a topic of further study supporting the development of the service system, it is important to follow the patient’s progress throughout the entire chain of care, e.g. as a case study. On the other hand, there is also a need to study the views of nurses and other health care professionals in health care, e.g. in primary health care.

Organisational purchasing of service design – Agency and client perspectives

There has been an increase in the interest in service design, as companies have become more customer-centric and their focus has shifted to customer experiences. The actual organisational purchasing of service design has been given little attention, until recent years. The purpose of this study is to explore the purchasing of service design from the perspectives of sellers (service design agencies) and buying clients (business organisations). In order to understand the phenomenon, also agencies and clients’ approaches to service design discipline, purchasing processes, challenges related to purchasing and ways of facilitating the purchasing are explored. The research follows qualitative research method and utilises abductive reasoning. A proposition framework was formed by combining services marketing, design and organisational buying behaviour literatures, and was tested against real-life business cases. Empirical data was gathered by interviewing eight service design agency representatives and five client representatives in Finland. The results of semi-structural interviews were analysed by finding repetitive themes. The proposition framework was updated according to interview findings. There were both similarities and differences in service design agencies and clients’ approaches to service design. Service design represents a strategic activity to both parties, and it helps in clients’ business development and in discovering opportunities. It is an ideology; a way of thinking and working. The driving force for purchasing service design seemed to be something else than service design itself. Projects have been bought for 1) change and innovation related development, 2) channel related development or for 3) customer experience related development. Seven purchasing challenge themes were recognised: 1) poor or differing service design understanding, 2) selling of service design, 3) varying expectations, 4) difficulty of pre-evaluation, 5) buyers and buying companies, 6) project process and nature and 7) unclear project results. These all can be considered to cause challenges in organisational service design purchasing. Challenges can be caused by either participant, the agency or the client, and take place at any point of the purchasing process. Some of the challenges could be considered as barriers to purchasing or they play a role in an unsuccessful service project – and therefore, result in an unsuccessful organisational purchase. Purchasing could be facilitated in various ways by either participant; some ways are more attitude based, others actionable improvements. Thesis’s theoretical and managerial findings can be utilised to both improve the selling and purchasing of service design services.

Quality time: exploring meaningful mandatory community involvement programs in secondary schools /

The purpose of this study was to explore the experiences of 5 stakeholder groups—students, parents, community organization representatives, guidance counsellors, and secondary school principals—in dealing with a mandatory secondary school graduation requirement in Ontario. The requirement is that students must complete 40 hours of eligible community involvement activities during their high school years in order to graduate. Ten stakeholders were interviewed regarding the nature of the community involvement program, what makes it work, and suggestions for improvement. The study found that although this program has the potential to provide a meaningful experience for students, and students are seen to gain from their experience in multiple ways, it depends substantially on the commitment of students, educators, and community organizations to make it worthwhile. Stakeholders recommended changes to the current program, which included making it a more structured process that would increase the consistency ofhow this program is implemented, finding ways to curb cheating and to reduce the administrative burden on schools, having more support from the Ontario provincial government and Ontario Ministry of Education and Training in the promotion and communication of this program, and developing partnerships between community organizations and schools to enrich the application of this program. This study concludes with a recommendation that the Ontario Ministry of Education and Training consider introducing Service-Learning, a curriculum-based experiential service and learning process, as an enhancement to the current community involvement program.

Benefits of Using Target Activities to Assist in Improvement of Striking in Striking and Fielding Games for Individuals with Autism: A Comparative Case Study

The purpose of the research study was to increase understanding about the potential benefits of combining target activities with striking-fielding games for individuals with high functioning autism spectrum disorder. A comparative case study was conducted to understand if target activities can assist in improving the skills of striking and throwing, aid the learning of tactics and add to current understanding of how certain teaching skills might be linked to the transfer between target and striking-fielding games. Data was collected through observations, student journals and interviews and were analyzed using both inductive and deductive methods. Results show an appearance of improvement in throwing, striking, bowling and badminton for overall skill levels. In regards to teaching skills, appropriate and effective teaching techniques, appropriate and effective equipment, dynamic of participants and student-instructors and consistency of attendance are vital. Future research should further look at the transferability to outdoor settings and interview the participants.

Queues with Customer Induced Interruption

In this thesis we have introduced and studied the notion of self interruption of service by customers. Service interruption in queueing systems have been extensively discussed in literature (see, Krishnamoorthy, Pramod and Chakravarthy [38]) for the most recent survey. So far all work reported deal with cases in which service interruptions are generated by sources other than customers. However, there are situations where interruptions are due to the customers rather than the system. Such situations are especially arise at doctors clinic, banks, reservation counter etc. Our attempt is to quantify a few of such problems. Systematically we have proceed from single server queue (in Chapter 2) to multi-server queues (Chapter 3). In Chapte 4, we have studied a very general multiserver queueing model with service interruption and protection of service phases. We also introduced customer interruption in a retrial setup (in Chapter 5). All models (from Chapter 2 to Chapter 4) that were analyzed involve 'non-preemptive priority' for interrupted customers where as in the model discussed in Chapter 5 interruption of service by customers is not encouraged. So the interrupted customers cannot access the server as long as there are primary customers in the system. In Chapter 5 we have obtained an explicit expression for the stability condition of the system. In all models analyzed in this thesis, we have assumed that no more than one interruption is allowed for a customer while in service. Since the models are not analytically tractable, a large number of numerical illustrations were given in each chapter it illustrate the working of the systems. We can extend the models discussed in this thesis to several directions. For example some of the models can be analyzed with both server induced and customer induced interruptions the results for which are not available till date. Another possible extension of work is to the case where there is no bound on the number of interruptions a customer is permitted to have before service completion. More complex is the case where a customer is permitted to have a nite number (K ≥ 2) of We can extend the models discussed in this thesis to several directions.

Materials Managenent Practices in Major Public Sector Undertakings in India

One of the basic functions of management is to employ capital efficiently so as to provide maximum customer service and earn a profit in the proces1s. It is possible to achieve these objectives in different ways with the given amount of capital, either by maximising the output or by maximising the margin of profit or by a combination of both these methods. This would mean that the management must try to make this capital work as fast as possible, which is often difficult to achieve under the present conditions of the factors of production. It is also not possible to increase extensively the margin of profit due to competition in business and in this process the capital turn over and productivity of capital often becomes totally ineffective. Several modern techniques have been developed and employed by managers to remedy this situation. Among these, materials management has become one of the most effective methods to achieve both the above goals. Materials management enables a manager to improve productivity of capital by reducing material costs, preventing blocking up of large working capital for long periods and improving the capital turn over This study examines the working of materials management departments in public sector undertakings in India and Suggests méthods to improve its efficiency.

“Studies on new base materials for microcellular soles"

The most important part of any footwear is the sole (or sole and heel) which withstands all the hannful external factors such as rouglmess of the ground or road, sharp objects, thorns and stones, heat, dampness and cold during walking. The properties desirable in soling material, therefore, would be 1. lightness 2. resistance to wear and tear for long service life 3. flexibility/softness for wearing comfort 4. thennal insulation Rubber soling surpasses all other soling materials in better performance and lower cost. Because MC sole is soft and very light, and has good abrasion resistance, flex properties and set behaviour it has become very popular all over the world and demand for better quality product is ever increasing. Due to the traditional approach adopted by the footwear industry in foot wear design, the rubber based footwear export surprisingly contributes only a small percentage. The essence of success for any industry lies in the expansion of the export market. Microcellular soles are manufactured for the last three decades without much change in the traditional design and colour pattern. In recent years domestic customers have also started demanding better quality products. In view of the changing taste of the customer and growing competition from other countries, substantial improvement in the export potential will require new base materials for regular or fashion rubber based footwears. The main objective of the present study is to develop new base materials for making MC soles with good quality, viz., light weight, durability and bright colours

User Profile Management and Selection in Context-Aware Service Platforms for Networks Beyond 3G

In recent years, progress in the area of mobile telecommunications has changed our way of life, in the private as well as the business domain. Mobile and wireless networks have ever increasing bit rates, mobile network operators provide more and more services, and at the same time costs for the usage of mobile services and bit rates are decreasing. However, mobile services today still lack functions that seamlessly integrate into users’ everyday life. That is, service attributes such as context-awareness and personalisation are often either proprietary, limited or not available at all. In order to overcome this deficiency, telecommunications companies are heavily engaged in the research and development of service platforms for networks beyond 3G for the provisioning of innovative mobile services. These service platforms are to support such service attributes. Service platforms are to provide basic service-independent functions such as billing, identity management, context management, user profile management, etc. Instead of developing own solutions, developers of end-user services such as innovative messaging services or location-based services can utilise the platform-side functions for their own purposes. In doing so, the platform-side support for such functions takes away complexity, development time and development costs from service developers. Context-awareness and personalisation are two of the most important aspects of service platforms in telecommunications environments. The combination of context-awareness and personalisation features can also be described as situation-dependent personalisation of services. The support for this feature requires several processing steps. The focus of this doctoral thesis is on the processing step, in which the user’s current context is matched against situation-dependent user preferences to find the matching user preferences for the current user’s situation. However, to achieve this, a user profile management system and corresponding functionality is required. These parts are also covered by this thesis. Altogether, this thesis provides the following contributions: The first part of the contribution is mainly architecture-oriented. First and foremost, we provide a user profile management system that addresses the specific requirements of service platforms in telecommunications environments. In particular, the user profile management system has to deal with situation-specific user preferences and with user information for various services. In order to structure the user information, we also propose a user profile structure and the corresponding user profile ontology as part of an ontology infrastructure in a service platform. The second part of the contribution is the selection mechanism for finding matching situation-dependent user preferences for the personalisation of services. This functionality is provided as a sub-module of the user profile management system. Contrary to existing solutions, our selection mechanism is based on ontology reasoning. This mechanism is evaluated in terms of runtime performance and in terms of supported functionality compared to other approaches. The results of the evaluation show the benefits and the drawbacks of ontology modelling and ontology reasoning in practical applications.

Application of the european customer satisfaction index to postal services. Structural equation models versus partial least squars

Customer satisfaction and retention are key issues for organizations in today’s competitive market place. As such, much research and revenue has been invested in developing accurate ways of assessing consumer satisfaction at both the macro (national) and micro (organizational) level, facilitating comparisons in performance both within and between industries. Since the instigation of the national customer satisfaction indices (CSI), partial least squares (PLS) has been used to estimate the CSI models in preference to structural equation models (SEM) because they do not rely on strict assumptions about the data. However, this choice was based upon some misconceptions about the use of SEM’s and does not take into consideration more recent advances in SEM, including estimation methods that are robust to non-normality and missing data. In this paper, both SEM and PLS approaches were compared by evaluating perceptions of the Isle of Man Post Office Products and Customer service using a CSI format. The new robust SEM procedures were found to be advantageous over PLS. Product quality was found to be the only driver of customer satisfaction, while image and satisfaction were the only predictors of loyalty, thus arguing for the specificity of postal services

Gestión de servicio y satisfacción en el consulado general de Colombia en Londres

Se observa como cada vez más el mundo va evolucionando en el campo organizacional. En donde el servicio se convierte en un factor clave para suplir de conformidad los rigurosos requerimientos que exige el panorama global. Para entidades de gran magnitud e importancia para el gobierno como el Consulado General de Colombia en Londres, es de vital importancia mantener una imagen íntegra para establecerse como un portal de prosperidad y satisfacción para la comunidad. La detección de los factores relevantes de servicio presentes en el consulado y las pautas para el mejoramiento de estos harán del consulado una organización más agradable para la comunidad colombiana residente en el Reino Unido.