Responding to Young People's Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing.

OBJECTIVE: To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians' detection of health risks and patients' risk taking behaviour, compared to a didactic seminar on young people's health. DESIGN: Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. SETTING: General practices in metropolitan and rural Victoria, Australia. PARTICIPANTS: General practices with at least one interested clinician (general practitioner or nurse) and their 14-24 year old patients. INTERVENTION: This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients' risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. OUTCOME MEASURES: Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients' sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. RESULTS: 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524 patients) practices. 69% of patients in both intervention (260) and comparison (360) arms completed the 12 month follow-up. Intervention clinicians discussed more health risks per patient (59.7%) than comparison clinicians (52.7%) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours (38.4% vs 26.7%, risk difference [RD] 11.6%, Confidence Interval [CI] 2.93% to 20.3%; adjusted odds ratio [OR] 1.7, CI 1.1 to 2.5). Patients reported less illicit drug use (RD -6.0, CI -11 to -1.2; OR 0·52, CI 0·28 to 0·96), and less risk for STI (RD -5.4, CI -11 to 0.2; OR 0·66, CI 0·46 to 0·96) at three months in the intervention relative to the comparison arm, and for unplanned pregnancy at 12 months (RD -4.4; CI -8.7 to -0.1; OR 0·40, CI 0·20 to 0·80). No differences were detected between arms on other health risks. There were no differences on secondary outcomes, apart from a greater detection of abuse (OR 13.8, CI 1.71 to 111). There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool. CONCLUSIONS: A complex intervention, compared to a simple educational seminar for practices, improved detection of health risk behaviours in young people. Impact on health outcomes was inconclusive. Technology enabling more efficient, systematic health-risk screening may allow providers to target counselling toward higher risk individuals. Further trials require more power to confirm health benefits. TRIAL REGISTRATION: ISRCTN.com ISRCTN16059206.

The local configuration of a science and innovation policy : a city into the nanoworld

Local trajectories and arrangements play a significant role because the development of a research field, such as nanoscience and nanotechnology, requires substantial investments in human and instrumental resources. But why are there often concentrated in a limited number of places? What dynamics lead to such concentration? The hypothesis is that there is an assemblage of heterogeneous resources through the action of local actors. The chapter will explore, from an Actor Network Theory (ANT) perspective, how the local emergence of research dynamics from: the revival of local traditions, the local and national action of institutional entrepreneurs, controversial dynamics, and researchers' arrangements to involve other actors. It will examine how they connect up with each other and mutually commit themselves to the development of new technologies. It will focus on the role of narratives in this assembling: how were the local narratives of the past mobilized and to what effect.

Customer driven business model – connecting customer value to firm resources in ICT value networks

The objective of this thesis is to provide a business model framework that connects customer value to firm resources and explains the change logic of the business model. Strategic supply management and especially dynamic value network management as its scope, the dissertation is based on basic economic theories, transaction cost economics and the resource-based view. The main research question is how the changing customer values should be taken into account when planning business in a networked environment. The main question is divided into questions that form the basic research problems for the separate case studies presented in the five Publications. This research adopts the case study strategy, and the constructive research approach within it. The material consists of data from several Delphi panels and expert workshops, software pilot documents, company financial statements and information on investor relations on the companies’ web sites. The cases used in this study are a mobile multi-player game value network, smart phone and “Skype mobile” services, the business models of AOL, eBay, Google, Amazon and a telecom operator, a virtual city portal business system and a multi-play offering. The main contribution of this dissertation is bridging the gap between firm resources and customer value. This has been done by theorizing the business model concept and connecting it to both the resource-based view and customer value. This thesis contributes to the resource-based view, which deals with customer value and firm resources needed to deliver the value but has a gap in explaining how the customer value changes should be connected to the changes in key resources. This dissertation also provides tools and processes for analyzing the customer value preferences of ICT services, constructing and analyzing business models and business concept innovation and conducting resource analysis.

ESTRO-HERO survey: Guidelines for equipment and staffing of radiotherapy facilities in the European countries: Final results of the ESTRO-HERO survey

Background and purpose: In planning to meet evidence based needs for radiotherapy, guidelines for the provision of capital and human resources are central if access, quality and safety are not to be compromised. A component of the ESTRO-HERO (Health Economics in Radiation Oncology) project is to document the current availability and content of guidelines for radiotherapy in Europe. Materials and methods: An 84 part questionnaire was distributed to the European countries through their national scientific and professional radiotherapy societies with 30 items relating to the availability of guidelines for equipment and staffing and selected operational issues. Twenty-nine countries provided full or partial evaluable responses. Results: The availability of guidelines across Europe is far from uniform. The metrics used for capital and human resources are variable. There seem to have been no major changes in the availability or specifics of guidelines over the ten-year period since the QUARTS study with the exception of the recent expansion of RTT staffing models. Where comparison is possible it appears that staffing for radiation oncologists, medical physicists and particularly RTTs tend to exceed guidelines suggesting developments in clinical radiotherapy are moving faster than guideline updating. Conclusion: The efficient provision of safe, high quality radiotherapy services would benefit from the availability of well-structured guidelines for capital and human resources, based on agreed upon metrics, which could be linked to detailed estimates of need

Computational and Experimental Investigation of the Grooved Roll in Paper Machine Environment

In the paper machine, it is not a desired feature for the boundary layer flows in the fabric and the roll surfaces to travel into the closing nips, creating overpressure. In this thesis, the aerodynamic behavior of the grooved roll and smooth rolls is compared in order to understand the nip flow phenomena, which is the main reason why vacuum and grooved roll constructions are designed. A common method to remove the boundary layer flow from the closing nip is to use the vacuum roll construction. The downside of the use of vacuum rolls is high operational costs due to pressure losses in the vacuum roll shell. The deep grooved roll has the same goal, to create a pressure difference over the paper web and keep the paper attached to the roll or fabric surface in the drying pocket of the paper machine. A literature review revealed that the aerodynamic functionality of the grooved roll is not very well known. In this thesis, the aerodynamic functionality of the grooved roll in interaction with a permeable or impermeable wall is studied by varying the groove properties. Computational fluid dynamics simulations are utilized as the research tool. The simulations have been performed with commercial fluid dynamics software, ANSYS Fluent. Simulation results made with 3- and 2-dimensional fluid dynamics models are compared to laboratory scale measurements. The measurements have been made with a grooved roll simulator designed for the research. The variables in the comparison are the paper or fabric wrap angle, surface velocities, groove geometry and wall permeability. Present-day computational and modeling resources limit grooved roll fluid dynamics simulations in the paper machine scale. Based on the analysis of the aerodynamic functionality of the grooved roll, a grooved roll simulation tool is proposed. The smooth roll simulations show that the closing nip pressure does not depend on the length of boundary layer development. The surface velocity increase affects the pressure distribution in the closing and opening nips. The 3D grooved roll model reveals the aerodynamic functionality of the grooved roll. With the optimal groove size it is possible to avoid closing nip overpressure and keep the web attached to the fabric surface in the area of the wrap angle. The groove flow friction and minor losses play a different role when the wrap angle is changed. The proposed 2D grooved roll simulation tool is able to replicate the grooved aerodynamic behavior with reasonable accuracy. A small wrap angle predicts the pressure distribution correctly with the chosen approach for calculating the groove friction losses. With a large wrap angle, the groove friction loss shows too large pressure gradients, and the way of calculating the air flow friction losses in the groove has to be reconsidered. The aerodynamic functionality of the grooved roll is based on minor and viscous losses in the closing and opening nips as well as in the grooves. The proposed 2D grooved roll model is a simplification in order to reduce computational and modeling efforts. The simulation tool makes it possible to simulate complex paper machine constructions in the paper machine scale. In order to use the grooved roll as a replacement for the vacuum roll, the grooved roll properties have to be considered on the basis of the web handling application.

Kuka suunnittelee mainokset? Tutkimus mainosalan kulisseista,yhteistyökäytännöistä ja ristiriidoista. Mainonnan suunnittelijan näkökulma

Tutkimus kuvaa tapahtumia mainonnan suunnittelun kulissien takana ja niiden vaikutusta suunnittelutyöhön mainonnan suunnittelijan näkökulmasta. Lähestymistapa on systeemiteoreettinen: tutkimuksessa tarkastellaan sekä mainostoimiston suunnittelijoiden, projektijohtajien ja muiden mainonnan suunnitteluun osallistuvien keskinäistä vuorovaikutusta että mainostoimiston ja mainoksia tilaavan asiakkaan vuorovaikutuksen asettamia rajoja ja mahdollisuuksia. Keskeinen työväline on Kurt Lewinin kentän käsite. Tutkimuksessa se konkretisoituu esitystavaksi mainonnan suunnittelun olennaisista piirteistä, jotka ovat toisistaan riippuvaisia. Tutkimusta pohjustaa ajatus mainonnan suunnittelun perusrakenteesta, joka on riippumaton taloudellisista, yhteiskunnallisista tai mainostoimialan liiketoimintaympäristön muutoksista. Mainostoimistossa työtä tehdään usein ryhmässä. Ydinryhmä muodostuu kirjoittavan ja visuaalisen suunnittelijan työparista, mutta projektijohtaja on avainasemassa hoitaessaan yhteydenpitoa mainostoimiston asiakkaaseen. Tutkimustyötä viitoittivat kysymykset mainonnan suunnittelijoiden tehtävästä ja asemasta, työssä koetuista haasteista sekä osuudesta ja vastuusta lopullisissa töissä. Keskiössä ovat suunnittelutyötä raamittavat haasteet, jotka ohjaavat suunnittelijoiden kykyjä ja haluja toteuttaa luovuuttaan. Tutkimus ammentaa teoreettisia aineksia työnjaon ja tiimityön käsitteiden ohella vallan tilanteisuudesta ja suhteista sekä sosiaalisen pääoman ja luottamuksen moniaineksisuudesta. Tutkimuksen aineisto kerättiin syksyllä 2008 ja alkuvuodesta 2009 haastattelemalla suomalaisten mainostoimistojen suunnittelijoita. Haastatteluaineisto koostuu kymmenestä ryhmähaastattelusta, johon kuhunkin osallistui 3–4 suunnittelijaa. Muu aineisto sisältää toimialan tilastoja ja julkaisuja sekä yksityisiä sähköpostikirjeenvaihtoja ja keskusteluja mainosammattilaisten kanssa. Haastatteluaineisto analysoitiin Milesin ja Hubermannin aineistolähtöisen sisällönanalyysin avulla ja sitä täydennettiin retorisella diskurssianalyysilla. Analyysin alkuvaiheessa koemetodina sovellettiin Straussin ja Corbinin aineistolähtöisen teorian (grounded theory) kolmivaiheista koodausta. Tutkimuksen tuloksena on malli mainonnan suunnittelun kentän jännitteistä, jotka johtavat toimimaan tietyllä tavalla. Mainonnan suunnittelijan tehtävinä näyttäytyvät vaikuttaminen, asiakkaan tarpeiden tunnistaminen ja tyydyttäminen sekä omakohtainen menestyminen. Suunnittelijan asema näyttää työssä koettujen haasteiden kautta häilyvän asiantuntijuuden ja alihankkijuuden välimaastossa. Työn henkilökohtaisina haasteina piirtyvät tarmokkuuden ja jatkuvan oivaltamisen vaateet. Ulkoisina tekijöinä talouden, teknologian ja sen myötä median murros sekä haastaa että kehittää: alituiseen kiireeseen näytetään verhoavan pulmia, joiden todellinen alkuperä paikantuu muualle. Keskeiset ristiriidat ja toiminnan edellytykset ilmenevät juuri yhteistyössä: mainostoimiston sisäinen yhteistyö ja asiakkaan antama palaute ovat merkittäviä tekijöitä luottamuksen taustalla. Siten avoin ja vastavuoroinen kommunikaatio piirtyy olennaiseksi asetettujen tavoitteiden saavuttamisessa ja asiakkaan menestymisessä. Mainonnan suunnittelussa tärkeäksi kysymykseksi nousevat portinvartijoiden roolit. Mainostoimiston sisäisessä työskentelyssä projektijohtajat hallinnoivat suunnitteluresursseja, välittävät tietoa asiak kaalta suunnittelijalle ja päinvastoin sekä tekevät tärkeimmät päätökset. Asiakkaan puolella mainoksia tilaava asiakashenkilö hallinnoi valjastamiaan resursseja, mutta varsinainen päätöksenteko tapahtuu tämän esimiehen toimesta. Tulosten valossa on perusteltua uskoa, että mainonnan suunnittelijat kokevat oman työnsä arvon alentuneen ja päätösvaltansa vähentyneen. Mainostoimialan murroksen kannalta tutkimus tuo esiin uudenlaisen tiimityön ymmärtämisen ja korostaa yksilöiden vahvuuksien tunnistamisen merkitystä. Kiristyvässä taloudessa se suuntaa huomion sekä mainostoimistojen että niiden asiakasyritysten sisäisten ja ulkoisten resurssien tehokkaaseen ja tuottavaan hyödyntämiseen ja organisoimiseen. Sosiologisesti tutkimus tarjoaa yhdenlaisen näkökulman ryhmätyön ulottuvuuksiin ja työelämän yhteistyöhaasteiden pohtimiseen. Siten tutkimuksen tuloksilla voi nähdä arvoa myös muiden kuin mainosalan yhteistyökäytäntöjentarkasteluun.

Quality and analysis of administration processes in server operations

IT outsourcing refers to the way companies focus on their core competencies and buy the supporting functions from other companies specialized in that area. Service is the total outcome of numerous of activities by employees and other resources to provide solutions to customers' problems. Outsourcing and service business have their unique characteristics. Service Level Agreements quantify the minimum acceptable service to the user. The service quality has to be objectively quantified so that its achievement or non-achievement of it can be monitored. Usually offshoring refers to the transferring of tasks to low-cost nations. Offshoring presents a lot of challenges that require special attention and they need to be assessed thoroughly. IT Infrastructure management refers to installation and basic usability assistance of operating systems, network and server tools and utilities. ITIL defines the industry best practices for organizing IT processes. This thesis did an analysis of server operations service and the customers’ perception of the quality of daily operations. The agreed workflows and processes should be followed better. Service providers’ processes are thoroughly defined but both the customer and the service provider might disobey them. Service provider should review the workflows regarding customer functions. Customer facing functions require persistent skill development, as they communicate the quality to the customer. Service provider needs to provide better organized communication and knowledge exchange methods between the specialists in different geographical locations.

On the development of object functions and restrictions for shapes made with a turret punch press

This study presents the information required to describe the machine and device resources in the turret punch press environment which are needed for the development of the analysing method for automated production. The description of product and device resources and their interconnectedness is the starting point for method comparison the development of expenses, production planning and the performance of optimisation. The manufacturing method cannot be optimized unless the variables and their interdependence are known. Sheet metal parts in particular may then become remarkably complex, and their automatic manufacture may be difficult or, with some automatic equipment, even impossible if not know manufacturing properties. This thesis consists of three main elements, which constitute the triangulation. In the first phase of triangulation, the manufacture occuring on a turret punch press is examined in order to find the factors that affect the efficiency of production. In the second phase of triangulation, the manufacturability of products on turret punch presses is examined through a set of laboratory tests. The third phase oftriangulation involves an examination of five industry parts. The main key findings of this study are: all possible efficiency in high automation level machining cannot be achieved unless the raw materials used in production and the dependencies of the machine and tools are well known. Machine-specific manufacturability factors for turret punch presses were not taken into account in the industrial case samples. On the grounds of the performed tests and industrial case samples, the designer of a sheet metal product can directly influence the machining time, material loss, energy consumption and the number of tools required on a turret punch press by making decisions in the way presented in the hypothesis of thisstudy. The sheet metal parts to be produced can be optimised to bemanufactured on a turret punch press when the material to be used and the kinds of machine and tool options available are known. This provides in-depth knowledge of the machine and tool properties machine and tool-specifically. None of the optimisation starting points described here is a separate entity; instead, they are all connected to each other.

Verbal learning in mild cognitive impairment and alzheimer's disease : behavioural and neural approaches

The main focus of the present thesis was at verbal episodic memory processes that are particularly vulnerable to preclinical and clinical Alzheimer’s disease (AD). Here these processes were studied by a word learning paradigm, cutting across the domains of memory and language learning studies. Moreover, the differentiation between normal aging, mild cognitive impairment (MCI) and AD was studied by the cognitive screening test CERAD. In study I, the aim was to examine how patients with amnestic MCI differ from healthy controls in the different CERAD subtests. Also, the sensitivity and specificity of the CERAD screening test to MCI and AD was examined, as previous studies on the sensitivity and specificity of the CERAD have not included MCI patients. The results indicated that MCI is characterized by an encoding deficit, as shown by the overall worse performance on the CERAD Wordlist learning test compared with controls. As a screening test, CERAD was not very sensitive to MCI. In study II, verbal learning and forgetting in amnestic MCI, AD and healthy elderly controls was investigated with an experimental word learning paradigm, where names of 40 unfamiliar objects (mainly archaic tools) were trained with or without semantic support. The object names were trained during a 4-day long period and a follow-up was conducted one week, 4 weeks and 8 weeks after the training period. Manipulation of semantic support was included in the paradigm because it was hypothesized that semantic support might have some beneficial effects in the present learning task especially for the MCI group, as semantic memory is quite well preserved in MCI in contrast to episodic memory. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, indicating that the MCI patients’ preserved semantic memory abilities compensated for their impaired episodic memory. The MCI group performed equally well as the controls in the tasks tapping incidental learning and recognition memory, whereas the AD group showed impairment. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that acquisition is compromised in both MCI and AD, whereas long13 term retention is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI. In studies III and IV, the neural correlates of naming newly learned objects were examined in healthy elderly subjects and in amnestic MCI patients by means of positron emission tomography (PET) right after the training period. The naming of newly learned objects by healthy elderly subjects recruited a left-lateralized network, including frontotemporal regions and the cerebellum, which was more extensive than the one related to the naming of familiar objects (study III). Semantic support showed no effects on the PET results for the healthy subjects. The observed activation increases may reflect lexicalsemantic and lexical-phonological retrieval, as well as more general associative memory mechanisms. In study IV, compared to the controls, the MCI patients showed increased anterior cingulate activation when naming newly learned objects that had been learned without semantic support. This suggests a recruitment of additional executive and attentional resources in the MCI group.

Integrating environmental education in primary school education in Tanzania : teachers’ perceptions and teaching practices

The study focuses on primary school teachers’ perceptions of environmental education, its integration into primary school education and teachers’ teaching practices in Tanzania. The thesis is based on empirical research. The theoretical underpinnings of the study are based on Palmer’s (1998) model of environmental education. According to the model, meaningful environmental education should include education about, in or through and for the environment. The study is supported by national and international literature from research done on environmental education and education for sustainable development and policy statements. The study is qualitative in nature, adopting phenomenography and phenomenology as points of departure. The empirical data was collected from four primary schools in Morogoro region in Tanzania. The study sample consisted of 31 primary school teachers. Data was collected through interviews and lesson observations. According to the results of the study, primary school teachers expressed variations in their perceptions of environmental education and education for sustainable development. Most of the teachers focused on the aspect of knowledge acquisition. According to Tanzanian education and training policy, environmental education has to be integrated into all subjects. Although there is environmental education in the primary school curriculum, it is not integrated on an equal footing in all subjects. Some subjects like science, social studies and geography have more environmental content than other subjects. Teachers claim that the approach used to integrate environmental education into the school curriculum was not favoured because many claimed that what is to be taught as environmental education in the various subjects is not shown clearly. As a result, many teachers suggested that to ensure that it is taught properly it should be included in the curriculum as an independent subject or as specific topics. The study revealed that teachers’ teaching practices in integrating environmental education varied from one subject to another. Although most of the teachers said that they used participatory methods, lesson observations showed that they limited themselves to question and answer and group discussion. However, the teachers faced a number of barriers in the teaching of environmental education, some of which include lack of teaching and learning resources, time and large class size. The role of teachers in the implementation of environmental education in developing an environmentally literate citizenry is of great significance. The responsibility of the government in developing a curriculum with clear goals and content, developing teachers’ capacity in the teaching of environmental education and provision of teaching and learning materials needs to be taken seriously by the government in educational plans and programs.

An Infant with Food Allergy and Eczema in the Family – The Mental and Economic Burden of Caring

Allergic diseases including food allergy and eczema in an infant in combination with the everyday activities of caring for a family will pose challenges to parents. Only fragments of these challenges are revealed to health care professionals. Families have varying mental, social and economic resources to help them care for an allergic infant, and all such resources are important in determining how families succeed in meeting these challenges and the quality of the infant’s care. This study evaluated the whole burden to the family caused by an infant's allergic disease during the first 24 months of life. As the primary caregiver during this period is usually the mother, her perspective was considered important. Ecocultural theory, which considers families as capable of modifying the positive and negative forces facing them, was taken as the frame of reference. Data were collected as part of an ongoing prospective mother-infant study, and the methods included severity scoring of atopic dermatitis, dietary records, health-related quality of life measurements and assessments of the use of health care services and medications for treating the infant’s eczema, food allergy and asthma. Interviews with mothers were analysed by deductive content analysis on the basis of ecocultural theory and the family empowerment model. The theme “Living an ordinary family life” guided the organization of family activities essential for treating the infant's food allergy and eczema. These activities were sources of both strain and support for the mothers, the allergy-related supporting factors being the mother’s own knowledge of the allergy, hopes for an improvement in the infant’s condition, social support and work. An infant’s food allergy at the age of one year caused considerable strain for the mother in cases where the introduction of new foods into the child’s diet was delayed. This delay was still causing the mother additional strain when the child was 24 months of age. The infants waking at night at the ages of 12 and 24 months because of itching related to eczema caused strain for the mothers. The infants’ health-related quality of life was impaired at ages of 6 and 12 months compared with healthy infants. The principal reasons for impairments were itching, scratching and sleep disturbances at 6 and 12 months and treatment difficulties at 6 months. Problems with getting to sleep were reported at all stages irrespective of eczema and were also present in healthy infants. The economic impact of the treatment of allergic diseases on families during the first 24 months was 131 EUR (2006 value) in cases of eczema and 525 EUR in cases of food allergy. From the societal perspective, the costs of food allergy were a median of 3183 EUR (range 628–11 560 EUR) and of eczema a median of 275 EUR (range 94–1306 EUR). These large variations in costs in food allergy and eczema indicate that disease varies greatly . In conclusion, food allergy and eczema cause extra activities and costs to families which arrange these disease-related activities in such a way that they support the leading family theme “Living an ordinary family life”. Health care professionals should consider this thematic character of family life and disease-related activities in order to ensure that new treatments are sustainable, meaningful and tailored to daily activities. In addition, those mothers who are experiencing difficulties with food allergic infants or infants with eczema should be recognized early and provided with individual encouragement and support from health clinics. In the light of the present results, early detection of symptoms and effective parental guidance can contribute to the well-being and health-related quality of life of the child and family.

Strategic alliances as an international entry strategy: Finnish cleantech SMEs and the Indian market

The demand for environmental technologies, also called cleantech, is growing globally but the need is especially high in emerging markets such as India where the rising economy and rapid industrialisation have led to increasing energy needs and environmental degradation. The market is of great potential also for the Finnish cleantech cluster that represents advanced expertise in several fields of environmental technologies. However, most of the Finnish companies in the field are SMEs that face challenges in their internationalisation due to their limited resources. The objective of this study was to estimate, whether strategic alliances could be an efficient entry strategy for Finnish cleantech SMEs entering the Indian market. This was done by studying what are the key factors influencing the international entry mode decision of Finnish cleantech SMEs, what are the major factors affecting the entry of Finnish cleantech SMEs to the Indian market and how do Finnish cleantech SMEs use strategic alliances in their internationalisation process. The study was realised as a qualitative multi-case study through theme interviews of Finnish cleantech SME representatives. The results indicated that Finnish cleantech SMEs prefer to enter international markets through non-equity and collaborative modes of entry. These entry modes are chosen because of the small size and limited resources of companies, but also because they want to protect their innovative technologies from property rights violations. India is an attracting market for Finnish cleantech SMEs mainly because of its size and growth, but insufficient environmental regulation and high import tariffs have hindered entry to the market. Finnish cleantech SMEs commonly use strategic alliances in their internationalisation process but the use is rather one-sided. Most of the formed strategic alliances are low-commitment, international contractual agreement in sales and distribution. Alliance partner selection receives less attention. In the future, providing Finnish cleantech SMEs with international experience and training could help in diversifying the use of strategic alliances and increase their benefits to SME internationalisation.

The challenges and success factors of commercializing cleaner technologies

Cleaner technologies include products, services, technologies, processes and systems that in use create less environmental hazard than the existing alternatives. Rapidly growing cleantech sector possesses an essential competitive advantage in the future. However, no profound research has been conducted on the characteristics of cleaner technologies and their effect on the commercialization process. This thesis aims at synthesizing scattered information and creating a basis for accelerating cleaner technology commercialization in Finnish context. Two research questions are defined: 1. What are the key challenges and success factors in the commercialization of cleaner technologies based on the existing literature? 2. What kind of lessons can be learned from the Finnish success stories of cleantech commercialization? The research was conducted as a literature review and supported with three case interviews. The results suggest that literature-based challenges are mostly related to, for example, difficulty in gathering customer information, unrealistic customer expectations, lack of resources, networks and proper success indicators, legislation, and unstructured strategy planning stemming from company culture. Handling the barriers require, above all, open communication from all stakeholders, management commitment and accurate goal setting, government-driven funding and incentives, and cooperation with educational facilities. Finnish success cases emphasize especially customer attention: listening to customers and receiving feedback from them during the whole commercialization process to correct the errors early and save resources, visionary in fulfilling customer needs, ability to question company’s own business performance, not being afraid of making mistakes but learning from them, and continuously observing and evaluating the commercialization process.

On Innovative Search: the use of internal and external sources of innovation among Finnish innovators

This dissertation explores the use of internal and external sources of knowledge in modern innovation processes. It builds on a framework that combines theories such as a behavioural theory of the firm, the evolutionary theory of economic change, and modern approaches to strategic management. It follows the recent increase in innovation research focusing on the firm-level examination of innovative activities instead of traditional industry-level determinants. The innovation process is seen as a problem- and slack- driven search process, which can take several directions in terms of organizational boundaries in the pursuit of new knowledge and other resources. It thus draws on recent models of technological change, according to which firms nowadays should build their innovative activities on both internal and external sources of innovation rather than relying solely on internal resources. Four different research questions are addressed, all of which are empirically investigated via a rich dataset covering Finnish innovators collected by Statistics Finland. Firstly, the study examines how the nature of problems shapes the direction of any search for new knowledge. In general it demonstrates that the nature of the problem does affect the direction of the search, although under resource constraints firms tend to use external rather than internal sources of knowledge. At the same time, it shows that those firms that are constrained in terms of finance seem to search both internally and externally. Secondly, the dissertation investigates the relationships between different kinds of internal and external sources of knowledge in an attempt to find out where firms should direct their search in order to exploit the potential of a distributed innovation process. The concept of complementarities is applied in this context. The third research question concerns how the use of external knowledge sources – openness to external knowledge – influences the financial performance of firms. Given the many advantages of openness presented in the current literature, the focus is on how it shapes profitability. The results reveal a curvilinear relationship between profitability and openness (taking an inverted U-shape), the implication being that it pays to be open up to a certain point, but being too open to external sources may be detrimental to financial performance. Finally, the dissertation addresses some challenges in CISbased innovation research that have received relatively little attention in prior studies. The general aim is to underline the fact that comprehensive understanding of the complex process of technological change requires the constant development of methodological approaches (in terms of data and measures, for example). All the empirical analyses included in the dissertation are based on the Finnish CIS (Finnish Innovation Survey 1998-2000).

Immediate Decision-Making and Information Needs in Intensive Care Coordination

The aim of this study was to develop a theoretical model for information integration to support the deci¬sion making of intensive care charge nurses, and physicians in charge – that is, ICU shift leaders. The study focused on the ad hoc decision-making and immediate information needs of shift leaders during the management of an intensive care unit’s (ICU) daily activities. The term ‘ad hoc decision-making’ was defined as critical judgements that are needed for a specific purpose at a precise moment with the goal of ensuring instant and adequate patient care and a fluent flow of ICU activities. Data collection and research analysis methods were tested in the identification of ICU shift leaders’ ad hoc decision-making. Decision-making of ICU charge nurses (n = 12) and physicians in charge (n = 8) was observed using a think-aloud technique in two university-affiliated Finnish ICUs for adults. The ad hoc decisions of ICU shift leaders were identified using an application of protocol analysis. In the next phase, a structured online question¬naire was developed to evaluate the immediate information needs of ICU shift leaders. A national survey was conducted in all Finnish, university-affiliated hospital ICUs for adults (n = 17). The questionnaire was sent to all charge nurses (n = 515) and physicians in charge (n = 223). Altogether, 257 charge nurses (50%) and 96 physicians in charge (43%) responded to the survey. The survey was also tested internationally in 16 Greek ICUs. From Greece, 50 charge nurses out of 240 (21%) responded to the survey. A think-aloud technique and protocol analysis were found to be applicable for the identification of the ad hoc decision-making of ICU shift leaders. During one day shift leaders made over 200 ad hoc decisions. Ad hoc decisions were made horizontally, related to the whole intensive care process, and vertically, concerning single intensive care incidents. Most of the ICU shift leaders’ ad hoc decisions were related to human resources and know-how, patient information and vital signs, and special treatments. Commonly, this ad hoc decision-making involved several multiprofessional decisions that constituted a bundle of immediate decisions and various information needs. Some of these immediate information needs were shared between the charge nurses and the physicians in charge. The majority of which concerned patient admission, the organisation and management of work, and staff allocation. In general, the information needs of charge nurses were more varied than those of physicians. It was found that many ad hoc deci-sions made by the physicians in charge produced several information needs for ICU charge nurses. This meant that before the task at hand was completed, various kinds of information was sought by the charge nurses to support the decision-making process. Most of the immediate information needs of charge nurses were related to the organisation and management of work and human resources, whereas the information needs of the physicians in charge mainly concerned direct patient care. Thus, information needs differ between professionals even if the goal of decision-making is the same. The results of the international survey confirmed these study results for charge nurses. Both in Finland and in Greece the information needs of charge nurses focused on the organisation and management of work and human resources. Many of the most crucial information needs of Finnish and Greek ICU charge nurses were common. In conclusion, it was found that ICU shift leaders make hundreds of ad hoc decisions during the course of a day related to the allocation of resources and organisation of patient care. The ad hoc decision-making of ICU shift leaders is a complex multi-professional process, which requires a lot of immediate information. Real-time support for information related to patient admission, the organisation and man¬agement of work, and allocation of staff resources is especially needed. The preliminary information integration model can be applied when real-time enterprise resource planning systems are developed for intensive care daily management