966 resultados para Literature reviews
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1 Summary This dissertation deals with two major aspects of corporate governance that grew in importance during the last years: the internal audit function and financial accounting education. In three essays, I contribute to research on these topics which are embedded in the broader corporate governance literature. The first two essays consist of experimental investigations of internal auditors' judgments. They deal with two research issues for which accounting research lacks evidence: The effectiveness of internal controls and the potentially conflicting role of the internal audit function between management and the audit committee. The findings of the first two essays contribute to the literature on internal auditors' judgment and the role of the internal audit function as a major cornerstone of corporate governance. The third essay theoretically examines a broader issue but also relates to the overall research question of this dissertation: What contributes to effective corporate governance? This last essay takes the perspective that the root for quality corporate governance is appropriate financial accounting education. r develop a public interest approach to accounting education that contributes to the literature on adequate accounting education with respect to corporate governance and accounting harmonization. The increasing importance of both the internal audit function and accounting education for corporate governance can be explained by the same recent fundamental changes that still affect accounting research and practice. First, the Sarbanes-Oxley Act of 2002 (SOX, 2002) and the 8th EU Directive (EU, 2006) have led to a bigger role for the internal audit function in corporate governance. Their implications regarding the implementation of audit committees and their oversight over internal controls are extensive. As a consequence, the internal audit function has become increasingly important for corporate governance and serves a new master (i.e. the audit committee) within the company in addition to management. Second, the SOX (2002) and the 8th EU Directive introduced additional internal control mechanisms that are expected to contribute to the reliability of financial information. As a consequence, the internal audit function is expected to contribute to a greater extent to the reliability of financial statements. Therefore, effective internal control mechanisms that strengthen objective judgments and independence become important. This is especially true when external- auditors rely on the work of internal auditors in the context of the International Standard on Auditing (ISA) 610 and the equivalent US Statement on Auditing Standards (SAS) 65 (see IFAC, 2009 and AICPA, 1990). Third, the harmonization of international reporting standards is increasingly promoted by means of a principles-based approach. It is the leading approach since a study of the SEC (2003) that was required by the SOX (2002) in section 108(d) was in favor of this approach. As a result, the Financial Accounting Standards Board (FASB) and the International Accounting Standards Board (IASB) commit themselves to the development of compatible accounting standards based on a principles-based approach. Moreover, since the Norwalk Agreement of 2002, the two standard setters have developed exposure drafts for a common conceptual framework that will be the basis for accounting harmonization. The new .framework will be in favor of fair value measurement and accounting for real-world economic phenomena. These changes in terms of standard setting lead to a trend towards more professional judgment in the accounting process. They affect internal and external auditors, accountants, and managers in general. As a consequence, a new competency set for preparers and users of financial statements is required. The basil for this new competency set is adequate accounting education (Schipper, 2003). These three issues which affect corporate governance are the initial point of this dissertation and constitute its motivation. Two broad questions motivated a scientific examination in three essays: 1) What are major aspects to be examined regarding the new role of the internal audit function? 2) How should major changes in standard setting affect financial accounting education? The first question became apparent due to two published literature reviews by Gramling et al. (2004) and Cohen, Krishnamoorthy & Wright (2004). These studies raise various questions for future research that are still relevant and which motivate the first two essays of my dissertation. In the first essay, I focus on the role of the internal audit function as one cornerstone of corporate governance and its potentially conflicting role of serving both management and the audit committee (IIA, 2003). In an experimental study, I provide evidence on the challenges for internal auditors in their role as servant for two masters -the audit committee and management -and how this influences internal auditors' judgment (Gramling et al. 2004; Cohen, Krishnamoorthy & Wright, 2004). I ask if there is an expectation gap between what internal auditors should provide for corporate governance in theory compared to what internal auditors are able to provide in practice. In particular, I focus on the effect of serving two masters on the internal auditor's independence. I argue that independence is hardly achievable if the internal audit function serves two masters with conflicting priorities. The second essay provides evidence on the effectiveness of accountability as an internal control mechanism. In general, internal control mechanisms based on accountability were enforced by the SOX (2002) and the 8th EU Directive. Subsequently, many companies introduced sub-certification processes that should contribute to an objective judgment process. Thus, these mechanisms are important to strengthen the reliability of financial statements. Based on a need for evidence on the effectiveness of internal control mechanisms (Brennan & Solomon, 2008; Gramling et al. 2004; Cohen, Krishnamoorthy & Wright, 2004; Solomon & Trotman, 2003), I designed an experiment to examine the joint effect of accountability and obedience pressure in an internal audit setting. I argue that obedience pressure potentially can lead to a negative influence on accountants' objectivity (e.g. DeZoort & Lord, 1997) whereas accountability can mitigate this negative effect. My second main research question - How should major changes in standard setting affect financial accounting education? - is investigated in the third essay. It is motivated by the observation during my PhD that many conferences deal with the topic of accounting education but very little is published about what needs to be done. Moreover, the Endings in the first two essays of this thesis and their literature review suggest that financial accounting education can contribute significantly to quality corporate governance as argued elsewhere (Schipper, 2003; Boyce, 2004; Ghoshal, 2005). In the third essay of this thesis, I therefore focus on approaches to financial accounting education that account for the changes in standard setting and also contribute to corporate governance and accounting harmonization. I argue that the competency set that is required in practice changes due to major changes in standard setting. As the major contribution of the third article, I develop a public interest approach for financial accounting education. The major findings of this dissertation can be summarized as follows. The first essay provides evidence to an important research question raised by Gramling et al. (2004, p. 240): "If the audit committee and management have different visions for the corporate governance role of the IAF, which vision will dominate?" According to the results of the first essay, internal auditors do follow the priorities of either management or the audit committee based on the guidance provided by the Chief Audit executive. The study's results question whether the independence of the internal audit function is actually achievable. My findings contribute to research on internal auditors' judgment and the internal audit function's independence in the broader frame of corporate governance. The results are also important for practice because independence is a major justification for a positive contribution of the internal audit function to corporate governance. The major findings of the second essay indicate that the duty to sign work results - a means of holding people accountable -mitigates the negative effect of obedience pressure on reliability. Hence, I found evidence that control .mechanisms relying on certifications may enhance the reliability of financial information. These findings contribute to the literature on the effectiveness of internal control mechanisms. They are also important in the light of sub-certification processes that resulted from the Sarbanes-Oxley Act and the 8th EU Directive. The third essay contributes to the literature by developing a measurement framework that accounts for the consequences of major trends in standard setting. Moreovér, it shows how these trends affect the required .competency set of people dealing with accounting issues. Based on this work, my main contribution is the development of a public interest approach for the design of adequate financial accounting curricula. 2 Serving two masters: Experimental evidence on the independence of internal auditors Abstract Twenty nine internal auditors participated in a study that examines the independence of internal auditors in their potentially competing roles of serving two masters: the audit committee and management. Our main hypothesis suggests that internal auditors' independence is not achievable in an institutional setting in which internal auditors are accountable to two different parties with potentially differing priorities. We test our hypothesis in an experiment in which the treatment consisted of two different instructions of the Chief audit executive; one stressing the priority of management (cost reduction) and one stressing the priority of the audit committee (effectiveness). Internal auditors had to evaluate internal controls and their inherent costs of different processes which varied in their degree of task complexity. Our main results indicate that internal auditors' evaluation of the processes is significantly different when task complexity is high. Our findings suggest that internal auditors do follow the priorities of either management or the audit committee depending on the instructions of a superior internal auditor. The study's results question whether the independence of the internal audit function is actually achievable. With our findings, we contribute to research on internal auditors' judgment and the internal audit function's independence in the frame of corporate governance.
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Even though the research on innovation in services has expanded remarkably especially during the past two decades, there is still a need to increase understanding on the special characteristics of service innovation. In addition to studying innovation in service companies and industries, research has also recently focused more on services in innovation, as especially the significance of so-called knowledge intensive business services (KIBS) for the competitive edge of their clients, othercompanies, regions and even nations has been proved in several previous studies. This study focuses on studying technology-based KIBS firms, and technology andengineering consulting (TEC) sector in particular. These firms have multiple roles in innovation systems, and thus, there is also a need for in-depth studies that increase knowledge about the types and dimensions of service innovations as well as underlying mechanisms and procedures which make the innovations successful. The main aim of this study is to generate new knowledge in the fragmented research field of service innovation management by recognizing the different typesof innovations in TEC services and some of the enablers of and barriers to innovation capacity in the field, especially from the knowledge management perspective. The study also aims to shed light on some of the existing routines and new constructions needed for enhancing service innovation and knowledge processing activities in KIBS companies of the TEC sector. The main samples of data in this research include literature reviews and public data sources, and a qualitative research approach with exploratory case studies conducted with the help of the interviews at technology consulting companies in Singapore in 2006. These complement the qualitative interview data gathered previously in Finland during a larger research project in the years 2004-2005. The data is also supplemented by a survey conducted in Singapore. The respondents for the survey by Tan (2007) were technology consulting companies who operate in the Singapore region. The purpose ofthe quantitative part of the study was to validate and further examine specificaspects such as the influence of knowledge management activities on innovativeness and different types of service innovations, in which the technology consultancies are involved. Singapore is known as a South-east Asian knowledge hub and is thus a significant research area where several multinational knowledge-intensive service firms operate. Typically, the service innovations identified in the studied TEC firms were formed by several dimensions of innovations. In addition to technological aspects, innovations were, for instance, related to new client interfaces and service delivery processes. The main enablers of and barriers to innovation seem to be partly similar in Singaporean firms as compared to the earlier study of Finnish TEC firms. Empirical studies also brought forth the significance of various sources of knowledge and knowledge processing activities as themain driving forces of service innovation in technology-related KIBS firms. A framework was also developed to study the effect of knowledge processing capabilities as well as some moderators on the innovativeness of TEC firms. Especially efficient knowledge acquisition and environmental dynamism seem to influence the innovativeness of TEC firms positively. The results of the study also contributeto the present service innovation literature by focusing more on 'innovation within KIBs' rather than 'innovation through KIBS', which has been the typical viewpoint stressed in the previous literature. Additionally, the study provides several possibilities for further research.
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The main objective of this study is to analyze the role and potential of transfer pricing as a means of management control in large organizations. The special emphasis is on analyzing the potential of transfer pricing when we are motivating the profit center managers. The research approach is theoretical and literature reviews include studies about profit center organizations, performance measurement and analysis, incentive systems, transfer pricing techniques and agency theory. Based on the analysis, it seems that transfer pricing is a suitable tool for controlling, motivating and managing profit center managers. This requires that the performance measurement can be done fairly and transfer prices are set using fair assumptions. The motivating effects of transfer pricing can be enhanced if the reward system is connected to performance measurement system. In synthesis there is presented effects of transfer pricing to profit center managers behavior. There is also presented opinion about fair transfer pricing policy.
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Työn tarkoituksena oli laatia suunnitelma ilmaan johdettavien epäpuhtauksien päästökartoitukselle Porvoon öljynjalostamolla. Raskasmetallien, metaanin, fluorivetyhapon, rikkivedyn ja ammoniakin merkittävät päästöpaikat ja -tarkkailumenetelmät kartoitettaisiin tulevaa päästöraportointia varten. Tarkkailun alaisten komponenttien muodostuminen, kulkeutuminen ja merkittävät päästöpaikat Porvoon jalostamolla selvitettiin kirjallisuuslähteiden, jalostamon toimintajärjestelmän ohjeiden sekä työntekijöiden haastattelujen perusteella. Merkittäviä häiriöpäästötilanteita kartoitettiin ja arvioitiin jalostamon poikkeamatilastojen ja haastattelujen avulla. Normaalitoiminnan aikana tarkkailun alaisista epäpuhtauksista vapautuu ilmaan merkittäviä määriä ainoastaan metaania ja raskasmetalleja. Metaania vapautuu ilmaan polttoprosesseissa sekä hajapäästönä. Raskasmetallipäästöjä syntyy pohjaöljyn poltossa energialaitoksella sekä leijukatalyyttisessä krakkauksessa. Rikkilaitosten häiriötilanteista aiheutuu rikkivety- ja ammoniakkipäästöjä pääasiassa soihtujärjestelmän kautta. Alkylointiyksikön vuodoissa voi vapautua fluorivetyhappoa ilmaan. Päästömääriä arvioidaan pääosin laskennallisesti. Päästökartoitussuunnitelma on kokonaisuudessaan tämän työn liitteenä. Näyttäisi siltä, että TRS-yhdisteiden, ammoniakin ja fluorivetyhapon ilmapäästöt eivät ole merkittäviä Porvoon öljynjalostamolla. Uuden pohjaöljy-yksikön käyttöönotto on vähentänyt myös raskasmetallipäästöjä energialaitoksella. Metaanipäästö vaikuttaa kartoitukseen sisällytettävistä epäpuhtauksista merkityksellisimmältä Porvoon öljynjalostamolla.
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The thesis deals with the phenomenon of learning between organizations in innovation networks that develop new products, services or processes. Inter organizational learning is studied especially at the level of the network. The role of the network can be seen as twofold: either the network is a context for inter organizational learning, if the learner is something else than the network (organization, group, individual), or the network itself is the learner. Innovations are regarded as a primary source of competitiveness and renewal in organizations. Networking has become increasingly common particularly because of the possibility to extend the resource base of the organization through partnerships and to concentrate on core competencies. Especially in innovation activities, networks provide the possibility to answer the complex needs of the customers faster and to share the costs and risks of the development work. Networked innovation activities are often organized in practice as distributed virtual teams, either within one organization or as cross organizational co operation. The role of technology is considered in the research mainly as an enabling tool for collaboration and learning. Learning has been recognized as one important collaborative process in networks or as a motivation for networking. It is even more important in the innovation context as an enabler of renewal, since the essence of the innovation process is creating new knowledge, processes, products and services. The thesis aims at providing enhanced understanding about the inter organizational learning phenomenon in and by innovation networks, especially concentrating on the network level. The perspectives used in the research are the theoretical viewpoints and concepts, challenges, and solutions for learning. The methods used in the study are literature reviews and empirical research carried out with semi structured interviews analyzed with qualitative content analysis. The empirical research concentrates on two different areas, firstly on the theoretical approaches to learning that are relevant to innovation networks, secondly on learning in virtual innovation teams. As a result, the research identifies insights and implications for learning in innovation networks from several viewpoints on organizational learning. Using multiple perspectives allows drawing a many sided picture of the learning phenomenon that is valuable because of the versatility and complexity of situations and challenges of learning in the context of innovation and networks. The research results also show some of the challenges of learning and possible solutions for supporting especially network level learning.
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The aim of this study was to create an outsourcing process for pharmaceutical product development. This study focuses on two main questions. The first question is “What is the outsourcing process model?” In the second phase key success factors of the outsourcing process are identified. As a result of the literature reviews, a general outsourcing process was created. Transaction cost economics and resource based view were used to derived a theoretical framework to the process by combining the existing processes presented in the literature. The model of process is considered used to the outsourcing broadly. The general outsourcing process was then developed further with the key factors that affect the success of pharmaceutical product development and the interviews of pharmaceutical outsourcing experts. The result of the research was the process consists of seven phases with key activities and expected outputs for each of the phases. In addition, the strategic decision-making framework for outsourcing decision in pharmaceutical product development is giving as well as the tools for selecting supplier and preparing structured contract. This study also gives some recommendations for managing the outsourcing process.
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The management of port-related supply chains is challenging due to the complex and heterogeneous operations of the ports with several actors and processes. That is why the importance of information sharing is emphasised in the ports. However, the information exchange between different port-related actors is often cumbersome and it still involves a lot of manual work and paper. Major ports and port-related actors usually have advanced information systems in daily use but these systems are seldom interoperable with each other, which prevents economies of scale to be reached. Smaller ports and companies might not be equipped with electronic data transmission at all. This is the final report of the Mobile port (MOPO) project, which has sought ways to improve the management and control of port-related sea and inland traffic with the aid of ICT technologies. The project has studied port community systems (PCS) used worldwide, evaluated the suitability of a PCS for the Finnish port operating environment and created a pilot solution of a Finnish PCS in the port of HaminaKotka. Further, the dry port concept and its influences on the transportation system have been explored. The Mobile Port project comprised of several literature reviews, interviews of over 50 port-related logistics and/or ICT professionals, two different kinds of simulation models as well as designing and implementing of the pilot solution of the Finnish PCS. The results of these multiple studies are summarised in this report. Furthermore, recommendations for future actions and the topics for further studies are addressed in the report. The study revealed that the information sharing in a typical Finnish port-related supply chain contains several bottlenecks that cause delays in shipments and waste resources. The study showed that many of these bottlenecks could be solved by building a port community system for the Finnish port community. Almost 30 different kinds of potential services or service entities of a Finnish PCS were found out during the study. The basic requirements, structure, interfaces and operation model of the Finnish PCS were also defined in the study. On the basis of the results of the study, a pilot solution of the Finnish PCS was implemented in the port of HaminaKotka. The pilot solution includes a Portconnect portal for the Finnish port community system (available at https://www.portconnect.fi) and two pilot applications, which are a service for handling the information flows concerning the movements of railway wagons and a service for handling the information flows between Finnish ports and Finland-Russian border. The study also showed that port community systems can be used to improve the environmental aspects of logistics in two different ways: 1) PCSs can bring direct environmental benefits and 2) PCSs can be used as an environmental tool in a port community. On the basis of the study, the development of the Finnish port community system should be continued by surveying other potential applications for the Finnish PCS. It is also important to study if there is need and resources to extend the Finnish PCS to operate in several ports or even on a national level. In the long run, it could be reasonable to clarify whether there would be possibilities to connect the Finnish PCS as a part of Baltic Sea wide, European-wide or even worldwide maritime and port-related network in order to get the best benefit from the system
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This Master´s thesis illustrates how growing a business ties up the company´s working capital and what the cost of committed capital. In order to manage a company´s working capital in rapid business growth phase, the thesis suggests that by monitoring and managing the operating and cash conversion cycles of customers´ projects, a company can find ways to secure the required amount of capital. The research method of this thesis was based on literature reviews and case study research. The theoretical review presents the concepts of working capital and provides the background for understanding how to improve working capital management. The company in subject is a global small and medium-sized enterprise that manufactures pumps and valves for demanding process conditions. The company is expanding, which creates lots of challenges. This thesis concentrates to the company´s working capital management and its efficiency through the supply chain and value chain perspective. The main elements of working capital management are inventory management, accounts receivable management and accounts payable management. Prepayments also play a significant role, particularly in project-based businesses. Developing companies´ working capital management requires knowledge from different kind of key operations´ in the company, like purchasing, production, sales, logistics and financing. The perspective to develop and describe working capital management is an operational. After literature reviews the thesis present pilot projects that formed the basis of a model to monitor working capital in the case company. Based on analysis and pilot projects, the thesis introduces a rough model for monitoring capital commitments in short time period. With the model the company can more efficiently monitor and manage their customer projects.
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The threat of global warming and its consequences are widely recognized, and the question of how to proceed with the long transition towards fossil fuel -neutral economies concerns many nations and people. At the same time the world’s primary energy use is predicted to increase significantly during the next decades as a result of global population and welfare increase. Improved energy efficiency and increased use of renewable energy sources in the world’s energy mix play important roles in the future energy production and consumption. The objective of this thesis is to study how novel renewable energy technologies, such as distributed small-scale bio-fueled combined heat and power production and wind power technologies could be commercialized efficiently. A wide array of attributes may contribute to the diffusion of new products. In general, the bioenergy and wind power technologies are in emerging phases, and the diffusion stage varies from country to country. The effects of firms’ technology choices, collaboration and alliances are studied in this thesis. Furthermore, the roles of national energy infrastructure and energy support schemes in the commercialization of new renewable energy products are explored. The empirical data is based on energy expert interviews, financial and patent data, and literature reviews of different case studies. The thesis comprises two parts. The first part provides an overview of the study, and the second part includes six research publications. The results reveal that small-scale bio-fueled combined heat and power production and wind power technologies are still in emerging phases in their life cycles, and energy support schemes are crucial in the market diffusion. The study contributes to earlier findings in the literature and industry by confirming that adequate energy policies and energy infrastructure are fundamental in the commercialization of novel renewable energy technologies. Firm-specific issues, including business relationships and new business models, and market-related issues will have a more significant role in the market penetration in the future, when the technologies mature and become competitive without political support schemes.
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The purpose of this study was to examine and expand understanding concerning young Finnish registered nurses (RN) with an intention to leave the profession and the related variables, specifically when that intention has emerged before the age of 30. The overall goal of the study was to develop a conceptual model in relation to young RNs’ intention to leave the profession. Suggestions for policymakers, nurse leaders and nurse managers are presented for how to retain more young RNs in the nursing workforce. Suggestions for future nursing research are also provided. Phase I consists of two sequential integrative literature reviews of 75 empirical articles concerning nurses’ intention to leave the profession. In phase II, data had been collected as part of the Nurses’ Early Exit (NEXT) study, using the BQ-12 structured postal questionnaire. A total of 147 young RNs participated in the study. The data were analysed with statistical methods. In phase III, firstly, an in-depth interpretive case study was conducted in order to understand how young RNs explain and make sense of their intention to leave the profession. The data in this study consisted of longitudinal career stories by three young RNs. The data was analysed by using narrative holistic-content and thematic methods. Secondly, a total of 15 young RNs were interviewed in order to explore in-depth their experiences concerning organizational turnover and their intent to leave the profession. The data was analysed using conventional content analysis. Based on earlier research, empirical research on the young RNs intention to leave the profession is scarce. Nurses’ intention to leave the profession has mainly been studied with quantitative descriptive studies, conducted with survey questionnaires. Furthermore, the quality of previous studies varies considerably. Moreover, nurses’ intention to leave the profession seems to be driven by a number of variables. According to the survey study, 26% of young RNs had often considered giving up nursing completely and starting a different kind of job during the course of the previous year. Many different variables were associated with an intention to leave the profession (e.g. personal burnout, job dissatisfaction). According to the in-depth inquiries, poor nursing practice environments and a nursing career as a ‘second-best’ or serendipitous career choice were themes associated with young RNs’ intention to leave the profession. In summary, young RNs intention to leave the profession is a complex phenomenon with multiple associated variables. These findings suggest that policymakers, nurse leaders and nurse managers should enable improvements in nursing practice environments in order to retain more young RNs. These improvements can include, for example, adequate staffing levels, balanced nursing workloads, measures to reduce work-related stress as well as possibilities for advancement and development. Young RNs’ requirements to provide high-quality and ethical nursing care must be recognized in society and health-care organizations. Moreover, sufficient mentoring and orientation programmes should be provided for all graduate RNs. Future research is needed into whether the motive for choosing a nursing career affects the length of the tenure in the profession. Both quantitative and in-depth research is needed for the comprehensive development of nursing-turnover research.
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Kemira Chemicals Oy:n Joutsenon kloori-alkalitehtaalla valmistetaan elektrolyysin avulla lipeää, suolahappoa, natriumhypokloriittia ja vetyä. Tämän työn tavoitteena on kartoittaa kloori-alkalitehtaan tuotantokapasiteetin kasvatuksen yhteydessä esiin tulevat pullonkaulat, lähitulevaisuuden kunnossapitotarpeet sekä parhaat käytettävissä olevat teknologiavaihtoehdot kloori-alkalitehtaan osa-alueille, joihin tuotantokapasiteetin kasvatuspaineet kohdistuvat: elektrolyysi, lipeän haihdutus ja suolahappopolttimet. Pullonkaulojen kartoittaminen toteutettiin rakentamalla taulukkolaskentamalli kloori-alkalitehtaan prosesseista. Mallin avulla simuloitiin elektrolyysin kloorin tuotantoa, jota kasvatettiin asteittain 54 kt:sta/a aina 100 kt:iin/a asti ja tutkittiin prosessien käyttäytymistä. Tarkastelun pohjalta havaittiin, että kloorin tuotantoa kasvattaessa, tulee lisätä myös tuotantokapasiteettia suolahapon valmistukseen, elektrolyysiin, demineralisoidun veden valmistukseen ja lipeän haihdutuslaitokseen sekä suolahapon ja lipeän varastointikapasiteetteihin. Vaihtoehtoiset teknologiat määritettiin kirjallisuudesta ja laitetoimittajien esitteistä. Lähivuosien kunnossapitotarpeet kartoitettiin haastattelemalla tehtaan henkilökuntaa. Työstä eskaloitui useita jatkotutkimuskohteita, joita ovat bipolaari-teknologian soveltuvuus Joutsenon kloori-alkalitehtaalle, uusien HCl-polttimien esisuunnittelu, höyryn käytön tehostaminen nykyisessä lipeän haihdutuslaitoksessa sekä uusien haihdutusteknologioiden soveltuvuus Joutsenon kloori-alkalitehtaalle, höyry- ja jäähdytysverkostojen kartoitukset sekä demineralisoidun veden valmistuskapasiteetin kasvattaminen.
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Controversy still exists over whether the benefits of the available HPV vaccines outweigh the risks and this has suppressed uptake of the HPV vaccines in comparison to other vaccines. Concerns about HPV vaccine safety have led some physicians, healthcare officials and parents to withhold the recommended vaccination from the target population. The most common reason for not administering the prophylactic HPV vaccines are concerns over adverse effects. The aim of this review is the assessment of peer-reviewed scientific data related to measurable outcomes from the use of HPV vaccines throughout the world with focused attention on the potential adverse effects. We found that the majority of studies continue to suggest a positive risk-benefit from vaccination against HPV, with minimal documented adverse effects, which is consistent with other vaccines. However, much of the published scientific data regarding the safety of HPV vaccines appears to originate from within the financially competitive HPV vaccine market. We advocate a more independent monitoring system for vaccine immunogenicity and adverse effects to address potential conflicts of interest with regular systematic literature reviews by qualified individuals to vigilantly assess and communicate adverse effects associated with HPV vaccination. Finally, our evaluation suggests that an expanded use of HPV vaccine into more diverse populations, particularly those living in low-resource settings, would provide numerous health and social benefits.
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Researchers have widely recognised and accepted that firm performance is increasingly related to knowledge-based issues. Two separately developed literature streams, intellectual capital (IC) and knowledge management (KM), have been established as the key discussions related to knowledge-based competitive advantage of the firm. Intellectual capital has provided evidence on the strategic key intangible resources of the firm, which could be deployed to create competitive advantage. Knowledge management, in turn, has focused on the managerial processes and practices which can be used to leverage IC to create competitive advantage. Despite extensive literature on both issues, some notable research gaps remain to be closed. In effect, one major gap within the knowledge management research is the lack of understanding related to its influence on firm performance, while IC researchers have articulated a need to utilise more finegrained conceptual models to better understand the key strategic value-creating resources of the firm. In this dissertation, IC is regarded as the entire intellectual capacity, knowledge and competences of the firm that can be leveraged to achieve sustained competitive advantage. KM practices are defined as organisational and managerial activities that enable the firm to leverage its IC to create value. The objective of this dissertation is to answer the research question: “What is the relationship between intellectual capital, knowledge management practices and firm performance?” Five publications have addressed the research question using different approaches. The first two publications were systematic literature reviews of the extant empirical IC and KM research, which established the current state of understanding regarding the relationship between IC, KM practices and firm performance. Publications III and IV were empirical research articles that assessed the developed conceptual model related to IC, KM practices and firm performance. Finally, Publication V was among the first research papers to merge IC and KM disciplines in order to find out which configurations could yield organisational benefits in terms of innovation and market performance outcomes.
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Malgré des années de recherches sur la douleur et les incapacités chroniques, peu de conclusions claires émergent quant aux facteurs de risque les plus pertinents. La majorité des auteurs s’entendent toutefois sur un fait, les troubles musculo-squelettiques et l’adaptation à leurs nombreuses conséquences est un processus complexe, multidimensionnel et déterminé par l’interaction de facteurs biopsychosociaux. Deux articles sont présentés avec comme objectifs généraux d’identifier les déterminants importants de l’ajustement à un trouble musculo-squelettique. Le premier article consiste en une recension des écrits systématique visant à résumer tous les facteurs pronostiques biopsychosociaux de l’ajustement multidimensionnel aux troubles musculo-squelettiques et examinant leur pertinence à déterminer ces divers indicateurs d’ajustement, principalement la participation au travail, les limitations fonctionnelles, la douleur, la qualité de la vie, la détresse psychologique et la rechute. Les 105 études prospectives recensées et correspondant aux critères d’inclusion et d’exclusion ont été analysés et chaque association significative a été résumée. Par la suite, 68 études qui ont inclus des facteurs sociodémographiques, biologiques, psychologiques et sociaux ont été analysées séparément. Leur qualité méthodologique a été évaluée, un niveau d’évidence a par la suite été établi pour chaque association entre les facteurs de risque et les diverses variables de résultats. Les divergences dans ces associations entre les différentes phases de chronicité ont également été identifiées. Un niveau d’évidence élevée a été découvert concernant le rôle des attentes de rétablissement, certaines pratiques de gestion intégrées de l’incapacité, les stratégies d’adaptation (coping), la somatisation, la comorbidité, la durée de l’épisode symptomatique et un niveau modéré d’évidence a été découvert pour les comportements de douleur. Lorsque vient le temps de prédire les divers indicateurs d’ajustement de sujets souffrant de troubles musculo-squelettiques, chacun tend à être associé à des facteurs de risque différents. Peu de différences ont été relevées lorsque les phases de chronicité ont été prises en compte. Ces résultats confirment la nature biopsychosociale de l’ajustement aux troubles musculo-squelettiques bien que les facteurs psychosociaux semblent être prédominants. Le second article est une étude prospective avec un suivi de 2 et 8 mois. Elle a été menée auprès de 62 travailleurs accidentés, principalement en phase de chronicité et prestataires d’indemnités de revenu de la CSST (Commission en Santé et Sécurité du Travail du Québec). L’objectif de cette étude était d’identifier les déterminants de l’engagement actif dans un processus de retour a travail par opposition à l’incapacité chronique, tout en adoptant une approche biopsychosociale. Cet objectif a été poursuivi en faisant l’étude, d’une part, de la pertinence de facteurs de risque ayant déjà fait l’objet d’études mais pour lesquelles aucun consensus n’est atteint quant à leur utilité prédictive et d’autre part, de certains facteurs de risque négligés, voire, même omis de ce domaine de recherche. Suite à des analyses multivariées, le genre, les attentes de rétablissement en terme de capacité à retourner au travail et l’importance du travail ont été identifiés comme des déterminants de l’incapacité chronique liée au travail. Après 8 mois, l’âge, la consolidation médicale, les symptômes traumatiques, le support au travail et l’importance du travail ont été également identifiés comme des déterminants d’incapacité chronique liée au travail. Ces résultats démontrent l’importance d’aborder l’étude de l’incapacité chronique et de la réinsertion professionnelle selon une perspective multidimensionnelle. Ces résultats corroborent également les conclusions de notre recension des écrits, puisque les facteurs psychosociaux ont été identifiés comme étant des déterminants importants dans cette étude.
Resumo:
L’intégration des soins et des services de santé est vue autant, par les décideurs, par les professionnels que par les usagers, comme une nécessité pour assurer une meilleure accessibilité, pour favoriser la continuité et la coordination et pour améliorer la qualité des soins et services tout en contrôlant les coûts. Depuis près de deux décennies, des réseaux intégrés de soins et de services de santé se développent dans les pays de l’OCDE. Ce phénomène a généré une littérature plutôt abondante sur les conditions organisationnelles supportant l’intégration des soins et plus récemment, sur l’importance du rôle et de la place des professionnels dans ces structures. Les données empiriques et les écrits mettent en évidence que les infirmières ont joué un rôle important dans la mise en place des réseaux intégrés de services depuis leurs débuts. Cette étude vise à identifier les pratiques stratégiques des infirmières qui sont impliquées dans des réseaux intégrés de services de santé et de comprendre comment ces pratiques favorisent des apprentissages organisationnels permettant l’ajustement des pratiques de l’ensemble des intervenants dans le sens de l’intégration clinique. Elle vise aussi à mettre en évidence les facteurs individuels et organisationnels impliqués dans le développement de ces pratiques et dans le processus d’apprentissage organisationnel. Une revue des écrits sur les réseaux de services intégrés et sur l’intégration clinique, ainsi que sur l’apprentissage organisationnel et sur l’analyse stratégique a confirmé que ces écrits, tout en étant complémentaires, soutenaient les objectifs de cette étude. En effet, les écrits sur l’intégration présentent des déterminants de l’intégration sans aborder les pratiques stratégiques et sont discrets sur l’apprentissage organisationnel. Les écrits sur l’apprentissage organisationnel abordent le processus d’apprentissage, mais ne décrivent pas les pratiques favorisant l’apprentissage organisationnel et sont peu loquaces sur les facteurs influençant l’apprentissage organisationnel. Enfin, les écrits sur l’analyse stratégique discutent des systèmes et des processus dynamiques en incluant les conditions individuelles et organisationnelles, mais ne font pas allusion à l’apprentissage organisationnel. Afin de découvrir les pratiques stratégiques ainsi que les apprentissages organisationnels, et de comprendre le processus d’apprentissage et les facteurs impliqués dans celui-ci, nous avons eu recours à un devis d’étude de cas multiples où nous nous sommes attardés à étudier les pratiques d’infirmières évoluant dans quatre situations visant l’intégration clinique. Ces situations faisaient partie de trois réseaux intégrés de services de santé impliquant des professionnels de différentes disciplines rattachés soit, à un centre hospitalier ou à un centre local de services communautaires. Trois études de cas ont été rédigées à partir des informations émanant des différentes sources de données. Dans le cadre de cette étude, quatre sources de données ont été utilisées soit : des entrevues individuelles avec des infirmières, d’autres professionnels et des gestionnaires (n=60), des entrevues de groupe (n=3), des séances d’observations (n=12) et l’étude de documents d’archives (n=96). À l’aide des données empiriques recueillies, il a été possible de découvrir quinze pratiques stratégiques et de préciser la nature des apprentissages qu'elles généraient. L’analyse des cas a également permis de mieux comprendre le rapport entre les pratiques stratégiques et les apprentissages organisationnels et d’apporter des précisions sur le processus d’apprentissage organisationnel. Cette étude contribue à la pratique et à la recherche, car en plus d’offrir un modèle d’apprentissage organisationnel intégré, elle précise que le processus d’apprentissage organisationnel est propulsé grâce à des boucles d’apprentissages stimulées par des pratiques stratégiques, que ces pratiques stratégiques s’actualisent grâce aux ressources individuelles des infirmières et aux facteurs organisationnels et enfin, que ces apprentissages organisationnels favorisent des changements de pratiques soutenant l’intégration clinique.
