Narrative innovations predict symptom improvement: Studying innovative moments in narrative therapy of depression

Objective:Innovative moments (IMs) are moments in the therapeutic dialog that constitute exceptions toward the client's problems. These narrative markers of meaning transformation are associated with change in different models of therapy and diverse diagnoses. Our goal is to test if IMs precede symptoms change, or, on the contrary, are a mere consequence of symptomatic 15 change. Method: For this purpose, IMs and symptomatology (Outcome Questionnaire-10.2) were assessed at every session in a sample of 10 cases of narrative therapy for depression. Hierarchical linear modeling was conducted to explore whether (i) IMs in a given session predict patients' symptoms in the following session and/or (ii) symptoms in a given session predict IMs in the next session. Results: Results suggested that IMs are better predictors of symptoms than the reverse. Conclusions: These results are discussed considering the contribution of meanings and narrative processes' changes to symptomatic improvement.

Mejoramiento del comportamiento térmico de sistemas de calentamiento de agua solares termosifónicos hechos con materiales no convencionales y con tanques de almacenamiento verticales y horizontales Performance improvement of solar thermosyphonic systems for water heating made of non conventional materials and using horizontal and vertical storage tanks

El objeto de estudio de este proyecto son los sistemas de calentamiento de agua mediante energía solar que funcionan termosifónicamente. En particular se tratará con dos diseños particulares generados por fabricantes de la Provincia de Córdoba y que han solicitado el asesoramiento del Grupo de Energía Solar (GES) para el mejoramiento de la performance térmica de dichos equipos. Se trata de dos sistemas que tienen materiales no tradicionales y se diferencian además por tener una distinta disposición del tanque de almacenamiento: uno es en forma vertical y el otro en forma horizontal. Basados en los resultados de un ensayo bajo norma internacional, donde se detectaron algunas puntos factibles de mejora, se propone en este proyecto el análisis en detalle de los equipos, para lo cual se les debe desarmar completos, para realizar un estudio analítico y experimental de los mismos con el objeto de hacer un planteo teórico-analítico del comportamiento de los mismos, con la implementación de propuestas de mejora y chequeo de los resultados. Se propone entonces como objetivo lograr un mejoramiento de la performance térmica de los citados equipos a partir de un estudio experimental y analítico. Asumiendo esta posibilidad de mejora, se plantea la hipótesis de que es posible representar el funcionamiento de estos equipos mediante modelos físico-matemáticos desarrollados a partir de ecuaciones y correlaciones conocidas y procesos a interpretar mediante resoluciones numéricas y softwares específicos de simulación. De esta manera, se plantea el despieze completo de los equipos para estudiar en detalle su estructura y conexiones internas y a partir de la geometría, dimensiones y propiedades termofísicas de materiales constructivos y fluidos de trabajo, realizar modelos físico-matemáticos que permitan realizar variaciones de propiedades y geometría y así buscar las mejores combinaciones que produzcan equipos más eficientes térmicamente. Los modelos físico-matemáticos serán codificados en lenguajes de alto nivel para poder luego de una validación de los modelos, correr simulaciones en un software de reconocimiento internacional que permite sumar dichos modelos mediante un protocolo de comunicación, haciendo que las poderosas prestaciones del software se puedan aplicar a nuestros modelos. Se complementará el estudio con un análisis exergético para identificar los puntos críticos en que se producen las pérdidas de oportunidad de aprovechar la energía disponible, para así analizar cómo solucionar los problemas en dichos puntos. Los materiales a utilizar serán los propios equipos provistos por los fabricantes, que serán modificados convenientemente para operarlos como prototipos Se espera obtener un conocimiento acabado de los procesos y principios de funcionamiento de los equipos, que permita plantear las mejoras, las cuales se implementarán en los prototipos, realizándose una medición mediante norma igual a la inicial para ver en que magnitud se logran las mejoras esperadas. Se pretende además que las mejoras a implementar, en la etapa de transferencia a las empresas involucradas, redunden no sólo en un beneficio técnico, sino que también los sea desde el punto de vista económico. Para ello se trabajará también sobre los procesos y métodos de fabricación para que los equipos mejorados no sean mas caros que los originales y de ser posible sean aún más económicos, todo esto apuntando a la difusión de la energía solar térmica y poner al alcance de todos estos equipos tan convenientes para la propagación de las energías limpias. El proyecto redundará también en un importante beneficio para el conocimiento de la comunidad científica en general, con el aporte de nuevos resultados en diseños novedosos y con nuevos materiales. Además, la institución se beneficiará con la formación que obtendrán los integrantes del proyecto, muchos de ellos en etapa de realización de sus estudios de posgrado y en una etapa importante de su vida como investigadores. The main goal of this project is the improvement of two thermosyphonic solar water heating systems, made of non conventional materials and with different arrangement of their storage tanks: one is vertical and the other one horizontal. The thermosyphonic systems are provided by manufacturers of the Córdoba Province, who came to the Solar Energy Group (GES) of the National University of Río Cuarto looking for help for the design of their products. In an agreement with these manufacturers, it was proposed this project in order to work analytically and experimentally in order to obtain physical-mathematical models of these two systems, which allow for changes to look by means of simulations the best changes to implement on the equipments for the improvement of their thermal performance. Then, the materials to be used are the proper systems provided by the manufacturers, which will be disarmed to be studied in detail. After the analytical study the proposals of improvement will be implemented in a high level language of programming to perform simulations in the environment of a well-known software for energy simulations (TRNSYS). After the simulations, the best modifications will be physically implemented in the prototypes to perform finally the same normalized test of the beginning and check the magnitude of the implemented improvements. The importance of this project is based on the offer of better systems the companies would make, which would benefit the deployment of the thermal solar energy. Another relevant point is to make the new equipments at the same cost of the previous ones or cheaper, in order to achieve a good deployment of the solar water heating systems; then, the manufacture processes and methods must be studied to obtain not only good technical solutions, but also economical equipments. In addition, this project will contribute to the increasing of the knowledge in the area of thermosyphonic solar systems and the training of postgraduate students.

DAS-28-based EULAR response and HAQ improvement in rheumatoid arthritis patients switching between TNF antagonists

INTRODUCTION No definitive data are available regarding the value of switching to an alternative TNF antagonist in rheumatoid arthritis patients who fail to respond to the first one. The aim of this study was to evaluate treatment response in a clinical setting based on HAQ improvement and EULAR response criteria in RA patients who were switched to a second or a third TNF antagonist due to failure with the first one. METHODS This was an observational, prospective study of a cohort of 417 RA patients treated with TNF antagonists in three university hospitals in Spain between January 1999 and December 2005. A database was created at the participating centres, with well-defined operational instructions. The main outcome variables were analyzed using parametric or non-parametric tests depending on the level of measurement and distribution of each variable. RESULTS Mean (+/- SD) DAS-28 on starting the first, second and third TNF antagonist was 5.9 (+/- 2.0), 5.1 (+/- 1.5) and 6.1 (+/- 1.1). At the end of follow-up, it decreased to 3.3 (+/- 1.6; Delta = -2.6; p > 0.0001), 4.2 (+/- 1.5; Delta = -1.1; p = 0.0001) and 5.4 (+/- 1.7; Delta = -0.7; p = 0.06). For the first TNF antagonist, DAS-28-based EULAR response level was good in 42% and moderate in 33% of patients. The second TNF antagonist yielded a good response in 20% and no response in 53% of patients, while the third one yielded a good response in 28% and no response in 72%. Mean baseline HAQ on starting the first, second and third TNF antagonist was 1.61, 1.52 and 1.87, respectively. At the end of follow-up, it decreased to 1.12 (Delta = -0.49; p < 0.0001), 1.31 (Delta = -0.21, p = 0.004) and 1.75 (Delta = -0.12; p = 0.1), respectively. Sixty four percent of patients had a clinically important improvement in HAQ (defined as > or = -0.22) with the first TNF antagonist and 46% with the second. CONCLUSION A clinically significant effect size was seen in less than half of RA patients cycling to a second TNF antagonist.

Improvement in growth after two years of growth hormone therapy in very young children born small for gestational age and without spontaneous catch-up growth: results of a multicenter, controlled, randomized, open clinical trial.

CONTEXT GH treatment is effective in children born small for gestational age (SGA); however, its effectiveness and safety in very young SGA children is unknown. OBJECTIVE The aim was to analyze the outcome of very young SGA children treated with GH and followed for 2 yr. The results after 24 months of treatment, compared with a control group without treatment during 12 months followed by 12 months of treatment, are shown. DESIGN We performed a multicenter, controlled, randomized, open trial. SETTINGS The pediatric endocrinology departments of 14 public hospitals in Spain participated in the study. PATIENTS Seventy-six children, aged 2-5 yr born SGA and without catch-up growth, were studied. INTERVENTION Children received GH at 0.06 mg/kg.d for 2 yr (group I) or were followed for 12 months with no treatment and then treated for 12 months (group II). MAIN OUTCOME MEASURES Age, general health status, pubertal stage, bone age, height, weight, biochemical and hormonal analyses, and adverse side effects were determined at biannual check-ups. RESULTS The mean height sd score gain for chronological age in children treated for 24 months (group I) was 2.10, whereas in those treated only during the last 12 months (group II) was 1.43. In both groups, children under 4 yr of age had the greatest gain in growth velocity. No significant acceleration of bone age or side effects related to treatment was seen. CONCLUSION Very young SGA children without spontaneous catch-up growth could benefit from GH treatment because growth was accelerated and no negative side effects were observed.

Conceiving Comparative Policy Analysis : Implementing Air Quality Improvement Programs

The comparative analysis of air quality control policies provides an interesting field for studies of comparative policy analysis including program formulation and implementation processes. In European countries, the problem is comparable, whereas implementation structures, programs and policy impacts vary to a considerable extent. Analysis testing possibilities and constraints of air control policies under varying conditions are likely to contribute to a further development of a theory of policy analysis. This paper presents the analytical framework applied in a continuing empirical study explaining program formulation and implementation processes with respect to the different actors involved. Concrete emitter behavior can be explained by interaction processes at the very local level, by program elements of national legislation, and by structural constraints under which such programs are produced.

Tetracycline-regulated expression of VEGF-A in beta cells induces angiogenesis: improvement of engraftment following transplantation.

Early revascularization of pancreatic islet cells after transplantation is crucial for engraftment, and it has been suggested that vascular endothelial growth factor-A (VEGF-A) plays a significant role in this process. Although VEGF gene therapy can improve angiogenesis, uncontrolled VEGF secretion can lead to vascular tumor formation. Here we have explored the role of temporal VEGF expression, controlled by a tetracycline (TC)-regulated promoter, on revascularization and engraftment of genetically modified beta cells following transplantation. To this end, we modified the CDM3D beta cell line using a lentiviral vector to promote secretion of VEGF-A either in a TC-regulated (TET cells) or a constitutive (PGK cells) manner. VEGF secretion, angiogenesis, cell proliferation, and stimulated insulin secretion were assessed in vitro. VEGF secretion was increased in TET and PGK cells, and VEGF delivery resulted in angiogenesis, whereas addition of TC inhibited these processes. Insulin secretion by the three cell types was similar. We used a syngeneic mouse model of transplantation to assess the effects of this controlled VEGF expression in vivo. Time to normoglycemia, intraperitoneal glucose tolerance test, graft vascular density, and cellular mass were evaluated. Increased expression of VEGF resulted in significantly better revascularization and engraftment after transplantation when compared to control cells. In vivo, there was a significant increase in vascular density in grafted TET and PGK cells versus control cells. Moreover, the time for diabetic mice to return to normoglycemia and the stimulated plasma glucose clearance were also significantly accelerated in mice transplanted with TET and PGK cells when compared to control cells. VEGF was only needed during the first 2-3 weeks after transplantation; when removed, normoglycemia and graft vascularization were maintained. TC-treated mice grafted with TC-treated cells failed to restore normoglycemia. This approach allowed us to switch off VEGF secretion when the desired effects had been achieved. TC-regulated temporal expression of VEGF using a gene therapy approach presents a novel way to improve early revascularization and engraftment after islet cell transplantation.

Brain dynamics underlying training-induced improvement in suppressing inappropriate action.

Inhibitory control, a core component of executive functions, refers to our ability to suppress intended or ongoing cognitive or motor processes. Mostly based on Go/NoGo paradigms, a considerable amount of literature reports that inhibitory control of responses to "NoGo" stimuli is mediated by top-down mechanisms manifesting ∼200 ms after stimulus onset within frontoparietal networks. However, whether inhibitory functions in humans can be trained and the supporting neurophysiological mechanisms remain unresolved. We addressed these issues by contrasting auditory evoked potentials (AEPs) to left-lateralized "Go" and right NoGo stimuli recorded at the beginning versus the end of 30 min of active auditory spatial Go/NoGo training, as well as during passive listening of the same stimuli before versus after the training session, generating two separate 2 × 2 within-subject designs. Training improved Go/NoGo proficiency. Response times to Go stimuli decreased. During active training, AEPs to NoGo, but not Go, stimuli modulated topographically with training 61-104 ms after stimulus onset, indicative of changes in the underlying brain network. Source estimations revealed that this modulation followed from decreased activity within left parietal cortices, which in turn predicted the extent of behavioral improvement. During passive listening, in contrast, effects were limited to topographic modulations of AEPs in response to Go stimuli over the 31-81 ms interval, mediated by decreased right anterior temporoparietal activity. We discuss our results in terms of the development of an automatic and bottom-up form of inhibitory control with training and a differential effect of Go/NoGo training during active executive control versus passive listening conditions.

Estimation of jump-diffusion processes via empirical characteristic functions

Preface The starting point for this work and eventually the subject of the whole thesis was the question: how to estimate parameters of the affine stochastic volatility jump-diffusion models. These models are very important for contingent claim pricing. Their major advantage, availability T of analytical solutions for characteristic functions, made them the models of choice for many theoretical constructions and practical applications. At the same time, estimation of parameters of stochastic volatility jump-diffusion models is not a straightforward task. The problem is coming from the variance process, which is non-observable. There are several estimation methodologies that deal with estimation problems of latent variables. One appeared to be particularly interesting. It proposes the estimator that in contrast to the other methods requires neither discretization nor simulation of the process: the Continuous Empirical Characteristic function estimator (EGF) based on the unconditional characteristic function. However, the procedure was derived only for the stochastic volatility models without jumps. Thus, it has become the subject of my research. This thesis consists of three parts. Each one is written as independent and self contained article. At the same time, questions that are answered by the second and third parts of this Work arise naturally from the issues investigated and results obtained in the first one. The first chapter is the theoretical foundation of the thesis. It proposes an estimation procedure for the stochastic volatility models with jumps both in the asset price and variance processes. The estimation procedure is based on the joint unconditional characteristic function for the stochastic process. The major analytical result of this part as well as of the whole thesis is the closed form expression for the joint unconditional characteristic function for the stochastic volatility jump-diffusion models. The empirical part of the chapter suggests that besides a stochastic volatility, jumps both in the mean and the volatility equation are relevant for modelling returns of the S&P500 index, which has been chosen as a general representative of the stock asset class. Hence, the next question is: what jump process to use to model returns of the S&P500. The decision about the jump process in the framework of the affine jump- diffusion models boils down to defining the intensity of the compound Poisson process, a constant or some function of state variables, and to choosing the distribution of the jump size. While the jump in the variance process is usually assumed to be exponential, there are at least three distributions of the jump size which are currently used for the asset log-prices: normal, exponential and double exponential. The second part of this thesis shows that normal jumps in the asset log-returns should be used if we are to model S&P500 index by a stochastic volatility jump-diffusion model. This is a surprising result. Exponential distribution has fatter tails and for this reason either exponential or double exponential jump size was expected to provide the best it of the stochastic volatility jump-diffusion models to the data. The idea of testing the efficiency of the Continuous ECF estimator on the simulated data has already appeared when the first estimation results of the first chapter were obtained. In the absence of a benchmark or any ground for comparison it is unreasonable to be sure that our parameter estimates and the true parameters of the models coincide. The conclusion of the second chapter provides one more reason to do that kind of test. Thus, the third part of this thesis concentrates on the estimation of parameters of stochastic volatility jump- diffusion models on the basis of the asset price time-series simulated from various "true" parameter sets. The goal is to show that the Continuous ECF estimator based on the joint unconditional characteristic function is capable of finding the true parameters. And, the third chapter proves that our estimator indeed has the ability to do so. Once it is clear that the Continuous ECF estimator based on the unconditional characteristic function is working, the next question does not wait to appear. The question is whether the computation effort can be reduced without affecting the efficiency of the estimator, or whether the efficiency of the estimator can be improved without dramatically increasing the computational burden. The efficiency of the Continuous ECF estimator depends on the number of dimensions of the joint unconditional characteristic function which is used for its construction. Theoretically, the more dimensions there are, the more efficient is the estimation procedure. In practice, however, this relationship is not so straightforward due to the increasing computational difficulties. The second chapter, for example, in addition to the choice of the jump process, discusses the possibility of using the marginal, i.e. one-dimensional, unconditional characteristic function in the estimation instead of the joint, bi-dimensional, unconditional characteristic function. As result, the preference for one or the other depends on the model to be estimated. Thus, the computational effort can be reduced in some cases without affecting the efficiency of the estimator. The improvement of the estimator s efficiency by increasing its dimensionality faces more difficulties. The third chapter of this thesis, in addition to what was discussed above, compares the performance of the estimators with bi- and three-dimensional unconditional characteristic functions on the simulated data. It shows that the theoretical efficiency of the Continuous ECF estimator based on the three-dimensional unconditional characteristic function is not attainable in practice, at least for the moment, due to the limitations on the computer power and optimization toolboxes available to the general public. Thus, the Continuous ECF estimator based on the joint, bi-dimensional, unconditional characteristic function has all the reasons to exist and to be used for the estimation of parameters of the stochastic volatility jump-diffusion models.

La Participación de los estudiantes en la universidad: dificultades percibidas y propuestas de mejora = Student participation in the university: perceived problems and proposals for improvement

Este artículo se centra en el análisis de la participación de los estudiantes en el gobierno de la universidad y muestra específicamente las principales dificultades que hay para ella y las propuestas que pueden facilitar la implicación de los estudiantes en el funcionamiento de las universidades. A partir de una investigación desarrollada durante los cursos 2007-08 y 2008-09, en la que se utilizaron cuestionarios y grupos de discusión con estudiantes y entrevistas dirigidas al profesorado, se obtiene información sobre los principales obstáculos para la participación estudiantil. El estudio realizado muestra que, de acuerdo con la tónica general reflejada en otras investigaciones sobre esta misma temática en nuestro contexto, la participación de los estudiantes en los distintos estamentos universitarios es escasa. Ahora bien, la metodología seguida en esta investigación permite contrastar las opiniones de los estudiantes con las percepciones del profesorado y obtener así matices significativos que muestran las principales direcciones que hay que tomar para facilitar un cambio de orientación en el asunto. Los cambios que debemos emprender están relacionados no solo con la mejora de los mecanismos de información acerca de los canales de participación, sino también con el replanteamiento de los procesos participativos por parte de la universidad, así como del papel del profesorado y, específicamente, de los coordinadores de los órganos de gestión más próximos a los estudiantes. En las conclusiones del documento se presentan las propuestas de mejora dirigidas a potenciar la implicación de los estudiantes en el funcionamiento universitario. Entre ellas se apuntan las siguientes: mejorar la información y los canales de comunicación con los estudiantes, mejorar los procesos electorales, ofrecer formación a los estudiantes para la participación y formación al profesorado acerca de las metodologías, recursos e instrumentos que pueden repercutir en la motivación de los estudiantes

Fifty years of wheat breeding in Southern Brazil: yield improvement and associated changes

The objective of this study was to assess the impact of genetic breeding on grain yield, and to identify the physiological traits associated to the increment in yield and their related growth processes, for wheat cultivars grown in Southern Brazil, in the past five decades. Seven wheat cultivars released between 1940 and 1992, were compared for physiological aspects associated with grain yield. Grain yield, biological yield, biomass partitioning, harvest index and grain yield components were also determined. The number of grains per square meter was more affected by plant breeding and was better correlated with grain yield (r = 0.94, p<0.01) than with grain weight (r = -0.39ns). The higher number of grains per square meter was better correlated with the number of grains per spike in the modern cultivars than in the older ones. The genetic gain in grain yield was 44.9 kg ha-1 per year, reflecting important efforts of the breeding programs carried out in Southern Brazil. Grain yield changes, during the period of study, were better associated with biomass production (r = 0.78, p<0.01) than with harvest index (r = 0.65, p<0.01).

Continuous Quality Improvement Snow Plow Accident Study Report, 1995

Identify processes to modify in order to reduce snow plow accidents. Reviewed all [Iowa] D.O.T. snow plow accidents that occurred in calendar years 1992 and 1993.

Developing Processes and Learning in a Project-based Firm

Tämän diplomityön tavoitteena on kuvata tiedonkulkua projektiliiketoimintaa harjoittavassa yrityksessä sekä analysoida kuvausta määrittäen mahdolliset kehityskohdat. Työssätuotetut kuvaukset ja kehityskohtien määrittäminen toimivat pohjana yrityksen kehittäessä projektien hallintaansa tulevaisuudessa. Työssä valitaan tietojohtamisen näkökulma sopivaksi lähestymistavaksi yrityksen toiminnananalysointiin. Haastatteluin kerätyn tutkimusmateriaalin perusteella luodaan prosessikuvaukset jotka mallintavat tietovirtoja yrityksen projektien aikana tapahtuvien prosessien välillä. Kuvausta peilataan tietämyksen luomisen sekä projektien tietojohtamisen teoriaan ja määritetään kehityskohteita. Kehityskohteiden määrittämisen lisäksi ehdotetaan mahdollisia toimenpiteitä tiedon ja tietämyksen hallinnan kehittämiseksi. Kokemusten ja opittujen asioiden sekäpalautteen kerääminen projektien aikana sekä niiden jälkeen havaittiin tärkeimmäksi kehityskohdaksi. Näiden keräämisen voidaan todeta vaativan järjestelmällisyyttä jotta projektien onnistumiset sekä niissä saavutetut parannukset voidaan toistaa jatkossa ja virheet sekä epäonnistumiset sitä vastoin välttää.

Service Improvement with Process Modernizations

Työn tarkoituksena on tuottaa liikkeenjohdon konsulttiyritykselle uusi työmenetelmä, jonka avulla se voi vetää kehitysprojekteja joissa asiakasyritysten teollisia palveluprosesseja parannetaan. Prosessiparannusten tulisi tuottaa selvää hyötyä asiakkaille sekä palveluntarjoajan henkilöstölle ja johdolle pian sen jälkeen kun ajanmukaistetut prosessit on menestyksellisesti otettu käyttöön. Menetelmän luonti käynnistyy kirjallisuuskatsauksella, jossa käsitellään aiheita kuten palvelut, teolliset palvelut ja liiketoimintaprosessien uudelleensuunnittelu. Menetelmän luonnin vaatimukset määritellään. Asiakasprojekti, jossa menetelmää koekäytetään, esitellään. Menetelmä esitellään. Se on ylhäältä alaspäin muodostettu kehitysprosessin vetäjän opas. Päätavoitteet asetettiin ensin. Niitä tukevat alitavoitteetasetettiin seuraavaksi. Työohjeet luotiin siten, että tavoitteiden saavuttaminen mahdollistuisi. Samalla kehitettiin menetelmää tukevia työkaluja. Alustavat työohjeet ja työkalut jalostuivat menetelmän koekäytön aikana nykyiseen muotoonsa.Menetelmän laatua arvioidaan koekäytön jälkeen asetettujen tavoitteiden ja saavutettujen tulosten eroja vertaamalla. Valmistumisen jälkeen toteutettavat menetelmän jatkokehitystoimenpiteet esitellään.

Improving globally distributed software development and support processes - A workflow view

We propose a new approach and related indicators for globally distributed software support and development based on a 3-year process improvement project in a globally distributed engineering company. The company develops, delivers and supports a complex software system with tailored hardware components and unique end-customer installations. By applying the domain knowledge from operations management on lead time reduction and its multiple benefits to process performance, the workflows of globally distributed software development and multitier support processes were measured and monitored throughout the company. The results show that the global end-to-end process visibility and centrally managed reporting at all levels of the organization catalyzed a change process toward significantly better performance. Due to the new performance indicators based on lead times and their variation with fixed control procedures, the case company was able to report faster bug-fixing cycle times, improved response times and generally better customer satisfaction in its global operations. In all, lead times to implement new features and to respond to customer issues and requests were reduced by 50%.

Developing Supply Management Processes in a Global Process Automation Organization

Tämän työn tarkoituksena on tutkia prosessien uudelleensuunnittelua ja erityisesti hankintaprosessien uudistamista kansainvälisessä prosessiautomaatioyrityksessä. Työn aihealuetta tutkitaan sekä henkilöstön, uuden teknologian että prosessien kehittämisen näkökulmasta. Prosessien kehittämisessä työkaluna on käytetty tunnettua laatutyökalua, Six Sigmaa. Työn päätavoitteena on luoda uudet toimintamallit kehitettäville prosesseille. Kirjallisuuden lisäksi työ perustuu kirjoittajan kokemuksiin ja havaintoihin projektitiimin jäsenenä. Prosessien kehittämistä tarkastellaan myös muutoksenhallinnan näkökulmasta. Tämä on alue, jota ei saisi koskaan jättää huomiotta kehityshankkeissa. Kehitettäessä liiketoimintaprosesseja muutoksenhallinta on menestyksen kannalta ensisijaisen tärkeää. Muutoksenhallintaa tutkitaan työssä sekä organisaation että yksilön kannalta. Tässä työssä esitellään lisäksi maailmanlaajuisesti tunnettu ja käytetty laatutyökalu, Six Sigma. Six Sigmaa on käytetty myös työn lopussa tarkasteltavassa case-osuudessa. Case-osuudessa prosesseja tutkitaan aina nykytilasta uusiin toimintamalleihin saakka. Prosesseja ja niiden suorituskykyä analysoidaan yhtäjaksoisesti kehitysprojektien edetessä.