Waste management policies for industrial symbiosis development: case studies in European countries

Industrial symbiosis (IS) emerged as a self-organizing business strategy among firms that are willing to cooperate to improve their economic and environmental performance. The adoption of such cooperative strategies relates to increasing costs of waste management, most of which are driven by policy and legislative requirements. Development of IS depends on an enabling context of social, informational, technological, economical and political factors. The power to influence this context varies among the agents involved such as the government, businesses or coordinating entities. Governmental intervention, as manifested through policies, could influence a wider range of factors; and we believe this is an area which is under-researched. This paper aims to critically appraise the waste policy interventions from supra-national to sub-national levels of government. A case study methodology has been applied to four European countries i.e. Denmark, the UK, Portugal and Switzerland, in which IS emerged or is being fostered. The findings suggest that there are commonalities in policy instruments that may have led to an IS enabling context. The paper concludes with lessons learnt and recommendations on shaping the policy context for IS development.

Information and risk management during the first trimester care for pregnant women: Some reflections about the ethical challenges and the legal framework in Switzerland. [L'information et la gestion des risques dans le suivi de la grossesse lors du 1er trimestre : quelques réflexions sur le défi éthique et le cadre légal en Suisse.]

The progress in prenatal medicine raises complex questions with respect to the physician-patient relationship. The physician needs to reconcile medical aspects, ethical principles as well as judicial norms. Already, during the first trimester, the physician has to put into practice the schedule combining for each individual pregnancy physical, laboratory and other appropriate exams. Physicians are under the obligation to inform in a clear and comprehensive way without creating unnecessary anxiety for their patients. Legal requirements include informed consent, the respect for the patient's right to self-determination, and compliance with the Swiss federal law on genetic testing, especially with its articles on prenatal screening and diagnosis. This article discusses the complexity of obstetrical practice when it comes to delivering adequate information within the scope of ethical and legal requirements in Switzerland. L'évolution de la médecine prénatale soulève des enjeux complexes dans la relation médecin-patient. Il s'agit de concilier à la fois les aspects médicaux, les principes éthiques et les normes juridiques. Dès le premier trimestre de la grossesse le médecin doit poser le cadre du suivi et des examens appropriés pour chaque grossesse. Son devoir est d'informer de manière claire et précise sans inquiéter inutilement, en respectant l'exigence légale d'un consentement éclairé et plus largement le droit de la patiente à l'autodétermination ainsi que le cadre de la loi fédérale suisse sur l'analyse génétique humaine dans le domaine du dépistage et du diagnostic prénatal. Cet article discute de la complexité de l'information et de l'application des principes éthiques et légaux dans la pratique obstétricale en Suisse.

Argemone mexicana decoction versus artesunate-amodiaquine for the management of malaria in Mali: policy and public-health implications.

A classic way of delaying drug resistance is to use an alternative when possible. We tested the malaria treatment Argemone mexicana decoction (AM), a validated self-prepared traditional medicine made with one widely available plant and safe across wide dose variations. In an attempt to reflect the real situation in the home-based management of malaria in a remote Malian village, 301 patients with presumed uncomplicated malaria (median age 5 years) were randomly assigned to receive AM or artesunate-amodiaquine [artemisinin combination therapy (ACT)] as first-line treatment. Both treatments were well tolerated. Over 28 days, second-line treatment was not required for 89% (95% CI 84.1-93.2) of patients on AM, versus 95% (95% CI 88.8-98.3) on ACT. Deterioration to severe malaria was 1.9% in both groups in children aged </=5 years (there were no cases in patients aged >5 years) and 0% had coma/convulsions. AM, now government-approved in Mali, could be tested as a first-line complement to standard modern drugs in high-transmission areas, in order to reduce the drug pressure for development of resistance to ACT, in the management of malaria. In view of the low rate of severe malaria and good tolerability, AM may also constitute a first-aid treatment when access to other antimalarials is delayed.

Team Effectiveness in Patient Health Management: An Overview of Reviews

Background: The desire to improve the quality of health care for an aging population with multiple chronic diseases is fostering a rapid growth in inter-professional team care, supported by health professionals, governments, businesses and public institutions. However, the weight of evidence measuring the impact of team care on patient and health system outcomes has not, heretofore, been clear. To address this deficiency, we evaluated published evidence for the clinical effectiveness of team care within a chronic disease management context in a systematic overview. Methods: A search strategy was built for Medline using medical subject headings and other relevant keywords. After testing for perform- ance, the search strategy was adapted to other databases (Cinhal, Cochrane, Embase, PsychInfo) using their specific descriptors. The searches were limited to reviews published between 1996 and 2011, in English and French languages. The results were analyzed by the number of studies favouring team intervention, based on the direction of effect and statistical significance for all reported outcomes. Results: Sixteen systematic and 7 narrative reviews were included. Diseases most frequently targeted were depression, followed by heart failure, diabetes and mental disorders. Effective- ness outcome measures most commonly used were clinical endpoints, resource utilization (e.g., emergency room visits, hospital admissions), costs, quality of life and medication adherence. Briefly, while improved clinical and resource utilization endpoints were commonly reported as positive outcomes, mixed directional results were often found among costs, medication adherence, mortality and patient satisfaction outcomes. Conclusions: We conclude that, although suggestive of some specific benefits, the overall weight of evidence for team care efficacy remains equivocal. Further studies that examine the causal interactions between multidisciplinary team care and clinical and economic outcomes of disease management are needed to more accurately assess its net program efficacy and population effectiveness.

The transtheoretical model in weight management: Validation of the Processes of Change Questionnaire

Objective: The processes of change implied in weight management remain unclear. The present study aimed to identify these processes by validating a questionnaire designed to assess processes of change (the P-Weight) in line with the transtheoretical model. The relationship of processes of change with stages of change and other external variables is also examined. Methods: Participants were 723 people from community and clinical settings in Barcelona. Their mean age was 32.07 (SD = 14.55) years; most of them were women (75.0%), and their mean BMI was 26.47 (SD = 8.52) kg/m2. They all completed the P-Weight and the stages of change questionnaire (SWeight), both applied to weight management, as well as two subscales from the Eating Disorders Inventory-2 and Eating Attitudes Test-40 questionnaires about the concern with dieting. Results: A 34-item version of the PWeight was obtained by means of a refinement process. The principal components analysis applied to half of the sample identified four processes of change. A confirmatory factor analysis was then carried out with the other half of the sample, revealing that the model of four freely correlated first-order factors showed the best fit (GFI = 0.988, AGFI = 0.986, NFI = 0.986, and SRMR = 0.0559). Corrected item-total correlations (0.322-0.865) and Cronbach"s alpha coefficients (0.781-0.960) were adequate. The relationship between the P-Weight and the S-Weight and the concern with dieting measures from other questionnaires supported the validity of the scale. Conclusion: The study identified processes of change involved in weight management and reports the adequate psychometric properties of the P-Weight. It also reveals the relationship between processes and stages of change and other external variables.

Identification and Management of Operational Risks in IT Organization of Financial Service Provider

Työn tavoitteena on tunnistaa toiminnallisia riskitekijöitä rahoituspalveluita tarjoavan yrityksen IT-organisaatiossa sekä löytää arkipäiväisiä keinoja hallita näitä riskejä. Työssä riskejä on myös tarkasteltu mahdollisen ulkoistuksen yhteydessä. Fuusiot ovat yleisiä rahoitusalan yrityksissä. Yhteenliittymien tuloksena yritysten IT-arkkitehtuuri voi olla monimutkainen ja kulttuurierot yrityksessä suuria. Synergia- ja mittakaavaetuja saadakseen yritys keskittää toimintojaan ja IT-ratkaisujaan. Riskien tunnistaminen on riskienhallintaprosessin tärkein vaihe. Tässä tutkimuksessa riskit ja riskitekijät tunnistettiin itsearvioinnin avulla kysymyssarjoja hyväksikäyttäen. Monet riskitekijät liittyivät sisäisen valvonnan ja seurannan puutteisiin. Myöhemmin näille riskeille pohdittiin työryhmässä käytännönläheisiä hallintakeinoja. Yritys voi siirtää tai jakaa IT -riskejä ulkoistamalla. Ulkoistaminen voi kuitenkin tuoda mukaan myös uusia riskitekijöitä. Ennen ulkoistamispäätöstä yrityksen sisäisten prosessien ja organisaation on oltava järjestyksessä, jotta sopimuksen kannattavuutta voidaan verrata luotettavasti saman palvelun tuottamiseen sisäisesti.

Compliance management is becoming a major issue in IS design

This article aims at improving the information systems management support to Risk and Compliance Management process, i.e. the management of all compliance imperatives that impact an organization, including both legal and stra- tegically self-imposed imperatives. We propose a process to achieve such regula- tory compliance by aligning the Governance activities with the Risk Management ones, and we suggest Compliance should be considered as a requirement for the Risk Management platform. We will propose a framework to align law and IT compliance requirements and we will use it to underline possible directions of investigation resumed in our discussion section. This work is based on an exten- sive review of the existing literature and on the results of a four-month internship done within the IT compliance team of a major financial institution in Switzer- land, which has legal entities situated in different countries.

Service product structure supported by remote diagnostics

Työn tavoitteena oli määrittää etähuoltokonseptin yleinen rakenne sekä selvittää asiakkaille tarjottavia modulaarisia palvelutuotteita. Aluksi selvitettiin huoltokonseptin rakennetta kirjallisuuden ja asiantuntijoiden haastattelujen avulla. Asiantuntijoiden haastattelut toteutettiin vapaamuotoisesti kysymyslistaa apuna käyttäen. Tämän lisäksi työssä pohditaan KM, CRM ja PDM rooleja etähuoltokonseptin kannalta sekä tutkaillaan etähuollon tulevaisuuden näkymiä.Diplomityössä käsitellään modulaarisuutta yleisellä tasolla. Moduularisuus on moniulotteinen termi. Usein sillä tarkoitetaan yrityksen sisäistä tuotekehityksen hallintaa. Toisaalta se voidaan nähdä myös asiakkaalle tarjottavina tuotteina ja tässä diplomityössä on keskitytty tähän puoleen. Loppuosa diplomityöstä käsittelee palvelutuotteiden tuotteistamisprosessia.Diplomityön tuloksena hahmoteltiin etähuolto konseptia ja tutkittiin mahdollisia palvelutuotteita, joita voidaan sisällyttää etähuoltokonseptiin. Tämän lisäksi toteutettiin osa tuotteistamisprosessista. Etähuollon kehittäminen on haasteellista. Haasteeksi jää tuotekehitystoiminnan ja palvelupuolen toiminnan tehostaminen, jotta tuotteita voitaisiin jo suunnittelupuolella kehittää etähuollon tarpeisiin. Kehittäminen vaatii molempien puolien aktiivista osallistumista.

Asiakkuudenhallinnan tukeminen neuroverkkoteknologian avulla

CRM on yritysten tietojärjestelmä, jolla voidaan tukea asiakkuuden hallintaa ja kehittämistä. Monilla suuryrityksillä on paljon asiakkaita ja niiden on mahdotonta tunnistaa asiakkaitaan yksilöinä. Kuitenkin asiakkaat arvostavat yhä enemmän henkilökohtaista palvelua ja kontakteja. Yritysten asiakastietokantoihin kertyy runsaasti tietoa asiakkaista ja heidän ostokäyttäytymisestään. Suuresta informaatiomäärästä johtuen tarvitaan kehittynyttä tietotekniikkaa asiakkaiden tyypittelyyn ja asiakastarpeiden tunnistamiseen. Tässä diplomityössä kehitetään neuroCRM-teoriaa määrällisesti suuren ja monimutkaisen asiakasinformaation hallintaan. Teoria perustuu itseorganisoituvien neuroverkkojen käyttöön asiakasinformaation analysoimiseksi CRM-järjestelmässä. Asiakkaat segmentoidaan ja personoidaan iteratiivisia SOM-analyysejä suorittamalla. Tulosten perusteella kehitetään asiakkaiden yksilöllisyyttä huomioivia markkinointikeinoja ja käytetään uusia kanavia, esimerkiksi mobiilia viestintätekniikkaa asiakkaiden tavoittamiseen. Asiakaskannattavuuden parantamiseksi voi- daan tehdä strategisia valintoja ja päätöksiä markkinoinnin kohdentamista varten.

Distal and proximal influences on the use of business and moral frames in responsible decisions

We empirically contribute to the debate on business education in building on a decision frame perspective of decision making in corporate responsibility settings. Business schools have been accused to teach amoral theories, leading their students to behave less morally and engendering corporate responsibility scandals. Research has also pointed toward self-selection: business students would differ from non-business students before entering business school. We examine the role of socioeconomic status, core self-evaluations in this regard. Further, we investigate the belief in a free market as a distal influence triggering a business frame, and moral intensity as a proximal influence triggering a moral frame on responsible decision making by business and non-business students. Cross-sectional data obtained from 566 students on two decision making scenarios mostly supported our hypotheses. Socioeconomic status but not core self-evaluations explain the belief in a free market, and had indirect effects on the likelihood to make a less responsible decision. Importantly, the relationship between business studies and the belief in a free market remained significant after accounting for these variables. Our study thus contributes to the socialization and self-selection arguments. We discuss theoretical and practical implications for research on decision frames and for business education, respectively.

National and Gender Measurement Invariance of the Utrecht-Management of Identity Commitments Scale (U-MICS) : A 10-Nation Study With University Students

The purpose of this study was to examine the psychometric properties of the Utrecht-Management of Identity Commitments Scale (U-MICS), a self-report measure aimed at assessing identity processes of commitment, in-depth exploration, and reconsideration of commitment. We tested its factor structure in university students from a large array of cultural contexts, including 10 nations located in Europe (i.e., Italy, the Netherlands, Poland, Portugal, Romania, and Switzerland), Middle East (i.e., Turkey), and Asia (i.e., China, Japan, and Taiwan). Furthermore, we tested national and gender measurement invariance. Participants were 6,118 (63.2% females) university students aged from 18 to 25 years (Mage = 20.91 years). Results indicated that the three-factor structure of the U-MICS fitted well in the total sample, in each national group, and in gender groups. Furthermore, national and gender measurement invariance were established. Thus, the U-MICS can be fruitfully applied to study identity in university students from various Western and non-Western contexts.

Performance Management of a Next Generation Network

Today's communication networks consist of numerous interdependent network components. To manage these networks and to ensure their reliable and efficient operation to meet the increasing customer usability demands, extensive network management tools are required from the service provider. The goal of this study was to adapt the Next Generation Network (NGN) providing VoIP services within a performance oriented network management system. This study focuses only on NGN network and the project was implemented as an assignment of the Network Operations Center of Elisa Corporation. The theoretical part of this study introduces the network environment of the Elisa NGN platform: its components and used signalling protocols as well as other exploitable communication protocols. In addition, the Simple Network Management Protocol (SNMP) is closely examined since it is commonly used as the basis of IP (Internet Protocol) network management. Also some primary applications enabled by the NGN technology are introduced. The empirical part of this study contains a short overview of the implemented network performance management system and its properties. The most crucial monitored MIB modules, SNMP parameters and implemented performance measurements are described. The trap topology and the role of the traps for management of the NGN platform are considered and finally, the conclusion based on the several disquisitions is made supported with suggestions for future improvements.

Continuing Medical Education Self-Assessment Questions Vol. 50, No. 1 - January 2014. Actual evidence in the medical approach to adolescents with idiopathic scoliosis

Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and trunk. The most common form involve ado- lescents (AIS). The prevalence for AIS is 2-3% of the population, with 1 out of 6 patients requiring treatment of which 25% progress to surgery. Physical and rehabilitation medicine (PRM) plays a primary role in the so-called conservative treatment of adolescents with AIS, since all the therapeutic tools used (exercises and braces) fall into the PRM domain. According to a Cochrane systematic review there is evidence in favor of bracing, even if it is of low quality. Another shows that there is evidence in favor of exercises as an adjunctive treatment, but of low quality. Three meta-analysis have been published on bracing: one shows that bracing does not reduce surgery rates, but studies with bracing plus exercises were not included and had the highest effectiveness; another shows that full time is better than part-time bracing; the last focuses on observational studies following the SRS criteria and shows that not all full time rigid bracing are the same: some have the highest effectiveness, others have less than elastic and nighttime bracing. Two very important RCTs failed in recruitment, showing that in the field of bracing for scoliosis RCTs are not accepted by the patients. Consensuses by the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) show that there is no agree- ment among experts either on the best braces or on their biomechanical action, and that compliance is a matter of clinical more than patients' behavior (there is strong agreement on the management criteria to achieve best results with bracing). A systematic review of all the existing studies shows effectiveness of exercises, and that auto-correction is the main goal of exercises. A systematic review shows that there are no studies on manual treatment. Research on conservative treat- ment of AIS has continuously decreased since the 1980s, but this trend changed only recently. The SOSORT Guidelines offers the actual standard of conservative care.

Interdependency management in universities: a case study

There remains uncertainty in scientific discussions regarding the governance of universities in new public management regimes in terms of who actually 'rules' in the university. Apparently, a strengthened management leadership is confronted with continuing elements of academic self-regulation and professional autonomy in knowledge production and diffusion. Organisational and academic rationales coexist in today's management of universities. This article endeavours to clarify some of the ambiguities pertaining to the coexistence of two authorities by demonstrating the working of 'interdependency management' that is taking place within universities. For this purpose, the authors have scrutinised research, teaching and recruitment policies in one Swiss university that is subject to such ambiguities. The study confirms existing research in that a command-and-control system is not applied. Policymaking in universities is instead based on a mix of negotiations in faculties that are taking place in the 'shadow of hierarchy', negotiated bargaining between faculties and leaders and occasional unilateral decisions of leaders. This mitigates latent conflicts between management and the academic community: strategic orientations of the university are generally accepted by the academic community while the academic community has influence on policy formulation and maintains defining powers over policy substance.

Patients' Needs for Care in Public Mental Health: Unity and Diversity of Self-Assessed Needs for Care.

PURPOSE: Needs assessment is recognized to be a key element of mental health care. Patients tend to present heterogeneous profiles of needs. However, there is no consensus in previous research about how patients' needs are organized. This study investigates both general and specific dimensions of patients' needs for care. METHODS: Patients' needs were assessed with ELADEB, an 18-domain self-report scale. The use of a self-assessment scale represents a unique way of obtaining patients' perceptions. A patient-centered psychiatric practice facilitates empowerment as it is based on the patients' personal motivations, needs, and wants. Four seventy-one patients' profiles were analyzed through exploratory factor analysis. RESULTS: A four-factor bifactor model, including one general factor and three specific factors of needs, was most adequate. Specific factors were (a) "finances" and "administrative tasks"; (b) "transports," "public places," "self-care," "housework," and "food"; and (c) "family," "children," "intimate relationships," and "friendship." CONCLUSION: As revealed by the general factor, patients expressing urgent needs in some domains are also more susceptible to report urgent needs in several other domains. This general factor relates to high versus low utilizers of public mental healthcare. Patients also present specific needs in life domains, which are organized in three dimensions: management, functional disabilities, and familial and interpersonal relationships. These dimensions relate to the different types of existing social support described in the literature.