Prevalence and management of familial hypercholesterolaemia in patients with acute coronary syndromes.

AIMS: We aimed to assess the prevalence and management of clinical familial hypercholesterolaemia (FH) among patients with acute coronary syndrome (ACS). METHODS AND RESULTS: We studied 4778 patients with ACS from a multi-centre cohort study in Switzerland. Based on personal and familial history of premature cardiovascular disease and LDL-cholesterol levels, two validated algorithms for diagnosis of clinical FH were used: the Dutch Lipid Clinic Network algorithm to assess possible (score 3-5 points) or probable/definite FH (>5 points), and the Simon Broome Register algorithm to assess possible FH. At the time of hospitalization for ACS, 1.6% had probable/definite FH [95% confidence interval (CI) 1.3-2.0%, n = 78] and 17.8% possible FH (95% CI 16.8-18.9%, n = 852), respectively, according to the Dutch Lipid Clinic algorithm. The Simon Broome algorithm identified 5.4% (95% CI 4.8-6.1%, n = 259) patients with possible FH. Among 1451 young patients with premature ACS, the Dutch Lipid Clinic algorithm identified 70 (4.8%, 95% CI 3.8-6.1%) patients with probable/definite FH, and 684 (47.1%, 95% CI 44.6-49.7%) patients had possible FH. Excluding patients with secondary causes of dyslipidaemia such as alcohol consumption, acute renal failure, or hyperglycaemia did not change prevalence. One year after ACS, among 69 survivors with probable/definite FH and available follow-up information, 64.7% were using high-dose statins, 69.0% had decreased LDL-cholesterol from at least 50, and 4.6% had LDL-cholesterol ≤1.8 mmol/L. CONCLUSION: A phenotypic diagnosis of possible FH is common in patients hospitalized with ACS, particularly among those with premature ACS. Optimizing long-term lipid treatment of patients with FH after ACS is required.

Ecosystem impacts of Alpine water intakes for hydropower: the challenge of sediment management

The natural flow hydrological characteristics (such as the magnitude, frequency, duration, timing, and rate of change of discharge) of Alpine streams, dominated by snowmelt and glacier melt, have been established for many years. More recently, the ecosystems that they sustain have been described and explained. However, natural Alpine flow regimes may be strongly modified by hydroelectric power production, which impacts upon both river discharge and sediment transfer, and hence on downstream flora and fauna. The impacts of barrages or dams have been well studied. However, there is a second type of flow regulation, associated with flow abstraction at intakes where the water is transferred laterally, either to another valley for storage, or at altitude within the same valley for eventual release downstream. Like barrages, such intakes also trap sediment, but because they are much smaller, they fill more frequently and so need to be flushed regularly. Downstream, while the flow regime is substantially modified, the delivery of sediment (notably coarser fractions) remains. The ecosystem impacts of such systems have been rarely considered. Through reviewing the state of our knowledge of Alpine ecosystems, we outline the key research questions that will need to be addressed in order to modify intake management so as to reduce downstream ecological impacts. Simply redesigning river flows to address sediment management will be ineffective because such redesign cannot restore a natural sediment regime and other approaches are likely to be required if stream ecology in such systems is to be improved.

Peatlands and plantations in Sumatra, Indonesia : Complex realities for resource governance, rural development and climate change mitigation

Peatlands play a crucial role in Indonesia's economic development, and in its stated goal of reducing greenhouse gas emissions. Improved peatland management - including a national moratorium on the granting of any new conversion licenses - forms a cornerstone of Indonesia's climate change mitigation commitment. At the same time, rapid expansion of the plantation sector is driving wide-scale drainage and conversion of peat swamp ecosystems. The province of Riau, in central Sumatra, finds itself at the crossroads of these conflicting agendas. This essay presents a case study of three islands on Riau's east coast affected by industrial timber plantation concessions. It examines the divergent experiences, perceptions and responses of communities on the islands. A mix of dramatic protests, localised everyday actions and constructive dialogue has succeeded in delaying or perhaps halting one of the concessions, while negotiations and contestation with the other two continue. With the support of regional and national non-governmental organisations and local government, communities are pursuing alternative development strategies, including the cultivation of sago, which requires no peat drainage. While a powerful political economy of state and corporate actors shapes the contours of socio-environmental change, local social movements can alter trajectories of change, promoting incremental improvements and alternative pathways.

Language Learning in Task Management and Task Accomplishment

In this paper we study student interaction in English and Swedish courses at a Finnish university. We focus on language choices made in task-related activities in small group interaction. Our research interests arose from the change in the teaching curriculum, in which content and language courses were integrated at Tampere University of Technology in 2013. Using conversation analysis, we analysed groups of 4-5 students who worked collaboratively on a task via a video conference programme. The results show how language alternation has different functions in 1) situations where students orient to managing the task, e.g., in transitions into task, or where they orient to technical problems, and 2) situations where students accomplish the task. With the results, we aim to show how language alternation can provide interactional opportunities for language learning. The findings will be useful in designing tasks in the future.

Predicting the future effectiveness of protected areas for bird conservation in Mediterranean ecosystems under climate change and novel fire regime scenarios

AimGlobal environmental changes challenge traditional conservation approaches based on the selection of static protected areas due to their limited ability to deal with the dynamic nature of driving forces relevant to biodiversity. The Natura 2000 network (N2000) constitutes a major milestone in biodiversity conservation in Europe, but the degree to which this static network will be able to reach its long-term conservation objectives raises concern. We assessed the changes in the effectiveness of N2000 in a Mediterranean ecosystem between 2000 and 2050 under different combinations of climate and land cover change scenarios. LocationCatalonia, Spain. MethodsPotential distribution changes of several terrestrial bird species of conservation interest included in the European Union's Birds Directive were predicted within an ensemble-forecasting framework that hierarchically integrated climate change and land cover change scenarios. Land cover changes were simulated using a spatially explicit fire-succession model that integrates fire management strategies and vegetation encroachment after the abandonment of cultivated areas as the main drivers of landscape dynamics in Mediterranean ecosystems. ResultsOur results suggest that the amount of suitable habitats for the target species will strongly decrease both inside and outside N2000. However, the effectiveness of N2000 is expected to increase in the next decades because the amount of suitable habitats is predicted to decrease less inside than outside this network. Main conclusionsSuch predictions shed light on the key role that the current N2000may play in the near future and emphasize the need for an integrative conservation perspective wherein agricultural, forest and fire management policies should be considered to effectively preserve key habitats for threatened birds in fire-prone, highly dynamic Mediterranean ecosystems. Results also show the importance of considering landscape dynamics and the synergies between different driving forces when assessing the long-term effectiveness of protected areas for biodiversity conservation.

Predicted decrease in global climate suitability masks regional complexity of invasive fruit fly species response to climate change

Climate change affects the rate of insect invasions as well as the abundance, distribution and impacts of such invasions on a global scale. Among the principal analytical approaches to predicting and understanding future impacts of biological invasions are Species Distribution Models (SDMs), typically in the form of correlative Ecological Niche Models (ENMs). An underlying assumption of ENMs is that species-environment relationships remain preserved during extrapolations in space and time, although this is widely criticised. The semi-mechanistic modelling platform, CLIMEX, employs a top-down approach using species ecophysiological traits and is able to avoid some of the issues of extrapolation, making it highly applicable to investigating biological invasions in the context of climate change. The tephritid fruit flies (Diptera: Tephritidae) comprise some of the most successful invasive species and serious economic pests around the world. Here we project 12 tephritid species CLIMEX models into future climate scenarios to examine overall patterns of climate suitability and forecast potential distributional changes for this group. We further compare the aggregate response of the group against species-specific responses. We then consider additional drivers of biological invasions to examine how invasion potential is influenced by climate, fruit production and trade indices. Considering the group of tephritid species examined here, climate change is predicted to decrease global climate suitability and to shift the cumulative distribution poleward. However, when examining species-level patterns, the predominant directionality of range shifts for 11 of the 12 species is eastward. Most notably, management will need to consider regional changes in fruit fly species invasion potential where high fruit production, trade indices and predicted distributions of these flies overlap.

Research Priorities for seabirds: Improving seabird conservation and management in the 21st century

Seabirds are facing a growing number of threats in both terrestrial and marine habitats, and many populations have experienced dramatic changes over past decades. Years of seabird research have improved our understanding of seabird populations and provided a broader understanding of marine ecological processes. In an effort to encourage future research and guide seabird conservation science, seabird researchers from 9 nations identified the 20 highest priority research questions and organized these into 6 general categories: (1) population dynamics, (2) spatial ecology, (3) tropho-dynamics, (4) fisheries interactions, (5) response to global change, and (6) management of anthropogenic impacts (focusing on invasive species, contaminants and protected areas). For each category, we provide an assessment of the current approaches, challenges and future directions. While this is not an exhaustive list of all research needed to address the myriad conservation challenges seabirds face, the results of this effort represent an important synthesis of current expert opinion across sub-disciplines within seabird ecology. As this synthesis highlights, research, in conjunction with direct management, education, and community engagement, can play an important role in facilitating the conservation and management of seabird populations and of the ocean ecosystems on which they and we depend.

IDEAS for Strategic Technology Management: Design of an electronically mediated scenario method

The age-old adage goes that nothing in this world lasts but change, and this generation has indeed seen changes that are unprecedented. Business managers do not have the luxury of going with the flow: they have to plan ahead, to think strategies that will meet the changing conditions, however stormy the weather seems to be. This demand raises the question of whether there is something a manager or planner can do to circumvent the eye of the storm in the future? Intuitively, one can either run on the risk of something happening without preparing, or one can try to prepare oneself. Preparing by planning for each eventuality and contingency would be impractical and prohibitively expensive, so one needs to develop foreknowledge, or foresight past the horizon of the present and the immediate future. The research mission in this study is to support strategic technology management by designing an effective and efficient scenario method to induce foresight to practicing managers. The design science framework guides this study in developing and evaluating the IDEAS method. The IDEAS method is an electronically mediated scenario method that is specifically designed to be an effective and accessible. The design is based on the state-of-the-art in scenario planning, and the product is a technology-based artifact to solve the foresight problem. This study demonstrates the utility, quality and efficacy of the artifact through a multi-method empirical evaluation study, first by experimental testing and secondly through two case studies. The construction of the artifact is rigorously documented as justification knowledge as well as the principles of form and function on the general level, and later through the description and evaluation of instantiations. This design contributes both to practice and foundation of the design. The IDEAS method contributes to the state-of-the-art in scenario planning by offering a light-weight and intuitive scenario method for resource constrained applications. Additionally, the study contributes to the foundations and methods of design by forging a clear design science framework which is followed rigorously. To summarize, the IDEAS method is offered for strategic technology management, with a confident belief that it will enable gaining foresight and aid the users to choose trajectories past the gales of creative destruction and off to a brighter future.

Innovations of ageing and societal transition : Dynamics of change of the socio-technical regime of ageing

The purpose of this dissertation is to examine the dynamics of the socio-technical system in the field of ageing. The study stems from the notion that the ageing of the population as a powerful megatrend has wide societal effects, and is not just a matter for the social and health sector. The central topic in the study is change: not only the age structures and structures of society are changing, but also at the same time there is constant development, for instance, in technologies, infrastructures and cultural perceptions. The changing concept of innovation has widened the understanding of innovations related to ageing from medical and assistive technological innovations to service and social innovations, as well as systemic innovations at different levels, which means the intertwined and co-evolutionary change in technologies, structures, services and thinking models. By the same token, the perceptions of older people and old age are becoming more multi-faceted: old age is no longer equated to illnesses and decline, but visions of active ageing and a third age have emerged, which are framed by choices, opportunities, resources and consumption in later life. The research task in this study is to open up the processes and mechanisms of change in the field of ageing, which are studied as a complex, multi-level and interrelated socio-technical system. The question is about co-effective elements consisting of macro-level landscape changes, the existing socio-technical regime (the rule system, practices and structures) and bottom-up niche-innovations. Societal transitions do not account for the things inside the regime alone, or for the long-term changes in the landscape, nor for the radical innovations, but for the interplay between all these levels. The research problem is studied through five research articles, which offer micro-level case studies to macro-level phenomenon. Each of the articles focus on different aspects related to ageing and change, and utilise various datasets. The framework of this study leans on the studies of socio-technical systems and multi-level perspective on transitions mainly developed by Frank Geels. Essential factors in transition from one socio-technological regime to another are the co-evolutionary processes between landscape changes, regime level and experimental niches. Landscape level changes, like the ageing of the population, destabilise the regime in the forms of coming pressures. This destabilization offers windows for opportunity to niche-innovations outside or at fringe of the regime, which, through their breakthrough, accelerate the transition process. However, the change is not easy because of various kinds of lock-ins and inertia, which tend to maintain the stability of the regime. In this dissertation, a constructionist approach of society is applied leaning mainly to the ideas of Anthony Giddens’ theory of structuration, with the dual nature of structures. The change is taking place in the interplay between actors and structures: structures shape people’s practices, but at the same time these practices constitute and reproduce social systems. Technology and other material aspects, as part of socio-technical systems, and the use of them, also take part in the structuration process. The findings of the study point out that co-evolutionary and co-effective relationships between economic, cultural, technological and institutional fields, as well as relationships between landscape changes, changes in the local and regime-level practices and rule systems, are a very complex and multi-level dynamic socio-technical phenomenon. At the landscape level of ageing, which creates the pressures and triggers to the regime change, there are three remarkable megatrends: demographic change, changes in the global economy and the development of technologies. These exert pressures to the socio-technical regime, which as a rule system is experiencing changes in the form of new markets and consumer habits, new ways of perceiving ageing, new models of organising the health care and other services and as new ways of considering innovation and innovativeness. There are also inner dynamics in the relationships between these aspects within the regime. These are interrelated and coconstructed: the prevailing perceptions of ageing and innovation, for instance, reflect the ageing policies, innovation policies, societal structures, organising models, technology and scientific discussion, and vice versa. Technology is part of the inner dynamics of the sociotechnological regime. Physical properties of the artefacts set limitations and opportunities with regard to their functions and uses. The use of and discussion about technology, contributes producing and reproducing the perceptions of old age. For societal transition, micro-level changes are also needed, in form of niche-innovations, for instance new services, organisational models or new technologies, Regimes, as stabilitystriven systems, tend to generate incremental innovations, but radically new innovations are generated in experimental niches protected from ‘normal’ market selection. The windows of opportunity for radical novelties may be opened if the circumstances are favourable for instance by tensions in the socio-technical regime affected by landscape level changes. This dissertation indicates that a change is taking place, firstly, in the dynamic interactionbetween levels, as a result of purposive action and governance to some extent. Breaking the inertia and using the window of opportunity for change and innovation offered by dynamics between levels, presupposes the actors’ special capabilities and actions such as dynamic capabilities and distance management. Secondly, the change is taking place the socio-technological negotiations inside the regime: interaction between technological and social, which is embodied in the use of technology. The use of technology includes small-level contextual scripts that also participate in forming broader societal scripts (for instance defining old age at the society level), which in their turn affect the formation of policies for innovation and ageing. Thirdly, the change is taking place by the means of active formation of the multi-actor innovation networks, where the role of distance management is crucial to facilitate the communication between actors coming from different backgrounds as well as to help the niches born outside the regime to utilise the window of opportunity offered by regime destabilisation. This dissertation has both theoretical and practical contributions. This study participates in the discussion of action-oriented view on transition by opening up of the socio-technological, coevolutionary processes of the multi-faceted phenomenon of ageing, which has lacked systematic analyses. The focus of this study, however, is not on the large-scale coordination and governance, but rather on opening up the incremental elements and structuration processes, which contribute to the transition little by little, and which can be affected to. This increases the practical importance of this dissertation, by highlighting the importance of very tiny, everyday elements in the change processes in the long run.

Incubation period of Hemileia vastatrix in coffee plants in Brazil simulated under climate change

Risk analysis of climate change on plant diseases has great importance for agriculture since it allows the evaluation of management strategies to minimize future damages. This work aimed to simulate future scenarios of coffee rust (Hemileia vastatrix) epidemics by elaborating geographic distribution maps using a model that estimates the pathogen incubation period and the output from three General Circulation Models (CSIRO-Mk3.0, INM-CM3.0, and MIROC3.2.medres). The climatological normal from 1961-1990 was compared with that of the decades 2020s, 2050s and 2080s using scenarios A2 and B1 from the IPCC. Maps were prepared with a spatial resolution of 0.5 × 0.5 degrees of latitude and longitude for ten producing states in Brazil. The climate variables used were maximum and minimum monthly temperatures. The maps obtained in scenario A2 showed a tendency towards a reduction in the incubation period when future scenarios are compared with the climatological normal from 1961-1990. A reduction in the period was also observed in scenario B1, although smaller than that in scenario A2.

Public-Private Partnerships: Managing organizational change for acquiring value creative capabilities

The objective of the dissertation is to examine organizational responses of public actors to customer requirements which drive the transformation of value networks and promote public-private partnership in the electricity distribution industry and elderly care sectors. The research bridges the concept of offering to value networks where capabilities can be acquired for novel product concepts. The research contributes to recent literature, re-examining theories on interactions of customer requirements and supply management. A critical realist case study approach is applied to this abductive the research which directs to describe causalities in the analyzed phenomena. The presented evidence is based on three sources, which are in-depth interviews, archival analysis and the Delphi method. Service provision requires awareness on technology and functionalities of offering. Moreover, service provision includes interactions of multiple partners, which suggests the importance of the co-operative orientation of actors. According to the findings,portfolio management has a key role when intelligent solutions are implemented in public service provision because its concepts involve a variety of resources from multiple suppliers. However, emergent networks are not functional if they lack leaders who have access to the customer interface, have power to steer networks and a capability to build offerings. Public procurement policies were recognized to focus on a narrow scope in which price is a key factor in decisions. In the future, the public sector has to implement technology strategies and portfolio management, which mean longterm platform development and commitment to partnerships. On the other hand, the service providers should also be more aware of offerings into which their products will be integrated in the future. This requires making the customer’s voice in product development and co-operation in order to increase the interconnectivity of products.

Management zones using fuzzy clustering based on spatial-temporal variability of soil and corn yield

Clustering soil and crop data can be used as a basis for the definition of management zones because the data are grouped into clusters based on the similar interaction of these variables. Therefore, the objective of this study was to identify management zones using fuzzy c-means clustering analysis based on the spatial and temporal variability of soil attributes and corn yield. The study site (18 by 250-m in size) was located in Jaboticabal, São Paulo/Brazil. Corn yield was measured in one hundred 4.5 by 10-m cells along four parallel transects (25 observations per transect) over five growing seasons between 2001 and 2010. Soil chemical and physical attributes were measured. SAS procedure MIXED was used to identify which variable(s) most influenced the spatial variability of corn yield over the five study years. Basis saturation (BS) was the variable that better related to corn yield, thus, semivariograms models were fitted for BS and corn yield and then, data values were krigged. Management Zone Analyst software was used to carry out the fuzzy c-means clustering algorithm. The optimum number of management zones can change over time, as well as the degree of agreement between the BS and corn yield management zone maps. Thus, it is very important take into account the temporal variability of crop yield and soil attributes to delineate management zones accurately.

Process approach in quality management - Case: ECO process development in EMS industry

The aim of the thesis was to study quality management with process approach and to find out how to utilize process management to improve quality. The operating environment of organizations has changed. Organizations are focusing on their core competences and networking with suppliers and customers to ensure more effective and efficient value creation for the end customer. Quality management is moving from inspection of the output to prevention of problems from occurring in the first place and management thinking is changing from functional approach to process approach. In the theoretical part of the thesis, it is studied how to define quality, how to achieve good quality, how to improve quality, and how to make sure the improvement goes on as never ending cycle. A selection of quality tools is introduced. Process approach to quality management is described and compared to functional approach, which is the traditional way to manage operations and quality. The customer focus is also studied, and it is presented, that to ensure long term customer commitment, organization needs to react to changing customer requirements and wishes by constantly improving the processes. In the experimental part the theories are tested in a process improvement business case. It is shown how to execute a process improvement project starting from defining the customer requirements, continuing to defining the process ownership, roles and responsibilities, boundaries, interfaces and the actual process activities. The control points and measures are determined for the process, as well as the feedback and corrective action process, to ensure continual improvement can be achieved and to enable verification that customer requirements are fulfilled.

Evaluating the Maturity of Data Management Practices in a Major Energy Provider Company

Data is the most important asset of a company in the information age. Other assets, such as technology, facilities or products can be copied or reverse-engineered, employees can be brought over, but data remains unique to every company. As data management topics are slowly moving from unknown unknowns to known unknowns, tools to evaluate and manage data properly are developed and refined. Many projects are in progress today to develop various maturity models for evaluating information and data management practices. These maturity models come in many shapes and sizes: from short and concise ones meant for a quick assessment, to complex ones that call for an expert assessment by experienced consultants. In this paper several of them, made not only by external inter-organizational groups and authors, but also developed internally at a Major Energy Provider Company (MEPC) are juxtaposed and thoroughly analyzed. Apart from analyzing the available maturity models related to Data Management, this paper also selects the one with the most merit and describes and analyzes using it to perform a maturity assessment in MEPC. The utility of maturity models is two-fold: descriptive and prescriptive. Besides recording the current state of Data Management practices maturity by performing the assessments, this maturity model is also used to chart the way forward. Thus, after the current situation is presented, analysis and recommendations on how to improve it based on the definitions of higher levels of maturity are given. Generally, the main trend observed was the widening of the Data Management field to include more business and “soft” areas (as opposed to technical ones) and the change of focus towards business value of data, while assuming that the underlying IT systems for managing data are “ideal”, that is, left to the purely technical disciplines to design and maintain. This trend is not only present in Data Management but in other technological areas as well, where more and more attention is given to innovative use of technology, while acknowledging that the strategic importance of IT as such is diminishing.

Establishment of a health and safety management system according to the OHSAS 18001 standard

The thesis develops guidelines for the implementation of the health and safety management system according to the OHSAS 18001 standard, as well as the feasible threat analysis, project proposal schedule, future system quality improvements and organizational change evaluation. The theoretical part clarifies determination of occupational health and safety, its management system, the OHSAS 18001 standard and integrated management system compounded of triple ISO 14001, ISO 9001 and OHSAS 18001 standards. The literature includes such important aspects as human factor, organizational policies, possible benefits, threats, organizational safety culture, Deming’s quality improvement cycle, system implementation, maintenance and cost matters. The empirical part demonstrates real-life situation by using Andritz Pulp & Paper Oy as a case study. Prior the thesis proposal, Andritz Group is analysed including separate business areas, acquisition and integration strategies, current status of the health and safety management and parallel experiences of the largest business area Andritz Hydro. The proposal is aimed at improving the current health and safety system for the permanent and sub-contracted employees at Andritz Pulp & Paper both in Finland and in various projects globally.