Customer Driven Service Development – Technology-based Care and Services for the Elderly

The objective of this master’s thesis was to examine technology-based smart home devices and services. Topic was approached through basic theories, transaction cost theory and resource-based view in order to build basis for this thesis. Conceptual framework was discussed by means of networks, value networks and service systems which provide a useful framework for service development. The needs of the elderly living at home were discussed in order to find out which technology-based services could be used to satisfy the needs. Segmentation and need data collected previously during proactive home visits was exploited and additionally a survey targeted to experts and professionals of social and health care sector was done to verify the needs. Finally, the results of the survey were analyzed using quality function deployment method to figure out the most important and suitable service offerings for the elderly. As a conclusion of analysis, social media and monitoring services are the most useful technology-based services. However, traditional home services will still maintain their necessity too.

Influence of distance, geometry and number of control stations on quality of local geodetic networks for the purpose of georeferencing of rural properties

The implementation of local geodetic networks for georeferencing of rural properties has become a requirement after publication of the Georeferencing Technical Standard by INCRA. According to this standard, the maximum distance of baselines to GNSS L1 receivers is of 20 km. Besides the length of the baseline, the geometry and the number of geodetic control stations are other factors to be considered in the implementation of geodetic networks. Thus, this research aimed to examine the influence of baseline lengths higher than the regulated limit of 20 km, the geometry and the number of control stations on quality of local geodetic networks for georeferencing, and also to demonstrate the importance of using specific tests to evaluate the solution of ambiguities and on the quality of the adjustment. The results indicated that the increasing number of control stations has improved the quality of the network, the geometry has not influenced on the quality and the baseline length has influenced on the quality; however, lengths higher than 20 km has not interrupted the implementation, with GPS L1 receiver, of the local geodetic network for the purpose of georeferencing. Also, the use of different statistical tests, both for the evaluation of the resolution of ambiguities and for the adjustment, have enabled greater clearness in analyzing the results, which allow that unsuitable observations may be eliminated.

Understanding and improving quality of secondary school education : conceptions among teachers in Tanzania

Temat för studien handlar om gymnasielärares uppfattningar om kvalitet och om hur kvalitet kan utvecklas i gymnasieutbildningen in Tanzania. Studien är till sin karaktär kvalitativ och består av utprövade semistrukturerade intervjuer med sammanlagt trettio lärare som arbetar i fyra gymnasieskolor både i urbana och rurala miljöer. Lärarna har varierande arbetserfarenhet och undervisar i olika ämnen. Huvudfokus har gällt identifieringen av variationer i lärares uppfattningar om kvalitet. På basen av två forskningsfrågor avslöjar analysen uppfattningar av hur lärare förstår och önskar utveckla kvaliteten på gymnasieutbildningen. Resultaten visar att lärare förstår kvaliteten på utbildningen i sina skolor som försök att möta skolans och samhällets mål, som individuella prestationer och förmågor som att inneha kompetenser och som att möta utmaningar inom utbildning, Identifierade uppfattningar var baserade på lärarnas personliga kunskap, arbetsmiljön och varierande omständigheter som rådde i deras skolor. Uppfattningar om en förbättring av kvaliteten i gymnasieutbildningen innefattade utveckling av lärares motivation, skolmiljön, arbetet i klassrum, kvaliteten på lärares kunskaper och färdigheter och undervisningsmaterial. Ambitionen bakom studien ar att erbjuda en plattform för strategier för att förbättra kvaliteten på gymnasieutbildningen. Resultaten strävar till att ge en fördjupad insikt i uppfattningar hos en utvald grupp av lärare som arbetar under samma villkor inom gymnasieskolor I Tanzania. Av den här anledningen är den genererade kunskapen därför relevant för att belysa lärares uppfattningar även utanför den studerade gruppen av respondenter.

Quality enhancement in teacher education : Tanzanian teacher educators’ conceptions and experiences

The overall aim of this study was to investigate and examine teacher educators’ conceptions and experiences of quality of teacher education. The research interest therefore was two-fold: a) to deepen understanding of the concept quality and b) scrutinize experiences of teacher educators of quality enhancement. To achieve this ambition the study was conducted in the context of a newly established university college-based teacher education in Tanzania. Two research questions guided the study. The first focused on investigating how teacher educators conceived quality in the domain of teacher education and the second intended to explore teacher educators’ experiences of quality enhancement. The theoretical framework of the study centered on the concepts of teacher education, quality, and criteria for quality enhancement. Phenomenographic and phenomenological approaches under the main umbrella of qualitative research design were selected. Twenty five teacher educators participated in the study. Interviews were used for the collection of the data. The results of the first research question, in brief, indicate that teacher educators’ conceptions of quality are expressed in two main categories, namely, outstanding academic scholarship and adequate professional scholarship. Quality as outstanding academic scholarship was illustrated by two subcategories: excellence and positive transformation. While the former was composed of two aspects, the latter was demonstrated by three aspects. Quality as adequate professional scholarship was described in three sub-categories. The first was improved teaching competency, consisting of two aspects. The second was conscious research orientation, which is displayed by three aspects, and the last was enhancing the ability to reflect, represented by two aspects. The results of the second research question, which focused on exploring teacher educators’ experience of quality enhancement, were classified into two main categories of description: insufficient programs of teacher education and unsatisfactory professional development of teacher educators. From the two categories, the strengths, weaknesses, opportunities and challenges related to programs of educating teachers, particularly curriculum development and implementation, and the professional development of educators, were exposed. Since the ambition of conducting the study was to deepen the understanding by producing insight that would act as a platform for appraising and enhancing the quality of teacher education, the results hopefully can be used for the development of the quality of teacher education in Tanzania.

Coercion, Perceived Care and Quality of Life Among Patients in Psychiatric Hospitals

The goals of the study were to describe patients’ perceptions of care after experiencing seclusion/restraint and their quality of life. The goal was moreover to identify methodological challenges related to studies from the perspective of coerced patients. The study was conducted in three phases between September 2008 and April 2012. In the first phase, the instrument Secluded/ Restrained Patients’ Perception of their Treatment (SR-PPT) was developed and validated in Japan in cooperation with a Finnish research group (n = 56). Additional data were collected over one year from secluded/restrained patients using the instrument (n = 90). In the second phase, data were collected during the discharge process (n = 264). In the third phase, data were collected from electronic databases. Methodological and ethical issues were reviewed (n = 32) using systematic review method. Patients perceived that co-operation with the staff was poor; patients’ opinions were not taken into account, treatment targets collated and treatment methods were seen in different ways. Patients also felt that their concerns were not well enough understood. However, patients received getting nurses’ time. In particular, seclusion/restraint was considered unnecessary. The patients felt that they benefited from the isolation in treating their problems more than they needed it, even if the benefit was seen to be minor. Patients treated on forensic wards rated their treatment and care significantly lower than in general units. During hospitalization secluded/restrained patients evaluated their quality of life, however, better than did non-secluded/restrained patients. However, no conclusion is drawn to the effect that the better quality of life assessment is attributable to the seclusion/restraint because patients’ treatment period after the isolation was long and because of many other factors, as rehabilitation, medication, diagnostic differences, and adaptation. According to the systematic mixed studies review variation between study designs was found to be a methodological challenge. This makes comparison of the results more difficult. A research ethical weakness is conceded as regards descriptions of the ethical review process (44 %) and informed consent (32 %). It can be concluded that patients in psychiatric hospital care and having a voice as an equal expert require special attention to clinical nursing, decision-making and service planning. Patients and their family members will be consulted in plans of preventive and alternative methods for seclusion and restraint. The study supports the theory that in ethical decision-making situations account should be taken of medical indications, in addition to the patients’ preferences, the effect of treatment on quality of life, and this depends on other factors. The connection between treatment decisions and a patient’s quality of life should be evaluated more structurally in practice. Changing treatment culture towards patients’ involvement will support daily life in nursing and service planning taking into account improvements in patients’ quality of life.

Intended Quality: Relationships between Development, Testing and Quality

An empirical study was conducted in the area of software engineering to study relationships between development, testing and intended software quality. International standards served as a starting point of the study. For analysis a round of interviews was kept and transcribed. It was found that interaction between humans is critical, especially in transferring knowledge and standards’ processes. The standards are communicated through interaction and learning processes are involved before compliance. One of the results was that testing is the key to sufficient quality. The outcome was that successful interaction, sufficient testing and compliance with the standards combined with good motivation may provide most repeatable intended quality.

Long-term nutrient load management and lake restoration: Case of Säkylän Pyhäjärvi (SW Finland)

Eutrophication caused by anthropogenic nutrient pollution has become one of the most severe threats to water bodies. Nutrients enter water bodies from atmospheric precipitation, industrial and domestic wastewaters and surface runoff from agricultural and forest areas. As point pollution has been significantly reduced in developed countries in recent decades, agricultural non-point sources have been increasingly identified as the largest source of nutrient loading in water bodies. In this study, Lake Säkylän Pyhäjärvi and its catchment are studied as an example of a long-term, voluntary-based, co-operative model of lake and catchment management. Lake Pyhäjärvi is located in the centre of an intensive agricultural area in southwestern Finland. More than 20 professional fishermen operate in the lake area, and the lake is used as a drinking water source and for various recreational activities. Lake Pyhäjärvi is a good example of a large and shallow lake that suffers from eutrophication and is subject to measures to improve this undesired state under changing conditions. Climate change is one of the most important challenges faced by Lake Pyhäjärvi and other water bodies. The results show that climatic variation affects the amounts of runoff and nutrient loading and their timing during the year. The findings from the study area concerning warm winters and their influences on nutrient loading are in accordance with the IPCC scenarios of future climate change. In addition to nutrient reduction measures, the restoration of food chains (biomanipulation) is a key method in water quality management. The food-web structure in Lake Pyhäjärvi has, however, become disturbed due to mild winters, short ice cover and low fish catch. Ice cover that enables winter seining is extremely important to the water quality and ecosystem of Lake Pyhäjärvi, as the vendace stock is one of the key factors affecting the food web and the state of the lake. New methods for the reduction of nutrient loading and the treatment of runoff waters from agriculture, such as sand filters, were tested in field conditions. The results confirm that the filter technique is an applicable method for nutrient reduction, but further development is needed. The ability of sand filters to absorb nutrients can be improved with nutrient binding compounds, such as lime. Long-term hydrological, chemical and biological research and monitoring data on Lake Pyhäjärvi and its catchment provide a basis for water protection measures and improve our understanding of the complicated physical, chemical and biological interactions between the terrestrial and aquatic realms. In addition to measurements carried out in field conditions, Lake Pyhäjärvi and its catchment were studied using various modelling methods. In the calibration and validation of models, long-term and wide-ranging time series data proved to be valuable. Collaboration between researchers, modellers and local water managers further improves the reliability and usefulness of models. Lake Pyhäjärvi and its catchment can also be regarded as a good research laboratory from the point of view of the Baltic Sea. The main problem in both of them is eutrophication caused by excess nutrients, and nutrient loading has to be reduced – especially from agriculture. Mitigation measures are also similar in both cases.

CTQ process flow development and the impact for cost of quality

Tämä työ tehtiin Kone Industrial Oy:lle Major Projects yksikköön, laatuosastolle. Kone Major Projects yksikkö keskittyy erikoisiin ja suuriin hissi- ja liukuporras projekteihin. Työn tavoitteena oli luoda harmonisoitu prosessi hissikomponenttien laaduntarkkailua varten sekä tarkastella ja vertailla kustannussäästöjä, jota tällä uudella prosessilla voidaan saavuttaa. Tavoitteena oli saavuttaa 80-prosentin kustannussäästöt laatukustannuksissa uuden laatuprosessin avulla. Työn taustana ja tutkimusongelmana ovat lisääntyneet erikoisprojektit ja niiden myötä lisääntynyt laaduntarkkailun tarve. Ongelmana laaduntarkkailussa voitiin pitää harmonisoidun ja selkeän prosessin puuttumista C-prosessikomponenttien valmistuksessa. Lisäksi kehitysprosessin aikana luotiin vanhojen työkalujen pohjalta keskeinen laaduntarkkailutyökalu, CTQ-työkalu. Työssä käsitellään ensin Konetta yhtiönä ja selvitetään Koneen keskeisimmät prosessit työn taustaksi. Teoria osuudessa käsitellään prosessin kehitykseen liittyviä teorioita sekä yleisiä laatukäsitteitä ja esitetään teorioita laadun asemasta nykypäivänä. Lopuksi käsitellään COQ eli laatukustannusten teoriaa ja esitellään teoria PAF-analyysille, jota käytetään työssä laatukustannusten vertailuun case esimerkin avulla. Työssä kuvataan CTQ prosessin luominen alusta loppuun ja case esimerkin avulla testataan uutta CTQ prosessia pilottihankkeessa. Tässä case esimerkissä projektin bracket eli johdekiinnitysklipsi tuotetaan uuden laatuprosessin avulla sekä tehdään kustannusvertailu saman projektin toisen bracketin kanssa, joka on tuotettu ennen uuden laatuprosessin implementoimista. Työn lopputuloksena CTQ prosessi saatiin luotua ja sitä pystyttiin testaamaan käytännössä case esimerkin avulla. Tulosten perusteella voidaan sanoa, että CTQ prosessin käyttö vähentää laatukustannuksia huomattavasti ja helpottaa laadunhallintaa C-prosessikomponenttien tuotannossa.

Use of herbicides on turfgrass

In crop production, weeds must be controlled so as not to adversely affect crop yield and crop quality. Thus, a low level of weeds infesting a field, in most instances, is not a problem. Except in sod or seed production, turfgrass does not have a yield component. The value of turfgrass is its inherent aesthetic quality and usability. Aesthetic quality is the beauty and value that turfgrass adds to a managed landscape. Usability can be the durability of a sport field, trueness of golf putting green roll, or reduction in soil loss from water runoff or wind. Any weed presence in turfgrass can decrease the aesthetic quality and usability of turfgrass. Utilizing herbicides is the only way to completely control weeds in a turfgrass stand. While it is possible to reduce weed populations using cultural or mechanical management practices, it is impossible to completely eliminate weeds as can be accomplished with herbicides. This manuscript will review the major herbicides used in turfgrass in the United States with respect to their modes of action, herbicide family, and primary use in turfgrass.

Suunnittelulla ja ruo´on hyötykäytöllä tehokkuutta rantojen hoitoon : Tuloksia ja kokemuksia VELHO-hankkeesta

Varsinais-Suomen ELY-keskuksen toteuttamassa VELHO-hankkeessa kehitettiin kustannustehokkaita ratkaisuja ranta-alueiden umpeenkasvun aiheuttamiin ongelmiin luomalla uusi konsepti ranta-alueiden monikäyttösuunnitteluun, edistämällä järviruo’on hyötykäyttöä ja valmistelemalla esityksiä uuteen maaseudun kehittämisohjelmaan. Tässä julkaisussa esitellään työn tulokset ja johtopäätökset. Hankkeessa laadittiin kolme ranta-alueiden monikäyttösuunnitelmaa: Mynälahden Sarsalanaukko ja Musta-aukko, Oukkulanlahti – Naantalinaukko ja Eurajoen - Luvian rannikko. Suunnitelmissa sovitettiin yhteen ranta-alueiden eri käyttömuotoja ja pyrittiin löytämään optimaalinen verkosto hyötykäyttöön leikattavien ruovikoiden, avoimena pidettävien merenrantaniittyjen ja säilytettävien ruovikoiden välille. Kustannustehokkuuteen pyrittiin kohdentamalla hoitotoimet laajoihin kokonaisuuksiin sekä järviruo’on hyötykäytöllä. Suunnitelmat laadittiin laajassa osallistavassa prosessissa. Hankkeessa laadituissa ranta-alueiden monikäyttösuunnitelmissa esitettiin erilaisia maankäyttötavoitteita ja hoitosuosituksia yli 2000 hehtaarille. Ruovikoiden ja rantaniittyjen lisäksi suunnittelun kohteena olivat myös rantojen läheiset peltoalueet, reunavyöhykkeet ja muut perinnebiotoopit. Hoitotoimilla tavoitellaan alueiden luonnon monimuotoisuuden ja vesien tilan paranemista, maiseman avartumista ja virkistyskäytön helpottumista. Ruovikoiden erilaisia leikkuumenetelmiä (talvileikkuut, vesileikkuut, maaleikkuut) testattiin 90 hehtaarin alalla. Rantaniittyjen kunnostuksessa testattiin maaleikkuun lisäksi ruovikon niittomurskausta. Ruokomassan hyötykäyttökokeissa testattiin kahden eri ruokolaadun eli tuoreen kesäruo’on ja kuivan talviruo’on esikäsittelyä ja hyötykäyttöä energiantuotannossa (poltto, biokaasutus) ja maataloudessa (maanparannusaine, viherlannoite, kuivike, katemateriaali). Maaseudun kehittämisohjelmaan tehtiin esityksiä tukimuotojen kehittämiseksi: rantaniittyjen kunnostuksen lisääminen ja hoidon laadun parantaminen, ruovikoiden vesileikkuut ravinteiden poistajina sekä ruokomassojen käyttö maan orgaanisen aineen lisääjänä. Hankkeen kokemusten mukaan yksi kustannustehokkaimmista hoito- ja käyttöketjuista on ruovikon leikkuu loppukesällä ja siitä kertyvän massan käyttö ranta-alueiden läheisillä pelloilla viherlannoitteena ja maanparannusaineena. Yhden hehtaarin ruovikon kesäleikkuulla poistetaan keskimäärin 80 kg typpeä ja 7 kg fosforia. Vesiensuojelullisten hyötyjen lisäksi leikkuulla parannetaan umpeenkasvusta kärsivien lajien elinoloja, lisätään rantojen vetovoimaisuutta ja edistetään luonnonhoitoyrittäjyyden edellytyksiä. Peltokäytössä käsittelyketju on lyhyt eikä se vaadi pitkiä kuljetusmatkoja. Ruokomassa kierrättää ravinteita takaisin pelloille ja parantaa maan rakennetta. Järviruo’on hyötykäytöllä ei pystytä kattamaan koko leikkuu- ja käyttöketjun kustannuksia. Leikkuusta ja hyötykäytöstä saatavien monien eri aineellisten ja aineettomien ekosysteemipalveluhyötyjen vuoksi toimintaan on tarpeen suunnata yhteiskunnan tukea ja luoda käytännön toteutusta edistäviä tukimuotoja. Kustannustehokkuutta voidaan edelleen parantaa laitteita ja menetelmiä kehittämällä.

Software development methods and quality assurance: Special focus on South Korea

The purpose of this study was to explore software development methods and quality assurance practices used by South Korean software industry. Empirical data was collected by conducting a survey that focused on three main parts: software life cycle models and methods, software quality assurance including quality standards, the strengths and weaknesses of South Korean software industry. The results of the completed survey showed that the use of agile methods is slightly surpassing the use of traditional software development methods. The survey also revealed an interesting result that almost half of the South Korean companies do not use any software quality assurance plan in their projects. For the state of South Korean software industry large number of the respondents thought that despite of the weakness, the status of software development in South Korea will improve in the future.

Project Controlling and Management in IT Consulting Enterprise

Liiketoiminnan organisoiminen projekteiksi on erittäin yleistä nykyisin. Suuri osa projekteista erityisesti IT-alalla epäonnistuu kuitenkin saavuttamaan tavoitteensa. Projektin menestys on tyypillisesti mitattu budjetin, aikataulun, laadun ja sidosryhmien tyytyväisyyden perusteella. Tämän Pro Gradu -tutkielman tarkoituksena on etsiä tyypillisimpiä syitä projektien epäonnistumiseen ja löytää projektien seurannan ja mittaamisen avulla keinoja näiden epäonnistumisten ehkäisemiseen. Tutkimusmenetelmänä on laadullinen tapaustutkimus. Empiirinen aineisto on kerätty haastattelujen, eri materiaalien analysoinnin ja havainnoinnin avulla. Teoriaosuus tarjoaa kattavan yhteenvedon projektiliiketoiminnan ja yksittäisten projektien johtamiseen sekä projektien seurantaan ja mittaamiseen aikaisemman kirjallisuuden perusteella. Empiirisessä osiossa suoritetaan analyysi Case -yrityksen projektien seurantaan ja valittuihin projekteihin. Analyysien, haastattelujen ja havainnoinnin pohjalta tehdään johtopäätökset tyypillisimmistä, ongelmia projekteissa aiheuttavista tekijöistä sekä näiden esiintymisestä projektin elinkaaren eri vaiheissa. Mahdolliset ongelmia ehkäisevät keinot esitetään myös. Ehdotuksia kehityskohteiksi esitetään lopuksi teorian ja empirian pohjalta.

Female pelvic floor disorders – outcome after mesh-augmented procedures and studies on vaginal connective tissue

Pelvic floor disorders, such as urinary incontinence (UI) and pelvic organ prolapse (POP), are common disorders in women. Because of the prolonged life expectancy the prevalence of UI and POP and the probability of ending up in surgery are increasing. However, the pathophysiology behind these disorders is still unsolved. The aim of this thesis is to study possible alterations in the connective tissue in the vaginal wall in patients with and without POP. The long-term outcome and complications of mid-urethral slings (MUS) and mesh-augmented POP surgery were studied in heterogenic patient populations. More elastin and a slight increase in immunostaining of type III and V collagens in tissue samples were obtained from patients with POP compared to controls in whom type I collagen was more prominent. The studies assessing the mesh-augmented procedures revealed good efficacy and high patient satisfaction after a long-term follow-up. Patients operated on because of mixed incontinence and with BMI >30 kg/m² reported significantly more urinary symptoms and a lower quality of life than the patients operated on because of stress urinary incontinence and the ones with BMI ≤30 kg/m². The objective outcome was equal between the groups. Mesh exposure through vaginal mucosa occurred in 23 % of the patients after POP surgery, most of these being asymptomatic. There are alterations in connective tissues in patients with POP. Mid-urethral sling procedures produced good long-term cure rates and patient satisfaction. As to the prolapse surgery, in spite of relatively high exposure rate, mesh-augmented procedure proved to be safe and effective method for the correction of POP.

Environmental Challenges in the Joint Border Area of Norway, Finland and Russia

This report examines the human impact on the subarctic environment of the joint border area of Norway, Finland and Russia. The aim is to present the current state and recent changes that have taken place in the region. The main threat to the environment is the Pechenganikel mining and metallurgical industrial combine in the towns of Nikel and Zapolyarny in the Kola Peninsula. Emissions from this complex include high levels of heavy metals, persistent organic pollutants and sulfur dioxide. Pollution, along with climate change, water level regulation and other anthropogenic effects, has affected the aquatic ecosystems in the joint border area. The main heavy metals in the area are copper and nickel, the highest concentrations of which are measured near the combine. Direct discharge of sewage into the river continues and airborne heavy metal particles are also deposited to areas farther away. Climate changeinduced increase in temperature and precipitation in the Kola Peninsula is evident. Water level regulation with seven hydropower plants in the Pasvik River have changed it into a series of lakes and lake-like reservoirs. This report discusses modelling, which was enabled to estimate the effect of climate change on Lake Inarijärvi and the Pasvik River hydrology, water level fluctuation and ecology and to follow the sulfur dioxide emissions emitted from the Pechenganikel. Effects of pollution on the nature and concentrations of the main pollutants were studied and climate change in the border area and its effects on the ecology were estimated. Also the effects of water level regulation on the ecological status of the aquatic ecosystems were addressed.

Restless leg syndrome, sleep quality and fatigue in multiple sclerosis patients

We have tested the hypothesis that restless leg syndrome (RLS) is related to quality of sleep, fatigue and clinical disability in multiple sclerosis (MS). The diagnosis of RLS used the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Fatigue was assessed by the Fatigue Severity Scale (FSS >27), quality of sleep by the Pittsburgh Sleep Quality Index (PSQI >6), excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS >10) and clinical disability by the Expanded Disability Status Scale (EDSS). Forty-four patients (32 women) aged 14 to 64 years (43 ± 14) with disease from 0.4 to 23 years (6.7 ± 5.9) were evaluated. Thirty-five were classified as relapsing-remitting, 5 as primary progressive and 4 as secondary progressive. EDSS varied from 0 to 8.0 (3.6 ± 2.0). RLS was detected in 12 cases (27%). Patients with RLS presented greater disability (P = 0.01), poorer sleep (P = 0.02) and greater levels of fatigue (P = 0.03). Impaired sleep was present in 23 (52%) and excessive daytime sleepiness in 3 cases (6.8%). Fatigue was present in 32 subjects (73%) and was associated with clinical disability (P = 0.000) and sleep quality (P = 0.002). Age, gender, disease duration, MS pattern, excessive daytime sleepiness and the presence of upper motor neuron signs were not associated with the presence of RLS. Fatigue was best explained by clinical disability and poor sleep quality. Awareness of RLS among health care professionals may contribute to improvement in MS management.