Etelä-Karjalan kuntien aineeton pääoma ja sen kehittämisen haasteet

Tämän kvalitatiivisin menetelmin suoritetun tutkimuksen tavoite on selvittää, mikä on aineettoman pääoman tila Etelä-Karjalan kunnissa ja mitkä ovat niiden aineettoman pääoman kehittämisen haasteet. Kunnat valittiin tutkimukseen kunta- ja palvelurakenneuudistuslaissa määrätyn kaupunkiseutusuunnitelman velvoitteen rajaamana. Tutkimuksen aineisto perustuu kuntien aineettoman pääoman raportteihin sekä kuntien johdolle tehtyihin puolistrukturoituihin haastatteluihin. Aineettoman pääoman raporttien analysointi on suoritettu kirjallisuusanalyysina henkilöstötilinpäätösmallia viitekehyksenä käyttäen, teoreettinen viitekehys on muodostettu kirjallisuusanalyysina aineettoman pääoman ja tietojohtamisen tutkimuskirjallisuudesta. Etelä-Karjalan kunnissa aineetonta pääomaa on osaaminen, koulu-tus, kuntien erilaiset prosessit ja järjestelmät sekä yhteistyö erilaisten sidosryhmien kanssa ja kuntien maine. Kehittämishaasteita aineettomalle pääomalle asettaa kuntien henkilöstön eläköityminen, kuntien yhteistyön lisääntyminen ja erilaisten prosessien ja järjestelmien kehittäminen.

Arvopaperistaminen ja CDO-lainat

Tutkimuksen tavoitteena on tarkastella kansainvälisillä rahoitusmarkkinoilla nopeasti yleistynyttä arvopaperistamista prosessina sekä arvopaperistamalla muodostettuja sijoitustuotteita pääomamarkkinainstrumentteina ja sijoituskohteina. Yksittäisistä arvopaperistamalla luoduista sijoitusinstrumenteista tutkielmassa keskitytään erityisesti collateralized debt obligation -tyyppiin. Tutkimuksen ensimmäisessä osassa selvitetään arvopaperistamistoiminnan perusrakenteita sekä erilaisten arvopaperistamistapojen eroja toisiinsa nähden. Toisessa osassa perehdytään collateralized debt obligaton instrumenttiin, sen ominaispiirteisiin ja eroihin perinteisiin joukkovelkakirjalainoihin ja sijoitusrahastoihin verrattuna. Tutkimuksen kolmannessa osassa selvitetään institutionaalisen sijoittajan kannalta mahdollisuuksia ja ongelmia sijoitettaessa arvopaperistettuihin sijoitusinstrumentteihin. Viimeisessä osassa tarkastellaan arvopaperistettujen sijoitustuotteiden markkinaa yleisesti ja sen aiheuttamien ongelmien vaikutusta koko rahoitusmarkkinoihin.

Välimiehen esteellisyys ja korvausvastuu

Tutkielman tarkoituksena oli välimiehen vastuun johtaminen korvausperusteen ollessa esteellisyys. Tutkielmassa paneuduttiin syvällisesti välimiehen asemaan, velvollisuuksiin, esteellisyyteen ja vastuun johtamiseen. Tutkimusmetodi oli lainopillinen systematisointi ja tulkinta, ja jossain määrin käsiteanalyysi. Tutkimusaineisto koostui ennakkopäätöksen KKO:2005:14 lisäksi suurimmalta osalta lakiartikkeleista ja -teksteistä. Tutkielmassa päädyttiin siihen johtopäätökseen, että välimiehen esteellisyys voi johtaa korvausvastuuseen, kun tuottamus ja syy-yhteys vahinkoon todetaan. Tuottamus voi KKO:2005:14 mukaisesti ilmetä myös velvollisuuden laiminlyöntinä. Tällaisena rikottuna velvoitteena toimi välimiesmenettelylain 9.2 §. Todettavissa on, ettei välimiehen korvausvastuun määrittyminen etenkin esteellisyyden kyseessä ollessa ole selkeää eikä yksioikoista.

Nursing discharge planning for older medical inpatients in Switzerland: A cross-sectional study.

Nursing discharge planning for elderly medical inpatients is an essential element of care to ensure optimal transition to home and to reduce post-discharge adverse events. The objectives of this cross-sectional study were to investigate the association between nursing discharge planning components in older medical inpatients, patients' readiness for hospital discharge and unplanned health care utilization during the following 30 days. Results indicated that no patients benefited from comprehensive discharge planning but most benefited from less than half of the discharge planning components. The most frequent intervention recorded was coordination, and the least common was patients' participation in decisions regarding discharge. Patients who received more nursing discharge components felt significantly less ready to go home and had significantly more readmissions during the 30-day follow-up period. This study highlights large gaps in the nursing discharge planning process in older medical inpatients and identifies specific areas where improvements are most needed.

Valoració de la qualitat de vida dels familiars de pacients amb fibromiàlgia

Fonament i objectiu: La Fibromiàlgia (FM) és una malaltia reumàtica caracteritzada per dolor generalitzat, que afecta a un tant per cent elevat de la població general , majoritàriament dones i d’etiologia desconeguda, i que pensem que no afecta tan sols als qui la pateixen, sinó que també als seus familiars. En aquest estudi s’han avaluat diferents variables com l’impacte emocional, la vida social, aspectes econòmics i laborals i altres activitats en familiars de primer grau de pacients amb FM. L’objectiu principal és determinar quin és el grau d’afectació negativa en la seva qualitat de vida. Material i mètodes: Es va fer un estudi observacional clínic a un grup de 27 familiars de 1er grau que convivien a la mateixa casa que els respectius afectats per FM. Se’ls va passar un qüestionari ad- hoc de 16 preguntes tancades, basades en estudis previs , i també una entrevista oberta amb l’objectiu de reforçar les dades estadístiques. Les entrevistes es varen fer a la Unitat de Fibromiàlgia de l’Hospital Santa Maria de Lleida. Resultats: Es va entrevistar a 27 familiars, 85’2 % homes, la majoria de entre 51 – 70 anys (63%). El 85’2 % eren casats, amb estudis primaris el 59’3% i el 88% tenien coneixements sobre la malaltia del familiar afectat. El percentatge de familiars que van opinar que hi havia una minva del grau de felicitats amb la malaltia era del 74’1%. El 85% no havia pensat mai en trencar la relació familiar. El 70% referien canvis en la vida social i relacional arrel del diagnòstic de FM , un 88’9% havien tingut que augmentar l’ajut en tasques domèstiques i el 70’4% patien efectes econòmics negatius arrel de la malaltia. La relació sexual es va veure afectada en un 85% dels casos, en canvi no es varen veure alteracions del son ni de la percepció de salut. Conclusions: El fet de conviure amb una persona afectada de FM suposa pèrdua del grau de felicitat i canvis en la vida social, relacional i sexual amb empitjorament del nivell econòmic.

La vaccination - une thématique controversée: l'exemple de la grippe

Chaque année en automne, la discussion se répète : faut-il ou non se faire vacciner contre la grippe ? Cette question revêt une importance particulière lorsqu'elle est posée à des professionnel-le-s de la santé puisque ceux-ci peuvent être en contact direct avec des patients présentant un risque particulier de contracter une forme sévère de la maladie. Bien que ce danger soit connu, se faire vacciner ne constitue pas une démarche logique systématiquement adoptée par les professionnel-le-s de la santé et l'introduction d'une éventuelle obligation de vaccination pour cette catégorie de personnes soulève une vive controverse.

Attachment and coping in psychosis in relation to spiritual figures

Background: Studies have found higher levels of insecure attachment in individuals with schizophrenia. Attachment theory provides a framework necessary for conceptualizing the development of interpersonal functioning. Some aspects of the attachment of the believer to his/her spiritual figure are similar to those between the child and his/her parents. The correspondence hypothesis suggests that early child-parent interactions correspond to a person's relation to a spiritual figure. The compensation hypothesis suggests that an insecure attachment history would lead to a strong religiousness/spirituality as a compensation for the lack of felt security. The aim of this study is to explore attachment models in psychosis vs. healthy controls, the relationships between attachment and psychopathology and the attachment processes related to spiritual figures. Methods: Attachment models were measured in 30 patients with psychosis and 18 controls with the AAI (Adult Attachment interview) in relationship with psychopathology. Beliefs and practices related to a spiritual figure were investigated by qualitative and quantitative analyses. Results: Patients with psychosis showed a high prevalence of insecure avoidant attachment. Spiritual entities functioned like attachment figures in two thirds of cases. Interviews revealed the transformation of internal working models within relation to a spiritual figure: a compensation process was found in 7 of the 32 subjects who showed a significant attachment to a spiritual figure. Conclusions: Attachment theory allows us to highlight one of the underlying dimensions of spiritual coping in patients with psychosis.

L'impact du nouveau financement hospitalier sur les hôpitaux publics : exemple de l'Hôpital du Valais

L'objectif de ce mémoire est d'évaluer les conséquences du nouveau financement hospitalier de la LAMaI sur les hôpitaux publics et plus particulièrement sur l'Hôpital du Valais. Les nouvelles dispositions votées le 21 décembre 2007 par le Parlement ont pour but d'accroître la concurrence entre les hôpitaux et de mettre sur un pied d'égalité les établissements privés et publics. Ce document traite des principales modifications législatives et de leur entrée en vigueur, des nouveautés concernant le calcul des coûts et des tarifs à la charge de l'assurance obligatoire des soins avec l'inclusion des investissements et la nouvelle défmition des frais de formation, de l'introduction des forfaits par pathologie SwissDRG, des problématiques de l'ouverture des frontières cantonales et de la concurrence. Selon les hypothèses retenues, des effets peu importants sont à prévoir en Valais pour l'ouverture des frontières, la liste hospitalière et la répartition du tarif entre assureurs et cantons. Par contre on estime que la prise en compte des investissements augmentera les coûts de l'Hôpital du Valais de 5 à 13% alors les activités d'intérêt général se chiffrent entre 4 et 22 Mio. Les conséquences de l'introduction de la concurrence voulue par le législateur sont plus difficiles à évaluer, car elles dépendent de paramètres encore inconnus tels que le gain espéré et le comportement des parties. Une concurrence par les prix prétéritera les hôpitaux publics si leurs spécificités, telles que les urgences, les soins intensifs et l'obligation d'admission, ne sont pas prises en compte dans la structure tarifaire, le prix ou la planification. Le changement de comportement du patient, des assureurs, des médecins traitants voire des cantons ou des médias constitue également une inconnue qui pourrait avoir de fortes conséquences et contraindre les hôpitaux publics à développer leurs concepts de marketing et de communication. [Auteur, p. 2]

The relationship between virtual body ownership and temperature sensitivity.

In the rubber hand illusion tactile stimulation seen on a rubber hand, that is synchronous with tactile stimulation felt on the hidden real hand, can lead to an illusion of ownership over the rubber hand. This illusion has been shown to produce a temperature decrease in the hidden hand, suggesting that such illusory ownership produces disownership of the real hand. Here we apply immersive virtual reality (VR) to experimentally investigate this with respect to sensitivity to temperature change. Forty participants experienced immersion in a VR with a virtual body (VB) seen from a first person perspective. For half the participants the VB was consistent in posture and movement with their own body, and in the other half there was inconsistency. Temperature sensitivity on the palm of the hand was measured before and during the virtual experience. The results show that temperature sensitivity decreased in the consistent compared to the inconsistent condition. Moreover, the change in sensitivity was significantly correlated with the subjective illusion of virtual arm ownership but modulated by the illusion of ownership over the full virtual body. This suggests that a full body ownership illusion results in a unification of the virtual and real bodies into one overall entity - with proprioception and tactile sensations on the real body integrated with the visual presence of the virtual body. The results are interpreted in the framework of a"body matrix" recently introduced into the literature.

Nursing Advocacy: A concept clarification in context of procedural pain care

The purpose of this study was to clarify the concept of advocacy in context of procedural pain care and to investigate the implementation of advocacy in that context. First, the concept of advocacy was described on the basis of a literature review (n = 89 empirical studies from 1990 to 2003). Then, the concept was described in the context of procedural pain care on the basis of interview data (n = 22 patients, 21 nurses) in a medical and surgical context. In the second phase, an instrument exploring the content of advocacy and the implementation of advocacy in context of procedural pain care was developed and validated. Then, the content of advocacy and implementation of it was explored in a sample of otolaryngeal patients (n = 405) and nurses (n = 118) in 12 hospitals. In the third phase, an update literature review (n = 35 empirical studies from 2003 to 2007) was conducted, and all data from phases one and two were reviewed in order to refine the elements the concept of advocacy, and the relationships between these elements. As a result of this study, advocacy in context of procedural pain care was defined as consisting of the dual aspects of patient advocacy and professional advocacy, and called nursing advocacy. It was divided into dimensions and subdimensions in which patient and nurse empowerment seems to play a vital role. All the data obtained lend support to this definition of nursing advocacy. Patients and nurses felt that nearly all of the activities that they considered as advocacy were implemented.

A influência da Química nos saberes médicos acadêmicos e práticos do século XVIII em Portugal e no Brasil

At the dawn of the eighteenth century chemistry was establishing itself as a physical science on its own right, after a long ancillary relationship with medicine and pharmacy, which had began two centuries before. This association, and the many changes that came along the scientific revolution spread into many walks of life. The Luso-Brazilian world, apparently so removed from the new developments, could not help to be touched by them, as this study shows, in which two contemporary medical authors are analysed. Both were Portuguese who had long lived in Brazil; both practised and wrote extensively on Medicine; both felt the influence of the new times, albeit in quite different ways.

Economia de átomos, engenharia molecular e catálise organometálica bifásica: conceitos moleculares para tecnologias limpas

For economical and ecological reasons, synthetic chemists are confronted with the increasing obligation of optimizing their synthetic methods. Maximizing efficiency and minimizing costs in the production of molecules and macromolecules constitutes, therefore, one of the most exciting challenges of synthetic chemistry. The ideal synthesis should produce the desired product in 100% yield and selectivity, in a safe and environmentally acceptable process. In this highlight the concepts of atom economy, molecular engineering and biphasic organometallic catalysis, which address these issues at the molecular level for the generation of "green" technologies, are introduced and discussed.

Novos materiais à base de nanofibras de carbono como suporte de catalisador na decomposição da hidrazina

Today satellites propulsion is based on the use of monopropellant and/or bipropellant chemical systems. The maneuvering of satellite is based on the hydrazine decomposition micropropulsors catalyzed by metallic iridium supported on g-alumina. This reaction is a surface reaction and is strongly exothermic and implies that the operation of the micropropulsor is controlled by the mass and heat diffusions. For this reason and for the fact that the propulsor operation is frequently in pulsed regime, the catalyst should support high pressure and temperature variations within a short time period. The performance and the durability of the commercial catalyst are jeopardized by the low thermal conductivity of the alumina. The low thermal conductivity of the alumina support restricts the heat diffusion and leads to the formation of hot spots on the catalyst surface causing the metal sintering and/or fractures of the support, resulting in loss of the activity and catalyst destruction. This work presents the synthesis and characterization of new carbon composite support for the active element iridium, in substitution of the commercial catalysts alumina based support. These supports are constituted of carbon nanofibers (30 to 40 nm diameter) supported on a macroscopic carbon felt. These materials present high thermal conductivity and mechanical resistance, as well as the easiness to be shaped with different macroscopic shapes. The mechanical stability and the performance of the iridium supported on the carbon composite support, evaluated in a laboratory scale test in hydrazine decomposition reaction, are superior compared to the commercial catalyst.

Reparar y sustituir cosas en la compraventa : evolución y últimas tendencias

International texts recognise the buyer's right to the repair or replacement if the goods do not conform with the contract, and at the same time, establish exceptions to their application and certain rules of protection for the seller (Art. 46 CISG, Art. 7.2.3 UNIDROIT Principles of International Commercial Contracts, Art.9:102 PECL and Arts. 4:202 y 4:204 (1) PEL S). This approach is a result of a compromise between civil law systems and the common law and it has been widely extended to the regulation of consumer sales over the last decade (Art. 3.3 of the Directive 1999/44/CE, Art. III.-3:302 DCFR, Art. 26 of the proposal for a Directive on Consumer Rights). These norms regulate the different ways of requiring the fulfilment of a contractual obligation from a new paradigm which has little to do with a need to protect the weak consumer which governed the origins of consumer policy in the European Community. Now the idea of the consumer who shall behave economically efficiently prevails in Art. 3.3 of the Directive 1999/44/CE, a norm which is clearly influenced by the international texts and whose transposing into the national legislation of Member States has created important problems for traditional dogmas. In this sense there are still some unclear issues, such as the possibility of replacing in sales of goods of specific nature or second-hand goods, some aspects on the exercise of repair and replacement, and, even, their use as primary remedies rather than a reduction in price or a rescission of the contract. With regard to this, in England the possibility of offering the consumer free choice between these measures if the goods do not conform with the contract has been raised. This is far from the principle of pacta sunt servanda and is clearly contrary to the economic approach of the proposal for a Directive on Consumer Rights. Up to now Spain has limited itself to implementing Art. 3.3 Directive 1999/44/CE into its legal system in almost literal terms and the case law on the issue has completely turned out to be insufficient. By contrast with Germany, the Spanish legislator has not extended the application of the rules of repair and replacement of Directive 1999/44/CE to nonconsumer sales, even though two draft bill proposals along these lines presented by the General Commission for Codifying (“Comisión General de Codificación”), the last one being in January, 2009