Can smartphones and tablets improve the management of childhood illness in Tanzania? A qualitative study from a primary health care worker's perspective.

BACKGROUND: The impact of the Integrated Management of Childhood Illness (IMCI) strategy has been less than anticipated because of poor uptake. Electronic algorithms have the potential to improve quality of health care in children. However, feasibility studies about the use of electronic protocols on mobile devices over time are limited. This study investigated constraining as well as facilitating factors that influence the uptake of a new electronic Algorithm for Management of Childhood Illness (ALMANACH) among primary health workers in Dar es Salaam, Tanzania. METHODS: A qualitative approach was applied using in-depth interviews and focus group discussions with altogether 40 primary health care workers from 6 public primary health facilities in the three municipalities of Dar es Salaam, Tanzania. Health worker's perceptions related to factors facilitating or constraining the uptake of the electronic ALMANACH were identified. RESULTS: In general, the ALMANACH was assessed positively. The majority of the respondents felt comfortable to use the devices and stated that patient's trust was not affected. Most health workers said that the ALMANACH simplified their work, reduced antibiotic prescription and gave correct classification and treatment for common causes of childhood illnesses. Few HWs reported technical challenges using the devices and complained about having had difficulties in typing. Majority of the respondents stated that the devices increased the consultation duration compared to routine practice. In addition, health system barriers such as lack of staff, lack of medicine and lack of financial motivation were identified as key reasons for the low uptake of the devices. CONCLUSIONS: The ALMANACH built on electronic devices was perceived to be a powerful and useful tool. However, health system challenges influenced the uptake of the devices in the selected health facilities.

Is blood still thicker than water? A life-course perspective on the transformation of family and friends' roles in personal networks

This thesis addresses the issue of the moving boundaries between family and friends' roles in personal networks, adopting a life-course perspective and using Switzerland as a case study. In a period of major changes in personal life happening in contemporary Western societies, understanding the organization of personal networks intertwined with the unfolding of individual life courses is of prime importance in facing new challenges with regard to social integration. The data stem from a representative national survey carried out in 2011 named Family tiMes, including 803 individuals born either in 1950-1955 or in 1970-1975. An innovative research design was adopted, combing cross-sectional ego-centered network data and retrospective longitudinal life-course data. The results show continuing boundaries between family and friends' roles and that family keeps a prominent role in personal networks despite the notable importance of friendship ties. One relationship stands out above all, that with the partner, followed quite a few steps behind by those with children. Regarding life courses, de-standardization tendencies were found in family formation and also a persistent gendering of occupational trajectories. Two kinds of life trajectories are particularly intertwined with personal networks, co-residence and partnership trajectories, both related to the unfolding of family life. In particular, transition to parenthood functions as a turning point in individuals' lives, deeply transforming their sociability. Finally, a twofold pluralization process was identified, affecting simultaneously the organization of personal networks and the unfolding of individual life courses. This thesis contributes to the literature on the sociology of family and personal life, and to fruitful interlinkage between the network approach and the life-course perspective.

Assessment of inflammatory Bowel Disease patient's needs and problems from a nursing perspective

BACKGROUND: In this study, we aimed at assessing Inflammatory Bowel Disease patients' needs and current nursing practice to investigate to what extent consensus statements (European Crohn's and Colitis Organization) on the nursing roles in caring for patients with IBD concur with local practice. METHODS: We used a mixed-method convergent design to combine quantitative data prospectively collected in the Swiss IBD cohort study and qualitative data from structured interviews with IBD healthcare experts. Symptoms, quality of life, and anxiety and depression scores were retrieved from physician charts and patient self-reported questionnaires. Descriptive analyses were performed based on quantitative and qualitative data. RESULTS: 230 patients of a single center were included, 60% of patients were males, and median age was 40 (range 18-85). The prevalence of abdominal pain was 42%. Self-reported data were obtained from 75 out of 230 patients. General health was perceived significantly lower compared with the general population (p < 0.001). Prevalence of tiredness was 73%; sleep problems, 78%; issues related to work, 20%; sexual constraints, 35%; diarrhea, 67%; being afraid of not finding a bathroom, 42%; depression, 11%; and anxiety symptoms, 23%. According to experts' interviews, the consensus statements are found mostly relevant with many recommendations that are not yet realized in clinical practice. CONCLUSION: Identified prevalence may help clinicians in detecting patients at risk and improve patient management. © 2015 S. Karger AG, Basel.

A Cellular Perspective on Brain Energy Metabolism and Functional Imaging.

The energy demands of the brain are high: they account for at least 20% of the body's energy consumption. Evolutionary studies indicate that the emergence of higher cognitive functions in humans is associated with an increased glucose utilization and expression of energy metabolism genes. Functional brain imaging techniques such as fMRI and PET, which are widely used in human neuroscience studies, detect signals that monitor energy delivery and use in register with neuronal activity. Recent technological advances in metabolic studies with cellular resolution have afforded decisive insights into the understanding of the cellular and molecular bases of the coupling between neuronal activity and energy metabolism and point at a key role of neuron-astrocyte metabolic interactions. This article reviews some of the most salient features emerging from recent studies and aims at providing an integration of brain energy metabolism across resolution scales.

Are Evaluation of ICTs Investment Using Decision Support Systems:Case Applications from Distributor's and End User's Perspective Group Decision

The evaluation of investments in advanced technology is one of the most important decision making tasks. The importance is even more pronounced considering the huge budget concerning the strategic, economic and analytic justification in order to shorten design and development time. Choosing the most appropriate technology requires an accurate and reliable system that can lead the decision makers to obtain such a complicated task. Currently, several Information and Communication Technologies (ICTs) manufacturers that design global products are seeking local firms to act as their sales and services representatives (called distributors) to the end user. At the same time, the end user or customer is also searching for the best possible deal for their investment in ICT's projects. Therefore, the objective of this research is to present a holistic decision support system to assist the decision maker in Small and Medium Enterprises (SMEs) - working either as individual decision makers or in a group - in the evaluation of the investment to become an ICT's distributor or an ICT's end user. The model is composed of the Delphi/MAH (Maximising Agreement Heuristic) Analysis, a well-known quantitative method in Group Support System (GSS), which is applied to gather the average ranking data from amongst Decision Makers (DMs). After that the Analytic Network Process (ANP) analysis is brought in to analyse holistically: it performs quantitative and qualitative analysis simultaneously. The illustrative data are obtained from industrial entrepreneurs by using the Group Support System (GSS) laboratory facilities at Lappeenranta University of Technology, Finland and in Thailand. The result of the research, which is currently implemented in Thailand, can provide benefits to the industry in the evaluation of becoming an ICT's distributor or an ICT's end user, particularly in the assessment of the Enterprise Resource Planning (ERP) programme. After the model is put to test with an in-depth collaboration with industrial entrepreneurs in Finland and Thailand, the sensitivity analysis is also performed to validate the robustness of the model. The contribution of this research is in developing a new approach and the Delphi/MAH software to obtain an analysis of the value of becoming an ERP distributor or end user that is flexible and applicable to entrepreneurs, who are looking for the most appropriate investment to become an ERP distributor or end user. The main advantage of this research over others is that the model can deliver the value of becoming an ERP distributor or end user in a single number which makes it easier for DMs to choose the most appropriate ERP vendor. The associated advantage is that the model can include qualitative data as well as quantitative data, as the results from using quantitative data alone can be misleading and inadequate. There is a need to utilise quantitative and qualitative analysis together, as can be seen from the case studies.

Lack of support for the association between facial shape and aggression: a reappraisal based on a worldwide population genetics perspective

Antisocial and criminal behaviors are multifactorial traits whose interpretation relies on multiple disciplines. Since these interpretations may have social, moral and legal implications, a constant review of the evidence is necessary before any scientific claim is considered as truth. A recent study proposed that men with wider faces relative to facial height (fWHR) are more likely to develop unethical behaviour mediated by a psychological sense of power. This research was based on reports suggesting that sexual dimorphism and selection would be responsible for a correlation between fWHR and aggression. Here we show that 4,960 individuals from 94 modern human populations belonging to a vast array of genetic and cultural contexts do not display significant amounts of fWHR sexual dimorphism. Further analyses using populations with associated ethnographical records as well as samples of male prisoners of the Mexico City Federal Penitentiary condemned by crimes of variable level of inter-personal aggression (homicide, robbery, and minor faults) did not show significant evidence, suggesting that populations/individuals with higher levels of bellicosity, aggressive behaviour, or power-mediated behaviour display greater fWHR. Finally, a regression analysis of fWHR on individual"s fitness showed no significant correlation between this facial trait and reproductive success. Overall, our results suggest that facial attributes are poor predictors of aggressive behaviour, or at least, that sexual selection was weak enough to leave a signal on patterns of between- and within-sex and population facial variation.

Evolution and perspective of the temperate fruit crops in São Paulo state, Brazil

This work was carried out to show the current situation of the temperate fruit crops in São Paulo state, Brazil, with an emphasis on grapes, peaches, apples, plums, nectarines and pears crops. Current economic data of crops, major growing regions, main cultivars produced, as well as the new technologies generated by research are presented. Regarding the grape crop, a decrease in the national production as well as in the major growing states was observed. The main grapes growing centers in São Paulo state are presented, highlighting its peculiarities regarding cultivars, cultural crop management and current researches. A trend has been observed toward increasing Niagara Rosada grape growing area rather than the fine table grape cultivars. It was also observed the adoption of cultural practices, aiming to increase productivity, to improve the fruits quality and to reduce manpower necessity. In terms of stone fruits, peaches are the most widely cultivated in São Paulo state, followed by plums and nectarines. Both for stone fruits crop and for apples and pears crops, statistics and comments are presented on the crops evolution as well as the current researches results and the requirements of these fruit crops in São Paulo state, Brazil.

External Location Factors of Foreign Direct Investment in Russia – Finnish Perspective

Tämän diplomityön tavoitteena on selvittää, mitä alueellisia tekijöitä suomalaiset yritykset ottavat huomioon valitessaan sopivaa sijaintia suoralle investoinnille Venäjän sisällä. Muutamia yrityksen sisäisiä tekijöitä käytetään taustamuuttujina selittämään sijaintitekijöiden painotuksissa havaittavia eroja erilaisten yritysten välillä. Venäjän alueita vertaillaan lopuksi painotusten valossa. Työn ensimmäisessä osassa keskitytään suorien ulkomaisten investointien teoreettiseen taustaan. Aiempia tutkimuksia käydään läpi, jotta tekijät, joilla on havaittu olevan vaikutusta investointien sijoittumiseen maan sisällä, saadaan kartoitettua. Työn jälkimmäinen osa perustuu yrityskyselyn avulla kerättyyn empiiriseen aineistoon. Aineiston avulla selvitetään mitä tekijöitä suomalaisyritykset huomioivat sijaintipäätöstä tehdessään. Tulosten valossa on ilmeistä, että alueen markkinapotentiaali on suomalaisyrityksissä tärkein huomioitava tekijä investoinnin sijainnista päätettäessä. Myös infrastruktuuri ja kustannushyödyt vaikuttavat päätökseen. Erityyppisten yritysten painotukset ovat hyvin samanlaisia. Moskova ja Pietari vastaavat Venäjän alueista parhaiten suomalaisyritysten investoinnin sijainnille asettamia kriteerejä.

The biological family from the perspective of kinship fostered adolescents

Background: Previous studies emphasise the importance of the biological family to the welfare of fostered adolescents. However, the majority of these studies only take into consideration the viewpoints of the professionals, foster parents and biological parents not those of the adolescents themselves. For this reason little is known about the perceptions the adolescents have and the needs they express. Method: This study has gathered data from 57 adolescents in kinship family fostering in Spain (AFE). The study applied qualitative reseach, using focus groups to gather data and the Atlas.ti programme to analyse the data. The qualitative data give us a more profound understanding of how the fostered adolescents relate to their biological families. Results: The results highlight the specific needs of these adolescents a) an understanding of their family history b) the impact of visits from and relationship with their biological family and c) the relationship between the biological family and the foster family. Conclusions: These findings reveal implications to consider when creating support programmes aimed at this group.

Integrating Financial Perspective to Quality Orientated Management System. Case: ALSTOM Finland Oy

Tutkimuksen päätavoitteena on tutkia taloudellisen näkökulman integroimista laatuajatteluun pohjautuvaan johtamisjärjestelmään esimerkkiyrityksessä. Johtamisjärjestelmän tulee tuottaa tietoa johdon strategiselle päätöksenteolle ja lisäksi täyttää laatujärjestelmän (ISO 9001:2000) asettamat vaatimukset. Tutkimuksen kohteena oleva työkalu on balanced scorecard (tasapainotettu tuloskortti). Työn tarkoituksena on ehdottaa balanced scorecard- talouden tunnuslukuja esimerkkiyritykselle. Tutkimuksen tavoitteisiin päästään empiiristä tutkimusta varten tehdyn teoreettisen viitekehyksen avulla. Empiiristä tutkimustietoa kerätään osallistuvan havainnoinnin, haastattelujen ja keskustelujen avulla. Tutkimusmenetelmänä on laadullinen case -tutkimus. Balanced scorecardin eri näkökulmille ehdotettiin tunnuslukuja empiirisen tutkimuksen pohjalta. Lisäksi talouden näkökulmaa tutkittiin tarkemmin. Tutkimuksen johtopäätöksenä esitettiin, että taloudelliset tunnusluvut mittaavat ensisijaisesti strategiaa eivätkä laatua. Lisäksi huomioitiin, että tuloskorttien tulisi olla koekäytössä ennen bonuspalkkauksen ja balanced scorecardin yhdistämistä.

Competitive Analysis of the Northwest Russian Transport Logistics Cluster – Finnish Perspective

Tutkimus tarkastelee Luoteis-Venäjän liikennelogistiikkaklusteria. Tarkoitus on selvittää klusterin nykyinen rakenne ja kilpailukyky sekä klusterin tarjoamat liiketoimintamahdollisuudet suomalaisille logistiikkayrityksille. Työssä käsitellään neljää perusliikennemuotoa: rautatie-, maantie-, meri- ja sisävesi-, sekä ilmaliikennettä. Tutkimuksen aineisto on kerätty tutkimusta varten laadituista kyselyistä, haastatteluista sekä aiemmin julkaistusta materiaalista. Venäjä on suunnitellut kehittävänsä voimakkaasti liikenneinfrastruktuuria, mm. julkaisemalla protektionistisen liikennestrategiasuunnitelman. Ongelmana ovat olleet toteutukset, jotka ovat jääneet yleensä puutteellisiksi. Tällä hetkellä todellista kilpailukykyä löytyy ainoastaan rautatieliikenteestä, muut kolme liikennemuotoa omaavat potentiaalisen kilpailukyvyn. Venäjällä on mahdollisuus hyötyä laajasta pinta-alastaan Aasian ja Euroopan liikenteen yhdistäjänä. Yksi konkreettisimmista esimerkeistä on Trans Siperian rautatie, joka kaipaisi vielä lisäkehitystä. Suomi on toiminut Venäjän liikenteessä arvotavaran kauttakulkumaana, vuonna 2003 noin 30–40 % Venäjän tuonnin arvosta kulki Suomen kautta. Venäjälle tullaan tuomaan arvotavaraa vielä useita vuosia, mutta reittien osalta kilpailu on tiukentunut. Suomalaisten yritysten liiketoimintamahdollisuuksiin esitetään kaksi mallia: kauttakulkuliikenteen lisäarvologistiset (VAL) operaatiot Suomessa tai etabloituminen Venäjän logistisiin ketjuihin. Suomalaisten olisi syytä parantaa yhteistyötään yritysten ja yliopistojen ym. koulutuslaitosten välillä. Myös yhteistyökumppaneiden hakeminen esimerkiksi Ruotsista voisi tuoda merkittäviä etuja. Suomalaista osaamista voitaisiin hyödyntää parhaiten etabloitumalla Venäjän markkinoille, esimerkiksi keskittymällä Venäjän logististen ketjujen johtamiseen. Myös VAL palveluiden johtamiseen Venäjällä olisi erittäin hyvä tilaisuus, koska Venäjän oma tietotaito logistiikassa ei ole vielä kehittynyt kansainväliselle tasolle, mutta kustannustaso on alhaisempi kuin Suomessa.