Cost-effectiveness analysis in South Karelia Central Hospital

The target organization of this study, otherwise South-Karelia Social and Health Care District (Eksote) provides health, senior, family and social welfare services. South Karelia Central Hospital provides special health care and offers health services from all of the most important medical specialties. Eksote has in use 15D instrument to measure the health-related quality of life (HRQoL) of their patients before and after their interventions for observing the health effects of the medical care. Furthermore, 15D allows measuring the effectiveness and cost-effectiveness of health care when comparing these before and after results of the 15D measurements and adding the costs of the interventions into this research. The main purposes of this study were to analyze the effectiveness and cost-effectiveness of medical care in South Karelia Central Hospital by using the gathered 15D data to calculate effectiveness and cost-effectiveness ratios and to analyze the reliability and availability of the data. Study has been conducted using literature review and quantitative research methods. The results indicate that from the patients within the eight units selected to this study the 15D change information was available from the 52 %, the 15D change and the cost information from 38 % and the information of quality-adjusted life years (QALYs) produced and the cost information from 35 %. The effectiveness and cost-effectiveness of medical care were greatest at the units of Pain Outpatient Clinic and Rheumatic Diseases Outpatient Clinic. The most effective medical care is given in the unit where the average price of one produced QALY is the highest (Orthopedics). However, the calculated standard deviations pointed out that there are great variances in the effectiveness and cost-effectiveness within the units also.

Diversification benefits for a Finnish non-industrial private forest investor: Real Estate Investment Trusts in the USA

This thesis examined both domestic and international forest investment options for a Finnish non-industrial private forest investor. The focus was on forest-based investment instruments. The influence of movements of currency exchange rates on foreign returns were also taken into account. Annual data from 1995 to 2011 was used. The main portfolio optimization model in this study was the Mean-Variance model but the results were also validated by using the Value at Risk and Expected Shortfall models. In addition, the exchange rate risk hedging was established by using one-week-maturity forward contracts. The results suggested that 75 % of the total wealth should be invested in Finnish private forests and the rest, 25 %, to a US REIT, in this case Rayonier. With hedging, the total return on the portfolio was 7.21 % (NIPF 5.3%) with the volatility of 6.63 % (NIPF 7.9%). Taxation supported US investments in this case. As a conclusion, a Finnish private forest investor may, as evidenced, benefit in diversifying a portfolio using REITs in the US.

Ihmisten johtaminen taistelussa : elokuva Saving Private Ryan johtamisen opettamisen työkaluna

Johtamisen opetuksessa yleensä käytetty menetelmä on pohjautunut dia- tai vielä perinteisempään kalvoesitykseen. Opetuksen elävöittämisessä sekä viretason ja motivaation ylläpitämisessä opetuksen aikana ei ole tapahtunut juurikaan kehitystä. Opiskelijoiden keskittyminen valuu hukkaan, kun kaikki tarmo pitää laittaa siihen, että pysyy hereillä opetuksen aikana. Elokuvien käyttö opetuksen apuna on hiljalleen vallannut jalansijaa itselleen. Kuitenkin niiden käyttö on edelleen hyvin rajallista, vaikka ne ovat äärimmäisen tehokas ja helppo keino sekä elävöittää että piristää opetusta. Tämän tutkimuksen tavoitteena on, selvittää yhden potentiaalisen vaihtoehdon, Saving Private Ryan – Pelastakaa sotamies Ryan, käytettävyyttä johtamisen opetuksen työkaluna ja apuvälineenä. Toisena tavoitteena tutkimukselle voidaan pitää ajatusta, että tämä tutkimus innostaisi aktiiviseen elokuvien tarkasteluun, varsinkin johtamisen opetuksen näkökulmasta sekä elokuvien käytäntöön soveltamiseen. Tutkimuksessa lähestyttiin edellä mainitun elokuvan kahta johtajaa, kapteeni Milleriä ja kersantti Horvathia. Tutkimuksen pääkysymykset oli suhteutettu heidän johtamiskäyttäytymisessä mahdollisesti esiintyvään syväjohtamiseen, syväjohtamisen malliin ja johtajalle luontaisiin ominaisuuksiin. Pääkysymysten tueksi tutkimukselle asetettiin myös alakysymyksiä, joiden avulla oli tarkoituksena selventää edellä mainittujen henkilöiden johtamisprosessin hallintaa, sotilaskuria ja alaisista huolenpitoa. Tutkimusmenetelmänä käytettiin perusanalyysimenetelmää, jota voidaan käyttää kaikissa laadullisissa tutkimuksissa. Kyseessä on sisällönanalyysi, tarkemmin sanottuna teorialähtöinen sisällönanalyysi. Tutkimuksen teoriaosan avulla rakennetut strukturoidut analyysirungot ohjasivat henkilöiden johtamiskäyttäytymisen analysointia. Tuloksien perusteella voidaan vilpittömästi todeta, että tulevaisuudessa elokuvien käyttö opetuksen apuna tulee näyttelemään suurta osaa. Elokuvat tuovat opetukseen tarvittavaa piristystä ja mahdollistavat esimerkiksi aktiivimonisteiden tehokkaan käytön.

Finnish game developers’ perception on public and private funding sources: a survey analysis

The aim of this study is to find out how game companies perceive the three traditional funding sources and how well their opinions and needs are reflected on the choices they make. To accomplish this, 20 game companies were questioned about multiple topics with the help of Tekes and Neogames. The results of this study show that game developers clearly differentiate the three major funding sources and the public sector ends up being the most significant source of external funding. This study also points out that most game companies are indeed facing issues in acquiring funding as well as various other resources.

Public and private sector cooperative opportunities in the Finnish healthcare internationalization : views from the public sector’s perspective

Traditionally mostly publicly provided Finnish healthcare services are confronted today by the evident challenge of rising healthcare costs as the expenditure on health and social case has exceeded Finland’s national GDP growth significantly since the new millennium. While the opening of the traditional barriers through the EU’s new patient directive resulting in increasing international competition and the free flow of patients within the EU present opportunities for the Finnish healthcare services industry there are also several challenges for the existing healthcare system as proposed by the Ministry of Employment and the Economy in 2011. Due to the structure and nature of the current Finnish healthcare service system the greatest potential for internationalization is seen from a joint cooperation of the public and private sectors in an internationalization network for Finnish healthcare services. As its formation has recently also taken as a strategic initiative to be completed by the Ministry of Employment and the Economy and no earlier research exists on how this is seen in practice by the network actors, the purpose of this study is to examine the proposed solution of forming an internationalization network between the public and private sector actors in Finland in practice from the viewpoint of public sector actors. The research relied heavily on the reports by the Finnish Ministries in understanding the current situation of the Finnish healthcare services internationalization and its potential. Suitable theories were also used to build a more comprehensive view of the matter. The study applied a qualitative research approach on the explorative research problem. The data collection was achieved through expert interviews in two of the largest Finnish public healthcare service providers; the Turku and Helsinki Central University Hospitals. Expert interviews were considered as the most suitable method for data collection in order to create an in-depth understanding of the topic within the limitations of this thesis. In turn, two different public healthcare service providers were chosen to give a broader view of the field instead of focusing on a specific unit and also to allow a possible comparison between the two different organizations. The latter however was shown not to be suitable for the purposes of this study as the opinions of the respondents varied largely also within their own organizations. The conclusion is that while the actors agree on the evident internationalization of Finnish healthcare services, there are several large-scale structural challenges effectively preventing such activities while at the same time the opportunities within Finland vary, as there are several niches but no real large-scale advantages in the highly competitive industry. Interest towards cooperation between the sectors are seen especially in exploiting the advantages offered by the private sector in commercialization and marketization, yet however no clear views exist on how these activities should be governed or structured in the short-term as a larger reform of the entire Finnish healthcare service sector is needed in the long-term.

Glyphosate Effectiveness in the Control of Macrophytes Under a Greenhouse Condition

The aim of this study was to assess the effectiveness of glyphosate, as Rodeo(r) formulation, to control Eichhornia crassipes, Pistia stratiotes, Salvinia molesta, Salvinia herzogii and Urochloa subquadripara, under greenhouse conditions. The doses assessed were (480, 960, 1440, 1920, 2400, 2880, 3360 and 3840 g ha-1 of glyphosate) with 0.5% of the Aterbane(r) BR surfactant and a control, with no herbicide application. All experiments were conducted in a completely randomized experimental design with ten replications. Applications were carried out by precision backpack sprayer at a CO2 constant pressure of 25 psi and spray solution consumption of 200 L ha-1. Product effectiveness was determined by assessing the growth inhibitions and phytotoxicity signals during the periods of 3, 7, 15, 21, 30 and 45 days after application (DAA). At 45 DAA, the highest glyphosate dose (3840 g ha-1) displayed 100% effectiveness for all four macrophyte species. Under greenhouse conditions, the glyphosate in formulation Rodeo(r) with 0.5% of Aterbarne(r) BR surfactant showed excellent effectiveness, inhibiting the growth of the floating aquatic macrophytes. This procedure can be included on the tillage plans for these species.

Effectiveness of Diquat, Copper Hydroxide, Copper Oxychloride and their Association in Control of Submerged Macrophytes Ceratophyllum demersum

The aims of this study were to evaluate the effectiveness of diquat, copper hydroxide, copper oxychloride and their associations diquat + 0.1% copper oxychloride and diquat + 0.1% copper hydroxide to control Cerathophyllum demersum. Therefore, the concentrations used were 0.1, 0.3, 0.5, 0.7, 1.0 and 1.5 mg L-1 oxychloride and copper hydroxide and 0.2, 0.4, 0.8 and 1.2 mg L-1 diquat and their associations with 0.1% copper oxychloride and 0.1% copper and a control hydroxide. The experimental design was completely randomized with ten replications for 45 days. For evaluation we used a scale of 0-100% control of notes and rated the weight (g) and length (cm) of pointers at the end of the trial period. Diquat showed 100% efficacy at 30 DAA, associations in 21 DAA and copper sources promoted regrowth of C. demersum. Diquat and its associations were more effective in controlling C. demersum. The use of herbicide in combination with a copper source is more efficient for the control of submerged weeds because it potentiates the effect of the herbicide in weed control

Effectiveness of plant growth promoting rhizobacteria in facilitating lead and nutrient uptake by little seed canary grass

We investigated the effectiveness of Nitroxin inoculation on lead (Pb) and nutrient uptakes by little seed canary grass. The factors tested included inoculation (or not) with Nitroxin and different soil concentrations of Pb (0, 200, 400 and 800mgPbkg-1 soil). Increasing soil concentrations of Pb decreased stem, leaf and root dry weights. Shoot phosphorus concentrations increased in parallel with increasing soil Pb concentrations. Nitroxin inoculation did not alter the phosphorus concentration of the roots. The Pb translocation factor was >1 in inoculated treatments in the Pb soil concentration range of 200 to 400mgkg-1; the translocation factor for 800mgPbkg‑1 with no inoculation of Nitroxin was, however, <1. Our results indicated that the Pb bioaccumulation factor for little seed canary grass was <1, indicating that it is a Pb excluding plant.

Private Equity Fund Performance Determinants: Evidence From Fund Characteristics

The purpose of this thesis is to investigate whether different private equity fund characteristics have any influence on the fund performance. Fund characteristics include fund type (venture capital or buyouts), fund size (sizes of funds are divided into six ranges), fund investment industry, fund sequence (first fund or follow-on fund) and investment market (US or EMEA). Fund performance is measured by internal rate of return, and tested by cross-sectional regression analysis with the method of Ordinary Least Squares. The data employs performance and characteristics of 997 private equity funds between 1985 and 2008. Our findings are that fund type has effect on fund performance. The average IRR of venture capital funds is 2.7% less than average IRR of buyout funds. However, We did not find any relationship between fund size and performance, and between fund sequence and performance. Funds based on US market perform better than funds based on EMEA market. The fund performance differs across different industries. The average IRRs of industrial/energy industry, consumer related industry, communications and media industry and medical/health industry are higher than the average IRR of other industries.

Strategic management of value networks: how to create value in cross-sector collaboration and partnerships

Cross-sector collaboration and partnerships have become an emerging and desired strategy in addressing huge social and environmental challenges. Despite its popularity, cross-sector collaboration management has proven to be very challenging. Even though cross-sector collaboration and partnership management have been widely studied and discussed in recent years, their effectiveness as well as their ability to create value with respect to the problems they address has remained very challenging. There is little or no evidence of their ability to create value. Regarding all these challenges, this study aims to explore how to manage cross-sector collaborations and partnerships to be able to improve their effectiveness and to create more value for all partners involved in collaboration as well as for customers. The thesis is divided into two parts. The first part comprises an overview of relevant literature (including strategic management, value networks and value creation theories), followed by presenting the results of the whole thesis and the contribution made by the study. The second part consists of six research publications, including both quantitative and qualitative studies. The chosen research strategy is triangulation, as the study includes four types of triangulation: (1) theoretical triangulation, (2) methodological triangulation, (3) data triangulation and (4) researcher triangulation. Two publications represent conceptual development, which are based on secondary data research. One publication is a quantitative study, carried out through a survey. The other three publications represent qualitative studies, based on case studies, where data was collected through interviews and workshops, with participation of managers from all three sectors: public, private and the third (nonprofit). The study consolidates the field of “strategic management of value networks,” which is proposed to be applied in the context of cross-sector collaboration and partnerships, with the aim of increasing their effectiveness and the process of value creation. Furthermore, the study proposes a first definition for the strategic management of value networks. The study also proposes and develops two strategy tools that are recommended to be used for the strategic management of value networks in cross-sector collaboration and partnerships. Taking a step forward, the study implements the strategy tools in practice, aiming to show and to demonstrate how new value can be created by using the developed strategy tools for the strategic management of value networks. This study makes four main contributions. (1) First, it brings a theoretical contribution by providing new insights and consolidating the field of strategic management of value networks, also proposing a first definition for the strategic management of value networks. (2) Second, the study makes a methodical contribution by proposing and developing two strategy tools for value networks of cross-sector collaboration: (a) value network mapping, a method that allows us to assess the current and the potential value network and (b) the Value Network Scorecard, a method of performance measurement and performance prediction in cross-sector collaboration. (3) Third, the study has managerial implications, offering new solutions and empirical evidence on how to increase the effectiveness of cross-sector collaboration and also allow managers to understand how new value can be created in cross-sector partnerships and how to get the full potential of collaboration. (4) And fourth, the study also has practical implications, allowing managers to understand how to use in practice the strategy tools developed in this study, providing discussions on the limitations regarding the proposed tools as well as general limitations involved in the study.

A comparison of public and private obstructive sleep apnea clinics

The aim of the present study was to compare the clinical findings and polysomnography results obtained at public and private clinics in Brazil, the follow-up after diagnosis, and the therapeutic aspects related to continuous positive airway pressure. Patients who snore and who have obstructive sleep apnea were retrospectively divided into two groups, i.e., public clinic (N = 307) and private clinic (N = 317). Data concerning age, sex, body mass index (BMI), neck circumference, medical history, sleepiness scale, follow-up after diagnosis, and acceptance of continuous positive airway pressure therapy were collected. Mean age was 50 ± 12 (range: 15-80) for public patients and 48 ± 12 years (range: 19-91) for private patients. Mean BMI was 30 ± 6 (range: 19-67) for public patients and 31 ± 6 kg/m² (range: 21-59) for private patients. The public clinic had a significantly higher frequency of women than the private clinic (M:F ratio of 2.0:1 and 6.9:1, respectively). The condition of private patients (apnea-hypopnea index = 31 ± 25) was more severe than that of public patients (apnea-hypopnea index = 25 ± 24 events/h; P = 0.0004). In the public and private clinics, 19 and 15% of patients were snorers, respectively, and 81 and 85% of them had sleep apnea. After diagnosis, follow-up was longer in the private group. The continuous positive airway pressure acceptance was similar for both groups (32 vs 35%), but patients from the public clinic abandoned treatment more than private ones (65 vs 13%). Social status was significant in terms of the severity of obstructive sleep apnea age and gender distribution. Private patients look for a diagnosis earlier in the course of the disease than public patients, adhere more to follow-up, and abandon continuous positive airway pressure treatment less than public patients do.

From statin efficacy to everyday effectiveness: Studying the gap in between.

Statins are indicated for preventing cardiovascular disease events. Patients with diabetes have a risk of major cardiovascular events double the risk of their peers without diabetes. Thus, clinical treatment guidelines recommend statins for the management of diabetic dyslipidemia. The evidence base for statin use in cardiovascular disease derives from the randomized controlled statin trials designed to prove statin efficacy under ideal conditions, among a homogenous study population meeting strict trial eligibility criteria. This thesis was implemented as four pharmacoepidemiological statin studies using register data on realworld statin users. The overall purpose was to evaluate the trends, patterns and effectiveness of statin use in everyday life. More specifically, nationwide secular trends in statin use in Finland were analysed, especially among patient groups which had been underrepresented in the statin trials. Furthermore, the benchmarking statin trials in diabetes, the Heart Protection Study and the Collaborative Atorvastatin Diabetes Study, were evaluated for their representativeness for real-world diabetes care with the emphasis placed on adherence to statin use. The association between good adherence and the incidence of major cardiovascular events in the real-world was further investigated in diabetes. These studies demonstrate that statin initiations increased from 1995 to 2005 in Finland. The increase was most pronounced among those aged at least 75 years and was observed already before the publication of rigorous trial data conducted in elderly subjects. Thus, statins seem to have been initiated in clinical practice also going beyond the strict trial eligibility criteria. Nonetheless, low adherence to statin use among the real-world patients with diabetes was found not only to limit the representativeness of the trials for clinical care but also to attenuate in all likelihood their benefits in the real-world. In fact, good adherence to statin use was found to associate with a decreased risk for major cardiovascular events in patients with diabetes. In conclusion, these studies highlight the importance of good adherence to statin use in clinical practice in order to obtain the full therapeutic value demonstrated in the statin trials. Simply increasing the number of statin users will not alone suffice in sharing our common resources appropriately.

Comparison of the effectiveness of initial combined antiretroviral therapy with nelfinavir or efavirenz at a university-based outpatient service in Brazil

Since there are some concerns about the effectiveness of highly active antiretroviral therapy in developing countries, we compared the initial combination antiretroviral therapy with zidovudine and lamivudine plus either nelfinavir or efavirenz at a university-based outpatient service in Brazil. This was a retrospective comparative cohort study carried out in a tertiary level hospital. A total of 194 patients receiving either nelfinavir or efavirenz were identified through our electronic database search, but only 126 patients met the inclusion criteria. Patients were included if they were older than 18 years old, naive for antiretroviral therapy, and had at least 1 follow-up visit after starting the antiretroviral regimen. Fifty-one of the included patients were receiving a nelfinavir-based regimen and 75 an efavirenz-based regimen as outpatients. Antiretroviral therapy was prescribed to all patients according to current guidelines. By intention-to-treat (missing/switch = failure), after a 12-month period, 65% of the patients in the efavirenz group reached a viral load <400 copies/mL compared to 41% of the patients in the nelfinavir group (P = 0.01). The mean CD4 cell count increase after a 12-month period was also greater in the efavirenz group (195 x 10(6) cells/L) than in the nelfinavir group (119 x 10(6) cells/L; P = 0.002). The efavirenz-based regimen was superior compared to the nelfinavir-based regimen. The low response rate in the nelfinavir group might be partially explained by the difficulty of using a regimen requiring a higher patient compliance (12 vs 3 pills a day) in a developing country.