Hankintariskienhallinta Suomen IVD-teollisuudessa

Kansainvälinen ja kiristyvä kilpailu on muuttanut yritysten liiketoimintaympäristöä yhä monimutkaisemmaksi ja riskialttiimmaksi. Yritysten keskittyessä yhä syvemmin omaan ydinosaamiseensa on ulkoisten resurssien hallinnan merkitys korostunut. Työnjakoa syventämällä tavoitellaan parempaa joustavuutta, ajanhallintaa sekä kustannustehokkuutta. Myös hankintatoimen tehtävät ja vastuualueet muuttuvat ennakoivampaan ja riskialttiimpaan suuntaan. Modernin hankintatoimen on kyettävä tunnistamaan, analysoimaan ja hallitsemaan riskejä yhä pirstaloituneemmista lähteistä ja muodoista. Proaktiivinen hankintatoimi osallistuu yrityksen strategiseen suunnitteluun ja riskienhallintaan. Hankintariskit voidaan luokitella seuraaviin kymmeneen riskiluokkaan: keskeytymisriskit, saatavuusriskit, hintariskit, varasto- ja aikatauluriskit, teknologiariskit, luottamuksellisen tiedon vuotoriskit, laaturiskit, konfiguraatioriskit, opportunismiriskit sekä riippuvuusriskit. Tässä tutkimuksessa hankintariskienhallintaa tarkastellaan hankintastrategian valinnan näkökulmasta. Hankintastrategian yksi elementti on toimittajasuhteen ja toimittajien lukumäärän valinta. Tilanteesta riippuen yhteistyöstrategialla tai perinteisellä kilpailuttamisella voidaan tavoitella parempaa riskienhallintaa. Yhteistyöstrategioita ovat eri tasoiset kumppanuussuhteet ja liittoutumat, jolloin suhde toimittajaan on syvä ja luottamuksellinen hyödyttäen aidosti molempia osapuolia. Riskienhallinnan näkökulmasta yhteistyöstrategia soveltuu parhaiten tilanteissa, joissa toimittajista on pitkä kokemus sekä hankintanimikkeen tuottama arvo on merkittävä. Kilpailuttamisstrategia eli hankintojen toteuttaminen usealta toimittajalta vaatii ostavalta organisaatiolta tehokkaasti hyödynnettynä suurempia resursseja kuin yhteistyöstrategian käyttö. Kilpailuttaminen soveltuu usein parhaiten silloin, kun hankintanimikkeet ovat tavanomaisia ja vaihtoehtoisia hankintalähteitä on runsaasti. Lisäksi usean toimittajan käyttö suojaa materiaalivirran katkoksilta sekä lisää hankintamarkkinoiden tuntemusta. Empiirisessä tutkimusosassa tutkitaan, miten soveltuviksi riskienhallintamenetelmiksi erilaiset hankintastrategiat koetaan Suomen IVD-teollisuudessa. Lisäksi tunnistetaan Suomen IVD-teollisuudessa merkittävimmiksi koetut hankintariskiluokat sekä selvitetään millä organisaation tasolla hankintariskienhallinta pääasiassa suoritetaan. Lisäksi selvitetään, millä menetelmin hankintariskejä pääasiassa analysoidaan.

“La lliga dels magnats”. La Premier League i el negoci del futbol en l’era dels mitjans globals

The relationship between the mass media and sport has reached a state of symbiosis. The great media companies and sports organizations have combined synergies to get the best return on their products, both communicationrelated and sports-related. To define this situation, some authors have spoken of the “new sport oligopoly” or of the “global media sports complex”. This article analyzes the formation of this complex based on real examples of financial relations between media companies and sports organizations and, finally, draws attention to how these relations took place in the Premier League during the 2009-2010 season, taking into account the fact that this was the European football league which consolidated the process of international commercialization the soonest, which has the most highly valued football brand (Manchester United) and which has the clubs that make the most money from television rights and commercials.

Effectiveness of a primary care-based intervention to reduce sitting time in overweight and obese patients (SEDESTACTIV): a randomized controlled trial; rationale and study design

Background: There is growing evidence suggesting that prolonged sitting has negative effects on people's weight, chronic diseases and mortality. Interventions to reduce sedentary time can be an effective strategy to increase daily energy expenditure. The purpose of this study is to evaluate the effectiveness of a six-month primary care intervention to reduce daily of sitting time in overweight and mild obese sedentary patients. Method/Design: The study is a randomized controlled trial (RCT). Professionals from thirteen primary health care centers (PHC) will randomly invite to participate mild obese or overweight patients of both gender, aged between 25 and 65 years old, who spend 6 hours at least daily sitting. A total of 232 subjects will be randomly allocated to an intervention (IG) and control group (CG) (116 individuals each group). In addition, 50 subjects with fibromyalgia will be included. Primary outcome is: (1) sitting time using the activPAL device and the Marshall questionnaire. The following parameters will be also assessed: (2) sitting time in work place (Occupational Sitting and Physical Activity Questionnaire), (3) health-related quality of life (EQ-5D), (4) evolution of stage of change (Prochaska and DiClemente's Stages of Change Model), (5) physical inactivity (catalan version of Brief Physical Activity Assessment Tool), (6) number of steps walked (pedometer and activPAL), (7) control based on analysis (triglycerides, total cholesterol, HDL, LDL, glycemia and, glycated haemoglobin in diabetic patients) and (8) blood pressure and anthropometric variables. All parameters will be assessed pre and post intervention and there will be a follow up three, six and twelve months after the intervention. A descriptive analysis of all variables and a multivariate analysis to assess differences among groups will be undertaken. Multivariate analysis will be carried out to assess time changes of dependent variables. All the analysis will be done under the intention to treat principle. Discussion: If the SEDESTACTIV intervention shows its effectiveness in reducing sitting time, health professionals would have a low-cost intervention tool for sedentary overweight and obese patients management.

Meeting report of the European mouse complex genetics network SYSGENET.

The second scientific meeting of the European systems genetics network for the study of complex genetic human disease using genetic reference populations (SYSGENET) took place at the Center for Cooperative Research in Biosciences in Bilbao, Spain, December 10-12, 2012. SYSGENET is funded by the European Cooperation in the Field of Scientific and Technological Research (COST) and represents a network of scientists in Europe that use mouse genetic reference populations (GRPs) to identify complex genetic factors influencing disease phenotypes (Schughart, Mamm Genome 21:331-336, 2010). About 50 researchers working in the field of systems genetics attended the meeting, which consisted of 27 oral presentations, a poster session, and a management committee meeting. Participants exchanged results, set up future collaborations, and shared phenotyping and data analysis methodologies. This meeting was particularly instrumental for conveying the current status of the US, Israeli, and Australian Collaborative Cross (CC) mouse GRP. The CC is an open source project initiated nearly a decade ago by members of the Complex Trait Consortium to aid the mapping of multigenetic traits (Threadgill, Mamm Genome 13:175-178, 2002). In addition, representatives of the International Mouse Phenotyping Consortium were invited to exchange ongoing activities between the knockout and complex genetics communities and to discuss and explore potential fields for future interactions.

Systematics and phylogeography of the Dysdera erythrina species complex (Araneae, Dysderidae) in Sardinia

Sardinia is the second largest island in the Mediterranean and, together with Corsica and nearby mainland areas, one of the top biodiversity hotspots in the region. The origin of Sardinia traces back to the opening of the western Mediterranean in the late Oligocene. This geological event and the subsequent Messinian Salinity Crisis and Pleistocene glacial cycles have had a major impact on local biodiversity. The Dysdera woodlouse hunter spiders are one of the most diverse ground-dweller groups in the Mediterranean. Here we describe the first two species of this genus endemic to Sardinia: Dysdera jana sp. n. and Dysdera shardana sp. n. The two species show contrasting allopatric distribution: D. jana sp. n. is a narrow endemic while D. shardana sp. n. is distributed throughout most of the island. A multi-gene DNA sequence phylogenetic analys based on mitochondrial and nuclear genes supports the close relationships of the new species to the type species of the genus Dysdera erythrina. Age estimates reject Oligocene origin of the new Dysdera species and identify the Messinian Salinity Crises as the most plausible period for the split between Sardinian endemics and their closest relatives. Phylogeographic analysis reveals deep genetic divergences and population structure in Dysdera shardana sp. n., suggesting that restriction to gene flow probably due to environmental factors could explain local speciation events. Taxonomy, phylogeny, DNA sequencing, Mediterranean biogeography, phylogeography

Conservation banking and the economization of nature : an institutional analysis

During the last decade, conservation banking mechanisms have emerged in the environmental discourse as new market instruments to promote biodiversity conservation. Compensation was already provided for in environmental law in many countries, as the last step of the mitigation hierarchy. The institutional arrangements developed in this context have been redefined and reshaped as market-based instruments (MBIs). As such, they are discursively disentangled from the complex legal-economic nexus they are part of. Monetary transactions are given prominence and tend to be presented as stand alone agreements, whereas they take place in the context of prescriptive regulations. The pro-market narrative featuring conservation banking systems as market-like arrangements as well as their denunciation as instances of nature commodification tend to obscure their actual characteristics. The purpose of this paper is to describe the latter, adopting an explicitly analytical stance on these complex institutional arrangements and their performative dimensions. Beyond the discourse supporting them and notwithstanding the diversity of national policies and regulatory frameworks for compensation, the constitutive force of these mechanisms probably lies in their ability to redefine control, power and the distribution of costs and in their impacts in terms of land use rather than in their efficiency.

Beyond contact-based transmission networks: the role of spatial coincidence.

Animal societies rely on interactions between group members to effectively communicate and coordinate their actions. To date, the transmission properties of interaction networks formed by direct physical contacts have been extensively studied for many animal societies and in all cases found to inhibit spreading. Such direct interactions do not, however, represent the only viable pathways. When spreading agents can persist in the environment, indirect transmission via 'same-place, different-time' spatial coincidences becomes possible. Previous studies have neglected these indirect pathways and their role in transmission. Here, we use rock ant colonies, a model social species whose flat nest geometry, coupled with individually tagged workers, allowed us to build temporally and spatially explicit interaction networks in which edges represent either direct physical contacts or indirect spatial coincidences. We show how the addition of indirect pathways allows the network to enhance or inhibit the spreading of different types of agent. This dual-functionality arises from an interplay between the interaction-strength distribution generated by the ants' movement and environmental decay characteristics of the spreading agent. These findings offer a general mechanism for understanding how interaction patterns might be tuned in animal societies to control the simultaneous transmission of harmful and beneficial agents.

Does working memory training affect decision making ? : a neuroeconomic study

We all make decisions of varying levels of importance every day. Because making a decision implies that there are alternative choices to be considered, almost all decision involves some conflicts or dissatisfaction. Traditional economic models esteem that a person must weight the positive and negative outcomes of each option, and based on all these inferences, determines which option is the best for that particular situation. However, individuals rather act as irrational agents and tend to deviate from these rational choices. They somewhat evaluate the outcomes' subjective value, namely, when they face a risky choice leading to losses, people are inclined to have some preference for risk over certainty, while when facing a risky choice leading to gains, people often avoid to take risks and choose the most certain option. Yet, it is assumed that decision making is balanced between deliberative and emotional components. Distinct neural regions underpin these factors: the deliberative pathway that corresponds to executive functions, implies the activation of the prefrontal cortex, while the emotional pathway tends to activate the limbic system. These circuits appear to be altered in individuals with ADHD, and result, amongst others, in impaired decision making capacities. Their impulsive and inattentive behaviors are likely to be the cause of their irrational attitude towards risk taking. Still, a possible solution is to administrate these individuals a drug treatment, with the knowledge that it might have several side effects. However, an alternative treatment that relies on cognitive rehabilitation might be appropriate. This project was therefore aimed at investigate whether an intensive working memory training could have a spillover effect on decision making in adults with ADHD and in age-matched healthy controls. We designed a decision making task where the participants had to select an amount to gamble with the chance of 1/3 to win four times the chosen amount, while in the other cases they could loose their investment. Their performances were recorded using electroencephalography prior and after a one-month Dual N-Back training and the possible near and far transfer effects were investigated. Overall, we found that the performance during the gambling task was modulated by personality factors and by the importance of the symptoms at the pretest session. At posttest, we found that all individuals demonstrated an improvement on the Dual N-Back and on similar untrained dimensions. In addition, we discovered that not only the adults with ADHD showed a stable decrease of the symptomatology, as evaluated by the CAARS inventory, but this reduction was also detected in the control samples. In addition, Event-Related Potential (ERP) data are in favor of an change within prefrontal and parietal cortices. These results suggest that cognitive remediation can be effective in adults with ADHD, and in healthy controls. An important complement of this work would be the examination of the data in regard to the attentional networks, which could empower the fact that complex programs covering the remediation of several executive functions' dimensions is not required, a unique working memory training can be sufficient. -- Nous prenons tous chaque jour des décisions ayant des niveaux d'importance variables. Toutes les décisions ont une composante conflictuelle et d'insatisfaction, car prendre une décision implique qu'il y ait des choix alternatifs à considérer. Les modèles économiques traditionnels estiment qu'une personne doit peser les conséquences positives et négatives de chaque option et en se basant sur ces inférences, détermine quelle option est la meilleure dans une situation particulière. Cependant, les individus peuvent dévier de ces choix rationnels. Ils évaluent plutôt les valeur subjective des résultats, c'est-à-dire que lorsqu'ils sont face à un choix risqué pouvant les mener à des pertes, les gens ont tendance à avoir des préférences pour le risque à la place de la certitude, tandis que lorsqu'ils sont face à un choix risqué pouvant les conduire à un gain, ils évitent de prendre des risques et choisissent l'option la plus su^re. De nos jours, il est considéré que la prise de décision est balancée entre des composantes délibératives et émotionnelles. Ces facteurs sont sous-tendus par des régions neurales distinctes: le chemin délibératif, correspondant aux fonctions exécutives, implique l'activation du cortex préfrontal, tandis que le chemin émotionnel active le système limbique. Ces circuits semblent être dysfonctionnels chez les individus ayant un TDAH, et résulte, entre autres, en des capacités de prise de décision altérées. Leurs comportements impulsifs et inattentifs sont probablement la cause de ces attitudes irrationnelles face au risque. Cependant, une solution possible est de leur administrer un traitement médicamenteux, en prenant en compte les potentiels effets secondaires. Un traitement alternatif se reposant sur une réhabilitation cognitive pourrait être appropriée. Le but de ce projet est donc de déterminer si un entrainement intensif de la mémoire de travail peut avoir un effet sur la prise de décision chez des adultes ayant un TDAH et chez des contrôles sains du même âge. Nous avons conçu une tâche de prise de décision dans laquelle les participants devaient sélectionner un montant à jouer en ayant une chance sur trois de gagner quatre fois le montant choisi, alors que dans l'autre cas, ils pouvaient perdre leur investissement. Leurs performances ont été enregistrées en utilisant l'électroencéphalographie avant et après un entrainement d'un mois au Dual N-Back, et nous avons étudié les possibles effets de transfert. Dans l'ensemble, nous avons trouvé au pré-test que les performances au cours du jeu d'argent étaient modulées par les facteurs de personnalité, et par le degré des sympt^omes. Au post-test, nous avons non seulement trouvé que les adultes ayant un TDAH montraient une diminutions stable des symptômes, qui étaient évalués par le questionnaire du CAARS, mais que cette réduction était également perçue dans l'échantillon des contrôles. Les rsultats expérimentaux mesurés à l'aide de l'éléctroencéphalographie suggèrent un changement dans les cortex préfrontaux et pariétaux. Ces résultats suggèrent que la remédiation cognitive est efficace chez les adultes ayant un TDAH, mais produit aussi un effet chez les contrôles sains. Un complément important de ce travail pourrait examiner les données sur l'attention, qui pourraient renforcer l'idée qu'il n'est pas nécessaire d'utiliser des programmes complexes englobant la remédiation de plusieurs dimensions des fonctions exécutives, un simple entraiment de la mémoire de travail devrait suffire.

La collaboration interprofessionnelle à l'interface des institutions socio-éducative et psychiatrique. Jeux et enjeux de l'intervention auprès de personnes en situation de handicap mental et de troubles psychiques

La prise en charge et le suivi de personnes en situation de handicap mental souffrant de troubles psychiques et se trouvant donc à l'interface des domaines socio:éducatif et psychiatrique, constituent des défis complexes en matière de collaboration interprofessionnelle. Dans le canton de Vaud, les acteurs concernés par ce problème s'efforcent depuis de nombreuses années de créer des réseaux pluridisciplinaires visant un meilleur échange entre professionnels et le développement de compétences et de connaissances permettant d'améliorer le bien:être des bénéficiaires. Ce travail se propose ainsi d'étudier et de questionner ces modalités de travail dans une perspective socioculturelle (Vygotski, 1934/1997), afin d'en comprendre le fonctionnement, d'en éclairer les mécanismes et de fournir des pistes de réflexion aux professionnels. Il repose sur un travail de terrain mené auprès des membres du Dispositif de Collaboration Psychiatrie Handicap Mental (DCPHM) du Département de psychiatrie du CHUV, dont la mission principale est de faciliter la collaboration entre les institutions socio:éducatives et psychiatriques spécialisées dans le suivi des personnes en situation de handicap mental et souffrant de troubles psychiques. Le travail empirique est basé sur une approche qualitative et compréhensive des interactions sociales, et procède par une étude de terrain approfondie. Les données recueillies sont variées : notes de terrain et récolte de documentation, enregistrement de réunions d'équipe au sein du DCPHM et de réunions de réseau, et entretiens de différents types. L'analyse montre que le travail de collaboration qui incombe à l'équipe est constitué d'obstacles qui sont autant d'occasions de développement professionnel et de construction identitaire. Les résultats mettent en lumière des mécanismes discursifs de catégorisation concourant à la fois à la construction des patients comme objets d'activité, et à la construction d'une place qui légitime les interventions de l'équipe dans le paysage socio:éducatif et psychiatrique vaudois et la met au centre de l'arène professionnelle. -- Care and follow:up for people with mental disabilities suffering from psychological disorders : therefore at the interface between the socio:educational and psychiatric fields : represent complex challenges in terms of interprofessional collaboration. In the canton of Vaud, the caregivers involved in this issue have been trying for years to build multidisciplinary networks in order to better exchange between professionals and develop skills and knowledge to improve the recipients' well:being. This work thus proposes to study and question these working methods in a sociocultural perspective (Vygotski, 1934/1997) so as to understand how they operate, highlight inherent mechanisms and provide actionable insights to the professionals. It is based on fieldwork conducted among members of the Dispositif de Collaboration Psychiatrie Handicap Mental (DCPHM), of the Psychiatry Department at the CHUV University Hospital in Lausanne, whose main mission is to facilitate collaboration between the socio:educational and psychiatric institutions specialising in monitoring people presenting with both mental handicap and psychiatric disorder. The empirical work is based on a qualitative and comprehensive approach to social interactions, and conducted based on an in:depth field study. The data collected are varied - field notes and documentation collection, recordings of team meetings within the DCPHM and network meetings, and various types of interviews. The analysis shows that the collaborative work that befalls the team consists of obstacles, all of which provide opportunities for professional development and identity construction. The results highlight discursive strategies of categorisation which contribute both to the construction of the patients as objects of activity and to building a position that legitimates the team's interventions in the socio: educational and psychiatric landscape of canton Vaud and puts it in the centre of the professional arena.

Prevalence of alcohol-impaired drivers based on random breath tests in a roadside survey

Sobriety checkpoints are not usually randomly located by traffic authorities. As such, information provided by non-random alcohol tests cannot be used to infer the characteristics of the general driving population. In this paper a case study is presented in which the prevalence of alcohol-impaired driving is estimated for the general population of drivers. A stratified probabilistic sample was designed to represent vehicles circulating in non-urban areas of Catalonia (Spain), a region characterized by its complex transportation network and dense traffic around the metropolis of Barcelona. Random breath alcohol concentration tests were performed during spring 2012 on 7,596 drivers. The estimated prevalence of alcohol-impaired drivers was 1.29 PER CENT, which is roughly a third of the rate obtained in non-random tests. Higher rates were found on weekends (1.90 PER CENT on Saturdays, 4.29 PER CENT on Sundays) and especially at night. The rate is higher for men (1.45 PER CENT) than for women (0.64 PER CENT) and the percentage of positive outcomes shows an increasing pattern with age. In vehicles with two occupants, the proportion of alcohol-impaired drivers is estimated at 2.62 PER CENT, but when the driver was alone the rate drops to 0.84 PER CENT, which might reflect the socialization of drinking habits. The results are compared with outcomes in previous surveys, showing a decreasing trend in the prevalence of alcohol-impaired drivers over time.

Territorialisation des politiques énergétiques dans l'agglomération franco-valdo-genevoise : la planification énergétique comme opportunité de réaménagement des zones frontières ?

La présente recherche traite des défis posés à l'action publique territoriale par la transition énergétique, transition désormais érigée au rang de priorité par les autorités françaises et suisses, comme plus globalement européennes. Elle prend pour cela appui sur une analyse des démarches de planification énergétique territoriale menées entre 2007 et 2014 sur le territoire franco-valdo-genevois (agglomération du « Grand-Genève »). Considérées comme des laboratoires d'expérimentation de la territorialisation des politiques énergétiques, ces démarches sont ici examinées selon une perspective institutionnaliste et pragmatiste visant à mettre lumière les éléments qui interviennent dans la délimitation du champ des possibles en matière d'action publique énergétique et territoriale. Ce positionnement découle des évolutions observées sur le territoire franco-valdo-genevois durant la période d'étude (chapitre 1). Il découle plus précisément du constat de récurrence de certains points de blocage rencontrés aussi bien dans les démarches de planification énergétique elles-mêmes que dans les travaux méthodologiques qui ont pu être réalisés parallèlement à ces démarches, dans le but d'en affiner les outils techniques et organisationnels de mise en oeuvre. Ainsi, le point de départ de la présente recherche est le constat selon lequel on peine tout autant à construire des solutions énergétiques appropriables et réalisables par les acteurs des territoires concernés qu'à reconfigurer les outils de production de ces solutions. De ce constat découle l'intérêt porté aux cadres institutionnels qui régissent ces planifications énergétiques territoriales. Définis comme l'ensemble des repères - formels et informels - qui rendent possibles en même temps qu'ils contraignent les interactions territorialisées entre les acteurs, ces cadres institutionnels sont placés au coeur de la grille de (re)lecture des expériences de planification énergétique territoriale établie au chapitre 2 de la thèse. En référence aux concepts institutionnalistes et pragmatistes sur lesquels elle prend appui, cette grille conduit à appréhender ces expériences comme autant d'enquêtes contribuant, à travers le travail de mobilisation et construction de représentations territoriales auquel elles donnent lieu, à l'équipement sociocognitif d'un champ d'intervention territorial spécifique. Partant de l'hypothèse selon laquelle les potentialités comme les limites associées à l'équipement sociocognitif de ce champ orientent les possibilités d'action collective, la réflexion consiste en une application de cette grille à une trentaine d'expériences de planification énergétique territoriale. Cette application s'effectue en deux temps, correspondant à deux niveaux de lecture de ces démarches. Le premier porte sur les dispositifs organisationnels et les modalités d'interactions entre les cultures d'action qu'elles réunissent (chapitre 3). Le second se concentre davantage sur les supports cognitifs (représentations territoriales) autour desquels se structurent ces interactions (chapitre 4). Présentés dans le dernier chapitre de la thèse (chapitre 5), les enseignements tirés de ce travail de réexamen des démarches franco-valdo-genevoises de planification énergétique territoriale sont de deux ordres. Ils portent d'abord sur les caractéristiques des cadres institutionnels existants, la manière dont ils orientent ces démarches et délimitent les évolutions possibles dans les modes d'action collective et plus particulièrement d'action publique qui y sont associés. Mais ils portent aussi sur les potentiels de changement associés à ces démarches, et sur les pistes envisageables pour mieux valoriser es potentiels, dont l'activation passe par des évolutions profondes des systèmes institutionnels en place. -- In France as in Switzerland, local authorities stand out as leading players of energy transition, a transition that requires an important renewal of public intervention instruments. It is the stakes and the conditions of such a renewal that the present work aims to examine, based on the experiments of territorial energy planning led on the franco-valdo-genevan cross-border territory. Conceived as initiatives of relocation of the energy supply system, these energy planning initiatives are examined through an institutionalist and pragmatic « reading template ». This « reading template » consists of seeing these energy planning initiatives as pragmatist inquiries aiming, through a collective work of cognitive equipment of the territorial franco-valdo-genevan field of intervention, at the reconstruction of the means of coordination between people about their material, organizational and political territory. It opens towards a double reading of the energy planning initiatives. The first one concentrates on the organizational dimension of these inquiries - i.e. on the cultures of action which they gather and the modalities of interaction between them - whereas the second focuses on the cognitive substance which represents the medium of the interactions. This double reading provides insights at various levels. The first one concerns the (cognitive) territorial field of intervention that these energy-planning experiments contribute to draw. A field which, although better and better characterized in its technical dimensions, remains at the same time limited and " deformed " so that it values more the fossil energy systems, from which we want to release ourselves, than the renewable ones, which we would like to replace them with. The second level of teaching concerns the processes of production of territorial knowledge (PPTK) which presides over the demarcation and « equipment » of the territorial field of intervention. Examined through the institutional norms and the culture of action at stake in them, this PPTK turns out to create a sociocognitive "cross-border" area, the kind of area that could shelter the desired reconfigurations...on the condition that they are beforehand correctly "equipped", in cognitive and also in organizational terms. The determining factor for the quality of this equipment is concentrated in the third category of teaching. Starting with the opportunities created by these energy planning experiments concerning the renewal of public intervention instruments, these elements also allow us to take a new look at the urban area project under construction in this cross-border territory, a project th t shows itself closely linked to the energy experiments through a common challenge of territorialisation.

Multimorbidity in primary care : protocol of a national cross-sectional study in Switzerland.

INTRODUCTION: With the ageing of the population and the general improvement of care, an increasing number of people are living with multiple chronic health conditions or 'multimorbidity'. Multimorbidity often implies multiple medical treatments. As a consequence, the risk of adverse events and the time spent by patients for their treatments increase exponentially. In many cases, treatment guidelines traditionally defined for single conditions are not easily applicable. Primary care for individuals with multimorbidity requires complex patient-centred care and good communication between the patient and the general practitioner (GP). This often includes prioritising among the different chronic conditions. METHODS AND ANALYSIS: The main objectives of this study are to describe the burden related to multimorbidity (disease-related burden and burden of treatment) in primary care and to identify the factors influencing it. Other objectives include evaluating patients' perception of treatment burden and quality of life, assessing factors influencing that perception, and investigating prioritisation in the management of multimorbidity from the perspectives of GPs and patients. For this cross-sectional study, patient enrolment will take place in GP's private practices across Switzerland. A convenient sample of 100 GPs will participate; overall, 1000 patients with at least three chronic health conditions will be enrolled. Data will be collected as paper-based questionnaires for GPs and delayed telephone interview questionnaires for patients. GPs will provide demographic and practice-related data. In addition, each GP will complete a paper-based questionnaire for each patient that they enrol. Each patient will complete a telephone interview questionnaire. ETHICS AND DISSEMINATION: This study has been approved by the research ethics committee of Canton Vaud, Switzerland (Protocol 315/14). The results of the study will be reported in international peer-reviewed journals.

Swiss family physicians' perceptions and attitudes towards knowledge translation practices.

BACKGROUND: Several studies have been performed to understand the way family physicians apply knowledge from medical research in practice. However, very little is known concerning family physicians in Switzerland. In an environment in which information constantly accumulates, it is crucial to identify the major sources of scientific information that are used by family physicians to keep their medical knowledge up to date and barriers to use these sources. Our main objective was to examine medical knowledge translation (KT) practices of Swiss family physicians. METHODS: The population consisted of French- and German-speaking private practice physicians specialised in family medicine. We conducted four interviews and three focus groups (n = 25). The interview guides of the semi-structured interviews and focus groups focused on (a) ways and means used by physicians to keep updated with information relevant to clinical practice; (b) how they consider their role in translating knowledge into practice; (c) potential barriers to KT; (d) solutions proposed by physicians for effective KT. RESULTS: Family physicians find themselves rather ambivalent about the translation of knowledge based on scientific literature, but generally express much interest in KT. They often feel overwhelmed by "information floods" and perceive clinical practice guidelines and other supports to be of limited usefulness for their practice. They often combine various formal and informal information sources to keep their knowledge up to date. Swiss family physicians report considering themselves as artisans, caring for patients with complex needs. CONCLUSION: Improved performance of KT initiatives in family medicine should be tailored to actual needs and based on high quality evidence-based sources.

Spatiotemporal Aspects of Environmental Monitoring in the Complex Coastal Region of Southwest Finland

The management and conservation of coastal waters in the Baltic is challenged by a number of complex environmental problems, including eutrophication and habitat degradation. Demands for a more holistic, integrated and adaptive framework of ecosystem-based management emphasize the importance of appropriate information on the status and changes of the aquatic ecosystems. The thesis focuses on the spatiotemporal aspects of environmental monitoring in the extensive and geomorphologically complex coastal region of SW Finland, where the acquisition of spatially and temporally representative monitoring data is inherently challenging. Furthermore, the region is subject to multiple human interests and uses. A holistic geographical approach is emphasized, as it is ultimately the physical conditions that set the frame for any human activity. Characteristics of the coastal environment were examined using water quality data from the database of the Finnish environmental administration and Landsat TM/ETM+ images. A basic feature of the complex aquatic environment in the Archipelago Sea is its high spatial and temporal variability; this foregrounds the importance of geographical information as a basis of environmental assessments. While evidence of a consistent water turbidity pattern was observed, the coastal hydrodynamic realm is also characterized by high spatial and temporal variability. It is therefore also crucial to consider the spatial and temporal representativeness of field monitoring data. Remote sensing may facilitate evaluation of hydrodynamic conditions in the coastal region and the spatial extrapolation of in situ data despite their restrictions. Additionally, remotely sensed images can be used in the mapping of many of those coastal habitats that need to be considered in environmental management. With regard to surface water monitoring, only a small fraction of the currently available data stored in the Hertta-PIVET register can be used effectively in scientific studies and environmental assessments. Long-term consistent data collection from established sampling stations should be emphasized but research-type seasonal assessments producing abundant data should also be encouraged. Thus a more comprehensive coordination of field work efforts is called for. The integration of remote sensing and various field measurement techniques would be especially useful in the complex coastal waters. The integration and development of monitoring system in Finnish coastal areas also requires further scientific assesement of monitoring practices. A holistic approach to the gathering and management of environmental monitoring data could be a cost-effective way of serving a multitude of information needs, and would fit the holistic, ecosystem-based management regimes that are currently being strongly promoted in Europe.

Multifactor Performance Study on Complex Systems for the Benefit of Management

The primary objective is to identify the critical factors that have a natural impact on the performance measurement system. It is important to make correct decisions related to measurement systems, which are based on the complex business environment. The performance measurement system is combined with a very complex non-linear factor. The Six Sigma methodology is seen as one potential approach at every organisational level. It will be linked to the performance and financial measurement as well as to the analytical thinking on which the viewpoint of management depends. The complex systems are connected to the customer relationship study. As the primary throughput can be seen in a new well-defined performance measurement structure that will also be facilitated as will an analytical multifactor system. These critical factors should also be seen as a business innovation opportunity at the same time. This master's thesis has been divided into two different theoretical parts. The empirical part consists of both action-oriented and constructive research approaches with an empirical case study. The secondary objective is to seek a competitive advantage factor with a new analytical tool and the Six Sigma thinking. Process and product capabilities will be linked to the contribution of complex system. These critical barriers will be identified by the performance measuring system. The secondary throughput can be recognised as the product and the process cost efficiencies which throughputs are achieved with an advantage of management. The performance measurement potential is related to the different productivity analysis. Productivity can be seen as one essential part of the competitive advantage factor.