Effects of continuous positive airway pressure treatment on coronary vasoreactivity measured by (82)Rb cardiac PET/CT in obstructive sleep apnea patients.

PURPOSE: Obstructive sleep apnea syndrome (OSA) increases the risk of cardiovascular disease. We aimed at evaluating the effect of continuous positive airway pressure (CPAP) treatment on coronary endothelium-dependent vasoreactivity in OSA patients by quantifying myocardial blood flow (MBF) response to cold pressure testing (CPT). METHODS: In the morning after polysomnography (PSG), all participants underwent a dynamic (82)Rb cardiac positron emitting tomography/computed tomography (PET/CT) scan at rest, during CPT and adenosine stress. PSG and PET/CT were repeated at least 6 weeks after initiating CPAP treatment. OSA patients were compared to controls and according to response to CPAP. Patients' characteristics and PSG parameters were used to determine predictors of CPT-MBF. RESULTS: Thirty-two untreated OSA patients (age 58 ± 13 years, 27 men) and 9 controls (age 62 ± 5 years, 4 men) were enrolled. At baseline, compared to controls (apnea-hypopnea index (AHI) = 5.3 ± 2.6/h), untreated OSA patients (AHI = 48.6 ± 19.7/h) tend to have a lower CPT-MBF (1.1 ± 0.2 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.09). After initiating CPAP, CPT-MBF was not different between well-treated patients (AHI <10/h) and controls (1.3 ± 0.3 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.83), but it was lower for insufficiently treated patients (AHI ≥10/h) (0.9 ± 0.2 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.0045). CPT-MBF was also higher in well-treated than in insufficiently treated patients (1.3 ± 0.3 mL/min/g vs. 0.9 ± 0.2 mL/min/g, p = 0.001). Mean nocturnal oxygen saturation (β = -0.55, p = 0.02) and BMI (β = -0.58, p = 0.02) were independent predictors of CPT-MBF in OSA patients. CONCLUSIONS: Coronary endothelial vasoreactivity is impaired in insufficiently treated OSA patients compared to well-treated patients and controls, confirming the need for CPAP optimization.

Expanding the Customer Relationship Management scope to the non-profit organizations : an analysis focused on the e-university domain

Peer-reviewed

Liderazgo y dirección de empresas en el s. XXI

Peer-reviewed

Choosing hybrid organizations for local services delivery : An empirical analysis of partial privatization

The empirical literature about factors explaining local government delivery choices has traditionally focused the attention on the public or private production dilemma. However, hybrid organizational forms such as mixed public-private firms are increasingly used in several European countries. This paper makes use of survey data from Spanish municipalities to examine motivations of local governments for engaging in hybrid organizational forms. Data refer to two very relevant local services: water distribution and solid waste collection. The empirical analysis indicates that the use of mixed firms emerge as a type of pragmatically based ‘third way’ between pure public and pure private production. Indeed, local governments make use of mixed firms when cost considerations (scale economies, transaction costs and soon), financial constraints and private interests exert contradictory pressures. On the contrary, political and ideological factors do not play any significant role on the local government decision of engaging or not in joint ventures with private partners.

Tietotyön avainhenkilöiden sitoutuminen - Case Kymenlaakson sairaanhoitopiirin lääkärit

Tutkielmassa tarkasteltiin affektiivista eli tunnepohjaista sitoutumista organisaatioon ja selvitettiin, mitkä ovat sitä lisääviä ei-taloudellisia motivointikeinoja. Tulokset osoittivat, että organisaatioon sitoutumista lisääviä ulottuvuuksia ovat itsensä kehittäminen, työtehtävien vaihto ja työn arvostus. Lisäksi selvitettiin affektiivisen sitoutumisen ja innovatiivisuuden välistä suhdetta ja niiden välillä todettiin merkittävä positiivinen yhteys. Tarkastelun kohteena olivat tietotyön avainhenkilöt, joiden sitoutuminen organisaatioon on merkityksellisintä sen toiminnan ja tuottavuuden kannalta. Ilmiötä tarkasteltiin ensisijaisesti tilastollisin menetelmin. Teoriaa testattiin empiirisesti Kymenlaakson sairaanhoitopiirin lääkäreihin, jotka edustavat erikoisosaamista julkisella sektorilla.

Toimintolaskenta tuotehallinnan tukena

Tämän tapaustutkimuksen päätavoitteina on luoda toimintolaskentamalli kohdeyritykselle ja testata toimintolaskennan soveltuvuutta pilottiprojektilla, joka toteutetaan vain pienelle osalle tuotteista. Toimintolaskentaprojektin tavoitteena on tarkentaa tuotteiden kustannuslaskentaa ja näin tukea yrityksen päätöksentekoa tuotehallinnan päätöksissä. Tutkimuksen tuloksena pilottiprojekti on vahvistanut ennakkokäsityksiä laskentakohteina olleiden tuotteiden osalta. Implementointiprosesseilla on sekä inhimillisiä että teknisiä ongelmia. Resurssikustannusten kohdistaminen asetettiin projektin tärkeimmäksi tekniseksi ongelmaksi. Pilottiprojekti keskittyy lähinnä laskennan tekniseen toteutukseen, mutta kattavampi muutosprojekti vaatii muutosjohtajuutta ja keskittymistä inhimillisiin tekijöihin. Pilottivaiheessa tärkein inhimillinen ongelma on saavuttaa johdon tuki ja osallistuminen projektiin. Toimintolaskentaprojekti onnistui kohdeyrityksessä hyvin ja johdon tuki onnistuttiin saavuttamaan. Tutkimuksen tuloksena nähdään toimintolas-kennan hyödyttävän tuotehallintaa ja tutkimuksen seurauksena toimintolaskentaprojektia jatketaan kattamaan koko tuotevalikoima. Yrityksessä havaittiin laskentaprojektin aikana myös toiminnan kehityskohteita, jotka vaativat tarkempaa tarkastelua toimintoanalyysin avulla.

Web 2.0 technology assisted global knowledge network as an organizations key asset

Aim of the Thesis is to study and understand the theoretical concept of Metanational corporation and understand how the Web 2.0 technologies can be used to support the theory. Empiric part of the study compares the theory to the case company’s current situation Goal of theoretical framework is to show how the Web 2.0 technologies can be used in the three levels of the Metanational corporation. In order to do this, knowledge management and more accurately knowledge transferring is studied to understand what is needed from the Web 2.0 technologies in the different functions and operations of the Metanational corporation. Final synthesis of the theoretical framework is to present a model where the Web 2.0 technologies are placed on the levels of the Metanational corporation. Empirical part of the study is based on interviews made in the case company. Aim of the interviews is to understand the current state of the company related to the theoretical framework. Based on the interviews, the differences between the theoretical concept and the case company are presented and studied. Finally the study presents the found problem areas, and where the adoption of the Web 2.0 tools is seen as beneficiary, based on the interviews and theoretical framework.

Condiciones de trabajo psicosociales y desgaste psíquico en trabajadores de diversos sectores empresariales de centro-oriente, suroccidente y región Caribe en Colombia

Objetivo: Determinar la percepción de trabajadores de distintos sectores empresariales de Colombia sobre los factores psicosociales presentes en su entorno laboral y la relación entre los factores psicosociales nocivos y los síntomas subjetivos y alteraciones de la salud. Materiales y métodos: Estudio no experimental, transversal y cuantitativo. Participaron 370 trabajadores, de diferentes sectores empresariales de Colombia (Centro-Oriente, Suroccidente y región Caribe). Instrumento: batería para el estudio de las condiciones de trabajo de carácter psicosocial (CTCPS-MAC), validada para población iberoamericana, permite evaluar cuatro dimensiones: Contexto de trabajo, Contenido de trabajo, Factores individuales y Desgaste psíquico e incluye catorce factores psicosociales. Los datos se analizaron con IBM SPSS statistics 21. Se realizó análisis bivariado y regresión logística multivariante de factores psicosociales nocivos y desgaste psíquico. Resultados: Los factores formación, baja médica, contexto de trabajo, contenido de trabajo y factores individuales están asociados en este estudio con desgaste psíquico. El contexto de trabajo es la variable que infiere mayor riesgo (p=0.000; Exp (B)= 5.355) para provocar desgaste psíquico, seguida de la formación técnica o superior y del contenido del trabajo. Conclusiones: Si bien aquellos trabajadores cuya percepción nociva del contexto de trabajo (interrelación trabajo-vida familiar/personal, cultura de la organización, gestión de la empresa, etc.), del contenido de trabajo (concepción tareas, carga y ritmo de trabajo, etc.) y los que tienen formación técnica o superior tienen mayor probabilidad de padecer desgaste psíquico, se observan aspectos positivos de las condiciones de trabajo psicosocial y su influencia en los trabajadores y en las organizaciones.

Buying behavior of public organizations and its influence on export partner governance

Public organizations form a significant part of any economy, yet their buying behavior has received very little attention. Operating with complex public sector is further complicated when sales and marketing activities are done by foreign export partners. This thesis explores the buying behavior of public organizations and how partnership governance is influenced by it. The theoretical part focuses on two subjects. Firstly the strictly regulated purchase process, rigid decision making and other special characteristics of public organizations are examined. Secondly the thesis examines partnership governance forms and how coordination is arranged in the relationships. The empirical part investigates the subjects of public organization buying behavior and partnership governance using a case study of a Finnish SME and their two export partners. The findings suggest high degree of uniformity between public organizations enables the use of unilateral governance forms. By creating mutual dependence through training the possibility of adopting a purely bilateral governance form exists as well.

Coopetitive advantage – How firms create and appropriate value by collaborating with their competitors

Collaboration between competing firms (coopetition) has emerged as an important issue forn business practice in many industries. Extant literature has examined coopetition on many levels of analysis, but lacks clarity in distinguishing it explicitly from cooperation between noncompeting organizations. Because of this, the performance implications of coopetition from the perspective of an individual firm are still ambiguous – some research suggests positive results whereas other studies suggest detrimental outcomes. The aim in this dissertation is to narrow these gaps by exploring how firms create and appropriate value through collaboration with their competitors. The dissertation is divided into two parts. The first part comprises an overview of the relevant literature, as well as the conclusions of the whole study, and the second part includes six research publications. Both qualitative and quantitative methodologies are utilized. The results suggest that coopetition embodies the distinctive logic of value creation and appropriation from the perspective of an individual firm, and thus differs in terms of performance implications from cooperation between non-competitors. The distinction comes from the fact that competitors have somewhat similar understanding, capabilities and interest related to certain markets, which is potentially both challenging and beneficial in terms of the individual firm’s competitiveness. It appears from the findings that there are distinctive firm-external and firm-specific factors affecting the success of a coopetition strategy. This study makes three main contributions. First, on the conceptual level it shows the distinction between coopetition and cooperation between non-rivals as a collaborative inter-organizational relationship. Secondly, it sets out a framework and propositions that enhance understanding of how value is created and appropriated in coopetition from the perspective of an individual firm. Thirdly, it offers empirical evidence of how coopetition affects firms’ innovation and market performance, and identifies the focal internal and external factors involved. In general terms, the thesis adds to our knowledge of how a firm can successfully utilize a coopetition strategy in its pursuit of improved performance.

Survival and Quality of Life among Patients with Severe Lower Extremity Peripheral Arterial Disease

Lower extremity peripheral arterial disease (PAD) is associated with decreased functional status, diminished quality of life (QoL), amputation, myocardial infarction, stroke, and death. Nevertheless, public awareness of PAD as a morbid and mortal disease is low. The aim of this study was to assess the incidence of major lower extremity amputation due to PAD, the extent of reamputations, and survival after major lower extremity amputation (LEA) in a population based PAD patient cohort. Furthermore, the aim was to assess the functional capacity in patients with LEA, and the QoL after lower extremity revascularization and major amputation. All 210 amputees due to PAD in 1998–2002 and all 519 revascularized patients in 1998–2003 were explored. 59 amputees alive in 2004 were interviewed using a structured questionnaire of QoL. Two of each amputee age-, gender- and domicile-matched controls filled in and returned postal self-administered QoL questionnaire as well as 231 revascularized PAD patients (the amount of these patients who engaged themselves to the study), and one control person for each patient completed postal self-administered QoL questionnaire. The incidence rate of major LEA was 24.1/100 000 person-years and it was considerably high during the years studied. The one-month mortality rate was 21%, 52% at one-year, and the overall mortality rate was 80%. When comparing the one-year mortality risk of amputees, LEAs were associated with a 7.4-fold annual mortality risk compared with the reference population in Turku. Twenty-two patients (10%) had ipsilateral transversions from BK to AK amputation. Fifty patients (24%) ended up with a contralateral major LEA within two to four amputation operations. Three bilateral amputations were performed at the first major LEA operation. Of the 51 survivors returning home after their first major LEA, 36 (71%) received a prosthesis; (16/36, 44%) and were able to walk both in- and outdoors. Of the 68 patients who were discharged to institutional care, three (4%) had a prosthesis one year after LEA. Both amputees and revascularized patients had poor physical functioning and significantly more depressive symptoms than their controls. Depressive symptoms were more common in the institutionalized amputees than the home-dwelling amputees. The surviving amputees and their controls had similar life satisfaction. The amputees felt themselves satisfied and contented, whether or not they lived in long-term care or at home. PAD patients who had undergone revascularizations had poorer QoL than their controls. The revascularized patients’ responses on their perceived physical functioning gave an impression that these patients are in a declining life cycle and that revascularizations, even when successful, may not be sufficient to improve the overall function. It is possible that addressing rehabilitation issues earlier in the care may produce a more positive functional outcome. Depressive symptoms should be recognized and thoroughly considered at the same time the patients are recovering from their revascularization operation. Also primary care should develop proper follow-up, and community organizations should have exercise groups for those who are able to return home, since they very often live alone. In rehabilitation programs we should consider not only physical disability assessment but also QoL.

Use Of Systems Approach with Total Quality Management in Industrial Organizations

The objective of the work has been to study why systems thinking should be used in combination with TQM, what are the main benefits of the integration and how it could best be done. The work analyzes the development of systems thinking and TQM with time and the main differences between them. The work defines prerequisites for adopting a systems approach and the organizational factors which embody the development of an efficient learning organization. The work proposes a model based on combination of an interactive management model and redesign to be used for application of systems approach with TQM in practice. The results of the work indicate that there are clear differences between systems thinking and TQM which justify their combination. Systems approach provides an additional complementary perspective to quality management. TQM is focused on optimizing operations at the operational level while interactive management and redesign of organization are focused on optimization operations at the conceptual level providing a holistic system for value generation. The empirical study demonstrates the applicability of the proposed model in one case study company but its application is tenable and possible also beyond this particular company. System dynamic modeling and other systems based techniques like cognitive mapping are useful methods for increasing understanding and learning about the behavior of systems. The empirical study emphasizes the importance of using a proper early warning system.

Structured software development with the IPIDDDT method - A lean method for small agile organizations

A software development process is a predetermined sequence of steps to create a piece of software. A software development process is used, so that an implementing organization could gain significant benefits. The benefits for software development companies, that can be attributed to software process improvement efforts, are improved predictability in the development effort and improved quality software products. The implementation, maintenance, and management of a software process as well as the software process improvement efforts are expensive. Especially the implementation phase is expensive with a best case scenario of a slow return on investment. Software processes are rare in very small software development companies because of the cost of implementation and an improbable return on investment. This study presents a new method to enable benefits that are usually related to software process improvement to small companies with a low cost. The study presents reasons for the development of the method, a description of the method, and an implementation process for the method, as well as a theoretical case study of a method implementation. The study's focus is on describing the method. The theoretical use case is used to illustrate the theory of the method and the implementation process of the method. The study ends with a few conclusions on the method and on the method's implementation process. The main conclusion is that the method requires further study as well as implementation experiments to asses the value of the method.