Capturing diagnosis-timing in ICD-coded hospital data: recommendations from the WHO ICD-11 topic advisory group on quality and safety.

PURPOSE: To develop a consensus opinion regarding capturing diagnosis-timing in coded hospital data. METHODS: As part of the World Health Organization International Classification of Diseases-11th Revision initiative, the Quality and Safety Topic Advisory Group is charged with enhancing the capture of quality and patient safety information in morbidity data sets. One such feature is a diagnosis-timing flag. The Group has undertaken a narrative literature review, scanned national experiences focusing on countries currently using timing flags, and held a series of meetings to derive formal recommendations regarding diagnosis-timing reporting. RESULTS: The completeness of diagnosis-timing reporting continues to improve with experience and use; studies indicate that it enhances risk-adjustment and may have a substantial impact on hospital performance estimates, especially for conditions/procedures that involve acutely ill patients. However, studies suggest that its reliability varies, is better for surgical than medical patients (kappa in hip fracture patients of 0.7-1.0 versus kappa in pneumonia of 0.2-0.6) and is dependent on coder training and setting. It may allow simpler and more precise specification of quality indicators. CONCLUSIONS: As the evidence indicates that a diagnosis-timing flag improves the ability of routinely collected, coded hospital data to support outcomes research and the development of quality and safety indicators, the Group recommends that a classification of 'arising after admission' (yes/no), with permitted designations of 'unknown or clinically undetermined', will facilitate coding while providing flexibility when there is uncertainty. Clear coding standards and guidelines with ongoing coder education will be necessary to ensure reliability of the diagnosis-timing flag.

Competitive policy and pricing in business-to-business relationships within the EC market.

Tutkielman tarkoituksena oli tarkastella hinnoittelun ja hinnanalennusten merkitystä toimittaja-asiakassuhteissa yritysmarkkinoilla, sekä sitä kuinka kilpailuoikeus säätelee hinnoittelua. Tutkielman ensisijaisena tavoitteena oli selvittää kuinka alennuspolitiikka tulisi laatia jotta se olisi EY:n kilpailuoikeuden mukaan sallittu. Aluksi hinnoittelupolitiikkaan ja strategiaan vaikuttavia seikkoja tarkasteltiin teoreettisesti ja tämän pohjalta laadittua viitekehystä sovellettiin empiiristä tutkimusta suoritettaessa. Empiirinen tutkimus oli normatiivinen case-tutkimus, jossa tarkasteltiin kahdessa toimittaja-asiakassuhteessa noudatettuja hinnoittelu- ja alennuskäytäntöjä. Aineisto kerättiin haastattelemalla toimittajan myyntihenkilöitä, ja lisänä käytettiin yrityksen sisäistä materiaalia. Analyysin tulokset osoittivat nykyisissä käytännöissä joitakin kilpailuoikeudellisia ristiriitaisuuksia, ja näihin annettiin parannusehdotuksia.

Value creation and capital market valuation in the forest product industry

Tämä työ tähtää löytämään mahdollisia poikkeamia metsäteollisuusyritysten markkina-arvoissa ja tunnistaa tekijöitä jotka ovat vaikuttaneet pääomamarkkinoiden odotuksiin yritysten tulevaisuuden suorituskyvystä sekä yrityksen markkina-arvoon. Tämän työn päätavoitteena on kehittää diskontattuihin kassavirtoihin perustuva arvonmääritysmalli jolla mitataan metsäteollisuusyritysten tosiasiallista arvoa yritysten suorituskyvyn ja arvoajureiden perusteella. Lisäksi tavoitteena on löytää selittäviä tekijöitä havaituille eroille yritysten tosiasiallisesten arvojen ja markkinaperusteisten arvojen välisillä. Teoreettisessa osassa esitellään rahoitusteorian pääpiirteet arvonmäärityksen kannalta, aikasempia tutkimuksia sekä metsäteollisuuden toimialakohtaisia tekijöitä. Empiirisessä osassa kehittetään diskontattuihin kassavirtoihin perustuvaa arvonmääritymalli. Otos koostuu 32 suurimmasta Pohjoismaisesta ja Pohjoisamerikkalaisesta metsäteollisuusyrityksestä vuonna 2000. Tutkimuksen aikavälien 1991 -2000. Tulokset tukevat aikaisempia tutkimuksia jonka mukaan kasvuinvestoinnit eivät luo positiivisia odotuksia yrityksen tulevaisuuden kassavirroista. Tarkemmat löydöt ovat, että arvon luominen tutkimusajanjakson aikana ei vaikuttanut yhtä merkittävästi pääomamarkkinoiden odotuksiin yrityksen tulevaisuuden suorituskyvystä kuin mitatut tosiasialliset arvot. Tulokset viittaavat siihen, että metsäteollisuusyritysten markkina- arvot olivat keskimäärin riippuvaisempia itse yrityksestä, kuin sen toiminnasta.

Evaluation and realisation of a market entry method: The entry of a small high technology company into the British construction software markets

Tutkielman tavoitteena on tutkia, mikä olisi parhaiten case-yritykselle sopiva menetelmä tulla tekemään kauppaa ulkomaan markkinoille. Kaikki yleiset kansainvälisille markkinoilletulomenetelmät esitetään ja niiden edut ja haitat tuodaan esille. Selvittäessä tehtävänantajayrityksen resurssit, odotukset ja vaatimukset todetaan, että yhteistyössä tehtävä markkinoilletulo on pätevin vaihtoehto. Tämän jälkeen valitaan parhaiten tarkoitukseen sopiva yritys ennalta valitusta yritysvaihtoehtojen ryhmästä ja testataan tämän yrityksen yhteistyösopivuus case-yrityksen kanssa. Yritysten välinen yhteistyösopivuus arvioidaan analysoimalla yritykset haastattelujen avulla ja tutkielmassa esitettyjen teorioiden avulla. Sopivuus todetaan hyväksi, kattaen 71 prosenttia analysoiduista kohdista. Kaksikymmentäyhdeksän prosenttia kohdista todetaan kohdiksi, joissa yritysten välinen yhteisymmärrys ei ole toimeksiantajayrityksen minimivaatimukset täyttävää. Näitä kohtia tullaan käyttämään suunnittelun pohjana kun suunnitellaan jatkoneuvotteluja yhteistyön käynnistämiseksi.

Value at Risk in measuring market risk: Historical simulation

In this study the theoretical part was created to make comparison between different Value at Risk models. Based on that comparison one model was chosen to the empirical part which concentrated to find out whether the model is accurate to measure market risk. The purpose of this study was to test if Volatility-weighted Historical Simulation is accurate in measuring market risk and what improvements does it bring to market risk measurement compared to traditional Historical Simulation. Volatility-weighted method by Hull and White (1998) was chosen In order to improve the traditional methods capability to measure market risk. In this study we found out that result based on Historical Simulation are dependent on chosen time period, confidence level and how samples are weighted. The findings of this study are that we cannot say that the chosen method is fully reliable in measuring market risk because back testing results are changing during the time period of this study.

Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation: effect of Anticoagulation and Its Timing: the RAF Study.

BACKGROUND AND PURPOSE: The best time for administering anticoagulation therapy in acute cardioembolic stroke remains unclear. This prospective cohort study of patients with acute stroke and atrial fibrillation, evaluated (1) the risk of recurrent ischemic event and severe bleeding; (2) the risk factors for recurrence and bleeding; and (3) the risks of recurrence and bleeding associated with anticoagulant therapy and its starting time after the acute stroke. METHODS: The primary outcome of this multicenter study was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding within 90 days from acute stroke. RESULTS: Of the 1029 patients enrolled, 123 had 128 events (12.6%): 77 (7.6%) ischemic stroke or transient ischemic attack or systemic embolism, 37 (3.6%) symptomatic cerebral bleeding, and 14 (1.4%) major extracranial bleeding. At 90 days, 50% of the patients were either deceased or disabled (modified Rankin score ≥3), and 10.9% were deceased. High CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesion and type of anticoagulant were predictive factors for primary study outcome. At adjusted Cox regression analysis, initiating anticoagulants 4 to 14 days from stroke onset was associated with a significant reduction in primary study outcome, compared with initiating treatment before 4 or after 14 days: hazard ratio 0.53 (95% confidence interval 0.30-0.93). About 7% of the patients treated with oral anticoagulants alone had an outcome event compared with 16.8% and 12.3% of the patients treated with low molecular weight heparins alone or followed by oral anticoagulants, respectively (P=0.003). CONCLUSIONS: Acute stroke in atrial fibrillation patients is associated with high rates of ischemic recurrence and major bleeding at 90 days. This study has observed that high CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesions, and type of anticoagulant administered each independently led to a greater risk of recurrence and bleedings. Also, data showed that the best time for initiating anticoagulation treatment for secondary stroke prevention is 4 to 14 days from stroke onset. Moreover, patients treated with oral anticoagulants alone had better outcomes compared with patients treated with low molecular weight heparins alone or before oral anticoagulants.

Market Orientation in Rapidly Internationalizing Small Companies — Evidence from the Software Industry

For more than a decade, researchers have been aware of the increased pace of small-firm internationalization and the greater effect of these rapidly growing small businesses on the wealth, international trade, and job-creation opportunities of countries. Due to the small size of the home market, Finnish companies have been generally considered highly interested in internationalization. One particular domain in which rapid internationalization has been considered feasible is the global software business, with its knowledge-intensive nature and high growth potential. However, over time the failure rate of small entrepreneurial firms has remained especially high in high-technology markets. One of the reasons for this seems to lie in the fact that these companies are often formed by people with a strong technological background but limited competences in other areas. Further, research on the marketing capabilities of rapidly internationalizing high-tech firms has been scarce thus far. In addition, while there is much research on the first years of operations of rapidly internationalizing companies, it is not well known what becomes of them later on. Therefore, there is a need for more investigation into the managerial mindset, competences and decision-making in these small companies, especially from the perspective of how they acquire and exploit market knowledge, and enhance their networking capabilities in order to promote international expansion. The present study focuses on market orientation in small software firms that internationalize their operations rapidly in global software markets. It builds on qualitative data to illustrate how these companies develop their market-oriented product-market strategies during the process of increasing international commitment. It also shows how they manage their network relationships in order to be able to offer better customer service and to thrive in the fierce global competition. The study was conducted in the empirical context of Finnish small software companies, and the main data consists of interviews with top managers in these businesses. The interviews were designed to cover a minimum period of five years of the company's international operations, thus offering a retrospective in-depth perspective on market orientation, internationalization and partnerships in the given context. One particular focus is on less successfully internationalized software companies, and the challenges they face when approaching international markets. This study makes a significant contribution to the literature on market orientation for several reasons. First, building on data from the software industry, it clarifies the existing theory in the context of rapid internationalization and network relationships. Secondly, it provides a good body of evidence on market orientation in both successfully and less successfully internationalized companies, and identifies the key related differences between the two company groups. Thirdly, it highlights the importance of inter-firm networks in the rapid internationalization of small software firms, providing companies with important market knowledge and, in some cases, management challenges. Fourthly, this investigation clarifies market orientation in the context of different software-product strategies, thus, combining the perspectives of market orientation in both manufacturing and services. In sum, the results of the study are significant for both small software firms and public-policy makers since they shed light on the market-oriented managerial mindset and the market-information gathering and sharing processes that are needed in successful rapid internationalization.

Railway Wagon Market Analysis and New Multi-Purpose Wagon Solution for Freight Transports - Finnish Manufacturing Perspective

Rautateillä käytettävät tavaravaunut ovat vanhenemassa hyvin nopeasti; tämä koskee niin Venäjää, Suomea, Ruotsia kuin laajemminkin Eurooppaa. Venäjällä ja Euroopassa on käytössä runsaasti vaunuja, jotka ovat jo ylittäneet niille suositeltavan käyttöiän. Silti niitä käytetään kuljetuksissa, kun näitä korvaavia uusia vaunuja ei ole tarpeeksi saatavilla. Uusimmat vaunut ovat yleensä vaunuja vuokraavien yritysten tai uusien rautatieoperaattorien hankkimia - tämä koskee erityisesti Venäjää, jossa vaunuvuokraus on noussut erittäin suosituksi vaihtoehdoksi. Ennusteissa kerrotaan vaunupulan kasvavan ainakin vuoteen 2010 saakka. Jos rautateiden suosio rahtikuljetusmuotona kasvaa, niin voimistuva vaunukysyntä jatkuu huomattavan paljon pidemmän aikaa. Euroopan ja Venäjän vaunukannan tilanne näkyy myös sitä palvelevan konepajateollisuuden ongelmina - yleisesti ottaen alan eurooppalaiset yritykset ovat heikosti kannattavia ja niiden liikevaihto ei juuri kasva, venäläiset ja ukrainalaiset yritykset ovat olleet samassa tilanteessa, joskin aivan viime vuosina tilanne on osassa kääntynyt paremmaksi. Kun näiden maanosien yritysten liikevaihtoa, voittoa ja omistaja-arvoa verrataan yhdysvaltalaisiin kilpailijoihin, huomataan että jälkimmäisten suoriutuminen on huomattavan paljon parempaa, ja näillä yrityksillä on myös kyky maksaa osinkoja omistajilleen. Tutkimuksen tarkoituksena oli kehittää uuden tyyppinen kuljetusvaunu Suomen, Venäjän sekä mahdollisesti myös Kiinan väliseen liikenteeseen. Vaunutyypin tarkoituksena olisi kyetä toimimaan monikäyttöisenä, niin raaka-aineiden kuin konttienkin kuljetuksessa, tasapainottaen kuljetusmuotojen aiheuttamaa kuljetuspaino-ongelmaa. Kehitystyön pohjana käytimme yli 1000 venäläisen vaunutyypin tietokantaa, josta valitsimme Data Envelopment Analysis -menetelmällä soveliaimmat vaunut kontinkuljetukseen (lähemmin tarkastelimme n. 40 vaunutyyppiä), jättäen mahdollisimman vähän tyhjää tilaa junaan, mutta silti kyeten kantamaan valitun konttilastin. Kun kantokykyongelmia venäläisissä vaunuissa ei useinkaan ole, on vertailu tehtävissä tavarajunan pituuden ja kokonaispainon perusteella. Simuloituamme yhdistettyihin kuljetuksiin soveliasta vaunutyyppiä käytännössä löytyvässä kuljetusverkostossa (esim. raakapuuta Suomeen tai Kiinaan ja kontteja takaisin Venäjän suuntaan), huomasimme lyhemmän vaunupituuden sisältävän kustannusetua, erityisesti raakaainekuljetuksissa, mutta myös rajanylityspaikkojen mahdollisesti vähentyessä. Lyhempi vaunutyyppi on myös joustavampi erilaisten konttipituuksien suhteen (40 jalan kontin käyttö on yleistynyt viime vuosina). Työn lopuksi ehdotamme uuden vaunutyypin tuotantotavaksi verkostomaista lähestymistapaa, jossa osa vaunusta tehtäisiin Suomessa ja osa Venäjällä ja/tai Ukrainassa. Vaunutyypin tulisi olla rekisteröity Venäjälle, sillä silloin sitä voi käyttää Suomen ja Venäjän, kuten myös soveltuvin osin Venäjän ja Kiinan välisessä liikenteessä.

Stock and Bond Market Integration: Evidence from Russian Financial Markets

Minimizing the risks of an investment portfolio but not in the favour of expected returns is one of the key interests of an investor. Typically, portfolio diversification is achieved using two main strategies: investing in different classes of assets thought to have little or negative correlations or investing in similar classes of assets in multiple markets through international diversification. This study investigates integration of the Russian financial markets in the time period of January 1, 2003 to December 28, 2007 using daily data. The aim is to test the intra-country and cross-country integration of the Russian stock and bond markets between seven countries. Our test methodology for the short-run dynamics testing is the vector autoregressive model (VAR) and for the long-run cointegration testing we use the Johansen cointegration test which is an extension to VAR. The empirical results of this study show that the Russian stock and bond markets are not integrated in the long-run either at intra-country or cross-country level which means that the markets are relatively segmented. The short-run dynamics are also relatively low. This implies a presence of potential gains from diversification.

Russian mobile telecommunications market: players and trends

Objective of this work was to clarify the competitive situation of Russian mobile telecommunications market: who are the main players, are there many regional operators, what is the possibility of new entrants and how intensive is the competition. In the beginning the history of Russian mobile telecommunications sector is described. In the next chapter environmental factors of the market are examined with the help of PESTEL analysis. After that, players of the market are introduced to ease the following of next chapters. The main theory for this work was industry analysis of five competitive forces by Michael Porter, which is presented before the theory related industry analysis of Russian mobile telecommunications industry. Research for the industry analysis is mainly based on up-to-date articles describing Russian market. As a result of the industry analysis, competitive situation of Russian mobile telecommunications industry and the future prospects are described with the help of factors coming from the PESTEL-analysis. Finally development and future prospects for Russian 3G are reported. As a result of this work, it can be said that Russian mobile telecommunications market is not likely to maintain the growth of previous years, because the market is near saturation. According to passive SIM-cards it has already received saturated. The saturation will also make the market share game between operators more volatile. The market is dominated by three national operators that covered 88% of the income in the first half of 2007. In addition to these three, there are also several regional operators. Structure of the market is likely to consolidate.

Three Essays on International Trade and the Labor Market

The thesis is made of three independent chapters interested in the impact of globalization on workers in industrialized countries. The dissertation is especially focused on identifying the causal impact of international trade on workers' mobility, wages, and employment with both a short- and medium-term perspective. The first paper explores the relation between intra-industry trade (IIT) expansion and associated worker flows, taking the latter as an indicator of labor-market adjustment costs. Being the first study to combine theoretical simulations and a novel identification strategy, we find that both theoretical and empirical analyses are consistent with the "smooth adjustment hypothesis", according to which IIT expansion is less disruptive than inter-industry trade expansion. The study therefore lends support to the use of IIT indices as first-pass proxies for the adjustment effects of trade expansion. The second chapter contrasts the impact of increased import competition coming from China and the European Union (EU) on workers in the United Kingdom over a 15-year period. The most salient findings show that increased imports from China had significantly negative effects on workers' earnings, wages and employment. In contrast, larger imports from the EU are associated with positive worker-level outcomes, which is largely explained by the fact that increased imports from the EU were mostly offset by increased same-industry exports to the EU. Besides, we find that increased imports from China exert additional pressure on workers through spillovers to employment and wages in downstream industries. Finally, the last chapter is focused on the impact of exposure to trade and real exchange rate shocks on wages for Swiss manufacturing workers. A particular attention is made to consistently estimate the causal effect in using a two-step gravity-type identification strategy. The study shows that the impact of trade and exchange rate movements is concentrated among high-skilled workers almost exclusively.

One more lie: the Monday effect in Spain’s retail petrol market

Empirical evidence drawn from the economic literature points to a low level of competition in the retail petrol market. Similar evidence can be found for the Spanish market. In fact, both Spain’s antitrust authority -Comisión Nacional de la Competencia- and its energy regulator -Comisión Nacional de la Energía- have recently initiated disciplinary proceedings against the majors on the grounds of suspected price manipulation in the retail petrol market. They are accused of cutting retail prices on Mondays so as to distort the rank position of Spain in European Union statistics in a practice that has received the name of the Monday effect. Here, we analyze this effect by constructing a database that includes daily retail prices for all petrol stations in Spain in the period 2009-2012, and a more detailed database for the city of Barcelona in 2013. Our estimations confirm that: 1- in 2011 and 2012 prices fell on Mondays at retailers branded by majors; 2- prices were unchanged at stations in our two control groups; 3- prices were also seen to fall when a more detailed analysis was conducted, and this price cut was also found in 2013. In short, one more indicator of collusion in this sector and … one more lie.

Labour market innovations and policy learning : report on Switzerland

This paper analyses learning and implementation of labour market reforms in Switzerland.