Critical elements underpinning the emergence of the medical game ecosystem: gamifying traumatic brain injury rehabilitation in Finland

The healthcare sector is currently in the verge of a reform and thus, the medical game research provide an interesting area of research. The aim of this study is to explore the critical elements underpinning the emergence of the medical game ecosystem with three sub-objectives: (1) to seek who are the key actors involved in the medical game ecosystem and identify their needs, (2) to scrutinise what types of resources are required in medical game development and what types of relationships are needed to secure those resources, and (3) to identify the existing institutions (‘the rules of the game’) affecting the emergence of the medical game ecosystem. The theoretical background consists of service ecosystems literature. The empirical study conducted is based on the semi-structured theme interviews of 25 experts in three relevant fields: games and technology, health and funding. The data was analysed through a theoretical framework that was designed based upon service ecosystems literature. The study proposes that the key actors are divided into five groups: medical game companies, customers, funders, regulatory parties and complementors. Their needs are linked to improving patient motivation and enhancing the healthcare processes resulting in lower costs. Several types of resources, especially skills and knowledge, are required to create a medical game. To gain access to those resources, medical game companies need to build complex networks of relationships. Proficiency in managing those value networks is crucial. In addition, the company should take into account the underlying institutions in the healthcare sector affecting the medical game ecosystem. Three crucial institutions were identified: validation, lack of innovation supporting structures in healthcare and the rising consumerisation. Based on the findings, medical games cannot be made in isolation. A developmental trajectory model of the emerging medical game ecosystem was created based on the empirical data. The relevancy of relationships and resources is dependent on the trajectory that the medical game company at that time resides. Furthermore, creating an official and documented database for clinically valdated medical games was proposed to establish the medical game market and ensure an adequate status for the effective medical games. Finally, ecosystems approach provides interesting future opportunities for research on medical game ecosystems.

Integrated reporting – a new form of a firm’s interaction with stakeholders

This study examines a new kind of public reporting, called integrated reporting as a form of a firm’s interaction with stakeholders. The study concerned issues such as how the studied organization defined its stakeholders and how this definition evolved during the transition period from 2009 to 2013, how has the integrated reporting of the organization evolved as an instrument of interaction with stakeholders over the transition period, and how the organization reported its value creation according to the international integrated reporting framework in the final, full-featured report. In examining the theory, the study used a qualitative analysis method that allowed deriving conceptual tools necessary to carry out the study. This study is based on the material of the five integrated reports written in Russian from a subsidiary of a Russian public company. The subsidiary carried out the transition to an integrated reporting for the five years from 2009 to 2013. A comparative qualitative method was used in reviewing the empirical material. During the research, an active cooperation of the organization with key stakeholders was revealed, which occurred during the whole period of development of integrated reporting. As a result, integrated reports were produced in cooperation with various key stakeholders, allowing balancing the financial and non-financial information in the reports. The study found that during the transition period, integrated reports gradually changed in the direction of greater clarity and ease of access to perception, consistency of presentation and materiality. The integrated reporting of the organization began reflect the basic requirements of the international integrated reporting framework regarding the content elements and guiding principles. Thus, the organization’s reports began including features of financial and non-financial reporting and connecting the three aspects of the organization's activities: economic, environmental and social. This study reveals the importance of identifying key stakeholders and their influence on the creation of organizational value. The new form of reporting suits better the requirements of modern organizations to interact with their stakeholder groups. The integrated reporting, which reflects the principles of the international integrated reporting framework, is an active resource for companies to communicate with stakeholders and a platform of transmission the necessary information on the creation of value in the long term.

Exploring two cases of Piano Teacher Education in Finland and Germany

Research about music instrument teacher education is scattered and fairly recent, especially in the European context. The purpose of this study was to explore two cases of piano teacher education programs at higher music education institutions, one in Finland, and one in Germany, to gain insights into the preparation of piano teachers for their professional working life. The aim was to identify issues for consideration in curriculum development of piano teacher education to enhance the teaching and learning of piano playing, and to ultimately increase musical practice and engagement among young learners. Nine semi-structured interviews with piano teacher educators, heads of program, other lecturers within the program, and student piano teachers in both cases were analyzed using applied thematic analysis. Three main themes with subcategories emerged: (1) the organization of the piano teacher education program, such as the structure, the content, the learning environments provided, and the development mechanisms of the program; (2) the views on the piano teacher profession, the working environment and resulting requirements, including further education during professional life; and (3) the professional skills and teacher identity development of student teachers. While the supposed working environments and requirements of future piano teachers, the student teachers' development characteristics, and the content were found reasonably concurrent in both cases, the structure of the teacher education program, and the organization of learning environments presented notable differences. While the complete teacher qualification in the Finnish case was offered as option in the Bachelor and Master of Music program within the piano department, the German case offered a separate program for music instrument educators. Other main differences concerned the organizations of practical teaching experiences, and the linking of practical with theoretical pedagogy. Conviction and enthusiasm for improving piano and other music instrument teacher education seemed remarkable. These improvements could include the development of a comprehensive teacher education pedagogy for music instrument teacher educators, intensified cross-linking within and of higher music education institutions in local contexts, and the expansion of professional development opportunities.

The Formation Of Internationalization Strategies Within The Construction Industry:Vision and Strategy

Internationalization represents a complex topic that has been researched for quite some time. However, since it continues to be extremely current a topic, its significance has not diminished, but maybe even increased in importance. Companies today face extreme pressure to enter new markets in the hope of growing, becoming more profitable, increasing market share, attracting new customers and meeting the requirements of its share- and stakeholders. In the increasingly global business environment of today, companies are facing both challenges and possible advantages of internationalization. Few companies are not operating internationally and it is becoming the question of ‘Why not?’ rather than ‘Why?’ to internationalize business operations. Internationalization and the importance of strategy are discussed in this research from the viewpoint of three case companies that were interviewed about internationalization strategies. This research project is a qualitative study that answers the research question of How is a business strategy constructed for entering a new market? The sub-questions are • How are goals set and what indicators are used to monitor the achievement of these goals? • What are the key characteristics of a strategy implementation process? The research method chosen for this study is a multiple-case study. Three case companies were chosen for the interviews in order to gain in-depth data of internationalization strategies within the construction industry.

Critical elements underpinning the emergence of the medical game ecosystem:gamifying traumatic brain injury rehabilitation in Finland

The healthcare sector is currently in the verge of a reform and thus, the medical game research provide an interesting area of research. The aim of this study is to explore the critical elements underpinning the emergence of the medical game ecosystem with three sub-objectives: (1) to seek who are the key actors involved in the medical game ecosystem and identify their needs, (2) to scrutinise what types of resources are required in medical game development and what types of relationships are needed to secure those resources, and (3) to identify the existing institutions (‘the rules of the game’) affecting the emergence of the medical game ecosystem. The theoretical background consists of service ecosystems literature. The empirical study conducted is based on the semi-structured theme interviews of 25 experts in three relevant fields: games and technology, health and funding. The data was analysed through a theoretical framework that was designed based upon service ecosystems literature. The study proposes that the key actors are divided into five groups: medical game companies, customers, funders, regulatory parties and complementors. Their needs are linked to improving patient motivation and enhancing the healthcare processes resulting in lower costs. Several types of resources, especially skills and knowledge, are required to create a medical game. To gain access to those resources, medical game companies need to build complex networks of relationships. Proficiency in managing those value networks is crucial. In addition, the company should take into account the underlying institutions in the healthcare sector affecting the medical game ecosystem. Three crucial institutions were identified: validation, lack of innovation supporting structures in healthcare and the rising consumerisation. Based on the findings, medical games cannot be made in isolation. A developmental trajectory model of the emerging medical game ecosystem was created based on the empirical data. The relevancy of relationships and resources is dependent on the trajectory that the medical game company at that time resides. Furthermore, creating an official and documented database for clinically validated medical games was proposed to establish the medical game market and ensure an adequate status for the effective medical games. Finally, ecosystems approach provides interesting future opportunities for research on medical game ecosystems

Adherence to Treatment in Psychotic Disorders - Development of user-centered mobile health intervention

The aim of this study was to explore adherence to treatment among people with psychotic disorders through the development of user-centered mobile technology (mHealth) intervention. More specifically, this study investigates treatment adherence as well as mHealth intervention and the factors related to its possible usability. The data were collected from 2010 to 2013. First, patients’ and professionals’ perceptions of adherence management and restrictive factors of adherence were described (n = 61). Second, objectives and methods of the intervention were defined based on focus group interviews and previously used methods. Third, views of patients and professionals about barriers and requirements of the intervention were described (n = 61). Fourth, mHealth intervention was evaluated based on a literature review (n = 2) and patients preferences regarding the intervention (n = 562). Adherence management required support in everyday activities, social networks and maintaining a positive outlook. The factors restricting adherence were related to illness, behavior and the environment. The objective of the intervention was to support the intention to follow the treatment guidelines and recommendations with mHealth technology. The barriers and requirements for the use of the mHealth were related to technology, organizational issues and the users themselves. During the course of the intervention, 33 (6%) out of 562 participants wanted to edit the content, timing or amount of the mHealth tool, and 23 (4%) quit the intervention or study before its conclusion. According to the review, mHealth interventions were ineffective in promoting adherence. Prior to the intervention, participants perceived that adherence could be supported, and the use of mHealth as a part of treatment was seen as an acceptable and efficient method for doing so. In conclusion, the use of mHealth may be feasible among people with psychotic disorders. However, clear evidence for its effectiveness in regards to adherence is still currently inconclusive.

Globalization of pharmaceutical R&D. Pharmaceutical R&D governance forms in People's Republic of China

Yrityksen selviytyminen ja menestyminen ovat riippuvaisia sen kyvystä innovoida, luoda tietoa ja hyödyntää tietämystä ja keksintöjä (Dunk ja Kilgore 2001). Yrityksen menestyminen erityisesti korkean teknologian alalla on siten suoraan riippuvainen sen T&T:stä, johon tehdyt investoinnit tuovat merkittäviä taloudellisia etuja yritykselle uusien tuotteiden, palveluiden ja prosessien muodossa (McEvily ja Chakravarthy 1999). Teknologinen etumatka ja sen tuotteistaminen innovatiivisiksi tarjoamiksi mahdollistaa monopolististen etujen saavuttamisen yrityksen kansainvälisessä kilpailussa (Lall 1977). Tämä kaltainen kilpailuetu voidaan saavuttaa yrityksen kyvyllä yhdistää maantieteellisesti hajautettu T&T:nsä tehokkaaksi verkostoksi (Porter 1986). Boehen (2008) mukaan T&T:n globalisoitumista voidaan johtaa eri hallintömuodoilla: T&T:n kansainvälistymisellä, T&T:n ulkomaille sijoittamisella ja T&T ulkomaille ulkoistamisella. T&T:n globalisoituminen on osa 2000-luvun taloudellista muutosta, ja sille on esitetty useita vaikuttavia tekijöitä, kuten kustannuserot, työvoimaresurssit, erityisosaamiskeskukset, paikallinen teknologia osaaminen ja kohdemarkkinoiden potentiaali (bardhan 2006; Norwood, ym. 2006; von Zedtwitz ja Gassmann 2002). Tutkimuksen on osoitettu eroavan tuotekehityksestä ja eri tekijöiden on osoitettu vaikuttavan niihin (von Zedtwitz ja Gassmann 2002; Leifer ja Triscari 1987). Samoin T&T on osoitettu olevan jatkumo perustavanlaatuisesta soveltavaan ja lääkekehityksen muodostavan vastaavan T&T jatkumon (Lall 1980; Iansiti 1993), jonka yksittäiset osat vaikuttavat sen hallintomuotoon. Tutkimus esittää eri tekijöitä voivan hyödyntää hallintomuodosta riippuen. Tätä tutkimusta varten tutkija haastatteli lääketeollisuuden johtajia Kiinassa vahvistaakseen tai hylätäkseen eri tekijöitä ja niiden suhdetta lääketeollisen T&T:n hallintomuotoihin. Markkinoiden todettiin olevan ensisijainen tekijä mutta myös kustannuserojen, insentiivien, työvoimaresurssien ja erityisosaamiskeskusten merkitys T&T:n globalisoitumiseen vaikuttavina tekijöinä vahvistettiin yhdessä perusvaatimusten ja riskitekijöiden kanssa. Tutkimuksessa vahvistetaan myös lääketeollisen T&T-jatkumon vaikutus ja esitetään viitekehys hallintomuodoille.

Globalization of pharmaceutical R&D Pharmaceutical R&D governance forms in People's Republic of China

Firm's survival and success, which are dependent on its ability to innovate, to create knowledge and to capitalize on inventions and know-how, is in essence directly linked to its R&D process (Dunk and Kilgore 2001). Especially in technology driven industries, such as the pharmaceuticals, there are significant positive returns to R&D investments through introduction of new or improved products and services (McEvily and Chakravarthy 1999). Technological lead and its transformation to innovative products as fruits of corporate R&D can be seen as monopolistic advantage that helps enterprises to compete in today’s market (Lall 1977). This competitive advantage can be derived from corporation's ability to integrate its activities across geographic locations (Porter 1986). According to Boehe (2008) globalization of R&D can executed with different governance forms: R&D internationalization, R&D offshoring or R&D offshore outsourcing. Globalization of R&D is intervened with the changes in global economy of the 21st century. Some studies argue for its influencing factors to be access to vast skilled labor pools and centers of excellence (Bardhan 2006). Other studies indicate the R&D cost differentials between countries to be the major expected benefit (Norwood et al. 2006). Von Zedtwitz and Gassmann (2002) presented benefits as divided to accessing markets and customers or to accessing local science and technology. This study proposes that based on governance form distinct factor derived benefits can be capitalized. To corroborate or refute factors and their relations on R&D globalization governance forms, an empirical study based on expert interviews of pharmaceutical directors was conducted in the People's Republic of China. The market was found to be the major influencing factor. Local requirements and adaptation were corroborated as factors connected with markets. Furthermore, influencing factors, such as labour, centers of excellence, cost, financial incentives were corroborated together with conditional and risk factors. Furthermore this research argues that the globalization of pharmaceutical R&D is dependent on the financial, scientific and operational requirements of the drug discovery stage. And thus establishes the influence of drug discovery's stages continuum on pharmaceutical R&D globalization. Finally, a R&D globalization governance form decision framework is proposed based on the frameworks presented in literature and author's corroborated empirical findings.

An examination of learning resulting from a transition from a directed to a self-directed work environment

~ This study focuses on the process of self-directed learning that individuals go through as they adapt to new work situations. This is a study of how one critical incident, specifically the transition from a traditional office structure to a home office structure, affected employees and what their learning process was as they adapted to the new environment. This study has 3 educational foundations: adult learning, self-directed learning, and the social context from which the learning will occur. Six women and 2 men were interviewed approximately 1 year following the transition. Analysis of the data revealed 5 themes of: impacts of the self-directed environment on participants' personal lives, their roles, skill set, productivity, and the physical environment; support offered by the organization, family, and office administration; personal development, specific learning needs, and personal skills; boundaries as they relate to family and work; and skill set and orientation requirements of new home office employees. The findings revealed the learning processes of the 8 participants. The learning processes of these participants were discussed within a theoretical framework of the learners, their immediate surroundings, and the larger social environment. The results indicated that the transition from a directed work environment to a self directed work environment is a complex, interrelated process. An element found throughout the theoretical framework is that of control. A second critical element is the need for participants to have a clearly defined work role and an opportunity to engage in discussion with peers and the community. Further findings reinforced the importance of climate and found that the physical environment is a key factor in a successful selfdirected work environment. The findings of this study revealed that no one factor makes an individual function successfully in a self-directed work environment, but that it is a complex interplay among the leamer, their immediate surroundings, and the social environment that will have the greatest impact on success. Recommendations are made which can be used to guide organizational leaders in facilitating employees' transition from a directed to a self-directed work environment. Additionally, recommendations are made for further research in the area of self-directed work environments.

A constructivist grounded theory of firefighter perceptions of stress, coping and the relationship to health

This qualitative research was a constructivist grounded theory designed to develop an understanding of how firefighters perceive and cope with stressful situations and the impact this has on their perceptions of health. This study was framed in a social ecological perspective with the community of firefighting providing the environment within which to explore stress and coping. Of particular concern here are the stressors associated with firefighting. Prior research with firefighters has often been epidemiological and statistical in nature, focusing on measures of cardiovascular disease, cancer, and depression (Baker & Williams, 2001 ; Brown et al., 2002; Murphy et al.,1999; Regehr et al., 2002; Regehr et al., 2003). Qualitative research examining the perception of stress among firefighters that includes personal stories allows firefighters the opportunity to describe what it is like to be met with physically and mentally challenging situations on a daily basis. Twelve in-depth, semi-structured, face-to-face interviews with a brief questionnaire were conducted with firefighters from a Southern Ontario Fire Department. Four main themes emerged describing the persona of the firefighter, the stressors of firefighters, coping strategies of firefighters, and firefighters' perceptions of health. Stressors include requirements of the job, traumatic calls, tensions with co-workers, the struggle between the family at home and the family at work, political stressors with the City, and the inner struggle. Avoidance coping, approach coping, and gaining perspective emerged as the three coping styles of firefighters. Health was defined as including physical, mental, social and spiritual aspects. A model of the findings is provided that depicts the cyclical nature of the stress-coping-health relationship among firefighters.

A tale of two childhoods : the virtual child and the real child in Romania, 1970s and 1980s

This thesis deals with the everyday use of propaganda in Romania, between 1971 and 1989. It explores the way in which the propaganda discourse of the Romanian Communist Party was disseminated through popular culture artifacts targeting children: Pioneers' magazines, textbooks, Almanacs and moralizing stories. These artifacts configured the image of a model child, whose preoccupations complied with the requirements of the Romanian Communist Party and communicated a set of recommended practices, to be followed by Romanian children. At the same time, the thesis incorporates the response of the actual children to these desirable practices, and implicitly, their response to state propaganda.

Foreign trained teachers : the emergence of the right to practise their profession in Ontario

The purpose of this thesis is to examine the impact of 2 recent legal events, specifically the Fair Access to Regulated Professions Act (2006) and Siadat v. Ontario College of Teachers (2007) decision, with regards to the opportunity of foreign trained teachers to practice their profession in Ontario. The emphasis is on the case of Fatima Siadat, who was a teacher in Iran but was unable to satisfy all the licensing requirements of the Ontario College of Teachers and consequently was unable to practise her profession in Ontario. When the Ontario College of Teachers Appeals Committee upheld the previous decision of the Ontario College of Teachers Registrar to refuse to issue her a teacher's certificate, Ms. Fatima Siadat decided to initiate a lawsuit. Ms. Fatima Siadat challenged the decision ofthe Ontario College of Teachers Appeals Committee by raising a question of applicability of human rights legislation (i.e., The Ontario Human Rights Code, 1990) on the Ontario College of Teachers' decisions. The Ontario Superior Court of Justice decided in January of2007 in favour of Ms. Fatima Siadat (Siadat v. Ontario College of Teachers , 2007) and ordered that her licensing application be reconsidered by the Ontario College of Teachers Appeals Committee. In this thesis the author argues that the Fatima Siadat decision, together with the Fair Access to Regulated Professions Act, 2006, will likely make a significant contribution to enhancing the access of foreign trained teachers and other professionals to practice their regulated professions in Ontario.

Understanding space, place and leisure of women over 85 living in the community

There is an increase in the number of older adults 85 and over, who are choosing to live alone within the community. Moreover, older adults who live alone are reportedly spending an extensive amount of time alone within the home environment. In an effort to provide additional support and resources to older adults living in the community, a compliment of services are being offered through public and private organizations. These in-home supports focus on the instrumental or functional tasks of daily living, such as personal and rehabilitative care, nourishment, maintenance and upkeep of the home, as well as volunteer social visitation. However leisure resources and programs are not included among these services. Consequently, this creates a gap in leisure provision among this segment of the population. Throughout the life course, an individual's identity, role and purpose are developed and sustained through instrumental work roles in the formal and informal sector, as well as through personally meaningful leisure pastimes and experiences. Although roles shift post retirement, participation in instrumental and expressive activities can provide opportunities through which older adults are able to fulfill their need for agency (individuality and autonomy) and affiliation (social relatedness). Therefore barriers that inhibit instrumental or leisure experiences can negatively impact older adults' quality of life. This study explored the leisure lifestyles of four older adults, all of whom were over 85, lived alone within the community and were oriented to person, time and place. It became apparent that participants ordered their lives around a routine that consisted of instrumental, expressive and socially integrated tasks and activities. Moreover participants purposely chose to remain at home because their home environment facilitated freedom, choice and independence. As a result all four participants viewed their independence within the home as a critical determinant to their overall quality of life. Challenges associated with the home environment, participants' personal capacities and relationships were negotiated on a daily basis. Failure to positively adapt to these challenges inhibited meaningful engagement and personal fulfillment. Traditionally, leisure service delivery has been offered within institutions and through various community based venues. As a result leisure provision has been focused on the needs of the frail elderly who reside in institutions or the well elderly who are able to access leisure amenities within the community. However the growing number of older adults electing to live alone is on the rise. As individuals age the home becomes the preferred context for leisure experiences. If older adults are choosing to live alone, then both their instrumental and leisure needs must be addressed. As a result, it is imperative that leisure professionals extend the scope of service delivery to include home centered older adults.

Predictors of primary health care utilization by former residents of institutions in Ontario

For years institutionalization has been the primary method of service delivery for persons with developmental disabilities (DD). However, in Ontario the last institution was closed on March 31, 2009 with former residents now residing in small, communitybased homes. This study investigated potential predictors of primary health care utilization by former residents. Several indirect measures were employed to gather information from 60 participants on their age, health status, adaptive functioning level, problem behaviour, mental health status and, total psychotropic medication use. A direct measure was used to gather primary health care utilization information, which served as the dependent variable. A stepwise linear regression failed to reveal significant predictors of health care utilization. The data were subsequently dichotomized and the outcomes of a logistic regression analysis indicated that mental health status, psychotropic medication use and, an interaction between mental health status and health status significantly predicted higher primary health care usage.

Speech of the Hon. Daniel Webster

Full Title: Speech of the Hon. Daniel Webster, delivered in the House of Representatives of the United States, on the 14th January, 1814, on a bill making further provision for filling the ranks of the regular army, encouraging enlistments, and authorising the enlistments for longer periods of men whose terms of service are about to expire Printed by Snowden and Simms