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

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

Green Service Level Agreement under Sustainability Lens in IT Industry

Nowadays, when most of the business are moving forward to sustainability by providing or getting different services from different vendors, Service Level Agreement (SLA) becomes very important for both the business providers/vendors and as well as for users/customers. There are many ways to inform users/customers about various services with its inherent execution functionalities and even non-functional/Quality of Services (QoS) aspects through negotiating, evaluating or monitoring SLAs. However, these traditional SLA actually do not cover eco-efficient green issues or IT ethics issues for sustainability. That is why green SLA (GSLA) should come into play. GSLA is a formal agreement incorporating all the traditional commitments as well as green issues and ethics issues in IT business sectors. GSLA research would survey on different traditional SLA parameters for various services like as network, compute, storage and multimedia in IT business areas. At the same time, this survey could focus on finding the gaps and incorporation of these traditional SLA parameters with green issues for all these mentioned services. This research is mainly points on integration of green parameters in existing SLAs, defining GSLA with new green performance indicators and their measurable units. Finally, a GSLA template could define compiling all the green indicators such as recycling, radio-wave, toxic material usage, obsolescence indication, ICT product life cycles, energy cost etc for sustainable development. Moreover, people’s interaction and IT ethics issues such as security and privacy, user satisfaction, intellectual property right, user reliability, confidentiality etc could also need to add for proposing a new GSLA. However, integration of new and existing performance indicators in the proposed GSLA for sustainable development could be difficult for ICT engineers. Therefore, this research also discovers the management complexity of proposed green SLA through designing a general informational model and analyses of all the relationships, dependencies and effects between various newly identified services under sustainability pillars. However, sustainability could only be achieved through proper implementation of newly proposed GSLA, which largely depends on monitoring the performance of the green indicators. Therefore, this research focuses on monitoring and evaluating phase of GSLA indicators through the interactions with traditional basic SLA indicators, which would help to achieve proper implementation of future GSLA. Finally, this newly proposed GSLA informational model and monitoring aspects could definitely help different service providers/vendors to design their future business strategy in this new transitional sustainable society.

Creating better customer experiences: Service Design effects on customer experience

Pro gradu –tutkielman tavoitteena oli tutkia, kuinka palvelumuotoilua voidaan käyttää parempien asiakaskokemusten luomisessa. Tutkimuksen teoreettisessa osuudessa keskityttiin tutkimaan palvelumuotoilun ja asiakaskokemuksen käsitteitä. Tutkielman empiirinen osuus tehtiin laadullisena tutkimuksena, jossa vertailtiin asiakaskokemuksia kahdessa Espoon kaupungin yhteispalvelupisteessä: Leppävaarassa sijaitseva yhteispalvelupiste oli hiljattain suunniteltu uudelleen käyttäen palvelumuotoilun periaatteita; Matinkylän palvelupiste oli alkuperäisessä muodossaan tutkimuksen aikana. Tutkimuksen yhtenä tavoitteena oli myös selvittää, oliko palvelumuotoilun menetelmin tehty muotoiluprojekti Leppävaaran yhteispalvelupisteessä onnistunut, kun sitä arvioitiin asiakaskokemuksen näkökulmasta. Tutkielman aineisto kerättiin suoran havainnoinnin ja haastattelun keinoin. Yhteensä 33 yksittäistä asiakasta havannoitiin ja haastateltiin tutkimusta varten toukokuussa 2015. Vastaajat valikoituivat satunnaisesti havannointipäivien asiakkaista. Heitä havainnoitiin koko asiakaspolun ajan minkä jälkeen heitä haastateltiin. Tutkimuksen tulokset ovat kaksiosaiset. 1) Arvioitaessa asiakkaiden kokemuksia liittyen palvelutilan toimivuuteen ja aineelliseen ympäristöön todettiin, että palvelumuotoilulla saavuttettiin parempi asiakaskokemus, ja täten Leppävaaran muotoiluprojekti oli onnistunut tavoitteissaan. 2) Kun taas tuloksia tarkasteltiin asiakaspalvelutilanteiden näkökulmasta, projekti ei ollut päässyt tavoitteisiin ja palvelumuotoilun menetelmillä ei pystytty parantamaan asiakaskokemuksta. Espoon kaupungin muotoiluprojekti on vielä kesken, tulosten perusteella tutkija ehdotti jatkotoimenpiteenä muun muassa lisäkoulutusta palveluhenkilökunnalle.

Value added KPI service delivery with quality function deployment: Multiple case study in asset & real estate management

The aim of this study is to investigate value added service concept for an asset and real estate management case company. The initial purpose was to recognize the most value adding key performance indicators (KPIs) information delivered for its customers, real estate investors with value added service. The multiple case study strategy included two focus group interviews with five case interviews in total. Additionally, quality function deployment (QFD) was used in order to form up the service process. The study starts with introduction and methodology explaining the demand for the thesis study. The subsequent chapter presents the theoretical background on real estate management KPIs in four main points of views and quality function deployment from the service development point of view. The chapter also defines research gap for the case study. According to the case study interviews, the most favored KPIs to deliver for the clients are income maturity of lease agreements and leasing activity. These KPIs and quality characteristics are translated into the QFD. In total, the service QFD explains the service planning, process control, and action plan phases.

Evaluation of novel programs in health counseling – their effectiveness in the oral health of young children, and their acceptance by parents and professionals in public dental service.

Aim and design: To evaluate family-based health counseling for young children, and to study the significance of adding parental self-care or the training of professionals to the programs. The effectiveness and acceptability of the programs were evaluated by comparing two new programs with an earlier one. Subjects and methods: The study was carried out in Vantaa, which was divided into three study areas. The subjects consisted of children born in 2008, particularly fi rstborn children, while children born in 2006 formed the historical control. The fi rst of the new programs emphasized oral hygiene and use of fl uoride, and the second program focused on proper diet and use of xylitol. The main outcome measure was mutansstreptococci (MS) in the dental biofi lm of two-year-olds, and the opinions of parents and dental professionals were evaluated using questionnaires. Results: The programs found wide acceptance among dental professionals. There were no group-related differences found in the MS scores of the two-year-olds. However, all groups combined, father’s advanced level of education and child’s proper use of xylitol were associated with negative MS scores. In the opinion of parents, the oral healthcare guidance at least somewhat met their expectations. Conclusions: The present fi ndings suggest that providing training and support for professionals in health education is important. The addition of parental self-care to supplement programs aimed at young children does not improve the program, although it may improve parental readiness to change their own health habits. Counseling for families might be best carried out through a routine patient-centered program.

The new era of customer experience in the omni-channel environment of a communication service provider

This study discusses the evolution of an omni-channel model in managing customer experience. The purpose of this thesis is to expand the current academic literature available on omni-channel and offer suggestions for omni-channel creation. This is done by studying the features of an omni-channel approach into engaging with customers and through the sub-objectives of describing the process behind its initiation as well as the special features communication service providers need to take in consideration. Theories used as a background for this study are related to customer experience, channel management, omni-channel and finally change management. The empirical study of this thesis consists of seven expert interviews conducted in a case company. The interviews were held between March and November 2014. One of the interviewees is the manager of an omni-channel development team, whilst the rest were in charge of the management of the various customer channels of the company. The organization and analysis of the interview data was conducted topically. The use of themes related to major theories on the subject was utilized to create linkages between theory and practice. The responses were also organized in two groups based on the viewpoint to map responses related to the company perspective as well as the customers´ perspective. The findings in this study are that omni-channel is among the best tools for companies to respond to the challenge induced by changing customer needs and preferences, as well as intensifying competitive environment. The omni-channel model was found to promote excellent customer experience and thus to be a source of competition advantage and increasing financial returns by creating an omni-experience for the customer. Through omniexperience customers see all of the transactions with a company presenting one brand and providing ease and effortlessness in every encounter. The processes behind omni-channel formulation were identified as customer experience proclaimed as the most important strategic goal, mapping and establishing a unified brand experience in all (service) channels and empowering the first line personnel as the gate keepers of omniexperience. Further the tools, measurement and supporting strategies were to be in accordance with the omni-channel strategy and the customer needs to become a partner in a two way transaction with the firm. Based on these findings a model for omni-channel creation is offered. Future research is needed to firstly, further test these findings and expand the theoretical framework on omni-channel, as it is quite scarce to date and secondly, to increase the generalizability of the model suggested.

Roadmap for Service Charging Development

Corporate support functions are increasingly being concentrated into service centers. Service Management principles guide companies in the transition. Service Financial Management is an integral part in supporting the strategic positioning of the service center. The main goal of this thesis is to create a step-by-step plan to improve and automate the service charging processes for the finance service function of the case company. Automating the service transaction data collection for reporting is expected to improve efficiency, reliability and transparency. Interviews with finance service managers are held to define current processes and areas for improvement. These create the basis for the creation of a development roadmap that takes place in two phases. The first phase is to create an environment where automation is possible, and the second phase is the automation of each finance service. Benchmarking interviews are held with the service centers in three other companies to discover best practices. The service charging processes between the studied companies are found incompatible, and suggestions for process automation cannot be inferred. Some implications of Service Financial Management decisions to the strategy of the service center are identified. The bundling of services and charging them inside or outside of the goal-setting frame of the business unit can be used to support the strategic choice and customer acceptance of the service center.

Embedded Service Bus for Internet of Things Interoperability

Internet of Things (IoT) technologies are developing rapidly, and therefore there exist several standards of interconnection protocols and platforms. The existence of heterogeneous protocols and platforms has become a critical challenge for IoT system developers. To mitigate this challenge, few alliances and organizations have taken the initiative to build a framework that helps to integrate application silos. Some of these frameworks focus only on a specific domain like home automation. However, the resource constraints in the large proportion of connected devices make it difficult to build an interoperable system using such frameworks. Therefore, a general purpose, lightweight interoperability framework that can be used for a range of devices is required. To tackle the heterogeneous nature, this work introduces an embedded, distributed and lightweight service bus, Lightweight IoT Service bus Architecture (LISA), which fits inside the network stack of a small real-time operating system for constrained nodes. LISA provides a uniform application programming interface for an IoT system on a range of devices with variable resource constraints. It hides platform and protocol variations underneath it, thus facilitating interoperability in IoT implementations. LISA is inspired by the Network on Terminal Architecture, a service centric open architecture by Nokia Research Center. Unlike many other interoperability frameworks, LISA is designed specifically for resource constrained nodes and it provides essential features of a service bus for easy service oriented architecture implementation. The presented architecture utilizes an intermediate computing layer, a Fog layer, between the small nodes and the cloud, thereby facilitating the federation of constrained nodes into subnetworks. As a result of a modular and distributed design, the part of LISA running in the Fog layer handles the heavy lifting to assist the lightweight portion of LISA inside the resource constrained nodes. Furthermore, LISA introduces a new networking paradigm, Node Centric Networking, to route messages across protocol boundaries to facilitate interoperability. This thesis presents a concept implementation of the architecture and creates a foundation for future extension towards a comprehensive interoperability framework for IoT.

Role of service and data reuse in enterprises

Digitalization has been predicted to change the future as a growing range of non-routine tasks will be automated, offering new kinds of business models for enterprises. Serviceoriented architecture (SOA) provides a basis for designing and implementing welldefined problems as reusable services, allowing computers to execute them. Serviceoriented design has potential to act as a mediator between IT and human resources, but enterprises struggle with their SOA adoption and lack a linkage between the benefits and costs of services. This thesis studies the phenomenon of service reuse in enterprises, proposing an ontology to link different kinds of services with their role conceptually as a part of the business model. The proposed ontology has been created on the basis of qualitative research conducted in three large enterprises. Service reuse has two roles in enterprises: it enables automated data sharing among human and IT resources, and it may provide cost savings in service development and operations. From a technical viewpoint, the ability to define a business problem as a service is one of the key enablers for achieving service reuse. The research proposes two service identification methods, first to identify prospective services in the existing documentation of the enterprise and secondly to model the services from a functional viewpoint, supporting service identification sessions with business stakeholders.