Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals

Background: As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia. Methods: This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (3742 weeks) singleton births. Results: Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals. Conclusions: Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births.

Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals

Background: As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia. Methods: This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (3742 weeks) singleton births. Results: Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals. Conclusions: Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births.

Success of service-intensive manufacturing firms - resource-based view

The main objective of this study is to examine the relationships between resources, competitive advantage and firm success. The study focuses, on one hand, on the financial performance of service-intensive manufac-turing firms against competitors with a lower service intensity and, on the other hand, on the resources as drivers for competitive advantage and success. The purpose of the theoretical part is to link the study in the field of the strategy research. The empirical part of the study is based on the quantitative analyses of the survey data collected from 50 major suppliers of industrial machinery and transportation equipment in Europe and North America. Results indicate that service-intensive manufacturing firms have performed better and their performance has been more stable vis-à-vis their peers. The main resources that differentiate service-intensive manufacturing firms from their non-service intensive competitors are service strategy and service-oriented top management. The analyses on the VRIO resources produced only a limited amount of information and solely service-centred culture appeared to be a rent generating resource.

The Impact of Service Quality and Relationship Quality on Customer Loyalty in Business-to-Business Context

The main objective of this Master’s Thesis was to examine the interrelations of service quality and relationship quality (customer satisfaction, trust and commitment), and find out are they antecedents for customer loyalty in business-to-business context. Literature review revealed some research gaps concerning these focal concepts, which should be studied more closely. The theoretical basis for this research was collected for evaluating a strategic increase of customer’s perceptions of service quality and relationship quality as well as customer loyalty in business-to-business environment, and it was tested empirically in a sample of 164 corporate customers, who responded to the Internet-based survey. The measures, used in the survey, were first assessed by using confirmatory factor analysis (CFA), and then the hypothesized relationships were further verified using structural equation modeling (SEM) in LISREL 8.80. There was found support for a half of the hypothesized construct relations. The results of the research confirm the direct influence of trust and commitment on customer loyalty. Also, service quality turned out to have an indirect impact on customer loyalty through trust. No support, however, was offered for the proposed impact of customer satisfaction on loyalty in this case. The research provides managerially relevant and actionable results that may help service providers execute more specific customer relationship quality strategies that lead to higher customer loyalty.

The Effects of Service Quality, Customer Satisfaction and Customer Perceived Value on Behavioral Intentions

The intent of this research was to develop a model that describes the extent to which customer behavioral intentions are influenced by service quality, customer satisfaction and customer perceived value in the business-to-business service context. Research on customer behavioral intentions is quite fragmented and no generalized model has been presented. Thus, there was need for empirical testing. This study builds on the services marketing theory and assesses the relationships between the identified constructs. The data for the empirical analysis was collected via a quantitative online survey and a total of 226 usable responses were obtained for further analysis. The model was tested in an employment agency service setting. The measures used in this survey were first assessed by using confirmatory factor analysis (CFA) after which the hypothesized relationships were further verified using structural equation modeling (SEM) in LISREL 8.80. The analysis identified that customer satisfaction played a pivotal role in the model as it was the only direct antecedent of customer behavioral intentions, however, customer perceived value showed a strong indirect impact on buying intentions via customer satisfaction. In contrast to what was hypothesized, service quality and customer perceived value did not have a direct positive effect on behavioral intentions. Also, a contradicting finding with current literature was that sacrifice was argued to have a direct but positive impact on customer perceived value. Based on the findings in this study, managers should carefully think of their service strategies that lead to their customers’ favorable behavioral intentions.

Mathematical modeling of level of anaesthesia from EEG measurements

Problem of modeling of anaesthesia depth level is studied in this Master Thesis. It applies analysis of EEG signals with nonlinear dynamics theory and further classification of obtained values. The main stages of this study are the following: data preprocessing; calculation of optimal embedding parameters for phase space reconstruction; obtaining reconstructed phase portraits of each EEG signal; formation of the feature set to characterise obtained phase portraits; classification of four different anaesthesia levels basing on previously estimated features. Classification was performed with: Linear and quadratic Discriminant Analysis, k Nearest Neighbours method and online clustering. In addition, this work provides overview of existing approaches to anaesthesia depth monitoring, description of basic concepts of nonlinear dynamics theory used in this Master Thesis and comparative analysis of several different classification methods.

Relation between the level of self-mutilation and theconcentration of fecal metabolites of glucocorticoids incaptive chimpanzees (Pan troglodytes)

The influence of stress in an environment, according with the behavioral and endocrine variables of primates, are increasingly being studied by a diversity of authors, and have shown that abnormal behaviors associated with increased glucocorticoids may be directly related with the impairment of their well-being. In this work were used 22 adult chimpanzees (Pan troglodytes), 11 males and 11 females, kept in captivity in three different institutions. All animals had their behavior registered by focal session using a 30 seconds sample interval, during six months, totaling 4,800 registries per each animal. During this period, fecal samples were collected 3 times a week for the extraction and measurement of the concentration of fecal metabolites of glucocorticoid by radioimmunoassay. Of the total observed, stereotypical behaviors represented 13,45±2.76%, and among them, self-mutilation represented 38.28±3.98 %. The animals were classified into three different scores, according with the percentage of body surface with alopecia due to self-mutilation. It was found a positive correlation of high intensity between the scores of alopecia due to the observed mutilation and the average concentrations of fecal metabolites of glucocorticoids. This result strongly suggests that this measurement of self-mutilation in a chimpanzee can be used as an important auxiliary tool to evaluate de conditions of adaptation of an animal in captivity, functioning as a direct indicator of the presence of chronic stress.

What do Sports Sponsors Really Want? The effects of service quality, service value and customer satisfaction on behavioral intentions in sports sponsorship context

The aim of this Master’s thesis was to study the antecedents of customer satisfaction and behavioral intentions and their relative relationships in the sports sponsorship context. The possible antecedents under investigation in the current research are service value and service quality. As the academic background in the sports sponsorship literature is still rather modest there was a need for further empirical testing. The theoretical part of the research builds on the existing services marketing literature with sports sponsorship and business-to-business contexts in mind. The empirical study focused on the case company Liiga-SaiPa Oy. The data for the empirical analysis was collected via quantitative online survey. The total sample consisted of 357 the case company’s business customers and a total of 80 usable responses were collected. The data was analyzed by using statistical analysis software, SPSS. According to the results of the empirical analysis the most important antecedent of behavioral intentions in the underlying context is customer satisfaction. Also service value was found to have a direct and positive relationship with behavioral intentions. Moreover no indirect relationships through satisfaction were found between service quality and service value and behavioral intentions. However both constructs of service value and service quality were diagnosed to have a direct and positive effect on customer satisfaction. Service quality was also found to be a direct antecedent of service value with other service value benefits. However a contradicting finding with the current literature was, that service value sacrifices were not found to have a significant relationship with overall service value perceptions.

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.

Influence of the moisture at harvest and drying process of the grains on the level of carotenoids in maize (Zea mays)

AbstractMaize is considered a source of carotenoids; however, these compounds are highly unstable, degraded by high temperatures, exposure to light and presence of oxygen. The objective of this work was to evaluate the influence of the moisture and type of drying applied to grains on the level of carotenoids in yellow maize. The experiment was conducted in a completely randomized design (2 × 4 factorial), two levels of initial moisture at the harvest (22 and 19%) and three types of drying (in the sun; in the shade and in a dryer) and control (no drying). The samples of grains after drying with 12% of final moisture were analyzed by concentration of total carotenoids, carotenes (α-carotene + β-carotene), monohydroxilated carotenoids (β-cryptoxanthin), and xanthophylls (lutein + zeaxanthin). Initial moisture, type of drying and the interaction between moisture versus drying influence (p≤0.05) the levels of carotenoids in grains. This is the first report about the drying conditions and harvest’s initial moisture as influence on the profile and content of carotenoids in maize grains. Based on the results, this work suggested that the harvest be carried out preferably when the grains present 22% humidity, with drying in a dryer or in shade for further use or storage.

Tolerance level of green seed in soybean seed lots after storage

The occurrence of green soybean seed due to forced maturation or premature plant death caused by drought or foliar and/or root diseases has been common in several Brazilian production areas. Physiological quality of seed lots with green seed may have their germination and vigor potentials affected and therefore discarded by the grain industry. The objective of this experiment was to determine the maximum tolerated level of green seed in soybean seed lots, which is information of major importance for seed producers when taking the decision whether to sell these lots. Soybean seed of the cultivars CD 206, produced in Ubirata, Parana, and ‘FMT Tucunare,’ produced in Alto Garças, Mato Grosso, were used in the study. Green seed and yellow seed of both cultivars were mixed in the following proportions: 0%, 3%, 6%, 9%, 12%, 15%, 20%, 30%, 40%, 50%, 75% and 100%. Seed quality was evaluated by the germination, accelerated aging, tetrazolium and electrical conductivity tests. The contents of a, b and total chlorophyll in the seed were also determined. A complete randomized block design in a factorial scheme (two cultivars x 12 levels of green seed) was used. Seed quality was negatively affected and chlorophyll contents incremented with the increase in the percentage of green seed. Seed germination, viability and vigor, measured by the accelerated aging test, were not reduced with levels of up to 3% green seed, for both cultivars. Levels above 6% green seed significantly reduced the quality of the seed. The quality of seed lots with 9% or more green seed was significantly reduced to the point that their commercialization is not recommended.

Organisational purchasing of service design – Agency and client perspectives

There has been an increase in the interest in service design, as companies have become more customer-centric and their focus has shifted to customer experiences. The actual organisational purchasing of service design has been given little attention, until recent years. The purpose of this study is to explore the purchasing of service design from the perspectives of sellers (service design agencies) and buying clients (business organisations). In order to understand the phenomenon, also agencies and clients’ approaches to service design discipline, purchasing processes, challenges related to purchasing and ways of facilitating the purchasing are explored. The research follows qualitative research method and utilises abductive reasoning. A proposition framework was formed by combining services marketing, design and organisational buying behaviour literatures, and was tested against real-life business cases. Empirical data was gathered by interviewing eight service design agency representatives and five client representatives in Finland. The results of semi-structural interviews were analysed by finding repetitive themes. The proposition framework was updated according to interview findings. There were both similarities and differences in service design agencies and clients’ approaches to service design. Service design represents a strategic activity to both parties, and it helps in clients’ business development and in discovering opportunities. It is an ideology; a way of thinking and working. The driving force for purchasing service design seemed to be something else than service design itself. Projects have been bought for 1) change and innovation related development, 2) channel related development or for 3) customer experience related development. Seven purchasing challenge themes were recognised: 1) poor or differing service design understanding, 2) selling of service design, 3) varying expectations, 4) difficulty of pre-evaluation, 5) buyers and buying companies, 6) project process and nature and 7) unclear project results. These all can be considered to cause challenges in organisational service design purchasing. Challenges can be caused by either participant, the agency or the client, and take place at any point of the purchasing process. Some of the challenges could be considered as barriers to purchasing or they play a role in an unsuccessful service project – and therefore, result in an unsuccessful organisational purchase. Purchasing could be facilitated in various ways by either participant; some ways are more attitude based, others actionable improvements. Thesis’s theoretical and managerial findings can be utilised to both improve the selling and purchasing of service design services.