Implementation of the National SAM Innovation Project: A Comparison of Project Designs

Compares increases in principals' instructional time and other benefits of hiring school administration managers specifically for the position to help principals with time management and of assigning the task to those who hold other school positions

Evaluation of the School Administration Manager Project

Examines the results to date of a Wallace-supported project to help principals delegate some administrative and managerial tasks to school administration managers and spend more time interacting with teachers, students and others on instructional matters

Johdon konsultointipalveluiden ostopäätösprosessi julkisen sektorin organisaatioissa

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Tämän työn tavoitteena on tuottaa kattava kuvaus johdon konsultointipalveluista ja niiden ostamiseen vaikuttavista tekijöistä Suomen julkisen sektorin organisaatioissa. Tutkielman kohteena on johdon konsultointipalveluiden ostopäätösprosessi. Tutkittavana ilmiönä on siis organisaation päätöksenteon prosessi ja siihen vaikuttavat tekijät ostotapahtumassa. Julkisen sektorin ostopäätösprosessia johdon konsultointia hankittaessa tarkastellaan tässä työssä historiallisessa ja teoreettisessa kontekstissa, sekä empiirisen tutkimuksen avulla. Lähdeaineistona käytettiin konsultointiin ja organisaation ostokäyttäytymiseen liittyvää kirjallisuutta, sekä empiirisellä kyselyllä kerättyä aineistoa. Kirjallisuuslähteistä ensisijaisimpana käytettiin Paula Kyrön PKT-säätiölle tekemiä laajoja selvityksiä johdon konsultoinnista toimialana vuosilta 1996 ja 1999. Tutkielman pääasiallisena lähteenä käytettiin tutkielman empiirisessä osuudessa kerättyä tutkimustietoa. Empiirinen kysely toteutettiin internetissä syksyllä 1999. Kysely kohdistettiin kahdelle eri ryhmälle: julkisen sektorin hallintojohtajille, sekä joukolle johdon konsultointipalveluiden asiantuntijoita joiden vastauksia käytettiin vertailuaineistona. Internet-kyselyllä kerätty aineisto analysoitiin kuvailevan tilastotieteen keinoin. Tutkimuksessa havaittiin, että johdon konsultointipalveluiden käyttö on varsin yleistä julkisen sektorin organisaatioiden keskuudessa: noin 75% julkisen sektorin organisaatioista käyttää tänä päivänä johdon konsultointipalveluja ja käyttö on tulevaisuudessa lisääntymässä. Konsultointipalveluja ostetaan tyypillisimmin johdon ja henkilöstön koulutukseen, organisaatiomuutoksiin sekä strategiseen suunnitteluun. Tutkimuksen perusteella voidaan osoittaa, että johdon konsultointipalvelujen ostaminen on organisaatiolle vaativa ja riskialtis tehtävä, sillä alalla ei ole markkinasuojaa, vaan käytännössä kuka tahansa voi tarjota johdon konsultointipalveluja. Asiakkaan tehtäväksi jää löytää usein laajastakin joukosta palvelun tarjoajia tilanteeseen sopiva asiantuntija. Julkisen sektorin organisaatiot osoittautuivat hyvin asiantunteviksi konsultointi palveluiden ostajiksi. Julkisen sektorin organisaatiot arvostavat johdon konsultointiyrityksissä etenkin yrityksen erityisasiantuntemusta ja hyvää mainetta sekä omia aiempia kokemuksiaan palvelun toimittajasta. Tämän tyyppisten kriteerien painottaminen on alan tutkijoiden mukaan rationaalisinta, sillä johdon konsultointipalveluiden kaltaista aineetonta palvelua ei voida arvioida ennen ostopäätöksentekoa. Tutkimuksen johtopäätöksenä voidaan todeta, että julkinen sektori on tänä päivänä aktiivinen ja varsin vaativa johdon konsultointipalveluiden käyttäjä

COVID-19 Sequelae and the Host Pro-Inflammatory Response: An Analysis From the OnCovid Registry

Background: Fifteen percent of patients with cancer experience symptomatic sequelae, which impair post–COVID-19 outcomes. In this study, we investigated whether a proinflammatory status is associated with the development of COVID-19 sequelae. / Methods: OnCovid recruited 2795 consecutive patients who were diagnosed with Severe Acute Respiratory Syndrome Coronavirus 2 infection between February 27, 2020, and February 14, 2021. This analysis focused on COVID-19 survivors who underwent a clinical reassessment after the exclusion of patients with hematological malignancies. We evaluated the association of inflammatory markers collected at COVID-19 diagnosis with sequelae, considering the impact of previous systemic anticancer therapy. All statistical tests were 2-sided. / Results: Of 1339 eligible patients, 203 experienced at least 1 sequela (15.2%). Median baseline C-reactive protein (CRP; 77.5 mg/L vs 22.2 mg/L, P < .001), lactate dehydrogenase (310 UI/L vs 274 UI/L, P = .03), and the neutrophil to lymphocyte ratio (NLR; 6.0 vs 4.3, P = .001) were statistically significantly higher among patients who experienced sequelae, whereas no association was reported for the platelet to lymphocyte ratio and the OnCovid Inflammatory Score, which includes albumin and lymphocytes. The widest area under the ROC curve (AUC) was reported for baseline CRP (AUC = 0.66, 95% confidence interval [CI]: 0.63 to 0.69), followed by the NLR (AUC = 0.58, 95% CI: 0.55 to 0.61) and lactate dehydrogenase (AUC = 0.57, 95% CI: 0.52 to 0.61). Using a fixed categorical multivariable analysis, high CRP (odds ratio [OR] = 2.56, 95% CI: 1.67 to 3.91) and NLR (OR = 1.45, 95% CI: 1.01 to 2.10) were confirmed to be statistically significantly associated with an increased risk of sequelae. Exposure to chemotherapy was associated with a decreased risk of sequelae (OR = 0.57, 95% CI: 0.36 to 0.91), whereas no associations with immune checkpoint inhibitors, endocrine therapy, and other types of systemic anticancer therapy were found. / Conclusions: Although the association between inflammatory status, recent chemotherapy and sequelae warrants further investigation, our findings suggest that a deranged proinflammatory reaction at COVID-19 diagnosis may predict for sequelae development

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

A Story about a Message that was a Story: Message Form and its Implications to Knowledge Flow

Knowledge Flow, my dear friend! I would like to introduce you to a close relative of yours: Organizational Communication. You might want to take a moment to hear what your newfound kin has to say. As bright as you are dear Flow, you're missing a piece of the puzzle - for one cannot study any aspect of an organization relating to communication without acknowledging the message. Without a message, communication does not exist. Organizational Communication has always appreciated this. Perhaps the time has come for you to join rank and do so too? The main point of this work is to prove that the form of a message considerably affects communication, interpretation - and knowledge flow. As stories are at the heart of this thesis; and entertaining, reader-friendly communication its main argument, the entire manuscript is written in story form and is intentionally breaking academic writing tradition as far as writing style goes. Each chapter reads as a story of sorts and put together they create a grand narrative of my journey as a PhD student, the research I have conducted and the outcomes of this work. Thus if a reader hopes to make any sense of this title, she must read it in the same way one would read a novel, from beginning to end. This is a thesis with three aspirations. First, it sets out to prove that knowledge flow cannot be studied without a message. Second, it moves on to give the reader a once-over of a much used message form: storytelling. After these two goals are tackled the path is clear to research if message form indeed is as essential as claimed. I do so through both a qualitative and a quantitative study. The former acted as both a stepping stone into the research area and as an inspirational pilot, from which the research design for the larger quantitative study was drawn. Together, these two studies answered my research question - and allowed me to fulfill the third, final and foremost aspiration of this study - bridging the gap between two separate fields of knowledge management: knowledge flow and storytelling

Access to Palliative Care Services: Innovative Development of a Statewide Network

In 2018, the Avera Sacred Heart Hospital and two partners were awarded a planning grant to improve palliative health care services in South Dakota (SD), United States, by assessing palliative care in rural SD communities. Through this effort, a newly formed South Dakota Palliative Care Network (SDPCN) convened statewide partners to develop a palliative care strategy for improving quality palliative care access for individuals with serious illness. Guided by a multidisciplinary governing board, the SDPCN completed needs assessments to (1) better understand the perception of palliative care in SD; (2) assess the palliative care landscape in the state; and (3) explore possible solutions to address the uneven access to palliative care. This article shares the process of network development, considers the future of the SDPCN, and provides a blueprint for improving palliative care in rural areas. The SDPCN sought first to inventory community-based palliative care resources and increase awareness of the need for services followed by addressing gaps identified through a comprehensive assessment. The SDPCN has engaged partners, captured data, and mapped a blueprint for sustaining accessible quality palliative care. Three years since its inception, the SDPCN secured additional funding to sustain the Network and to provide education on palliative care to providers and community members as a first strategic step toward improving overall palliative care in rural communities. The SDPCN currently serves rural SD patients by increasing knowledge of palliative care among health professionals (current and future), fostering Network member engagement, and maintaining an active governing board