Strategiutvikling gjennom strategisk planlegging eller logisk inkrementalisme? En studie av strategiprosesser i norske bedrifter

Strategiprosessen er en kompleks prosess, og i mange tiår har man forsøkt å skape normative teorier om hvordan strategiprosessen foregår og hvordan den bør foregå. En av de tradisjonelle teoriretningene for strategiprosesser er den strategiske planleggingsskolen. Den forklarer strategiprosessen som en rasjonell og omfattende prosess for avgjørelser. Strategiprosessen går her ut på å analysere omgivelsene og formulere en strategisk plan for måloppnåelse. En av de utfordrende strategiske retningene er den lærende skolen og logisk inkrementalisme, som påstår at de i større grad kan lykkes i dynamiske omgivelser. Her utvikles strategien stegvis etterhvert som omgivelsene forandrer seg. Diskusjonen mellom de to retningene innenfor strategi er sentral i vår oppgave, hvor vi også ser på funn fra tidligere studier. Formålet med denne oppgaven er å studere strategiprosesser i bedrifter. Funnene blir sammenliknet med strategiteoriene for å se hvilken som best beskriver prosessene. Sammen med dette ser vi på hvordan dynamiske omgivelser har en betydning for strategiprosessen. Masteroppgaven er en kvalitativ casestudie hvor vi undersøker følgende fire norske bedrifter: Jotun, Norsk Tipping, NSB og Norwegian. Bedriftene ble valgt ut for å undersøke tilstedeværelsen av likheter og ulikheter mellom bransjer, karakter og omgivelser, hvor vi skiller på offentlig- og privat sektor. Data ble samlet inn gjennom dybdeintervjuer av to deltakere i hver bedrift. Resultatet av denne undersøkelsen ga oss innsikt i hvordan strategiprosesser foregår i bedrifter som er ulike i henhold til eierskap, bransje og omgivelser. Vi finner at grad av dynamiske omgivelser kan spille inn på bedrifters strategiprosesser på flere områder. Funnene gir ikke holdepunkt for å støtte kun den ene eller andre av de to strategiske teoriene, men at alle bedriftene hadde en kombinasjon av trekk fra de to. Funnene tyder på at eierskap, størrelse og grad av dynamiske omgivelser er faktorer som spiller inn på hvordan man velger å gjennomføre strategiprosesser. Våre funn støtter teorien rundt et integrert rammeverk.The strategy process is a complex process, and for decades people have tried to create normative theories of how the strategy process takes place and how it should be done. One of the traditional theories related to strategy processes is strategic planning, and portrays strategy formulation as a rational and comprehensive process for decisions. This strategy process analyzes the environment and formulates a strategic plan for goal achievement. One of the most challenging strategic directions is the learning school and logical incrementalism, which claims that they are more able to succeed in dynamic surroundings. Here the strategy is developed stepwise as the environment changes. The purpose of this thesis is to study strategic processes in companies. The discussion between the two directions within strategy theories is central, and we also look at the findings from previous studies. Our findings are compared with strategy theories to see which one best describes the processes. Along with this, we look at how dynamic environment has an impact on the strategy process. The study is a qualitative case study where we examine the following four Norwegian companies: Jotun, Norsk Tipping, NSB and Norwegian. The companies were selected to investigate the presence of similarities and differences between industries, characters and settings, where we divide between the public- and private sectors. The data were collected through in-depth interviews with two participants in each business. The results of this study gave us insight into how strategy processes take place in firms that differ according to ownership, industry and environment. We find that the degree of dynamic environments can affect corporate strategy processes in several areas. The finding does not support only one or the other of the two strategic theories. We found that all four companies had a combination of characteristics from both theories. The findings suggest that ownership, size and degree of dynamic environments are factors that play into how one chooses to manage strategic processes. Our findings support the theory of an integrated framework.Master i okonomi og administrasjo

A study of the association of HLA DR, DQ, and complement C4 alleles with systemic lupus erythematosus in Iceland

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVE: To perform an exploratory analysis of the relative contribution of single MHC genes to the pathogenesis of systemic lupus erythematosus (SLE) in a homogenous white population. METHODS: MHC class II alleles and C4 allotypes were determined in 64 SLE patients and in ethnically matched controls. HLA-DR and DQ typing was performed by polymerase chain reaction amplification with sequence specific primers. C4 allotypes were determined by agarose gel electrophoresis. RESULTS: The frequency of C4A*Q0 was significantly higher in patients than in controls (46.9% v 25.3%, p = 0.002). HLA-DRB1, DQA1, and DQB1 alleles in the whole group of SLE patients were not significantly different from those of controls. On the other hand increase in DRB1*03 was observed in the group of patients with C4A*Q0, as compared with patients with other C4A allotypes (p = 0.047). There was no significant correlation between severe and mild disease, as judged by the SLEDAI, and HLADR, DQ alleles and comparing the patients with C4A*Q0 with those with other C4A allotypes there was no significant difference regarding clinical manifestations. CONCLUSION: The results are consistent with the argument that C4A deficiency contributes independently to susceptibility and the pathogenesis of SLE. C4A*Q0 in SLE patients in Iceland shows weaker linkage disequilibrium with DR3 genes than reported in most other white populations and emphasises the role of ethnicity

Primary sclerosing cholangitis: Surrogate markers of natural history, disease severity, and prognosis

Sammendrag Bakgrunn: Primær skleroserende kolangitt (PSC) er en immunrelatert leversykdom av ukjent årsak som karakteriseres av kolestase, inflammasjon og strikturer i galletreet og vanligvis utvikler seg til generell leverfibrose, cirrhose og endestadium leversykdom. Til tross for at tilstanden er sjelden, har den i flere tiår vært den vanligste årsaken til levertransplantasjoner i Norge. Sykdomsforløpet er høyst varierende og uforutsigbart. Mangelen på etablerte biomarkører til stratifisering av risiko og sykdomsaktivitet er det største hinderet for å utvikle effektiv behandling. Følgelig er nye biomarkører sterkt etterspurt for å bedre pasientseleksjon og effektmåling i kliniske studier. Mål: Målsetningen for studien var å karakterisere prognostiske biomarkører ved PSC og identifisere potensielle nye biomarkører. Vi har derfor vurdert variasjon over tid innen og mellom personer med PSC for dagens to mest lovende prediktive markører, «enhanced liver fibrosis test» (ELF) og leverstivhetsmålinger (LSM) (Artikkel I). I tillegg ønsket vi å undersøke om et panel med flere biomarkører ga bedret prediktiv verdi ved PSC sammenlignet med nåværende kliniske risikoscorer og enkeltmarkører (Artikkel II). Til slutt har vi studert markører for mitokondriefunksjon ved PSC (Artikkel III). Metoder: I Artikkel I ble det brukt en longitudinell blandet modell for å analysere ELF og LSM ved skjærebølge-elastografi i repeterte målinger fra et prospektivt pasientpanel med 113 pasienter fra Bergen og Oslo. I Artikkel II brukte vi elastisk nettverk og multivariat regresjon for å identifisere et prognostisk multimarkørpanel for PSC, basert på tverrsnittsdata fra et retrospektivt panel med 138 personer med PSC fra NoPSC biobank. I Artikkel III utførte vi omfattende analyser av lipidomsetning og anvendte romlig regresjonsanalyse. Her gjorde vi tverrsnittsanalyser av markører på mitokondriefunksjon i plasma fra 191 pasienter og 100 friske kontroller, samt levervev fra personer med PSC og ikke-kolestatiske leversykdommer som kontrollgruppe fra NoPSC biobank. Resultater: I Artikkel I fant vi en signifikant økning av ELF og LSM over tid, men subgruppeanalyse viste at økningen kun forekom i gruppen med høy ALP. Fem år fra baseline hadde ca. 30 til 40% av pasientene reduksjon i LSM og ELF. En undergruppe på 10% av pasientene viste samvariasjon med reduksjon i ELF, LSM og ALP, og understrekker behovet for bedre forståelse og definisjon av hva som utgjør klinisk signifikant reduksjon. Effekter mellom pasienter forklarte 78% av variasjonen i ELF og 56% av variasjonen i LSM, og foreslår at ELF muligens har bedre evne for risikostratifisering sammenlignet med LSM. I Artikkel II illustrerte vi hvordan prognostiske biomarkører i PSC dannet tre grupper med tett korrelerte variabler. Vi demonstrerte at et panel bestående av biomarkører fra ulike deler av patogenesen i PSC hadde den den beste prediktive evnen, det vil si fibrose (ELF), inflammasjon (kynurenin-tryptofan ratio; KT-ratio) og en mikrobiell metabolitt (pyridoxal 5’-fosfat; PLP). I Artikkel III viste vi at det er uttalte forskjeller i fettsyreprofilen i plasma ved PSC sammenlignet med friske kontroller, inkludert økning av enumettede fettsyrer (MUFA), reduksjon av langkjedete mettede fettsyrer (SFA), total n-3 og n-6 flerumettede fettsyrer (PUFA). Funnene våre indikerte at mitokondriell dysfunksjon er fremtredende ved PSC og mer uttalt med økende kolestase og sykdomsstadium. Konklusjon: Våre funn understreker behovet for å forstå variasjonen i biomarkører ved PSC og å etablere klare definisjoner av hva som er klinisk signifikante endringer. Videre har vi vist at det er mulig å bedre prediksjonen ved å kombinere biomarkører fra ulike sykdomsprosesser ved PSC. Dette fordrer videre studier i større og uavhengige pasientpaneler. Til slutt har vi vist endringer i lipidomsetning og mitokondriefunksjon, som gir et behov for videre studier for utforsking av biomarkører og mulige behandlingsmål.  Abstract Background: Primary sclerosing cholangitis (PSC) is an immune-associated liver disease of unknown aetiology characterized by cholestasis, inflammation, and stricturing of the biliary tree, which typically progresses to general liver fibrosis, cirrhosis, and end-stage liver disease. Despite its status as a rare disease, it has been the leading cause of liver transplantation in Norway for decades. The disease course is highly variable and notoriously unpredictable. The lack of established biomarkers to stratify risk and assess disease activity is a major hurdle to developing effective therapy. Hence, new biomarkers are highly warranted to improve patient selection and effect assessment in clinical trials. Aims: The objective of the present study was to further characterize biomarkers of prognosis in PSC and explore novel potential biomarkers. Thus, we aimed to evaluate the within- and between-patient variability over time in PSC for the two currently most promising predictive markers, the enhanced liver fibrosis test (ELF) and liver stiffness measurement (LSM) (Paper I). Moreover, we aimed to identify a panel of multiple biomarkers with improved predictive abilities in people with PSC compared to current clinical risk scores or single biomarkers (Paper II). Lastly, we aimed to study markers of mitochondrial function in PSC (Paper III). Methods: In Paper I, we applied a longitudinal mixed model to analyse ELF and LSM by point shear wave elastography in repeated measurements from a prospective patient panel of 113 patients from Bergen and Oslo. In Paper II, we used elastic net- and multivariate regression to identify a prognostic multimarker panel for PSC based on cross-sectional, retrospective data from a panel of 138 PSC patients from the NoPSC biobank. In Paper III, we performed comprehensive lipidomic analyses and applied spatial regression. Here we explored markers of mitochondrial function cross-sectionally in plasma from 191 patients and 100 healthy controls and in liver tissue from people with PSC and non-cholestatic liver disease controls from the NoPSC biobank. Main findings: In Paper I, we found a significant increase in ELF and LSM over time, which was restricted to the high-ALP group (>1.5 x upper limit of normal) in subgroup analysis. Five years from baseline, about 30 to 40% of patients had reduced LSM and ELF values. A subgroup of 10% of patients showed a concomitant decrease in ELF, LSM, and ALP, underscoring the need to understand and define a clinically significant reduction. Between-patient effects explained 78% of ELF variation and 56% of LSM variation, suggesting that ELF may have superior reliability for risk stratification compared to LSM. In Paper II, we illustrated how prognostic biomarkers proposed in PSC seemed to form three groups of tightly intercorrelated variables. We demonstrated the best predictive ability in a panel consisting of biomarkers reflecting different aspects of PSC pathogenesis, i.e., fibrosis (ELF), inflammation (kynurenine-tryptophan ratio; KT-ratio), and a microbiota metabolite (pyridoxal 5’-phosphate; PLP). In Paper III, we demonstrated extensive differences in fatty acid profile in plasma from PSC patients compared to healthy controls, including increased mono-unsaturated fatty acids (MUFA), decreased long-chain saturated fatty acids (SFA), total n-3 and n-6 polyunsaturated fatty acids (PUFA). Moreover, our findings clearly indicated mitochondrial dysfunction as a prominent feature in PSC, which was more pronounced with increasing cholestasis and disease stage. Conclusion: Our findings underscore the need to understand the variation in biomarkers in PSC and establish a definition of clinically significant change. Furthermore, we have demonstrated the potential to improve the predictive abilities in PSC by combining biomarkers reflecting several pathogenic processes, warranting further studies in large and independent patient panels. Finally, we demonstrated lipidomic changes and mitochondrial dysfunction, which need further exploration to identify biomarkers or putative therapeutic targets.Doktorgradsavhandlin

Online Consequence Analysis of Situational Awareness for Autonomous Vehicles

The maritime industry is undergoing substantial changes with regards to autonomy, and lately important steps has been done in realizing highly autonomous vessels for industry use. This master s thesis presents a framework for an online consequence analysis (OCA) as an approach for increased situation awareness (SA), for marine vessels in transit. It cov- ers important steps towards this, in form of an overview of how different industries have defined autonomy, and how situation awareness currently is achieved for autonomous sys- tems. The proposed framework is validated through simulation, and lastly a general discus- sion is presented, including positive outcome and challenges with the framework. A review of how different industries have defined taxonomies for level of autonomy (LoA) is conducted, along with a review on how situation awareness is achieved for a marine vessel. Based on this, a comparison between the different taxonomies and how they fare with each other is provided, together with a visualization of how different sensors are used in order to achieve the first step of situation awareness, perception of the surrounding environment. The second and third step of SA are comprehension and projection, and this is where the OCA contributes. The proposed framework is able to simulate the vessel s dynamics in different failure modes, when initialized at the vessel s current state and with the prevailing weather condi- tions. Results from the OCA simulations are evaluated with respect to the vessel s distance to obstacles, and a consequence level for each failure mode is calculated. Based on the consequence levels, a quantitative measure of the total risk of collision is presented online, which builds a foundation for further decision-making. Furthermore, a simulation model was built in order to validate the functionality of the proposed OCA. A case study presents a set of scenarios simulated for validation, consisting of straight line transit, simple maneuvering between static obstacles and passage through a narrow channel. The results from the simulations showed promising behavior of the OCA. It was able to capture transient effects and the overall increase in risk when maneuvering in confined waters. The simulation model is flexible, as it allows for testing several failure modes and capture potential severe consequences. Initialization frequency of the OCA was important as it affected resolution of the risk indicator. A result of increasing the frequency was an earlier discovery of potential risk. The applicability and limitations of the framework are discussed, and proposals for further work are suggested, together with a brief discussion regarding the framework s compli- ance with COLREGs. Based on an assessment of the research question in hindsight of the development process, it is concluded that the framework allows for increased situa- tion awareness and that it shares capabilities of those defined as a LoA-3 management by exception autonomy level. It is further recommended to expand the framework by implementation of moving obsta- cles. This will enhance the framework s capabilities to comprehend perceived information, thus making better calculations of consequence levels and associated risk

Substrate-specific transcription of the enigmatic GH61 family of the pathogenic white-rot fungus Heterobasidion irregulare during growth on lignocellulose

The GH61 represents the most enigmatic Glycoside Hydrolase family (GH) regarding enzymatic activity and importance in cellulose degradation. Heterobasidion irregulare is a necrotizing pathogen and white-rot fungus that causes enormous damages in conifer forests. The genome of H. irregulare allowed identification of ten HiGH61 genes. qRT-PCR analysis separate the HiGH61 members into two groups; one that show up regulation on lignocellulosic substrates (HiGH61A, HiGH61B, HiGH61D, HiGH61G, HiGH61H, and HiGH61I) and a second showing either down-regulation or constitutive expression (HiGH61C, HiGH61E, HiGH61F, and HiGH61J). HiGH61H showed up to 17,000-fold increase on spruce heartwood suggesting a pivotal role in cellulose decomposition during saprotrophic growth. Sequence analysis of these genes reveals that all GH61s except HiGH61G possess the conserved metal-binding motif essential for activity. The sequences also divide into groups having either an insert near the N terminus or an insert near the second catalytic histidine, which may represent extensions of the substrate-binding surface. Three of the HiGH61s encode cellulose-binding modules (CBM1). Interestingly, HiGH61H and HiGH61I having CBM1s are up-regulated on pure cellulose. There was a common substrate-specific induction patterns of the HiGH61s with several reference cellulolytic and hemicellulolytic GHs, this taken together with their low transcript levels on media lacking lignocellulose, reflect the concerted nature of cell wall polymer degradation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00253-012-4206-x) contains supplementary material, which is available to authorized users

Extreme low temperature tolerance in woody plants

Woody plants in boreal to arctic environments and high mountains survive prolonged exposure to temperatures below -40°C and minimum temperatures below -60°C, and laboratory tests show that many of these species can also survive immersion in liquid nitrogen at -196°C. Studies of biochemical changes that occur during acclimation, including recent proteomic and metabolomic studies, have identified changes in carbohydrate and compatible solute concentrations, membrane lipid composition, and proteins, notably dehydrins, that may have important roles in survival at extreme low temperature (ELT). Consideration of the biophysical mechanisms of membrane stress and strain lead to the following hypotheses for cellular and molecular mechanisms of survival at ELT: (1) Changes in lipid composition stabilize membranes at temperatures above the lipid phase transition temperature (-20 to -30°C), preventing phase changes that result in irreversible injury. (2) High concentrations of oligosaccharides promote vitrification or high viscosity in the cytoplasm in freeze-dehydrated cells, which would prevent deleterious interactions between membranes. (3) Dehydrins bind membranes and further promote vitrification or act stearically to prevent membrane–membrane interactions.© 2015 Strimbeck, Schaberg, Fossdal, Schröder and Kjellsen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms

"Oh oobe doo, I wanna be like you" : associations between preschool teacher's - and children's activity level

Masteroppgave i kroppsøvings- og idrettsvitenskap - Nord universitet, 201

Newfound sexuality and the New Woman: Challenging societal fears and cultural preoccupations with Bram Stoker’s Dracula.

The aim of this thesis is to examine how Bram Stoker’s Dracula reflect societal fears and cultural preoccupations of newfound sexuality and the New Woman in the late 19th century. In recent discussions of Dracula, scholars have argued that how women are portrayed and treated in the novel, represents different ways the New Woman appeared and were feared in the Victorian society. In the words of scholar Ioana Baciu, “to be accepted in society, the woman could only exist as the male projection of purity envisioned by her suitors and husband-to-be” (84). According to this view, the Victorian woman could either adhere to society and the male perspective of how a woman should behave or behave however they like with the risk of being shunned and mistreated. Similarity, both scholars Charles E. Prescott and Grace A. Giorgio dive deeper into the new women who strive to achieve the same as any man, but at the same time does anything to please their husbands. Building on this is the element of sexuality, which the scholar Christopher Craft argues controls of numerous actions taken throughout the novel. In the context of discussions on Dracula, I will focus on the different aspects of societal fears surrounding changes in gender roles, gender inversion, and the New woman of the late 19th century. The New Woman brought a change to society, which is one of the major themes in Bram Stoker’s Dracula. To achieve this, I will analyse Stoker’s description of Mina and Lucy, and their role in society, how the two women were treated by the male characters, and how Dracula affected the women’ s traditional femininity, as well as how he influences Jonthan Harker’s masculinity. This is significant, because at the time the novel was written, women started to change their attitude against their position in society, wanting more equality and opportunities, both inside and outside of marriage. Overall, I want to examine how Dracula reflects on gender and sexuality in an era where this topic was still socially taboo.The aim of this thesis is to examine how Bram Stoker’s Dracula reflect societal fears and cultural preoccupations of newfound sexuality and the New Woman in the late 19th century. In recent discussions of Dracula, scholars have argued that how women are portrayed and treated in the novel, represents different ways the New Woman appeared and were feared in the Victorian society. In the words of scholar Ioana Baciu, “to be accepted in society, the woman could only exist as the male projection of purity envisioned by her suitors and husband-to-be” (84). According to this view, the Victorian woman could either adhere to society and the male perspective of how a woman should behave or behave however they like with the risk of being shunned and mistreated. Similarity, both scholars Charles E. Prescott and Grace A. Giorgio dive deeper into the new women who strive to achieve the same as any man, but at the same time does anything to please their husbands. Building on this is the element of sexuality, which the scholar Christopher Craft argues controls of numerous actions taken throughout the novel. In the context of discussions on Dracula, I will focus on the different aspects of societal fears surrounding changes in gender roles, gender inversion, and the New woman of the late 19th century. The New Woman brought a change to society, which is one of the major themes in Bram Stoker’s Dracula. To achieve this, I will analyse Stoker’s description of Mina and Lucy, and their role in society, how the two women were treated by the male characters, and how Dracula affected the women’ s traditional femininity, as well as how he influences Jonthan Harker’s masculinity. This is significant, because at the time the novel was written, women started to change their attitude against their position in society, wanting more equality and opportunities, both inside and outside of marriage. Overall, I want to examine how Dracula reflects on gender and sexuality in an era where this topic was still socially taboo

Using laser micro-dissection and qRT-PCR to analyze cell type-specific gene expression in Norway spruce phloem

The tangentially oriented polyphenolic parenchyma (PP) and radially organized ray parenchyma in the phloem are central in the defense of conifer stems against insects and pathogens. Laser micro-dissection enables examination of cell-specific defense responses. To examine induced defense responses in Norway spruce stems inoculated with the necrotrophic blue-stain fungus Ceratocystis polonica, RNA extracted from laser micro-dissected phloem parenchyma and vascular cambium was analyzed using real-time RT-PCR (qRT-PCR) to profile transcript levels of selected resistance marker genes. The monitored transcripts included three pathogenesis-related proteins (class IV chitinase (CHI4), defensin (SPI1), peroxidase (PX3), two terpene synthesis related proteins (DXPS and LAS), one ethylene biosynthesis related protein (ACS), and a phenylalanine ammonia-lyase (PAL). Three days following inoculation, four genes (CHI4, PAL, PX3, SPI1) were differentially induced in individual cell and tissue types, both close to the inoculation site (5 mm above) and, to a lesser degree, further away (10 mm above). These resistance marker genes were all highly induced in ray parenchyma, supporting the important role of the rays in spruce defense propagation. CHI4 and PAL were also induced in PP cells and in conducting secondary phloem tissues. Our data suggests that different cell types in the secondary phloem of Norway spruce have overlapping but not fully redundant roles in active host defense. Furthermore, the study demonstrates the usefulness of laser micro-dissection coupled with qRT-PCR to characterize gene expression in different cell types of conifer bark

COVID-19 Vaccination Rates and Political Party Affiliation in Norway - An Empirical Analysis of Voting Patterns and Vaccine Rejection

Vaccines are widely accepted as one of the most effective means in combating contagious diseases due to their health- and economic benefits both on individual- and societal levels. As politicisation of vaccines has proven prominent throughout the COVID-19 pandemic in several Western countries, this paper examines the relationship between vaccination rates and political affiliation in Norway. Data on vaccination rates and votes measured on a municipal level are drawn from publicly available sources. The same can be said for socioeconomic factors which are included as control variables. With a theoretical foundation of social identity theory, we use Inglehart & Norris’ (2016) heuristic model of party competition in Western societies to identify and classify Norwegian political parties into constellations of similar characteristics. We hypothesise that voters of different party constellations will show different COVID-19 vaccination rates. By using OLS regression models, we find that voting for political parties with no governmental history is associated with significantly lower vaccination rates. We also find a negative relationship between vaccination rates and perceived political distance to historically governing parties amongst the non-governing parties. In particular on the political right this effect is significant and robust for controls. Although voting for the parties furthest to the political left show a negative relationship with vaccination rates compared to historically governing parties, this result is sensitive to precise party classification. The results coincide with social identity theory and previous literature in other Western countries. If voters belong to what they perceive as an out-group to those in governing power, they are more likely to hold negative attitudes towards public recommendations from governing organs and -agencies, and thus vaccinate less. As this effect is stronger for voters of parties further away from the governing parties, we conclude that the degree of belonging to an out-group also matters.nhhma