System Dynamic Simulation of Pricing

In a classical sense pricing is the most important preference driver for consumer choice. By adjusting the pricing strategy of a product a company seeks to position itself such that it maximises its profits. In this work we study a defensive case, where an incumbent company faces new competition in the markets. Competitors bring in new products with inferior quality but lower price. The incumbent company must face a decision between deteriorating the price and maintaining customers or maintaining the current price premium, but losing customers. In the study we will introduce a system dynamical model to simulate market development and demonstrate its operation with approximated parameters. The theoretical background lies in the Bass diffusion model, which is used to simulate diffusion of innovations. In this work we will use the model and its mathematical framework to simulate diffusion of lower price level to the markets. The Bass model states that as the number of new consumers for product accumulates, the pace at which which even more people adapt to the new product increases. Finally the vast majority of the consumers are adapted to the new product. A complex system dynamical model was developed which takes into consideration consumer price preferences, considered price premium for superior product and strength of internal and external effect of the Bass model. The model produces reasonable estimates for pricing with the used imaginary but reasonable parameters.Klassisessa mielessä hinnoittelu on tärkein yksittäinen ajava tekijä kuluttajien valinnalle. Säätämällä hinnoittelustrategiaansa voi yritys hakea tuotteelleen sellaisen aseman, joka maksimoi sen voiton. Tässä työssä keskitytään defensiiviseen hinnoitteluun, jossa olemassa oleva yritys kohtaa uutta kilpailua markkinoilla. Kilpailijat tuovat markkinoille uuden tuotteen, joka on laadultaan matalampi, mutta hinnaltaan alhaisempi. Olemassa olevan yrityksen tulee valita strategiakseen joko hintatason alentaminen säilyttääkseen markkinaosuutensa tai vastaavasti hintapreemion säilyttämisen, jolloin asiakaskuntaa menetetään. Työssä esitellään systeemidynaaminen malli, jolla markkinoiden kehitystä seurataan ja mallin toimintaa tarkastellaan arvioiduilla parametreilla. Mallin teoreettinen tausta perustuu Bassin diffuusiomalliin, jota käytetää innovaatiodiffuusion simulointiin. Tässä työssä käytämme mallia ja sen matemaattista viitekehystä simuloidaksemme matalamman hintatason diffuusiota markkinoille. Bassin mallin mukaan kun yhä laajempi joukko uusia kuluttajia siirtyy käyttämään uutta tuotetta, kiihtyy tuotteen adaptaatio yhä laajemmille kuluttajajoukoille. Lopulta merkittävä enemmistö kuluttajista siirtyy käyttämään uutta tuotetta. Työtä varten kehitettiin kompleksinen systeemidynaaminen malli, joka ottaa huomioon kuluttajien hintapreferenssit, arvioidut hintapreemiot korkeampi laatuiselle tuotteelle sekä Bassin mallin mukaiset sisäisen ja ulkoisen vaikutuksen parametrit. Malli tuottaa uskottavia estimaatteja hinnoittelulle käyttämällä työtä varten valikoituja kuvitteellisia, mutta uskottavia parametreja

Kaksikielinen Vaasan keskussairaala : Laadukkaan hoidon toteutuminen medisiinisen klinikkaryhmän vuodeosastoilla omalla äidinkielellä

Vaasan keskussairaala on kaksikielinen sairaala. Sairaalassa toimii vähemmistökielinen lautakunta, joka toivoi tutkimusta siitä, kuinka potilaat kokevat kaksikielisyyden. Tässä työssä haluttiin kartoittaa potilaiden mielipiteitä äidinkielen vaikutuksesta hoidon laatuun. Haluttiin selvittää, ovatko potilaat saaneet Vaasan kes-kussairaalassa laadukasta hoitoa, ja onko potilaan äidinkieli vaikuttanut hoidon laatuun. Toiseksi haluttiin selvittää, käyttääkö henkilökunta potilaan äidinkieltä kommunikoidessaan hänen kanssaan. Lisäksi haluttiin selvittää, ovatko potilaat saaneet riittävästi tietoa ja ohjausta omalla äidinkielellään. Tutkimuksen teoreettisessa viitekehyksessä tuotiin esille tutkittua tietoa laadusta, viestinnästä ja kaksikielisyydestä. Tutkimusaineisto kerättiin kyselylomakkeiden avulla ja vastaukset käsiteltiin tilastollisen tutkimuksen keinoin. Kohderyhmä oli medisiinisen klinikkaryhmän osastojen potilaat. Tutkimukseen osallistui 108 potilasta. Tutkimuksen tulosten mukaan potilaat kokivat saavansa laadukasta hoitoa Vaasan keskussairaalassa, eikä kaksikielisyys heikentänyt laatua. Kommunikointi hoitajien kanssa sujui hyvin omalla äidinkielellä sekä suomeksi että ruotsiksi. Ruotsinkieliset eivät saaneet lääkäreiltä niin hyvin palvelua omalla äidinkielellään kuin suomenkieliset. Kuitenkin ruotsinkieliset pitivät kieliä tasavertaisempina kuin suomenkieliset. Toimenpiteissä ja lääkärinkierrolla henkilökunta puhui keskenään usein muuta kuin potilaan äidinkieltä. Osa suomenkielisistä ei hyväksynyt sitä, että henkilökunta ei puhu täydellisesti potilaan äidinkieltä. Potilaat kokivat saaneensa pääsääntöisesti riittävästi tietoa ja ohjausta omalla äidinkielellään. Suhtautuminen kaksikielisyyteen vaihteli hyväksymisestä kriittiseen suhtautumiseen.The Vaasa Central Hospital is a bilingual hospital. There is a council in the hospital that wanted research made on how the patients experience the bilingualism. The purpose of this study was to find out if the patients feel there is a correlation between the mother tongue and the quality of care. The aim was to find out if the patients have received care of high quality in Vaasa Central Hospital and whether the patient`s mother tongue has affected the quality of care. A further purpose was to find out whether the staff uses the patient`s mother tongue in communicating with him/her and whether the patients received enough information and education in their own mother tongue. The theoretical frame deals with research information about quality, communication and bilingualism. The material was collected with questionnaires and the re-sponses were analyzed with statistical methods. The target group included the pa-tients in internal diseases clinical unit. The study was participated by 108 patients. The results of the study show that the patients feel they receive good care in Vaasa Central Hospital and the bilingualism did not reduce the quality of care. There were no problems in the communication with the nurses in the patient`s mother tongue. However, the Swedish-speaking patients did not feel they received as good care with the physicians as did the Finnish-speaking patients. The Swedish-speaking patients felt that the languages are more equal when compared to the opinions on the Finnish-speaking patients. During procedures and on doctor`s round the language used by the personnel was often other than the patient`s mother tongue. Some of the Finnish-speaking patients did not accept the fact that the personnel does not speak the patient`s mother tongue perfectly. Most of the patients felt they have received enough information and education in their own mother tongue. The attitude towards bilingualism varied from acceptance to a critical attitude

A 2-Year Follow-Up After a 2-Year RCT with Vitamin D and Exercise : Effects on Falls, Injurious Falls and Physical Functioning Among Older Women

Background: Both exercise and vitamin D are recommended means to prevent falls among older adults, but their combined effects on fallinduced injuries are scarcely studied. Methods: A 2-year follow-up of a previous 2-year randomized controlled trial with vitamin D and exercise (Ex) of 409 older home-dwelling women using a factorial 2 x 2 design (D(-)Ex(-), D(+)Ex(-), D(-)Ex(+), D(+)Ex(+)). Besides monthly fall diaries, femoral neck bone mineral density (fn-BMD), and physical functioning were assessed at 1 and 2 years after the intervention. Results: After the intervention, S-25OHD concentrations declined to baseline levels in both supplement groups. The groups did not differ for change in fn-BMD or physical functioning, except for leg extensor muscle strength, which remained about 10% greater in the exercise groups compared with the reference group (D(-)Ex(-)). There were no between-group differences in the rate of all falls, but medically attended injurious falls reduced in D+ Ex-and D(-)Ex(+) groups compared with D(-)Ex(-). However, all former treatment groups had less medically attended injured fallers, HRs (95% CI) being 0.62 (0.39-1.00) for D+ Ex-, 0.46 (0.28-0.76) for D(-)Ex(+), and 0.55 (0.34-0.88) for D(+)Ex(+), compared with D(-)Ex(-). Conclusions: Exercise-induced benefits in physical functioning partly remained 2 years after cessation of supervised training. Although there was no difference in the rate of all falls, former exercise groups continued to have lower rate of medically attended injured fallers compared with referents even 2 years after the intervention. Vitamin D without exercise was associated with less injurious falls with no difference in physical functioning.Peer reviewe

Impacts of emission reductions on aerosol radiative effects

The global aerosol-climate model ECHAM-HAMMOZ was used to investigate changes in the aerosol burden and aerosol radiative effects in the coming decades. Four different emissions scenarios were applied for 2030 (two of them applied also for 2020) and the results were compared against the reference year 2005. Two of the scenarios are based on current legislation reductions: one shows the maximum potential of reductions that can be achieved by technical measures, and the other is targeted to short-lived climate forcers (SLCFs). We have analyzed the results in terms of global means and additionally focused on eight subregions. Based on our results, aerosol burdens show an overall decreasing trend as they basically follow the changes in primary and precursor emissions. However, in some locations, such as India, the burdens could increase significantly. The declining emissions have an impact on the clear-sky direct aerosol effect (DRE), i.e. the cooling effect. The DRE could decrease globally 0.06-0.4 W m(-2) by 2030 with some regional increases, for example, over India (up to 0.84 W m(-2)). The global changes in the DRE depend on the scenario and are smallest in the targeted SLCF simulation. The aerosol indirect radiative effect could decline 0.25-0.82 W m(-2) by 2030. This decrease takes place mostly over the oceans, whereas the DRE changes are greatest over the continents. Our results show that targeted emission reduction measures can be a much better choice for the climate than overall high reductions globally. Our simulations also suggest that more than half of the near-future forcing change is due to the radiative effects associated with aerosol-cloud interactions.Peer reviewe

Psychotropic drugs and the risk of fractures in old age: a prospective population-based study

<p>Abstract</p> <p>Background</p> <p>There is evidence that the use of any psychotropic and the concomitant use of two or more benzodiazepines are related to an increased risk of fractures in old age. However, also controversial results exist. The aim was to describe associations between the use of a psychotropic drug, or the concomitant use of two or more of these drugs and the risk of fractures in a population aged 65 years or over.</p> <p>Methods</p> <p>This study was a part of a prospective longitudinal population-based study carried out in the municipality of Lieto, South-Western Finland. The objective was to describe gender-specific associations between the use of one psychotropic drug [benzodiazepine (BZD), antipsychotic (AP) or antidepressant (AD)] or the concomitant use of two or more psychotropic drugs and the risk of fractures in a population 65 years or over. Subjects were participants in the first wave of the Lieto study in 1990-1991, and they were followed up until the end of 1996. Information about fractures confirmed with radiology reports in 1,177 subjects (482 men and 695 women) during the follow-up was collected from medical records. Two follow-up periods (three and six years) were used, and previously found risk factors of fractures were adjusted as confounding factors separately for men and women. The Poisson regression model was used in the analyses.</p> <p>Results</p> <p>The concomitant use of two or more BZDs and the concomitant use of two or more APs were related to an increased risk of fractures during both follow-up periods after adjusting for confounding factors in men. No similar associations were found in women.</p> <p>Conclusions</p> <p>The concomitant use of several BZDs and that of several APs are associated with an increase in the risk of fractures in older men. Our findings show only risk relations. We cannot draw the conclusion that these drug combinations are causes of fractures.</p

Study protocol for prevention of falls: A randomized controlled trial of effects of vitamin D and exercise on falls prevention

Peer reviewe

Exercise for reducing fear of falling in older people living in the community

Background: Fear of falling is common in older people and associated with serious physical and psychosocial consequences. Exercise (planned, structured, repetitive and purposive physical activity aimed at improving physical fitness) may reduce fear of falling by improving strength, gait, balance and mood, and reducing the occurrence of falls. Objectives: To assess the effects (benefits, harms and costs) of exercise interventions for reducing fear of falling in older people living in the community. Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2013), the Central Register of Controlled Trials (CENTRAL 2013, Issue 7), MEDLINE (1946 to July Week 3 2013), EMBASE (1980 to 2013 Week 30), CINAHL (1982 to July 2013), PsycINFO (1967 to August 2013), AMED (1985 to August 2013), the World Health Organization International Clinical Trials Registry Platform (accessed 7 August 2013) and Current Controlled Trials (accessed 7 August 2013). We applied no language restrictions. We handsearched reference lists and consulted experts. Selection criteria: We included randomised and quasi-randomised trials that recruited community-dwelling people (where the majority were aged 65 and over) and were not restricted to specific medical conditions (e.g. stroke, hip fracture). We included trials that evaluated exercise interventions compared with no intervention or a non-exercise intervention (e.g. social visits), and that measured fear of falling. Exercise interventions were varied; for example, they could be 'prescriptions' or recommendations, group-based or individual, supervised or unsupervised. Data collection and analysis: Pairs of review authors independently assessed studies for inclusion, assessed the risk of bias in the studies and extracted data. We combined effect sizes across studies using the fixed-effect model, with the random-effect model used where significant statistical heterogeneity was present. We estimated risk ratios (RR) for dichotomous outcomes and incidence rate ratios (IRR) for rate outcomes. We estimated mean differences (MD) where studies used the same continuous measures and standardised mean differences (SMD) where different measures or different formats of the same measure were used. Where possible, we performed various, usually prespecified, sensitivity and subgroup analyses. Main results: We included 30 studies, which evaluated 3D exercise (Tai Chi and yoga), balance training or strength and resistance training. Two of these were cluster-randomised trials, two were cross-over trials and one was quasi-randomised. The studies included a total of 2878 participants with a mean age ranging from 68 to 85 years. Most studies included more women than men, with four studies recruiting women only. Twelve studies recruited participants at increased risk of falls; three of these recruited participants who also had fear of falling. Poor reporting of the allocation methods in the trials made it difficult to assess the risk of selection bias in most studies. All of the studies were at high risk of performance and detection biases as there was no blinding of participants and outcome assessors and the outcomes were self reported. Twelve studies were at high risk of attrition bias. Using GRADE criteria, we judged the quality of evidence to be 'low' for fear of falling immediately post intervention and 'very low' for fear of falling at short or long-term follow-up and all other outcomes. Exercise interventions were associated with a small to moderate reduction in fear of falling immediately post intervention (SMD 0.37 favouring exercise, 95% confidence interval (CI) 0.18 to 0.56; 24 studies; 1692 participants, low quality evidence). Pooled effect sizes did not differ significantly between the different scales used to measure fear of falling. Although none of the sensitivity analyses changed the direction of effect, the greatest reduction in the size of the effect was on removal of an extreme outlier study with 73 participants (SMD 0.24 favouring exercise, 95% CI 0.12 to 0.36). None of our subgroup analyses provided robust evidence of differences in effect in terms of either the study primary aim (reduction of fear of falling or other aim), the study population (recruitment on the basis of increased falls risk or not), the characteristics of the study exercise intervention or the study control intervention (no treatment or alternative intervention). However, there was some weak evidence of a smaller effect, which included no reduction, of exercise when compared with an alternative control. There was very low quality evidence that exercise interventions may be associated with a small reduction in fear of falling up to six months post intervention (SMD 0.17, 95% CI -0.05 to 0.38; four studies, 356 participants) and more than six months post intervention (SMD 0.20, 95% CI -0.01 to 0.41; three studies, 386 participants). Very low quality evidence suggests exercise interventions in these studies that also reported on fear of falling reduced the risk of falling measured either as participants incurring at least one fall during follow-up or the number of falls during follow-up. Very low quality evidence from four studies indicated that exercise interventions did not appear to reduce symptoms of depression or increase physical activity. The only study reporting the effects of exercise interventions on anxiety found no difference between groups. No studies reported the effects of exercise interventions on activity avoidance or costs. It is important to remember that our included studies do not represent the totality of the evidence of the effect of exercise interventions on falls, depression, anxiety or physical activity as our review only includes studies that reported fear of falling. Authors' conclusions: Exercise interventions in community-dwelling older people probably reduce fear of falling to a limited extent immediately after the intervention, without increasing the risk or frequency of falls. There is insufficient evidence to determine whether exercise interventions reduce fear of falling beyond the end of the intervention or their effect on other outcomes. Although further evidence from well-designed randomised trials is required, priority should be given to establishing a core set of outcomes that includes fear of falling for all trials examining the effects of exercise interventions in older people living in the community

Non-pharmacological management of osteoporosis: a consensus of the Belgian Bone Club

This consensus article reviews the various aspects of the non-pharmacological management of osteoporosis, including the effects of nutriments, physical exercise, lifestyle, fall prevention, and hip protectors. Vertebroplasty is also briefly reviewed. Non-pharmacological management of osteoporosis is a broad concept. It must be viewed as an essential part of the prevention of fractures from childhood through adulthood and the old age. The topic also includes surgical procedures for the treatment of peripheral and vertebral fractures and the post-fracture rehabilitation. The present document is the result of a consensus, based on a systematic review and a critical appraisal of the literature. Diets deficient in calcium, proteins or vitamin D impair skeletal integrity. The effect of other nutriments is less clear, although an excessive consumption of sodium, caffeine, or fibres exerts negative effects on calcium balance. The deleterious effects of tobacco, excessive alcohol consumption and a low BMI are well accepted. Physical activity is of primary importance to reach optimal peak bone mass but, if numerous studies have shown the beneficial effects of various types of exercise on bone mass, fracture data as an endpoint are scanty. Fall prevention strategies are especially efficient in the community setting, but less evidence is available about their effectiveness in preventing fall-related injuries and fractures. The efficacy of hip protectors remains controversial. This is also true for vertebroplasty and kyphoplasty. Several randomized controlled studies had reported a short-term advantage of vertebroplasty over medical treatment for pain relief, but these findings have been questioned by recent sham-controlled randomized clinical studies