Työkyvyn hallinta, seuranta ja varhainen tuki : Tutkimus sairausvakuutuslain vuoden 2011 muutoksen vaikutuksista työpaikkojen toimintaan

Tutkimuksessa selvitettiin vuoden 2011 sairausvakuutuslain muutoksen vaikutuksia työkyvyn hallintaan, seurantaan ja varhaiseen tukeen. Sairausvakuutuslakimuutos (L 1056/2010) edellyttää, että ”työpaikalla on yhteistyössä työterveyshuollon kanssa sovitut käytännöt siitä, miten työkyvyn hallintaa, seurantaa ja varhaista tukea toteutetaan työpaikan ja työterveyshuollon yhteisenä toimintana”, jotta työterveyshuollon korvausluokkaan 1 kuuluvista palveluista aiheutuvista kustannuksista korvattaisiin 50 %:n sijaan 60 %. Tutkimus toteutettiin kahdessa vaiheessa. Ensimmäisessä vaiheessa tehtiin laaja, sähköinen kyselytutkimus, johon osallistui yli 1 000 työnantajaa. Toisessa vaiheessa kartoitettiin syvemmin työnantajien hyviksi kokemia työkyvyn hallinnan käytäntöjä sekä kehitysehdotuksia case-tutkimuksen menetelmin suppeammasta 22 työnantajan otoksesta. Tämän lisäksi haastateltiin viittä eri työterveyshuollon palveluntuottajaa. Yli 85 % kyselytutkimukseen osallistuneista ilmoitti sopineensa toimintakäytännöistä tai laatineensa toimenpideohjelman yhteistyössä työterveyshuollon kanssa, mikä on noin 10 prosenttiyksikköä enemmän kuin ennen vuotta 2011. Erilaisille toimintamalleille on laadittu suunnitelmia melko kattavasti, mutta suunnitelmien seuranta ei ole vielä systemaattista: suunnitelmiin ei ole kytketty tavoitteita, ja seurattavat mittarit puolestaan eivät välttämättä kytkeydy suunnitelmiin. Suurin osa tutkimuksen toiseen vaiheeseen osallistuneista organisaatioista koki lakimuutoksen onnistuneeksi tavaksi edistää työkyvyn hallintaa. Osallistuneissa organisaatioissa työkyvyn hallinta ja varhainen tuki on tullut viime vuosina keskimäärin systemaattisemmaksi ja tavoitteellisemmaksi. Haastateltavat kuitenkin korostivat organisaation omaa toimintaa ja valmiutta tärkeämmäksi työkyvyn hallinnassa. Haastateltavat pitivät suunnitelmien tekoa melko hyödyllisenä työkyvyn hallinnan kannalta ja osasivat mainita esimerkkejä hyvistä työkykykäytännöistä. Tavoitteiden seuranta ja mittaaminen ei kuitenkaan ole niin systemaattista kuin laajat suunnitelmat antaisivat olettaa. Tavoitteet on suunnitelmissa ilmaistu tyypillisesti yleisellä tasolla, jolloin niitä on vaikea mitata tai asettaa tavoitetasoja. Työpaikoilla seurataankin tyypillisesti helposti mitattavia asioita, kuten työtapaturmia, sairauspoissaoloja ja ennenaikaisia eläköitymisiä. Nämä kuvastavat myöhäisen vaiheen ongelmia. Varhaisen vaiheen tunnistamista tai ennaltaehkäisyn toteutumista ei seurata, oletettavasti niiden vaikean mitattavuuden vuoksi, vaikka tavoitteista nämä teemat löytyvät. Työkyvyn hallinnan kehittäminen on monivaiheinen prosessi, joka lähteäkseen käyntiin edellyttää yleistä tietoisuutta työkyvyn hallinnasta sekä henkilöstöasioista vastaavien tahojen kykyä kommunikoida muun johdon kanssa työkyvyn hallinnan kustannusvaikuttavuudesta. Onnistunut työkyvyn hallinta edellyttää lisäksi, että johto on sitoutunut siihen, sisäinen viestintä esimiehille ja työntekijöille toimii ja että henkilöstö osallistuu prosessiin

Cognitively-inspired Agent-based Service Composition for Mobile & Pervasive Computing

Automatic service composition in mobile and pervasive computing faces many challenges due to the complex and highly dynamic nature of the environment. Common approaches consider service composition as a decision problem whose solution is usually addressed from optimization perspectives which are not feasible in practice due to the intractability of the problem, limited computational resources of smart devices, service host's mobility, and time constraints to tailor composition plans. Thus, our main contribution is the development of a cognitively-inspired agent-based service composition model focused on bounded rationality rather than optimality, which allows the system to compensate for limited resources by selectively filtering out continuous streams of data. Our approach exhibits features such as distributedness, modularity, emergent global functionality, and robustness, which endow it with capabilities to perform decentralized service composition by orchestrating manifold service providers and conflicting goals from multiple users. The evaluation of our approach shows promising results when compared against state-of-the-art service composition models.Comment: This paper will appear on AIMS'19 (International Conference on Artificial Intelligence and Mobile Services) on June 2

Urinary Biomarkers Indicative of Apoptosis and Acute Kidney Injury in the Critically Ill

BackgroundApoptosis is a key mechanism involved in ischemic acute kidney injury (AKI), but its role in septic AKI is controversial. Biomarkers indicative of apoptosis could potentially detect developing AKI prior to its clinical diagnosis.MethodsAs a part of the multicenter, observational FINNAKI study, we performed a pilot study among critically ill patients who developed AKI (n = 30) matched to critically ill patients without AKI (n = 30). We explored the urine and plasma levels of cytokeratin-18 neoepitope M30 (CK-18 M30), cell-free DNA, and heat shock protein 70 (HSP70) at intensive care unit (ICU) admission and 24h thereafter, before the clinical diagnosis of AKI defined by the Kidney Disease: Improving Global Outcomes - creatinine and urine output criteria. Furthermore, we performed a validation study in 197 consecutive patients in the FINNAKI cohort and analyzed the urine sample at ICU admission for CK-18 M30 levels.ResultsIn the pilot study, the urine or plasma levels of measured biomarkers at ICU admission, at 24h, or their maximum value did not differ significantly between AKI and non-AKI patients. Among 20 AKI patients without severe sepsis, the urine CK-18 M30 levels were significantly higher at 24h (median 116.0, IQR [32.3-233.0] U/L) than among those 20 patients who did not develop AKI (46.0 [0.0-54.0] U/L), P = 0.020. Neither urine cell-free DNA nor HSP70 levels significantly differed between AKI and non-AKI patients regardless of the presence of severe sepsis. In the validation study, urine CK-18 M30 level at ICU admission was not significantly higher among patients developing AKI compared to non-AKI patients regardless of the presence of severe sepsis or CKD.ConclusionsOur findings do not support that apoptosis detected with CK-18 M30 level would be useful in assessing the development of AKI in the critically ill. Urine HSP or cell-free DNA levels did not differ between AKI and non-AKI patients

Driving a low critical current Josephson junction array with a mode-locked laser

Data for article "Driving a low critical current Josephson junction array with a mode-locked laser"

Policy evaluation and behavioral economics

Empirical policy evaluation is necessary to answer the question: what is a good policy? To answer this question, this chapter will review the management of policy evaluation and cover key performance indicators for evaluation, such as efficiency and fidelity. On the basis of these indicators, common frameworks for policy evaluation are explained. Some of the challenges in conducting policy evaluation, though, are the complex and variable aspects of all policies, as well as their context-specific antecedents and outcomes. This makes comparison between policies very challenging, if not impossible; hence, we close with an example of strategies for standardizing the evaluation of policies across domains and approaches. Ultimately, the purpose of this chapter is to identify not only what comprises a strong policy but also how to produce effective policies that maximize the number of people reached and impacted.</p

Probabilistic Verification at Runtime for Self-Adaptive Systems

An effective design of effective and efficient self-adaptive systems may rely on several existing approaches. Software models and model checking techniques at run time represent one of them since they support automatic reasoning about such changes, detect harmful configurations, and potentially enable appropriate (self-)reactions. However, traditional model checking techniques and tools may not be applied as they are at run time, since they hardly meet the constraints imposed by on-the-fly analysis, in terms of execution time and memory occupation. For this reason, efficient run-time model checking represents a crucial research challenge. This paper precisely addresses this issue and focuses on probabilistic run-time model checking in which reliability models are given in terms of Discrete Time Markov Chains which are verified at run-time against a set of requirements expressed as logical formulae. In particular, the paper discusses the use of probabilistic model checking at run-time for self-adaptive systems by surveying and comparing the existing approaches divided in two categories: state-elimination algorithms and algebra-based algorithms. The discussion is supported by a realistic example and by empirical experiments

Charting the reach and contribution of IMP literature in other disciplines: A bibliometric analysis

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordThe acknowledgement of a research tradition by other disciplines shows its contribution to the development of the broader body of scientific knowledge. This paper investigates the contribution of IMP (Industrial Marketing and Purchasing) research to broader research disciplines by analyzing how researchers within and beyond IMP have cited core IMP articles. First, through quantitative bibliometric analysis, the paper identifies the diffusion to other research disciplines. Thereafter, through qualitative analysis, the impact of the IMP perspective is captured to understand how strong these imprints are. The analyses show that IMP research has been noticed among a range of adjacent research disciplines. However, the use of IMP references has generally been rudimentary, and without a deeper understanding of the IMP ontology, meaning that IMP still has some “weak ties” to the other disciplines. Establishing IMP's contribution through enduring imprints would need further engagement with researchers from other research disciplines and publications in top journals. The paper contributes empirically with how the IMP perspective has spread beyond the IMP Group and theoretically by adding insight into how research ideas travel and transform to other disciplines

Comparing the effectiveness and cost-effectiveness of self-management interventions in four high-priority chronic conditions in Europe (COMPAR-EU): a research protocol

Introduction Population ageing and increasing chronic illness burden have sparked interest in innovative care models. While self-management interventions (SMIs) are drawing increasing attention, evidence of their efficacy is mostly based on pairwise meta-analysis, generally derived from randomised controlled trials comparing interventions versus a control or no intervention. As such, relevant efficacy data for comparisons among dif

Immune epitope database analysis resource (IEDB-AR)

We present a new release of the immune epitope database analysis resource (IEDB-AR, http://tools.immuneepitope.org), a repository of web-based tools for the prediction and analysis of immune epitopes. New functionalities have been added to most of the previously implemented tools, and a total of eight new tools were added, including two B-cell epitope prediction tools, four T-cell epitope prediction tools and two analysis tools