A Federal Ombudsman

This thesis has been written on commission by Laboratoriemedicin VLL, which is a part of region’s hospital. The organization did not work as efficiently as it could, and senior managers have encountered various problems. We have been asked to estimate the situation, analyze it, and come up with solutions which could increase efficiency and productivity; in other words, increase organizational performance. After preliminary interview with the senior manager, we have identified our areas of the interest: organizational structure, leadership, and communication.   This preliminary interview made us very interested at the situation at Laboratoriemedicin, and helped us to formulate our research question: “How do organizational structure, leadership, and communication affect productivity and efficiency of the public health-care organization?” Moreover, it made our research have two purposes, one of academic character, and one of practical character. The academic purpose is in investigating relationship between organizational structure, leadership, and communication and organizational performance, i.e. efficiency and productivity. The practical purpose is in giving analysis-based recommendations about possible ways to increase productivity and efficiency to Laboratoriemedicin VLL.   In order to find out the answer to the research question and to fulfill both purposes of the research, we have conducted a qualitative research. This has been done by interviewing ten people working at Laboratoriemedicin. We have tried to talk to representatives of different layers of the organization to make our research more diversificated and complete. These semi-structured interviews resulted in qualitative data, which had been processed and analyzed using coding technique.   The findings of our research revealed that structure, leadership, and communication affect efficiency and productivity. Structure defines how productive the operational processes are; leadership affects the whole personnel and the way they strive for achieving their goal; communication affects how fast things are getting done and how happy and willing personnel are. Additionally, we have spotted two areas affecting the relationship between structure, communication, leadership, and organizational performance: development issues and personal issues. Moreover, we have found that leadership and organization are the most problematic spots in Laboratoriemedicin. After careful analysis of the situation we have come up with the list of suggestions that can help the organization to achieve increased efficiency and productivity.

Adenomyosis : imaging features for diagnosing the disease and treatment effects of bromocriptine

Background: Adenomyosis is a benign uterine disease, causing various symptoms including heavy menstrual bleeding (HMB) and pelvic pain. In affected women, endometrial glands and stroma are located in the myometrium surrounded by hypertrophied myometrial tissue. The eutopic endometrium is associated with increased proliferation, high migration and a high invasive capacity. The knowledge of the pathogenesis is largely unknown; however, mice models have shown a link between increased uterine concentration of prolactin (PRL) and the disease. The gold standard in the treatment for hyperprolactinemia is the dopamine agonist bromocriptine. Vaginal administration is effective in reducing serum PRL and has less gastrointestinal side effects than oral administration. Reducing uterine PRL may improve symptoms and could be a possible medical treatment in the future if PRL is associated with the disease. Whether bromocriptine reduce uterine PRL is not known. In the presence of clinical symptoms adenomyosis diagnosis can be confirmed using Magnetic Resonance Imaging (MRI) or Transvaginal ultrasonography (TVS). The reproducibility has been reported high for both modalities, but consensus criteria for diagnosing the disease are still lacking in both MRI and TVS. Aim: The overall aim was to examine the effects of the dopamine agonist bromocriptine in women with adenomyosis and to assess agreement between MRI and TVS for imaging features associated with the disease. The specific objectives were to assess symptoms before and after treatment with vaginal bromocriptine. Another objective was to assess changes in MRI and TVS during treatment and to analyze changes in the endometrium regarding protein biomarkers and differentially expressed genes. A further objective was to compare the inter-rater agreement between MRI and TVS for diagnosing adenomyosis and for various features in the same set of women. Methods and results: In study I, 18 women from Sweden and 1 woman from the USA with regular HMB and suspected adenomyosis were included. Women were treated with a daily dose of 5mg vaginal bromocriptine for 6 months. Self-administered questionnaires were used to assess symptoms at baseline, 3 months, 6 months, and 9 months (3 months after cessation of the study drug). The Pictorial Blood Assessment Chart (PBLAC) and the Aberdeen Menorrhagia Clinical Outcomes Questionnaire (AMCOQ) were used to assess the amount of bleeding. The Visual Analog Scale for pain (VAS) and the McGill Pain Questionnaire (MPQ) were used to assess pain. The Fibroid Symptom Quality of Life (UFS‐QOL), the Endometriosis Health Profile (EHP‐30) and the Female Sexual Function Index (FSFI) were used to assess quality of life. PBLAC, AMCOQ, VAS, and MPQ showed a significant reduction at 6 months, indicating an improvement in bleeding and pain severity. An improvement in quality of life was seen with UFS-QOL. Total EHP and FSFI did not show any significant differences. Study II was a secondary outcome of study I. The 18 women at the Swedish site underwent MRI and TVS at baseline and after treatment with vaginal bromocriptine. The MRIs were assessed by one radiologist and the TVS were assessed by one gynecologist specialized in gynecologic ultrasound. For MRI, no significant differences were found in Junctional Zone (JZ) max, JZ differential, ratio JZ/myometrium or myometrial cysts. TVS showed a significant reduction in JZmax and in asymmetric wall thickness. No significant changes were seen in irregular JZ, fan shaped shadowing, striations, hyperechogenic islands, or cystic lesions. In study III, MRI and TVS images from the same set of 51 women with HMB and suspected adenomyosis were assessed. MRIs were assessed by four radiologists and the TVS images were assessed by five gynecological ultrasonographers. For MRI, the inter-rater reliability for JZ measurements were ‘moderate to good’. Inter-rater agreement for wall asymmetry and irregular JZ were ‘moderate’, while the inter-rater agreement for globular uterus shape was ‘poor’ and ‘fair’ for cysts. The overall subjective impression if adenomyosis was present or not was ‘fair’. For TVS, the inter-rater agreement for globular uterus shape and wall asymmetry were ‘moderate’. Irregular JZ, fan shaped shadowing and buds or striations were ‘fair’ and the inter-rater agreement for cysts were poor. Measurement of the JZ did not show any agreement between the raters. The overall subjective impression of whether adenomyosis was present or not was ‘moderate’. Study IV was a secondary outcome of study I. Endometrial biopsies were taken at baseline and after treatment with vaginal bromocriptine. 12 paired (i.e 12x2) samples were included in the study. Analyses were carried out to evaluate PRL and differentially expressed genes before and after treatment were performed. A significant reduction in serum PRL was observed following bromocriptine treatment, but no changes in the eutopic endometrium. Gene expression analysis showed a significant upregulation of BAX (a marker of apoptosis) and downregulation of Ki67 (a marker of proliferation) and downregulation of genes associated with glucose metabolism. Conclusion: A significant improvement in menstrual bleeding, pain, and quality of life was seen after 6 months of vaginal bromocriptine treatment. A significant decrease in JZmax and asymmetric myometrial wall thickness were demonstrated with TVS. An anti-proliferative effect by downregulating genes associated with glucose metabolism was seen in the eutopic endometrium after treatment. The inter-rater agreement for diagnosis was higher for TVS than for MRI despite MRI manifesting higher agreement in most features associated with the disease

Owner Perceived Behavior in Cats and the Influence of Husbandry Practices, Housing and Owner Attitudes in Sweden

Simple Summary In this paper, we describe the results from an online survey that targeted cat owners in Sweden. The aim of the study was to investigate how owners perceived the behavior of their cats, and if the cat characteristics could influence the owner attitudes. In this study, we describe the data from 3253 cats and their owners. Less than one in five cat owners reported that they had experienced behavioral problems with their cats. Owners of cats with outdoor access reported experiencing fewer problems. However, we could not find an effect of the length of time a cat was left home alone. If owners had university level knowledge in animal behavior, we could see an effect on the perception of cat behaviors such as cats misbehaving out of spite. Many owners did not believe that cats could be trained to overcome behavior problems, and many owners also thought that cats could manage on their own. These attitudes can in the long run have negative effects on the welfare of cats. This study consisted of an online survey based on a convenience sample among cat owners in Sweden. The aim was to investigate how owner and cat characteristics influenced the perceived behavior of cats, focusing on perceived behavioral or temperamental problems. The relation between owner knowledge, the provided environment, and owner perceived behavior of 3253 pet cats were investigated. Few respondents (18%) reported behavioral or temperamental problems, and consequently 82% perceived no problem whatsoever. Fewer cats with outdoor access were reported to display behavioral or temperamental problems. However, there was no effect of the length of time a cat was left home alone. Having studied animal behavior at university level influenced the perception of some cat behaviors, but not the incidence of reporting perceived problems. Many owners did not believe that it was possible to prevent behavioral problems in cats by training (58.5%), and many owners thought that cats could manage independently on their own (66%). Attitudes like this can cause challenges in the owner-cat interactions. The perception of problems with cats will be influenced by factors relating to husbandry routines such as outdoor access, which in the future could help to implement recommendations for cat husbandry and care

A framework for barriers, opportunities, and potential solutions for renewable energy diffusion: Exemplified by liquefied biogas for heavy trucks

This study has developed and applied a framework to analyse barriers, opportunities, and potential solutions for the diffusion of alternative fuels, here exemplified by liquefied biogas (LBG) for heavy trucks. The study is based on expert and stakeholder interviews in Sweden. Also, the study estimates a cost example of using heavy duty LBG-trucks instead of conventional diesel trucks. The framework is based on two previously published frameworks to categorise barriers, opportunities, and potential solutions and comprises five categories: financial, technical/commercial/physical, policy, public acceptability, and market structure/interaction barriers. Each category considers both the system and actor levels. The results of this study fit the framework\u27s categories well, and the framework is appropriate for analysing the diffusion of liquefied biogas for heavy trucks, and other technologies with similar characteristics. The results further indicate that a network level, in addition to the system and actor levels, could advance our understanding of renewable energy diffusion. The most mentioned opportunities were climate/environmental benefits, potential profitability, and newly introduced policies. The cost estimates show that given current taxes and policies in Sweden, the costs of using LBG-trucks are only marginally higher than those of using conventional diesel trucks. Commonly cited barriers were financial issues, an unstable policy context, lack of infrastructure, and lack of knowledge. Suggested solutions for overcoming barriers were financial incentives, a stable policy context, demonstration projects, and information campaigns. Improved knowledge and working together throughout the biogas value chain, with a palette of renewable energy options, are important for accelerating a sustainable renewable fuel diffusion. Several policy instruments that currently exists in Sweden already target the mentioned barriers. Thus, it is important to continuously evaluate policy instruments to understand if they are effective and efficient, or if anything need to be changed to reach the targets of the policy instrument

Stick–slip motion and controlled filling speed by the geometric design of soft micro-channels

HypothesisLiquid can move by capillary action through interconnected porous materials, as in fabric or paper towels. Today mass transport is controlled by chemical modification. It is, however, possible to direct mass transport by geometrical modifications. It is here proposed that it is possible to tailor capillary flow speed in a model system of micro-channels by the angle, size and position of attached side channels.ExperimentsA flexible, rapid, and cost-effective method is used to produce micro-channels in gels. It involves 3D-printed moulds in which gels are cast. Open channels of micrometre size with several side channels on either one or two sides are produced with tilting angles of 10 – 170\ub0. On a horizontal plane the meniscus of water driven by surface tension is tracked in the main channel.FindingsThe presence of side channels on one side slowed down the speed of the meniscus in the main channel least. Channels having side channels on both sides with tilting angles of up to 30\ub0 indicated tremendously slower flow, and the liquid exhibited a stick-slip motion. Broader side channels decreased the speed more than thinner ones, as suggested by the hypothesis. Inertial forces are suggested to be important in branched channel systems studied here

Window dressing inequalities and constructing women farmers as problematic—gender in Rwanda’s agriculture policy

Rwanda is often depicted as a success story by policy makers when it comes to issues of gender. In this paper, we show how the problem of gendered inequality in agriculture nevertheless is both marginalized and instrumentalized in Rwanda’s agriculture policy. Our in-depth analysis of 12 national policies is informed by Bacchi’s What’s the problem represented to be? approach. It attests that gendered inequality is largely left unproblematized as well as reduced to a problem of women’s low agricultural productivity. The policy focuses on framing the symptoms and effects of gendered inequality and turns gender mainstreaming into an instrument for national economic growth. We argue that by insufficiently addressing the socio-political underlying causes of gendered inequality, Rwanda’s agriculture policy risks reproducing and exacerbating inequalities by reinforcing dominant gender relations and constructing women farmers as problematic and men as normative farmers. We call for the policy to approach gendered inequality in alternative ways. Drawing on perspectives in feminist political ecology, we discuss how such alternatives could allow policy to more profoundly challenge underlying structural constraints such as unequal gender relations of power, gender norms, and gender divisions of work. This would shift policy’s problematizing lens from economic growth to social justice, and from women’s shortcomings and disadvantages in agriculture to the practices and relations that perpetuate inequality. In the long term, this could lead to transformed gender norms and power relations, and a more just and equal future beyond what the dominant agricultural development discourse currently permits

The arboretum in Skäftekärr : history, inventory and action proposals

Arboretet i Skäftekärr ligger i Böda socken på norra Öland. Trädsamlingen ligger intill en jägmästarbostad som var bebodd från mitten av 1800-talet och ända fram till ungefär 1980. Då var Domänverket ägare av arboretet och ytterligare cirka 5000 hektar barrskog som täcker nästan hela norra delen av Öland. Området blev en kronopark under 1800-talet och idag är det en del av den nya ägaren, Sveaskogs, Ekopark Böda. Arboretet påbörjades under andra halvan av 1800-talet av dåvarande jägmästare J E Boman som var mycket intresserad av främmande växtmaterial. Han planterade in mängder av exoter och än idag står många av dessa träd kvar i arboretet. Det huvudsakliga syftet med detta arbete har varit att genomföra en inventering av trädindividerna i arboretet och utefter denna komma fram till förslag på åtgärder för platsens framtida utveckling. För att få en djupare förståelse om platsens geografi, klimat och historia har en litteraturstudie genomförts och presenteras före inventeringen i detta arbete. Inventeringen av arboretet förbereddes genom att granska en tidigare inventering som gjorts av platsen från 1999, genomföra ett par intervjuer bland annat med Björn Lüning som gjort den föregående inventeringen samt genom att ta fram de bedömningsgrunder som ansågs vara lämpliga att använda. Dessa var, förutom trädnummer, vetenskapligt namn och planteringsår: omfång i brösthöjd, vitalitet (skala A, B eller C där A är ett fullt vitalt träd, B är ett vitalt träd som behöver en åtgärd och C är ett träd som har stora skador och/eller ett allvarligt angrepp som snart kommer leda till dess död), åtgärd samt övrigt. Själva inventeringen gjordes under en vecka i april 2010 med ett par återbesök av platsen senare under våren. Arboretet delades in i sju olika områden. Varje delområde beskrivs övergripande och samtliga träds positioner är markerade på kartskisser. Efter detta sammanställdes inventeringsmaterialet och för att kunna få ett så bra upplägg som möjligt studerades ett par andra åtgärdsförslag och skötselmanualer. Studien resulterade så småningom i riktlinjer för åtgärdsförslag. Åtgärderna som sedan presenteras delas upp i två olika kategorier, dels de generella som gäller för hela parken och dels de specifika för de olika delområdena som parken utgörs av. I de sistnämnda finns även förslag till plantering av ett antal specifika trädindivider. De specifika förslagen baserades på de examensarbeten som diskuteras i riktlinjerna, tillsammans med en föreläsning i kursen Trädvård och Malmö stads skötselmanual. De generella förslagen baserades på Klaus Vollbrechts bok Träd – deras biologi och vård (2007). Åtgärdsförslagen visar på ett antal viktiga insatser i arboretet. Många gånger handlar det om beskärning, både uppbyggnadsbeskärning och riskbeskärning. Det handlar ofta också om att ge relativt nyplanterade träd alla förutsättningar för att kunna etablera sig väl, till exempel en ordentlig planteringsgrop och riktigt med vatten. Det föreslås även att många träd som planterades för cirka tio år sedan byts ut då de inte fått någon etableringsskötsel vilket lett till att de har dött eller håller på att dö. I arbetet behandlas endast träden i arboretet, alla buskar lämnas utanför både inventering och åtgärdsförslag. Detta på grund av att tiden inte räckte till men för att kunna sköta arboretet optimalt bör därför en inventering göras även av buskarna

(O)jämställd fysisk aktivitet

Landskapsarkitektur och fysisk planering påverkar det offentliga rummets utformning och därmed hur människorna i staden lever sina liv. Fokus för uppsatsen har varit att studera hur den offentliga miljön används av ungdomar eftersom det finns studier som visar på stora könsskillnader i nyttjandet av näridrottsplatser, där killar är starkt överrepresenterade (Blomdahl, Elofsson, Åkesson, 2012). Det finns även studier som visar på att den fysiska aktiviteten bland befolkningen har förskjutits från vardagen till fritiden (Faskunger, 2007) vilket ställer krav på den enskilde individens egna initiativ till motion och på utformningen av den byggda miljön. Fysisk planering och landskapsarkitektur kan således användas som verktyg för att skapa miljöer som stödjer fysisk aktivitet för alla, oavsett könstillhörighet. Målet med arbetet har varit att studera hur den offentliga miljön används av ungdomar utifrån ett genusperspektiv samt att undersöka hur ett genusperspektiv behandlas inom den fysiska planeringen med Lunds kommuns översiktsplan som praktiskt exempel. Arbetet har syftat till att ta fram ett kunskapsunderlag för hur landskapsarkitektur kan skapa förutsättningar för människor att leva på lika villkor i staden. Arbetet är uppdelat i tre delar. Den första delen utgörs av en litteraturstudie, vilken syftar till att besvara den fösta frågeställningen; hur kan en aktivitetsyta planeras och gestaltas med ett genusperspektiv? Den andra delen består av en studie av Lunds kommuns översiktsplan utifrån ett genusperspektiv samt en observationsstudie av aktivitetsytan Aktivia, för att besvara den andra frågeställningen; vilket resultat har de riktade satsningarna för att skapa en jämställd aktivitetsyta gett för användningen av Aktivia? Den tredje och sista delen syftar till att knyta ihop resultatet av de båda studierna för att jämföra hur aktivitetsytor för ungdomar används och approprieras i teorin jämfört med hur Aktivia används i praktiken. Resultatet av studierna visar att ett genusperspektiv kan involveras genom en långsiktig och processinriktad fysisk planering. Genom att arbeta med ett underifrånperspektiv, att identifiera kategorier och individer samt att involvera underrepresenterade grupper i planeringsprocessen kan en större variation i utformningen av det offentliga rummet skapas, vilket gör att det kan svara mot fler målgruppers preferenser. Med översiktsplaner som lyfter konkreta exempel kan kommuner visa på hur deras visioner kan bli förverkligade i den byggda miljön. På så sätt lyfts genusproblematiken till översiktligt nivå och den hierarkiska ordningen mellan översiktsplan och detaljplan kan kastas om, både tid- och planmässigt. Resultatet av observationsstudierna visar att Aktivia har en alternativ utformning som erbjuder funktioner och aktiviteter som skiljer sig från renodlade idrotter och idrottsplatser, vilket gör att platsen attraherar och svarar mot flera målgruppers preferenser. Platsens utformning stödjer fysisk aktivitet i bostadens närmiljö och möjliggör därmed fysisk aktivitet utanför den organiserade idrotten. Vissa könsskillnader har kunnat urskiljas vad gäller användningen, då tjejer ägnade sig åt mer stillsamma aktiviteter, medan killars aktiviteter var mer livliga. Även om fysisk planering kan skapa förutsättningar för en jämställd stad krävs omfattande samhälleliga insatser för att omkullkasta rådande samhällsstrukturer. Satsningar på exempelvis aktivitetsytor kan däremot bidra till att ett genusperspektiv lyfts till översiktlig nivå samt att på en lokal nivå skapa goda förutsättningar för människor att leva på lika villkor, vilket ungdomarna på Aktivia verkar göra, enligt resultatet av observationsstudien.Landscape architecture and spatial planning affect the design of the public environment and thus the way people in the city live their lives. The focus of the essay has been to study how the public environment is used by youths, as studies show major gender differences in the use of the public environment, where boys are highly overrepresented (Blomdahl, Elofsson, Åkesson, 2012). Studies also show that the physical activity of the population has shifted from everyday life to the free time (Faskunger, 2007) which requires the individual's own initiative for exercise, but also the possibility of physical activity in the public environment. Spatial planning and landscape architecture can thus be used as tools for creating environments that support physical activity for all, regardless of gender. The aim of the paper has been to study how the public environment is used by youths from a gender perspective and to investigate how the gender perspective is addressed in spatial planning with Lund municipality as an example. The purpose of the paper is to develop a knowledge base in order to provide possibilities for people to live on equal terms in the city. The paper is divided into three parts. The first part consists of a literature study, which aims to answer the first question; how can spatial planning involve a gender perspective in order to provide attractive places for physical activity? The second part consists of a study of Lund municipality based on a gender perspective and an observation study of Aktivia to answer the second question; what is the result of the venture to create a gender equality site for physical planning? The third and last part aims to merge the results of both studies to compare how sites are used and appropriated in theory, as compared to how Aktivia is used in practice. The results of the studies show that a gender perspective can be involved through a long-term and a process-oriented spatial planning. By identifying categories and individuals as well as involving underrepresented groups in the planning process, a greater variation in the design of the public environment can be created. With spatial planning documents that highlight practical examples, municipalities can show how their visions can be realized in the built environment. In this way the inequality between women and men is raised to an overview level and the hierarchical order between the comprehensive plan and the detailed development plan can be reversed. The result of the observation studies shows that Aktivia has an alternative design that offers activities that differ from pure sports and sports venues, which makes the site attractive for several target groups, although some gender differences have been distinguished in terms of use. The site supports physical activity in the residential and community setting and enables physical activity outside the compound sporting. Although spatial planning can create conditions for an equal city, extensive social efforts are required to overcome social structures. Ventures as Aktivia may contribute to raising a gender perspective to an overview level and to the comprehensive plan, in order to create good conditions for women and men to live in the city on equal terms, as the girls and boys at Aktivia seems to do, according to the results of the observation study