Hindringer og suksesskriterier for implementering av kvalitetshjulet.no i Gjesdal kommune

Vi lever i en digital tidsalder der omlegging til digitale prosesser i det offentlige skyter fart. Det blir utviklet digitale verktøy med lovnad om å øke effektiviteten og høyne kvaliteten på produksjon av tjenester. Kvalitetshjulet som er utviklet av Gjesdal kommune er et digitalt verktøy utviklet for dette formålet, og for å sikre høy kvalitet av samspillet mellom voksne og barn i de kommunale barnehagene. Dette forskningsprosjektet har til hensikt å utforske hvordan implementering av et digitalt verktøy har foregått og hvordan den er tilpasset de ansattes arbeidskontekst og kultur. Problemstillingen jeg har utformet er «Hindringer og suksesskriterier for implementering av kvalitetshjulet.no i Gjesdal kommune». For å besvare denne problemstillingen har jeg utar-beidet 4 forskningsspørsmål som tar for seg hvordan implementeringsprosessen har foregått, hvilke hindringer som gjør seg gjeldende og hvilke suksesskriterier som må ligge til grunn for å lykkes med prosessen. Forskningsprosjektet er basert på en innledende casestudie av prosessen som Gjesdal kommune har vært gjennom fra de definerte et behov for en digital plattform i 2019, og følger implementeringsprosessen fra utvikling og fram til hvordan bruken i barnehagene er i dag. Det videre datagrunnlaget er basert på kvalitativ metode, feltsamtaler og interne prosessdokumenter. Det ble gjennomført intervjuer med kvalitetsutvikler, barnehagesjef, og ansatte i to utvalgte barnehager bestående av styrere, pedagogiske ledere, fagarbeidere og assistenter. Det teoretiske rammeverket består av implementeringsteori basert på en hierarkisk forståel-sesramme, translasjonsteori, Lærende organisasjoner, Lean-ledelse og Teori U. Konklusjonen dette forskningsprosjektet har kommet fram til er kort oppsummert, at nød-vendige suksesskriterier for å lykkes med implementeringen i alle kommunale barnehager, er at de ansatte har en forståelse av at kvalitetshjulet ikke er én organisasjonsside som kan stå alene. Det er et verktøy i en endringsprosess som involverer implementering av Lean-metodikk og metode for kompetanseheving for å nå et høykvalitetsmål. For å overkomme hindringer for bruk av kvalitetshjulet, vil det være nødvendig med lokale tilpasninger som møter en barnehagekontekst styrt av lovverk og rammebetingelser. Lederne i barnehagene har en avgjørende rolle for å holde liv i endringsprosessene, men dette avhenger av at ledere på alle nivå får nødvendig opplæring i Lean-ledelse. Forskningsleder har ledet to samskap-ningsgrupper basert på et tverrsnitt av de ansatte i barnehagen for å presentere Teori U som metode for å skape løsninger og nye visjoner i fellesskap. Dette møter suksesskriteriet som handler om å motivere og føle eierskap slik at alle ansatte i barnehagen tar ansvar for endringsprosessene.We live in a digital age where the transition to digital processes in the public sector is gaining momentum. Digital tools are being developed with the promise of increasing efficiency and improving the quality of service production. Kvalitetshjulet.no developed by Gjesdal municipality is a digital tool developed for this purpose, and to ensure high quality of interaction between adults and children in kindergartens. This research project aims to explore how the implementation of a digital tool has taken place and how it is adapted to the employees’ work context and culture. The main research question I have formulated is Obstacles and success criteria for the implementation of kvalitetshjulet.no in Gjesdal municipality. To answer this research question, I have formulated 4 underlying questions that address how the implementation process has taken place, what obstacles are present and what success criteria must be in place to succeed with the process. The research project is based on an introduction case study of the process that Gjesdal municipality has gone through since they defined a need for a digital platform in 2019, and follows the implementation process from development to how it is used in kindergartens today. Further data is based on a qualitative research method, field conversations and internal process documents. Interviews were conducted with the quality developer, kindergarten manager, and employees in two selected kindergartens consisting of managers, educational leaders, skilled workers and assistants. The theoretical framework consists of implementation theory based on a hierarchical understanding framework, Translation theory, Lean learning organizations, Lean leadership and Theory U. The conclusion this research project has come to is that the necessary success criteria for succeeding with the implementation in all municipal kindergartens is that the employees have an understanding that «Kvalitetshjulet» is not just one organizational ide that can stand alone. It is a tool in a change process that also involves the implementation of lean methodology for use in competence development to achieve a goal of high standard practice. To overcome obstacles in the use of Kvalitetshjulet, local adaptations that meet a kindergarten context governed by legislation and framework conditions will be necessary. Kindergarten leaders play a crucial role in keeping the change processes alive. To achieve this leaders at all levels must receive necessary training in Lean leadership. The research leader has led two co-creating workshops based on a cross-section of kindergarten employees to present Theory U as a method for being visionary and creating solutions together. This meets the success criterion of being able to motivate and create ownership so that all kindergarten employees take responsibility for the change processes

Fatigue after initiating rivaroxaban for venous thromboembolism

Background Rivaroxaban was the first new oral anticoagulant approved for treatment of venous thromboembolism (VTE). Clinical trials have shown that rivaroxaban is noninferior to conventional anticoagulation for VTE in efficacy and safety. Increased fatigue after the initiation of rivaroxaban has been observed in clinical practice, but data on this potential side effect are lacking. Objective The study aimed to evaluate development of fatigue in patients treated for VTE, comparing rivaroxaban to other anticoagulants. Methods Patients were prospectively recruited after a diagnosis of VTE. The Fatigue Questionnaire was used to determine the level of fatigue at baseline, at 3 weeks of treatment, and either at 1 month after the discontinuation of treatment if the treatment was discontinued after 3 months or at 6 months if treatment was continued beyond this time. Data was analyzed by a linear mixed model. Results A total of 126 patients were included. Mean age was 59 years; 77 (61%) were males. Fifty‐seven patients (45%) were diagnosed with deep vein thrombosis, 48 (38%) with pulmonary embolism, and 21 (17%) with both. Predicted changes in fatigue scores from baseline to the last measurement were −0.007 and −2.49 for the rivaroxaban and the other‐anticoagulants groups, respectively, neither of which were statistically significant. No difference was detected between rivaroxaban and the other‐anticoagulants group at any time point, including subgroup analysis comparing over and under 6 months of treatment duration. Conclusion In this small study, our results suggest no increase in the level of fatigue after the initiation of treatment with rivaroxaban for VTE.publishedVersio

Novel mutation-deletion in the PHOX2B gene of the patient diagnosed with Neuroblastoma, Hirschsprung's Disease, and Congenital Central Hypoventilation Syndrome (NB-HSCR-CCHS) Cluster

INTRODUCTION: Neuroblastoma (NB), Hirschsprung disease (HSCR), Congenital Central Hypoventilation Syndrome (CCHS), clinically referred as the NB-HSCR-CCHS cluster, are genetic disorders linked to mutations in the PHOX2B gene on chromosome 4p12. SPECIFIC AIM: The specific aim of this project is to define the PHOX2B gene mutations as the genomic basis for the clinical manifestations of the NB-HSCR-CCHS cluster. PATIENT: A one day old male patient presented to the Jagiellonian University Medical College (JUMC), American Children Hospital, neonatal Intensive Care Unit (ICU) due to abdominal distention, vomiting, and severe apneic episodes. With the preliminary diagnosis of the NB-HSCR-CCHS, the blood and tissue samples were acquired from the child, as well as from the child’s parents. All procedures were pursued in accordance with the Declaration of Helsinki, with the patient’s Guardian Informed Consent and the approval from the Institutional Review Board. GENETIC/GENOMIC METHODS: Karyotyping was analyzed based upon Giemsa banding. The patient’s genomic DNA was extracted from peripheral blood and amplified by polymerase chain reaction. Direct microfluidic Sanger sequencing was performed on the genomic DNA amplicons. These procedures were pursued in addition to the routine clinical examinations and tests. RESULTS: G-banding showed the normal 46 XY karyotype. However, genomic sequencing revealed a novel, heterozygous deletion (8 nucleotides: c.699–706, del8) in exon 3 of the PHOX2B gene on chromosome 4. This led to the frame-shift mutation and malfunctioning gene expression product. CONCLUSION: Herein, we report a novel PHOX2B gene mutation in the patient diagnosed with the NB-HSCR-CCHS cluster. The resulting gene expression product may be a contributor to the clinical manifestations of these genetic disorders. It adds to the library of the mutations linked to this syndrome. Consequently, we suggest that screening for the PHOX2B mutations becomes an integral part of genetic counseling, genomic sequencing of fetal circulating nucleic acids and / or genomes of circulating fetal cells prenatally, while preparing supportive therapy upon delivery, as well as on neonates' genomes of intubated infants, when breathing difficulties occur upon extubation. Further, we hypothesize that PHOX2B may be considered as a potential target for gene therapy

Acute molecular responses to concurrent resistance and high-intensity interval exercise in untrained skeletal muscle

Concurrent training involving resistance and endurance exercise may augment the benefits of single-mode training for the purpose of improving health. However, muscle adaptations, associated with resistance exercise, may be blunted by a subsequent bout of endurance exercise, via molecular interference. High-intensity interval training (HIIT), generating similar adaptations to endurance exercise, may offer an alternative exercise mode to traditional endurance exercise. This study examined the influence of an acute HIIT session on the molecular responses following resistance exercise in untrained skeletal muscle. Ten male participants performed resistance exercise (4 9 8 leg extensions, 70% 1RM, (RE)) or RE followed by HIIT (10 x 1 min at 90% HRmax, (RE+HIIT)). Muscle biopsies were collected from the vastus lateralis before, 2 and 6 h post-RE to determine intramuscular protein phosphorylation and mRNA responses. Phosphorylation of Akt (Ser473) decreased at 6 h in both trials (P < 0.05). Phosphorylation of mTOR (Ser2448) was higher in RE+HIIT (P < 0.05). All PGC-1a mRNA variants increased at 2 h in RE+HIIT with PGC-1a and PGC-1a-ex1b remaining elevated at 6 h, whereas RE-induced increases at 2 and 6 h for PGC-1a-ex1b only (P < 0.05). Myostatin expression decreased at 2 and 6 h in both trials (P < 0.05). MuRF-1 was elevated in RE+HIIT versus RE at 2 and 6 h (P < 0.05). Atrogin-1 was lower at 2 h, with FOXO3A downregulated at 6 h (P < 0.05). These data do not support the existence of an acute interference effect on protein signaling and mRNA expression, and suggest that HIIT may be an alternative to endurance exercise when performed after resistance exercise in the same training session to optimize adaptations

“When you think like the state” : the political ecology of pastoral modernization in Finnmark, Norway

Reindeer herding in Norway is an indigenous pastoral livelihood exclusive to the Sámi people. The regulation of this source of livelihood by the Norwegian state intensified with the introduction of a new law and policy from the late 1970s. As a result of this increased state control and management of the reindeer industry, the Ministry of Agriculture and Food, working through the Reindeer Herding Administration, has in particular focused on increasing the sustainability and productivity of the industry. This has led to an overall aim of increasing meat production through implementing a bioeconomic model called the Røros model. The model, which has been promoted through economic incentives and information work entails reductions in reindeer numbers, the altering of herd structures and increased calf slaughter. Many reindeer herders have contested these recommendations. They claim that the model undermines the traditional knowledge that has been, and still is, accumulated and reproduced through experience in the herders’ own social institutions. Through qualitative interviews with reindeer herders in Finnmark I have explored such indigenous perspectives on herd structuring. Findings revolve around the following key issues: the products derived from reindeer husbandry; the importance of herd structure for coping with critical climatic events; and the role of the various animal categories. While the scientific criteria of the Røros model are presented as universal criteria by the promoters of this model, the herders own criteria seem to result from local contexts, with specific adaptations conditioned by heterogeneous landscapes. The second part of the thesis is a quantitative study, which assesses the scientific uncertainty behind the claim that reindeer herding operates in a stable and predictable environment, which is a premise of the Røros model. I argue that methodology applied by the Ministry and the Reindeer Administration for calculating maximum stocking rates is unreliable. The thesis is a contribution to the political ecology of environmental governance in Norway. Political ecology provides critical tools for analyzing human-environment issues. Through perspectives provided by Scott (1998), Li (2007) and Ferguson (1994), the management of reindeer husbandry is understood as a process that simplifies reality to create legibility and to implement policy through technically defined criteria. This is a process that expands the power of bureaucracies and which promotes scientific solutions in a narrow and technical sense to problems that are imbued with questions of politics and power. The thesis is not an argument against the Røros model as such. The thesis is rather a critique of the model’s claimed general applicability. I want to direct attention to the importance of the local context and the expert knowledge that the herders hold about their own landscapes.M-IE

Regional Study of the Stø Formation (Toarcian-Bajocian) in and around the area of the Fingerdjupet Subbasin, SW Barents Sea.

Postponed access: the file will be accessible after 2021-06-03Masteroppgave i geovitenskapGEOV399MAMN-GEO

Trykksensor interface kort

Bakgrunnen for hovedprosjektet er at ABB Robotics er i gang med et kostnad – og reduksjonsprosjekt; ” Step Change”. De vil med dette prøve å skifte ut gamle og dyre innkjøpte løsninger med nye egenproduserte løsninger som skal være billigere og bedre. Vi utarbeidet oppgavetekst og tittel ut ifra oppgaven vi fikk av ABB. Rapporten er en dokumentasjon på løsningene vi har kommet fram til. Oppgaven går ut på å lage et alternativ til den gamle løsningen, som hovedsaklig baserer seg på innkjøpte Exi barrierer. Exi barrierene er svært dyre. Oppgaven vil omfatte følgende problemstillinger med løsning: Vårt kretskort er et grensesnitt mellom trykksensorene og et eksternt kort. Kortet er supplert med 24 V eksternt. Denne blir videre brukt til å lage de andre spenningene vi trenger. For å løse dette brukte vi spenningsregulatorer. Trykksensorene står i et eksplosjons farlig område og derfor måtte vi begrense spenningene og strømmene ut til dette området, slik at antennelsesenergien ut er under 60 µJ. Dette løste vi ved å begrense spenningen til 5 V og strømmen til 33,3 mA ut til trykksensorene. Energien er da langt under grensen. Signalet fra trykk sensorene er på 0-100 mV. Et krav fra ABB er det skal ha en offsetjustering på ± 100 mV. Trykksensorsignalet er svært lite. Ved hjelp av en opamp og et nettverk av motstandere forsterket vi signalet og løste offsetjusteringen. Dette medførte at vi får et område på 300 mV inn til A/D omformeren. Arbeidsområdet til trykksensoren er bare 100 mV og derfor gikk vi opp fra en 12 bit A/D omformer som ABB har i den gamle løsningen til en 14 bit A/D omformer. Dette for å tilfredsstille ABBs krav til oppløsning. For å ha en plass til å lagre de målte verdiene valgte vi en mikrokontroller. Kravet til mikrokontrolleren var at den skulle ha to SPI linjer, for kommunikasjon med A/D omformeren og det eksterne kortet. I tillegg måtte den kunne programmeres med ABBs eksisterende programmeringsverktøy. For kommunikasjon med det eksterne kortet hadde vi flere valgmuligheter. En mulighet var å lage zenerbarriere slik at eventuelle feil fra det eksterne kortet ikke skulle kunne gi en eksplosjon, eller vi kunne lage et galvanisk skille. Vi valgt å lage et galvanisk skille ved hjelp av fiberoptiske kabler, dette er en svært moderne og billig løsning. Vi måtte sikre oss mot at 230 V AC kunne komme inn på kortet vårt ved en eventuell ekstern feil. Vi prøvde å løse dette selv uten å komme fram til en løsning som ville la seg realiseres. Dermed valgte vi en løsning som ABB har benyttet på et annet kretskort. Vi sjekket at sikringen ville ryke før vi får 230 V AC inn i det eksplosjonsfarlige område

MYC-driven Medulloblastoma : New Targeted Therapies and Mechanisms of Recurrence

Medulloblastoma is the most common malignant brain tumor of childhood. It arises in the posterior fossa but presents with distinct histological and molecular features. Hence, medulloblastoma is divided into four molecular subgroups, WNT, SHH, Group 3, and Group 4. The overall 5-year survival is ~70% across subgroups but varies with high- and low-risk disease. Standard treatment of medulloblastoma consists of maximal safe tumor resection, radiotherapy, and adjuvant chemotherapy. Despite the rather high success rate of treatment for many patients it also comes with severe long-term debilitating side effects.  MYC proteins are master regulators of gene expression often deregulated in cancer. MYC family members MYC and MYCN share similar roles and are found overexpressed or amplified in most medulloblastoma subgroups and correlate with a poor prognosis.  Medulloblastoma dissemination and recurrence patterns differ between subgroups but are always associated with a poor prognosis. Recurrent medulloblastoma is not yet curable and will lead to death.  In this thesis, we present the first transgenic mouse model of medulloblastoma recurrence and highlight the role of the transcription factor SOX9 in MYC-driven relapse mechanisms. By studying this recurrence model and matched primary-recurrent patient samples we propose a mechanism in which treatment-refractory and quiescent SOX9-positive cells in Group 3 medulloblastoma are necessary for tumor relapse, and how the recurrent tumors can be specifically treated with MGMT inhibitors and doxorubicin. In addition, we address efficient treatment options of primary MYC-driven medulloblastoma where BET bromodomain inhibition (JQ1) in combination with CDK2 inhibition (milciclib) of human Group 3 medulloblastoma will lead to apoptosis and prolonged survival of xenografted mice. This is explained by a dual hit on MYC transcriptional output and MYC protein stability exerted by JQ1 and milciclib respectively. Finally, in a different novel transgenic model of MYC-driven medulloblastoma, we show how temporal Cdk2 knock-out has no effect on MYC protein stability but slows down proliferation and prolongs survival of allografted mice.  The need for better treatments and increased understanding of recurrent medulloblastoma is huge. To that end, this thesis focuses on and addresses novel treatments, the role of the cell cycle protein CDK2 as well as relapse mechanisms depending on dormant SOX9-positive cells in highly aggressive MYC-driven medulloblastoma