EVALUATING TELEMEDICINE IN RURAL SETTINGS: ISSUES AND APPLICATIONS

Changes in health care policies, demographics, and technology have presented new opportunities for the delivery of medical care services and information to rural communities. Telemedicinethe use of electronic information and communications technologies to provide and support health care when distances separates the participantsis one technology that has impacted the efficiency of delivery of rural health care services. This paper presents an overview of the telemedicine technologies, government involvement in support of telemedicine, evaluation efforts to date for these technologies, and issues that need to be addressed in designing an economic-based framework to evaluate the net benefits of telemedicine technologies to rural communities and consumers. An evaluation framework needs to be capable of quantifying the tradeoffs among access to health care services, the costs of delivery of a given level of services, and changes in the quality of the service that is being delivered via electronic communications; and how these tradeoffs shift as the level of telemedicine and the technology changes. The framework that is proposed is based on models of consumer behavior that incorporate discrete choices among quality differentiated sites.rural health care, telemedicine, averted costs, economic benefits, telecommunications technology, R0, Community/Rural/Urban Development, Health Economics and Policy, I1,

EVALUATING TELEMEDICINE TECHNOLOGIES IN RURAL SETTINGS

Changes in health care policies, demographics, and technology have presented new opportunities for the delivery of medical care services and information to rural communities. Telemedicinethe use of electronic information and communications technologies to provide and support health care when distance separates the participantshas significantly impacted the delivery of rural health care services. This paper presents an overview of the telemedicine technologies, government involvement in support of telemedicine, and issues that need to be addressed in designing an economic framework to evaluate the net benefits of telemedicine to rural communities and consumers. Federal and state governments have invested millions of support dollars in the form of equipment, infrastructure, and incentives for consumers and providers to expand the use of telecommunications in medical care. Since disbursement of these funds is already underway, it only makes sense to develop a method to determine both where and whether an additional dollar of funding for telemedicine development would be of the greatest benefit to society. If telemedicine can prove itself as a useful method for improving the likelihood of survival of rural hospitals, then, in the interest of rural development, it may be a technology worth investing in; i.e., the social benefits, measured as the sum of the private and public benefits, may outweigh the costs. According to its supporters, telemedicine systems have the potential to simultaneously address several problems characteristic of health care in rural areas, including access to care, cost containment, and quality assurance. Access can be improved by linking providers in remote areas with specialists in metropolitan centers or peers in rural areas. Telemedicine not only enables a wider range of services to be offered in the local community but may have the added effect of improving physician retention in isolated areas, one of the primary challenges in maintaining access for frontier medical centers. Telemedicine can promote cost containment through the substitution of lower-cost rural providers and facilities. Ideally, improved quality will be achieved by the ready availability of consultations and referrals. These are the potential benefits of telemedicine implementation, but they have not yet been verified by research in a field setting. An evaluation framework for telemedicine needs to be capable of modeling changes in the behavior of health care consumers (i.e., altered visitation patterns), recognizing differences in quality of service, and finally, quantifying the value of these changes. This is no small task, and obtaining the required data will likely require the cooperation of many parties, including health care providers, patients, hospital and program administrators, and policymakers. These are the same groups that could benefit greatly from a better understanding of how telemedicine technologies affect health care delivery, but a meaningful framework for analysis needs to capture the many aspects of telemedicine implementation.rural health care, telemedicine, averted costs, economic benefits, telecommunications technology, R0, Community/Rural/Urban Development, Health Economics and Policy, Research and Development/Tech Change/Emerging Technologies, I1,

Universal Design: Planning and Design for All

[Excerpt] This report attempts to develop and illustrate the concept of universal design. The aim of universal design is to develop theory, principles and solutions to enable everybody to use the same physical solutions to the greatest extent possible, whether it be buildings, outdoor-areas, means of communication or household goods. Universal design opposes, ideologically and politically, all unnecessary and stigmatizing specialized solutions, whether they are intended for people with disabilities or other groups of the population. Equal status, equal treatment and equal merit are key concepts. The discussion in this report covers extensive spheres such as planning, architecture and product design. One may object that we try to cover too large an area within a relatively brief report. It is therefore important to emphasise that our main intention is to include more professionals and politicians in the further discussion of universal design or design for all

Spis ikke, med mindre helsa eller miljøet blir bedre! Om utviklingen i norske forbrukeres holdninger til genmodifisert mat

I denne artikkelen drøfter vi hvordan norske forbrukeres holdninger til genmodifisert mat har endret seg gjennom årene. Allerede da genteknologi ble etablert som et eget forskningsfelt og utviklingsområde på 1980-tallet, viste den norske opinionen stor skepsis. Den norske lovgivningen tidlig på 1990-tallet utmerket seg også som den mest restriktive i Europa. Dette bildet endret seg ikke mye i løpet av 1990-tallet, mens opinionen i mange europeiske land i disse årene kom mer på linje med den norske. I hele denne perioden var både forbrukeropinionen og lovgivningen i USA langt mer aksepterende enn i Europa, noe som ga seg utslag i en handelskonflikt som toppet seg med EU sitt moratorium for utsetting av genmodifiserte planter i 1999. I denne artikkelen stiller vi spørsmålet om norske forbrukeres holdninger til genmodifisert mat har endret seg de siste årene. Artikkelen viser at mellom 2002 og 2007 er det en voksende gruppe av forbrukere som ser ut til å akseptere genmodifiserte matvarer hvis det fører til en helse- eller miljøgevinst (mindre sprøytemidler). Men til tross for dette så er nordmenn fremdeles skeptiske til genmodifisert mat. Det kan tolkes slik at genmodifisert mat ikke har ført til den nytten som ansees nødvendig for å ta den risikoen det innebærer å gjøre et betydelig skifte i matseddel. Matpatriotisme og en kulturell konservatisme når det gjelder skifte i matvaner bidrar også til å forklare den dominerende vente-og-se-holdningen.© 2009 the author

Hydroacoustic Channel Emulator - HACE

Kongsberg Maritime wanted a channel emulator for testing their hydroacoustic equipment before deploying it at sea. The benefits of such a system are that it detects problems in an earlier phase of development, thus conveniently reducing the number of expensive sea trials necessary. This master thesis describes how a channel emulator with hydroacoustic properties can be made. The emulator will replace the transducers and water with a computer simulating the acoustics, an audio interface and voltage attenuation. Our approach has been to develop a stable and user-friendly channel emulator with a basis in acoustic wave theory. The hydroacoustic channel emulator, HACE, includes acoustic simulation models where the user is allowed to change acoustic parameters and place the positions of transducers for both point-to-point and network communication. This thesis has focused on advanced acoustic models such as Doppler spread, surface scatter, varying seabed and surface in 3D, sound speed profile with ray tracing, and network communication, together with the fundamental models such as, propagation loss and delay, and reflections. In order to meet the requirements of this master s thesis, with respect to latency and jitter, a good programming platform is important. MATLAB was chosen due to the huge library of built-in-functions, especially with respect to digital signal processing. To control the system a user interface was created with the focus on simplicity, where the interface allows the user to control the system and adjust parameters. The real-time requirement for the system was a latency with a maximum of 100 ms. Since the latency is dependent on both software and hardware, and varies from setup to setup, a calibration function was developed to ensure the best performance for each individual system. HACE has full control over the system latency and exploits it when adding the propagation delay. The minimum latency was measured as 34.2 ms, which resulted in a minimum distance between two nodes using a sound speed of 1500 m/s, being 51.3 meters. For the system to model other distances correctly, this latency must be taken into account when adding propagation delay. Ideally, zero latency would have been preferred so that all distances could be simulated. Two tests were performed to determine the performance of the total system, one that compared the real world impulse response with the simulated impulse response, and secondly to verify the propagation delay in HACE against the measured distance from APOS. The results showed that the simulated ranges corresponded well with the ranges measured in APOS, with an offset of around 20 cm throughout all the results. Impulse response measurements were performed at a sea trial in Horten (Breiangen) measuring at horizontal ranges from 0 to 3000 meters between two nodes. Results from the sea trial compared with those of HACE showed very good similarities between the two, with time deviations between the first and second arrival being from 0 - 3 ms (0 to 15 %), where the largest deviations were found at the shortest ranges

Overweight and obesity among children in rural areas: The importance of culture

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Lykkeligst alene? Om årsaker til små driftsenheter i norsk laksefiske

Driftsenhetene i de norske lakseelvene, i laksefisket omtalt som laksevald, er ofte små, og kan ha begrensede forutsetninger for å tilfredsstille sportsfiskernes kvalitetskrav til laksefiskeopplevelsen. En sterk nedgang i villaksbestanden de siste 40 årene har antakelig redusert bruksverdien av små laksevald ytterligere. Fiskerettshaverne, som i hovedsak er eiere av landbrukseiendommer, har i liten grad søkt å inngå i større driftsenheter som en tilpasning til dette. Oppgaven har følgende forskningsspørsmål: * Hvilke faktorer påvirker fiskerettshaveres motivasjon for å la seg inngå i større driftsenheter? * Hvilke tiltak kan legge til rette for driftsenheter som er bedre egnet for laksefiske? Svarene har betydning i et større perspektiv enn kun laksefiskeopplevelsen. Laksefisket med tilhørende ringvirkninger kan hevdes å være grunnleggende i en bærekraftig lakseforvaltning, da det både genererer ressurser til det lokale forvaltningsarbeidet i elveeierlagene, i tillegg til å gi laksefiskere og andre i opinionen motivasjon til aktivisme og engasjement på vegne av villaksen. Forskningsspørsmålene har blitt belyst gjennom intervju med elleve fiskerettshavere fra lakseelvene Fusta og Nausta. Felles normer og innarbeidet praksis for utleie av laksefiske hadde betydning for fiskerettshavernes adferd. Å handle på tvers av lokale normer kan innebære transaksjonskostnader, i form av tankevirksomhet, tidsbruk og andre immaterielle belastninger. Utsikter til forbedret økonomi, som kan oppveie for transaksjonskostnadene, blir dermed en viktig faktor i en vurdering av å la seg inngå i en større driftsenhet. Ulike interesser og ressurser blant fiskerettshavere kom også fram som en potensielt kompliserende faktor. Studien fant i tillegg at en følelse av redusert selvstendighet ved å involvere andre i beslutninger om utnyttelse av fiskeretten, antakelig bidrar til å befeste den oppstykkede valdstrukturen i norske lakseelver. Informantene i studien pekte på tilførsel av kunnskap som et mulig tiltak for å stimulere til større driftsenheter. Ekstern og offentlig finansiert eksperthjelp kan formidle erfaringer fra vellykkede eksempler, og initiere og veilede prøveprosjekt for valdsamarbeid. Offentlige reguleringer som tvinger fram større driftsenheter kan også være akseptabelt for fiskerettshaverne, såfremt det følger goder med som gjør reguleringen fordelaktig totalt sett for de som blir berørt. Offentlige myndigheter anbefales å vurdere de forvaltningsmessige fordelene ved større driftsenheter i laksefisket. Reguleringstiltak foreslått fra tidligere forskning bør utredes, herunder minimumsstørrelse på laksevald og lettere adgang til fradeling og omsetning av fiskeretter. I tillegg lanserer denne oppgaven to nye reguleringstiltak som kan vurderes: (1) Totalkvote for vassdrag fordelt ned på de enkelte fiskerettene. (2) Forbud mot å holde tilbake fiskeretter kun for eget bruk. Videre forskning bør se nærmere på erfaringer fra fiskesameier, samt undersøke hva fisketurismeentreprenører, lokale NJFF-lag og andre produktutviklere som ser flere fiskeretter i sammenheng i større driftsenheter, mener kan legge til rette for denne typen organisering.Since salmon beats in Norwegian rivers are typically small, satisfying the demands of anglers is challenging. Moreover, a strong decline in the stocks of Atlantic salmon over the last 40 years has probably further reduced the usefulness of small salmon beats. The holders of fishing rights, who are predominantly owners of farm properties, have to a limited degree so far sought to adapt to this situation by pooling those fishing rights. This thesis explores two research questions: * Which factors influence the fishing rights holders’ motivation to allow their fishing to become part of larger salmon beats? * What measures might encourage the establishment of larger salmon beats? The answers are helpful, not merely from a salmon fishing perspective. It can be argued that salmon fishing as an enterprise is key for the successful conservation of the species as it generates funds for the conservation work undertaken by the associations of river owners. It also fuels the motivation of anglers and other stakeholders to influence policy making. The research questions have been investigated through interviews of eleven fishing rights holders in the Fusta and Nausta rivers. Shared norms for how fishing have been let were found to have influenced attitudes. In contrast not acting in accordance with local norms might induce transaction costs in the form of concerns, excess time use and other non-material burdens. One important factor is the prospect of increased profits which could outweigh the transaction costs. The asymmetrical interests and resources among fishing rights holders were found to be a factor which might challenge co-operation. In addition, a feeling of reduced autonomy by involving others in the decision-making over a private property right appeared to consolidate the overall fragmented structure of the salmon beats in Norwegian rivers. The participants in this study pointed to the transfer of knowledge as a possible means of stimulating the establishment of larger salmon fishing beats. Government-funded experts are able to provide information from successful examples of salmon beat collaboration as well as facilitating local test projects. The fishing rights owners would consider governmental regulations as an acceptable means for establishing larger salmon beats provided that such regulations included benefits which made the new outcome advantageous. It is recommended that the authorities consider the conservation benefits which could arise from the establishment of larger salmon beats. Regulations proposed in previous research should be looked at more closely, such as a minimum size for salmon beats and an easier way to sell and acquire fishing rights. This thesis offers two further types of regulation: (1) The total permitted catch for rivers, distributed per beat. (2) Making it illegal to reserve beats solely for personal use. Future research is recommended to investigate both the experiences from common fishing rights ownership and the needs identified by fishing tourism entrepreneurs and others who develop products by pooling several fishing rights

Støy i tilrettelagt enhet på sykehjem

Støy blir omtalt som en betydelig helseutfordring for mennesker i dag. Det beskrives utfordringer blant annet i forhold til støy ved utvikling av nye boligprosjekter, i skoler og barnehager. Denne studien har undersøkt støy på kommunale sykehjem

‘Godt foreldreskap’ i middelklassefamilier: En narrativ posisjoneringsanalyse av norske barnevernsarbeideres fortellinger

This article investigates norms of parenting in the context of the Norwegian child welfare service (CWS). Research from both international and Norwegian contexts shows that current parenting ideals are built on middle-class values that are often taken for granted. However, there is limited knowledge about the interaction between the CWS and middle-class families. Through narrative positioning analysis, we explore how child welfare workers (CWWs) construct the identities of two middle-class families in contact with the service and how the CWWs’ ideals about parenting are expressed through these stories. Both families are positioned as well-off, and the CWWs provide classed and gendered descriptions of the parents that coincide with dominant narratives of intensive mothering. As clients, the parents are constructed as active adaptive agents and active expert agents. The CWWs relationally construct themselves as a catalyst for change and as a support. The analysis provides insight into how the middle-class ideal is almost unnoticeably being solidified as a standard, and we metaphorically see the interaction between the parents and the CWS as ‘status maintenance ceremonies’. We argue that a narrative positioning analytical framework can be further developed and used to increase reflection on social work practice and education.Denne artikkelen utforsker normer for foreldreskap i en norsk barnevernskontekst. Både internasjonal og norsk forskning viser at foreldreskapsidealer er bygget på middelklasseverdier som ofte tas for gitt. Samtidig finnes det begrenset kunnskap om interaksjonen mellom barnevernet og middelklassefamilier. Gjennom en narrativ posisjoneringsanalyse utforsker vi hvordan barnevernsarbeidere konstruerer identitetene til to middelklassefamilier som er i kontakt med tjenesten, og hvordan barnevernsarbeidernes idealer om foreldreskap uttrykkes gjennom disse narrativene. Analysen viser at begge familiene posisjoneres som ressurssterke, og barnevernsarbeiderne gir klassebaserte og kjønnede beskrivelser av foreldrene som samsvarer med dominerende normer for intensivt moderskap. Som klienter blir foreldrene konstruert som tilpasningsdyktige aktive aktører og aktive ekspertaktører. Barnevernsarbeiderne posisjonerer seg selv relasjonelt som katalysator for endring og som støtte. Analysen gir innsikt i hvordan middelklasseidealet nesten umerkelig blir konsolidert som en standard, og vi ser metaforisk på samhandlingen mellom foreldrene og barnevernsarbeiderne som ‘seremonier for opprettholdelse av status’ (‘Status maintenance ceremonies’). Vi argumenterer for at narrativ posisjoneringsanalyse kan videreutvikles og brukes for å øke refleksjonen i sosialt arbeid i praksis og utdanning