Organisational culture and information systems implementation: a critical perspective

This research explores how information systems (IS) implementation is accomplished when cultural change of an organisation is attempted and what this accomplishment means for those touched by it. Efforts of this kind are being made in the UK National Health Service (NHS), Where modernisation programmes involving technological rationalisation and change are aiming to make the NHS more responsive to contemporary public demands. This study focuses on the ambulance services and specifically on a history of IS implementation efforts over 20 year at the largest and most appraised of the English services, the London Ambulance Service (LAS). A perceived need for cultural change involving the use of advanced information technologies is pervasive in managerial and ministerial discourses about modernising the health service. Yet the way that ambulance services are regulated and monitored has given rise to a modernisation programme in which cultural change and IS implementation have been conceived largely instrumentally in terms of achieving performance targets. Moreover, goals to which the modernisation efforts aspire are at most partially realised. Organisational change is uneven, and the performance improvements achieved are contradictory, and this is not only true in London but elsewhere in the UK. Drawing from organisational theory and critical social theory, past IS implementation efforts at the LAS are reinterpreted in light of recent developments, with contributions to theory and practice in mind. The theoretical contribution rests in exploring how emotion as well as rationality may be conceptualised to examine historically and culturally constituted working practices. Implications for practice address how IS implementation can give rise to cultural fragmentation, and also how professional identity can constrain IS innovation. Finally, the research contributes to a current debate about the future for ambulance services and the mechanisms used to evaluate their performance

Changing Models of Healthcare Provision in Britain: How Can ICTs Contribute to This Process

My research in progress is informed by the view that the implementation and use of ICTs is deeply intertwined with changes in organisational structures and practices. Hence the new coalition government‟s proposals to reform the NHSwill require the introduction of new information systems and modifications to existingprogrammes. Already, the Health Secretary has announced that the multi-billion poundNHS IT Programme will be dismantled, but at this stage it is unclear whatsystems will be required to support the new proposals. My research focuses on what theseproposals mean for primary care in the UK, addressing general practitioners (GPs) stateof readiness, how they plan to reorganise delivery of their services and the informationsystems that will need to be in place to do so. At present, a consultation process isunderway and early indications are that some GP surgeries will amalgamate and purchaseoff-the-shelf packages available from the US. Even before the new proposals wereannounced, a number of software vendors were working on these systems in thebackground in light of the ongoing debate about the future for the National ITProgramme

ICTs AND SUSTAINABLE DEVELOPMENT: A CAPABILITY PERSPECTIVE

Much research on developing countries highlights the developmental potential associated with ICTs as a rationale for implementing particular information systems. However, such initiatives are often problematic to realize and difficult to sustain. In this paper we examine the promise of development associated with the introduction of an Electronic Voters’ Registration (EVR) system in Nigeria. We employ key concepts from Sen’s capability approach to assess the arrangements made by the Nigerian government and its Independent National Electoral Commission (INEC) to enable participation in registration and polling exercises, focusing on the scope these opportunities provided for expanding people’s freedoms to engage in developmental activities. Our analysis shows that the arrangements were sufficient to encourage significant voter turnout but inadequate to sustain developmental potential. We conclude with some implications for policy makers advancing an agenda of ‘ICTs for development’

Total Dissolved Gas Effects on Fishes of the Lower Columbia River

Gas supersaturation problems generated by spill from dams on the Columbia River were first identified in the 1960s. Since that time, considerable research has been conducted on effects of gas supersaturation on aquatic life, primarily juvenile salmonids. Also since that time, modifications to dam structures and operations have reduced supersaturated gas levels produced by the dams. The limit for total dissolved gas saturation (TDGS) as mandated by current Environmental Protection Agency water quality standards is 110%. State management agencies issue limited waivers to water quality, allowing production of levels of up to 120% TDGS to facilitate the downstream migration of juvenile salmonids. Recently, gas supersaturation as a water quality issue has resurfaced as concerns have grown regarding chronic effects of spill-related total dissolved gas on salmonids, including incubating embryos and larvae, resident fish species, and other aquatic organisms. Because of current concerns, and because the last comprehensive review of research on supersaturation effects on fishes was conducted in 1997, we reviewed recent supersaturation literature to identify new or ongoing issues that may not be adequately addressed by the current 110% TDGS limit and the 120% TDGS water quality waiver. We found that recent work supports older research indicating that short-term exposure to levels up to 120% TDGS does not produce acute effects on migratory juvenile or adult salmonids when compensating depths are available. Monitoring programs at Snake and Columbia river dams from 1995 to the early 2000s documented a low incidence of significant gas bubble disease or mortality in Columbia River salmonids, resident fishes, or other taxa. We did, however, identify five areas of concern in which total dissolved gas levels lower than water quality limits may produce sublethal effects on fishes of the Columbia River. These areas of concern are 1) sensitive and vulnerable species or life stages, 2) long-term chronic or multiple exposure, 3) vulnerable habitats and reaches, 4) effects on incubating fish in hyporheic habitats, and 5) community and ecosystem effects. Although some of these areas of concern may have been identified previously in earlier works, we suggest that consideration of the issues is warranted to avoid detrimental impacts on aquatic resources of the Columbia River system. We discuss these issues and provide recommendations to regulatory and management agencies based on our review of recent literature. In general, we recommend that additional attention be directed toward resolving the uncertainties within these five areas

Universal Test and Treat is not associated with sub-optimal antiretroviral therapy adherence in rural South Africa: the ANRS 12249 TasP trial

Introduction HIV treatment guidelines now recommend antiretroviral therapy (ART) initiation regardless of CD4 count to maximise benefit both for the individual and society. It is unknown whether the initiation of ART at higher CD4 counts would affect adherence levels. We investigated whether initiating ART at higher CD4 counts was associated with sub-optimal adherence (<95%) during the first 12 months of ART. Methods A prospective cohort study nested within a two-arm cluster-randomised trial of universal test and treat implemented March 2012 - June 2016 to measure impact of ART on HIV incidence in rural KwaZulu-Natal. ART was initiated regardless of CD4 count in the intervention arm and according to national guidelines in the control arm. ART adherence was measured monthly using a visual analogue scale (VAS) and pill counts (PC). HIV viral load was measured at ART initiation, 3 and 6 months, and six monthly thereafter. We pooled data from participants in both arms and used random-effects logistic regression models to examine the association between CD4 count at ART initiation and sub-optimal adherence, and assessed if adherence levels were associated with virological suppression. Results Among 900 individuals who initiated ART ≥ 12 months before study end, median (IQR) CD4 at ART initiation was 350 cells/mm3 (234, 503); median age was 34.6 years (IQR 27.4-46.4) and 71.7% were female. Adherence was sub-optimal in 14.7% of visits as measured by VAS and 20.7% by PC. In both the crude analyses and after adjusting for potential confounders, adherence was not significantly associated with CD4 count at ART initiation (adjusted OR for linear trend in sub-optimal adherence with every 100 cells/mm3 increase in CD4 count: 1.00, 95% CI 0.95-1.05, for VAS, and 1.03, 95%CI 0.99-1.07, for PC). Virological suppression at 12 months was 97%. Optimal adherence by both measures was significantly associated with virological suppression (p<0.001 for VAS; p=0.006 for PC). Conclusions We found no evidence that higher CD4 counts at ART initiation were associated with sub-optimal ART adherence in the first 12 months. Our findings should alleviate concerns about adherence in individuals initiating ART at higher CD4 counts, however long-term outcomes are needed

Syrian Refugees’ Participation in Language Classes: Motivators and Barriers

Resettlement country language literacy facilitates integration and counteracts social and economic marginalization. Thus, access to language learning is a social justice issue. Resettled refugees in Canada are eligible for free English/French language training. Between 2015-2017, Canada resettled 47,735 Syrian refugees. We explored predictors of language class participation for Syrian refugees, examining data from 1915 adult Syrian refugees in government-funded language classes in British Columbia, Ontario, and Quebec. Findings suggest access to language programs are shaped by provincial policies. Factors hindering participation varied by province and included gender, physical/mental health, education, English/French literacy, and employment. Practice and policy recommendations are discussed.L'alphabétisation dans la langue du pays d’accueil facilite l'intégration et réduit la marginalisation sociale et économique. Ainsi, l'accès à l'apprentissage de la langue est une question de justice sociale. Les réfugiés réinstallés au Canada sont admissibles à une formation gratuite en anglais/français. Entre 2015 et 2017, le Canada a réinstallé 47 735 réfugiés syriens. Nous avons exploré les prédicteurs de la participation aux cours de langue pour les réfugiés syriens, en examinant les données de 1 915 réfugiés syriens adultes dans des cours de langue financés par le gouvernement en Colombie-Britannique, en Ontario et au Québec. Les facteurs entravant la participation variaient selon la province et comprenaient le sexe, la santé physique/mentale, l'éducation, l'alphabétisation en anglais/français et l'emploi. Des recommandations pratiques et politiques sont discutées

Strategic planning evaluation of creating a new professional association

A reoccurring question examined by the Working Group has been “why change?” This long report has carefully explored the pros and cons of creating a new association and provided numerous suggestions for its services and organization structures. A better question than “why change?” is “what kind of change is demanded by postsecondary education and needed by these professionals?” Perhaps others can provide a paradigm for us when considering the future. When writing a dialogue among several of his characters in a play discussing the future, Shakespeare penned the expression “The Undiscovered Country” to describe this place. While everyone will visit the future, no one can come back and tell others exactly what it will be like. However, all of us will walk into The Undiscovered Country. We have the choice regarding how we walk into the future. Change can be proactively managed or simply reacted to. The best of past traditions can be brought into the future and merged with new structures and traditions or all can be left to chance. The most important element that moves forward into the new association are members of the current organizations. They form the core of the new future and bring forward the history and traditions of the previous organizations. Let us encourage new members to join these veterans as we walk together into The Undiscovered Country as colleagues and friends. Let’s build a new future together

Red Nuggets at z~1.5: Compact passive galaxies and the formation of the Kormendy Relation

We present the results of NICMOS imaging of a sample of 16 high mass passively evolving galaxies with 1.3<z<2, taken primarily from the Gemini Deep Deep Survey. Around 80% of galaxies in our sample have spectra dominated by stars with ages >1 Gyr. Our rest-frame R-band images show that most of these objects have compact regular morphologies which follow the classical R^1/4 law. These galaxies scatter along a tight sequence in the Kormendy relation. Around one-third of the massive red objects are extraordinarily compact, with effective radii under one kiloparsec. Our NICMOS observations allow the detection of such systems more robustly than is possible with optical (rest-frame UV) data, and while similar systems have been seen at z>2, this is the first time such systems have been detected in a rest-frame optical survey at 1.3<z<2. We refer to these compact galaxies as "red nuggets". Similarly compact massive galaxies are completely absent in the nearby Universe. We introduce a new "stellar mass Kormendy relation" (stellar mass density vs size) which isolates the effects of size evolution from those of luminosity and color evolution. The 1.1 < z < 2 passive galaxies have mass densities that are an order of magnitude larger then early type galaxies today and are comparable to the compact distant red galaxies at 2 < z < 3. We briefly consider mechanisms for size evolution in contemporary models focusing on equal-mass mergers and adiabatic expansion driven by stellar mass loss. Neither of these mechanisms appears able to transform the high-redshift Kormendy relation into its local counterpart. Comment: Accepted version (to appear in ApJ

Persistently high incidence of HIV and poor service uptake in adolescent girls and young women in rural KwaZulu-Natal, South Africa prior to DREAMS.

BACKGROUND: Adolescent girls and young women (AGYW) bear the brunt of the HIV epidemic in South Africa. 'DREAMS' aims to reduce HIV incidence through multi-level combination prevention. We describe HIV incidence and uptake of HIV and sexual reproductive health (SRH) by AGYW in KwaZulu-Natal (KZN), prior to DREAMS. METHODS: Longitudinal and cross-sectional analysis of women (15-24 year old) in a population-based HIV incidence cohort within a demographic surveillance site in KZN. Observation time for HIV incidence was person-years at risk while resident. "Current use of contraceptives" and "having an HIV test in the past 12 months" was compared between 2011 and 2015. RESULTS: In 2015, HIV prevalence was 11.0% and 34.1% and HIV incidence (2011-2015) was 4.54% (95%CI:3.89-5.30) and 7.45% (95%CI:6.51-8.51) per year in 15-19 and 20-24 year olds respectively, with no significant decline compared to 2006-2010. In 2015, 90.7% of 20-24-year-olds were unemployed, 36.4% and 51.7% of 15-19 and 20-24 year olds reported recent migration; 20.9% and 72.6% of 15-19 and 20-24 year olds had ever been pregnant. In 2015, less than 50% reported condom-use at last sex, 15.0% of 15-19 year olds and 48.9% of 20-24 year olds were currently using contraception and 32.0% and 66.7% of 15-19 and 20-24 year olds had tested for HIV in the past 12 months. There had been no improvement compared to 2011. Factors associated with AGYW testing for HIV in the past 12 months were, survey year-2011 more likely than 2015 (aOR = 0.50), number of partners (aOR = 3.25), ever been pregnant (aOR = 2.47) and knowing where to find ART (aOR = 1.54). Factors associated with contraception use were being older (aOR = 4.83); ever been pregnant (aOR = 12.62); knowing where to get ART (aOR = 1.79) and having had an HIV test in past 12 months (aOR = 1.74). CONCLUSION: Prior to DREAMS, HIV incidence in AGYW was high. HIV and SRH service uptake did not improve and was suboptimal. Findings highlight the need for combination HIV prevention programmes for AGYW in this economically vulnerable area