Creating a Pre-Illness COVID-19 Action Plan: A Web-Based Public Education Initiative

Abstract Background: The COVID-19 pandemic took the world by storm in the beginning stages of 2020. Public health agencies were overwhelmed, undermanned, and therefore slow to respond. Information began to flow at an unprecedented rate. Yet, very limited resources were put into place to present this information or to instruct the public on evidence-based prevention, treatment, or care at home during active infection. Intervention: A project website was created and accessed through a QR code on the project flyer or by entering the URL into any browser. Participants were able to access three evidence- based video modules, which introduced the idea of creating a COVID-19 action plan and provided the tools necessary to formulate an effective plan in conjunction with a healthcare provider, ideally prior to infection. Results: Participants (n=29) were neither likely nor unlikely to have an organized COVID-19 action plan prior to the intervention (M = 3.10, SD = 1.113). Participants (n=28) were much more likely to implement an organized COVID action plan after the intervention (M = 4.36, SD = .780). A Wilcoxon Matched Pairs Signed-Rank Test indicated that this difference was statistically significant T = 210.000, z = 4.008, p \u3c .001. Conclusion: Though this project had noteworthy limitations, it serves as a template for future research projects and patient education quality improvement initiatives. With ever limited time for the clinician and patient interaction, it is time healthcare evolves to provide the quality of patient education that leads to genuine shared decision-making and improved compliance

Enterprise Architects’ Logics across Organizational Levels: A Case Study in the Norwegian Hospital Sector

In this paper, we report about a multilevel case study on the introduction of enterprise architecture (EA) in the Norwegian hospital sector. We utilize institutional logics as a theoretical lens, focusing on the enterprise architects’ logics that are underexplored in information systems research. We have col-lected empirical evidence at national (macro), regional (meso), and local (micro) levels. The findings are classified into nine categories with illustrative statements from the informants, demonstrating their reasoning about the contributions of EA. Furthermore, we identify tensions between enterprise archi-tects and managers and between enterprise architects and medical actors, which indicate the co-existence of multiple competing institutional logics. The most prominent tension is the paradox of EA—demands for local flexibility and autonomy at the micro level versus the predefined rules and standardization that EA imposes across all levels—which makes the institutionalizing process chal-lenging. The enterprise architect logics demonstrate similarities and differences across the various levels, indicating heterogeneity. We conclude this paper with a suggested persona of the enterprise architect, which illustrates the empirical findings

Institutional Work for Enterprise Architecture

Enterprise architecture (EA) is a systematic approach used for designing and implementing changes in technological systems and processes to improve organizational performance and align technology with business. This paper unpacks the process through which EA moves from strategic-level endorsement to diffusion across organizations. The insights provided are based on a longitudinal case study within the Norwegian hospital sector. An institutional work lens is adopted to analyze the purposeful activities carried out to introduce EA in Norwegian hospitals providing a granular view on diffusion. The paper provides a rich description of the institutional work employed by the key actors involved mapping them to different turns in EA’s trajectory. Drawing from this analysis, we contribute to Information Systems literature with a conceptual model that illustrates how institutional work can mitigate the challenges of moving from the strategic-level endorsement of novelty to its diffusion and institutionalization smoothing downturns along the way. The findings indicate ways to facilitate the introduction of EA within complex organizations, providing insights for practitioners involved in EA initiatives, and advancing extant EA research through an institutional perspective

Estradiol Valerate Vs. Ethinylestradiol In Combined Oral Contraceptives : Effects On The Pituitary-Ovarian Axis

Context There are limited studies comparing the effects of combined oral contraceptives (COCs) containing natural estrogens and synthetic ethinylestradiol (EE) on reproductive hormones. Objective To compare estradiol valerate (EV)+dienogest (DNG), EE+DNG, and DNG alone (an active control) on levels of follicle stimulating hormone (FSH), luteinizing hormone, Anti-Mullerian hormone (AMH), ovarian steroids, sex hormone binding globulin (SHBG), and the Free Androgen Index (FAI). Design Spin-off study from a randomized trial. Setting Outpatient setting at Helsinki and Oulu University Hospitals, Finland. Participants 59 healthy, 18-35-year-old ovulatory women were enrolled. Three women discontinued. The groups were comparable as regards age and body mass index. Interventions EV 2mg+DNG 2-3mg (n=20), EE 0.03mg+DNG 2mg (n=20) and DNG 2mg (n=19) were used continuously for nine weeks. Blood samples were drawn at baseline, and at 5 and 9 weeks. Main Outcome Measures EV+DNG suppressed FSH by -27% (-51:-3) (median [95%CI]) vs. EE+DNG, -64% (-78: -51), P=0.04, but AMH levels decreased similarly by -9% (-18: -0.1) vs. -13% (-28:0.2), P=0.38, respectively. EV+DNG increased SHBG levels by 56% (30:82) and EE+DNG by 385% (313:423), PPeer reviewe

Circulating antimullerian hormone and steroid hormone levels remain high in pregnant women with polycystic ovary syndrome at term

Objective: To investigate plasma antimullerian hormone (AMH) concentration and its relation to steroid hormone levels in pregnant women with polycystic ovary syndrome (PCOS) and controls at term. Design: Case-control study. Setting: University-affiliated hospital. Patient(s): A total of 74 pregnant women at term: 25 women with PCOS (aged 31.6 +/- 3.9 years [mean +/- standard deviation], body mass index 24.0 +/- 3.9 kg/m2, mean gestational length 279 +/- 9 days) and 49 controls (aged 31.7 +/- 3.3 years, body mass index 24.0 +/- 3.3 kg/m2, mean gestational length 281 +/- 9 days). Intervention(s): None. Main Outcome Measure(s): Plasma AMH and steroid hormone levels. Result(s): Antimullerian hormone, T, and androstenedione levels were higher in women with PCOS at term compared with controls, whereas estrogen and P levels were similar. The differences were pronounced in women carrying a female fetus. Testosterone and AMH levels correlated positively in both groups, but E2 levels only in women with PCOS. Conclusion(s): Pregnant women with PCOS present with elevated AMH and androgen levels even at term, suggesting a hormonal imbalance during PCOS pregnancy. Differences were detected especially in pregnancies with a female fetus, raising the question of whether female pregnancies are more susceptible to AMH and steroid hormone actions. (C) Copyright (C) 2018 The Authors. Published by Elsevier Inc. on behalf of the American Society for Reproductive Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Peer reviewe

First-in-human pharmacokinetics of tamoxifen and its metabolites in the milk of a lactating mother. A case study

Background Breast cancer represents the most frequent neoplasm diagnosed in women of childbearing age. When the tumour is oestrogen receptor-positive, tamoxifen is among the recommended endocrine treatments. Lactating women are advised not to breastfeed while receiving tamoxifen. However, information about tamoxifen transfer into breast milk is lacking. Methods We measured the concentration of tamoxifen and its metabolites by liquid chromatography-tandem mass spectrometry in the milk of a nursing mother that was treated for pregnancy-associated breast cancer diagnosed a few months after delivery. She was advised not to breastfeed her child and she collected milk samples for 23 days while the baby was fed with formula. Results Tamoxifen concentrations in milk increased reaching a maximum of 214 nM. The two active metabolitesZ-4-hydroxy-tamoxifen and Z-endoxifen, could not be quantified in milk the first days after tamoxifen intake, but increased over time and reached clinically significant levels after day 18. Conclusion This study demonstrates for the first time in human that tamoxifen and its metabolites transfer into milk. Since tamoxifen has a complete oral bioavailability, a long half-life (>7 days) and may interfere with the normal development of the infant, mothers should not breastfeed during tamoxifen treatment

Steroidogenic factor 1 (NR5A1) induces multiple transcriptional changes during differentiation of human gonadal-like cells

Peer reviewe