Institutional Determinants of Co-Production: Norway as an Illustrative Case

This article focuses on collective engagement through voluntary organizations to advance a theoretical understanding of the determinants of varying patterns of co-production, and we conduct an empirical investigation of how these determinants shape local-level co-productive relationships in Norwegian municipalities. We use a policy fields approach in which we compare four policy areas that each constitute an institutional field. The study uses a qualitative design, with data from 89 interviews in 12 municipalities. We find strong systematic differences between the fields, suggesting that the institutional space for local co-production is structured by national welfare policies and public management practices. We also identify feedback processes in co-production between the design and implementation stages of the policy process. We conclude that, unlike the often-prescriptive embrace of co-production in the literature and among policymakers, co-production is a more suitable organizational form in some service areas than others, depending on the institutional context.Institutional Determinants of Co-Production: Norway as an Illustrative CasepublishedVersio

Collective co-production of health and care services – a systematic review of research from the United Kingdom, Germany and Norway

This article reviews all published English-language articles concerning collective co-production of welfare services in the United Kingdom, Germany and Norway, which are countries representing different welfare regimes. The review identifies facilitators for collective co-production and inductively identifies four themes that are important for successful collective co-production: (1) the motivation individuals have for engaging in collective co-production, (2) the institutional contextual conditions for co-production, (3) the relational conditions for co-production, and (4) the facilitation of different effects of co-production. No studies have investigated why public sector entities or voluntary sector organisations choose to engage in co-production, and we lack studies that compare sectors with different institutional settings.Collective co-production of health and care services – a systematic review of research from the United Kingdom, Germany and NorwaypublishedVersio

Den besværlige arbeidstiden : en komparativ studie av deltid i Bodø kommune og Nordlandssykehuset

Masteroppgave i personalledelse - Universitetet i Nordland, 201

Third-Sector Organizations in Area-Based Initiatives: Instruments for Public Policies or Partners in Co-Production?

Area-based initiatives are central government strategies for community development in particularly deprived urban areas. A core strategy in ABIs is to involve third-sector organizations through co-production. In these areas, the organized civil society is weak, and the public sector has special interests and a willingness to use resources. We ask: if and how can co-production be developed in areas with such power assymetries? Through documents and qualitative interviews, we examined seven ABIs in Norway. We find that managerial ability and coordination, autonomy of action, and, especially, the possession of resources are important dimensions for understanding the development of a co-productive relationship. In the ABIs, we find considerable interdependence between TSO and municipalities as both actors lack resources needed to fulfill their respective goals. This interdependence facilitated co-production.Third-Sector Organizations in Area-Based Initiatives: Instruments for Public Policies or Partners in Co-Production?publishedVersio

SAT1, A Glutamine Transporter, is Preferentially Expressed in GABAergic Neurons

Subsets of GABAergic neurons are able to maintain high frequency discharge patterns, which requires efficient replenishment of the releasable pool of GABA. Although glutamine is considered a preferred precursor of GABA, the identity of transporters involved in glutamine uptake by GABAergic neurons remains elusive. Molecular analyses revealed that SAT1 (Slc38a1) features system A characteristics with a preferential affinity for glutamine, and that SAT1 mRNA expression is associated with GABAergic neurons. By generating specific antibodies against SAT1 we show that this glutamine carrier is particularly enriched in GABAergic neurons. Cellular SAT1 distribution resembles that of GAD67, an essential GABA synthesis enzyme, suggesting that SAT1 can be involved in translocating glutamine into GABAergic neurons to facilitate inhibitory neurotransmitter generation

Serum phosphate and social deprivation independently predict all-cause mortality in chronic kidney disease

Background: Hyperphosphataemia is linked to cardiovascular disease and mortality in chronic kidney disease (CKD). Outcome in CKD is also affected by socioeconomic status. The objective of this study was to assess the associations between serum phosphate, multiple deprivation and outcome in CKD patients. Methods: All adult patients currently not on renal replacement therapy (RRT), with first time attendance to the renal outpatient clinics in the Glasgow area between July 2010 and June 2014, were included in this prospective study. Area socioeconomic status was assessed as quintiles of the Scottish Index of Multiple Deprivation (SIMD). Outcomes were all-cause and cardiovascular mortality and commencement of RRT. Results: The cohort included 2950 patients with a median (interquartile range) age 67.6 (53.6–76.9) years. Median (interquartile range) eGFR was 38.1 (26.3–63.5) ml/min/1.73 m 2 , mean (±standard deviation) phosphate was 1.13 (±0.24) mmol/L and 31.6 % belonged to the most deprived quintile (SIMD quintile I). During follow-up 375 patients died and 98 commenced RRT. Phosphate ≥1.50 mmol/L was associated with all-cause (hazard ratio (HR) 2.51; 95 % confidence interval (CI) 1.63-3.89) and cardiovascular (HR 5.05; 95 % CI 1.90–13.46) mortality when compared to phosphate 0.90–1.09 mmol/L in multivariable analyses. SIMD quintile I was independently associated with all-cause mortality. Phosphate did not weaken the association between deprivation index and mortality, and there was no interaction between phosphate and SIMD quintiles. Neither phosphate nor SIMD predicted commencement of RRT. Conclusions Multiple deprivation and serum phosphate were strong, independent predictors of all-cause mortality in CKD and showed no interaction. Phosphate also predicted cardiovascular mortality. The results suggest that phosphate lowering should be pursued regardless of socioeconomic status

Poliklinisk behandling i tverrfaglig spesialisert rusbehandling – tilpasset pasientene?

Bakgrunn: Tema for denne masteroppgaven er poliklinisk rusbehandling i spesialisthelsetjenesten (TSB) og hvordan behandlerne opplever å kunne jobbe etter faglige retningslinjer og samtidig tilpasse behandlingen etter pasientenes behov. Som utgangspunkt for dette har jeg sett på gjeldene faglige retningslinjer, nasjonalt pasientforløp for tverrfaglig spesialisert rusbehandling og innsatsstyrt finansiering som er en del av finansieringsordningen i helseforetakene. Problemstillingen er: Hvordan opplever behandlere ved ruspoliklinikker (TSB) handlingsrommet til å tilby tilpasset behandling når de arbeider ut fra gjeldende retningslinjer og organisering? Teori: Som teoretisk grunnlag har jeg benyttet Lipskys (1980/2010) teori om bakkebyråkrati og bakkebyråkrater. Dette beskriver ansatte som både jobber ansikt til ansikt med tjenestemottakeren, men som også forvalter politisk gitte føringer. Som utgangspunkt for å forstå poliklinisk rusbehandling har jeg presentert flere relevante retningslinjer innen poliklinisk rusbehandling. Metode: Jeg har valgt en kvalitativ metode for å belyse dette temaet og har gjennomført 11 semistrukturerte intervjuer med behandlere på 3 ulike poliklinikker. Disse intervjuene har jeg analysert ved hjelp av Tjora (2018a) sin Stegvis-deduktiv induktiv metode (SDI). Funn: Informantene beskriver en kompleks pasientgruppe med ulike behov, og de har dilemmaer knyttet til standardisering av behandlingen. Hovedtemaene i resultatdelen er: Opplevd handlingsrom i tjenesteutføringen, ulike behov til ulike pasienter og dilemmaer knyttet til utredning og kartlegging. Diskusjon/konklusjon: Den totale mengden sentrale føringer og retningslinjer er krevende å håndtere for behandlerne. Samtidig gjør spriket i føringene at de får et handlingsrom da de må prioritere hvilke føringer de vil vektlegge. Dette handlingsrommet brukes for å gi den enkelte pasient tilpasset behandling.Background: This thesis is about outpatient addiction treatment in the specialist health service (TSB) and how the therapists experience being able to follow the complex set of national guidelines and also adapt the treatment to the patients' needs. The research question is: How do therapists at outpatient clinics for substance abuse (TSB) perceive the latitude to offer differentiated treatment when working based on current guidelines and organisational structure? Theory: I have used Lipsky's (1980/2010) theory of Street-level bureaucracy and Street-level bureaucrats. This describes employees who both work face to face with the service recipient, but who also administer politically given guidelines. These thoroughly present and analyse these guidelines. Method: I have chosen a qualitative method to shed light on this topic and have conducted 11 semi-structured interviews with therapists at 3 different outpatient clinics. I have analysed these interviews using Tjora (2018a)'s stepwise-deductive inductive approach (SDI). Findings: The informants describe a complex patient group with different needs, and they have dilemmas related to standardization of treatment. The main topics in the results section are: Perceived room for maneuver in the provision of services, different needs of different patients and dilemmas related to assessment and mapping. Discussion/conclusion: The total amount of central guidelines is challanging for therapists to handle. At the same time, the diversity and incoherence in the guidelines give them room for manoeuvre as they must prioritise which guidelines to emphasise. This latitude is used to provide the individual patient with adapted treatment

Sett, hørt, forstått og anerkjent: Hvordan redusere vold på NAV?

Studentoppgave videreutdanning rus, avhengighet og psykiske lidelser, 2016Oppsummering: I denne oppgaven har jeg sett på hvordan NAV-ansatte kan møte brukere på en slik måte at de ikke kjenner behov for å utøve vold eller true med det. Dette er en sentral problematikk da sosionomer, vernepleiere og barnevernpedagoger er av de yrkesgruppene som er mest utsatt for vold på jobb (Svalund, 2009). Jeg har beskrevet en del litteratur som beskriver hvordan ansatte kan redusere voldelig atferd på institusjon og på psykiatriske avdelinger. Elementer av dette vil være gjeldene også på NAV, men mye er annerledes. De ansatte på NAV har ikke mulighet til å jobbe med relasjon på lik linje med en miljøterapeut, og tidsaspektet vil være helt annerledes. Det som derimot er like relevant i alt type sosialt arbeid er holdningen til den ansatte. At den ansatte har et ønske om å forså brukeren og at brukeren vet mest om eget liv. Hvor bevist den ansatte er på seg selv, sin følelse av avmakt og på sin egen fagutøvelse vil påvirke atferden til brukeren. Avmakt har vært et sentralt begrep i oppgaven. Følelse av avmakt i eget liv for brukerne, men også følelse av avmakt for de ansatte. Det kan skyldes mange ulike faktorer at en ansatt kjenner avmakt i jobbes sin som for eksempel, konflikter på arbeidsstedet, redsel, følelse av manglende kompetanse og at den ansatte tar avmaktsfølelsen til brukeren på seg selv. Dette kan påvirke hvordan den ansatte møter brukeren. En tentativ konklusjon basert på diskusjonen i denne oppgaven peker mot at det er viktig med god opplæring og refleksjon på arbeidsstedet. De ansatte må kjenne seg trygge på seg selv, på systemet og på faget sitt. De må jevnlig ha mulighet til å reflektere over egen praksis og få tydelige og gode tilbakemeldinger slik at de klargjør egne holdninger og yrkesutøvelse. Det må være rom for å diskutere hva de ansatte kan endre for å møte brukerne på en måte som gjør at de føler seg sett, hørt, forstått og anerkjent. For å kunne møte brukernes følelse av avmakt slik at vi reduserer vold på NAV, må vi være klar over vår egen avmaktsfølelse og holdninger

Analyzing dynamic species abundance distributions using generalized linear mixed models

Understanding the mechanisms of ecological community dynamics and how they could be affected by environmental changes is important. Population dynamic models have well known ecological parameters that describe key characteristics of species such as the effect of environmental noise and demographic variance on the dynamics, the long-term growth rate, and strength of density regulation. These parameters are also central for detecting and understanding changes in communities of species; however, incorporating such vital parameters into models of community dynamics is challenging. In this paper, we demonstrate how generalized linear mixed models specified as intercept-only models with different random effects can be used to fit dynamic species abundance distributions. Each random effect has an ecologically meaningful interpretation either describing general and species-specific responses to environmental stochasticity in time or space, or variation in growth rate and carrying capacity among species. We use simulations to show that the accuracy of the estimation depends on the strength of density regulation in discrete population dynamics. The estimation of different covariance and population dynamic parameters, with corresponding statistical uncertainties, is demonstrated for case studies of fish and bat communities. We find that species heterogeneity is the main factor of spatial and temporal community similarity for both case studies.Analyzing dynamic species abundance distributions using generalized linear mixed modelspublishedVersio