Studying technology use as social practice: the untapped potential of ethnography

Information and communications technologies (ICTs) in healthcare are often introduced with expectations of higher-quality, more efficient, and safer care. Many fail to meet these expectations. We argue here that the well-documented failures of ICTs in healthcare are partly attributable to the philosophical foundations of much health informatics research. Positivistic assumptions underpinning the design, implementation and evaluation of ICTs (in particular the notion that technology X has an impact which can be measured and reproduced in new settings), and the deterministic experimental and quasi-experimental study designs which follow from these assumptions, have inherent limitations when ICTs are part of complex social practices involving multiple human actors. We suggest that while experimental and quasi-experimental studies have an important place in health informatics research overall, ethnography is the preferred methodological approach for studying ICTs introduced into complex social systems. But for ethnographic approaches to be accepted and used to their full potential, many in the health informatics community will need to revisit their philosophical assumptions about what counts as research rigor

Volunteer satisfaction in sports clubs: A multilevel analysis in 10 European countries

Regular voluntary engagement is a basic resource for sports clubs that may also promote social cohesion and active citizenship. The satisfaction of volunteers is an imperative factor in this engagement, and the purpose of this article is to explore individual and organizational determinants of volunteer satisfaction in sports clubs. Theoretically, our study builds on the actor-theory concepts where volunteer satisfaction depends on subjective evaluations of expectations and experiences in a sports club (‘logic of situation’), so that positive evaluations lead to higher satisfaction and, hopefully, retention of volunteers. This research uses a sample of 8131 volunteers from 642 sports clubs in 10 European countries, and is the first analysis to combine determinants at the level of the club and the volunteer (multilevel). Results show that the most important determinants of satisfaction are the conditions of volunteering (recognition, support, leadership and material incentives) and the workload of volunteers. Surprisingly, club characteristics, size or having paid staff are not significant determinants of volunteer satisfaction. The results of this analysis can assist more effective volunteer management in sports clubs that are facing challenges of individualization and professionalization

Integration of a nationally procured electronic health record system into user work practices

BACKGROUND: Evidence suggests that many small- and medium-scale Electronic Health Record (EHR) implementations encounter problems, these often stemming from users' difficulties in accommodating the new technology into their work practices. There is the possibility that these challenges may be exacerbated in the context of the larger-scale, more standardised, implementation strategies now being pursued as part of major national modernisation initiatives. We sought to understand how England's centrally procured and delivered EHR software was integrated within the work practices of users in selected secondary and specialist care settings. METHODS: We conducted a qualitative longitudinal case study-based investigation drawing on sociotechnical theory in three purposefully selected sites implementing early functionality of a nationally procured EHR system. The complete dataset comprised semi-structured interview data from a total of 66 different participants, 38.5 hours of non-participant observation of use of the software in context, accompanying researcher field notes, and hospital documents (including project initiation and lessons learnt reports). Transcribed data were analysed thematically using a combination of deductive and inductive approaches, and drawing on NVivo8 software to facilitate coding. RESULTS: The nationally led "top-down" implementation and the associated focus on interoperability limited the opportunity to customise software to local needs. Lack of system usability led users to employ a range of workarounds unanticipated by management to compensate for the perceived shortcomings of the system. These had a number of knock-on effects relating to the nature of collaborative work, patterns of communication, the timeliness and availability of records (including paper) and the ability for hospital management to monitor organisational performance. CONCLUSIONS: This work has highlighted the importance of addressing potentially adverse unintended consequences of workarounds associated with the introduction of EHRs. This can be achieved with customisation, which is inevitably somewhat restricted in the context of attempts to implement national solutions. The tensions and potential trade-offs between achieving large-scale interoperability and local requirements is likely to be the subject of continuous debate in England and beyond with no easy answers in sight

A possible role of mouse Fused (STK36) in Hedgehog signaling and Gli transcription factor regulation

The segment polarity gene Fused (Fu) encodes a putative serine–threonine kinase Fu, which has been shown to play a key role in the Hedgehog signaling pathway of Drosophila. Human FU (hFU) has been shown to enhance the activity of Gli transcription factors, targets of the signaling pathway. However, Fu−/− mice do not show aberrant embryonic development indicating that mouse Fu (mFu) is dispensable for Hedgehog signaling until birth. In order to investigate if there are important differences between hFU and mFu, we cloned the cDNA, analyzed expression and tested the ability of mFu to regulate Gli proteins. Of the tested tissues only brain and testis showed significant expression. However, in transient overexpression analyses mFu was able to enhance Gli induced transcription in a manner similar to hFU. Thus, we turned to RNAi in order to test if mFu would be important for Hedgehog signaling after all. In one cell line with reduced mFu expression the Hedgehog signaling was severely hampered, indicating that mFu may have a role in Hedgehog signaling and Gli regulation in some cellular situations

Increased antibody levels to stage-specific Epstein–Barr virus antigens in systemic autoimmune diseases reveal a common pathology

The immune responses to antigens from different stages of the Epstein–Barr virus (EBV) life cycle were investigated in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjögren’s syndrome (SS), and systemic sclerosis (SSc) to gain knowledge of EBV’s involvement in the etiology of systemic autoimmune diseases (SADs) and for an overview of the humoral immune responses against EBV. Investigations were performed by the use of ELISA. IgM, IgA, and IgG antibody binding to 11 EBV antigens: EBNA1, EBNA2, BALF5, EAD, BALF2, EA/R, VCA p18, VCA p23, gB, gp350, and gp42 were examined in serum pools from SAD patients and healthy controls (HCs). Increased antibody levels against the 11 EBV antigens in the SAD pools were seen compared to the HC pool. Specifically, SLE was characterized by strongly increased IgA to EAD both compared to HCs and other SADs, and RA was characterized by increased IgM levels to several EBV antigens. The SADs may be partly distinguished by their differential immune responses to various antigens in the EBV life cycle. All together, these findings support an association between EBV infection and SADs