Occasioning Dialogic Spaces of Innovation: The pan-Canadian EHR, Infoway and the Re-Scripting of Healthcare

The Canadian public healthcare system appears to currently be under considerable strain. Escalating costs, dwindling budgets and growing patient dissatisfaction are just a few of the systemic pressures that have called into question our current ways of delivering healthcare. As a consequence, there is a growing recognition that renewal is needed, and that this renewal, to be successful, should meet the needs of a wide array of stakeholders, hence calling for unprecedented levels of collaboration among increasingly fragmented interests. In order to bring about this renewal, the federal government seems to be intent on implementing a pan-Canadian electronic health record (EHR) system. To that end, in 2001, Canada Health Infoway was born out of a novel collaboration between federal and jurisdictional health ministries with the specific mandate to accelerate the implementation of EHRs across Canada. In this thesis, I use material-semiotic and dialogic approaches to gain a more nuanced understanding of how the pan-Canadian EHR system is unfolding and in what ways Infoway is trying to accelerate that unfolding. I conclude by suggesting that a more dialogic approach to innovating, in which the innovator focuses on finding various ways to occasion dialogic spaces, may better foster the creation of new meanings of the innovation and therefore result in a more, and not less, harmonious change process. Furthermore, through these dialogic spaces, it is not just multiple meanings of the innovation that are being occasioned, but the innovation itself seems to become more meaningful

Technologizing Humanitarian Space: Darfur Advocacy and the Rape-Stove Panacea 1

We examine how an unassuming domestic technology-the fuelefficient stove-came to be construed as an effective tool for reducing sexual violence globally. Highlighting the process of problematization, the linking of problems with actionable solutions, we show how US-based humanitarian advocacy organizations drew upon spatial, gender, perpetrator, racial, and interventionist representations to advance the notion that "stoves reduce rape" in Darfur. Though their effectiveness in Darfur remains questionable, efficient stoves were consequently adopted as a universal technical panacea for sexual violence in any conflict or refugee camp context. By examining the emergence and global diffusion of the rape-stove problematization, our study documents an important example of the technologizing of humanitarian space. We postulate fuel-efficient stoves to be a technology of Othering able to simplify, combine, decontextualize, and transform problematizations from their originating contexts elsewhere. When humanitarian advocates construe immensely complex crises as "manageable problems," the promotion of simple technical panaceas may inadvertently increase the burden of poverty for user-beneficiaries and silence the voices of those they claim to champion and serve. Material things have magic powers only in the contexts of the narratives in which they are embedded. (Harr e 2002:25

Technologizing Humanitarian Space: Darfur Advocacy and the Rape-Stove Panacea 1

We examine how an unassuming domestic technology-the fuelefficient stove-came to be construed as an effective tool for reducing sexual violence globally. Highlighting the process of problematization, the linking of problems with actionable solutions, we show how US-based humanitarian advocacy organizations drew upon spatial, gender, perpetrator, racial, and interventionist representations to advance the notion that "stoves reduce rape" in Darfur. Though their effectiveness in Darfur remains questionable, efficient stoves were consequently adopted as a universal technical panacea for sexual violence in any conflict or refugee camp context. By examining the emergence and global diffusion of the rape-stove problematization, our study documents an important example of the technologizing of humanitarian space. We postulate fuel-efficient stoves to be a technology of Othering able to simplify, combine, decontextualize, and transform problematizations from their originating contexts elsewhere. When humanitarian advocates construe immensely complex crises as "manageable problems," the promotion of simple technical panaceas may inadvertently increase the burden of poverty for user-beneficiaries and silence the voices of those they claim to champion and serve. Material things have magic powers only in the contexts of the narratives in which they are embedded. (Harr e 2002:25

Need of physical and chemical restraints: Experiences at inpatient psychiatric ward in a tertiary care hospital in Karachi, Pakistan

In psychiatry, agitated / aggressive patients are often treated with de-escalation techniques. If this does not work, physical or chemical restrains are required; but in the event of resistance, seclusion is applied. We report the findings of baseline study of experiences of physical and chemical restraints in a tertiary care hospital in Karachi, where 104 files were evaluated retrospectively. The mean age of patients was 32.5 ±14.3 years with 54.8% men, while the average length of stay was 11.5 ±9.3 days. Agitation, violent behaviour, and aggression were the most common indications for restraints. In total, 94.5% of patients had both physical and chemical restraints with the latter being used as the first choice in 70 patients; whereas, 67.1% of patients\u27 families were not informed before application of restraints. The seclusion need assessment was conducted in 4.1% of patients

Governance disclosure quality and market valuation of firms

This study develops a ‘comply or explain’ index which captures compliance and quality of explanations given for non-compliance with the corporate governance codes in UK and Germany. In particular, we explain, how compliance and quality of explanations provided in non-compliance disclosures, and various other internal corporate governance mechanisms, affect the market valuation of firms in the two countries. A dynamic generalised method of moments (GMM) estimator is employed as the research technique for our analysis, which enabled us to control for the potential effects of endogeneity in our models. The findings of our content analysis suggest that firms exhibit significant differences in compliance, board independence and ownership structure in both countries. The ‘comply or explain’ index is positively associated with the market valuation of UK firms suggesting that compliance and quality governance disclosure is value relevant in the UK. Institutional blockholders’ ownership is however, negatively associated with the market value of firms, which raises questions about the monitoring role of institutional shareholders in both countries. We argue that both compliance and explanations given for non-compliance are equally important, as long as valid reasons and justifications for non-compliance are provided by the reporting companies. These findings thus imply that the ‘comply or explain’ principle is working well and that UK and German companies could benefit from the flexibility offered by this principle. With respect to the role of board size, board independence, ownership structure, and institutional ownership of firms, this study offers policy implications

Firm performance, corporate governance and executive compensation in Pakistan

yesThis study examines the effects of firm performance and corporate governance on chief executive officer (CEO) compensation in an emerging market, Pakistan. Using a more robust Generalized Method of Moments (GMM) estimation approach for a sample of non-financial firms listed at Karachi Stock Exchange (KSE) over the period 2005 to 2012, we find that both current and previous year accounting performance has positive influence on CEO compensation. However, stock market performance does not appear to have a positive impact on executive compensation. We further find that ownership concentration is positively related with CEO compensation, indicating some kind of collusion between management and largest shareholder to get personal benefits. Inconsistent with agency theory, CEO duality appears to have a negative influence, while board size and board independence have no convincing relationship with CEO compensation, indicating board ineffectiveness in reducing CEO entrenchment. The results of dynamic GMM model suggest that CEO pay is highly persistent and takes time to adjust to long-run equilibrium

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The burden of unintentional drowning: Global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study

__Background:__ Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017. __Methods:__ Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning. __Results:__ Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes. __Conclusions:__ There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low-and middle-income countries

The burden of unintentional drowning : global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study

Background Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017. Methods Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning. Results Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes. Conclusions There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low- and middle-income countries.Peer reviewe