Hospitals as innovators in the health-care system: a literature review and research agenda

This paper aims to improve understanding of the role of hospitals in the generation of innovations. It presents a systematic and critical review of the interdisciplinary literature that addresses the links between the activities of hospitals and medical innovation. It identifies three major research streams: studies of the contribution of medical research and clinical staff to innovation, analyses of novel practices developed and diffused in hospitals, and evolutionary studies of technical change in the context of human health care. This is a highly heterogeneous body of literature, in which comprehensive theoretical frameworks are rare, and empirical studies have tended to focus on a narrow range of hospitals' innovation activities. The paper introduces and discusses a framework integrating different perspectives that can be used to analyze the functions performed by hospitals at the intersection with different partners in the health innovation system and at different stages of innovation trajectories. On the basis of current gaps in the literature, a research agenda is discussed for a relational and co-evolutionary approach to the study of hospitals as innovators.Research for this article was funded by the Research Council of Norway under the project “Synergies and tensions in innovation in the life sciences,” as well as by the South-Eastern Norway Regional Health Authority and the University of Oslo

Lønnsomhet i norske transportbedrifter: En studie av lønnsomhetsforskjeller i norske transportbedrifter

Denne mastergradsoppgaven tar sikte på å belyse mulige årsaker til lønnsomhetsforskjeller blant norske transportselskap. Bransjen er preget av svært lav lønnsomhet, og opplever stadig økende konkurranse fra utenlandske transportører som konkurrerer med helt andre rammebetingelser og kostnadsbilde. Det vises til spesielt dårlig lønnsomhet blant mellomstore til store selskaper, noe som tyder på at bransjen er preget av stordriftsulemper. Studiens problemstilling er «hvordan kan lønnsomhetsforskjellene blant norske transportbedrifter forklares?». Det er gjort et utvalg på ti transportselskap innenfor segmentet langtransport av temperert/tørr/stykkgods, hvor lønnsomhetsforskjellene studeres over en tiårsperiode. Lønnsomhetsforskjellene forsøkes forklart ved å analysere konkurransesituasjonen. PESTEL-rammeverket benyttes for makroomgivelser, og Porter’s konkurransekrefter for bransjeanalyse. Videre tas kostnadsdriverlitteratur i bruk for å forsøke å identifisere hvilke av disse som kan forklare lønnsomhetsforskjellene. Det gjennomføres korrelasjons- og regresjonsanalyser som viser at kompleksitet, størrelse og involvering av ansatte er av størst betydning for lønnsomheten i transportbedriftene, i tillegg til at rentekostnader også viser stor forklaringskraft for endringer i lønnsomheten

Evidence-based interventions in dementia: A pragmatic cluster-randomised trial of an educational intervention to promote earlier recognition and response to dementia in primary care (EVIDEM-ED)

Background: The National Dementia Strategy seeks to enhance general practitioners' diagnostic and management skills in dementia. Early diagnosis in dementia within primary care is important as this allows those with dementia and their family care networks to engage with support services and plan for the future. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice. An earlier unblinded, cluster randomised controlled study tested the effectiveness of educational interventions in improving detection rates and management of dementia in primary care. In this original trial, a computer decision support system and practice-based educational workshops were effective in improving rates of detecting dementia although not in changing clinical management. The challenge therefore is to find methods of changing clinical management. Our aim in this new trial is to test a customised educational intervention developed for general practice, promoting both earlier diagnosis and concordance with management guidelines.Design/Method: The customised educational intervention combines practice-based workshops and electronic support material. Its effectiveness will be tested in an unblinded cluster randomised controlled trial with a pre-post intervention design, with two arms; normal care versus the educational intervention. Twenty primary care practices have been recruited with the aim of gaining 200 patient participants. We will examine whether the intervention is effective, pragmatic and feasible within the primary care setting. Our primary outcome measure is an increase in the proportion of patients with dementia who receive at least two dementia-specific management reviews per year. We will also examine important secondary outcomes such as practice concordance with management guidelines and benefits to patients and carers in terms of quality of life and carer strain.Discussion: The EVIDEM-ED trial builds on the earlier study but the intervention is different in that it is specifically customised to the educational needs of each practice. If this trial is successful it could have implications for the implementation of the National Dementia Strategy

A factor analysis approach to examining relationships among ovarian steroid concentrations, gonadotrophin concentrations and menstrual cycle length characteristics in healthy, cycling women

STUDY QUESTION: How are ovarian steroid concentrations, gonadotrophins and menstrual cycle characteristics inter-related within normal menstrual cycles? SUMMARY ANSWER: Within cycles, measures of estradiol production are highly related to one another, as are measures of progesterone production; however, the two hormones also show some independence from one another, and measures of cycle length and gonadotrophin concentrations show even greater independence, indicating minimal integration within cycles. WHAT IS KNOWN ALREADY: The menstrual cycle is typically conceptualized as a cohesive unit, with hormone levels, follicular development and ovulation all closely inter-related within a single cycle. Empirical support for this idea is limited, however, and to our knowledge, no analysis has examined the relationships among all of these components simultaneously. STUDY DESIGN, SIZE, DURATION: A total of 206 healthy, cycling Norwegian women participated in a prospective cohort study (EBBA-I) over the duration of a single menstrual cycle. Of these, 192 contributed hormonal and cycle data to the current analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS: Subjects provided daily saliva samples throughout the menstrual cycle from which estradiol and progesterone concentrations were measured. FSH and LH concentrations were measured in serum samples from three points in the same menstrual cycle and cycle length characteristics were calculated based on hormonal data and menstrual records. A factor analysis was conducted to examine the underlying relationships among 22 variables derived from the hormonal data and menstrual cycle characteristics. MAIN RESULTS AND THE ROLE OF CHANCE: Six rotated factors emerged, explaining 80% of the variance in the data. Of these, factors representing estradiol and progesterone concentrations accounted for 37 and 13% of the variance, respectively. There was some association between measures of estradiol and progesterone production within cycles; however, cycle length characteristics and gonadotrophin concentrations showed little association with any measure of ovarian hormone concentrations. LIMITATIONS, REASONS FOR CAUTION: Our summary measures of ovarian hormones may be imprecise in women with extremely long or short cycles, which could affect the patterns emerging in the factor analysis. Given that we only had data from one cycle on each woman, we cannot address how cycle characteristics may covary within individual women across multiple cycles. WIDER IMPLICATIONS OF THE FINDINGS: Our findings are generalizable to other healthy populations with typical cycles, however, may not be applicable to cycles that are anovulatory, extreme in length or otherwise atypical. The results support previous findings that measures of estradiol production are highly correlated across the cycle, as are measures of progesterone production. Estradiol and progesterone concentrations are associated with one another, furthermore. However factor analysis also revealed more complex underlying patterns in the menstrual cycle, highlighting the fact that gonadotrophin concentrations and cycle length characteristics are virtually independent of ovarian hormones. These results suggest that despite integration of follicular and luteal ovarian steroid production across the cycle, cycle quality is a multi-faceted construct, rather than a single dimension. STUDY FUNDING/COMPETING INTEREST(S): The EBBA-I study was supported by a grant from the Norwegian Cancer Society (49 258, 05087); Foundation for the Norwegian Health and Rehabilitation Organizations (59010-2000/2001/2002); Aakre Foundation (5695-2000, 5754-2002) and Health Region East. The current analyses were completed under funding from the National Institutes of Health (K12 ES019852). No competing interests declared.Anthropolog

Towards a neurodynamical understanding of the prodrome in schizophrenia

The identification of biomarkers for the early diagnosis of schizophrenia that could inform novel treatment developments is an important objective of current research. This paper will summarize recent work that has investigated changes in oscillatory activity and event-related potentials with Electro/Magnetoencephalography (EEG/MEG) in participants at high-risk for the development of schizophrenia, highlighting disruptions in sensory and cognitive operations prior to the onset of the syndrome. Changes in EEG/MEG-data are consistent with evidence for alterations in Glutamatergic and GABAergic neurotransmission as disclosed by Magnetic Resonance Spectroscopy and brain stimulation, indicating changes in Excitation/Inhibition Parameters prior to the onset of psychosis. Together these data emphasize the importance of research into neuronal dynamics as a crucial approach to establish functional relationships between impairments in neural circuits and emerging psychopathology that together could be fundamental for early intervention and the identification of novel treatments for emerging psychosis

Hofstadter butterflies of carbon nanotubes: Pseudofractality of the magnetoelectronic spectrum

The electronic spectrum of a two-dimensional square lattice in a perpendicular magnetic field has become known as the Hofstadter butterfly [Hofstadter, Phys. Rev. B 14, 2239 (1976).]. We have calculated quasi-one-dimensional analogs of the Hofstadter butterfly for carbon nanotubes (CNTs). For the case of single-wall CNTs, it is straightforward to implement magnetic fields parallel to the tube axis by means of zone folding in the graphene reciprocal lattice. We have also studied perpendicular magnetic fields which, in contrast to the parallel case, lead to a much richer, pseudofractal spectrum. Moreover, we have investigated magnetic fields piercing double-wall CNTs and found strong signatures of interwall interaction in the resulting Hofstadter butterfly spectrum, which can be understood with the help of a minimal model. Ubiquitous to all perpendicular magnetic field spectra is the presence of cusp catastrophes at specific values of energy and magnetic field. Resolving the density of states along the tube circumference allows recognition of the snake states already predicted for nonuniform magnetic fields in the two-dimensional electron gas. An analytic model of the magnetic spectrum of electrons on a cylindrical surface is used to explain some of the results.Comment: 14 pages, 12 figures update to published versio

Adult Height, Insulin Levels and 17β-Estradiol in Young Women

Background: Adult height and insulin levels have independently been associated with breast cancer risk. However, little is known about whether these factors influence estradiol levels. Thus, we hypothesize that adult height in combination with insulin levels may influence premenopausal 17β-estradiol throughout the entire menstrual cycle of possible importance of breast cancer risk. Methods: Among 204 healthy women, aged 25-35 years who participated in the Norwegian EBBA I study, birth weight and age at menarche were assessed by questionnaire, personal health record and interview. 17β-estradiol concentrations were estimated by daily saliva samples throughout one entire menstrual cycle using radioimmunoassay (RIA). Measures of height (cm) were taken as well as waist circumference (cm), body mass index (BMI kg/m2) and total fat percentage (DEXA % fat). Fasting blood samples were drawn, and serum concentrations of insulin were determined. Results: The women reported a mean height of 166.5 cm, birth weight of 3389 g and age at menarche 13.1 years. Mean BMI was 24.4 kg/m2, mean waist circumference 79.5 cm and mean total fat percentage 34.1%. Women with an adult height of more than 170 cm and insulin levels higher than 90 pmol/L experienced on average an 37.2 % increase in 17β- estradiol during an entire menstrual cycle compared to those with the same height, and insulin levels below 90 pmol/L. Moreover, this was also observed throughout the entire menstrual cycle. Conclusion: Our findings support that premenopausal levels of 17β-estradiol vary in response to adult height and insulin levels, suggesting that women who become taller are put at risk for higher estradiol levels when their insulin levels rise of possible importance for breast cancer risk.Anthropolog

High tea consumption diminishes salivary 17beta-estradiol concetration in Polish women

Artykuł recenzowany / peer-reviewed articleWe hypothesized that among reproductive-age women consuming large quantities of tea, the production of estradiol would be suppressed. It has been shown that catechins and theaflavines, the major constituents of tea, inhibit aromatase, an enzyme which catalyses the conversion of androgens to estrogens. Our study included Polish women living in urban (N=61) and rural (N=48) areas. Women collected daily saliva samples for one complete menstrual cycle and filled out dietary questionnaires. Saliva samples were analyzed by radioimmunoassay for concentration of 17-β estradiol (E2). Women with high (above the median) average daily consumption of black tea had reduced levels of salivary E2, in comparison with women who drank less black tea (below median). This effect was observed within the whole study group, as well as separately within urban (p = 0.0006) and rural (p = 0.013) groups. High intake of the sum of subclasses of tea catechins and epigallocatechin gallate, assessed using the USDA database [http://www.nal.usda.gov], was also associated with lower concentrations of E2 within all women (p = 0.01 and p = 0.0001, respectively) and within the urban group (p = 0.0001 and p = 0.004, respectively). Similar relationships were observed between the sum of subclasses of theaflavines and thearubigines and E2 levels for the whole group (p = 0.002) and for urban women (p = 0.02). Women with high consumption of tea had lower levels of E2 concentration throughout the entire menstrual cycle. These results may have implications for reducing hormone-related cancer risk by a relatively easy dietary intervention.the State Committee for Scientific Research, Warsaw, Poland, project No. 3 P05E 016 25 and 6 P05D 112 20, the Radcliffe Institute of Advanced Study, Harvard University and the Norwegian Cancer Society

Physical Activity, Heart Rate, Metabolic Profile, and Estradiol in Premenopausal Women

Purpose: To study whether physical inactive women with a tendency to develop metabolic syndrome have high levels of 17[beta]-estradiol (E2) of importance for breast cancer risk. Methods: Two hundred and four healthy women of reproductive age were assessed for self-reported leisure-time physical activity (LPA), resting heart rate (HR), blood pressure (BP), anthropometry, and serum glucose, lipids, and insulin [Norwegian Energy Balance and Breast Cancer Aspect (EBBA) study]. E2 was measured in daily saliva samples throughout an entire menstrual cycle. A clustered metabolic risk score [z metabolic syndrome (zMS); total cholesterol-high-density lipoprotein-cholesterol (HDL-C) ratio, insulin resistance, total fat tissue, BP, and triglycerides] was defined. Linear regression and linear mixed models were used, and confounding factors were tested. Results: Physically active women had lower fat percentage (Ptrend = 0.003) and HRs (Ptrend = 0.003) than sedentary women. We estimated an increase in E2 of 1.27 pmol[middle dot]L-1 [95% confidence interval (CI), 0.06-2.47] for each 11.7 beats[middle dot]min-1 (1 SD) increase in HR, and this corresponds to the 7% change in mean concentration of E2 for the total group. Associations with E2 were also found for fat tissue, total cholesterol-HDL-C ratio, insulin resistance, and triglycerides. A dose-response relationship was observed among the three levels of LPA and HR and zMS (Ptrend = 0.03 for LPA; Ptrend = 0.004 for HR). Women in the highest tertile of the clustered metabolic risk score had average salivary E2profiles that were markedly higher, throughout the cycle, than those of the other groups, with a cycle peak-day difference in E2 of 22-28%. Conclusion: LPA and HR were associated with metabolic risk score, and this score was associated with daily level of E2, pointing to important biologic mechanisms operating between a sedentary lifestyle and an increased breast cancer risk.AnthropologyHuman Evolutionary Biolog