537 research outputs found
User Attitudes and Support in Health Information Systems Implementation - the case of the Danish Sundhedsplatformen
The implementation of Health Information Systems (HIS) has been heralded as bringing numerous benefits to the healthcare sector. When implementing a HIS, the attitudes of the various users (nurses, doc-tors, admin people) towards the HIS can be influenced by a number of different factors. User support has proved to be one of the most important ones. Most recently, Sundhedsplatformen, one of the largest public HIS in Denmark, is being implemented in 18 hospitals across Zealand. In this context, we conducted 21 interviews at one of the major hospitals, Rigshospitalet, and qualitatively coded them. This allowed us to explore three archetypical groups of user attitudes toward Sundhedsplatformen: ‘Dedicated’, ‘Frustrated’ and ‘Despondent’. Further, we identified manifestations of insufficient user sup-port on different levels. We clustered these elements into three levels of support: ‘Individual’, ‘Techno-logical’ and ‘Organisational’. Reflecting on the manifestations of insufficient user support enables us to achieve a nuanced and holistic understanding of user support as an important adoption factor and further how user attitudes can be addressed when implementing HIS
Hospital productivity and the Norwegian ownership reform – A Nordic comparative study
In a period where decentralisation seemed to be the prominent trend, Norway in 2002 chose to re-centralise the hospital sector. The reform had three main aims; cost control, efficiency and reduced waiting times. This study investigates whether the hospital reform has improved hospital productivity using the other four major Nordic countries as controls. Hospital productivity measures are obtained using data envelopment analysis (DEA) on a comparable dataset of 728 Nordic hospitals in the period 1999 to 2004. First a common reference frontier is established for the four countries, enveloping the technologies of each of the countries and years. Bootstrapping techniques are applied to the obtained productivity estimates to assess uncertainty and correct for bias. Second, these are regressed on a set of explanatory variables in order to separate the effect of the hospital reform from the effects of other structural, financial and organizational variables. A fixed hospital effect model is used, as random effects and OLS specifications are rejected. Robustness is examined through alternate model specifications, including stochastic frontier analysis (SFA). The SFA approach in performed using the Battese & Coelli (1995) one stage procedure where the inefficiency term is estimated as a function of the set of explanatory variables used in the second stage in the DEA approach. Results indicate that the hospital reform in Norway seems to have improved the level of productivity in the magnitude of approximately 4 % or more. While there are small or contradictory estimates of the effects of case mix and activity based financing, the length of stay is clearly negatively associated with estimated productivity. Results are robust to choice of efficiency estimation technique and various definition of when the reform effect takes place.Efficiency; productivity; DEA; SFA; hospitals
Governing Parental Drug Use in the UK: What's Hidden in "Hidden Harm?"
In 2003, the UK Advisory Council on the Misuse of Drugs published Hidden Harm, the product of an inquiry that exposed the ‘problems’ of parental drug use and its neglect by professionals. It outlined an extensive program of reforms designed to protect children from harm. Despite its far-reaching influence, it has rarely been subject to scrutiny, with analyses focusing on its impact instead. Drawing on Bacchi’s post-structuralist ‘What’s the Problem Represented to be’ approach, we examine problematizations within Hidden Harm and their implications for the governance of family life. We illustrate how Hidden Harm produced a simplified version of parenting and child welfare within the context of drug use by largely equating drug use with ‘bad’ parenting and child maltreatment and by ignoring the social determinants of health and the wider social ecology of family life. Using a tried-and-tested driver of policy change, Hidden Harm created a ‘scandal’ about the lack of intervention by professionals that was used to justify and legitimize increased state intervention into the lives of parents who use drugs. Hidden Harm proposed simplistic ‘solutions’ that centred on drug treatment, child protection and the responsibilization of professionals to govern ‘risky’ parents. We argue these rationalities, subjectivities and strategies serve to marginalize and stigmatize families further and hide alternative approaches to understanding, representing and responding to the complex needs of children and families who are disproportionately affected by health and social inequalities. By uncovering what is hidden in Hidden Harm, we aim to stimulate further research and theoretically informed debate about policy and practice related to child welfare, parenting and family life within the context of drug use. We conclude with some ideas about how to reframe public discourse on parents who use drugs and their children, in tandem with collaborative responses to alleviate child poverty and inequalities
Co-creation of IT-value in a cluster of small enterprises
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Intramuscular Priming and Intranasal Boosting Induce Strong Genital Immunity Through Secretory IgA in Minipigs Infected with Chlamydia trachomatis
International efforts in developing a vaccine against Chlamydia trachomatis have highlighted the need for novel immunization strategies for the induction of genital immunity. In this study, we evaluated an intramuscular (IM) prime/intranasal boost vaccination strategy in a Göttingen Minipig model with a reproductive system very similar to humans. The vaccine was composed of C. trachomatis subunit antigens formulated in the Th1/Th17 promoting CAF01 adjuvant. IM priming immunizations with CAF01 induced a significant cell-mediated interferon gamma and interleukin 17A response and a significant systemic high-titered neutralizing IgG response. Following genital challenge, intranasally boosted groups mounted an accelerated, highly significant genital IgA response that correlated with enhanced bacterial clearance on day 3 post infection. By detecting antigen-specific secretory component (SC), we showed that the genital IgA was locally produced in the genital mucosa. The highly significant inverse correlation between the vaginal IgA SC response and the chlamydial load suggests that IgA in the minipig model is involved in protection against C. trachomatis. This is important both for our understanding of protective immunity and future vaccination strategies against C. trachomatis and genital pathogens in general
Perturbation drives changing metapopulation dynamics in a top marine predator
Funding: O.E.G. was supported by the Marine Alliance for Science and Technology for Scotland, funded by the Scottish Funding Council (grant no. HR09011). E.L.C. was supported by a Newton Fellowship (Royal Society of London), Marie Curie Fellowship (EU Horizon2020) and a Rutherford Discovery Fellowship (Royal Society of New Zealand). A.J.H. and D.J.F.R. were supportedby NERC (grant no. SMRU 10/001).Metapopulation theory assumes a balance between local decays/extinctions and local growth/new colonisations. Here we investigate whether recent population declines across part of the UK harbour seal range represent normal metapopulation dynamics or are indicative of perturbations potentially threatening the metapopulation viability, using 20 years of population trends, location tracking data (n = 380), and UK-wide, multi-generational population genetic data (n = 269). First, we use microsatellite data to show that two genetic groups previously identified are distinct metapopulations: northern and southern. Then, we characterize the northern metapopulation dynamics in two different periods, before and after the start of regional declines (pre-/peri-perturbation). We identify source-sink dynamics across the northern metapopulation, with two putative source populations apparently supporting three likely sink populations, and a recent metapopulation-wide disruption of migration coincident with the perturbation. The northern metapopulation appears to be in decay, highlighting that changes in local populations can lead to radical alterations in the overall metapopulation's persistence and dynamics.PostprintPeer reviewe
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