On administrative borders and accessibility to public services: : The case of hospitals in Sweden.

An administrative border might hinder the optimal allocation of a given set of resources by restricting the flow of goods, services, and people. In this paper we address the question: Do administrative borders lead to poor accessibility to public service such as hospitals? In answering the question, we have examined the case of Sweden and its regional borders. We have used detailed data on the Swedish road network, its hospitals, and its geo-coded population. We have assessed the population’s spatial accessibility to Swedish hospitals by computing the inhabitants’ distance to the nearest hospital. We have also elaborated several scenarios ranging from strongly confining regional borders to no confinements of borders and recomputed the accessibility. Our findings imply that administrative borders are only marginally worsening the accessibility.

An analysis of the aspects attracting medical tourists : a case study in Seoul, South Korea

Many countries recognized the potential of medicaltourism as an alternative source of economic growth. Especially after theeconomic crisis many Asian countries joined medical tourism in hopes to escapethe severe financial difficulty. However, yet only few countries have managedto become a famous medical tourism destination. With growing number ofcompetitors, newly joined countries of medical tourism, face the difficulty inintroducing them self as attractive medical tourism destination. South Koreaas a new medical tourism destination, should consider what to offer to themedical tourists to attract them. The aim of the thesis was to investigate aspects influencing the participationof medical tourists to discover how South Korea could develop anattractive medical tourism destination. After examining the casestudy and results from the text analysis, researcher reached to the conclusionthat quality, cost and accessibility to treatment are the major reasons toparticipate in medical tourism. Also in the fierce competition, it is importantto develop differentiated offers from other destinations. Therefore, Koreashould concentrate on specialized treatments and ICT system to become anattractive medical tourism destination.

Game Audio in Audio Games : Towards a Theory on the Roles and Functions of Sound in Audio Games

For the past few decades, researchers have increased our understanding of how sound functions within various audio–visual media formats. With a different focus in mind, this study aims to identify the roles and functions of sound in relation to the game form Audio Games, in order to explore the potential of sound when acting as an autonomous narrative form. Because this is still a relatively unexplored research field, the main purpose of this study is to help establish a theoretical ground and stimulate further research within the field of audio games. By adopting an interdisciplinary approach to the topic, this research relies on theoretical studies, examinations of audio games and contact with the audio game community. In order to reveal the roles of sound, the gathered data is analyzed according to both a contextual and a functional perspective. The research shows that a distinction between the terms ‘function’ and ‘role’ is important when analyzing sound in digital games. The analysis therefore results in the identification of two analytical levels that help define the functions and roles of an entity within a social context, named the Functional and the Interfunctional levels. In addition to successfully identifying three main roles of sound within audio games—each describing the relationship between sound and the entities game system, player and virtual environment—many other issues are also addressed. Consequently, and in accordance with its purpose, this study provides a broad foundation for further research of sound in both audio games and video games.

Managing Seasonality in Tourism : Challenges and Opportunities for the Tourism Industry in Húsavík, Iceland

Seasonality is a common phenomenon in the tourism industry around the world. Húsavík, a town on the northern coast of Iceland, has experienced tremendous growth in tourism in recent years and is sometimes recognised as the „Whale Watching Capital of Europe‟. However, Húsavík faces extreme seasonality with high demand mainly during the summer months and limited or no demand at other times of the year. As is emphasised in the tourism literature and widely in practice, seasonality is frequently seen as a problem for the tourism industry which has to be tackled. Academic research has never before been done on seasonality in Húsavík and the aim of this thesis is to understand the nature of seasonality within the tourism industry in Húsavík and discover potential ways to reduce seasonality in Húsavík tourism. In order to fulfil the aim, qualitative semi-structured interviews were undertaken with six tourism managers in Húsavík to investigate their perceptions of seasonality and if and how it could be managed. The results confirmed that the peripheral location of the destination stimulates seasonality and it poses major economic challenges for tourism businesses in Húsavík. Managers would prefer a longer tourism season. Several recommendations were provided for how to reduce seasonality such as develop other attractions than whale watching, improve accessibility, focus marketing on seasons outside the summer, and offer winter packages for foreign and domestic tourists.

Optimization heuristic solutions, how good can they be? : With empirical applications in location problems

Combinatorial optimization problems, are one of the most important types of problems in operational research. Heuristic and metaheuristics algorithms are widely applied to find a good solution. However, a common problem is that these algorithms do not guarantee that the solution will coincide with the optimum and, hence, many solutions to real world OR-problems are afflicted with an uncertainty about the quality of the solution. The main aim of this thesis is to investigate the usability of statistical bounds to evaluate the quality of heuristic solutions applied to large combinatorial problems. The contributions of this thesis are both methodological and empirical. From a methodological point of view, the usefulness of statistical bounds on p-median problems is thoroughly investigated. The statistical bounds have good performance in providing informative quality assessment under appropriate parameter settings. Also, they outperform the commonly used Lagrangian bounds. It is demonstrated that the statistical bounds are shown to be comparable with the deterministic bounds in quadratic assignment problems. As to empirical research, environment pollution has become a worldwide problem, and transportation can cause a great amount of pollution. A new method for calculating and comparing the CO2-emissions of online and brick-and-mortar retailing is proposed. It leads to the conclusion that online retailing has significantly lesser CO2-emissions. Another problem is that the Swedish regional division is under revision and the border effect to public service accessibility is concerned of both residents and politicians. After analysis, it is shown that borders hinder the optimal location of public services and consequently the highest achievable economic and social utility may not be attained.

How does employment density influence individuals’ wages? : A micro data approach.

We estimate the effect of employment density on wages in Sweden in a large geocoded data set on individuals and workplaces. Employment density is measured in four circular zones around each individual’s place of living. The data contains a rich set of control variables that we use in an instrumental variables framework. Results show a relatively strong but rather local positive effect of employment density on wages. Beyond 5 kilometers the effect becomes negative. This might indicate that the effect of agglomeration economies falls faster with distance than the effects of congestion.

Methodological issues in applying Location Models to Rural areas

Location Models are usedfor planning the location of multiple service centers in order to serve a geographicallydistributed population. A cornerstone of such models is the measure of distancebetween the service center and a set of demand points, viz, the location of thepopulation (customers, pupils, patients and so on). Theoretical as well asempirical evidence support the current practice of using the Euclidian distancein metropolitan areas. In this paper, we argue and provide empirical evidencethat such a measure is misleading once the Location Models are applied to ruralareas with heterogeneous transport networks. This paper stems from the problemof finding an optimal allocation of a pre-specified number of hospitals in alarge Swedish region with a low population density. We conclude that the Euclidianand the network distances based on a homogenous network (equal travel costs inthe whole network) give approximately the same optimums. However networkdistances calculated from a heterogeneous network (different travel costs indifferent parts of the network) give widely different optimums when the numberof hospitals increases.  In terms ofaccessibility we find that the recent closure of hospitals and the in-optimallocation of the remaining ones has increased the average travel distance by 75%for the population. Finally, aggregation the population misplaces the hospitalsby on average 10 km.

Transport and tourism : a weak symbiosis. An introduction to the special issue

“Tourism’s very existence depends on transport. Still, researchers in transportation and logistics do not show much interest in tourism whereas travel and tourism researchers pay more attention to accessibility than to transport.” These were the opening sentences of the call for papers for the TTRA European Chapter Conference “Transport and Tourism: Challenges, Issues and Conflicts” held in Rotterdam and Breda, The Netherlands from 22 to 24 April 2009.

Unga vuxnas upplevelse av sjuksköterskans bemötande av psykisk ohälsa vid kontakt med hälso- och sjukvården - en litteraturöversikt

Bakgrund: Unga vuxna som sökte vård sökte oftast inte för den psykiska ohälsan utan istället för något somatiskt. Det är viktigt att få de yngre vuxna att söka sig till vården när behov uppstår och underlätta till en god förbindelse mellan sjukvården och de unga vuxna. Syfte: Syftet med denna studie var att beskriva unga vuxnas upplevelser av sjuksköterskans bemötande av psykisk ohälsa vid kontakt med hälso- och sjukvården. Metod: Studien genomfördes som en litteraturöversikt. Resultat: För de unga vuxna var det inte lätt att komma in i vården på rätt vårdnivå om personen inte kom i kontakt med en sjuksköterska som hade ett holistiskt synsätt. Vården för de unga med psykisk ohälsa bör vara tillgänglig och informationen om tillgängligheten behöver ständigt upprepas. Slutsats: Det är viktigt att sjuksköterskor har kunskap och erfarenhet av unga psykiska människor för att kunna hjälpa dem med den psykiska ohälsan när de söker vård. Relationen mellan patienten och sjuksköterskan är av stor vikt för den fortsatta kontakten med vården för den unge vuxna. Det är viktigt att de känner tillit och förtroende.

Upplevelser av stöd från diabetessjuksköterskan hos personer med diabetes typ 1 : – Sekundäranalys av en kvalitativ intervjustudie

Introduction: Type 1 diabetes is a chronic disease that affects the individual in everyday life. The diabetes team sets the treatment goals together with the patient aiming for a good quality of life and to prevent complications. The diabetes nurse should include in-depth knowledge of the daily life of people with diabetes, and have respect for the individual's choices and life situation. Aim: To describe how people with type 1 diabetes experience the support from the diabetes nurse. Method: A qualitative content analysis with an inductive approach has been used. A secondary analysis including semi-structured interviews with 15 adults (> 18 years) with type 1 diabetes was conducted. Result: The result was summarized with an overall theme "At the clinic - experience of the support offered" describes how people experience the support from their diabetes nurse. The theme constituted three categories "Access to the diabetes nurse", "The diabetes nurse - a source of information and knowledge that might need to be complemented with the support from other professionals" and,"Mutual trust - the patient's experience of the district nurse as a discussion partner and support". Conclusion: The results showed that the accessibility to diabetes nurses was experienced as good. It was simple and easy to make contact. The diabetes nurses were experienced to be engaged and provide good support to the patients. A good dialogue with the diabetes nurse and commitment from the diabetes nurse were mentioned as important factors that made the visits to be experienced as good and important. There were requests for greater access and expanded opportunities for help from counselors, as well as an increased focus on how the person is feeling.

Flipped classroom and learning strategies

This paper seeks to answer the research question "How does the flipped classroom affect students’ learning strategies?" In e-learning research, several studies have focused on how students and teachers perceive the flipped classroom approach. In general, these studies have reported pleasing results. Nonetheless, few, if any, studies have attempted to find out the potential effects of the flipped classroom approach on how students learn. This study was based on two cases: 1) a business modelling course and 2) a research methodology course. In both cases, participating students were from information systems courses at Dalarna University in Sweden. Recorded lectures replaced regular lectures. The recorded lectures were followed by seminars that focused on the learning content of each lecture in various ways. Three weeks after the final seminar, we arranged for two focus group interviews to take place in each course, with 8 to 10 students participating in each group. We asked open questions on how the students thought they had been affected and more dedicated questions that were generated from a literature study on the effects of flipped classroom courses. These questions dealt with issues about mobility, the potential for repeating lectures, formative feedback, the role of seminars, responsibility, empowerment, lectures before seminars, and any problems encountered. Our results show that, in general, students thought differently about learning after the courses in relation to more traditional approaches, especially regarding the need to be more active. Most students enjoyed the mobility aspect and the accessibility of recorded lectures, although a few claimed it demanded a more disciplined attitude. Most students also expressed a feeling of increased activity and responsibility when participating in seminars. Some even felt empowered because they could influence seminar content. The length of and possibility to navigate in recorded lectures was also considered important. The arrangement of the seminar rooms should promote face-to-face discussions. Finally, the types of questions and tasks were found to affect the outcomes of the seminars. The overall conclusion with regard to students’ learning strategies is that to be an active, responsible, empowered, and critical student you have to be an informed student with possibilities and mandate to influence how, where and when to learn and be able to receive continuous feedback during the learning process. Flipped classroom can support such learning.

Barriers and facilitators in the provision of post-abortion care at district level in central Uganda : a qualitative study focusing on task sharing between physicians and midwives

Background: Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods: In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results: Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions: Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.

Geoprocessing journey-to-work data : delineating commuting regions in Dalarna, Sweden

Delineation of commuting regions has always been based on statistical units, often municipalities or wards. However, using these units has certain disadvantages as their land areas differ considerably. Much information is lost in the larger spatial base units and distortions in self-containment values, the main criterion in rule-based delineation procedures, occur. Alternatively, one can start from relatively small standard size units such as hexagons. In this way, much greater detail in spatial patterns is obtained. In this paper, regions are built by means of intrazonal maximization (Intramax) on the basis of hexagons. The use of geoprocessing tools, specifically developed for the processing ofcommuting data, speeds up processing time considerably. The results of the Intramax analysis are evaluated with travel-to-work area constraints, and comparisons are made with commuting fields, accessibility to employment, commuting flow density and network commuting flow size. From selected steps in the regionalization process, a hierarchy of nested commuting regions emerges, revealing the complexity of commuting patterns.