IT support for administrative planning of clinical practice.

The administration of clinical practice placements for nursing students is a highly complex and information driven task. This demonstration is intended to give insight into the web based system KliPP (a Swedish acronym for Clinical Practice Planning) and to discuss the possibilities for further development and use.

Decisions with Impact on Energy Reduction Opportunities : Swedish manufacturers and buyers of new single-family houses

This article discusses some of the complexities of human decision-making. It aims, in particular, at relating the nature of decision-making to the illusory dichotomies of change and stability, individual actions and cultural sharing. Serving as an illustration to the discussion of the article is ongoing fieldwork in contexts of buying, selling and constructing pre-fabricated detached houses in the central Sweden, and the very specific question of how decisions to install one kind of heating-system rather than another come about. A common reductionism is to narrow down the understanding of decisions about heating systems and energy consumption to conscious choices made by individual householders. I have asked myself whether, on the contrary, anyone actually makes such decisions at all. Perhaps some of these decisions are merely outcomes of interaction between different individuals with their respective responsibilities and focuses of interest.

Kvalitetsuppföljningar och sjuksköterskans omvårdnadsprioriteringar i särskilt boende : En kvalitativ intervjustudie

Syfte: Att undersöka hur sjuksköterskor inom särskilt boende resonerar kring kvalitetsuppföljningar och dess eventuella konsekvenser för omvårdnaden. Metod: Semistrukturerade intervjuer efter öppen intervjuguide med sex sjuksköterskor. Kvalitativ innehållsanalys enligt Graneheim och Lundmans metod. Huvudresultat: I vilken grad kvalitetsregistren och kvalitetsuppföljningarna integreras i omvårdnadsarbetet och dess utveckling är centralt för om dessa uppfattas som stöd eller hinder för god kvalité i omvårdnaden. Dubbel dokumentation bidrar till att sjuksköterskorna omprioriterar arbetstiden och arbetar mer konsultativt och administrativt. Detta minskar tiden för omvårdnadsobservationer och handleding av omvårdnadspersonal samt gör att kvalitetsregistreringar snarast uppfattas som ett hinder. Sjuksköterskorna använde sin professionella kunskap och kliniska erfarenhet i högre grad än registerdata vid omvårdnadsbedömningar. Dessa sågs som alltför komplexa för att kunna fångas i kryssfrågeformulär. Mer kliniska observationer efterfrågas i kvalitetsuppföljningarna för ökad medvetenhet om hög arbetsbelastning och dess eventuella konsekvenser samt för att garantera de boende god omvårdnadskvalité. Konklusion: Sjuksköterskorna upplever att de arbetar under svår tidspress. Tiden anges som essentiell för vilken omvårdnadskvalité som erbjuds. Vid beslut om registreringar av kvalitetsindikatorer bör sjuksköterskornas totala arbetsbörda beaktas. Registreringarna bör integreras i befintliga journalsystem så att sjuksköterskornas omprioriteringar inte får negativa konsekvenser för omvårdnadskvaliten.

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.

Assumptions of retail price strategy and price tactic decisions

This licentiate thesis sets out to analyse how a retail price decision frame can be understood. It is argued that it is possible to view price determination within retailing by determining the level of rationality and using behavioural theories. In this way, it is possible to use assumptions derived from economics and marketing to establish a decision frame. By taking a management perspective, it is possible to take into consideration how it is assumed that the retailer should strategically manage price decisions, which decisions might be assumed to be price decisions, and which decisions can be assumed to be under the control of the retailer. Theoretically, this licentiate thesis has its foundations in different assumptions about decision frames regarding the level of information collected, the goal of the decisions, and the outcomes of the decisions. Since the concepts that are to be analysed within this thesis are price decisions, the latter part of the theory discusses price decision in specific: sequential price decisions, at the point of the decision, and trade-offs when making a decision. Here, it is evident that a conceptual decision frame that is intended to illustrate price decisions includes several aspects: several decision alternatives and what assumptions of rationality that can be made in relation to the decision frame. A semi-structured literature review was conducted. As a result, it became apparent that two important things in the decision frame were unclear: time assumptions regarding the decisions and the amount of information that is assumed in relation to the different decision alternatives. By using the same articles that were used to adjust the decision frame, a topical study was made in order to determine the time specific assumptions, as well as the analytical level based on the assumed information necessary for individual decision alternatives. This, together with an experimental study, was necessary to be able to discuss the consequences of the rationality assumption. When the retail literature is analysed for the level of rationality and consequences of assuming certain assumptions of rationality, three main things becomes apparent. First, the level of rationality or the assumptions of rationality are seldom made or accounted for in the literature. In fact, there are indications that perfect and bounded rationality assumptions are used simultaneously within studies. Second, although bounded rationality is a recognised theoretical perspective, very few articles seem to use these assumptions. Third, since the outcome of a price decision seems to provide no incremental sale, it is questionable which assumptions of rationality that should be used. It might even be the case that no assumptions of rationality at all should be used. In a broader perspective, the findings from this licentiate thesis show that the assumptions of rationality within retail research is unclear. There is an imbalance between the perspectives used, where the main assumptions seem to be concentrated to perfect rationality. However, it is suggested that by clarifying which assumptions of rationality that is used and using bounded rationality assumptions within research would result in a clearer picture of the multifaceted price decisions that could be assumed within retailing. The theoretical contribution of this thesis mainly surround the identification of how the level of rationality provides limiting assumptions within retail research. Furthermore, since indications show that learning might not occur within this specific context it is questioned whether the basic learning assumption within bounded rationality should be used in this context.

Automating condition monitoring of vegetation on railway trackbeds and embankments

Vegetation growing on railway trackbeds and embankments present potential problems. The presence of vegetation threatens the safety of personnel inspecting the railway infrastructure. In addition vegetation growth clogs the ballast and results in inadequate track drainage which in turn could lead to the collapse of the railway embankment. Assessing vegetation within the realm of railway maintenance is mainly carried out manually by making visual inspections along the track. This is done either on-site or by watching videos recorded by maintenance vehicles mainly operated by the national railway administrative body. A need for the automated detection and characterisation of vegetation on railways (a subset of vegetation control/management) has been identified in collaboration with local railway maintenance subcontractors and Trafikverket, the Swedish Transport Administration (STA). The latter is responsible for long-term planning of the transport system for all types of traffic, as well as for the building, operation and maintenance of public roads and railways. The purpose of this research project was to investigate how vegetation can be measured and quantified by human raters and how machine vision can automate the same process. Data were acquired at railway trackbeds and embankments during field measurement experiments. All field data (such as images) in this thesis work was acquired on operational, lightly trafficked railway tracks, mostly trafficked by goods trains. Data were also generated by letting (human) raters conduct visual estimates of plant cover and/or count the number of plants, either on-site or in-house by making visual estimates of the images acquired from the field experiments. Later, the degree of reliability of(human) raters’ visual estimates were investigated and compared against machine vision algorithms. The overall results of the investigations involving human raters showed inconsistency in their estimates, and are therefore unreliable. As a result of the exploration of machine vision, computational methods and algorithms enabling automatic detection and characterisation of vegetation along railways were developed. The results achieved in the current work have shown that the use of image data for detecting vegetation is indeed possible and that such results could form the base for decisions regarding vegetation control. The performance of the machine vision algorithm which quantifies the vegetation cover was able to process 98% of the im-age data. Investigations of classifying plants from images were conducted in in order to recognise the specie. The classification rate accuracy was 95%.Objective measurements such as the ones proposed in thesis offers easy access to the measurements to all the involved parties and makes the subcontracting process easier i.e., both the subcontractors and the national railway administration are given the same reference framework concerning vegetation before signing a contract, which can then be crosschecked post maintenance.A very important issue which comes with an increasing ability to recognise species is the maintenance of biological diversity. Biological diversity along the trackbeds and embankments can be mapped, and maintained, through better and robust monitoring procedures. Continuously monitoring the state of vegetation along railways is highly recommended in order to identify a need for maintenance actions, and in addition to keep track of biodiversity. The computational methods or algorithms developed form the foundation of an automatic inspection system capable of objectively supporting manual inspections, or replacing manual inspections.

Monitoring vegetation on railway embankments : supporting maintenance decisions

The national railway administrations in Scandinavia, Germany, and Austria mainly resort to manual inspections to control vegetation growth along railway embankments. Manually inspecting railways is slow and time consuming. A more worrying aspect concerns the fact that human observers are often unable to estimate the true cover of vegetation on railway embankments. Further human observers often tend to disagree with each other when more than one observer is engaged for inspection. Lack of proper techniques to identify the true cover of vegetation even result in the excess usage of herbicides; seriously harming the environment and threating the ecology. Hence work in this study has investigated aspects relevant to human variationand agreement to be able to report better inspection routines. This was studied by mainly carrying out two separate yet relevant investigations.First, thirteen observers were separately asked to estimate the vegetation cover in nine imagesacquired (in nadir view) over the railway tracks. All such estimates were compared relatively and an analysis of variance resulted in a significant difference on the observers’ cover estimates (p<0.05). Bearing in difference between the observers, a second follow-up field-study on the railway tracks was initiated and properly investigated. Two railway segments (strata) representingdifferent levels of vegetationwere carefully selected. Five sample plots (each covering an area of one-by-one meter) were randomizedfrom each stratumalong the rails from the aforementioned segments and ten images were acquired in nadir view. Further three observers (with knowledge in the railway maintenance domain) were separately asked to estimate the plant cover by visually examining theplots. Again an analysis of variance resulted in a significant difference on the observers’ cover estimates (p<0.05) confirming the result from the first investigation.The differences in observations are compared against a computer vision algorithm which detects the "true" cover of vegetation in a given image. The true cover is defined as the amount of greenish pixels in each image as detected by the computer vision algorithm. Results achieved through comparison strongly indicate that inconsistency is prevalent among the estimates reported by the observers. Hence, an automated approach reporting the use of computer vision is suggested, thus transferring the manual inspections into objective monitored inspections

Local politico-administrative perspectives on quality improvement based on national registry data in Sweden : a qualitative study using the Consolidated Framework for Implementation Research.

Background. Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data. Methods. Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Results. The politicians and administrators perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians¿ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations. Conclusions. The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.