Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

Acoustic Design in Urban Development : analysis of urban soundscapes and acoustic ecology research in New York City

The world is urbanizing rapidly with more than half of the global population now living in cities. Improving urban environments for the well-being of the increasing number of urban citizens is becoming one of the most important challenges of the 21st century. Even though it is common that city planners have visions of a ’good urban milieu’, those visions are concerning visual aesthetics or practical matters. The qualitative perspective of sound, such as sonic diversity and acoustic ecology are neglected aspects in architectural design. Urban planners and politicians are therefore largely unaware of the importance of sounds for the intrinsic quality of a place. Whenever environmental acoustics is on the agenda, the topic is noise abatement or noise legislation – a quantitative attenuation of sounds. Some architects may involve acoustical aspects in their work but sound design or acoustic design has yet to develop to a distinct discipline and be incorporated in urban planning.My aim was to investigate to what extent the urban soundscape is likely to improve if modern architectural techniques merge with principles of acoustics. This is an important, yet unexplored, research area. My study explores and analyses the acoustical aspects in urban development and includes interviews with practitioners in the field of urban acoustics, situated in New York City. My conclusion is that to achieve a better understanding of the human living conditions in mega-cities, there is a need to include sonic components into the holistic sense of urban development.

Narration in Swedish pre- and primary school : a recourse for language development and multilingualism

Increased immigration in Europe and worldwide has led to more pre- and primary school students being educated through the medium of a second language, and there is considerable research, much of it coming from Australia, to suggest that in order to cope with this situation, children will need to begin to acquire, from their earliest years in pre-school, a variety of knowledge-based language skills that will be sufficient to carry them through the subject-based education they will encounter in their subsequent schooling. This is particularly important for L2-students who are less likely to meet academic language outside the school. In this paper, based on transcripts of oral interactions in the classroom, it is argued that conversational and story-telling skills, oral and written, provide a rich environment for the development of academic school language, while at the same time promoting and making good use of the cultural diversity that is increasingly a feature of pre-primary and primary classrooms.

Proceedings from the 2nd seminar on Development of Modular Products : December 13-14, 2004, Campus Framtidsdalen, Dalarna University, Sweden

Companies are focusing on efforts increasing the overall efficiency at the same time as the ability to meet customer needs becomes even more important. There is a need to improve the organisation and the product design at the same time through the visualisation of how a product family design should be performed in order to adapt to customers, company internal issues, and long-term strategy. Therefore, there is a need for qualified personnel in today’s companies with the knowledge of product development and modularity. The graduate course Development of Modular Products at Högskolan Dalarna has the objective to provide such knowledge. As a part of the course, each student will individually perform extensive research within a chosen area with respect to Product Development and Modularity. This proceeding is the result of the students own work and was presented during a two day seminar at Dalarna University. The contents of the papers cover many areas, from the identification of customer needs to cost effective manufacturing, and benefits of modularisation. The reader of this proceeding will not only benefit from many areas within Product Development and Modularity but also from the colour of many cultures. In this proceeding, students from nine countries are represented (Bangladesh, China, Costa Rica, Germany, Holland, India, Luxembourg Nigeria, and Sweden). Enjoy the reading.

Akademisk kvalitet, vad är det? : Om utarmningen av den akademiska autonomin

What is academic quality? On the decline of academic autonomy In light of the transformations that universities currently undergo, with Bologna as a keyword, the following questions are put: What ideals lie behind the assessment of academic “excellence” and “quality”? What agents have the ability to define what is good science and education today? These questions are approached through Pierre Bourdieus concept of field. Looking at the development the last decade, traditional academic values, such as the ideal of universal knowledge as (personal and collective) enrichment and the intellectual independence “of all political authority and economic power”, as stated in the Magna Charta Universitatum, seem to have emerged into the shadow of employability, knowledge control, competitiveness, and economic benefit. In connection with the formation of concepts such as “the knowledge society” and “knowledge based economies” the university has received a somewhat different and more central role in society. The university has come to take the role more of a knowledge producing enterprise clearly directed towards the surrounding society. There are higher demands on academic knowledge to contribute to economic, regional or national development and competitiveness. When the university is regarded as a knowledge company whose task is to accoun tfor the requests of the students, the labour market, and the business world it undertakes to follow trends and short term social phases rather than to critically examine them, which has been a traditional task for the university. If the academic work is guided by the market economical principle, that the client requests decide what quality is, instead of the experts on the academic field themselves (i.e. the scientists,) it is obviously not scientific ideals that constitute the criteria for what is good science and education.

När det inte blir som man har tänkt sig : - En fallstudie av undervisningssituationer med elever med behov av särskilt stöd

Fallstudien beskriver och diskuterar några lektioner med elever som har specifika inlärnings-svårigheter, utifrån skolverkets Allmänna råd, och belyser vilka pedagogiskt svårhanterliga problem och dilemman som kan uppstå när det inte blir som läraren har planerat. Teorin om den proximala utvecklingszonen åskådliggörs. Aktivitetens betydelse för inlärning belyses. Komplexiteten kring lärarskap och ledarskap illustreras. Skolverkets teori om kunskap genom progression, enligt givna årskurser med givet innehåll, stämmer inte alltid med erfarenheterna hos några av verklighetens elever. Samspelet mellan lärare och elever belyses i studien. Be-skrivningar av utvecklingsrelaterade funktionsnedsättningar och psykiskt sårbara barn visar ytterligare hur elevers individuella förutsättningar kan ge konsekvenser för inlärning.