Skoterturismen och utvecklingen i Funäsdalsfjällen : En uppföljning av projektet "Hållbar utveckling i Funäsdalsfjällen"

Projektet ”Hållbar utveckling i Funäsdalsfjällen” pågick under 1999-2001 och har både nationellt och internationellt omskrivits som ett lyckosamt och banbrytande projekt med målsättning att utveckla skoterturism i den svenska fjällvärlden utan att konflikter och störningar uppstår som kan försämra förutsättningarna för andra turismgrenar i området. Syftet med denna rapport är att redovisa resultaten från en uppföljningsstudie av projektet ”Hållbar utveckling i Funäsdals¬fjällen”. Projektets olika delmål har följts upp dels via en enkätstudie riktad till ett urval av skoter- och turskidåkare som besökt Funäsdalsfjällen, dels via ett antal djupintervjuer med företrädare för de olika lokala intressegrupperna. Dessutom har skoterturismens effekter på den lokala ekonomin specialstuderas inom ramen för ett examensarbete. Vi bedömer att projektet har varit lyckat och uppfyllt de målsättningar som satts upp för projektets verksamhet på kort sikt. En viktig förklaring till detta har varit projektets utgångspunkt i konsensusbeslut. Från intervjustudien blir det tydligt att de olika grupperna av aktörer och intressenter har olika syn på hur utvecklingen i Funäsdalsfjällen ska se ut på lång sikt. Vissa vill exempelvis fortsätta att utveckla skoterturismen medan andra anser att gränsen för skoteråkningens påverkan i området är nådd. För fortsatt hållbar utveckling i området är det sannolikt mycket viktigt att alla intressegrupper fortsätter att delta i arbetet med att utveckla Funäsdalfjällen.

Nätverkssamarbete och destinationsutveckling : En jämförelse av ett storskaligt och ett småskaligt turismutvecklingsprojekt

Hållbar destinationsutveckling kräver samarbete mellan offentliga och privata aktörer. Denövergripande forskningsfrågan som genomsyrat arbetet med denna rapport handlar om hursamhällets resurser bäst kan användas för att utveckla turistdestinationer. Projekten NordicSnowmobile Center och Projekt Entreprenörsutbildning Småland/Kronoberg, vilka har finansieratsmed olika mycket offentliga medel, utvärderas i denna rapport. Resultaten från utvärderingenutgör sedan grund för diskussion och analys av destinationsutveckling. Rapporten redogörockså för följeforskning genomförd på Projekt Nordic Snowmobile Center (NSC) mellan åren2004-2007.Vi konstaterar att båda projekten uppfyller sina huvudsyften. Projekt NSC kan däremot inteanses ha uppfyllt alla sina delmål. Förklaringarna till detta står att finna i faktorer somförankringen av projektets mål och delmål i projektområdet; en asymmetri i budgeterade investeringskostnadermellan projektets delområden; institutionella faktorer såsom projektadministrationsamt redovisningsprinciper hos EU-sekretariat och de andra offentliga finansiärerna.Följeforskningen av Projekt NSC identifierade dessutom ett antal faktorer som kan bidra till ökadförståelse för hur ett projekt av denna storlek bör organiseras och ledas samt vilka stöd som ettprojekt av den här typen kräver för att åstadkomma destinationsutveckling.

Applikationsövervakning : Dess möjliga bidrag till en verksamhet

Applikationsövervakning är en term för att i realtid övervaka applikationer och kunna upptäcka fel innan slutanvändaren märker av ett problem. Med övervakning av applikationer menas inte bara den enskilda programvaran utan allt som rör applikationen i fråga. Trafikverkets önskemål är att leverera en hög kvalité i sina applikationer. I nuläget har utvecklare ingen eller dålig insyn i hur en applikation levererar i en skarp miljö efter att de lämnat över ansvaret till drift. För att kunna hålla en bra kvalité i sina applikationer så vill de undersöka hur applikationsövervakning kan hjälpa till att se behov av ändringar i applikationer innan större problem uppstår. I en fallstudie bestående av intervjuer och dokumentstudier kommer genom användning av situationsbaserad FA/SIMM nuvarande arbetssätt fångas. Samt fånga mål och problem som uttrycks i verksamheten kring utveckling & förvaltning och drift av applikationer. Dessa kommer sedan analyseras för att undersöka på vilket sätt applikationsövervakning skulle hjälpa utvecklare & förvaltare, men även driftspersonal i deras arbete. Resultatet av detta visar att de problem och mål som tas upp dels är organisatoriska i sin natur och arbetssättet DevOps framhålls som en möjlig lösning. Även att applikationsövervakning de facto skulle kunna bidra till en ökad kvalité i applikationerna genom att tillföra en möjlighet att arbeta mer proaktivt.

Regionalekonomisk betydelse av travsporten : exemplet Dalatravet Rättvik

Tidigare studier har visat att hästnäringen inklusive spridningseffekter årligen omsätter ca 46 miljarder kronor och bidrar till sysselsättning för ca 30 000 helårsverken. Motsvarande beräkningar för travsportens del av hästnäringen eller för en mindre region finns däremot inte. Denna rapport syftar till att uppskatta regionalekonomisk betydelse av travsport i Sverige med utgångspunkt i en mindre travbanas verksamhet. Dalatravet Rättvik (DT Rättvik) används som en fallstudie. Resultaten baseras dels på registerdata över faktiskt registrerade hästar med koppling till DT Rättvik dels på enkätmaterial insamlat från ett urval av besökare vid tävlingar under sommaren 2014. Totalt används svar från 444 besökare i analysen. Resultaten från beräkningarna visar att den direkta ekonomiska effekten av DT Rättviks 333 travhästar i amatör- eller proffsträning genererar 20 miljoner i travhästtrelaterad konsumtion. DT Rättviks travsportevenemang uppskattas generera ca 29 miljoner varav 11,1 miljoner ärett tillskott till den regionala ekonomin i form av turistekonomisk omsättning. Travsportens sammanlagda regionalekonomiska effekt beräknas således uppgå till minst 31,1 miljonerkronor. Inkluderas även utbildning, avel och uppfödning samt sysselsättning vid ATG-ombudså uppskattas travsporten generera ca 40 helårsverken inom DT Rättviksregionen.  

Passive MVC och MVVM designmönster i Android : En jämförelse av kodkomplexitet mellan Passive MVC och MVVM

Det mobila operativsystemet Android är idag ett ganska dominerande operativsystem på den mobila marknaden dels på grund av sin öppenhet men också på grund av att tillgängligheten är stor i och med både billiga och dyra telefoner finns att tillgå. Men idag har Android inget fördefinierat designmönster vilket leder till att varje utvecklare får bestämma själv vad som ska användas, vilket ibland kan leda till onödigt komplex kod i applikationerna som sen blir svårtestad och svårhanterlig. Detta arbete ämnar jämföra två designmönster, Passive Model View Controller (PMVC) och Model View View-Model (MVVM), för att se vilket designmönster som blir minst komplext med hjälp av att räkna fram mätvärden med hjälp av Cyclomatic Complexity Number (CCN). Studien är gjord utifrån arbetssättet Design & Creation och ämnar bidra med: kunskap om vilket mönster man bör välja, samt om CCN kan peka ut vilka delar i en applikation som kommer att ta mer eller mindre lång tid att testa. Under studiens gång tog vi även fram skillnader på om man anväder sig av den så kallade Single Responsibilyt Principle (SRP) eller inte. Detta för att se om separerade vyer gör någon skillnad i applikationernas komplexitet. I slutändan så visar studien på att komplexiteten i små applikationer är väldigt likvärdig, men att man även på små applikationer kan se skillnad på hur komplex koden är men också att kodkomplexitet på metodnivå kan ge riktlinjer för testfall.

Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden

BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process.

Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

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.

Amalgamation of health services in South-West Victoria: reinvention or survival?

In Australia 'the hospital' has long been considered the cornerstone of small, rural health services. However, this premise has been altered significantly by the introduction of casemix loading and diagnostic-related groups that promote a rationalised output-based model of management. In the light of these changes, many rural health services have struggled to reinvent themselves by establishing a range of service models such as Multi-purpose Service (MPS) and Health Streams, while maintaining traditional models (i.e. bush nursing centres, nursing homes and aged-care facilities). These changes are about survival. This paper analyses one such case in south-west Victoria, the Macarthur and District Community Outreach Service, and compares the outcomes with other similar Victorian rural health research projects. Particular attention is paid to the nature of the health services, the management of change and the proposed health outcomes for the local rural communities. In conclusion, it is argued that this study adds to the body of knowledge surrounding the construction of models of community health and development programming, These models impact upon future rural and remote area initiatives throughout Australia.

Straddling the pathway from paediatrician to mainstream health care : transition issues experienced in disability care

Objective: To identify the strengths and limitations of health care and related services provided to young adults with a disability during the period of transition from the care of a paediatrician to the mainstream health system.
Design: A descriptive design was used to address the study objectives.
Setting: Barwon and south-western region of Victoria.
Subjects: Twelve focus group discussions, with young adults with a disability, carers of young adults with a disability and health care service providers. Each focus group involved eight to 10 participants.
Results: The findings revealed a number of problems with the transition period. All participants acknowledged the supportive, coordinating role of the paediatrician. In the absence of this type of role, carers felt they lacked the knowledge and support to manage the adolescent with a disability. Communication problems between all service providers were identified as being problematical. The general lack of continuity of care between providers made it difficult for individuals to negotiate the transition period and increased the burden of care on carers.
Conclusion: There is a need for policy makers to address these transition problems and develop appropriate services that improve the situation for young adults with a disability and their carers.
What is already known: It is well documented that the transition period from paediatrician to adult health care services is problematic for the young adult with a disability and their carer. The difficulties experienced are attributed to poor communication between service providers and a lack of continuity of care.
What does this study add: This study provides insights from a number of different consumer and health care professionals' perspectives. The findings identify service delivery gaps and a need to develop health care services that could assist the young adult with the disability negotiate this transition from the paediatric services to mainstream health care services in rural and regional settings in Victoria.

Retention of allied health professionals in the south-west of Victoria

The article reports on the research studies about the role of the allied health professionals in primary and preventive health care in Victoria. The studies shows that allied health practice in rural areas provide information on the strategies to maintain the health workforce. The results of the final report regarding the allied workforce issues in south-west Victoria was discussed. The details about the participants, methods and results of the survey regarding the retention of allied health professionals in south-west Victoria.

Evaluation of a stress management course in adult education centres in rural Australia

Objective: To investigate whether attending a six-week stress management course in a rural adult education centre is effective in reducing participants' levels of stress, anxiety and depression.

Design: Repeated measures design using self-report measures of stress, anxiety and depression at commencement and completion of a six-week stress management course, and six months post-completion follow up.

Setting and participants: One hundred and thirty-two adults (age range 18–73 years) living in a rural community who self-enrolled in the stress management course at adult education centres.

Intervention: The course consisted of six weekly group sessions. Each two-hour session conducted by mental health professionals, included teaching cognitive behavioural strategies targeted at reducing individual symptoms of stress.

Main outcome measures: Comparative analysis of pre- and post-test and six-month follow up on measures of stress (Stress Symptom Checklist), anxiety and depression (Hospital Anxiety and Depression Scale).

Results: Results indicated a significant reduction in stress symptoms (F(7,90) = 34.92, P < 0.001), anxiety and depression (F(3,95) = 87.92, P < 0.001) from course commencement to course completion. These improvements were sustained six months after course completion for stress symptoms (F(11,65) = 22.40, P < 0.001), anxiety and depression (F(5,73) = 41.78, P < 0.001).

Conclusion: Findings demonstrate the stress management course is an effective community intervention in a rural community. Challenges for future implementation of the program are discussed.

Prevalence of psychological distress, anxiety and depression in rural communities in Australia

Objective: To describe the prevalence of psychological distress, depression and anxiety in three Australian rural settings and to identify the levels of risk by gender and age.

Design and setting: Three cross-sectional surveys in the Greater Green Triangle area covering the south-east of South Australia (Limestone Coast), and south-west (Corangamite Shire) and north-west (Wimmera) of Victoria.

Participants: A total of 1563 people, aged 25–74 years, randomly selected from the electoral roll.

Main outcome measures: Psychological distress assessed by the Kessler 10, and anxiety and depression assessed by the Hospital Anxiety and Depression Scale.

Results: The prevalence of psychological distress was 31% for both men and women with two-thirds reporting moderate and one-third high levels of psychological distress. The prevalence of depression and anxiety was approximately 10%. The highest rate of psychological distress, anxiety and depression occurred in the 45–54 years age group. There were no consistent gender or area differences in the prevalence of psychological distress, depression or anxiety.

Conclusions: A third of the rural population reported psychological distress, with the highest prevalence observed in middle-aged men and women. Thus, health professionals should attend not only to physical health, but also to mental health status in this age group. It is also important to target prevention strategies at the 20% who reported moderate levels of psychological distress in order to prevent the development of more serious conditions.