Subordinating careers to market forces? A critical analysis of European career guidance policy

This study explores language regarding career and career development in European policy documents on career guidance in order to disclose underlying view(s) of these phenomena conveyed in the texts. Qualitative content analysis was used to approach the subject in the texts, followed by a sender-oriented interpretation. Sources for interpretation include several sociological and pedagogical approaches based upon social constructionism. These provide a framework for understanding how different views of career phenomena arise. The characterization of career phenomena in the documents falls into four categories: contextual change, environment-person correspondence, competence mobility, and empowerment. An economic perspective on career dominates, followed by learning and political science perspectives. Policy formulations convey contradictory messages and a form of career \u27contract\u27 that appears to subordinate individuals\u27 careers to global capitalism, while attributing sole responsibility for career to individuals. (DIPF/Orig.

Pressure control for managing and optimizing adjacent subsurface operations in large scale CCS

Injecting CO2 in to the subsurface for safe storage of CO2 the pressure propagates far away from the injection point and this can be a potential problem if the overpressure extents to neighbouring subsurface activities or potential leakage pathways. For structural closure trap configurations the CO2 plume is captured within the local structural closure but the pressure footprint is on a more regional scale. This rise the question on, how large the storage complex needs to be for any individual storage operations and how large an area monitoring activities have to cover. The EC CCS guidance document addresses the issues with statements on competitions between subsurface operations but returns no absolute values. Pressure modelling of CO2 injection process with state of the art reservoir simulation tools is challenges by use of realistic model boundary conditions in order to model a realistic pressure level. Combined use of models on a site scale and on a regional scale can instruct how boundary conditions are set-up for a site scale model. Pressure management through pressure release wells could be an option to mitigate undesirable over-pressure developments. For local structural closures the pressure release wells can be placed outside the closure hereby mitigate the overpressure without introducing a potential leakage by drilling inside the trap. The paper addresses the issue of selecting model boundary conditions and modelling mitigation of pressure development by use of a large regional model with local structural traps in the Bunter Sandstone Formation in the UK Southern North Sea

Can economic evaluation in telemedicine be trusted? A systematic review of the literature

<p>Abstract</p> <p>Background</p> <p>Telemedicine has been advocated as an effective means to provide health care services over a distance. Systematic information on costs and consequences has been called for to support decision-making in this field. This paper provides a review of the quality, validity and generalisability of economic evaluations in telemedicine.</p> <p>Methods</p> <p>A systematic literature search in all relevant databases was conducted and forms the basis for addressing these issues. Only articles published in peer-reviewed journals and written in English in the period from 1990 to 2007 were analysed. The literature search identified 33 economic evaluations where both costs (resource use) and outcomes (non-resource consequences) were measured.</p> <p>Results</p> <p>This review shows that economic evaluations in telemedicine are highly diverse in terms of both the study context and the methods applied. The articles covered several medical specialities ranging from cardiology and dermatology to psychiatry. The studies analysed telemedicine in home care, and in primary and secondary care settings using a variety of different technologies including videoconferencing, still-images and monitoring (store-and-forward telemedicine). Most studies used multiple outcome measures and analysed the effects using disaggregated cost-consequence frameworks. Objectives, study design, and choice of comparators were mostly well reported. The majority of the studies lacked information on perspective and costing method, few used general statistics and sensitivity analysis to assess validity, and even fewer used marginal analysis.</p> <p>Conclusion</p> <p>As this paper demonstrates, the majority of the economic evaluations reviewed were not in accordance with standard evaluation techniques. Further research is needed to explore the reasons for this and to address how economic evaluation in telemedicine best can take advantage of local constraints and at the same time produce valid and generalisable results.</p

From Paper to E-Prescribing of Multidose Drug Dispensing: A Qualitative Study of Workflow in a Community Care Setting

E-prescribing is now widespread and, in some countries, has completely replaced paper prescriptions. In Norway, almost all prescribing is electronic, except for multidose drug dispensing (MDD), which is still sent to the pharmacy by fax or ordinary mail. MDD is an adherence aid used by one-third of all patients receiving home care services. In this paper, we present results from a qualitative study evaluating the introduction of e-prescribing for MDD in a community health care setting. The focus is on the work and workflow for the pharmacists and nurses involved in the medication-handling process. We used the pragmatic process evaluation framework and the systematic text condensation method to analyse the data. We conducted 12 interviews with 34 nurses and pharmacists. This study shows that the e-prescribing of MDD led to greater integration between systems, both within the existing MDD system and across care levels, potentially improving patient safety. However, the structured prescriptions increased the need for clarifications, resulting in an increased overall workload. A greater understanding of the roles and responsibilities of the different professionals in the medication management chain and their needs would improve the workflow of the nurses and pharmacists involved

CO2 capture from offshore oil installations: An evaluation of alternative methods for deposition with emphasis on carbonated water injection

Capture and storage of CO2 from gas turbine power plants can be an alternative to electrification from shore to reduce the emissions from petroleum production facilities on the Norwegian Continental Shelf. The objective of this work was to analyse and rank various options for storage using technical economic analyses. The following alternatives were considered: 1. Dissolution of CO2 in sea water and aquifer storage of carbonated water 2. Injection of pure CO2 into an aquifer 3. Compression of CO2 and pipeline transport to a collection centre 4. Liquefaction of CO2 and ship transport to a collection centre 5. Dissolution of CO2 in sea water and injection into oil fields (carbonated water injection, CWI) For each alternative the investment costs and operating costs were estimated, and the net present values were determined. Credit for saved CO2 tax was included as incomes for all alternatives. The CO2 tax is expected to increase significantly from present level to Year 2030. For Alternative 5, CWI into oil fields, incomes from incremental oil production was also included. This required more comprehensive analyses. Using both a heterogeneous and a homogeneous field scale simulation model incremental oil productions and CO2 retention were estimated for CWI into both green and brown fields cases. The economic calculations show that alternatives 1 – 4 have negative net present values. A higher future CO2 tax than presently envisaged will be needed to make the alternatives economically viable. All cases related to Alternative 5 (project lifetime, heterogeneous and homogeneous reservoir models, green and brown fields) exhibit positive net present values due to incremental oil production. Most, but not all, injected CO2 remained in the reservoir, depending on the injection period. Oxygen in the captured CO2, formation of gas hydrates and corrosion of well materials may cause operational problems of injecting sea water with dissolved CO2. These aspects have been briefly discussed. Some additional measures may have to be taken to alleviate undesired effects, but none of the issues are likely to prohibit implementation of CWI. The results obtained suggest that CWI into producing oil reservoirs offers an economic viable and safe way for disposal of CO2 captured from offshore petroleum production plants provided that a capture plant can be installed, and that the remaining lifetime of the reservoir is so long that the benefits of improved oil recovery can be realised.publishedVersio

Medication Self-Management for Home Care Users Receiving Multidose Drug Dispensing: Qualitative Interview Study

Background: Multidose drug dispensing (MDD) is an adherence aid where medicines are machine-dispensed in disposable unit bags, usually for a 14-day period. MDD replaces manually filled dosettes in many home care services in Norway. While evidence suggests that MDD can improve medication adherence and reduce errors, there are few studies on how patients manage MDD at home and how this affects their daily routines. Objective: The aim of the study is to identify factors influencing medication self-management behavior among MDD users living at home and explore how MDD affects medication self-management. Methods: We conducted semistructured interviews with 19 MDD users in Oslo between August 2019 and February 2020. The interviews were held at the participants’ homes, and the interview transcripts were analyzed thematically. Results: All participants in the study received some form of assistance with medication management from home care services. This assistance ranged from MDD delivery every other week to actual assistance with medication administration multiple times daily. However, regardless of the level of assistance received, participants primarily managed their MDD medications themselves. Daily medication routines and knowledge about medicines varied among the participants, with some taking an active role in their medication management, while others relied on others to take responsibility. The degree of involvement seemed determined by motivation rather than capability. Conclusions: MDD can support medication self-management, but its effectiveness varies among patients. The level of medication management by MDD users is not solely determined by their actual capabilities. Factors such as interest in self-care and independence, available support, information, and cognitive capacity all play a role in determining the degree of autonomy

From paper-based to electronic prescribing of multidose drug dispensing — effects on pharmacy workload

Since 2014, an electronic prescribing system has been piloted for patients receiving medications as multidose drug dispensing; a system commonly used in home care services. In this longitudinal study of 499 patients, we investigate workload at the pharmacies, measured as the number of times pharmacists assess prescriptions. In the 26-week period before the implementation, 17% of the patients got their prescriptions assessed by a pharmacist every 2 weeks, in the 42 weeks after, this increased to 47%. This considerably increases the pharmacy workload, with an estimated additional 602.000 pharmacist assessments every year if all eligible patients get the new prescribing system

The effectiveness and cost effectiveness of the PAtient-Centred Team (PACT) model: Study protocol of a prospective matched control before-and-after study

Background: The present study protocol describes the evaluation of a comprehensive integrated care model implemented at two hospital sites at the University Hospital of North Norway (UNN). The PAtient Centred Team (PACT) model includes proactive, patient-centred interdisciplinary teams that aim to improve the continuum and quality of care of frail elderly patients and reduce health care costs. The main objectives of the evaluation are to analyse the effectiveness and cost effectiveness of using patient-centred teams as part of routine service provision for this patient group. The evaluation will analyse the effect on patient health and functional status, patient experiences and hospital utilisation, and it will conduct an economic evaluation. This paper describes the PACT model and the rationale for and design of the planned effectiveness and cost-effectiveness study. Methods/design: This is a prospective, non-randomised matched control before-and-after intervention study. Patients in the intervention group will be recruited from the hospital sites that have implemented the PACT model. The controls will be recruited from two hospitals without the model. The control patients and the index patients will be matched according to sex, age and number of long-term conditions. The study aims to include 600 patients in each group, which will provide sufficient power to detect a clinical change in the primary outcome. The primary outcome is the physical dimension of the Short Form Health Survey (SF-36). Secondary outcomes are the Patient Generated Index (PGI), the Patient Activation Measure (PAM), the Patient Assessment of Chronic Illness Care (PACIC), hospitalisation and length of stay. The cost-effectiveness study takes a health provider perspective and calculates the cost per quality-adjusted life-years (QALYs) gained. The data will be collected at baseline, 6 and 12 months. The data will be analysed using techniques and models that recognise the lack of randomisation and the correlation of cost and effect data. Discussion: The study results will provide knowledge about whether the integrated care model implemented at UNN improves the quality of care for the frail elderly with multiple conditions. The study will establish whether the PAC. T model improves health and functional status and is cost effective compared to the usual care for this patient group

The effectiveness and cost effectiveness of the PAtient-Centred Team (PACT) model: Study protocol of a prospective matched control before-and-after study

Background: The present study protocol describes the evaluation of a comprehensive integrated care model implemented at two hospital sites at the University Hospital of North Norway (UNN). The PAtient Centred Team (PACT) model includes proactive, patient-centred interdisciplinary teams that aim to improve the continuum and quality of care of frail elderly patients and reduce health care costs. The main objectives of the evaluation are to analyse the effectiveness and cost effectiveness of using patient-centred teams as part of routine service provision for this patient group. The evaluation will analyse the effect on patient health and functional status, patient experiences and hospital utilisation, and it will conduct an economic evaluation. This paper describes the PACT model and the rationale for and design of the planned effectiveness and cost-effectiveness study. Methods/design: This is a prospective, non-randomised matched control before-and-after intervention study. Patients in the intervention group will be recruited from the hospital sites that have implemented the PACT model. The controls will be recruited from two hospitals without the model. The control patients and the index patients will be matched according to sex, age and number of long-term conditions. The study aims to include 600 patients in each group, which will provide sufficient power to detect a clinical change in the primary outcome. The primary outcome is the physical dimension of the Short Form Health Survey (SF-36). Secondary outcomes are the Patient Generated Index (PGI), the Patient Activation Measure (PAM), the Patient Assessment of Chronic Illness Care (PACIC), hospitalisation and length of stay. The cost-effectiveness study takes a health provider perspective and calculates the cost per quality-adjusted life-years (QALYs) gained. The data will be collected at baseline, 6 and 12 months. The data will be analysed using techniques and models that recognise the lack of randomisation and the correlation of cost and effect data. Discussion: The study results will provide knowledge about whether the integrated care model implemented at UNN improves the quality of care for the frail elderly with multiple conditions. The study will establish whether the PAC. T model improves health and functional status and is cost effective compared to the usual care for this patient group