There exists little research into how value is effectively generated by temporary projects from the wider perspective of a permanent organisation. This paper investigates empirically how ‘Governance ...of Projects’ – the way in which a single, permanent organisation identifies, creates, and subsequently harvests value through multiple projects – occurs in four private-sector case companies. Data were collected from in-depth interviews with a wide range of employees and from internal operational documents. These data were codified and analysed as evidence of the types and intensity of links between organisational elements. The results illuminate the complex interplay of links that are imperative if the permanent organisation is to derive value from its projects, and shows that these links are context-dependent and vary between organisations. It is that the links exist, and not what the type of link is, that matters most. That these links extend beyond the project's execution is critical for maximising value. The paper demonstrates the advantages of adopting an organisational perspective in order to properly understand how Governance of Projects generates value within a permanent organisation.
•Governance of Projects link projects with their permanent organisation to generate value.•Governance of Projects (GoP) spans the entire value process.•Five elements of GoP have been identified as central for value generation.•The network of links between the elements of GoP is a driver of value generation.•Types of links between elements and between domains are context-dependent.
Based on findings from five case studies, we discuss benefits obtained by using a common project management model. The case studies are part of an international research project aimed at determining ...the value of project management. All five companies applied a customized project management model. The five models are presented, and their characteristics, similarities, and differences are discussed. Based on interviews and comparisons with literature, the values obtained are identified. The values relate to efficiency, legitimacy, power and control, and stakeholder satisfaction. Further, the article points to necessary preconditions (both technical and human factors) in order to harvest the values.
In this article, we suggest that organizations should not focus on selecting between various project management approaches, tools, or behaviors. Instead, we claim that the real benefit from project ...management implementations comes from the mere creation of a common frame of reference. Based on four case studies, we identify elements that enhance such a common frame of reference: (1) a common project management model, (2) common project management training, (3) common project management examinations/certifications, and (4) activities for knowledge sharing. Values created, especially when the application of the elements was mandatory, were better communication, better customer satisfaction, and easier knowledge sharing.
Primarily, this study aims to examine whether children attending sports schools are more active than their counterpart attending normal schools. Secondary, the study aims to examine if physical ...activity (PA) levels in specific domains differ across school types. Finally, potential modifications by status of overweight/obesity and poor cardio-respiratory fitness are examined.
Participants were from the first part of the CHAMPS-study DK, which included approximately 1200 children attending the 0th - 6th grade. At the sports schools, the mandatory physical education (PE) program was increased from 2 to 6 weekly lessons over a 3-year period. Children attending normal schools were offered the standard 2 PE lessons. PA was assessed at two different occasions with the GT3X ActiGraph accelerometer, once during winter in 2009/10 and once during summer/fall in 2010. Leisure time organized sports participation was quantified by SMS track. Based on baseline values in 2008, we generated a high-BMI and a low-cardio-respiratory fitness for age and sex group variable.
There were no significant differences in PA levels during total time, PE, or recess between children attending sports schools and normal schools, respectively. However, children, especially boys, attending sports schools were more active during school time than children attending normal schools (girls: β=51, p=0.065; boys: β=113, p<0.001). However, in the leisure time during weekdays children who attended sports schools were less active (girls: β=-41, p=0.004; boys: β=-72, p<0.001) and less involved in leisure time organized sports participation (girls: β=-0.4, p=0.016; boys: β=-0.2, p=0.236) than children who attended normal schools. Examination of modification by baseline status of overweight/obesity and low cardio-respiratory fitness indicated that during PE low fit girls in particular were more active at sports schools.
No differences were revealed in overall PA levels between children attending sports schools and normal schools. Sports schools children were more active than normal schools children during school time, but less active during leisure time. In girls, less organized sports participation at least partly explained the observed differences in PA levels during leisure time across school types. Baseline status of cardio-respiratory fitness modified school type differences in PA levels during PE in girls.
The aim of this study is to examine some teachers and assistants’ perception of conditions for students’ democratic participation in the compulsory school for learning disabilities specialization ...training school. In order to deepen and more clearly describe the purpose of the study, three issues have been selected. Firstly, how do teachers and assistants perceive the concept of participation? Secondly, how do teachers and assistants perceive students opportunities for participation in teaching? And finally, do teachers and assistants perceive students’ opportunities for participation in democratic activities of school? It is a qualitative study using semi-structured interviews. A total of four interviews are included: two with teachers and two with assistants. The study has Shier’s (2001) model of participation as a theoretical basis. The study shows that teachers and assistant’s perception of participation can be divided into three areas. One is the point of view of making the students’ voices heard. The second is the idea that the students are given the opportunity to make choices, and finally participation perceives as the right to be part of a context. The results also show that teachers and assistants perception of the student’s opportunity to participation in education extends to the opportunity to make choices in every-day-school-life and not to actively participate in their own learning process. Finally, the results show that teachers and assistant’s perception of students’ opportunities to participate in democratic processes are limited within the training school.
Syftet med studien är att undersöka några lärares och assistenters uppfattning om förutsättningarna för elevers demokratiska delaktighet på grundsärskolan inriktning träningsskola. För att fördjupa och tydligare beskriva syftet med studien har tre frågeställningar valts. För det första, hur uppfattar lärare och assistenter begreppet delaktighet? För det andra, hur uppfattar lärare och assistenter elevers förutsättningar för delaktighet i undervisningen? Och slutligen, hur uppfattar lärare och assistenter elevers möjlighet till delaktighet i skolans demokratiska verksamheter? Det är en kvalitativ studie med semistrukturerade intervjuer. Två stycken med lärare och två stycken med assistenter, totalt fyra intervjuer ingår. Studien har Shiers (2001) delaktighetsmodell som teoretisk utgångspunkt. Studiens resultat visar på att lärares och assistenters uppfattningar om delaktighet delas in i tre områden. Det första är uppfattningen om att göra elevens röst hörd. Det andra är uppfattningen om att eleven får möjlighet att göra val och slutligen uppfattas delaktighet som rätten att vara en del i ett sammanhang. Resultaten visar också att lärares och assistenters uppfattning om elevens möjlighet till delaktighet i undervisningen sträcker sig till val i skolvardagen och inte till att aktivt delta i sin egen kunskapsprocess. Slutligen visar resultaten att lärares och assistenters uppfattning om elevers möjlighet att delta i demokratiska processer är begränsad inom träningsskolans praktik.
This study aimed to derive a new score, the Alcohol Septal Ablation-Sudden Cardiac ARREst (ASA-SCARRE) risk score, that can be easily used to evaluate the risk of sudden cardiac arrest events (sudden ...cardiac death, resuscitation, or appropriate implantable cardioverter-defibrillator discharge) after alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy. We analyzed 1,834 patients from the Euro-ASA registry (49% men, mean age 57 ± 14 years) who were followed up for 5.0 ± 4.3 years (9,202 patient-years) after ASA. A total of 65 patients (3.5%) experienced sudden cardiac arrest events, translating to 0.72 events per 100 patient-years. The independent predictors of sudden cardiac arrest events were septum thickness before ASA (hazard ratio 1.09 per 1 mm, 95% confidence interval 1.04 to 1.14, p <0.001) and left ventricular outflow tract (LVOT) gradient at the last clinical checkup (hazard ratio 1.01 per 1 mm Hg, 95% confidence interval 1.01 to 1.02, p = 0.002). The following ASA-SCARRE risk scores were derived and independently predicted long-term risk of sudden cardiac arrest events: “0” for both LVOT gradient <30 mmHg and baseline septum thickness <20 mm; “1” for LVOT gradient ≥30 mm Hg or baseline septum thickness ≥20 mm; and “2” for both LVOT gradient ≥30 mm Hg and baseline septum thickness ≥20 mm. The C statistic of the ASA-SCARRE risk score was 0.684 (SE 0.030). In conclusion, the ASA-SCARRE risk score may be a useful and easily available clinical tool to predict risk of sudden cardiac arrest events after ASA in patients with hypertrophic obstructive cardiomyopathy.
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•Hydromorphology, flow regime, drought determine stream typology in S. Mediterranean.•Flow regime causes taxonomical and functional responses in macrophytes assemblages.•Macrophytes ...functional traits strongly related to drought and light availability.•Significant macrophyte traits: canopy height, growth form, dispersal type, SLA.•Flow intermittency promotes highly species number with wider ecological preferences.
Macrophytes have a crucial impact on stream functioning. However, there is a significant gap of knowledge about how hydromorphological fluctuations affect their structural and functional responses in southern Mediterranean streams. In this study, we investigated the impact of hydromorphology on macrophyte stream assemblages in Cyprus and analysed their structural and functional responses. We collected macrophytes and hydromorphological data from 63 sites along a gradient from permanent to intermittent streams. We applied Principal Component Analysis (PCA) to identify and characterise stream sub-types. We performed an Indicator Species Analysis (ISA) and estimated taxonomical diversity indices to investigate whether differences among stream sub-types affect macrophytes assemblage structure. Functional responses to the flow regime were tested by allocating traits related to persistence, regeneration, dispersibility and ecological preferences for moisture, light, nutrients and salinity. The results indicated the existence of two permanent and two intermittent flow sub-types. A total of 25 indicator species were identified showing taxonomic variation in macrophyte assemblages among streams with different flow regimes. We demonstrated that flow intermittency promotes a higher number of indicator species with wider ecological preferences and traits allowing resilience to drought. Specifically, we found that macrophytes in the intermittent streams, survive during dry period through the establishment of dormant seed bank or through belowground organs. They also showed lower values of Specific Leaf Area and therefore a reduction of water loss through evapotranspiration. In the light of climate change, where droughts are anticipated to increase, more permanent streams will become intermittent especially in south Mediterranean countries, and new habitats will be released, including marginal zones. Our results showed that these alterations in stream hydromorphology will produce changes in macrophyte assemblages which might cause shifts in stream ecosystem functions and services. Therefore, our knowledge about the direction of these changes is crucial for future management and conservation plans.
Colorectal cancer recurrences are difficult to ascertain accurately and efficiently. We developed and validated an algorithm to identify recurrences that uses Danish medical registries. The algorithm ...uses metastasis and chemotherapy codes in the Danish National Patient Registry and codes indicating cancer recurrence in the Danish Pathology Registry. We applied the algorithm to a cohort (n = 21,246) of colorectal cancer patients diagnosed 2001–2011 and followed through 2012. In a cohort (n = 355) of two groups of actively followed patients, we compared the imputed recurrence data with recurrences diagnosed by regular follow‐up. We compared cumulative incidence curves of imputed recurrence in local and regional stage patients from the large cohort, and of imputed and diagnosed recurrences in the actively followed cohort. In the 355 members of the actively followed cohort, our algorithm correctly identified 60 of 63 recurrences sensitivity = 95%; 95% confidence interval (CI) 87–99% and misclassified only 10 of 292 without recurrence (specificity = 97%; 95% CI 94–98%). Cumulative incidence curves showed that members of the large cohort with regional disease had much higher incidence of imputed recurrence than those with local disease. In the actively followed cohort, the cumulative incidence of recurrence overlapped substantially when recurrence was imputed by our algorithm or using the follow‐up data. Despite some limitations regarding ambiguous pathology codes, our algorithm showed excellent performance against actively followed recurrence data, and the expected relation between recurrence risk and cancer stage. It can be used in the Danish registries and adapted to similar registries elsewhere.
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Steady gains in patient survival following the recurrence of tumors in colorectal cancer have brought into question the reliability of mortality as a surrogate of disease outcome. This study examined the ability of a newly developed algorithm to identify colorectal cancer recurrences using routinely collected registry data. The algorithm correctly identified 60 out of 63 recurrences in a Danish cohort of 355 patients under active surveillance. In cumulative incidence curves, it revealed an increased incidence of imputed recurrence in patients with regional versus local disease. The algorithm is applicable to settings where electronic health data are available.
Research indicates that active involvement of patients′ relatives generally has a positive impact on patients′ hospitalisation, including patient safety. Campaigns urge relatives to ask questions in ...relation to nursing care and treatment to enhance patient safety and to increase involvement of both patient and relatives. The question is how nurses experience relatives who ask questions. The aim of this study was to explore how nurses experienced contact with patients′ relatives during admissions to a somatic emergency ward including nurses′ experience of relatives asking questions related to nursing care and treatment. Six nurses were interviewed. The participants gave written consent to participate after receiving both oral and written information about the study. Data were analysed using combined theory and data‐driven qualitative content analysis. The findings formed three main themes: (i) relatives’ involvement as a means to efficiency during hospitalisation, (ii) relatives welcomed on the terms of the system and (iii) tension between high ideals and frustrating realities. The six interviews answered the research questions. However, more interviews could have broadened the study and contributed with further details. The nurses experienced relatives as an important resource – ‘an ace up the sleeve’, while reality seemed to challenge the relationship between nurses and relatives. The study contributes to discussions before development and implementation of specific initiatives aiming at increasing involvement of relatives of patients in a somatic emergency ward.
Reduced androgen action during early fetal development has been suggested as the origin of reproductive disorders comprised within the testicular dysgenesis syndrome (TDS). This hypothesis has been ...supported by studies in rats demonstrating that normal male development and adult reproductive function depend on sufficient androgen exposure during a sensitive fetal period, called the masculinization programming window (MPW). The main aim of this study was therefore to examine the effects of manipulating androgen production during different timepoints during early human fetal testis development to identify the existence and timing of a possible window of androgen sensitivity resembling the MPW in rats.
The effects of experimentally reduced androgen exposure during different periods of human fetal testis development and function were examined using an established and validated human ex vivo tissue culture model. The androgen production was reduced by treatment with ketoconazole and validated by treatment with flutamide which blocks the androgen receptor. Testicular hormone production ex vivo was measured by liquid chromatography-tandem mass spectrometry or ELISA assays, and selected protein markers were assessed by immunohistochemistry.
Ketoconazole reduced androgen production in testes from gestational weeks (GW) 7-21, which were subsequently divided into four age groups: GW 7-10, 10-12, 12-16 and 16-21. Additionally, reduced secretion of testicular hormones INSL3, AMH and Inhibin B was observed, but only in the age groups GW 7-10 and 10-12, while a decrease in the total density of germ cells and OCT4
gonocytes was found in the GW 7-10 age group. Flutamide treatment in specimens aged GW 7-12 did not alter androgen production, but the secretion of INSL3, AMH and Inhibin B was reduced, and a reduced number of pre-spermatogonia was observed.
This study showed that reduced androgen action during early development affects the function and density of several cell types in the human fetal testis, with similar effects observed after ketoconazole and flutamide treatment. The effects were only observed within the GW 7-14 period-thereby indicating the presence of a window of androgen sensitivity in the human fetal testis.
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