Traditionally, medical residency positions have been primarily funded by the federal government. However, due to declining governmental funding support over time, medical schools have resorted to fund these programs through other means such as clinical fees and payments for services. This change has affected the number and types of residencies available to medical school graduates. The purpose of this study was to measure how the availability of fiscal resources shape mission-related outputs, particularly medical residency positions at medical schools. Using academic capitalism as the theoretical framework provided a lens through which to examine how federal policies have shaped the availability and funding of medical residencies today at the institutional level. This concept has been studied in traditional colleges and universities and how they balance mission and money, but less so in the context of medical schools. This study used a fixed effect panel analysis to study the impact of selected variables over a 10-year period on financing of medical residencies. Findings included that tuition revenues, paid for by undergraduate medical students, are increasingly funding medical residency positions. There was little to no effect from hospital revenues and federal research monies on increasing the number of medical residency positions. The funding of university based medical education is particularly timely and of national importance to understand the consequences of federal policies for medical schools and how medical residency funding caps and limits have affected one of the missions of medical schools which is to train physicians.

<p>Агротуризам&nbsp; редставља&nbsp; осебни,&nbsp; селективни&nbsp; вид&nbsp; туризма&nbsp; који&nbsp; обједињује&nbsp; скуп&nbsp; активности&nbsp; на&nbsp;сеоским&nbsp; туристичким&nbsp; домаћинствима&nbsp; и&nbsp; у&nbsp; објектима&nbsp; у&nbsp; домаћој&nbsp; радиности.&nbsp; У&nbsp; раду&nbsp; је&nbsp; дат &nbsp;преглед&nbsp; владајуће&nbsp;литературе&nbsp; о&nbsp; агротуризму&nbsp; у AП&nbsp; Војводини (Србији)&nbsp; и&nbsp; иностраним&nbsp; државама&nbsp; и&nbsp; дефинисане&nbsp; су&nbsp; основне&nbsp; карактеристике&nbsp; овог&nbsp; вида&nbsp; туризма.&nbsp; Приказане&nbsp; су&nbsp; туристичко-географске&nbsp; карактеристике&nbsp; истраживаног&nbsp;ростора,&nbsp; описана&nbsp; је&nbsp; студија&nbsp; случаја&nbsp; стања&nbsp; и&nbsp; развоја&nbsp; агротуризма&nbsp; у&nbsp; Војводини&nbsp; и&nbsp; упоређена&nbsp; са&nbsp; осталим&nbsp;деловима&nbsp; Србије&nbsp; и&nbsp; са &nbsp;примерима&nbsp; из&nbsp; иностранства.&nbsp; У&nbsp; методолошком&nbsp; делу &nbsp;приказани&nbsp; су&nbsp; инструменти, процедура&nbsp; и&nbsp; узорак&nbsp; истраживања,&nbsp; а&nbsp; остављене&nbsp; су&nbsp; и&nbsp; хипотезе&nbsp; рада.&nbsp; Кроз &nbsp;резултате&nbsp; и&nbsp; дискусију,&nbsp; хипотезе&nbsp;су &nbsp;потврђене,&nbsp; делимично &nbsp;потврђене&nbsp; или&nbsp; оповргнуте,&nbsp; уз &nbsp;помоћ&nbsp; статистичких &nbsp;прорачуна&nbsp; и&nbsp; других&nbsp; метода провере,&nbsp; док&nbsp; су&nbsp; у&nbsp; закључку&nbsp; рада &nbsp;представљени&nbsp; научни&nbsp; и &nbsp;практични&nbsp; допринос&nbsp; теоријског&nbsp; и &nbsp; теренског&nbsp;истраживања,&nbsp; као&nbsp; и&nbsp; ограничења&nbsp; истраживања.&nbsp; У&nbsp; овом&nbsp; сегменту&nbsp; наведени&nbsp; су&nbsp; и&nbsp; основни &nbsp;проблеми&nbsp;администрације, &nbsp;праксе&nbsp; и&nbsp; теорије&nbsp; о &nbsp;аспектима&nbsp; квалитета&nbsp; агротуризма&nbsp; у&nbsp; Војводини.&nbsp; Такође,&nbsp; изложене&nbsp; су&nbsp;идеје&nbsp; и &nbsp;предлози&nbsp; за&nbsp; будућа&nbsp; истраживања&nbsp; и &nbsp;практични&nbsp; савети&nbsp; који&nbsp; имају&nbsp; за&nbsp; циљ&nbsp; да&nbsp; сугеришу&nbsp; и&nbsp; мотивишу&nbsp;окретање &nbsp;промена&nbsp; које&nbsp; могу&nbsp; довести&nbsp; до &nbsp;побољшања&nbsp; квалитeта&nbsp; агротуристичке &nbsp;понуде&nbsp; у&nbsp; Војводини&nbsp; и&nbsp;читавој Србији.</p> / <p>Agroturizam&nbsp; redstavlja&nbsp; osebni,&nbsp; selektivni&nbsp; vid&nbsp; turizma&nbsp; koji&nbsp; objedinjuje&nbsp; skup&nbsp; aktivnosti&nbsp; na&nbsp;seoskim&nbsp; turističkim&nbsp; domaćinstvima&nbsp; i&nbsp; u&nbsp; objektima&nbsp; u&nbsp; domaćoj&nbsp; radinosti.&nbsp; U&nbsp; radu&nbsp; je&nbsp; dat &nbsp;pregled&nbsp; vladajuće&nbsp;literature&nbsp; o&nbsp; agroturizmu&nbsp; u AP&nbsp; Vojvodini (Srbiji)&nbsp; i&nbsp; inostranim&nbsp; državama&nbsp; i&nbsp; definisane&nbsp; su&nbsp; osnovne&nbsp; karakteristike&nbsp; ovog&nbsp; vida&nbsp; turizma.&nbsp; Prikazane&nbsp; su&nbsp; turističko-geografske&nbsp; karakteristike&nbsp; istraživanog&nbsp;rostora,&nbsp; opisana&nbsp; je&nbsp; studija&nbsp; slučaja&nbsp; stanja&nbsp; i&nbsp; razvoja&nbsp; agroturizma&nbsp; u&nbsp; Vojvodini&nbsp; i&nbsp; upoređena&nbsp; sa&nbsp; ostalim&nbsp;delovima&nbsp; Srbije&nbsp; i&nbsp; sa &nbsp;primerima&nbsp; iz&nbsp; inostranstva.&nbsp; U&nbsp; metodološkom&nbsp; delu &nbsp;prikazani&nbsp; su&nbsp; instrumenti, procedura&nbsp; i&nbsp; uzorak&nbsp; istraživanja,&nbsp; a&nbsp; ostavljene&nbsp; su&nbsp; i&nbsp; hipoteze&nbsp; rada.&nbsp; Kroz &nbsp;rezultate&nbsp; i&nbsp; diskusiju,&nbsp; hipoteze&nbsp;su &nbsp;potvrđene,&nbsp; delimično &nbsp;potvrđene&nbsp; ili&nbsp; opovrgnute,&nbsp; uz &nbsp;pomoć&nbsp; statističkih &nbsp;proračuna&nbsp; i&nbsp; drugih&nbsp; metoda provere,&nbsp; dok&nbsp; su&nbsp; u&nbsp; zaključku&nbsp; rada &nbsp;predstavljeni&nbsp; naučni&nbsp; i &nbsp;praktični&nbsp; doprinos&nbsp; teorijskog&nbsp; i &nbsp; terenskog&nbsp;istraživanja,&nbsp; kao&nbsp; i&nbsp; ograničenja&nbsp; istraživanja.&nbsp; U&nbsp; ovom&nbsp; segmentu&nbsp; navedeni&nbsp; su&nbsp; i&nbsp; osnovni &nbsp;problemi&nbsp;administracije, &nbsp;prakse&nbsp; i&nbsp; teorije&nbsp; o &nbsp;aspektima&nbsp; kvaliteta&nbsp; agroturizma&nbsp; u&nbsp; Vojvodini.&nbsp; Takođe,&nbsp; izložene&nbsp; su&nbsp;ideje&nbsp; i &nbsp;predlozi&nbsp; za&nbsp; buduća&nbsp; istraživanja&nbsp; i &nbsp;praktični&nbsp; saveti&nbsp; koji&nbsp; imaju&nbsp; za&nbsp; cilj&nbsp; da&nbsp; sugerišu&nbsp; i&nbsp; motivišu&nbsp;okretanje &nbsp;promena&nbsp; koje&nbsp; mogu&nbsp; dovesti&nbsp; do &nbsp;poboljšanja&nbsp; kvaliteta&nbsp; agroturističke &nbsp;ponude&nbsp; u&nbsp; Vojvodini&nbsp; i&nbsp;čitavoj Srbiji.</p> / <p>Agritourism is a specific, selective type of tourism that combines a set of activities on farms and in<br />self-service&nbsp; beds&nbsp; (accomodation&nbsp; type)&nbsp; in&nbsp; rural&nbsp; areas.&nbsp; This&nbsp; paper&nbsp; presents&nbsp; a&nbsp; literature&nbsp; review&nbsp; of&nbsp; agritourism&nbsp; in<br />Vojvodina&nbsp; Province&nbsp; (Serbia)&nbsp; and&nbsp; foreign&nbsp; countries&nbsp; and&nbsp; defines&nbsp; the&nbsp; basic&nbsp; characteristics&nbsp; of&nbsp; this&nbsp; type&nbsp; of&nbsp; tourism.&nbsp; A<br />tourist-geographical&nbsp; characteristics&nbsp; of&nbsp; the&nbsp; study&nbsp; area&nbsp; are&nbsp; presented,&nbsp; the&nbsp; case&nbsp; study&nbsp; situation&nbsp; and&nbsp; development&nbsp; of<br />agritourism in Vojvodina are described and comparedwith other parts of Serbia and with examples from abroad. In the<br />methodological&nbsp; part,&nbsp; the&nbsp; tools,&nbsp; procedures,&nbsp; and&nbsp; sample&nbsp; surveys,&nbsp; together&nbsp; with&nbsp; working&nbsp; hypotheses&nbsp; are&nbsp; presented.<br />Throughout the results and discussion, the hypotheses are confirmed, partially confirmed or refuted, using statistical<br />calculations and other methods of testing. On the other hand, in the conclusion of the paper, a scientific and practical<br />contribution to the theory and field studies, as well as the limitations of the research are shown. Inthis segment of<br />paper, the main problems of administration, practices, and theories on quality&rsquo; aspects of agritourismin Vojvodina are<br />listed. Together with these, the ideas and suggestions for future research and practical advices aimedto motivate the<br />initiation of changes in the quality of agritourismin Vojvodina Province and in the Republic Serbia are expressed.</p>

Denna studie syftar till att undersöka värdet av en plats och hur det kan påverka lokalbefolkningens inställning till storskalig turismutveckling och nyetablering. För att besvara syftet har naturområdet Skutberget i Karlstad valts ut och etableringen av Muminvärlden utifrån frågeställningarna: Hur värderas naturområdet Skutberget som plats? samt Vad har invånarna för inställning till etableringen av en Muminvärld på Skutberget? I studien testades även fyra olika hypoteser där hypotes 1 och 2 ämnar besvara frågeställning 1 medan hypotes 3 och 4 kopplar an till frågeställning 2. Studien grundar sig på följande fyra teman: värdet av en plats, planeringsperspektiv, friluftsliv samt destinationsutveckling. Dessa teman utgör också studiens teoretiska ramverk. Studien har använt sig av en kvantitativ metod där en enkätstudie har varit det valda tillvägagångssättet för insamling av data och kritisk realism är studiens vetenskapsteoretiska förhållningssätt. Utifrån hypoteserna har enkäten strukturerats i verktyget Survey &amp; Report och den insamlade data sedan har analyserats i SPSS för att komma fram till ett resultat. Resultatet visar tydligt på att Skutberget som plats har ett stort värde för Karlstads invånare och att det råder en skepticism mot etableringen av Muminvärlden. Detta diskuteras närmare i analyskapitlet som sedan övergår i en slutsats med förslag till framtida forskning. / The purpose of this essay is to study the value of a place and how it can affect the local residents’ attitudes towards a large-scale tourism development and a new establishment. To fulfill the purpose, the nature area Skutberget in Karlstad Sweden, has been selected and the establishment of the Moomin inspired theme park. The questions for this study to answer is: How is the nature area Skutberget valued as a place? and What are the local residents’ attitude towards establishing a Moomin inspired theme park at Skutberget? The study also tested four different hypotheses in which hypothesis 1 and 2 intend to answer question 1, while hypothesis 3 and 4 relate to question 2. The study is structured with topics as: the value of a place, the planning perspective, outdoor life and destination development. These themes also form this study’s theoretical framework. The study has used a quantitative method where a questionnaire was chosen as a method for data collection and the study is based on the notion of critical realism. The survey has been constructed in Survey &amp; Report and the collected data has been analyzed in SPSS to compile the results. The results clearly show that Skutberget has a great value for the local residents’ and that there is a skepticism towards the establishment of the Moomin inspired theme park. This is discussed in more details in the analysis chapter, and to conclude the study discusses conclusions with suggestions for further research.

The science and technology of medicine is evolving and changing at a fast pace. With these rapid advances, it is paramount that physicians maintain a level of medical knowledge that is current and relevant to their practice in order to address the challenges of patient care and safety. One way physicians can maintain a level of medical knowledge that is current and relevant to their practice is through self-directed, lifelong learning, however little is known about how to develop these traits during clinical training. Schön (1983, 1987) theorized that one way learners can become self-directed, lifelong learners is through reflective practice. This study utilized an experimental design and employed quantitative methods to investigate the effects of a reflective practice exercise, based on Gibbs' (1988) model of reflection, on readiness for self-directed learning as measured by Guglielmino's (1977) Self-Directed Learning Readiness Scale/Learning Preference Assessment (SDLRS/LPA). A total of 51 anesthesiology residents training in three residency programs in the United States participated in this study. A follow-up survey was administered to all study participants to determine if participation in the reflective exercises affected future engagement in or attitudes about reflective practice. While the data analysis showed that participation in reflective practice did not affect readiness for self-directed learning in these study participants, this study has implications for medical education. Responses to the follow-up survey indicated that participants plan to engage in reflective practice in the future and that participating in reflective practice would have an impact on patient care. Chapter 5 includes ways to integrate the findings of this study into medical education and outlines next steps for future research utilizing both evidence from the literature and the qualitative responses from this study.

Problem background: This thesis in building technology at Mälardalen University examines the noise level of the constructions on Öster Mälarstrand. The area Öster Mälarstrand is in the eastern part of Västerås next to the water area Mälaren. This district began to build in the end of the 20th century, and the area went from an industrial field to become as described, one of the best places in Västerås to live at. The district is now an area with a large extent of residentials and other necessities such as banking, gym, cafes, restaurants, shops and a large marina. Öster Mälarstrand is still under constant construction of new buildings. The purpose of the survey is to investigate the noise level on Öster Mälarstrand, and if the construction sites are customised to the guidelines that exist regarding noise and noise levels outside in a residential area. The work is summarized and ends by giving examples of measures to reduce noise and noise levels in the area. The method is based on own noise measurements, calculations and interviews. The noise measurements carried out at three specific locations on Öster Mälarstrand during four working days when constructions were underway. Interviews have also been conducted with 50 people who live in the area. The calculations of the noise measurments showed several varying values, but one thing that is clear is that the noise calculations that was executed, exceeds the guideline values set for noise-levels in Öster Mälarstrand. The interviews that were conducted presents that a majority of the interviewees thought that the noise level of the constructions on Öster Mälarstrand was disturbing, especially now during the pandemic of Covid-19, when several people started working from home. The conclusion in this thesis is that noise levels exceeds the guideline values ​​that exist according to the Swedish Environmental Protection Agency. The interviews in the area show that the majority of the participants experience the noise from the construction site as a disturbance.

博士(社会福祉学) / Doctor of Philosophy in Social Welfare / 同志社大学 / Doshisha University

Bakgrund: Sjuksköterskor inom hemsjukvård har till uppgift att bland flera andra arbetsuppgifter även symtomlindra patienter med palliativt vårdbehov som lider på grund av fysiska, psykiska, psykosociala eller existentiella orsaker. Palliativ vård innebär ett personcentrerat synsätt där kärnan ligger i att se hela människan och inte bara sjukdomen eller det för stunden framträdande symtomet. Palliativ vård bedrivs inom flera verksamheter med olika huvudmän. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av symtomlindring vid palliativ vård i hemsjukvård. Metod: En kvalitativ litteraturöversikt utfördes på 16 artiklar som hittades genom sökningar i databaserna CINAHL, PubMed och PsycInfo. Artiklarnas resultat analyserades med inspiration av integrativ metod. Genom analys framkom tre kategorier med sex underkategorier gällande sjuksköterskors erfarenheter av symtomlindring vid palliativ vård i hemsjukvård. Resultat: Resultatet visar att sjuksköterskor som arbetar inom hemsjukvård behöver kunskap och kompetens inom palliativ vård och symtomlindring. Det behöver även finnas ett fungerande samarbete med ansvarig läkare för att kunna erbjuda patienten en personcentrerad vård och symtomlindring. Att arbeta som sjuksköterska i hemsjukvård kan i arbetet med palliativ vård ge en känslomässig påverkan i form av frustration och oro. Slutsats: För att patienter med palliativt vårdbehov inom hemsjukvård ska få optimal symtomlindring krävs att sjuksköterskor har kunskap och tidigare erfarenhet, vilket påverkar i vilken utsträckning patienters symtom blir lindrade. Det är även viktigt att det finns en fungerande samverkan med ansvarig läkare i primärvård. Läkares engagemang, kunskap, tid och intresse för palliativ vård är avgörande för kvaliteten på vården. / Background: Nurses in home care have the task of among several other tasks, also relieving symptoms of patients with palliative care needs who suffer due to physical, menthal, psychosocial or existential causes. Palliative care involves a person centered approach where the core lies in seeing the whole person, not just the disease or the currently prominent symptom. Palliative care is conducted in many different activities with different principals. Aim: The aim was to describe nurses experiences of symptom management in palliative care in home care services. Method: A qualitative literature review was performed on 16 articles found through searches in the databases CINAHL, PubMed and PsychInfo. The result of the articles were then analyzed with inspiration from an integrative method. Through analysis three categories emerged with six subcategories regarding nurses experiences of symptoms relief in palliative care in home care. Results: The result showed that in order for nurses to be able to offer the patient optimal symptom relief, conditions were required in form of time, right prescriptions, commitment and collaboration with the district physician. Nurses' experience and knowledge of palliative care were also important for the outcome of the effect of symptom relief, as increased experience provided greater security in symptom relief. Regardless of previous experience and knowledge level, more training in symptom relief was requested. Deficiencies in collaboration with the district physician could create anxiety and frustration among the nurses. Conclusion: In order for patients with palliative care needs in home care to receive optimal symptom relief, it is required that nurses have knowledge and previous experience, which affect the extent to which patient´s symptoms are alleviated. It is also important that there is a functioning collaboration with the responsible doctor in primary care. The doctor's commitment, knowledge, time and interest in palliative care are crucial for the quality of care.

Second homes are a widespread part of the Swedish landscape and in many municipalities along the coastline the population can vary seasonally due to that. This cause planning issues for the municipalities, in how they plan their infrastructure, service etc. Studies has also shown that there are two sides in the discussion about second homes, some areas want to attract second home owners because they believe that this group help the municipality to grow while others try to attract permanent residents and restrict new development of second homes. The subject has been of discussion for a long time from many angels, for instance implementation of regulations to prevent second homes.  The purpose of this thesis is to investigate what planning strategies municipalities apply in areas that change so heavily in population depending on season. The method for this thesis is based on a mixture between comparative analysis and content analysis of six comprehensive plans and two policy documents from six municipalities with archipelagos. Furthermore, from the content analysis of the different documents, three themes were produced from the strategies which then were compared in comparative analysis where similarities and differences were highlighted. The themes were population and housing, infrastructure and transport communication, service, business sector and labor. The analysis was subsequently put into context with related academic research such as urbanization theories, rural gentrification, planning theories among others. This ended with a discussion and conclusion. Conclusively the analysis show that municipalities no longer plan for second homes but for permanent residents, the municipalities believed that it is reactionary to plan for second home owners and not primary for permanent residents. / Fritidsboende är en utbredd del av det svenska landskapet och i många kommuner längs kusten kan befolkningen variera säsongsmässigt på grund av det. Detta skapar viss planeringsproblematik för kommunerna i hur de planerar sin infrastruktur, service etc. Studier har också visat att det finns två sidor i diskussionen om fritidsbostäder, vissa områden vill locka fritidsboende eftersom de anser att denna grupp hjälper kommunen att utvecklas medan andra försöker locka permanenta invånare och begränsa ny utveckling av fritidsbostäder. Ämnet har diskuterats länge och från många vinklar, exempelvis implementering av regelverk för att förhindra fritidsbostäder. Syftet med detta examensarbete är att undersöka vilka planeringstrategier kommuner tillämpar i sådana områden som skiftar så kraftigt i befolkningen säsongsvis. Metoden i denna studie har bestått av en blandning mellan komparativ analys och innehållsanalys på sex översiktsplaner och två styrdokument gällande kust och skärgården från sex kust- och skärgårdskommuner Från innehållsanalysen av de olika dokumenten, producerades tre teman från de strategier som sedan jämfördes i den komparativa analysen, där likheter och skillnader lyfts fram. Teman var befolkning och bostäder, infrastruktur och kommunikation, service, näringsliv och arbetsmarknad. Analysen relaterades sedan till forskningsöversikten och den teoretiska utgångspunkten Detta avslutades med en diskussion och slutsats. Sammanfattningsvis visar analysen att kommunerna inte längre planerar för fritidsboende utan för fastboende, kommunerna menade att det är förlegat att planera för främst fritidsboende och inte fastboende.

Over the years, graduate medical education has changed in order to create learning environments to best prepare physicians. The present system of residency and hospital affiliation was the model adopted to give students opportunities for active learning along with lecture and observation. This study investigated the varied ways residents learn the knowledge, skills, and dispositions necessary for family practice. A within-site case study approach was used since this was a study of peer learning among family practice residents at a single community based hospital in a university affiliated network having an opposed program. A purposeful and typical case sampling strategy was used so that key participants provided information about their experiences with how the peer interactions among residents contributed to learning. The study had a sample of 11 residents progressing through this program and each participant was interviewed twice. Additional data were collected through observations of the morning and teaching rounds, an observation of the orientation session for new residents, and from program requirement documents. Each interview, observation, and document underwent content analysis for the identification of any emerging central themes or patterns and patterns were grouped according to recurring categories. Of particular interest were the themes that flowed from the interview and observation analysis for each resident class and the application of these themes to major learning theories. Matrix displays of themes that emerged between resident classes, of themes within the same resident class, and of the themes demonstrating relevant learning theories were developed and presented. Data analysis revealed themes categorized by learning process, achievement, identity as a physician, competence, and program improvement. The learning process consisted of various strategies, peer interactions, and use of resources. The within class analysis found varying degrees of strategies and peer interactions for each of the classes and the between class analysis found a progression of strategies, skills, achievement, identity, and changing peer interactions. Themes analyzed according to major learning theories demonstrated similarities to activity theory, social learning theory, and communities of practice. This study revealed that peer mentoring, coaching, and learning occurred within the context of a community of practice.

No description available.