Assessing drivers of export orientation in the subsea oil and gas industry.

The purpose of this short study was to identify the drivers of export orientation of firms in the subsea oil and gas industry in Western Norway. As the oil fields in the North Sea are approaching a stage of maturity, gaining knowledge of these drivers is crucial. An online survey was conducted of firms operating in the subsea oil and gas industry in the region. Consistent with previous research, the data reveal that product innovation and a majority share of international ownership increase firms' export rates. The use of instrumental variables indicates that both product innovation and international ownership are causes of subsea petroleum exports. The study moreover finds that subcontractors have a lower rate of direct exports than system providers, but international ownership in particular boosts subcontractors' export rates, probably by decreasing their market dependency on regional system providers. A clear recommendation for managers and stakeholders is that they should encourage foreign investments throughout the value chain. The results of such a strategy appear to be especially positive for subcontractors.

Vertical and horizontal control dilemmas in public hospitals.

PURPOSE: The hospital sector in Norway has been continuously reorganized since 2002 and the reforms have created organizations that are functionally/vertically controlled, whereas the production lines are coordinated on a process or a lateral basis. The purpose of this paper is to focus on both the perceived functional vertical control and horizontal controls within and between the local hospitals and the regional administrative levels. DESIGN/METHODOLOGY/APPROACH: A national survey study, complemented with interviews of some key informants and document studies. FINDINGS: The study shows that the functional and vertical lines of management control are perceived to be operating according to the traditional views of management control. The study indicates that the horizontal tasks are not very well implemented, and we did not find interactive and lateral uses of management control systems for managerial purposes. PRACTICAL IMPLICATIONS: New control problems arise when services are to be coordinated between autonomous units. ORIGINALITY/VALUE: The paper focuses on the control problems found within the horizontal, flat relationship between production units in hospitals; new organizational structures have emerged where lateral relations are important, but traditional control practices follow functional, vertical lines.

Governance and the functions of boards: an empirical study of hospital boards in Norway.

OBJECTIVE: This paper describes the implementation of hospital governance under the Norwegian hospital reforms 2001-2008. METHODS: Data are analysed from interviews with key decision makers in hospital boards and among hospital managers (N=13), and a survey among a national sample of board members (N=130). The analysis integrates findings from both the qualitative and quantitative data, which are analysed according to the theoretical framework. RESULTS: The findings indicate a transition of the roles given to the hospital board from a model with professional and autonomous boards towards two different roles. These roles are a mixture between the tasks of a formal decision body and the behaviour of a body to secure the interests of different stakeholders. CONCLUSIONS: The hospital boards have to act in contexts of ambiguity and uncertainty. In such situations, a wide decision space will face the boards with problems related to emotions and opportunism. Thus, the principals in the context of public sector hospitals have to balance among strong political influence, hierarchical modes of governance and discretion given to the boards.

Reforms and clinical managers' responses: a study in Norwegian hospitals.

PURPOSE: This paper seeks to explore the legitimacy of budgets as management control processes in hospitals after comprehensive reforms were implemented in the Norwegian hospital sector in 2002. DESIGN/METHODOLOGY/APPROACH: The paper employs qualitative interviews with top level clinical managers in three large hospitals. FINDINGS: The study shows a variety of practices among the clinical managers as to management control adjustments. The managers use different strategies in order to cope with the budget frames. RESEARCH LIMITATIONS/IMPLICATIONS: This paper contributes to the current debate and research relating to the budgeting and performance management practices in hospital settings. PRACTICAL IMPLICATIONS: These findings contribute to contextual knowledge that is relevant in understanding the diverse practices of clinical managers in hospitals as complex service producing organizations. SOCIAL IMPLICATIONS: The findings give information to decision makers as to the diversity in management practices within knowledge intensive organizations. ORIGINALITY/VALUE: The paper challenges the idea that the strategies used by managers can be understood by the concepts of the means-end rationality prescribed in most of the reforms introduced into the hospital sector.

Expression of iNOS--a favourable prognostic marker for early-stage carcinoma of the uterine cervix.

In former studies, raised urine cGMP levels have been reported to predict adverse outcome in cervical cancer. The main objective of the present study was to investigate the value of nitric oxide synthase (iNOS) and other members of the cGMP pathway as potential biomarkers for prognosis of cervical carcinoma. Tissue samples from 85 patients surgically treated for early-stage cervical carcinoma were immunohistochemically stained for iNOS, soluble guanylyl cyclase subunits α1 (sGC-α1), soluble guanylyl cyclase α2 (sGC-α2), and phosphodiesterase 5, each sample evaluated microscopically by a semi-quantitative score. Results were correlated to recurrence and FIGO stage (depth of tumour cell infiltration). Correlation was found between high expression of iNOS in tumour cells and low risk of recurrence (p=0.019, p=0.05, p=0.022 and p=0.025). High expression of iNOS, sGC-α1 and sGC-α2 also correlated to superficial tumour growth. Our results demonstrate that iNOS expression in cervical tumour tissue is a robust prognostic marker for cervical cancer.

Trust-based or performance-based management: a study of employment contracting in hospitals.

Hospitals are frequently changing managerial practices due to numerous public sector reforms taking place. In general, these reforms include the making and monitoring of contracts that regulate relations between the hospitals and their professional staffs. The aim of this paper is to discuss some main characteristics of the contracts that regulate the perceived relations between physicians as employees and the public hospital as employer. The theoretical framework is based on a contract theory approach. The empirical data is based on survey data from full-time employed physicians in the medical and surgical divisions in one of the largest university hospitals in Norway. This study shows that perceived obligations and psychological contracts indicate high degree of relational contracts between the hospital and the physicians. These socio-cultural elements should be recognized as important mechanisms of coordination and communication when policy makers and hospital managers are designing hospital management control systems.

Down-regulated progesterone receptor A and B coinciding with successful treatment of endometrial hyperplasia by the levonorgestrel impregnated intrauterine system.

OBJECTIVE: To investigate whether regression of endometrial hyperplasia observed after 3 months of treatment with levonorgestrel impregnated intrauterine system device (LNG-IUS) was sustained after 6 months and whether these effects were still occurring synchronously with extinguished expression of progesterone receptors and increased apoptosis. DESIGN: Retrospective population-based observational study. SETTING: Six local hospitals and one university hospital in northern Norway. POPULATION: Patients (n = 41) with low and medium risk endometrial hyperplasia. METHODS: Histopathological treatment response comparing LNG-IUS (n = 25) and standard per oral medroxyprogesterone (n = 16). Expression of progesterone receptor A (PR-A), progesterone receptor B (PR-B), ER-alpha, ER-beta, Bcl-2, BAX, Caspase-3 and metallothionein (MT) were investigated by immunohistochemistry; results were evaluated by a semi-quantitative H-score. MAIN OUTCOME MEASURES: Response to progestin treatment. RESULTS: All the LNG-IUS treated patients had therapy response after 6 months. PR-A and PR-B in glands were almost extinguished for IUD users compared to the oral group. Estrogen receptors were also reduced. Co-existent changes in apoptosis were differently modulated in glands and stroma in the two treatment groups. Bcl-2 was different in glands and stroma in responders and non-responders to oral therapy. CONCLUSION: The study confirms that LNG-IUS can be safely used for 6 months as treatment for endometrial hyperplasia. The clinical effect is accompanied by almost extinguished PR-receptors in glands coinciding with modulation of apoptosis. The results strongly indicate that progestins activate non-classical initiated signaling pathways.

Prognostic markers for coexistent carcinoma in high-risk endometrial hyperplasia with negative D-score: significance of morphometry, hormone receptors and apoptosis for outcome prediction.

OBJECTIVES: Hysterectomy represents the current routine therapy for high-risk endometrial precancers. More sophisticated methods are needed for treatment decision among women who want to preserve fertility and seriously ill patients. Among women diagnosed with high-risk hyperplasia, approximately 40% show signs of endometrial cancer in the hysterectomy specimen. Thus, more sophisticated methods are needed to select the women at risk. SETTING: University Hospital of Tromsø, Regional Center for Gynecological Oncology in northern Norway. POPULATION: From 1999 to 2004, 258 consecutive patients had endometrial hyperplasia diagnosed by D-score; 57 among these were high-risk cases (D-score < 0) and 10 had coexisting endometrial carcinoma. No further cancers were detected after long-term follow-up (4-10 years). DESIGN: From the initial histological specimens, material from the 10 patients with cancer and from the 13 cases without cancer (high-risk D-score < 0) was analyzed with selected histomorphometric (architectural and nuclear) and immunohistochemical (hormone receptors and apoptotic) features blinded to the investigator. METHOD: Original slides were used for computerized histomorphometry (4-class rule and related procedures). Serial sections from the paraffin embedded material were used for immunohistochemical investigations. Immunohistochemical expression in glands and stroma was evaluated by the semi-quantitative H-score (ER-alpha, ER-beta, PR-A, PR-B, RCAS-1, Bcl-2, BAX, and Caspase-3). RESULTS: The histomorphometric 4-class rule differentiates between presence and absence of cancers with a sensitivity of 80% and specificity of 77%. Several morphometric and immunohistochemical features were significantly different in cases with cancer and hyperplasia. CONCLUSIONS: Histomorphometry seems superior in predicting coexistent carcinoma in high-risk endometrial hyperplasia and should be considered for clinical use.

Treatment results of endometrial hyperplasia after prospective D-score classification: a follow-up study comparing effect of LNG-IUD and oral progestins versus observation only.

OBJECTIVES: Three different treatment options for endometrial hyperplasia were evaluated in a prospective long-time follow-up study, comparing effects of intrauterine levonorgestrel impregnated device (LNG-IUD), low oral dose of medroxyprogesterone acetate (MPA) and no treatment (observation only). To select patients with high probability for co-existing or future carcinoma we used the objective morphometric algorithm, D-score, stratifying patients into three different risk groups. As far as we know, this is the first prospective long-time follow-up study in which treatment recommendation and outcome is based on the D-score assessment. METHODS: From a total of 370 patients initially diagnosed with endometrial hyperplasia from eight different hospitals in North Norway, 258 were available for long-time follow-up. After D-score classification, one of three different treatment options was chosen: LNG-IUD, low oral dose of MPA or observation only. Follow-up controls were performed and biopsies taken in the local hospitals. RESULTS: Among the 370 investigated cases with endometrial hyperplasia, only ten endometrial cancers were detected at the entrance of the study, all belonging to the high risk group (D-score <0). No further cancers were detected during follow-up, irrespective of risk group. After 6 months treatment with LNG-IUD proved significantly superior to oral treatment (p=0.001 for D-score >1 and p=0.003 for D-score 0-1 groups) and observation only (p=0.001 for D-score >1 and p=0.001 for D-score 0-1 groups). After 56 to 108 months the LNG-IUD proved significantly superior to oral treatment and to the observation group. Comparison of oral therapy to observation only showed no significant differences, neither after 6 months nor after long-time observation. CONCLUSIONS: LNG-IUD is the optimal treatment for endometrial hyperplasia. Outcome after oral low-dose MPA regimen is comparable to expectation.

Management and control of public hospitals--the use of performance measures in Norwegian hospitals. A case-study.

This paper investigates the use of performance measures in the management control and decision-making processes in the Norwegian hospital sector. The motivation for the study is to understand the implementation of performance-based management systems which is an element in the international New Public Management (NPM) reforms waves now affecting the hospital sector. The theoretical framework is based on the description of hospitals as complex and decoupled organizations. The use of benchmarking is discussed, and the focus is put on the information biases that exist in such data. The main finding in the empirical study is that the ambiguous information which exists in the performance measures used at the hospital department level, maintains the decoupling between the clinical activities and the management control practices. This decoupling creates management control problems because it hampers the knowledge on the cause-effects of actions, which is important in order to undertake strategic decisions and diagnostic action. In order to increase transparency, cost information should be decomposed as to develop practical indicators for interactive control purposes in clinical departments.