| 31. |
- Ahlström, Gerd, et al.
(författare)
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Implementation of knowledge-based palliative care in nursing homes and pre-post post evaluation by cross-over design : a study protocol
- 2018
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Ingår i: BMC Palliative Care. - : BioMed Central. - 1472-684X. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: The demography of the world is changing as the population is ageing. Because of this change to a higher proportion of older people, the WHO has called for improved palliative care for older persons. A large number of all deaths in the industrialised world occur while older people are living in nursing homes and therefore a key question becomes how the principles of palliative care can be implemented in that context. The aims of this study are: a) to describe a model of an educational intervention with the goal of implementing knowledge-based palliative care in nursing homes, and b) to describe the design of the evaluation of the effectiveness regarding the implementation of knowledge-based palliative care. Methods/design: A complex intervention is evaluated by means of a cross-over design. An educational intervention concerning palliative care consisting of five seminars during 6 months for staff and managers has been developed and conducted in 20 nursing homes in two counties. Before the intervention started, the feasibility was tested in a pilot study conducted in nursing homes not included in the main study. The intervention is evaluated through a non-randomized experimental design with intervention and control groups and pre- and post-assessments. The evaluation includes older persons living in nursing homes, next-of-kin, staff and managers. Data collection consists of quantitative methods such as questionnaires and register data and qualitative methods in the form of individual interviews, focus-group interviews and participant observations. Discussion: The research will contribute to new knowledge about how to implement knowledge-based palliative care in a nursing home setting. A strength of this project is that the Medical Research Council framework of complex intervention is applied. The four recommended stages, Development, Feasibility and piloting, Evaluation and Implementation, are combined for the educational intervention, which functions as a strategy to achieve knowledge-based palliative care in the nursing homes. Implementation is always a question of change and a good theoretical understanding is needed for drawing valid conclusions about the causal mechanisms of change. The topic is highly relevant considering the world's ageing population. The data collection is completed and the analysis is ongoing.
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| 32. |
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| 33. |
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| 34. |
- Akselsson, Cecilia, et al.
(författare)
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The influence of N load and harvest intensity on the risk of P limitation in Swedish forest soils
- 2008
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Ingår i: Science of the Total Environment. - : Elsevier BV. - 1879-1026 .- 0048-9697. ; 404, s. 284-289
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Tidskriftsartikel (refereegranskat)abstract
- Nitrogen (N) is often considered to be the major factor limiting tree growth in northern forest ecosystems. An increased N availability, however, increases the demand for other nutrients such as base cations and phosphorous (P) which in turn may change which nutrient is the limiting factor. If P or base cations become limiting, N will start to leach which means a risk of increased eutrophication of surface waters. As many studies focus on base cations, this study instead aims at estimating P budgets on a regional scale for different harvesting scenarios relevant for Swedish conditions. P budget calculations were carried out for 14,550 coniferous sites from the Swedish National Forest Inventory, as weathering+deposition–harvesting–leaching. Three scenarios with different harvest intensities were used: 1) no harvesting, 2) stem harvesting and 3) wholetree harvesting. The input data were derived from measurements and model results. The P budget estimates indicate that harvesting, especially whole-tree harvesting, result in net losses of P in large parts of Sweden. The highest losses were found in southern Sweden due to high growth rate in this area. In the whole-tree harvesting scenario the losses exceeded 1 kg ha−1 y−1 on many sites. N budget calculations on the same sites indicate that N generally accumulates in the whole country and especially in the southern parts. Consequently, the N and P budget calculations indicate that the forests in southern Sweden are in a transition phase from N-to P-limitation to growth. This transition will proceed as long as the accumulation of N continues. These results are important in a sustainable forestry context, as a basis for assessing the risk of future N leaching, and in designing recommendations for abatement strategies of N deposition and for application of wood ash recycling and N fertilization.
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| 35. |
- Akter, Shaheda T., et al.
(författare)
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A numerical study of the stiffness and strength of cross-laminated timber wall-to-floor connections under compression perpendicular to the grain
- 2021
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Ingår i: Buildings. - : MDPI AG. - 2075-5309. ; 11:10
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Tidskriftsartikel (refereegranskat)abstract
- The use of cross-laminated timber (CLT) in multi-story buildings is increasing due to the potential of wood to reduce green house gas emissions and the high load-bearing capacity of CLT. Compression perpendicular to the grain (CPG) in CLT is an important design aspect, especially in multi-storied platform-type CLT buildings, where CPG stress develops in CLT floors due to loads from the roof or from upper floors. Here, CPG of CLT wall-to-floor connections are studied by means of finite element modeling with elasto-plastic material behavior based on a previously validated Quadratic multi-surface (QMS) failure criterion. Model predictions were first compared with experiments on CLT connections, before the model was used in a parameter study, to investigate the influence of wall and floor thicknesses, the annual ring pattern of the boards and the number of layers in the CLT elements. The finite element model agreed well with experimental findings. Connection stiffness was overestimated, while the strength was only slightly underestimated. The parameter study revealed that the wall thickness effect on the stiffness and strength of the connection was strongest for the practically most relevant wall thicknesses between 80 and about 160 mm. It also showed that an increasing floor thickness leads to higher stiffness and strength, due to the load dispersion effect. The increase was found to be stronger for smaller wall thicknesses. The influence of the annual ring orientation, or the pith location, was assessed as well and showed that boards cut closer to the pith yielded lower stiffness and strength. The findings of the parameter study were fitted with regression equations. Finally, a dimensionless ratio of the wall-to-floor thickness was used for deriving regression equations for stiffness and strength, as well as for load and stiffness increase factors, which could be used for the engineering design of CLT connections.
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| 36. |
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| 37. |
- Akter, Shaheda T., et al.
(författare)
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Numerical modelling of wood under combined loading of compressionperpendicular to the grain and rolling shear
- 2021
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Ingår i: Engineering structures. - : Elsevier. - 0141-0296 .- 1873-7323. ; 244
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Tidskriftsartikel (refereegranskat)abstract
- Numerical modeling is an efficient tool for experimental validation and for gaining a deeper understanding of complex material phenomena, especially when causal relationships are overlaid by material variability. Wood is such a highly orthotropic and complex material, which in engineering problems however is considered as macro- homogeneous. The aim of this study is to numerically investigate stress and strain states of wood in the radial- tangential plane and the influence of the orthotropic material behavior on the structural response. Model vali-dation is based on experiments performed on clear wood of Norway spruce (Picea abies) by using a biaxial test setup. Three material models were used, namely Hill’s plasticity model, the Hoffman criterion and a novel quadratic multi-surface (QMS) criterion. After validation on the local material scale, the models were applied to the engineering problem of compression perpendicular to the grain for studying the effect of the unloaded length. As a novel part, the influence of the annual ring structure on the local material behavior and the global elasto- plastic force–displacement behavior of wood under compression perpendicular to the grain were numerically investigated. Hill’s failure criterion was found to be the least suitable at both length scales, local material behavior and global structural response. The Hoffman and the QMS criteria showed quite good agreement with the biaxial experiments in terms of force–displacement relations and strain distributions for different loading situations, especially for combinations with radial compression, while there was less agreement with experiments for the behavior of combinations with tangential compression. Application of these material models to compression perpendicular to the grain for studying the unloaded length effect yielded similar trends as observed in structural tests. A reasonable and similar force–displacement response by Hoffman and QMS criteria was observed, while Hill’s model yielded significantly overestimated force carrying capacity. Differences in force-–displacement response for different loading situations were well in line with literature findings and the infl-ence of the annual ring curvature on the overall force–displacement behavior could be quantified.
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| 38. |
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| 39. |
- Al Musawi, Ahmed, et al.
(författare)
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Intervention for a correct medication list and medication use in older adults : a non-randomised feasibility study among inpatients and residents during care transitions
- 2024
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Ingår i: International Journal of Clinical Pharmacy. - : Springer. - 2210-7703 .- 2210-7711.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMedication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient's medication use at home.AimIn preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients, and data collection to reduce medication discrepancies at discharge and improve medication adherence, and (2) to explore the outcomes of the interventions.MethodParticipants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed.ResultsOf 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores.ConclusionBased on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs.
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| 40. |
- Al-Najjar, Basim
(författare)
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Condition-Based Maintenance: Selection and Improvement of a Cost-Effective Vibration-Based Maintenance Policy for Rolling element Bearings
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Modern machinery is expensive and therefore must run at high availability and effectiveness which cannot be achieved without an effective maintenance policy. Condition monitoring, (CM), techniques can be utilised to reduce or arrest the rate of deterioration of a component so increasing operating life. The main result reported in this thesis is that the rolling element bearing’s mean effective life could be extended appreciably if an existing vibration-based maintenance policy is used effectively. This result is achieved by a combination of data analysis and logical development. A new maintenance approach was developed to overcome some of the limitations of total productive maintenance, TPM, and reliability-centered maintenance, RCM, and is based upon the Deming managerial feedback cycle (Plan-Do-Check-Act). This method is called Total Quality Maintenance, (TQMain). It is a methodology to sustain and improve continuously the technical and economic effectiveness of the manufacturing process elements. It is shown logically that by using vibration-based monitoring, (VBM), program in the frame of a common database for a plant IT-system the causes behind quality deviations and failures can be identified and eliminated effectively at an early stage and the company’s economics would be improved. The condition-based maintenance effectiveness and accuracy are usually related to the ability of the CM system to detect failure causes and follow defect development. Criteria to select the most cost-effective VBM system and the most cost-effective vibration-based maintenance policy are developed. But, in most real cases, CM systems are not utilised effectively and companies are satisfied with the partial savings achieved in maintenance cost. It is shown, by two case studies, that improvements in vibration-based maintenance can be achieved by effective feedback of the results of failures, renewal condition and VBM history analysis. Unfortunately the data coverage and quality in these studies were not sufficient, among other reasons due to the low number of failures and long bearing lives, so the conclusions, although supported by the work results, remain strong qualitative indications, rather than statistical proof. Criteria to measure the effect of improvements to confirm whether it is economically beneficial and to identify the basic reasons why it is not, are developed. The contribution of this thesis is: The development of a sequential method for the selection and improvement of a cost-effective vibration-based maintenance policy. This methodology can be used to justify, on economic criteria, the use of VBM systems to indicate when rolling element bearings should be renewed. It is achieved through; Tools used in quality and maintenance technology and reliability analysis have either been modified or developed beyond their original concept such as; Maintenance cost equation, Total Time On Test-plots. Development of new tools to monitor maintenance effectiveness and accuracy, select the most informative CM parameter(s) and cost-effective vibration-based maintenance policy. A new maintenance approach, (TQMain), and a new envelope alarming method for VBM programs are also developed. Theoretical basis for improvements to the effectiveness of vibration-based maintenance of bearings in paper mill machines and two case studies which tend to confirm the theory.
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