| 541. |
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| 542. |
- Wickbom, Fredrik, et al.
(författare)
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Management of paediatric traumatic brain injury in Sweden : a national cross-sectional survey.
- 2022
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 30:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies have shown variations in management routines for children with traumatic brain injury (TBI) in Sweden. It is unknown if this management has changed after the publication of the Scandinavian Neurotrauma Committee guidelines in 2016 (SNC16). Also, knowledge of current practice routines may guide development of an efficient implementation strategy for the guidelines. The aim of this study is therefore to describe current management routines in paediatric TBI on a hospital/organizational level in Sweden. Secondary aims are to analyse differences in management over time, to assess the current dissemination status of the SNC16 guideline and to analyse possible variations between hospitals.METHODS: This is a sequential, cross-sectional, structured survey in five sections, covering initial management routines for paediatric TBI in Sweden. Respondents, with profound knowledge of local management routines and recommendations, were identified for all Swedish hospitals with an emergency department managing children (age 0-17 year) via phone/mail before distribution of the survey. Responses were collected via an on-line survey system during June 2020-March 2021. Data are presented as descriptive statistics and comparisons were made using Fisher exact test, when applicable.RESULTS: 71 of the 76 identified hospitals managed patients with TBI of all ages and 66 responded (response rate 93%). 56 of these managed children and were selected for further analysis. 76% (42/55) of hospitals have an established guideline to aid in clinical decision making. Children with TBI are predominately managed by inexperienced doctors (84%; 47/56), primarily from non-paediatric specialities (75%; 42/56). Most hospitals (75%; 42/56) have the possibility to admit and observe children with TBI of varying degrees and almost all centres have complete access to neuroradiology (96%; 54/56). In larger hospitals, it was more common for nurses to discharge patients without doctor assessment when compared to smaller hospitals (6/9 vs. 9/47; p < 0.001). Presence of established guidelines (14/51 vs. 42/55; p < 0.001) and written observation routines (16/51 vs. 29/42; p < 0.001) in hospitals have increased significantly since 2006.CONCLUSIONS: TBI management routines for children in Sweden still vary, with some differences occurring over time. Use of established guidelines, written observation routines and information for patients/guardians have all improved. These results form a baseline for current management and may also aid in guideline implementation.
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| 543. |
- Wickbom, Fredrik, et al.
(författare)
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Pediatric head injury guideline use in Sweden: a cross-sectional survey on determinants for successful implementation of a clinical practice guideline
- 2024
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Ingår i: BMC HEALTH SERVICES RESEARCH. - 1472-6963. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The Scandinavian Neurotrauma Committee guideline (SNC-16) was developed and published in 2016, to aid clinicians in management of pediatric head injuries in Scandinavian emergency departments (ED). The objective of this study was to explore determinants for use of the SNC-16 guideline by Swedish ED physicians. Methods This is a nationwide, cross-sectional, web-based survey in Sweden. Using modified snowball sampling, physicians managing children in the ED were invited via e-mail to complete the validated Clinician Guideline Determinants Questionnaire between February and May, 2023. Baseline data, data on enablers and barriers for use of the SNC-16 guideline, and preferred routes for implementation and access of guidelines in general were collected and analyzed descriptively and exploratory with Chi-square and Fisher's tests. Results Of 595 invitations, 198 emergency physicians completed the survey (effective response rate 33.3%). There was a high reported use of the SNC-16 guideline (149/195; 76.4%) and a strong belief in its benefits for the patients (188/197; 95.4% agreement). Respondents generally agreed with the guideline's content (187/197; 94.9%) and found it easy to use and navigate (188/197; 95.4%). Some respondents (53/197; 26.9%) perceived a lack of organizational support needed to use the guideline. Implementation tools may be improved as only 58.9% (116/197) agreed that the guideline includes such. Only 37.6% (74/197) of the respondents agreed that the guideline clearly describes the underlying evidence supporting the recommendation. Most respondents prefer to consult colleagues (178/198; 89.9%) and guidelines (149/198; 75.3%) to gain knowledge to guide clinical decision making. Four types of enablers for guideline use emerged from free-text answers: ease of use and implementation, alignment with local guidelines and practice, advantages for stakeholders, and practicality and accessibility. Barriers for guideline use were manifested as: organizational challenges, medical concerns, and practical concerns. Conclusions The findings suggest high self-reported use of the SNC-16 guideline among Swedish ED physicians. In updated versions of the guideline, focus on improving implementation tools and descriptions of the underlying evidence may further facilitate adoption and adherence. Measures to improve organizational support for guideline use and involvement of patient representatives should also be considered.
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| 544. |
- Williams, K.E., et al.
(författare)
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The surface energy balance at the Huygens landing site and the moist surface conditions on Titan
- 2012
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Ingår i: Planetary and Space Science. - : Elsevier BV. - 0032-0633 .- 1873-5088. ; 60:1, s. 376-385
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Tidskriftsartikel (refereegranskat)abstract
- The Huygens Probe provided a wealth of data concerning the atmosphere of Titan. It also provided tantalizing evidence of a small amount of surface liquid. We have developed a detailed surface energy balance for the Probe landing site. We find that the daily averaged non-radiative fluxes at the surface are 0.7 W m -2, much larger than the global average value predicted by McKay et al. (1991) of 0.037 W m -2. Considering the moist surface, the methane and ethane detected by the Probe from the surface is consistent with a ternary liquid of ethane, methane, and nitrogen present on the surface with mole fractions of methane, ethane, and nitrogen of 0.44, 0.34, and 0.22, respectively, and a total mass load of ∼0.05 kg m -2. If this liquid is included in the surface energy balance, only a small fraction of the non-radiative energy is due to latent heat release (∼10 -3 W m -2). If the amount of atmospheric ethane is less than 0.6×10 -5, the surface liquid is most likely evaporating over timescales of 5 Titan days, and the moist surface is probably a remnant of a recent precipitation event. If the surface liquid mass loading is increased to 0.5 kg m -2, then the liquid lifetime increases to ∼56 Titan days. Our modeling results indicate a dew cycle is unlikely, given that even when the diurnal variation of liquid is in equilibrium, the diurnal mass variation is only 3% of the total liquid. If we assume a high atmospheric mixing ratio of ethane (>0.6×10 -5), the precipitation of liquid is large (38 cm/Titan year for an ethane mixing ratio of 2×10 -5). Such a flux is many orders of magnitude in excess of the photochemical production rate of ethane
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| 545. |
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| 546. |
- Wilson, Christopher, 1974, et al.
(författare)
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Dressed relaxation and dephasing in a strongly driven two-level system
- 2010
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Ingår i: Physical Review B - Condensed Matter and Materials Physics. - 2469-9950 .- 2469-9969. ; 81:2, s. Art. no. 024520-
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Tidskriftsartikel (refereegranskat)abstract
- We study relaxation and dephasing in a strongly driven two-level system interacting with its environment. We develop a theory which gives a straightforward physical picture of the complex dynamics of the system in terms of dressed states. In addition to the dressing of the energy diagram, we describe the dressing of relaxation and dephasing. We find a good quantitative agreement between the theoretical calculations and measurements of a superconducting qubit driven by an intense microwave field. The competition of various processes leads to a rich structure in the observed behavior, including signatures of population inversion.
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| 547. |
- Wilson, Christopher, 1974, et al.
(författare)
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Photon Generation in an Electromagnetic Cavity with a Time-Dependent Boundary
- 2010
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Ingår i: Physical Review Letters. - 1079-7114 .- 0031-9007. ; 105:23, s. 233907-
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Tidskriftsartikel (refereegranskat)abstract
- We report the observation of photon generation in a microwave cavity with a time-dependent boundary condition. Our system is a microfabricated quarter-wave coplanar waveguide cavity. The electrical length of the cavity is varied using the tunable inductance of a superconducting quantum interference device. It is measured at a temperature significantly less than the resonance frequency. When the length is modulated at approximately twice the static resonance frequency, spontaneous parametric oscillations of the cavity field are observed. Time-resolved measurements of the dynamical state of the cavity show multiple stable states. The behavior is well described by theory. Our results may be considered a preliminary step towards demonstrating the dynamical Casimir effect.
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| 548. |
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| 549. |
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| 550. |
- Wirsén, Erik, et al.
(författare)
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Burdens experienced and perceived needs of relatives of persons with SMI : A systematic meta-synthesis
- 2020
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Ingår i: Journal of Mental Health. - : Taylor & Francis. - 0963-8237 .- 1360-0567. ; 29:6, s. 712-721
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Close relatives of people with severe mental illness (SMI) experience problems known as family burdens. In addition, they may have their own needs for support, something often overlooked by the healthcare system. Meta-syntheses in this area may help explore the meaning of the experience of living with someone who has a SMI.AIM: Our aim was to describe the burdens experienced and needs perceived on a daily basis by relatives to someone who has a SMI.METHODS: The databases PubMed, CINAHL, and PsychInfo were searched using a systematic search strategy. Studies were screened for relevance and quality was appraised. A meta-synthesis of nine qualitative studies was then conducted.RESULTS: The nine studies discerned the following themes. Burden themes; Forced to carry a sometimes unbearable burden; Burdened by own ill-health and disrupted relationships; Distressed and stigmatized by society. Needs themes; strengthening protective factors; Skills and practical support greatly appreciated.CONCLUSIONS: The burdens and needs of relatives of persons with SMI strongly influence their lives. They require relief from both practical and emotional burdens. Family interventions and other programs to support relatives should be encouraged with this knowledge in mind.
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