| 1. |
- Adelsjö, Igor
(författare)
-
Medication communication with older adults experiencing chronic illness and polypharmacy
- 2023
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Populations in many high-income countries are ageing, with an ever-increasing proportion of the population aged 65 years or older. Despite increasingly better health in older people, susceptibility to chronic illness increase with age. As life expectancy increases, the length of time people can live with chronic illness increases correspondingly, mainly due to improved medication treatments. Decreased number of hospital beds per capita and length of stay in hospital has gained primary care an increasing role in the healthcare system, with higher demands on patients and their knowledge and abilities to manage medications and self-management.Aim: The overarching aim of this thesis was to explore how medication regimens are communicated in primary care consultations and in written discharge letters.Methods: In Study I, passive participant observations of primary care consultations were audio-recorded, transcribed and analysed using content analysis. Study II had a convergent mixed methods design. An assessment matrix, constructed based on previous research, was used to assess and quantify discharge letter content. The quantified discharge letter content, questionnaires and register data were used to calculate correlations between discharge letter content and readmission rate as well as self-rated quality of care transition. Finally, associations between discharge letter content and time to readmission were calculated both univariable and multivariable. In addition to discharge letter content, several other potential independent variables were included in the multivariable analysis.Results: Both studies show that physicians were prone to give information about medications and blood-samples or other examinations performed in advance to the consultation (Study I) or during the hospital admission (Study II). The physicians were, however, less prone to inform patients about self-management and lifestyle changes, symptoms to be aware of, and what to do in case they would appear. Communication was occasionally hindered by misunderstandings, e.g., when vague expressions or words with ambiguous meaning was used. Ambiguities e.g., arose due to dialectal disparity. Although physicians mainly communicated in plain language with patients, medication names imposed a significant problem for patients and in communication about medications. Discharge letter content was not associated to readmissions, the only significant predictor variables for time to readmission were previous admission the past 180 days and birth outside the Nordic countries. Discharge letters with more content were, on the other hand, correlated to worse self-estimated quality of care transition from hospital to home (Study II).Conclusions: Physicians informed patients about tests and examinations performed in the past time, and comprehensive information was provided about medications, both during consultations and in discharge letters. However, information about symptoms to be aware of and measures to take in case they would appear was scarce in consultations and discharge letters. In conversations where lifestyle changes were raised, the topic was quickly dropped without recommendations or offering support if the patient showed unconcern. Lifestyle changes in relation to chronic illness and medications were rarely discussed. Improved lifestyle as a means of reducing the need for medications was not discussed or informed about in discharge letters. Discharge letter content did not have any impact on readmissions.
|
|
| 2. |
- Ek, Patrik, 1980-
(författare)
-
Mass Spectrometry with Electrospray Ionization from an Adjustable Gap
- 2008
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis the fabrication and analytical evaluation of two new electrospray emitters utilized for mass spectrometry analysis is presented. The emitters are based on a new concept, where the spray orifice can be varied in size. The thesis is based on two papers. All present-day nanoelectrospray emitters have fixed dimensions. The range of the applicable flow rate for such an emitter is therefore rather limited and exchange of emitters may be necessary from one experiment to another. Optimization of the signal of the analyte ions is also limited to adjustments of the applied voltage or the distance between the emitter and the mass spectrometer inlet. Furthermore, clogging can occur in emitters with fixed dimensions of narrow orifice sizes. In this thesis, electrospray emitters with a variable size of the spray orifice are proposed. An open gap between two thin substrates is filled with sample solution via a liquid bridge from a capillary. Electrospray is generated at the end point of the gap, which can be varied in width. In Paper I, electrospray emitters fabricated in polyethylene terephthalate have been evaluated. Triangular tips are manually cut from the polymer film. The tips are mounted to form a gap between the edges of the tips. The gap wall surfaces are subjected to a hydrophilic surface treatment to increase the wetting of the gap walls. In Paper II, silicon electrospray chips with high precision are fabricated and evaluated. A thin beam, elevated from the bulk silicon chip is fabricated by means of deep reactive ion etching. The top surfaces of the beams of two chips act as a sample conduit when mounted in the electrospray setup. An anisotropic etching step with KOH of the intersecting <100> crystal planes results in a very sharp spray point. The emitters were given a hydrophobic surface treatment except for the hydrophilic gap walls. For both emitter designs, the gap width has been adjusted during the experiments without any interruption of the electrospray. For a continuously applied peptide mixture, a shift towards higher charge states and increased signal to noise ratios could be observed when decreasing the gap width. The limit of detection has been investigated and the silicon chips have been interfaced with capillary electrophoresis.
|
|
| 3. |
- Gustafsson Gillbrand, Patrik
(författare)
-
Stenbruk : Stenartefakter, råmaterial och mobilitet i östra Mellansverige under tidig- och mellanmesolitikum
- 2018
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines artefacts, raw materials and lithic technology between c. 9200–6200 cal BC in Eastern Central Sweden. The overall purpose of this study is to investigate when people first came to Eastern Central Sweden and where they came from. More precisely, it provides a typological, geographical and chronological survey of artefacts and the use of different raw materials. The study deals with assemblages with artefacts from more than thirty archaeologically excavated sites and loose finds in Eastern Central Sweden. The objects consist of chubby pecked axes, core axes, flake axes, shaft hole picks, microliths and micro burins, points, burins, rulers, unifacial blade core, conical cores, micro blade cores, blades, drills, retouched blades and micro blades. The artefacts have been compared with established typologies and chronologies for the rest of the Nordic countries and to some extent Russia and the Baltic States. An analysis of different raw materials present at Early and Middle Mesolithic sites in Eastern Central Sweden was also carried out. The materials are put into a chronological and geographical context. The raw materials included in the study are the non-local rocks flint and Cambrian flint, as well as local raw materials such as quartz, greenstone, local vulcanite, mylonite and red porphyry. From 9200 cal BC there is evidence of the first groups of people in the area, just shortly after that the Weichselian ice cap had withdrawn. Throughout the period studied the artefacts as well as the non-local raw materials exhibit great similarities to those found in the western part of Sweden. The study also shows, regarding the use of different raw materials and presence of certain artefacts, that some major events took place, suggesting a new chronological time frame for the Early- and Middle Mesolithic periods. In addition, a discussion regarding mobility and migration in Eastern Central Sweden during Early Post Glacial time is carried out.
|
|
| 4. |
- Jonsson, Patrik
(författare)
-
Intelligent networked sensors for increased traffic safety
- 2011
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Our society needs to continuously perform transports of people and goods toensure that business is kept going. Every disturbance in the transportation ofpeople or goods affects the commerce and may result in economical losses forcompanies and society. Severe traffic accidents cause personal tragedies forpeople involved as well as huge costs for the society. Therefore the roadauthorities continuously try to improve the traffic safety. Traffic safety may beimproved by reduced speeds, crash safe cars, tires with better road grip andimproved road maintenance. The environmental effects from roadmaintenance when spreading de-icing chemicals need to be considered, i.e.how much chemicals should be used to maximize traffic safety and minimizethe environmental effects. Knowledge about the current and upcoming roadcondition can improve the road maintenance and hence improve traffic safety.This thesis deals with sensors and models that give information about the roadcondition.The performance and reliability of existing surface mounted sensors wereexamined by laboratory experiments. Further research involved field studies tocollect data used to develop surface status models based on road weather dataand camera images. Field studies have also been performed to find best usageof non intrusive IR technology.The research presented here showed that no single sensor give enoughinformation by itself to safely describe the road condition. However, the resultsindicated that among the traditional road surface mounted sensors only theactive freezing point sensor gave reliable freezing point results. Furtherresearch aimed to find a model that could classify the road condition indifferent road classes from existing road weather sensor data and road images.The result was a model that accurately could distinguish between the roadconditions dry, wet, snowy and icy. These road conditions are clearly dissimilarand are therefore used as the definition of the road classes used in this thesis.Finally, results from research regarding remote sensing IR technology showedthat it significantly improves knowledge of the road temperature and statuscompared to data from surface mounted sensors.
|
|
| 5. |
- Nilsson, Emil, 1989-
(författare)
-
Borehole Thermal Energy Storage Systems for Storage of Industrial Excess Heat : Performance Evaluation and Modelling
- 2020
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Improving industrial energy efficiency is considered an important factor in reducing carbon dioxide emissions and counteract climate change. For many industrial companies in cold climates, heat generated at the site in summer will not be needed to fulfil the site heat demand during this time, and is thus removed to the outdoor air. Although a mismatch between heat generation and heat demand primarily being seasonal, a mismatch may also exist at times in the winter, e.g. during milder winter days or high production hours. If this excess heat instead of being sent to the outdoors was stored for later use when it is needed, purchased energy for the site could be decreased. One way to do this is by the use of a borehole thermal energy storage (BTES) system.A BTES system stores energy directly in the ground by using an array of closely drilled boreholes through which a heat carrier, often water, is circulated. So far, BTES systems used for heating purposes have mainly been used for storage of solar thermal energy. The BTES system has then been part of smaller district solar heating systems to reduce the seasonal mismatch between incoming solar radiation and heat demand, thus increasing system solar fraction. For this application of BTES systems, energy for storage can be controlled by the sizing of the solar collector area. At an industrial site, however, the energy that can be stored will be limited to the excess heat at the site, and the possible presence of several time-varying processes generating heat at different temperatures gives options as to which processes to include in the heat recovery process and how to design the BTES system. Moreover, to determine the available heat for storage at an industrial site, individual measurements of the heat streams to be included are required. Thus, this must be made more site-specific as compared to that of the traditional usage of BTES systems where solar thermal energy is stored, in which case long-time historic solar radiation data to do this is readily accessible for most locations. Furthermore, for performance predictions of industrial BTES systems to be used for both seasonal and short-term storage of energy, models that can treat the short-term effects are needed, as traditional models for predicting BTES performance do not consider this.Although large-scale BTES systems have been around since the 1970’s, little data is to be found in the literature on how design parameters such as borehole spacing and borehole depth affect storage performance, especially for industrial BTES applications. Most studies that can be found with regard to the designing of ground heat exchanger systems are for traditional ground source heat pumps, working at the natural temperature of the ground and being limited to only one or a few boreholes.In this work, the performance of the first and largest industrial BTES system in Sweden was first presented and evaluated with regard to the storage’s first seven years in operation. The BTES system, which has been used for both long- and short-term storage of energy, was then modelled in the IDA ICE 4.8 environment with the aim to model actual storage performance. Finally, the model was used to conduct a parametric study on the BTES system, where e.g. the impact on storage performance from borehole spacing and characteristics of the storage supply flow at heat injection were investigated. From the performance evaluation it could be concluded that lower than estimated quantities and/or quality of the excess heat at the site, resulting in lower storage supply flow temperatures at heat injection, has hindered the storage from reaching temperatures necessary for significant amounts of energy to be extracted. Based on the repeating annual storage behavior seen for the last years of the evaluation period, a long-term annual heat extraction and ratio of energy extracted to energy injected of approximately 400 MWh/year and 20% respectively are likely.For the comparison of predicted and measured storage performance, which considered a period of three years, predicted values for total injected and extracted energy deviated from measured values by less than 1 and 3% respectively, and predicted and measured values for injected and extracted energy followed the same pattern throughout the period. Furthermore, the mean relative difference for the storage temperatures was 4%. A time-step analysis confirmed that the intermittent heat injection and extraction, occurring at intervals down to half a day, had been captured in the three-year validation. This as predictions would become erroneous when the time step exceeded the time at which these changes in storage operation occur.Main findings from the parametric study include that 1) for investigated supply flows at heat injection, a high temperature was more important than a high flow rate in order to achieve high annual heat extractions and that 2) annual heat extraction would rapidly reduce as the borehole spacing was decreased from the one yielding the highest annual heat extraction, whereas the reduction in annual heat extraction was quite slow when the spacing was increased from this point. Another conclusion that came from the performance evaluation and the parametric study, as a consequence of the Emmaboda storage being designed as a high-temperature BTES system, intended working temperatures being 40–55 °C, was that the possibility of designing the BTES system for low working temperatures should be considered in the designing of a BTES system. Lower storage operation temperatures allow for more energy to be injected and in turn for more energy to be extracted and reduces storage heat losses to the surroundings.
|
|
| 6. |
|
|
| 7. |
- Nilsson, Viktor, 1985-
(författare)
-
Highly Concentrated Electrolytes for Lithium Batteries : From fundamentals to cell tests
- 2018
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The electrolyte is a crucial part of any lithium battery, strongly affecting longevity and safety. It has to survive rather severe conditions, not the least at the electrode/electrolyte interfaces. Current commercial electrolytes based on 1 M LiPF 6 in a mixture of organic solvents balance the requirements on conductivity and electrochemical stability, but they are volatile and degrade when operated at temperatures above ca. 70°C. The salt could potentially be replaced with e.g. LiTFSI, but corrosion of the aluminium current collector is an issue. Replacing the graphite negative electrode by Li metal for large gains in energy density challenges the electrolyte further by exposing it to freshly deposited Li, leading to poor coulombic efficiency (CE) and consumption of both Li and electrolyte. Highly concentrated electrolytes (up to > 4 M) have emerged as a possible remedy, by a changed solvation structure such that all solvent molecules are coordinated to cations – leading to a lowered volatility and melting point, an increased charge carrier density and electrochemical stability, but a higher viscosity and a lower ionic conductivity.Here two approaches to highly concentrated electrolytes are evaluated. First, LiTFSI and acetonitrile electrolytes with respect to increased electrochemical stability and in particular the passivating solid electrolyte interphase (SEI) on the anode is studied using electrochemical techniques and X-ray photoelectron spectroscopy. Second, lowering the liquidus temperature by high salt concentration is utilized to create an electrolyte solely of LiTFSI and ethylene carbonate, tested for application in Li metal batteries by characterizing the morphology of plated Li using scanning electron microscopy and the CE by galvanostatic polarization. While the first approach shows dramatic improvements, the inherent weaknesses cannot be completely avoided, the second approach provides some promising cycling results for Li metal based cells. This points towards further investigations of the SEI, and possibly long-term safe cycling of Li metal anodes.
|
|
