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- Adelsjö, Igor
(författare)
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Medication communication with older adults experiencing chronic illness and polypharmacy
- 2023
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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.
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- ADENIER, Guillaume
(författare)
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Probabilistic Analysis of the EPR-Bohm Experiment
- 2007
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bell's Theorem was developed on the basis of considerationsinvolving a linear combination of spin correlation functions, eachof which has a distinct pair of arguments. The simultaneouspresence of these different pairs of arguments in the sameequation is investigated, and the implicit counterfactualassumption in Bell's theorem is discussed.We show how an explicit contextuality can arise from a modeldisplaying unfair sampling, and we discuss it in theframework of David Mermin's cleverly simple version of Bell'stheore, which pinpoints in a very straightforward way howinterpreting entanglement from a realistic point of view can beproblematic. We present an extended version of Mermin's devicethat can actually be given a straightforward realisticinterpretation.We stress that the low efficiency of detectors in all experimentswith photons makes the use of the fair sampling assumptionunavoidable. Since this very assumption is false in all existinglocal realistic models based on inefficient detection, we thusquestion its validity. We show that it is no more reasonable toassume fair sampling than it is impossible to test, and weactually propose an experimental test which would provides clearcut results in case of unfair samplingWe then analyze optical EPR experimental data performed by Weihs et al in Innsbruck 1997-1998. We show that for some linearcombinations of the raw coincidence rates, the experimentalresults display some anomalous behavior that a more general source state (like non-maximally entangled state) cannotstraightforwardly account for. We use the fair samplingassumption, and assume explicitly that the detection efficienciesfor the pairs of entangled photons can be written as a product ofthe two corresponding detection efficiencies for the singlephotons. We show that this explicit use of fair sampling cannot bemaintained to be a reasonable assumption as it leads to anapparent violation of the no-signalling principle.
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- Ahlgren, Fredrik, 1980-
(författare)
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Waste heat recovery in a cruise vessel
- 2016
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In three studies of a cruise ship the author has investigated waste heat recovery (WHR)from exhaust gases using an organic Rankine cycle (ORC), and also mapped the energyand exergy flows within the ship. Data were collected from the ship’s machinerysystem for a total extent of one year, and this data were used for simulations andenergy calculations. An off-design analysis was made and an ORC was simulated andoptimised with regards to the ship’s operating conditions. The ORC working fluid wasoptimised in terms for maximum electrical production in the off-design condition. Theoff-design analysis showed that the ship speed and power consumption was far fromits original design. The results indicate that there is a potential for significant savingsby using an organic Rankine cycle for waste heat recovery. The energy and exergyanalysis gave a better understanding of the energy flows and showed that the singlelargest exergy destruction occurs in the ship’s diesel engines.
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- Ahlgren, Thorbjörn, 1959-
(författare)
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Ungdomsbehandling : Hemmaplanslösning som idé och praktik
- 2007
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Title: Open-care Treatment of Youth. Home-ground Solutions in Theory and Practice This dissertation is a case study in two parts, which describes how ideas about open-care treatment of youth aged 13-20 years are interpreted and concretized in a local context. The study, i.a., aims at creating deeper knowledge about target group, content of treatment, and reported results concerning a form of treatment in social care which has hitherto been sparsely researched in Sweden. The results of the interview study demonstrate that the driving forces for developing local forms of open care treatments have first and foremost been to offer better care and to improve the professionalism of the social worker. Studies of the social welfare documents of 97 young people reveal that most of these youngsters are in bad need of treatment and that they have experiences of various kinds of treatment before the present efforts. The study also demonstrates that the efforts are rarely evaluated and lack systematic documentation. Finally, the study reveals that more than 60 per cent of the youth get some sort of continuous support by the social welfare system after the open-care treatment has come to an end. The results from both parts of the study are analysed by means of neo- institutional theory. According to this theory the local open-care treatment consists of an indistinct target group, family-oriented methods, and activities that have been legitimised by strong proponents, good timing, professional development, and by representing important political values. In conclusion, the author argues that open care treatment shows signs of a beginning institutionalisation, a taken-for-granted-ness, which he thinks is risky, as we still do not know if open-care treatment is more favourable to the young people than different kinds of 24-hour care. In addition, the author holds, that the future role of the social worker should include knowledge that decreases unfounded taken-for-granted ideas.
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- Akeab, Imad, 1975-
(författare)
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Accurate techniques for 2D electromagnetic scattering
- 2014
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis consists of three parts. The first part is an introduction and referencessome recent work on 2D electromagnetic scattering problems at high frequencies. It alsopresents the basic integral equation types for impenetrable objects. A brief discussionof the standard elements of the method of moments is followed by summaries of thepapers.Paper I presents an accurate implementation of the method of moments for a perfectlyconducting cylinder. A scaling for the rapid variation of the solution improves accuracy.At high frequencies, the method of moments leads to a large dense system of equations.Sparsity in this system is obtained by modifying the integration path in the integralequation. The modified path reduces the accuracy in the deep shadow.In paper II, a hybrid method is used to handle the standing waves that are prominentin the shadow for the TE case. The shadow region is treated separately, in a hybridscheme based on a priori knowledge about the solution. An accurate method to combinesolutions in this hybrid scheme is presented.
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- Al-Najjar, Basim, 1954-
(författare)
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Some problems on the selection of a condition based maintenance technique for mechanical systems
- 1990
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the first paper we focused mainly on establishing a sequential method for the selection of a maintenance technique for mechanical systems. The selection problem is studied for the components having considerable consequences and a non-negligible failure intensity. Identification of these components based on their failure mechanisms and failure causes is discussed and a modified version of the usual Failure Modes, Effects and Criticality Analysis, FMECA is suggested. A cumulative sum chart is proposed to identify a replacement time. This is explained by way of two examples. In order to run cost per unit time is proposed. The selection of a maintenance technique based on the intrinsic information of monitoring parameters is introduced.Ability of a monitoring parameter in predicting failures, can be described as a probability of failure in the future conditionally on the current value of a model monitoring parameter. Thus, the second paper is focused on introducing a model relating a condition dependent failure rate to a component condition. For the selection of a cost-effective technique a modified proportional hazards model, PHM, is proposed. The modified model is able to reveal the effect of observing monitoring parameters and operating conditions on failure rate function.A graphical method, based on a Generalized Total Time on Test, a GTTT- plot, for the selection of a cost-effective technique is proposed in the third paper. Also, a graphical method to estimate the threshold level for a cost-effective technique based on the same concept is suggested. These methods are illustrated by way of an example.
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| 10. |
- Al-Talibi, Haidar
(författare)
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Nelson-type Limits for α-Stable Lévy Processes
- 2010
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Brownian motion has met growing interest in mathematics, physics and particularly in finance since it was introduced in the beginning of the twentieth century. Stochastic processes generalizing Brownian motion have influenced many research fields theoretically and practically. Moreover, along with more refined techniques in measure theory and functional analysis more stochastic processes were constructed and studied. Lévy processes, with Brownian motionas a special case, have been of major interest in the recent decades. In addition, Lévy processes include a number of other important processes as special cases like Poisson processes and subordinators. They are also related to stable processes. In this thesis we generalize a result by S. Chandrasekhar [2] and Edward Nelson who gave a detailed proof of this result in his book in 1967 [12]. In Nelson’s first result standard Ornstein-Uhlenbeck processes are studied. Physically this describes free particles performing a random and irregular movement in water caused by collisions with the water molecules. In a further step he introduces a nonlinear drift in the position variable, i.e. he studies the case when these particles are exposed to an external field of force in physical terms. In this report, we aim to generalize the result of Edward Nelson to the case of α-stable Lévy processes. In other words we replace the driving noise of a standard Ornstein-Uhlenbeck process by an α-stable Lévy noise and introduce a scaling parameter uniformly in front of all vector fields in the cotangent space, even in front of the noise. This corresponds to time being sent to infinity. With Chandrasekhar’s and Nelson’s choice of the diffusion constant the stationary state of the velocity process (which is approached as time tends to infinity) is the Boltzmann distribution of statistical mechanics.The scaling limits we obtain in the absence and presence of a nonlinear drift term by using the scaling property of the characteristic functions and time change, can be extended to other types of processes rather than α-stable Lévy processes. In future, we will consider to generalize this one dimensional result to Euclidean space of arbitrary finite dimension. A challenging task is to consider the geodesic flow on the cotangent bundle of a Riemannian manifold with scaled drift and scaled Lévy noise. Geometrically the Ornstein-Uhlenbeck process is defined on the tangent bundle of the real line and the driving Lévy noise is defined on the cotangent space.
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