Não há consenso entre os estudos quanto à associação entre a presença de problemas de comportamento e resultados piores no tratamento com alarme para enurese. O objetivo do presente estudo foi investigar a ocorrência de associações entre a presença de problemas de comportamento e os resultados do tratamento com alarme para enurese primária com acompanhamento semanal de um terapeuta. Os participantes foram 20 crianças com enurese primária, 13 do sexo masculino e 7, do sexo feminino, com idades entre seis e dez anos. Metade das crianças apresentava escores clínicos indicativos de problemas de comportamento segundo o Child Behavior Checklist. As oito crianças sem problemas de comportamento que concluíram o tratamento alcançaram o critério de sucesso inicial (14 noites secas consecutivas) e apenas duas desistiram. Das dez crianças com problemas de comportamento, somente metade atingiu o sucesso inicial, quatro desistiram e uma completou o período de tratamento e não obteve sucesso. Essas diferenças nos resultados finais não foram significativas em termos estatísticos. Também não foram encontradas diferenças significativas nas taxas de recaídas entre as crianças com e sem problemas de comportamento. Quatro das oito crianças sem problemas de comportamento que haviam alcançado o critério de sucesso inicial apresentaram recaídas e quatro conseguiram manter o controle noturno adquirido. Das cinco crianças com problemas de comportamento que alcançaram o sucesso inicial, três, apresentaram recaídas e duas, enquadraram-se no critério de sucesso continuado. A única diferença estatística encontrada entre os dois grupos de crianças foi no tempo de tratamento necessário para alcance do critério de sucesso inicial. Em 12 semanas de tratamento, a probabilidade de atingir o sucesso inicial foi de 86,11% para as crianças sem problemas de comportamento e de 10% para as crianças com problemas de comportamento; em 20 semanas, a probabilidade foi de 100% para as crianças sem problemas de comportamento e de 40% para as crianças com problemas de comportamento. Pode-se dizer, portanto, que, na amostra de crianças atendidas, os problemas de comportamento parecem ter ocasionado dificuldades para que progressos fossem alcançados no tratamento da enurese com alarme. Na maioria dos casos, entretanto, essas dificuldades não foram suficientes para que as crianças com problemas de comportamento apresentassem ao final do tratamento resultados significativamente diferentes das crianças sem problemas de comportamento. Esses resultados sugerem que as crianças com problemas de comportamento podem beneficiar-se do tratamento com alarme para enurese tanto quanto as crianças sem problemas de comportamento. Considerando o tempo necessário para o alcance do sucesso inicial, os resultados indicam que, provavelmente, as crianças com problemas de comportamento precisam mais de acompanhamento intensivo durante o tratamento com alarme para enurese do que as crianças sem problemas de comportamento. / There is no consensus among the studies regarding the association between behavior problems and worse outcomes in alarm treatment for enuresis. The aim of this study was to investigate the relationship between behavior problems and outcome in alarm treatment for primary enuresis with weekly sessions with a therapist. The participants were 20 children with primary enuresis, 13 boys and 7 girls, between the ages of six and ten. Half of these children presented clinical scores on the Child Behavior Checklist. Eight out of the 10 children without behavior problems who finished the treatment have achieved the criteria for initial success (14 consecutive dry nights) and two of them dropped out. Only half of the children with behavior problems attained initial success, four of them dropped out and one finished without success. These differences on the outcome were not statistically significant. There were also not found significant statistical differences in the occurrence of relapses rates between children with and without behavior problems. Four of the eight children without behavior problems who attained initial success have relapsed, and four have maintained the acquired nocturnal control. Three of the five children with behavior problems who achieved the initial success have relapsed and two of them satisfied the criteria for continued success. The only statistical difference found between the children groups was the time required to achieve initial success. In 12 weeks of treatment, the probability of attaining initial success was 86.11% for children without behavior problems and 10% for children with behavior problems; in 20 weeks, the probability was 100% for children without behavior problems, and 40% for the children with behavior problems. Therefore, it is possible to say that in that sample of children the behavior problems seemed to provide difficulties in achieving progresses in the alarm treatment for enuresis. On most of the cases, those difficulties were not enough to make the outcomes at the end of the treatment of children with behavior problems being statistically different from the children without behavior problems. These results suggest that children with behavior problems may benefit from alarm treatment as well as children without behavior problems. Considering the time required for achieving success, the results indicate that they probably need more intensive support during enuresis treatment with alarm than children without other problems.

A enurese é uma condição caracterizada pela perda de urina durante o sono, em crianças com mais de cinco anos sem outra condição clínica que explique os episódios. A enurese pode ser primária, no caso das crianças que nunca obtiveram controle prévio, ou secundária, em que a enurese cessou por pelo menos seis meses. Também é classificada como monossintomática, na ausência de sintomas diurnos do trato urinário inferior ou não-monossintomática, quando está associada a tais sintomas, como a urgência miccional. A enurese, cujas causas apresentam componentes hereditários ainda pouco claros, tem sua etiologia baseada na combinação de três fatores: a poliúria noturna ou a hiperatividade detrusora ligada á incapacidade de despertar em resposta aos sinais da bexiga cheia. Há tratamentos medicamentosos e psicológicos, sendo que a desmopressina, análogo sintético da vasopressina, que atua na poliúria noturna e o alarme, que atua na incapacidade de despertar, apresentam os níveis mais altos de recomendação e evidência. Embora tais tratamentos estejam consolidados, ainda não há total clareza sobre seus mecanismos de funcionamento e o porquê de não alcançarem todos os casos. Este trabalho teve como objetivo verificar se um conjunto de variáveis atuaria como moderador do resultado do tratamento com alarme, ou seja, em que medida influenciava, positiva ou negativamente, o desempenho dos participantes atendidos. As variáveis avaliadas foram: tipo de acompanhamento (presencial e à distância), frequência inicial de episódios, nível de problemas de comportamento, escolaridade dos pais, sexo e idade. Foram incluídos na amostra 61 crianças e adolescentes de 6 a 17 anos que receberam tratamento com alarme, sendo que 34 foram acompanhados à distância e 27 presencialmente. No total, 37 participantes obtiveram sucesso, caracterizado por 14 noites consecutivas sem episódios, num período de 28 semanas. Doze participantes não obtiveram sucesso e outros 12 desistiram. Caracterizaram-se como moderadoras do resultado do tratamento as seguintes variáveis: tipo de acompanhamento (grupo acompanhado à distância obteve mais sucessos), frequência inicial de episódios (participantes que obtiveram sucesso tinham menos episódios, em média, no início do tratamento) e nível de problemas de comportamento (participantes que não obtiveram sucesso tinham escores maiores de problemas de comportamento externalizantes). Os resultados indicam a efetividade do alarme e apontam para os aspectos que devem receber atenção do clínico ao administrar esse tipo de tratamento / Enuresis is a condition in which children of at least five years of age lose urine during sleep, without another clinical condition that could explain the wetting episodes. Enuresis may be primary, when the child has not obtained previous bladder control, or secondary, when such control was achieved for at least six months. It is also classified as monosymptomatic, when it is not associated with other lower urinary tract symptoms or non monosymptomatic, when these symptoms, such as urgency, are present. Enuresis etiology has unclear hereditary aspects. Its physiology is based on a combination of at least two of three malfunctioning systems: incapacity to wake in response to the full bladder signals plus nocturnal polyuria or detrusor hyperactivity. There are evidence based pharmacological and psychological treatments. Desmopressin, a synthetic version of hormone vasopressin that reduces nocturnal polyuria is the first line pharmacological treatment, whereas the alarm, which acts in the incapacity to wake is the first line psychological treatment. Both have the higher levels of evidence and recommendation by the specialized literature. However, the mechanisms underlying these treatments results and the reasons they are not successful with every enuretic children are not entirely clear. The objective of this work was to verify to what stand a series of variables are moderators of alarm treatment outcome. These variables were: type of support (face-to-face versus long distance), initial bedwetting frequency, behavior problems scores, level of parents education, gender and age. Sixty-one children with ages from 6 to 17 were included. All received full spectrum home training. Thirty-four received long distance support during treatment and 27 received face-to-face support. Success was defined by 14 consecutive dry nights within a 28 weeks treatment period. Success was obtained by 37 children, while 12 did not succeed and other 12 dropped out. Three variables were observed as moderators of treatment outcome: type of support (long distance had better results), initial bedwetting frequency (participants who succeeded had fewer initial wet nights) and behavior problem scores (participants who did not succeed had higher externalizing problems scores). Results indicate alarm effectiveness and aspects that should be focuses of attention when this kind of treatment is administered

A functional and effective alarm signal is a critical component of alarm systems designed to alert workers of impending danger. In a previous study (Hansson, 2017) background alarm sirens composed of changing-state sounds with an embedded temporal deviant, produced greater disruption of serial short-term memory than a signal without a deviant. However, to give rise to disruption the siren needed to change from fast to slow, since a change from slow to fast was impotent in its effect on task performance. In the current study, whether acoustic change was a necessary prerequisite for obtaining the fast-to-slow deviant effect was explored. Thus, repeated tones—steady-state sequences—presented at slow or fast rates were used with or without a temporal deviant (change from slow-to-fast vs. change from fast-to-slow). In the context of the steady-state sequences, both slow-to-fast and fast-to-slow temporal deviants produced disruption relative to the fast and slow control sequences. This suggests that a changing-state sequence is required for the fast-to-slow temporal deviant effect to arise. However, an alternative explanation based upon inter-stimulus intervals is also entertained. Understanding the acoustic parameters of sound is necessary to develop alarms sirens that are better at capturing attention. The current study suggests that embedding temporal deviants within sirens can promote greater attentional capture, but that this may depend on the nature of the alarm signal (whether it is changing vs. steady-state) and the direction of the change of speed (slow-to-fast vs. fast-to-slow).

Alarm signals such as sirens are crucial in alerting users of impending dangers. Therefore, it is important that the siren is designed so it can capture user's attention. In a previous study (Hansson, 2017) background alarm sirens composed of changing-state sounds with an embedded temporal deviant, produced greater disruption of serial short-term memory than a signal without a temporal deviant. However, to give rise to disruption the siren needed to change from fast to slow, since a change from slow to fast was impotent in its effect on task performance. This was further addressed in Hansson (2018) where it was shown that acoustic change appeared to be a necessary prerequisite for obtaining the fast-to-slow temporal deviant effect: When steady-state sounds were used fast-to-slow and or slow-to-fast temporal deviants were equally disruptive of serial recall. However, in order to create a steady-state siren, inter-stimulus intervals were incorporated into the siren to prevent the continuous uninterrupted presentation of a single tone. Since inter-stimulus intervals were not used in Hansson (2017) it could be the presence of these that eliminated the potency of the fast-to-slow over the slow-to-fast temporal deviation effect in Hansson (2018). Therefore, the current study was undertaken to investigate whether the embedding inter-stimulus intervals within a changing-state siren would restore the potency of the fast-to-slow temporal deviation over the slow-to-fast temporal deviation in capturing attention. The additional disruption for fast-to-slow temporal deviants over slow-to-fast temporal deviants (that did not produce disruption relative to control) returned in the current study when inter-stimulus intervals were included within the siren. The results support the notion that the additional disruption produced by fast-to-slow, over slow-to-fast temporal deviants depend on the changing-state properties of the siren. Implications of this result for the design and operation of sirens within ecologically valid settings are discussed.

Buller påverkar människor på många olika sätt, både fysiskt och psykiskt. Hörselskador, tinnitus, sömnproblem och koncentrationssvårigheter är några av effekterna av bullerstörning. Intensivvårdsavdelningen är en arbetsplats som är dokumenterat bullrig. Sjuksköterskor på intensivvårdsavdelning utsätts i sitt dagliga arbete för en hög bullernivå. Det är en apparattät och tekniskt avancerad miljö. Teknisk apparatur bidrar med en stor mängd larm. Det krävs också ständig överblick över en stor mängd informationskällor, både via syn och hörselintryck. Forskning visar att vid komplicerade arbetsuppgifter har buller en negativ påverkan på människors prestationsförmåga.Studien är baserad på nio vetenskapliga artiklar. Tre kvalitativa och sex kvantitativa artiklar. Analysmodellen är en litteraturöversikt där syftet har varit att över ett givet område skapa en överblick över forskningen. I vårt resultat framkom att hur buller påverkar oss som individer beror på flera olika faktorer. Vilken personlighet en individ har är av stor betydelse, likaså den subjektiva känsligheten för buller. Om vi har möjlighet att hantera bullret i vår miljö inverkar det direkt på vår arbetsprestation och på tillfredsställelse på arbetsplatsen. I resultatet ser vi också att miljön på IVA, med buller och larm, framkallar stress hos de sjuksköterskor som tycker sig ha dålig möjlighet att påverka sin arbetsmiljö. I våra artiklar framkom det att en sänkt ljudnivå bör leda till en bättre arbetsmiljö med mindre stress och med en minskad risk för att felbedömningar ska ske.Nyckelord: Nurse, Noise, ICU, Stress, Environment, Pollution, Alarm, Annoyance / Program: Fristående kurs

Maritime surveillance radars are critical in commerce, transportation, navigation, and defense. However, the sea environment is perhaps the most challenging of natural radar backdrops because maritime radars must contend with electromagnetic backscatter from the sea surface, or sea clutter. Sea clutter poses unique challenges in very low grazing angle geometries, where typical statistical assumptions regarding sea clutter backscatter do not hold. As a result, traditional constant false alarm rate (CFAR) detection schemes may yield a large number of false alarms while objects of interest may be challenging to detect. Solutions posed in the literature to date have been either computationally impractical or lacked robustness. This dissertation explores whether fully polarimetric radar offers a means of enhancing detection performance in low grazing angle sea clutter. To this end, MIT Lincoln Laboratory funded an experimental data collection using a fully polarimetric X-band radar assembled largely from commercial off-the-shelf components. The Point de Chene Dataset, collected on the Atlantic coast of Massachusetts’ Cape Ann in October 2015, comprises multiple sea states, bandwidths, and various objects of opportunity. The dataset also comprises three different polarimetric transmit schemes. In addition to discussing the radar, the dataset, and associated post-processing, this dissertation presents a derivation showing that an established multiple input, multiple output radar technique provides a novel means of simultaneous polarimetric scattering matrix measurement. A novel scheme for polarimetric radar calibration using a single active calibration target is also presented. Subsequent research leveraged this dataset to develop Polarimetric Co-location Layering (PCL), a practical algorithm for mitigation of low grazing angle sea clutter, which is the most significant contribution of this dissertation. PCL routinely achieves a significant reduction in the standard CFAR false alarm rate while maintaining detections on objects of interest. Moreover, PCL is elegant: It exploits fundamental characteristics of both sea clutter and object returns to determine which CFAR detections are due to sea clutter. We demonstrate that PCL is robust across a range of bandwidths, pulse repetition frequencies, and object types. Finally, we show that PCL integrates in parallel into the standard radar signal processing chain without incurring a computational time penalty.

<p>The purpose of this study was to depict some elderly people’s experiences of personal safety alarms. Furthermore, the aim was to look into whether there is any difference in experience between men and women and depending on their level of care. Using a qualitative method, semi-structured interviews were carried out with eight elderly people; six women and two men. The main questions of the study were: How do the elderly people experience the practical use of personal safety alarms? In what ways, if any, do the elderly people experience that the personal safety alarm has changed their daily life? In what ways do the elderly people experience that the personal safety alarm effects their ability to stay in their own home? A cognitive perspective was mainly used to analyze the results. The results of the study showed that there were no significant differences between men and women’s experiences or considering their level of care. In the elderly people’s opinion, the personal safety alarm works well and affects their ability to remain in their own home. The personal safety alarm has not made any significant difference in the elderly people’s daily life, although some of them feel a sense of safety.</p>

<p>Commissioned by the government, SOS Alarm has undertaken the assignment to be responsible for the emergency calls within Sweden. They are also performing commissions for the county councils in dispatching ambulances. SOS Alarms business concept is to develop, offer and perform services to create safety in emergency situations and to create a safer society.</p><p>To develop the ambulance services in Sweden, SOS Alarm started a project in the beginning of 2003. The project is called OPAL, Optimized Ambulance Logistics, and it is being conducted in cooperation with Linköpings Universitet. Ambulance Logistics is the planning, implementation and control of resources and information used to facilitate an efficient way of serving a person in need of out-of-hospital medical care, including possible transportation.</p><p>Among other things, the OPAL-project has resulted in a preparedness calculator. The calculator calculates the preparedness for certain areas in Sweden (so far Dalarna and the county of Stockholm) and visualizes the preparedness on a digital map to support the persons who dispatch the ambulances. If an area has “bad preparedness”, in simple terms it means that there are not enough ambulances in the surrounding area to cover the probable needs.</p><p>The inputs for the preparedness calculator include forecasts of where and when ambulance calls are probable to occur in Sweden. The purpose with this thesis is to create a method to produce these forecasts. A method to update the forecasts when new input data is available also has to be created. The data analysis and production of forecasts in this thesis are based on data from Dalarna. However, the method has to be generalized and eventually applicable to produce forecasts for the rest of Sweden.</p><p>An analysis of historical data shows that the demand is constant, with no obvious trend. It is obvious that number of ambulance calls is differentiated over the days of the week and also over the hours of the day. Therefore, the week is categorized into 168 different indexes, one for each hour of the week. The next step is to examine two reasonable forecasting methods, moving average and exponential smoothing, and compare their quantitative and qualitative characteristics. Based on these comparisons, the moving average method is recommended.</p><p>With the forecasts, the preparedness in selected areas can be calculated and SOS Alarm receives excellent assistance in dispatching ambulances in a more efficient way. The preparedness calculator will assist in preventing bad preparedness and it makes sure that the best possible preparedness is being upheld. Therefore, good forecasting can contribute to a safer society and to saving human lives.</p> / <p>SOS Alarm har, med staten som uppdragsgivare, åtagit sig att svara för nödnumret 112 inom Sverige. De utför även uppdrag för landstingens räkning, inom ambulansalarmering och inom ambulansdirigering. SOS Alarms affärsidé är att utveckla, erbjuda och utföra tjänster för att skapa trygghet i nödsituationer och bidra till ett tryggare samhälle.</p><p>I början av år 2003 inledde SOS Alarm projektet OPAL med målet att utveckla ambulansverksamheten i Sverige. OPAL står för Optimerad Ambulanslogistik och drivs i samarbete med Linköpings universitet. Ambulanslogistik är den planering, implementering och kontroll av resurser och information som utförs för att åstadkomma ett effektivt sätt att betjäna en person i behov av vård utanför sjukhuset, inklusive eventuell transport.</p><p>OPAL-projektet har bland annat resulterat i en beredskapskalkylator. Denna kalkylator beräknar beredskapen för vissa områden i Sverige (för närvarande i Dalarna och Stockholms län) och visualiserar dessa beredskaper på en digital karta som stöd för de personer som styr ambulanserna och tilldelar dem uppdrag. ”Dålig beredskap” i ett område innebär förenklat att det inte finns tillräckligt många ambulanser i närheten för att uppfylla det förväntade behovet.</p><p>En ingående parameter som behövs till beredskapskalkylatorn är prognoser för när det är troligt att uppdrag kommer att uppstå i olika områden. Syftet med examensarbetet är att skapa en metod för att prognostisera detta förväntade antal uppdrag för ambulanserna i Sverige. En metod ska även skapas för att prognoserna ska kunna uppdateras i takt med att ny data samlas in. Analysen av data och framtagning av prognoserna utförs i examensarbetet för Dalarna som exempel, men metoden ska kunna användas även för att ta fram prognoser för övriga Sverige.</p><p>En analys av historiska data för Dalarna visar en bakomliggande konstant efterfrågemodell utan tydlig trend. Det visar sig tydligt att antal uppdrag beror på vilken veckodag samt vilken timme på dygnet som råder. Valet blir därför att tilldela veckan 168 olika index, ett för varje timme under veckan. Sedan undersöks två rimliga prognosmetoder, glidande medelvärde och exponentiell utjämning, som jämförs kvalitativt och kvantitativt. Med dessa analyser som grund rekommenderas metoden glidande medelvärde.</p><p>Med prognosvärden kan beredskapen i utvalda områden beräknas och SOS Alarm får god hjälp att dirigera ambulanser på ett mer effektivt sätt. Beredskapskalkylatorn är ett verktyg som hjälper till att förebygga dålig beredskap och att se till att bästa möjliga beredskap hålls. Goda prognoser kan alltså bidra till ett tryggare samhälle och att rädda människoliv.</p>

The purpose of this study was to depict some elderly people’s experiences of personal safety alarms. Furthermore, the aim was to look into whether there is any difference in experience between men and women and depending on their level of care. Using a qualitative method, semi-structured interviews were carried out with eight elderly people; six women and two men. The main questions of the study were: How do the elderly people experience the practical use of personal safety alarms? In what ways, if any, do the elderly people experience that the personal safety alarm has changed their daily life? In what ways do the elderly people experience that the personal safety alarm effects their ability to stay in their own home? A cognitive perspective was mainly used to analyze the results. The results of the study showed that there were no significant differences between men and women’s experiences or considering their level of care. In the elderly people’s opinion, the personal safety alarm works well and affects their ability to remain in their own home. The personal safety alarm has not made any significant difference in the elderly people’s daily life, although some of them feel a sense of safety.

Fishes in the superorder Ostariophysi, including fathead minnows (Pimephales promelas), possess specialized epidermal club cells that contain an alarm substance. Damage to these cells, as would occur during a predator attack, causes the release of the alarm substance and can indicate the presence of actively foraging predators to nearby conspecifics. For nearly 70 years, research involving epidermal club cells has focused on the alarm substance and the role it plays in predator/prey interactions. However, recent studies have indicated that there may be a connection between epidermal club cells and the fish immune system. Fish increase investment in epidermal club cells upon exposure to skin penetrating pathogens and parasites. In this study I tested for differences in epidermal club cell investment by fathead minnows exposed to the immunosuppressive effects of the glucocorticoid hormone cortisol. In experiment 1, fathead minnows were exposed to either a single intraperitoneal injection of corn oil or no injection at all. The purpose of this experiment was to determine whether corn oil, the vehicle for cortisol injections in later experiments, had an effect on epidermal club cell density. The treatments had no effect on epidermal club cell size, cell area, or epidermal thickness. In experiment 2, skin extract was prepared from the skin of corn oil injected and non injected fathead minnows as in experiment 1 to determine whether corn oil had an effect on the epidermal club cell alarm substance concentration. The treatments showed no significant differences in observed anti-predator behaviour, including change in shelter use, dashing and freezing. In experiment 3, fathead minnows were exposed to either a single intraperitoneal injection of cortisol or corn oil. The purpose of this experiment was to determine whether cortisol, a known immunosuppressant, had an effect on epidermal club cell investment. Fathead minnows exposed to a single cortisol injection had significantly reduced respiratory burst activity of kidney phagocytes indicating that there was suppression of the innate immune system. Furthermore, cortisol treated fathead minnows showed significantly lower numbers of epidermal club cells. The treatments had no effect on individual epidermal club cell area, epidermal thickness and serum cortisol levels after 12 days. The results from this experiment suggest that pharmacological cortisol injections in fathead minnows have a suppressive effect on the fish innate immune system. Furthermore, the findings that cortisol induced immunosuppression also influences epidermal club cell investment provides support for the hypothesis that epidermal club cells may function as part of the fish immune system.