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Yes / The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. Methods Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. Results The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. Conclusions The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.

Syftet med studien var att kartlägga urininkontinensarbetet med kvalitetsregistret Senior Alerts urininkontinensmodul i två kommuner över en bestämd tid januari till juni 2014 samt januari till juni 2015. Metoden bestod i att använda sig av registerdata som tillhandahölls av registerhållaren för Senior Alert. Resultatet visade att mer än hälften av de personer som riskbedömts i kommun G hade någon form av urininkontinens under båda tidsperioderna. I kommun M var andelen ännu högre cirka 80 %. Bakomliggande orsaker till urininkontinens visade sig vara de aspekter som nämns i Senior Alerts modul förutom förstoppningsproblematik samt nedsatt känsel i underlivet som inte framkom lika tydligt som övriga aspekter. Genom att använda Senior Alert kan ett mönster utkristalliserats och det går att erbjuda individuellt anpassade åtgärder för personer med inkontinensproblematik. Med enkla åtgärder kan personer få hjälp med avföringsregim, toalettassistans, utprovning av inkontinenshjälpmedel hjälpas enligt skalan i Senior Alert. Det vill säga skalan påvisar vilken hjälp som kan behövas för patienten, samt för vårdpersonal som sedan utför avsedda åtgärder. / The purpose of the study is to identify urinary incontinence work with quality registry Senior Alerts urinary incontinence module in two municipalities over a fixed period January to June 2014 and from January to June 2015. The method was to use the registry data that is later held by the Depositary of the Senior Alert. The result showed that more than half of the individuals in risk assessments were conducted on municipal G had any form of urinary incontinence in both periods. The municipality M proportion was even higher, about 80%. Underlying causes of urinary incontinence was found to be the aspects mentioned in the Senior Alerts module except constipation problems and loss of sensation in the genital area that is not revealed as clearly as the other aspects. Using Senior Alert, a pattern emerged, and it is possible to provide individually tailored measures for people with incontinence problems. With simple measures, can patients with feces regime, toilet assistance, testing of incontinence aids can the scale of Senior Alert be helpful. The scale demonstrates what assistance may be needed for patients, health professionals then perform the action.

Bakgrund: Undernäring förekommer hos uppemot 30 % av äldre personer på särskilda boenden (SÄBO). Det är ett av distriktssköterskans ansvarsområden att upprätthålla en god nutritionsvård. Syfte: Syftet var att undersöka förekomst av undernäring bland äldre personer (65 år och äldre) på särskilt boende samt relationer mellan undernäring och fallrisk, risk för trycksår respektive nedsatt munhälsa. Vidare var syftet att undersöka vilka preventiva åtgärder distriktssköterskan erbjöd för att förbygga alternativt behandla undernäring hos äldre personer. Metod: Studien hade en kvantitativ ansats. Antalet studiedeltagare var 436 personer som bodde på SÄBO. Gruppjämförelser gjordes mellan tre oberoende grupper (ej risk för undernäring, risk för undernäring och undernärd) avseende fallrisk, risk för trycksår samt nedsatt munhälsa. Vidare gjordes logistisk regressionsanalys för att undersöka relationen mellan risk för undernäring/undernärd och fallrisk, risk för trycksår samt nedsatt munhälsa. Deskriptiv statistik användes för att beskriva preventiva och behandlande åtgärder. Resultat: Undernäring relaterar starkt till risk för trycksår. Relation kunde inte påvisas mellan undernäring och fallrisk samt munhälsa. Preventiva åtgärder användes i låg utsträckning. Slutsats: Nutritionsomvårdnad är ett komplext område vilket kräver att distriktssköterskan arbetar i ett multidisciplinärt team med riskbedömningar, utredningar, åtgärder och uppföljningar. Nutritionsåtgärder bör erbjudas i högre utsträckning till personer med risk för undernäring eller som är undernärda. / Background: Undernutrition occurs in up to 30 % of older people in special accommodation (SA). It is one of the district nurse's responsibility areas to maintain good nutritional care. Purpose: The purpose was to investigate the prevalence of undernutrition among older people (65 years and older) in special accommodation and relationships between undernutrition and fall risk, risk of pressure ulcers and impaired oral health. A further aim was to investigate the preventive measures district nurse’s offered to prevent alternatively treat undernutrition in older people. Method: The study had a quantitative approach. The number of study participants was 436 people who lived in SA. Group comparisons were made between three independent groups (not at risk of undernutrition, risk of undernutrition and undernourished) regarding fall risk, risk of pressure ulcers and impaired oral health. Furthermore, logistic regression analysis was conducted to examine the relationship between risk of undernutrition/undernourished and fall risk, risk of pressure ulcers and impaired oral health. Descriptive statistics were used to describe the preventive and treatment measures. Results: Undernutrition relate strongly to the risk of pressure ulcers. No relationship was detected between undernutrition and risk of falling and impaired oral health. Preventive measures was used to a low extent. Conclusion: Nutritional care is a complex area that requires that the district nurse work in a multidisciplinary team with risk assessments, investigations, actions and follow up. Nutritional measures should be offered to a greater extent to persons at risk of undernutrition or with manifest undernutrition.

Increasing numbers of alerts produced by network intrusion detection systems (NIDS) have burdened the job of security analysts especially in identifying and responding to them. The tasks of exploring and analysing large quantities of communication network security data are also difficult. This thesis studied the application of visualisation in combination with alerts classifier to make the exploring and understanding of network security alerts data faster and easier. The prototype software, NSAViz, has been developed to visualise and to provide an intuitive presentation of the network security alerts data using interactive 3D visuals with an integration of a false alert classifier. The needs analysis of this prototype was based on the suggested needs of network security analyst's tasks as seen in the literatures. The prototype software incorporates various projections of the alert data in 3D displays. The overview was plotted in a 3D plot named as "time series 3D AlertGraph" which was an extension of the 2D histographs into 3D. The 3D AlertGraph was effectively summarised the alerts data and gave the overview of the network security status. Filtering, drill-down and playback of the alerts at variable speed were incorporated to strengthen the analysis. Real-time visual observation was also included. To identify true alerts from all alerts represents the main task of the network security analyst. This prototype software was integrated with a false alert classifier using a classification tree based on C4.5 classification algorithm to classify the alerts into true and false. Users can add new samples and edit the existing classifier training sample. The classifier performance was measured using k-fold cross-validation technique. The results showed the classifier was able to remove noise in the visualisation, thus making the pattern of the true alerts to emerge. It also highlighted the true alerts in the visualisation. Finally, a user evaluation was conducted to find the usability problems in the tool and to measure its effectiveness. The feed backs showed the tools had successfully helped the task of the security analyst and increased the security awareness in their supervised network. From this research, the task of exploring and analysing a large amount of network security data becomes easier and the true attacks can be identified using the prototype visualisation tools. Visualisation techniques and false alert classification are helpful in exploring and analysing network security data.

In der vorliegenden Arbeit wurden neue Untersuchungsmöglichkeiten mit dem BacT/Alert 3D Mykobakterien-Testsystem erprobt. Erstens wurden Untersuchungen durchgeführt, um die Testkonzentrationen für Protionamid (PTH) und Linezolid (LIZ) für die standardmäßige Empfindlichkeitstestung von M. tuberculosis (Mtb) mit dem BacT/Alert 3D-System festzulegen. Dazu wurden die MHK-Werte für 32 Mtb-Stämme bestimmt: Referenzstamm Mtb H37Rv, sensible Patientenstämme, Patientenstämme mit verschiedenen Resistenzen (u. a. PTH-Resistenz) sowie eigens für die Arbeit isolierte LIZ-resistente Mutanten. Die PTH-MHK betrug für 20 von 21 sensiblen Mtb-Stämmen einschließlich des Referenzstammes Mtb H37Rv 0,125 - 1 mg/l (0,25 mg/l bei 11 von 21 Stämmen). Lediglich ein Stamm mit Resistenz gegenüber Isoniazid, Ethambutol und Streptomycin fiel mit einer etwas erhöhten PTH-MHK von 2 mg/l auf. Sechs PTH-resistente Stämme (z. T. mit anderen Resistenzen gegenüber Erstrang-Antituberkulotika) zeigten PTH-MHK von 4 - 16 mg/l. Die Gruppen der PTH-sensiblen und resistenten Stämme zeigten ein bimodales Verteilungsmuster, das mit einem Schwellenwert von 2 mg PTH/l gut zu differenzieren ist. Für die standardmäßige Durchführung der Empfindlichkeitstestung gegenüber PTH mit dem BacT/Alert 3D-System empfehlen wir deshalb eine PTH-Testkonzentration von 2 mg/l. Die LIZ-MHK betrug für 20 sensible Mtb-Stämme (inklusive Referenzstamm Mtb H37Rv) und sieben Stämme mit verschiedenen Resistenzen gegenüber Erstrang-Antituberkulotika 0,25 - 2 mg/l (0,5 mg/l bei 17 von 27 Stämmen). Für die vier isolierten LIZ-resistenten Mutanten betrug die LIZ-MHK 8 - 16 mg/l. Es zeigt sich auch bei der Verteilung der LIZ-MHK ein bimodales Verteilungsmuster; die Gruppen der sensiblen und resistenten Stämme sind gut zu differenzieren. Wir empfehlen für die standardmäßige Durchführung der Empfindlichkeitstestung gegenüber LIZ mit dem BacT/Alert 3D-System eine LIZ-Testkonzentration von 4 mg/l. Die festgestellten MHK-Werte von PTH und LIZ und die vorgeschlagenen Testkonzentrationen entsprechen Ergebnissen aus der Literatur, die mit ähnlichen Methoden erhoben wurden. Zweitens wurden mit dem BacT/Alert 3D-System Untersuchungen zur Kombinationstestung von Antituberkulotika bei Mtb und Stämmen des MAC-Komplexes durchgeführt, bisher liegen keine Publikationen für Untersuchungen von Wirkstoff-Kombinationen bei Mykobakterien mit diesem System vor. Es wurde geprüft, ob die MHK eines Antituberkulotikums durch die Zugabe einer subinhibitorischen Menge eines anderen Antituberkulotikums verändert wird. Bei Mtb wurden dazu folgende Kombinationen geprüft: Rifampicin (RMP) + LIZ, Moxifloxacin + LIZ, Isoniazid + PTH, RMP + PTH, PTH + LIZ. In keinem Fall konnten signifikante Effekte beobachtet werden. Ein tendenziell synergistischer Effekt der PTH-RMP-Kombination beim Stamm Mtb H37Rv (Reduktion der RMP-MHK um eine Stufe) wurde durch die Analyse der Wachstumskinetik des Stammes unterstützt. Bei zufällig ausgewählten Stämmen des MAC-Komplexes wurde die Kombination Ciprofloxacin (CIP) + Ethambutol (EMB) geprüft. Es zeigte sich bei sieben von zehn Stämmen eine Reduzierung der CIP-MHK um mindestens drei Stufen bei Zugabe einer subinhibitorischen Konzentration von EMB. Dieser synergistische Effekt wurde bereits in den 1990er Jahren mit einer ähnlichen Methode festgestellt, allerdings ohne die Stämme des MAC-Komplexes zu differenzieren (Arbeitsgruppe von S. Hoffner). Interessanterweise handelte es sich bei den von uns untersuchten Stämmen, bei denen dieser synergistische Effekt nachgewiesen wurde, um M. avium-Stämme. Diese Problematik sollte weiter verfolgt werden, da sich daraus Konsequenzen für die Therapieempfehlung ergeben könnten.

Active safety systems that warn automobile drivers of various types of impending collisions have been developed. How these systems alert drivers when integrated, however, is a crucial component to their effectiveness that hinges on the consideration of human factors. Drivers' ability to comprehend multiple alerts presented through a haptic driver seat was investigated in this dissertation. Twenty-four participants, balanced for age and gender, drove an instrumented vehicle on a test-track while haptic alerts (vibrations in the driver seat) were generated. Drivers' ability to transmit the information conveyed by the alerts was investigated through two experiments. The first experiment investigated the effects of increasing the number of potential alerts on drivers' response performance. The second experiment investigated whether presenting haptic alerts through unique versus common locations in the driver seat affects drivers' response performance. Younger drivers (between the ages of 18 and 25 years old) were found to efficiently process the increased information contained in the alerts, while older drivers were not as efficient. However, it is foreseeable that older driver performance decrements may be assuaged when a crash context is provided. A third experiment evaluated the haptic driver seat's ability to alert distracted drivers to an actual crash threat. Drivers that received a haptic seat alert returned their gaze to the forward roadway sooner, removed their foot from the throttle sooner, pressed the brake pedal sooner, and stopped farther away from an inflatable barricade than drivers that did not receive a haptic seat alert. No age or gender effects were found in this experiment. Furthermore, half of the drivers that received the haptic seat alert lifted up on the throttle before returning their eyes to the forward roadway. This suggests these drivers developed an automatic response to the haptic seat alerts through their experience with the previous two experiments. A three-alert haptic seat approach, the intermediate alternative tested, is recommended providing specific design requirements are met. / Ph. D.

Bakgrund: Senior alert är ett nationellt kvalitetsregister som avser att förebygga trycksår, fall, undernäring, ohälsa i munnen och blåsdysfunktion hos patienter över 65 år. För att identifiera dessa riskområden används olika bedömningsinstrument och sjuksköterskor ansvarar för att registreringarna genomförs och att förebyggande åtgärder sätts in. Syfte: Studiens syfte var att studera sjuksköterskors upplevelse av att arbeta med kvalitetsregistret Senior alert samt hur sjuksköterskorna upplever att arbetet med kvalitetsregistret påverkar vården hos de äldre. Metod: Sex sjuksköterskor verksamma inom Uppsala kommun med erfarenhet av att arbeta med Senior alert intervjuades och en kvalitativ innehållsanalys användes för att bearbeta den insamlade datan.   Resultat: Utifrån den insamlade datan utformades fyra kategorier, Upplevelser av Senior alert som redskap, Senior alert kan förbättras, Tillämpandet av senior alert i praktiken och Arbetet med Senior alert bidrar till ökad vårdprevention och sju underkategorier. Slutsats: Senior alert upplevs som ett bra redskap för att arbeta förebyggande och främja teamarbete, men uppfattas som tidskrävande. Sjuksköterskorna i den här studien anser att vården av de äldre förbättras då identifiering av riskområden sker tidigt och åtgärder sätts in. För att kunna göra resultatet överförbart och veta på vilket sätt vården förbättras behövs ett större urval och frågor som är utformade för att kunna besvara syftet. / Background: Senior Alert is a quality registry which aims to prevent pressure ulcers, falling, malnutrition, bad oral health and urinary incontinence among patients over 65 years. To identify these areas different evaluation tools are used and nurses are responsible for the registrations and making sure preventive actions are made. Aim: The aim of this study was to describe how nurses experience working with the quality registry Senior Alert and how it affects the care of the elderly. Methods: Six nurses working in Uppsala county with experience of working with Senior Alert was interviewed. The interviews were analyzed using a qualitative content analysis. Results: Four categories, Senior Alert as a tool, Senior Alert needs improvement, Working with Senior Alert and Senior Alert contributes to a better health care and seven subcategories were identified. Conclusions: The respondents found Senior Alert to be a helpful tool for preventive work and that it promotes teamwork, but is perceived as time consuming. The nurses in this study think that the care of the elderly improves by early identification and preventive actions, but to do this, study-result transferability and knowing in what way the care will improve it will need a larger target group and more questions to answer the aim of the study.

A variabilidade espaçotemporal das inundações determinam os processos ecológicos e influenciam as atividades humanas no Pantanal. O entendimento da dinâmica das inundações é a chave para melhores práticas de gerenciamento e reação no caso de eventos extremos. Nesse estudo, métodos de quantificação de água e extração de sazonalidade foram aplicados numa série temporal de dez anos (2000 a 2009) das imagens MODIS13Q1 para a modelagem contínua das inundações. Foram determinadas 25 sub-regiões, totalizando 150.502 km2, baseado no regime das inundações e na geomorfologia. A área inundada variou de 5.539 km2 até 52.894 km2, com média de 18.329 km2, refletindo um período seco comparado às décadas anteriores. A maior parte do Pantanal (86.841 km2) inundou pelo menos uma vez no período, mas uma área relativamente grande permaneceu não inundada ou inundou por um período curto de tempo. Áreas não inundadas ou inundadas por curtos períodos de tempo ficaram espalhadas por todo o Pantanal, enquanto que áreas que inundam por longos períodos de tempo ou permanentemente inundadas se concentraram apenas em alguns locais. Quatro estágios principais de inundação foram determinados e os principais fluxos e armazenagem de água foram mapeados embora tenha ocorrido uma alta variabilidade interanual. Apesar das limitações de escala e problemas de sobreposição dos mapas, foi obtida uma boa concordância entre o mapa de frequência de inundação e os mapas de vegetação e solos. Modelos estatísticos logísticos não lineares foram determinados para as relações entre os principais compartimentos hidrológicos e foi possível estimar cenários passados de inundação baseado na relação entre a área inundada total do Pantanal e o nível do rio Paraguai. Relações de similaridade e de fluxos de água foram determinados entre os sub-compartimentos, caracterizando o comportamento espacial e temporal da água. Baseado nos dados e informações gerados foi proposto um sistema de alerta de inundações e secas para o Pantanal (SISMONPAN). / The flood variability in space and time determine the ecological process and influences human activities in the Pantanal wetland. The understanding of the flood dynamics is the key for better management practices and reaction in case of extreme events. In this study, methods for water quantification and seasonality extraction were applied to a ten years time series (2000 to 2009) of MODIS13Q1 images for continuous modeling of floods. Based in flood regime and geomorphology an area of 150.502 Km2 distributed in 25 sub-regions was determined for the Pantanal. The flooded area varied from 5.539 km2 to 52.894 km2, averaging 18.329km2, reflecting a dry period compared with the previous decades. Most of the Pantanal (86.841 km2) flooded at least once in the period, but a relative big area keeps no flooded or flooded in a short period. No flooded or short time flooded areas was spread over all the Pantanal, while long time to permanent flooded areas were concentrated in just some spots. Four main stages of floods were determined and the main water fluxes and water storage areas were mapped, although a high inter annual variability has been occurred. Despite the limitations of scale and map matching, a good agreement between flood frequency map with vegetation and soils maps was obtained. Nonlinear Logistic statistical models were determined for the relationships between the main hydrological compartments. It was possible to estimate past flood scenarios based in the relationship between total flooded area and Paraguay River stage. Similarity and water fluxes relationships were determined between the sub-compartments, characterizing the spatial and temporal water behavior. Based on the data and information generated, an alert system for dry and flood events (SISMONPAN) was proposed for the Pantanal.