Bakgrund Vid palliativ vård är ett av de grundläggande målen att identifiera och lindra smärta och andra besvärande symtom. Studier har visat att patient och vårdpersonal skattar patientens symtom olika, vilket visar på vikten av att genom systematisk symtomskattning få kännedom om patientens symtom. Patienter i palliativ vård har ofta komplexa symtom som påverkar varandra sinsemellan, och är samtidigt påverkade av sin sjukdom så att möjligheten att själv skatta symtomen försämras. Ett antal olika symtomskattningsinstrument (SSI) kan användas vid palliativ vård, och symtomskattning är en av de kompetenser som ingår i sjuksköterskans ansvarsområde. Dock visar resultat från Svenska Palliativregistret att de målnivåer för symtomskattning som Socialstyrelsen rekommenderar är långt ifrån att uppfyllas. En förutsättning för att kunna öka frekvensen av symtomskattning och därmed även vårdkvaliteten, är att få en större förståelse för vilka faktorer som bidrar till detta, genom att studera sjuksköterskors perspektiv på att använda SSI vid palliativ vård. Syftet var att beskriva sjuksköterskors perspektiv på att använda SSI vid allmän och specialiserad palliativ vård. Metod för studien var kvalitativa semistrukturerade fokusgruppsintervjuer med sjuksköterskor från hospice, avancerad sjukvård i hemmet (ASIH) och allmän hemsjukvård. Alla tre intervjuerna hade fyra deltagare och varade mellan 55 - 57 minuter. Intervjuerna spelades in och transkriberades. Data analyserades med kvalitativ innehållsanalys. Resultatet består av fyra kategorier: 1. SSI innebär en kvalitetssäkring, 2. Sjuksköterskans arbetssätt med SSI är viktigt för resultatet, 3. Hinder och begränsningar i användningen av SSI, och 4. Organisationens betydelse i arbetet med SSI. Slutsats Resultatet visar att sjuksköterskorna upplevde att användandet av SSI kan innebära en kvalitetssäkring av vården, men är inget heltäckande verktyg som kan användas i alla situationer och kan inte ersätta klinisk erfarenhet. Sjuksköterskans kunskap om SSI är avgörande för utförandet, varför utbildning i SSI för sjuksköterskor inom palliativ vård, men även för övriga professioner i teamet kring patienten, är av stor vikt. Organisationen spelar en viktig roll i att se till att rutiner och etablerade arbetssätt finns. Fortsatt forskning bör därför vidare undersöka vilka kunskaper sjuksköterskor anser sig behöva för att kunna använda SSI på ett effektivt sätt.

A avaliação somativa é a que prevalece nas instituições de ensino superior, os instrumentos de avaliação tradicionalmente utilizados (provas e relatórios) fornecem informações sobre a aprendizagem de conteúdos conceituais e ficam à margem a avaliação dos conteúdos procedimentais e atitudinais. Além disso, provas e relatórios são realizados num momento final das atividades, tardio para um feedback adequado, não havendo tempo para intervir na aprendizagem. Emerge nesse contexto a necessidade de se estudar e refletir sobre os processos avaliativos utilizados na disciplina de Química Analítica Qualitativa (QAQ). Diante disto, tinha-se uma pergunta: haveriam instrumentos adequados e ao mesmo tempo abrangentes que permitissem melhorar o processo avaliativo na disciplina QAQ? Com o objetivo de responder a esta questão foram aplicadas e analisadas duas modalidades de instrumentos de avaliação: pré-exercícios de laboratório (PEL) e grades de observação (GO). Esta pesquisa é de natureza qualitativa, e foi fundamentada em contribuições teóricas de autores que são a favor da avaliação no decorrer do processo de ensino. Sendo assim, teve-se como uma das principais referências Fernandes (2006), que propõe a expressão Avaliação Formativa Alternativa (AFA), alternativa a tradições avaliativas em que o resultado é obtido após o processo de ensino e aprendizagem. Na AFA o professor vai obtendo informações sobre a aprendizagem dos alunos, permitindo assim, o feedback das atividades propostas, interações aluno-professor, e as notas são consideradas pois estas servem como registro. A pesquisa foi desenvolvida no decorrer da disciplina QAQ, com a turma do terceiro semestre do curso de Licenciatura em Química noturno na Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (FFCLRP/USP). Concluiu-se que os instrumentos de avaliação PEL e GO foram eficientes no acompanhamento da aprendizagem dos alunos no decorrer da disciplina. Estes instrumentos proporcionaram a AFA, e complementam a avaliação realizada tradicionalmente na disciplina QAQ, dessa forma reforçam o acompanhamento dos alunos contribuindo para a melhoria na aprendizagem e no processo de avaliação da disciplina. / The summative assessment is prevailing in higher education institutions, the traditional evaluation tools used (tests and reports) provide information on conceptual learning does not include assessments of experimental procedures and attitudinal content. Besides, examinations and reports are performed in a final stage of activities without proper feedback, there is no time to help in the learning. Emerges in this context the need to study and reflect on the assessment processes used in the discipline of Qualitative Analytical Chemistry (QAC). This rises to the following question: are there more specific and more comprehensive instruments, which allow an improvement of the evaluation process in the Qualitative Analytical Chemistry (QAC)? In order to answer this question, we applied and analyzed two types of assessment tools: pre-lab work (PLW) and observation grids (GO). This research qualitative in nature was based on theoretical contributions of the authors that are in favor of the assessment during the teaching process. Fernandes (2006) was as one of the main references, he proposed the term Alternative Formative Assessment (AFA), the alternative assessment traditions in which the result is obtained after the process of teaching and learning. While using AFA, the teacher obtains information about students\' learning, allowing the feedback of the proposed activities, student-teacher interactions and considering the marks, as they serve as a record. The research was developed during the discipline of QAC, with the class of the third semester of the degree chemistry at night in the Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (FFCLRP/USP). It was concluded that the assessment instruments PLW and GO were effective in accompaniment students\' learning during the discipline. These instruments provided the AFA, for the evaluation supplement traditionally held in the discipline QAC, and thus reinforce the monitoring of students contributing to the improvement in learning and evaluation process of the discipline.

Denna licentiatuppsats handlar om hur lärare dokumenterar elevers kunskaper i ämnet idrott och hälsa. Syftet med studien var att undersöka hur lärare arbetar med dokumentation, hur detta arbete upplevs utifrån olika förutsättningar samt om det finns skillnader i lärares erfarenheter av dokumentationsarbetet och vad dessa skillnader i så fall består i. I dagens skola ställs allt högre krav på dokumentation av elevernas kunskaper som underlag för en rättssäker bedömning och betygsättning.  Många lärare upplever att det är ett problem i ämnet idrott och hälsa där det inte finns någon direkt tradition av skriftliga underlag för bedömning. De ökade kraven på dokumentation och att bedriva en traditionellt utformad undervisning i ämnet uppfattas av många lärare som en omöjlig ekvation. Studiens perspektiv är läroplansteoretiskt. Begrepp som transformering och realisering av undervisningsinnehåll, ramfaktorer för undervisningen samt former av pedagogik, har använts för att analysera problematiken kring dokumentation i idrott och hälsa. Studiens resultat visar att en stor andel av lärarna upplever dokumentation av elevers kunskaper som svårt. Det som framstår som lätt att dokumentera blir också lärarnas underlag för bedömning snarare än det som styrdokumenten stipulerar. En grupp lärare upplever dock inte alls samma problem med dokumentation, trots att de står inför samma utmaningar i form av undervisningstid, schema och elevgrupper som andra lärare. Vad som utmärker dessa lärare, de systematiska planerarna, är att deras undervisningspraktik, innefattande planering, undervisning och bedömning, i stora delar skiljer sig från övriga lärares vilket skapar andra möjligheter för dokumentation. / In several Swedish research studies about the school subject physical education and health (PEH), assessment emerges as a difficult task for teachers. Assessment and grading is largely based on observation and teachers’ gut feeling, even though a reliable assessment process requires some form of documentation. The aim of this study is to examine how teachers in the Swedish primary and secondary schools document the students' knowledge and how this work is perceived in relation to influencing factors. The theoretical framework consists of curriculum theory with a focus on frame factors and the transformation and realization of the subject content. In the first part of the data collection 144 PE teachers completed a survey about their perceptions of the documentation process. The second part was conducted as semi-structured interviews with ten PE teachers focusing on the teachers’ work with the documentation of students’ knowledge in PEH. The results show that a large majority of the teachers experience the documentation of students' knowledge as difficult. The main obstacles are frame factors such as time, schedule and class numbers. The teachers, however, have a broad repertoire of documentation methods that they use. The analysis indicates that the teachers' documentation of the students’ performances is guided by what is possible to document rather than what learning objectives the curriculum stipulate. However, exceptions emerged among some of the interviewed teachers whose teaching clearly differed from the other teachers. These “systematic planners” had already decided in the planning stages of teaching what content should be assessed, how it should be made, and what kind of information that should be collected and documented. For "the systematic planners" the frame factors did not constitute a major obstacle. The national PE curriculum has undergone significant changes over the last 20 years and the teachers have problems transforming the curriculum into daily practice. The teaching is characterized by a wide variety of content but with few lessons per activity. The collision between the realization of the subject content, and the increased demands for a legally secure assessment practice, is perceived by many teachers as an impossible equation. Having enough time to observe, assess and document all the students' knowledge of a specific subject content, delivered over two to three lessons, is problematic. However in the perspective of "the systematic planners", with perhaps six to eight lessons in the same subject matter, this does not seem to be a problem. / Forskarskolan idrott och hälsas didaktik / Forskningslinjen Utbildning

<p>The medication errors associated with intravenous (IV) administration may cause severe patient harm. To address this issue, smart infusion pumps now include a built-in dose error reduction system (DERS) to help ensure the safety of IV administration in clinical settings. However, a drug limit alert triggered by DERS may be overridden by the practitioners which can potentially cause patient harm, especially for high-risk medications. Most analytical measures used to estimate the associated risk of harm are frequency-based and only consider the overall drug performance rather than the severity impact from individual alerts. Unlike these other measures, the IV medication harm index attempts to quantify risk of harm for individual alerts. However, it is not known how well these measures describe the risk associated with alert-overridden scenarios. The goal of this research was (1) to quantitatively measure the risk for simulated individual alert-overridden infusions, (2) to compare these assessments against the risk scores obtained among four different analytical methods, and (3) to propose better risk quantification methods with a higher correlation to risk benchmarks than traditional measures, such as the IV Harm index. </p> <p>In this study, 25 domain experts (20 pharmacists and 5 nurses) were recruited to assess the risk (adjusted for risk benchmarks) for representative scenarios created based on hospital alert data. Four analytical methods were applied to quantify risk for the scenarios: the linear mixed models (Method A), the IV harm index (Method B), Huang and Moh’s matrix-based ranking method matrix-based method (Method C), and the analytical hierarchy process method, adjusted by linear mixed models (Method D). Method A used seven alert factors (identified as key risk factors) to build models for risk prediction, and Methods B and C used two out of seven factors to obtain risk scores. Method D used pairwise comparison surveys to calculate the risk priorities. The quantified scores from the four methods were evaluated in comparison to the risk benchmarks.</p> <p>Risk assessment results from the domain experts indicated that overdosing scenarios with continuous and bolus dose field limit types had significantly higher risks than those of bolus dose rate type. About the soft limit type, the expected risk in the group with a large soft maximum limit was significantly higher than the group with a small soft maximum limit. This significant difference could be found in the adult intensive care unit (AICU), but not in adult medical/surgical care unit (AMSU). The comparisons between four analytical methods and risk benchmarks showed that the risk scores from Method A (<i>ρ</i> = 0.94) and Method D (<i>ρ </i>= 0.87) were highly correlated to the risk benchmarks. The risk scores derived from Method B and Method C did not have a positive correlation with the benchmarks.</p> <p>This study demonstrated that the traditional IV harm index should include more risk factors, along with their interaction effects, for increased correlation with risk benchmarks. Furthermore, the linear mixed models and the adjusted AHP method allow for better risk quantification methods where the quantified scores most correlated with the benchmarks. These methods can provide risk-based analytical support to evaluate alert overrides of four high-risk medications, propofol, morphine, insulin, and heparin in the settings of adult intensive care unit (AICU) and adult medical/surgical care unit (AMSU). We believe that healthcare systems can use these analytical methods to efficiently identify the riskiest medication-care unit combinations (e.g. propofol in AICU), and reduce medication error/harm associated with infusions to enhance patient safety.</p> <p> </p>

Bakgrund: Konfusion är ett vanligt förekommande syndrom som ofta drabbar äldre människor inom sjukhusvård. Konfusion förväxlas ofta med andra sjukdomstillstånd eller förbises av sjuksköterskor vilket i sin tur kan leda till onödigt lidande för patienter. Sjuksköterskor förväntas arbeta personcentrerat och till sitt förfogande har sjuksköterskan en mängd bedömningsverktyg för att bedöma patientens status och identifiera konfusion. Syfte: Att undersöka sjuksköterskors erfarenheter av att bedöma samt vårda äldre patienter med konfusion på sjukhusavdelning. Metod: En kvalitativ intervjustudie med sjuksköterskor som arbetar på sjukhusavdelning. Resultat: Sjuksköterskor saknar utbildning om konfusion, kunskapen om syndromet har de fått genom erfarenhet. För att identifiera konfusion använder sig sjuksköterskor av sin kliniska blick samt patientens anamnes, anhöriga och gemensam reflektion inom teamet. Kognitiva bedömningsverktyg används inte. Patienter med konfusion har ett stort behov av trygghet och tid, behoven är svåra att tillfredsställa för sjuksköterskor inom akutsjukvård och under tillfällen av hög arbetsbelastning på avdelningar. Slutsats: Kunskapsbristen som råder om konfusion behöver belysas för att utbildning om syndromet ska prioriteras. Äldre patienter med konfusion bör inte vårdas på akutvårdsavdelningar om deras sjukdomstillstånd inte kräver det. Medvetenheten och kunskapen om kognitiva bedömningsverktyg bör förbättras inom sjukhusvården för att underlätta en tidig identifiering och undvika onödigt lidande för patienter. / Background: Delirium is a common syndrome that often affects older people when admitted into hospital care. Delirium is often misinterpreted as other medical conditions or overlooked by nurses, which in turn can lead to unnecessary suffering for patients. Nurses are expected to work person-centered and the nurse has a variety of assessment tools at her disposal to assess the patient's status and identify delirium. Aim: To investigate nurses' experiences of assessing and caring for patients with delirium in a hospital ward Method: A qualitative interview study with nurses working in hospital wards Results: Nurses lack education on delirium, they have gained knowledge about the syndrome through experience. To identify delirium, nurses use their clinical gaze as well as the patient's anamnesis, relatives and joint reflection within the team. Cognitive assessment ools are not being used. Patients with delirium have a great need for security and time, these needs are difficult to satisfy for nurses in emergency care and in times of high workload in hospital wards. Conclusion: The lack of knowledge about delirium needs to be highlighted in order to prioritize education about the syndrome. Elderly patients with delirium should not be cared for in emergency departments unless their medical condition so requires. Awareness and knowledge of cognitive assessment tools should be improved in hospital care to facilitate early identification and avoid unnecessary suffering for patients.

<p>Dietary supplement (DS) use is highly prevalent in the U.S. and can contribute substantial amounts of micronutrients to the one-half of U.S. adults and nearly one-third of U.S. children who use them. Despite their pervasive use, the best practices for assessing the prevalence of use of and measuring nutrient intakes from supplemental sources remain largely unknown, and currently no metric designed to assess total micronutrient exposures from foods, beverages, and DS exists. Comprehensive and robust methods for assessing the prevalence of use of and nutrient intakes from DS are critical for population-level research and surveillance. </p> <p>Therefore, the overarching aims of the research presented in this dissertation were to 1) identify the most comprehensive method for assessing the prevalence of use of and estimating nutrient intakes from DS, 2) characterize DS use and examine trends in overall and micronutrient-containing DS use among the U.S. population using multiple modes of DS assessment, 3) develop the first micronutrient-based diet quality index designed to capture usual intakes from all sources of under-consumed micronutrients among the U.S. population (i.e., the Total Nutrient Index (TNI)) and 4) to determine if the TNI is a useful measure for assessing total micronutrient exposures among the U.S. adult population.</p> <p>National Health and Nutrition Examination Survey (NHANES) 2011-2014 data among U.S. adults were employed to evaluate four combinations of methods constructed from two data collection instruments (i.e., the 24-hour dietary recall (24HR) and the NHANES in-home inventory with a frequency-based DS prescription medicine questionnaire (DSMQ)) for measuring the prevalence of use of and amounts of selected nutrients from DS. The results from the analysis indicated that a higher prevalence of DS use is reported when using frequency-based methods, like the DSMQ, but higher nutrient amounts are reported on the 24HR. Thus, combining the DSMQ with at least one 24HR (i.e., DSMQ or ≥1 24HR) provides the most comprehensive approach for measuring DS use and estimating nutrient intakes from supplemental sources among U.S. adults.</p> <p>Differences in the estimated prevalence of use of DS on the DSMQ or ≥1 24HR as compared with the DSMQ only were also noted among a nationally representative sample of the U.S. population from the 2007-2018 NHANES. When characterizing DS use and examining trends in overall and micronutrient-containing DS use among the U.S. population using multiple modes of DS assessment, increases in both overall and micronutrient-containing DS use were observed over time, but the prevalence of use was lower on the DSMQ than the DSMQ or ≥1 24HR among the total population and across all population subgroups. Therefore, the findings from this study were congruent with our previous analysis and contributed to a growing body of literature that utilizes multiple methods of DS assessment to improve the comprehensiveness of DS exposure assessment. </p> <p>The insights garnered from identifying the most comprehensive method for approximating micronutrient intakes from supplemental sources were implemented in the development and initial application of the first micronutrient-based diet quality index designed to capture usual intakes from all sources of under-consumed micronutrients among the U.S. population, named the TNI. The TNI assesses U.S. adults’ total nutrient intakes relative to the Recommended Dietary Allowance or Adequate Intake for eight under-consumed micronutrients identified by the Dietary Guidelines for Americans: calcium, magnesium, potassium, choline, and vitamins A, C, D, E. In the initial application of the TNI, based on dietary data from the 2011-2014 NHANES, the mean TNI score of U.S. adults was 75.4 out of 100, whereas the mean score when ignoring contributions from DS was only 69.0 (t-test; p<0.001). Therefore, the results from this analysis suggested that the TNI extends existing measures of diet quality by including nutrient intakes from all sources.</p> <p>However, another analysis designed to examine the construct and criterion validity of the TNI was completed using data from a nationally representative sample of U.S. adults who participated in the 2011-2014 NHANES, as well as exemplary menus reflective of high-quality diets. The results showed that the TNI yielded high scores on exemplary menus (84.8-93.3 out of 100), was moderately correlated with the Healthy Eating Index-2015 (r=0.48) and was able to differentiate between groups with known differences in nutrient intake for DS users vs. non-DS users, non-smokers vs. smokers, and those who were food-secure vs. food insecure (all <em>p</em><0.001). Moreover, correlations of TNI component scores with nutritional biomarkers for vitamins A, C, D, and E were significantly higher when compared with those obtained via the diet alone.</p> <p>Taken together, the research findings from the studies presented in this dissertation contribute evidence supporting the use of multiple modes of DS assessment to improve the comprehensiveness of DS exposure assessment, as well as the importance of capturing micronutrient exposures from all sources. These results also highlight the broad applicability of the TNI framework as a tool for comprehensively representing the totality of nutrient exposures, inclusive of DS. Our outcomes point towards a need for additional investigation into the random and systematic error that pervades DS assessment, the development of tools that can be used to describe micronutrient exposures more completely and how those relate to nutritional status, as well as further applications of the TNI. </p>

This research paper looks at teachers’ views, and use, of formative assessment in the subject of English 6. It also highlights students understanding and processing of feedback and their opinions of eight assessment tools. The study was carried out using mixed methods research with individual teacher interviews, a student focus group interview, and a questionnaire. My finding shows the difficulties with identifying formative assessment and working with this in a way that helps students in their development of English 6, and the need for tools to make feedback and guidance clearer for students. Furthermore, this study identifies the need for guidance from the Swedish national agency of education regarding how teachers should incorporate formative assessment in their classroom.

The building sector is one of the largest energy consumers and there are global efforts toward sustainable and energy-efficient new buildings and existing buildings retrofit. The application of Building Information Modelling (BIM) in environmental assessment was practiced and studied following the increasing number of projects adopting the BIM workflows and pursuing green building certifications. The interest of this thesis is to study the use of different Building Information Modelling tools used globally for energy and environmental assessment to examine their practical benefits and challenges. Case studies of two primary school buildings that achieved the Swedish Miljöbyggnad system were used to compare what could have been achieved with Leadership in Energy and Environmental Design (LEED) categories of energy and atmosphere and indoor environmental quality to what has been achieved in similar Miljöbyggnad areas. A review and summary of energy and atmosphere and indoor environmental categories in the LEED version 4 user’s guide is presented to evaluate the case study potential score in them. The early adoption of modeling in the evaluation from the conceptual design is the best approach to achieve better performance. It will improve the way of working and result in a more efficient and sustainable building. The Building Information Modelling software can be used directly in assessment using the integrated modules within the popular authoring tools such as Revit’s lighting and Insight the cloud base service or by transferring the model data to a stand-alone tool like IDA-ICE. The energy plug-ins of the authoring tools such as Revit are still lacking full control over the analytical model and the limited input options. The identified and discussed advantages of Building Information Modelling implementation are collaboration, accuracy, time, and cost saving. Data exchange issues, knowledge, and the differences in assessment tools were discussed as implementation barriers. Although the full comparison of certification systems is difficult, the comparison between the potential LEED score and achieved Miljöbyggnad rating showed some differences and similarities in the rating systems. The comparison requires rearranging the rating system indicators into unified categories. The framework that compares the scope, structure, content, and aggregation, would give a meaningful comparison. The way that the LEED and Miljöbyggnad are rewarding the indicators and the aggregation of aspects towards the final rating is totally different.

Hand-intensive work significantly correlates with the increased risks of developing Distal upper-extremity (DUE) Work-related musculoskeletal disorders (WMSDs), such as carpal tunnel syndrome and tendinitis. Many studies have investigated the physical risk factors and their contribution to the occurrence of the DUE WMSDs. These factors include but are not limited to hand force, level of hand movement repetition, and non-neutral hand-wrist postures. Several observational-based risk assessment methods have emerged from these studies to control these risk factors and reduce the DUE WMSDs' development. In this regard, The RAMP Tool's Hand Model (RAMP's HM) has been developed recently by the Ergonomics Division at KTH Royal Institute of Technology as a new model within the RAMP Tool .The aim with RAMP's HM is to fulfill the need for an observational-based, preventive, research-oriented, and systematic method of risk management targeting the elevated risks of DUE occupational injuries associated with hand-intensive tasks. Moreover, the RAMP's HM seeks to investigate and combine a more significant number of ergonomic risk factors than those covered by existing DUE observational-based risk assessment methods. This master's thesis project evaluated the latest prototype of RAMP's HM for reliability, usability, and face validity. A group of ten ergonomists and ergonomics coordinators, all working at Scania AB, had volunteered to participate in this evaluation study. They assessed eight video records of hand-intensive work tasks across various industries using RAMP's HM. The raters assessed the model's inter-rater and intra-rater reliability by evaluating eight video records of hand-intensive work tasks in two assessment sessions, which were separated by a 21-day gap. The ergonomists also used the 2018 ACGIH® Hand Activity Level (HAL)– Threshold Limit Value (HAL Tool) to assess the same video-recorded tasks in the two sessions to evaluate the reliability of RAMP's HM in comparison (the inter-method reliability). Seven of the ten ergonomists volunteered to complete a quantitative questionnaire using a 5-Likert scale to assess the usability and face validity of the new RAMP model. The evaluation showed that the RAMP Tool's Hand Model has fair inter-rater and moderate intra-rater reliability. The reliability test also showed a similar level of reliability for the two methods, with no significant differences between the reliability results of RAMP's HM and HAL. The reliability results of the RAMP's HM may have been adversely influenced by statistical factors, and factors related to the observation process, raters' experience and background, and pre-test training. The categories of the resulting ratings for overall risk levels on the task level using RAMP's HM and the HAL Tool agreed in over 75% of ratings. According to the ergonomists, RAMP's HM is usable; it supports the systematic risk management approach, and their answers indicated that it has been designed in a user-centered way. Furthermore, the evaluation results indicated a strong face validity for RAMP's HM. Raters perceived the new model as a practical tool for systematically managing DUE WMSDs and the corresponding risk factors across various work environments and industries. Based on the results of this study, it is recommended that comprehensive education and practical training on RAMP's HM are provided before conducting further evaluations, i.e., on the complete RAMP 2.0 version. Furthermore, it is recommended to include more participants and tasks in such evaluations. Additionally, it may be valuable to consider using other reliability parameters besides the weighted Cohen's kappa.

Nature provides various services to society that humans are completely dependent on for their survival. These services are called ecosystem services, and can be, for example, clean air, clean water and pollination of crops. To live close to nature and green areas is also important for our well being. Although we are often aware of the values that nature creates and its importance, green areas are often replaced with buildings and roads as the big cities grow and densify. The ongoing densification of cities, combined with the projected climate changes will result in that the capacity of storm water pipes is likely to be insufficient during major rainstorms which can create big problems with, for example, flooding. The increasing challenges of storm water management resulted in that open storm water solutions began to be used as supplement to the storm water pipes. Open water solutions are designed to take care of water in a way that mimics nature's way of taking care of rainfall. These open water systems are a form of urban ecosystems and, in addition to dampen the water flows, can provide a range of other ecosystem services. The aim of this thesis was to create a method for integrating and valuing ecosystem services in the design of open storm water management and thus make the values from ecosystem services visible. The thesis was limited to investigating seven different open storm water solutions: green roofs, infiltration of lawns, temporary damming on specially constructed flood areas, percolation trenches, natural streams, ponds and wetlands. In addition to the ability to manage and control large water flows, 11 ecosystem services were identified that can be obtained from the open storm water solutions: drinking water, non-potable water, natural water purification, carbon sequestration and storage, local climate control and air purification, noise reduction, pollination, habitat and biodiversity, activity based cultural values, aesthetic values and resource for research and education. The values of the ecosystem services were determined in a semi-quantitative survey in which 16 people responded to questions examining to what extent they consider that ecosystem services can be obtained in the various storm water solutions. The values of the ecosystem services also depend largely on the site's potential and how the solutions are designed. Factors that can affect the value of the ecosystem services with respect to these aspects were investigated in a literature study and in the questionnaire study. The results of the literature study and questionnaire study formed the basis for the non-site adapted assessment tool that was developed as the last step in the thesis. The tool was designed in Excel and consists of three steps. Step 1 aims to weight the ecosystem services by the sites’ potential, step 2 involves the actual valuation and possible adaption to alternative design, and in step 3 a factor is calculated as a measure of the values obtained from ecosystem services created from open storm water solutions in relation to the total area. The aim is that the assessment tool should be used as a complement to an investigation about which storm water treatment solution that is most suitable in a project. / Naturområden och grönytor levererar olika tjänster som människan är helt beroende av för sin överlevnad. Dessa tjänster kallas ekosystemtjänster och är exempelvis ren luft, rent vatten och pollinering av grödor. Närhet till naturen och grönområden har också stor betydelse för människans välbefinnande, till exempel genom att ha en stressdämpande effekt. Trots att vi är medvetna om värdena som naturen skapar, byggs grönytor i städer bort i takt med att de växer och förtätas. Täta städer innebär stora arealer hårdgjorda ytor vilket också resulterar i större volymer dagvatten då nederbörden inte kan infiltrera ner i marker och istället rinner av på ytan. Ledningarnas kapacitet riskerar att överskridas vid stora skyfall vilket kan orsaka stora problem med översvämningar. Problemet kommer dessutom förvärras i framtiden med de väntade klimatförändringarna. Ökande utmaningar med dagvattenhanteringen har resulterat i att öppna dagvattenlösningar började användas som komplement till ledningar under mark. Öppna dagvattenlösningar innebär att vattnet tas omhand på ett sätt som efterliknar naturens sätt att ta hand om nederbörd, och är en form av urbana ekosystem som, utöver att dämpa vattenflöden, kan tillhandahålla en rad andra ekosystemtjänster. Syftet med detta examensarbete var att skapa en metod för att integrera och värdera ekosystemtjänster i utformningen av öppen dagvattenhantering och därmed synliggöra ekosystemtjänsternas värden. Examensarbetet avgränsades till att utreda sju olika öppna dagvattenlösningar: gröna tak, infiltration på gräsytor, tillfällig uppdämning på översvämningsytor, svackdiken, naturliga diken och bäckar, dammar samt våtmarker. 12 ekosystemtjänster identifierades kunna erhållas från de öppna dagvattenlösningarna. Dessa var dricksvattenresurs, icke drickbart vatten, vattenrening, kolbindning och lagring, klimatreglering och luftrening, bullerreducering, flödesreglering, pollinering, livsmiljöer och biologisk mångfald, aktivitetsbaserade kulturella värden, estetiska värden samt resurs för forskning och utbildning. Ekosystemtjänsternas värden hos de olika dagvattenlösningarna bestämdes i en semikvantitativ enkätstudie där 16 personer fick värdera dagvattenlösningarnas kapacitet att bidra till de olika ekosystemtjänsterna. Värdena beror också till stor del på platsens förutsättningar och hur de utformas. Vilka faktorer som kan påverka värdet av ekosystemtjänsterna med avseende på dessa aspekter utreddes i en kvalitativ litteraturstudie. Resultatet från litteraturstudien samt enkätstudien utgjorde grunden för det icke platsanpassade värderingsverktyget som togs fram som det sista steget i examensarbetet. Verktyget utformades i Excel och består av tre steg där steg 1 syftar till att vikta ekosystemtjänsternas värden efter platsens förutsättningar, i steg 2 sker själva värderingen samt en eventuell anpassning till alternativ utformning och i steg 3 beräknas en faktor fram som är ett mått på ekosystemtjänsternas värden som fås från öppna dagvattenlösningar i förhållande till den totala arean. Syftet är att värderingsverktyget ska användas som ett komplement till en utredning om vilken dagvattenhantering som är lämpligast i ett projekt.