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Bakgrund: Smärtintensitet är en viktig del i smärtbedömningen som utförs av hälso- och sjukvårdspersonal. Om smärtintensitet inte bedöms på ett bra sätt riskerar det att leda till en otillräcklig smärtbehandling. Ett av de mest validerade instrumenten för att ta reda på patientens självskattade smärtintensitet är Numeric Rating Scale (NRS). Dagens forskning visar att det finns brister i arbetet med smärtskattningsskalor och behandlingen av smärta inom vården. Syfte: Att beskriva betydelsen av ett värde på Numeric Rating Scale och hur en förändring av värdet ska tolkas, ur ett patientperspektiv. Metod: En litteraturstudie baserad på 8 studier med kvantitativ ansats. Resultat: Resultatet presenterades under tre huvudkategorier och två underkategorier, dessa tre huvudkategorierna var: Vad det numeriska värdet har för innebörd i patientens NRS-skattning, Vad en förändring i patientens NRS skattning innebär samt vad NRS-värdet säger om patientens önskan av smärtlindring. Konklusion: Ett värde på NRS ger inte hela bilden av hur en patient upplever sin smärta. Ett värde på NRS kan vara en god indikator på smärtnärvaro hos patienten. När ett värde på NRS förändras säger det mest om patientens upplevelse när förändringen tolkas procentuellt. Det kan vara problematiskt för sjuksköterskan att bedöma en patients behov av åtgärd på endast ett NRS värde då dess betydelse kan variera stort mellan patienter. Utifrån detta bör hälso-och sjukvårdspersonal alltid föra en dialog om vad ett värde och en förändring på NRS betyder för patienten.

Wavelike spiral asymmetries are an intriguing aspect of Tropical Cyclone dynamics. Previous work hypothesized that some of them are Vortex Rossby Waves propagating on the radial gradient of mean–flow relative vorticity. In the Intermittently Forced Vortex Rossby Wave theory, intermittent convection near the eyewall wind maximum excites them so that they propagate wave energy outward and converge angular momentum inward. The waves’ energy is absorbed as the perturbation vorticity becomes filamented near the outer critical radii where their Doppler–shifted frequencies and radial group velocities approaches zero. This process may initiate outer wind maxima by weakening the mean–flow just inward from the critical radius. The waves are confined to a relatively narrow annular waveguide because of their slow tangential phase velocity and the narrow interval between the Rossby wave cut–off frequency, where the radial wavenumber is locally zero, and the zero frequency, where it is locally infinite.

Akute Nierenschädigung (acute kidney injury, AKI) ist ein häufiger Grund für die Aufnahme auf eine Intensivstation und hat eine hohe Morbidität und Mortalität, insbesondere bei Patienten mit Indikation zur Nierenersatztherapie. In etwa 7-10% wird eine Rhabdomyolyse als mögliche Ursache angegeben. Die rasche Entfernung vom Myoglobin, als direkt renal schädigendes Molekül, erscheint sinnvoll. Allerdings gibt es bisher wenige Daten zur Wirksamkeit einer Nierenersatztherapie bei akuter Nierenschädigung im Rahmen einer Rhabdomyolyse. In dieser prospektiven, randomisierten, einfach verblindeten, monozentrischen Studie wurde erstmalig die Myoglobinclearance bei einer CVVHDF mit „Standard“ high-flux Filter im Postdilutionsmodus (Kontrollarm) mit einer CVVHD mit high-cutoff Filter (Interventionsarm) verglichen. In beiden Gruppen erfolgte die Antikoagulation des extrakorporalen Kreislaufs mit Citrat. Das Ziel der Studie bestand darin, die „Nicht-Unterlegenheit“ des CVVHD-HCO Arms gegenüber des CVVHDF Arms zu zeigen („Non-inferiority design“). Im Rahmen dieser Studie wurden 70 Intensivpatienten mit der Indikation zur kontinuierlichen Nierenersatztherapie eingeschlossen und zu gleichen Teilen in beide Therapiearme randomisiert. Die Patientencharakteristika beider Studienarme unterschieden sich nicht. Die Myoglobin-Clearance war im Interventionsarm durchschnittlich 5.5ml/min (4-7ml/min (95%-Konfidenzintervall), p< 0.0005) höher und damit dem Kontrollarm nicht unterlegen bzw. sogar signifikant überlegen. Ebenso war die Clearance von β2-Mikroglobulin im Interventionsarm signifikant höher. Die Kreatinin- und Harnstoffclearance in den beiden Studienarmen war nach Adjustierung anhand des Dialysegesamtumsatzes gleich. Die Clearance von Interleukin-6 und Albumin während des gesamten Beobachtungszeitraums unterschied sich nicht. Im Vergleich der einzelnen Zeitpunkte war allerdings die Il-6 Clearance nach 1, 6 und 24 Stunden signifikant höher im Interventionsarm. In beiden Studienarmen kam es zu keinem relevanten Albumin-verlust. Die Dialysefilterstandzeit war im Interventionsarm länger, so betrug diese im Kontrollarm: 57.0 [38.0, 72.0] Stunden und im Interventionsarm 70.0 [56.75, 72.0] Stunden (p = 0.029). Frühere Studien zu HCO-Filtern untersuchten häufig β2-Mikroglobulin als Markermolekül für mittleres Molekulargewicht. Die klinische Bedeutung erhöhter β2-Mikroglobulin Spiegel bei akuter Nierenschädigung ist allerdings unklar. Im Gegensatz dazu sind hohe Myoglobin Plasmaspiegel mit akuter Nierenschädigung und einer erhöhten Mortalität assoziiert. Eine rasche und effektive Entfernung dieses nephrotoxischen Moleküls erscheint sinnvoll und ist relevant. Aus diesem Grund wurde in dieser Studie die Myoglobin Clearance bewusst als primärer Endpunkt ausgewählt. Eine gesunde Niere kann deutlich mehr Myoglobin ausscheiden als ein extrakorporales System, weshalb immer der Versuch unternommen werden sollte, die Diurese mit ausreichender Flüssigkeitsgabe zu erhalten. Sollte dennoch eine Nierenersatztherapie notwendig werden, ist aktuell unklar, welches extrakorporale System dafür am besten geeignet ist und ob dies die Erholung der Nierenfunktion oder die Mortalität beeinflussen könnte. Eine bessere Il-6 Clearance im Interventionsarm konnte nur zu Beginn der Dialysebehandlung gezeigt werden. Die Beobachtung einer schlechter werdenden Clearance während zunehmender Behandlungsdauer ist vereinbar mit Ergebnissen anderen Studien. Als Ursache diskutiert werden Proteinablagerungen und Polarisierung am Dialysefilter. Die längere Dialysestandzeit im CVVHD-HCO Arm könnte mit der der Hämokonzentration am Dialysefilter im CVVHDF Arm zusammenhängen. Dieser Effekt wird durch den Postdilutionsmodus verstärkt. Durch das konzentrierte Blut steigt das Risiko der Gerinnselbildung und einer vorzeitigen Verstopfung der Dialysekapillaren. Eine weitere mögliche Erklärung der kürzeren Dialysestandzeit ist die komplexere technische Betreuung einer CVVHDF mit RCA, da unterschiedliche Dialysat- und Substituatlösungen verwendet werden müssen. Die Ergebnisse dieser Studie zeigen, dass durch den Einsatz einer CVVHD mit high cutoff Filter Myoglobin sicher aus der Zirkulation bei Patienten mit akuter Nierenschädigung entfernt werden kann. Die Myoglobin Clearance ist dabei sogar höher als beim Einsatz einer CVVHDF mit high-flux Filter. Besonders blutungsgefährdete oder blutende Patienten mit Rhabdomyolyse und akutem Nierenversagen können vom Einsatz einer CVVHD-HCO unter Nutzung einer regionalen Citratantikoagulation profitieren. Die signifikant längere Dialysefilterstandzeit stellt einen weiteren großen Vorteil des Einsatzes einer CVVHD-HCO dar. Die generierten Ergebnisse der vorliegenden Arbeit liefern die Basis für die Planung weiterer klinischer Studien. Perspektivisch könnte untersucht werden, ob der Einsatz einer CVVHD-HCO die Prognose bei Patienten mit schwerer akuten Nierenschädigung und Rhabdomyolyse verbessern könnte und zu welchem Zeitpunkt die Nierenersatztherapie begonnen werden sollte.:1. EINFÜHRUNG 4 1.1. Akute Nierenschädigung beim kritisch kranken Patienten 4 1.2. Nierenersatztherapie bei akuter Nierenschädigung 5 1.3. Clearance von Molekülen mit mittlerem Molekulargewicht bei verschieden Nierenersatzverfahren 7 1.4. Renale Schädigung durch Myoglobin 10 1.5. Fragestellung und Studiendesign 12 2. PUBLIKATION 15 3. ZUSAMMENFASSUNG DER ARBEIT 16 4. LITERATURVERZEICHNIS 19 5. ANHANG 27 5.1. Supplemental Table 1: Dialysis protocol 27 5.2. Supplemental Table 2: Substance specific clearances (ml/min) after 1h and adjustment for TTR 28 5.3. Supplemental Table 3: Substance specific clearances (ml/min) at different time points 29 III. Nachweis über Anteile der Co-Autoren 30 IV. Erklärung über die eigenständige Verfassung der Arbeit 32

This thesis is oriented to technological and design direction. It is focused on the upgrading of existing machinery from a structural perspective. There is studied the impact of design modifications to the existing production process from a technological point of view. This thesis is specifically concentrated on the technology division of the material, especially on the technology cutting-off in dry condition. There is examined the ability of self-sharpening cutting tools and the quality of the final product under varying input conditions. The job is finished by the carried out techno-economic evaluation, where are compared the costs of the structural adjustments in comparison with mechanical equipment, that could be purchased on the market. The thesis is finished with overall analysis of the optimal efficiency of the production process.

<p>A novel two-loop estimation and control strategy is proposed to reduce the natural gas (NG) spark-ignition (SI) engine tail pipe emissions, with focus on the outer loop development. In the outer loop, an fractional oxidation state (FOS) estimator consisting of a three-way catalyst (TWC) model and an extended Kalman-filter is used to estimate the real-time TWC's FOS, and a robust controller is used to control the first-half TWC's FOS by manipulating the desired engine lambda (i.e., air–fuel equivalence ratio; lambda=1 at stoichiometry). The outer loop estimator and controller are combined with an industry-production baseline inner loop controller, which controls the engine $\lambda$ based on the desired lambda value. This novel two-loop control strategy reduces more CH4 and NOx emissions over no-outer-loop control strategy and the conventional two-loop control strategies through simulation. </p> <p><br></p> <p>Engine with and without fuel cut-off are both investigated. Although fuel cut-off brings better fuel economy, it also over-oxidizes the TWC during fuel cut events, which makes the FOS-based controller's competence in NOx reduction over non-FOS-based controllers less significant. By comparing simulation results with and without fuel cut-off, it shows huge potential for much better emission result if fuel cut-off's side effect can be alleviated. Considering that fuel cut-off generally being cutting engine fueling during zero load periods and introducing unreacted oxygen into the after-treatment system, the best way of dealing with the issue is to cut off or reduce the oxygen input to the TWC during those events. Several advanced engine technologies such as cylinder deactivation and exhaust gas re-circulation are good candidates to approach this issue. </p> <p><br></p> <p>An industry-production Cummins B6.7N natural gas SI engine was installed in the Ray W. Herrick Laboratories for study of variable valve actuation (VVA) technology, for the purpose of evaluating/improving SI engine's fuel efficiency, emission reduction, and engine knock resistance. A one-dimensional, physics-based natural gas SI engine model was investigated and calibrated in GT-Power software. To calculate the burn rates in the cylinder, three different pressure analysis methods were investigated and implemented. It is observed that all six cylinders' pressure curves are different, which in turn render different burn rates cylinder-to-cylinder. Cylinder with a higher peak cylinder pressure has a faster burn rate. Each operating condition has its unique pressure curve, and their burn rates are different under different operating conditions. Considering that the burn rate profile can vary cylinder-to-cylinder and operation-to-operation, to make the GT combustion model work for a larger range of loads, a fixed burn rate model may help in the preliminary research phase, but a predictive combustion model is more preferable.</p> <p><br></p> <p>The GT-Power model's VVA capability is investigated, where intake valve closure (IVC) modulation and cylinder de-activation (CDA) are built and analyzed. To mitigate TWC's over-oxidation issue during engine's fuel cut-off events, the CDA is implemented and simulated to demonstrate its benefit on further emission and fuel consumption reductions.</p>

Three studies were conducted to better understand the current status of the industry and create a design process and taxonomy. Study 1 assessed current industry usage of dust control technologies and stakeholder perceptions in the concrete and masonry trades. Study 2 was similar but assessed emission control technologies in the asphalt roofing trade. Study 3 used the information from studies 1 and 2 to select a tool for further evaluation. The handheld cutoff concrete saw was chosen. An iterative design process was utilized to evaluate the saw. The design process and subsequent usability inspection engendered a taxonomy, or set of design recommendations can be applied to large handheld powered tools. / Ph. D.

Akut- och psykiatriska avdelningar på länssjukhuset Ryhov i Jönköping använder sig av snabbtest för drogscreening med varierande kvalitet under de tider då analysinstrumentet Konelab Prime 30i inte är bemannat. Syftet med studien var att utvärdera sensitivitet och specificitet hos Multitest 15 från tillverkaren Acro Biotech, och jämföra resultat från två olika avläsningstider. Antalet urinprover som samlades in för analys uppgick till 272. Positiva och negativa urinprover med drogkoncentrationer inom ±50% från varje drogs gränsvärde insamlades. Senare inkluderades drogkoncentrationer utanför detta intervall. Proverna testades med Multitest 15 vid laboratoriet för klinisk kemi på Ryhov efter utförd analys med Konelab Prime 30i, vars analysresultat utgjorde referens. De droger som testades var amfetamin, metamfetamin, ecstasy, bensodiazepiner, buprenorfin, kokain, metadon, morfin, THC, oxykodon och tramadol. För alla droger sammantaget var sensitiviteten 86,7% - 100%, specificiteten 33,3% - 100% och träffsäkerheten 71,4% - 94,7%. Provurvalet inom intervallet ±50% från gränsvärdet var begränsat, vilket avsevärt påverkat dessa beräkningar, och Konelab Prime 30i använder semikvantitativ metod vilken endast ger approximativa koncentrationsvärden som referens. / The emergency and psychiatric wards on the county hospital Ryhov in Jönköping utilize onsite drug testing with varying quality during evenings and night-time when no staff are operating the chemistry analyzer Konelab Prime 30i. The aim of the study is to evaluate the performance of sensitivity and specificity of Acro Biotech Multitest 15 and comparing results from two different reading-times. The number of urine samples collected for analysis was 272. Positive and negative urine samples with drug concentrations within ± 50% from cut-off were collected. Later, concentrations outside of this range was included. The samples were tested with Multitest 15 at the laboratory for clinical chemistry at Ryhov after analysis with Konelab Prime 30i providing reference results. The drugs tested were amphetamine, methamphetamine, ecstasy, benzodiazepines, buprenorphine, cocaine, methadone, morphine, THC, oxycodone and tramadol. All drugs included, the sensitivity was 86.7% - 100%, the specificity 33% - 100% and the accuracy 71.4% - 94.7%. The sample selection within the range ±50% from the cut-off value was limited, which significantly affected these calculations, and Konelab Prime 30i uses a semi-quantitative method only providing approximate concentration values for reference.

Estimativas sobre alterações climáticas globais têm aumentando a demanda por estudos sobre propriedades dos solos relativamente secos e limitações impostas à absorção de água pelas plantas em condições de escassez hídrica. Neste estudo, fatores que influenciam a retenção da água no solo e o murchamento de plantas foram avaliados com base no conceito de equilíbrio da água no solo. Objetivou-se com este estudo: (i) avaliar a confiabilidade de medições do conteúdo de água no solo sob altas sucções matriciais em câmaras de pressão, usando como referência a técnica de ponto de orvalho (ii) avaliar as interações entre espécies de plantas e solos com diferentes classes texturais no ponto de murcha permanente (iii) investigar as relações entre equilíbrio hidráulico da água no solo e murchamento de plantas a partir do conceito de corte hidráulico. Para tanto, um experimento para avaliar a influência dos tipos de solos e espécies de plantas, no ponto de murcha permanente foi conduzido em casa de vegetação da Escola Superior de Agricultura \"Luiz de Queiroz\" da Universidade de São Paulo, Piracicaba, São Paulo. Avaliou-se o murchamento de plantas de girassol (Helianthus annuus L.), milho (Zea mays L.) e soja (Glycine max L.). Os solos utilizados no estudo foram coletados na camada superficial (0-10 cm) em quatro áreas, selecionadas com o objetivo de obter classes texturais contrastantes, localizadas no município de Piracicaba, São Paulo, Brasil. Sub-amostras foram utilizadas para determinação da distribuição do tamanho de partículas e atributos químicos. Amostras indeformadas foram coletadas para a determinação da curva de retenção da água no solo pela técnica de câmaras de pressão. Adicionalmente, amostras deformadas foram utilizadas para determinação das características de retenção da água no solo pela técnica do ponto de orvalho em altos valores de sucções matriciais. Os dados de retenção de água no solo foram ajustados a modelos empíricos para estimativas da sucção matricial e conteúdo de água relacionada à água em equilíbrio hidráulico (água residual). Foram observadas similaridades nas determinações das características de retenção da água no solo entre as técnicas de câmaras de pressão e ponto de orvalho, sugerindo a boa drenagem das amostras de solo em câmaras de pressão. Interações significativas foram observadas entre os tipos de solos e espécies de plantas no ponto de murcha permanente, indicando que o movimento de água no contínuo solo-planta-atmosfera foi dependente de resistências relacionadas tanto ao solo quanto às plantas. Ou seja, tanto à capacidade do solo em transportar água até raízes, quanto à habilidade das plantas em absorver a água transportada, assim como, aos processos de regulação de água que ocorrem nas plantas. A abordagem baseada no conteúdo de água residual para o intervalo de sucções matriciais de 0 a 15.000 hPa não foi adequada para ilustrar a condição de equilíbrio hidráulico da água no solo, definidos pelo corte hidráulico, e relações com as sucções matriciais em ocorre o murchamento de plantas. / Estimates about climate changes have increased the demand for studies of the properties of relatively dry soil and limitations on the plants water uptake in conditions of water scarcity. In this study, factors influencing the soil water retention and wilting plants were evaluated based on the concept of soil water equilibrium. The objectives of this study were: (i) to evaluate the reliability measurements of the soil water retention on pressure plate apparatus at high matric suctions using as reference the dew point meter (ii) to evaluate the interactions between soil types and plant species at permanent wilting point (iii) investigate the relationship between the hydraulic equilibrium of soil water and the plant wilting based on the hydraulic cut-off concept. A pot experiment to evaluate the effect of plant and soil types at permanent wilting point was carried out in a greenhouse at the Agricultural\'s College \"Luiz de Queiroz\" from University of São Paulo in Piracicaba, São Paulo, Brazil. Soil samples were collected at the topsoil (0-10 cm) from four different locations around the city of Piracicaba, São Paulo, Brazil. Subsamples were taken to determine the particle size distribution and chemical analysis. To determine soil water retention curve 30 soil samples were collected with undisturbed soil cores. The soils were selected to have a range of texture and organic carbon content. The wilting was evaluated using plants of sunflower (Helianthus annuus L.), maize (Zea mays L.) and soybean (Glycine max L.). The soil water retention data were fitted to the empirical models for estimating the matric suction and water content related soil water at hydraulic equilibrium (residual water content). Similar soil water content were observed for measurements at pressure plate apparatus and dew point meter, suggesting good drainage of the soil samples in pressure plate apparatus for the dry range of soil water retention curve. Significant interactions were observed between soil types and plant species at permanent wilting point, indicating that the water movement in the soil-plant-atmosphere continuum was dependent of resistances related to soil and the plants properties. The approach based on the residual water content for the matric suctions from 0 to 15,000 hPa was not adequate to illustrate the hydraulic equilibrium of the soil water defined by the cut-hydraulic and relations with the matric suction at wilting plants.