Bakgrund: Depression drabbar 25 procent av kvinnorna i Sverige. Det kan behandlas på olika vis. Elektrokonvulsiv terapi är en behandlingsform som används när symtomen är svåra. Sjuksköterskans roll är att se patientens behov och utifrån dem ge god omvårdnad där patienten kan känna sig förstådd.  Syfte: Syftet var att belysa hur kvinnor med depressiva symtom upplevt behandling med elektrokonvulsiv terapi. Metod: En kvalitativ litteraturstudie baserad på sex bloggar gjordes. Materialet har analyserats med en kvalitativ innehållsanalys som utmynnade i tre kategorier och nio underkategorier. Resultat: Elektrokonvulsiv terapi beskrivs som en väg ut ur depressionen, det fanns ett hopp om att behandlingen skulle hjälpa. Olika farhågor infann sig inför behandlingen, liksom olika reaktioner efteråt där minnespåverkan var framträdande. Effekten av ECT kunde både ses vara positiv och utebliven. Resultatet bildade kategorierna ’Vilja må bättre’, ’Slitas mellan upplevelse av befrielse och obehag’ och ’Att påverkas av behandlingen’. Slutsats: Studien visar att behandlingen framkallar olika sorters känslor och upplevelser. Ett förbättrat omhändertagande kan utföras och lidande minskas när sjuksköterskor tar del av patientens upplevelser.

In the theoretical part of our study, we provide a systematic review of contemporary methods (pharmacological and non-pharmacological) of ECT augmentation, as scored by three factors - manipulation of the seizure threshold, length of therapeutic seizures and the effect on ECT efficacy measured by the total number of ECT sessions and the rate/quantity of change on used objective/subjective scales. We also provide a summary of possible side effects and risks associated with the use of respective ECT augmentation methods. In the research part of our study, we explore the effect of high frequency transcranial magnetic stimulation on the respective ECT parameters, in a double blinded, placebo controlled, randomised study on a sample of 46 patients treated for a major depressive episode. During ECT titration, we registered a significantly lower seizure threshold in the experimental group, an average decrease in charge by 34.55%, from 34.23mC to 22.4mC, p< 0.001 (Wilcox test). We have not observed a significant effect of HF rTMS on the length of seizure or ECT efficacy. Our study confirms the hypothesis, that the application of HF rTMS briefly before an ECT session reduces the seizure threshold, which might be useful in certain types of patients.

No description available.

Mood disorders (MD) are among the most common mental disorders worldwide. Low treatment adherence and treatment resistance are two of the most substantial challenges facing clinicians who treat persons with MD. This thesis examined: (1) a pilot study investigating whether a one-on-one personalized medication training program, called PIMM/SAM, improves medication adherence in persons with MD; and (2) a systematic review and meta-analysis on the effects of electroconvulsive therapy (ECT) on cognitive functioning in persons with depression. To evaluate the impact of PIMM/SAM on medication adherence, a randomized controlled trial was launched in a mood disorders inpatient unit to compare PIMM/SAM (partnership in medication management/self-administered medication) program to standard prescribing practice (SPP). Over follow-up in the feasibility portion of the trial, participants in the PIMM/SAM group (n = 7) held fewer negative beliefs about medications and had lower depersonalization scores compared to participants in the SPP group (n = 5). Between-group differences on the Medication Adherence Rating Scale favoured the PIMM/SAM group, but were not statistically significant. To examine the effects of bilateral versus unilateral ECT on cognitive performance in persons with TRD, 18 studies across 10 different cognitive domains were meta-analyzed. In the 8- to 30-day timeframe post-ECT, persons who received bilateral versus unilateral ECT had over double the odds of worse cognitive performance in global cognition, non-verbal memory delayed recall, verbal memory immediate and delayed recall, subjective memory, and verbal memory immediate recall. A personalized medication training program in a mood disorders clinic may have positive implications for medication adherence. The trial to evaluate PIMM/SAM versus SPP is ongoing and further evidence about the training program is expected within the next 12 months. The systematic review and meta-analysis showed that cognitive performance was worse in persons who received bilateral versus unilateral ECT in some cognitive domains at 8 to 30 days post-treatment. / Thesis / Doctor of Philosophy (PhD) / Mood disorders (MD), including major depressive disorder (MDD) and bipolar disorder, are among the most common mental disorders worldwide. Treating MD is a challenge because of long treatments, the presence of other illnesses, treatment side effects, problems with memory, attention, and decision-making, a lack of understanding about medications, or incorrect beliefs about medication (BAM). Persons with MD who do not respond to drug treatment are often given electroconvulsive therapy (ECT). This thesis explored the challenges of treating persons with MD through: (1) a pilot study examining whether a one-on-one personalized medication training program, called PIMM/SAM, would help persons with MD take their medications as prescribed; and (2) a study of the effects of ECT on cognitive functioning in depression. Results: (1) participants randomized to PIMM/SAM group held fewer negative BAM than participants receiving standard care; (2) evidence showed worse cognitive functioning in persons who received more intense forms of ECT.

No description available.

Introduction : L'électroconvulsivothérapie (ECT) est un traitement non pharmacologique du trouble dépressif résistant. Bien que son efficacité ait été démontrée dans cette indication, les mécanismes cérébraux qui sous-tendent ce processus restent très imprécis. Il n'existe actuellement pas de travail étudiant l'effet d'une ECT efficace au niveau des modifications structurofonctionnelles cérébrales. Il semble primordial de poursuivre l'étude des corrélats neuroanatomiques précoces et plus tardifs sous tendant les processus neurofonctionnels responsables de l'amélioration de la clinique. Méthodes : Il s'agit d'une étude mono centrique menée sur le CHU de Toulouse. Chez des patients présentant un trouble dépressif résistant, des évaluations cliniques et en IRM multimodale sont réalisées à 4 temps. La 1ère évaluation a lieu avant le début de la cure, la 2ème après une 1ère ECT, la 3ème après une 1ère ECT efficace et la 4ème après rémission.Résultats: Concernant le volume de l'hippocampe et de l'amygdale à la première visite n'était pas diffèrent du volume à la troisième visite (t(135) = .329, p = .94). Au contraire, il y avait une différence significatif entre le volume de deux structures entre la première et la quatrième visite (t(135) = -2.47, p = .039) et entre la troisième et la quatrième visite (t(135) = -3.51, p = .002). Concernant la diffusivité moyenne en tant que l'effet des visites tend vers la significativité pour la DM (F(2,136) = 2.67, p = .072). En IRM resting state, il existe une hypoconnectivité précoce entre (i) l'hippocampe Droit et le cortex Cingulaire antérieur dorsal (t = -6.20 ; pFDR : 0.0123) ; (ii) l'hippocampe Droit et le noyaux caudé gauche ( t = -7.69 ; pFDR : 0.0035) et (iii) le vermis cervelet et le precuneus (t = -5.93 p FDR : 0.0363). Il existe une hyperconnectivité entre V4 et V1 entre (i) le cortex orbito frontal médian droit et le gyrus occipital médian (t = 6.58 ; p FDR : 0.0146) et (ii) le gyrus frontal inférieur droit et le cortex fronto median gauche (t = 6.83 ; pFDR : 0.0104). Il existe une diminution significative des symptomes de depression entre la V4 et la V1 à l'échelle d'Hamilton (V4: 3,08 ET : 1,62 ; V1 : 23,17 ET : 3,21 ; p <0.001).Conclusion : Il semble exister des modifications structuro-fonctionnelle à l'issu de la cure d'ECT sans modifications structurelles et micro structurelles précoces. / Background: Electroconvulsive Therapy (ECT) is a non-pharmacological treatment of resistant depressive disorder. Although its efficacy has been demonstrated in this indication, the brain mechanisms underlying this process remain very imprecise. There is currently no work studying the effect of one effective ECT on cerebral structural changes. It seems essential to continue the study of the early and late neuroanatomical correlates underlying neurofunctional processes responsible for improving the clinic. Methods: This is a mono-centric study conducted on the Toulouse University Hospital. In patients with resistant depressive disorder, clinical and multimodal MRI assessments are performed at 4-step intervals. The first evaluation takes place before the beginning of the treatment, the 2nd after a 1st ECT, the 3rd after a 1st effective ECT and the 4th after remission. Results: Regarding the volume of the hippocampus and amygdala at the first visit was not different from the volume at the third visit (t (135) = .329, p = .94). On the contrary, there was a significant difference between the volume of two structures between the first and the fourth visit (t (135) = -2.47, p = .039) and between the third and fourth visits (t (135) = -3.51, p = .002). For mean diffusivity, the effect of visits showed a trend toward significance for MD (F (2.136) = 2.67, p = .072). In the MRI resting state, there is early hypoconnectivity between (i) the right hippocampus and the dorsal anterior cingulate cortex (t = -6.20, pFDR: 0.0123); (ii) right hippocampus and left caudate nucleus (t = -7.69, pFDR: 0.0035) and (iii) vermis cerebellum and precuneus (t = -5.93 p FDR: 0.0363). There is hyperconnectivity between V4 and V1 between (i) the right medial orbit frontal cortex and the medial occipital gyrus (t = 6.58; p FDR: 0.0146) and (ii) the right inferior frontal gyrus and left fronto medial cortex (t = 6.83, pFDR: 0.0104). There is a significant decrease in the symptoms of depression between V4 and V1 at the Hamilton scale (V4: 3.08 AND: 1.62, V1: 23.17 AND: 3.21, p <0.001). Conclusion: There appears to be structural-functional changes at the end of the ECT course. However, we do not find early structural and micro structural changes.

The basement of the Tonga intraoceanic forearc comprises Eocene arc volcanic crust formed during the earliest phases of subduction. Volcanic rocks recovered from the forearc include boninites and arc tholeiites, apparently erupted into and upon older mid-oceanic ridge tholeiites. Rock assemblages suggest that the forearc basement is a likely analog for large supra-subduction zone (SSZ) ophiolites not only in structure and Ethology, but also in the style of hydrothermal alteration. Dredged volcanic samples from the central Tonga forearc (20-24�� S) exhibit the effects of seafloor weathering, low (<200��C, principally <100��C) alteration, and high temperature (>200��C) alteration. Tholeiites and arc tholeiites are significantly more altered than boninites. Seafloor weathering is due to extensive interaction with cold oxidizing seawater, and is characterized by red-brown staining and the presence of Fe-oxyhydroxides. Low temperature alteration is due to circulation of evolving seawater-derived fluids through the volcanic section until fluid pathways were closed by secondary mineral precipitation. Low temperature alteration is characterized by smectites, celadonite, phillipsite, mixed-layer smectite/chlorite, carbonates, and silica. All phases fill veins and cavities; clay minerals and silica also replace the mesostasis and groundmass phases. Low temperature alteration enriches the bulk rock in K, Ba, and Na, and mobilizes other elements to varying extents. The few high temperature samples are characterized by mobilizes other elements to varying extents. The few high temperature samples are characterized by epidote, chlorite, quartz, oxides, and fibrous amphibole, which replace groundmass and phenocrysts, and fill cavities, and are presumed to have originated in zones of concentrated hydrothermal upflow.These three alteration types are similar to those seen in many ophiolites such as Troodos, where low temperatures prevailed in the volcanic section except in localized upflow zones. Alteration mineral chemistries are also broadly similar to those observed for the Troodos Ophiolite. Tonga forearc alteration differs from mid-oceanic ridge alteration in the presence of Al-rich dioctahedral smectites (not common in mid-oceanic ridge crust), the high Al content of saponite, and the predominance of K as an interlayer cation in clays. Hydrothermal alteration of the Tonga forearc is likely the product of extensive interaction with compositionally evolving seawater-derived fluids beginning at the time of emplacement. The distribution and intensity of alteration in these crustal sections depend principally on the porosity and permeability of the crust during alteration, which are influenced by the primary porosity, igneous morphology, and the presence of faults and fractures which could affect fluid flow. / Graduation date: 1999

This study aims to highlight patients´ experiences about and thoughts of side effects fromelectroconvulsive therapy (ECT), a therapeutic method commonly used when having severedepressions. The framing of questions were how the respondents of this study describe theirlife before, during and after ECT-treatment, how the treatment has affected their daily life andhow these experiences may contribute to the awareness of power in professional relations.The study is based on three semi-structured narrative interviews and the main result showedthat, according to my interpretation, ECT as a treatment obliterated memories, quality of lifeand daily structure for all participants. Unfortunately they have all become subjects ofpsychiatric power and have faced considerable difficulty in getting professional recognitionaccording to their severe memory issues. The respondents have lost the ability to relate totheir past which clearly makes them struggle in their present context. A point in commonamong them is that neither of them wanted ECT but, because of the lack of communicationbetween them as patients and the health care in general, they all ended up getting it.

Elektromagnetisk provning (ECT) har blivit en av de mest använda metoderna för attkvalitetssäkra produkter där icke-destruktiv testning av material krävs. Vid provning av ståltrådinteragerar utrustningen med det testade materialet och upptäcker ytdefekter och, i vissomfattning, om strukturen skiljer sig från det kalibrerade provet. Om produkten befinner sigutanför specifikationen, skrotas den eller ombearbetas. Denna Mastersuppsats undersökerkalibreringsförfarandet för elektromagnetisk provning som utförs av Suzuki Garphyttan, som är enav de största tillverkarna i världen av ventil- och transmissionsfjädrar för bilindustrin. Genom deslutsatser som framgår av denna rapport, som baseras på undersökningar gjorda i vetenskapligaartiklar och genom att analysera den data som inhämtats från produktionen, presenteras enstandardisering av kalibreringsförfarandet. Detta är nödvändigt för att säkerställa såväl testernastillförlitlighet, såväl som minimering av risken för att skrota ut material på grund av felaktigainställningar, till exempel på grund av otillräckligt signal-brus (S/N)-förhållande. Fokus ligger påsond-baserad, roterande testning, i denna avhandling kallad circografen, eftersom den är manuelltkalibrerad.Några av de konstaterade resultaten i rapporten är:● Standard Operating Procedures (SOP)-baserade instruktioner implementeras i företagetskvalitetssystem. Detta för att minska variationer i kvalitet mellan olika operatörer ochmaskiner.● Ett förslag på intervaller för värden (fasvinkel, förstärkning, korrigering av filter och såvidare) presenteras. Detta är baserat på insamlad unik produktionsdata från operatöreroch utförda test.● Fasvinklarna som används varierar inom specifika intervaller och bestäms av materialval iallmänhet och frekvensval i synnerhet.● Konduktivitets- och permeabilitetsvärdena för oljehärdad tråd, liksom penetrationsdjupetför tre olika frekvenser presenteras.● Härdningsfel kan inte detekteras i roterande provning● Ökat kolinnehåll minskar den elektriska ledningsförmågan och ger ökad resistivitet, vilketgör att fasen flyttar sig och resulterar i ett minskande gap mellan brussignal ochspricksignal. / Eddy current testing (ECT) has become one of the most extensively used methods to secure theproducts and constructions when non-destructive testing is required. In typical cases of steel wiretesting, the equipment interacts with the tested material and discovers surface defects and, to alimited extent, if the inner structure is differing from the calibration sample. If the product isfound to be outside specification, it is either scrapped or reworked. This master thesis investigatesthe Eddy current testing calibration procedures performed by steel wire manufacturer SuzukiGarphyttan, which is one of the largest producers in the world of valve and transmission springwire for the automotive industry. By the research shown in this thesis, based on the investigationmade in scientific papers and by analyzing data extracted from production, a standardization ofthe calibration procedure is being presented. This is to secure both the testing reliability, andminimizing the risk of scrapping material due to inaccurate settings, for example due toinsufficient signal to noise (S/N) ratio. The focus is on probe-based, rotating testing, in this thesiscalled the circograph, since it is manually calibrated.Some of the findings established in the report: Standard Operating Procedures (SOP) based instructions is being implemented in thecompany's Quality system. This is to decrease the process variations between differentoperators and machines. Suggestions of intervals for values (Phase angle, gain, filter correction and so forth) arepresented. These values are based on collected unique production data from operators andmachines, as well as performed tests. The phase angles used are ranging between specific value intervals, and set by materialchoice in general and choice of frequency in particular. The conductivity and permeability values for oil-tempered wire, as well as penetrationdepth for three different frequencies, are presented. Hardening error cannot be detected in the circograph. Increased carbon content is decreasing conductivity and increasing resistivity, causing thephase to move slightly and decreasing the gap between noise signal and crack signal.

This study proposes a model of e-shopping continuance intentions that incorporate the revised technology acceptance model and expectation confirmation theory to measure continuance online shopping intentions within Saudi Arabia. Using structural equation modelling to confirm the model fit, and a 463-person sample, the author finds that perceived usefulness, enjoyment, and subjective norms determine online shopping continuance intentions, across male (30% of the sample) and female (70%) respondents. The structural weights are largely equivalent, yet the regression paths from site quality to perceived usefulness and perceived usefulness to continuation intentions are not invariant across the research sample. This research thus moves beyond consideration of online shopping intentions to include factors that may affect online shopping continuance. The research model is able to explain 61% of the variance in intentions to continue shopping online. Therefore, online strategies cannot ignore either direct or indirect differences in continuance intentions due to behaviour differences among shoppers in Saudi Arabia. With the high percentages of participants from the main populated regions in Saudi Arabia, the research model can be generalized across Saudi Arabia. Thus, the research has added to the limited literature on online repurchase intention or continuance intention by testing the proposed model in a context that has never before been tested. Furthermore, few prior studies use SEM as their methodological approach, and even fewer apply invariance analysis to verify behavioural differences based on gender, regional, education, e-shopping experience, and e-shopping spending with a sample obtained from Saudi Arabia. This study addresses these various knowledge gaps. Moreover, this thesis provides managers with useful and important information they can use to plan their Web sites and marketing strategies. The findings will help e-retailers to identify which web site attributes influence consumers’ e-shopping intentions, and thus improve the effectiveness of their e-shopping sites. A more thorough understanding of e-shopping continuance intention helps e-retailers to entice e-shoppers to shop online more, and entice non-online shoppers to shop online. Keywords: Internet shopping, e-shopping, technology acceptance, behavioural differences, continuance intentions, online shopping, Saudi Arabia.