Introduction: Balance between the essential nutritive substances is important for a person to maintain health. The surgical patient can be stricken with conditions, which have a negative impact on this balance and can lead to malnutrition. Working as a nurse it is important to identify patients that are malnourished or is in the risk zone of malnourishment since 30 % of all patients in hospitals are malnourished. Aim: The aim of this study was to examine the compliance to the guidelines for nutritional assessment and parenteral nutrition on a surgical ward. Also whether the nutritional treatment/-support was reported to the next caregivers if the patient was malnourished or was in the risk zone of malnourishment at the time of discharge. Method: 80 patients enrolled on the ward in the beginning of year 2011 were included. Audit of patient records was made according to the hospital guidelines for nutrition and parenteral nutrition and followed a study specific protocol. Results: The examination of the case records showed that the guidelines for nutrition were partly complied with. Nutritional treatment/-support was reported to the next caregivers when needed. Compliance to the guidelines for parenteral nutrition was deficient. Conclusion: The guidelines for nutritional assessment and parenteral nutrition are not used adequately. / Introduktion: En stadig balans mellan de livsviktiga näringsämnena krävs för att en person ska kunna hålla sig frisk och för att kroppen ska fungera. Den kirurgiska patienten kan drabbas av tillstånd som har en negativ inverkan på denna balans och kan riskera att drabbas av malnutrition. Det är viktigt att som sjuksköterska identifiera de patienter som är malnutrierade eller är i riskzonen för att drabbas av malnutrition då 30 % av alla patienter som vårdas på sjukhus är malnutrierade. Syfte: Syftet med denna studie var att undersöka om de riktlinjer som finns för nutritionsbedömning och parenteral nutrition följs på en kirurgisk vårdavdelning samt om nutritionsbehandlingen/-stödet rapporteras vidare till nästa vårdform då en malnutrierad patient/riskpatient för malnutrition skrivs ut. Metod: 70 patienter som var inskrivna på den aktuella avdelningen i början av år 2011 inkluderades i studien. En journalgranskning gjordes utifrån ett journalgranskningsprotokoll, där innehållet utgick från de nutritionsriktlinjer som finns för verksamhetsområdet för kirurgi samt riktlinjerna för parenteral nutrition. Resultat: Journalgranskningen visade att de riktlinjer som finns för nutrition följs till viss del. Vad gäller rapportering av nutritionsbehandling/-stöd till nästa vårdgivarform görs detta då det är aktuellt. Följsamheten till riktlinjerna för parenteral nutrition var det som var mest bristfälligt. Slutsats: Riktlinjerna för nutritionsbedömning och parenteral nutrition följs inte i den utsträckning som det borde.

Bakgrund. Ordet eutanasi betyder dödshjälp och detta ämne väcker stor debatt världen över. Holland, Belgien, Luxemburg och delstaten Oregon i USA har legaliserat eutanasi. Riktlinjer som beskriver sjuksköterskors roll i eutanasiprocessen har utformats, dock syns stora skillnader länderna emellan. Syfte. Att belysa sjuksköterskors upplevelse av delaktigheten i eutanasiprocessen, samt hur omvårdnaden av patienten såg ut under denna process. Metod. En allmän litteraturstudie utfördes med induktiv innehållsanalys. Resultat. Studien belyser flera aspekter av sjuksköterskors upplevelser kring omvårdnaden av patienter under eutanasiprocessen. Kategorierna visar sjuksköterskors reaktioner på eutanasiförfrågan, vikten av ett gott samtal mellan patient och sjuksköterska, hur sjuksköterskor vårdar patienten under processen som leder fram till eutanasi samt hur hon finns som stöd för patienten och agerar patientens ”advokat”. Det framkom att sjuksköterskor åsidosätter sina egna åsikter om eutanasi och ställer upp för patienten samt hur de finner stöd i kollegor för att klara av den psykiskt påfrestande uppgift som eutanasiprocessen innebär. Slutsats. I flera studier anser sjuksköterskor det svårt att ge patienten bästa omvårdnad då riktlinjer som beskriver deras arbetsuppgifter under eutanasiprocessen är bristfälliga. / Background. Euthanasia can be translated into the meaning of helping a person to end his/her life. Holland, Belgium, Luxembourg and the State of Oregon (USA) have legalized euthanasia. Guidelines describing the nurses’ role in the process of euthanasia exists, though great differences can be seen between countries. Aim. To illuminate the nurses’ perception on their involvement in the euthanasiaprocess and what the care during this process looked like. Method. A general review of qualitative literature was conducted with analysis of the articles. Result. This study showed the nurses’ first reaction to the euthanasia request, the importance of in-depth conversations between the patient and the nurse, the nurses’ care for the patient during the process, how they stood by their patients’ side at all times and sometimes acted the role of the patients’ lawyer. This study raised issues about how nurses’ sometimes sat their negative thoughts about euthanasia aside to care for the patient and how they found support and comfort in their colleagues. Conclusion. Many nurses feel they cannot give the patient proper care due to failing guidelines describing their tasks during the euthanasia process.

Nosokomiala infektioner förekommer världen över och är en stor orsak till sjukdomar och dödlighet. Även i Sverige är nosokomiala infektioner ett problem, både på sjukhus och i andra vårdformer. Basala hygienrutiner är den viktigaste åtgärden för att förebygga uppkomst av infektionssjukdomar.  Syftet med denna studie var att undersöka och jämföra hemtjänstens undersköterskor och vårdbiträden, gällande deras kunskaper och följsamhet till basala hygienrutiner, samt deras kunskaper angående den vanligaste smittvägen inom vården. Datainsamlingen gjordes med en enkät som innehöll 22 frågor. Fyra hemtjänstgrupper ingick i studien, där totalt 66 vårdbiträden och 30 undersköterskor inkluderades. Resultatet visade att följsamheten till handtvätt och handdesinfektion efter ett omvårdnadstillfälle var hög, dock var följsamheten till handdesinfektion före ett omvårdnadstillfälle mindre bra. Följsamheten till handskar vid personlig hygien var mycket god, resultatet visade dock att de flesta endast använde plastförkläde/skyddsrock ibland. Många av respondenterna i båda undersökningsgrupperna kände inte till vilka områden som ingår i begreppet basala hygienrutiner, däremot kände många till den vanligaste smittvägen inom vården. Endast en statistisk signifikant skillnad kunde påvisas mellan undersköterskor och vårdbiträden. Slutsatsen var att begreppet basala hygienrutiner måste tydliggöras och att mer information behövs om vid vilka tillfällen händerna ska tvättas eller desinficeras. Ytterligare information behövs även om varför och vid vilka tillfällen plastförkläde eller skyddsrock ska användas. / Nosocomial infections is a big cause of disease and mortality worldwide. In Sweden nosocomial infections also is a big problem, both in hospitals and other care facilities. Hygiene guidelines is the most important measure to prevent infection diseases. The aim of this study was to measure and compare licensed practical nurses and nursing assistants in homemaker services, concerning their knowledge and compliance to hygiene guidelines and their knowledge about the most common way of spread of infection in healthcare. The data collection was conducted with a questionnaire including 22 questions. Four groups in homemaker services were included in the study, totally 66 nursing assistants and 30 licensed practical nurses. The result showed that the compliance to hand washing and hand disinfection after a  care opportunity was high, however the result showed that hand disinfection before a  care opportunity was less good. The compliance of using gloves was very good in personal hygiene opportunities. The result also showed that most of the respondents only used aprons occasionally. Many of the respondents didn’t know which areas are included in hygiene guidelines, however many had knowledge about the most common way of spread of infection in healthcare. Only one statistical significant distinction was established between nursing assistants and licensed practical nurses. The conclusion showed that hygiene guidelines must be elucidate and that more information is needed about when hands should be washed or disinfected. Further information is also needed about why and in which occasions aprons should be used.

Vårdrelaterade infektioner [VRI] skapar onödigt lidande för patienter, förlänger vårdtider och kostar samhället enorma summor varje år. Det är därför viktigt att öka personalens kunskaper och följsamhet till gällande föreskrifter angående basala hygienrutiner. Syftet med denna studie var att belysa vårdpersonalens följsamhet, synliggöra mindre uppmärksammade smittkällor och redogöra för de åtgärder med vilka man kan minska spridningen av VRI. Artiklar samt litteratur till denna systematiska litteraturstudie söktes främst via sökmotorn ELIN, tillgänglig vid Högskolan Dalarnas bibliotek samt Mora Lasaretts bibliotek och Orsa- och Moras kommunbibliotek. Artiklar som inkluderades var publicerade 2000-2009, tillgängliga i fulltext, ej avgiftsbelagda eller skrivna på andra språk än engelska och svenska. Resultatet visar att följsamheten hos vårdpersonalen var låg och att införandet av åtgärdsprogram i de flesta fall endast gav temporär förbättring av följsamheten och att vårdpersonalen efter kort tid återgick till ett felaktigt beteende. När personalens bristande kunskap ledde till felaktigt användande av skyddsutrustning såsom handskar och plastförkläden kunde detta vara en källa till spridning av VRI. Vårdpersonalens arbetskläder visade sig bära på flertalet potenta mikroorganismer som kan orsaka VRI. Även patientnära- och medicinsk utrustning visade sig bära på smittförande mikroorganismer. Slutsatserna av litteraturstudien visar att punktprevalensmätningar är en preventiv åtgärd som på sikt kan minska spridningen av dessa VRI. För att även på lång sikt förbättra vårdpersonalens följsamhet behövs kontinuerlig uppföljning av åtgärdsprogram och studier.

Abstract Although Grade 1-9 Curriculum has been put into practice in Social Studies learning area for a period of time, there isn¡¦t a complete discussion about it. Therefore, the purpose of the study is to analyze the related studies in ¡§core rationale and curriculum goal¡¨ part, ¡§competence indicators and main content¡¨ part and ¡§implement guidelines¡¨ part and to investigate the suggestions of the related studies. The subjects are 177 curriculum guideline studies studies. The results are as follows: 1. ¡§Competence indicators and main content¡¨ studies and ¡§implement ation guidelines¡¨ studies are the most part. They are 109 and 61 separately. 2. The number of ¡§core rationale and curriculum goal¡¨ studies is seven. They all agree with the integration trand which the curriculum guideline and curriculum goals pursue. However, there is no connection between theory and practice. 3. Developing competence indicators and main content: there are some discussions according to the nine theme axes and main content. 4. Implementation guideline: First: cognitive part: more and more teachers understand the curriculum guideline, which facilitates the accomplishment of curriculum guideline. Secont: integration part: there is lack of the principle explanation of the connection between integration, cognition, and practice. Therefore, it is necessary to offer the main reasons of pursuing the integration. Third: textbook: Teachers¡¦ transformations are crucial. Forth: evaluation: Although that the government should establish the professional institution to develop the long-term which is still lack in corrent elementary schools and junior high schools. Fifth: competence indicators are too abstract to understand. Therefore, it increases the difficulties in designing learning materials. Key Words: Social Studies learning area, Social Studies, Grade 1-9 Curriculum Guidelines

The river water quality management strategy involves a series of complex inter-disciplinary decisions based on speculated responses of water and sediment quality to changing controls. In the aquatic system a rapid removal of the heavy metals from the water to sediments may occur by settling particles while some of these pollutants can be mobilized by getting accumulated into the biota from the sediments sink. Thus, sediment plays a major role in the determining pollution pattern of aquatic systems. It acts as both carriers and sinks for contaminants, reflecting the history of pollution, and providing a record of catchment inputs into aquatic ecosystems. The Yan Shuei Gang River watershed is one the river watersheds in Kaohsiung City, Taiwan. It is 5-km long, drains a catchment of more than 1,200 ha. Part of the river water is from the domestic drainage areas located in the upper catchment. In Linhai Industrial Parks, there are more than 493 registered industrial factories that discharge their wastewater into the Yan Shuei Gang River. Thus, recent water and sediments quality analysis indicates that the Yan Shuei Gang River is heavily polluted. The major objectives of this study were to (1) perform water quality and sediments sampling and analyses, (2) perform water quality simulation and demonstrates the model application to the Yan Shuei Gang River, (3) assess the water and sediments quality, (4) provide foci for immediate remediation efforts, (5) provide benchmark levels to test outcomes of future remediation efforts, (6) design a novel extraction technique that utilizes a mildly elevated pressure in consecutive cycles with a chelating agent for the sediment slurry. Water quality investigation results show that the biochemical oxygen demand (BOD), ammonia-nitrogen (NH3-N), and suspended solid (SS) average concentrations in water samples of the Salt-water River varied from 10.2 to 194, 8.51 to 18.3, and 7.9 to 19.5 mg/L, respectively. The results of the chemical analysis of the Salt-water River surface sediments showed that the sediments present highly elevated Cd, Cr, Ni, Cu, Pb, Zn and Fe concentrations. Investigation results reveal that sediment samples contained significant amount of iron (up to 3.6%), Cr (up to 66.5 mg/kg), Pb (up to 36.5 mg/kg), Ni (up to 43 mg/kg), and Al (up to 1.8%). All heavy metal concentrations were higher than the world average, sediments average and sediment quality guidelines (SQGs). Although all metals showed varied concentrations, the approaches of factor analysis, normalized enrichment factor (EF), and the geo-accumulation index (Igeo) proposed in this paper were effectively used to differentiate the natural and anthropogenic sources of the metals. Both the EF and Igeo indicated similar anthropogenic contamination degree of the metals. The potential acute toxicity in sediment of Yan Shuei Gang River was observed to be mainly due to Cu contamination. Cu was the major toxicity contributor accounting for 32-46% of the total toxicity in Salt-water River, followed by Zn. The Water Quality Analysis Simulation Program (WASP) model developed by US Environmental Protection Agency (EPA) was selected as a water quality planning tool to perform the water quality evaluation. Modeling results show that the current daily pollutant inputs were much higher than the calculated carrying capacity for nutrients and BOD of the Yan Shuei Gang River. Based on the results from this study, the following remedial strategies have been proposed to minimize the impacts of industry and domestic source pollution on the water quality of Salt-water River: (1) increase the flow by transporting 1 m3/s unpolluted surface water from other sources to dilute the polluted river water, (2) construction of the intercepting systems to effective intercept and transport the untreated wastewater to the wastewater treatment systems. The sediments batch extracted by 150 psi pressure cycles has the most Cu removed rater (70%), much higher than without treatment (55%) or with 90 psi pressure cycles treatment (65%). Pressure-assisted extraction achieves in 60 min the amounts of Cu equal to or exceeding those achieved in 240 min without pressure cycles under the same concentration conditions. This research indicates that the advantages of pressure cycle system are increased process speed, more thorough extraction, and reduced use of the chelating agent. The heightened treatment is explained by sediments aggregate fracturing upon pressure cycles that exposes the contaminants as well as by the chelating agents. The technique is expected to accelerate extraction treatment of a wide range of heavy metal contaminants, and it may provide treatment to dredged and stored contaminated sediments. Experience obtained from this study will be helpful in designing the sediment and river management strategies for other similar river watersheds.

The distribution of butyltin compounds (BTs) in the sediments and seawater, at the river outfalls, fishing ports, shipyards, and industrial zone docks of Kaohsiung Harbor, Taiwan were investigated. Twenty sediment and seawater samples were collected from various locations in the Harbor in 2006, and analyzed for monobutyltin (MBT), dibutyltin (DBT), and tributyltin (TBT). Results showed that the concentration of total BTs varied from 1.5 to 151 ng/g in sediment samples, with TBT being the major component of the sediment samples. This suggests that sediments could be the most possible sink of TBT brought by the sorption mechanism. The concentrations of BTs ranged from 9.7 to 270 ng/L in seawater samples, whereas DBT and MBT, the degradation byproducts of TBT, were mainly the most abundant BT compounds of the seawater samples. This indicates that the abiotic or biotic degradation potential of TBT was significant. Spatially, the highest concentrations of BTs were observed in both water and sediment samples collected from the shipyard and fishing port areas. This indicates that the shipping related activities (e.g., navigation, ship repair, and ship building), would contribute most of BTs in the environment. Results show that the concentrations of degradation products (DBT and MBT) were related closely to temperature, salinity, dissolved oxygen (DO), and chlorophyll-a of the seawater. This implies that seasonal changes of the water parameters controlled the degradation of TBT in seawater. The observed levels of BT compounds in both seawater and sediments were much higher than those required to induce toxic effects on marine organisms suggesting that appropriate TBT control strategies should be taken in Kaohsiung Harbor. Sediment samples were collected from the river outfalls, fishing ports, shipyards, and industrial zone docks of Kaohsiung Harbor, Taiwan to evaluate the distribution of polycyclic aromatic hydrocarbons (PAHs) in sediments. Collected sediment samples from 12 locations were analyzed for 17 different PAHs, organic content, and grain size. The results show that the total PAH concentrations varied from 472 to 16,201 ng/g dry wt, with a mean concentration of 5,764 ng/g dry wt The highest PAH concentrations were from the industrial zone docks situated in south Kaohsiung Harbor, ranging from 8,788 to 16,201 ng/g dry wt Among those sediment samples, the 5-, 6-ring PAHs were predominant PAH congeners in sediments, ranging from 42 to 71%. However, the dominant PAH congeners were 2-, 3-ring PAHs (37 to 42%) collected from steel industrial zone docks. This indicates that the sources for the PAH contamination at steel industrial zone docks were different from the other zones in Kaohsiung Harbor. According to the diagnostic ratios, the possible source of PAHs in the industrial zone dock could be coal combustion while in the other zones it could be petroleum combustion. The total PAH levels were expressed as the total toxic equivalent (TEQcarc). The total TEQcarc varied from 55 to 1,964 ng TEQ/g dry wt. Higher total TEQcarc values were found at industrial zone docks (from 1,404 to 1,964 ng TEQ/g dry wt). As compared with the US Sediment Quality Guidelines (SQGs), the observed levels of PAHs at industrial zone docks exceeded the effects range low (ERL), and could thus cause acute biological damage. However, the lower levels of PAHs at the other zones would not exert adverse biological effects. Results would be helpful in developing strategies for sediment remediation in Kaohsiung Harbor.

Clinical guidelines are developed to assist healthcare practitioners to make decisions on a patient&#039 / s medical problems and as such they communicate with external applications to retrieve patient data, to initiate medical actions through clinical workflows and to transmit information to alert/reminder systems. The interoperability problems in the healthcare IT domain for interacting with heterogeneous clinical workflow systems and Electronic Healthcare Record (EHR) Systems prevent wider deployment of clinical guidelines because each deployment requires a tedious custom adaptation phase. In this thesis, we provide machine processable mechanisms that express the semantics of clinical guideline interfaces so that automated processes can be used to access the clinical resources for guideline deployment and execution. For this purpose, we propose a semantically enriched clinical guideline representation formalism by extending one of the computer interpretable guideline representation languages, GuideLine Interchange Format (GLIF). To be able to deploy the semantically extended guidelines to healthcare settings semi-automatically, the underlying application&#039 / s semantics must also be available. We describe how this can be achieved based on two prominent implementation technologies in use in the eHealth domain: Integrating Healthcare Enterprise (IHE) Cross Enterprise Document Sharing Integration Profile (XDS) for discovering and exchanging EHRs and Web service technology for interacting with the clinical workflows and wireless medical sensor devices. Since the deployment and execution architecture should be dynamic, and address the heterogeneity of underlying clinical environment, the deployment and execution is coordinated by a multi-agent system. The system described in this thesis is realized within the scope of the SAPHIRE Project.

Autism is a pervasive developmental disorder that is seen more and more in the society and it significantly affects the lives of not only those who have autism but also their families and close ones. There is no known cure for autism, the most effective treatment is education. The choice between the several approaches regarding the education of autistic children is shaped according to education choices, children&rsquo / s age, the severity of symptoms and children&rsquo / s intellectual capabilities. The thesis focuses on the architectural design of special education schools among other education opportunities. The aim is to draw architectural guidelines for the design of a special school for children who are diagnosed with autism and who require special education support. These architectural guidelines are hoped to aid architects who will work with similar architectural programs in the future. The study concludes with an appraisal of the design of Private ilgi Special Education School, realized by the author of this thesis and architect Kadri AtabaS. In the light of information gathered during the study, the preliminary design is evaluated. Suggestions are offered concerning the architectural design, in the subjects of program elements, natural lighting, layout of education and circulation spaces, acoustics and color scheme.

The recent advancement of robotic technology brings robots closer to assisting us in our everyday spaces, providing support for healthcare, cleaning, entertaining and other tasks. In this dissertation, I refer to these robots as everyday robots. Scholars argue that the key to successful human acceptance lies in the design of robots that have the ability to blend into everyday activities. A challenge remains; robots are an autonomous technology that triggers multi-faceted interactions: physical, intellectual, social and emotional, making their presence visible and even obtrusive. These challenges need more than technological advances to be resolved; more human-centered approaches are required in the design. However to date, little is known about how to support that human-centered design of everyday robots. In this thesis, I address this gap by introducing an initial set of design guidelines for everyday robots. These guidelines are based on four empirical studies undertaken to identify how people live with robots in the home. These studies mine insights about what interaction attributes of everyday robots elicit positive or negative user responses. The guidelines were deployed in the development of one type of everyday robot: a senior-care robot called HomeMate. It shows that the guidelines become useful during the early development process by helping designers and robot engineers to focus on how social and emotional values of end-users influence the design of the technical functions required. Overall, this thesis addresses a question how we can support the design of everyday robots to become more accepted by users. I respond to this question by proposing a set of design guidelines that account for lived experiences of robots in the home, which ultimately can improve the adoption and use of everyday robots.