The project was aimed at describing the mixing phenomena relevant for both safety analysis, particularly in steam line break and boron dilution scenarios, and mixing phenomena of interest for economical operation and the structural integrity. Measurement data from a set of mixing experiments, gained by using advanced measurement techniques with enhanced resolution in time and space help to improve the basic understanding of turbulent mixing and to provide data for Computational Fluid Dynamics (CFD) code validation. Slug mixing tests simulating the start-up of the first main circulation pump are performed with two 1:5 scaled facilities: The Rossendorf coolant mixing model ROCOM and the VATTENFALL test facility, modelling a German Konvoi type and a Westinghouse type three-loop PWR, respectively. Additional data on slug mixing in a VVER-1000 type reactor gained at a 1:5 scaled metal mock-up at EDO Gidropress are provided. Experimental results on mixing of fluids with density differences obtained at ROCOM and the FORTUM PTS test facility are made available. Concerning mixing phenomena of interest for operational issues and thermal fatigue, flow distribution data available from commissioning tests (Sizewell-B for PWRs, Loviisa and Paks for VVERs) are used together with the data from the ROCOM facility as a basis for the flow distribution studies. The test matrix on flow distribution and steady state mixing performed at ROCOM comprises experiments with various combinations of running pumps and various mass flow rates in the working loops. Computational fluid dynamics calculations are accomplished for selected experiments with two different CFD codes (CFX-5, FLUENT). Best practice guidelines (BPG) are applied in all CFD work when choosing computational grid, time step, turbulence models, modelling of internal geometry, boundary conditions, numerical schemes and convergence criteria. The BPG contain a set of systematic procedures for quantifying and reducing numerical errors. The knowledge of these numerical errors is a prerequisite for the proper judgement of model errors. The strategy of code validation based on the BPG and a matrix of CFD code validation calculations have been elaborated. Besides of the benchmark cases, additional experiments were calculated by new partners and observers, joining the project later. Based on the "best practice solutions", conclusions on the applicability of CFD for turbulent mixing problems in PWR were drawn and recommendations on CFD modelling were given. The high importance of proper grid generation was outlined. In general, second order discretization schemes should be used to minimise numerical diffusion. First order schemes can provide physically wrong results. With optimised "production meshes" reasonable results were obtained, but due to the complex geometry of the flow domains, no fully grid independent solutions were achieved. Therefore, with respect to turbulence models, no final conclusions can be given. However, first order turbulence models like K-e or SST K-w are suitable for momentum driven slug mixing. For buoyancy driven mixing (PTS scenarios), Reynolds stress models provide better results.

<p>Background: Companies today are under increasing pressure from their stakeholders to become more and more transparent regarding the way they deal with the impact on the environment and the communities where they operate in. This type of information is mainly provided by means of sustainability reports. Several guidelines have been developed to aid report makers on the way. Currently however these sustainability reports still differ widely in the quantity of information provided which makes them difficult to compare and it is therefore important to understand the factors that can influence the amount of information being published.</p><p>Purpose: The purpose of this study is to identify the factors having an impact on the amount of sustainability information published by Swedish companies using the guidelines developed by the Global Reporting Initiative (GRI).</p><p>Method: Telephone interviews were conducted with eleven of the twenty-three Swedish companies listed in the GRI register in order to get their point of view regarding these factors.</p><p>Results: The study identified that the willingness to communicate with more than one stakeholder group is the most important factor that can influence the amount of information disclosed in sustainability reports. The authors also argue that a proactive attitude towards identifying legitimation strategies instead of an adaptive approach can also influence the degree of disclosure. Finally, a positive attitude towards the GRI guidelines may also contribute to producing a more detailed report.</p>

Problem: Mostly attributed to lack of time, only about 15% of Canadian adults are currently reaching the Canadian Physical Activity Guidelines (CPAG). Recently, studies have suggested that any bout of aerobic exercise reaching moderate to vigorous intensity has the potential to improve health. Methods: Sixty adults (20 young non-overweight adults, 20 overweight adults, 20 older adults) already doing some resistance training (RT) were recruited. Participants performed eight RT exercises during three visits. The objective was to identify the proportion of time spent at moderate to vigorous intensity during RT sessions. Results: Overall, the participants were at moderate to vigorous intensity during 82% of the time. However, the older adult group compared to the young adult group spent lower proportion of time at moderate to vigorous intensity during RT sessions. Conclusion: Most Canadian adults can reach HR equivalent to those achieved during moderate to vigorous aerobic activity by doing RT.

Många svenska organisationer har idag en bristfällig förmåga att planera och förbereda en storskalig utrymning. Enligt MSB:s vägledning om utrymning 2014 anses dagens planering ofta vara förlegad och återföring av erfarenheter sker godtyckligt. Vidare varierar tolkning och tillämpning av gällande lagstiftning. Denna upplevs generellt som otydlig och ansvarsförhållandet mellan olika organisationer behöver tydliggöras. Syftet med studien är att utifrån erfarenheter från internationella exempel och allmänna principer för storskalig utrymning jämföra det med svensk kontext. Hypotesen är att avsaknaden av erfarenheter från att faktiskt genomföra utrymning i större omfattning sannolikt påverkar hur samhällets beredskap ser ut idag. Vald metod är semistrukturerade intervjuer som genomfördes med personer i nyckelfunktioner vid olika myndigheter på lokal och regional nivå i Halmstad, Halland. Materialet behandlades med kvalitativ innehållsanalys. Studien består också av en fallstudie där Halmstads kommun utgör en avgränsning och ett fall att studera. Resultatet påvisar att kunskap och förmåga att genomföra storskalig utrymning är bristfällig eller saknas. Samtliga organisationer som deltog i studien saknar praktisk erfarenhet från storskaliga utrymningar och ser genomförandet som en stor utmaning. Behov finns för åtgärder, dels planering i egen organisation dels gemensam planering med berörda organisationer. Det anses också att det finns kompetens inom organisationerna där exempelvis Varbergs och Kungsbackas kommuner tillsammans med Polismyndigheten Väst har mångårig erfarenhet av utrymningsplanering och övningar rörande kärnteknisk olycka. En gemensam utbildningsinsats, utifrån allmänna principer, med målsättning att skapa en gemensam inriktning och handlingsstruktur för storskalig utrymning rekommenderas. / Today many Swedish organizations have weak capacity to plan and prepare for a large-scale evacuation. According to MSB:s guide on evacuation 2014 todays planning is often considered outdated and feedback of experience is done arbitrarily. Furthermore, interpretation and application of existing legislation is varying. The legislation is generally perceived as unclear and responsibilities between different organizations need to be clarified. The purpose of the study is, based on the experience of international examples and general principles for large-scale evacuation compare it with Swedish context. The hypothesis is that the lack of experience actually implementing the evacuation on a large scale is likely affecting how society's preparedness looks today. Semi-structured interviews were conducted with people in key positions at various agencies on local and regional level in Halmstad, Halland. A qualitative content analysis was used. The study also consists of a case study where Halmstad Municipality and its proximity to the nuclear power plant in Ringhals represent delimitation and a case study. The result demonstrates that knowledge and ability to carry out large-scale evacuation is incomplete or missing. All organizations miss practical experience of large-scale evacuations and envision the implementation as a major challenge. There is a need for planning, in own organization and joint with interested organizations. It is also considered to be expertise within the organizations, as example Varbergs and Kungsbackas municipalities together with Police Authority West has many years of experience in emergency planning and exercises related to nuclear accidents. A joint training program, from general principles, with the aim of creating a common focus and action structure for large-scale evacuation is recommended.

SAMMANFATTNING Patienter som drabbas av höftfrakturer är en vårdkrävande och utsatt patientgrupp inom sjukvården. Riktlinjer för handläggning av misstänkta höftfrakturer har utformats för ett snabbare omhändertagande, så kallat snabbspår. Dessa används för att optimera och förkorta handläggningstiden, förbättra behandlingen samt minska risken för komplikationer. I Västernorrlands län tillämpas detta snabbspår, vilket medför att delar av den behandling som tidigare utfördes på akutmottagningen, nu utförs av ambulanssjuksköterskor redan i den prehospitala vården. Dessa medicinska och omvårdnadsmässiga åtgärder utförs i varierande och ibland svåra vårdmiljöer. Därför finns ett behov av att studera ambulanssjuksköterskornas upplevelser och erfarenheter av att vårda patienter med misstänkt höftfraktur. Syftet med studien var att beskriva ambulanssjuksköterskors upplevelser och erfarenheter vid omhändertagande av patienter med misstänkt höftfraktur. Kvalitativ ansats användes och designen var semistrukturerade intervjuer som analyserades med kvalitativ manifest innehållsanalys. Studiepopulationen bestod av åtta ambulanssjuksköterskor stationerade i Ångermanland. I resultatet framkom att ambulanssjuksköterskorna innehar både positiva och negativa erfarenheter av att arbeta med misstänkta höftfrakturer. Äldre människor utgjorde den största patientgruppen och dessa patienter led ofta av demenssjukdomar samt andra sjukdomar och tillstånd som försvårade kommunikation och interaktion, vilket skapade svårigheter i handläggningen av dessa patienter. Vårdmiljön försvårade arbetet ytterligare för ambulanssjuksköterskorna och innebar ofta svåra förflyttningar och lyft. Positivt för både patienten och ambulanssjuksköterskorna var att det strukturerade omhändertagandet gav en snabbare vårdkedja och likvärdig vård för patienterna samt mer tid för omvårdnad. Andra aspekter som framkom var att ambulanssjuksköterskorna hade en del förutfattade meningar gällande patientgruppen och svårigheter att få patienten tillräckligt smärtlindrad. Själva omhändertagandet uppgavs vara alltför strukturerad, handläggningen tog lång tid och att det var svårt att få patienten tillräckligt smärtlindrad utan biverkningar. Slutsatsen var att ambulanssjuksköterskorna hade både positiva och negativa erfarenheter kring det strukturerade omhändertagandet, samt en del förutfattade meningar. Samtliga informanter ansåg att de hade mer tid för omvårdnaden och att de på så vis fick lära känna patienten bättre, därför kunde de enklare utvärdera behandlingsresultatet. De positiva erfarenheterna var att omhändertagandet gav en snabbare handläggning med bättre struktur och därigenom en likvärdig vård i hela länet gällande denna patientgrupp. Det accepterades att uppdragen tog längre tid och därför fick personalen även mer tid tillsammans med patienterna. Ambulanssjuksköterskorna kunde se ett konkret resultat av omhändertagandet. De negativa erfarenheterna innefattade att patientgruppen var svårbedömd på grund av eventuella tidigare sjukdomar och läkemedelsbehandlingar. Att anhöriga och vårdpersonal ibland trängde sig in i vårdrummet, med syfte att vara behjälplig, men flyttade istället fokus från patienten. / ABSTRACT Patients with hip fractures are a care-intensive and vulnerable patient population in health care. Guidelines for dealing with suspected hip fractures have been designed for a faster disposal, so-called fast track. These are used to optimize and shorten the processing time, improve treatment and reduce the risk of complications. Västernorrland county has applied a fast track, which means that parts of the processing previously performed in the emergency department, now is performed by ambulance nurses already in the prehospital care. These medical and nursing activities performed in varying and sometimes difficult healthcare environments. Therefore there was a need to study the ambulance nurses' experiences of caring for patients with suspected hip fracture. AIM: The aim of the study was to describe Ambulance nurses experiences of treatment of patients with suspected hip fracture. Qualitative approach was used and the design was semi-structured interviews were analyzed using qualitative manifest content analysis. The study population consisted of eight ambulance nurses stationed in Ångermanland, Sweden. The result showed that ambulance nurses possess both positive and negative experiences of working with suspected hip fracture. Older people represented the largest group of patients and these patients often suffered from dementia and other diseases and conditions that impeded communication and interaction, which created difficulties in dealing with these patients. The healthcare environment complicated the work further for the ambulance nurses and often includes difficult movements and lifting. Positive for both the patient and ambulance nurses was that it structured the care provided faster care chain and equivalent care for patients as well as more time for care. Other aspects that emerged were that the ambulance nurses have some preconceptions regarding the patient group and the difficulties in getting the patient adequate pain relief. The fast track was described to be too structured, the processing takes a long time and that it was difficult to get the patient enough pain relief without side effects. The conclusion was that it emerged that the ambulance nurses had both positive and negative experiences of the structured care, and had some preconceptions. All the respondents felt that they had more time for care, and that they got to know the patient better, because they could more easily evaluate the treatment outcome. The positive experience was that the fast track provided faster processing with better structure and thereby an equal treatment throughout the county regarding this population. It was accepted that missions took longer therefore the staff spent more time with the patients. The ambulance nurses could see concrete result of the fast track. The negative experiences included that the patient group was difficult to assess because of past illnesses and drug treatments. Relatives and caregivers are sometimes forced into the nursing room, with the aim to be helpful, but instead moved focus from the patient.

I have in this thesis studied how guidelines for organizing information in a custom- made user interface could be made. Teletal is service with a special designed user interface were information is stored. The purpose of this study is to encourage a consistent organization, and management of information in a user interface. The methods used in this study are as follows – qualitative interviews and two card-sorting tests, of which one was closed and the other open. The purpose with the methods used was to identify existing problems with the user interface and to test categories. Based on existing knowledge and principles, I have constructed guidelines for how to organize information. / I det här examensarbetet har jag studerat hur riktlinjer för organisering av information i ett specialutformat användargränssnitt kan tas fram. Teletal är en tjänst som har ett specialutformat användargränssnitt där information lagras. Syftet med studien är att främja konsekvent organisering, hantering och användning av informationen i användargränssnittet. I min studie har jag använt mig av tre metoder – kvalitativ intervju och två card sorting-tester, varav den ena var öppen och den andra stängd. Syftet med metoderna var att identifiera nuvarande problem med användargränssnittet, och att testa kategorier. Utifrån det aktuella kunskapsläget och principer, har jag arbetat fram riktlinjer om hur organiseringen bör ske.

Bakgrund: Var tionde patient i svensk sjukvård drabbas av vårdrelaterade infektioner vilket gör det till den vanligaste vårdskadan. Infektionerna leder till ökad dödlighet, längre vårdtideroch ökade kostnader för sjukvården. Trots tydliga riktlinjer och evidens för att basalahygienrutiner minskar förekomsten av vårdrelaterade infektioner är vårdpersonalensföljsamhet inte optimal. Samtidigt har förekomsten av bakterier som är resistenta mot antibiotika ökat i svensk sjukvård vilket ställer ökade krav på en rationell antibiotikaanvändning och att vårdpersonalen följer de basala hygienrutinerna. Syfte: Att undersöka vilka faktorer som påverkar vårdpersonalens följsamhet till basala hygienrutiner. Metod: Allmän litteraturstudie som genom en innehållsanalys sammanställer evidens utifrån tio vetenskapliga artiklar som svarar mot syftet. Resultat: Faktorer som ofta angavs somhinder mot följsamheten var tidsbrist, avsaknad av nödvändig utrustning, bristande kunskap och torra händer. Återkommande faktorer som ökade följsamheten var rädsla för att själv smittas, att vårdsituationen uppfattades som oren, positiva förebilder i arbetsgruppen ochkunskap om hygienens betydelse. Slutsats: För att öka följsamheten till de basalahygienrutinerna behövs en förändring i vårdpersonalens attityd. Följsamhet till basalahygienrutiner behöver göras till norm och vårdpersonalen behöver känna att de ges möjlighettill kontroll över sitt beteende kring hygienrutiner. Klinisk betydelse: För att förbättra hurvårdpersonalen följer de basala hygienrutinerna krävs kunskap om de faktorer som påverkarföljsamheten. / Background: Every tenth patient in Swedish hospitals contracts healthcare associatedinfections making it the most common hospital-acquired condition. Infections lead toincreased mortality, additional days in hospital and increased costs. Despite evidence thatbasic hygiene guidelines results in decreased healthcare associated infections complianceremains variable. Multi-drug resistant bacteria are an increasing threat within the healthcaresystem making rational antibiotic use and compliance with basic hygiene guidelines the mostimportant preventive measures. Aim: The aim of this study was to examine factors that influence healthcare workers compliance with basic hygiene guidelines. Method: Through content analyze this literature review compiles evidence from ten scientific articles that relatesto the aim. Result: Among the factors that were perceived as barriers to hygiene compliancewas time, availability of hygiene products, lack of knowledge and skin condition. Factors thatincreased compliance was fear of becoming infected, perception of procedures as unclean,positive role models in the team and knowledge about infection prevention practices. Conclusion: To increase compliance to basic hygiene guidelines a change is needed in the healthcare workers attitude towards the importance of hygiene. Compliance needs to becomean unquestionable norm and the health care staff needs to be given opportunity to control theirbehavior. Clinical significance: To increase healthcare workers compliance to hygieneguidelines, knowledge about the factors that may influence their behavior is required.

Canal maintenance, involving mechanical removal of sediments and algal growth from canal basins, is necessary for sustaining the viability of the irrigation water delivery system in the Imperial Valley of California. Maintenance activities, however, disturb canal sediments laden with bacteria and can negatively impact water quality downstream. Our work quantified fecal indicator bacteria (Escherichia coli) and pathogens (Salmonella) in canal water prior to, during, and post-maintenance events. The goal of this study was to construct a post-maintenance time matrix that will allow growers downstream to estimate when canal water once again meets water quality guidelines. In addition, we assessed the water quality impacts of lining canals with concrete, which is a costly endeavor in the short term, but may be beneficial in the long term as lined canals do not require routine dredging to maintain canal integrity. During eight maintenance events from March 2013 through August 2014, 22% of 396 water samples collected exceeded the irrigation water quality guidelines (<126 MPN E. coli 100 mL-1) during canal maintenance. During summer months (July and August 2013-2014), E. coli concentrations in water samples commonly reached maximum values (>2419.6 MPN E. coli 100 mL-1), and these samples were more readily collected from unlined canal sampling sites. During winter and spring months, 80.8% of E. coli exceedances for unlined canals met guideline standards in less than 22 hours, while 19.2% of exceedances took longer (up to 48 hours) to return to acceptable levels; in lined sites, 63.6% and 36.4% met guidelines in less than 22 hours and 48 hours, respectively. Summer months showed a different trend: in unlined canal sites, 56.3% of E. coli exceedances met standards within 22 hours and 43.7% within 48 hours; in lined sites, 100% of water samples met standards in less than 22 hours. Unlined sites averaged higher temperatures overall compared to lined sites, and canal water in July (2013) was extremely warm (averaging 32.8°C) and reached human body temperature (37°C) at several unlined sites, a temperature at which enteric bacteria are known to thrive. Culturable Salmonella were detected in water samples collected in summer, with 22.2% of Salmonella-positive samples within 1°C of human body temperature. E. coli concentrations were significantly correlated with temperature and pH in unlined canals only. Unlined canals showed 15.2% of water samples were Salmonella-positive during summer maintenance whereas 1.7% of lined canals were positive. Salmonella significantly correlated with pH in lined canals. Fecal indicators (E. coli) did not predict pathogen (Salmonella) presence. Molecular methods (qPCR) suggested far higher levels of Salmonella when compared to cultural methods, with molecular markers for Salmonella exceeding culturing by more than 600%. The results of this work suggest that growers should exercise caution when irrigating after canal maintenance events, and to be completely certain of acceptable irrigation water quality, should wait for 48 hours following the onset of maintenance (typically 24 hours following the re-introduction of water to the channels) prior to irrigating crops. Further, irrigation district guidelines may consider: 1) disposing of the“first flush”of canal water following maintenance into nearby open areas, rather than sending poor-quality water into the irrigation canal system; 2) collect sediments and algae deposited on canal banks and transport to a secondary location to prevent precipitation runoff and re-introduction of bacteria-laden sediments to canals, and 3) consider the long-term costs and benefits of canal lining.

Background: Lung cancer causes more deaths than any other cancer. Smoking causes roughly 90% of lung cancer cases. Concurrent chemoradiation therapy is the standard of care for stage IIIb patients with performance status (PS) 0-1. A less toxic approach is warranted for less fit patients. To optimize care, the understanding of common clinical variables such as haematological responses to inflammation could be much improved. Adherence to guidelines for proper clinical work-up is vital to ensure patients’ optimal care, especially for predictive assays. Screening of high-risk patients is now being implemented internationally. Chronic pulmonary obstructive disease (COPD) patients, a group at high risk to develop lung cancer, could be of interest for screening. Methods: Patient cohorts collected nationally and regionally by manual search in patient records or automated search in electronic patient records and national registries were analysed in relation to overall survival, comorbidities, medication, treatment, smoking status, biomarkers and adherence to guidelines. Standard statistics were applied to adjust for confounding factors. Results: Induction chemotherapy results in longer overall survival than radiotherapy alone (15.6 and 11.6 months respectively). The overall survival for patients with combined anaemia, leucocytosis and thrombocytosis at diagnosis is half of what could be anticipated if blood samples are normal (8.0 and 16.0 months respectively). Fifty percent of patients were overlooked in the routine work-up with EGFR analysis. Less than 40% of the patients received EGFR-tyrosine kinase inhibitors in first-line therapy. The frequency of EGFR mutation was 9.9%. COPD patients with asthma and medicating with inhaled corticosteroids, specific serotonin reuptake inhibitors (SSRI) or beta-blockers have a significantly decreased risk of lung cancer. Conclusions: Patients unfit to receive chemoradiation therapy should be considered for induction chemotherapy sequentially to radiotherapy. A patient that presents with pathological blood samples is likely to have poor prognosis and diagnostic work-up should be thorough to optimize outcome. Inadequate adherence to the national guidelines regarding treatment and EGFR analysis was shown. COPD patients medicating with ICS, beta-blockers or SSRI and with a concurrent asthma diagnosis have a decreased risk of lung cancer.

Bakgrund: Vårdrelaterade infektioner skapar stora påfrestningar i vården på samhälls-,organisations och individnivå. Vårdpersonalens tillämpning och följsamhet tillbefintliga evidensbaserade riktlinjer är det mest effektiva sättet att förbygga VRI. För attsjuksköterskor skall kunna bedriva ett preventivt arbete och möjliggöra en patientsäkervård är det av vikt att undersöka de faktorer som påverkar följsamheten till dessariktlinjer.Syfte: Syftet med litteraturstudien var att beskriva faktorer som kan leda till attsjuksköterskor inte följer evidensbaserade riktlinjer för att förebygga vårdrelateradeinfektioner. Vidare har syftet varit att granska artiklarna avseende dess datainsamlingsmetod.Metod: En deskriptiv litteraturstudie med fjorton artiklar som underlag. Artiklarna haräven granskats utifrån dess datainsamlingsmetodHuvudresultat: Flera olika faktorer samverkar till varför sjuksköterskor inte följerevidensbaserade riktlinjer, där både inre och yttrefaktorer ingår. Tydligt framkommer attsjuksköterskor saknar kunskap och praktiska färdigheter. Sjuksköterskansföreställningar om den egna kapaciteten och den faktiska tillämpningen av riktlinjernaöverensstämmer med verkligheten. Vidare framkom att sjuksköterskornasföreställningar om konsekvenser, där sjuksköterskan har en tendens att minimeraomfattningen av de konsekvenser, som deras handlande eller underlåtelse av handlande,kan medföra.Slutsats: Sjuksköterskor saknar kunskap kring evidensbaserade riktlinjer för attförebygga vårdrelaterade infektioner. Dock finns det flera faktorer som kan förklaravarför inte riktlinjerna efterföljs. / Background: Healthcare associated infections creates great strains in healthcare at asocietal-, organizational- and individual level. Healthcare workers implementation andadherence to existing evidence-based guidelines is the most effective way to preventnosocomial infections. For nurses to conduct preventive work and enabling a safe carefor patients, it is important to examine the cause of deficiencies in adherence to theseguidelines.Aim: The aim of this survey was to describe factors that can explain why nurses do notfollow evidence-based guidelines for preventing healthcare-associated infections.Furthermore, the aim has been to examine the articles regarding the data collection method.Method: A descriptive literature survey based on fourteen articles. Articles have beenexamined in terms of the data collection method.Main result: Several different factors contribute to why nurses do not follow evidence-based guidelines, where both internal and external factors interact. It’s clearly revealedthat nurses lack knowledge and practical skills. Nurses' beliefs about their own capacityand actual application of the guidelines correspond poorly with reality. It has alsoemerged that according to the nurses' beliefs about consequences, the nurse has atendency to minimize the extent of the consequences of their act or omission of action. Conclusion: Nurses lack knowledge about evidence-based guidelines for preventinghealthcare-associated infections. However, there are several factors that could explainwhy the guidelines are not applied.