The purpose of the thesis is to contribute to grid planning and public debate about how the electric power system can cope with electrification and decarbonisation. The thesis is based on the assumption that Sweden, in accordance with the climate goals, will achieve climate neutrality by 2045. Based on a literature review, an analysis is made of how different scenarios predict the future national electricity demand up until 2045 and identifies the underlying drivers for changes in electricity demand. A more detailed analysis based on results from a literature review and interviews with industry representatives is made for four chosen regions, Norrbotten, Västra Götaland, Stockholm and Skåne. For each region, estimates are made of how high the electrification potential is in the industrial, transport, residential and service sectors. The prerequisites for the electricity grid to handle the identified electrification potential, in terms of grid capacity, have been analysed in order to highlight what challenges there are for large-scale electrification to be a key factor in achieving the climate goals. The general belief in the studied scenarios is that the national electricity demand will increase until 2045. The investigated scenarios predict increases resulting in an annual national electricity demand of up to 207 TWh in 2045, corresponding to an increase of almost 60 %. The most significant increases are due to decarbonisation in the industry and transport sector. The regional analysis shows significant electrification potentials in the investigated regions. A few industries stand out with dramatic increases, Borealis AB in Västra Götaland shows an electrification potential of 8 TWh and 1 000 MW and SSAB in Norrbotten shows an electrification potential of 9 TWh and 900 MW. Significant electrification potentials in the transport, residential and service sectors have been identified in metropolitan areas, i.e. in the region of Stockholm, Västra Götaland and Skåne. The grid analysis shows that it will be challenging to increase grid capacity at sufficient speed. It is concluded that there is currently insufficient grid capacity to meet large-scale electrification, and that the grids need to be reinforced. However, the concession process for grid reinforcements is considered too slow to meet the demands that arise, primarily in the industry sector. Three ways to address this challenge have been identified: -          If the permission process for electricity grid expansion does not change and the industry is to choose the electrification route, this needs to be decided before 2030 in order for reinforcements in the electricity grid to be ensured before 2045. -          Speed up the permit process to allow shorter lead times for power grid expansions. -          The industry choose another route for decarbonisation than electrification. The overall conclusion is that new approaches for expanding the electricity grid will be required if large-scale electrification is to be a key factor in achieving the climate goals in 2045.

The deinstitutionalization of the intellectually disabled (ID) and their transition to community living in New York State necessitated training initiatives for staff to manage challenging behaviors safely and humanely. However, the use of physical interventions to control self-injury and physical aggression may have become organizationally habituated, and limited research has compared programs that use physical versus nonphysical interventions. This mixed-method, comparative case study compared a restraint-free day habilitation program with one that used physical interventions, examining the differences in reducing self-injury, aggression, and types of interventions applied. Qualitative differences in philosophical approach to behavior intervention strategies and staff training protocols were examined using semi-structured interviews with employees (n -¬=11). Insufficient sample size precluded inferential analyses, but descriptively the results revealed more incidents of physical assault and self-injury in the program that used physical interventions. Further, behaviors ceased without intervention more frequently than they did in the restraint-free program. Qualitative results revealed shared qualities of person-centered organizational culture across both programs. These results suggest that an organizational culture that incorporates training and staff support in the use of restraint-free strategies may influence the type and frequency of challenging behaviors in this population. This study promotes positive social change by providing information that the Office of Persons with Developmental Disabilities can use to inform the development of ID-serving agency policies and staff training protocols to promote safety, respect, and well-being in ID persons who access community learning services.

Agtarap, Wright, Mlynski, Hammad, and Blackledge took an initial step in providing support for the predictive validity of a new conceptual analysis concerned with behavioral restraint, defined as active resistance against a behavioral impulse or urge. The current study was designed to partially replicate and extend findings from their study, employing a common film protocol and a procedure for inducing low- and high levels of fatigue. Analyses on key data indicated that the fatigue manipulation was ineffective. On the other hand, they supported the suggestion that behavioral restraint should be proportional to the strength of an urge being resisted so long as success is perceived as possible and worthwhile. Analyses also provided evidence of gender differences for this behavioral restraint task. Women showed relatively enhanced CV responses to my manipulation of urge magnitude, performed less well, rated the behavioral restraint challenge as harder, and rated success on the more difficult behavioral restraint task as more important. A broad indication is that men and women can differ in the strength of impulses they experience in response to stimulus presentations as well as in the importance they place on resisting the impulses.

Over the last decades, researchers have proposed a number of tools for the condition assessment of concrete infrastructure affected by alkali-silica reaction (ASR). Amongst those, increasing attention has been given to the Stiffness Damage Test (SDT), Damage Rating Index (DRI), and Residual Expansion (RE) laboratory test procedures that aim to determine the cause and extent (i.e., diagnosis) of damage along with the potential of further deterioration (i.e., prognosis) of affected concrete. Yet, most of the data gathered so far while using the aforementioned tools has been obtained on laboratory test specimens presenting distinct conditions from affected structural members in the field, especially regarding restraint effects. This work aims to understand the impact of restraint on ASR-induced expansion and damage. Thirty-two 450 mm by 450 mm by 675 mm concrete blocks with various reinforcement configurations (i.e., unreinforced, 1D and 2D reinforcement) and incorporating highly reactive coarse and fine aggregates (i.e., Springhill coarse and Texas sand) were manufactured and stored in conditions enabling ASR-induced development (i.e., 38°C and 100 R.H). Two expansion levels were selected for analysis (i.e., 0.08% and 0.15%); once reached, cores were extracted from three different directions (i.e., longitudinal, transversal and vertical) of all blocks and mechanical (i.e., SDT and compressive strength), microscopic (i.e., DRI, scanning electron microscope, etc.) and expansion (i.e., RE) test procedures were conducted on the concrete cores. Results suggest that the presence of restraint influences the induced expansion, resulting in an anisotropic response of the specimens. Furthermore, similar to the expansion behavior, an anisotropic distribution of induced damage and mechanical properties reduction are observed for the restrained concrete blocks in which the restraint configuration seems to significantly affect ASR-induced damage development and features. This led to the observation of a higher number of damage features, ASR development and mechanical properties reduction in cores obtained from unrestrained directions. Yet, some anticipated results from the current research will be studied in detail in the near future where the reliability of the existing techniques (i.e., residual expansion and soluble alkalis) for appraising ASR potential for further induced development and distress (i.e., prognosis) in affected concrete presenting distinct restraint scenarios will be evaluated.

Bakgrund: Den psykiatriska heldygnsvården ämnas att vila på samma värdegrund som övriga vården; en humanistisk människosyn med respekt och omtanke för den som vårdas. Patienten som vårdas inom psykiatrisk heldygnsvård har i samma utsträckning rätt till en god vård där hens självbestämmande och integritet respekteras. Trots detta kräver situationen ibland att detta frångås och sjuksköterskan blir i stället tvungen att ta till tvångsåtgärder av olika slag, som riskerar att kränka patientens värdighet och skada vårdrelationen. Samtidigt som psykisk ohälsa har blivit alltmer vanligt förekommande i samhället har psykiatrin diskuterats och granskats i media. Allt fler visar ett stort missnöje kring hur vården bedrivs och har starka åsikter kring det faktum att patienterna fråntas sina rättigheter och vårdas med tvång. Sjuksköterskan slits mellan viljan att göra gott och att göra rätt gentemot patienten samtidigt som den egna hälsan står på spel. Syfte: En litteraturöversikt för att belysa sjuksköterskors erfarenheter av att utföra tvångsåtgärder inom psykiatrisk heldygnsvård. Metod: Strukturerad litteraturöversikt enligt granskningsmallen av Bettany-Saltikov och McSherry (2016). Kvalitativa artiklar från tre olika databaser analyserades och sammanställdes i en kvalitativ innehållsanalys. Tretton artiklar relevanta för ämnet analyserades och la grunden till litteraturöversiktens fem kategorier för att belysa sjuksköterskors erfarenheter av tvångsåtgärder inom den psykiatriska heldygnsvården. Resultat: Baserat på de tretton artiklar som valdes ut för denna litteraturöversikt skapades fem kategorier som uppmärksammar sjuksköterskans utsatthet och etiska dilemma vid tvångsåtgärder, hur viktigt det är med en god vårdrelation, stöd i arbetet och slutligen hur tvångshandlingar är en balansgång mellan gott och ont. Slutsats: Att som sjuksköterska utsätta patienten för tvångsåtgärder kan ses som en nödvändighet men även vara ett svårt etiskt dilemma som sätter både den vårdande relationen och patientens välbefinnande på spel. Sjuksköterskor inom den psykiatriska heldygnsvården har ett uttalat behov av ökad utbildning och stöd samt tid för reflektion där de får möjlighet att bearbeta de känslor som uppkommer vid utförandet av tvångsåtgärder. Det krävs även er tid och möjlighet för sjuksköterskor att skapa en god vårdrelation till patienterna då det inte bara kan underlätta vid tvångsåtgärder utan även kan fungera förebyggande.

No description available.

No description available.

In psychiatric settings, the use of seclusion and/or restraints can be emotionally and psychologically traumatizing for patients. Patients often experience these interventions as inhumane and humiliating, and such interventions can have physical and mental adverse effects and in some cases can be fatal. This study examined the role of demographic, clinical, and hospital variables in predicting seclusion and/or restraint episodes in adult psychiatric inpatients. A total of 395 patients were included in the study. Adult psychiatric inpatients previously restrained (n = 91) were compared to psychiatric inpatients never restrained (n = 304). A binary logistic regression research design was used to examine the relationship of demographic variables, clinical variables, and hospital variables on the likelihood of being placed in seclusion or restraints. The results yielded age as a significant predictor for patients being restrained. Also, individuals diagnosed with bipolar disorder were less likely to experience a seclusion and/or restraint event than patients diagnosed with depressive disorder or within the schizophrenia spectrum. In addition, findings suggest that adult psychiatric inpatients that experienced restraint episodes were restrained within the 1st month of admission, during the weekday and during the 1st shift. In summary, given the findings from this study, knowledge of risk factors that precede patient restraint could enhance education and provide staff with information necessary to meet the clinical needs of the psychiatric inpatient population. Research indicates that the use of seclusion and restraint has decreased followed by implementation of educational programs designed to help staff assess patient clinical care needs and develop more therapeutically appropriate alternatives (Bower et al., 2003). By being aware of possible risk factors associated with seclusion and/or restraint, mental health providers can use early intervention and prevention strategies to reduce the use of seclusion and/or restraint. This would provide safer environments for mental health patients receiving treatment.

No description available.

Introduction: The purpose of this study is to examine how nursing home (NH) characteristics, specifically racial composition of nursing homes residents, influences the use of physical restraints. As the population ages and becomes more diverse, it is essential to mitigate/eliminate racial/ethnic disparities in quality care. Methods: This is cross-sectional study using a 2010 national data set from Brown University Center for Gerontology and Healthcare Research. This study employs Donabedian's Structure-Process-Outcome (SPO) conceptual framework. Statistical analysis includes univariate, bivariate, and a logistic regression model. It is hypothesized that nursing homes with higher proportions of black residents, more Medicaid residents, and for-profit ownership status will be associated with higher prevalence of physical restraint use. Results: Findings show that nursing homes with high proportions of blacks have a lower likelihood of high physical restraint use. Nursing homes with a higher proportion of Medicaid-reliant residents have a higher likelihood of restraint use, as does for-profit nursing homes. Discussion: The findings indicate that there are no racial/ethnic disparities present in the use of physical restraints in nursing homes. There is indication of socio-economic disparities, since nursing homes with higher Medicaid-reliant residents are associated with greater restraint. There are policy implications associated with these findings, including raising Medicaid per diem or implementing a quality performance payment incentive. Further research will be needed to determine ways to reduce racial/ethnic disparities in nursing homes. This research, adds to the nursing home literature focused on socio-economic disparities.