O presente trabalho realiza uma leitura da chamada segunda trilogia em prosa de Samuel Beckett composta pelos textos Company (1980), Ill Seen Ill Said (1981) e Worstward Ho (1983), com especial atenção para a obra Company. Tais textos fazem parte da prosa final do autor, marcada pelo hibridismo de gêneros e por um intenso questionamento da linguagem e da representação literária. Destacando as características desta fase procuramos argumentar que, em meio a todos os experimentos do narrador beckettiano, há um mecanismo de busca de companhia na própria narrativa, tema que atravessa diversos trabalhos de Beckett e se evidencia com a publicação de Company. A necessidade de companhia através do ato de narrar, contudo, processa-se de forma ambígua e conflituosa. / This dissertation presents a reading of Samuel Beckett´s so-called second trilogy in prose comprising the works Company (1980), Ill Seen Ill Said (1981), and Worstward Ho (1983), with special focus on Company. These texts belong to the authors late prose, characterized by a mixture of genres and the intense questioning of both language and literary representation. While highlighting the specificities of this period, we argue that among all the experiments of the Beckettian narrator there is a mechanism that seeks for company within the very narrative a theme present in many of Becketts works, which is further stressed by the publication of Company. The need for company through the act of narrative, however, unfolds in an ambiguous and conflicted manner.

O presente trabalho realiza uma leitura da chamada segunda trilogia em prosa de Samuel Beckett composta pelos textos Company (1980), Ill Seen Ill Said (1981) e Worstward Ho (1983), com especial atenção para a obra Company. Tais textos fazem parte da prosa final do autor, marcada pelo hibridismo de gêneros e por um intenso questionamento da linguagem e da representação literária. Destacando as características desta fase procuramos argumentar que, em meio a todos os experimentos do narrador beckettiano, há um mecanismo de busca de companhia na própria narrativa, tema que atravessa diversos trabalhos de Beckett e se evidencia com a publicação de Company. A necessidade de companhia através do ato de narrar, contudo, processa-se de forma ambígua e conflituosa. / This dissertation presents a reading of Samuel Beckett´s so-called second trilogy in prose comprising the works Company (1980), Ill Seen Ill Said (1981), and Worstward Ho (1983), with special focus on Company. These texts belong to the authors late prose, characterized by a mixture of genres and the intense questioning of both language and literary representation. While highlighting the specificities of this period, we argue that among all the experiments of the Beckettian narrator there is a mechanism that seeks for company within the very narrative a theme present in many of Becketts works, which is further stressed by the publication of Company. The need for company through the act of narrative, however, unfolds in an ambiguous and conflicted manner.

Ökosystem-Ingenieure sind Organismen, deren Auswirkung auf die Funktion von Ökosystemen im Vergleich zu ihrer Anzahl und Biomasse überproportional groß ist. Ein klassisches Beispiel für Ökosystem-Ingenieure sind grabende Organismen, deren Aktivitäten (Bioturbation) sowohl die Sedimentmatrix als auch das Porenwasser in aquatischen Sedimenten beeinflussen. Solche Tiere wirken auf eine große Anzahl von biogeochemischen Prozessen in benthischen Ökosystemen ein, unter anderem auf die aerobe Atmung (Respiration). Die Respiration aquatischer Sedimente umfasst häufig über 50 % der gesamten Respiration von aquatischen Systemen und spielt eine große Rolle im globalen Kohlenstoffkreislauf. Die vorliegende Doktorarbeit beschäftigt sich mit den Auswirkungen der physikalischen Umwelt (Sedimenteigenschaften, am meistens hydraulischer Leitfähigkeit) auf die mikrobielle Respiration von Sedimenten, in denen Bioturbation durch Chironomidenlarven stattfindet. Um die Auswirkungen von Bioturbation auf Respiration zu messen und zu identifizieren, wurde eine neue Messmethode entwickelt (Kapitel 4.1). Kapitel 4.2 zeigt, dass der Einfluss von Bioturbation auf die Respiration des Sediments mit zunehmender Temperatur ansteigt. Kapitel 4.3 belegt, dass Resazurin auch für die Messung der Respiration in marinen Sedimenten geeignet ist. Kapitel 4.4 vergleicht und begutachtet die große Anzahl und Vielfalt hydrologischer, biogeochemischer und ökologischer Tracer einschließlich Resazurin. Die physikalische Umwelt (Sedimentmatrix) kontrolliert wie stark die Auswirkungen der Bioturbation auf die Respiration des Sedimentes sind. Dementsprechend liefert diese Doktorarbeit die Basis für das Verständnis der Auswirkungen benthischer Bioturbation auf Respiration und Kohlenstoffumsatz in limnischen und marinen Sedimenten. / Ecosystem engineers are organisms, whose impact on ecosystem functioning is disproportionally large compared to their abundance and biomass. A classic example of ecosystem engineers are burrowing organisms whose activities (bioturbation) affect the sediment matrix and pore solutes in aquatic sediments. Bioturbating animals are impacting on a number of biogeochemical processes in benthic ecosystems, including, among others, aerobic respiration. Respiration of aquatic sediments often comprises over 50% of the total respiration of aquatic systems, and plays a tremendous role in the global carbon cycle. The present thesis deals with the impacts of the physical environment (sediment characteristics, mainly hydraulic conductivity and grain fractions) on the (microbial) respiration of bioturbated sediments. In order to disentangle the effects of bioturbation on respiration, a novel measurement method has been developed (Chapter 4.1). Chapter 4.2 reveals that the impact of bioturbation on sediment respiration increases with increasing temperature. Chapter 4.3 shows that resazurin can also be used for the measurement of respiration in bioirrigated marine sediments. Chapter 4.4 reviews the large number and diversity of hydrological, biogeochemical and ecological tracers including resazurin. The present thesis shows that in sediments with low hydraulic conductivity (diffusion-dominated sediments) (Chapters 4.1,4.2) bioturbation is altering sediment respiration to a larger extent than in sediments with high hydraulic conductivity (advection-dominated sediment) (Chapter 4.3). The physical environment (sediment matrix) controls the intensity of the impacts of bioturbation on sediment respiration. Thus, this thesis provides a basis for understanding the impact of benthic bioturbators on respiration and carbon sequestering in freshwater and marine sediments.

The Affordable Care Act of 2010 increased the number of patients seen in a northeast, urban trauma emergency department by 34%. This created a problem as it occurred simultaneously with a nursing shortage. Consequently, patient satisfaction scores fell below the national average benchmark. The rate patients left the emergency department without being seen was 2.6% higher than the national average and patient fall rates increased by 20%. A review of the literature to search for solutions led to the support of an hourly rounding project and an educational workshop promoting proactive nurse behaviors as a way to address the quality and safety gap. The goal of this scholarly project was to develop this evidence based, theory supported project and to conduct a formative and summative evaluation by an expert review panel in order to achieve consensus before implementation. An executive team was formed and led through the process of development of a detailed hourly rounding protocol and workshop, which will be implemented at the facility at a later time. A 10 member expert panel was formed. The panel members consented to participate in an explanatory session, to review all project materials, and to complete an anonymous 20 question survey tool. The panel also consented to review any changes made to materials as part of a summative evaluation. Descriptive analysis of the formative data demonstrated a 90% overall agreement that the workshop was comprehensive and covered key concepts within 5 categories. Minor requested revisions were made in response to formative results. The summmative review demonstrated 100% consensus on the revisions. This project will bring about social change by engaging nurses in proactively caring for patients in a safe and efficient manner.

The lakes of the East African Rift System (EARS) have been intensively studied to better understand the influence of climate change on hydrological systems. The exceptional sensitivity of these rift lakes, however, is both a challenge and an opportunity when trying to reconstruct past climate changes from changes in the hydrological budget of lake basins on timescales 100 to 104 years. On one hand, differences in basin geometrics (shape, area, volume, depth), catchment rainfall distributions and varying erosion-deposition rates complicate regional interpretation of paleoclimate information from lacustrine sediment proxies. On the other hand, the sensitivity of rift lakes often provides paleoclimate records of excellent quality characterized by a high signal-to-noise ratio. This study aims at better understanding of the climate-proxy generating process in rift lakes by parameterizing the geomorphological and hydroclimatic conditions of a particular site providing a step towards the establishment of regional calibrations of transfer functions for climate reconstructions. The knowledge of the sensitivity of a lake basin to climate change furthermore is crucial for a better assessment of the probability of catastrophic changes in the future, which bear risks for landscapes, ecosystems, and organisms of all sorts, including humans. Part 1 of this thesis explores the effect of the morphology and the effective moisture of a lake catchment. The availability of digital elevation models (DEM) and gridded climate data sets facilitates the comparison of the morphological and hydroclimatic conditions of rift lakes. I used the hypsometric integral (HI) calculated from Shuttle Radar Topography Mission (SRTM) data to describe the morphology of ten lake basins in Kenya and Ethiopia. The aridity index (AI) describing the difference in the precipitation/evaporation balance within a catchment was used to compare the hydroclimatic of these basins. Correlating HI and AI with published Holocene lake-level variations revealed that lakes responding sensitively to relatively moderate climate change are typically graben shaped and characterized by a HI between 0.23-0.30, and relatively humid conditions with AI >1. These amplifier lakes, a term first introduced but not fully parameterized by Alayne Street-Perrott in the early 80s, are unexceptionally located in the crest of the Kenyan and Ethiopian domes. The non-amplifier lakes in the EARS either have lower HI 0.13-0.22 and higher AI (>1) or higher HI (0.31-0.37) and low AI (<1), reflecting pan-shaped morphologies with more arid hydroclimatic conditions. Part 2 of this work addresses the third important factor to be considered when using lake-level and proxy records to unravel past climate changes in the EARS: interbasin connectivity and groundwater flow through faulted and porous subsurface lithologies in a rift setting. First, I have compiled the available hydrogeological data including lithology, resistivity and water-well data for the adjacent Naivasha and Elmenteita-Nakuru basins in the Central Kenya Rift. Using this subsurface information and established records of lake-level decline at the last wet-dry climate transitions, i.e., the termination of the African Humid Period (AHP, 15 to 5 kyr BP), I used a linear decay model to estimate typical groundwater flow between the two basins. The results suggest a delayed response of the groundwater levels of ca. 5 kyrs if no recharge of groundwater occurs during the wet-dry transition, whereas the lag is 2-2.7 kyrs only using the modern recharge of ca. 0.52 m/yr. The estimated total groundwater flow from higher Lake Naivasha (1,880 m a.s.l. during the AHP) to Nakuru-Elmenteita (1,770 m) was 40 cubic kilometers. The unexpectedly large volume, more than half of the volume of the paleo-Lake Naivasha during the Early Holocene, emphasizes the importance of groundwater in hydrological modeling of paleo-lakes in rifts. Moreover, the subsurface connectivity of rift lakes also causes a significant lag time to the system introducing a nonlinear component to the system that has to be considered while interpreting paleo-lake records. Part 3 of this thesis investigated the modern intraseasonal precipitation variability within eleven lake basins discussed in the first section of the study excluding Lake Victoria and including Lake Tana. Remotely sensed rainfall estimates (RFE) from FEWS NET for 1996-2010, are used for the, March April May (MAM) July August September (JAS), October November (ON) and December January February (DJF). The seasonal precipitation are averaged and correlated with the prevailing regional and local climatic mechanisms. Results show high variability with Biennial to Triennial precipitation patterns. The spatial distribution of precipitation in JAS are linked to the onset and strength of the Congo Air Boundary (CAB) and Indian Summer Monsoon (ISM) dynamics. while in ON they are related to the strength of Positive ENSO and IOD phases This study describes the influence of graben morphologies, extreme climate constrasts within catchments and basins connectivity through faults and porous lithologies on rift lakes. Hence, it shows the importance of a careful characterization of a rift lake by these parameters prior to concluding from lake-level and proxy records to climate changes. Furthermore, this study highlights the exceptional sensitivity of rift lakes to relatively moderate climate change and its consequences for water availability to the biosphere including humans. / Die Seen des Ostafrikanischen Riftsystems (EARS) wurden bereits intensiv untersucht, um den Einfluss des Klimawandels auf das hydrologische Systeme besser verstehen zu können. Dabei stellt die außergewöhnliche Sensitivität dieser Riftseen sowohl eine Herausforderung als auch eine Möglichkeit dar, um den historischen Klimawandel von dem hydrologischen Budget der Seebecken auf Zeitskalen von 10 bis 10000 Jahre abzuleiten. Auf der einen Seite verkomplizieren verschiedene Beckengeometrien (Form, Fläche, Volumen, Tiefe), unterschiedliche Niederschlagsverteilungen der einzelnen Zuflüsse und variierende Erosions- und Sedimentationsraten, die aus den Informationen von Seesedimenten generierten, regionalen Interpretationen des Paleoklimas. Andererseits ergibt sich aus der hohen Sensitivität der Riftseen eine exzellente Datenqualität, was sich in dem hohen Signal - Rausch-Verhältnis widerspiegelt. Das Ziel meiner Untersuchungen ist das verbesserte Verständlichkeit der Klimainformationen generierenden Prozesse in den Riftseen als Voraussetzung für weitere Klimarekonstruktion. Fortschritte gab es vor allem in der Entwicklung von regionalen Kalibrationen durch die Parametrisierung der geomorphologischen und hydroklimatischen Gegebenheiten einer wichtigen Lokalität, wodurch es jetzt möglich ist, von Sedimentfunden auf die Umgebungsbedingungen Rückschlüsse zu ziehen. Das Wissen um die Reaktion der Seebecken auf Klimaschwankungen ist unerlässlich für eine bessere Abschätzung der Wahrscheinlichkeit von katastrophalen Änderungen in der Zukunft:ein Szenario das sowohl für Umwelt, Ökosysteme und Organismen, einschließlich des Menschen, Risiken birgt. Im ersten Teil meiner Doktorarbeit untersuche ich den Effekt der Morphologie und der effektiven Feuchtigkeit auf das Einzugsgebiet eines Sees. Die Verfügbarkeit von digitalen Höhenmodellen (DEM) und gerasterten Klimadatensätzen ermöglicht den Vergleich von morphologischen und hydroklimatischen Bedingungen der Riftseen. Ich nutzte das hypsometrische Integral (HI), berechnet aus Daten der “Shuttle Radar Topography Mission (SRTM)”, um die Morphologie von zehn Seebecken in Kenia und Äthopien zu beschreiben. Der Dürreindex (AI), der die Differenz von Niederschlag zu Verdunstung innerhalb eines Einzugsgebietes beschreibt, wurde benutzt, um das Hydroklima dieser Becken zu vergleichen. Die Korrelation von hypsometrischem Integral und Dürreindex mit publizierten holozänen Seespiegelschwankungen zeigte, dass vor allem Seen mit kleiner Oberfläche und großer Tiefe (Grabenform), charakterisiert durch ein HI von 0.23-0.30 und feuchte Bedingungen mit einem AI > 1, empfindlich auf relativ moderate Klimaänderungen reagieren. Diese “verstärkenden” Seen (amplifier lakes), ein Begriff der von Alayne Street-Perrott in den Achzigerjahren eingeführt wurde aber bis heute nicht völlig quantitativ definiert ist, sind ohne Ausnahme in den tiefen Gräben der kenianischen und äthiopischen Dome zu finden. Seen innerhalb des EARS, die nicht derart empfindlich reagieren, haben entweder ein niedrigeres HI von 0.13-0.22 und einen höheren AI (>1) oder ein höherers HI (0.31-0.37) aber einen niedrigen AI (<1) und zeigen großflächige, flache Morphologien (Pfannenform) unter trockenen klimatischen Bedingungen. Der zweite Teil der Arbeit beschäftigt sich mit einem weiteren wichtigen Faktor innerhalb der Klimarekonstruktion, wenn Seespiegelschwankungen und indirekte Messungen (Proxies) betrachtet werden:den störungsbezogenen und porösen Gesteinsschichten geschuldeten Grundwasserverbindungen zwischen den Becken. Als erstes habe ich die vorhandenen hydrogeologischen Daten bestehend aus den Gesteinsformationen, deren Widerstandsfähigkeit und den wasserbezogenen Bohrdaten für die Seen Naivasha und Elementaita-Nakuru zusammengestellt. Mit diesen bereits etablierten Untergrunddaten, z.B. zum Seespiegelrückgang am letzten Übergang von feuchtem zum trockeneren Klima am Ende der afrikanischen Feuchtperiode (AHP) um 15000 bis 5000 Jahre vor heute, schätzte ich den typischen Grundwasserfluss zwischen den beiden benachbarten Becken mittels eines linearen Modells ab. Die Ergebnisse zeigen eine Zeitverzögerung der Grundwasserspiegelanpassung um ca. 5000 Jahre an, falls keine Auffüllung der Grundwasserzufuhr zum Ende der letzten Feuchtperiode eintrat. In heutiger Zeit, ist bedingt durch die Grundwassererzufuhr von ca. 0.52 m/Jahr, nur eine Zeitverzögerung um ca. 2000-2700 Jahre zu sehen. Der geschätzte totale Grundwasserfluss vom höher gelegenden Naivasha See (1880 m über dem Meeresspiegel zum Ende der AHP) zum Elementaita-Nakuru See (1770 m) betrug 40 km3. Dieses unerwartet große Volumen, mehr als die Hälfte des Volumens vom Naivasha See während des frühen Holozäns, verdeutlicht, dass das Grundwasser für die hydrologische Modellierung von Paleoseen in Riftgebieten unbedingt mit einbezogen werden muss. Darüber hinaus führt die Grundwasserverbindung dieser Riftseen zu einer Zeitverzögerung in deren Reaktionen, was eine nichtlineare Komponente darstellt und bei jeder Interpretation von Paleoseespiegeldaten beachtet werden muss. Der dritte Teil dieser Arbeit untersucht die intrasaisonale Niederschlagsvariabilität innerhalb von 11 Einzugsgebieten die im ersten Teil Arbeit vorgestellt wurden, mit Ausnahme des Viktoriasees, aber inklusive des Tanasees. Aus Satellitenbilddaten des FEWS NET der Jahre 1996-2010 wurden Niederschlagsabschätzungen für die Monatsreihen März-April-Mai (MAM), Juli-August-September (JAS), Oktober-November (ON) und Dezember-Januar-Februar (DJF) berechnet. Der jahreszeitliche Niederschlag wurde gemittelt und mit den dominierenden regionalen und lokalen Klimafaktoren korreliert. Die Ergebnisse zeigen eine deutliche zwei- bis dreijährige Niederschlagsvariabilität. Die räumliche Niederschlagsverteilung innerhalb des Ostafrikanische Rifts im JAS ist an die Ausbildung und Stärke der Kongoluftmassengrenze (CAB) und an die Dynamik des Indischen Sommermonsuns gekoppelt, während sie im ON an die Stärke der positiven ENSO und IOD Phasen gebunden ist. Diese Doktorarbeit beschreibt den Einfluss von Grabenmorphologien, extremen Klimakontrasten innerhalb der Zuflussgebiete und die unterirdischen Beckenverbindung durch Störungszonen und poröse Gesteinsschichten zwischen den Riftseen. Damit zeigt sie die Unerlässlichkeit einer genauen Charakterisierung von Riftseen durch morphologische und klimatische Parameter, bevor von Seespiegelschwankungen und indirekten Datensätzen auf Klimaänderungen geschlossen werden kann. Desweiteren stellt diese Arbeit die hohe Empfindsamkeit dieser Seen gegenüber relativ moderaten Klimaänderungen und deren Konsequenzen für die insgesamte Wasserverfügbarkeit heraus.

Die vorliegende Dissertation beschäftigt sich mit den Faktoren, die das Wachstum und die Vertikalverteilung von Planktonalgen in extrem sauren Tagebaurestseen (TBS; pH 2-3) beeinflussen. Im exemplarisch untersuchten TBS 111 (pH 2.7; Lausitzer Revier) dominiert die Goldalge Ochromonas sp. in oberen und die Grünalge Chlamydomonas sp. in tieferen Wasserschichten, wobei letztere ein ausgeprägtes Tiefenchlorophyll-Maximum (DCM) ausbildet. Es wurde ein deutlicher Einfluss von Limitation durch anorganischen Kohlenstoff (IC) auf das phototrophe Wachstum von Chlamydomonas sp. in oberen Wasserschichten nachgewiesen, die mit zunehmender Tiefe von Lichtlimitation abgelöst wird. Im Vergleich mit Arbeiten aus neutralen Seen zeigte Chlamydomonas sp. erniedrigte maximale Wachstumsraten, einen gesteigerten Kompensationspunkt und erhöhte Dunkelrespirationsraten, was auf gesteigerte metabolische Kosten unter den extremen physikalisch-chemischen Bedingungen hinweist. Die Photosyntheseleistungen von Chlamydomonas sp. waren in Starklicht-adaptierten Zellen durch IC-Limitation deutlich verringert. Außerdem ergaben die ermittelten minimalen Zellquoten für Phosphor (P) einen erhöhten P-Bedarf unter IC-Limitation. Anschließend konnte gezeigt werden, dass Chlamydomonas sp. ein mixotropher Organismus ist, der seine Wachstumsraten über die osmotrophe Aufnahme gelösten organischen Kohlenstoffs (DOC) erhöhen kann. Dadurch ist dieser Organismus fähig, in tieferen, Licht-limitierten Wasserschichten zu überleben, die einen höheren DOC-Gehalt aufweisen. Da die Vertikalverteilung der Algen im TBS 111 jedoch weder durch IC-Limitation, P-Verfügbarkeit noch die in situ DOC-Konzentrationen abschließend erklärt werden konnte (bottom-up Kontrolle), wurde eine neue Theorie zur Entstehung der Vertikalverteilung geprüft. Grazing der phagotrophen und phototrophen Alge Ochromonas sp. auf der phototrophen Alge Chlamydomonas sp. erwies sich als herausragender Faktor, der über top-down Kontrolle die Abundanz der Beute in höheren Wasserschichten beeinflussen kann. Gemeinsam mit der Tatsache, dass Chlamydomonas sp. DOC zur Wachstumssteigerung verwendet, führt dies zu einer Akkumulation von Chlamydomonas sp. in der Tiefe, ausgeprägt als DCM. Daher erscheint grazing als der Hauptfaktor, der die beobachtete Vertikalschichtung der Algen im TBS 111 hervorruft. Die erzielten Ergebnisse liefern grundlegende Informationen, um die Auswirkungen von Strategien zur Neutralisierung der TBS auf das Nahrungsnetz abschätzen zu können. / In this thesis, I investigated the factors influencing the growth and vertical distribution of planktonic algae in extremely acidic mining lakes (pH 2-3). In the focal study site, Lake 111 (pH 2.7; Lusatia, Germany), the chrysophyte, Ochromonas sp., dominates in the upper water strata and the chlorophyte, Chlamydomonas sp., in the deeper strata, forming a pronounced deep chlorophyll maximum (DCM). Inorganic carbon (IC) limitation influenced the phototrophic growth of Chlamydomonas sp. in the upper water strata. Conversely, in deeper strata, light limited its phototrophic growth. When compared with published data for algae from neutral lakes, Chlamydomonas sp. from Lake 111 exhibited a lower maximum growth rate, an enhanced compensation point and higher dark respiration rates, suggesting higher metabolic costs due to the extreme physico-chemical conditions. The photosynthetic performance of Chlamydomonas sp. decreased in high-light-adapted cells when IC limited. In addition, the minimal phosphorus (P) cell quota was suggestive of a higher P requirement under IC limitation. Subsequently, it was shown that Chlamydomonas sp. was a mixotroph, able to enhance its growth rate by taking up dissolved organic carbon (DOC) via osmotrophy. Therefore, it could survive in deeper water strata where DOC concentrations were higher and light limited. However, neither IC limitation, P availability nor in situ DOC concentrations (bottom-up control) could fully explain the vertical distribution of Chlamydomonas sp. in Lake 111. Conversely, when a novel approach was adopted, the grazing influence of the phagotrophic phototroph, Ochromonas sp., was found to exert top-down control on its prey (Chlamydomonas sp.) reducing prey abundance in the upper water strata. This, coupled with the fact that Chlamydomonas sp. uses DOC for growth, leads to a pronounced accumulation of Chlamydomonas sp. cells at depth; an apparent DCM. Therefore, grazing appears to be the main factor influencing the vertical distribution of algae observed in Lake 111. The knowledge gained from this thesis provides information essential for predicting the effect of strategies to neutralize the acidic mining lakes on the food-web.

Influenza is a highly contagious respiratory virus that can cause very severe health complications in people, and can be especially dangerous for young children. The peak influenza season occurs in the winter months with February usually being the month with the highest number of reported infections. As the virus can cause serious illness, pediatric institutions during the winter months see a very large number of patients who have influenza or influenza related complications. Pediatric Emergency Departments (ED) similarly see a dramatic increase in the number of patients who visit the ED during the winter influenza season. Therefore, it is important that pediatric EDs develop ways to handle the increased patient population while still maintaining quality care to the rest of the ED. Thus, a novel influenza clinic run entirely by non-ED Nurse Practitioners (NP) was implemented into the operations of the ED as an annexed clinic in February 2013 during the winter influenza season. The clinic was beneficial in improving the average quality measures of the ED against similar days without the influenza clinic, lowering the average length of stay (LOS) by 24 minutes (13% decrease) and lowering the left without being seen rates (LWBS) by 1.35% (3 fewer patients on average). In addition, using NPs instead of higher cost physicians dramatically lowered the cost of the clinic by nearly half. While the influenza clinic was beneficial in lowering the average LOS and LWBS rates against similar days without the clinic the data did not reach statistical significance, perhaps due to the small amount of data available. The results, despite the statistical insignificance, show a promising future in addition of an NP run influenza clinic to handle the increased patient population during the winter influenza season.

Detta examensarbete handlar om elevers matematikinlärning och hur elevers förutsättningar till att lyckas med matematikstudierna kan stödjas utanför skolan. Alla elever har inte samma förutsättningar för att studera utanför skolan, vissa kan t.ex. få hjälp av sina föräldrar medan andra elever inte har den möjligheten. Matteboken.se är ett verktyg som erbjuder elever som studerar på högstadie- eller gymnasienivå alternativ hjälp för deras studier i matematik. Ett ytterligare syfte har således varit att undersöka hur matteboken.se fungerar som stöd för elevers matematikstudier och vilka som använder sig av detta redskap. Litteraturstudier och en enkätundersökning användes som metoder för denna studie. Utifrån ett studerandeperskektiv analyseras resultaten med hjälp av Stadlers begrepp, matematikens lärobjekt, matematiska resurser och studenten som lärande aktör. Analysen görs även utifrån teorier från tidigare forskning om nätbaserad undervisning, studier utanför skoltid, motivation att studera samt elevers självbild. Slutsatser som kan dras från undersökningen är att läraren och läroboken är för eleverna de viktigaste resurserna för deras matematikinlärning. Elever med tillgång till hjälp hemma erhåller ett högre medelbetyg än vad elever som inte får någon hjälp gör. De elever som använder matteboken.se är främst elever som läser högskoleförberedande program, elever som får hjälp hemifrån samt elever vars föräldrar har högre utbildningsnivå. Elever får hjälp och stöd genom att utnyttja de olika funktionerna på matteboken.se. Elever lär sig matematik på olika sätt och det gäller för dem själva att veta hur de bör agera för att ta till sig kunskaperna på bästa sätt. Eleverna måste alltså både lära matematik och lära hur man lär matematik. / This thesis is about students' mathematics learning and how students' opportunities to succeed with math studies can be supported outside of school. All students do not have the same opportunities to study outside of school; some may get help from their parents while other students don't have that option. Matteboken.se is a tool that offers students who are studying at lower or upper secondary level alternative means for their studies in mathematics. A further aim of this degree project has thus been to examine how matteboken.se works to support students' mathematics study and which students make use of this tool. Literature studies and a survey are used as methods of this study. From a student perspective the results are analysed by using the concepts developed by Stadler regarding mathematical learning; mathematical learning objects, mathematical resources and student acting as a learner. The analysis is also being made in regards to theories from earlier research on netbased teaching, studysituations outside of school, motivation to study and students' selfimage. Conclusions that can be drawn from the study are that students see the teacher and the textbook as the most important mathematical resources for learning. Students with access to help at home receive a higher average grade than students who do not receive any help. The students who use matteboken.se are primarily students who study college preparatory programs, students who receive assistance from home and students whose parents have a higher level of education. Students receive help and support by exploiting the various features on matteboken.se. Students learn mathematics in different ways, and it is up to them to know how they should act to absorb knowledge in the best way. Students must therefore learn mathematics as well as learn how to learn mathematics.

Lake Vostok, East Antarctica, represents an extensive water surface at the base of the ice sheet. Snow, ice and atmospheric pressure loads applied anywhere within the lake area produce a hydrostatic response, involving deformations of the ice surface, ice–water interface and particle horizons. A modelling scheme is developed to derive height changes of these surfaces for a given load pattern. It is applied to a series of load scenarios, and predictions based on load fields derived from a regional climate model are compared to observational datasets. Our results show that surface height changes due to snow-buildup anomalies are damped over the lake area, reducing the spatial standard deviation by one-third. The response to air pressure variations, in turn, adds surface height variability. Atmospheric pressure loads may produce height changes of up to 4 cm at daily resolution, but decay rapidly with integration time. The hydrostatic load response has no significant impact neither on ICESat laser campaign biases determined over the lake area nor on vertical particle movements derived from GNSS observations.

This study sought to hear the narratives of individuals that have recovered from self-harming, with the intention of bearing witness to both the narratives and remaining scars in order to better understand and inform clinical practice. A purposive sample of seven individuals was recruited. Participants were asked to photograph their scars and bring them to an interview. Narratives were generated and explored through a relatively unstructured individual interview. Both the images and narratives were analysed using a narrative approach exploring content, performance and structural aspects, emphasising researcher reflexivity throughout. Findings were understood through psychoanalytic theory and highlighted a theme of validation and ‘being seen’, evidenced in stories of past invalidation that had been internalised into the self-structure and defended against by presenting a ‘defended’ self. Self-harm enabled this ‘unseen self’ to be expressed, validated and contained. Recovery was storied in terms of internalising experiences of validation, which enabled integration of the invalidated parts of the self. Many of the participants highlighted how their scars told a story of discovery; of becoming, coping and surviving. In the healing of scars this recovery is evident, but they may also continue to convey the unseen and unspoken experiences of pain, incoherence and invalidation. Self-harm and remaining scars may be understood as connecting, containing and re-embodying the internalised invalidation and ‘unseen’ aspects of the self. These findings are discussed with reference to the clinical implications, strengths and limitations of the methodology and directions for future research.