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<strong>Background</strong>: The rate of maternal death from sepsis has increased in several European countries, most notably the UK, where sepsis is now the leading cause of direct maternal death. An increase in maternal mortality also implies an increase in the number of women with severe, life-threatening morbidity. Key information gaps in the understanding of severe maternal sepsis in the UK are: the incidence, main causative organisms, infection sources, and risk factors for severe maternal sepsis. <strong>Methods</strong>: Four population-based observational studies were conducted to address these evidence gaps. <strong>Results</strong>: The incidence of severe maternal morbidity from sepsis is increasing in the UK, a trend also evident in the USA. The most common sources are respiratory tract, genital tract and urinary tract infection. The predominant organisms causing infection are E. coli, group A streptococcus, and strong circumstantial evidence of Streptococcus pneumonia. Sepsis progresses very rapidly particularly with group A streptococcal infection. Approximately 20% of women with severe sepsis progress to septic shock and 2% of women die. Risk factors for severe maternal sepsis in the UK with a large effect size are: febrile illness or antibiotics in the 2 weeks prior to onset of severe sepsis (aOR=12.1, 95% CI 8.1-18.0), caesarean section after the onset of labour (aOR= 8.1, 95% CI 4.7-14.0), multiple pregnancy (aOR= 5.8, 95% CI 1.5-21.5), infection with group A streptococcus (aOR=4.8 for progression to septic shock, 95% CI 2.2-10.8), pre-labour caesarean section (aOR= 3.8, 95% CI 2.2-6.6), low socioeconomic status (aOR=2.6, 95% CI 1.03-6.7), and operative vaginal delivery (aOR=2.5, 95% CI 1.3-4.7). Risk factors are significantly cumulative. <strong>Conclusions</strong>: Infection prior to or after delivery, even if the woman appears to be well, should be a marker for close clinical monitoring. Suspicion of group A streptococcus should be regarded as an obstetric emergency and treated ahead of laboratory confirmation.

The purpose of this research study was to provide training for peer tutors to use simultaneous prompting to increase the percentage of correct responses of sight words by students with moderate to severe disabilities. The study included four students with moderate to severe disabilities in an elementary school setting. A multiple probe (days) design across behaviors replicated across students was used to evaluate the effectiveness of the simultaneous prompting procedure used by peer tutors to teach students with moderate to severe disabilities in the general education setting. The results indicated the peers were able to reliably implement the procedures, but a functional relation was demonstrated with only one participant.

The purpose of this study was to teach telling time to the hour, half-hour, quarter to the hour, and to 5 min to students with austim spectrum disorder (ASD) or other developmental disabilities using video modeling (VM). Two research questions were asked: 1. Is there a functional relation between VM and increases in level and trend for telling time to the hour, half-hour, quarter hour, or 5 min for students with ASD and/or other developmental disabilities? 2. Will the use of the VM help students reach criterion on the task analytic steps for the process of telling time? A multiple probe (days) across participants design was used evaluate the effectiveness of the VM. The results showed student improvement of telling time, but no functional relation was found. The results showed improvement of telling time once System of Least Prompts was added to the VM.

Background: The World Health Organization (WHO) recommends the community-based Outpatient Therapeutic Program (OTP) as a standard treatment protocol for the management of uncomplicated Severe Acute Malnutrition (SAM) at the community level. OTP has been scaled up and integrated into the existing grassroots level government health systems in several developing countries. The aim of this thesis was to assess the implementation and outcome of a scaled-up and integrated OTP service provided at community level. Methods: One qualitative study and three quantitative studies were conducted in southern Ethiopia. Children admitted to 94 integrated OTPs, their caregivers and health extension workers providing primary health care services in the nearby health posts were included in this study. The quantitative studies were based on data generated from observation of a cohort of 1,048 children admitted to the integrated OTPs. Result: On admission 78.8% of the children had SAM. The majority of these children 60.2% exited the program neither achieving program recovery criteria nor being transferred to inpatient care. Fourteen weeks after admission to OTP, 34.6% were severely malnourished and 34.4% were moderately malnourished, thus 69.0% were still acutely malnourished. Ready-to-use Therapeutic Foods (RUTFs) provided for SAM children were commonly shared with other children in the household and sold as a commodity for the collective benefit of the family thus admitted children received only a portion of the provided amount. Further, the program suffered a severe shortage of RUTFs, where only  46.6% of admitted children were given the recommended amount of RUTFs by providers on admission and only 34.9% of these had uninterrupted provision during the follow-up. Conclusion: The integrated OTPs we studied provide a constrained service and the use of RUTFs by families is not as intended by the program. The majority of admitted children remained acutely malnourished after participating in the program for the recommended duration. For integrated OTPs to be effective in chronically food-insecure contexts, interventions that also address the economic and food needs of the entire household are essential. This may require a shift to view SAM as a symptom of broader problems affecting a family rather than as a disease of an individual child. In addition, further research is needed to understand the health system context regarding RUTFs and medication supply and service utilization of integrated OTPs.

The purpose of this study was to examine the effectiveness of using the system of least prompts and concrete representations to teach students with moderate and severe disabilities (MSD) to solve simple linear equations. A multiple-probe (days) across participants, single case research design was used to evaluate the effectiveness of task analytic instruction along with concrete representation on teaching students with MSD to solve algebraic equations. The results showed the system of least prompts and concrete representations were effective in teaching students with MSD to solve simple linear equations.

The North American monsoon (NAM) is the principal driver of summer severe weather in the Southwest U.S. With sufficient atmospheric instability and moisture, monsoon convection initiates during daytime in the mountains and later may organize, principally into mesoscale convective systems (MCSs). Most monsoon-related severe weather occurs in association with organized convection, including microbursts, dust storms, flash flooding and lightning. The overarching theme of this dissertation research is to investigate simulation of monsoon severe weather due to organized convection within the use of regional atmospheric modeling. A commonly used cumulus parameterization scheme has been modified to better account for dynamic pressure effects, resulting in an improved representation of a simulated MCS during the North American monsoon experiment and the climatology of warm season precipitation in a long-term regional climate model simulation. The effect of urbanization on organized convection occurring in Phoenix is evaluated in model sensitivity experiments using an urban canopy model (UCM) and urban land cover compared to pre-settlement natural desert land cover. The presence of vegetation and irrigation makes Phoenix a "heat sink" in comparison to its surrounding desert, and as a result the modeled precipitation in response to urbanization decreases within the Phoenix urban area and increase on its periphery. Finally, analysis of how monsoon severe weather is changing in association with observed global climate change is considered within the context of a series of retrospectively simulated severe weather events during the period 1948-2010 in a numerical weather prediction paradigm. The individual severe weather events are identified by favorable thermodynamic conditions of instability and atmospheric moisture (precipitable water). Changes in precipitation extremes are evaluated with extreme value statistics. During the last several decades, there has been intensification of organized convective precipitation, but these events occur with less frequency. A more favorable thermodynamic environment for monsoon thunderstorms is the driver of these changes, which is consistent with the broader notion that anthropogenic climate change is presently intensifying weather extremes worldwide.

Självstigma hos personer med allvarlig psykisk störning behöver undersökas med tanke på att den psykiska ohälsan ökar. Syftet med studien var att undersöka hur självstigma påverkat individer med allvarlig psykisk störning. Studien utfördes som en litteraturstudie och resultatet utgjordes av tre kategorier: Att bli sin diagnos, Att känna skam och Att känna hopplöshet. Självstigma påverkar personer med allvarlig psykisk störning genom att försvåra förutsättningarna till återhämtning. Kombinationen av en allvarlig psykisk störning och självstigma skapar negativa konsekvenser utifrån individens egna stereotypa och fördomsfulla föreställningar. Individerna har svårt att känna mening med livet och undviker att söka hjälp på grund av skam och hopplöshet. Detta i sin tur kan leda till förvärrade symptom och ökat lidande. Sjuksköterskan behöver därför vara medveten kring problematiken med självstigma och vara observant kring individens egna fördomar, skamkänslor och känsla av hopplöshet kring sin diagnos. Det är av vikt att skapa förutsättningar för empowerment i vårdsituationen. Interventioner och omvårdnad bör ha som målsättning att minska symptomen av självstigma hos individer med allvarlig psykisk störning. Interventioner torde kunna utformas, men behöver anpassas utifrån vilket samhälle som vården utförs i. Det finns begränsningar i aktuell forskning och fler studier där självstigma som fenomen belyses vore önskvärt, liksom longitudinella studier för att ge en djupare förståelse. / Severe mental illness is a growing health problem. Severe mental illness and self-stigma in combination needs to be examined to clarify what impact they have in combination for each individual. The purpose of this study was to examine what kind of impact self-stigma has to individuals with severe mental illness. The study was conducted as a literature review and the results consisted of three categories: Becoming ones illness Feeling of shame and Feeling of hopelessness. Self-stigma affects the individuals negatively and makes it harder for them to recover. The combination of severe mental illness and self-stigma creates negative consequences from the stereotypical and jaundiced. Individuals have problems with finding meaning of life and are reluctant to seek treatment for their symptoms because of the feeling of shame and hopelessness. In return the symptoms of the mental illness increases and provides more suffering and decreases the meaning of life. It is important that nurses are aware of and are mindful to the individuals prejudice, feelings of shame and hopelessness about their mental illness. Nurses need to make sure that it is possible to be empowered as a patient. Interventions and nursing that aim to reduce the symptoms of self-stigma in severe mental illness should be adapted to the prejudice of the society. More scientific research is needed because of the limited number of present studies concerning self-stigma. There is a need to further investigate self-stigma in severe mental illness. Preferably studies with longitudinal design that focus on the phenomenon self-stigma and how it affects people with severe mental illness, to give a greater understanding.

The purpose of the study was to evaluate the effects of a system of least prompts procedure and use of a graphic organizer to teach an academic standard for elementary students with moderate intellectual disabilities. A multiple probe (days) across participants design was used to evaluate the effectiveness of using a system of least prompts and a graphic organizer to teach students how to compare two characters from adapted text. The results showed a system of least prompts and the use of graphic organizer was effective in teaching an academic standard for students with moderate intellectual disabilities.

Bakgrund: Tjugo procent av de som vårdar en närstående i Sverige idag är föräldrar som vårdar sina barn i hemmet. Vårdandet är så tidskrävande och omfattande att det innebär stor påfrestning för föräldrarna. Den kontinuerliga kontakten föräldrarna måste ha med sjukvården gör sjuksköterskan betydelsefull. I sjuksköterskans kompetensbeskrivning ingår en stödjande roll till anhöriga. Syfte: Syftet var att belysa föräldrars upplevelse av att vårda sitt allvarligt sjuka barn. Metod: En litteraturöversikt enligt Fribergs (2012) metod gjordes. Översikten är baserad på tolv vetenskapliga artiklar hämtade ur databaserna CINAHL och PubMed. Teman som utkristalliserade sig i artiklarnas resultat delades in i kategorier och subkategorier.  Resultat: Resultatet presenteras i två huvudkategorier med tillhörande subkategorier. Första huvudkategorin “Diagnostillfället” beskriver föräldrarnas känslomässiga upplevelser och sjukvårdens betydelse i samband med diagnostillfället. Andra huvudkategorin “Upplevelser av det konstanta vårdandet” beskriver hur föräldrarna påverkats känslomässigt och socialt, den påverkan vårdarrollen haft på identiteten, svårigheter i kontakten med sjukvården samt det behov av hjälp och stöd som framkom. Diskussion: Resultatet diskuteras med Betty Neumans omvårdnadsteoretiska systemmodell som utgångspunkt. Föräldrarna påverkades på flera plan och sjukvården visade sig ha en betydande roll i detta. Föräldrarna beskrev behov av hjälp och stöd som sjukvården inte tillgodosåg i tillräcklig utsträckning. Sjuksköterskor behöver ha en helhetssyn med fokus på ett individ- och grupperspektiv i både bemötande och utformning av hjälp och stöd. / Background: Twenty procent of people giving care to a relative in Sweden today are parents who care for their severe ill child at home. The care is time-consuming and extensive and becomes a big strain for the parents. The continuous encounters with the health care makes the nurse’s role more significant. The nurse's competence description embrace a supportive attitude towards relatives. Aim: The aim of this study was to describe parents' experience of caring for their severe ill child. Method: A literature review in accordance to Fribergs (2012) method was carried out. The review is based on twelve scientific articles retrieved from the databases CINAHL and PubMed. Themes that emerged in the results of the articles were sorted into categories and subcategories. Results: The results is presented in two main categories with associated subcategories. The first main category "diagnosis" describes parents’ emotional experiences and the significance of the health care system associated with the occasion of the diagnosis. The second main category "experiences of providing constant care" describes how parents are affected emotionally and socially, the impact the caring role had on the identity, difficulties in dealing with the health care system and the need for help and support that were identified. Discussions: The results are discussed using the Neuman systems model as a framework. The parents were affected on several levels and in relation to this the health care system played a significant role. The parents described need of help and support was not fully provided for. To meet these parents in the best way possible, nurses need to have a holistic view with an individual and a group perspective both in approach and design of the health care.