<p>Syftet med studien var att beskriva hur vårdpersonal skattar användbarheten av stöd samt i vilken frekvens de använder sig av stöd gentemot syskon till svårt sjuka barn. Syftet var även att undersöka skillnader mellan sjuksköterskor och undersköterskor gällande den skattade användbarheten samt frekvens i användandet av stöd till syskon till svårt sjuka barn.</p><p>Studien var deskriptiv och jämförande. Ett bekvämlighetsurval användes. Datainsamlingen skedde med hjälp av en enkät som delades ut till 94 personer på tre avdelningar och mottagningar i ett mellansvenskt län. Femtiofem respondenter besvarade enkäten och inklusionskriterierna motsvarades av 53 respondenter, vilka inkluderas i studien. Undersökningsgruppen bestod av sjuksköterskor och undersköterskor, alla kvinnor. Enkäten var en, till svenska, översatt version av instrumentet Sibling Social Support Questionnaire. Deltagarna bedömde "användbarhet" och "frekvens" av stöd inom 30 påståenden. Dessa berörde områdena emotionellt-, instrumentellt- och informativt stöd samt uppskattning som stöd. Huvudresultatet visade att stödområdet "Uppskattning som stöd" sammantaget ansågs vara mest användbart och också användes mest. Resultatet visar också en statistiskt signifikant skillnad mellan yrkesgrupperna (p = 0,03). Sjuksköterskorna använde stödområdet "Uppskattning som stöd" mer frekvent (mean rank 29,88) än undersköterskorna (mean rank 20,63).</p> / <p>The purpose of the study was to describe how health professionals estimate the usefulness of support and in what frequency they use the support towards siblings of seriously ill children. The aim was also to examine differences between nurses and assistant nurses regarding the estimated usefulness and frequency of use of support for siblings of severely ill children.</p><p>The study was descriptive and comparative. A convenience sample was used. The data collection was done using a questionnaire that was distributed to 94 people in three care units and open care units in a mid-swedish region. Fifty-five respondents answered the survey and 53 of those met the inclusion criteria and were included in the study. The study group consisted of nurses and assistant nurses, all women. The questionnaire was a, into Swedish translated version of the instrument Sibling Social Support Questionnaire. The participants assessed the "usefulness" and "frequency" of support within 30 claims. These areas touched emotional-, instrumental-, informational-, and appraisal support. The main results showed that the area <em>"Appraisal support"</em> was considered most useful and also used most frequently. The results also showed a statistically significant difference between professional categories (p = 0.03). The nurses used the support area <em>"Appraisal support"</em> more frequently (mean rank 29.88) than the assistant nurses (mean rank 20.63).</p>

<p>The newly established Swedish Apheresis Registry makes it possible to do national inter-center comparisons. This study was undertaken to describe and analyze the use of therapeutic apheresis and the adverse effects in such therapy. The special case of plasma exchange as rescue therapy in multi-organ failure, including renal failure, was also studied. In Sweden, plasma for transfusion is prepared and stored to ensure rapid availability. Due to new EU legislation, validation of such plasma was performed. </p><p>The analysis indicated that the use of therapeutic apheresis was in line with recommendations of other international societies. The frequency and types of adverse effects were comparable to those reported in other studies from analogous time periods. Compared with other countries, it appears that more therapeutic resources are available in Sweden and that there is a lower frequency of adverse effects in specific procedures. No fatalities were reported. The unique comparison of differences between centers regarding plasma exchange identified areas for further improvement.</p><p>The study on plasma exchange as rescue therapy in severe sepsis or septic shock is the second largest reported. The result was promising, with a survival rate of 82%. The rapid availability of plasma for transfusion appears to be of clinical importance in patients with early coagulopathy and severe trauma but the present selection and storage procedures for plasma lead to a time-dependent increase of the number of units with cold-induced activation of the contact system and C1 inhibitor consumption before day 14. Improvements of plasma quality can be attained by using plasma from male donors only and by reducing the storage time from 14 to 7 days. </p><p>Further studies are needed to define the role of plasma exchange in severe sepsis/septic shock, to evaluate the outcome of each patient’s treatment and to establish the indications for the transfusion of plasma.</p>

NiTiHf alloys have attracted considerable attention as potential high temperature Shape Memory Alloy (SMA) but the instability in transformation temperatures and significant irrecoverable strain during thermal cycling under constant stress remains a major concern. The main reason for irrecoverable strain and change in transformation temperatures as a function of thermal cycling can be attributed to dislocation formation due to relatively large volume change during transformation from austenite to martensite. The formation of dislocations decreases the elastic stored energy, and during back transformation a reduced amount of strain is recovered. All these observations can be attributed to relatively soft lattice that cannot accommodate volume change by other means. We have used Equal Channel Angular Extrusion (ECAE), hot rolling and marforming to strengthen the 49.8Ni-42.2Ti-8Hf (in at. %) material and to introduce desired texture to overcome these problems in NiTiHf alloys. ECAE offers the advantage of preserving billet cross-section and the application of various routes, which give us the possibility to introduce various texture components and grain morphologies. ECAE was performed using a die of 90º tool angle and was performed at high temperatures from 500ºC up to 650ºC. All extrusions went well at these temperatures. Minor surface cracks were observed only in the material extruded at 500 °C, possibly due to the non-isothermal nature of the extrusion. It is believed that these surface cracks can be eliminated during isothermal extrusion at this temperature. This result of improved formability of NiTiHf alloy using ECAE is significant because an earlier review of the formability of NiTiHf using 50% rolling reduction concluded that the minimum temperature for rolling NiTi12%Hf alloy without cracks is 700°C. The strain level imposed during one 90° ECAE pass is equivalent to 69% rolling reduction. Subsequent to ECAE processing, a reduction in irrecoverable strain from 0.6% to 0.21% and an increase in transformation strain from 1.25% to 2.18% were observed at a load of 100 MPa as compared to the homogenized material. The present results show that the ECAE process permits the strengthening of the material by work hardening, grain size reduction, homogeneous distribution of fine precipitates, and the introduction of texture in the material. These four factors contribute in the increase of stability of the material. In this thesis I will be discussing the improvement of mechanical behavior and stability of the material achieved after various passes of ECAE.

Ultra-fine grained (UFG) materials have attracted considerable interest due to the possibility of achieving simultaneous increase in strength and ductility. Effective use of these materials in engineering applications requires investigating the processing-microstructure-property inter-relations leading to a comprehensive understanding of the material behavior. Research efforts on producing UFG hexagonal close packed (hcp) materials have been limited in spite of their envisaged utilization in various technologies. The present study explores multiple UFG hcp materials to identify the general trends in their deformation behaviors, microstructural features, crystallographic texture evolutions and mechanical responses under strain path changes. UFG hcp materials, including commercial purity Ti, Ti-6Al-4V alloy and high purity Zr, were fabricated using equal channel angular extrusion (ECAE) as a severe plastic deformation (SPD) technique following various processing schedules. Several characterization methods and a polycrystal plasticity model were utilized in synergy to impart the relationships between the UFG microstructure, the texture and the post-ECAE flow behavior. Pure UFG hcp materials exhibited enhanced strength properties, making them potential substitutes for coarse-grained high strength expensive alloys. Incorporation of post-ECAE thermo-mechanical treatments was effective in further improvement of the strength and ductility levels. Strong anisotropy of the post-ECAE flow response was evident in all the materials studied. The underlying mechanisms for anisotropy were identified as texture and processing-induced microstructure. Depending on the ECAE route, the applied strain level and the specific material, the relative importance of these two mechanisms on plastic flow anisotropy varied. A viscoplastic self-consistent approach is presented as a reliable model for predicting the texture evolutions and flow behaviors of UFG hcp materials in cases where texture governs the plastic anisotropy. Regardless of the material, the initial billet texture and the extrusion conditions, ECAE of all hcp materials revealed similar texture evolutions. Accurate texture and flow behavior predictions showed that basal slip is the responsible mechanism for such texture evolution in all hcp materials independent of their axial ratio. High strength of the UFG microstructure was presented as a triggering mechanism for the activation of unexpected deformation systems, such as high temperature deformation twinning in Ti-6Al-4V and room temperature basal slip in pure Zr.

No description available.

No description available.

The newly established Swedish Apheresis Registry makes it possible to do national inter-center comparisons. This study was undertaken to describe and analyze the use of therapeutic apheresis and the adverse effects in such therapy. The special case of plasma exchange as rescue therapy in multi-organ failure, including renal failure, was also studied. In Sweden, plasma for transfusion is prepared and stored to ensure rapid availability. Due to new EU legislation, validation of such plasma was performed. The analysis indicated that the use of therapeutic apheresis was in line with recommendations of other international societies. The frequency and types of adverse effects were comparable to those reported in other studies from analogous time periods. Compared with other countries, it appears that more therapeutic resources are available in Sweden and that there is a lower frequency of adverse effects in specific procedures. No fatalities were reported. The unique comparison of differences between centers regarding plasma exchange identified areas for further improvement. The study on plasma exchange as rescue therapy in severe sepsis or septic shock is the second largest reported. The result was promising, with a survival rate of 82%. The rapid availability of plasma for transfusion appears to be of clinical importance in patients with early coagulopathy and severe trauma but the present selection and storage procedures for plasma lead to a time-dependent increase of the number of units with cold-induced activation of the contact system and C1 inhibitor consumption before day 14. Improvements of plasma quality can be attained by using plasma from male donors only and by reducing the storage time from 14 to 7 days. Further studies are needed to define the role of plasma exchange in severe sepsis/septic shock, to evaluate the outcome of each patient’s treatment and to establish the indications for the transfusion of plasma.

Background: During the last decades patient satisfaction has become an important measurement of quality in psychiatric care. However the patients are seldom asked to evaluate the treatments. Objectives: The aim is to determine which factors the outpatients regard as beneficial in their psychiatric treatment. The purpose is explorative. During the study another purpose developed; to present research on the importance of the relationship between the caretaker and the caregiver for the outcome. Method: 30 persons were interviewed about what they found helpful in psychiatric treatment. The interviews were open using Grounded Theory as methodological input. Result: The most prominent topic was the quality of the relationship between the caregiver and the caretaker. The characteristics of a helping relationship seem to be when the patient: - is being listened to and understood by a caregiver who is interested and concerned. - is not only seen as a caretaker with problems but also as a complete person, someone more than an equation of symptoms, diagnoses and shortcomings - is seen as a person worth listening to with unique knowledge which matters to the caregiver - is seen as a unique person not possible to minimize to just another case

One of the assumptions made when mental problems are defined as a medical problem is that certain problems, certain diagnoses, are chronic. Nevertheless, a substantial number of follow-up studies have shown that the course of development in patients with these diagnoses is neither uniform nor chronic. The aim of this dissertation is to summarise the state of the art in the knowledge about recovery from severe mental disorders and to examine in depth which factors people who have recovered regard as having helped them in their recovery, and in which ways. These two aims have resulted in two separate but complementary presentations of results. The review of the state of the art, which focuses on the diagnosis schizophrenia, shows that some two-thirds of the patients who received this diagnosis have recovered, either totally or socially. The variation in the percentage of persons who have recovered is explained in the study by such factors as fluctuations in national and local unemployment rates, in definitions of the diagnoses and in access to psychiatric care. On the other hand, the introduction of various treatment interventions seems to have had no noticeable effect on the recovery rate, although it has affected the relapse frequency. There is still a long way to go towards understanding the recovery process and how it can be facilitated. The interview study with persons who have been treated for severe mental disorders and recovered show the patients themselves to be a crucial factor in their own recovery. Throughout the whole course of the disorder, they struggle to find ways to manage both their symptoms and the factors that cause them. What appears to others as symptoms might instead be theperson’s unsuccessful attempts to manage existential problems. Entering into and maintaining relationships with other people is another crucial factor in recovery work. Professionals from a variety of backgrounds as well as family members and other laypersons can contribute to recovery, first and foremost in that they represent continuity between diverse facets of the person’s life; they engage with the person in his/her full complexity, not as someone reduced to a diagnosis and a given patient role, nor by denying the fact of the person’s suffering. Still another factor in recovery work is material conditions which impact on the person’s possibility to regain an identity as a full member of the community. Lastly, the descriptions that the respondents give of their recovery practice have certain constructed meanings in common. These meanings can be categorised as medical, therapeutic, spiritual and interactional. In many of the life stories collected in this study, several of these categories of meaning appear in unison, co-existing in one and the same life story. There is a recurrent theme running through these practice stories of recovery: that people in their everyday lives are not reducible to their problems, but at the same time these problems must not be denied. That people have both weaknesses and strengths, sometimes existing within the same spheres of life and occurring simultaneously; but that in relationships with other people they are given scope to manage and live with these contradictions is of central importance for recovery practice.

Syftet med studien var att beskriva hur vårdpersonal skattar användbarheten av stöd samt i vilken frekvens de använder sig av stöd gentemot syskon till svårt sjuka barn. Syftet var även att undersöka skillnader mellan sjuksköterskor och undersköterskor gällande den skattade användbarheten samt frekvens i användandet av stöd till syskon till svårt sjuka barn. Studien var deskriptiv och jämförande. Ett bekvämlighetsurval användes. Datainsamlingen skedde med hjälp av en enkät som delades ut till 94 personer på tre avdelningar och mottagningar i ett mellansvenskt län. Femtiofem respondenter besvarade enkäten och inklusionskriterierna motsvarades av 53 respondenter, vilka inkluderas i studien. Undersökningsgruppen bestod av sjuksköterskor och undersköterskor, alla kvinnor. Enkäten var en, till svenska, översatt version av instrumentet Sibling Social Support Questionnaire. Deltagarna bedömde "användbarhet" och "frekvens" av stöd inom 30 påståenden. Dessa berörde områdena emotionellt-, instrumentellt- och informativt stöd samt uppskattning som stöd. Huvudresultatet visade att stödområdet "Uppskattning som stöd" sammantaget ansågs vara mest användbart och också användes mest. Resultatet visar också en statistiskt signifikant skillnad mellan yrkesgrupperna (p = 0,03). Sjuksköterskorna använde stödområdet "Uppskattning som stöd" mer frekvent (mean rank 29,88) än undersköterskorna (mean rank 20,63). / The purpose of the study was to describe how health professionals estimate the usefulness of support and in what frequency they use the support towards siblings of seriously ill children. The aim was also to examine differences between nurses and assistant nurses regarding the estimated usefulness and frequency of use of support for siblings of severely ill children. The study was descriptive and comparative. A convenience sample was used. The data collection was done using a questionnaire that was distributed to 94 people in three care units and open care units in a mid-swedish region. Fifty-five respondents answered the survey and 53 of those met the inclusion criteria and were included in the study. The study group consisted of nurses and assistant nurses, all women. The questionnaire was a, into Swedish translated version of the instrument Sibling Social Support Questionnaire. The participants assessed the "usefulness" and "frequency" of support within 30 claims. These areas touched emotional-, instrumental-, informational-, and appraisal support. The main results showed that the area "Appraisal support" was considered most useful and also used most frequently. The results also showed a statistically significant difference between professional categories (p = 0.03). The nurses used the support area "Appraisal support" more frequently (mean rank 29.88) than the assistant nurses (mean rank 20.63).