Person with hearing impairment (PHI) and their Communication partners (CPs) have a range of experiences and milestones before, during and after their audiological assessment and/or rehabilitation sessions. The term ‘patient journey’ refers to understanding the experiences and the processes the patient goes through during the course of the disease and the treatment regime. The aims of the current thesis were: (1) to further develop patient journey models of individuals with gradual-onset hearing impairment and CPs by taking their views into consideration; (2) to develop the patient journey model for PHI of sudden-onset; (3) to develop a self-reported measure of hearing disability acceptance and to study its construct and concurrent validity; (4) to investigate the health behaviour change characteristics of people noticing hearing difficulties using the stages-of-change model.  Papers I (n=32) and III (n=9) were aimed at further developing the journey model of PHI and their CPs proposed by the Ida Institute. Both studies employed qualitative methods (i.e., focus groups and interviews for data collection and thematic analysis for data analysis), and defined the models based on the perspectives of PHI and CPs both of which had seven main phases. These data were compared with the professionals’ perspectives of the journey as reported in the Ida Institute model which had six main phases. Our studies highlight new phases (i.e., self-evaluation in PHI journey and adaptation in CP journey) and also various commonalities and differences in the perspectives expressed by professionals and patients. Paper II included a pilot study to explore the patient journey of sudden-onset acquired hearing impairment from both professionals (n=16) and patients (n=4) perspectives. Both identified all the six main phases, which include: awareness; movement; diagnostics; rehabilitation; self-evaluation; and resolution. The pre-awareness phase may hinder the realisation of hearing loss in persons with gradual onset hearing loss, whereas it is far more straightforward in persons with sudden-onset due to its nature of onset. Papers IV and V employed a cross-sectional design (n=90). Paper IV was aimed at developing a Hearing Disability Acceptance Questionnaire (HDAQ), and to study its construct and concurrent validity. Results suggested that the HDAQ has a two factor structure which explains 75.7% of the variance and had good internal consistency (Cronbach’s alpha of 0.86). Also, the scale had good concurrent validity in relation to self-reported hearing disability, self-reported anxiety and depression and readiness to change measures. Paper V was aimed at understanding the stages-of-change in adults with hearing disability using the University of Rhode Island Change Assessment Scale.  As predicted a high percentage of participants (over 90%) were in the contemplation and preparation stages, supporting the stages-of-change model. Overall, the papers presented in this thesis may contribute to a better understanding of process of change through hearing impairment in PHI and their CPs. / Personer med hörselnedsättning (eng. PHI) och deras kommunikationspartners (eng. CPs) har en uppsättning upplevelser och erfarenheter före, under och efter audiologisk bedömning och/eller hörselrehabilitering. Begreppet "patientprocess" avser förståelsen av de erfarenheter och de förändringsprocesser patienten genomgår under sjukdomsförloppet och behandlingen av denna. Syftet med avhandlingen var: (1) att ytterligare utveckla individuella modeller för patientprocessen vid gradvis debut av hörselnedsättning och att ta CPs erfarenheter under beaktande, (2) att utveckla modeller för patientprocessen vid plötslig debut av hörselnedsättning, (3) att utveckla självskattningsmått på acceptans av hörselnedsättning och att studera dess begreppsvaliditet och samtidig validitet, (4) att undersöka beteendeförändring avsende hälsa för personer som upplever hörselnedsättning. Artikel I (n = 32) och artikel III (n = 9) syftade bland annat till att vidareutveckla modell av patientprocessen som och deras kommunikationspartner som föreslagits av Ida Institutet. I båda studierna användes kvalitativa metoder (fokusgrupper och intervjuer för datainsamling och tematisk analys) för att bygga modeller av patientprocessen personen med hörselnedsättning och dess kommunikationspartner, där båda modellerna kom att inkludera sju huvudfaser av processen. Resultaten jämfördes med sjukvårdspersonalens perspektiv på patientprocessen enligt Ida Institutets modell. Studierna visar nya faser (självvärdering för PHIs process och anpassning för CPs process). Dessutom identifierades likheter och skillnader i jämförelsen mellan sjukvårdspersonalens och patientens perspektiv. Artikel II innehåller en pilotstudie för att undersöka och skapa modeller för patientprocessen vid plötslig förvärvad hörselnedsättning från både vårdgivarens (n = 16) och patientens (n = 4) perspektiv. Båda grupper identifierade alla sex huvudfaser. Dessa inkluderar: medvetenhet; rörelse; diagnos; rehabilitering; självvärdering; och lösning på problemet. Pre-awareness (för-medvetande) fasen kan eventuellt fördröja/förhindra förståelsen för hörselnedsättningen för personer med gradvis tilltagande hörselnedsättning, emedan förståelsen är mer direkt för personer med plötslig förvärvad hörselnedsättning. Artikel IV och artikel V var bägge baserade på en tvärsnittsstudie (n=90). Artikel IV syftade till att utveckla ett frågeformulär angående acceptans av hörselhandikapp (eng. Hearing Disabiliy Acceptance Questionnaire, HDAQ) och att studera dess begreppsvaliditet och samtidig validitet. Resultaten visar att HDAQ fick en två-faktor struktur som förklarde 75,7 % av variansen och uppvisade god intern konsistens (Cronbach’s alpha 0,86). Dessutom hade skalan god samtidig validitet i förhållande till självrapporterad hörselnedsättning, självrapporterad ångest och depression, samt i förhållande till beredskap för förändring. Artikel V (n = 90) syftade till att undersöka stadier av beteendeförändring för personer med tidig, förmodad hörselnedsättning, via den så kallade stages-of-change modellen. Mätinstrumentet för beteendeförändring var University of Rhode Island Change Assessment Scale. Som förväntat var en hög andel av deltagarna (över 90%) i tidiga stadier (eng. contemplation and preparation), vilket stöder stages-of-change modellen. Sammanfattningsvis, bidrar artiklarna i denna avhandling till en bättre förståelse av förändingsprocesser via hörselnedsättning för personer med hörselnedsättning och deras kommunikationspartners.

Tobaksbruk är förknippat med ohälsa, stor risk finns att drabbas av följdsjukdomar. Syftet var att beskriva distriktssköterskors erfarenheter och upplevelser av att arbeta med tobaksavväjning i grupp. En studie med kvalitativ ansats och deskriptiv design har gjorts. Åtta distriktssköterskor som arbetar med tobaksavväjning i grupp har intervjuats. Materialet har analyserats med hjälp av kvalitativ innehållsanalys. I resultatets första kategori ”Viktigt med tydliga arbetsrutiner vid tobaksavvänjning i grupp” beskrevs exempelvis arbetsrutiner såsom att hemuppgifter gavs mellan grupptillfällena, tobaksstoppdatum planerades och uppföljningar gjordes. Dock beskrevs svårigheter att rekrytera deltagare till tobaksavvänjningsgrupperna, vilket innebar att personerna hänvisades till individuell tobaksavväjning. Det rapporterades vara psykiskt påfrestande att leda grupper om deltagare hade psykisk ohälsa och komplexa sociala problem. Andra kategorin ”Möjligheter och svårigheter vid gruppbehandling” beskrev att motiverande samtal användes och deltagarnas motivation ansågs avgörande för tobaksstoppet. Tobaksavväjningen uppgavs fungera när distriktssköterskan inte ”föreläste” utan uppmuntrade alla till att bli hörda, så att erfarenheter delades och stöd gavs åt varandra. Distriktssköterskorna upplevde arbetet stimulerande men även frustrerande, möjligheter till stöd av tobakssamordnare eller kollegor fanns, dock saknades stöd av läkare. Önskvärt enligt distriktssköterskorna vore att vara två som genomförde gruppträffarna tillsammans, ha tillräckligt med administrativ tid samt ha tid för fortbildning. Slutsatsen är att distriktssköterskorna arbetade efter tydliga arbetsrutiner. De upplevde både möjligheter och svårigheter med att genomföra gruppbehandling. Dock behövs mer fokus läggas på att rekrytera personer till grupperna så att grupper inte behöver ställas in, samt att ökad möjlighet till vidareutveckling av tobaksavvänjnings arbete i grupp bör ges till distriktssköterskorna.

This study focuses on the identification of didactic guidelines for presenting values education in secondary schools. The studied literature sends a clear message that values education is of cardinal importance in education, teaching and training. In 2000 the National Department of Education of South Africa assembled a task team to identify a set of values in particular relevant to education and training. In the report Manifesto on Values Education and Democracy (DOE, 2001) six core values are singled out as of primary importance to the new dispensation in South Africa: equality, equal rights, tolerance, multilingualism, transparency, accountability, and social responsibility. The Report focuses only on national, political and social values, however. From research performed by Rens (2005), Hattingh (1999) en Bagarette (1995), it is clear that an individual needs to be educated as a holistic being and all life values thus need to be addressed integratively . A literature study was undertaken to clarify the concepts values, value orientation and values education, and also to determine how adolescents experience values education. Consequently, different values education programmes currently implemented in foreign countries were analysed . It was found that the 'Cornerstone-waardes" programme of John Heenan, applied in New Zealand, could reasonably easily be adapted for the South African context. From the discussion of the curriculating process as applicable to values education, didactic guidelines could be formulated for values education in South African schools. To identify the current orientation to values as manifested by learners, teachers and school principals in South Africa, the values questionnaire compiled by Vreken and Rens (2001) for research on the values orientation of university learners, was adapted and completed by the population involved in this study. Principals were subjected to partly-structured interviews to gain their opinions on values education in schools. Interviews on possible guidelines for values education in South Africa were also conducted by e-mail with international experts. Since the primary aim of the study was to determine the values orientation of secondary school learners and to recommend didactic guidelines for values education, the aim was mainly attained by means of the empirical study. Noteworthy is, however, that there is no symmetry between learners' views on important values and those that the Department of Education finds it necessary to be promoted. / Thesis (Ph.D. (Education))--North-West University, Potchefstroom Campus, 2005.

The shift from Modernism to Postmodernism had a dramatic impact on different spheres of life, especially on premarital relationships. The Song of songs has been used as basis theory in this study on premarital relationships. The study attempts to lay down guidelines for premarital relationships from the conviction that human relationships are grounded in God's love for man. The perspectives which have became evident are developed and evaluated through the meta-theory. Any study on young people in relationships must consider changes in society due to the fact that young people perform an important seismographic function. This is due to the fact that they are not only deeply affected by these changes but are also acting as indicators for the demands and challenges that changing times has on people and relationships. The lifecycle from late adolescence to early adulthood is studied. Special focus is given to different areas of development in this lifecycle as well as to different relationships young people are involved with. Qualitative interviews have been used to determine the effect of the Postmodernism and the specific lifecycle on young people in premarital relationships. A practice-orientated theoretical framework for pastoral guidance of young people in premarital relationships is drafted. / Thesis (Ph.D. (Pastoral))--North-West University, Potchefstroom Campus, 2006.

The behavioral ecology of the American Wigeon (Anas americana) was studied over its annual cycle in western Canada between 1974 and 1978. The objective of this work was to examine the cross-seasonal interactions of the biology and behavior of the wigeon as they underlie the evolution of its mating system. The wigeon was more herbivorous than any other dabbling duck studied so far and spent a considerable amount of time feeding in upland habitats. Vegetation was important in the diet year round but particularly from late summer through the winter. Plant seeds were a rich source of protein and carbohydrate early in the spring. During breeding stages animal foods were selected by wigeons, particularly females. Wigeons usually did not feed on small crustaceans and gastropods but selected larger aquatic insect foods. Relative to other Anas soecies, the wigeon has a goose-like bill whose structure facilitates feeding on upland and aquatic vegetation. With the evolution of this specialization, efficient surface-straining of small foods has been sacrificed. To increase food digestibility, wigeons altered gizzard grit composition and organ sizes. Through these mechanisms I have demonstrated how wigeons have been able to increase the efficiency of digestion.

The purpose of this mixed-methods, multi-site study was to identify and explore the concerns of teachers and principals implementing a pilot Response to Intervention (RTI) model in three elementary schools in the southeast United States and to determine whether these concerns differed significantly from the beginning to the end of the first year of implementation. The Stages of Concern from the Concerns-Based Adoption Model (George, Hall, & Stiegelbauer, 2006; Hord, Rutherford, Huling, & Hall, 2004) served as the theoretical framework for the design and analysis of this study. Between Fall 2008 and Spring 2009, 18 participants, including six administrators and 12 teachers, were interviewed through semi-structured interviews. Observations and documents also served as data sources. The Stages of Concern Questionnaire was completed by 168 teachers and principals in Fall 2008 and Spring 2009. Paired samples t-tests were performed on the data to determine if levels of concern differed significantly over time. Themes developed in the fall suggested: (a) confusion over the RTI process and difficulty scheduling the required components of RTI; (b) additional responsibilities placed on teachers, questioning the appropriateness of the RTI model for schools’ population of students, and delaying the process for referral for special education; (c) role impact on teachers feeling hampered in their duty to refer for special education services; and (d) improved instructional practices as a facilitating factor. Spring themes included: (a) ongoing confusion over the RTI process and scheduling difficulties with additional concerns regarding insufficiency of training and the need for additional resources to sustain RTI implementation; (b) delay of services for struggling students; (c) role impact as teachers being forced to learn new ways of teaching and principals having to lead their staffs through conflict, in addition to guiding and supporting them; and (d) improved outcomes for students as a facilitating factor. Implications for practice and research are discussed.

The development of a biorefining process acknowledges the feedstock characterization as it can often dictate the process technology. The maturity stages of agricultural feedstocks also have the potential for altering the process conditions. Thus, the variability of growth stages at 4-6 leaf, flowering, milk and soft dough were assessed for use of immature cereal crops in a green biomass biorefinery. Hence, the primary objective of this project was to evaluate the composition of green biomass at different harvest stages. Four varieties of triticale, two wheat varieties and two rye varieties were analyzed for starch, protein, phenols, fatty acids and sterols. To further characterize the feedstocks, an alternate extraction strategy was explored based on solvent polarity. It was found that for triticale varieties, the milk to soft dough harvest stages showed a decrease in proteins and phenols content and an increase in starch content. This could potentially provide benefit to organic acid production through fermentation. / Bioresource and Food Engineering

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniversitet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniversitet, 2006. / Härtill 3 uppsatser.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniversitet, 2006. / Härtill 4 uppsatser.