I möten mellan människor sker samspelet på ett kommunikativt plan där den professionella förhållningen innebär att bemöta och inte bara att möta en annan person. Polisens bemötande har stor betydelse för hur ett brottsoffer bearbetar upplevelsen av brottet hon upplevt. Syftet med studien var att undersöka och beskriva polisens uppfattningar av bemötande av brottsoffer, utifrån deras personliga erfarenheter av att vara brottsoffer. Studien genomfördes med en fenomenografisk forskningsansats och kvalitativa forskningsintervjuer av sex poliser. I en fenomenografisk studie är avsikten att försöka hitta variationen i och kategorisera människors erfarenheter i det tilltänkta undersökningsområdet. Resultatet visade att polisens olika uppfattningar av bemötande av brottsoffer kunde delas in i tre kvalitativt skilda beskrivningskategorier. Naturligt-, förvärvat- och rutinmässigt bemötande. Naturligt bemötande var något som fanns med sedan uppväxten, förvärvat bemötande var något som förvärvades genom olika erfarenheter, i rutinmässigt bemötandet gick arbetsuppgiften före bemötandet av brottsoffren. Studien visade också att brottsoffrets lidande hade en avgörande betydelse för polisens bemötande. Fler studier inom ämnet är att rekommendera för att få en större inblick och förståelse för hur polisens erfarenheter kan avspegla sig i mötet med brottsoffer, samt att öka kunskapen om hur negativa följder av erfarenheter kan förebyggas inför nya möten med brottsoffer.

<p><p>Clean water is a critical natural resource. We do not have much available: only 2.5% of water on Earth is freshwater and of that only 31% is in liquid form. 96% of the liquid fresh water is groundwater. Unfortunately that resource is subject to contamination by hazardous materials accidentally or illicitly spilled, leaked, or deposited in or on the ground. Among the methods to remediate these disasters, pump-and-treat (P&T) is the most common. The vertical circulation well (VCW) is a P&T configuration with extraction and injection sites within the same well. It can be adapted to many remediation techniques and has been gaining popularity since the 1990s and is often a better alternative to conventional P&T. Conventional P&T and VCWs are typically run with steady flow.</p></p><p><p>The major bottleneck to steady flow remediation is that contaminants become trapped in dead-end pores. In an aquifer there are two types of pores: <it>pass-through</it> pores and <it>dead-end</it> pores. The flow in former completely sweeps through the pore space while the flow does not enter the later; however, the flow through the <it>pass-through</it> pore induces a vortex in the <it>dead-end</it> pore. Under steady flow the only mechanism for contaminants to escape the <it>dead-end</it> pores is molecular diffusion.</p></p><p><p>A similar problem is encountered in the removal of surfactants in the manufacture of semiconductor and the removal of oil residue build-up in small ducts. Manufacturers discovered that pulsed flow would accelerate the mass transfer between the cavities and grooves on these surfaces and the external flow. This was because the unsteady ramp-up in flow rate initiated a deep sweep of the cavities. The unsteady ramp-down in flow rate initiated a vortex ejection where the sequestered vortex is no longer constrained and protrudes from the cavity.</p></p><p><p>We hypothesized that just as pulsed flow improves cleaning of grooved surfaces in several manufacturing procedures, rapidly pulsed pumping (with a period on the order of a second rather than weeks or months) in pump-and-treat groundwater remediation would boost the diffusion-limited removal of contaminants trapped in dead-end pores by generating transient deep sweeps and vortex ejections in these pores. These processes have not yet been exploited in groundwater remediation to any significant degree.</p></p><p><p>We tested our hypothesis in a series of numerical and laboratory experiments. We considered unwashed and washed media. For unwashed media (Chapter 1) we used as a square pore in the numerical domain and crushed glass (for its negligible sorption capacity) in laboratory column studies. For washed media (Chapter 2) we used a smooth dead-end pore constructed with two tangential quarter circles as the pore in the numerical domain and glass spheres in the laboratory column studies. In all our laboratory experiments we used a fluorescent dye, Fluorescein, as a conservative tracer. We used the same parameters in our numerical experiments. However, in some we also considered immiscible contaminants such as NAPLs (Chapter 4).</p></p><p><p>All numerical experiments were conducted with the computational fluid dynamics software, FIDAP. In numerical experiments we studied the contaminant removal from interacting dead-end pores connected to both a straight pass-through pore and a divergent pass-through pore. The latter with the flow somewhat analogous to the radial spreading encountered around a around a well in field applications (Chapter 5).</p></p><p><p>To elucidate the dead-end pore dynamics (Chapter 3), we performed numerical experiments and used a physical model to obtain a relationship between the rapidly pulsed flow frequency and length of the pore. Our dimensional analysis pointed to the change in pressure as the key component in the initiation of transient deep sweeps and vortex ejections, two new pore-cleaning mechanisms.</p></p><p><p>We conclude that the rapidly pulsed flow improves the recovery of contaminants from unwashed, or rough, porous media. In numerical experiments with a pore system consisting of just a single square dead-end pore and a single pass-through pore, at 100 pore volumes pumped the rapidly pulsed flow improved cleanup of the dead-end pore alone by approximately 40%. This translates into a 10% improvement of the cleanup of the pore system (dead-end and pass-through pore). Since the dead-end pore is the bottleneck of the current groundwater remediation, it the first measure that is relevant.</p></p><p><p>In corresponding laboratory column experiments with crushed glass, the dead-end pore volume alone is not known. The cleanup of the whole pore space was improved by roughly 10% with the rapidly pulsed pumping, which corresponds nicely to our numerical results.</p></p><p><p>Our numerical experiments demonstrate that there exists an optimal pulsed pumping frequency that is a function of the local flow velocity and the pore geometry (size and morphology).</p></p><p><p>The contaminant recovery from washed, or rounded, media was not as pronounced in the laboratory experiments and the numerical experiments showed no improvement. While both rapidly pulsed and steady flow recovered all of the contaminant in the laboratory column tests, the difference in the time between the two pumping schemes was approximately 0.9 pore volumes pumped. This improvement is likely to be amplified with sorbing contaminants.</p></p><p><p>Many contaminants are non-aqueous phase liquids (NAPLs), which do not readily dissolve in water. We showed in numerical experiments that rapidly pulsed flow can recover NAPLs with viscosity lower than water, but is not as effective with higher viscosity materials; however, these results were based on a model that did not account for interfacial tension and wetting; therefore we will require additional numerical and laboratory experiments.</p></p><p><p>In practice, a flow through porous media is significantly more complex than the one-directional dominated flows considered in our numerical and laboratory column experiments. Around a well the flow is typically three-dimensional and largely radially dominated. We constructed two numerical domains to study the interactions between the cleanup of three square pores: one in a straight channel and one in a divergent channel to study the radial spread that would be experienced around a well. For a series of three dead-end pores, there was a 35% improvement by rapidly pulsed flow over steady flow in the straight channel and a 33% improvement in the divergent domain. The optimal frequency was different in the divergent flow even though the pores were the same size as in the previous study. Since the divergent channel reduced the flow velocity, the pulses reached the pores at a decreasing rate. Due to this divergence and the range of pore-sizes in a natural aquifer, implementation of rapidly pulsed flow should likely include a range of frequencies.</p></p><p><p>We concluded that the rapidly pulsed flow on the time scale of one-second would greatly enhance the cleanup of contaminated aquifers by P&T or VCW approaches. We measured significant improvements in the time to recovery. For our preliminary VCW experiment showed that rapidly pulsed pumping recovers 50% of the contaminant four times faster than steady pumping. P&T and VCW remediation typically use a steady flow; there are some methods that change the flow rate in P&T and other configurations, such as the VCW. These periodic changes in rate are on the scale of months to years. Some VCWs and air sparging technologies pulse oxygen, surfactants, and/or nutrients into the aquifer to oxidize, mobilize, or bioremediate the contaminants. As reviewed in chapter 6 in detail, all pulsing so far applied in remediation is on the time scale of a day or longer. Such low pulsing frequency does not produce sufficiently many deep sweeps to make a significant difference in cleaning dead-end pores.</p></p><p><p>Implementation of rapidly pulsed technology will utilize the same extraction and injection wells currently used in pump-and-treat remediation but will require replacement or significant modification of the pumps.</p></p><p><p>There are public health and financial implications of this research. In the dissertation conclusions section we reinterpret our numerical experiments with the multiple interacting dead-end pores and a divergent pass-through pore and laboratory experiments with a vertical circulation well chamber by calculating and plotting the ratio of times needed to reach a specified fraction recovered (specified cleanup level) in the steady and rapidly pulsed pumping modes, \tau_{s} / \tau_{p}. This ratio represents the speedup factor, i.e., the factor by which the time needed to reach the specified cleanup level with the conventional remediation (with steady pumping) would be reduced. From our experiments it appears that with the increasing level of targeted cleanup (contaminant fraction recovered), the speedup factor increases and may even exceed an order of magnitude. As we demonstrate in the dissertation conclusions section, this could translate into tens of billions of dollars in savings. Whether or not the laboratory speedup factors would hold in the field cannot be established without field-scale experiments.</p></p> / Dissertation

The effect of heterogeneity correlation scale (&amp / #61548 / ) of hydraulic conductivity (K), equilibrium distribution coefficient (Kd) and mass transfer rate (&amp / #61537 / ) on the design and cost of the P&amp / T remediation system for different heterogeneity levels (defined by the variance (&amp / #963 / 2lnK)) and parameter distributions under the rate-limited sorption conditions was evaluated in this study. In addition, the impacts of initial amount of contaminant mass and plume configuration on the remediation design and cost were explored. The effects of different K heterogeneity and remediation design conditions on the length of remediation period, the influence of &amp / #61548 / anisotropy of K, correlation between K and Kd, and Kd and &amp / #61537 / , and the fraction of equilibrium sorption sites (f) on the pump-and-treat (P&amp / T) design and cost were the other studied subjects. In this study, simulation-optimization approach, in which a groundwater flow and contaminant transport simulation model was linked with a genetic algorithm (GA) library, was used. Results showed that not only the amount of PCE mass initially present in the aquifer was important in terms of P&amp / T design, cost and remediation time, but also the location and size of the high and low K regions defined by &amp / #955 / lnK as well as the magnitudes of K represented by geometric mean and &amp / #963 / 2lnK were influential. It was also found that P&amp / T designs utilizing higher numbers of wells with lower pumping rates may be more robust predicting the time-to-compliance compared to a single well with higher pumping rate for aquifers heterogeneous in K. Homogenous Kd assumption might cause serious error in both the design and the cost of remediation. The magnitude of this error may change depending on the spatial distribution of K and Kd, &amp / #955 / lnKd, &amp / #963 / 2lnKd and &amp / #963 / 2lnK. The effect of heterogeneity in &amp / #61537 / on the design and cost of remediation may or may not be significant depending on K, Kd and &amp / #61537 / distributions, &amp / #61548 / ln&amp / #61537 / and &amp / #963 / 2ln&amp / #61537 / . Increased amount of kinetically sorbed mass defined by decreased f value resulted in more costly remediation.

Purposes/Aims: The purpose of this study was to determine the professional, workplace and personal factors that significantly relate to advanced practice nurses' (APNs) self-efficacy to treat intimate partner violence (IPV).Rationale/Conceptual Basis/Background: IPV affects one in three women in the U.S. and is the leading cause of maternal death during the prenatal and first year post-partum periods. Older women victims suffer earlier death from all causes. IPV is under diagnosed and undertreated based on large surveys of emergency departments and outpatient clinics. APNs are providing health care to large numbers of potential victims, thus they are important as diagnosticians and treating clinicians. Methods: A national quantitative survey of APNs was performed with the aim of obtaining APNs from diverse specialties, geographic areas, and demographics within the U.S. Participants completed an electronic survey using modifications of standardized questionnaires on professional factors of hours of previous IPV education, IPV knowledge, years in practice, current practices, role belief, and self-efficacy to treat IPV. A new scale was developed to test workplace factors of screening tools and protocols, institutional, and community supports. Personal factors of age, gender, past IPV experience, vicarious trauma (VT), resilience, and general self-efficacy were tested using previously validated tools. Results: A sample of 494 APNs was obtained. Respondents were demographically representative of U.S. practicing APN population. Findings from this study indicate that APNs' current self-reported practice behaviors regarding IPV, total hours of IPV education, age in years, role belief, resilience, absence of VT and IPV knowledge are the most significant contributors to APNs' self-efficacy to treat IPV. Implications: APNs with strong clinical experience with IPV, more hours of IPV education, older age, belief that it is their role to treat IPV, and greater IPV knowledge, reported the best self-efficacy to treat IPV. Educational institutions should provide more formal and ongoing education in IPV. VT in APNs who treat IPV should be further explored. Health care organizations should provide continuing IPV education and provide work environments that promote the treatment of IPV for APNs to effectively identify and engage in treatment those patients who may be victims.

Thesis (M.S.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Embargoed. Vita. Bibliography: 83-96.

Introdução: A estratégia de tratamento baseado em metas tem sido extensamente estudada em pacientes com AR inicial. No entanto, estudos sobre os benefícios de longo prazo do controle de atividade de doença em pacientes com AR estabelecida ainda são escassos. Objetivo: Avaliar a efetividade de longo prazo da estratégia de tratamento baseado em metas em pacientes com artrite reumatoide estabelecida na prática diária. Métodos: Pacientes com AR, previamente tratados de forma convencional, iniciaram estratégia de tratamento baseado em metas, sendo incluídos de março de 2005 a fevereiro de 2007 e acompanhados até dezembro de 2014. Os pacientes eram avaliados a cada 3 meses até remissão ou baixa atividade de doença serem alcançadas, e após a cada 6 meses. O tratamento seguiu um escalonamento de acordo com as recomendações vigentes. A atividade de doença foi mensurada através do DAS28 e do CDAI e a capacidade funcional, através do HAQ-DI. As informações foram extraídas pela revisão de formulários e de tabelas padronizadas. Variações na atividade de doença e na capacidade funcional foram comparadas pelo teste de Wilcoxon e Equações de Estimativas Generalizadas (GEE) A mortalidade foi avaliada através da curva de Kaplan-Meier. Resultados: Duzentos e vinte e nove pacientes foram incluídos, com duração média de doença 10,6±7,4 anos. Dentre os pacientes em moderada e alta atividade de doença no início da coorte, houve significativa redução do DAS28 (4,6±0,1 vs. 3,1±0,1; p<0,001) e do CDAI (21,2±1,0 vs. 7,9±0,7; p<0,001). Também houve redução do HAQ-DI (1,3±0,05 vs 1,0±0,1; p<0,001). A proporção de pacientes em remissão ou em baixa atividade de doença aumentou de 20% para 62% pelo DAS28. Com a estratégia de tratamento baseado em metas, houve um aumento na proporção de pacientes em uso de biológico para 30%. A taxa de mortalidade foi de 24,2 por 1000 pacientes-ano, discretamente superior à descrita na literatura. Conclusão: A estratégia de tratamento baseado em metas com objetivo de remissão e de baixa atividade de doença é efetivo em pacientes com AR estabelecida. / Introduction: Treating RA to a target has become a landmark strategy to be pursued in every patient. Nonetheless, few studies have addressed the true long-term impact of a T2T strategy in a real-world setting with established RA patients. Objective. To examine the long-term effectiveness of a treat-to-target (T2T) strategy in patients with established rheumatoid arthritis (RA) in daily practice. Methods. Patients with RA who were previously given the standard of care were started on a T2T strategy between March 2005 and February 2007 and followed through December 2014. Participants were seen every 3 months until remission/low disease activity was achieved and every 6 months thereafter. Treatment escalation followed a step-up strategy, according to national recommendations. Disease activity was measured by the DAS28 score and Clinical Disease Activity Index (CDAI), and physical function by the Health Assessment Questionnaire (HAQ). Data were extracted with standardized forms and a chart review. Changes in disease activity and physical function were compared using Wilcoxon’s test and generalized estimating equations. Mortality was analyzed using a Kaplan–Meier survival curve. Results. Two hundred and twenty-nine patients were included, with a mean (S.D.) disease duration of 10.6 (7.4) years. Significant reductions were observed in DAS28 (4.6±0.1 vs. 3.1±0.1; p<0.001), CDAI (21.2±1.0 vs. 7.9±0.7; p<0.001), and HAQ (1.3±0.05 vs 1.0±0.1; p<0.001) scores. The proportion of participants in remission/with low disease activity according to DAS28 increased from 20% to 62%. During implementation of the T2T strategy, a gradual increase in the proportion of participants using biologics was observed, to nearly 30%. The mortality rate was 24.2 per 1000 patient-years, slightly higher than that reported in other cohorts. Conclusion. A treat-to-target strategy aiming for remission or low disease activity is effective in patients with established RA.

Introdução: A estratégia de tratamento baseado em metas tem sido extensamente estudada em pacientes com AR inicial. No entanto, estudos sobre os benefícios de longo prazo do controle de atividade de doença em pacientes com AR estabelecida ainda são escassos. Objetivo: Avaliar a efetividade de longo prazo da estratégia de tratamento baseado em metas em pacientes com artrite reumatoide estabelecida na prática diária. Métodos: Pacientes com AR, previamente tratados de forma convencional, iniciaram estratégia de tratamento baseado em metas, sendo incluídos de março de 2005 a fevereiro de 2007 e acompanhados até dezembro de 2014. Os pacientes eram avaliados a cada 3 meses até remissão ou baixa atividade de doença serem alcançadas, e após a cada 6 meses. O tratamento seguiu um escalonamento de acordo com as recomendações vigentes. A atividade de doença foi mensurada através do DAS28 e do CDAI e a capacidade funcional, através do HAQ-DI. As informações foram extraídas pela revisão de formulários e de tabelas padronizadas. Variações na atividade de doença e na capacidade funcional foram comparadas pelo teste de Wilcoxon e Equações de Estimativas Generalizadas (GEE) A mortalidade foi avaliada através da curva de Kaplan-Meier. Resultados: Duzentos e vinte e nove pacientes foram incluídos, com duração média de doença 10,6±7,4 anos. Dentre os pacientes em moderada e alta atividade de doença no início da coorte, houve significativa redução do DAS28 (4,6±0,1 vs. 3,1±0,1; p<0,001) e do CDAI (21,2±1,0 vs. 7,9±0,7; p<0,001). Também houve redução do HAQ-DI (1,3±0,05 vs 1,0±0,1; p<0,001). A proporção de pacientes em remissão ou em baixa atividade de doença aumentou de 20% para 62% pelo DAS28. Com a estratégia de tratamento baseado em metas, houve um aumento na proporção de pacientes em uso de biológico para 30%. A taxa de mortalidade foi de 24,2 por 1000 pacientes-ano, discretamente superior à descrita na literatura. Conclusão: A estratégia de tratamento baseado em metas com objetivo de remissão e de baixa atividade de doença é efetivo em pacientes com AR estabelecida. / Introduction: Treating RA to a target has become a landmark strategy to be pursued in every patient. Nonetheless, few studies have addressed the true long-term impact of a T2T strategy in a real-world setting with established RA patients. Objective. To examine the long-term effectiveness of a treat-to-target (T2T) strategy in patients with established rheumatoid arthritis (RA) in daily practice. Methods. Patients with RA who were previously given the standard of care were started on a T2T strategy between March 2005 and February 2007 and followed through December 2014. Participants were seen every 3 months until remission/low disease activity was achieved and every 6 months thereafter. Treatment escalation followed a step-up strategy, according to national recommendations. Disease activity was measured by the DAS28 score and Clinical Disease Activity Index (CDAI), and physical function by the Health Assessment Questionnaire (HAQ). Data were extracted with standardized forms and a chart review. Changes in disease activity and physical function were compared using Wilcoxon’s test and generalized estimating equations. Mortality was analyzed using a Kaplan–Meier survival curve. Results. Two hundred and twenty-nine patients were included, with a mean (S.D.) disease duration of 10.6 (7.4) years. Significant reductions were observed in DAS28 (4.6±0.1 vs. 3.1±0.1; p<0.001), CDAI (21.2±1.0 vs. 7.9±0.7; p<0.001), and HAQ (1.3±0.05 vs 1.0±0.1; p<0.001) scores. The proportion of participants in remission/with low disease activity according to DAS28 increased from 20% to 62%. During implementation of the T2T strategy, a gradual increase in the proportion of participants using biologics was observed, to nearly 30%. The mortality rate was 24.2 per 1000 patient-years, slightly higher than that reported in other cohorts. Conclusion. A treat-to-target strategy aiming for remission or low disease activity is effective in patients with established RA.

Background Globally, external HIV-related stigma is a major threat to all HIV prevention, care and treatment interventions including the recently launched Universal Test and Treat (UTT) strategy in South Africa and the 90-90-90 targets set by UNAIDS for the global response by 2020. The 90-90-90 targets are put in place to track the progression from HIV testing to durable viral load suppression among people living with HIV. The targets guide HIV programmes to achieve 90% known HIV status, to access 90% antiretroviral therapy and to suppress 90% viral loads (UNAIDS, 2017). Achievement of the 90-90-90 targets has since become a part of South Africa's National Strategic Plan for HIV, TB and STIs 2017-2022. External HIV-related stigma in this study was defined as the presence of one or more of the following attitudes and behaviours: rejection, avoidance, intolerance, stereotyping, discrimination, and physical violence towards people living or perceived as having HIV. There have not been many efforts to attenuate HIV-related stigma in South Africa, as it continues to exist. There has been a scale up of other HIV responses, such as HIV Counselling and Testing (HCT) and treatment, with the argument made that in scaling up these biomedical approaches, stigma would disappear. Furthermore, its exact magnitude, trends over the years and correlates have not been explored fully at national level, hence the present study known as Stigma Assessment Study in South Africa (SASSA). SASSA is based on the Institutional Social Construction theory framework. It explores the external HIV-related stigma magnitude and its trends between 2005 and 2012, as well as the associated factors which influence its prevalence in South Africa at a national level. The study further explores the mediating and moderating factors of external HIV-related stigma and tries to explore external HIV-related stigma by viewing individuals with HIV living in families, societies and structures, with the hope of contributing to the development of new systematic HIV-related stigma interventions in South Africa as well as, strengthening existing ones. Methodology The project used secondary data obtained from three South African national population HIV surveys which were conducted in 2005, 2008 and 2012 by a research consortium led by the Human Sciences Research Council. Sub-samples of the original surveys consisting of respondents aged 15 years and older who had responded to the stigma questions in the three surveys were extracted and included in the SASSA analysis. A nationally representative sample of a total of 16 140 individual respondents from the 2005 survey, 13 134 from the 2008 survey and 30 748 from the 2012 survey was used in the study. Two different measures of external HIV stigma are used in this analysis, one is a summary measure from the latest survey data, i.e. 2012, which was used to do a regression analysis. The summary measure was regarded as reliable to use for the regression analysis as it provides crude effect of the exposure factors on external HIV stigma. However, this summary measure was not included in the previous surveys, i.e. 2005 and 2008, and therefore could not be used for trends analysis. We therefore used 4 individual stigma items for the trends analysis as these were included in all 3 surveys. The use of 4 individual stigma items was important because when data from a variety of sources or categories have been joined together, the meaning of the data can be difficult to see. It was therefore considered ideal to assess the performance of the individual constructs on their individual contribution to the impact on HIV external stigma. Furthermore, analysis using individual constructs provided an opportunity to see specific patterns which could have remained obscure in crude analysis. The first measure of external HIV-related stigma used in the regression analysis was measured by five individual items which elicited attitudes towards people living with HIV (PLHIV). The five items were based on a 9-item scale that was originally developed and tested in a South African population, and the 9-item scale was found to be internally consistent (alpha = 0.75) and reliable (r = 0.67). The 5 items were (1) People who have AIDS are dirty; (2) People who have AIDS are cursed; (3) People who have AIDS should be ashamed; (4) People with AIDS must expect some restrictions on their freedom; (5) A person with AIDS must have done something wrong and deserves to be punished. As explained above, the specific external HIV stigma patterns second measure, which was utilized to explore stigma trends over the years 2005, 2008 and 2012, consists of four individual stigma items which elicited attitudes towards PLHIV. The four individual stigma items included: (1) If you knew that a shopkeeper or food seller had HIV, would you buy food from them? (2) Would you be willing to care for a family member with AIDS? (3) Is it a waste of money to train or give a promotion to someone with HIV/AIDS? (4) Would you want to keep the HIV positive status of a family member a secret? Findings Overall, external HIV-related stigma was found to exist among 38.3% of adult South Africans in 2012. Multiple regression analysis showed that predictors of external HIV-related stigma were race, sex, education level, self-perceived risk of HIV infection and HIV knowledge (p< 0.01). Females were less likely to report external HIV-stigma than males (AOR = 0.9, P< 0.001). Those who perceived themselves to be at high risk of HIV infection were less likely to display some stigma than those who believed they were at low risk (AOR = 0.89, p < 0.01). The study did not find any significant associations between HIV testing or awareness of HIV status, with external HIV-related stigma in this study. Looking at the individual external HIV stigma items used to measure trends, the study reveals a slight decrease in the reporting of stigma over the three time periods (2005 vs 2008 vs 2012) on responses for two of the stigma items (Q1: If you knew that a shopkeeper or food seller had HIV, would you buy food from them, and Q2: Would you be willing to care for a family member with AIDS). While an increase was observed in the reporting of stigma over the three years on responses for two of the stigma items (Q3: Is it a waste of money to train or give a promotion to someone with HIV/AIDS, and Q4: Would you want to keep the HIV positive status of a family member a secret). The structural equation modelling (SEM) showed likelihood ratio test results with a p-value greater than 0.05, a root mean square error of approximation (RMSE) of 0.008 and Tucker–Lewis index (TLI) value of 0.985. The model fit assessment results allow us to accept that an hypothesized model of the study is not far from a perfect model. The SEM results also showed a direct effect of sex on HIV knowledge statistically significant at p < 0.001, with race having an effect of 3.3% and education a direct effect of 9.5%, and both of these showed a statistically significant effect (p < 0.001) respectively. HIV knowledge showed to have a statistically significant inverse relationship on external HIV stigma of -10.4% (95% CI: -12.3-0.09) p< 0.001. Awareness of HIV status had the highest positive direct effect on external stigma of 10% (95% CI: 4.41-15.67%) p<0.001. With regard to indirect effects, sex, race, and education had minimal negative indirect effects on external stigma, which was statistically significant for all the three covariates. With the said effects of external HIV-related stigma, it was found that HIV knowledge independently mediates the relationship between Level of Education, Awareness of HIV status, Race, HIV testing history, and Sex, with External HIV-related stigma. Conclusion External HIV-related stigma still exists in South Africa despite previous success in massive ART rollout, HTC campaigns, and most recently test-and-treat programmes, which were arguably thought to have a parallel effect in the decrease of HIV related stigma. The focus on individualistic health structural approaches that do not generally have stigma-reduction as a specific aim, as discussed, is likely to undermine the successes achieved in the fight against HIV thus far. There is a need to develop innovative holistic interventions which are specifically intended for HIV stigma reduction. These should be inclusive of both social institutional elements and health structural elements to address the challenge of external HIV-related stigma.

Bakgrund: Bemötandet är en essentiell del i vårdmötet. Att ambulanssjuksköterskan har insikt kring bemötandets betydelse i vårdmötet med patienten är av största vikt. Ett bristande bemötande kan leda till att bedömningen blir undermålig vilket äventyrar patientsäkerheten. Tidigare forskning kring hur ambulanssjuksköterskan upplever bemötandet inom ambulanssjukvården är begränsad.  Syfte: Var att belysa ambulanssjuksköterskors upplevelser kring bemötande inom ambulanssjukvården. Metod: En kvalitativ intervjustudie där deltagarna valdes genom ett bekvämlighetsurval. Graneheim och Lundmans innehållsanalys användes för att analysera de nio ostrukturerade intervjuerna som ägde rum på två ambulansstationer, belägna i södra Sverige.  Resultat: I resultatet framgick det att upplevelsen av bemötandet inom ambulanssjukvården är gott och de flesta hade en klar bild över hur ett gott bemötande i vårdmötet bör vara. Ambulanssjuksköterskorna hade en insikt i att de själva och kollegor ibland brast i sitt bemötande och kunde i de flesta fall beskriva orsaker till detta skedde och efterföljande konsekvenser. Studiens främsta fynd visar på att ambulanssjuksköterskan upplever att det är ett hårdare klimat idag och att problematiken kring bemötande har en tendens att öka.  Slutsats: Ambulanssjuksköterskor är medvetna om betydelsen av ett bra bemötande i vårdmötet. De har god kännedom kring vilka olika konsekvenser ett bristande bemötande kan få för patienten och att det kan påverka patientsäkerheten. Det finns en viss problematik kring ett bristande bemötande som ambulanssjuksköterskorna upplever har ökat men även att klimatet har blivit hårdare. Aktuell forskning behöver uppdateras för att belysa problemområdet och skapa handlingsplaner för att förhindra en negativ utveckling. / Introduction:  How we treat others is an essential part of the care meeting with patients. To possess an insight and to own a self knowledge regarding the treatment of others is of great importance.                 Bad treatment can lead to poor assessments and examinations, which jeopardizes patient safety. Previous research on how the ambulance nurse experiences how we treat others in the ambulance services is very limited.  Purpose: Was to illustrate the ambulance nurse´s experience of how we treat others among the ambulance services.  Methods: A qualitative interview study were conducted where the informants were chosen through a convenience selection. The method for analysis were the one of Graneheim and Lundman and was applied to analyse the nine unstructured interviews that took place in two ambulance stations, both situated in the south of Sweden.  Results: The results showed that the experience of the treatment in the ambulance care is good and that most ambulance nurses had a clear picture of what good treatment in the care meeting should be like. The ambulance nurses had an insight that they themselves and colleagues sometimes burst in their treatment regarding patients and could in most cases describe reasons why this happened and the consequences of it. The study's main findings show that the ambulance nurse nowadays feels that there is a harsher climate in the ambulance care and that the problems regarding treatment tend to increase. Conclusion:Ambulance nurses are aware of the importance in how we treat others during the care meeting. They also possess good knowledge in various consequences that a lack of treatment can bring the patient and the negative effects regarding patient safety. However, there are certain problems in how we treat others which the ambulance nurses experience has increased, they also describe that the climate has become more harsh. Current research needs an update to highlight the problem area to enable action plans that will prevent further negative progress.

The Fukushima Daiichi nuclear accidents in 2011 sparked considerable interest in the U.S. to develop new nuclear fuel with enhanced accident tolerance. Throughout the development of these new fuel concepts they will be extensively modeled using specialized computer codes and experimentally tested for a variety of different postulated accident scenarios. One accident scenario of interest, reactivity-initiated accident, is a nuclear reactor event involving a sudden increase in fission rate that causes a rapid increase in reactor power and temperature of the fuel which can lead to the failure of the fuel rods and are lease of radioactive material. The focus of this work will be on the fuel performance modeling of reactivity-initiated accidents using the BISON code being developed at Idaho National Laboratory. The overall goal of this work is to provide the best possible modeling predictions for future experimental tests. Accurate predictive capability modeling using BISON is important for safe operation of these tests and provides a cheaper alternative to the expensive experiments.