Thesis (M.Ing. (Electrical Engineering))--North-West University, Potchefstroom Campus, 2007.

Effekter av utvidet slagbehandling og samarbeid på tvers av forvaltningsnivå. Hjerneslag er en av de hyppigste årsaker til alvorlig funksjonshemming og død i Norge, i tillegg at sykdommen medfører betydelige samfunnsmessige kostnader. Forekomsten er ca. 14 000 hjerneslag pr. år, og antallet forventes å øke betraktelig i årene fremover da antall eldre over 65 år vil øke sterkt. Det er en stor utfordring å organisere helsetjenesten slik at behandlingstilbudet for denne pasientgruppen blir best mulig. Akuttbehandling i slagenhet er i dag det best dokumenterte behandlingstiltak, men effekten av videre rehabilitering og oppfølging har vært et lite prioritert område for forskning. Hovedhensikten med denne avhandlingen har vært å framskaffe mer kunnskap om hva som kan oppnås for slagpasienter ved en systematisk organisering og samarbeid mellom sykehus og primærhelsetjeneste når det gjelder behandling og rehabilitering etter akuttbehandling i slagenhet. Studien som ligger til grunn for avhandlingen ble gjennomført ved Seksjon for hjerneslag, Medisinsk avdeling, St. Olavs Hospital i perioden 1995-1998. Intervensjonen var å konstruere en ny behandlingskjede for slagpasienter hvor fokus på bedre samarbeid med primærhelsetjenesten, oppfølging av et ambulerende team, tidlig utreise fra sykehus og rehabilitering med utgangspunkt i hjemmet ble sterkt vektlagt. Den konstruerte behandlingskjeden ble evaluert med tanke på helsegevinst for den enkelte og bedre ressursutnytting sammenlignet med det tradisjonelle behandlingstilbudet. Studien ble gjennomført som en klinisk randomisert kontrollert studie der 320 pasienter med akutt hjerneslag ble inkludert. 160 pasienter fikk ordinær slagenhet behandling med videre institusjonsrehabilitering og/eller oppfølging av primærhelsetjenesten, mens de øvrige 160 pasienter fikk oppfølging av et ambulerende team i henhold til den nye og konstruerte behandlingskjeden. I de fire arbeidene som inngår i avhandlingen er det sett på risiko for alvorlig funksjonshemning og død, endring i funksjonsnivå og livskvalitet, samt kostnadsanalyser og ressursforbruk av helsetjenester. Pasientene i de to gruppene ble undersøkt og sammenlignet 6 og 12 måneder etter sykdomsdebut. Resultatene av studien viste at sammenlignet med tradisjonell behandling oppnådde pasientene i intervensjonsgruppen signifikant bedre funksjonsnivå (p=0.017) og redusert risiko for alvorlig funksjonshemning og død (p=0.044) etter ett år. De viste også tendens til bedret livskvalitet samtidig som initial liggetid i institusjon ble redusert med 40 % (p=0.032). Det var ingen økning i totalt ressursforbruk eller kostnader i intervensjonsgruppen. Oppsummert viser avhandlingen at en slagbehandlingskjede med fokus på samarbeid på tvers av forvaltningsnivå, oppfølging av et ambulerende team og rehabilitering mens pasientene bor hjemme gir meget positiv effekt. Den kliniske betydning av disse resultater er at en oppfølging i form av en slagbehandlingskjede i tillegg til akutt behandling i slagenhet bør inngå som en integrert del av behandlingstilbudet for denne pasientgruppen. Arbeidene er utført ved INM og ISM, Det medisinske fakultet, NTNU. 1.amanuensis, dr.med Bent Indredavik har vært hovedveileder og Professor dr.med Roar Johnsen biveileder. / Extended Stroke Unit Service and Early Supported Discharge. Short and Long-term Effects. Background and purpose Stroke imposes a considerable burden for patients, their caregivers and the society worldwide. It is a challenge to organise the healthcare service that can provide effective management of patients who have suffered from stroke. Several trials have shown that stroke unit care improves the outcome for stroke patients. More limited information exists about the most effective way to organise the follow-up care after the acute care in a stroke unit. Stroke patients conventionally receive a substantial part of their rehabilitation in hospital or in other institutions that offer 24 hours-stay. The primary aim of this thesis was to increase knowledge about the organising of follow-up care for stroke patients after the acute care in a stroke unit. To achieve this we performed a trial to evaluate the short and long-term effects of an extended stroke unit service (ESUS), with early supported discharge from hospital, co-operation with the primary health care, and more emphasize on rehabilitation at home as essential elements. Methods We performed a randomized controlled trial in which 320 acute stroke patients admitted to the Stroke Unit at St. Olavs Hospital, Trondheim University Hospital were included and allocated either to ordinary stroke unit care (OSUS) (160 patients) with further in-patient rehabilitation or follow-up from the primary healthcare service, or to stroke unit care with early supported discharge (160 patients). The ESUS consisted of a mobile team which co-ordinate early supported discharge and further rehabilitation. Included in this thesis are 4 papers based on data from this study population of acute stroke patients followed in one year after the onset of stroke. We wanted to compare the groups in relation to independency, quality of life (QoL) and resource use and costs. • Functional outcome were measured as the proportion of patients who were independent as assessed by modified Rankin Scale (RS)(RS<2 =global independence) and Barthel Index (BI)(BI>95 = independent in ADL) at 26 weeks and 52 weeks, the differences in final residence and analyses to identify patients who benefited most of an early supported discharge service (paper I and II). All assessments were blinded. • The outcome of QoL was measured by the Nottingham Health Profile (NHP) at 52 weeks. Other outcomes measured at 52 weeks were differences between the groups according to social activity, depression, cognitive function and the burden for carers’. (paper III). • The use of all health services during the first 52 weeks was recorded prospectively in both groups; its costs were measured as service costs and represent a combination of calculated average costs and tariffs. Hospital expenses were measured as costs per inpatient day. The secondary objectives were to explore differences in costs between the groups with respect to different types of services, time of service delivery and stroke severity (paper IV). Results • Extended stroke unit service with early supported discharge and co-ordination by a mobile team improves functional outcome 6 months and 12 months after stroke. The Odds Ratio for independence at one year was 1.56 (95% C.I, 1.01-to 2.44). It was most beneficial for patients with moderate stroke (papers I and II). • Extended stroke unit service with early supported discharge can improve long-term quality of life measured by global NHP. The ESUS group had a significant better QoL after one year than the OSUS group (p = 0.048). There were no significant differences between the groups in the secondary outcomes social activity, depression and cognitive function. The caregivers who got their patients early at home did not report an increased burden compared to caregivers whose patients became ordinary stroke unit care (paper III). • The length of initial institutional stay (hospital and rehab.clinic) were reduced with 40 % for the patients offered extended stroke unit service (18.6 days in the ESUS versus 31.1 days in the OSUS) (p=0.032). There was also a reduction in average number of total inpatient days during the first year in favour of the ESD group (p = 0.012) (paper IV). • The total health services costs for ESUS was equal or less than costs for ordinary care during the first year after stroke. There was a non-significant reduction in total mean service costs in the ESUS group (EUR 18937 / EUR 21824). The service seemed to be most cost effective for patients with moderate severity of stroke (23% lower mean costs compared to OSUS). The important cost savings caused by reduced length of institutional stay did not lead to an increase in costs for home-based rehabilitation (paper IV). Conclusion An extended stroke unit service with early supported discharge improved functional outcome and reduced the length of stay in institutions compared to traditional stroke unit care. It also seems that this service can improve long-term quality of life. The costs are equal or less than costs for ordinary care. An early, well organised discharge from hospital co-ordinated by a mobile team seems to be an important contribution in the treatment of stroke patients and should be considered, in addition to organised in-patient stroke unit care, as a part of a comprehensive stroke care.

The purpose of the current study was to develop a manualized treatment for fibromyalgia syndrome (FM) and to examine the efficacy of the treatment in a randomized controlled clinical trial. FM is a chronic musculoskeletal pain disorder characterized by tender points and generalized pain. Depression, chronic fatigue, and sleep disturbance are common. A biopsychosocial model served as a framework for understanding FM by integrating psychological, social, and physical factors. Cognitive-behavioural therapy (CBT), an empirically validated treatment for arthritis, has also been used with FM patients in an attempt to improve pain control, reduce disability, and increase self-efficacy. Overall, the attention/placebo controlled studies employing CBT as a treatment for FM show that it is not superior to a credible attention placebo. The current study attempted to combine the necessary components of CBT with interpersonal therapy to address relational patterns and personality characteristics that can affect ability to cope with chronic pain. One hundred and five women diagnosed with FM by a rheumatologist were randomly assigned to the CBT-interpersonal treatment condition or an attention-control condition. There were 8 treatment groups with a mean of 6-7 participants in each. The treatment consisted of weekly 2-hour sessions over 8 consecutive weeks. Outcome measures included: FM impact, pain, health care utilization, depression, coping, and self-efficacy. An intention-to-treat analysis was conducted. Results showed that the impact of FM symptoms was reduced following treatment compared to the control group and this was statistically and clinically significant, but was not maintained at 3-month follow-up. Significant improvements were also observed in coping strategies, some of which were maintained at follow-up. Importantly, self-efficacy improved significantly following treatment compared to the control group. Self-efficacy beliefs have been related to pain, coping efforts, disability, and psychological functioning. Directions for future research may include a focus on long-term maintenance of treatment gains that may be mediated by improvements in self-efficacy. There is strong evidence that changes in self-efficacy are enduring and affect changes in health behaviours and health status.

Vi har alltsedan våra praktikperioder haft en grundläggande förståelse för hur mankan arbeta inom organisationer där innovation är ett centralt begrepp. Vi har dockaldrig kommit i kontakt med beslutsprocesserna runt dessa projekt. Efter praktikenhar vi ifrågasatt de värderingsmetoder som vi tidigare sett som relativt heltäckande.Vi är båda aktiva på börsen vilket är ytterligare en faktor som ökat vårt intresse förämnet då börsens värdering av bolag med hög risk och hög innovationshöjd ärosäker. Där saknas analyser som belyser problemet. Detta har lett till att vi söktvärderingar på dessa bolag med hjälp av olika metoder och ökat förståelsen för hurextern värdering går till.Författarnas studier har naturligtvis inspirerat valet av uppsatsämne. Studierna harockså påverkat hur vi ser på värdering och vilka resultat vi förväntar oss av studien.Vi har läst finansiering där värdering är väldigt centralt eftersom det är viktigt att sättamöjligheter i relation till varandra. Här har vi under hösten berört flera metoder där deflesta är baserade på diskonterade kassaflöden. Den andra parametern förutomkassaflöden är risken. Eftersom risk och avkastning alltid ska följa varandra så måsteavkastningen vara hög nog för risknivån. Risken har vi beräknat med hjälp av CAPMeller WACC. Dessa metoder använder sig av antingen marknadsförhållanden ellermer specifika förhållanden inom bolaget för att mäta risken. Vi har också kommit ikontakt med BASEL-fördragen och därmed Value-at-Riskmåtten som beräknar hurmycket man riskerar att förlora under en viss tid med en specificerad säkerhet. Medhjälp av dessa metoder och genom att jämföra nyckeltal har vi värderat allt frånprojekt till portföljer. Vi har alltid haft kassaflöden som grund för beräkningarna dockmed osäkerhet kring omfattningen av dessa.Under våra praktikperioder så arbetade vi båda två i väldigt innovativa miljöer. Ingenav oss kom i direktkontakt med beslutsprocessen då man valde mellan projekt, menett intresse för hur det gick till föddes. Bristen på förklaringar hur man hanteradeprojekt utan säkra kassaflöden under vår utbildning och även i de rapporter vi läst harbara ökat vårt intresse kring företag och deras projektval.Eftersom vi vill sätta oss in i hur beslutsprocessen ser ut på innovativa företag har vivalt en abduktiv metod, dvs. att utgå från vår data och teori för att utforska ettforskningsgap. Vår förhoppning är att den här studien kan vara en inspirationskälla tillandra abduktiva eller induktiva studier liksom vara en grund för vidare deduktivforskning i ämnet.Vi vill också passa på att tacka de medverkande företagen och personerna viintervjuat. Vi vill också rikta ett tack till vår handledare Anders Isaksson för all hjälpgenom denna snåriga process.

The purpose of the current study was to develop a manualized treatment for fibromyalgia syndrome (FM) and to examine the efficacy of the treatment in a randomized controlled clinical trial. FM is a chronic musculoskeletal pain disorder characterized by tender points and generalized pain. Depression, chronic fatigue, and sleep disturbance are common. A biopsychosocial model served as a framework for understanding FM by integrating psychological, social, and physical factors. Cognitive-behavioural therapy (CBT), an empirically validated treatment for arthritis, has also been used with FM patients in an attempt to improve pain control, reduce disability, and increase self-efficacy. Overall, the attention/placebo controlled studies employing CBT as a treatment for FM show that it is not superior to a credible attention placebo. The current study attempted to combine the necessary components of CBT with interpersonal therapy to address relational patterns and personality characteristics that can affect ability to cope with chronic pain. One hundred and five women diagnosed with FM by a rheumatologist were randomly assigned to the CBT-interpersonal treatment condition or an attention-control condition. There were 8 treatment groups with a mean of 6-7 participants in each. The treatment consisted of weekly 2-hour sessions over 8 consecutive weeks. Outcome measures included: FM impact, pain, health care utilization, depression, coping, and self-efficacy. An intention-to-treat analysis was conducted. Results showed that the impact of FM symptoms was reduced following treatment compared to the control group and this was statistically and clinically significant, but was not maintained at 3-month follow-up. Significant improvements were also observed in coping strategies, some of which were maintained at follow-up. Importantly, self-efficacy improved significantly following treatment compared to the control group. Self-efficacy beliefs have been related to pain, coping efforts, disability, and psychological functioning. Directions for future research may include a focus on long-term maintenance of treatment gains that may be mediated by improvements in self-efficacy. There is strong evidence that changes in self-efficacy are enduring and affect changes in health behaviours and health status.

Based on the Information Integration Theory, the current study investigates whether students¡¦ integration model of ticket fare and total travelling time difference will change when facing different safety conditions after they join the trials held by the Kaohsiung Rapid Transit Company (KRTC). The result indicates that the students¡¦ integration model of ticket fare and total travelling time difference is the ¬Û¥[ model. By using a different model of discussion, the result of my questionnaire shows that the linear transportation behavior found by traditional Mode Choice Model can be maintained. The result of data analysis suggests that KRTC has to adopt different strategies to enhance students¡¦ willingfulness to change their vehicles for transportation. It is shown that students add the scale values of ticket fare and total travelling time difference to motivate them to change their vehicles for transportation. Therefore, if we want to enhance the willingness to change their transporting vehicles, it is more effective to provide a solution with a higher scale value. In this study, students' scale value of total travelling time difference was higher than ticket price. Hence, if KRTC wants to enhance their willingfulness to change transporting vehicles, it is a more effective strategy to devise a way to decrease total travelling time.

Persuasion scholars have documented the use of compliance-gaining messages in both negotiation and negotiation. The extant research offers suggestions for litigators and negotiators, but fails to compare the methods of persuasion in the two circumstances in order to advise attorneys and clients which communication messages to employ in the different contexts. The present study explores differences in use of 7 common compliance-gaining message strategies (“It's Up To You”, “This Is The Way Things Are”, “Equity”, “Benefit (Other)”, “Bargaining”, and “Cooperation”; Kellerman, 2004) in separate negotiation and litigation cases. Findings indicate that “This Is The Way Things Are” messages were more frequent in litigation than negotiation, but “Cooperation” messages were more common in negotiation than litigation. No other significant differences in strategy frequency across the different contexts were found. These results indicate that some differences exist between the messages used in negotiation and litigation and that future research should investigate what other messages may be used differently in the two contexts. / text

Most individuals who die by suicide have contact with a physician in the year before their death. There are no randomized trials that have evaluated suicide intervention training for medical students or physicians. The objective of this study was to determine the effectiveness of a gatekeeper training program on suicide intervention behavior using Objective Structured Clinical Examinations (OSCEs) in medical students. A randomized controlled trial design was used. Participants were 112 undergraduate medical students at the University of Manitoba. The 2-day Applied Suicide Intervention Skills Training (ASIST) program was completed by half of the participants, according to a stratified block randomization design. Scores on OSCEs and scores on the Suicide Intervention Response Inventory (SIRI-2) were used as objective measures of intervention behaviors. There was a a significant Group-by-Time interaction on OSCE data, demonstrating that medical students who received ASIST performed significantly better than medical students who received training as usual (p<.001). The two groups did not differ significantly from each other on the SIRI-2 (p=.78). ASIST training improved the ability of medical students to detect and intervene with a standardized suicidal patient as assessed by OSCEs, compared to medical school training as usual. This study provides support for ASIST training for medical students to develop skills in recognition and management of suicidal patients. / October 2015

The aim of this research programme was to investigate the effects of different music applications: The differentiated exposure of music and the synchronous application of music. In Study 1, participants completed a series of 10-km cycling time trials under four single-blinded conditions: No-music control, music 0-10 km (M1), music 0-5 km (M2), and music 5-10 km (M3). The largest performance gains were noticed under M1, followed by M3, when compared to control, while the most positive psychological response was observed only in M3. Study 2 further examined the notion of differentiated music exposure by incorporating both quantitative and qualitative modes of inquiry. In addition, participants were given foreknowledge of the experimental conditions. Although no performance gains were found across conditions, M3 significantly reduced perceived exertion and prevented affective decline. Qualitative findings suggest that prolonged exposure to music may have negative psychological and psychophysical consequences. The last study contrasted the effects of synchronous and asynchronous application of music in a 6-min submaximal cycling task. Synchronous music was more effective than asynchronous music in terms of reducing perceptions of exertion and increasing subjective arousal. Although no changes in oxygen uptake were found across conditions, auditory-motor synchronisation appeared to reduce heart rate. The contribution of this thesis is twofold. Firstly, the provision of music in the latter stages of a task appears to have significant psychological and psychophysical benefits when compared against constant music exposure. Secondly, more positive effects, in terms of perceived exertion and subjective arousal, are observed when music is applied synchronously compared to asynchronously; this suggests a need for a separate conceptual framework for the application of synchronous music.

This dissertation is an empirical study of the actors and organizations working in criminal and drug courts. Specifically, the dissertation examines the structure (as defined by the interactions and relationships of players) of a criminal court and a drug court operating under a state trial court system in the United States. Recent reforms to trial courts indicate that the organizational structure of a typical trial court has changed in many states. Separately, specialty courts which help coordinate treatment for offenders like drug users and mental patients in many jurisdictions have changed the structure, process, and the nature of trial courts.The study is an inductive study using a case method research strategy to build new theory from past findings of organizational studies of criminal courts and from the little we know about drug courts as organizations. The method of inquiry in the study is a triangular research strategy that incorporates both qualitative and quantitative data collection and analysis. The qualitative data collection methods include primarily participant observations of drug team meetings and court proceedings, and semi-structured interviews with actors representing organizations participating in both criminal and drug courtrooms. The study uses network analysis as the primary method for analyzing quantitative data. The research site is the Arizona Superior Court in Pima County, located in Tucson, Arizona.I found that the most important central actors across all phases of the criminal court case disposition process are judges, prosecutors, and defense attorneys, and that measuring core workgroup actors across all phases give a more accurate picture of the criminal court case disposition process. I also found that defense attorneys may be less familiar with other court actors than prosecutors because they may enter the criminal justice system from many different sponsoring organizations. As for the drug court case disposition process, the study shows that the most central player is not always the judge. In addition, the study reveals that drug courts, as court reforms, have little overall connection to overall criminal court organization. Important policy implications and theory inferences, as well as recommendations for future court studies, are discussed.