<p>Abstract</p><p>Kerstin Forslund (2007): Challenges in prehospital emergency care – patient, spouse and personnel perspectives. Örebro Studies in Caring Sciences 16. 75 pp.</p><p>Prehospital emergency care (PEC) with the emergency call to the Emergency Medical Dispatch (EMD) centre is an essential part of the health-care system. It is important to obtain knowledge about the links in the PEC chain from the perspectives of those providing the service and those receiving it. The overall aim of this thesis was to describe the challenges surrounding PEC based on the experiences of patients, spouses and personnel. A qualitative descriptive design was used in the five papers included. The data analysis methods were phenomenological-hermeneutics (I–III), qualitative content analysis (IV–V) and descriptive statistics (V).</p><p>Interviews with thirteen patients who had called the EMD-centre due to acute chest pain (I) revealed a general satisfaction with PEC. They were aware of the number to call in an emergency but were uncertain when to call. The potentially life threatening emergency situation was marked by vulnerability and dependency and was fraught with pain, fear and a sense of aloneness.</p><p>An overall theme of aloneness emerged from the interviews with nineteen spouses who had placed an emergency call for their husband or wife that was experiencing acute chest pain (II). The challenges in being a spouse to a person in need of PEC were associated with: “Being responsible and trying to preserve life” and “Being able to manage the uneasiness and feel trust in an uncertain situation”. The spouses were in an escalating spiral of aloneness, worry, uncertainty, stress, fear of loss and desperation.</p><p>Interviews with sixteen emergency operators dealt with situations they considered difficult to deal with and their reflections on how they managed such situations (III). Uncertainty, communication difficulties and insufficient resources characterized those situations. Skills, knowledge, experience, as well as personal qualities such as sensitivity, self-insight, empathy and intuition were regarded as important when handling them.</p><p>Interviews with four nurses and fifteen emergency operators related to their experiences of working together for two years at an EMD-centre were conducted after the nurses were added to the EMD-centre to increase medical and nursing competence (IV). Initial frustration and scepticism changed to positive experiences with improved cooperation and service. The nurses voiced difficulties dealing with the more medically urgent calls and the emergency operators with the more complicated and diffuse medical cases.</p><p>A total of 336 questionnaires related to alarms involving acute chest pain and given the highest priority by the emergency operator were collected in a study aimed at describing the ambulance personnel’s perceptions of the quality of the information received from the EMD-centre (V). The ambulance personnel perceived most of the information such as patient assessment, condition, history, preparedness and in particular pain status to be of high quality.</p><p>In summary: In PEC there is many interdependent complexities that present demands and challenges to the actors involved (I–V). In general those who received emergency assistance from PEC were satisfied, but the margins between success and failure are small. Risks for errors exist throughout the PEC chain and time poses a challenge. Understanding is crucial for all involved, and the same situation can be experienced differently. Challenges inherent in PEC are the communication problems, unpredictability and uniqueness along with daring to be in the acute situation and dealing with a sense of aloneness, uncertainty and dependency. The personnel that do not have the ability to see the person they are helping are even more challenged. Important attributes for PEC personnel are caring attitudes, personal skills, experiences and professional knowledge. PEC personnel have the authority and power to act and make decisions, in which responsibility, sensitivity, and human dignity must be addressed. Lives are saved with PEC despite all the challenges and possibilities for error, such as those that exist between the different actors. It is vital that the PEC chain is as strong as possible.</p><p>Keywords: challenge, prehospital, emergency, care, patient, spouse, personnel,</p><p>chain, acute chest pain.</p>

In their challenge-point framework (CPF) Guadagnoli and Lee’s (2004) argue that learning is maximized when a person faces an optimal level of challenge during practice. It is suggested that challenge level can be manipulated through the combination of different practice variables. The purpose of this study was to investigate how practice schedule and self-controlled feedback frequency manipulations affect performance and learning of motor skills. Participants (n=96) attempted to learn three versions of a key-pressing task. The task consisted of pressing five computer keys in specified sequences in a goal criterion time. Participants were assigned to either a blocked practice schedule with self-controlled feedback (BLK-SC), a random practice schedule with self-controlled feedback (RND-SC), a blocked practice schedule with yoked feedback (BLK-YK), a random practice schedule with yoked feedback (RND-YK), a blocked practice schedule and 100 percent feedback (BLK-100), or a random practice schedule with 100 percent feedback (RND-100). Participants in the blocked conditions practiced 30 trials of each task according to a blocked practice schedule. Participants in the random conditions practiced 30 trial of each task according to a random practice schedule. Participants in the self-controlled feedback condition were allowed to choose whether or not to receive feedback on each trial. Yoked participants had their feedback schedule matched to a participant with similar characteristics in the self-control condition. Participants in the 100% feedback condition received feedback after every trial. Participants were also asked to complete the NASA Task Load Index (Hart & Staveland, 1988) and an adapted Perceived Competence for Learning scale (adapted from Williams & Deci, 1996) after the completion of the 5th and 90th trial. After 24 hr participants performed a retention test. The results indicated no difference between groups during retention or for the NASA-TLX and PCL scores. The feedback frequency analysis indicated no differences between BLK-SC and RND-SC groups. In general, the findings of the present study show that the effects of practice schedule conditions can be offset by self-controlled feedback manipulations. They also suggest that a number of different combinations of practice schedules and feedback frequencies can lead to similar challenge levels.

<p>Koi and goldfish have been released into rivers in South Africa since the 1800&rsquo / s for food and sport fish and have since spread extensively. These fish are present in most of the river systems in South Africa and pose an additional threat the indigenous cyprinids in the Western Cape. Monogenean parasites of the genus Gyrodactylus are of particular concern, as their unique biology renders them a possible threat. Gyrodactylus kherulensis and G. kobayashii were identified from koi and goldfish respectively imported from Asia, Europe and locally bred fish. Morphometrics and the use of statistical classifiers, which includes univariate (ANOVA and Kruskal-Wallis), bivariate (Pearson&rsquo / s correlation) and multivariate (Principal Component Analysis) placed the two species within their respective groups. There was some intraspecific variation among the different populations collected from the various locations, especially in the hamulus and ventral bar features, but the marginal hooklets, however, remained static for both helminth species.</p>

Background: Atopic disease is an increasing problem. Eczema affects 10-20% of young children, and 33-37% of children with eczema are food allergic. Among other factors, nitric oxide (NO) is thought to play a role in eczema and food allergy. Following the atopic march, pproximately 80% of children with atopic eczema will become sensitized to aeroallergens and develop asthma and/or allergic rhinitis. Skin prick test is used for investigating sensitization and is considered a safe method. However, systemic allergic reactions may appear when the test is performed. In diagnosing food allergy and for evaluating achievement of tolerance, the oral food challenge is the method of choice, and the double-blind placebocontrolled fashion is 'the gold standard'. Skin prick test: We examined six cases of generalized allergic reactions in connection with skin prick testing in order to identify risk factors, and thereby increase safety, and we investigated the necessity of performing skin prick tests in duplicate. We found that all six children with generalized reactions were &lt;6 months of age. When analyzing skin prick tests in duplicate, we found only 1.3% that showed diverging results, and in infants &lt;6 months even fewer, 0.9%. Food challenge: We developed recipes and a protocol for low-dose oral food challenge to milk and egg to be used in young children outgrowing their food allergy so as to facilitate early re-/introduction of small amounts of milk and egg. We performed 52 challenges, both open and double-blind placebo controlled. The recipes were validated for blinding. The lowdose challenge was tolerated well by the children and was easy to perform. Four children had a positive challenge outcome, all reacting to very small amounts of milk. All but two of the non-reacting children were able to introduce milk and egg into their diet. Nitric oxide and eczema: We investigated the effect of eczema treatment on the NO levels in urine. The sum of nitrite and nitrate was measured in urinary samples from 94 infants at two visits, with an interval of 6 weeks, and the results were compared with clinical data. The levels of NO products increased significantly when the eczema improved. The atopic march: The aim was to evaluate the atopic march in children with eczema, from referral at &lt;2 years until 4½ years of age. We followed 123 children with eczema, 78 sensitized and 45 not sensitized to milk and/or egg, with respect to eczema severity, other allergic manifestations, development of airway sensitization, and achievement of food tolerance. The difference in severity of eczema at referral was significant when comparing food-sensitized with non-sensitized children. At follow-up, 62% were still affected by eczema, although 56% only mildly so. Tolerance was achieved in 81% of the children allergic to milk and 68% of those allergic to egg. Fifty-eight percent of the food-sensitized children and 26% of the non-sensitized children had become sensitized to aeroallergens, a significant difference. The difference in airway symptoms was not significant. Very few children were exposed to tobacco smoke in their homes. Conclusions: Increased precautions should be considered when performing skin prick tests in infants &lt;6 months of age. The use of a single prick, to avoid the risk of summation of reactions, is justified when performing skin prick tests. We report recipes and a protocol for standardized open and double-blind placebo-controlled low-dose food challenge in young children, enabling the introduction of small amounts of egg and milk into the diet during tolerance development. NO products in urine increases when eczema improves. This might be due to a Th2/Th1 shift induced by the eczema treatment and skin healing, and the variation in NO response may be due to individual variations in NO-induced feedback downregulation of Th1 and Th2 proliferation. The prognosis for achieving clinical tolerance is very good in children early sensitized and allergic to milk and egg, but they will become significantly more often sensitized to aeroallergens.

In current business global society, every food industry company is making efforts to provide high quality of products and satisfaction to customers. Balancing the low cost but with high efficiency when undertaking cold chain logistics becomes competitiveness in business market. This thesis is mainly to study cold chain management in food logistics by a multiple case study on food industry. The purpose of the paper is to advance the understanding of the cold chain management in food industry, aim to find how an efficient way to combine the logistics cost and the effectiveness of cold chain logistics and the challenges of the cold chain logistics in food industry. In this multiple case study, qualitative method was used to describe findings. The data collected can be divided into two types, the primary data and the secondary data. Primary data indicates the face-to-face interview with the managers and employees working for customer service in the selected companies. The secondary data are resources from archives, websites and other printed materials. To improve the validity, related literature were reviewed by authors to find the research questions. The reliability can be guaranteed because the theory part of the thesis abstracted from the publications, which have been approved for many years. The authors give the overview and practice in cold chain logistics of the three case companies, also mention the challenges both in developing and developed countries. The study finds the way to improve the utilization in cold chain logistics, fill the gap of logistics in food industry and give some advices for food industry.

To become successful in China is a challenge not every international company can cope with. The competition is cruel as everyone struggle for a larger piece of share. Some manage to find the “secret” formula, others simply are left behind. Still, the market is too big to be neglected and extremely unpredictable to be easily handled. Nokia has proved to be foreseeing and wise enough to not only enter that market, but also climb up the ladder of success and stay there for a decade. This work aims to give a clear and thorough picture of Nokia’s successful strategy in penetrating the Chinese market. It follows and explains the steps Nokia took back in the days in building strong brand awareness and thousands of loyal customers in the face of the Chinese consumer. Its purpose is not only to tell the story of success, but also to teach important lesson future investors and perhaps give a precious insight into the topic. The Chinese market needs to be studied and analyzed as well in order to build a better understanding for it. We need to find out how they feel, what they think and what factors influence their behavior and finally how to approach them. A series of different research methods like secondary data, personal and group interviews, and online survey will be used here. The approach in this study will be inductive, where specific theory will be developed based on research.

The purpose of this study was to characterize and evaluate the performance of a whole-body human exposure chamber for controlled test atmospheres of gases and particulates. The chamber was constructed from Plexiglass, has a volume of 75 ft 3, operated at a flowrate of 33.8 CFM, and both the makeup and exhaust air are HEPA filtered. Fly ash dust was generated using a Wright Dust Feeder. An elutriator was used to eliminate particles larger 8 μm aerodynamic diameter from the airstream. A direct reading instrument, the Rupprecht and Patashnick PM-10 TEOM, was used for determination of particle concentration. Particle size distributions were determined by a QCM cascade impactor. Data from gravimetric analysis were used to test for the evenness of dust concentrations in the chamber. CO2 is used as a representative gas and its concentration was measured using the Metrosonics aq-5000. Total dust concentrations as measured by the TEOM, in μg/m 3, at 0.2, 0.4, 0.6 and 1.6 RPMs of the Wright Dust Feeder, were 110 + 2.8, 173 + 8.5, 398 + 20 and 550 + 17, respectively. For these RPMs, particle size distributions were associated with a MMD of 1.27 μm and a GSD of 2.35, a MMD of 1.39 and a GSD of 2.22, a MMD of 1.46 and a GSD of 2.08, a MMD of 1.15 and a GSD of 2.2, respectively. Total dust concentrations as measured by gravimetric analysis, in μg/m3 for the respirable fraction. Dust concentrations measured at different points within the chamber showed uniform distribution with a variability less than 10%. Similarly, the particle size distributions were found to be consistent across the different RPMs settings. Regarding carbon dioxide, its concentration was straightforward and the measured and theoretical maximum concentration levels were in agreement. The performance of this whole-body human exposure chamber has been characterized and evaluated for low levels of particles and gases and now it is a valuable research tool for inhalation challenge studies.

Across three studies, the role that testosterone plays in how individuals respond psychologically, behaviorally, and physiologically to status challenges was investigated. Preliminary Studies 1 focused on how testosterone related to physiological and psychological responses to a medical threat. Preliminary 2 replicated the psychological effects observed in Preliminary Study 1. Study 3 examined how experimentally manipulated testosterone levels corresponded to responses to a socially judged physical endurance task across all three response types. Preliminary Study 1 examined the relationship between testosterone and conscious evaluations of and physiological reactions to a health threat. Participants were diagnosed with a fictitious enzyme deficiency before rating their views of the deficiency, as well as providing saliva samples before and after diagnosis. Basal testosterone was negatively associated with the belief that one actually had the deficiency, despite the diagnosis. Testosterone was also positively associated with a greater increase in salivary cortisol levels following the diagnosis. Self-reported anxiety was found to be positively associated with evaluating the deficiency as threatening. Preliminary Study 2 replicated the findings observed in Preliminary Study 1 regarding conscious evaluations of a medical threat. Using the same experimental manipulation, testosterone was again found to be negatively associated with ratings of the enzyme deficiency. In Preliminary Study 2, high levels of testosterone were associated with viewing the deficiency as less serious and viewing medical conditions, in general, as less threatening. Study 3 used a transdermal administration procedure to artificially elevate individuals’ testosterone levels before completing a socially evaluated task. Participants who received the testosterone administration showed greater physiological responses to the task, including cardiovascular responses and cortisol responses, compared to the placebo group. Unlike Preliminary Studies 1 and 2, Study 3 did not show any effect of testosterone on conscious evaluations of the task nor behavioral measures of performance. Taken together, the three studies highlight the different ways in which testosterone is related to responding to social threats. Testosterone appears to be associated with mobilizing physiological systems to theoretically facilitate behavioral responses to status threats. Testosterone also appears to be negatively associated with consciously evaluating certain types of threats. / text

The purpose of this study is to investigate five teachers’ opinions on the work with individualization with focus on above-average pupils. I have issued four questions based on the purpose of this study: - How do these teachers define the theoretical concepts of individualization and above-average pupils? - How do the teachers reason about the concept of individualization with focus on the above-average pupils? - How do the teachers reason regarding the work with individualization in the Swedish language? - Do these teachers consider that there are difficulties to individualize the work so that it will challenge above-average pupils? The method used to conduct this study was a semi-structured qualitative interview with five teachers in primary school. The theory and the theoretical concepts this study is based on is: what defines the above- average pupils, the zone of proximal development, the concept of individualization and motivation and the importance of cognitive and non-cognitive abilities. The study shows that the theoretical concept of above-average pupils is hard to define and it shows a difference between how the teachers choose to define it. However, the teachers show a good understanding of the concept of individualization which they define as an approach based on each individual's level of knowledge. It also shows that the teachers are having difficulties individualizing the school assignments to challenge and stimulate the above-average pupils. The teachers mean that the main reason for this problem is the lack of resources the teachers have available.

Innovation is not always enough. In the beginning of the 2000s established pharmaceutical firms had developed several drugs, yet these new products were far too few. Patents of many blockbuster drugs were to soon expire and substantial profit would then be lost. A potential solution emerged: implementing new biomarker technologies in drug development. Biomarkers are required for knowledge creation about the drug effect on underlying causes of a disease. The problem is this: although academia, industry, and policy makers have deemed biomarkers as necessary for successful drug development, pharmaceutical firms have not used them in actual drug development projects.  Since the 1990s, established pharmaceutical firms have invested financially and restructured organizationally in order to implement biomarkers. Still, cases show that more than 50% of project termination in Clinical Phase 2 (the bottle neck of drug development) can be attributed to the lack of implementing biomarkers.   Challenges of established firms transforming in the face of technology change is a commonly studied phenomenon within innovation management literature. Several explanations have attempted to determine why established firms fail in following technology change. However, most of this literature has been based upon an empirical context where technology change is conceptualized as an innovation of the dominant product design in the industry. Consequently, the challenge is to develop or adapt a discontinuous product innovation. Conversely, implementing biomarkers is a case of technology change that impacts R&amp;D. Since drugs lose their value when the patent protection expires, the established pharmaceutical firms need to continuously develop new block buster drugs – not just one product. More research is needed to fill this gap in the literature in order to develop an understanding of the established firm challenge in implementing biomarkers. This thesis builds upon a longitudinal case study of AstraZeneca. Using multiple data sources, the findings show that the dominant architecture of the drug development process during the 2000s impeded the implementation of biomarkers. AstraZeneca required an “architectural process innovation” in order to complete this implementation. The company’s process-based management structures distorted it from recognizing the need for process change. This thesis has three contributions: First, it describes the process change and the firm’s managerial challenges associated with biomarker implementation; Second, it contributes to the literature on the established firm challenge by developing an understanding of the phenomenon of architectural process innovation; Third, it develops a process-based framework for studying technology change that affects R&amp;D. / <p>QC 20151106</p>