Sammanfattning Bakgrund: I Sverige har cirka 200 000 personer hjärtsvikt. Sjukdomen kan vara kronisk, komplex och innebär en livslång behandling. Det är en allvarlig sjukdom där cirka 50 % med svår hjärtsvikt dör inom ett år. Det finns inga klara riktlinjer när transition till palliativ vård för patienter med hjärtsvikt sker. Syfte: Syftet var att identifiera erfarenheter som sjuksköterskor ansåg vara av betydelse för att initiera palliativ vård för patienter med hjärtsvikt, samt vilka åtgärder som därefter vidtogs. Metod: En kvalitativ design med induktiv ansats valdes. Totalt genomfördes 15 ostrukturerade intervjuer, alla intervjuer analyserades utifrån Critical Incident Technique. Resultat: Det framkom att ett allmänt försämrat hälsotillstånd var erfarenheter som sjuksköterskan ansåg vara av betydelse för transition till palliativ vård. I resultatet framkom även att åtgärder som vidtogs ledde till att vården blev mer palliativt inriktad. Slutsats: Att identifiera patienter med hjärtsvikt som var i behov av palliativ vård var viktigt men svårt och krävde kunskap. Det finns behov av att utarbeta hjälpmedel och verktyg för att underlätta identifieringen till palliativ vård, eftersom det leder till att vården blir mer personcentrerad och behandlingsstrategin förändras. / Abstract Background: In Sweden, approximately 200,000 people have heart failure. Heart failure can be chronic, complex and involves lifelong treatment. It is a serious disease in which about 50% with severe heart failure die within a year. There are no clear guidelines when transition to palliative care for patients with heart failure occurs. Objective: The purpose was to identify experiences that nurses considered to be important for initiating palliative care for patients with heart failure, and what actions thereafter were taken. Methods: A qualitative design with inductive approach was chosen for this study. A total of 15 unstructured interviews were conducted and analyzed on the basis of the Critical Incident Technique. Results: The result was divided into two parts. It was found that a generally deteriorated health were experiences that the nurse considered to be of importance for transition to palliative care. In the results it emerged that measures that was taken led to more oriented palliative care for the patients. Conclusion: To identify patients with heart failure who were in need of palliative care was important but difficult and required knowledge. There is a need to develop aids and tools to facilitate identification for palliative care, as it causes care to be more person-centered and the treatment strategy changes.

Constructing the genomic median of several given genomes is crucial in developing evolutionary trees, since the genomic median provides an estimate for the ordering of the genes in a common ancestor of the given genomes. This is due to the fact that the content of DNA molecules is often similar, but the difference is mainly in the order in which the genes appear in various genomes. The mutations that affect this ordering are called genome rearrangements, and many structural differences between genomes can be studied using genome rearrangements. In this thesis our main focus is on applying combinatorial optimization techniques to genomic median problems, with particular emphasis on the breakpoint distance as a measure of the difference between two genomes. We will study different variations of the breakpoint median problem from signed to unsigned, unichromosomal to multichromosomal, and linear to circular to mixed. We show how these median problems can be formulated in terms of problems in combinatorial optimization, and take advantage of well-known combinatorial optimization techniques and apply these powerful methods to study various median problems. Some of these median problems are polynomial and many are NP-hard. We find efficient algorithms and approximation methods for median problems based on well-known combinatorial optimization structures. The focus is on algorithmic and combinatorial aspects of genomic medians, and how they can be utilized to obtain optimal median solutions.

'...Zugriffsfehler im Modul xyz...' - solche oder ähnliche Fehlermeldungen sehen Benutzer von Computern meist dann, wenn sie versuchen mit einem Programm Operationen auszuführen, die fehlerhaft programmiert wurden. Die Ursachen für derartige Fehler sind dabei recht vielfältig. Oftmals sind sie bereits in der benutzten Programmiersprache zu suchen, dazu kommen zusätzlich Fehler in den Compilern, Beschränkungen in dem Betriebssystem sowie Seiteneffekte anderer Programme, wie z.B. falsches Speichermanagement. Angeführt wird die Liste möglicher Fehlerquellen allerdings vom Menschen selbst. Wobei auch hier noch zu unterscheiden ist, ob der Mensch einen Fehler aus Unwissenheit gemacht hat, oder ob er dessen Relevanz einfach unterschätzt hat. In beiden Fällen wird es immer schwer sein in einem Endprodukt die genaue Ursache eines Fehlverhaltens zu lokalisieren. Ähnlich wie es zu Problemen bei der Erstellung von Software kommen kann, treten natürlich auch während der Entwicklung einer Schaltung grundlegende Schwierigkeiten auf...

We assume pairs of random variables (X_i, Y_i), whereby the real variable X_i measures the creditworthiness of individual i with i = 1, . . . , n. The Bernoulli variable Y_i represents the default indicator of individual i. Our main target is a division of the creditworthiness into a given number of groups with a homogeneous default risk, i.e. to estimate rating classes. The framework of change point analysis provides a nonparametric method to estimate the breakpoints between the rating classes under quite weak assumptions. Up to now, the theory of breakpoint estimation is developed under the assumption of exactly one breakpoint. The contribution at hand, basically implements this theory, but extends it into a multi-stage heuristic. That means, we sequentially apply the theory for only one breakpoint as a multi-stage procedure. With this article we transfer the interesting theoretical issue of breakpoint estimation into an applicable form. Thereby, all the results are checked and obtained by simulation. The main results are as follows. Applying a sequential breakpoint estimation basically works and leads to outcomes of practical purpose. Thereby, the multistage heuristic reveals some weakness esp. in the case of quite huge differences between default probabilities that can be resolved by some interventions.

In the course of evolution, genomes diverge from their ancestors either via global mutations and by rearrangement of their chromosomal segments, or through local mutations within their genes. In this thesis (Chapters: 2, 3 and 4) we analyze the evolution of genomes based on different rearrangement operations including: in Chapter 2 both restricted and unrestricted double-cut-and-join (DCJ) operations, in Chapter 3 both internal and general reversal and translocation (IRT and HP, respectively) operations, and in Chapter 4 translocation, weighted reversal (WR) and maximum length reversal (MLR) operations. Based on the rearrangement operation chosen we can model the evolution of genomes as a discrete or continuous-time Markov chain process on the space of signed genomes. For each model of evolution, we study the stochastic process by investigating the time up to which the difference between the number of operations along the evolutionary trajectory and the edit distance of the genome from its ancestor is negligible, as soon as these two values starts diverging drastically from one another we say the process escapes from parsimony. One of the major parameters in the known edit distance formulas between any two genomes (such as reversal, DCJ, IRT, HP and translocation) is the number of cycles in their breakpoint graph. For DCJ, IRT and HP models by adopting the method elaborated by Berestycki and Durret, we estimate the number of cycles in the breakpoint graph of the genome at time t and its ancestor by the number of tree components of the random graph constructed from the model of evolution at time t, which is an Erdös-Rényi. We also proved that for each of the DCJ, IRT and HP models of evolution, the process on a genome of size n is bound to its parsimonious estimate up to t ≈ n/2 steps. Since the random graph constructed from the models of evolution for the translocation, WR and MLR processes are not Erdös-Rényi, the proofs of their parsimony- bound require more advanced mathematical tools, however our simulation shows for the translocation, two types of WR, and MLR (except for reversals with very short maximum length) models, the escape from parsimony do not occur before n/2 steps, where n is the number of genes in the genome. A basic result in this field is due to Berestycki and Durrett, from 2006, who found that a random transposition (pairwise exchange of the elements in the corresponding permutation of the genome) evolves along its parsimonious path of evolution up to n/2 steps, where n is the number of the genes. Although, this transposition model is applicable solely for evolution of a unichromosomal ancestor which remains unichromosomal at each step t of the process; however for the DCJ, IRT, HP and translocation models the genomes are multichromosomal which increases the difficulty of the problem at hand. The models studied in Chapters 2 - 4 are all based on signed permutation representations of genomes, where each "gene" occurs exactly once, with either positive or negative polarity. The same genes occur in all the genomes being considered. There is no distinction between the same gene in two different genomes. In Chapter 5 we generalize our representation to genes that may have several copies of a gene, which differ only by a few point mutations. This leads to problems of identifying copies in two genomes that are primary orthologs, under the assumptions of differentials in point mutation rate. We provide algorithms, software and test examples.

Bakgrund: Brytpunktssamtal är ett samtal som sker mellan den ansvarige läkare, patienten och dess närstående med syfte att informera om vårdens inriktning samt ger möjlighet för den äldre personen att framföra sina önskemål i livet slutskedet. Sjuksköterskan har en viktig roll vid brytpunktsamtal genom att ge emotionellt stöd till den äldre och dennes närstående under samtalet, att följa upp efter samtalet samt planera personcentrerad vård utifrån den äldres och dess närståendes behov och önskemål.  Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter före, under och efter brytpunktssamtal med äldre personer och dennes närstående i kommunalt särskilt boende. Metod: Studien har en deskriptiv design med kvalitativ ansats. Total åtta sjuksköterskor med fem till trettiotvå års erfarenheter inom den kommunala äldreomsorgen i tre kommuner i mellan Sverige deltog i intervju.  Insamlade data analyserades med hjälp av innehållsanalys Resultat: Tre kategorier framkom under analysen nämligen, att agera professionellt, att ge stöd till närstående, att skapa förutsättningar för- och motverka hinder för ett bra brytpunktssamtal.  Slutsats:  Sjuksköterskorna upplevde att förutom utöva sin yrkesroll i vården av patienten, samt att tillsammans med vårdpersonalen bedöma patientens tillstånd och ta ställning till om brytpunktssamtal behöver genomföras, tar de också ofta ansvarar för att genomföra brytpunktssamtal. Vidare beskrev sjuksköterskorna att de flesta äldre inte deltog i samtalet, vilket uppfattades som syftet med brytpunktssamtal och vikten av att kommunikationen inte uppfylldes. / Background: A breakpoint conversation is a conversation that takes place between the responsible doctor, the patient, and their relatives with the purpose of informing about the direction of care and giving the elderly person the opportunity to express their wishes in the final stages of life. The nurse has an important role in end-of-life conversations, to provide emotional support to the elderly and their relatives during the conversation, to follow up after the conversation and to plan person-centered care based on the elderly's and their relatives' needs and wishes.   Aim: The aim of this study was to describe nurses' experiences before, during and after breakpoint conversations with elderly people and their relatives in municipal nursing homes. Methods: The study has a descriptive design with a qualitative approach. A total of eight nurses with five to thirty-two years of experience in municipal elderly care in three municipalities in the middle of Sweden were interviewed. The collected data was analysed using content analysis methods.  Results: Three categories emerged during the analysis, namely: to act professionally, to provide support to relatives, to create conditions for and counteract obstacles for a good breakpoint conversation.  Conclusion: The nurses experienced that apart from exercising their professional role in the care of the patient, which means, together with the nursing staff, assessing the patient's condition and deciding whether break-point conversations need to be carried out, they are also often responsible for carrying out breakpoint calls. Furthermore, the nurses described that most elderly people did not participate in the conversation, which was perceived as the purpose of break point conversations and the importance of communication not being met.

This mater's thesis deals with introducing principles of debugging and debuggers. The thesis examines in detail format of debugging information and it describes the design of debugger created within the project Lissom. Furthermore, the thesis also contains implementation of each designed part, which the debugger consists of. Last part of this thesis deals with testing of the implemented solution with two types of processor architectures and it also contains the conclusion of the results.

This study aims at analysing how African oil benchmarks within the OPEC Reference Basket relative to the WTI and Brent benchmarks which are considered as global pricing benchmarks for the period starting from 1997-2008. The Nigerian Bonny Light and Algerian Saharan blend were the two benchmarks used for this study. A time series analysis was applied to the weekly price data series set and with the aid of a breakpoint unit root test and Cusum of Squared test to determine if there was a change in the persistence of the spread of each African benchmark relative to the global benchmarks. The results for from the unit root test indicated the presence of a structural break in the price spread in 2004 for the Bonny Light benchmark and in 2005 for the Saharan blend relative to both global benchmarks. The Cusum Squared test for the four benchmark pairings indicated a change in persistence of the price spreads. The null hypothesis was rejected for the alternative hypothesis of the price spread process having a relatively high persistence value after a while. The Cusum Test results showed a change in persistence for both African benchmarks relative to the WTI benchmark and no change in persistence relative to the Brent benchmark. The results of from the Time series analysis indicated the competitive nature of African benchmarks relative to global benchmarks and this could benefit exporting countries by virtue of setting up derivative markets. The derivative markets would allow for the trade of benchmark spreads, futures contracts, options and other financial instruments for African oil producers.

Demens är en obotlig sjukdom som leder till döden. En stor andel personer som bor i permanenta särskilda boendeformer i Sverige lider av demenssjukdom. Det ligger ett stort ansvar för omvårdnaden av personer med demenssjukdom på sjuksköterskan, som bland annat informerar och samtalar med närstående när livet hos den demenssjuke närmar sig slutet. Identifiering av hinder och förutsättningar för genomförande av dessa samtal bidrar till en bättre förståelse och utveckling av detta område. Syftet med denna studie var att belysa sjuksköterskors erfarenheter av att samtala med närstående till personer med demenssjukdom i samband med övergången till sen palliativ fas på särskilda boenden.En kvalitativ studie med semistrukturerade intervjuer genomfördes, där sju sjuksköterskor som arbetade vid demensenheter inkluderades. Data analyserades med kvalitativ innehållsanalys med induktiv ansats. Resultatet utgörs av 8 kategorier: vårdplanering, personcentrerad vård, information och kommunikation, kunskap och utbildning, övergång till sen palliativ fas, teamarbete, LCP och att dö hemma.Denna studie påvisar hinder som kan uppstå i genomförande av brytpunktsamtal med närstående till personer med demenssjukdom. Några av dem är bristande kunskaper om demenssjukdomar hos närstående, brist på tidig planering av vården vid den sista tiden och osäkerhet bland sjuksköterskorna kring att hantera svåra samtal. Vidare presenteras förbättringsförslag som kan öka tryggheten och säkerheten i vården och på så sätt kan förbättra situationen för sjuksköterskor vid brytpunktssamtal. De två viktigaste förbättringsförslagen är dels att skapa en bättre kontinuitet i omvårdnadsarbetet och dels att organisera kontinuerliga utbildningar för att höja kompetensen hos omvårdnadspersonalen. / Dementia is an incurable disease that leads to death. A large proportion of people living in nursing homes in Sweden have dementia. Nurses have a great responsibility for the care of people with dementia since they, among other things, carry out informative communication with the family when the resident approaches the end of life. Identification of barriers and facilitators for such communication could lead to a better understanding and development of this matter. The purpose of this study was to illuminate nurses’ experiences of conversations with families of people with dementia in the transition to end-of-life care in nursing homes.A qualitative study with semi-structured interviews was conducted, where seven nurses, working in nursing homes specialized in dementia, were included. A qualitative content analysis with an inductive approach was performed. The result consists of 8 categories: planning of care, person-centred care, information and communication, knowledge and education, transition to end-of-life care, teamwork, LCP and to die home.This study identified challenges that might hinder breakpoint communication with families of people with dementia. Some of them are families’ lack of knowledge about dementia, lack of early planning of end-of-life care and uncertainties among nurses on how to handle difficult conversations. Furthermore, improvement suggestions are presented that can increase the safety in care and improve the situation for the nurses in breakpoint communication. The two most important suggestions are the creation of a better continuity in the nursing and to organize continuous educations to increase the competence among staff.Keywords:

Bakgrund: Under år 2022 vårdades cirka 42 200 patienter på IVA runtom i Sverige. Åtta % av de som vårdades på IVA avled. Detta innebär att intensivvårdssjuksköterskor möter patient och närstående i en svår tid. I arbetet som intensivvårdssjuksköterska förekommer brytpunktssamtal. Detta ställer krav på att intensivvårdssjuksköterskan är förberedd på att möta både patientens och närståendes känslor som uppkommer när beslut tas om att avbryta behandling. Syfte: Syftet med studien var att undersöka intensivvårdssjuksköterskors erfarenheter av brytpunktssamtal på en allmän intensivvårdsavdelning. Metod: En kvalitativ studie där intensivvårdssjuksköterskor harintervjuats i fokusgrupper. Materialet har analyserats med en kvalitativ innehållsanalys. Resultat: I resultatet framkom det fem kategorier; ”När vården ändrar riktning”, ”Att vara trygg i professionen”, ”Samverkan i det professionella teamet”, ”Konsten att förmedlabesked” och ”Ge utrymme för tid och känslor”. För intensivvårdssjuksköterskorna innebar ordet brytpunktssamtal att förmedla svårt besked till patient och närstående. Att ge tid till att svara på frågor, samarbete mellan olika professioner och resursbrist var det som belystes mest. Slutsats: Brytpunktssamtal påverkar alla inblandade, både patient, närstående och vårdpersonal. Intensivvårdssjuksköterskorna har en betydelsefull roll i hur brytpunktssamtalet förmedlas och tas emot. Förståelse för sin roll i brytpunktssamtalet är nödvändig för att kunna möta patient och närstående i en svår tid i livet. / Background: During 2022 circa 42 200 patients were treated in ICU’s in Sweden. Eight % of those treated deceased in ICUs. This means, ICU nurses encounter patients and relatives in a difficult time. Breakpoint conversations are guaranteed occurances for these nurses. This in turn requires the nurses to be prepared to respond appropriately to feelings of patients and relatives, when the decision to end treatment is taken. Aim: The aim of this study was to investigate nurses’ experiences of breakpoint conversations. Method: A qualitative study where nurses were interviewed in focus groups. The resulting material was analyzed with a qualitative content analysis. Results: Five categories were highlighted; ”When care changes direction”, ”To be comfortable in the profession”, ”Cooperation in the professional team”, ”The art of conveying information” and ”Allowing space for time and emotions”. For the nurses, the words breakpoint conversation, implies giving tough information to patients and relatives. Dedicating time to answering questions, cooperation between professions and lack of resources were highlighted in the results. Conclusion: Breakpoint conversations affects all who are involved, both patient, relatives and health-care professionals. Nurses have an impactful role in ho breakpoint conversations are formed and received. Understanding one’s role in breakpoint conversations is a necessity in encountering patients and relatives in a difficult situation.