Cumulative risk models provide a convenient, parsimonious way to identify outcomes associated with multiple, highly correlated risk factors. In this paper, we explored linkages between a cumulative sociodemographic risk index, which included rurality status, and aspects of temperamental difficulty in an early school age sample of 53 school-aged children from Southcentral Appalachia. Cumulative risk was significantly predictive of temperamental difficulty, as defined by high negative affectivity and low effortful control, but post-hoc analyses revealed this association to be driven primarily by two of the eight risk indicators: rural status and income-to-needs risk. Although rurality status was highly correlated with income-to-needs risk, rurality predicted negative affectivity over and above income-to-needs risk and income-to-needs risk predicted effortful control over and above rurality status. Future models of cumulative risk may benefit from including rurality status as a risk indicator, despite high collinearity with income-to-needs risk.

The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner's novice to expert model was chosen as the theoretical framework to guide the additional training, critical thinking, problem-solving, and skill acquisition necessary for team member inclusion. The practice-focused question for the project answered whether DUC team nurses, through advanced training and demonstrated procedural competence, have been effective with DUC insertions. Sources of evidence included primary and secondary articles in peer-reviewed journals, as well as clinical evidence collected from internal sources. During the project time-line, 463 DUC team consultations were recorded with an insertion success rate of 89.6%. Based on the DUC team concept, additional didactic content and simulation training may be developed for other cognitive and skill-based clinical procedures. The implications for positive social change include improved patient safety and comfort, as well as cost savings for the organization and overall healthcare system.

The purpose of this research was to understand the meaning of caring as narrated, lived, moral experience. Forty-five good nurses experienced in the care of patients in surgical, medical and geriatric wards were interviewed. They described their experience of; caring, caring abilities, the worthwhile of caring, the strength related to caring and narrated situations (n=88) in which they had experienced that their caring had made a difference to the patient. Surgical nurses described care and cure as an integrated whole, medical nurses described care as integrated with the patients' social context and geriatric nurses described care as enhancing the autonomy of patients (I). The nurses' narrated, lived, experiences of caring situations revealed ways of intervening and interacting with the patient including caring actions (II). Eighteen good nurses experienced in the care of cancer patients were also interviewed. Their narrated, lived experiences of morally difficult care situations i.e. situations where it had been hard to know what was the right and good thing to do for the patient (n=60), revealed that relationships with their co-workers were very important for their possibility to act according to their moral reasoning and feelings(III). The situations for the nurses were either disclosed as overwhelming or possible to grasp. When narrating about these situations the nurses used different terms about themselves and their co-workers (One, They, I and We). The nurses viewed the patients either as a task to be accomplished or as a valuable unique person. In the latter situations ethical demands were interpreted, judged and acted upon (IV). Interpretations of these nurses' skills in managing morally difficult care situations disclosed two levels; one group of nurses who described positive paradigm cases, liberating maxims and disclosed open minds, while the other group described negative paradigm cases, restrictive maxims and revealed closed minds. The latter nurses were mostly the nurses who disclosed in Paper III that they used the term "one" about themselves and "they" about their co-workers (V).en patients recently cared for at surgical and medical wards were interviewed(IV). They narrated lived experiences of receiving/not receiving the help they needed or wanted when suffering from pain and anxiety/fear. The patients revealed that the most important thing for them to feel cared for in these situations was to be listened to, taken seriously and trusted, if they were not treated in this way the patients revealed that they felt they were in the hands of somebody who was uncaring. The findings are interpreted within the framework of Paul Tillich's philosophy concerning love, power, justice and courage, thereby showing the tension between these phenomena in the narrated, lived, moral experience. Light is also thrown on the dynamics of openness, vulnerability, fallibility, forgiveness, affirmation as well as powerlessness, meaninglessness, insufficiency, dissociation and exclusion. Reflections are made concerning practical wisdom. / <p>S. 1-60: sammanfattning, s. 61-151: 6 uppsatser</p> / digitalisering@umu

Många kvinnor betraktar amning som det naturligaste sättet att ge sitt nyfödda barn föda. Mödrar får information av sjukvården att bröstmjölk innehåller all näring som det nyfödda barnet behöver samt antikroppar som skyddar barnet mot de vanligaste barnsjukdomarna. Det är inte alla kvinnor som kan amma i dagens samhälle och detta kan leda till att känslor väcks hos den nyblivna mamman som under graviditeten tänkt amma men som sedan inte kunnat göra det. Syftet med studien var att utifrån bloggtexter beskriva mödrars upplevelser av amningssvårigheter under de första sex månaderna efter barnets födelse. Studien har en kvalitativ metod med en induktiv ansats. Data samlades in genom blogginlägg samt kommentarer från femton olika bloggar och analyserades sedan med hjälp av en kvalitativ innehållsanalys. I resultatet framkom två kategorier: ”Leva upp till samhällets normer och attityder” samt ”Det professionella stödet i amningsrådgivning”. Kategorierna bildade sedan temat: ”Mödrars kamp att kunna balansera krav och förväntningar på amningen”. Utifrån denna studie kan personal som arbetar med mödrar och amningsrådgivning på olika vårdenheter, få ökad kunskap om hur mödrar upplever amningssvårigheter. Studien kan ligga till grund för ändrade vårdrutiner samt att patientsäkerheten ökas. Det i sin tur kan bidra till att mödrar upplever mindre lidande i möte med hälso- och sjukvården. / Many women consider breastfeeding as the most natural way to give their newborn child nutrition. Mothers receive information from medical staff that breast milk contains all the nutrients that the infant needs and antibodies that protect the baby against common childhood diseases. Not all women can breastfeed in today's society and that could wake feelings in mothers that during the pregnancy has been thinking to breastfeeding but who involuntarily have been unable to do so. The aim of the study was to with blog texts describe mother’s experiences of breastfeeding difficulties in the first six months following the birth. The study was based on a qualitative approach with an inductive approach. Data were collected through blog posts and comments from fifteen different blogs and then analysed using qualitative content analysis. The results are based on two categories: “Living up to the norms and attitudes” and “Professional support in breastfeeding consulting”. These categories formed a theme: “Mothers struggle to balance between the requirements and expectations of breastfeeding”. Based on this study, the staff who work with mothers and breastfeeding consulting on various health care units enhance the understanding of how mothers experiencing breastfeeding difficulties. This furthermore could contribute to mother´s experiencing less distress interaction with health and medical care.

The aim of this diploma thesis is to introduce the notion of ugliness as an aesthetic category, concerning the question of its position in the aesthetic experience, based in particular on the conception of difficult beauty by Bernard Bosanquet. The first part of the thesis discusses the possibility of aesthetic experiencing of unpleasantness and so specifies ugliness as inherently aesthetic category, in comparison to the unaesthetic response of disgust. The second part of the thesis deals with the question of position of ugliness and the feeling of unpleasantness if ugliness is an adequate part of the aesthetic experience which is regarded as excellent and contributing. The solution offered by Bosanquet in his conception of difficult beauty however isn't fully sufficient and therefore the last chapter introduces the problem of ugliness from a different viewpoint which emphasizes the negativity and disturbance of ugliness, impossible to dissolve. The key feature of ugliness is the ambivalent link amongst the repulsion and the attraction in aesthetic experiencing. The attribution of a meaning in the whole of the aesthetic experience, i.e. the possibility of attaining new insight thanks to ugliness, may however lead to a tendency to the reconciliation of ugliness. The original unpleasantness and...

Automobile and aero industries have an increasing interestin materials with improved mechanical properties. However, manyof these new materials are classified as difficult-to-cut withconventional tools. It is obvious that tools, cutting processesand cutting models has to be devel-oped parallel to materialsscience. In this thesis rotary cutting tools are tested as analternative toexpensive diamond or cubic bore nitridetools. Metal matrix composites mostly consist of a light metalalloy (such as aluminium or titanium) reinforced with hard andabrasive ceramic parti-cles or fibres. On machining, thereinforcement results in a high rate of tool wear. This is themain problem for the machining of MMCs. Many factors affect thelife length of a tool, i.e. matrix alloy, type, size andfraction of the reinforcement, heat treatment, cuttingconditions and tool properties. In tests, the Al-SiC MMC formed a deformation layer duringmilling, probably affected by lack of cooling. The dominatingfactor for tool life was the cutting speed. Water jet or CO2cooling of turning did not provide dramatic increase in toollife. With PCD, cutting speeds up to 2000 m/min were usedwithout machining problems and BUE formation. Tool flank wearwas abrasive and crater wear created an "orange-peel type" wearsurface. PCD inserts did not show the typical increase in flankwear rate at the end of its lifetime. The use of self-propelled rotary tools seems to be apromising way to increase tool life. No BUE was formed on therotary tool at high cutting data. The measurements indicatethat the rotary tool creates twice as good surface as PCDtools. The longest tool life was gained with an inclinationangle of 10 degrees. Tool costs per component will beapproximately the same, but rotary cutting tool allows higherfeeds and therefore a higher production rate and thus a lowerproduction cost. The rotary cutting operation might have a potential toincrease productiv-ity in bar peeling. The lack of BUE withrotary cutting gives hope on higher tool life. The test resultsshow that tool wear was 27% lower with rotary cutting tools.Increase of cutting speed from 22 to 44 m/min did not affectcutting forces. This indicates that the cutting speed canincrease without significant change in tool wear rate. Issues related to rotary cutting like cutting models,cutting processes, standards, tools and models have beendiscussed. A tool wear model with kinetic energy has beendiscussed. KEYWORDS:Difficult-to-Cut material, Metal MatrixComposite (MMC), Machining, Machinability, Rotary Cutting Tool,Acoustic Emission / <p>QCR 20161026</p>

Bakgrund: Svåra besked lämnas dagligen inom vården och definieras som svår eller ledsam information som drastiskt förändrar en persons uppfattning om livet och framtiden negativt. Sjuksköterskans yrkesroll i överlämnandet av ett svårt besked är att vara närvarande för läkare, patient och anhöriga. Majoriteten av den forskning som är gjord riktar sig till läkare och mindre till sjuksköterskor. Syfte: Syftet var att belysa sjuksköterskans erfarenheter i samband med att svåra besked delges till patienten. Metod: Studien genomfördes som en allmän litteraturstudie. Resultat: I litteraturstudiens resultat framkom fem kategorier: Vikten av att anpassa information, Vikten av att använda sin professionalitet, Vikten av att bibehålla en god relation, Meningsskiljaktighet i teamet och Kunskapsbrist. Sjuksköterskan gav information och stöd samt skapade en relation med patient och anhöriga. Meningsskiljaktighet mellan läkare och sjuksköterska angående undvikande av svåra besked identifierades samtidigt som det i motsats identifierades att läkare och sjuksköterska delade samma värderingar angående hög sanningsenlighet till patient. Det framkom även att utbildning och övning saknades och efterlyses. Konklusion: Forskning och utbildning kring sjuksköterskans involvering i svåra besked anses bristfällig och litteraturstudiens resultat visar att fortsatt forskning behövs för att kunna ge evidensbaserad omvårdnad. / Background: In healthcare difficult news are given on a daily basis and is defined as any difficult or sad information that drastically changes a persons perceptions about his or her life and future in a negative way. The nurses role in delivering difficult news is to be present for physicians, patients and relatives. The majority of the previous research focuses more on physicians than nurses. Aim: The aim was to illuminate the nurses experience when difficult news is delivered to the patient. Method: The study was conducted as a literature study. Results: In the literature study´s result five categories emerged: The importance of adjusting information, The importance of using one’s professionalism, The importance of maintaining a good relationship, Disagreement in the team and Lack of knowledge. The nurse gave information and support and established a relationship with the patient and relatives. Disagreement between physicians and nurses regarding evasion of difficult news was identified while in the contrary physicians and nurses shared the same values regarding truthfulness to the patient. It also emerged that education and practise was missing and requested. Conclusion: Research and education about the nurses involvement in delivering bad news is considered being inadequate and the results of the literature study shows that continued research is required in order to give care based on scientific evidence.

This study focuses on the difficult Sami heritage which is exhibited within local history museums in northern Sweden. The study incorporates theories from cultural science and sociology but it is written within religious history as a philological and text-oriented discipline where discourses and social constructions of the Sami heritage and worldviews are in focus. The overall aim of this study is to increase the understanding of the difficult Sami heritage. This means that the analysis focuses on perspectives and discourses within local museums and Sami organisations.   The first research question revolves around the significances and meanings of the difficult Sami heritage: What phenomena (artefacts) and dimensions (immaterial culture) of the difficult past in Sapmi are highlighted? The second research question revolves around the power to represent the Sami heritage: How is the difficult Sami heritage represented? The third research question revolves around perspectives within museum practices: What approaches are the museum practice based upon?   This study focuses on four museums in northern Sweden; Ajtte museum, Samgården, Norrbottens museums and Hägnan museum. They are all local history museums which exhibit the past within a specific region from a rather broad or holistic historical perspective. The student visited each museum and observed the exhibitions then. She read texts, analysed artefacts and watched movies. Facts and interpretations were documented with a pen and the most important phenomena authenticated with a camera.   The difficult phenomena and dimensions within the museums were structured in three groups: living conditions, dark artefacts and colonization. The group living condition refers to poor people, risks, cold climate, hard work, illnesses and social classes. Dark artefacts refer to very old graves and drums which have been lost to the external society. Colonization refers to representations of Sápmi, uses of lands and resources, wounds, lack of local participation within decision-making processes, conflicts and women´s rights.   The analysis of representations highlights reflections about the meanings of the difficult and how subjective this is. Many dimensions within the Sami culture which have appeared as difficult from a colonialist perspective may be bright from an insider perspective. The museum practices follow discourses but there are few expressions within the museums which are associated with ethnocentrism. The external society is not presented as something higher, better or more valuable, but it is obvious that the government did hurt the region in the past.   The museums which were included in this study, based practices on a local separatist/patriotic approach since the unique Sami culture was in focus. It was portrayed as something which stays in contrast to the overall society. The Sami culture was associated with positive characteristics such as traditional, peaceful, original and authentic. The peace and international understanding approach was also embedded since exhibitions were based on ideas expressed within The Universal Declaration of Human Rights (UDHR) about the rights indigenous people have. The study also concludes that these museums rather based the practice on patriotic thinking, than a cosmopolitan. The museums made use of a bottom-up approach into a varying extent.  When the local perceptions were in focus are the following phenomena highlighted: the inner compass (director with wisdom), wounds of colonization, local worldviews and interaction with nature and animals.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-18T17:50:01Z No. of bitstreams: 1 LucianaPalacioCabeca.pdf: 2342971 bytes, checksum: e2373d00bc8296307898091b1041db60 (MD5) / Made available in DSpace on 2017-05-18T17:50:01Z (GMT). No. of bitstreams: 1 LucianaPalacioCabeca.pdf: 2342971 bytes, checksum: e2373d00bc8296307898091b1041db60 (MD5) Previous issue date: 2014-06-15 / The environment of the Neonatal Intensive Care Unit is characterized by constant expectations of emergency situations, where the newborn will be constantly submitted to invasive procedures and subject to risks of complications and sudden changes in the general state. Thus, it is frequent that family members are approached by health professionals with information that can be translated as difficult news. The starting point of this research is associated with the rationality of the actors as well as the contexts, situations and events that emerge from the process of illness of seriously ill newborn, delimited by the following research problem: What experiences and skills emerge from announcement process of difficult news between professionals and family members in the Neonatal Intensive Care Unit? The research intended to understand skills, experiences and implications in the announcement process of difficult news in the context of the Neonatal Intensive Care Unit (NICU) from the conceptions of health professionals and families. For this it was realized descriptive exploratory study with qualitative approach. To find out information was used open interview with data analysis from the Thematic Analysis. The study was consisted in a corpus defined by 24 interviews in which involving 10 mothers of high-risk newborns hospitalized in the NICU and 14 health professionals specialized in this service and contemplated the inclusion criteria defined in the survey. From the analysis process were extracted 1.359 units of sense that after organized and grouped, built eight themes: Characterizing difficult news in the context of the Neonatal Intensive Care Unit; Dimensions Qualifying for communication of difficult news in Neonatal Intensive Care Unit; Process noise communication of difficult news in the Neonatal Intensive Care Unit; Feelings and maternal reactions and professionals front communication of difficult news in Neonatal Intensive Care Unit; Experiencing the process of communication of difficult news in Neonatal Intensive Care Unit; Maternal strategies to access information about their child in the Neonatal Intensive Care Unit; The Announcement of Difficult News in Neonatal Intensive Care Unit: Who and Where?; The Dynamics of Negotiations in the context of the Neonatal Intensive Care Unit. The theme Dimensions Qualifying for communication of difficult news in Neonatal Intensive Care Unit two sub-themes emerged: Helpers Strategies in/ for communication of difficult news in the Neonatal Intensive Care Unit; Structural Elements for Communication of difficult news in the Neonatal Intensive Care Unit. The themes and subthemes, as a result of this investigation, it is configured as elements that frame the process of communication of difficult news in context studied, sometimes facilitating others, limiting the care to the newborn and family. This dynamic movement that is health communication, the participants showed skills, knowledge, fears, insecurities and needs for the announcement of difficult news in neonatal intensive care. The themes, while groups of concepts, bring some clinical implications for the care in the neonatal intensive care which include: interventions that promote trust; recognize patterns of behavior revealed in the mother-infant relationship; opt for family-centered care; maintain, support and encourage the maternal participation in child care when appropriate; help to promote and strengthen the network of family support; increase the probability of behavior patterns for the development of relationship/attachment; care sensitive to the environment and the special needs of mothers. These are some of the statements that make it necessary to value the theme and, especially, require relational, interpersonal and communication skills among professionals, from an expanded perspective of care and caring that goes beyond the technical and technological dimension so prevalent in intensive care. / O ambiente da Unidade de Terapia Intensiva Neonatal caracteriza-se por constantes expectativas de situações de emergência, onde o recém-nascido será constantemente submetido a procedimentos invasivos e sujeito a riscos de complicações e mudanças súbitas no estado geral. Diante disto, é frequente os familiares serem abordados pelos profissionais com informações que poderão ser traduzidas como notícias difíceis. O ponto de partida desta investigação associa-se à racionalidade dos atores, aos contextos, situações e acontecimentos que emergem do processo de adoecimento do recém-nascido gravemente enfermo, delimitado pelo problema de pesquisa: Que experiências e habilidades emergem do processo de comunicação de notícias difíceis entre profissionais e familiares na Unidade de Terapia Intensiva Neonatal? A pesquisa teve como objetivo compreender habilidades, experiências e implicações no processo de comunicação de notícias difíceis no contexto da UTI Neonatal a partir das concepções de profissionais de saúde e mães de recém-nascidos de alto risco. Foi realizado estudo exploratório descritivo com abordagem qualitativa. Para apreensão dos dados foi utilizada entrevista aberta com análise dos dados por meio da Análise Temática. Participaram da pesquisa 10 mães de recém-nascidos de alto risco internados na UTI Neonatal e 14 profissionais de saúde com exercício nesse serviço e que contemplaram os critérios de inclusão definidos na pesquisa. Do processo de análise emergiram oito temas: Caracterizando notícias difíceis no contexto da Unidade de Terapia Intensiva Neonatal; Dimensões Qualificadoras para a comunicação de notícias difíceis em Unidade de Terapia Intensiva Neonatal; Ruídos do processo da comunicação de notícias difíceis na Unidade de Terapia Intensiva Neonatal; Sentimentos e reações maternas e profissionais frente à comunicação de notícias difíceis em Unidade de Terapia Intensiva Neonatal; Vivenciando o processo de comunicação de notícias difíceis em Unidade de Terapia Intensiva Neonatal; Estratégias maternas para acessar informações sobre o filho na Unidade de Terapia Intensiva Neonatal; A comunicação de Notícias Difíceis em Unidade de Terapia Intensiva Neonatal: Quem e Onde?; A Dinâmica das Negociações no contexto da Unidade de Terapia Intensiva Neonatal. No tema Dimensões Qualificadoras para a Comunicação de Notícias Difíceis em Unidade de Terapia Intensiva Neonatal emergiram dois subtemas: Estratégias Auxiliadoras no/para a Comunicação de Notícias Difíceis na Unidade de Terapia Intensiva Neonatal; Elementos Estruturais para a Comunicação de Notícias Difíceis na Unidade de Terapia Intensiva Neonatal. Os temas e subtemas configuraram-se como elementos que emolduram o processo de comunicação de notícias difíceis no contexto estudado, às vezes facilitando outras, limitando o cuidado ao recémnascido e à família. Os participantes revelaram habilidades, saberes, medos, inseguranças e necessidades para a comunicação de notícias difíceis em terapia intensiva neonatal e trouxeram algumas implicações para o cuidado em terapia intensiva neonatal das quais destaca-se: Intervenções que promovam confiança; reconhecer padrões de comportamento revelados nas relações mãe-bebê; optar pelo cuidado centrado na família; manter, apoiar e incentivar a participação materna no cuidado a criança quando apropriado; ajudar a promover e fortalecer a rede de suporte familiar; aumentar a probabilidade de padrões de comportamento para o desenvolvimento de vínculo/apego; cuidado sensível ao ambiente e às necessidades especiais das mães. Estas são algumas das assertivas que tornam necessário valorizar a temática e, sobretudo, a exigência de competências relacionais, interpessoais e comunicacionais nos profissionais, a partir de uma perspectiva ampliada do cuidado e do cuidar que ultrapassa a dimensão técnica e tecnológica tão prevalentes em terapia intensiva.

This study examined the efficacy of a multimodal intervention with conduct disordered boys in the middle primary years. The intervention consisted of a behavioural classroom program; a small group, social skills program; and a behavioural parenting program Resource implications of this model were also evaluated. A review of the current literature on conduct disorders showed that these children account for less than 5% of the population, but they have a strong impact on families, teachers, peers, schools and the wider community. About 50% of children with severe, early behavioural problems will continue with these problems, not only throughout their adult lives, but into the next generation. Early intervention appears to offer our best hope of altering this trajectory. Interventions with this population have been largely unsuccessful. At the present time the most promising intervention is behavioural parent training programs. Combining these with child focused social skills programs, and behavioural programs in the school setting, increases their efficacy. This study used a single subject experimental design to examine the effects of this program on four boys with behavioural difficulties. Continuous measures were taken with parent, and teacher daily record charts, and classroom observations. Pre, post and followup measures were taken with the Child Behaviour Checklist. The results of the study were mixed. Some subjects, according to some respondents, improved in home and school behaviours. All three subjects, for whom there was followup data, had improved. The classroom, and parenting programs appeared to be associated with positive changes in child behaviour, the small group was associated with more disruptive behaviour at school.