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.

<p><strong>Bakgrund:</strong> Nya tekniska lösningar för att intubera patienter börjar bli tillgängliga för operationsavdelningar. Glidescope är ett videolaryngoskop som visar lovande resultat när det gäller underlättande av intubationer för personal framförallt vid svåra luftvägar och intubationer. Forskningen pekar på att Glidescope reducerar antalet intubationsförsök och ökar andelen lyckade förstagångsintubationer. Studier pekar på att det för patienten är fördelaktigt med så få intubationsförsök som möjligt.</p><p><strong>Syfte: </strong>Att undersöka anestesipersonals erfarenheter av att arbeta med Glidescope.</p><p><strong>Metod: </strong>Semistrukturerade individuella intervjuer genomfördes med nio anestesisjuksköterskor och två läkare. En kvalitativ beskrivande ansats med en kvalitativ innehållsanalys som analysmetod har använts. Intervjuerna genomfördes våren 2010 på ett sjukhus i södra norrland.</p><p><strong>Resultat: </strong>Glidescope är ett enkelt och lättanvänt redskap för intubation och detta gäller även för personer med begränsad erfarenhet av Glidescope. Det underlättar intubationer men kan förlänga tiden för att placera tuben. Det reducerar patienttraumat som förknippas med en intubation och ökar patientsäkerheten. Ur ett hygienperspektiv behövs bättre rutiner för användning av Glidescopet. En begränsning för Glidescopet är pågående blödning i svalget.</p><p><strong>Slutsats: </strong>Glidescope är i de flesta fall ett enkelt och lättanvänt redskap för intubation som underlättar främst vid svåra intubationer. Glidescope förbättrar patientsäkerheten. Glidescope är användbart vid studenthandledning. Glidescope begränsas av pågående blödning i svalget och är sämre ur ett hygienperspektiv jämfört med Macintoshlaryngoskopet.</p> / <p><strong>Background:</strong> New technical solutions for patient intubation are becoming available for surgical wards. Glidescope is a video laryngoscope which shows promising results for easy intubation for staff, especially in difficult airways and intubations. Research shows that Glidescope reduces the number of tries and increases the proportion of successful first try intubations. Studies show that the patient benefits from a reduced number of tried intubations.</p><p><strong>Purpose: </strong>To examine anaesthesia staffs experience of working with Glidescope.</p><p><strong>Method: </strong>Semi structured personal interviews were conducted with nine anaesthetic nurses and two anaesthesiologists. A qualitative descriptive approach with a qualitative content analysis as an analysis method was used. The interviews were conducted at a hospital in the middle part of Sweden during the spring of 2010.</p><p><strong>Results: </strong>Glidescope is an easy to use tool for intubation and this is also true for staff with limited experience with Glidescope. It makes intubation easier but may prolong the time to place the tube. Glidescope reduces the trauma for the patient associated with intubation and increases patient safety. From a hygiene perspective better routines are needed for the use of the Glidescope. Glidescope is limited by ongoing bleeding in the throat area.</p><p><strong>Conclusion: </strong>Glidescope is for the most part an easy to use tool which eases difficult intubations. Glidescope improves patient safety. Glidescope is useful in student instruction. Glidescope is limited by on going bleeding in the throat area and is less hygienic than the Macintoshlaryngscope.</p>

Bronfenbrenners Process-Person-Context-Time model was used to examine the relationships among the process of negative parenting, the person characteristics of child temperament and early aggressive behaviour and the contexts of family income (in)adequacy and maternal depression from infancy to school entry and their effects on the outcome of aggressive behaviour in boys at school entry. The sample included 361 boys in two-parent families who participated in the Canadian National Longitudinal Survey of Children and Youth (NLSCY). Structural equation modeling was used with a repeated measures longitudinal design. The model explained 43% of the variance in boys aggressive behaviour at school age. The results indicated that, by preschool age, boys and mothers behaviours are well established, and that process, person, and context variables all influence the persistence of boys aggressive behaviour. The strength of the effects of these variables increased with their proximity to the developing child and decreased over time. By school age, concurrent effects were not significant. The addition of the contextual variables resulted in ill-fitting models. Modification indices suggested the ill fit was localized in modeling the persistence of maternal depression, and not in the relationship between maternal depression and the other variables in the model. Modification indices also suggested there may be reciprocal effects between boys aggressive behaviour and both negative parenting and maternal depression, but this was not tested. Future research using a cross-lagged panel design could clarify these relationships. This study contributes to a growing body of research on the development of aggressive behaviour in children and underscores the importance of examining the contribution of the multiple levels of process, person, context, and time to the development of aggressive behaviour. Findings of this study provide evidence that the effects of proximal processes and proximal contexts on the development of boys aggressive behaviour are strongest in infancy and toddlerhood, and their consequences extend through to school entry. Initiating prevention and intervention efforts in early childhood that provide parents-to-be and parents of young children with practical direction in ways to engage in positive and responsive interactions with their children would do more to reduce the development of aggressive behaviour in children than would later interventions aimed at changing entrenched behaviours in both parents and children.

Bakgrund: Nya tekniska lösningar för att intubera patienter börjar bli tillgängliga för operationsavdelningar. Glidescope är ett videolaryngoskop som visar lovande resultat när det gäller underlättande av intubationer för personal framförallt vid svåra luftvägar och intubationer. Forskningen pekar på att Glidescope reducerar antalet intubationsförsök och ökar andelen lyckade förstagångsintubationer. Studier pekar på att det för patienten är fördelaktigt med så få intubationsförsök som möjligt. Syfte: Att undersöka anestesipersonals erfarenheter av att arbeta med Glidescope. Metod: Semistrukturerade individuella intervjuer genomfördes med nio anestesisjuksköterskor och två läkare. En kvalitativ beskrivande ansats med en kvalitativ innehållsanalys som analysmetod har använts. Intervjuerna genomfördes våren 2010 på ett sjukhus i södra norrland. Resultat: Glidescope är ett enkelt och lättanvänt redskap för intubation och detta gäller även för personer med begränsad erfarenhet av Glidescope. Det underlättar intubationer men kan förlänga tiden för att placera tuben. Det reducerar patienttraumat som förknippas med en intubation och ökar patientsäkerheten. Ur ett hygienperspektiv behövs bättre rutiner för användning av Glidescopet. En begränsning för Glidescopet är pågående blödning i svalget. Slutsats: Glidescope är i de flesta fall ett enkelt och lättanvänt redskap för intubation som underlättar främst vid svåra intubationer. Glidescope förbättrar patientsäkerheten. Glidescope är användbart vid studenthandledning. Glidescope begränsas av pågående blödning i svalget och är sämre ur ett hygienperspektiv jämfört med Macintoshlaryngoskopet. / Background: New technical solutions for patient intubation are becoming available for surgical wards. Glidescope is a video laryngoscope which shows promising results for easy intubation for staff, especially in difficult airways and intubations. Research shows that Glidescope reduces the number of tries and increases the proportion of successful first try intubations. Studies show that the patient benefits from a reduced number of tried intubations. Purpose: To examine anaesthesia staffs experience of working with Glidescope. Method: Semi structured personal interviews were conducted with nine anaesthetic nurses and two anaesthesiologists. A qualitative descriptive approach with a qualitative content analysis as an analysis method was used. The interviews were conducted at a hospital in the middle part of Sweden during the spring of 2010. Results: Glidescope is an easy to use tool for intubation and this is also true for staff with limited experience with Glidescope. It makes intubation easier but may prolong the time to place the tube. Glidescope reduces the trauma for the patient associated with intubation and increases patient safety. From a hygiene perspective better routines are needed for the use of the Glidescope. Glidescope is limited by ongoing bleeding in the throat area. Conclusion: Glidescope is for the most part an easy to use tool which eases difficult intubations. Glidescope improves patient safety. Glidescope is useful in student instruction. Glidescope is limited by on going bleeding in the throat area and is less hygienic than the Macintoshlaryngscope.

I det dagliga arbetet och som en del av omvårdnaden måste sjuksköterskan samtala med patienterna. Samtal kan vara väldigt svåra, vissa samtal är svårare än andra. För att oerfarna sjuksköterskor lättare skall kunna relatera och hantera dessa samtal i yrkeslivet var syftet med studien att beskriva vad sjuksköterskor anser vara det svåraste i svåra samtal. Ett fåtal studier beskriver vad sjuksköterskor anser vara svåra samtal och ingen studie har funnits som beskriver vad de anser vara det svåraste i dessa samtal. En kvalitativ metod valdes och innehållsanalys användes som metodanalys. Studien innefattar intervjuer med sex sjuksköterskor från ett sjukhus i västra Sverige. Resultatet av analysen visar sex huvudkategorier som innehåller sex sjuksköterskors beskrivning av vad det svåraste är i svåra samtal. Kategorierna är: samtal när personkemin inte stämmer, hoppfulla samtal vid negativa besked, samtal med arga patienter, känsliga samtal, försonande samtal med anhöriga och närvara i samtal under tidsbrist. Alla sjuksköterskorna upplevde att det svåraste i alla samtalen var att vara närvarande i samtalet för att behålla patientens hopp och få patienten att försonas med sin situation. / In the daily work of a nurse, talking to patients is part of the nursing care. Communication can be very difficult, and some conversations are harder than others. To make it easier for inexperienced nurses to relate and handle these conversations it’s important to establish what conversations nurses consider difficult and what the most challenging aspects are, and this was the aim of this study. Only a few previous studies describe what nurses consider difficult communication, and none of them focus on what the nurses perceive as the most challenging aspects. A qualitative method was chosen and content analysis was used as an analyze method. The study comprises interviews with six nurses in one hospital in the west of Sweden. The results of the analysis show six main categories which contain six nurses’ descriptions of what they consider to be the most difficult communication. The categories are: communication when the personal chemistry don’t match, hopeful communication when delivering negative notification, communicating with angry patients, sensitive communication, conciliating communication with relatives, and being presence in communication under stress. What all nurses found most challenging was, to be present in the conversation to keep the patients hope and help the patient accept their situation.

Hard turning of difficult-to-cut materials is an economical method of machining components with high surface quality and mechanical performance. Conventionally in the machining industry, generating a component from raw goods includes a casting or forging process, rough machining, heat treatment to a desired hardness, and then finished-machining through a grinding process. Given the relative disadvantages of grinding, which include high specific energy consumption and low material removal rates, a newer technology has been introduced; hard turning. After the heat treatment of a cast part (generally in a range of 50-65 HRC), hard turning allows for immediate finished-machining. Hard turning reduces the production time, sequence, cost, and energy consumed. In addition, dry machining offsets environmental concerns associated with the use of coolant in grinding operations as well as other common turning operations. Higher specific forces and temperatures in the contact area between the tool and workpiece lead to excessive tool wear. Generated tool wear affects the quality of the machined surface. Therefore, minimizing tool wear and consequently the generated surface quality become the status quo. Adverse effects associated with generated heat at the tool tip can be reduced by using cutting fluid or by continuously providing a fresh cutting edge. The latter method will be applied in this thesis. Rotary tool cutting involves a tool in the form of a disk that rotates about its axis. Different types of rotary tools have been developed, all with similar functional characteristics, however few are commercially available. Rotary tools can be classified as either driven or self-propelled. The former is provided rotational motion by an external source while the latter is rotated by the chip flow over the rake face of the tool. A prototype self-propelled rotary tool (SPRT) for hard turning was developed which provides economical benefits and affordability for the user. It was tested on a turret-type CNC lathe by machining AISI 4140 Steel that was heat treated to 54-56HRC and Grade 5 Titanium (Ti-6Al-4V). Carbide inserts with ISO designation RCMT 09 T3 00 (9.5mm diameter) were used during machining. Both the SPRT rotational speed and the workpiece surface roughness were measured. Also, chips were collected and analyzed for each of the cutting conditions. The same procedure was followed during machining with the same tool which was denied the ability to rotate, therefore simulating a fixed tool with identical cutting conditions. Comparisons were made between tool life, surface roughness, and chip formation for the fixed tool and SPRT. Tool rotational speed was also analyzed for the SPRT. In general, the designed and prototyped SPRT showed very good performance and validated the advantages of self-propelled rotary tools. A typical automotive component that is hard turned from difficult-to-cut materials is a transmission input shaft. These components demand high strength and wear resistance as they couple the vehicle‟s engine power to the transmission and remaining driveline. / UOIT

Background: Health care is a strange place for the patient. To make this enviroment as good as possible, would the patient be well informed. The patient has right to know if it is a bad mews and often he/she needs caring after the information. Nurse´s basic responsibility is caring, for her/him it´s important to prevent the shock for the patient that can appear.  Aim: Describe the nursing staff responses to the patient, using the patient´s perspective in relation to bad news.  Method: A litterture review has been made with nine articles. Current research materials that meet the study´s purpose has been applied in databases and analyzed. Four themes and nine subthemes was emerged.  Results: Nurse should allow patient to talk, when bad news had been given. Conversation is important for the patient, because they want information to be able to participate in care. Good communication skills are important for the nurse in connection with bad news. Patient wants information in an honest, peaceful and transparent manner. Time is often in short supply in this conversation. To have the family in care is a good support for the patient, but not all patients want the family to participate.  Conclusion: Patients desire individually aids at handover of bad news. It gives them a safety. The most common mould of aids according to patients where that the nurse shows that she/he has time for them.

No description available.

<p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p><b>KEYWORDS:</b>Difficult-to-Cut material, Metal MatrixComposite (MMC), Machining, Machinability, Rotary Cutting Tool,Acoustic Emission</p>

Depression can be a profoundly disabling and costly disorder and is a major public health concern. Despite the efficacy of treatment options, it is often unrecognized, under-diagnosed, and inadequately treated in primary care settings. Research on patient-provider communication supports the connection among the quality of the patient-provider interaction, patient behavior, and health outcomes. The purpose of this study was to systematically examine the impact of patients' depressive symptoms on the patient-provider relationship, patient-provider communication, and patient satisfaction with the primary care office visit. One hundred twenty three patient-provider encounters were audiotaped and coded using the Roter Interaction Analysis System (RIAS). A 2 x 2 x 2 within-subjects factorial model provided the analytic framework for examining eight verbal communication behaviors categorized by speaker (patient or provider), type of utterance (question or information giving), and content of utterance (medical or psychosocial talk). Hierarchical linear modeling was used to analyze the two-level nested structure of the data. Results indicated that depression is associated with, but does not predict, increased provider-perceived difficulty in the patient-provider relationship. There was no significant change in either patient or provider communication behavior in relation to the severity of patients' depressive symptoms. Significantly more provider medical information was given during encounters with "difficult" patients and this behavior had a consistent negative effect on patient satisfaction. Patient-provider communication, by itself, does not appear to be a source of depressed patients' oft-reported dissatisfaction with medical care. Additional research is needed to further understand the core processes and structures of primary care practice in relation to the diagnosis and management of depression, their effect on patient outcomes, and to uncover opportunities for enhancing the effectiveness of depression care in primary care.