Bakgrund och problemformulering: Vård i livets slutskede innebär att vården övergår från att vara livsförlängande till att vara lindrande. Vården kan pågå från dagar till månader och det är viktigt att sjuksköterskan anpassar vården utifrån patientens hälso- och livssituation. Sjuksköterskan ska erbjuda patienten en säker och evidensbaserad vård som utgår från patientens aktuella behov och önskemål. Syfte: Syftet är att belysa sjuksköterskans erfarenheter av vård i livets slutskede i hemmet. Metod: En litteraturöversikt enligt Friberg gransknings- och analysmetod. Resultat: Resultatet presenteras i två teman och fem subteman. Teman som identifierades var att skapa en vårdande relation vid vård i livets slutskede och sjuksköterskas roll vid vård i livets slutskede i hemmet. Slutsats: Det krävs att sjuksköterskan har kompetens, kunskap och engagemang för att kunna erbjuda patienten en god vård i livets slutskede. Trots att vård i hemmet blir allt vanligare inriktar sig den aktuella grundutbildningen för sjuksköterskor i stor utsträckning från att vårda på sjukhus. / Background and problem formulation: Care in the final stages of life means that the care transitions from being life-extending to being palliative. The care can last from days to months and it is important that the nurse adapts the care based on the patient's health and life situation. The nurse must offer the patient safe and evidence-based care based on the patient's current needs and wishes. Aim: The aim is to illustrate the nurse's experiences of end-of-life care at home. Method: A literature review according to Friberg's review and analysis method. Results: The results are presented in two themes and five sub-themes. Themes that were identified were to create a caring relationship in end-of-life care and the role of nurses in end-of-life care at home. Conclusion: It is required that the nurse has the competence, knowledge and commitment to be able to offer the patient good care in the final stages of life. Despite the fact that home care is becoming more common, the current basic education for nurses largely focuses on nursing in hospitals.

<p dir="ltr">The purification of most active pharmaceutical ingredients (APIs) is primarily achieved through crystallization, conducted in batch, semi-batch, or continuous modes. Recently, continuous crystallization has gained interest in the pharmaceutical industry for its potential to reduce manufacturing costs and maintenance. Crystal characteristics such as size, purity, and polymorphism significantly affect downstream processes like filtration and tableting, as well as physicochemical properties like bioavailability, flowability, and compressibility. Developing an optimal operation that meets the critical quality attributes (CQAs) of these crystal properties is essential.</p><p dir="ltr">This dissertation begins by focusing on designing an innovative integrated crystallization system to enhance control over crystalline material properties. The system expands the attainable region of crystal size distribution (CSD) by incorporating multiple Mixed-Suspension Mixed-Product Removal (MSMPR) units and integrating wet milling, classification, and a recycle loop, enhancing robustness and performance. Extensive simulations and experimental data validate the framework, demonstrating significant improvements in efficiency and quality. The framework is further generalized to optimize crystallizer networks for controlling critical quality attributes such as mean size, yield, and CSD by evaluating various network configurations to identify optimal operating parameters.</p><p dir="ltr">The final part of this work concentrates on using the framework to improve continuous production of a commercial API, Atorvastatin calcium (ASC), aiming for higher yield and lower costs. This approach establishes an attainable region to increase crystal sizes and productivity. Due to ASC’s nucleation-dominated nature, the multi-stage system could not grow the crystals sufficiently to bypass granulation, the bottleneck process in ASC manufacturing. Therefore, spherical agglomeration was proposed as an intensification process within an integrated two-stage crystallization spherical agglomeration system to control the size and morphology of ASC crystals and improve downstream processing and tableting. This method proved highly successful, leading to the development of an end-to-end continuous manufacturing process integrating reaction, crystallization, spherical agglomeration, filtration, and drying. This modular system effectively addressed challenges in integrating various unit operations into a coherent continuous process with high production rates.</p>

While historical newspapers recently have gained a lot of attention in the digital humanities, transforming them into machine-readable data by means of OCR poses some major challenges. In order to address these challenges, we have developed an end-to-end OCR pipeline named Origami. This pipeline is part of a current project on the digitization and quantitative analysis of the German newspaper “Berliner Börsen-Zeitung” (BBZ), from 1872 to 1931. The Origami pipeline reuses existing open source OCR components and on top offers a new configurable architecture for layout detection, a simple table recognition, a two-stage X-Y cut for reading order detection, and a new robust implementation for document dewarping. In this paper we describe the different stages of the workflow and discuss how they meet the above-mentioned challenges posed by historical newspapers.

The overall aim of this thesis was to study palliative end-of-life care outside specialist palliative care settings, from an organizational perspective and from professionals’ and relatives’ experiences. In Study I 174 individuals were identified retrospectively from nursing records and palliative care identification forms as being in a palliative phase. Data were analyzed with descriptive and analytic statistical methods. In Study II a total of nine nurses working in primary home care, community care, and hospitals were interviewed. Phenomenological methodology was used to analyze data. In Study III 17 enrolled nurses, who worked in community or primary care and in a sitting service organization, participated in four focus group interviews. Data were analyzed with qualitative content analysis. In Study IV seven relatives from four families were interviewed twice. They had each cared in the private home for a dying family member who had received sitting service. Direct interpretation and categorical aggregation were used to analyze data. The results highlight challenges in palliative care, vulnerable situations, and a need of support (I–IV). Individuals’ needs for both palliative care and sitting service were identified, including those of a smaller part of the population who actually received the sitting service. (I). Registered nurses’ responsibilities included care at the same time for individuals in both palliative and curative phases. This created vulnerable situations for the nurses, since their ambitions concerning the care did not correspond to available resources (II). The enrolled nurses’ task was to manage ongoing life and dying in different care settings, to meet individual needs and still provide equivalent care. Despite experiences of vulnerable situations, they felt safe (III). Relatives experienced care situations differently, related to differences in families, the illness trajectory, the need for support, and the support offered. Without sufficient support, vulnerable situations occurred, which made the relatives feel insecure (IV). Thus, care situations in palliative end-of-life care can be experienced in different ways, with different levels of vulnerability. One implication of the research might be to suggest that professional caregivers, to supplement the relatives’ own resources with support tailored to the individual’s and the family’s needs

The aim of the study is, based on the staff’s perspective, to describe and analyse the existential needs of elderly in end-of-life living in nursing homes. The aim was also to examine how the staff perceive working with elderly in end-of-life care. Three qualitative focus groups were conducted by interviewing nursing home staff. The analysis is based on Weisman’s the appropriate death, Tornstam’s gerotranscendence and Hasenfeld’s human service organizations. The main findings were that the term ‘existential needs’ is described as wide and hard to define. Uneasiness and anxiety were common in the end-of-life and it was hard for the staff to meet the existential needs. The staff also described that the “little things” matter, such as holding one’s hand, as well as being present with the elderly. The relationship between the elderly and the staff was vital in order for the elderly to have as good an end-of-life and death experience as possible. The staff felt sorrow when the elderly had passed away and had little time to grieve. In difference to earlier research the staff did not request further education nor tutoring, however they wanted more time to grieve and process the deaths of the elderly.

Bakgrund: Sjuksköterskan arbetar nära vuxna patienter i livets slutskede där försök till läkande behandling gått över till en palliativ behandling. Många av dessa patienter har en komplicerad symtombild som kräver kunskaper i symtomhantering och de har också ofta oro, ångest och funderingar kring existentiella frågor som sjuksköterskan kan behöva hantera.Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att vårda vuxna patienter i livets slutskedeMetod: Metoden som valdes var en litteraturbaserad studie grundat på kvalitativ forskning, baserat på tolv vetenskapliga artiklar.  Resultat: Ur analysen framträdde tre kategorier såsom Frustration, skicklig kommunikatör, få till ett nära samarbete med åtta underkategorier. Slutsats: Sjuksköterskors erfarenheter vid vård i livets slutskede påvisar betydelsen av att relationer mellan patienten, anhöriga och vårdpersonal skapas.

ITC/USA 2005 Conference Proceedings / The Forty-First Annual International Telemetering Conference and Technical Exhibition / October 24-27, 2005 / Riviera Hotel & Convention Center, Las Vegas, Nevada / The Joint Advance Missile Instrumentation (JAMI) program has developed a Time Space Position Information (TSPI) unit (JTU). The JTU employs a novel use of GPS technology and inertial measurement units (IMU) to provide a real time trajectory for high dynamic missile systems. The GPS system can function during high g maneuvers that an air-to-air missile might encounter. The IMU is decoupled from the GPS sensor. The IMU data is a secondary navigation source for the JTU and will provide platform attitude. The GPS data and IMU data are sent to the ground in a telemetry packet called TUMS (TSPI Unit Message Structure). The TUMS packet is sent to a computer that hosts the JAMI Data Processing (JDP) software, which performs a Kalmam filter on the GPS and IMU data to provide a real-time TSPI solution to the range displays. This paper focuses on the equipment and software needed at a telemetry ground station to display the real time TPSI solution on the range displays. It includes an overview of the system data flow. This overview should help a potential user of the system understand what is involved in running the JAMI system. The post mission tools to provide an accurate trajectory and end-game scoring will not be discussed in this paper.

This research focuses on improving the remanufacturing process efficiency by estimating the workstation utilization through identifying percentage of %Blocking and %Waiting on individual workstations within a remanufacturing flow line. It attempts to achieve this aim such that improved use of methods to overcome the effect of variability can be employed. Extensive literature review revealed the requirement of strategies to recover End of Life products due to the introduction and implementation of legislative directives demanding manufacturers to recover the End of Life resources. Upon analyzing the range of product recovery strategies, End of Life product remanufacturing has emerged as an appropriate and suitable strategy to be used since it extends the operational life of existing products without the need for the new resources required when making products. Remanufacturing is a process in which a product is disassembled to component level. Each of the components will be thoroughly examined for defects. Upon identifying defects, they will either be repaired or components will be replaced. This process in turn increases the product life span. However, remanufacturing is not widely used process applied into various industry sectors due to the fact that it is labour intensive and expensive process compared to new products. Although remanufacturing process is in infancy where small number of industry such as Automotive and Aerospace are deriving benefit from it by making effective use of remanufacturing. Ideally, the suitable manufacturing methods i.e. flow processing system, should be used to remanufacture products. However when flow processing is deployed, it is found that there are a number of factors affecting the process that if not tackled, will result in poor performance and poor efficiency of the overall remanufacturing system. This inefficiency is primarily due to the number of sources of variation found in terms of supply, product design, parts specification, operation and demand variability. Further investigation led to the characterizing the remanufacturing variability and identified ways the effect of this variability can be removed or reduced using Lean principles e.g. Single Minute Exchange of Dies and use of an appropriate manufacturing system. Based on the information revised in literature and experimental design, novel equations were developed along with a set of rules that accurately measures the workstation utilization in terms of %Blocking and %Waiting on individual workstation.

The type 1 insulin-like growth factor receptor (IGF-1R) is a receptor tyrosine kinase that mediates diverse cellular functions including growth, differentiation, migration and apoptosis protection. IGF-1R signalling has been implicated in tumorigenesis in a variety of cancers, and IGF-1R inhibitory drugs are currently undergoing clinical evaluation. Previous work in our laboratory has shown IGF-1R over-expression in urological cancers at both the mRNA and protein level, thus making it a potential therapeutic target. The first aim of this project was to develop a protocol for IGF-1R immunohistochemistry, investigate the expression and cellular distribution of the IGF-1R receptor in clear cell renal cell carcinomas (ccRCC), and assess correlation with clinical parameters. In tissue microarray analysis, IGF-1R was detected in ~90% of 195 ccRCCs, with signal in the plasma membrane, cytoplasm and also in the nucleus. The presence of nuclear IGF-1R in up to 50% of ccRCCs and its association with adverse prognosis was a novel finding, and suggests that nuclear IGF-1R may influence ccRCC biology. Further investigations will clarify its role in the nucleus and its potential as a prognostic biomarker. The second aim was to investigate effects of IGF-1R inhibition on radiosensitivity and DNA repair, following previous work in our laboratory showing that IGF-1R depletion enhances chemo- and radio-sensitivity, delays double strand break (DSB) resolution, and may play a role in the homologous recombination (HR) pathway of DNA DSB repair. However, the repair defect seen in these early experiments was larger than could be entirely explained by a defect in HR. The current project used a small molecule IGF-1R tyrosine kinase inhibitor AZ12253801 (AstraZeneca), which blocked IGF-1 induced IGF-1R activation and inhibited cell survival. AZ12253801 enhanced the radiosensitivity of prostate cancer cells, which appeared to be independent of effects of IGF-1R inhibition on cell cycle distribution and apoptosis induction. IGF-1R inhibition delayed the resolution of γH2AX foci, supporting a potential role for the IGF-1R in DSB repair. This delay in focus resolution was apparent at early time-points (less than 4 hr), and was epistatic with DNA dependent protein kinase (DNAPK) inhibition in prostate cancer cells and DNAPK deficiency in glioblastoma cells. These results suggest a role for the IGF-1R in the non-homologous end-joining (NHEJ) pathway of DNA DSB repair. A cell-based reporter assay in HEK-293 cells confirmed that IGF-1R inhibition suppressed DSB repair by NHEJ, helping to explain the radiosensitization demonstrated upon IGF-1R inhibition. There was lack of support for a transcriptional effect, with no significant change observed in gene expression on microarray analysis. Although the mechanism of this effect remains unclear, the observed inhibition of NHEJ has implications for the use of IGF-1R inhibitors in combination with DNA damaging agents in cancer treatment.

Music therapy plays an integral role in end-of-life care, positively impacting emotional, social, physical, cognitive and spiritual health. The purpose of this integrative review was to collect and compile studies (N= 55) between 2000 and 2016 on the topic of music therapy interventions in end-of-life care, in order to provide both music therapy students and therapists access to the most recent and commonly used music therapy interventions and goals. Results of the integrative literature review indicate that the most common intervention for all age groups in end-of-life care is songwriting and composition, with the most common therapeutic goal being emotional expression and catharsis. Details of music therapy interventions, goals and song details are written in tables for readers to refer to as a guide. Further research is needed with each specific age group and setting, in order to provide refined results beyond what is revealed through this review. Additionally, evaluating therapeutic outcomes of the interventions and goals obtained through this integrative review is another step that can be taken for future research.