Cardio-respiratory dysfunction, sepsis and necrotizing enterocolitis are responsible for a large numberof deaths in the neonatal population. Despite ecient monitoring and screening in Intensive CareUnits, diagnosis prior to clinical symptoms remains a dicult task. Based on Heart Rate Monitoring,the state-of-the-art HeRO system indicates the risk for sepsis and has already proven its ability toreduce mortality in the neonatal ICU. Recent studies have shown that a particular respiratory behaviorknown as ABD-events, can be used as a physiomarker for sepsis and is therefore an early warningsign. Detecting ABD-events is currently done by simple thresholding techniques. Based on cardiorespiratorydata and hindsight from previous patients, we aim at improving the early warning systemby applying machine learning algorithms. Data with higher frequency than those used in the HeROsystem and biological samples are still to be collected, but still, using low frequency data, we managedto obtain a specicity (true positive) of 70% and a sensitivity (true negative) of 65% on manuallylabeled events. In this report, the theoretical framework is presented along with the practical issuesencountered during the project. / Varje år dör många nyfödda barn i hjärtproblem, sepsis och nekrotiserande enterokolit. Att ställadiagnos innan kliniska symptom är uppenbara är fortfarande mycket svårt, trots effektiv övervakningoch screening inom intensivvården. Med hjälp av kontinuerlig hjärtövervakning med hjälp HeROsystemetkan kan risken för sepsis beräknas. Förekomsten av särskilda förändringar i barnets andningsmönster (apné, bradykardi och desaturation - ABD) kan användas som en tidig fysiomarkörför sepsis och fungerar därför som en varningssignal. I nyligen presenterade studier har detta visatsminska dödligheten på neontalavdelningar. Dessa ABD-händelser har fram till nu upptäckts genomenkel tröskelnivåbedömning. Baserat på hjärt- och andningsövervakningsdata och kunskap om tidigarepatienter, vill vi förbättra detta system för tidiga varningssignaler genom att använda maskininlärningsalgoritmer. Analys av högfrekvensdata och biomarkörer kvarstår att göra, men ävenbaserat på lågfrekvensdata kunde vi uppnå en specificitet på 70% och en sensitivitet på 65%. Dennarapport sammanfattar den teoretiska bakgrunden till analysmetoden och diskuterar praktiska frågorsom identiferats under arbetets gång.

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Bakgrund: När sjukdomar inte längre går att bota och det inte finns kurativ behandling att tillgå, då övergår vården till symtomlindrande och bromsande behandling dvs. palliativ vård. I Sverige är majoriteten av alla dödsfall förväntade dödsfall och ca. 60% registreras i palliativregistret. Drygt hälften har erbjudits ett brytpunktssamtal innan de dör. Ett samtal där patienterna och deras närstående ska ha möjlighet att förberedda sig såväl fysiskt, psykiskt, socialt och emotionellt i samband med övergången till palliativ vård. Syfte: Syftet var att belysa sjuksköterskors erfarenheter av brytpunktssamtal i livets slutskede. Metod: Studien är en litteraturöversikt med kvalitativ ansats. Där 16 vetenskapliga artiklar har analyserats enligt Friberg för att kunna svara till studiens syfte. Av texten som analyserats framkom två huvudtema och fem subtema. Resultat: Resultatet visar att kommunikationen med patienten, närstående och vårdteamet har stor betydelse i brytpunktsamtalet. Sjuksköterskans roll och samarbete mellan vårdteamet minskar lidandet hos patienterna och närstående. Patientens ålder, religion/tro, kulturella aspekter, sjuksköterskornas okunskap och oerfarenhet är några exempel på utmaningar i brytpunktssamtalet. Sjuksköterskans, patienternas och närståendes känslor är alltid påverkade i samband med detta. Slutsats: Slutsatsen är att resultatet kan leda till ökad förståelse om vilka upplevelser sjuksköterskor har i samband med samtalen och ge en insikt i de olika utmaningar de brottas med i samband med detta. Det finns ett behov av att utbilda, för att öka kunskaperna i ämnet, då både i hur ett samtal skall utföras praktiskt och för att teamet ska kunna skapa bästa samarbetet för att säkerställa möjligheterna till bästa förberedelserna för patienterna och närstående till en trygg och individuell övergång. / Background: When diseases can no longer be cured and there is no curative treatment available, then the care is transferred to symptom-relieving and slowing treatment called palliative care. In Sweden, most of all deaths are expected deaths, and approximately 60% are registered in the palliative care register. But only over half of these patients have been offered a breaking point conversation before they die. This is a conversation where patients and their relatives would have the opportunity to prepare physically, mentally, socially, and emotionally in connection with the transition to palliative care. Aim: was to shed light on nurses' experiences of breaking point conversations in the final stages of life. Method: The study is a literature review with a qualitative approach. Where 16 scientific articles have been analyzed to corresponds to the purpose of the overview. During the analysis, two main themes and five sub-themes emerged. Result: The results show that communication with the patient, relatives and the health team is of great importance in the breaking point conversation. The nurse's role in the breakpoint conversation and cooperation between the health team reduces the suffering of the patients and relatives. The patient's age, religion / belief and cultural aspects, the nurses' ignorance and inexperience are some examples of the challenges in the breaking point conversation. The emotions of the nurse, patients and relatives are always affected in connection with this. The conclusion is that the result may lead to an increased understanding of nurses’ experiences in connection with conversations and give an insight into the different challenges they struggle with in connection with it. There is a need for education, to increase the knowledge in the subject, both in how a conversation should be carried out in practice and for the team to be able to create the best collaboration, to ensure the opportunities for the best preparation for patients and relatives to a safe and individual transition.

The United States currently provides a health care system that is neither efficient nor equitable. Despite outspending the world on health care, over three-fourths of developed countries produce better health outcomes (Auerbach et al., 2000). Simultaneously, the "Ecological School of Thought" has documented the large impact that social, economic, and environmental circumstances play in health outcomes. Unfortunately, these 'ecological" studies are frequently conducted without theoretical justification, and rely solely on a cross-sectional research design and a myriad of unrelated variables. This study represents an important step towards the development of a true theory of "ecology". More specifically, we argue that the adversity associated with socio-economic disadvantage, social disorganization, and a lack of health care resources, leads to adverse health outcomes, represented by sentinel health events. This research employs both a cross-sectional (2000) and longitudinal designs (1990 - 2000) to assess the antecedents of sentinel health events in 309 United States counties. Structural Equation Modeling was the statistical technique employed in the study. Findings revealed that socioeconomic disadvantage remains a primary contributor to sentinel health. Indeed the economic growth between 1990 and 2000 was associated with increased rates of sentinel health events. Social disorganization was identified as a primary contributor to sentinel health events at a specific time point (2000), but was not significant over time (1990 -2000). Conversely, the inadequacy of health care resources was non-significant in the cross-sectional model (2000), but significant in the longitudinal model (1990 -2000). In both models, racial characteristics were fundamentally linked to ecological predictors of health We found support for the notion that sentinel health events would be reduced through economic equity and the development of healthy environments where community ties are reinforced. Less support is found for saturating given geographical areas with health care resources in order to reduce sentinel health events. Future research should be directed by the theoretical advancements made by this study. More specifically, future studies should examine independent cross-level effects, that is, through the inclusion of behavior variables as mediating factors for ecological constructs.

Att uppnå balans är en viktig aspekt inom hållbarhetsredovisning, trots detta är det inte ovanligt att företagens hållbarhetsrapporter är i en obalans. Det har visat sig vara en överrepresentation av positiva händelser i dessa rapporter. Tidigare forskning har visat att legitimitetsteori ligger till grund för upprättandet av en hållbarhetsrapport och förklarar varför företag väljer att presentera negativa händelser. Det finns incitament för företag att presentera negativa händelser, då det skapar legitimitet gentemot företagens intressenter. Syftet med denna studie är att undersöka vilken typ av negativa händelser som presenteras och hur företag presenterar negativa händelser. Genom en kvalitativ innehållsanalys sker en branschjämförelse för att identifiera eventuella mönster och skillnader. Det empiriska materialet består av en kvalitativ innehållsanalys som tillämpats på nio företag inom branscherna dagligvaruhandel, IT-och telekom och byggbranschen. Hållbarhetsrapporter från samtliga bolag har analyserats och sedan har all data kodats med hjälp av ett kodningsschema där strategier och kategorier har identifierats. Utformning av kodningsschemat präglades av tidigare forskning och lagtext där tidigare definierade legitimeringsstrategier och kategorier identifierats. Strategierna som identifierats från tidigare forskning var marginalisering, avskiljande, rationalisering, korrigerande åtgärder samt återge fakta. Resultatet påvisar att samtliga strategier framtagna från tidigare forskning kunde identifieras i studiens empiriska material. Där vissa strategier förekom mer frekvent än andra. Det var även möjligt att urskilja mönster inom och mellan branscherna, framför allt inom dagligvaruhandeln fanns ett samförstånd i hur negativa händelser presenteras och vilket område dessa berörde. De typer av negativa händelser som presenterades har även identifierats som småskaliga händelser. / Balance plays a key role in sustainability reporting, despite this it has been shown that there is an overrepresentation of the positive aspects. This indicates an imbalance in sustainability reporting. The legitimacy theory is the foundation in sustainability reporting and explains why companies choose to disclose. It has been shown that incentive to disclose negative aspects exists, because it provides the companies with legitimacy towards stakeholders. The purpose of this study was to examine which type of negative events companies choose to disclose and how companies choose to disclose information concerning negative events. Further the aim was to do an industry comparison, in order to identify patterns and differences. A qualitative content analysis was conducted and applied to nine companies, in the food industry, IT &- telecom and the construction industry. The sustainability reports from all the companies, got analyzed and then coded with the help of a coding scheme. The coding scheme helped identify the companies strategies and categories of the negative events. The coding scheme was conducted with previous research and laws as a base. The results show that all the strategies from earlier research could be identified, and those strategies were marginalization, authorization, indicating facts, rationalizing and corrective action. Some strategies occurred more frequently than others. Some patterns were identified, both within the industries and between the industries. Especially in the food industry, there was a consensus on how the negative events were to be presented and within which area. Further, the result showed that the negative events that were presented, could be identified as insignificant events.

The purpose of this study was to apply the Revised Theory of Planned Behavior and EVENTQUAL models to explore (1) event qualities that significantly impact guests’ satisfaction with a university event that they attend, (2) significant factors influencing university loyalty as a result of an event, and (3) willingness to make a charitable donation to a university as a result of attending an event. An online survey was sent to attendees of an annual Cal Poly auction event between 2002 and 2016 that directly benefits Cal Poly students. The data were used to test a series of hypotheses to determine the fit of a proposed theoretical model. Although the study was limited by a small sample size of 74 subjects, it resulted in the creation of a revised event fundraising model. Student involvement proved to be the only quality significantly predicting a guest’s overall satisfaction with the event, explaining 12% of the variance. The combination of overall event satisfaction with a subset of the revised theory of planned behavior variables (attitude, descriptive norm, and moral norm) explained 51% of the variance in predicting university loyalty. Finally, intention to donate was best predicted as a combination of prescriptive norm, attitude, and university loyalty, accounting for 57% of the variance. Overall, the revised model is applicable in aspects of university event planning including event branding, marketing, and the involvement of students at the event. Of serious note is the statistically significant attitude variable. If an event planner can utilize a university event to shift the guests’ attitudes towards the event and university, this can greatly enhance not only intention to donate at one particular event, but the loyalty these people feel to the university or program.

Bakgrund: I Sverige insjuknar cirka 220–250 personer av Amyotrofisk Lateralskleros (ALS) per år. Sjukdomen innebär att nervceller som styr skelettmusklerna förtvinar och slutligen dör vilket leder till svåra symtom. Idag finns inget botemedel utan insatserna riktas till symtomlindring och livslängden är cirka två till tre år. Sjuksköterskor som vårdar personer med ALS upplevde svårigheter att balansera både den sjukes och anhörigas vilja/upplevelser samtidigt.   Syfte: Att beskriva upplevelser om hur det är att vara anhörig till personer som lever med Amyotrofisk lateralskleros (ALS). Metod: En deskriptiv litteraturstudie bestående av 14 vetenskapliga artiklar med kvalitativ ansats som söktes i databasen Medline via PubMed. Huvudresultat: Känslor som maktlöshet och sorg uppstod hos de anhöriga samt en känsla av att vara fängslad till personen med ALS och hemmet. Anhöriga genomgick en livsomställning och hittade olika hanteringsstrategier för att klara av situationen. Förändrade roller i familjen medförde starkare och svagare familjerelationer samtidigt som kärleken blev mer komplex. Anhöriga fick en negativ bild av vården och lyfte bristen på information, istället verkade stödet från det sociala nätverket vara mer betydelsefullt.  Slutsats: Anhöriga till personer med ALS kände sig maktlösa och sorgsna men dem hittade hanteringsstrategier som underlättade vardagen. Anhöriga sökte stöd inom det sociala nätverket då vården ofta var en besvikelse. Dem lyfte ett behov av bättre informationshantering från vården och önskade att den skulle vara familjecentrerad. Denna litteraturstudie kan komma att bidra till ett ökat perspektiv hos anhöriga, personer med ALS och vården. / Background: 220–250 people get diagnosed with Amyotrophic Lateral Sclerosis (ALS) every year in Sweden. The disease entails that the nerve cells controlling skeletal muscles degenerate and die creating severe symptoms. Today, there is no cure, so the resources focus on symptom-management, the average lifespan after diagnosis is two to three years. Nurses caring for people with ALS struggled with balancing the will/experience of the person with ALS and the close relatives concurrently.  Aim: Describe experiences of being a close relative to people living with Amyotrophic Lateral Sclerosis. Method: Descriptive literature study based on 14 scientific articles with qualitative approach searched on the database Medline via PubMed. Main results: Emotions such as feeling powerless and grief was identified, they felt imprisoned to the person with ALS and their home. Close relatives went through life-changing events and found coping strategies. Changed family roles created stronger and weaker family relationships and love got complex. Close relatives got a negative picture of the health-system and highlighted the lack of information, instead they valued the support from their social networks. Conclusion: Close relatives to people with ALS felt powerless and grief but found coping strategies that eased their situation. Close relatives soughed support within the social network since the health-system disappointed. They highlighted needs for better information management from the health-system and whished for it to be family-focused. This literature study may create wider perspectives among close relatives, people with ALS and the health-system.

This study examined the hindering and helpful events that transgender and gender-nonconforming Ontarians experienced in therapy. To explore descriptive accounts of these experiences, we employed a systematic and rigorous investigation using the significant events framework and thematic analysis to interpret findings. Eleven participants underwent semi-structured interviews, providing rich accounts of their recent therapy experiences alongside their contexts and impacts. From these interview transcripts, we constructed eight major themes relevant to the research question: (1) Helpful and Hindering Relational Gestures; (2) Expectations about the Therapist’s Role; (3) Therapist’s Perception of Transness; (4) Topics in Therapy; (5) Significant Relational-Emotional Experiences; (6) Significant Event Impacts on the Client; (7) Client Processes in Understanding Significant Therapy Events; and (8) Contexts. Implications for therapeutic work are discussed.

Psychological stress is a major risk factor for cardiovascular diseases. While the relevance of early life stress, such as that which is due to child maltreatment (CM), is well known to impact individual stress responses in the long-term, and data on the interplay between CM and stressful events in adulthood on cardiovascular health are sparse. Here, we aimed to assess how stressful life events in adulthood are associated with cardiovascular health infarction in later life and whether this association is independent of CM. In a cross-sectional design, a probability sample of the German population above the age of 14 was drawn using different sampling steps. The final sample included 2510 persons (53.3% women, mean age: 48.4 years). Participants were asked about sociodemographic factors, adult life events, CM, and health conditions in adulthood. Results indicate that the number of experienced adverse life events in adulthood is associated with significantly increased odds for obesity (Odds Ration (OR)women = 1.6 [1.3; 2.0], ORmen = 1.4 [1.1; 1.9]), diabetes (ORwomen = 1.5 [1.1; 2.1], ORmen = 1.5 [1.1; 2.3]) and myocardial infarction (ORwomen = 2.1 [1.0; 4.3], ORmen = 1.8 [1.1; 2.8]). This association is not moderated by the experience of CM, which is associated with cardiovascular problems independently. Taken together, adult stressful life events and CM are significantly and independently associated with cardiovascular health in men and women in the German population in a dose-dependent manner. General practitioners, cardiologists and health policy-makers should be aware of this association between psychosocial stressors during childhood and adulthood and cardiovascular health.

A Kaizen event (KE) may be defined as a structured improvement project that uses a cross-functional team and specific improvement goals to improve a targeted work area or process in an accelerated time frame. KEs, also known as Rapid Improvement Events (RIEs), have been utilized within hospitals to achieve beneficial operations, stakeholder (i.e., social), financial, and clinical outcomes. Due to their potential to achieve positive results in a rapid timeframe, understanding the determinants of KE success within a hospital environment is a valuable research undertaking. To date there has been limited rigorous empirical quantitative research focused on identifying success factors (SFs) influencing socio-technical outcomes of hospital-based KEs. Hence, this empirical research study seeks to determine the critical success factors (CSFs) for KEs in hospitals. For the first phase of this research work, a comprehensive systematic literature review (SLR) was conducted to identify the success factors (SFs) for KEs in hospitals as reported in the literature. This SLR resulted in the identification of 54 unique success factors mapping to four broad success factor categories, KE Task Design, KE Team Design, Organization, and KE Process. Thereafter, the second phase, which involved the variable reduction process, was performed to determine the strength of effect, or importance, of the SFs in order to determine a feasible number of SFs to include in further empirical work. Two robust methods were applied; a Meta-synthesis Evaluation and an Expert Survey, to query the SFs and to determine high priority factors for the empirical study. As a result, a total of 30 factors were finalized for empirical study. Next, the last phase, the empirical study to investigate and determine the CSFs for KEs in hospitals, was executed using a retrospective field study survey research design. Specifically, a survey questionnaire was designed to elicit feedback on perceptual measures from targeted hospital KE facilitators/leaders on the criticality of SFs on socio-technical outcomes for KEs in hospitals. Sixty usable responses were obtained, which were subjected to Exploratory Factor Analysis (EFA) and Partial Least Squares-Structural Equation Modeling (PLS-SEM), which were used to identify latent factor constructs and to determine the significance of the SFs, respectively. The results of this study identified seven significant direct relationships. Kaizen Event Design Characteristics (KEDC) and Target Area Buy-in (TABI) were found to have significant direct effects with both dependent variables, Performance Impact (PI) and Growth in Kaizen Capabilities (KCG). In addition, KEDC also had a significant direct relationship with Performance Culture (PC) and Team Dynamics (TD), respectively. Also, PC has a significant direct relationship with TD. Furthermore, Logistic Regression was utilized to test the SFs impact on the one objective technical outcome measure in the study, Goal Attainment (GOALATT). This analysis revealed one significant negative relationship occurring between TD and GOALATT. Overall, the study's findings provide evidence-based results for informing hospital managers, leaders, and continuous improvement practitioners on the key factors or value-added practices that can be adopted in their hospital KE initiatives to achieve beneficial socio-technical outcomes, as well as overall hospital KE success. Furthermore, this research can enable academia/researchers to strategize more confirmatory analysis approaches for theory validation and generalizability. / Doctor of Philosophy / The focus of this research study is to identify the most significant factors for Kaizen events (KEs) in hospitals, referred herein as critical success factors (CSFs). A KE may be defined as a structured improvement project that uses a cross-functional team and specific improvement goals to improve a targeted work area or process in an accelerated time frame. The aim of the study is to ultimately improve KE practice in hospitals through increased understanding of CSFs that can be planned or designed into KE processes to increase the likelihood of successful event outcomes. Various research formulation, development, and testing techniques are applied to frame the research study according to the aims and objectives and to achieve targeted research outcomes. The overall research design encompasses a retrospective study approach, performing a large-scale field study using a survey questionnaire to empirically identify the CSFs for KEs in hospitals. To help frame the research, a systematic literature review (SLR) along with bibliometric analyses were conducted. To help refine and select the success factors for empirical study, a meta-synthesis evaluation and an expert survey study were conducted. Exploratory factor analysis (EFA) and partial least squares-structural equation modeling (PLS-SEM) along with mediation analyses (MA) were performed to identify key factors, determine the significance of those factors, and to understand the influential relationships of those factors to hospital KE success. Results from this study aim to inform healthcare managers, healthcare improvement practitioners, researchers, and other relevant stakeholders about the critical components needed to achieve hospital KE success. The dissertation is documented according to a "manuscript style," using a journal/conference paper format to organize and report on the key findings and results obtained from the investigation. The Introduction chapter is provided to introduce the research study topic, study significance, indicate the overall research aims and objectives, present the overall research approach and design methodology, and to enumerate the main publication outputs and outcomes from this dissertation work. The Conclusions chapter summarizes the overall research outcomes, key study findings, study limitations, and provides areas for future research.