Bakgrund: I Sverige drabbas cirka 30 000 personer av stroke varje år. Stroke är ett samlingsnamn för hjärnskador orsakade av blödning eller infarkt i hjärnan. Stroke uppenbarar sig som en plötslig förlust av kroppsfunktion som styrs av hjärnan. En genomsnittlig strokepatient förlorar nästan två miljoner neuroner, 14 miljarder synapser och 12 km myeliniserade nervfibrer varje minut som stroken är obehandlad. För dessa patienter krävs det en snabb handläggning och snabba insatser för att minimera de hjärnskador som uppstår. Det finns olika behandlingsalternativ för att återskapa blodflödet i hjärnan för de patienter som drabbats av infarkt i hjärnan. Innan behandling påbörjas behöver stroke-diagnosen bli bekräftad, och andra sjukdomar uteslutna, med radiologi. Det är ambulanssjuksköterskan som prehospitalt bedömer strokepatienten och beslutar om fortsatt handläggning. Till sin hjälp har ambulanssjuksköterskan skattningsskala för att fortast möjligt identifiera patient som drabbats av stroke. Om ambulanssjuksköterskan bedömer att patient drabbats av stroke och patienten uppfyller vissa förutbestämda kriterier, förvarnar ambulanssjuksköterskan mottagande sjukhus om patienten. Detta för att vårdkedjan skall bli så snabb som möjligt och tid till behandling skall kunna bli så kort som möjligt. Syfte: Syftet var att belysa hur ambulanssjuksköterskan identifierar patienters strokesymptom prehospitalt. Metod: Studien är en forskningsöversikt som baserades på kvantitativa, vetenskapliga, empiriska studier. Litteratursökningen gjordes i databaserna Cinahl och Pubmed. Resultat: Resultatet visade att det fanns flera olika skattningsskalor som ambulanssjuksköterskan kunde använda vid identifiering av stroke. Det fanns även andra undersökningar som kunde utföras prehospitalt som var gynnsam för strokepatienten. Det var av vikt att ambulanssjuksköterskan fortast möjligt kunde identifiera en strokepatient för att sedan transportera patienten till lämplig sjukvårdsinrättning. Slutsats: Tidsfaktorn är den viktigaste aspekten gällande att genomföra en framgångsrik behandling av strokepatienten. För att korta ned tiden till behandling är det viktigt med snabb identifiering av strokepatienten, snabb transport till sjukhus som erbjuder rätt behandling och en effektiv vårdkedja. Eftersom kompetensen i Sveriges ambulanser är hög, med specialistutbildade ambulanssjuksköterskor, skulle de kunna tillämpa NIHSS-skattningsskalan, vilket är en mer omfattande skattningsskala, prehospitalt under transport av patienten till sjukhus. På detta sätt skulle läkare på mottagande sjukhus få ett bättre underlag för sin bedömning som då kan gå snabbare, och på så sätt korta ned tid till behandling. / Background: In Sweden about 30 000 persons suffering a stroke every year. Stroke is a generic name for brain damages caused by a hemorrhage or an infarction in the brain. Stroke appears as a suddenly loss of body function controlled by the brain. There is a loss of about 14 billion synapses and 12 km myelinated nerve fibers in an average stroke patient every minute the stroke is untreated. It takes a fast processing and action to minimize the brain damages that appears to these patients. There are different kinds of treatment possible to restitute blood flow in the brain for those patients suffering an infarction in the brain. Before treatment can be started, the stroke diagnosis must be confirmed and other diseases ruled out by radiology. It is the ambulance the nurse assesses the stroke patient in the prehospital settings. As a support the ambulance nurse can use a rating scale to rapidly identify a patient suffering a stroke. If the ambulance nurse’s prehospital diagnosis is that a patient is suffering a stroke, and the patient fulfills a certain criteria, the ambulance nurse pre-warns the receiving hospital. The reason of that is to make the care chain as fast as possible and the time to treatment as short as possible. Aim: The purpose of this study was to illustrate how an ambulance nurse identifies patient’s stroke symptoms in the prehospital setting. Method: The study is a literature review based on quantive, scientific, empirical studies. The literature search was made in the databases Cinahl and PubMed. Result: The result showed that there were several different rating scales that an ambulance nurse could use in the identification of stroke. There were other examinations that could be performed pre-hospital, which was beneficial for stroke patients. It was important that the ambulance nurse could quickly identify a stroke victim in order to rapidly transport the patient to an appropriate medical facility. Conclusion: Time is the most important aspect regarding the implementation of a successful treatment of stroke patients. In order to shorten time to treatment it is essential for a rapid identification of stroke patients, rapid transport to hospitals that offer the right treatment and efficient health services. Since the competence in Swedish ambulances is high, with specialist trained ambulance nurses, they would be able to apply the NIHSS-rating scale, which is a more extensive rating scale, in the prehospital setting, during transport of patient to hospitals. In this way, doctors at the receiving hospital have better basis for its assessment, which then can be accelerated, and could shorten time to treatment.

Syftet med föreliggande studie är att undersöka några svensklärares uppfattningar om Chat GPTs påverkan på elevers textproduktion i svenskämnet. Materialet utgörs av semistrukturerade intervjuer med nio legitimerade svensklärare och har bearbetats enligt innehållsanalys. Resultatet visar att lärare anger att elever använder Chat GPT i varierande utsträckning, och att det finns skillnader mellan skolor och mellan klasser på samma skola. Det varierar också varför elever väljer att använda Chat GPT. Resultatet visar att lärarna har olika inställning till Chat GPT i svenskämnet men alla av de tillfrågade lärarna framhåller olika sätt hur verktyget kan användas både av lärare och elever. Konsekvenserna av elevers användande av Chat GPT är förändrade examinationsformer, och negativ påverkan på elevers läs- och skrivförmåga. Studiens slutsats är att det varierar i vilken utsträckning elever använder Chat GPT men utifrån studiens resultat kan man dra slutsatsen att det kan påverka elevers textproduktion negativt. Andra slutsatsen är att åtta av lärarna har kunskaper om Chat GPT men har däremot vaga kunskaper hur verktyget kan användas för att främja textproduktion.

It is the critique of Western metaphysics in the thought of the later Martin Heidegger that poses the problem for consideration in this work. Namely, if Western metaphysics as onto-theology has indeed fulfilled its prefigured configurations and found its completion in the work of Friedrich Nietzsche, as Heidegger claims, then what place, if any, is left for those theologians inspired by Alfred North Whitehead's metaphysics? To assist in developing a basis upon which to address this issue, I limit this work to a critical examination of Whitehead's metaphysics in light of the later Heidegger's critique of onto-theology. Therefore Heidegger's critique is normative for this project. The application of Heidegger's critique to Whitehead's metaphysics results in the following conclusion: Whitehead's metaphysics does not commit the mistakes detailed in Heidegger's critique of metaphysics. It is demonstrated, further, that the general character of Whitehead's metaphysics as fallibilistic at least leaves his metaphysics open to the possibility of Being (Sein). Specifically, it is shown that Whitehead's metaphysics does not divide entities into existence and essence; nor does it search for the explanatory principle (arche); nor is God understood as causa prima and therefore causa sui; nor is Creativity an empty concept and therefore nihilistic; nor is his metaphysics rooted in the cogito sum, nor does it anthropomorphize the world in order to secure certainty amongst multiple perspectives. Whitehead's metaphysics does not lead away from Being (Sein); rather, it may very well provide an occasion for Being (Sein). After this evaluation there are some brief remarks offered about how Whitehead's metaphysics, while not obscuring Being (Sein) in any of the ways detailed by Heidegger, also offers a philosophy of nature. This philosophy of nature leaves open the possibility of developing a natural theology that is not necessarily indicted by Heidegger's critique. / Thesis / Doctor of Philosophy (PhD)

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Regarding the myriad disputed documents encountered within the science of forensic document examination, questioned handwriting is the most prevalent. This includes the simulation or alteration of and or additions to handwriting and signatures. The current study examined the changes that may occur in writing when given a limited amount of space. Several participants completed a survey wherein writing samples were taken under varying space allowances. These space restrictions were made under differing conditions such as boxed signatures, additions to prewritten material, and alterations to letters and numbers. The results of the study found characteristics of reflex of avoidance in the participants' handwriting. These characteristics included changes in height, width, and letter spacing in accordance to the amount of space provided. The examples of reflex of avoidance defined throughout this study may serve to assist forensic document examiners in the detection of alterations within questioned documents.

The purpose of this study was to determine if a relationship exists between teacher variables and the Tennessee Comprehensive Assessment Program (TCAP) student annual scores in reading and mathematics for students in grades 3 through 8 in Hamblen County, Tennessee. The teacher variables included number of days absent, Praxis II Principles of Learning and Teaching (PLT) scores, and years of experience. The population of the study was limited to 3rd- through 8th grade reading and mathematics teachers employed by the Hamblen County school district during the 2006-2007 school year. Raw scores from the 2006-2007 TCAP criterion-referenced assessment were used as the testing variable. A Pearson correlation coefficient was used to analyze teacher absenteeism. Praxis II PLT scores were grouped as above or below median scores and analyzed with an independent samples t test. Years of experience was defined by the state department of education as vested years of experience and grouped using an analysis of variance. Based on analysis of the findings, the relationship between teachers' days absent, Praxis II PLT scores, and years of experience and TCAP achievement annual scores in reading and mathematics for students in grades 3 through 8 in Hamblen County, Tennessee were not statistically significant.

Exposure to abuse, neglect, and familial dysfunction in childhood is connected to long-term negative effects on mental and physical health in adulthood. Current research of adverse childhood experience is overwhelmingly focused on community samples. Those populations that tend to experience a greater number of adversities (e.g., high-risk forensic populations) are largely overlooked. Studies investigating differential risk factors and outcomes among those in high-risk populations could indicate environmental 2015 Appalachian Student Research Forum Page 107 responsiveness to experiences of abuse, neglect, and household dysfunction in early development. A pilot study was conducted to investigate the prevalence and severity of childhood trauma, maltreatment, and familial dysfunction using the Adverse Childhood Experience (ACE) survey in a sample of forensic mental health offenders. Participants were randomly selected forensic inpatients (n = 185) from a maximum- and intermediate-security psychiatric facility. The sample is predominantly male (81.0%) and majority Caucasian (56.0%), African American (40.0%), and Hispanic (2.0%) with a mean age of 42.5 (SD=13.2). Approximately 29.0% of the current forensic sample has experienced 4 or more adversities in childhood (e.g., intrafamilial sexual abuse). This is a significantly higher percentage compared to the Center for Disease Control community norms of 12.5% indicating that a greater number of childhood adversities were experienced by the current sample of forensic mental health inpatients than in the general population. Additionally, significant percentages of diagnosed mental health disorders have been revealed. Diagnosed mental disorders in the current sample include, but are not limited to: psychotic disorders (59.0%), intellectual disability or cognitive developmental disorders (57.3%), mood disorders (45.0%), impulse disorders (22.2%), and post-traumatic stress disorder (13.0%). Comprehension of type, severity, and length of exposure to adversities, environmental responsiveness to abuse, maltreatment and familial dysfunction, and the onset and severity of mental and behavioral health outcomes are needed to better inform treatment, intervention, and rehabilitation of forensic psychiatric inpatient populations.

Syfte: Syftet med studien är att sammanställa vetenskap om nyttan med att utföra självundersökning av brösten samt utröna vilken roll sjuksköterskan kan ha. Metod: I en litteraturstudie har nio artiklar valts ut och det vetenskapliga värdet har granskats och utav dessa är sju kvantitativa studier och de resterande två litteraturstudier. Resultat: Resultatet visar att självundersökningar av brösten inte reducerar mortaliteten i bröstcancer. Nyttan av självundersökningarna av brösten råder det delade meningar om då de kan leda till en ökad oro och flera läkarbesök. Sjuksköterskan spelar en viktig roll som pedagog och inspiratör. Slutsats: Sannolikt är nyttan av självundersökningar av brösten större i länder med begränsade ekonomiska resurser och avsaknad av screeningprogram jämfört med exempelvis Sverige som idag har ett etablerat nationellt screeningprogram för mammografi. Om evidensbaserad omvårdnad ska tillämpas framkommer det i litteraturstudien att sjuksköterskan bör förespråka bröstmedvetenhet framför självundersökningar av brösten. / Aim: The purpose of this study was to compile resent science about the benefits of performing breast self-examinations and to find out the eventual role of the nurse. Method: In a literature review nine scientific articles were chosen and their scientific value was evaluated. From this evaluation we indentified nine articles, seven of these articles are based on quantitative studies and two of them are a compilation of literature. Results: This study shows that breast self-examination do not reduce mortality in breast cancer. The benefits of breast self-examination is debated, when the research displays that breast self-examination leads to an increased anxiety and increased numbers of doctor appointments. The nurse plays a key role as an educator and a spokesman. Conclusion: It is possible that the benefits of brest self-examinations are greater in a country of limited resources and screening programs, than for instance in Sweden where a national mammography screening is established. If evidenced based care should be applied the results from this study suggests that the nurse should advocate breast awareness instead of breast self-examinations.

OBJECTIVES: Tools are needed for determining appropriate weights for complex performance assessment components in medical education. The feasibility of using judgmental policy capturing (JPC), a procedure to statistically describe the information processing strategies of experts, for this purpose was investigated. METHODS: Iterative JPC was used to determine appropriate weighting for the six core communication skill scores from a communications objective structured clinical examination (OSCE) for medical students using a panel of four communication skill experts. RESULTS: The mean regression weights from the panel indicated they placed less importance on information management (8.5%), moderate and nearly equal importance on rapport building (15.8%), agenda setting (15.4%), and addressing feelings (14.1%), and greater importance on active listening (20.1%) and reaching common ground with the patient (25.5%). DISCUSSION: JPC is an effective procedure for determining appropriate weights for complex clinical assessment components. The derived weights may be very different for those assessment components.

Physical examination education begins early for medical learners. A hindrance to physical exam competency is lack of exposure to pathology in standardized patient settings. This research focuses on improving medical education through the utilization of cadavers that have undergone a soft-embalming technique: the Thiel method. Three scenarios were created in four Thiel cadavers: anterior cruciate ligament (ACL) tear, posterior cruciate ligament (PCL) tear, and sham incision. Students were asked to diagnose ACL tears using the Lachman exam. A total of 54 learners participated in the study. Post-surveys indicated most learners: (1) prefer to use standardized patients (SPs) and soft-embalmed cadavers in their physical examination courses, (2) increased their confidence in performing the Lachman exam on real patients, and (3) enhanced their Lachman technique. SPs ultimately cannot volitionally reproduce the physical exam findings of ACL deficiency. Consequently, learners cannot accurately identify positive versus negative examination findings. Thiel-embalmed cadavers are a valuable resource for physical examination education. (Journal of Surgical Orthopaedic Advances 30(2):112-115, 2021).