Denna uppsats fokus ligger på den praktik inom socialt arbete där kategorier produceras, upprätthålls, modifieras och bryts. Huvudsyftet har varit att studera professionell retorik i relation till det kategoriseringsarbete som sker inom välfärdsstatliga miljöer. En diskursanalytisk metod har valts som grund i form av en kategoriseringsanalys. De teoretiska förutsättningarna har varit poststrukturalism, social konstruktionism och diskurspsykologi och mer specificerat i form av institutionell kategorisering, medan Jonathans Potters (1996) metodologiska retoriska verktyg kring faktakonstruktion tillämpats för att analysera hur respondenterna framställt sina utsagor som trovärdiga och faktamässiga. Addiction Severity Index (ASI) manualen har använts som utgångspunkt för insamlandet av empiri, men även som ett sätt att försöka fånga in professionell hjälpverksamhets generella ambition att standardisera och säkra sitt arbetssätt. Sammanlagt har tio yrkesverksamma professionella hjälpare som aktivt använts sig av ASI manualen i sitt dagliga arbete intervjuats, dessa kom även från en och samma institution. Analysresultatet visar att de professionella hjälparna beskriver två olika huvudkategorier som relevanta för deras verksamhet, nämligen sexualbrottslingen och missbrukaren. Kategorierna skildras även på vitt skilda sätt avseende motivation, vilja och samarbete, där olika moralarbeten leder till att de professionella hjälparna agerar mot sexualbrottslingen och missbrukaren på skilda sätt. Det som stått på spel i intervjusituationen har varit professionalitet, moralarbete och säkerhet inom välfärdsstatliga miljöer. Där de professionella hjälparna byggt upp sina påstående så att de kan hantera dessa frågor, både för att kunna styrka sin professionalitet inför sig själva och inför mig som forskare, men även för att visa att de kan hantera frågor kring moral och ansvar och att arbetet de utför är säkert ur ett klientperspektiv, dvs. att besluten som tas grundas på säkra bedömningar och omdömen från de professionella hjälparnas sida.

ABSTRACT Standardized assessment instruments have increasingly come to be used in social work. Although national studies of ASI and DOK's reliability and validity has only been examined to a limited extent. In order to improve knowledge of assessment instruments conditions, relevance and scope, this present literature study highlights the background and the application of the interview methods ASI and DOK, used in swedish abuse and dependent care. In answering the survey questions, a qualitative content analytical method has been used. ASI and DOK are multidimensional interviews which take into account that several areas affecting the client's treatment outcome. Assessment instruments differ in respect of use, approach to the assessment of client needs and help troubled, the basis for the interview estimates and its rating scales. International research shows that the ASI and DOK include a number of methodological problems that affect the reliability and validity in self-reported data. Assessment instruments different question areas, however, lacks a theoretical framework that allows any assumptions about the causal relationships between key areas of life and substance abuse problems. In accordance with a social constructionism perspective, ASI and DOK's usability are time and culture bound and must therefore be seen as methods that are in a constant process of change to generate as reliable knowledge as possible. Keywords: assessment instrument, social work, Addiction Severity Index, ASI, documentation system, DOC, structured interviews, addiction, substance abuse.

Traffic safety is an important problem in today&rsquo / s world with increasing number of fatalities and injuries in traffic accidents. For the solution of this problem, determination of accident prone locations on a network and reasons behind is an essential step, which is studied to some extend via different traffic accident analyses in the literature. While major factors affecting accident risk, such as speed, congestion, infrastructural aspects are known, it is still very difficult to figure out the interaction among these factors, due to complexity in the spatial and temporal distribution of the aforementioned factors and traffic network characteristics. While the case of accident analysis on highways is simpler, in case of urban roads, it requires more effort due to more complex traffic networks with quite a number of conflict points and varying flow characteristics. To investigate possible relationships between speed and accident occurrence on urban arterials, a Geographic Information Systems based accident analysis methodology (GIS-TAAM) is developed in this study. This methodology uses time-dependent average link speeds (calculated from GPS-based data) and accident history of links, and three safety measures in thematic accident maps: i) total number of accident, ii) a severity index based on number of fatality and injury accidents, and iii) an alternative severity index based on total number of fatalities and injuries. The implementation of the proposed methodology and its deliverables are discussed over a pilot study on in&ouml / n&uuml / Boulevard &ndash / EskiSehir Road, Ankara.

本論文之目的在於瞭解現行核能保險之保單內容，歸納出核能事件發生後的各項損失，以建立一套台灣核能保險保費之估計模式。 該模式的建立包含以下步驟：首先，針對核能事件所造成的各項人身、財產、責任損失進行分類；其次，建立個別損失金額之評估公式。第三，對於核能電廠發生損失的機率與幅度分別進行探討。在損失機率方面，配合台灣核能電廠過去的損失經驗以及核研所之PRA（probabilistic risk assessment）模型，對於各級核能事件之發生機率進行假設。在損失幅度方面，估計各項損失項目之最大損失金額，配合各級核能事件下各項損失項目之損害比例，對於各級核能事件之損失幅度進行假設。最後，各級核能事件損失機率與損失幅度乘積之總和，即代表核能保險之危險保費；此外，加上附加費用後，即可求得適當的保費金額。 核能保險雖然是迅速且容易取得之財務補償工具，但所費不貲。整體而言，核能發電具有成本低、污染少等優點，若核能電廠能確保其安全性，並於損失發生後有足夠的財務保證，則可使核能發電的效益充分發揮。 / The aim of this article attempts to know the content of the nuclear energy insurance policy, to induce all kinds of losses after the nuclear events, and to establish an assessment model for the premium of the nuclear energy insurance in Taiwan. This model consists of the following steps: First, various kinds of personal, property, and liability losses which occurred after nuclear events are classified into different categories. Secondly, assessment formula for the loss amount is established. Third, loss frequency and loss severity for the damage of nuclear power plants are studied separately. Lastly, the result of multiplying “loss frequency” by “loss severity” stands for the risk premium for the nuclear energy insurance. Also, adding together the above results and the loading expense, the appropriate premium amount can be figured out. On the whole, utilizing nuclear energy for producing electric power possesses the advantage of being low costs and less pollution. If the nuclear power plants can ensure its safety as fully as possible, and provide adequate financial guarantees as damages occur, people will greatly benefit from the efficiency of nuclear power.

Safety at intersections is of significant interest to transportation professionals due to the large number of possible conflicts that occur at those locations. In particular, rural intersections have been recognized as one of the most hazardous locations on roads. However, most models of crash frequency at rural intersections, and road segments in general, do not differentiate between crash type (such as angle, rear-end or sideswipe) and injury severity (such as fatal injury, non-fatal injury, possible injury or property damage only). Thus, there is a need to be able to identify the differential impacts of intersection-specific and other variables on crash types and severity levels. This thesis builds upon the work of Bhat et al., (2013b) to formulate and apply a novel approach for the joint modeling of crash frequency and combinations of crash type and injury severity. The proposed framework explicitly links a count data model (to model crash frequency) with a discrete choice model (to model combinations of crash type and injury severity), and uses a multinomial probit kernel for the discrete choice model and introduces unobserved heterogeneity in both the crash frequency model and the discrete choice model, while also accommodates excess of zeros. The results show that the type of traffic control and the number of entering roads are the most important determinants of crash counts and crash type/injury severity, and the results from our analysis underscore the value of our proposed model for data fit purposes as well as to accurately estimate variable effects. / text

El objetivo del estudio fue determinar la utilidad de la proteína C reactiva (PCR) en el manejo de la neumonía adquirida de la comunidad (NAC). Se estudiaron de forma prospectiva 169 pacientes con diagnóstico de NAC. Se utilizó como criterio diagnóstico de la presencia de infiltrado en radiografía de tórax anteroposterior frente y perfil, más uno de los siguientes signos y/o síntomas: fiebre o hipotermia, rales crepitantes, tos productiva y hemocultivos o cultivo de esputo con gérmenes compatibles con el diagnóstico de NAC. La edad promedio fue de 70,96 años (rango 25-97 años). La distribución por sexo fue la siguiente femenino 52% y masculino 48%. La mortalidad observada fue 7,69 % (13/169). Se compararon dos scores de severidad de neumonía: PSI (Pneumonia Severity Index) y CURB-65 (Confusion, Urea, Respiratory Rate, Blood Preasure, Age > 65) con proteína C reactiva. Se establecieron cinco categorías de PCR: I menor a 29 mg/l, II entre 29 y 39 mg/l, III entre 40 y 59 mg/l, IV 60 y 75 mg/l y V mayores 76 mg/l. Se consideraron valores positivos mayores o iguales a 39 mg/l. Se encontró correlación entre CURB-65 y PSI y entre CURB-65 (en todas las clases de severidad) y PCR (P < 0,000), como así también entre PSI categoría IV y PCR (P < 0,007). Los valores de PCR poseen relación con respecto a la gravedad de la neumonía utilizando CURB65.

Des anomalies dans la morphologie pelvienne, la posture du tronc et le contrôle de l’équilibre de jeunes filles atteintes de scoliose idiopathique de l’adolescence (SIA) ont souvent été l’objet d’études. Rares sont celles ayant distingué ces troubles en fonction de la sévérité de la déformation vertébrale. De plus, aucune n’a évalué à l’intérieur d’une même étude l’orientation et la distorsion pelvienne, l’asymétrie posturale et l’instabilité en position debout de sujets SIA. Une telle étude permettrait de comprendre le développement de la maladie et de mettre en évidence des facteurs de risque aidant au pronostic. L’objectif général de cette thèse est d’identifier des facteurs biomécaniques associés à la croissance osseuse, la posture et l’équilibre distinguant une SIA modérée d’une sévère. Les positions 3D de 14 repères prises sur 46 filles ayant une SIA droite (modérée et sévère) et 28 sujets témoins ont été captées pour quantifier la morphologie pelvienne et la posture. Un maintien en position debout de 64 s sur une plate-forme de force a aussi été enregistré afin d’évaluer leur équilibre. Les paramètres retenus sont les angles d’orientation pelvienne et du tronc; les distances entre la crête iliaque et S1 mesurant la distorsion pelvienne; la moyenne, l’amplitude et la vitesse du centre de pression (COP) en médiolatéral (ML) et antéropostérieur ainsi que la moyenne et l’amplitude du moment libre. Les différences entre les trois groupes (témoin, SIA modérée et SIA sévère) sont testées par des ANOVA et les relations entre l’angle de Cobb et les paramètres pelviens, posturaux ou d’équilibre, par des coefficients de corrélations. De plus, des régressions multiples exprimant l’angle de Cobb sont effectuées avec les paramètres pelviens, posturaux et d’équilibre afin de déterminer la classe de paramètres prédisant le mieux l’angle de Cobb. Aucune ANOVA n’est significative pour l’orientation pelvienne, bien que des différences de géométrie pelvienne soient notées entre les deux groupes de sujets SIA. Les SIA modérées ont un pelvis gauche moins profond que les SIA sévères et les sujets témoins, tandis que les SIA sévères ont un pelvis droit plus large d’environ 1,5 cm que celui des SIA modérées. Un coefficient de corrélation de -0,54 associe une rotation pelvienne droite à l’augmentation de la largeur de la crête iliaque. Au niveau postural, les SIA sévères démontrent des inclinaisons latérales et antérieures du tronc ainsi qu’une rotation axiale du haut du corps plus marquées que les SIA modérées. Les corrélations entre les paramètres posturaux, l’angle de Cobb et la morphologie pelvienne indiquent que l’attitude posturale est associée à la distorsion pelvienne dans tous les plans anatomiques, tandis qu’elle ne l’est que dans les plans sagittal et horizontal à l’angle de Cobb. Les différences retrouvées entre les deux groupes SIA concernant les troubles d’équilibre résultent en une augmentation de l’amplitude et de la vitesse du COPML. Une régression multiple de 0,896 est observée par l’emploi des paramètres pelviens, posturaux et d’équilibre, bien que ceux se rapportant à la distorsion pelvienne soient les mieux corrélés à l’angle de Cobb. Cette thèse permet de distinguer la morphologie pelvienne de sujets SIA sévères des modérées, soulignant la détection d’une anomalie de croissance avant que l’angle de Cobb ne soit élevé. Bien que les indices de croissance pelvienne soient davantage corrélés à ce dernier, c’est en considérant globalement la morphologie pelvienne, la posture et l’équilibre qu’une détermination précise de la sévérité d’une scoliose est réalisée. La mise en évidence de tels facteurs de prédiction de la SIA peut faciliter le pronostic d’une courbure. / The effect of adolescent idiopathic scoliosis (AIS) on pelvis morphology, body posture and standing balance in young girls has been studied many times. However, only few studies have distinguished the effect associated with moderate AIS from a severe one. Moreover, no one ever assessed within one investigation pelvis orientation and distortions, postural asymmetry and standing imbalance in AIS subjects. This would help understanding the evolution of the disease and to shed light on risk factors that would facilitate the prognostic. The aim of this thesis is to identify biomechanical factors related to bone growth, posture and balance which can distinguish a moderate AIS from a severe one. The 3D coordinates position of 14 body landmarks taken on 46 young girls with right AIS (moderate and severe) curvature and 28 control subjects is captured to quantify pelvis morphology and body posture. An upright standing is recorded during 64 s on a force plate to assess standing balance. From these data, the following parameters are calculated: orientation angle in all 3 planes for pelvis and trunk; distances between S1 and iliac crest to evaluate pelvis distortion; mean position, range and velocity of the center of pressure (COP) in mediolateral (ML) and anteroposterior axis and mean and range of the free moment. Differences between groups (control, AIS moderate and AIS severe) are tested by ANOVA and relationship between Cobb angle and pelvis, postural and balance parameters are calculated by correlation coefficients. Multiple regressions expressing Cobb angle by pelvis, postural and balance parameters are also carried out to determine which class of parameters is able to predict more effectively the Cobb angle’s curvature. No significant ANOVA is found for pelvis orientation, even though differences in pelvis geometry are noticed between the two groups of AIS subjects. Moderate AIS have a left pelvis with a depth less than severe AIS, whereas AIS severe have a larger right pelvis of 1,5 cm than moderate AIS. A correlation coefficient of -0,54 relates a right pelvis rotation to an increase in iliac crest’s width. About postural asymmetries, severe AIS shows lateral and anterior trunk bending and an axial rotation in the upper level of the trunk that are more pronounced compared to moderate AIS. Correlations between postural parameters, Cobb angle and pelvis morphology indicate a relationship between posture and pelvis distortion in all three planes, but only in the sagittal and horizontal plane between posture and Cobb angle. Differences in standing balance between the two groups of AIS show an increase in COPML range and velocity. A multiple regression of 0,896 is found for the Cobb angle using pelvis, postural and balance parameters. Parameters related to pelvis distortion correlate the most with Cobb angle (0,70). This thesis was able to differentiate severe AIS pelvis morphology from those of the moderate one. Pelvis morphology allows detecting a growth abnormality before the Cobb angle becomes high. Even if pelvis growth is more correlated to the Cobb angle, considering globally pelvis morphology, posture and standing balance will allow determining precisely the severity of AIS. Shedding light on such factors during the evolution of the disease helps an AIS curvature prognosis.

Background: It has been proposed that depression plays a role in how psoriasis affects quality of life. However, primary data are limited. Objective: To investigate the role depression plays in how patients experience psoriasis. Methods: Cross-sectional study conducted between January and May 2005. Recruitment of 265 adults with prevalent psoriasis through Internet advertisements. Standardized assessment of depressive symptoms, health-related quality of life (HRQL), illness-related stress, and clinical severity of psoriasis using validated scales. Results: Thirty-two percent of all participants screened positive for depression. We observed a graded relationship between depressive symptoms and HRQL impairment (p < 0.001). Only 16.5% of those with high depression scores were currently treated for depression. Both dissatisfaction with antipsoriatic treatment and illness-related stress were highly associated with depression. After adjustment for HRQL, patients with more severe psoriasis were less likely depressed, although this association failed to reach statistical significance (multiadjusted odds ratio 0.37; 95% CI 0.13–1.02; p = 0.06). Conclusion: Patients with high subjective distress and low objective measures of psoriasis should be evaluated for depression. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Puumala hantavirus (PUUV) causes hemorrhagic fever with renal syndrome in Europe. After inhalation of virus shed by bank voles, the virus systemically targets the vascular endothelium leading to vascular dysfunction and leakage. Many patients with PUUV infection experience cardiopulmonary manifestations but the underlying mechanisms have not been determined. The aims of the studies presented were to describe cardiopulmonary manifestations, investigate pathogenetic mechanisms including presence of virus in the lungs and the local immune response in PUUV infection. The results showed cardiopulmonary involvement of varying severity in almost all studied patients. High-resolution computed tomography frequently revealed vascular leakage into the lungs or pleural cavities. Pulmonary function tests generally showed reduced gas diffusing capacity, evidenced in patients as dyspnea, poor oxygenation and frequent need of oxygen treatment. Among patients who were not fully recovered at 3 months follow-up, remaining decreased gas diffusing capacity was highly common. Echocardiography revealed mainly right heart dysfunction which was related to manifestations within the lungs, in terms of increased estimated pulmonary vascular resistance, mild to moderate pulmonary hypertension, and reduced right ventricular systolic function in patients with more pronounced lung involvement, as indicated by need of oxygen treatment. Analyses on bronchoalveolar lavage (BAL) and bronchial biopsies revealed a highly activated cytotoxic T cell (CTL) response in the lungs. The CTL response was not balanced by the expansion of regulatory T cells and high numbers of CTLs were associated with more severe disease. PUUV RNA was detected in almost all patients’ BAL samples and the viral load was inversely correlated to the number of CTLs. Three patients presenting with severe and fatal cardiopulmonary distress were also described. Autopsies revealed PUUV protein in vascular endothelium in all investigated organs, including the heart and lungs, along with a massive CTL response mainly in the lungs. In conclusion, cardiopulmonary involvement of varying severity was present in almost all patients with PUUV infection. Cytotoxic immune responses could contribute to disease development but also help in clearing the infection. Long lasting fatigue after hantavirus infection may be explained by remaining manifestations within the lungs.

Heating milk to high temperatures such as 140 ºC, as used in ultra high temperature (UHT) processing, causes physical and chemical changes in the milk. The production of a cooked flavour is a major change which reduces consumer acceptance of the UHT milk. It has been correlated with the formation of volatile sulphur compounds (VSCs) that result from milk proteins, principally the whey proteins β-lactoglobulin, containing the the sulphur amino acids cystine, cysteine and methionine. The VSCs in milk, whose concentrations are in the parts per billion to parts per million range, are highly reactive, easily oxidised, and sensitive to heat during thermal processing and analysis; this makes them a challenge to analyse. A sensitive method based on gas chromatography with pulsed flame photometric detection coupled with headspace sampling by solid phase microextraction (SPME/GC/PFPD) was developed to detect these compounds in commercial UHT milk and to investigate their production and disappearance during heating and storage. The SPME/GC/PFPD procedure was optimised using different extraction time (15 min, 30 min, & 60 min) – temperature (30 oC, 45 oC & 60 oC) combinations with CAR/PDMS fibre to obtain maximum sensitivity. A short extraction time (15 min) at low temperature (30 oC) was chosen to provide high sensitivity for detecting all VSCs in UHT milk without introducing artefactual VSCs. The extraction method and GC run time (16 min) make this method simple and fast. Nine VSCs were detected in commercial indirectly processed UHT milk, skim and whole. These are hydrogen sulphide (H2S), carbonyl sulphide (COS), methanethiol (MeSH), dimethyl sulphide (DMS), carbon disulphide (CS2), dimethyl disulphide (DMDS), dimethyl sulphoxide (DMSO), dimethyl sulphone (Me2SO2) and dimethyl trisulphide (DMTS). An additional unknown compound was detected but could not be identified by GC/MS because its concentration was below the detection limit of the MS detector. The concentrations of H2S, DMS and DMTS were higher than their threshold values indicating their importance in milk flavour, especially cooked flavour. Several attempts have been made to reduce the cooked flavour in UHT milk. In the current research, the use of hydrogen peroxide (H2O2) to oxidise the VSCs and thereby reduce cooked flavour was investigated. H2O2 is used as a milk preservative and is generally recognised as safe (GRAS) in USA. Several concentrations of H2O2 (0.001%, 0.005%, 0.01%, 0.02% & 0.03%) were added to milk to assess its effects on VSCs and on whey proteins denaturation in UHT milk. H2O2 effectively reduced the concentration of all VSCs, except DMDS which was increased, presumably by oxidation of MeSH. H2S was completely oxidised or reduced below its threshold value. Low concentrations of H2O2 (0.001% & 0.005%) had no effect on, or decreased, the extent of denaturation of β-lactoglobulin when added after or before processing, respectively. Some UHT plants use severe heating conditions, leading to high levels of denaturation of whey proteins, particularly β-Lg, the main source of the VSCs in milk. Correlations between heat severity, β-Lg denaturation and individual VSC generation were investigated in milk batch-heated at 80 oC and 90 oC, and UHT milk processed at 120-150 oC. In accordance with previous reports, β-Lg was more heat-sensitive than α-La. Only five VSCs were detected. The concentrations of H2S and MeSH correlated well with denaturation of β-Lg and α-La. DMS concentration correlated well with β-Lg in UHT milk but not in the batch-heated milk. CS2 did not show a good correlation with heat intensity and appeared to plateau out after a certain level of heating. Conversely, COS and MeSH seemed to require a certain minimum amount of heat before generation commenced; this corresponded to denaturation of β-Lg above 49% and 89% respectively at 80 oC. The higher concentrations of DMS and H2S in UHT milk compared with batch-heated samples having similar degrees of denaturation suggested other possible sources for their production and the importance of the heat severity in generating them. For example, at high heat intensity, S-methylmethionine and thiamine could be sources of DMS and H2S respectively. Furthermore, in whole milk as used in this work, milk fat globule membrane proteins are another source of VSCs. The outcome of this study will help UHT manufacturers to understand the production and disappearance of the VSCs in commercial UHT milk and how to adjust the processing conditions to avoid generation of cooked flavour. Additionally, the promising results of using low concentrations of H2O2 to oxidise the VSCs will provide the industry with another means of reducing cooked flavour. Before H2O2 use is implemented in UHT processing, future studies are required to evaluate all of its effects, including sporicidal effects. Overall, this study makes a contribution to finding a solution to the cooked flavour problem in UHT milk, thereby increasing market share of this milk in countries such as Australia, the UK and North America where cooked flavour is the main barrier to its consumer acceptance.