Background: The challenges of research in economically stunted countries’ settings remains a profound concern and is linked to socioeconomic development of these countries. More research is needed regarding psychiatric morbidity in rural areas of the developing and poverty stricken countries. The present studies were undertaken within the framework of a broader ongoing community-based project on the course and outcome of major psychiatric disorders in the rural Butajira district located in Ethiopia. This thesis treats the course and outcome of bipolar I disorder in the district. Objectives: Through appraising mental health and population based research in a rural Ethiopian district, to evaluate the utility of modern research instruments, and to obtain baseline information relating to bipolar I disorder in the poverty stricken rural Butajira district of Ethiopia. The specific objectives were: 1. Evaluating and comparing two different screening methods of case detection and identification for schizophrenia and bipolar I disorder in the adult population of Butajira district. 2. Assesing the prevalence and clinical characteristics of of bipolar I disorder in Butajira at the community level. 3. Evaluating short-term outcome at follow-up of bipolar I disorder in the Butajira district. 4. Determining Neurological Soft Signs in community-identified cases of bipolar I disorder in Butajira district in comparison with healthy controls. 5. Assessing the burden of care among caregivers of those affected by bipolar I disorder identified in the Butajira Study. Methods: The district’s entire adult population aged 15-49 was identified through a double-sampling design. In the first stage of screening, door-to-door interviews were conducted by lay trained high school completed individuals who knew the culture of the people. Females interviewed females whereas males interviewed males. Additionally, the key-informants method was used to identify cases that would be missed by the CIDI or otherwise. The final confirmatory diagnostic interview was conducted by clinicians using the SCAN on door-to-door basis as well. The probable cases that fulfilled the lifetime DSM-IV diagnosis of bipolar I disorder were assigned for assessment by other baseline research instruments such as Neurological Evaluation vii Scale (NES), Young Mania Rating Scale, Hamilton Rating Scale for Depression, LCSS, PANS and SANS, BISS, BII, FIS and so on. Cases so identified with bipolar I disorder were subject to a follow-up for upto 2.5 years on the average (range 1 to 4 years). Two of the main clinical outcomes assessed were relapse to a mood episode, and remission from a mood episode. Outcomes were assessed annually by the instruments, and were further assessed monthly by trained psychiatric nurses. We also did a cross-sectional study of caregivers of bipolar I disorder cases, and assessed objective burden on the caregivers as considered from social, family strain, occupational and financial domains. Results: Information provided by the key informants was better at detecting schizophrenia or chronic psychiatric disease, whereas the CIDI was better at detecting affective disorders. Of the around 100 000 adults living in Butajira, 83.3% were found by the project’s census, of which 82% (68,378 subjects) were successfully screened by the CIDI, yielding 2,161 CIDI positive. These, together with 719 cases identified by the key informants, were invited for the SCAN interview, of which 74.7% agreed. This yielded 315 SCAN positive cases for bipolar I disorder, and complete information could be collected on 295 of these. Lifetime prevalence was estimated as 0.6% for males and 0.3% for females. The mean age of onset of the manic phase was 22.0 years and that of the depressive phase was 23.4 years. For 22.7% of the cases the illness started with a depressive episode and for the remaining 77.3% it started with a manic episode. Over half of the cases (55.9%) had never sought help from modern health care sector, and only 13.2% had ever been admitted to psychiatric hospital. At follow-up, 65.9% had exprerienced a relapse and 31.1% had persistent illness, while only 5% of the patients were in remission for most of the follow-up time. The bipolar I cases, as compared with healthy controls, performed worse on several items of NES, thus having more neurological dysfunction compared to controls. Caregives were largely (80.3%) first-degree relatives and spouses. Overall, 84% of the caregivers reported difficulties in at least one of the domains of family burden. Of these, 58.7% reported a severe degree of difficulties. Caregivers reported a high level of difficulties in intrafamilial relationships and social restrictions, disruption in earning a livelihood, and financial difficulties. Conclusions: The prevalence of bipolar I disorder is comparable to the prevalences reported from other countries, and our findings support the cross-cultural validity of the concept of bipolar I disorder. Majority of the cases are not treated in contrast to that in the developed countries. The burden of care for the caregivers is substantial in the population studied.

Background – People with functional impairments have unmet needs and they are not given the support and service they are entitled to. According to international studies, early measures and treatment may slow down the outbreak of mental illness and relieve its course. Aims - To elucidate and compare both somatic poor health and social needs of people with either physical or mental functional impairments in a rural district, and to explore and compare how different personnel in the primary health care service and psychiatric services are able to detect early signs of psychosis. Moreover, to find out how early signs of psychosis are detected in primary health services, and to explore the patients’ pathways to the GPs. Methods – In studies I and II, people with severe functional impairments were offered a screening health examination followed by an interview. Three vignettes were presented to personnel in the primary health care service and the psychiatric services in study III. The participants were asked to detect any signs and symptoms of psychosis in the vignettes. In studies IV and V, notes in primary health care records were studied during a period of two years and six months, respectively, before a diagnosis of psychosis was made by the general psychiatric services. Results – People with severe functional impairments had poorer health and more problems with their ADL (Activities of Daily Life), economy/work and Quality of Life than people in general. Among the groups studied, people with mental impairments had the poorest living conditions. There were no differences between the participants in study III regarding sex, age and occupation; and the participants detected the signs and symptoms in the vignettes to a high degree (75% of all signs and symptoms). In all, 152 patients (22 with schizophrenia/ schizoaffective disorders, 41 with schizophrenia preceded by other psychotic disorders and 89 with persisting psychiatric disorders) with the diagnosis of psychosis made by the general psychiatric services were included in study IV and V. There were notes in 77% of the primary health records during the two-year study period, and 70% of these notes were about psychiatric signs and symptoms, which means that the GPs detected signs and symptoms of psychosis in 2/3 of the cases. The analysis of the patients’ visiting patterns to GPs showed that many patients did not visit their “own” primary health care centre or their “own” GP. Furthermore, many patients had no contact with the primary health care service at all, and the subgroup with schizophrenia/schizoaffective disorders visited the primary health care service less frequently than the other groups. Main conclusion – People with severe functional impairments must be granted regular contacts with a GP, whose role must be: to identify and motivate the patients; to detect when there are needs for care and social needs; to function as a representative for the patients; to inform the patients about their rights and to guide them to other social or health authorities. The GPs detected early signs and symptoms of an emerging psychosis to a high degree, which would make early intervention possible. The more visits to the GPs, the more symptoms were detected, and out of all signs and symptoms with psychiatric content noted, the GPs would have suspected an emerging psychosis in almost every second patient who visited them. To detect early signs and symptoms of psychosis is difficult, and whenever in doubt, primary health care personnel must be able to consult psychiatric professionals. Otherwise we may miss the opportunity to intervene in an early phase of the illness. Additional training could also mean better understanding and earlier detection of people at risk of an emerging psychosis.

Abstract The purpose of the study was to examine if manual signs used as support to spoken and written language can be a god mnemonic for learning of word-pictures. I performed my study as an experiment in which I made a Memory game with word-pictures. I played the game with the children twice. The first time, we played without manual signs and the second time I used sign as a support. I observed the children and noted the words they learned to read with and without the support of manual signs. The result showed that most of the children remembered the word-pictures better if I also used manual signs. The conclusion I made was that manual signs can be a support in early reading development. It does not suit all children so you have to be sensitive to the different strategies used by the children.

Background: Corporal punishment has been banned in Sweden since 1979. Child abuse is known to exist in all cultures and social classes in our society. Therefore the nurse must be aware of this working with children. Aim: The aim of this study was to describe how nurses' can identify signs and symptoms of child abuse. Method: A literature review of ten articles containing six quantitative and four qualitative studies published between the years of 2000 and 2012. A content analysis was performed where similarities emerged in themes and subthemes. Results: The findings were signs and symptoms which concerns physical, psychological and social behaviors seen in child abuse. Additional findings were; an insecurity and lack of knowledge among nurses working with children. Experienced nurses believed to be more confident than less experienced nurses in identifying abused children and adolescents.  Conclusion: Nurses' ought to have a holistic and ethical approach towards evaluating child abuse. It's important to have in mind that child abuse appears in great variety in physical, physiological and social aspects. Nurses' expressed the need of clearer guidelines in how to identify child abuse and common risk factors.

Failure to recognize changes in a patient’s clinical condition is a barrier to the effectiveness of CCRT outreach programs. The development of a vital signs capture and decision system could alert care providers and CCRTs when a patient’s clinical condition deteriorates. However, point-of-care vital signs capture and documentation is often problematic in clinical practice. Ethnographic research was conducted to understand the difficulties of replacing pen and paper charts and barriers to electronic nursing documentation systems. Analysis of workflows directed the design of two solutions; 1) Apple iPhone facilitated manual vital signs entry, 2) Motorola MC55 enabled automatic data capturing from physiological monitors. Nurses participated in high-fidelity usability testing, comparing the traditional method of paper documentation with the two electronic solutions. As a result of user-centered design process, both solutions were comparable to the efficiency of paper methods, were found acceptable to nurses, and could be successfully incorporated into current workflows.

Wayfinding Design for Randomly Developed Areas: The Beltline Case Study proposes a wayfinding signage program for the new public transit project in Atlanta known as the Beltline. This program unites the Beltline with other transit options within Atlanta, such as MARTA, to form a comprehensive transit system. This program will be known as The Atlanta Unified Transit Program. My proposed signage program includes map kiosks, information posts and signs promoting the various levels of transit offered in Atlanta as well as information about the areas surrounded by public transit. The signage examples created for my thesis are prototypes that could later be applied to any location within the area serviced by public transit.

Denna kandidatuppsats behandlar wayshowing i en 3D-modell av Visualiseringscenter C, Norrköping. Syftet är att undersöka olika sätt att göra skyltar i virtuell miljö och vilket sätt som är mest lättarbetat för användaren som ska skapa dessa skyltar. Uppsatsen utgår från teori om wayshowing och om hur en bra skylt ska se ut för att uppfylla sitt syfte. Med hjälp av denna teori har skyltar skapats i en 3D-miljö. Det insamlade materialet som resultaten är baserade på kommer från två strukturerade observationer och en intervju. Deltagaren och observatören i observationerna var författaren själv och under intervjun hördes en student med liknande erfarenheter kring grafisk design och 3D som författaren. I observationerna testades två sätt att skapa skyltar; ett sätt där texturen gjordes innan skyltarna tillverkades i 3D-miljön och ett sätt där texturen gjordes efter det att skyltarna hade tillverkats i 3D- miljön. Resultaten från observationerna visar att det senare sättet är smidigast att använda eftersom det är lättare att anpassa texturen till skylten efter det att skylten har blivit modellerad i 3D. Observationerna undersökte även vilka digitala processer som användes och vilken tid de processerna tog. Under observationerna framkom att rendering var den digitala process om användes flest gånger. Den process som ansågs ta mest tid var så kallade tutorials, att ta reda på och införskaffa kunskap om hur ett moment kan utföras. Observationerna visade även att det är tidssparande att återanvända kameror, material och 3D-modeller. / This bachelor thesis is about wayshowing in a 3D model of Visualiseringscenter C, Norrköping. The aim is to examine different ways to make signs in a virtual environment and which of these ways is the easiest to apply for the user. The essay is based on theory regarding wayshowing and how a good sign should look in order to fulfill its purpose. With the use of this theory, signs have been created in a 3D environment. The collected data which the results are based on comes from two structured observations and one interview. The participant and the observer of the observations was the author herself and the interview was done with a student who has similar experiences in graphic design and 3D as the author. The observations evaluated two different ways to create signs. One way in which the texture was made before the signs were made in the 3D environment and one way in which the texture was made after the signs had been manufactured in the 3D environment. The results of the observations show that the latter approach is more convenient to use because it is easier to adjust the texture after the sign has been created. The observations also considered the digital processes used and the time spent on these processes. The observations revealed that rendering was the most used digital process. The digital process which was most time consuming was the use of tutorials, i.e. to acquire knowledge of how an previously unknown digital process could be performed. The observations also revealed that re-use of cameras, materials, and 3D models was time saving.

Failure to recognize changes in a patient’s clinical condition is a barrier to the effectiveness of CCRT outreach programs. The development of a vital signs capture and decision system could alert care providers and CCRTs when a patient’s clinical condition deteriorates. However, point-of-care vital signs capture and documentation is often problematic in clinical practice. Ethnographic research was conducted to understand the difficulties of replacing pen and paper charts and barriers to electronic nursing documentation systems. Analysis of workflows directed the design of two solutions; 1) Apple iPhone facilitated manual vital signs entry, 2) Motorola MC55 enabled automatic data capturing from physiological monitors. Nurses participated in high-fidelity usability testing, comparing the traditional method of paper documentation with the two electronic solutions. As a result of user-centered design process, both solutions were comparable to the efficiency of paper methods, were found acceptable to nurses, and could be successfully incorporated into current workflows.

Sammanfattning Syftet med denna litteraturstudie var att undersöka och beskriva hur hjärtinfarktsymtom yttrar sig och upplevs av kvinnor och vilka atypiska symtom sjuksköterskan bör vara uppmärksam på i mötet med kvinnor i sjukvården. En beskrivande litteraturstudie genomfördes där vetenskapliga artiklar av kvalitativ och kvantitativ karaktär analyserades. Huvudresultatet visade att central bröstsmärta var ett vanligt rapporterat symtom men att många kvinnor inte hade bröstsmärta som det enda och huvudsakliga symtomet. Kvinnor tenderade mer ofta än män att uppleva besvär från käke, hals och nacke. Rygg och skulderbladsmärta visade sig förekomma i liknande utsträckning som bröstsmärta hos kvinnor med hjärtinfarkt. Extrem trötthet tillsammans med dyspné var två av de mest frekvent rapporterade tidiga teckenen vid hjärtinfarkt, dessa upplevdes ofta lång tid innan hjärtinfarkten men var för kvinnorna svåra att sammankoppla med hjärtinfarkt. Illamående och kräkning var frekvent rapporterande symtom som framför allt visade sig i den akuta fasen av hjärtinfarkt. Svettningar i kombination med andra symtom var också vanligt i den akuta fasen av hjärtinfarkten, kraftig svettning var något som fick kvinnor att reagera på att något var allvarligt fel och det påverkade kvinnors beslut att söka sjukvård. / Abstract The aim of this literature study was to explore and describe how the heart attack symptoms manifested and were experienced by women and the atypical symptoms the nurse should be alert to when meeting women in health care. A descriptive literature review was conducted in which scientific papers of qualitative and quantitative characteristics were analyzed. The main results showed that central chest pain was a commonly reported symptom, but that many women did not have it as the only and main symptom. Women tended more often than men to experience symptoms of jaw, neck and throat. Back and shoulder pain were found to occur in a similar extent as chest pain in women with myocardial infarction. Extreme fatigue with dyspnoea' were two frequently reported early signs of heart attack, often felt long before the heart attack but difficult for women to connect with myocardial infarction. Nausea and vomiting were symptoms that mainly appeared in the acute phase of myocardial infarction. Sweating in combination with other symptoms were also common in the acute phase of myocardial infarction, excessive sweating was something that got women to respond to that something was seriously wrong and it affected women's decisions to seek care.

When a traffic signals malfunction monitoring unit detects a problem with a traffic signal such as the simultaneous display of green indications to conflicting movements or loss of power to some signal heads, the signal is automatically placed into flash mode as a safety precaution. Signals can have either red/red malfunction flash mode or yellow/red malfunction flash mode, and the mode cannot change by time of day or day of week. This study analyzed traffic operation at 34 instances of yellow/red malfunction flash and 9 instances of red/red malfunction flash in the Atlanta, Georgia area. Many of these instances were during high volume periods. A high level of driver confusion exists at malfunction flash intersections. The rate at which through major street drivers (i.e. those facing a flashing yellow signal) stopped exceeded 75 percent at some yellow/red flash intersections. This creates a safety hazard for other major street drivers who are not expecting vehicles to stop, and for minor street drivers who cannot tell what type of control is being presented to cross traffic or do not understand that vehicles are not required to stop when approaching a flashing yellow indication. Furthermore, high stopping rates at a flashing yellow signal eliminate many of the operational benefits that yellow/red flash is assumed to have over red/red flash. Based on the findings of this study, the use of red/red flash should be the primary flash mode and possibly used exclusively. Requiring all vehicles to stop will improve safety conditions and not have large operational impacts at intersections where a majority of major street vehicles are already stopping at a flashing yellow signal. Yellow/red flash may be an acceptable malfunction flash mode at the intersection of a very large street and a very small street, but additional measures would be required at these intersections to address potential driver confusion.