SAMMANFATTNING     Bakgrund: Patienter på kirurgavdelningar är komplexa såtillvida att de förutom den kirurgiska åkomman kan ha olika medicinska diagnoser vilket ofta komplicerar både vården, behandlingen samt medför svårigheter i att upptäcka ett försämrat tillstånd. För att kunna bedöma patientens tillstånd och få en uppfattning om hur denne mår måste objektiva och lätt mätbara parametrar användas. Modified Early Warning Score (MEWS) är ett poängsystem som mäter några av patientens vitala funktioner och baseras på sex mätbara/bedömningsbara  funktioner: andningsfrekvens, puls, systoliskt blodtryck, kroppstemperatur, vakenhet och urinmängd. Poängsumman varierar mellan 0 och 17, där 0 är normalt.   Syfte: Att kartlägga fördelningen av poäng enligt MEWS hos akuta patienter med kirurgiska åkommor på två kirurgavdelningar på ett universitetssjukhus i Sverige samt undersöka vilka åtgärder som vidtagits vid respektive poäng enligt MEWS.   Metod: Retrospektiv journalgranskningsstudie  där dokumentation av mätningar med MEWS för 94 patienter granskades.   Resultat: Totalt återfanns 229 poäng enligt MEWS varav 76 var från mätningar vid ankomst till avdelning och resterande  153 från mätningar under fortsatt vårdtid. Antalet MEWS-mätningar per patient varierade mellan  1 och 31. Nitton åtgärder som ingår i sjuksköterskans profession kopplade till en poäng enligt MEWS återfanns. De mest förekommande åtgärderna var att ge smärtstillande läkemedel på generell ordination samt att utföra upprepade kontroller av patientens vitala funktioner. Tjugotvå medicinska åtgärder kopplade till en poäng enligt MEWS återfanns. De mest  förekommande medicinska åtgärderna var att ordinera provtagning eller odling samt att ordinera  extra dropp. Inte i något fall ledde en poäng enligt MEWS till att någon patient flyttade till en högre vårdnivå.   Slutsats: Det fanns mätningar enligt MEWS för 85 % av patienterna där medianpoängen var 1 av maximala 17. Medianpoängen när åtgärd som ingår i sjuksköterskans profession eller medicinska åtgärder vidtogs var 4. De vanligaste åtgärderna var att ge smärtstillande läkemedel på generell ordination, göra upprepade kontroller, ordinera provtagning,  odling eller extra dropp. / ABSTRACT     Background: Patients with surgical conditions are complex, since many patients have various medical diagnoses besides their surgical condition. Apart from complicating care and treatment, this makes it difficult to detect deterioration in the patient's condition. In order to assess the patient's condition, objective and easily measurable parameters are preferably used. A scoring system, the Modified Ear­ ly Waming Score, MEWS, was developed in the early 1990s and based on some ofthe patient's vital functions: respiratory rate, heart rate, systolic blood pressure, body temperature, alertness/awareness and urine output. The result varies between 0 and 17, with 0 demonstrating normal vital functions.   Objective: To describe the distribution of MEWS scores for emergency patients with surgical condi­ tions in two surgical wards at a university hospital in Sweden, and to examine what actions had been taken based on the MEWS scores.   Methods: A retrospective review was performed on MEWS measurements and medical records for 94 patients.   Results: In total, 229 MEWS measurements had been performed, ofwhich 76 were taken on arrival at the ward, and the remaining 153 <luring the continued hospitalization. The number ofMEWS measurements per patient ranged from 1 to 31. Nineteen actions, based on MEWS scores, related the nursing professions were found, with the administration of painkillers and repeated checks ofthe pa­ tient's vital functions, being the two most common. Twenty-two medical procedures, based on MEWS scores, were identified, where sampling for bacterial cultures or prescribing extra intravenous fluid were the most frequent. No patient was transferred toa higher level of care because of their MEWS score.   Conclusion: MEWS measurements were performed in 85% of the patients and the median result was 1 of maximum 17. Different actions, related the nursing or medical profession, were taken at a me­ dian result of 4. No patient was transferred toa higher level of care. The most common actions were administration of painkillers, repeated checks ofthe patient's vital functions, sampling for bacterial cultures and prescribing extra intravenous fluid

With perpetual strains on resources, road agencies need to develop network-level decision-making frameworks to ensure optimum resource allocation. This is especially true for incident management services and in particular variable message signs (VMS), which are relatively immature disciplines compared to traditional road engineering. The objective of incident management and VMS is to minimise the safety, efficiency, reliability and environmental impacts of incidents on the operations of the transport system. This may be achieved by informing travellers of the incidents so they can adapt their behaviour in a manner that reduces community impacts, such as lateness and the associated vehicle emissions, unreliability of travel times, as well as secondary accidents due to incidents. Generally, road authorities do carry out needs assessments, but qualitatively in many cases. Therefore, this masters research presents a framework that is systematic, quantitative and relatively easy to implement. In order to prioritise VMS infrastructure deployment, a risk management approach was taken that focuses on minimising the impacts on, and costs to the community. In the framework and case study conducted, safety, efficiency and reliability, and environmental impacts are quantified using an economic risk management approach to determine an overall risk score. This score can be used to rank road sections within the network, indicating the roads with the highest risk of incident network impacts and therefore the roads with the highest need for intervention. A cost-effectiveness based risk-reduction ranking can then be determined for each incident management treatment type, comparing the net risk with treatment to that without treatment, and dividing by the net present value of deployment. The two types of ranking, pure risk and cost-effectiveness based risk reduction, will help to minimise the network impacts on the community and optimise resource allocation.

The purpose of this study is to investigate factors which can influence the emergence of high musical ability during the developmental process of musical talent achievement, comparing students in Seoul (Korea) and those in Sydney (Australia). The main focuses of the investigation concern the comparison of musical giftedness demonstrated in early childhood, the developmental process, and various factors, such as the environmental and intrapersonal, which can affect the emergence of talent, especially in those of different cultural backgrounds. For this purpose, Gagn????s Differentiated Model of Giftedness and Talent (DMGT, Gagn??, 2003) was adopted as an analytical tool for the present study, in particular for empirical research. A total number of 137 students and 88 parents participated in this research. Student participants consisted of two groups: young musicians aged below 10 who show high musical achievements; and teenage students who are musically superior. All students completed a questionnaire, and their parents also completed a questionnaire. Data showed some significant differences between students in the two countries. Three research instruments are employed based on Harnischmacher (1997). SCI (the Self-Concept Scale of Instrumental Abilities), GOP (Goal Orientation of Practice) and EAD (External Action Distraction) were included in the student questionnaire in order to examine intrapersonal catalysts (motivation) which can affect the developmental process of musical talent. A significant difference was found in SCI between countries. Self-concept of student groups in Sydney was significantly higher than that of students in Seoul among all age groups concerning musical abilities. However, there were no significant differences in GOP and EAD between students in Seoul and Sydney. Other differences emerged concerning the role of parents, expenditure on music lessons, time spent on practice, and environmental factors. In particular, cultural milieu was revealed as one of important environmental factors in the present study.

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The thesis reviews the literature on early communication development, communication intervention with persons with severe intellectual disability, and on picture recognition and use. Drawing from both developmental and behaviourist perspectives, a theoretical base is described for designing intervention and assessment strategies to teach and monitor picto-graphic symbol use for augmentative and alternative communication (AAC). These strategies were investigated with students with severe intellectual disability, little or no spoken language, poor verbal comprehension and poor picture recognition skills. / Doctor of Philosophy (PhD)

Thesis (Ph.D.)--Edith Cowan University, 2007. / Submitted to the Faculty of Computing, Health and Science. Includes bibliographical references.