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A problem in self-driving vehicle (SDV) development is replacing human intuition in the diagnostic process. Some fundamental interactions between driver, service personnel, and system developer are hard to replace by onboard systems and processes. One solution to this problem is to have a staffed control tower that supports the vehicle’s decision-making. In this thesis, a decision-making process for short-term fault avoidance and uptime maximization was developed. A system architecture was proposed and implemented on the SVEA platform. By integrating the onboard system with a control tower, an increase in safe operation was achieved when the vehicle lacked knowledge. In addition, some critical interactions between SDV and control tower were tested: Diagnosis verification and plan correction. By communicating onboard data such as system warnings, symptoms, speed, and location, the vehicle could support the control tower in its decision-making. One conclusion from the thesis was that the SDV with a control tower lowered the threshold for vehicle autonomy. Also, it was shown that both vehicle safety and uptime could be considered in the route planning of SDV:s. In the future, the diagnostic and prognostic algorithms employed in the proposed architecture could be integrated with machine learning tools to update degradation models online. This could make their outputs more reliable and accurate and ultimately make the whole system more safe and reliable. / Ett problem i utvecklingen av självkörande fordon är hur man bäst ersätter den mänskliga intuitionen i diagnosprocessen. Många av nyckelinteraktionerna mellan förare, verkstadspersonal och utvecklingsingenjörer är svåra att ersätta med autonoma processer. En lösning på detta problem är att ha ett kontrolltorn som ger stöd till fordonets beslutsfattande. I det här examensarbetet föreslås en beslutsfattandeprocess för felhantering och uptime-maximering på kort sikt, under körning. En systemarkitektur utvecklades och implementerades på SVEA-plattformen. Genom att integrera systemen i fordonet med ett kontrolltorn kunde en säkrare körning säkerställas i situationer där fordonet saknade relevant kunskap. Några nyckelinteraktioner testades även: Diagnosverifikation och beslutskorrigering. Genom att kommunicera relevant data till kontrolltornet så som systemvarningar, symptom, hastighet och position kunde fordonet även stödja människan i dess beslutandeprocess. En slutsats från arbetet var att detta föreslagna system, självkörande fordon med kontrolltorn, sänkte tröskeln för autonomi i fordon. Det visades också hur både fordonets säkerhet och uptime kan användas som parametrar i ruttplanering för självkörande fordon. I framtiden skulle de framtagna diagnos och prognosalgoritmerna kunna integreras med maskininlärningsverktyg för att möjliggöra live uppdatering av bl.a. degraderingsmodeller. Detta skulle göra dem mer tillförlitliga och precisa vilket i slutändan gör systemet som helhet mer säkert och tillförlitligt.

Introduction: Nurses and other health care professionals meet patients with heart failure (HF) who report they are thirsty. Thirst is described by the patients as a concern, and it is distressing. Currently there are no standardized procedures to identify patients with increased thirst or to help a patient to manage troublesome thirst and research in the area of thirst is scarce. In order to prevent and relieve troublesome thirst more knowledge is needed on how thirst is experienced and what factors cause increased thirst. Aim: The aim of this thesis was to describe the thirst experience of patients with HF and describe the relationship of thirst with physiologic, psychologic and situational factors. The goal was to contribute to the improvement of the care by identifying needs and possible approaches to prevent and relieve thirst in patients with HF. Methods: The studies in this thesis used a cross-sectional design (Study I) and prospective observational designs (II-IV). Studies include data from patients with HF who were admitted to the emergency department for deterioration in HF (I, IV) or visited an outpatient HF clinic for worsening of HF symptoms (III); others were patients who were following up after HF hospitalization (II), and patients with no HF diagnosis who sought care at the emergency department for other illness (I). Patients completed questionnaires on thirst intensity, thirst distress, HF self-care behaviour, feeling depressive and feeling anxious. Data on sociodemographic, clinical characteristics, pharmacological treatment and prescribed fluid restriction were retrieved from hospital medical records and by asking the patients. Data were also collected from blood, urine and saliva samples to measure biological markers of dehydration, HF severity and stress. Results: Thirst was prevalent in 1 out of 5 patients (II) and 63% of patients with worsening of HF symptoms experienced moderate to severe thirst distress at hospital admission (IV). Patients at an outpatient HF clinic who reported thirst at the first visit were more often thirsty at the follow-up visits compared to patients who did not report thirst at the first visit (II). Thirst intensity was significantly higher in patients hospitalized with decompensated HF compared to patients with no HF (median 75 vs. 25 mm, visual analogue scale [VAS] 0-100 mm; P < 0.001) (I). During optimization of pharmacological treatment of HF, thirst intensity increased in 67% of the patients. Thirst intensity increased significantly more in patients in the high thirst intensity group compared to patients in the low thirst intensity group (median +18 mm vs. -3 mm; P < 0.001) (III). Patients who were admitted to the hospital with high thirst distress continued to have high thirst distress over time (IV). A large number of patients were bothered by thirst and feeling dry in the mouth when they were thirsty (III, IV). Patients with a fluid restriction had high thirst distress over time and patients who were feeling depressed had high thirst intensity over time (IV). Thirst was associated with fluid restriction (III-IV), a higher serum urea (IIIII), and depressive symptoms (II). Conclusions: A considerable amount of patients with HF experiences thirst intensity and thirst distress. Patients who reported thirst at the first follow-up more often had thirst at the subsequent follow-ups. The most important factors related to thirst intensity or thirst distress were a fluid restriction, a higher plasma urea, and depressive symptoms. Nurses should ask patients with HF if they are thirsty and measure the thirst intensity and thirst distress, and ask if thirst is bothering them. Each patient should be critically evaluated if a fluid restriction really is needed, if the patient might be dehydrated or needs to be treated for depression.

L'objectif de la présente étude vise à déterminer si la présence de constipation dyssynergique durant la grossesse est un facteur de risque des déchirures du troisième et du quatrième degré lors d'un premier accouchement vaginal. Un dispositif de recherche cas-témoin rétrospectif a été utilisé. La population était constituée de femmes primipares recrutées à l'aide du registre de la salle des naissances selon leur degré de déchirure périnéale. Les participantes ont ensuite été classées en deux groupes. Le premier groupe, les cas, était constitué de femmes ayant eu une déchirure du troisième ou du quatrième degré. Le deuxième groupe, les témoins, était composé de femmes présentant un périnée intact ou une déchirure du premier ou du deuxième degré. La variable dépendante, soit le degré de déchirure périnéale, a été identifiée à l'aide du dossier obstétrical. La variable indépendante principale, soit la présence de constipation dyssynergique, a été documentée à l'aide du questionnaire Knowles-Eccersley-Scott-Symptom (KESS) envoyé par la poste aux femmes primipares. Les autres facteurs de risque des déchirures périnéales ont été documentés à l'aide du dossier obstétrical et d'un questionnaire maison postal. Un modèle de régression logistique, avec le rapport de cote comme mesure d'association et un intervalle de confiance de 95%, a été utilisé afin de déterminer les facteurs influençant les déchirures du troisième et du quatrième degré. Au total, 549 femmes primipares ont participé à l'étude ; 140 étaient dans le groupe des cas et 409 dans le groupe témoin. Dix-sept pourcent des femmes du groupe des cas et 7,6% des femmes du groupe témoin souffraient de constipation dyssynergique (p=0,001). Une régression logistique multiple a démontré que la présence de constipation dyssynergique est associée à 2,94 fois (95%Cl : 1,47 - 5,88) plus de risque de déchirure du troisième et du quatrième degré. En conclusion, cette étude a démontré que la présence de constipation dyssynergique durant la grossesse augmente le risque de subir une déchirure du troisième et du quatrième degré. Une étude prospective devra cependant être conduite afin d'établir la relation de cause à effet entre la présence de l'incoordination des muscles du plancher pelvien rencontrée dans la constipation dyssynergique et les déchirures du troisième et du quatrième degré."--Résumé abrégé par UMI.

Knee osteoarthritis (OA) is the commonest form of lower limb OA with a lifetime risk of over 40%. It is a disease characterised by symptoms such as pain and loss of function. In addition there are typical structural features on both radiographs and MRI. Knee OA represents a spectrum of disease, ranging from early preclinical cartilage change to established full thickness disease. Anteromedial knee OA is a particular phenotype of knee OA where disease is confined to the medial compartment. Whilst end stage arthritis is treated reliably with joint arthroplasty, those with early stage disease are treated with a variety of non- surgical interventions with varying success. This thesis is concerned with understanding the disease of patients that have early radiographic changes but symptoms not controlled by conservative measures. Up to 150 of these patients a year present to the Nuffield Orthopaedic Centre, Oxford. They have been described as being in the “Treatment Gap”. A series of validation studies were performed to determine the optimal method for diagnosing cartilage defects within the knee. The three commonest diagnostic methods were examined for their validity. Arthroscopic assessments of cartilage lesions demonstrated a moderate level of intra and inter observer reliability. In contrast, radiographs and MRI demonstrated high levels of reliability. When using MRI as a criterion standard, both radiographs and arthroscopic assessment were found to have poor accuracy. Based on the work in this thesis a formal definition of the cartilage changes exhibited in early knee OA was proposed. A cross sectional cohort of 100 patients with the symptoms and radiological features of early knee OA were identified. Their pain and function profile was compared to two comparison groups of patients at the end stage of knee OA (defined by the need for partial or total arthroplasty). In up to 78% of individual cases those with early OA had pain and function profiles as bad as those with end stage disease. The cross sectional symptoms of early knee OA demonstrate a marked discordance with their mild radiographic changes. The same cohort was extended to 125 patients. They were followed over one year with monthly PROM assessments to determine how symptoms change over time. 43% of patients experience a clinical improvement over 12 months, 31% experience a clinical deterioration and 26% remain unchanged. The range in OKS variation over 12 months was on average 12 points, with clinically relevant variation occurring on 45% of monthly measurements. Patients with early knee OA can expect to experience considerable variation in their symptoms over 12 months and this must be considered when planning interventions. A number of patients with early knee OA were noticed to demonstrate medial meniscal extrusion. Using data from the Osteo Arthritis Initiative (OAI) a nested case control study was designed to determine how the presence of meniscal extrusion in an otherwise normal knee affects the risk of developing knee OA over the next 48 months. This demonstrated an Odds Ratio of 3.5, suggesting that meniscal extrusion is a considerable risk factor for the development of OA. The presence of a knee injury or operative intervention to the index meniscus was shown to increase this risk. Many phenotypes of OA are known to demonstrate familial aggregation. In an attempt to determine where the earliest structural changes occur in medial compartment knee OA, a cohort of patients selected only for their family history of the disease were developed. This cohort was compared to spouse controls for the presence of knee OA, as well as meniscal extrusion and long leg alignment. In addition, a functional analysis of their cartilage was performed. This cohort was not shown to be at increased risk of disease compared to controls. Discussion of the possible reasons for this finding is presented. Early knee osteoarthritis is a considerable clinical problem. This thesis has aided the understanding of the condition by firstly defining the radiological description of these patients. Secondly, their cross sectional and longitudinal symptom profile have been described for the first time. In addition, the presence of an extruded meniscus has been demonstrated as a substantial risk factor for the disease. Finally, family history has not been demonstrated as a risk factor for the disease within the limits of the study described here. Future work has been proposed.

This thesis focusses on the role of attentional bias for health-threat information in the production and maintenance of medically unexplained symptoms, somatoform disorders and high levels of physical symptom reporting. It is comprised of three separate papers. Paper 1 was prepared for Clinical Psychology Review as a systematic review of the evidence concerning attentional bias for health–threat information in populations presenting with somatoform/somatic symptom disorders and high levels of physical symptom reporting. From the 20 studies deemed relevant for review, it was concluded that - although limited - the evidence indicated that a relationship existed between attentional bias for health-threat information and levels of physical symptom reporting. No robust evidence was found to establish whether this relationship was a casual one. Paper 2 was prepared for Journal of Abnormal Psychology and investigated whether an exogenous cueing task could be used to reduce presumed attentional bias for health-threat information in a sample of high symptom reporting students. The results showed an unexpected attentional avoidance of health-threat information at baseline, which the study manipulation unintentionally exacerbated. No change in levels of physical symptom reporting was noted between groups (attributed to a methodological error) but a trend in relatively greater anxiety for those who received the manipulation was noted. It was concluded that avoidance may be a key factor in high symptom reporting and that this merited further research. Paper 3 provided a critical reflection of Papers 1 and 2, as well as the research process as a whole. Implications for theory and clinical practice as well as future research directions were discussed.

Bakgrund: "The Immigrant Health Paradox" indikerar att invandrade från ofta upplever en bättre psykisk hälsa i jämförelse med majoritetsbefolkningen, trots nackdelar som en lägre social status. Syfte: Studien syftade till att testa skillnader i internaliserade symptom och familjerelationer hos unga med svensk och utländsk bakgrund. Studien testade om en högre grad av emotionellt stöd, familjesammanhållning och akademiskt stöd kunde förklara skillnader i internaliserade symptom hos första och andra generationens invandrade från icke-väst och väst samt majoritetsbefolkningens unga. Även kön, föräldrarnas utbildningsbakgrund samt familjestruktur testades. Metod: Studien utgick från en kvantitativ ansats och statistiska analyser genomfördes med one-way anova samt multivariata regressionsanalyser. Data: Studien baserades på n=4344 svenska skolelever i årskurs 8, med en medelålder på 14,65 år. Data hämtades från första vågen (2010/2011) av "Children of Immigrants Longitudinal Survey in Four European Countries" (CILS4EU) som är baserad på 251 svenska skolor. Resultat: Resultaten visade vissa skillnader i internaliserade symptom och familjerelationer hos invandrade unga och majoritetsbefolkningens unga. Invandrade från icke-väst och andra generationen från väst rapporterade en lägre grad av internaliserade symptom i jämförelse med majoritetsbefolkningen, som delvis kunde förklaras av bättre emotionellt stöd samt familjesammanhållning och en intakt familjestruktur. En lägre grad av internaliserade symptom hos första generationen i jämförelse med andra generationen kunde inte urskiljas. Slutsats: Paradoxen kunde delvis bekräftas hos skolelever i Sverige genom en bättre psykisk hälsa hos invandrade unga från icke-väst och andra generationen från väst i jämförelse med majoritetsbefolkningen, som kunde förklaras av kvalitativt bättre familjerelationer hos invandrade unga.

Bean pod mottle virus (BPMV), a member of the genus Comovirus in the family Comoviridae, is widespread in the major soybean-growing areas in the United States. Soybean yield losses of 10-40% have been reported as a consequence of BPMV infection. The complete nucleotide sequences of two strains, K-Ha1 and K-Ho1, were determined. Field isolates of BPMV were classified into two distinct subgroups (I and II) based on slot blot hybridization and sequence analyses. Full-length cDNA clones from which infectious transcripts can be produced were constructed for strains K-G7, K-Ho1 and K-Ha1. Whereas strains K-Ha1 and K-G7 induced mild or moderate symptoms in infected soybean plants, strain K-Ho1 produced very severe symptoms. Symptom severity was mapped to RNA1. Chimeric RNA1 constructs were generated by exchanging full or partial coding regions of the five RNA1-encoded mature proteins between the full-length cDNA clones of the three RNA1s and the resultant transcripts were inoculated onto soybean. The results showed that the coding regions of the protease co-factor (Co-pro) and the putative helicase (Hel) are determinants of symptom severity. Although symptom severity correlated well with accumulation of viral RNA, neither the Co-pro nor Hel protein could be demonstrated as a suppressor of RNA silencing. Furthermore, separate expression of the Co-pro or Hel proteins from a PVX vector induced necrosis on the inoculated leaves of Nicotiana benthamiana. Characterization of BPMV K-Ho1 indicated that it is a diploid reassortant, containing two distinct types of RNA1s and one type of RNA2. Examination of field isolates from various locations in the United States and Canada revealed that diploid reassortants are of frequent occurrence in natural populations of BPMV. The vary severe symptoms induced by BPMV K-Ho1 can be mimicked by inoculation of plants with a mixture of RNA1 transcripts from two distinct strain subgroups and RNA2 transcript from either subgroup. Plants inoculated with a mixture of transcripts containing two types of RNA1 from the same strain subgroup did not produce very severe symptoms. These are due to interactions between two distinct types of RNA1s. At present, no soybean cultivars with resistance to BPMV are commercially available. Therefore, the feasibility of cross protection as an alternative disease management strategy was studied. Two mild strains of BPMV (K-Da1 and K-Ha1), belonging to subgroup II, were tested for their ability to protect infected plants against a severe strain (K-Ho1). Inoculation of the soybean cultivar Essex on the primary leaves with either of the two mild strains conferred complete protection against challenge inoculation with the severe strain K-Ho1, regardless of the timing of challenge inoculation. Cross-protection was evident regardless of whether virions or BPMV-RNA were used as inocula. Cross protection was independent of the soybean cultivar used and method of virus inoculation, sap-inoculation or by the bean leaf beetle, vector of BPMV. Protection was complete and durable.

<p>The focus of this research is the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for tuberculosis. The goal of this&nbsp / research study was to do an explorative study in order to establish the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for Tuberculosis. The objectives to meet the goal were an exploration and description of patients&rsquo / experiences with regards to social and health service factors contributing to delays in seeking&nbsp / treatment for Tuberculosis. Another goal was to make recommendations on social and health service factors that contribute to patients&rsquo / delays in seeking treatment based on the findings. The research study had been of a qualitative nature exploring patients&rsquo / experiences of social and health services factors that contribute to delays in seeking treatment for Tuberculosis. Qualitative&nbsp / research was used in this study using semi-structured interviews with an interview guide. Data analysis was done according to the eight steps as recorded in Tesch in Creswell (1994: 155). The&nbsp / findings of this research were or include social factors contributing to patients&rsquo / delays in seeking treatment for TB. There were four categories related to social factors namely socio-economic,&nbsp / substance abuse, psycho-social and interpersonal relations factors. The findings also indicated that there were health service factors contributing to patients&rsquo / delay in seeking treatment for TB.&nbsp / These include quality of health care services, attitudes of medical staff and other medical conditions treatment. It was concluded that social and health services, as mentioned indeed contribute to patients&rsquo / delays in seeking treatment for Tuberculosis. Recommendations for practice included better case detection, treatment and health education. In order to address the various social&nbsp / factors as described above it is necessary to treat TB holistically and include a social worker as part of the multidisciplinary team.</p>

Bakgrund: Att få ett cancerbesked kan för vissa upplevas som att få en dödsdom. Det väcker inte allt för sällan starka känslor hos både den drabbade och dess anhöriga. Att leva med cancer upplevs för många påfrestande både fysiskt och psykiskt från symtom och biverkningar från olika behandlingar såsom cytostatika och strålning. Däremot kan hoppet ofta leva kvar men i olika grader innan det infinner sig på nytt. Syfte: Syftet med denna litteratöversikt var att beskriva massage och beröring som symptomlindring hos patienter som lever med cancer. Metod: Denna uppsats har utformats som en litteraturöversikt bestående av 13 artiklar med både kvalitativ och kvantitativ metod. Datainsamling har gjorts i form av litteratursök i databaserna CINAHL, PubMed samt via manuella sökningar. Resultat: Resultatet presenterades under två huvudkategorier: symtomlindrande effekter med hjälp av massage och beröring och påverkan av livskvalitén med hjälp av massage och beröring. De underliggande kategorierna var: smärta och illamående, respektive ångest, sömn och relationer. Massage, beröring och aromaterapi kunde minska både smärta och illamående även om effekten avtog när behandlingen avslutades. Detsamma gällde ångest. Även sömnkvalitén förbättrades och beröring kunde i vissa fall medföra ett känslomässigt stöd och sågs att relationer kunde fördjupas. Slutsats: Olika typer av beröringsformer är bland de äldsta behandlingsmetoder som finns och har börjat användas allt mer inom hälso- och sjukvården. Massage, beröring och aromaterapi kan ge en god symtomlindrande effekt både fysiskt och psykiskt och öka livskvalitén vid kontinuerlig behandling. / Background: Receiving a cancer diagnosis can for some be seen as getting a death sentence. It often evokes strong feelings of both the patients and their relatives. Living with cancer is often experienced as stressful both physically and mentally from the symptoms and side effects from treatments such as chemotherapy and radiation. However, hope often survive, only in different degrees before it find its way back. Aim: The purpose of this study was to describe massage and touch as a method for symptom relief in cancer patients. Method: This study has been designed as a litterature review consisting of 13 qualitative and quantitative articles. Data was collected in the databases CINAHL, PubMed and by searching manually. Results: The results were presented in two main categories: symptomatic effect of massage and touch and impact of the quality of life by means of massage and touch. The underlying categories were: pain and nausea, and anxiety, sleep and relationships. Massage, touch and aromatherapy could help reduce pain, nausea and anxiety, although the effect waned when treatment ended. Sleep quality improved and touch could in some cases be seen as a way of deepen relationships. Conclusion: Different types of touchtherapy are some among the oldest methods in history and are being used more in health care. Massage, touch and aromatherapy can provide a good symptomatic effect both physically and mentally, and increase quality of life when receiving treatment continuously.