Att vårda en patient i livets slutskede innebär att bekanta sig med känslomässiga situationer som ofta påverkar sjuksköterskans omvårdnadshandling exempelvis effektiv symtomlindring. Syfte: Syftet med denna studie var att beskriva sjuksköterskans upplevelse av det vårdande mötet med patienten i samband med palliativ vård. Metod: Metoden var en litteraturstudie med kvalitativa ansatser. Sex vetenskapliga artiklar samlade in och användes som analysmaterial av denna studie. Innehållanalysen inspirerad av Graneheim och Ludman (2003) användes för att analysera insamlade data. Resultat: Resultatet visade att sjuksköterskan upplever tillfredställelse och välbefinnande om hon lyckas med att tillgodose patientens behov exempelvis smärta. Effektiv smärtlindring upplevdes som meningsfull och det innebar att hon hade betytt något för patienten och dess närstående. Däremot upplevdes hon stress, frustration, maktlöshet och konflikt när hennes omvårdnadshandling inte mött patientens behov. Samverkan mellan arbetsteamen och stöd från kollegor upplevdes som viktigt i den palliativa vården. Sjuksköterskan höll distans för att kunna hjälpa patienten. Slutsatsen: Sjuksköterskan behöver kunskap om smärtlindring samt kunskap om palliativ vård för att effektivt lindra patientens smärta. För att tillgodose patientens behov i sin helhet behöver hon tillräcklig med tid och frihet att själv planerar sitt arbete. Samarbetet med andra vårdteam och kollegornas stöd måste stärkas och ha ett gemensamt mål: patientens välbefinnande då kan sjuksköterskan uppleva välbefinnande.

P[Kappa]a is not responsible for the improved activity. Hence, stabilization of an enediolate intermediate may be important for catalysis. In the second part of this work, the Chloroflexus aurantiacus J-10-fl heterohexameric 4-OT tautomerase was employed in random and rational directed evolution studies to introduce a CaaD activity. Genetic selection and a high throughput screening assay were used to identify mutants. Genetic selection was unsuccessful due to plasmid instability in the host strain. A small mutant library in the screening assay precluded the identification of any mutants with CaaD activity. Finally, rational design using structure-function relationships was investigated and a single mutant was discovered for hh4-OT that incorporated CaaD activity into the enzyme, the [alpha]L9R hh4-OT, this mutant has been characterized kinetically and the evolutionary implications for the tautomerase superfamily are described. / text

No description available.

The recent expansion of focus within medicine to include palliative care has created a new corps of professionals who fulfill a role that might be considered antithetical to their profession. This new medical role calls for individuals who have personality characteristics that will allow them to constantly face death. This study was concerned with examining, in Adlerian life style terms, the personality characteristics of one segment of that corps--the hospice home care nurse. The subjects used in this study represent the population of nurses (N = 6) who provide the care within the framework of the home care program of Hillhaven Hospice of Tucson. A structured interview was held by the researcher at which time the subjects responded to each of the items on the Life Style Interview Guide. Three experts trained in Adlerian psychology and life style interpretation collectively analyzed each life style in order to arrive at a life style summary for each nurse as well as a composite summary. The results of this study showed a high degree of similarity and consistency with regard to attitudes, personality characteristics and life style themes of the hospice home care nurses studied.

The purpose of this study was to explore spiritual and psychological issues as experienced by persons who know they have a terminal illness. An existentialphenomenological method was chosen to understand and articulate the structure and meaning underlying the experience of living with the knowledge that one has a terminal illness. The study had its genesis at the bedside(s) of people who were dying, yet living or living, yet dying. The experience of knowing one has a terminal illness serves to bring life and consciousness to those who may have otherwise continued to live unconsciously, to exist in a potentially weary and dormant state, oblivious to the fact that life was passing them by. The evidence of experience of knowing what it means to have a terminal illness exists in the words and expressions of the twenty-one people who graciously participated in this study as co-researchers. They have given testimony of their own experience to those of us who seek to understand that experience, to understand what it means to have a terminal illness, to confront one's end to life as it is known, to embrace life or to prepare to die. For some it was a single in-depth interview, for others there were numerous indepth interviews over the course of two to eleven months. Eight of the twenty-one coresearcher narratives were presented in this study. Each interview was recorded by audio and video tape, the former being used for transcription. Subsequently, transcriptions were reviewed for accuracy. As a measure of trustworthiness, themes were identified by the principal investigator and presented in the context of the narrative to the coresearchers who confirmed the data and validated the themes. Implications based on the themes identified in this study are presented under theory development, professional practice and future research. One of the strongest implications pertains to clinical practice in that the results could serve as the framework for a palliative care program which models palliative care as defined by the World Health Organization. The co-researchers were eager to tell their stories and to speak their truth with the hope that the care of persons with terminal illness would some day include care of people as whole persons—physical, psychological and spiritual.

The most important issue at a container terminal is to minimize the ship’s turnaround time which is determined by the productivities of quay cranes (QCs). The tandem lift quay cranes have 33% higher productivities than single lift QCs. However, the tandem lift operations bring new challenges to the vehicle dispatching at terminals and this has become a big issue in the application of tandem lift QCs. The vehicle dispatching at terminals is to enhance the QCs’ productivities by coordinating the QCs’ operation schedules and the vehicles’ delivery schedules. The static version of the problem can be formulated as an MILP model and it is a combinational optimization problem. When the type of QC is tandem lift, the problem becomes more complicated because it requires two vehicles side by side under the QC. Thus, the alignments of vehicles have to be considered by coordinating the delivery schedules between vehicles. On the other hand, because the containers are operated alone by the yard cranes, the vehicles could not be grouped and dispatched in pairs all the time. This dissertation investigates the static and dynamic version of the problem and proposes heuristic methods to solve them. For the static version, Local Sequence Cut (LSC) Algorithm is proposed to tighten the search space by eliminating those feasible but undesirable delivery sequences. The time windows within which the containers should be delivered are estimated through solving sub-problems iteratively. Numerical experiments show the capability of the LSC algorithm to find competitive solutions in substantially reduced CPU time. To deal with the dynamic and stochastic working environment at the terminal, the dissertation proposes an on-line dispatching rule to make real-time dispatching decisions without any information of future events. Compared with the longest idle vehicle rule, the proposed priority rule shortens the makespan by 18% and increases the QCs’ average productivities by 15%. The sensitivity analysis stated that the superiority of the priority rule is more evident when the availability of vehicles is not sufficient compared with the frequency of releasing transportation requests.

No description available.

Detta examensarbete är en fallstudie på ett företag som är verksamt inom transportbranschen. Företaget upplever idag problem med internpallar som försvinner från deras terminal i Stockholm. Genom att effektivisera hanteringen av internpallarna tros svinnet kunna minska. Syftet med studien är att kartlägga hur hanteringen av internpallar fungerar idag för att undersöka om det finns förbättringsmöjligheter. Med hjälp av kartläggningen har flertalet problem kopplade till hanteringen kunnat identifieras. En riskanalysmatris användes för att rangordna problemen och därigenom tydliggöra i vilken ordning problemen borde åtgärdas. Dessa problem ligger till grund för de rekommendationer som författarna presenterar i rapporten.

Syftet med examensarbetet är att göra en marknadsjämförelse mellan logistikfastigheter och andra industrifastigheter sett utifrån investeringsrisk, belåningsgrad, avkastningskrav, hyreskontrakt och betydelsen av lokalisering. Intervjuer genomfördes med representanter från sex segment som är logistikfastighetsägande bolag/investerare, fastighetsägande bolag av industrilager & industriproduktion, värderingsinstitut/banker, mäklarbyråer, logistikföretag samt branschorganisationer/markberedare. Intervjuerna genomfördes mellan 17 april – 8 maj år 2015. Logistikfastigheter ses generellt som en bättre och säkrare investering än andra industrifastigheter i bankens synvinkel, då andra industrifastigheter kan vara så mycket olika slags fastigheter som däcklager, sågverk, industriproduktion som är osäkrare och har en sämre alternativanvändning än vad logistikfastigheter har, även om industrilager och logistikfastigheter inte skiljer sig jättemycket åt. Belåningsgraden ligger generellt lite lägre för andra industrifastigheter än logistikfastigheter och avkastningskravet ligger lite högre vilket tyder på att den generella risken är lite högre för andra industrifastigheter än för logistikfastigheter. Den generella åsikten hos fastighetsbolag med ägande av industrifastigheter och mäklarbyråer är att bankerna ställer höga krav på eget kapital. Förutom att ställa krav på eget kapital så vill bankerna gärna inte belåna till mer är 60 % av fastighetsvärdet och ofta inte mer än 50 %. Bankerna belånar ut till lägre belåningsgrad idag än den belåningsgraden som erbjöds för 7-8 år sedan. Logistikmarknaden är annars het och det är många aktörer som vill in på marknaden och nå logistikfastigheter med bra läge. Logistikfastigheter byggs numera på spekulation i Sverige, vilket i kombination med den låga räntan gör det förmånligt att investera i fastigheter som i längden kan öka konkurrensen. Det finns p.g.a. att logistikfastigheter byggs på spekulation risk för överetableringar av logistikfastigheter på olika platser i Sverige. De mest värdepåverkande faktorerna för logistikfastigheter är läget, hyreskontraktet och kassaflödet. / The aim of this dissertation is to do a market comparison between logistic and other industrial property from the perspective of investment risk, mortgage rate, yield, leases and the importance of location. Interviews were carried out with representatives from six segments which are logistic property owning logistic companies/investors, companies owning property of industrial- warehouse or production, assessment institutes/banks, property brokers, logistic companies and logistic development organization/property developers. The interviews were conducted between the 17 of April and the 8 of May 2015. Logistic property is in general seen as a better and safer investment than other industrial property in the banks point of view. Other industrial property can be many other kinds of property such as tire storage, sawmill, industrial production which can be high risk investment and have worse alternative usage than logistic property, although logistic property and industrial warehouses does not differ very much compared to industrial production property. The mortgage rate is lower for industrial property than it is for logistic property and the yield is higher which suggests that the general risk is higher for industrial property compared to logistic property. The general opinion of companies who own property for industrial warehouses and production and property brokers is that the banks have high requirements on equity. The banks do not want to mortgage more than 60 % of the property value and often not more than 50 %. The banks do not mortgage to same mortgage rate that they used to do for 7-8 years ago. The market for logistic property is otherwise hot and there are many players who want to enter the market and get logistic property in good locations. Logistic property are now being built on speculation, which combined with low interest rates making it advantageous to invest in property that may lead to increased competition. Due to logistic property is being built on speculation there is a risk of too high rate of establishment in some places in Sweden. The most value-influencing factors of logistics property is location, the lease, and cash flow.

As the research part of my thesis work, I had the opportunity to be involved in the Manhattan Ferry Terminal design undertaken by the New York City firm Schwartz Architects. Being a gateway to Manhattan, the Whitehall Ferry Terminal's psychological impact consists of elements that invoke a notion of arrival in people. An analysis of historical gateway examples from Ancient to Modern times shows their similarity with the architectural symbols used in the design. Those macro symbols of the gate are the metaphors of Edge, Destination, Gathering, Information, Flow and Lights. The analysis of macro elements led to a discovery of the micro architectural factors used in the smaller scale of the Ferry Terminal design. The analysis has provided several conclusions:1. In the design process, the architect uses a knowledge-base to choose architecturalelements that will support the symbolic message of a structure built on a specific site. 2. The number of these elements is infinite and the architect uses his or her experienceto choose the most appropriate elements that will support the intended message.3. Both overall and detailed analyses in the design process are oriented to produce thedesired impression of gateway.4. Comparison of historical examples and elements used in Whitehall Ferry Terminal design shows that impressions created by architecture are constant throughout history and always executed using contemporary technology. / Department of Architecture