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Respiratory pathogens in cases of Sudden Unexpected Death in Infancy (SUDI) at Tygerberg forensic pathology service mortuaryLa Grange, Heleen 04 1900 (has links)
Thesis (MScMedSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background: Sudden infant death syndrome (SIDS) is considered the second most frequent cause of infant mortality worldwide. Research specifically pertaining to SIDS is limited in the South African setting. Identifiable causes for sudden infant death remain challenging despite full medico-legal investigations inclusive of autopsy, scene visit and ancillary studies. Viral infections could contribute to some sudden unexpected death in infancy (SUDI) cases, especially since a multitude of respiratory viruses have been detected from autopsy specimens. The specific contribution of viruses in the events preceding death, including the subsequent involvement of the immature immune response in infants, still warrants deciphering. Infancy is characterised by marked vulnerability to infections due to immaturities of their immune systems that may only resolve as infants grow older when these sudden deaths rarely still occur. In South Africa there is a lack of a standard protocol for investigations into the causes of SIDS, including the lack of standard guidelines as to which specimens should be taken, which viruses should be investigated and which laboratory assays should be utilised.
Objectives: In this prospective descriptive study we aimed to investigate the prevalence of viruses in SUDI and SIDS cases at Tygerberg Forensic Pathology Service (FPS) Mortuary over a one year period. The primary aim was to explore possible respiratory viral infections in SUDI and SIDS cases and to determine the usefulness of molecular techniques to detect viruses from SUDI cases. To determine the significance of viruses, we assessed signs of infection from lung histology. The secondary objectives included collecting demographic data to investigate possible risk factors for SUDI and to look for possible similarities between viruses confirmed in living hospitalised infants at Tygerberg, during the study period compared to viruses detected from SUDI cases.
Methods: Between May 2012 and May 2013 samples were collected from 148 SUDI cases presenting at Tygerberg FPS Mortuary. As part of the mandatory routine investigations into SUDI, shell vial culture (SVC) results were collected from lung and liver tissue specimens and bacterial culture results were collected from left and right lung and heart swabs at autopsy. To investigate the possibility of viruses implicated in some of the infant deaths we used the Seeplex® RV15 Ace detection multiplex polymerase chain reaction (PCR) assay to establish the frequency of 13 ribonucleic acid (RNA) respiratory viruses (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus) from RNA extracted from tracheal and lower left and right lung lobe swabs. Tissue from the lower left and right lung lobes were also assessed for histology signs of infection.
Results: During our study we confirmed multiple known demographic risk factors for SIDS, such as the age peak around 1-3 months, the male predominance, bed-sharing, sleeping in the prone position, heavy wrapping in warm blankets, prenatal smoke exposure, and socio-economic factors. With the Seeplex® RV15 Ace detection assay between one and three viruses were detected in 59.5% (88/148) of cases. Of the 88 cases that had viruses detected, 75% (66/88) had one virus and 25% (22/88) had co-detections of two to three viruses. The most common viruses detected were HRV in 77% (68/88) of cases, RSV in 18% (16/88) of cases and HCoV in 14% (12/88) of cases. Many of the viruses we detected from our cases are included in the SVC test that forms part of the medico-legal laboratory investigation for all SUDI cases at Tygerberg FPS Mortuary. SVCs were positive in 9.5% (14/148) of all cases only. We showed that the SVC method is potentially missing most of the 13 respiratory viruses we investigated that could contribute to death in some of the SUDI cases. Conclusion: In some cases that had a Cause of Death Classification - SIDS, the PCR viruses detected cannot be ignored, especially when it is supported by histological evidence of infection. We thus propose that the use of PCR could alter a Cause of Death Classification from SIDS to Infection in some of these cases. Further research is needed to determine the significance of detecting viruses from SUDI cases wherein no significant histological evidence of infection was observed. This questions whether PCR may be too sensitive and is detecting past and latent viral infections that do not play any role in the cause of death. The histological picture also requires further characterisation to determine if it accurately predicts infections or lethal events and can truly support virology findings, especially in young infants whose immune systems are still maturing. Without determining the true prevalence of viruses in SUDI cases and the viral-specific immune response, the contribution of virus-specific infections to this syndrome will remain largely undetermined. / AFRIKAANSE OPSOMMING: Agtergrond: Wiegiedood (“SIDS/SUDI”) word beskou as die tweede mees algemene oorsaak van sterftes in kinders jonger as een jaar wêreldwyd. Toegewyde SIDS-spesifieke navorsing in die Suid-Afrikaanse samelewing is beperk. Dit bly steeds „n uitdaging om oorsake te probeer identifiseer vir hierdie onverwagte sterftes in kinders (SUDI) ten spyte van volledige medies-geregtelike ondersoeke, insluitende die lykskouing, ondersoek van die doodstoneel en aanvullende ondersoeke. Virusinfeksies kan aansienlik bydra tot sommige onverwagte sterftes in kinders, aangesien verskeie respiratoriese virusse alreeds aangetoon is in monsters verkry tydens outopsies. Die spesifieke rol wat virusse speel in die prosesse wat die dood voorafgaan, asook die bydraende rol van „n onder-ontwikkelde immuunrespons in babas, regverdig verdere ondersoek. Die eerste jaar van lewe word gekenmerk deur verhoogde vatbaarheid vir infeksies weens die ontwikkelende immuunstelsels soos wat babas ouer word, en die voorkoms van SUDI neem stelselmatig af met „n toename in ouderdom. In Suid-Afrika bestaan daar tans geen standaard protokol vir die ondersoek van wiegiedood nie en daar is ook nie standaard riglyne oor die tipe monsters wat geneem moet word, watter virusse ondersoek moet word en watter laboratorium toetse uitgevoer moet word nie.
Doelstellings: In hierdie prospektiewe beskrywende studie is gepoog om die virusse wat in gevalle van wiegiedood of SUDI voorkom te ondersoek. Die studie is uitgevoer by die Tygerberg Geregtelike Patologie Dienste lykshuis oor 'n tydperk van een jaar. Molekulêre tegnieke om virusse aan te toon in hierdie gevalle is gebruik om spesifieke virusinfeksies te ondersoek. Die resultate is met histologiese tekens van infeksie in longweefsel gekorreleer. Demografiese data is verder versamel om moontlike risikofaktore vir wiegiedood te ondersoek. Dit is verder vergelyk met virusse wat met dieselfde diagnostiese tegnieke in babas geïdentifiseer is wat tydens die studieperiode in Tygerberg Hospitaal opgeneem was met lugweginfeksies. Metodes: Monsters van 148 SUDI gevalle wat by die Tygerberg lykshuis opgeneem is, is versamel tussen Mei 2012 en Mei 2013. As deel van die roetine ondersoeke in SUDI gevalle, was selkultuur resultate verkry van long en lewer weefsel, asook bakteriële kulture van deppers wat van beide longe en hart geneem was tydens die lykskouings. „n Seeplex® RV15 Ace polimerase kettingreaksie (PKR) toets is gebruik om die teenwoordigheid van virusse te ondersoek wat moontlik by die babasterftes betrokke kon wees. Trageale- en longdeppers wat tydens die lykskouings versamel was, was getoets vir 13 ribonukleïensure (RNS) respiratoriese virusse (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus).
Resultate: Ons studie het verskeie bekende demografiese risikofaktore vir SUDI bevestig, byvoorbeeld „n ouderdomspiek tussen een en drie maande ouderdom, manlike predominansie, deel van „n bed met ander persone, slaap posisie op die maag, styf toedraai in warm komberse, blootstelling aan sigaretrook voor geboorte en sosio-ekonomiese faktore. Die Seeplex® RV15 Ace toets het tussen een en drie virusse geïdentifiseer in 59.5% (88/148) van die gevalle. Uit die 88 gevalle waarin virusse opgespoor was, was selgs een virus in 75% (66/88) van gevalle gevind en twee en drie virusse in 25% (22/88). Die mees algemene virusse was HRV in 77% (68/88) van gevalle, RSV in 18% (16/88) van gevalle en HCoV in 14% (12/88) van gevalle. Baie van die virusse wat tydens hierdie studie ondersoek was, was ingesluit in die roetine selkultuur toets wat deel vorm van die standaard medies-geregtelike laboratoriumondersoeke in alle SUDI gevalle by die Tygerberg lykshuis, alhoewel die selkulture positief was in slegs 9.5% (14/148) van gevalle. Ons het gevind dat baie respiratoriese virusse potensieel gemisdiagnoseer word wat „n rol kon speel in of bydra tot die dood van sommige SUDI gevalle. Gevolgtrekking: In sommige gevalle waarin SIDS geklassifiseer is as die oorsaak van dood, kan die virusse wat met PKR toetse opgespoor is nie geïgnoreer word nie, veral waar die bevinding ondersteun word deur histologiese bewyse van infeksie. Ons stel dus voor dat die gebruik van PKR toetse die oorsaak van dood klassifikasie kan verander van SIDS na Infeksie in sommige van hierdie gevalle. Verdere navorsing is nodig om die waarde van gelyktydige opsporing van virusse in SUDI gevalle te bepaal wanneer daar geen noemenswaardige histologiese bewyse van infeksie gevind word nie. Dit bevraagteken of die PKR toets dalk te sensitief is en gevolglik vorige en latente virusinfeksies identifiseer wat nie noodwendig 'n rol in die oorsaak van dood speel nie. Die diagnostiese en kliniese waarde van die histologiese beeld in terme van die rol van virusinfeksies as bydraende oorsaak van dood moet verder ondersoek word, veral in jong kinders wie se immuunstelsels nog nie volledig ontwikkel is nie. Indien die werklike voorkoms van virusse in SUDI gevalle en die virus-spesifieke immuunrespons nie bepaal word nie, sal die rol van virus-spesifieke infeksies in hierdie sindroom grootliks onbekend bly. / Harry Crossley Foundation / Poliomyelitis Research Foundation (PRF) / National Health Laboratory Services Research Trust
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Unexpected Events in Nigerian Construction Projects: A Case of Four Construction CompaniesPidomson, Gabriel Baritulem 01 January 2016 (has links)
In Nigeria, 50% to 70% of construction projects are delayed due to unexpected events that are linked to lapses in performance, near misses, and surprises. While researchers have theorized on the impact of mindfulness and information systems management (ISM) on unexpected events, information is lacking on how project teams can combine ISM and mindfulness in response to unexpected events in construction projects. The purpose of this case study was to examine how project teams can combine mindfulness with ISM in response to unexpected events during the execution phase of Nigerian construction projects. The framework of High Reliability Theory revealed that unexpected events could be minimized by mindfulness defined by 5 cognitive processes: preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, and deference to expertise. In-depth semi-structured interviews elicited the views of 24 project experts on team behaviors, tactics, and processes for combining mindfulness with ISM. Data analysis was conducted by open coding to identify and reduce data into themes, and axial coding was used to identify and isolate categories. Findings were that project teams could combine mindfulness with ISM in response to unexpected events by integrating effective risk, team, and communication management with appropriate training and technology infrastructure. If policymakers, project clients, and practitioners adopt practices suggested in this study, the implications for social change are that project management practices, organizational learning, and the performance of construction projects may improve, construction wastes may be reduced, and taxpayers may derive optimum benefits from public funds committed to construction projects.
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Nasazení dobrovolníků při řešení mimořádných událostí v Jihomoravském kraji / Engagement of the volunteers in the solution to the accidents in the South-Moravia regionVALOUŠKOVÁ, Aneta January 2010 (has links)
The theme of my diploma thesis is the engagement of the volunteers in the solution to the accidents in the South-Moravia region. In my diploma thesis I am involved in the issue of the engagement of the volunteers in the solution to the accidents in the South-Moravia region. I assume that the utilization of the potential of the volunteers is one of the possibilities of the acquisition of the forces, which could be used for the recovery of the consequences, post-traumatic care to struck persons and other activities within the solution to the accidents, all parallelly with the actions of the professional teams of the integrated rescue system bodies. The needs of the population in case of the accidents are rather differentiated, and the engagement of the volunteers completes the appointed forces and means of the integrated rescue system bodies. At present time, the adequate legal framework, modifying the engagement of the volunteers in the solution to the accidents, does not exist in the Czech Republic. Non-governmental non-profit organizations are united in the South-Moravia region into the Panel of the South-Moravia Region, which establishes the platform and enables the South-Moravia Region more effective engagement of the non-governmental non-profit organizations. The volunteers, organized in the Panel of the South-Moravia Region, are engaged in the solution to the accidents and the trainings organized in the level of the region, municipalities with widened competence and the integrated rescue system bodies.
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Altérations sérotoninergiques et hypersignal T2 en imagerie par résonance magnétique comme biomarqueurs potentiels des troubles respiratoires associés à l'épilepsie chez le rat / Pas de titre anglaisKouchi, Hayet 24 January 2014 (has links)
La mort soudaine inattendue (SUDEP) est fréquemment rapportée chez les patients qui souffrent d'épilepsie et compte pour près de 17% des décès dans cette population. Bien que son étiologie soit restée longtemps incertaine, des études menées sur des cas de victimes de SUDEP suggèrent fortement l'implication de l'apnée post-ictale dans la survenue de ce type de décès. Afin d'élucider les mécanismes physiopathologique de la SUDEP, il était nécessaire de mettre en place un modèle animal qui présente à la fois des crise spontanées récurrentes comme dans le syndrome épileptique et des altérations respiratoires. Dans une première partie, nous mettons en évidence la présence d'altérations respiratoires (RAs) chez 30 à 50% des rats qui présentent une épilepsie suite à un état de mal épileptique (SE) induit par l'administration de pilocarpine. Ces RAs, que nous avons assimilées à des apnées, ont été mises en évidence par thermochimie respiratoire et se traduisent par une diminution de la consommation en oxygène, dont la durée peut varier entre 20 secondes et 13 minutes. La présence des RAs est associée à des altérations du système sérotoninergique au niveau du tronc cérébral, où sont concentrés la majorité des groupes de neurones impliqués dans la régulation et dans la modulation de la fonction respiratoire. Nous montrons que de nombreux gènes du système sérotoninergique sont dérégulés lors de la mise en évidence des RAs ; toutefois, seules les altérations touchant le récepteur 5-HT2c semblent être associées au maintien des RAs. Ce résultat est d'autant plus important qu'il avait été montré que la délétion de ce récepteur chez les souris peut conduire à un arrêt respiratoire fatal suite à une crise épileptique, provoquée ou spontanée. Dans une seconde partie, nous montrons que la surface de la zone présentant un hypersignal T2 dans le système limbique ventral des rats épileptiques est prédictive de la présence de RAs. En outre, des différences d'expression du récepteur 5-HT2c similaires à celles qui avaient été observées dans le tronc cérébral sont retrouvées entre les rats épileptiques selon qu'ils présentent ou pas des RAs. Les résultats de cette thèse impliquent donc le récepteur 5-HT2c dans la survenue et/ou le maintien des altérations respiratoires associées à l'épilepsie. Dans le contexte de la SUDEP, nos résultats ouvrent comme première perspective clinique celle de développer des traitements permettant de cibler spécifiquement le récepteur 5-HT2c chez les patients qui présenteraient un risque de survenue de la SUDEP. La seconde perspective clinique serait de pouvoir identifier ces patients à risque à partir de biomarqueurs tels que les anomalies de signal T2 que nous avons identifiées dans la région limbique ventrale qui inclut notamment l'insula, dont il a été montré qu'elle contribue à la modulation de la fonction respiratoire / Pas de résumé anglais
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Inovace vybraných pojistných produktů a jejich alternativ / Innovation of Selected Insurance Products and their AlternativesKolouchová, Jana January 2018 (has links)
The diploma thesis deals with innovations selected insurance products and their alternatives. The theoretical part describes the insurance market and development of insurance in the Czech Republic, defines important terms as a coincidence, insured event, insurance products, risk and legal norms in the insurance. In the practical part is an analysis of the selected insurance company and its competitors. On the basis of obtained information are selected insurance products compared. In the proposal part are recommended changes for existing insurance products of the selected insurance company in terms of their content and coverage of risk in the unexpected event. The partial aim is the proposal an alternative insurance product for selected insurance company, which could arise in the future in its range of insurance products.
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La mortalité précoce auprès des utilisateurs de clozapineMichaud, Isabelle 08 1900 (has links)
Objectif : La mortalité précoce chez la population psychiatrique, notamment atteinte de schizophrénie, est un phénomène fort étayé dans la littérature médicale et l’exposition aux antipsychotiques a été postulée pour expliquer, en partie, celle-ci. À notre connaissance, aucune étude ne s’est intéressée à la mortalité précoce auprès des utilisateurs de clozapine. L’objectif de cette étude est l’exploration des causes spécifiques de la mortalité précoce chez ceux-ci, dont la mortalité subite, inattendue et d’origine indéterminée, et de leurs caractéristiques au moment du décès.
Méthodologie : Le devis est de type non expérimental, rétrospectif et descriptif par séries de cas. La population à l’étude est constituée de sujets âgés entre 18 et 64 ans utilisateurs de clozapine au moment du décès. Des variables sociodémographiques, psychiatriques, médicales, pharmacologiques et en lien avec la cause, l’origine et les circonstances du décès, incluant l’autopsie, ont été analysées.
Résultats : L’échantillon est composé de 100 sujets pour lesquels 67 ont fait l’objet d’une autopsie. L’âge moyen au moment du décès est de 47,4 ans (écart-type de 9,1 ans). La principale cause de mortalité est la mort subite, inattendue et d’origine indéterminée (n = 63; 63,0%). Si une origine naturelle est déterminée, elle est d’abord pulmonaire (n = 11; 37,9%), principalement en lien avec la pneumonie (n = 8; 72,7%). Une association significative entre la mort subite, inattendue et d’origine indéterminée, et le diagnostic de schizophrénie (valeur-p = 0,022), la dyslipidémie (valeur-p = 0,003) et la plage horaire de la survenue du décès (valeur-p = 0,020) est observée. La majorité, s’élevant à 53,5%, des individus décédés d’une mort subite, inattendue et d’origine indéterminée, dont la nature indéterminée est confirmée par l’autopsie, survient la nuit.
Conclusion : La mort subite, inattendue et d’origine indéterminée est la principale cause de mortalité auprès des utilisateurs de clozapine. Elle est associée au diagnostic de schizophrénie et à la plage horaire de la survenue du décès, dont la prépondérance s’avère nocturne, à l’instar de la mort subite chez les épileptiques, appelée Sudden unexpected death in epilepsy (SUDEP).
Déclaration d’intérêt : Aucun. / Objective: Early mortality is associated to psychiatric disorders, especially schizophrenia. Antipsychotics may explain, at least partly, this phenomenon. To our knowledge, there is no literature regarding early mortality among clozapine users. The purpose of this study is to explore the causes of early mortality among these individuals, including sudden, unexpected, and undetermined death, and their related characteristics.
Methodology: This study is a non-experimental, retrospective and descriptive case series. The population is aged from 18 to 64 years old and used clozapine at the time of their death. Sociodemographic, psychiatric, medical, pharmacological variables and others related to the cause, origin and circumstances of the death, including autopsy, were analyzed.
Results: The sample size is 100 participants. Of these, 67 were autopsied. The mean age at the time of death is 47,4 years (+/- 9,1 years). The leading cause of death is sudden, unexpected death of undetermined origin (n = 63, 63,0%). If a natural origin is determined, it is primarily related to a pulmonary disorder (n = 11; 37,9%), mainly pneumonia (n = 8, 72,7%). A significant association between sudden, unexpected, and undetermined death, and the diagnosis of schizophrenia (p-value = 0,022), dyslipidemia (p-value = 0,003), and time slot of occurrence of death (p-value = 0,020) is observed. Fifty-three percent of patients with sudden unexpected death of undetermined origin, meaning a medical cause could not be identified following an autopsy, died during their sleep or at night.
Conclusion: Sudden, unexpected and undetermined death is the leading cause of death among clozapine users. It is associated with schizophrenia and the time slot of the occurrence of death, whose preponderance is nocturnal, as Sudden unexpected death in epilepsy (SUDEP) is.
Declaration of interest: None.
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Three Essays in Applied EconometricsPallarés, Nina 23 March 2021 (has links)
La tesis engloba tres capítulos: el primero sobre fertilidad y "calidad" infantil, el segundo sobre planificación familiar y salud infantil, y el tercero sobre la estimación de un indicador de la actividad económica agregada regional. Concretamente, el primer capítulo examina empíricamente usando un modelo de diferencia-en-diferencias con efectos fijos, cómo un aumento inesperado de riqueza (proveniente de una transferencia intergeneracional) afecta a la fertilidad y la inversión de los padres en la calidad de los hijos. Se encuentra un efecto negativo en la cantidad de hijos junto a un efecto positivo en la calidad de los hijos demandados por los hogares. Estos efectos ocurren en diferentes momentos del tiempo para la muestra completa. En el corto plazo se observa una reducción de la fertilidad mientras que en el largo plazo se observa un aumento de la inversión en calidad infantil. También se encuentra un efecto positivo en la inversión en calidad infantil a corto plazo para las parejas que ya tenían hijos. En el segundo capítulo se evalúa una política, estudiando el impacto de haber sido expuesto a un programa de planificación familiar que promovió la anticoncepción quirúrgica/esterilización por primera vez en Perú (Programa de Salud Reproductiva y Planificación Familiar o PNSRPF, 1996- 2000). Los resultados muestran un mayor uso de métodos anticonceptivos temporales y permanentes entre las mujeres expuestas al programa y un menor riesgo de mortalidad infantil entre sus hijos. Este efecto es, en parte, debido a la prolongación de la lactancia materna. Finalmente, en el tercer capítulo se estima un indicador resumen de la actividad económica agregada, en frecuencia mensual, para las regiones españolas. Se utiliza un Modelo de Factores Dinámico dada la escasez de datos a nivel regional. Los indicadores estimados muestran la heterogeneidad del sistema productivo entre regiones a través de la inclusión de diferentes variables con el fin de reflejar con mayor precisión la evolución económica regional. Los indicadores obtenidos son especialmente útiles para estimar el impacto económico del reciente brote de COVID 19 a nivel regional en España. / Esta tesis ha sido elaborada con la financiación concedida por el Ministerio de Ciencia e Innovación (ECO2014-58434-P).
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Esplanadskolan – ett postmodernt skolpalats vid Årstafältet / Esplanade Elementary School – a postmodern, monumental school in ÅrstafältetSanning, Sofia, Eriksson, Alexander January 2018 (has links)
Lördagen den 26:e maj år 2018 sätts första spaden i marken för ett av vår tids största bostadsprojekt. Årstafältet, en i dag lantlig lunga i närmaste Söderort, skall under de nästkommande tolv åren bebyggas till två femtedelar med bostäder och i en avsevärt mer urban kontext erbjuda boende till 15 000 nya stockholmare – ett bostadsprojekt vars omfattning motsvarar hela Nynäshamns befolkning, eller en femtedel av Kungsholmens. Den nya detaljplanen, vars motto är "en plats för möten" och vars ledord är "variation", förordar att den nya bebyggelsen skall präglas av variation i höjder, former och stilar. I enlighet med detaljplanens ledord och kandidatarbetets program har vi gestaltat en skolbyggnad för 540 elever i åldrarna 10 till 16 år, som med en postmodern, eklektisk ansats förenat element och inspiration från många olika stilbildningar, och där de varierande miljöernas utformning ej underordnar sig någon enskild arkitektonisk princip, utan också i sig utgör en plats för möten – mellan tider, stilar, material och element. Esplanadskolan har utformats som ett postmodernt skolpalats, där kunskapens enastående värde och institutionens oerhörda vikt befästs i sin monumentalitet. Esplanadskolan riktar sig utåt till såväl den nya som befintliga stadsdelar som ett landmärke och symbolbyggnad, där en stor del av lokalerna är öppna för allmänheten utanför skoltid, och avser i sina inre rumsligheter att erbjuda skolungdomen intresseväckande och varierande lokaler, med ett vinterträdgårdsatrium, en monumental spiraltrappa och en fresnelprismatisk ljusobelisk som sammanbindande nav. / On Saturday May 26th, A.D. 2018, the ground work is initiated for one of our time’s most expansive housing projects. Årstafältet, a predominately natural park in southern Stockholm, will during the next twelve years be urbanized to two fifths of its total area, giving context for an entirely new urban quarter, accomodating 15 000 new Stockholmers. The scale of the housing project is comparable to the whole population of Nynäshamn, or one fifth of Kungsholmen’s. The new zoning plan has the motto “a place for meetings”, and its main principle is “variation”. The zoning plan requests that the new buildings should be characterized by a variation in different heights, forms and styles. In accordance with the main principle of the zoning plan, and with the program of the degree project, we have designed a school building for 540 pupils in the ages of 10 to 16 years, which embodies a postmodern, eclectical approach, in uniting diverse architectural elements and inspiration from many different historical styles, and in the standpoint that the diversity of elements and physical environments is not subordinated to any one architectural principle. The school is in itself a place of meetings – between epochs, styles, materials and elements. Esplanade Elementary School has been designed as a postmodern, monumental school, where the awesome dignity of knowledge, as well as the massive importance of the school as a societal institution, is fortified in the architecture’s monumentality. Esplanade Elementary School directs itself as a landmark and symbol to both old and new contexts in its urban vicinity, opening up its doors for the public in many aspects outside of school hours. It also aspires to offer its pupils physical environments which evoke their immersive interest and in its diversity allow for the phenomenological compatibility of equally diverse environmental preferences. The main elements which make up the directional essence of the interior environments are the Botanical atrium, the monumental spiral staircase and the Obelisk of Light, composed of hundreds of naturally and artificially lighted fresnel prisms.
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Inflation risk revisited : The hedging properties of major asset classes / Inflationsrisken återbesökt : De inflationsskyddande egenskaperna hos de stora tillgångsslagenBerdén, Andreas, Larsson, Hilding January 2023 (has links)
This paper is in large parts an update to a paper by Bekaert and Wang from 2010 called Inflation risk and the inflation risk premium. Its purpose is to find insights into the inflation hedging properties of the major asset classes. The analysis includes stocks, bonds, treasury bills, foreign bonds, real estate, gold, and gold futures for 43 countries and covers investment horizons up to five years. For developed countries it is found that gold, gold futures and bonds are the besthedge against inflation, both in the short and long run. Treasury bills have a relatively modest performance in the short term but improve with horizons to a great hedge. For emerging countries all asset classes provide a decent hedge, with a slight favor for treasury bills and a slightdisadvantage for real estate in the short and long run. All asset classes are poor hedges to unexpected inflation with an exception for real estate in longer investment horizons. The best hedge against unexpected inflation shocks is inflation-linked bonds. / Den här uppsatsen är i stort en uppdatering av en artikel av Bekaert och Wang från 2010 kallad Inflation risk and the inflation risk premium. Syftet är att hitta insikter i inflationsskyddande egenskaperna för de stora tillgångsklasserna. Analysen inkluderar aktier, obligationer, statsskuldväxlar, utländska obligationer, fastigheter, guld och guldterminer för 43 länder och täcker investeringshorisonter upp till fem år. För utvecklade länder finner vi att guld, guldterminer och obligationer är bästa skyddet mot inflation, både på kort och lång sikt. Statsskuldväxlar är ett relativt dåligt inflationsskydd på kort sikt, men blir ett bra skydd över längre horisonter. För tillväxtländer ger alla tillgångsslag en skapligt skydd, med en liten fördel för statsskuldväxlar och en liten nackdel för fastigheter i kort och långt perspektiv. Alla tillgångsklasser är dåliga skydd mot oväntad inflation, med ett undantag för fastigheter i längre investeringshorisonter. Det bästa skyddet emot oväntade inflationschocker är inflationskopplade obligationer.
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Som ett trygghetsnät : En kvalitativ studie om kvinnors upplevelse av förlossningen där de fått kontinuerligt stöd av barnmorska / Like a safety net : an interview study of women's experience of childbirth with continuous support from a midwifeElwinger, Johanna January 2024 (has links)
Bakgrund: Stöd under födseln ger positiva följdverkningar och kan ges av olika personer, både från kvinnans eget nätverk och från professionella aktörer. När kvinnor får ett kontinuerligt professionellt stöd i tillägg till partnerstöd syns positiva utfall i form av bland annat färre kejsarsnitt och en minskad användning av syntetiskt oxytocin samt en mer positiv förlossningsupplevelse. Detta arbete har studerat hur kvinnor som fick "One to One"-stödunder förlossningen av en barnmorska upplevde sin förlossning i en svensk kontext där partnerstöd också är vanligt. Syfte: Syftet med denna studie är att undersöka hur födande som fått del av ett professionellt kontinuerligt stöd upplever sin förlossning med särskilt fokus på hur egen kapacitet, smärtupplevelse och trygghet samt hur oväntade händelser upplevdes. Metod: Studiens design är en kvalitativ deskriptiv studie med semistrukturerade intervjufrågor och induktiv ansats. Åtta kvinnor som fött inom ett “One to One- projekt" på ett universitetssjukhus i Sverige deltog. Analysen skedde med hjälp av reflexiv tematisk analys. Resultat: I analysen framkom tre huvudteman med 15 underteman. Namnen på huvudteman var “Jaget i födandet”, “Stöd och kontinuitet” och “Det väntade och det oväntade”. Resultatet visar att de deltagande upplevde en hög grad av autonomi och upplevde barnmorskorna som följsamma. Det var en kontinuerlig både verbal- och ickeverbal kommunikation par och barnmorska emellan, vilket både ledde till stor trygghet och känsla av att kunna vara helt i födandet. Deltagarna behövde inte värdera vad som skulle frågas eller meddelas då barnmorskan var på plats hela tiden. Stödet från barnmorska hade en positiv roll i hur smärtan kunde hanteras. Få upplevelser under födandet uppfattades som traumatiska då även det oväntade blev hanterbart tack vare tryggheten som stödet bidrog till. Slutsats: Studien bekräftar att ett kontinuerligt professionellt stöd ger en positiv förlossningsupplevelse och detta kan relateras till trygghetskänslan stödet ger. Klinisk tillämpning: Resultatet av studien bekräftar forskning kring kontinuerligt förlossningsstöd och kan förstärka synen på att det som rekommenderas måste implementeras. Studien tillför nya perspektiv på att med ett kontinuerligt stöd kan födande kan frikoppla sig och befinna sig helt i födandet och även hantera oväntade händelser. / Background: Support during birth has positive consequences and can be given by different people, both from the woman's own network and from professional actors. When women receive continuous professional support in addition to partner support, positive outcomes are seen in the form of, among other things, fewer caesarean sections and a reduced use of synthetic oxytocin as well as a more positive birth experience. This work has studied how women who received "One to One" support during the birth of a midwife experienced her birth in the Swedish context where partner support is also common. Aim: The aim of this study is to investigate how women in labor who have received professional continuous support experience their birth with particular focus on how their own capacity, pain experience and safety, as well as how unexpected events were experienced. Method: The design of the study is a qualitative descriptive study with semi-structured interview questions and an inductive approach. Eight women who gave birth within a "One to One" project at a university hospital in Sweden participated. The analysis was done using reflexive thematic analysis. Results: The analysis revealed three main themes with 15 subthemes. The names of the mainthemes where "The self in childbirth", "Support and continuity" and "The expected and the unexpected". The results show that the participants experienced a high degree of autonomy and perceived the midwives as compliant. There was continuous both verbal and non-verbal communication between the couple and the midwife, which both led to great safety and the feeling of being able to be fully involved in birthing. The participants did not have to evaluate what was to be asked or communicated as the midwife was present the whole time. The support from the midwife had a positive role in how the pain could be managed. Few experiences during childbirth were perceived as traumatic as even the unexpected became manageable thanks to the safety that the support contributed to. Conclusion: The study confirms that continuous professional support provides a positive childbirth experience, and this can be related to the sense of security the support provides. Clinical application: The results of the study confirm research on continuous childbirth support and can reinforce the view that what is recommended must also be implemented. The study adds new perspectives to the fact that with continuous support, women in labor can disengage and be completely present in childbirth and also deal with unexpected events.
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