Bakgrund: Vårdrelaterad pneumoni är en av de vanligaste vårdrelaterade infektionerna inom svensk sjukvård. Att drabbas av vårdrelaterad pneumoni ökar risken för sjuklighet samt dödlighet. Munvård är en basal omvårdnadsåtgärd som sjuksköterskan ansvarar över. I dagsläget är munvård en åtgärd som genomförs för patientens välbefinnande snarare än som en preventiv åtgärd. När munvård inte utförs kan det leda till förändringar i munhålan som i sin tur ger ökad risk för pneumoni. Syfte: Att undersöka effekterna av munvård som prevention mot vårdrelaterad pneumoni hos patienter inlagda på sjukhus. Metod: En litteraturstudie baserad på åtta kvantitativa interventionsstudier. Databassökningen genomfördes i Cinahl och PubMed. Analysen genomfördes med hjälp av Popenoes analysmodell för att sedan sammanställas till ett resultat. Resultat: I sju av åtta studier minskade insjuknandet av vårdrelaterad pneumoni efter implementering av en munvårdsintervention. Konklusion: Det finns ett samband mellan minskat insjuknande i vårdrelaterad pneumoni och munvårdsinterventioner. För att fastställa munvårdens effekt mot vårdrelaterad pneumoni krävs vidare forskning. / Background: Hospital acquired pneumonia is one of the most common healthcare associated infections in Sweden. Suffering from hospital acquired pneumonia increases the risk of morbidity and mortality. Oral care is basic nursing care. Oral care is often considered a comfort arrangement in caring for patients, rather than a preventive one. The risk of pneumonia increases due to changes in the oral cavity which is a cause of not receiving oral care. Aim: To investigate the effects of oral care as prevention of hospital acquired pneumonia in patients admitted to hospitals. Methods: The analysis was conducted using Popenoe's analysis model. Eight quantitative studies were analyzed, which were identified in the databases PubMed and Cinahl. Using Popenoe´s model a result could be concluded. Results: The analysis of the eight studies presented a decreased incidence of hospital acquired pneumonia in seven studies after an implementation of an oral care intervention. Conclusion: It was found to be a relationship between reduction in the incidence of hospital acquired pneumonia and oral care intervention. In order to determine the effect of oral care due to hospital acquired pneumonia, supplementary research is required.

Correcting wind tunnel data for wall interference is a critical part of relating the acquired data to a free-air condition. Accurately determining and correcting for the interference caused by the presence of boundaries in wind tunnels can be difficult especially for facilities employing ventilated boundaries. In this work, three varying levels of ventilation at the National Transonic Facility (NTF) were modeled and calibrated with a general slotted wall (GSW) linear boundary condition to validate the computational model used to determine wall interference corrections. Free-air lift, drag, and pitching moment coefficient predictions were compared for a range of lift production and Mach conditions to determine the uncertainty in the corrections process and the expected domain of applicability. Exploiting a previously designed statistical validation method, this effort accomplishes the extension of a calibration and validation for a boundary pressure wall interference corrections method. The foundational calibration and validation work was based on blockage interference only, while this present work extends the assessment of the method to encompass blockage and lift interference production. The validation method involves the establishment of independent cases that are then compared to rigorously determine the degree to which the correction method can converge free-air solutions for differing interference fields. The process involved first establishing an empty-tunnel calibration to gain both a centerline Mach profile of the facility at various ventilation settings, and to gain a baseline wall pressure signature undisturbed by a test article. The wall boundary condition parameters were then calibrated with a blockage and lift interference producing test article, and final corrected performance coefficients were compared for varying test section ventilated configurations to validate the corrections process and assess its domain of applicability. During the validation process discrimination between homogeneous and discrete implementations of the boundary condition was accomplished and final results indicated comparative strength in the discrete implementation's ability to capture experimental flow physics. Final results indicate that a discrete implementation of the General Slotted Wall boundary condition is effective in significantly reducing variations caused by differing interference fields. Corrections performed with the discrete implementation of the boundary condition collapse differing measurements of lift coefficient to within 0.0027, drag coefficient to within 0.0002, and pitching moment coefficient to within 0.0020. / Doctor of Philosophy / The purpose of conducting experimental tests in wind tunnels is often to acquire a quantitative measure of test article aerodynamic characteristics in such a way that those specific characteristics can be accurately translated into performance characteristics of the real vehicle that the test article intends to simulate. The difficulty in accurately simulating the real flow problem may not be readily apparent, but scientists and engineers have been working to improve this desired equivalence for the better part of the last half-century. The primary aspects of experimental aerodynamics simulation that present difficulty in attaining equivalence are: geometric fidelity, accurate scaling, and accounting for the presence of walls. The problem of scaling has been largely addressed by adequately matching conditions of similarity like compressibility (Mach number), and viscous effects (Reynolds number). However, accounting for the presence of walls in the experimental setup has presented ongoing challenges for ventilated boundaries; these challenges include difficulties in the correction process, but also extend into the determination of correction uncertainties. Exploiting a previously designed statistical validation method, this effort accomplishes the extension of a calibration and validation effort for a boundary pressure wall interference corrections method. The foundational calibration and validation work was based on blockage interference only, while this present work extends the assessment of the method to encompass blockage and lift interference production. The validation method involves the establishment of independent cases that are then compared to rigorously determine the degree to with the correction method can converge free-air solutions for differing interference scenarios. The process involved first establishing an empty-tunnel calibration to gain both a centerline Mach profile of the facility at various ventilation settings, and to gain a baseline wall pressure signature undisturbed by a test article. The wall boundary condition parameters were then calibrated with a blockage and lift interference producing test article, and final corrected performance coefficients were compared for varying test section ventilated configurations to validate the corrections process and assess its domain of applicability. During the validation process discrimination between homogeneous and discrete implementations of the boundary condition was accomplished and final results indicated comparative strength in the discrete implementation's ability to capture experimental flow physics. Final results indicate that a discrete implementation of the General Slotted Wall boundary condition is effective in significantly reducing variations caused by differing interference fields. Corrections performed with the discrete implementation of the boundary condition collapse differing measurements of lift coefficient to within 0.0027, drag coefficient to within 0.0002, and pitching moment coefficient to within 0.0020.

Critically ill patients experience overwhelming communication problems; caused by intubation and cognitive, sensory or language deficits that distance the patients from communicating their needs and wants from nurses and loved ones. The purpose of this study was to explore communication patterns and strategies with the aim of implementing intervention strategies for nurse/patient communication in the intensive care units. The American Association of Critical Care Nurses’ Synergy Model for Patient Care was used to guide the study. A mixed method approach using quasi-experimental design combining quantitative and qualitative data collections and analysis was used. Concurrent data collection for quantitative and qualitative data was used. Auditing of patient’s files, protocols, family counselling conference and in-service books and a survey for nurses was used for quantitative data. Qualitative data collection was through interviewing nurses and nurse managers. Lack of documentation and use of other communication strategies were the key findings of the study. In accordance with the model used for the study clinical judgment and moral distress were found to be common among nurses. Lack of collaboration between nurses and other health care workers was also attributed to poor communication with mechanically ventilated patients. Conclusions derived from the study are that nurses need to be supported through informal and formal training on documentation and use of communication methods available / Health Studies / D. Litt. et Phil. (Health Studies)

Purpose: Interpersonal communication is one of the most important abilities and skills in everyday life. But when patient's communication ability is limited due to endotracheal or tracheostomy tube insertion, the patient, who had communicated verbally, is not able to convey their feelings, needs and wishes anymore. The purpose of this thesis is to help improve communication skills of nurses in the area of communication with conscious, unconscious and analgosedated patients whose airways are intubated. Methods: The survey has form of quantitative research, the questionnaire method was used. Research data was obtained from a total of 144 nurses working at resuscitation departments at four hospitals in Prague. Results: By studying this issue, it has been found nurses have trouble communicating with intubated patients. The most difficult communication is with conscious patients, who are intubated by endotracheal tube. Communicating with patients with impaired consciousness is also very problematic. Conclusion: Despite the fact, that communication with intubated patients is inherently difficult, more than half of the respondents have never been educated about how to communicate with these patients. Not only but also to address this issue, the outcome of this thesis is information brochure with...

La protection des opérateurs et la surveillance des ambiances de travail en cas de mise en suspension d’aérosols radioactifs, dans un local ventilé d’une installation nucléaire, requièrent la connaissance de l’évolution spatio-temporelle de la concentration en particules, en tout point du local considéré. L’estimation précise de cette concentration a fait l’objet du développement de modèles spécifiques de transport et de dépôt d’aérosols dans un local ventilé, dans le cadre d’une thèse cofinancée par l’IRSN et EDF, en collaboration avec l’IMFT. Un formalisme eulérien de glissement est utilisé pour modéliser le transport des aérosols. Celui-ci est basé sur une unique équation de transport des concentrations en particules (« Diffusion-Inertia model »). L’étude spécifique du dépôt d’aérosols en parois a permis de développer un modèle de couche limite, qui consiste à déterminer précisément le flux de dépôt de particules en parois, quels que soient le régime de dépôt et l’orientation de la surface considérée. Les modèles de transport et de dépôt finalement retenus ont été implantés dans Code_Saturne, un logiciel de mécanique des fluides. La validation de ces modèles a été effectuée à partir de données de la littérature en géométries simples, puis sur la base de campagnes expérimentales de traçage dans des locaux ventilés d’environ 30 m³ et 1500 m³. / When particulate radioactive contamination is likely to become airborne in a ventilated room, assessment of aerosol concentration in every point of this room is important, in order to ensure protection of operators and supervision of workspaces. Thus, a model of aerosol transport and deposition has been developed as part of a project started with IRSN, EDF and IMFT. A simplified eulerian model, called “diffusion-inertia model” is used for particle transport. It contains a single transport equation of aerosol concentration. The specific study of deposition on walls has permitted to develop a boundary condition approach, which determines precisely the particle flux towards the wall in the boundary layer, for any deposition regime and surface orientation.The final transport and deposition models retained have been implemented in a CFD code called Code_Saturne. These models have been validated according to literature data in simple geometries and tracing experiments in ventilated rooms, which have been carried out in 30 m³ and 1500 m³ laboratory rooms.

Syfte: Idag riskerar cirka 300 000 hushåll med uteluftsventilerad krypgrund att bli angripna av fukt- och mögelskador. Klimatet i en uteluftsventilerad krypgrund påverkas i stor grad av temperaturen och den relativa luftfuktigheten. Det råder inga tvivel om att klimatet står inför förändringar, vilket innebär en höjd temperatur och en förändring av den relativa luftfuktigheten. Detta gör att den uteluftsventilerade krypgrunden inte har möjlighet att torka ut under vissa perioder på året och utsätts då för en förhöjd risk av fuktskador. Parallellt med klimatförändringen moderniseras även uppvärmningssystemen i småhusen, vilket ändrar förutsättningar för krypgrunderna. Målet med arbetet är att undersöka om klimatförändringarna och installation av golvvärme i träbjälklaget har bidragit till fuktskador i uteluftsventilerade krypgrunder och ge underlag till effektivare åtgärder av fuktskador. Metod: För att utreda om klimatförändringarna är ett problem för de uteluftsventilerade krypgrunderna har dokumentanalyser genomförts vilka sedan följdes av beräkningar av krypgrundens relativa luftfuktighet. På samma sätt gavs svar på om golvvärmen är en bidragande faktor till fuktskadorna. Båda frågeställningarna styrktes även av kvalitativa intervjuer med sakkunniga personer. Hur fuktskadorna effektivare kunde åtgärdas togs främst fram genom kvalitativa intervjuer men styrktes av dokumentanalyser. Resultat: Studien visar att klimatförändringarna kommer att påverka uteluftsventilerade krypgrunder i positiv bemärkelse då studien endast tog hänsyn till temperaturhöjningen. Installation av golvvärme har även visats vara positivt mot fuktskador i en uteluftsventilerad krypgrund om isolering i bjälklaget saknas eller är bristfällig. Branschen ser ingen vinst i att effektivisera åtgärdsmetoderna då dessa redan är välprövade och väl fungerande. Konsekvenser: Ett varmare klimat ger bättre förutsättningar för en uteluftsventilerad krypgrund. Medvetenheten om hur klimatförändringarna påverkar krypgrunderna ger byggbranschen ett försprång att förbereda sig inför kommande förändringar. Kunskapen om att golvvärme kan ge positiva effekter mot fuktskador i uteluftsventilerade krypgrunder ger nya förutsättningar för renoveringar och åtgärder mot fuktskador, dock måste energiförlusterna tas i hänsyn i dessa fall. Branschen ser ingen vinst i att effektivisera åtgärdsmetoderna, vilket gör att det inte finns någon anledning att gå djupare in i detta. Begränsningar: Arbetet behandlar endast uteluftsventilerade krypgrunder med träbjälklag som ligger inom Sveriges gränser. Denna studie är därför inte applicerbar på andra konstruktioner eller utanför Sveriges gränser. Endast klimatförändringarna det senaste seklet och fram till 2100 tas hänsyn till i rapporten. Studien tar heller inte hänsyn till fukttillskott från mark och dagvatten, likaså görs inga beräkningar på ventilation. / Purpose: Today are about 300 000 buildings with outdoor ventilated crawl space at risk to be contaminated by moisture and mold damage. An outdoor ventilated crawl space’s climate is greatly affected by the temperature and the relative humidity. There is no doubt that the climate is facing changes, which means an increased temperature and a change in the relative humidity. This prevents the outdoor ventilated crawl space from drying out during certain periods of the year and is then exposed to a heightened risk of moisture damage. Parallel to the climate change the heating systems are being modernized in houses, which changes the conditions for the crawl spaces. The objective of this essay is to do a research if climate change and the installation of underfloor heating in the greater part of the joist area has given rise to moisture damage in outdoor ventilated crawl spaces and provide good basis for more effective measures to moisture damage. Method: To investigate whether the climate change is a problem for outdoor ventilated crawl spaces have document analyzes been conducted, which was followed by calculations of the crawl spaces’ relative humidity. Calculations have been made to find out if the underfloor heating is a contributing problem to moisture damage. Both issues are also corroborated by interviews with qualified people. How the moisture damage more effective could be fixed was answered primarily through qualitative interviews, but corroborated by document analysis. Findings: The study shows that climate change will affect outdoor ventilated crawl spaces in a positive sense, only account to the temperature rise. Installing underfloor heating has also been shown to be positive against moisture damage in outdoor ventilated crawl spaces if insulation in the soffit is missing or deficient. The industry sees no gain in efficiency action methods as these are already proven and well- functioning. Implications: A warmer climate provides better conditions for outdoor ventilated crawl space. Being aware of the changes associated with climate change, and its effects on buildings give the construction industry a head start to prepare for future changes. Knowledge that underfloor heating can provide positive effects against moisture damage in crawl spaces creates new opportunities for renovations and actions against dampness but the energy losses in this case must be considered. Since the industry does not see profit in streamlining action methods is no need to go deeper into this. Limitations: The report deals only outdoor ventilated crawl spaces with wooden soffit that is located within the Swedish borders. This study is therefore not applicable to other constructions or other countries. Only climate change in the last century and up until 2100 are taken into account in the report. Further on the study does not take the excess moisture from the soil or the storm water into account; likewise there are no calculations for the ventilation.

O fenômeno de vibração induzida por vórtices (VIV) é particularmente danoso para estruturas submarinas como risers de exploração de petróleo. A maneira mais usual de se atenuarem os efeitos de VIV é instalar um supressor, como por exemplo strakes ou fairings. Dentre esses, foi desenvolvido por All Brow Universal Components um supressor chamado Ventilated Trousers (VT), que consiste em uma malha permeável feita de uma rede flexível e dezenas de bobbins. Através de um estudo experimental, procurou-se investigar os mecanismos hidrodinâmicos pelos quais o supressor V T funciona. Foram construídos três modelos diferentes de supressores: um modelo idêntico ao V T e duas malhas dele derivadas, alterando-se a geometria dos bobbins e a distribuição destes ao redor da malha. Foram realizados ensaios com o modelo xo e ensaios de VIV em um grau de liberdade alterando-se o amortecimento estrutural. Foram medidos deslocamento e forças de sustentação e arrasto. Os resultados mostraram que o supressor do tipo V T reduz as amplitudes de vibração, força de sustentação e arrasto quando comparados com um cilindro oscilando. No entanto, aumenta a força de arrasto quando comparado com o cilindro xo. A geometria da malha mostrou-se de grande importância para a supressão de VIV. Modelos que possuem o disco externo no bobbin impedem o surgimento de folga entre o modelo e o cilindro, além de aumentar o amortecimento hidrodinâmico. Três hipóteses foram levantadas para explicar o funcionamento do supressor V T. A primeira diz que a supressão é provocada pelo aumento do amortecimento hidrodinâmico. Os ensaios mostraram que, de fato, o supressor V T aumenta o amortecimento e, consequentemente, diminui as VIV. No entanto, somente esse efeito não explica toda a supressão obtida. As outras hipóteses, relacionadas à alterações bi e tridimensionais da esteira, foram avaliadas, porém não se pode afirmar que alguma delas seja isoladamente responsável por produzir o mecanismo hidrodinâmico de supressão. / The phenomenon of vortex-induced vibration (VIV) is particularly harmful to submarine structures such as risers used for oil extraction. The most usual way to attenuate the effects of VIV is the installation of suppressors, like strakes or fairings. Among them, All Brow Universal Components developed a VIV suppressor called Ventilated Trousers (VT), which consist of a permeable mesh made of a flexible net and tens of bobbins. Three different models of suppressors based on permeable meshes have been assembled with the objective to understand the hydrodynamic mechanism behind the suppression: one model identical to the VT and two meshes with different bobbin geometries and distribution. Tests were carried out with xed models and models free to oscillate in one degree of freedom varying the structural damping. Displacements, drag and lift forces were measured. Results showed that the VT suppressor reduced vibration amplitudes, lift and drag forces when compared to an oscillating circular cylinder. However, it increased drag force when compared to a fixed circular cylinder. The mesh geometry proved to be important to VIV suppression. Models that had an external disc on the bobbins avoided the appearance of a gap between the model and the cylinder. Three hypotheses were formulated to explain how the VT suppressor works. The first one says that the increase on hydrodynamic damping is responsible for suppression. In fact, tests showed that the VT increased hydrodynamic damping and, consequently, reduced the VIV response. However, this effect alone does not explain the suppression as a whole. The other two hypotheses related to two-dimensional and three-dimensional wake changes were evaluated, but it cannot be stated that any of them, on its own, is responsible for the whole of the suppression mechanism.

The energy crisis together with greater environmental awareness, has increased interest in the construction of low energy buildings. Fabric thermal storage systems provide a promising approach for reducing building energy use and cost, and consequently, the emission of environmental pollutants. Hollow core ventilated slab systems are a form of fabric thermal storage system that, through the coupling of the ventilation air with the mass of the slab, are effective in utilizing the building fabric as a thermal store. However, the benefit of such systems can only be realized through the effective control of the thermal storage. This thesis investigates an optimum control strategy for the hollow core ventilated slab systems, that reduces the energy cost of the system without prejudicing the building occupants thermal comfort. The controller uses the predicted ambient temperature and solar radiation, together with a model of the building, to predict the energy costs of the system and the thermal comfort conditions in the occupied space. The optimum control strategy is identified by exercising the model with a numerical optimization method, such that the energy costs are minimized without violating the building occupant's thermal comfort. The thesis describes the use of an Auto Regressive Moving Average model to predict the ambient conditions for the next 24 hours. A building dynamic lumped parameter thermal network model, is also described, together with its validation. The implementation of a Genetic Algorithm search method for optimizing the control strategy is described, and its performance in finding an optimum solution analysed. The characteristics of the optimum schedule of control setpoints are investigated for each season, from which a simplified time-stage control strategy is derived. The effects of weather prediction errors on the optimum control strategy are investigated and the performance of the optimum controller is analysed and compared to a conventional rule-based control strategy. The on-line implementation of the optimal predictive controller would require the accurate estimation of parameters for modelling the building, which could form part of future work.

Critically ill patients experience overwhelming communication problems; caused by intubation and cognitive, sensory or language deficits that distance the patients from communicating their needs and wants from nurses and loved ones. The purpose of this study was to explore communication patterns and strategies with the aim of implementing intervention strategies for nurse/patient communication in the intensive care units. The American Association of Critical Care Nurses’ Synergy Model for Patient Care was used to guide the study. A mixed method approach using quasi-experimental design combining quantitative and qualitative data collections and analysis was used. Concurrent data collection for quantitative and qualitative data was used. Auditing of patient’s files, protocols, family counselling conference and in-service books and a survey for nurses was used for quantitative data. Qualitative data collection was through interviewing nurses and nurse managers. Lack of documentation and use of other communication strategies were the key findings of the study. In accordance with the model used for the study clinical judgment and moral distress were found to be common among nurses. Lack of collaboration between nurses and other health care workers was also attributed to poor communication with mechanically ventilated patients. Conclusions derived from the study are that nurses need to be supported through informal and formal training on documentation and use of communication methods available / Health Studies / D. Litt. et Phil. (Health Studies)

O fenômeno de vibração induzida por vórtices (VIV) é particularmente danoso para estruturas submarinas como risers de exploração de petróleo. A maneira mais usual de se atenuarem os efeitos de VIV é instalar um supressor, como por exemplo strakes ou fairings. Dentre esses, foi desenvolvido por All Brow Universal Components um supressor chamado Ventilated Trousers (VT), que consiste em uma malha permeável feita de uma rede flexível e dezenas de bobbins. Através de um estudo experimental, procurou-se investigar os mecanismos hidrodinâmicos pelos quais o supressor V T funciona. Foram construídos três modelos diferentes de supressores: um modelo idêntico ao V T e duas malhas dele derivadas, alterando-se a geometria dos bobbins e a distribuição destes ao redor da malha. Foram realizados ensaios com o modelo xo e ensaios de VIV em um grau de liberdade alterando-se o amortecimento estrutural. Foram medidos deslocamento e forças de sustentação e arrasto. Os resultados mostraram que o supressor do tipo V T reduz as amplitudes de vibração, força de sustentação e arrasto quando comparados com um cilindro oscilando. No entanto, aumenta a força de arrasto quando comparado com o cilindro xo. A geometria da malha mostrou-se de grande importância para a supressão de VIV. Modelos que possuem o disco externo no bobbin impedem o surgimento de folga entre o modelo e o cilindro, além de aumentar o amortecimento hidrodinâmico. Três hipóteses foram levantadas para explicar o funcionamento do supressor V T. A primeira diz que a supressão é provocada pelo aumento do amortecimento hidrodinâmico. Os ensaios mostraram que, de fato, o supressor V T aumenta o amortecimento e, consequentemente, diminui as VIV. No entanto, somente esse efeito não explica toda a supressão obtida. As outras hipóteses, relacionadas à alterações bi e tridimensionais da esteira, foram avaliadas, porém não se pode afirmar que alguma delas seja isoladamente responsável por produzir o mecanismo hidrodinâmico de supressão. / The phenomenon of vortex-induced vibration (VIV) is particularly harmful to submarine structures such as risers used for oil extraction. The most usual way to attenuate the effects of VIV is the installation of suppressors, like strakes or fairings. Among them, All Brow Universal Components developed a VIV suppressor called Ventilated Trousers (VT), which consist of a permeable mesh made of a flexible net and tens of bobbins. Three different models of suppressors based on permeable meshes have been assembled with the objective to understand the hydrodynamic mechanism behind the suppression: one model identical to the VT and two meshes with different bobbin geometries and distribution. Tests were carried out with xed models and models free to oscillate in one degree of freedom varying the structural damping. Displacements, drag and lift forces were measured. Results showed that the VT suppressor reduced vibration amplitudes, lift and drag forces when compared to an oscillating circular cylinder. However, it increased drag force when compared to a fixed circular cylinder. The mesh geometry proved to be important to VIV suppression. Models that had an external disc on the bobbins avoided the appearance of a gap between the model and the cylinder. Three hypotheses were formulated to explain how the VT suppressor works. The first one says that the increase on hydrodynamic damping is responsible for suppression. In fact, tests showed that the VT increased hydrodynamic damping and, consequently, reduced the VIV response. However, this effect alone does not explain the suppression as a whole. The other two hypotheses related to two-dimensional and three-dimensional wake changes were evaluated, but it cannot be stated that any of them, on its own, is responsible for the whole of the suppression mechanism.