Cultural Competency in a Post-Model Rule 8.4(g) World

Självmord är en av de vanligaste dödsorsakerna i Sverige. Personer som begått självmord lämnar efter sig närstående med en stor sorg. Syftet med studien var att undersöka huruvida närstående till personer som begått självmord får det stöd som de önskar. Studien är baserad på en kvantitativ metod genom ett webb-baserat frågeformulär med 66 deltagare. Urvalet utgår ifrån en kontakt med en ansvarig för anhörigorganisationen SPES (Riksförbundet för SuicidPrevention och Efterlevandes Stöd). Resultatet analyserades sedan med en kvantitativ deskriptiv statistik och kvalitativ innehållsanalys. Studiens resultat visade att 30% av deltagarna var det mer än sex år sedan självmordet skett. Nästan alla av deltagarna söktes upp eller blev erbjudna, på ett eller annat sätt, minst ett slags stöd. Majoriteten av deltagarna sökte i första hand stöd hos sin familj, släkt, vänner eller arbetskamrater. Av de närstående svarade 33% att de var nöjda med det stödet. Hälften av de närstående som fått något slags professionellt stöd upplevde att stödet var bra. Behov av att få stöd i vardagen påtalades av 29%. Studien visade sammanfattningsvis att många av deltagarna är missnöjda med det professionella stöd de erhållit. Deltagarna har ett stort behov av att uttrycka sina tankar och känslor trots att det gått lång tid sedan självmordet skett

Hópmeðferð fyrir aldraða

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenFjöldi rannsókna hefur sýnt fram á að aukin sjúkdómsbyrði hjá öldruðum leiðir til aukinnar tíðni þunglyndiseinkenna og kvíða (1,2). Þarna er trúlega um að ræða samspil milli beinna áhrifa ýmissa sjúkdóma á heila ss. Parkinson, Alzheimer, hjarta-og æðasjúkdóma og sálfélagslegra afleiðinga, vegna færnisskerðingar og heilsubrests. Algengi klínísks þunglyndis er um 12-14% meðal allra eldri en 65 ára eða svipað og almennt gerist, en alvarlegt þunglyndi (DSM-IV) er 1-2% hjá sama þýði (Epidemilogical Catchment Study). Hins vegar eru tölurnar miklu hærri, þegar íbúar hjúkrunarheimila eru skoðaðir og þar telja flestar rannsóknir að um 30 % hafi klínískt þunglyndi, þ.e.a.s. þunglyndi, sem þarfnast meðferðar. Tölur upp í 60% sjást einnig. Þessi mismunur segir sína sögu um hve erfitt er að meta þunglyndi hjá fjölveikum öldruðum með þeim mælitækjum, sem tiltæk eru. Kvíði er oft áberandi samfara þunglyndi hjá öldruðum ásamt líkamlegum einkennum. Þunglyndiseinkennin auka færnisskerðingu og draga þannig úr lífsgæðum og lífsvilja og mótstöðuafli gagnvart sjúkdómum

Obsessive-compulsive disorder. A hidden disorder

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnÞráhyggjuárátturöskun er algeng og oft langvinn geðröskun sem leitt getur til verulegrar skerðingar á starfsgetu og lífsgæðum. Einkenni lýsa sér með óþægilegum, uppáþrengjandi og óviðeigandi kvíðavaldandi þrá- hyggjuhugsunum og tímafrekum og hamlandi áráttum. Einkennum fylgir oft mikil skömm og þekking almennings og heilbrigðisstarfsfólks á þessari geðröskun er víða takmörkuð. Því er algengt að röskunin greinist seint eða að einstaklingar fái ranga greiningu. Rannsóknir hafa sýnt að erfða- þættir eiga þátt í orsökum þráhyggjuárátturöskunar og nýlega hafa komið fram vísbendingar um að truflanir í tengingum ákveðinna heilasvæða eigi þátt í meingerð röskunarinnar. Ýmsar sálfræðikenningar um orsakir röskunarinnar sem studdar eru rannsóknum hafa einnig verið settar fram. Gagnreynd meðferð er annars vegar með lyfjum sem hafa áhrif á virkni serótóníns í heila og hins vegar ákveðnu afbrigði hugrænnar atferlismeð- ferðar sem nefnist berskjöldun með svarhömlun. Þörf er á bættum með- ferðarúrræðum þar sem allt að þriðjungur einstaklinga svarar meðferð lítið eða ekki. Hér er lýst tveimur tilfellum þráhyggjuárátturöskunar. Annars vegar ungum manni með dæmigerð einkenni sem svarar vel hefðbundinni meðferð og hins vegar miðaldra konu með mikil og hamlandi einkenni sem ekki svarar hefðbundinni lyfja- og sálfræðimeðferð. Í tilfelli konunnar var ákveðið að reyna raförvun á ákveðnum svæðum heilans með rafskautum sem komið var fyrir með þrívíddarísetningu í skurðaðgerð. Um er ræða meðferð sem er enn á tilraunastigi og hefur verið beitt í alvarlegustu tilfellum þráhyggjuáráttu sem ekki svara hefðbundinni meðferð.Obsessive-compulsive disorder is a common and often chronic psychiatric illness that significantly interferes with the patient´s functioning and quality of life. The disorder is characterized by excessive intrusive and inappropriate anxiety evoking thoughts as well as time consuming compulsions that cause significant impairment and distress. The symptoms are often accompanied by shame and guilt and the knowledge of the general public and professional community about the disorder is limited. Hence it is frequently misdiagnosed or diagnosed late. There are indications that the disorder is hereditary and that neurobiological processes are involved in its pathophysiology. Several psychological theories about the causes of obsessive-compulsive disorder are supported by empirical evidence. Evidence based treatment is either with serotoninergic medications or cognitive behavioral therapy, particularly a form of behavioral therapy called exposure response prevention. Better treatment options are needed because almost a third of people with obsessive-compulsive disorder respond inadequatly to treatment. In this review article two cases of obsessive-compulsive disorder are presented. The former case is a young man with typical symptoms that respond well to treatment and the latter is a middle aged lady with severe treatment resistant symptoms. She underwent stereotactic implantation of electrodes and received deep brain stimulation, which is an experimental treatment for severe obsessive-compulsive disorder that does not respond to any conventional treatment

Near-Death, Out-of-Body and Lucid Experiences: Additional Comments and Data

I was quite interested to read the material regarding the relationship between near-death experiences (NDE), out-of-body experiences (OBE) and lucid dreamers (LD). Here, I would just like to add a comment or two

Reaching across - managing variants of one application on multiple platforms

The number of platforms to support in today's software projects are many and there are a wide range of differences to consider. There are tons of programming languages on the market and each platform, both mobile and desktop, have different preferences on how to develop applications. This do often result in multiple applications, similar to the end user but different to the developers. The same functionality has to be developed and maintained in multiple versions of the application in different ways. To solve these issues there is a need to think of the applications and platform in a new way. They have to be unified and commonalities has to be found or made. New application structures and tools are also needed to keep the platforms in sync. When developing those concepts each platform’s flexibility must be protected. Each platform has it’s own advantages and features like a GPS and camera and they have to be available to build a competitive product. This report concludes that web technology such as HTML5, JavaScript and CSS is a promising way to introduce common parts in the application. This helps to manage the platforms in one way and reduces the differences. To retain the platform specifics, language bridges are used to directly communicate with the native platform from the web parts. This enables the full strength of each platform and makes the solution a fully featured competitor to native applications

Genetic Improvement of Software: From Program Landscapes to the Automatic Improvement of a Live System

In today’s technology driven society, software is becoming increasingly important in more areas of our lives. The domain of software extends beyond the obvious domain of computers, tablets, and mobile phones. Smart devices and the internet-of-things have inspired the integra- tion of digital and computational technology into objects that some of us would never have guessed could be possible or even necessary. Fridges and freezers connected to social media sites, a toaster activated with a mobile phone, physical buttons for shopping, and verbally asking smart speakers to order a meal to be delivered. This is the world we live in and it is an exciting time for software engineers and computer scientists. The sheer volume of code that is currently in use has long since outgrown beyond the point of any hope for proper manual maintenance. The rate of which mobile application stores such as Google’s and Apple’s have expanded is astounding. The research presented here aims to shed a light on an emerging field of research, called Genetic Improvement ( GI ) of software. It is a methodology to change program code to improve existing software. This thesis details a framework for GI that is then applied to explore fitness landscape of bug fixing Python software, reduce execution time in a C ++ program, and integrated into a live system. We show that software is generally not fragile and although fitness landscapes for GI are flat they are not impossible to search in. This conclusion applies equally to bug fixing in small programs as well as execution time improvements. The framework’s application is shown to be transportable between programming languages with minimal effort. Additionally, it can be easily integrated into a system that runs a live web service. The work within this thesis was funded by EPSRC grant EP/J017515/1 through the DAASE project

Appendicitis and appendectomy in children in Reykjavik Hospitals in 1996 and 2006

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenINTRODUCTION: Appendicitis is a common disease and can be life-threatening if not adequately treated. Studies have shown that if less than 20% of appendices removed are normal it indicates missing or delaying the diagnosis of appendicitis, resulting in an increased incidence of perforation. The purpose of this study was to analyze appendicitis in children during two separate time periods in the pediatric wards of the hospitals in Reykjavík and to increase our knowledge of appendicitis in children in the country. MATERIALS AND METHODS: Patients entering this study are two groups of 100 children (< or =16 years) consecutively undergoing appendectomy in the Reykjavik hospitals, one group in 1996 and the other in 2006. Data on sex, age, clinical symptoms and treatment was obtained from patients records. The impression of the surgeon at time of operation on the inflammation of the removed appendix was compared with results of histopathology analysis. All histopathology slides from appendices from 2006 were re-evaluated. The parameters in open appendectomies were compared to those in laparoscopic appendectomies. The two study periods were compared. RESULTS: The proportion of normal appendices was similar in both periods of the study, 18% in 2006 and 20% in 1996. The appendices were more often normal in female patients (p<0.05) and the large majority of those were removed by laparoscopic surgery. Perforation was present in 17% of inflamed appendices in both study groups. The time from patients arrival to hospital until surgery surpassed 10 hours in only one case in each study group. A discrepancy between the surgeon's assessment and the pathology result was noted only once in 2006 and in one additional case was the histopathological diagnosis altered following re-evaluation of the pathology slides. DISCUSSION: The proportion of non-inflamed appendices in appendectomies in children in Reykjavik is in accordance with that reported elsewhere and perforation is not common. There is a good concordance between surgical and pathological assessment with regard to inflammation of the appendices.Inngangur: Botnlangabólga er algengur sjúkdómur og lífshættulegur ef ekki er brugðist rétt við. Rannsóknir hafa sýnt að ef minna en fimmti hver fjarlægður botnlangi reynist óbólginn er fylgni við hækkun á hlutfalli rofinna botnlanga. Meginmarkmið rannsóknarinnar var að kanna hlutfall óbólginna fjarlægðra botnlanga á Barnaspítala Hringsins og barnadeild Sjúkrahúss Reykjavíkur á tveimur árum með 10 ára millibili og auka þekkingu á botnlangabólgu barna á Íslandi. Efniviður og aðferðir: Alls 100 börn (?16 ára) sem fóru í botnlangatöku á árinu 2006 og 100 börn frá árinu 1996 komu inn í rannsóknina, en hópurinn var samfelldur og því ekki valinn. Upplýsingum um kyn, aldur, klínísk einkenni og meðferð var safnað úr sjúkraskýrslum. Klínísk greining og mat skurðlækna á ástandi botnlanga í aðgerð var borin saman við vefjagreiningarniðurstöður. Öll vefjasýni ársins 2006 voru endurskoðuð af rannsakendum og matið borið saman við fyrri vefjagreiningar. Niðurstöður frá árunum tveimur voru bornar saman. Niðurstöður: Hlutfall óbólginna botnlanga var svipað bæði rannsóknarárin, eða 18% árið 2006 og 20% árið 1996. Botnlangi í stúlkum reyndist marktækt oftar eðlilegur (p<0,05) og nær eingöngu stúlkur fóru í aðgerð með kviðsjá. Bólgnu botnlangarnir reyndust rofnir í 17% tilvika bæði árin. Biðtími sjúklinga frá komu á sjúkrahús að aðgerð var aðeins í eitt skipti hvort árið lengri en 10 klst. Í einu tilviki 2006 kom fram misræmi milli mats skurðlæknis og niðurstöðu vefjagreiningar og meinafræðiáliti var breytt í eitt skipti eftir endurmat vefjasneiða. Ályktanir: Hlutfall óbólginna botnlanga í þessari rannsókn er í samræmi við það sem hingað til hefur verið viðurkennt að erfitt sé að komast hjá og rof á botnlanga reyndist ekki algengt. Gott samræmi er milli mats skurðlækna á botnlanga í aðgerð og meinafræðiniðurstöðu

Helical tomotherapy for total marrow and total skin irradiation : Optimisation, verification, and clinical results

In modern cancer therapy, radiotherapy (RT) is a vital part of most treatments. Most RT treatments in Sweden are performed using intensity-modulated radiotherapy (IMRT) with fixed or dynamic arc delivery. The dose gradients outside the target are steep, the margins are small, and the treatment delivery is complicated. Complicated treatments increase the requirement for control of the uncertainties in planning and delivery. This requires robust treatments and mitigation of the various uncertainties. In addition, robust planning and rigorous quality assurance (QA) of the patient treatments that takes account of all types of uncertainties are essential. A TomoTherapy device (Accuray Inc., Madison, WI, USA) is an RT device with a linear accelerator mounted on a slip-ring construction, giving it the ability to irradiate while continuously rotating around the patient, very similar to a CT scanner but with megavoltage instead of X-ray energy generation. Since helical tomotherapy can entail long and complicated irradiations, new treatment types targeting RT to large parts of the body have emerged. These new techniques are challenging regarding the optimization and verification of the planning and treatment process. Recurring blood cancers (leukaemias) can be treated with RT and chemotherapy before stem cell transplantation. Traditionally, the patient is irradiated with whole-body irradiation using a conventional linac at a large distance. The treatment can be performed with helical tomotherapy to avoid organs at risks to a greater extent. Another emerging treatment with helical tomotherapy is irradiation of whole-body neoplastic skin lesions, such as mycosis fungoides. These patients were traditionally treated with electron irradiation in different positions, subsequently complemented with x-ray fields in ‘hard-to-reach’ sites. Delivering this treatment with photons is complex but opens the possibility for integrated boost treatments of lesions and simultaneously avoiding OAR and previously treated areas.The clinical follow-up illustrated the potential and usefulness of helical tomotherapy targeting the bone marrow, with more patients surviving without severe complications after one year, than with the previous technique. Further, we showed the possibility to implement irradiation of the entire skin with helical tomotherapy. Overall, we demonstrated the usefulness of helical tomotherapy, and solutions to overcome challenges in implementing large-target techniques

Success factors of Nordic manufacturing companies – Manufacturing for the future

Issue of study: To be a well performing company over time, profitability and growth are considered the key strategic value drivers. Swedish and Finnish manufacturing companies are using different strategies to handle this challenge and some are performing better than others. In a world of globalization it is essential for the companies to remain competitive. Purpose: The purpose of this study is to identify strategies indicating why some companies within the manufacturing industry in Sweden and Finland are performing better than others. Method: A multiple case study of a number of manufacturing Swedish and Finnish manufacturing companies has been made. The study has been conducted through four hypotheses, created from a theoretical framework. The gathered data that has been analyzed has been formed through qualitative interviews. Conclusion: The conclusion of this study is that two strategies are more focused on in the better performing companies. These factors are; focus on profitability ahead of growth and focus on core competencies