Betamethasone in prevention of postoperative nausea and vomiting following breast surgery.

To investigate whether betamethasone decreases the incidence of postoperative nausea/vomiting (PONV) and reduces postoperative pain following partial mastectomy

A comparison of two emergency medical dispatch protocols with respect to accuracy

Background: Emergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols - the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A. Methods: A simulation study was carried out at the Emergency Medical Communication Centre (EMCC) in Stockholm, Sweden, between October and March 2016. Fifty-three voluntary telecommunicators working at SOS Alarm were recruited nationally. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients. Manuscripts for the scenarios were based on recorded real-life calls, representing the six most common complaints. A cross-over design with 13 + 13 calls was used. Priority level and medical condition for each scenario was set through expert consensus and used as gold standard in the study. Results: A total of 1293 calls were included in the analysis. For priority level, n = 349 (54.0%) of the calls were assessed correctly with Medical Index and n = 309 (48.0%) with RETTS-A (p = 0.012). Sensitivity for the highest priority level was 82.6% (95% confidence interval: 76.6-87.3%) in the Medical Index and 54.0% (44.3-63.4%) in RETTS-A. Overtriage was 37.9% (34.2-41.7%) in the Medical Index and 28.6% (25.2-32.2%) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7-8.5%) and 23.4% (20.3-26.9%) respectively. Conclusion: In this simulation study we demonstrate that Medical Index had a higher accuracy for priority level and less undertriage than the new prototype RETTS-A. The overall accuracy of both protocols is to be considered as low. Overtriage challenges resource utilization while undertriage threatens patient safety. The results suggest that in order to improve patient safety both protocols need revisions in order to guarantee safe emergency medical dispatching.Peer reviewe

A registry-based observational study comparing emergency calls assessed by emergency medical dispatchers with and without support by registered nurses

Background The requirement concerning formal education for emergency medical dispatcher (EMD) is debated and varies, both nationally and internationally. There are few studies on the outcomes of emergency medical dispatching in relation to professional background. This study aimed to compare calls handled by an EMD with and without support by a registered nurse (RN), with respect to priority level, accuracy, and medical condition. Methods A retrospective observational study, performed on registry data from specific regions during 2015. The ambulance personnel's first assessment of the priority level and medical condition was used as the reference standard. Outcomes were: the proportion of calls dispatched with a priority in concordance with the ambulance personnel's assessment; over- and undertriage; the proportion of most adverse over- and undertriage; sensitivity, specificity and predictive values for each of the ambulance priorities; proportion of calls dispatched with a medical condition in concordance with the ambulance personnel's assessment. Proportions were reported with 95% confidence intervals. chi(2)-test was used for comparisons. P-levels < 0.05 were regarded as significant. Results A total of 25,025 calls were included (EMD n = 23,723, EMD + RN n = 1302). Analyses relating to priority and medical condition were performed on 23,503 and 21,881 calls, respectively. A dispatched priority in concordance with the ambulance personnel's assessment were: EMD n = 11,319 (50.7%) and EMD + RN n = 481 (41.5%) (p < 0.01). The proportion of overtriage was equal for both groups: EMD n = 5904, EMD + RN n = 306, (26.4%) p = 0.25). The proportion of undertriage for each group was: EMD n = 5122 (22.9%) and EMD + RN n = 371 (32.0%) (p < 0.01). Sensitivity for the most urgent priority was 54.6% for EMD, compared to 29.6% for EMD + RN (p < 0.01), and specificity was 67.3% and 84.8% (p < 0.01) respectively. A dispatched medical condition in concordance with the ambulance personnel's assessment were: EMD n = 13,785 (66.4%) and EMD + RN n = 697 (62.2%) (p = 0.01). Conclusions A higher precision of emergency medical dispatching was not observed when the EMD was supported by an RN. How patient safety is affected by the observed divergence in dispatched priorities is an area for future research.Peer reviewe

Frihet över Heder:En post-strukturell diskursanalys av den mediala debatten kring hedersrelaterat våld och förtryck i Sverige

Hedersvåld är ett omtvistat och känsligt ämne på den politiska dagordningen i Sverige. Förhållningssättet gentemot problematiken delar den feministiska och antirasistiska rörelsen som, å ena sidan värnar etniska gruppers rättigheter och emancipation, men som å andra sidan inte vill underblåsa den tilltagande nationalismen och rasismen. Denna studie syftar till att synliggöra den politik och makt som genomsyrar hedersproblematiseringen. Vi har i vår forskning funnit att vissa betydelser och föreställningar låsts fast och fått en hegemonisk status i media samtidigt som andra förståelser och kunskaper marginaliserats. I gensvar mot detta argumenterar vi för att den mediala problemrepresentationen kring hedersbegreppet är problematisk och att ett breddat perspektiv är nödvändigt i sättet vi förstår och talar om problemet. Vidare argumenterar vi för att ett intersektionellt, post-kolonialt och reflexivt förhållningssätt har potential att destabilisera dessa låsta betydelser och möjliggöra en problematisering som undviker de skadliga effekter som den dominerande diskursen skapa

Emergency medical dispatchers' experiences of managing emergency calls : a qualitative interview study

Objectives To explore the emergency medical dispatchers (EMDs) experiences of managing emergency medical calls. Design A qualitative interview study with an inductive approach. EMDs were interviewed individually using a semistructured interview guide. The verbatim transcripts were analysed using a qualitative content analysis. Setting EMDs, without a professional background as registered nurses, were recruited from emergency medical communication centers (EMCCs) within Sweden. Participants To achieve a varied description of EMDs' experiences, participants were included from several EMCCs nationally, using a convenience sampling. Interviews were performed up until saturation of data, resulting in 13 EMDs from 7 EMCCs being interviewed. All the EMDs were women, ranging in age from 28 to 61 years (mean 42 years), and had worked in emergency medical dispatching between 1 and 13.5 years (mean 6.5 years). Results The analysis revealed the main category-to attentively manage a multifaceted, interactive task-made up of three categories: utilize creativity to gather information, continuously process and assess complex information, and engage in the professional role. The content of each category was reflected in several subcategories further described and illustrated with representative quotes. Conclusions Managing emergency medical calls was experienced by EMDs to attentively manage a multifaceted interactive task. Core parts were described as: the ability to utilize creativity to gather information, continuously process and asses complex information, and engage in the professional role. Our results could be beneficial for emergency care managers when designing training programmes and organising EMD work and the EMD work environment, including further development of dispatch protocols and implementation of regular feedback sessions. Moreover, the results indicate that aspects such as self-awareness and emotional challenges encountered during EMD work could be important matters to discuss during staff evaluations.Peer reviewe

Axial Concentration Profiles and NO Flue Gas in a Pilot-Scale Bubbling Fluidized Bed Coal Combustor

Atmospheric bubbling fluidized bed coal combustion of a bituminous coal and anthracite with particle diameters in the range 500-4000 ím was investigated in a pilot-plant facility. The experiments were conducted at steady-state conditions using three excess air levels (10, 25, and 50%) and bed temperatures in the 750-900 °C range. Combustion air was staged, with primary air accounting for 100, 80, and 60% of total combustion air. For both types of coal, high NO concentrations were found inside the bed. In general, the NO concentration decreased monotonically along the freeboard and toward the exit flue; however, during combustion with high air staging and low to moderate excess air, a significant additional NO formation occurred near the secondary air injection point. The results show that the bed temperature increase does not affect the NO flue gas concentration significantly. There is a positive correlation between excess air and the NO flue gas concentration. The air staging operation is very effective in lowering the NO flue gas, but there is a limit for the first stage stoichiometry below which the NO flue gas starts rising again. This effect could be related with the coal rank

A review of trisomy X (47,XXX)

Trisomy X is a sex chromosome anomaly with a variable phenotype caused by the presence of an extra X chromosome in females (47,XXX instead of 46,XX). It is the most common female chromosomal abnormality, occurring in approximately 1 in 1,000 female births. As some individuals are only mildly affected or asymptomatic, it is estimated that only 10% of individuals with trisomy X are actually diagnosed. The most common physical features include tall stature, epicanthal folds, hypotonia and clinodactyly. Seizures, renal and genitourinary abnormalities, and premature ovarian failure (POF) can also be associated findings. Children with trisomy X have higher rates of motor and speech delays, with an increased risk of cognitive deficits and learning disabilities in the school-age years. Psychological features including attention deficits, mood disorders (anxiety and depression), and other psychological disorders are also more common than in the general population. Trisomy X most commonly occurs as a result of nondisjunction during meiosis, although postzygotic nondisjunction occurs in approximately 20% of cases. The risk of trisomy X increases with advanced maternal age. The phenotype in trisomy X is hypothesized to result from overexpression of genes that escape X-inactivation, but genotype-phenotype relationships remain to be defined. Diagnosis during the prenatal period by amniocentesis or chorionic villi sampling is common. Indications for postnatal diagnoses most commonly include developmental delays or hypotonia, learning disabilities, emotional or behavioral difficulties, or POF. Differential diagnosis prior to definitive karyotype results includes fragile X, tetrasomy X, pentasomy X, and Turner syndrome mosaicism. Genetic counseling is recommended. Patients diagnosed in the prenatal period should be followed closely for developmental delays so that early intervention therapies can be implemented as needed. School-age children and adolescents benefit from a psychological evaluation with an emphasis on identifying and developing an intervention plan for problems in cognitive/academic skills, language, and/or social-emotional development. Adolescents and adult women presenting with late menarche, menstrual irregularities, or fertility problems should be evaluated for POF. Patients should be referred to support organizations to receive individual and family support. The prognosis is variable, depending on the severity of the manifestations and on the quality and timing of treatment

Samspel mellan barn och pedagoger i förskolans vardag. En undersökning av barns och pedagogers beröring av varandra på tre småbarnsavdelningar

Omsorgsfull, välkommen beröring har funnits vara avgörande för barns tillväxt och utveckling. Samspel mellan pedagoger och barn ses som det viktigaste för barns utveckling och lärande i förskolan. I flera förekommande diskurser inom förskolan i Sverige värderas emellertid fysisk distans mellan barn och pedagoger. Dit hör diskursen om det kompetenta barnet som kan mycket mer än de vuxna tror; diskursen om att barn måste tränas i självständighet av vuxna samt No touch-diskursen, vars syfte sägs vara att skydda barnen från sexuella övergrepp. Syftet med denna undersökning är att undersöka hur samspel mellan barn och pedagoger i form av beröring kan komma till uttryck i förskolans vardag. Den övergripande forskningsfrågan handlar om hur beröringsklimatet är på de undersökta förskolorna. En observationsstudie med mixed methods genomfördes på tre småbarnsavdelningar på olika förskolor i en sydsvensk stad, med sammanlagt 29 barn och 15 pedagoger. De teoretiska begrepp som användes vid analysen kommer från anknytningsteori, intersubjektivitetsteori, Educare-modellen och omsorgsetik. Resultatet visade att pedagoger framför allt initierade beröring av barnen i samband med den praktiska fysiska omsorgen med på- och avklädning av ytterkläder samt barnens hygien samt vid förflyttningar. De initierade beröring av barnen i socialt och kommunikativt syfte; i lek, för att påkalla uppmärksamhet samt för att skapa lugn. Vid några tillfällen uppstod situationer när beröring uteblev men möjligen hade ökat barnens fokus om det förekommit. Pedagogerna initierade även beröring i känslomässigt påfrestande situationer, som när barn grät, vid överlämningen från föräldrarna samt i samband med att barnen lades till vila och vaknade efter vilan. Pedagogerna, med undantag för en pedagog, initierade beröring i situationer när de hade en för observatören uppenbar anledning. Barnen å sin sida initierade beröring som till större del handlade om sökande av emotionell bekräftelse. Barnen kunde röra vid pedagogen med en hand eller fot när de var tillräckligt nära eller luta sig mot eller klamra sig intill pedagogen när de befann sig i pedagogens famn eller knä. Olika pedagoger förhöll sig olika inbjudande till beröring. Barnen vidrörde påfallande ofta pedagogernas ben eller fötter, även om pedagogen satt på golvet och hela kroppen var inom räckhåll. Barnen behövde beröring för att återfå jämvikt när de grät. Försök till avledning misslyckades och pedagogerna övergick till att trösta med beröring. I några fall vände sig barnen till en annan pedagog för att få tröst. De barn sin fick mest beröring fanns bland de som såg yngst ut. Dock fick inte alla de yngsta barnen mycket beröring. Några barn förhöll sig mer passiva och då uteblev beröring. Detta blev ytterligare betonat utomhus, där ytorna var större och bemanningen lägre på två av förskolorna. När ingen pedagog fanns till hands hände det att barn vände sig till en främmande vuxen (observatören) eller till äldre barn. Beröringsklimatet kan beskrivas som vänligt och tillåtande, men inom vissa gränser. Barnen fick beröring av pedagogerna i situationer som kan tänkas vara emotionellt krävande som när de grät eller skulle somna eller vakna, men de fick sällan beröring för dess egen skull. För barnens del innebar det att de till stor del hölls ansvariga för att de skulle få beröring i annat än den praktiska omsorgen. En enda pedagog bjöd in till beröring och fysisk kontakt utan att det fanns någon uppenbar anledning, och hen blev också oftare berörd av barn än andra pedagoger. Kompetensdiskursen och den kvardröjande självständighetsdiskursen kan ge vid hand att det är ”duktigt” att avstå från beröring. Ser man relaterande som barns främsta utvecklingsuppgift kan barns sökande efter beröring av pedagogerna kan räknas in i ett vidgat kompetensbegrepp. Kulturella och diskursiva föreställningar om att även små barn ska vara självständiga och fysiskt separerade från föräldrarna och andra omsorgsgivare kan försvåra barns anpassning till förskolan. Föreliggande undersökning ger inte stöd för idén att fysisk närhet blir en (dålig) vana som pedagoger aktivt måste träna bort. Omsorg i form av fysisk och känslomässig närhet har ett eget värde som behöver lyftas och kläs i ord. Eftersom långvarig fysisk kontakt mellan barn och pedagoger framför allt ägde rum när pedagogen satt ner behövs också soffor och andra sittmöbler såväl inomhus som utomhus på förskolorna. Pedagogers och barns beröring av varandra är ett ämne som är angeläget att utforska vidare. Är den diskrepans mellan pedagogers och barns syfte med att initiera beröring generell? Beröring har visats vara avstressande. Blir barn som får rika tillfällen till beröring med pedagogerna mindre stressade än barn med större fysisk distans till pedagogerna? Även pedagogernas förhållningssätt till beröring, och huruvida utbildning eller andra parametrar påverkar om och hur pedagoger berör barnen kan vara föremål för framtida forskning.Caring, human touch has been found to be crucial for young children’s growth and development. However, in several discourses regarding Swedish preschools value is placed on physical distance between children and caregivers. The aim of this investigation is to increase knowledge about how physical care of young children might be expressed in Swedish preschools, by observing physical interaction between teachers and children. The dominant research question is: What is the touch climate between teachers and young children in Swedish preschools like? An observational study was conducted of 3 preschool groups constituted by 29 children ages 1-2, and 15 teachers. Data was analyzed using mixed methods with several theoretical concepts including care ethics, the Educare framework, attachment theory and inter-subjectivity theory. The results showed that teachers initiated physical contact primarily through their roles as physical caregivers (i.e. in satisfying the children’s physical needs such as helping to put on clothes, toilet training, help with mobility). Touch was also used while teaching and playing, but to a lesser extent, and seemingly not necessarily in a self conscious way, by the teachers. Physical contact also occurred during social interactions between caregivers and children. Of the contact initiated by the teachers, 20% was “emotional”, or comfort giving touch, i.e., touch not related to the execution of other specific duties such as diaper changing or helping to put on clothes. In contrast, 76% of the touch initiated by the children was “emotional”, or comfort seeking. The children strikingly often touched the teachers’ hips, legs and feet. The children initiated physical contact more frequently with teachers who were more receptive and open to physical contact. The youngest children tended to receive the most physical contact. However, children who were vague in the cues used to communicate a desire for physical contact tended to receive less attention in this regard. This was more pronounced during outdoor activities. When a child began to cry, they would eventually be comforted. Attempts to divert the child’s attention tended to fail. Some children experienced extended periods of contact, some as long as 15- 27 minutes, when they were being put to sleep. Older preschool children would sometimes care for the younger children when no teachers were immediately available. There was a discrepancy between the kind of physical contact the teachers offered the children, and the kind of contact the children sought. When children are seen as subjects that actively relate to fellow humans, a greater emphasis on the emotional component of child care is required. The children’s touching of the lower parts of the teachers’ bodies may indicate a slight feeling of distance. Whereas the teachers offered contact mostly in the conduct of practical circumstances, the children sought emotional support. Thus, the children were, to some extent, responsible for physical contact. Touching the children gently, while respecting the childrens’ integrity, can be seen as a means to unite caring and teaching within the Educare framework

Modeling of waste heat recovery system and outdoor swimming pool : Waste heat from hotel kitchen recovered by heat exchanger transferred to pool

This project was performed to evaluate if waste heat from hotel kitchens is enough to heat outdoor swimming pools in southern Europe or if it can be used as a compliment to another heat source. Another aim was to analyze the simulations and calculations of the pools and the heat recovery system. Then estimate how much annual costs would be reduced when using the exhaust air in the heat recovery system, in comparison with the original heating system. If the project showed positive results the purpose was to select a waste heat recovery system that can integrate with Ozonetech’s ozone generator, keep a high temperature in the pool and reduce emissions of greenhouse gas by using waste heat. Ozonetech would also conduct a pilot study in Stockholm and eventually develop their own product. A simulation model of three different outdoor pool sizes were conducted. The models were constructed and meshed in COMSOL Multiphysics. Average weather conditions for Malaga, Spain, were implemented in the model. The models were simulated by integrating each physical phenomenon in COMSOL, by using the Multiphysics interface. This created convection, emitted radiation and evaporation as thermal heat losses from the pool models. The pools were simulated to determine heating demand, heating period and required inlet temperature to make up for thermal heat losses. A mathematical model of the thermal heat losses and gains were conducted to easily receive a result for the heat demand each month of the year. A mathematical model of the possible heat recovery from hotel kitchens were performed to determine heat recovery for various kitchen sizes. By knowing the heat demand and possible heat recovery from different kitchens, a heat exchanger was selected. The heat exchanger was selected based on literature review, requirements and discussions with manufacturers. A life cycle cost analysis and calculated payback time compared original heating systems with new heat recovery system. A sensitivity analysis using Gauss error propagation concluded the project. The simulations showed that all investigated outdoor pools require additional heat during the night, due to extensive heating periods. Since the kitchen is only active during the day, the pool requires an additional heat source during the night. This conclude that the new heat exchanger only can replace the original heating system during the day. The mathematical model of the heat transfer from the kitchen determined that the maximum heat capacity approximately is 350 kW ± 10.5 kW. The waste heat can only be used to heat small and medium sized pools, since the heat loss is too great for a large pool. Selected air to water heat exchanger that meets the requirements is an air cooler with finned tubes from Alfa Laval. The fins and the coil should be treated to form an e-coat. After calculating the life cycle cost it was determined not profitable to replace a heat pump for a small pool, since the life cycle cost was greater for the new heating system. However, it is profitable to replace an electric heater with the new heat exchanger together with three of the smallest ozone generators during the day, for a small pool. Costs will be reduced by 44 600 – 202 000 kr ± 5%. Payback time will be 2.4 – 3.2 years ± 9%. It is also profitable to replace a water to water heat exchanger heated with either electricity or oil, during the day, with the new heat exchanger combined with either of the ozone generators for a small pool. Costs will be reduced by 310 000 – 698 000 kr ± 5%. Payback time will be 1.8 – 2.5 years ± 9%. It is profitable to replace all original heating systems during the day with the new heat exchanger combined with either of the ozone generators for medium sized pools. Costs will be reduced by 689 000 – 12 600 000 kr ± 5%. Payback time will be 2.2 – 22 months ± 7%