Studier på nytt fordon för transport av skogsflis

Högskolan Dalarna har i samarbete med Naturbränsle i Mellansverige AB genomfört studier på ett nytt fordon för transport av skogsflis. Eftersom fordonet är utrustat med kran och skopa innebär det att flisskördaren kan tippa flisen direkt på marken, eller på en i förväg utlagd duk för att förhindra att föroreningar (grus, sten etc.) följer med vid lastningen av fordonet. Pro¬jektet har finansierats av EU-strukturfond Mål 2 Norra samt genom naturabidrag från deltag¬ande företag. Studier har även genomförts på lastväxlarfordon med container för att jämförel¬ser skall kunna göras mellan de båda fordonstyperna. Studierna omfattar sammanlagt tjugo lass, varav tio lass med det nya fordonet, fem lass med lastväxlarfordon och två containrar och fem lass med lastväxlarfordon och tre containrar. Den sammanlagda transportvolymen uppgick till 1 940 m3s. Tidsstudier har också genomförts på flisskördarens arbete, eftersom det i vissa delar är direkt beroende på vilket vidaretransportfordon som används. I de fall vidaretransporten sker med lastväxlarfordon vägs flisen innan den tippas i containern (en åtgärd för att fordonet inte skall överskrida tillåten lastvikt). Om lastvikten inte är begränsande genomför flisskördaren vissa åtgärder för att lastvolymen i respektive container skall kunna maximeras (t.ex. utjämning och viss packning av flisen med hjälp av kranen). I det fall vidaretransporten sker med det nya fordonet behöver flisskördaren inte väga flisen eftersom bilen är försedd med kranvåg. Där¬emot tillkommer andra arbetsuppgifter för flisskördaren, t.ex. preparering av avlägget (snö¬packning, sten- och buskröjning) samt hantering och utläggning av dukar.Arbetstiden för vidaretransporten är i huvudsak beroende av transportsträckan och medel¬transporthastigheten. När lastväxlarfordon används är arbetstiden dessutom beroende av last¬volymen (antalet containrar och deras volym) samt om tippmöjligheter endast finns på drag¬fordonet (containrar på släp måste omlastas till dragfordon innan flisen kan tippas) eller om tippmöjligheter finns på såväl dragbil som släp. Om släpet inte kan medföras till uppställ¬ningsplatsen för containrarna (p.g.a. alltför smal och kurvig väg eller utrymmesbrist för vänd¬ning av fordonsekipaget) påverkas även arbetstiden av avståndet mellan containrar och släp samt av medelhastigheten vid ”skotning” av containrar till och från släpet.Medelhastigheten vid transport var i stort sett densamma för de båda fordonstyperna. För last¬växlarfordonet med två containrar tog den totala arbetstiden (inklusive tom- och lasskörning) mellan 1,70 och 2,99 G0-tim per lass, vilket motsvarar en prestation på mellan 32 och 52 m3s/G0-tim. Arbetstiden för lastning och lossning varierade mellan 0,87 och 1,09 G0-tim/lass, eller 0,009-0,011 G0-tim/m3s (medeltal 0,98 G0-tim/lass, eller 0,011 G0-tim/m3s), vilket motsvarar en prestation på mellan 87 och 107 m3s/G0-tim.För fordonet med tre containrar tog den totala arbetstiden (inklusive tom- och lasskörning) mellan 2,40 och 3,53 G0-tim per lass, vilket motsvarar en prestation på mellan 30 och 45 m3s/ G0-tim. Arbetstiden för lastning och lossning varierade mellan 1,07 och 1,62 G0-tim/ lass, eller 0,011-0,016 G0-tim/m3s (medeltal 1,33 G0-tim/lass, eller 0,013 G0-tim/m3s), vilket mot¬svarar en prestation på mellan 64 och 89 m3s/G0-tim.Den totala arbetstiden för det nya fordonet (inklusive tom- och lasskörning) varierade mellan 2,11 och 5,08 G0-tim per lass, vilket motsvarar en prestation på mellan 18 och 45 m3s/G0-tim. Arbetstiden för lastning och lossning varierade mellan 0,96 och 1,46 G0-tim per lass, eller 0,01-0,02 G0-tim/m3s (medeltal 1,22 G0-tim/lass, eller 0,013 G0-tim/m3s), vilket mot¬svarar en prestation på mellan 65 och 94 m3s/G0-tim.

Association of soluble tumor necrosis factor receptors 1 and 2 with nephropathy, cardiovascular events, and total mortality in type 2 diabetes

AIMS/HYPOTHESIS: Soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2) contribute to experimental diabetic kidney disease, a condition with substantially increased cardiovascular risk when present in patients. Therefore, we aimed to explore the levels of sTNFRs, and their association with prevalent kidney disease, incident cardiovascular disease, and risk of mortality independently of baseline kidney function and microalbuminuria in a cohort of patients with type 2 diabetes. In pre-defined secondary analyses we also investigated whether the sTNFRs predict adverse outcome in the absence of diabetic kidney disease. METHODS: The CARDIPP study, a cohort study of 607 diabetes patients [mean age 61 years, 44 % women, 45 cardiovascular events (fatal/non-fatal myocardial infarction or stroke) and 44 deaths during follow-up (mean 7.6 years)] was used. RESULTS: Higher sTNFR1 and sTNFR2 were associated with higher odds of prevalent kidney disease [odd ratio (OR) per standard deviation (SD) increase 1.60, 95 % confidence interval (CI) 1.32-1.93, p < 0.001 and OR 1.54, 95 % CI 1.21-1.97, p = 0.001, respectively]. In Cox regression models adjusting for age, sex, glomerular filtration rate and urinary albumin/creatinine ratio, higher sTNFR1 and sTNFR2 predicted incident cardiovascular events [hazard ratio (HR) per SD increase, 1.66, 95 % CI 1.29-2.174, p < 0.001 and HR 1.47, 95 % CI 1.13-1.91, p = 0.004, respectively]. Results were similar in separate models with adjustments for inflammatory markers, HbA1c, or established cardiovascular risk factors, or when participants with diabetic kidney disease at baseline were excluded (p < 0.01 for all). Both sTNFRs were associated with mortality. CONCLUSIONS/INTERPRETATIONS: Higher circulating sTNFR1 and sTNFR2 are associated with diabetic kidney disease, and predicts incident cardiovascular disease and mortality independently of microalbuminuria and kidney function, even in those without kidney disease. Our findings support the clinical utility of sTNFRs as prognostic markers in type 2 diabetes.

Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care : a cluster randomised study

BACKGROUND: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44819426.

Exploring self-rated health among adolescents : a think-aloud study

BACKGROUND: Despite extensive use of self-rated health questions in youth studies, little is known about what such questions capture among adolescents. Hence, the aim of this study was to explore how adolescents interpret and reason when answering a question about self-rated health. METHODS: A qualitative study using think-aloud interviews explored the question, "How do you feel most of the time?", using five response options ("Very good", "Rather good", "Neither good, nor bad", "Rather bad", and "Very bad"). The study involved 58 adolescents (29 boys and 29 girls) in lower secondary school (7th grade) and upper secondary school (12th grade) in Sweden. RESULTS: Respondents' interpretations of the question about how they felt included social, mental, and physical aspects. Gender differences were found primarily in that girls emphasized stressors, while age differences were reflected mainly in the older respondents' inclusion of a wider variety of influences on their assessments. The five response options all demonstrated differences in self-rated health, and the respondents' understanding of the middle option, "Neither good, nor bad", varied widely. In the answering of potential sensitive survey questions, rationales for providing honest or biased answers were described. CONCLUSIONS: The use of a self-rated health question including the word 'feel' captured a holistic view of health among adolescents. Differences amongst response options should be acknowledged when analyzing self-rated health questions. If anonymity is not feasible when answering questions on self-rated health, a high level of privacy is recommended to increase the likelihood of reliability.

Medical students are afraid to include abortion in their future practices : in-depth interviews in Maharastra, India

BACKGROUND: Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education. METHOD: We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach. RESULTS: The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future. CONCLUSIONS: To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.

Parenthood in transition : Somali-born parents' experiences of and needs for parenting support programmes

BACKGROUND: Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to explore Somali-born refugees' experiences and challenges of being parents in Sweden, and the support they need in their parenting. METHODS: A qualitative descriptive study was undertaken. Data were collected from four focus group discussions (FGDs) among 23 Somali-born mothers and fathers living in a county in central Sweden. Qualitative content analysis has been applied. RESULTS: A main category, Parenthood in Transition, emerged as a description of a process of parenthood in transition. Two generic categories were identified: Challenges, and Improved parenting. Challenges emerged from leaving the home country and being new and feeling alienated in the new country. In Improved parenting, an awareness of opportunities in the new country and ways to improve their parenting was described, which includes how to improve their communication and relationship with their children. The parents described a need for information on how to culturally adapt their parenting and obtain support from the authorities. CONCLUSIONS: Parents experienced a process of parenthood in transition. They were looking to the future and for ways to improve their parenting. Schools and social services can overcome barriers that prevent lack of knowledge about the new country's systems related to parenthood. Leaving the home country often means separation from the family and losing the social network. We suggest that staff in schools and social services offer parent training classes for these parents throughout their children's childhood, with benefits for the child and family.