Upplevelser av palliativ vård i hemmet under livets slutskede – ur ett anhörigperspektiv : En litteraturöversikt

Bakgrund: Palliativ vård handlar om att ge stöd till patienten och anhöriga under och efter vårdtiden. De ”6 s:n” är en arbetsmodell inom palliativ vård där patienten har rätt till självbestämmande och att upprätthålla sina sociala relationer, även stöd till anhöriga ingår. Anhöriga har en betydelsefull roll i den palliativa vården, deras närvaro skapar möjlighet för den döende att vara hemma i livets slutskede. Syfte: Syftet var att beskriva anhörigas upplevelse av palliativ vård i hemmet under livets slutskede. Metod: Litteraturöversikt baserad på 15 vetenskapliga artiklar från fem olika länder med kvalitativ ansats. Resultat: Fem kategorier identifierades kopplade till anhörigas upplevelser: Palliativa teamets inträde i hemmet, anhörigas vårdansvar, den medicintekniska utrusningens inverkan på vardagslivet, känslor och konsekvenser för anhöriga samt förbättringsmöjligheter och anhörigas uppfattning om palliativ vård. Slutsats: Anledningen till anhörigas vårdansvar var löftet att få dö hemma, uppgiften upplevdes krävande och gav konsekvenser på sömnen och deras fysiska och psykiska mående. Detta var genomgående i hela litteraturöversikten. Vården i hemmet sågs som den rätta platsen att dö på för alla parter, endast en anhörig uttryckte avsky för situationen. Enligt anhöriga var stödet bra dock fanns det ett ökat behov av mer resurser för fullständig trygghet.

Barn och unga med en nära anhörig som avlidit : Barn och ungas erfarenheter av att delta i stödgrupp

I denna kvalitativa studie har enkäter insamlats från barn och unga som deltagit i stödgruppsverksamhet för barn och unga med en avliden nära anhörig i Dalarnas län. Syftet med studien har varit att beskriva deltagarnas erfarenheter av stödgrupperna. Genom kvalitativ innehållsanalys har tre kategorier identifierats; bearbetning, gemenskap och strukturens betydelse. Studien visar främst på betydelsen av att få träffa andra barn och unga i liknande situation samt indikerar till att deltagarnas KASAM (känsla av sammanhang) förhöjts genom deltagandet i stödgruppen.

Selection and Floral Evolution in Platanthera bifolia and P. chlorantha (Orchidaceae)

Natural selection mediated by pollinators has influenced the evolution of floral diversity of the flowering plants (angiosperms). The scope of this thesis was to study: 1) phenotypic selection, 2) mating systems, and 3) floral shifts involved in plant speciation. Model plant species were Platanthera bifolia and P. chlorantha (Orchidaceae). These orchids are moth-pollinated, strictly co-sexual (bisexual flowers), and produce a spike that displays 10-20 white flowers. I explored the influence of characters on plant fitness by using multiple linear regressions. Pollen removal (male fitness) and fruit set (female fitness) increased with more flowers per plant in three P. bifolia populations. There was selection towards longer spurs in a dry year when average spur length was shorter than in normal-wet years. Female function was sensitive to drought, which enabled an application of the male function hypothesis of floral evolution (Bateman's principle). The results show that selection may vary between populations, years, and sex-functions. I examined inbreeding by estimating levels of geitonogamy (self-pollination between flowers of an individual) with an emasculation method in two P. bifolia populations. Geitonogamy did not vary with inflorescence size. Levels of geitonogamy was 20-40% in the smaller, but non-significant in the larger population. This may relate to lower number of possible mates and pollinator activity in the smaller population. Platanthera bifolia exhibits the ancestral character state of tongue-attachment of pollinia on the pollinator. Its close relative P. chlorantha attaches its pollinia onto the pollinator's eyes. To explore the mechanism of a floral shift, pollination efficiency and speed was compared between the two species. The results showed no differences in pollination efficiency, but P. chlorantha had faster pollen export and import. Efficiency of pollination in terms of speed may cause floral shifts, and thus speciation.

Paper dimensional stability in sheet-fed offset printing : Papperets dimensionsstabilitet i en arkoffsetpress

In offset printing, dampening solution is used to create a good balance in the process. If too much water is transferred to the paper, the sheet can change its size between the printing units, due to water absorption, and cause a problem with the colour register. This phenomenon is usually referred to as fanout. In this degree project, an investigation was made to see if the paper dimensions changed through its way in the sheet-fed printing process. The instrument Luchs Register Measuring Systems (Lynx) was used, and a method for measuring if the paper changed its dimensions with this instrument, was developed. Paper qualities with three different grammages were used, 90, 130 and 250 gsm. This investigation showed that all paper qualities changed their size with widening in the gripper edge in the range of 10 - 70 µm and in the trailing edge the increase was 10 - 130 µm. The elongations of the papers were in the range of 10- 300 µm. The papers with lowest grammage changed more than the heavier. To see if the print had been affected of the widening and elongation, print quality parameters like relative contrast, dot gain and mottle were correlated with the Lynx data from the sheets. The group of papers that gave correlations were in 130 gsm. The sheets had visual doubling and the combined standard deviation from the Lynx marks K3, K5 and K21 correlated with dot gain. When the variations increased so did the dot gain and this indicates that the doubling was due to the widening. There was also a correlation between the standard deviation from K3 and Mottle. The sheets widened with an average of 30 µm in the gripper edge and since there probably were doubling due to widening it also affected the Mottle values. What the widening depends on is hard to tell. Since widening was so small, it could be due to water absorption, papers being ironed out or maybe the sheets have been flattened out. It probably needs a more detailed investigation to find out what causes the widening. Further investigations about how print quality is affected by the register accuracy of a printing machine should include a print form with measuring areas close to the Lynx marks. The measuring areas should contain fine hairlines, negative text printed with at least two colours and some pictures to evaluate together with standard measuring should give a good knowledge about the subject.

Minimization of stock weight during close-die forging of a spindle

In this paper, Finite Element method and full-scale experiments have been used to study a hot forging method for fabri-cation of a spindle using reduced initial stock size. The forging sequence is carried out in two stages. In the first stage, the hot rolled cylindrical billet is pre-formed and pierced in a closed die using a spherical nosed punch to within 20 mm of its base. This process of piercing or impact extrusion leads to high strains within the work piece but requires high press loads. In the second stage, the resulting cylinder is placed in a die with a flange chamber and upset forged to form a flange. The stock mass is optimized for complete die filling. Process parameters such as effective strain distribution, material flow and forging load in different stages of the process are analyzed. It is concluded from the simulations that minor modifications of piercing punch geometry to reduce contact between the punch and emerging vertical walls of the cylinder appreciably reduces the piercing load. In the flange chamber, a die surfaces angle of 52° instead of 45° is pro-posed to ensure effective material flow and exert sufficient tool pressure to achieve complete cavity filling. In order to achieve better compression, it is also proposed to shorten both the length of the inserted punch and the die “tongues” by a few mm.

Relative durations of post-vocalic consonants in readaloud Spanish by native Swedish L2-learners

Prosody is said to be a persistent feature in foreign accents, particularly in the speech of adult learners. Native Swedish speakers have been reported to lengthen vowels in Spanish as well as post-vocalic consonants in English and German, more than native speakers of the respective languages. The aim of the present study is to examine whether native Swedish learners of Spanish produce increased postvocalic consonant durations in a reading aloud exercise. The text contains certain words that could be expected to trigger complementary consonant lengthening in native Swedish speakers. The result shows that there is no general tendency for native Swedes to lengthen post-vocalic consonants more than native speakers of Spanish in the present speech material. There are examples of longer consonant durations in the speech of the native,Swedish subjects, but it could be a coincidence. A conclusion is that the text used in the study, and probably Spanish as a language, contains few words that are ideal for triggering lengthening of post-vocalic consonants in native Swedish speakers.

The relative perceptual weight of two Swedish prosodic contrasts

Abstract. In addition to 9 vowel and 18 consonant phonemes, Swedish has three prosodic phonemic contrasts: word stress, quantity and tonal word accent. There are also examples of distinctive phrase or sentence stress, where a verb can be followed by either an unstressed preposition or a stressed particle. This study focuses on word level and more specifically on word stress and tonal word accent in disyllabic words. When making curriculums for second language learners, teachers are helped by knowing which phonetic or phonological features are more or less crucial for the intelligibility of speech and there are some structural and anecdotal evidence that word stress should play a more important role for intelligibility of Swedish, than the tonal word accent. The Swedish word stress is about prominence contrasts between syllables, mainly signaled by syllable duration, while the tonal word accent is signaled mainly by pitch contour. The word stress contrast, as in armen [´arːmən] ‘the arm’ - armén [ar´meːn] ‘the army’, the first word trochaic and the second iambic, is present in all regional varieties of Swedish, and realized with roughly the same acoustic cues, while the tonal word accent, as in anden [´anːdən] ‘the duck’ - anden [`anːdən] ‘the spirit’ is absent in some dialects (as well as in singing), and also signaled with a variety of tonal patterns depending on region. The present study aims at comparing the respective perceptual weight of the two mentioned contrasts. Two lexical decision tests were carried out where in total 34 native Swedish listeners should decide whether a stimulus was a real word or a non-word. Real words of all mentioned categories were mixed with nonsense words and words that were mispronounced with opposite stress pattern or opposite tonal word accent category. The results show that distorted word stress caused more non-word judgments and more loss, than distorted word accent. Our conclusion is that intelligibility of Swedish is more sensitive to distorted word stress pattern than to distorted tonal word accent pattern. This is in compliance with the structural arguments presented above, and also with our own intuition.

Palliativ omvårdnad i hemmet - de anhörigas upplevelse av delaktighet : En litteraturstudie

Bakgrund: Tack vare en mer avancerad hemsjukvård har den palliativa vården utvecklats, vilket gör det möjligt för fler människor att dö i det egna hemmet. Palliativ vård handlar inte endast om patienten, utan involverar även de anhöriga. Det övergripande målet för palliativ vård är att patienten och den anhörige upplever god livskvalitet till livets slut. De anhörigas närvaro är betydelsefull, inte endast för patienten utan även för vårdarna. De anhöriga befinner sig i en mycket påfrestande situation och det är viktigt att vårdare har kunskap om vad de anhöriga upplever och hur man kan stötta de anhöriga i deras situation. Syfte: Att belysa anhörigas upplevelser av delaktighet i samband med palliativ omvårdnad i hemmet. Metod: En litteraturstudie baserad på 11 vetenskapliga artiklar av kvalitativ ansats. Resultat: 2 kategorier framkom ur studien. Delaktighet ger anhöriga upplevelsen av att få vardagen att fungera och Anhörigas delaktighet bidrar till personcentrerad vård. Det blev en drastisk förändring i livet för de anhöriga. Det var inte bara hemmet som förändras i och med all teknisk utrustning och hjälpmedel som patienten behövde. De anhörigas livsförändringar gjorde att det sociala livet fick lida. Tankar kring existentiella frågor dök upp när man levde så nära inpå döden och det var viktigt för de anhöriga att vårdarna kunde se och lyssna även på deras behov. En god kommunikation var viktigt för att de anhöriga skulle våga prata om sina egna behov, tankar och åsikter. Slutsats: Det viktigaste för de anhöriga var att kommunikationen, stödet och informationen fungerade mellan alla parter. Fungerade dessa delar så byggdes en god relation mellan parterna och man fick en god tillit till vården. Samarbetet blev bättre och de anhöriga kände sig som en i teamet.