Beröring - Ett sätt att få vård. Ett sätt att ge vård. : En systematisk litteraturstudie

Syftet med studien var att belysa faktorer som påverkar äldre, över 65 år, patienters upplevelse av beröring, dess effekter samt belysa sjuksköterskans upplevelse av att ge beröring. Metoden är en systematisk litteraturstudie, baserad på 15 vetenskapliga artiklar sökta via databaserna Cinahl, Cochrane och sökmotorn Elin@dalarna.Resultatet visade att genus, livserfarenhet, yrkeskompetens hos sjuksköterskan, relationer samt vilken del av kroppen som berördes var faktorer som styrde patientens upplevelse av beröring från sjuksköterskan.Sjuksköterskors upplevelse av att ge beröring visades genom en helhetssyn av patienten, ge bekräftelse, vårda med respekt samt kunna beröra på ett naturligt sätt. Beröring visades ha goda effekter både hos den äldre patienten och sjuksköterskan genom att relationsbanden mellan dem styrktes, minskade sömnproblemen samt lindrade smärta, stress och oro hos den äldre patienten.

Kommunikation bortom orden : En etnografisk studie om hur lärares actio och ickeverbala kommunikation påverkar elevers motivation

Syftet med detta examensarbete är att få insikt i hur lärarens ickeverbala kommunikation och actio påverkar elevers motivation. Utifrån en etnografisk arbetsmetod observerades en svensklärare på en gymnasieskola under fyra lektionstimmar för att undersöka hur läraren kommunicerade med sina elever ickeverbalt. Parallellt med observationerna intervjuades både läraren och eleverna som deltog i undersökningen. Undersökningen visade att lärares ickeverbala kommunikation och actio har en stor påverkan på elevernas motivation, att denna påverkan sker omedelbart och att den kan förändras under en pågående lektion. När en lärare medvetandegör hur hon eller han kommunicerar med sina elever ickeverbalt kan aspekter som oavsiktlig och intuitiv kommunikation få en mindre påverkan på undervisningen. Detta bidrar i sin tur till att utveckla lärarens ickeverbala kompetens och på så sätt sin förmåga att motivera sina elever under hela lektionen.

Vad händer med dialogen? : En studie av dialogisk interaktion mellan pedagog och barn i förskolan

The overall purpose of this study is to gain knowledge about dialogues in the setting of the preschool. The more in-depth purpose is to highlight what happens in dialogues between a teacher and a child when more children join the situation of interaction in which the dialogue is taking place. A further purpose is to attempt to understand what it is that influences change in the dialogue and what significance the actions of the teacher can have for this change. The study is based on several questions that concern interaction in preschools, who it is that initiates an increase in the number of participants in those situations that involve dialogue, and what happens with the dialogue when more children join and what causes the change in the dialogue. The study is based on video observations from a preschool; approximately 10 teachers and 50 children between the ages of one and six took part in the study. The situations that were observed and documented in video format were everyday activities (both indoor and outdoor) that were led at a nominal level by teachers. In total, 40 films were recorded. Film length was between one and 60 minutes. In 32 of the films, there was interaction between a teacher and several children, and 18 of these included dialogues between a teacher and several children. Dialogue is here given a specific significance and refers to the interaction that can be described in terms of presence, listening, reciprocity, and extending. This definition of dialogue derives from a combination of Martin Buber’s philosophy of dialogue and aspects of interaction that earlier research found to be significant for children’s learning. In two of the 18 films that showed dialogue, no other children became part of the situation of interaction; the remaining 16 films were transcribed; and both verbal and non-verbal events were made apparent in the transcriptions. Analyses of the recorded material and of the transcriptions were conducted using analytical terms borrowed from conversation analysis as well as the central term for this study dialogue.  The results demonstrate a complex practice and also demonstrate that dialogues in the sense given in this study take place between children and teachers. Situations of interaction also occur where dialogues take place in which a number of children join. It can be the child joining the situation of interaction who takes the initiative to an increased number of participants; however, it can also be the teacher or the child in the dialogue. The initial address can take place during a moment of transition in the interaction or at the same time as another participant is talking. The dialogue often changes when more children join the situation where the dialogue is taking place. The dialogue can end completely or be interrupted and resume. The results further demonstrate that the dialogue can continue without seemingly being affected by the fact that more children join. This happens when the child joining and the teacher in the dialogue interact in a non-verbal manner at the same time as the teacher is talking with the child in the dialogue. The dialogue can also be continued with more participants. Who takes the initiative, how the initial address occurs, and which content is given focus by the different participants are all factors that seem to affect what happens to the dialogue. How the teacher acts when more children join also appears to be significant in terms of what happens with the dialogue when more children join. In those situations where the teacher begins talking with a number of children about different subjects, the interaction ceases to be dialogic. When the teacher asks the joining child to wait, the dialogue is both interrupted and resumed, and on those occasions when the dialogue continues with more participants, the teacher listens to the joining child and the participants take turns speaking.

Evaluation of communication behavior in persons with dementia during caregivers’ singing

The number of persons with dementia (PWD) is increasing rapidly worldwide. Cognitive impairments and communication difficulties are common among PWD. Therefore, gaining mutual togetherness in caring relation between PWD and their caregivers is important. This study was to investigate the effects of music therapeutic care (MTC) during morning care situations on improving verbal and nonverbal communication behaviors in people with dementia. An observation study with 10 PWD participating. Videotaped interactions (VIO) between PWD and their caregivers were conducted during eight weekly sessions, four recordings consisted of usual morning care and four recordings were of morning care with MTC intervention. The Verbal and Nonverbal Interaction Scale was used to analyze the recorded interactions at a later time. The unsociable verbal variable Cursing decreased significantly (P=.037) during MTC when compared with the baseline measurement. A significant (P=.000) reduction was observed for the unsociable nonverbal variable Does not respond to question. MTC significantly (P=.01) increased the mean score for the sociable nonverbal variable – Calm – relaxed. For sociable verbal communication, significant differences were observed for the variables Use coherent communication (P=.012), Use relevant communication (P=.009), Responds to questions (P=.000), Humming (P=.004), Singing (P=.000). MTC during morning care situations can be an effective non-pharmacological treatment, as well as nursing intervention in order to improve sociable communication behaviors, as well as reduce unsociable communication behaviors of PWDs

Machine vision for the automatic classification of images acquired from Non-destructive tests

This project is based on Artificial Intelligence (A.I) and Digital Image processing (I.P) for automatic condition monitoring of sleepers in the railway track. Rail inspection is a very important task in railway maintenance for traffic safety issues and in preventing dangerous situations. Monitoring railway track infrastructure is an important aspect in which the periodical inspection of rail rolling plane is required.Up to the present days the inspection of the railroad is operated manually by trained personnel. A human operator walks along the railway track searching for sleeper anomalies. This monitoring way is not more acceptable for its slowness and subjectivity. Hence, it is desired to automate such intuitive human skills for the development of more robust and reliable testing methods. Images of wooden sleepers have been used as data for my project. The aim of this project is to present a vision based technique for inspecting railway sleepers (wooden planks under the railway track) by automatic interpretation of Non Destructive Test (NDT) data using A.I. techniques in determining the results of inspection.

ANALYSIS & STUDY OF AI TECHNIQUES FORAUTOMATIC CONDITION MONITORING OFRAILWAY TRACK INFRASTRUCTURE : Artificial Intelligence Techniques

Since the last decade the problem of surface inspection has been receiving great attention from the scientific community, the quality control and the maintenance of products are key points in several industrial applications.The railway associations spent much money to check the railway infrastructure. The railway infrastructure is a particular field in which the periodical surface inspection can help the operator to prevent critical situations. The maintenance and monitoring of this infrastructure is an important aspect for railway association.That is why the surface inspection of railway also makes importance to the railroad authority to investigate track components, identify problems and finding out the way that how to solve these problems. In railway industry, usually the problems find in railway sleepers, overhead, fastener, rail head, switching and crossing and in ballast section as well. In this thesis work, I have reviewed some research papers based on AI techniques together with NDT techniques which are able to collect data from the test object without making any damage. The research works which I have reviewed and demonstrated that by adopting the AI based system, it is almost possible to solve all the problems and this system is very much reliable and efficient for diagnose problems of this transportation domain. I have reviewed solutions provided by different companies based on AI techniques, their products and reviewed some white papers provided by some of those companies. AI based techniques likemachine vision, stereo vision, laser based techniques and neural network are used in most cases to solve the problems which are performed by the railway engineers.The problems in railway handled by the AI based techniques performed by NDT approach which is a very broad, interdisciplinary field that plays a critical role in assuring that structural components and systems perform their function in a reliable and cost effective fashion. The NDT approach ensures the uniformity, quality and serviceability of materials without causing any damage of that materials is being tested. This testing methods use some way to test product like, Visual and Optical testing, Radiography, Magnetic particle testing, Ultrasonic testing, Penetrate testing, electro mechanic testing and acoustic emission testing etc. The inspection procedure has done periodically because of better maintenance. This inspection procedure done by the railway engineers manually with the aid of AI based techniques.The main idea of thesis work is to demonstrate how the problems can be reduced of thistransportation area based on the works done by different researchers and companies. And I have also provided some ideas and comments according to those works and trying to provide some proposal to use better inspection method where it is needed.The scope of this thesis work is automatic interpretation of data from NDT, with the goal of detecting flaws accurately and efficiently. AI techniques such as neural networks, machine vision, knowledge-based systems and fuzzy logic were applied to a wide spectrum of problems in this area. Another scope is to provide an insight into possible research methods concerning railway sleeper, fastener, ballast and overhead inspection by automatic interpretation of data.In this thesis work, I have discussed about problems which are arise in railway sleepers,fastener, and overhead and ballasted track. For this reason I have reviewed some research papers related with these areas and demonstrated how their systems works and the results of those systems. After all the demonstrations were taking place of the advantages of using AI techniques in contrast with those manual systems exist previously.This work aims to summarize the findings of a large number of research papers deploying artificial intelligence (AI) techniques for the automatic interpretation of data from nondestructive testing (NDT). Problems in rail transport domain are mainly discussed in this work. The overall work of this paper goes to the inspection of railway sleepers, fastener, ballast and overhead.

MACHINE VISION FOR AUTOMATICVISUAL INSPECTION OF WOODENRAILWAY SLEEPERS USING UNSUPERVISED NEURAL NETWORKS

The motivation for this thesis work is the need for improving reliability of equipment and quality of service to railway passengers as well as a requirement for cost-effective and efficient condition maintenance management for rail transportation. This thesis work develops a fusion of various machine vision analysis methods to achieve high performance in automation of wooden rail track inspection.The condition monitoring in rail transport is done manually by a human operator where people rely on inference systems and assumptions to develop conclusions. The use of conditional monitoring allows maintenance to be scheduled, or other actions to be taken to avoid the consequences of failure, before the failure occurs. Manual or automated condition monitoring of materials in fields of public transportation like railway, aerial navigation, traffic safety, etc, where safety is of prior importance needs non-destructive testing (NDT).In general, wooden railway sleeper inspection is done manually by a human operator, by moving along the rail sleeper and gathering information by visual and sound analysis for examining the presence of cracks. Human inspectors working on lines visually inspect wooden rails to judge the quality of rail sleeper. In this project work the machine vision system is developed based on the manual visual analysis system, which uses digital cameras and image processing software to perform similar manual inspections. As the manual inspection requires much effort and is expected to be error prone sometimes and also appears difficult to discriminate even for a human operator by the frequent changes in inspected material. The machine vision system developed classifies the condition of material by examining individual pixels of images, processing them and attempting to develop conclusions with the assistance of knowledge bases and features.A pattern recognition approach is developed based on the methodological knowledge from manual procedure. The pattern recognition approach for this thesis work was developed and achieved by a non destructive testing method to identify the flaws in manually done condition monitoring of sleepers.In this method, a test vehicle is designed to capture sleeper images similar to visual inspection by human operator and the raw data for pattern recognition approach is provided from the captured images of the wooden sleepers. The data from the NDT method were further processed and appropriate features were extracted.The collection of data by the NDT method is to achieve high accuracy in reliable classification results. A key idea is to use the non supervised classifier based on the features extracted from the method to discriminate the condition of wooden sleepers in to either good or bad. Self organising map is used as classifier for the wooden sleeper classification.In order to achieve greater integration, the data collected by the machine vision system was made to interface with one another by a strategy called fusion. Data fusion was looked in at two different levels namely sensor-level fusion, feature- level fusion. As the goal was to reduce the accuracy of the human error on the rail sleeper classification as good or bad the results obtained by the feature-level fusion compared to that of the results of actual classification were satisfactory.

A home environment test battery for status assessment in patients with motor fluctuations

Background and aims Evaluating status in patients with motor fluctuations is complex and occasional observations/measurements do not give an adequate picture as to the time spent in different states. We developed a test battery to assess advanced Parkinson patients' status consisting of diary assessments and motor tests. This battery was constructed and implemented on a handheld computer with built-in mobile communication. In fluctuating patients, it should typically be used several times daily in the home environment, over periods of about one week. The aim of this battery is to provide status information in order to evaluate treatment effects in clinical practice and research, follow up treatments and disease progression and predict outcome to optimize treatment strategy. Methods Selection of diary questions was based on a previous study with Duodopa® (DIREQT). Tapping tests (with and without visual cueing) and a spiral drawing test were added. Rapid prototyping was used in development of the user interface. An evaluation with two pilot patients was performed before and after receiving new treatments for advanced disease (one received Duodopa® and one received DBS). Speed and proportion missed taps were calculated for the tapping tests and entropy of the radial drawing velocity was calculated for the spiral tests. Test variables were evaluated using non-parametric statistics. Results Post-treatment improvement was detected in both patients in many of the test variables. Conclusions Although validation work remains, preliminary results are promising and the test battery is currently being evaluated in a long-term health economics study with Duodopa® (DAPHNE).

Simplified follow-up after medical abortion using a low-sensitivity urinary pregnancy test and a pictorial instruction sheet in Rajasthan, India : study protocol and intervention adaptation of a randomised control trial

The World Health Organisation suggests that simplification of the medical abortion regime will contribute to an increased acceptability of medical abortion, among women as well as providers. It is expected that a home-based follow-up after a medical abortion will increase the willingness to opt for medical abortion as well as decrease the workload and service costs in the clinic. Trial design The study is a randomised, controlled, non-superiority trial . Methods Women screened to participate in the study are those with unwanted pregnancies and gestational ages equal to or less than nine weeks. Eligible women randomised to the home-based assessment group will use a low-sensitivity pregnancy test and a pictorial instruction sheet at home, while the women in the clinic follow-up group will return to the clinic for routine follow-up carried out by a doctor. The primary objective of the study is to evaluate the effectiveness of home-based assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet 10-14 days after an early medical abortion. Providers or research assistants will not be blinded during outcome assessment. To ensure feasibility of the self-assessment intervention an adaption phase took place at the selected study sites before study initiation. This was to optimise and tailor-make the intervention and the study procedures and resulted in the development of the pictorial instruction sheet for how to use the low-sensitivity pregnancy test and the danger signs after a medical abortion. Discussion In this paper, we will describe the study protocol for a randomised control trial investigating the efficacy of simplified follow-up in terms of home-based assessment, 10-14 days after a medical abortion. Moreover, a description of the adaptation phase is included for a better understanding of the implementation of the intervention in a setting where literacy is low and the road-connections are poor. Trial registration: Clinicaltrials.gov NCT01827995. Registered 04 May 2013

An empirical test of the gravity p-median model

A customer is presumed to gravitate to a facility by the distance to it and the attractiveness of it. However regarding the location of the facility, the presumption is that the customer opts for the shortest route to the nearest facility.This paradox was recently solved by the introduction of the gravity p-median model. The model is yet to be implemented and tested empirically. We implemented the model in an empirical problem of locating locksmiths, vehicle inspections, and retail stores ofv ehicle spare-parts, and we compared the solutions with those of the p-median model. We found the gravity p-median model to be of limited use for the problem of locating facilities as it either gives solutions similar to the p-median model, or it gives unstable solutions due to a non-concave objective function.

Acceptability of home-assessment post medical abortion and medical abortion in a low-resource setting in Rajasthan, India : Secondary outcome analysis of a non-inferiority randomized controlled trial

Background: Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective: To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Design: Secondary outcome of a randomised, controlled, non-inferiority trial. Setting Outpatient primary health care clinics in rural and urban Rajasthan, India. Population: Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85mg/l and were below 18 years. Methods: Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1: 1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Main outcome measures: Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. Results: 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as compared with 188 (70%) of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001). Conclusion: Home-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women's preference should be offered to foster women's reproductive autonomy.

Self-assessment of the outcome of early medical abortion versus clinic follow-up in India : a randomised, controlled, non-inferiority trial

Background: The need for multiple clinical visits remains a barrier to women accessing safe legal medical abortion services. Alternatives to routine clinic follow-up visits have not been assessed in rural low-resource settings. We compared the effectiveness of standard clinic follow-up versus home assessment of outcome of medical abortion in a low-resource setting. Methods: This randomised, controlled, non-inferiority trial was done in six health centres (three rural, three urban) in Rajasthan, India. Women seeking early medical abortion up to 9 weeks of gestation were randomly assigned (1:1) to either routine clinic follow-up or self-assessment at home. Randomisation was done with a computer-generated randomisation sequence, with a block size of six. The study was not blinded. Women in the home-assessment group were advised to use a pictorial instruction sheet and take a low-sensitivity urine pregnancy test at home, 10-14 days after intake of mifepristone, and were contacted by a home visit or telephone call to record the outcome of the abortion. The primary (non-inferiority) outcome was complete abortion without continuing pregnancy or need for surgical evacuation or additional mifepristone and misoprostol. The non-inferiority margin for the risk difference was 5%. All participants with a reported primary outcome and who followed the clinical protocol were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT01827995. Findings: Between April 23, 2013, and May 15, 2014, 731 women were recruited and assigned to clinic follow-up (n=366) or home assessment (n=365), of whom 700 were analysed for the main outcomes (n=336 and n=364, respectively). Complete abortion without continuing pregnancy, surgical intervention, or additional mifepristone and misoprostol was reported in 313 (93%) of 336 women in the clinic follow-up group and 347 (95%) of 364 women in the home-assessment group (difference -2.2%, 95% CI -5.9 to 1.6). One case of haemorrhage occurred in each group (rate of adverse events 0.3% in each group); no other adverse events were noted. Interpretation Home assessment of medical abortion outcome with a low-sensitivity urine pregnancy test is non-inferior to clinic follow-up, and could be introduced instead of a clinic follow-up visit in a low-resource setting.