En analys av ledmotivens narrativa funktioner i filmen Sagan om Ringen

I denna uppsats som i sin allra enklaste form är en analys av ledmotivsanvändningen i filmen Sagan om Ringen ville jag ta reda på vilka olika narrativa funktioner dessa ledmotiv kan ha. Genom att jag genomförde en analys där jag såg filmen i kronologisk ordning och tittade på två slumpmässigt utvalda ledmotiv och deras berättande funktioner kom jag fram till att ledmotiven verkligen har en central roll i filmens musikaliska struktur. Ledmotiven används föra att underbygga den fortskridande handlingen och hjälpa publiken följa med i denna. Samtidigt klargör vissa av dessa ledmotiv saker i handlingen som annars skulle vara dolda, saker som inte berättas med vare sig ord eller bilder utan med musik.

När hjärtat sviktar : Information och undervisning med hjälp av sjuksköterskan

Syftet med denna litteraturstudie var att ta reda på hur information och undervisning kan utformas och vara ett bra sätt att förbättra den hälsorelaterade livskvaliteten hos patienter med hjärtsvikt. Femton vetenskapliga artiklar valdes ut genom fulltextdatabasen United States National Library of Medicine (MEDLINE) och Högskolan Dalarnas sökmotor Electronic Library Information Navigator (ELIN). Sökorden som användes var heart failure, quality of life, information/education och nursing i olika kombinationer. Artiklarna som valdes ut granskades med hjälp av modifierade granskningsmallar för att säkerställa att dom var av så hög kvalite som möjligt. Fysisk funktionell förmåga och kunskap om sjukdomen har betydelse för patientens upplevelse av sin hälsorelaterade livskvalitet. Flera av artiklarna i litteraturstudien visar att sjuksköterskeinriktad patientutbildning är effektivt för att förbättra livskvaliteten och den hjälper patienterna att se sina symtom och främjar egenvård. Utbildningen innefattar ofta information om att förändra sin livsstil, fysisk aktivitet, daglig vägning, diet och läkemedelsdosering samt information och undervisning till både patienter och anhöriga om hjärtsvikt och dess symtom. Familj och vänner är ofta ett stort stöd för patienter med hjärtsvikt. Studier visar dock att de ofta har de begränsade kunskaper om vad hjärtsvikt är och hur behandlingen ser ut. De övergripande resultaten av litteraturstudien visar på att databaserad utbildning ger ökad kunskap om hjärtsvikt i jämförelse med sedvanlig utbildning.

Passive crosslaminated timber buildings : Final report Cerbof-project no. 76

In this project, Stora Enso’s newly developed building system has been further developed to allow building to the Swedish passive house standard for the Swedish climate. The building system is based on a building framework of CLT (Cross laminated timber) boards. The concept has been tested on a small test building. The experience gained from this test building has also been used for planning a larger building (two storeys with the option of a third storey) with passive house standard with this building system. The main conclusions from the project are:  It is possible to build airtight buildings with this technique without using traditional vapour barriers. Initial measurements show that this can be done without reaching critical humidity levels in the walls and roof, at least where wood fibre insulation is used, as this has a greater capacity for storing and evening out the moisture than mineral wool. However, the test building has so far not been exposed to internal generation of moisture (added moisture from showers, food preparation etc.). This needs to be investigated and this will be done during the winter 2013-14.  A new fixing method for doors and windows has been tested without traditional fibre filling between them and the CLT panel. The door or window is pressed directly on to the CLT panel instead, with an expandable sealing strip between them. This has been proved to be successful.  The air tightness between the CLT panels is achieved with expandable sealing strips between the panels. The position of the sealing strips is important, both for the air tightness itself and to allow rational assembly.  Recurrent air tightness measurements show that the air tightness decreased somewhat during the first six months, but not to such an extent that the passive house criteria were not fulfilled. The reason for the decreased air tightness is not clear, but can be due to small movements in the CLT construction and also to the sealing strips being affected by changing outdoor temperatures.  Long term measurements (at least two years) have to be carried out before more reliable conclusions can be drawn regarding the long term effect of the construction on air tightness and humidity in the walls.  An economic analysis comparing using a concrete frame or the studied CLT frame for a three storey building shows that it is probably more expensive to build with CLT. For buildings higher than three floors, the CLT frame has economic advantages, mainly because of the shorter building time compared to using concrete for the frame. In this analysis, no considerations have been taken to differences in the influence on the environment or the global climate between the two construction methods.

Fyrtiotalisterna och äldreomsorgen : massmediala konstruktioner av en ny sorts omsorgstagare

Baby boomers and elderly care: expectations in print media about a new kind of care users The Swedish baby boomer generation – known as the forties generation – has been characterized as youthful and powerful. At present, members of this generation are entering the category of old age and in about ten years they will start reaching ages where the likelihood of encountering elderly care increases significantly. The present study reports on how this expected meeting has been discussed in Swedish newspapers. Data consisted of 481 articles during the period 1995–2012 and was analyzed through qualitative content analysis. Results show that the generation was predicted to become a new type of demanding and self-conscious care users. Claims were backed by descriptions of formative events and typical characteristics that were projected onto a future as care user. Such projections tended to portray care users of present time as passive and submissive, and partly responsible for problems associated with elderly care 

Self-reported symptoms and motor tests via telemetry in a 36-month levodopa-carbidopa intestinal gel infusion trial

Objective To investigate if a home environment test battery can be used to measure effects of Parkinson’s disease (PD) treatment intervention and disease progression. Background Seventy-seven patients diagnosed with advanced PD were recruited in an open longitudinal 36-month study at 10 clinics in Sweden and Norway; 40 of them were treated with levodopa-carbidopa intestinal gel (LCIG) and 37 patients were candidates for switching from oral PD treatment to LCIG. They utilized a mobile device test battery, consisting of self-assessments of symptoms and objective measures of motor function through a set of fine motor tests (tapping and spiral drawings), in their homes. Both the LCIG-naïve and LCIG-non-naïve patients used the test battery four times per day during week-long test periods. Methods Assessments The LCIG-naïve patients used the test battery at baseline (before LCIG), month 0 (first visit; at least 3 months after intraduodenal LCIG), and thereafter quarterly for the first year and biannually for the second and third years. The LCIG-non-naïve patients used the test battery from the first visit, i.e. month 0. Out of the 77 patients, only 65 utilized the test battery; 35 were LCIG-non-naïve and 30 LCIG-naïve. In 20 of the LCIG-naïve patients, assessments with the test battery were available during oral treatment and at least one test period after having started infusion treatment. Three LCIG-naïve patients did not use the test battery at baseline but had at least one test period of assessments thereafter. Hence, n=23 in the LCIG-naïve group. In total, symptom assessments in the full sample (including both patient groups) were collected during 379 test periods and 10079 test occasions. For 369 of these test periods, clinical assessments including UPDRS and PDQ-39 were performed in afternoons at the start of the test periods. The repeated measurements of the test battery were processed and summarized into scores representing patients’ symptom severities over a test period, using statistical methods. Six conceptual dimensions were defined; four subjectively-reported: ‘walking’, ‘satisfied’, ‘dyskinesia’, and ‘off’ and two objectively-measured: ‘tapping’ and ‘spiral’. In addition, an ‘overall test score’ (OTS) was defined to represent the global health condition of the patient during a test period. Statistical methods Change in the test battery scores over time, that is at baseline and follow-up test periods, was assessed with linear mixed-effects models with patient ID as a random effect and test period as a fixed effect of interest. The within-patient variability of OTS was assessed using intra-class correlation coefficient (ICC), for the two patient groups. Correlations between clinical rating scores and test battery scores were assessed using Spearman’s rank correlations (rho). Results In LCIG-naïve patients, mean OTS compared to baseline was significantly improved from the first test period on LCIG treatment until month 24. However, there were no significant changes in mean OTS scores of LCIG-non-naïve patients, except for worse mean OTS at month 36 (p<0.01, n=16). The mean scores of all subjectively-reported dimensions improved significantly throughout the course of the study, except ‘walking’ at month 36 (p=0.41, n=4). However, there were no significant differences in mean scores of objectively-measured dimensions between baseline and other test periods, except improved ‘tapping’ at month 6 and month 36, and ‘spiral’ at month 3 (p<0.05). The LCIG-naïve patients had a higher within-subject variability in their OTS scores (ICC=0.67) compared to LCIG-non-naïve patients (ICC=0.71). The OTS correlated adequately with total UPDRS (rho=0.59) and total PDQ-39 (rho=0.59). Conclusions In this 3-year follow-up study of advanced PD patients treated with LCIG we found that it is possible to monitor PD progression over time using a home environment test battery. The significant improvements in the mean OTS scores indicate that the test battery is able to measure functional improvement with LCIG sustained over at least 24 months.

Emergency department triage scales and their components : a systematic review of the scientific evidence

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).

A systematic review of triage-related interventions to improve patient flow in emergency departments

Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

"Den dag vi slutar bli bättre, slutar vi vara bra" : Ledarskapets inverkan på medarbetares motivation till ständiga förbättringar

Syfte - Syftet med studien är att få en djupare insikt i sambandet mellan ledarskap och de faktorer som bidrar till ökat engagemang hos medarbetarna i arbetet med ständiga förbättringar. Studien riktar sig mot ett mellanstort industriföretag som implementerat lean production. Design/ metod - I vår undersökning valde vi att göra en kvalitativ fallstudie. Data samlades in i ett svenskt industriföretag. Totalt har 7 intervjuer genomförts. Undersökningsresultat - Resultatet vi kom fram till är att medarbetarna är i låg utsträckning delaktiga i förbättringsarbetet. Tidigare forskning visar att medarbetare som är delaktiga i beslut är också mer engagerade i arbetet. Metodkritik – Resultatet speglar enbart subjektiva bedömningar och de studerade variablerna bygger på respondenternas uppfattningar. Framtida forskning bör inkludera mer objektiva mått. Praktiska konsekvenser - Studien ger belägg till att medarbetarnas engagemang och motivation i förbättringsarbetet kan ökas genom att göra dem mer delaktiga. Forskning visar att medarbetare som får information och får delta i beslut känner större delaktighet i arbetet. Kunskapsbidrag - I den befintliga litteraturen hävdas det att ledarskapet är en viktig komponent för att öka medarbetarnas engagemang. Lite har dock skrivits om hur ledarskapet kan motivera medarbetarna till ständiga förbättringar i en organisation som arbetar i lean production. Nyckelord:

Materialising bodies : there is nothing more material than a socially constructed body.

Over the last one of two decades, researchers within the physical education (PE) and sport pedagogy research frequently use the concept ‘the material body’. An initial purpose of this article is to explore what a concept of a ‘material body’ might mean. What other bodies are there? Who would dispute the materiality of bodies? I suggest that the use of a concept as ‘the material body’ suggests a hesitation before the radicalism of the linguistic turn in the sense that the concept ‘discourse’ does not include a material dimension. In this way ‘the material body’ relates to an interpretation of ‘the socially (or discursively) constructed body’ as void of matter. A further purpose with the article is to re-inscribe matter in the concept of ‘discourse’. This is done by way of discussing what theorists like Michel Foucault and, in particular, Judith Butler, has to say about the materiality of the body. In their writings, discourse should not be limited to spoken and/or written language. Rather, discourse is understood in terms of actions and events that create meanings—that matters. One conclusion of the article is that it is important to problematise the mundane view of discourse as ‘verbal interchange’ because it reinforces the promise of an objective knowledge that will eventually shed light on the ‘real’ body and the mysteries of sexual difference, what its origins are, what causes it. Another conclusion is that the PE and sport pedagogy research should pay less attention to the body as an object (what it ‘is’), and pay more attention to how the body matters, and e.g. how movements make bodies matter.

Validity and responsiveness of at-home touch-screen assessments in advanced Parkinson's disease

The aim of this study was to investigate if a telemetry test battery can be used to measure effects of Parkinson’s disease (PD) treatment intervention and disease progression in patients with fluctuations. Sixty-five patients diagnosed with advanced PD were recruited in an open longitudinal 36-month study; 35 treated with levodopa-carbidopa intestinal gel (LCIG) and 30 were candidates for switching from oral PD treatment to LCIG. They utilized a test battery, consisting of self-assessments of symptoms and fine motor tests (tapping and spiral drawings), four times per day in their homes during week-long test periods. The repeated measurements were summarized into an overall test score (OTS) to represent the global condition of the patient during a test period. Clinical assessments included ratings on Unified PD Rating Scale (UPDRS) and 39-item PD Questionnaire (PDQ-39) scales. In LCIG-naïve patients, mean OTS compared to baseline was significantly improved from the first test period on LCIG treatment until month 24. In LCIG-non-naïve patients, there were no significant changes in mean OTS until month 36. The OTS correlated adequately with total UPDRS (rho = 0.59) and total PDQ-39 (0.59). Responsiveness measured as effect size was 0.696 and 0.536 for OTS and UPDRS respectively. The trends of the test scores were similar to the trends of clinical rating scores but dropout rate was high. Correlations between OTS and clinical rating scales were adequate indicating that the test battery contains important elements of the information of well-established scales. The responsiveness and reproducibility were better for OTS than for total UPDRS.

Utveckling av metod för att bedöma behovet av ogräsbekämpning i spår

A system for weed management on railway embankments that is both adapted to the environment and efficient in terms of resources requires knowledge and understanding about the growing conditions of vegetation so that methods to control its growth can be adapted accordingly. Automated records could complement present-day manual inspections and over time come to replace these. One challenge is to devise a method that will result in a reasonable breakdown of gathered information that can be managed rationally by affected parties and, at the same time, serve as a basis for decisions with sufficient precision. The project examined two automated methods that may be useful for the Swedish Transport Administration in the future: 1) A machine vision method, which makes use of camera sensors as a way of sensing the environment in the visible and near infrared spectrum; and 2) An N-Sensor method, which transmits light within an area that is reflected by the chlorophyll in the plants. The amount of chlorophyll provides a value that can be correlated with the biomass. The choice of technique depends on how the information is to be used. If the purpose is to form a general picture of the growth of vegetation on railway embankments as a way to plan for maintenance measures, then the N-Sensor technique may be the right choice. If the plan is to form a general picture as well as monitor and survey current and exact vegetation status on the surface over time as a way to fight specific vegetation with the correct means, then the machine vision method is the better of the two. Both techniques involve registering data using GPS positioning. In the future, it will be possible to store this information in databases that are directly accessible to stakeholders online during or in conjunction with measures to deal with the vegetation. The two techniques were compared with manual (visual) estimations as to the levels of vegetation growth. The observers (raters) visual estimation of weed coverage (%) differed statistically from person to person. In terms of estimating the frequency (number) of woody plants (trees and bushes) in the test areas, the observers were generally in agreement. The same person is often consistent in his or her estimation: it is the comparison with the estimations of others that can lead to misleading results. The system for using the information about vegetation growth requires development. The threshold for the amount of weeds that can be tolerated in different track types is an important component in such a system. The classification system must be capable of dealing with the demands placed on it so as to ensure the quality of the track and other pre-conditions such as traffic levels, conditions pertaining to track location, and the characteristics of the vegetation. The project recommends that the Swedish Transport Administration: Discusses how threshold values for the growth of vegetation on railway embankments can be determined Carries out registration of the growth of vegetation over longer and a larger number of railway sections using one or more of the methods studied in the project Introduces a system that effectively matches the information about vegetation to its position Includes information about the growth of vegetation in the records that are currently maintained of the track’s technical quality, and link the data material to other maintenance-related databases Establishes a number of representative surfaces in which weed inventories (by measuring) are regularly conducted, as a means of developing an overview of the long-term development that can serve as a basis for more precise prognoses in terms of vegetation growth Ensures that necessary opportunities for education are put in place

The fall descriptions and health characteristics of older adults with hip fracture : a mixed methods study

Background: In light of the multifactorial etiology of fall-related hip fracture, knowledge of fall circumstances may be especially valuable when placed in the context of the health of the person who falls. We aimed to investigate the circumstances surrounding fall-related hip fractures and to describe fall circumstances in relation to participants' health and functional characteristics. Methods: The fall circumstances of 125 individuals (age >= 50 years) with hip fracture were investigated using semi-structured interviews. Data concerning participants' health (comorbidities and medications) and function (self-reported performance of mobility, balance, personal activities of daily living and physical activity, previous falls and hand grip strength) were collected via medical records, questionnaires and dynamometry. Using a mixed methods design, both data sets were analysed separately and then merged in order to provide a comprehensive description of fall events and identify eventual patterns in the data. Results: Fall circumstances were described as i) Activity at the time of the fall: Positional change (n = 24, 19%); Standing (n = 16, 13%); Walking (n = 71, 57%); Balance challenging (n = 14, 11%) and ii) Nature of the fall: Environmental (n = 32, 26%); Physiological (n = 35, 28%); Activity-related indoor (n = 8, 6%) and outdoor (n = 8, 6%); Trips and slips on snow (n = 20, 16%) and in snow-free conditions (n = 12, 10%) and Unknown (n = 10, 8%). We observed the following patterns regarding fall circumstances and participants' health: those who fell i) during positional change had the poorest functional status; ii) due to environmental reasons (indoors) had moderate physical function, but high levels of comorbidity and fall risk increasing medications; iii) in snow-free environments (outdoors) appeared to have a poorer health and functional status than other outdoor groups. Conclusions: Our findings indicate that patterns exist in relation to the falls circumstances and health characteristics of people with hip fracture which build upon that previously reported. These patterns, when verified, can provide useful information as to the ways in which fall prevention strategies can be tailored to individuals of varying levels of health and function who are at risk for falls and hip fracture.

Quantification of upper limb motor symptoms of Parkinson’s disease using a smartphone

Panda