A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol

Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment. Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment. Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family. Trial registration: Current controlled trials: ISRCTN22444034

Mother’s experiences and perceptions of a continuous caring model with fathers after caesarean section : a qualitative study

Background: In Chile, mothers and newborns are separated after caesarean sections. The caesarean section rate in Chile is approximately 40%. Once separated, newborns will miss out on the benefits of early contact unless a suitable model of early newborn contact after caesarean section is initiated. Aim: To describe mothers experiences and perceptions of a continuous parental model of newborn care after caesarean section during mother-infant separation. Methods: A questionnaire with 4 open ended questions to gather data on the experiences and perceptions of 95 mothers in the obstetric service of Sótero Del Rio Hospital in Chile between 2009 and 2012. Data were analyzed using qualitative content analysis. Results: One theme family friendly practice after caesarean section and four categories. Mothers described the benefits of this model of caring. The fathers presence was important to mother and baby. Mothers were reassured that the baby was not left alone with staff. It was important for the mothers to see that the father could love the baby as much as the mother. This model of care helped create ties between the father and newborn during the period of mother-infant separation and later with the mother. Conclusions: Family friendly practice after caesarean section was an important health care intervention for the whole family. This model could be stratified in the Chilean context in the case of complicated births and all caesarean sections. Clinical Implications: In the Chilean context, there is the potential to increase the number of parents who get to hold their baby immediately after birth and for as long as they like. When the mother and infant are separated after birth, parents can be informed about the benefits of this caring model. Further research using randomized control trials may support biological advantages.

An Experimental Study of Submerged Entry Nozzles (SEN) Focusing on Decarburization and Clogging

The submerged entry nozzle (SEN) is used to transport the molten steel from a tundish to a mould. The main purpose of its usage is to prevent oxygen and nitrogen pick-up by molten steel from the gas. Furthermore, to achieve the desired flow conditions in the mould. Therefore, the SEN can be considered as a vital factor for a stable casting process and the steel quality. In addition, the steelmaking processes occur at high temperatures around 1873 K, so the interaction between the refractory materials of the SEN and molten steel is unavoidable. Therefore, the knowledge of the SEN behaviors during preheating and casting processes is necessary for the design of the steelmaking processes  The internal surfaces of modern SENs are coated with a glass/silicon powder layer to prevent the SEN graphite oxidation during preheating. The effects of the interaction between the coating layer and the SEN base refractory materials on clogging were studied. A large number of accretion samples formed inside alumina-graphite clogged SENs were examined using FEG-SEM-EDS and Feature analysis. The internal coated SENs were used for continuous casting of stainless steel grades alloyed with Rare Earth Metals (REM). The post-mortem study results clearly revealed the formation of a multi-layer accretion. A harmful effect of the SENs decarburization on the accretion thickness was also indicated. In addition, the results indicated a penetration of the formed alkaline-rich glaze into the alumina-graphite base refractory. More specifically, the alkaline-rich glaze reacts with graphite to form a carbon monoxide gas. Thereafter, dissociation of CO at the interface between SEN and molten metal takes place. This leads to reoxidation of dissolved alloying elements such as REM (Rare Earth Metal). This reoxidation forms the “In Situ” REM oxides at the interface between the SEN and the REM alloyed molten steel. Also, the interaction of the penetrated glaze with alumina in the SEN base refractory materials leads to the formation of a high-viscous alumina-rich glaze during the SEN preheating process. This, in turn, creates a very uneven surface at the SEN internal surface. Furthermore, these uneven areas react with dissolved REM in molten steel to form REM aluminates, REM silicates and REM alumina-silicates. The formation of the large “in-situ” REM oxides and the reaction of the REM alloying elements with the previously mentioned SEN´s uneven areas may provide a large REM-rich surface in contact with the primary inclusions in molten steel. This may facilitate the attraction and agglomeration of the primary REM oxide inclusions on the SEN internal surface and thereafter the clogging. The study revealed the disadvantages of the glass/silicon powder coating applications and the SEN decarburization. The decarburization behaviors of Al2O3-C, ZrO2-C and MgO-C refractory materials from a commercial Submerged Entry Nozzle (SEN), were also investigated for different gas atmospheres consisting of CO2, O2 and Ar. The gas ratio values were kept the same as it is in a propane combustion flue gas at different Air-Fuel-Ratio (AFR) values for both Air-Fuel and Oxygen-Fuel combustion systems. Laboratory experiments were carried out under nonisothermal conditions followed by isothermal heating. The decarburization ratio (α) values of all three refractory types were determined by measuring the real time weight losses of the samples. The results showed the higher decarburization ratio (α) values increasing for MgO-C refractory when changing the Air-Fuel combustion to Oxygen-Fuel combustion at the same AFR value. It substantiates the SEN preheating advantage at higher temperatures for shorter holding times compared to heating at lower temperatures during longer holding times for Al2O3-C samples. Diffusion models were proposed for estimation of the decarburization rate of an Al2O3-C refractory in the SEN. Two different methods were studied to prevent the SEN decarburization during preheating: The effect of an ZrSi2 antioxidant and the coexistence of an antioxidant additive and a (4B2O3 ·BaO) glass powder on carbon oxidation for non-isothermal and isothermal heating conditions in a controlled atmosphere. The coexistence of 8 wt% ZrSi2 and 15 wt% (4B2O3 ·BaO) glass powder of the total alumina-graphite refractory base materials, presented the most effective resistance to carbon oxidation. The 121% volume expansion due to the Zircon formation during heating and filling up the open pores by a (4B2O3 ·BaO) glaze during the green body sintering led to an excellent carbon oxidation resistance. The effects of the plasma spray-PVD coating of the Yttria Stabilized Zirconia (YSZ) powder on the carbon oxidation of the Al2O3-C coated samples were investigated. Trials were performed at non-isothermal heating conditions in a controlled atmosphere. Also, the applied temperature profile for the laboratory trials were defined based on the industrial preheating trials. The controlled atmospheres consisted of CO2, O2 and Ar. The thicknesses of the decarburized layers were measured and examined using light optic microscopy, FEG-SEM and EDS. A 250-290 μm YSZ coating is suggested to be an appropriate coating, as it provides both an even surface as well as prevention of the decarburization even during heating in air. In addition, the interactions between the YSZ coated alumina-graphite refractory base materials in contact with a cerium alloyed molten stainless steel were surveyed. The YSZ coating provided a total prevention of the alumina reduction by cerium. Therefore, the prevention of the first clogging product formed on the surface of the SEN refractory base materials. Therefore, the YSZ plasma-PVD coating can be recommended for coating of the hot surface of the commercial SENs.

A therapy dog's impact on daytime activity and night-time sleep for older persons with Alzheimer's disease : a case study

Background: Animal-Assisted Therapy using dogs have been described as having a calming effect, decrease sundowning and blood-pressure in persons with Alzheimer’s disease. The aim was to investigate how continuous and scheduled visits by a prescribed therapy dog affected daytime and night-time sleep for persons with Alzheimer’s disease. Methods: In this case study, registration of activity and sleep curves was conducted from five persons with moderate to severe Alzheimer’s disease living at a nursing home, over a period of 16 weeks using an Actiwatch. Data was analysed with descriptive statistics. Result: The study shows no clear pattern of effect on individual persons daytime activity and sleep when encounter with a therapy dog, but instead points to a great variety of possible different effects that brings an increased activity at different time points, for example during night-time sleep. Conclusions: Effects from the use of a Animal-Assisted Therapy with a dog in the care of persons with Alzheimer’s disease needs to be further investigated and analysed from a personcentred view including both daytime and nightime activities.

Continuous Delivery : Utmaningar ett förvaltningsuppdrag kan stå inför vid en övergång till Continuous Delivery

Continuous delivery (CD) is a software engineering approach where the focus lays on creating a short delivery cycle by automating parts of the deployment pipeline which includes build, deploy-, test and release process. CD is based on that during development should be possible to always automatically generate a release based on the source code in its current state. One of CD's many advantages is that through continuous releases it allows you to get a quick feedback loop leading to faster and more efficient implementation of new functions, at the same time fixing errors. Although CD has many advantages, there are also several challenges a maintenance management project must manage in the transition to CD. These challenges may differ depending on the maturity level for a maintenance management project and what strengths and weaknesses the project has. Our research question was: "What challenges can a maintenance management project face in transition to Continuous delivery?" The purpose of this study is to describe Continuous delivery and the challenges a maintenance management project may face during a transition to Continuous delivery. A descriptive case study has been carried out with the data collection methods of interviews and documents. A situation analysis was created based on the collected data in a shape of a process model that represent the maintenance management projects release process. The processmodel was used as the basis of SWOT analysis and analysis by Rehn et al's Maturity Model. From these analyzes we found challenges of a maintenance management project may face in the transition to CD. The challenges are about customers and the management's attitude towards a transition to CD. But the biggest challenge is about automation of the deployment pipeline steps.