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).

Rollbaserad åtkomstkontroll med geografisk avgränsning : En systematisk litteraturgenomgång av det befintliga kunskapstillståndet inom ämnesområdet

Rollbaserad åtkomstkontroll är en standardiserad och väl etablerad modell för att hantera åtkomsträttigheter i informationssystem. Den vedertagna ANSI-standarden 359-2004 saknar dock stöd för att geografiskt avgränsa rollbehörigheter. Informationssystem som behandlar geografiska data och de senaste årens ökade spridning av mobila enheter påkallar ett behov av att sådana rumsliga aspekter diskuteras inom kontexten av rollbaserad åtkomstkontroll. Arbetet syftar till att bringa klarhet i hur det befintliga kunskapstillståndet inom ämnesområdet rollbaserad åtkomst kontroll med geografisk avgränsning ser ut, och vilka aspekter hos detta som står i behov av vidare utveckling. Genom de teoretiska referensramar som skapats vid inledande litteraturstudier har en efterföljande systematisk litteraturgenomgång möjliggjorts, där vetenskapligt material selekterats genom fördefinierade urvalskriterier. Sammanställningen och analysen av den systematiska litteraturgenomgångens resultat har i samverkan med de teoretiska referensramarna lett fram till arbetets huvudsakliga kunskapsbidrag: en områdesöversikt där ämnets state-of-the-art presenteras och en strukturerad lista över angelägna forsknings- och utvecklingsbehov inom området.

Kassettbandet: Den gåtfulla överlevaren får ett uppsving?

Sedan kassettbandet trängdes undan av CD:n under 90-talet har det fört en alltmer tynande tillvaro, fram tills att det relativt nyligen började uppstå små oberoende musikbolag som helt eller delvis släpper begränsade albumupplagor på kassett och en del rykten började gå att kassettbandet var på väg tillbaka. Även större band och skivbolag hakade på trenden och släppte större upplagor av vissa få utvalda album på just kassettband. Kan det vara möjligt att detta gamla och uträknade medium håller på att få en renässans i vår digitala guldålder? De förklaringsmodeller och teoretiska begrepp jag använt mig för att förklara detta fenomen är Nostalgi, Analogisering och Nätverkande. I ett stort antal artiklar och debatter ges olika svar och synpunkter på kassettbandets eventuella gåtfulla comeback och denna uppsats är tänkt att fungera som en slags kompassnål som pekar ut en riktning till följd av det material jag har tillgodogjort mig och redovisat i denna uppsats. Här återfinns också ett antal intervjuer med både privatpersoner och skivbutiker som fördjupar och resonerar kring orsak och verkan kring kassettfenomenet. De önskvärda hårda data och tillgänglig och tydlig statistik lyser med sin frånvaro då kassettband sällan återfinns på några listor eller mätningar eftersom de aldrig fick någon högre status trots sin enorma spridning, till skillnad mot vinylskivor och CD. Med denna uppsats görs ett försök att sammanställa en bild av denna övervintrade dinosaurie till audioformat och får, åtminstone delvis, en förklaring till sin egen överlevnad.

A Unified Framework for e-Commerce Systems Development : Business Process Pattern Perspective

In electronic commerce, systems development is based on two fundamental types of models, business models and process models. A business model is concerned with value exchanges among business partners, while a process model focuses on operational and procedural aspects of business communication. Thus, a business model defines the what in an e-commerce system, while a process model defines the how. Business process design can be facilitated and improved by a method for systematically moving from a business model to a process model. Such a method would provide support for traceability, evaluation of design alternatives, and seamless transition from analysis to realization. This work proposes a unified framework that can be used as a basis to analyze, to interpret and to understand different concepts associated at different stages in e-Commerce system development. In this thesis, we illustrate how UN/CEFACT’s recommended metamodels for business and process design can be analyzed, extended and then integrated for the final solutions based on the proposed unified framework. Also, as an application of the framework, we demonstrate how process-modeling tasks can be facilitated in e-Commerce system design. The proposed methodology, called BP3 stands for Business Process Patterns Perspective. The BP3 methodology uses a question-answer interface to capture different business requirements from the designers. It is based on pre-defined process patterns, and the final solution is generated by applying the captured business requirements by means of a set of production rules to complete the inter-process communication among these patterns.

Towards Automation in Digital Investigations : Seeking Efficiency in Digital Forensics in Mobile and Cloud Environments

Cybercrime and related malicious activity in our increasingly digital world has become more prevalent and sophisticated, evading traditional security mechanisms. Digital forensics has been proposed to help investigate, understand and eventually mitigate such attacks. The practice of digital forensics, however, is still fraught with various challenges. Some of the most prominent of these challenges include the increasing amounts of data and the diversity of digital evidence sources appearing in digital investigations. Mobile devices and cloud infrastructures are an interesting specimen, as they inherently exhibit these challenging circumstances and are becoming more prevalent in digital investigations today. Additionally they embody further characteristics such as large volumes of data from multiple sources, dynamic sharing of resources, limited individual device capabilities and the presence of sensitive data. These combined set of circumstances make digital investigations in mobile and cloud environments particularly challenging. This is not aided by the fact that digital forensics today still involves manual, time consuming tasks within the processes of identifying evidence, performing evidence acquisition and correlating multiple diverse sources of evidence in the analysis phase. Furthermore, industry standard tools developed are largely evidence-oriented, have limited support for evidence integration and only automate certain precursory tasks, such as indexing and text searching. In this study, efficiency, in the form of reducing the time and human labour effort expended, is sought after in digital investigations in highly networked environments through the automation of certain activities in the digital forensic process. To this end requirements are outlined and an architecture designed for an automated system that performs digital forensics in highly networked mobile and cloud environments. Part of the remote evidence acquisition activity of this architecture is built and tested on several mobile devices in terms of speed and reliability. A method for integrating multiple diverse evidence sources in an automated manner, supporting correlation and automated reasoning is developed and tested. Finally the proposed architecture is reviewed and enhancements proposed in order to further automate the architecture by introducing decentralization particularly within the storage and processing functionality. This decentralization also improves machine to machine communication supporting several digital investigation processes enabled by the architecture through harnessing the properties of various peer-to-peer overlays. Remote evidence acquisition helps to improve the efficiency (time and effort involved) in digital investigations by removing the need for proximity to the evidence. Experiments show that a single TCP connection client-server paradigm does not offer the required scalability and reliability for remote evidence acquisition and that a multi-TCP connection paradigm is required. The automated integration, correlation and reasoning on multiple diverse evidence sources demonstrated in the experiments improves speed and reduces the human effort needed in the analysis phase by removing the need for time-consuming manual correlation. Finally, informed by published scientific literature, the proposed enhancements for further decentralizing the Live Evidence Information Aggregator (LEIA) architecture offer a platform for increased machine-to-machine communication thereby enabling automation and reducing the need for manual human intervention.

E-Government Collaboration in the Swedish Public Sector : Multiple Studies on Collaboration Facilitators and Collaboration Modes

Collaboration in the public sector is imperative to achieve e-government objectives such as improved efficiency and effectiveness of public administration and improved quality of public services. Collaboration across organizational and institutional boundaries requires public organizations to share e-government systems and services through for instance, interoperable information technology and processes. Demands on public organizations to become more open also require that public organizations adopt new collaborative approaches for inviting and engaging citizens in governmental activities. E-government related collaboration in the public sector is challenging, however, and collaboration initiatives often fail. Public organizations need to learn how to collaborate since forms of e-government collaboration and expected outcomes are mostly unknown. How public organizations can collaborate and the expected outcomes are thus investigated in this thesis by studying multiple collaboration cases on the acquisition and implementation of a particular e-government investment (digital archive). This thesis also investigates how e-government collaboration can be facilitated through artifacts. It is done through a case study, where objects that cross boundaries between collaborating communities in the public sector are studied, and by designing a configurable process model integrating several processes for social services. By using design science, this thesis also investigates how an m-government solution that facilitates collaboration between citizens and public organizations can be designed. The thesis contributes to literature through describing five different modes of interorganizational collaboration in the public sector and the expected benefits from each mode. It also contributes with an instantiation of a configurable process model supporting three open social e-services and with evidence of how it can facilitate collaboration. This thesis further describes how boundary objects facilitate collaboration between different communities in an open government design initiative. It contributes with a designed mobile government solution, thereby providing proof of concept and initial design implications for enabling collaboration with citizens through citizen sourcing (outsourcing a governmental activity to citizens through an open call). This thesis also identifies research streams within e-government collaboration research through a literature review and the thesis contributions are related to the identified research streams. This thesis gives directions for future research by suggesting that future research should focus further on understanding e-government collaboration and how information and communication technology can facilitate collaboration in the public sector. It is suggested that further research should investigate m-government solutions to form design theories. Future research should also examine how value can be co-created in e-government collaboration.

Tech Fashion : Fashion Institutionalization in Digital Technology

This thesis explores aesthetization in general and fashion in particular in digital technology design and how we can design digital technology to account for the extended influences of fashion. The thesis applies a combination of methods to explore the new design space at the intersection of fashion and technology. First, it contributes to theoretical understandings of aesthetization and fashion institutionalization that influence digital technology design. We show that there is an unstable aesthetization in mobile design and the increased aesthetization is closely related to the fashion industry. Fashion emerged through shared institutional activities, which are usually in the form of action nets in the design of digital devices. “Tech Fashion” is proposed to interpret such dynamic action nets of institutional arrangements that make digital technology fashionable and desirable. Second, through associative design research, we have designed and developed two prototypes that account for institutionalized fashion values, such as the concept “outfit-centric accessory.” We call for a more extensive collaboration between fashion design and interaction design.

Second-Order Risk Constraints

This paper discusses how numerically imprecise information can be modelled and how a risk evaluation process can be elaborated by integrating procedures for numerically imprecise probabilities and utilities. More recently, representations and methods for stating and analysing probabilities and values (utilities) with belief distributions over them (second order representations) have been suggested. In this paper, we are discussing some shortcomings in the use of the principle of maximising the expected utility and of utility theory in general, and offer remedies by the introduction of supplementary decision rules based on a concept of risk constraints taking advantage of second-order distributions.

Improving Readability of Swedish Electronic Health Records through Lexical Simplification : First Results

This paper describes part of an ongoing effort to improve the readability of Swedish electronic health records (EHRs). An EHR contains systematic documentation of a single patient’s medical history across time, entered by healthcare professionals with the purpose of enabling safe and informed care. Linguistically, medical records exemplify a highly specialised domain, which can be superficially characterised as having telegraphic sentences involving displaced or missing words, abundant abbreviations, spelling variations including misspellings, and terminology. We report results on lexical simplification of Swedish EHRs, by which we mean detecting the unknown, out-ofdictionary words and trying to resolve them either as compounded known words, abbreviations or misspellings.

Layering the Internet-of-Things with Multicasting in Flow-sensors for Internet-of-services

Development of Internet-of-Services will be hampered by heterogeneous Internet-of-Things infrastructures, such as inconsistency in communicating with participating objects, connectivity between them, topology definition & data transfer, access via cloud computing for data storage etc. Our proposed solutions are applicable to a random topology scenario that allow establishing of multi-operational sensor networks out of single networks and/or single service networks with the participation of multiple networks; thus allowing virtual links to be created and resources to be shared. The designed layers are context-aware, application-oriented, and capable of representing physical objects to a management system, along with discovery of services. The reliability issue is addressed by deploying IETF supported IEEE 802.15.4 network model for low-rate wireless personal networks. Flow- sensor succeeded better results in comparison to the typical - sensor from reachability, throughput, energy consumption and diversity gain viewpoint and through allowing the multicast groups into maximum number, performances can be improved.

Faktorer som påverkar omvårdnaden av patienter från olika kulturer inom palliativ vård – en litteraturöversikt

När befolkningen i Sverige blir allt äldre kommer det bland annat leda till ett ökat sjukvårdsbehov. I genomsnitt har människor födda i länder långt från Norden sämre hälsa än personer födda inom Norden, de kan ha en annan kultur och tolka kommunikationen inom vården annorlunda. Syfte: Att beskriva faktorer som påverkar omvårdnaden av patienter och anhöriga från andra kulturer inom palliativ vård. Metod: En litteraturöversikt. Resultat: Är baserat på nio vetenskapliga artiklar. Det fanns kulturella skillnader i synen på allvarlig sjukdom och död. Inom flera kulturer är det tabubelagt att tala om döden och detta var sjuksköterskorna inom västerländsk kultur oerfarna vid, de var mer vana vid en rak och ärlig kommunikation med patienterna. Sjuksköterskorna hade kommunikationssvårigheter med patienter och närstående då de inte hade samma språk. Det var även svårt och tidskrävande att finna lämpliga tolkar som kunde hantera känsliga ämnen relaterat till palliativ vård. Konklusion: Sjuksköterskor upplevde att möten med patienter och anhöriga från andra kulturer ofta var svåra om de inte pratade samma språk. Trots detta upplevde sjuksköterskorna arbetet som tillfredsställande. Det framkom att för lite tid och stress var ett av problemen samt att behovet av tolkar var stort.

Running economy and blood lactate accumulation in elite football players with high and low maximal aerobic power

The purpose was to determine running economy and lactate threshold among a selection of male elite football players with high and low aerobic power. Forty male elite football players from the highest Swedish division (“Allsvenskan”) participated in the study. In a test of running economy (RE) and blood lactate accumulation the participants ran four minutes each at 10, 12, 14, and 16 km•h-1 at horizontal level with one minute rest in between each four minutes interval. After the last sub-maximal speed level the participants got two minutes of rest before test of maximal oxygen uptake (VO2max). Players that had a maximal oxygen uptake lower than the average for the total population of 57.0 mL O2•kg-1•minute-1 were assigned to the low aerobic power group (LAP) (n=17). The players that had a VO2max equal to or higher than 57.0 mL O2•kg-1•minute-1 were selected for the high aerobic power group (HAP) (n=23). The VO2max was significantly different between the HAP and LAP group. The average RE, measured as oxygen uptake at 12, 14 and 16km•h-1 was significantly lower but the blood lactate concentration was significantly higher at 14 and 16 km•h-1 for theLAP group compared with the HAP group.