Patient participation : what it is and what it is not

In general, patient participation is regarded as being informed and partaking in decision making regarding one’s care and treatment. This interpretation is common in legislation throughout the Western world and corresponding documents guiding health care professionals, as well as in scientific studies. Even though this understanding of the word participation can be traced to a growing emphasis on individuals’ autonomy in society and to certain dictionary defi nitions, there are other ways of understanding participation from a semantic point of view, and no trace of patients’ descriptions of what it is to participate can be found in these definitions. Hence, the aim of this dissertation was to understand patients’ experience of the phenomenon of patient participation. An additional aim was to understand patients’ experience of non-participation and to describe the conditions for patient participation and non-participation, in order to understand the prerequisites for patient participation. The dissertation comprises four papers. The philosophical ideas of Ricoeur provided a basis for the studies: how communication can present ways to understand and explain experiences of phenomena through phenomenological hermeneutics. The first and second studies involved a group of patients living with chronic heart failure. For the fi rst study, 10 patients were interviewed, with a narrative approach, about their experience of participation and non-participation, as defi ned by the participants. For the second study, 11 visits by three patients at a nurse-led outpatient clinic were observed, and consecutive interviews were performed with the patients and the nurses, investigating what they experience as patient participation and non-participation. A triangulation of data was performed to analyse the occurrence of the phenomena in the observed visits. For paper 3 and 4, a questionnaire was developed and distributed among a diverse group of people who had recent experience of being patients. The questionnaire comprised respondent’s description of what patient participation is, using items based on findings in Study 1, along with open-ended questions for additional aspects and general issues regarding situations in which the respondent had experienced patient participation and/or non-participation. The findings show additional aspects to patient participation: patient participation is being provided with information and knowledge in order for one to comprehend one’s body, disease, and treatment and to be able to take self-care actions based on the context and one’s values. Participation was also found to include providing the information and knowledge one has about the experience of illness and symptoms and of one’s situation. Participation occurs when being listened to and being recognised as an individual and a partner in the health care team. Non-participation, on the other hand, occurs when one is regarded as a symptom, a problem to be solved. To avoid non-participation, the information provided needs to be based on the individual’s need and with recognition of the patient’s knowledge and context. In conclusion, patient participation needs to be reconsidered in health care regulations and in clinical settings: patients’ defi nitions of participation, found to be close to the dictionaries’ description of sharing, should be recognised and opportunities provided for sharing knowledge and experience in two-way-communication.

Dialekter och röstigenkänning : Ett röstigenkännings-API:s förmåga att uppfatta svenska dialekters kännetecken och röstkombinationer

Allt eftersom utvecklingen går framåt inom applikationer och system så förändras också sättet på vilket vi interagerar med systemet på. Hittills har navigering och användning av applikationer och system mestadels skett med händerna och då genom mus och tangentbord. På senare tid så har navigering via touch-skärmar och rösten blivit allt mer vanligt. Då man ska styra en applikation med hjälp av rösten är det viktigt att vem som helst kan styra applikationen, oavsett vilken dialekt man har. För att kunna se hur korrekt ett röstigenkännings-API (Application Programming Interface) uppfattar svenska dialekter så initierades denna studie med dokumentstudier om dialekters kännetecken och ljudkombinationer. Dessa kännetecken och ljudkombinationer låg till grund för de ord vi valt ut till att testa API:et med. Varje dialekt fick alltså ett ord uppbyggt för att vara extra svårt för API:et att uppfatta när det uttalades av just den aktuella dialekten. Därefter utvecklades en prototyp, närmare bestämt en android-applikation som fungerade som ett verktyg i datainsamlingen. Då arbetet innehåller en prototyp och en undersökning så valdes Design and Creation Research som forskningsstrategi med datainsamlingsmetoderna dokumentstudier och observationer för att få önskat resultat. Data samlades in via observationer med prototypen som hjälpmedel och med hjälp av dokumentstudier. Det empiriska data som registrerats via observationerna och med hjälp av applikationen påvisade att vissa dialekter var lättare för API:et att uppfatta korrekt. I vissa fall var resultaten väntade då vissa ord uppbyggda av ljudkombinationer i enlighet med teorin skulle uttalas väldigt speciellt av en viss dialekt. Ibland blev det väldigt låga resultat på just dessa ord men i andra fall förvånansvärt höga. Slutsatsen vi drog av detta var att de ord vi valt ut med en baktanke om att de skulle få låga resultat för den speciella dialekten endast visade sig stämma vid två tillfällen. Det var istället det ord innehållande sje- och tje-ljud som enligt teorin var gemensamma kännetecken för alla dialekter som fick lägst resultat överlag.

What affects recognition most – wrong wordstress or wrong word accent?

In an attempt to find out which of the two Swedish prosodic contrasts of 1) wordstress pattern and 2) tonal word accent category has the greatest communicative weight, a lexical decision experiment was conducted: in one part word stress pattern was changed from trochaic to iambic, and in the other part trochaic accentII words were changed to accent I.Native Swedish listeners were asked to decide whether the distorted words werereal words or ‘non-words’. A clear tendency is that listeners preferred to give more‘non-word’ responses when the stress pattern was shifted, compared to when wordaccent category was shifted. This could have implications for priority of phonological features when teaching Swedish as a second language.

Traffic and Road Sign Recognition

This thesis presents a system to recognise and classify road and traffic signs for the purpose of developing an inventory of them which could assist the highway engineers’ tasks of updating and maintaining them. It uses images taken by a camera from a moving vehicle. The system is based on three major stages: colour segmentation, recognition, and classification. Four colour segmentation algorithms are developed and tested. They are a shadow and highlight invariant, a dynamic threshold, a modification of de la Escalera’s algorithm and a Fuzzy colour segmentation algorithm. All algorithms are tested using hundreds of images and the shadow-highlight invariant algorithm is eventually chosen as the best performer. This is because it is immune to shadows and highlights. It is also robust as it was tested in different lighting conditions, weather conditions, and times of the day. Approximately 97% successful segmentation rate was achieved using this algorithm.Recognition of traffic signs is carried out using a fuzzy shape recogniser. Based on four shape measures - the rectangularity, triangularity, ellipticity, and octagonality, fuzzy rules were developed to determine the shape of the sign. Among these shape measures octangonality has been introduced in this research. The final decision of the recogniser is based on the combination of both the colour and shape of the sign. The recogniser was tested in a variety of testing conditions giving an overall performance of approximately 88%.Classification was undertaken using a Support Vector Machine (SVM) classifier. The classification is carried out in two stages: rim’s shape classification followed by the classification of interior of the sign. The classifier was trained and tested using binary images in addition to five different types of moments which are Geometric moments, Zernike moments, Legendre moments, Orthogonal Fourier-Mellin Moments, and Binary Haar features. The performance of the SVM was tested using different features, kernels, SVM types, SVM parameters, and moment’s orders. The average classification rate achieved is about 97%. Binary images show the best testing results followed by Legendre moments. Linear kernel gives the best testing results followed by RBF. C-SVM shows very good performance, but ?-SVM gives better results in some case.

Differences in muscle activity during hand dexterity tasks between women with arthritis and a healthy reference group

Background. Impaired hand function is common in patients with arthritis and it affects performance of daily activities; thus, hand exercises are recommended. There is little information on the extent to which the disease affects activation of the flexor and extensor muscles during these hand-dexterity tasks. The purpose of this study was to compare muscle activation during such tasks in subjects with arthritis and in a healthy reference group. Methods. Muscle activation was measured in m. extensor digitorium communis (EDC) and in m. flexor carpi radialis (FCR) with surface electromyography (EMG) in women with rheumatoid arthritis (RA, n = 20), hand osteoarthritis (HOA, n = 16) and in a healthy reference group (n = 20) during the performance of four daily activity tasks and four hand exercises. Maximal voluntary isometric contraction (MVIC) was measured to enable intermuscular comparisons, and muscle activation is presented as %MVIC. Results. The arthritis group used a higher %MVIC than the reference group in both FCR and EDC when cutting with a pair of scissors, pulling up a zipper and—for the EDC—also when writing with a pen and using a key (p < 0.02). The exercise “rolling dough with flat hands” required the lowest %MVIC and may be less effective in improving muscle strength. Conclusions. Women with arthritis tend to use higher levels of muscle activation in daily tasks than healthy women, and wrist extensors and flexors appear to be equally affected. It is important that hand training programs reflect real-life situations and focus also on extensor strength.

The hand of God is over their hands (Q. 48:10) : on the notion of covenant in al-Ṭabarī’s account of Karbalāʾ

This article is an analysis of the story of the killing of Ḥusayn b. ʿAlī at Karbalāʾ in 61/680, as it is presented by Abū Jaʿfar Muḥammad b. Jarīr al-Ṭabarī (d. 310/923). The main argument is that the notion of the divine covenant, which permeates the Qur’an, constitutes a framework through which al-Ṭabarī views this event. The Qur’anic idea of the covenant is read in structural/thematic continuity with the Hebrew Bible account of the covenant between Yahweh and the Hebrew people, which has, in turn, been traced back in its basic form to Late Bronze Era treaties between rulers and their vassals.   The present study focusses on four speeches ascribed to Ḥusayn during the encounter he and his group had with the vanguard of the Kūfan army led by al-Ḥurr. These are analysed in accordance with their use of Qur’anic covenant vocabulary. They are also categorised within the broader framework of the eight standard characteristics of Ancient West Asian and Biblical covenants, as presented by George Mendenhall and Gary Herion, which have recently been developed in a Qur’anic context by Rosalind Ward Gwynne. This article argues that al-Ṭabarī’s Karbalāʾ narrative presents the pact of loyalty to Ḥusayn as a clear extension of the divine covenant.