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USA Cycling, Inc. Governance & Election Info
- Amended and Restated Bylaws of USA Cycling, Inc. — Aug. 11, 2017
- Second Amended and Restated Articles of Incorporation — July 13, 2011
USA Cycling Election Overview
Each year, USA Cycling holds elections among our license holders for various positions on our sport committees. Members can vote for candidates in their various constituent groups. Sport committee terms are for two years for non-athletes and four years for athletes, and the positions are staggered such that there are elections for various positions held every year.
Nominations notices are usually published in May and voting begins later in the summer.
Election Information and Eligibility Guidelines
USA Cycling Board of Directors
National Technical Commission
The National Technical Commission (NTC) serves in an advisory function to the Technical Director and to the Chief Executive Officer of USA Cycling on issues relating to rules and regulations, officiating at the national level, and to communicate national policies relating to officiating to district- and regional-level organizations.
Sport Committees
The seven sport committees (Road, Mountain Bike, Professional, BMX, Collegiate, Track, and Cyclo-cross) were created in 2011 when the USA Cycling Board of Directors approved a revised organizational governance structure with the goal of ensuring the bylaws and operating principles of the company accurately reflect the current business models of the sport today and for the foreseeable future.
The role of the sport committees is to serve in an advisory capacity and work with USA Cycling staff to develop competition rules and consider issues relevant to their respective discipline. Each sport committee will also nominate and elect representatives to the USA Cycling Board of Directors. Representation on sport committees is based on membership categories rather than by region, allowing all of the stakeholders in our sport to have a more relevant and consistent role in the development and growth of each specific discipline.
- Policy I. Helmets
- Policy II. Medical Control
- Policy III. Administrative Grievances
- Policy IV. Officials Assignments
- Policy IVa. Nepotism
- Policy V. Officials Code of Ethics
- Policy VI. Race Permits and Race Director Responsibilities
- Policy VII. Transgender Athletes/IOC Transgender Guidelines
This Article Updated August 23, 2017 @ 03:53 PM For more information contact:


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The trial of George Zimmerman in the shooting death of Miami Gardens teen Trayvon Martin will begin June 10, his attorneys said Wednesday.
Zimmerman, 29, is charged with second-degree murder for fatally shooting Martin, 17, during a confrontation in a gated community in Sanford last February. Zimmerman is pleading not guilty, claiming self-defense.
Zimmerman's attorneys said there are still several unresolved pretrial matters to complete and another status hearing is set for Dec. 10.
U.S. & World
Stories that affect your life across the U.S. and around the world.
The attorneys also posted on Twitter that a self-defense immunity hearing is likely to be requested for early April or May.
Attorney Mark O'Mara estimated he expects the trial to last three weeks.
They'll be back in court Friday for what is expected to be a lengthy hearing for arguments on several motions, including the defense asking for more time to interview state witnesses.

subset: commoncrawl


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Five black helicopters conduct special ops in LA
Steve Watson
January 26, 2012
Video was captured last night of five military helicopters buzzing over downtown LA, conducting what the LAPD has described as a special ops urban warfare drill.
The footage, captured by CBS Los Angeles, shows a huge Black Hawk helicopter hovering over the US bank building along with four other OH-6 choppers, known as "Little Birds".
CBS reporters noted seeing the Black Hawk conduct a drop off in a nearby park before taking to the sky above LA again.
The helicopters, staged at Dodger Stadium throughout the exercise, were later spotted flying low over the Staples Center as the LA Lakers played inside.
Watch the footage below:
Former U.S. Army aviator David Duran was told CBS affiliate KCAL9 News that the training is likely a dry run for a future mission.
"They do a lot of mockup training," said Duran. "But it's always best to get the closest terrain layout to what the objective is."
"If it's a mountainous terrain, they go to the mountains; if it's a desert terrain, they use the desert; if they're in a coastal terrain, they use the coast," said Duran. "If it's an urban terrain, you know, whatever's needed."
As we highlighted Wednesday, a statement issued Monday by the LAPD, says that the exercises, closed to the public, are "designed to ensure the military's ability to operate in urban environments, prepare forces for upcoming overseas deployments, and meet mandatory training certification requirements."
Training sites "have been carefully selected to ensure the event does not negatively impact the citizens of Los Angeles and their daily routine," a department spokesperson said.
The drill is set to continue through Thursday.
The exercise is yet another in a spate of recent military drills to hit heavily populated areas throughout the country.
Back in April last year, residents of Brickell, Miami witnessed at least three large Black Hawk-like helicopters conducting military exercises over their heads. Some initially believed it was a movie shoot.
Further exercises of the same nature were reported in Boston in August:
Steve Watson is the London based writer and editor for Alex Jones' Infowars.net, and Prisonplanet.com. He has a Masters Degree in International Relations from the School of Politics at The University of Nottingham in England.
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Roof Repair in Grandy, Minnesota
A roof is constantly exposed to the sun, strong winds, and other harsh weather conditions. Over time, all of these elements can damage the surface of your roof. WeatherTek Exteriors, Isanti County's roof repair professionals, have been repairing Grandy roofs since 2000. We are Minnesota licensed, bonded, and insured to provide top quality roofing services in Grandy, Minnesota. All of our roofers are Minnesota certified to provide Grandy residential roof repair. Call (763) 308-5112 for a comprehensive, no-cost Grandy roof repair estimate.
Call for a Quote!
WeatherTek Exteriors's Grandy Roof Repair is Less Expensive than Roof Replacement
Worn, cracked, or curled shingles need to be repaired quickly to minimize the potential for more extensive damage to your Grandy roof and even your home's interior. The longer you wait to replace the damaged portion of your roof, the more likely it is that you will have costly secondary damage. Once a Grandy roof surface has been compromised, your roof is at risk for rotted sheathing and structural damage. Secondary damage can include damage to your home's interior. Once water seeps beyond the sheathing layer, there is a potential for mildew growth and water damage to ceiling and walls. If your roof has been damaged, call (763) 308-5112 for expert roof repair by the roofing professionals at WeatherTek Exteriors.
Professional Grandy Roofing Services by WeatherTek Exteriors
Grandy roof damage resulting from normal wear and tear, falling branches or trees, heavy snow, ice dams, fires, and even animals can be repaired by Grandy's roof repair specialists at WeatherTek Exteriors. If your Grandy roof damage is covered by your home owner's insurance policy, we can assist with the claims process to ensure that your claim is processed efficiently. WeatherTek Exteriors specializes in Grandy residential roof repair for all types of roofs, including asphalt or cedar shingles, tile, metal, and copper. Call (763) 308-5112 for expert residential roof repair in Grandy, Minnesota.
Call for FREE Roof Repair Quote
(763) 308-5112
Dial Area Code first please.
★★★★★ - "Great experience in dealing with Jerry and Adam to get my roof repaired. Awesome guys and will use them in future projects."
Jeff Bird , Roof Repair in Blaine, MN2019-07-19
★★★★★ - "I like everything, they fixed my house roofing. Looks good"
Ueland yang in Brooklyn Center, MN2018-07-31
★★★★★ - "During this recent hail storm, I had 2 homes affected that Randy was able to meet with my insurance adjuster & point out all the issues & got both covered. He's very responsive & professional & an all-around can do guy with a very positive attitude. He really wants to make his customers happy & it shows. I am a realtor & referred him to 2 clients from the same hail storm & both of them also were able to get their insurance to cover the hail claim & chose Randy & WeatherTek for the job. They both thanked me for the referral that they were very happy with his efforts & quality also. I'm glad to have someone as reliable & trustworthy as Randy that I can count on when it comes to roofs."
Julie S., Roof Repair in Anoka, MN2018-05-30
★★★★★ - "I reached out to WeatherTek on behalf of clients to get an estimate on roof repairs suggested from an Inspection Report. Jerry was able to come out the very next morning to take a look. He was honest about what needed to be fixed and really put our clients at ease. I'll definitely add him to our "preferred" list and call upon him for other roofing needs."
Katie S., Roof Repair in Champlin, MN2018-05-30
★★★★★ - "I had a significant roof leak resulting from some high winds during a recent storm (ripped shingles off my roof). Reached out to WeatherTek after a recommendation from a friend. Exemplary construction group! In the day-n-age where you often see hit or miss service,
it was great to have a team that:
1) was very good at communicating, and pro-active in their communication.
2) came out to inspect the damage on time
3) was on time for their appointment to fix my roof
4) made the whole process as hassle free as I could imagine it being
5) most importantly... did quality work!
Thanks again to the WeatherTek team and making this a great experience."
Ronald & Sheila A., Roof Repair in Ham Lake, MN2018-05-30
★★★★★ - "The WeatherTek team was very professional. They did an awesome job on my roof. He explained to me the product of shingles I was purchasing his crew did a fantastic clean up afterwards.......looks like they were never there. He gave me advice on my ceiling which was also damaged from the weather. I did the repair for my ceiling and with his advice it looks great. I admire his work so much I ask for some of his business cards to hand out. I highly recommend them. Thank you, WeatherTek and your crew for an outstanding job."
Patrick P., Roof Repair in Blaine, MN2018-05-30
★★★★★ - "We had the pleasure of working with Jerry throughout our hail damage claim. He was fun to work with and had a lot of knowledge. Ultimately we had our Roof and siding replaced, our home looks great. We would highly recommend using WeatherTek for any of your exterior projects. 5 out of 5 for overall experience."
Mary P., Roof Repair & Siding Repair in Brooklyn Park, MN2018-05-30
★★★★★ - "I was very impressed with Weathertek. They were very professional, arrived on time and were VERY honest. I was in a time crunch and needed my roof repairs completed by a specific date as my (new) homeowners' insurance was being canceled due to (sightings) by an agent indicating overgrowth of tree branches causing major granular loss and moss growing on roof shingles. Weathertek came out to survey the roof and saw no such granular loss caused by the tree branches; there was, however, (noticeable) moss growing. They wrote a statement I could send to my agent to get a different homeowner's policy with a different company. I had 50 to 60% of life left on the roof. Weathertek saved me $1500.00 in roof repairs which didn't need to be done. My husband took care of the moss. I would highly recommend this honest roofing company to anyone."
Cat in Champlin, MN2020-01-02
★★★★★ - "We had been experiencing a leak in the roof and water in our basement during heavy rains for a while. We hired WeatherTek to replace our roof and gutters. Not only does the roof look beautiful, but our leak and basement issues are also gone. We found Jerry and Cam to be very responsive and they addressed every concern we had, even when it wasn't directly related to the roof/gutters. They took the time to recaulk our front door, tap in the nails on our loose fascia, and even fixed our damaged 20-year old PVC fence (when other dedicated fencing companies had refused to take on the project). This was such a great experience after the nightmare we experienced with the company we hired for these projects 20 years ago. They will definitely be our go-to people for projects we will have going forward. We've already asked to have them pressure wash our house and fence and when it comes time in the next year or two, we'll be having them replace our aging deck. Highly recommend!"
Dawn Lewandowski, Storm Damage2019-07-19
★★★★★ - "Jerry made himself available via text, email, call, and in-person to answer all questions and concerns I had over the course my multi-stage project. Very professional, honest, and care about doing right by the customer."
Tara Schlomka, Roof Replacement in Blaine, MN2019-07-19
★★★★★ - "WeatherTek was very detailed, very professional, and when I had to contact them they answered on the first try and was more than happy to help me with my issues. Will definitely use them for any future projects."
Bryce Teinert, Roofing in Blaine, MN2019-07-19
★★★★★ - "Great Company, Honest and reliable."
Janice in Lino Lakes, MN2019-04-29
★★★★★ - "Jerry was very helpful and knowledgeable. Very friendly and professional. Great experience overall!"
Jim Egan in Brooklyn Center, MN2018-11-05
★★★★★ - "Our experience with Weathertek was wonderful. They were there when they said they would be and finished within the time period they stated. We would recommend WeatherTek to anyone who needs roofing done."
Anonymous in Brooklyn Park, MN2018-09-24
★★★★★ - "Very good! Fully satisfied and would recommend to anyone in need of exterior work"
Norman & Sheila Gast in Minneapolis, MN2018-08-20
★★★★★ - "Weather Tek, did a GREAT job roofing my Home. I have rarely ran into a contractor that made a job so seemless and did everything promised and more!!!"
Rodrigo Pierce, Roofing in Minneapolis, MN2018-07-11
★★★★★ - "It was the BEST experience ever! The WeatherTek Staff did a terrific job arranging everything for my new roof. The professionalism was amazing. Excellent quality materials and workmanship."
Sue Kotila, Roofing in Minneapolis, MN2018-07-09
★★★★★ - "In the process of selling our house we discovered hail damage and needed a new roof fast. Jerry was great to work with. He was always available to answer questions, even helping me navigate the insurance claim process. He made sure everything was done quickly and correctly. He checked in with me several times throughout the process. I would recommend working with Jerry and WeatherTek to anyone, especially new home owners or sellers. He is also dog friendly! Thanks again!"
Bob D., Roof Replacement in Blaine, MN2018-05-30
★★★★★ - "What a great experience! I had storm damage and WeatherTek saved the day. Not only did they work with my crazy schedule, but held my hand all along the process. From picking out the best color shingle to go with my home to painstakingly searching my yard for any trash or leftover fasteners (small kids with small feet) they were extremely professional and easy to work with. I'd absolutely recommend them to family and friends."
Maureen K., Roof Replacement in Champlin, MN2018-05-30
★★★★★ - "Thanks WeatherTek! I was afraid that it was going to be a huge hassle to get my roof replaced, but they helped make things simple. They were at our house the same day we called, and did an inspection, then walked us through the entire process. In less than 2 days they had our new roof on, and even took care of the rest of the insurance stuff for us after the job was done. The house looks great, and no trash left in the yard or anything. I am glad to find a local company who is all about a great customer experience, and quality work. I would definitely recommend calling these guys."
Patty H., Roof Replacement in Brooklyn Park, MN2018-05-30
★★★★★ - "After hearing horror stories from my neighbors about contractors, I was skeptical of choosing the right company for my roof. I choose WeatherTek, LLC for several reasons. They shared several references from real customers which helped a lot. Also, everything they said that would get done did in fact above what I expected. I was fully informed of what to expect before and after the roof replacement. All of my concerns with bad contractors are gone, I will only be using Weathertek in the future."
Brittany J., Roof Replacement in Plymouth, MN2018-05-30
★★★★★ - "After Choosing WeatherTek for our Windows and Insulation, I soon noticed why I selected them for my house. Several members of the team came out to insure all of our measurements were accurate. We had been wanting to do new windows for some time and these guys took the stress out of this project for us. They even had a Pella rep come out to insure we knew all of our options. We had everything done just before winter in 2017, and our heat stayed in and our utility bills went down noticeably. I would rate my experience a 10/10."
David C., Window Replacement in Champlin, MN2018-05-30
★★★★★ - "My wife and I had several contractors come out to our home and finally we meet Adam at Weathertek. From the very start, Adam was honest and upfront with the process. They had lots of products to choose from and gave us plenty of time to decide what roof color would look the best on our house. Once we went through their color meeting check list and choose our materials Adam took it from there informing us of every move made. Weathertek (Adam) blew our expectations out of the water. At the end of getting our roof replaced Adam stayed in contact and continued to make sure we were 100% satisfied. Highly recommended for your next remodeling project."
Ben and Trisha C., Roof Replacement in Ramsey, MN2018-05-30
★★★★★ - "From start to finish working with Weathertek Homes was simple. A trained Project Manager came out to look at my roof and determined the damage was significant. The staff informed us of every step from our insurance adjustment, color/product selection, install dates and permits pulled. The installers were very nice and did a great job! We will be using them in the future for all of our projects."
Greg T., Roof Installation in Maple Grove, MN2018-05-30
★★★★★ - "My roofing experience with Weathertek, LLC was a very positive and professional one. The entire process was quick and efficient! I received assistance with getting my inspection and insurance quote and decided to go forward with the job. I received guidance on roofing materials and they took care of scheduling and delivering all materials, keeping me well-informed of start dates and expected duration of the job. The work started and completed as promised with minimal disruption to my daily activities. A Project Manager from the company was on site frequently throughout the job to ensure quality work was being done. They also ensured the crew cleaned up all roofing debris before leaving for the last time! The best part to share is my monthly savings on utilities and reduced insurance premiums! I would highly recommend Weathertek, LLC for your home project needs; roofing, siding, or insulation!"
Deb L., Roof Replacement in Brooklyn Center, MN2018-05-30
Call for FREE Roof Repair Quote
(763) 308-5112
Dial Area Code first please.


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Direct Dimensions provides rapid turnaround 3D laser scanning services with a wide variety of file format outputs from points to STL polygons to Nurbs to fully engineered CAD models. DDI uses several high resolution 3D laser scanning systems to quickly and accurately capture complex shapes with intricate detail. DDI's website contains numerous graphical case studies of a wide variety of projects from a wide range of industries and applications. See our new rapid project quoting form complete with educational material, glossary, and downloadable sample models.
Charlie Matlin, Direct Dimensions, Inc.


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"The best thriller of the year." —San Francisco Bay Guardian
"Impressive. . . . The gripping plot runs on adrenaline as much as does Vanessa, who unleashes her violent tendencies when the powerless are threatened. . . . Vanessa makes for an intriguing heroine—at once tough, fearless, vulnerable, and compassionate." —Publishers Weekly (starred review)
"Much-anticipated. . . . Stevens vividly depicts a dark domain of manipulation, indoctrination, and abuse." —Booklist
"Part Lisbeth Salander, part Jason Bourne, Munroe comes out swinging hard again. . . . A gritty, suspenseful novel." —Library Journal
"If you haven't joined the Munroe bandwagon, now's the time to climb aboard." —Dallas News
"Fans of thrillers who haven't yet discovered Stevens are in for a treat…Those who have eagerly awaited this sequel will be delighted to find the same intelligent writing, masterful pacing, and tense and fluid action scenes that feel ready-made for the cinema, and an intensely emotional core that lends Stevens' novel a depth not often found in the genre." —Associated Press
"A whirlwind thriller about a seriously a**-kicking female renegade battle against a hair-raising cult." —Shelf Awareness
"Vanessa Michael Munroe earns her spot in the roll call next to a certain dragon-tattooed individual by virtue of calculated calm and serious self-defense skills." —Austin Chronicle
"[A] story about a tough-as-nails spy with a tortured past who is fighting to overcome her demons and save a young girl in the process. This one kept me up all night reading…If you enjoy a fast-paced thriller, check this one out." —Parkersburg News & Sentinel
"…as fast-paced, exciting and violent as Stevens' first novel. If you enjoy action thrillers, you do not want to miss "The Innocent." —Galveston Daily News
"The Innocent…is a provocative story about a women's tortured soul." —USA Today


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Band: Sorrowful Land
Album title: Of Ruins...
Release date: 7 November 2016
Label: Solitude Productions
Welcome to an epic doomy journey! Songs are raging from more traditonal doom metal to a pure funeral doom. The band is hailing form Ukraine, a country which is not really known for doom bands, but it's more than great to see that they have promising acts there. Crushing, highly melodic, yet dark and deep, the band marches forward slowly and steady. They are building up one hell of a really nice energy around itself, like a wall of fragile and elegant sounds. With beautiful clean melodies and a clear idea where things are heading the band presents six tracks of pure crushing epic melancholic doom, this is everything you could ever want from a doom metal album, really, this record is a pure pile of gold for all doom metal fans. The songs tend to stick to very typical slow doom tempo, but still there's more than enough going on that you would ever expect. Sorrowful Land will clearly left a mark in the scene for sure with this stunning release.
Read a full review HERE


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Trossen Robotics is proud to introduce the PhantomX line of pro-hobby & research robotic crawlers. These modular platforms offer an incredible feature list of specs and expandability. With the ability to carry up to 2 kilograms of payload and run at nearly a meter per second these crawlers boast some serious strength and agility. The crawlers come with 6 walking gaits already preloaded and a robust gait engine for further development. Open source software allows for freedom of development and community collaboration. Control wirelessly from the Arduino compatible RC Commander, wirelessly to a base PC, or from an onboard miniPC. Accessory add-ons coming soon include a Claw, RoboTurret, and Telepresence IP Camera. Sturdy, yet flexible ABS material make the Hexapods tough and hackable for individual projects. Drill, cut, screw, and bolt to modify and hack your bot. These crawlers raise the bar on hobby and entry level research robotics while lowering the cost point for so much technology.
Check out these Specs!
Speed (AX-12+): 1.44 fps / 0.44 mps
Speed (AX-18F): 2.82 fps / 0.86 mps
Weight: 4.6 lbs / 2.1 kg
Dimensions: L 19, W 20, H 7.5-9
Payload: 4 lbs / 2 kg
Ridiculous Feature List:
- 3 Degree-Of-Freedom Legs
- Arduino-Compatible ArbotiX Robocontroller
- Open Source Software
- Advanced Inverse Kinematics Driven Gait Engine
- 6 Different Walking Gaits Available
- High Quality LiPo Battery
- Rugged ABS Construction
- Totally Hackable!
- Add Arms, Grippers, Cameras, Pan/Tilts, even Computers!
- Wireless Xbee Control via PC or Handheld
- Tons of I/O available and fully programmable for autonomy
- Control Wirelessly from RC or PC
- Extra nuts and bolts provided for repair
- High payload means you can load up add ons
- Great platform for hobby, education, research, and Mech Warfare!
Four Kits Available:
$2,249.95 – PhantomX AX-18F Hexapod Comprehensive Kit
$1,349.95 – PhantomX AX-12+ Hexapod Comprehensive Kit
$ 649.95 – PhantomX Hexapod Comprehensive Kit – No Servos
$ 269.99 – PhantomX Hexapod Barebones Kit
Accessories Coming Soon!
PhantomX Claw (pre-order Available)
PhantomX Crawler Turret (pre-order Available)
Telepresence WiFi Camera Kit (pre-order Available)
Also Coming soon – Quadropods & Mech Warfare Ready Kits
Demand has been high for these kits so production runs have been going fast. We recommend getting your order in queue to reserve your kit. We appreciate everyone's patience as we ramp up production!


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NSML is committed to ensure that Nigerian crews are well represented in numbers of officers that work onboard NLNG Vessels and third party charterers. The Nigerianization Plan is to ensure that Nigerians are recruited straight from the cadetship phase and sponsored to obtain the CoCs in schools abroad after which their careers with the company is appropriately monitored and managed as they rise within the ranks.
Read More
Bonny Gas Transport Limited was established in 1989, following the incorporation of Nigeria LNG Limited, to provide shipping capacity for NLNG project. READ MORE


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The Blaugrana chief has breathed a sigh of relief following Madrid's announcement that they will part ways with the 50-year-old at the end of the season
Barcelona vice-president Carles Vilarrubi has hit out at Jose Mourinho in the wake of the announcement that the Portuguese coach will leave Real Madrid this summer and believes his exit is a positive thing for Spanish football.
Madrid president Florentino Perez revealed on Monday evening that Mourinho will not fulfil his contract with the Santiago Bernabeu side and Vilarrubi is pleased to see the 50-year-old leave La Liga at the end of this season.
"I can speak out now. Mourinho has been a scourge," Vilarrubi told Catalunya Radio.
"Seeing him leave is a positive thing for Spanish football in my opinion because he had created a negative atmosphere."
Mourinho joined Madrid from Inter in the summer of 2010 and has been surrounded by controversy ever since, most notably when he made the headlines for all the wrong reasons in August 2011 for poking then Barcelona assistant Tito Vilanova in the eye during a touchline brawl.
He guided los Blancos to one Liga title, one Copa del Rey and one Spanish Supercopa during his three-year spell in charge of the club, but failed to steer them to Champions League glory.


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On May 29, 1997 the Alabama State Legislature enacted Act 97-711 (Code of Alabama, Section 34-1A), providing for the establishment of the State of Alabama Electronic Security Board of Licensure (AESBL) which is appointed and serves
at the pleasure of the Governor of the State of Alabama. The AESBL is self-funded and neither contributes money to nor receives money from the State General Fund. Click on the "About" tab at the top of this page for more information on the AESBL.


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Are you keen to study for a degree, but feel apprehensive? Perhaps you've been out of education for a while, been busy raising a family, working or travelling. Maybe you left school early and decided – at the time – that education wasn't for you?
Our Access Course offers you the opportunity to get back into education – regardless of your circumstances. Getting back into a learning environment can seem like a daunting prospect, but our professional and friendly staff will help you settle right in.
Full time University-level courses are validated by the University of Northampton and offer exceptional value for money. Classes are taught in small group sizes and provide a vocationally focussed programme taught in a friendly and supportive environment with access to superb resources.
Courses are available in a PT mode in both further and higher education. A number of professional qualifications, legislative and competency course are also available. Short courses are designed to meet the needs and interests of adults who are looking for an introduction to a topic or craft.
Moulton College is delighted to help schools support their education provision at all ages. We work with schools, colleges and education advisors to provide information on the wide range of courses and apprenticeships that we offer to young people.
Moulton offers courses that are personalised to suit individual employer or business needs. Bespoke training can be arranged for groups of employees both on the businesses premises or at one of Moulton's sites. The College also works with a range of accredited partners to offer courses outside of Moulton's own expertise.
Sep 15TH


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A transition from discrete optical modes to 1D photonic bands is experimentally observed and numerically studied in planar photonic-crystal (PhC) L-N microcavities of length N. For increasing N the confined modes progressively acquire a well-defined momentum, eventually reconstructing the band dispersion of the corresponding waveguide. Furthermore, photon localization due to disorder is observed experimentally in the membrane PhCs using spatially resolved photoluminescence spectroscopy. Implications on single-photon sources and transfer lines based on quasi-1D PhC structures are discussed.
Accident models and analysis methods affect what accident investigators look for, which contributory factors are found, and which recommendations are issued. This paper contrasts the Sequentially Timed Events Plotting (STEP) method and the Functional Resonance Analysis Method (FRAM) for accident analysis and modelling. The main issue addressed in this paper is the comparison of the established multi-linear method STEP with the new systemic method FRAM and which new insights the latter provides for accident analysis in comparison to the former established multi-linear method. Since STEP and FRAM are based on a different understandings of the nature of accidents, the comparison of the methods focuses on what we can learn from both methods, how, when, and why to apply them. The main finding is that STEP helps to illustrate what happened, involving which actors at what time, whereas FRAM illustrates the dynamic interactions within socio-technical systems and lets the analyst understand the how and why by describing non-linear dependencies, performance conditions, variability, and their resonance across functions.
We have recently documented that trisomy 21 mosaicism is common in human foetal ovaries. On the basis of this observation we propose that the maternal age effect in Down syndrome (DS) is caused by the differential behaviour of trisomy 21 in relation to disomy 21 oocytes during development from foetal life until ovulation in adulthood. in particular, we suggest that trisomy 21 oocytes, lagging behind those that are disomic, may escape the timed pruning of the seven million in foetal life to the 300-400 finally selected for ovulation. The net effect of this preferential elimination will be an accumulation of trisomy 21 oocytes in the ovarian reserve of older women. We here highlight the implications of this Oocyte Mosaicism Selection (OMS) model with respect to the prevalent view that the maternal age effect is complex, dependent on many different biological and environmental factors. We examine conclusions drawn from recent large-scale studies in families, tracing DNA markers along the length of chromosome 21q between parents and DS children, in comparison to the OMS model. We conclude that these family linkage data are equally compatible with the maternal age effect originating from the accumulation of trisomy 21 oocytes with advancing maternal age. One relatively straightforward way to get to grips with what is actually going on in this regard would be to compare incidence of trisomy 21 oocytes (and their pairing configurations) in foetal ovaries with that in oocytes at the meiosis I stage from adult women.
Nowadays high speed and high data rate communication are highly demanded. Consequently, wideband and high frequency transmitter and receivers should be designed. New transmitters and receivers should also have low power consumption, simple design and low manufacturing price in order to fulfill manufacturers' requests for mass production. Having all above specifications, six-port correlator is a proper choice to be used as modulator and demodulator in transmitters and receivers.
In this thesis the six-port correlator is introduced, modeled and simulated using Advanced Design System (ADS) software. A simple six-port transmitter/receiver system with a line of sight link is modeled and analyzed in BER, path length and noise terms. The modulation in this system is QAM, frequency is 7.5 GHz and symbol rate is 500 Msymbol/s.
Furthermore two methods are proposed for high frequency and high symbol rate M-PSK and M-QAM modulation using six-port correlator. The 7.5 GHz modulators are modeled and simulated in ADS. Data streams generated by pseudo random bit generator with 1 GHz bandwidth are applied to modulators. Common source field effect transistors (FETs) with zero bias are used as controllable impedance termination to apply baseband data to modulator. Both modulators show good performance in M-PSK and M-QAM modulation.
Production transfers are a result of outsourcing and offshoring decisions. Because of the strategic focus of the outsourcing literature, the operational issues of relationship development between sender and receiver and its impact on the transfer progress have not been fully depicted. The purpose of the present paper is to explore relationship development during production transfer. To fulfil this purpose, we studied three different production transfers and derived four propositions for further testing. Our main conclusions included that dependence and power gradually shift between the sender and the receiver and that the relationship between them sets the arena for what types of relationships can be developed between the receiver and the suppliers. Furthermore, short social distances can bridge cultural and technological distances to some extent, because it motivates the actors to bring their relationship into a more developed state. Finally, we noticed that the headquarters' involvement can work both as an inhibitor as well as a converter.
Syftet med denna uppsats är att belysa hur visionen om det narkotikafria samhället uppenbarar sig i diskurser som behandlar narkotikamissbruk som socialt problem. Empiriskt material i form av ett policydokument och en debattföljetong har analyserats utifrån ett socialkonstruktivistiskt och diskursanalytiskt perspektiv. Analysen pekar mot att definitionskampen om narkotikamissbruk som socialt problem finns över många diskurser, samtidigt ses visionen om det narkotikafria samhället ofta vara närvarande. En nationell diskurs som kan ses utgå från vad vi som nation anser och vill ha i vårt land. En moraldiskurs som lägger värde i olika beteenden och åsikter. En juridisk och polisiär diskurs som utifrån narkotikas juridiska status ramar in fenomenet och en barn-och ungdomsdiskurs som formulerar narkotikan som det största hotet. Alla dessa kan enligt studien ses som en del i konstruktionen av narkotikamissbruk som socialt problem.
Research has indicated that patients in-session experience of previously avoided affects may be important for effective psychotherapy. The aim of this study was to investigate patients in-session levels of affect experiencing in relation to their corresponding levels of insight, motivation, and inhibitory affects in initial Experiential Dynamic Therapy (EDT) sessions. Four hundred sixty-six 10-min video segments from 31 initial sessions were rated using the Achievement of Therapeutic Objectives Scale. A series of multilevel growth models, controlling for between-therapist variability, were estimated to predict patients adaptive affect experiencing (Activating Affects) across session segments. In line with our expectations, higher within-person levels of Insight and Motivation related to higher levels of Activating Affects per segment. Contrary to expectations, however, lower levels of Inhibition were not associated with higher levels of Activating Affects. Further, using a time-lagged model, we did not find that the levels of Insight, Motivation, or Inhibition during one session segment predicted Activating Affects in the next, possibly indicating that 10-min segments may be suboptimal for testing temporal relationships in affective processes. Our results suggest that, to intensify patients immediate affect experiencing in initial EDT sessions, therapists should focus on increasing insight into defensive patterns and, in particular, motivation to give them up. Future research should examine the impact of specific inhibitory affects more closely, as well as between-therapist variability in patients in-session adaptive affect experiencing.
This chapter presents findings from a study of quality work in validation (recognition of prior learning) in three cases in Denmark, Finland, and Sweden. The quality work is based on a Nordic model for quality in validation and the study has an interactive approach.
Background: Although systems to collect information about suspected adverse drug reactions (ADRs) were established in many countries and by the WHO in the 1960s, few studies have examined reported ADRs related to national income. Objective: The aim of the study was to characterize ADRs reported to the WHO-ADR database, VigiBase (TM), and to relate data to national income. Methods: We analysed ADR reports submitted to VigiBase (TM) from 2000 to 2009 with respect to reporting rate, age and sex of patient, type, seriousness and medications. Reports were also analysed with respect to national income level, classified in accordance with the World Bank definition: low, lower-middle, upper-middle and high. Results: We analysed 1 359 067 ADR reports including 3 013 074 ADRs. Overall, 16% of reports were serious and 60% were reported for females. High-income countries had the highest ADR reporting rates (range 3-613 reports/million inhabitants/year) and low-income countries the lowest (range 0-21). Distribution of ADRs across income groups with respect to age group, seriousness and sex was non-significant. Overall, the majority of ADRs were reported for nervous system medications, followed by cardiovascular medicines. Low-income countries reported relatively more ADRs for antiinfectives for systemic use than high-income countries, and high-income countries reported more ADRs for antineoplastic and immunomodulating agents than lower-income groups. Conclusion: This study showed that high-income countries had the highest ADR reporting rates and low-income countries the lowest, with large variations across countries in each group. Significant differences in ADR reporting rates were only found for ADRs of the type skin and subcutaneous tissue disorders and for the therapeutic groups antiinfectives for systemic use and antineoplastic and immunomodulation agents. To strengthen ADR reporting rates, especially in low-income countries, more research is needed about the impact of organizational structures and economic resources of national pharmacovigilance centres and ADR reporting practices on the large variations in ADR reporting rates within income groups.
There have been multiple cases of drinking water related diseases in Ghana, particularly the cities. Kumasi, the second largest city is recording high figures of drinking water related diseases. The Ghana water and sewage company is supposed to provide adequate safe drinking water to the people. However, the company has failed to provide this service effectively. Various reasons have been given by the company on its inability to perform efficiently. Meanwhile the government decided lately to privatise water in the cities to facilitate access to quality water through what is called "FULL COST RECOVERY". This attracted a lot of international companies to Ghana but this has also generated protest and demonstrations. The argument is that these foreign companies are basically profit oriented and considering the fact that most of the affected people are very poor, suggesting they cannot afford it.
The study is aimed at finding out the relationship between water management and health in the study area and how effective water management through full community participation could help provide adequate safe drinking water. The study was a non-interventional descriptive type using both qualitative and quantitative methods. It was conducted in Kumasi, the second largest city in Ghana. A total of 100 residents from the communities was selected through systematic sampling and interviewed. This includes 86 local residents and 14 key informer interviews. The study also relied on observation as well as some selected literature.
The results confirmed that drinking water related diseases is on the increase with the most affected people being the poor living in shanty and informal areas of the city. It was also found that most people in the city are willing to render any services to provide safe drinking water. But in relative terms, most of these people are very poor with high percentage of illiterates and may only contribute if there is a good relation and trust among all. It however appears that community participation is a good option for the city provided that stakeholders are made to play effective roles.
Reference material was synthesised for 21 substances that are frequently present as synthetic impurities, i.e. by-products, in illicitly produced amphetamine. Each of these substances is a typical by-product for at least one of the three approaches most often used to synthesise amphetamine, namely, the Leuckart, the reductive amination of benzyl methyl ketone, and the nitrostyrene routes. A large body of data on the substances was recorded, including the following: mass spectra, ultraviolet spectra, Fourier transform infrared spectra, infrared spectra in gas phase, and 1H NMR and 13C NMR spectra. © 2004 Elsevier Ireland Ltd. All rights reserved.
It has previously been shown in an uncontrolled study that the IgE response to vaccine antigens is downregulated by co‐vaccination with cellular Bordetella pertussis vaccine.
In the present study, we compared in a controlled trial the humoral immune response to diphtheria toxoid (D) and tetanus toxoid (T) in relation to co‐vaccinated cellular or acellular B pertussis vaccine. IgE, IgG4, and IgG to D and T were analyzed at 2, 7, and 12 months of age in sera of children vaccinated with D and T (DT, N = 68), cellular (DTPw, N = 68), 2‐ or 5‐component acellular B pertussis vaccine (DTPa2, N = 64; DTPa5, N = 65).
One month after vaccination, D‐IgE was detected in 10% sera of DTPw‐vaccinated children, whereas vaccination in the absence of whole‐cell pertussis resulted in 50%‐60% IgE positivity. Six months after vaccination, the IgE antibody levels were found to be more persistent than the IgG antibodies. These diphtheria findings were mirrored by those for tetanus. Only minor differences between vaccine groups were found with regard to D‐IgG and T‐IgG. No immediate‐type allergic reactions were observed.
Cellular (but not acellular) B pertussis vaccine downregulates IgE to co‐vaccinated antigens in infants. We assume that the absence of immediate‐type allergic reactions is due to the high levels of IgG antibodies competing with IgE antibodies.
This book explores social capital as the multiple relationships between gender, management and entrepreneurship. Human resources are the social capital of a firm and business life, based on trust as well as on expertise, values and cultural diversity. This calls for cross-cultural knowledge and an understanding of gender issues and individual differences in the social capital of the firm and society. The dialogue between women entrepreneurship and social capital theory and research has its special place among other women entrepreneurship books, the number of which has lately increased. It strengthens still in some respect the fragmented voice of women entrepreneurship research by providing a landscape of women entrepreneurs as creators of, and created by, social capital. It indicates how women entrepreneurs appear to have a special position in forming, developing and reorganizing the social capital in the business world. In its eleven chapters, twenty-six researchers representing a variety of disciplines from different parts of the world are presenting findings on diverse aspects of the dialogue between women entrepreneurship and social capital. As a consequence the central concepts, social capital, entrepreneurship and gender, are given a variety of meanings. Women entrepreneurs and business owners regardless of their cultural context, branch and education provide interesting ideas to the global debate on equality and social capital.
Background: Borrelia infections, especially chronic neuroborreliosis ( NB), may cause considerable diagnostic problems. This diagnosis is based on symptoms and findings in the cerebrospinal fluid but is not always conclusive. Purpose: To evaluate brain magnetic resonance imaging ( MRI) in chronic NB, to compare the findings with healthy controls, and to correlate MRI findings with disease duration. Material and Methods: Sixteen well- characterized patients with chronic NB and 16 matched controls were examined in a 1.5T scanner with a standard head coil. T1- ( with and without gadolinium), T2-, and diffusion- weighted imaging plus fluid- attenuated inversion recovery ( FLAIR) imaging were used. Results: White matter lesions and lesions in the basal ganglia were seen in 12 patients and 10 controls ( no significant difference). Subependymal lesions were detected in patients down to the age of 25 and in the controls down to the age of 43. The number of lesions was correlated to age both in patients ( rho=0.83, P < 0.01) and in controls ( rho=0.61, P < 0.05), but not to the duration of disease. Most lesions were detected with FLAIR, but many also with T2- weighted imaging. Conclusion: A number of MRI findings were detected in patients with chronic NB, although the findings were unspecific when compared with matched controls and did not correlate with disease duration. However, subependymal lesions may constitute a potential finding in chronic NB.
Background: With the Open Innovation paradigm come new hopes for innovating companies. The ability to tap a global network of experts can, at least in theory, have a significant impact on an organization's competitive strength. Before such a 'network of experts' can be used to its full potential however, a number of challenges related to knowledge markets seem to need solutions. About 10 years ago however, we could witness the entry of a new breed of company – calling themselves innovation intermediaries. These companies are built to profit from delivering the usefulness of knowledge networks to client (Seeker) companies. Though the use of such networks and markets have so far been uncommon outside of high-tech fields they are now starting to be seen used by companies in more mature environments.Purpose: The purpose of this thesis is to examine the collaboration between SCA (a large Swedish corporation) and the innovation intermediary InnoCentive in order to create a better understanding of what kind of benefits can be derived from the use of an innovation intermediary, and how these benefits are best utilized. We also set out to identify relevant limitations of innomediary use and to seek to better understand how using an innomediary can fit a client company's higher-order activities such as exploration and exploitation.Completion and Results: Our findings include that SCA are using InnoCentive mainly as a tool to solve highly specific problems and/or problems with a low degree of complexity that they encounter in their everyday activities. The challenges related to knowledge markets, we find, are avoided by keeping problem complexity low and problem modularity high for the problems sent out to the network. In addition, InnoCentive's business model seems to eliminate costly negotiations between Seekers and Solvers. Using this kind of 'market solution' however, we argue, will put bounds on the usefulness of the network and makes it mainly suited as a tool for improving an organization's exploitation capacity.
Background: Resistance towards endocrine therapy is a great concern in breast cancer treatment and may partly be explained by the activation of compensatory signaling pathways. The aim of the present study was to investigate if the insulin-like growth factor-1 receptor (IGF1R) signaling pathway was activated or deregulated in breast cancer patients and to explore if any of the markers were prognostic, with or without adjuvant tamoxifen. This signaling pathway has been suggested to cause estrogen independent cell growth and thus contribute to resistance to endocrine treatment in estrogen receptor (ER) positive breast cancer. Methods: The protein expression of IGF1R, phosphorylated Mammalian Target of Rapamycin (p-mTOR) and phosphorylated S6 ribosomal protein (p-S6rp) were investigated by immunohistochemistry using tissue microarrays in two patient cohorts. Cohort I (N = 264) consisted of mainly postmenopausal women with stage II breast cancer treated with tamoxifen for 2 years irrespective of ER status. Cohort II (N = 206) consisted of mainly medically untreated, premenopausal patients with node-negative breast cancer. Distant disease-free survival (DDFS) at 5 years was used as end-point for survival analyses. Results: We found that lower IGF1R expression was associated with worse prognosis for tamoxifen treated, postmenopausal women (HR = 0.70, 95% CI = 0.52 - 0.94, p = 0.016). The effect was seen mainly in ER-negative patients where the prognostic effect was retained after adjustment for other prognostic markers (adjusted HR = 0.49, 95% CI = 0.29 - 0.82, p = 0.007). Expression of IGF1R was associated with ER positivity (p less than 0.001) in the same patient cohort. Conclusions: Our results support previous studies indicating that IGF1R positivity reflects a well differentiated tumor with low metastatic capacity. An association between lack of IGF1R expression and worse prognosis was mainly seen in the ER-negative part of Cohort I. The lack of co-activation of downstream markers (p-mTOR and p-S6rp) in the IGF1R pathway suggested that the prognostic effect was not due to complete activation of this pathway. Thus, no evidence could be found for a compensatory function of IGF1R signaling in the investigated cohorts.
Background. Oestrogen receptor (ER) status is important for the choice of systemic treatment of breast cancer patients. However, most data from randomised trials on the effect of adjuvant endocrine therapy according to ER status are based on the cytosol methods. Comparisons with immunohistochemical methods have given similar results. The aim of the present study was to examine whether different ER antibodies and heat-induced epitope retrieval (HIER) methods influence the prevalence of ER-positivity in primary breast cancer. Material and methods. This study is based on patients included in a clinical trial designed to compare the effect of two years of adjuvant tamoxifen versus no adjuvant systemic treatment in premenopausal women. From 1986 to 1991, 564 patients from two study centres in Sweden were enrolled and randomised. Patients were randomised independently of ER status. In the present study, ER status was assessed on tissue microarrays with the three different ER antibody/HIER combinations: 1D5 in citrate pH 6 (n = 390), SP1 in Tris pH 9 (n = 390) and PharmDx in citrate pH 6 (n = 361). Results. At cut-offs of 1% and 10%, respectively, the prevalence of ER-positivity was higher with SP1 (75% and 72%) compared with 1D5 (68% and 66%) and PharmDx (66% and 62%). At these cut-offs, patients in the discordant groups (SP1-positive and 1D5-negative) seem to have a prognosis intermediate between those of the double-positive and double-negative groups. Comparison with the ER status determined by the cytosol-based methods in the discordant group also showed an intermediate pattern. The repeatability was good for all antibodies and cut-offs, with overall agreement andgt;= 93%. Conclusion. The present study shows that the choice of antibody and HIER method influences the prevalence of ER-positivity. We suggest that this be taken into consideration when choosing a cut-off for clinical decision making.
Due to rapid growth of home entertainment consumer market, video technology has been continuously pushed to deliver sharper pictures with higher resolution. This has brought about stringent requirements on the video analog front end, which often coupled with the low power and low voltage regulations had to deal with short channel effects of the deep submicron CMOS processes.
This thesis presents the design of a fully differential programmable gain amplifier, as a subcircuit of a larger video digitizing IC designed at division of Electronic Systems. The switched capacitor architecture of the PGA does not only buffer the signal, but performs compensation for the sync-tip of analog video signal.
The pseudo differential OTA eliminates tail current source and maintains high signal swing and has efficient common mode feedforward mechanism. When coupled with a similar stage provides inherent common moode feedback without using an additional SC-CMFB block.
The PGA has been implemented using a 65 nm digital CMOS process. Expected difficulties in a 1.2 V OTA design make themselves evident in 65 nm, which is why cascaded OTA structures were inevitable for attaining gain specification of 60 dB. Nested Miller compensation with a pole shifting source follower, stabilizes the multipole system. The final circuit attains up to 200 MHz bandwidth and maintains high output swing of 0.85 V. High slew rate and good common mode and power supply rejection are observed. Noise requirements require careful design of input differential stage. Although output source follower stabilized the system, it reduces significant bandwidth and adds to second order non-linearity.
In this work, we describe the implementation of a 1. 2-V pseudo-differential operational transconductance amplifier (OTA) with common-mode feedforward (CMFF) and inherent common-mode feedback (CMFB) in a 65-nm, digital CMOS process. The OTA architecture provides an inherent CMFB when cascaded OTA structures are utilized andthis work has studied a cascaded amplifier consisting of fourstages. Due to the low-gain using core 65-nm circuit devices, the overall gain must be distributed on all four stages to acquire a gain of more than 60 dB, while maintaining a-3-dB bandwidth of 200 MHz. To achieve high gain, we propose using a modified, positive-feedback, cross-coupled input differential stage. The modified OTA achieves a high output swing of ± 0.85 V due to only two stacked transistors, 88 dB DC gain and a third-order harmonic of -60 dB for 800 mVpp at 30 MHz. Further on, in a capacitive buffer configuration, we achieve a high slew rate of 1240 V/µS, -3-dB bandwidth of 509 MHz, signal-to-noise ratio of 63 dB while consuming 10.4 mW power.
This work describes the implementation of a 1.2-V programmable gain amplifier (PGA) for high-definition (HD) video digitizers in a 65-nm digital CMOS process. The "pseudo" switched-capacitor (SC) PGA architecture buffers the video signal, without switching, during the active video. The SC circuitry is used for setup of DC operating point during horizontal and vertical blanking periods. Additionally, it compensates for the `sync-tip' of analog video signals to an equal blanking level for increased dynamic range to the digitizer following the PGA. The operational transconductance amplifier (OTA) employed as main amplifier in the PGA is a pseudo-differential, positive-feedback input stage architecture with a common-mode feedforward (CMFF) technique. The common-mode feedback (CMFB) is provided once two OTAs are cascaded. Schematic-level simulation results show that the OTA maintains a -3-dB bandwidth of 550 MHz, while keeping the distortion HD3 at -60 dB for a 30-MHz, 850 mVpp high definition video signal. The 88 dB DC gain is distributed among four OTA stages and the overall, combined PGA achieves a signal-to-noise ratio of 63 dB. Due to only two stacked transistors, it achieves high output swing of ±0.85 V, 1240 V/μs slew rate while consuming 10.4 mW power.
Background: Noninvasive telemonitoring (TM) can be used in heart failure (HF) patients to perform early detection of decompensation at home, prevent unnecessary health care utilization, and decrease health care costs. However, the evidence is not sufficient to be part of HF guidelines for follow-up care, and we have no knowledge of how TM is used in the Nordic Baltic region. Objective: The aim of this study was to describe health care professionals (HCPs) perception of and presumed experience with noninvasive TM in daily HF patient care, perspectives of the relevance of and reasons for applying noninvasive TM, and barriers to the use of noninvasive TM. Methods: A cross-sectional survey was performed between September and December 2016 in Norway and Lithuania with physicians and nurses treating HF patients at either a hospital ward or an outpatient clinic. A total of 784 questionnaires were sent nationwide by postal mail to 107 hospitals. The questionnaire consisted of 43 items with close- and open-ended questions. In Norway, the response rate was 68.7% (226/329), with 57 of 60 hospitals participating, whereas the response rate was 68.1% (310/455) in Lithuania, with 41 of 47 hospitals participating. Responses to the closed questions were analyzed using descriptive statistics, and the open-ended questions were analyzed using summative content analysis. Results: This study showed that noninvasive TM is not part of the current daily clinical practice in Norway or Lithuania. A minority of HCPs responded to be familiar with noninvasive TM in HF care in Norway (48/226, 21.2%) and Lithuania (64/310, 20.6%). Approximately half of the HCPs in both countries perceived noninvasive TM to be relevant in follow-up of HF patients in Norway (131/226, 58.0%) and Lithuania (172/310, 55.5%). For physicians in both countries and nurses in Norway, the 3 most mentioned reasons for introducing noninvasive TM were to improve self-care, to reduce hospitalizations, and to provide high-quality care, whereas the Lithuanian nurses described ability to treat more patients and to reduce their workload as reasons for introducing noninvasive TM. The main barriers to implement noninvasive TM were lack of funding from health care authorities or the Territorial Patient Fund. Moreover, HCPs perceive that HF patients themselves could represent barriers because of their physical or mental condition in addition to a lack of internet access. Conclusions: HCPs in Norway and Lithuania are currently nonusers of TM in daily HF care. However, they perceive a future with TM to improve the quality of care for HF patients. Financial barriers and HF patients condition may have an impact on the use of TM, whereas sufficient funding from health care authorities and improved knowledge may encourage the more widespread use of TM in the Nordic Baltic region and beyond.
Background: Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective: This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods: This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals-one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the Cardio Set Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results: The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions: Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.
Antineutrophil cytoplasm autoantibodies (ANCA) directed against bactericidal/permeability-increasing protein (BPI) are common in patients with cystic fibrosis (CF), and serum levels are correlated with lung colonization by Pseudomonas aeruginosa and the severity of lung damage. The production of BPI-ANCA may be due to the costimulation of BPI when mounting an immune response against P. aeruginosa. The effect of surgery aiming to eradicate bacteria and infected tissue on BPI-ANCA levels is sparsely described. A cohort of patients with CF were included: 53 patients having extensive image-guided sinus surgery (EIGSS) with topical postoperative antibiotic treatment, 131 non-operated controls and 36 who had double lung transplantation (LTX). In all 219 patients, serum samples before and after surgery or at similar intervals were analysed for IgG and IgA BPI-ANCA. The EIGSS group showed a highly significant decrease in both IgA and IgG BPI-ANCA levels compared with their own preoperative values and control group values (P andlt; 0.0010.02). The LTX patients also showed a highly significant decrease in both IgA and IgG BPI-ANCA levels (P andlt; 0.001). EIGSS and LTX decrease IgA and IgG BPI-ANCA levels in patients with CF, indicating that extensive removal of infected tissue influences the pathogenic process of autoantibody production. The results shown herein are in favour of applying EIGSS in selected patients with CF and for using BPI-ANCA as a surrogate marker for guiding further therapeutic interventions.
In a recent paper by the current authors a new methodology called the Extended-Domain-Eigenfunction-Method (EDEM) was proposed for solving elliptic boundary value problems on annular-like domains. In this paper we present and investigate one possible numerical algorithm to implement the EDEM. This algorithm is used to solve modified Helmholtz BVPs on annular-like domains. Two examples of annular-like domains are studied. The results and performance are compared with those of the well-known boundary element method (BEM). The high accuracy of the EDEM solutions and the superior efficiency of the EDEM over the BEM, make EDEM an excellent alternate candidate to use in the animation industry, where speed is a predominant requirement, and by the scientific community where accuracy is the paramount objective.
Standard analytical solutions to elliptic boundary value problems on asymmetric domains are rarely, if ever, obtainable. In this paper, we propose a solution technique wherein we embed the original domain into one with simple boundaries where the classical eigenfunction solution approach can be used. The solution in the larger domain, when restricted to the original domain, is then the solution of the original boundary value problem. We call this the extended-domain-eigenfunction method. To illustrate the methods strength and scope, we apply it to Laplaces equation on an annular-like domain.
The extended-domain-eigenfunction method (EDEM) proposed for solving elliptic boundary value problems on annular-like domains requires an inversion process. The procedure thus represents an ill-posed problem, whose numerical solution involves an ill-conditioned system of equations. In this paper, the ill-posed nature of EDEM is studied and numerical solutions based on regularization schemes are considered. It is shown that the EDEM solution methodology lends itself naturally to a formulation in terms of the well-known iterative Landweber method and the more general and faster converging semi-iterative regularization schemes. Theoretical details and numerical results of the regularization schemes are presented for the case of the two-dimensional Laplace operator on annular domains.
The aim of this study was to establish morning and evening reference ranges for cortisol in saliva. Another objective was to compare the concentrations of the mainly free cortisol in saliva to those of total cortisol in serum as determined with a commercial radioimmunoassay. The concentrations were determined in matched samples of saliva and serum collected at 8am and 10pm from 197 healthy volunteers. The saliva samples were stable for at least 7 days at room temperature and for 9 months at —20 °C. Reference ranges, the central 95%, were estimated to 3.5—27.0 nmol/1 at 8 am and < 6.0 nmol/1 at 10 pm. The intra-assay coefficient of variation (CV) was below 5% and total CV below 10%. The relation between the cortisol concentrations in serum and saliva was nonlinear with r = 0.86 for serum concentrations < 450 nmol/1 and r = 0.44 for serum concentrations ^ 450 nmol/1. In conclusion, the satisfactory precision of the analysis and the simple non-invasive sampling procedure suggest that saliva may be used for cortisol measurements in situations where blood sampling is difficult to perform.
The field of psychotraumatology has its roots in ancient history. During the past decades, the surveillance of the psychobiological background of reactions to and consequences of traumatic stress has made great progress and the complexity of the human stress response system stands out. The hypothalamic-pituitary-adrenocortical axis activity, modulated by various neuroimmunological substances, seems to play a major role in the stress response. However, there are still inconsistencies in explanations of relationships between biological and psychological changes following traumatic stress. Moreover, the matter of predictive factors for the development of posttraumatic morbidity is still in a speculative phase.
The aims of the present thesis were to further develop a commercial serum cortisol radioimmunoassay (RIA) for determination of cortisol in saliva and to test its reliability, specificity and sensitivity as a biochemical assay. The saliva sampling procedures and sample storage stability were also to be tested. Further issues were to investigate determinations of salivary cortisol and serum prolactin in relation to selfratings of posttraumatic psychological distress and general psychological health. Possible predictive and concurrent validity of salivary cortisol as a biochemical marker for posttraumatic psychological distress were to be tested.
Cortisol is present in saliva mainly in non-protein form, representing the free, biologically active fraction of the total plasma cortisol concentration. In a first phase of the present thesis, the commercial serum cortisol RIA was modified for determination of cortisol in saliva. The relation between salivary and serum cortisol concentrations was tested. Reference ranges at 8 AM and 10 PM for the salivary cortisol assay were established from 195 healthy subjects. Salivary cortisol concentrations were tested in relation to serum cortisol in estimating adrenocortical function during endocrine dynamic function tests in 37 patients and 13 healthy controls. In testing salivary cortisol as a marker for stress for fieldwork use, a screening study was performed on 66 male rescue workers. Salivary cortisol at 8 AM and 10 PM and serum prolactin were determined and general psychological health and posttraumatic psychological distress were estimated with the self-rating scales General Health Questionnaire, Impact of Event Scale and Posttraumatic Symptom Scale. These scales were used in the second phase of the thesis. Three applied follow-up studies were performed with sampling of salivary cortisol and self-ratings: (a) a study of 31 UN-soldiers five days, two and nine months after a mine accident; (b) a study of 145 UN-soldiers before, at return, and two and six month after a six month mission. (c) a study of 101 UN-soldiers six and twelve months after a six month mission with severe combat exposure.
The results from the present thesis indicate that the modified method of salivary cortisol determination possesses sufficient precision, accuracy, sample storage stability and procedural advantages for laboratory, clinical and field application. Moreover, it possesses moderate predictive information and moderate to high concurrent validity as a biochemical marker for posttraumatic psychological distress.
Background: The psychobiology of post-traumatic distress is known to some extent, however the pre-trauma psychobiology is not. The aims of the present study were to relate pre- and post-trauma salivary cortisol levels and general health to post-traumatic distress in a Swedish UN-battalion in Bosnia.
Methods: Salivary 8 AM and I 0 PM cortisol levels and "General Health Questionnaire" ratings were collected from 145 subjects before the six months' mission, at return and two and six months after mission. During follow-up, the ratings were extended by the "Impact of Events Scale" (IES) and "Post Traumatic Symptom Scale".
Results: Low pre-trauma morning and evening salivary cortisol levels were statistically significantly related to high scores in all rating scales six months after mission and to increasing IES scores during follow-up. Low morning and high evening post-trauma salivary cortisol levels were related to high ratings of psychological distress six months after mission
Conclusions: Pre-trauma salivary cortisol levels seem to be related to posttrauma psychological distress, however not to the extent that salivary cortisol levels in a simple way could be used for predictive screening.
Background: Because traumatic events are unpredictable, there are few studies of psychobiological states immediately following such events. Our study aimed to determine the relation of salivary cortisol to psychologic distress immediately after a traumatic event and then during follow-up.
Methods: Measurement of morning and evening salivary cortisol and ratings of psychologic distress (using the Impact of Events Scale [IES], the Post Traumatic Symptom Scale, and the General Health Questionnaire) were performed with 31 United Nations soldiers at three time points—5 days and 2 and 9 months—following a mine accident in Lebanon.
Results: Five days after the accident, 15 subjects reported substantial posttraumatic distress according to the IES, as well as significantly lower morning and higher evening cortisol levels compared with the low-impact group. Within 9 months, the posttraumatic distress of the high-impact group was reduced, accompanied by an increase in morning and a decrease in evening cortisol levels. There were significant relationships between evening cortisol and all rating scales at the first and third time points.
Conclusions: Subclinical posttraumatic stress following an adverse event can be measured biologically via salivary cortisol levels soon after the event.
Background: Our group has presented evidence of relationships between salivary cortisol levels and psychological distress before, during and after trauma-related stress. The aim of the present study was to confirm the part of evidence of relationships between salivary cortisol and posttraumatic distress and their change over time.
Methods: Salivary cortisol levels at 8 AM and 10 PM and self-ratings were collected from 106 subjects six and twelve months after a six months UNmission in Bosnia. The rating instruments were the "Impact of Event Scale" (IES), the "Post Traumatic Symptom Scale" and the "General Health Questionnaire".
Results: Significant statistical interactions were found between changes in mean cortisol levels and IES scores over time. Decreasing evening cortisol levels over time were significantly related to decreasing IES scores and vice versa. Morning cortisol levels showed negative, and evening cortisol positive correlations with all rating scores.
Conclusions: The evidence from previous studies on trauma related stress, that salivary cortisol is related to the development of posttraumatic stress reactions, the morning cortisol in reverse (negative) direction to that (positive) of evening cortisol, were confirmed.
Background: Rescue service personnel are often exposed to traumatic events as part of their occupation, and higher prevalence rates of psychiatric illness have been found among this group.
Methods: In 65 rescue workers, salivary cortisol at 8 am and 10 pm and serum prolactin at 8 am were related to the psychiatric self-rating scale General Health Questionnaire (GHQ-28) measuring psychiatric health, and the Impact of Events Scale (IES) and Post Traumatic Symptom Scale (PTSS) measuring posttraumatic symptoms.
Results: Seventeen percent of the study population scored above the GHQ-28 cut-off limit but none scored beyond the cut-off limit in the IES and PTSS questionnaires. Salivary cortisol concentration at 10 pm correlated with statistical significance to anxiety (p < .005) and depressive symptoms (p < .01) measured with GHQ-28, as well as to posttraumatic symptoms, with avoidance behavior measured with IES (p < .01) and PTSS (p < .005). Two of the rescue workers were followed over time with the same sampling procedure after a major rescue commission.
Conclusions: The correlation between evening salivary cortisol and anxiety, depressiveness, and posttraumatic avoidance symptoms indicates that these parameters can be used in screening and follow-up after traumatic stress events.
Salivary cortisol was measured as an alternative to serum cortisol as a marker for adrenocortical function following insulin tolerance test, corticotropin-releasing-hormone stimulation and adreno-corticotrophic hormone stimulation. During insulin tolerance test and corticotropin-releasing-hormone stimulation adreno-corticotrophic hormone was also measured. The tests were performed on healthy control subjects as well as on patients under investigation for various disturbances in the hypothalamic-pituitary-adrenocortical axis (insulin tolerance test: 3 controls on two occasions and 14 patients; corticotropin-releasing-hormone stimulation: 4 controls and 18 patients; adreno-corticotrophic hormone stimulation: 6 controls and 10 patients). Five patients underwent both insulin tolerance test and corticotropin-releasing-hormone stimulation. Using criteria for adequate cortisol response in serum, the patients were classified as good or poor responders. In 42 of the 45 tests performed the same conclusion as to cortisol status was drawn when based on serum and salivary cortisol responses. In healthy subjects and good responders the mean cortisol relative increase was greater in saliva than in serum in all three tests (p < 0.05). Characteristic of the results for the insulin tolerance test was a significant initial mean decrease (p < 0.05), not found in serum, and the highest observed salivary cortisol value was delayed for at least 30 minutes compared to that in serum. Plasma adreno-corticotrophic hormone correlated significantly with the cortisol concentrations determined 15 minutes later in serum (r = 0.54–0.64) and in saliva (r = 0.76–0.85). The more pronounced cortisol response in saliva than in serum and its closer correlation with adreno-corticotrophic hormone offer advantages over serum cortisol, suggesting salivary cortisol measurement may be used as an alternative parameter in dynamic endocrine tets.
Background: Blood donation is associated with iron depletion, but donor iron status is not usually investigated, as such tests are cumbersome and costly. It would therefore be desirable to have simple, fast and inexpensive tests that give information on a donors risk of developing iron depletion. In a pilot study we investigated whether novel erythrocyte and reticulocyte parameters can serve this goal. Methods: In regular blood donors extended red cell parameters were measured using the Abbott CELL-DYN Sapphire hematology analyzer and conventional biochemical tests of iron status. Donors were compared with a regionally matched group of non-donating controls. Results: In the controls, the reference ranges of extended RBC parameters were well comparable to published data. Donors had significantly more microcytic RBC than controls (median 0.9 vs 0.6%), lower serum ferritin concentration (median 43 vs 91 mg/L) and higher soluble transferrin receptor/ferritin index (median 1.60 vs 1.27). Overall 18-28% of the donors were iron depleted. Moreover, 3.3% of donors had iron-restricted erythropoiesis. Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with 70% and 64% sensitivities and specificities of 72% and 78%, respectively. When combined these two parameters increased the sensitivity to 82%. Conclusions: Our results in Swedish blood donors confirm a high prevalence of iron depletion, despite iron supplementation used by about half of the donors. Microcytic RBC and MCHr appeared to be helpful in identifying iron-depleted donors, who might benefit from iron supplementation. We recommend larger prospective investigations in order to confirm and extend the findings of this pilot study. (C) 2015 Elsevier Ltd. All rights reserved.
Exploring the Talent Management literature to understand the importance of Talent Management to strategy and the role the view on talent plays in consideration to Talent Management.
The purpose of this thesis is to increase the empirical research on Talent Management to enable a creation of a conceptual framework.
A multiple case study approach was taken, as 11 companies from diverse industries, sizes, backgrounds etc. was studied in order to gain a broader picture on the research topic. Furthermore, qualitative data collection method was used and main source of empirical data was interviews conducted with HR professionals of each case company.
The empirical findings indicated there to be a relationship between the strategy and the view on talent. There was further an indication that this relationship has an effect on the focus of the Talent Management activities.
In the pursuit of developing new materials for more efficient bulk-heterojunction solar cells, the blend poly (3-hexylthiophene):[ 6,6]-phenyl-C(61)-butyric acid methyl ester (P3HT:PCBM) serves as an important model system. The success of the P3HT: PCBM blend comes from efficient charge generation and transport with low recombination. There is not, however, a good microscopic picture of what causes these, hindering the development of new material systems. In this report UV photoelectron spectroscopy measurements on both regiorandom-(rra) and regioregular-(rr) P3HT are presented, and the results are interpreted using the Integer Charge Transfer model. The results suggest that spontaneous charge transfer from P3HT to PCBM occurs after heat treatment of P3HT: PCBM blends. The resulting formation of an interfacial dipole creates an extra barrier at the interface explaining the reduced (non-)geminate recombination with increased charge generation in heat treated rr-P3HT: PCBM blends. Extensive photoinduced absorption measurements using both above-and below-bandgap excitation light are presented, in good agreement with the suggested dipole formation.
This study problematizes activity frames and participation frameworks (Goffman 1981), exploring how students deploy online (MSN Messenger) and offline activity frames in identity performances. One problem in analyzing participation frameworks and particularly notions of subordinate forms, like crossplay, byplay, and sideplay, is that these concepts require that the analyst can identify one dominant activity. This was not possible in the present data, which consist of video recordings of computer activities in a seventh-grade classroom. It is shown how MSN (online) identities were invoked in subsequent and intermittent face-to-face interaction, a dialogue that started on MSN would continue in face-to-face interaction, and vice versa. This means that frame switches constituted important features of the students' identity work. Similarly, the students employed nicknames or what are here called tags, that is, textual-visual displays of speaker identities, located in the boundary zone between online and offline activities. In the classroom interactions, there was thus not one dominant activity frame, but rather the activities involved borderwork, and more specifically frame switches and a strategic use of tags. © Walter de Gruyter 2008.
The present data are based on an ethnographic study of computer use in everyday interactions in a seventh grade class (of 13-14 year-olds). The data were analysed in terms of activity frames and participation frameworks (Goffman 1981), exploring how students deployed online and offline activity frames in their identity performance. It is shown how MSN (online) identities are invoked in subsequent and intermittent face-to-face interaction; a dialogue can start on MSN and continue in faceto-face interaction, and vice versa. This means that frame switches are important features of the students' identity work. Similarly, the students employed nicknames or tags, that is, textual-visual displays of 'speaker' identities, located in the boundary zone between online and offline activities. In terms of participation frameworks, it is also documented ways in which students engaged in crossplay (Goffman 1981), where a ratified participant communicated with a non-ratified participant. Yet, one problem in analysing participation frameworks and particularly byplay and sideplay (Goffman 1981) is that these concepts require that the analyst can identify one dominant activity. This was not possible in the present data. Instead, the data are primarily analysed in terms of borderwork, that here entails frame switchings, crossplay and a strategic use of tags.
The present ethnography documents computer activities in everyday life. The data consist of video recordings, interviews and field notes, documenting (i) 16 students in a seventh grade class in a computer room and other school settings and (ii) 22 children, interacting with siblings, friends and parents in home settings. The thesis is inspired by discourse analytical as well as ethnographic approaches, including notions from Goffman (1974, 1981), e.g. those of activity frame and participation framework, which are applied and discussed.
The thesis consists of four empirical studies. The first study focuses on students' illegitimate use, from the school's point of view, of online chatting in a classroom situation. It is shown that the distinction offline/online is not a static one, rather it is made relevant as part of switches between activity frames, indicating the problems of applying Goffman's (1981) notions of sideplay, byplay and crossplay to analyses of interactions in which several activity frames are present, rather than one main activity. Moreover, it is shown that online identities, in terms of what is here called tags, that is, visual-textual nicknames, are related to offline phenomena, including local identities as well as contemporary aesthetics. The second study focuses on placement of game consoles as part of family life politics. It is shown that game consoles were mainly located in communal places in the homes. The distinction private/communal was also actualized in the participants' negotiations about access to game consoles as well as negotiations about what to play, when, and for how long. It is shown that two strategies were used, inclusion and exclusion, for appropriating communal places for computer game activities. The third study focuses on a digital divide in terms of a generational divide with respect to ascribed computer competence, documenting how the children and adults positioned each other as people 'in the know' (the children) versus people in apprentice-like positions (the adults). It is shown that this generation gap was deployed as a resource in social interaction by both the children and the adults. The forth study focuses on gaming in family life, showing that gaming was recurrently marked by response cries (Goffman, 1981) and other forms of blurted talk. These forms of communication worked as parts of the architecture of intersubjectivity in gaming (cf. Heritage, 1984), indexing the distinction virtual/'real'. It is shown how response cries, sound making, singing along and animated talk extended the virtual in that elements of the game became parts of the children's social interaction around the screen, forming something of an action aesthetic, a type of performative action for securing and displaying joint involvement and collaboration. As a whole, the present studies show how the distinctions master/apprentice, public/private, virtual/real and subject/object are indexicalized and negotiated in computer activities.
In this ethnographic study of family life, intergenerational video and computer game activities were videotaped and analysed. Both children and adults invoked the notion of a digital divide, i.e. a generation gap between those who master and do not master digital technology. It is argued that the digital divide was exploited by the children to control the game activities. Conversely, parents and grandparents positioned themselves as less knowledgeable, drawing on a displayed divide as a rhetorical resource for gaining access to playtime with the children. In these intergenerational encounters, the digital divide was thus an interactional resource rather than a problem.
The present study focuses on the ways in which response cries (Goffman, 1981) are deployed as interactional resources in computer gaming in everyday life. It draws on a large-scale data set of video recordings of the everyday lives of middleclass families. The recordings of gaming between children and between children and parents show that response cries were not arbitrarily located within different phases of gaming (planning, gaming or commenting on gaming). Response cries were primarily used as interactional resources for securing and sustaining joint attention (cf. Goodwin, 1996) during the gaming as such, that is, during periods when the gaming activity was characterized by a relatively high tempo. In gaming between children, response cries co-occurred with their animations of game characters and with sound making, singing along, and code switching in ways that formed something of an action aesthetic, a type of aesthetic that was most clearly seen in gaming between game equals (here: between children). In contrast, response cries were rare during the planning phases and during phases in which the participants primarily engaged in setting up or adjusting the game.
With the development of visual digital technologies it has become more common in the social sciences to both use and present research visually. This article explores different strategies for working with and including images in ethnomethodology and conversation analysis (EMCA) transcriptions. The purpose is to investigate how, and if, the ontology of the transcript changes when verbal transcripts become visual transcripts. The article explores what ensures that a transcript is still a transcript and what happens to the reflexive interpretative strategy fundamental to EMCA when new digital technologies make it possible to incorporate images in transcripts. The articles focus is on the social life of methods as well as methodological productivity showing how images can enact different social realities and scientific knowledge.
Questions posed to expert witnesses by the legal community and the courts are expanding to include not just those relating to source level (i.e. 'who is the donor of the trace?') but also those relating to activitity level (i.e. 'how did the DNA get there?'). The answers to these questions are usually formulated as the probability of the evidence under alternative scenarios. As activity level questions are part of investigative and legal considerations it is of paramount importance that expert witnesses are provided with knowledge and tools to address these questions.
To answer such questions within a probabilistic framework, empirical data is needed to estimate probabilities of transfer, persistence and recovery of DNA as well as background levels of DNA on everyday objects. There is a paucity of empirical data on these topics, but the number of studies is increasing both through in-house experiments and experimental data published in international scientific journals.
Laboratories that conduct such studies all use different experimental setups, trace recovery strategies and techniques and DNA analysis systems and equipment. It is essential for the forensic genetics community in general to establish whether the data generated by different labs are in concordance, and can therefore be readily used by the forensic community.
Moreover, if existing data and data generated from future experiments are made available to the (forensic) community, knowledge is needed on the key factors that underlie potential interlaboratory variation.
The aims and objectives of this ENFSI Monopoly 2013 project are to conduct a study of methodologies and data from different laboratories and to assess the comparability of the scientific data on transfer, persistence and recovery of DNA. This comparison will allow us to identify key factors that underlie potential variation. This information will be used to setup guidelines to enable sharing and database-storage of relevant scientific
data. This will improve the ability of forensic scientists and other professionals of the Criminal Justice System to give evidence-based answers to questions that relate to the activity level of the crime under investigation.
Bakgrund: ERAS (Enhanced Recovery After Surgery) är ett standardiserat multimodalt vårdprogram vid elektiv kolorektalkirurgi, som syftar till snabbare återhämtning och kortare vårdtider genom ett tvärprofessionellt samarbete. En vecka innan planerad operation träffar sjuksköterskan patienten för ett samtal om vårdförloppet.
Syfte: Att identifiera och beskriva patientens upplevelse av sjuksköterskans ERAS- samtal och dess betydelse för patientens delaktighet i sin vård.
Metod: Datainsamlingen skedde genom kvalitativa intervjuer. Tolv patienter, nio män och tre kvinnor har intervjuats. De ljudinspelade samtalen har transkriberats ordagrant och analyserats med hjälp av tolkande fenomenologisk analys (Interpretative Phenomenological Analysis).
Resultat: Analysarbetet resulterade i fem olika teman; bli sedd, trygghet, tillit, ansvar samt delaktighet. Alla teman relaterar till varandra och illustrerar en positiv och en negativ sida av den upplevda erfarenheten. Tillsammans bildar en helhet av upplevelsen; ERAS- samtalet och dess betydelse för patientens delaktighet.
Konklusion: Resultatet visar att patienterna känner sig sedda under informationssamtalet. Det är viktigt att bekräfta patienten och knyta an mer till informationssamtalet under vårdtiden för att patienterna ska vara delaktiga och ta eget ansvar. Tilliten till vårdpersonalen har betydelse för att patienterna ska känna trygghet. Studien visar att ERAS- samtalet upplevs strukturerat och individuellt men informationen måste följa patienterna under hela vårdtillfället.
Aims and objectives
To identify and describe patients' experiences of a preoperative information session with a nurse, as part of the enhanced recovery after surgery (ERAS) concept, and its impact on patient participation in their own care.
Enhanced recovery after surgery is a standardised, multimodal treatment programme for elective colorectal surgery, leading to faster recovery and shorter hospital stays via interprofessional collaboration. The ERAS concept is initiated for patients a week before surgery when the patient receives detailed information about the care process during a meeting with a nurse.
The study is a qualitative interpretive study based on interviews.
Twelve patients, nine men and three women, were interviewed. The interviews were transcribed verbatim and analysed using interpretive phenomenological analysis (IPA).
The analysis identified and formulated five themes: being seen, security, trust, responsibility and participation. All themes are closely related and illustrate positive and negative sides of the patient's experience. They hang together and form a complete set of experiences: ERAS conversation and its impact on patients' participation.
The results show that patients feel confirmed in the ERAS conversation. Healthcare professionals need to be bonding more information call during hospitalisation. It is important to confirm the patient in order for them to participate and take responsibility. Reliance on caregivers is important for patients to feel safe and to participate in their own care. This study shows that the ERAS conversation was experienced as being structured and individually tailored, but the information must apply to the patients throughout the period of care.
Relevance to clinical practice
Some shortcomings have been revealed, which should enable improvement in the care of patients. Healthcare professionals need to raise awareness of patients' responsibilities for participation in their own recovery and care. Healthcare professionals and patients need to be aware of each other's responsibilities.
Background In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. Methods Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. Results Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group ($4,602 vs $3,807; P = .047), as well as the cost of drugs ($1,309 vs $1,202; P = .001), whereas the cost of hospitalization was lower ($7,344 vs $9,278; P = .025). The cost of investigations, outpatient care, and loss of production did not differ significantly between the 2 treatment arms. Total cost and quality-adjusted survival were $25,315 and 0.759 vs $27,819 and 0.728 (both not significant) for the primary PCI and thrombolysis groups, respectively. Based on the 1-year follow-up, bootstrap analysis revealed that in 80%, 88%, and 89% of the replications, the cost per health outcome gained for PCI will be andlt;$0, $50,000, and $100,000 respectively. Conclusion In a 1-year perspective, there was a tendency toward lower costs and better health outcome after primary PCI, resulting in costs for PCI in comparison to thrombolysis that will be below the conventional threshold for cost-effectiveness in 88% of bootstrap replications.


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