Harnack estimates for degenerate parabolic equations modeled on the subelliptic p-Laplacian

We establish a Harnack inequality for a class of quasi-linear PDE modeled on the prototype {equation*} \partial_tu= -\sum_{i=1}^{m}X_i^\ast (|\X u|^{p-2} X_i u){equation*} where $p\ge 2$, \ \X = (X_1,..., X_m) is a system of Lipschitz vector fields defined on a smooth manifold \M endowed with a Borel measure $\mu$, and $X_i^*$ denotes the adjoint of $X_i$ with respect to $\mu$. Our estimates are derived assuming that (i) the control distance $d$ generated by \X induces the same topology on \M; (ii) a doubling condition for the $\mu$-measure of $d-$metric balls and (iii) the validity of a Poincar\'e inequality involving \X and $\mu$. Our results extend the recent work in \cite{DiBenedettoGianazzaVespri1}, \cite{K}, to a more general setting including the model cases of (1) metrics generated by H\"ormander vector fields and Lebesgue measure; (2) Riemannian manifolds with non-negative Ricci curvature and Riemannian volume forms; and (3) metrics generated by non-smooth Baouendi-Grushin type vector fields and Lebesgue measure. In all cases the Harnack inequality continues to hold when the Lebesgue measure is substituted by any smooth volume form or by measures with densities corresponding to Muckenhoupt type weights

Stillbirth : a loss for the whole family

Background: Stillbirth loss is a profound experience affecting around 450 families every year in Sweden. Method: Two questionnaires, one postal with three measurements over a two-year period with 55 parents (I), and a web questionnaire answered by 411 parents (III), five focus groups with a total of 25 parents (II), and individual face-to-face interviews with 13 bereaved adolescent siblings of a stillborn baby (IV) constitute the data collection. The qualitative data were analysed with a content analysis, descriptive statistics were used for the quantitative data. The overall aim of the thesis was to study the loss of a stillborn baby from the perspective of parents and siblings. Results: The parents strived to create an environment in which siblings are confidently allowed and invited to participate in processes surrounding the stillbirth. They promoted an understanding of the new and unexpected family situation. Some parents expressed difficulty in focusing on the needs of siblings during the acute grief after the loss. Most of the siblings met their stillborn sister or brother. The meeting was described as natural, enriching and self-evident and as an important component to create understanding; it attributed identity and personality to the stillborn baby. When the siblings created memories the baby was acknowledged and took on a tangible form. Furthermore, parents and siblings expressed feelings of broken expectations of becoming a larger family. Additionally, being a sister or brother of a stillborn baby brought up thoughts about the sibling relationship, and whether they could still identify themselves as big sisters or brothers. Many parents reported the loss had strengthened their relationship. Some parents and adolescent siblings expressed that they were grieving alone as well as together with other members of the family. They developed an inner strength and a trust in each other. For others, expectations of their own and other family members´ way of grieving could pose a threat to their close relationship; a lack of understanding for each other´s way to express grief or their needs could create an emotional distance. Some adolescents expressed feelings of being part of a common grief in the family, but simultaneously being outside. The loss of their baby sibling implied a temporary loss of their parents´ parenthood.clusions: This thesis gives new information on the thoughts and feelings in a family after they have experienced a stillbirth. Clinically the information can be used to help health-care professionals communicate with parents and siblings after this event. For parents seeking advice, it may help to know that the parents in this study, who actively involved the stillborn baby’s siblings in the meeting and farewell afterwards, by and large reported encouraging experiences only

Somaattinen hoitotyö psykiatrian poliklinikalla

Opinnäytetyön tarkoitus oli selvittää hoitajien näkemys omasta somaattisesta osaamisestaan sekä selvittää somaattisen hoitotyön toteutuminen hoitajien näkökulmasta psykiatrian poliklinikoilla. Tavoitteena on kehittää kuntoutujien somaattista hoitoa ja tuottaa tietoa, joka edistää JMTN psykiatrian poliklinikan henkilökuntaa oman somaattisen osaamisensa vahvistamisessa. Tiedolla pyritään edistämään kuntoutujien somaattisen voinnin seuraamisen ja muutosten havainnointia psykiatrian poliklinikalla. Tutkimuskysymyksinä olivat: Millainen on somaattisen hoitotyön toteutuminen psykiatrian poliklinikalla hoitajien kuvaamana? Millainen käsitys hoitajilla on omasta osaamisesta toteuttaa somaattista hoitotyötä psykiatrian poliklinikalla? Opinnäytetyössä teoreettisen viitekehyksen muodostavat seuraavat käsitteet: kokonaisvaltainen hoitotyö, terveyden edistäminen ja ohjaus psykiatrisessa hoitotyössä, psykiatriset palvelut, psykiatrinen sairaanhoitaja ja psykoosisairas potilas ja potilaan hoito. Opinnäytetyössä käytimme laadullista tutkimusmenetelmää, jonka toteutimme teemahaastattelun muodossa. Haastattelut toteutettiin JMTN psykiatrian poliklinikoilla ryhmähaastatteluina. Haastateltavat olivat psykiatrisia sairaanhoitajia, lähihoitaja sekä mielenterveyshoitaja. Haastattelut litteroitiin puhekielestä tekstiksi ja aineisto analysoitiin sisällönanalyysilla. Tutkimustulosten perusteella voidaan todeta, että hoitajat pitävät somaattista hoitotyötä tärkeänä osana psykiatrista hoitoa. Tärkeänä koettiin kuntoutujien muutosten havainnointi voinnissa, ja että kuntoutujat lähetetään oikeaan jatkohoitopaikkaan. Kokonaisvaltaisen hoidon toteutumista pidettiin tärkeänä, mutta haastateltujen hoitajien mukaan se ei aina toteudu halutulla tavalla psykiatrisen poliklinikan rajallisten mahdollisuuksien vuoksi toteuttaa somaattista hoitotyötä. Tuloksissa kävi ilmi, että JMTN psykiatrisilla poliklinikoilla seurataan kuntoutujien somaattista terveyttä ja vointia. Hoitajat arvioivat tarvitsevansa lisää osaamista somaattisista sairauksista ja varmuutta toteuttaa somaattista hoitotyötä psykiatrian poliklinikalla. Hoitajien kiinnostus somaattiseen hoitotyöhön ja sen osaamisen vahvistamiseen näkyi selkeänä tutkimustuloksissa. Tutkimustuloksissa kävi ilmi, että potilaan motivoiminen somaattisten sairauksien itsehoitoon on usein haastavaa psykiatrisen sairauden, ja sitä kautta kuntoutujan kognitiivisten kykyjen laskun vuoksi. Tuloksissa esille nousseet kehittämisideat koskivat hoitajien somaattisten koulutuksien lisäämistä, ja yhteistyön kehittämistä perusterveydenhuollon kanssa. Tulimme siihen tulokseen, että hoitajat arvioivat oman somaattisen hoitotyön osaamisen hyväksi. Perusasiat osataan, mutta lähes kaikki haastatellut kaipasivat lisäoppia ja kertausta. Somaattisten sairauksien oireita seurataan psykiatrian poliklinikoilla. Hoitajien mukaan yhteistyö perusterveydenhuollon kanssa jää kuinkin suppeaksi. Psykiatrian poliklinikoiden hoitotyöntekijöiden kiinnostus somaattista hoitotyötä kohtaan on hyvä, ja he ovat motivoituneita kehittämään somaattista hoitoa psykiatrian poliklinikoilla.The aim of this thesis was to clarify the views of nurses about their own skills in somatic care and to study the realization of somatic nursing care in psychiatric outpatient clinics from the point of view of nurses. The purpose was to develop the somatic care of outpatients and to produce knowledge which promotes the personnel in JMTN psychiatric outpatient clinics in strengthening their own somatic skills. The information obtained is aimed to promote the observation of control and change in somatic condition of the outpatients in the psychiatric outpatient clinics. The research questions in this study were the following questions: What does somatic care mean in practice in the psychiatric outpatient clinics described by nurses? What do the nurses themselves think about their own skills to carry out the somatic nursing care in the psychiatric outpatient clinics? In this study the theoretical background is based on the following concepts; total nursing care, health promotion and guidance in psychiatric nursing care, psychiatric services, psychiatric nurse and psychiatric outpatient and the nursing care of patient. In this thesis we used qualitative research methods in the form of semi-structed interviews. The interviews were carried out as a group interview in the JMTN psychiatric outpatient clinics. The persons interviewed were psychiatric nurses, practical nurse and mental health nurses. The interviews were translated from spoken language to written language and the data was categorized and sorted into patterns in accordance with thematic analyses. According to the results of the research it can be stated that the nurses considered the somatic nursing care as an important part of psychiatric nursing. Especially observation of the changes in the health of outpatients was considered important and to be able to send the outpatients to the right health services. The total nursing care was thought as an important part of the nursing care but according to the nurses interviewed it is not always possible to carry out somatic nursing care in the psychiatric outpatient clinics in the way that they would like because of limited resources. The results pointed out that the health and condition of outpatients were considered and followed in JMNT the psychiatric outpatients clinics. The nurses estimated to need more knowledge in somatic nursing care and self assurance to carry out somatic nursing care in the psychiatric outpatient clinics. It became clear in the results that the nurses were interested in somatic nursing care and to strengthen the abilities to use it. The results showed also that it is a challenge to motivate the outpatients to self take care of their somatic diseases because of the psychiatric problems and diminished cognitive skills. To develop further the ideas that came out in the results it was important to increase the somatic training and to develop the co-operation with primary health care. As a result we can note that the nurses evaluated their own somatic skills as good. They knew well the basic skills but they experienced that they needed more knowledge and repetition. In the psychiatric outpatient clinics the symptoms of somatic diseases were followed. According to the nurses the co-operation with primary health care was nevertheless slight. The nurses in the psychiatric outpatient clinics were interested in somatic nursing care and they were motivated to develop the somatic nursing care in their clinics

Concentration inequalities for leave-one-out cross validation

In this article we prove that estimator stability is enough to show that leave-one-out cross validation is a sound procedure, by providing concentration bounds in a general framework. In particular, we provide concentration bounds beyond Lipschitz continuity assumptions on the loss or on the estimator. In order to obtain our results, we rely on random variables with distribution satisfying the logarithmic Sobolev inequality, providing us a relatively rich class of distributions. We illustrate our method by considering several interesting examples, including linear regression, kernel density estimation, and stabilized / truncated estimators such as stabilized kernel regression