Rehabiliteringsråd från ett fysioterapeutiskt perspektiv för patienter som genomgår en axelledsprotesoperation : En handbok som stöder patienten under den pre- och postoperativa rehabiliteringen

Examenarbetet är ett beställningsarbete av Tölö sjukhus fysioterapiavdelning. Detta examensarbete basera sig på evidensbaserad litteratur som forskningar, artiklar och böcker. Syftet med examensarbetet är att skapa ett fysioterapeutiskt patientupplysningsmaterial för patienter som genomgår en axelledsprotesoperation på HNS. Arbetet är uppbyggt med hjälp av Carlström & Carlström Hagmans (2006) metod för uppsatsarbete. Examensarbetet är begränsat till den äldre befolkningen som på grund av artros förändringar i axelleden genomgår en axelledsprotesoperation. Vidare är arbetet begränsat till totalprotesmodellen Global AP och delprotesmodellen Copeland. Examensarbetets teoretiska referensram är uppbyggd enligt patientens förlopp från en frisk axelled till artrosförändringar med smärta och operation som följd. Innehållets fokus ligger på den postoperativa rehabiliteringen. På basen av litteratursökning och beställarens vision har en informativ handbok utformats. Handboken innehåller: vad en axelledsprotes medför, kort om allmänna preoperativa råd, smärtbehandlingsmetoder som kan utnyttjas både preoperativt och postoperativt, eventuella tidsbundna restriktioner, praktiska råd som underlättar patientens vardag, ett fysioterapeutiskt träningsprogram för de tre först veckorna med bilder och till sist kort om allmänna motionsråd som främjar hälsan efter operationen. Forskningsfrågorna behandlar den terapeutiska träningen som bäst lämpar sig efter en axelledsprotesoperation, vad som bör beaktas och övrig råd en fysioterapeut kan ge patienten utöver den terapeutiska träningen. Dessutom behandlar en av frågorna hur patienten kan modifiera sina alldagliga aktiviteter så att de följer angivna restriktioner under rehabiliteringsprocessen. Forskningsfrågorna har besvarats utifrån den inkluderade evidensbaserade litteraturen.This thesis is commissioned by Töölö Hospital at the department of physiotherapy. This thesis is based on evidence-based literature such as research, articles and books. The purpose of the thesis is to develop a physiotherapeutic client education material for patients undergoing a shoulder arthroplasty at HUS. This degree thesis is structured by Carlström & Carlström Hagman´s (2006) method for essay based thesis. The thesis is limited to the elderly population who, due to osteoarthritis in the shoulder joint, undergoes shoulder arthroplasty. Furthermore, it is limited to the models of total shoulder arthroplasty Global AP and hemiarthroplasty Copeland. The theoretical frame of this study is structured according to the patient's course from a healthy shoulder joint to osteoarthritis with pain and surgery as a result. The focus of the content is on the postoperative rehabilitation. An informative brochure is developed for this thesis as a result of literature research and the vision of the client. The brochure consists of: what a shoulder arthroplasty entails, shortly about common preoperative advice, pain management methods that can be used both preoperatively and postoperatively, possible time limited restrictions, practical advice that facilitates the everyday life of the patient, a physiotherapeutic training program with pictures for the initial three weeks and finally briefly about general exercise advice that promotes a healthy lifestyle after surgery. The research questions discuss the therapeutic exercise that is best suited after a shoulder arthroplasty for the patient, what to be considered and other advice a physiotherapist can give to the patient in addition to the therapeutic exercise. In addition, one of the questions discusses how patients can modify their everyday activities to follow specified restrictions during the rehabilitation process. The research questions have been answered with the included evidence based literature.Tämän opinnäytetyön toimeksiantaja on Töölön sairaalan fysioterapiayksikkö. Tämä opinnäytetyö perustuu näyttöön perustuvaan kirjallisuuteen, tutkimuksiin, artikkeleihin ja kirjoihin. Opinnäytetyön tarkoitus on luoda fysioterapeuttinen käsikirja potilaille, joille tehdään olkanivelen tekonivelleikkaus HUS:lla. Tämä opinnäytetyö on jäsennelty käyttämällä Carlström ja Carlström Hagmanin (2006) menetelmää tutkielmasta. Opinnäytetyö on rajattu ikäihmisiin, joille tehdään olkanivelen tekonivelleikkaus nivelrikkomuutoksien takia. Lisäksi työ on rajattu Global APn kokotekonivelmalliin ja Copeland osatekonivelmalliin. Tämän opinnäytetyön viitekehys on jäsennelty kattaen koko kaaren potilaan terveestä olkanivelestä nivelrikkomuutoksiin ja sen aiheuttamasta kivusta aina leikkaukseen asti. Sisällön keskipisteenä on leikkauksen jälkeinen kuntoutus. Tähän opinnäytetyöhön kehitettiin kirjallisuuden ja toimeksiantajan näkemysten perusteella informatiivinen opas. Oppaassa kerrotaan: mitä olkanivelen tekonivel merkitsee, lyhyesti yleisiä preoperatiivisista neuvoja, kivunhallintamenetelmiä joita voi hyödyntää sekä preoperatiivisesti että postoperatiivisesti, mahdollisia määräaikaisia rajoituksia, käytännön neuvoja potilaan arjen helpottamiseksi, kolmen ensimmäisten viikkojen terapeuttiset harjoitteet kuvineen ja viimeiseksi lyhyesti yleisiä liikuntasuosituksia terveyden edistämiseksi leikkauksen jälkeen. Tutkimuskysymykset käsittelevät terapeuttista harjoittelua, joka parhaiten soveltuu olkanivelen proteesileikkauksen jälkeen, mitä pitäisi huomioida ja muita neuvoja, joita fysioterapeutti voi antaa potilaalle terapeuttisten harjoitusten lisäksi. Lisäksi yksi kysymyksistä käsittelee millä tavoin potilaat voivat muokata jokapäiväistä toimintaansa niin, että he noudattavat tiettyjä rajoituksia kuntoutusprosessin aikana. Tutkimuskysymyksiin on vastattu käyttäen tutkimukseen sisältyvää näyttöön perustuvaa kirjallisuutta

How to create an organizational culture that promotes innovation - a case study at Siemens Industrial Turbomachinery AB

The purpose in this thesis is to construct a customized plan of action regarding how to improve the organizational culture for innovations. Siemens Industrial Turbomachinery Gas Turbine R&D experiences a successful past and present. They operate in a mature industry and have ascertained a need for improvement with innovations. Companies, likely SIT AB, that have practiced a successful past and are operating with a mature technology, often face the risk of being caught in the so called performance trap. The definition of a performance trap is a company that currently is performing well and experience sufficient growth, but is too occupied with its core business and forgets to search for those opportunities that will lead to future growth. The challenge for companies that are using mature technology is to be able to adopt new technology, i.e. perform radical innovations. Companies that have experienced successful pasts and are operating with mature technology, in mature industries, often face the risk of being caught in the performance trap. To increase radical innovations and not only incremental like improvements of products, companies and also SIT AB, need to develop a system or way of working to meet the challenge to avoid a performance trap. According to the academic theory of how to work with and support innovations, SIT GT R&D fulfills many factors that are essential to possess in order to promote innovation and creativity. The company has the necessary presumptions that are needed in order to generate innovations, but the presumptions are not sufficient enough and there is definitely room for improvement. SIT GT R&D, just like other companies in mature industries, faces the risk of being caught in a performance trap because they prioritize short time projects, with more immediate results and benefits, before the long term projects and solutions. Too become a more innovative organization changes need to be adopted, since innovation does not occur by itself just because the company states that it wants to be innovative. A plan of action for innovation is needed. The fours step solution presented in this thesis includes the following; Step one, clarify and implement a strategy for innovation. Step two; secure communication for innovation, e.g. effective communication between R&D and the market department. Step three; implement support systems for innovation, e.g. budget for innovation. Step four; provide the individual drivers and motivators needed for innovation, e.g. providing the employees with empowerment and autonomy. By implementing those steps that are presented in the plan of action, the organization will develop those capabilities and assets that are needed to promote innovations and to avoid a performance trap. This will not only lay the foundation for future survival but also bring along the potential of making the capability to generate innovations a signification competitive advantage

The Moo-carousel : how Holistic Planned Grazing can increase sustainability in a dwindling world

The problems raised due to rapid climate change are complex challenges with various underlying concerns. One of these concerns is the momentary solutions adapted in intensive factory farming, which have led to losses in nature’s finite resources. It is increasingly clear that farming practices, including conventional dairy farming, are unsustainable and contribute to ecosystem degradation and biodiversity depletion. Therefore, the aim of this study was to investigate the use of holistic grazing methods to improve sustainability and animal welfare while finding ethical solutions for small-scale dairy farmers in Sweden. The methods employed in this investigation consisted of a combination between a literature review and interviews with farmers who had already applied ho-listic planned grazing (HPG). HPG involves cows rotating through multiple paddocks to imitate natural grazing patterns, thereby potentially enhancing soil health and biodiversity. However, chal-lenges such as restricted land assets and workload remain. The existing literature on this subject requires more empirical research, as the data on dairy farming and HPG combined is largely non-existent. Nonetheless, the results from the Moo-Carousel indicated that adopting holistic strategies in small-scale dairy farming in Sweden would not pose significant problems, as evidenced by graz-ing management. This study provides a new, circular approach to small-scale dairy farming, that can help increase sustainability in a dwindling world

Building texture - the impact of mixing and recipe parameters on mayonnaise quality

Mayonnaise is an oil in water emulsion with a high oil content dispersed in a continuous water phase. The egg is used as the emulsifier, which stabilizes the oil droplets in the continuous phase. The objective was to increase the knowledge of the mayonnaise production process and its impact on the mayonnaise quality. The approach was to produce mayonnaise with a high shear rotor-stator mixer and vary mixing parameters and recipe parameters to evaluate their impact on the product. The produced mayonnaise was analysed with measurements of the oil droplet size (laser diffraction) and the texture (texture analyser and rheometer). The results from the experiments showed that several parameters have an impact on the properties of mayonnaise. Variations in the recipe showed that oil content, emulsifier content and type of emulsifier have a great influence on the properties of mayonnaise. The addition of thickener to the product significantly impacted both texture and droplet size of the mayonnaise. From the mixing parameters it was concluded that both mixing time and mixing speed during the emulsification has an impact on the texture and droplet size of the mayonnaise. The theory about colloidal glass has been successfully used to explain the complex system of mayonnaise and how building texture could be achieved. The theory of droplet break up in laminar flow was used to explain the droplet sizes obtained in the experiments.Majonnäs består till största delen av olja och ägg. Detta är två produkter med flytande karaktär, så hur kommer det sig då att majonnäs har en sådan krämig konsistens? Att majonnäsens konsistens kan vara nyckfull är vi nog många som kan skriva under på efter mindre lyckade försök i köket. Här ska det redas ut hur den perfekta konsistensen uppnås

Nonexistence of marginally trapped surfaces and geons in 2+1 gravity

We use existence results for Jang's equation and marginally outer trapped surfaces (MOTSs) in 2+1 gravity to obtain nonexistence of geons in 2+1 gravity. In particular, our results show that any 2+1 initial data set, which obeys the dominant energy condition with cosmological constant \Lambda \geq 0 and which satisfies a mild asymptotic condition, must have trivial topology. Moreover, any data set obeying these conditions cannot contain a MOTS. The asymptotic condition involves a cutoff at a finite boundary at which a null mean convexity condition is assumed to hold; this null mean convexity condition is satisfied by all the standard asymptotic boundary conditions. The results presented here strengthen various aspects of previous related results in the literature. These results not only have implications for classical 2+1 gravity but also apply to quantum 2+1 gravity when formulated using Witten's solution space quantization.Comment: v3: Elements from the original two proofs of the main result have been combined to give a single proof, thereby circumventing an issue with the second proof associated with potential blow-ups of solutions to Jang's equation. To appear in Commun. Math. Phy

Altruism or entrepreneurialism? The co-evolution of green place branding and policy tourism in Växjö, Sweden

More and more cities around the world are adopting green-city labels and are making use of their urban environmental policymaking for the purpose of place branding. However, the nature of the relationship between the branding of green cities and urban environmental policymaking is contested. Some researchers have highlighted so-called ‘greenwashing’ and the cherry-picking of easily attained goals. Others argue that green branding is driven by altruism, rather than intra-urban competition and entrepreneurialism. Drawing on literatures on policy tourism and green place branding, this article presents a longitudinal study of green branding in Växjö, Sweden. It contributes to the debate on green place branding by showing how two sets of contradictory impulses – entrepreneurialism/competition versus altruism/cooperation, and cherry-picking/greenwashing versus comprehensive environmental policymaking – affect the relationship between green place branding and environmental policy. In particular, the analysis illuminates the changing role played by policy tourism in shaping both the development of environmental policies and branding practices.</jats:p

Material Choices for a Fossil-Free Preschool - An Interview Study on How Materials are Chosen, and a Life Cycle Assessment of Hemp Insulation

Many of the materials used for constructing a preschool today are not fossil-free. Therefore, the administration of premises of the City of Gothenburg (Lokalförvaltningen) has decided to construct a fossil-free preschool as a first step towards the goal of becoming fossil-free before the year 2030. Thus, the purpose of this thesis was to contribute to the development towards a fossil-free construction industry by identifying the process of material choices for a fossil-free preschool and to assess if the choice of insulation material in an exterior wall could be fossil-free. The assessment of insulation materials was performed by comparing the standard material mineral wool with hemp insulation as an alternative material. A mixed methods research was conducted in this study. This included a qualitative interview study on actors in the industry and a quantitative life cycle assessment (LCA) of hemp insulation where GWP100 was assessed. Further, the global warming potential (GWP) of hemp insulation and mineral wool was compared. From the interview study, a result was that some of the interviewees thought that the client makes the material choice and others thought everyone makes the choice. However, the results are coloured by the methodological choice to only interview ten actors. Regarding the definition of fossil-free materials, some thought it aimed to the raw material while some thought it aimed to the whole lifecycle of a material. Further, the interviewees also had multiple suggestions regarding how the material choices can be affected, e.g. by green public procurement. The LCA was conducted on a cradle-to-gate basis. A result from the LCA was that the GWP of hemp insulation is -1.15 kg CO2e per m2 hemp insulation if biogenic CO2 of - 1 kg CO2e per kg hemp plant is accounted for and if it would be produced in Sweden. Compared to mineral wool, hemp insulation would be superior since mineral wool has a GWP of 0.62 to 1.94 kg CO2e per m2 insulation. From the results of the literature review, the interview study and the comparison, several conclusions were drawn. One conclusion was that it is important to state a clear definition and set boundaries of fossil-free to enable fossil-free materials to be chosen. Further, the actors in the construction industry have different opinions regarding actors’ possibility to affect the material choices for a fossil-free preschool. Another conclusion drawn was that the methodological choices of an LCA, highly affect the results. The comparison between mineral wool and hemp insulation resulted in the conclusion that hemp insulation could be a better option for a fossil-free preschool than mineral wool

Asymptotic Quasinormal Frequencies of Brane-Localized Black Hole

The asymptotic quasinormal frequencies of the brane-localized $(4+n)$-dimensional black hole are computed. Since the induced metric on the brane is not an exact vacuum solution of the Einstein equation defined on the brane, the real parts of the quasinormal frequencies $\omega$ do not approach to the well-known value $T_H \ln 3$ but approach to $T_H \ln k_n$, where $k_n$ is a number dependent on the extra dimensions. For the scalar perturbation $Re(\omega / T_H) = \ln 3$ is reproduced when $n = 0$. For $n \neq 0$, however, $Re(\omega / T_H)$ is smaller than $\ln 3$. It is shown also that when $n > 4$, $Im(\omega / T_H)$ vanishes in the scalar perturbation. For the gravitational perturbation it is shown that $Re(\omega / T_H) = \ln 3$ is reproduced when $n = 0$ and $n = 4$. For different $n$, however, $Re(\omega / T_H)$ is smaller than $\ln 3$. When $n = \infty$, for example, $Re(\omega / T_H)$ approaches to $\ln (1 + 2 \cos \sqrt{5} \pi) \approx 0.906$. Unlike the scalar perturbation $Im(\omega / T_H)$ does not vanish regradless of the number of extra dimensions.Comment: 15 pages, 1 eps figure: V2 one more reference added. The derivtaion of the effective potential is explained in detail. Version of PL

Klasslärarstuderandes tankar och förhållningssätt till simundervisning

Avhandlingens syfte är att kartlägga klasslärarstuderandes förhållningssätt och tankar kring simundervisning i årskurserna 3–6. Syftet är ytterligare att ta reda på vilka erfarenheter och verktyg klasslärarstuderande önskar för att utveckla för att känna sig trygga i att undervisa simning. För att uppnå detta syfte ställdes följande forskningsfrågor upp: 1. Vilka utmaningar ser klasslärarstuderande med simundervisning i årskurserna 3–6? 2. Vilka verktyg upplever klasslärarstuderande att de behöver för att undervisa simning? För att samla in data till undersökningen användes en kvantitativ forskningsansats, där en enkät skickades ut till klasslärarstuderande vid Åbo Akademi i Vasa och fick sammanlagt 40 svar. Resultaten visade att respondenterna önskade att simundervisningen skulle få mer utrymme i lärarutbildningen för att de ska känna sig trygga att undervisa simning. Verktyg som simlärarfortbildning, lärarhandledningar med tips och lektionsplaner var önskvärda för att stödja klasslärarstuderandes lärande

Neurojuridik och svensk bevisrätt - naturvetenskapliga rön mot rättsliga presumtioner

Det har på senare tid skett framsteg inom neurovetenskaplig forskning som skapat möjligheter för ett nytt ämnesområde inom juridiken, neurojuridik. Forskningen om neurojuridik sker främst i USA och en särskilt omdebatterad fråga där är om neurovetenskapliga lögndetektorer ska få användas i straffprocessen. Det finns även två privata bolag i USA som för närvarande lanserar den neurovetenskapliga lögndetektorn som vetenskapligt bevisad och starkt tillförlitlig, vilket tyder på att neurovetenskapliga metoder har potential att skapa bevisning som påverkar straffprocessen på ett betydande sätt och att sådan bevisning troligen kan skapa en faktisk presumtion om att den tilltalade är skyldig. Föreliggande uppsats utreder vilken påverkan neurojuridiken, som handlar om att neurovetenskapliga framsteg tillvaratas i den juridiska processen, har på svenska straffprocessrättsliga regler som principen om fri bevisprövning och oskyldighetspresumtionen. Den slutliga bedömningen är att neurovetenskaplig bevisning får anföras i svensk domstol och att neurovetenskaplig bevisning troligen inte kommer att tillmätas något bevisvärde i målet, vilket beror på att den neurovetenskapliga bevisningen saknar tillförlitlighet enligt aktuell forskning. Neurovetenskaplig bevisning kan dessutom medföra svårigheter i rättens bevisvärdering eftersom bevisningen är av vetenskaplig och grafisk natur, vilket troligen medför att den övertolkas eller missförstås av rätten. Neurovetenskaplig bevisning kan även framstå som objektiv och som att subjektiva bedömningar på så sätt undviks när bevisningen används. Det framgår emellertid att neurovetenskapliga metoder och sakkunnigbevisning kan medföra ett subjektivt element till bevisningen. Den tilltalades rätt till tystnad kan även bli tillämplig i vissa situationer när neurovetenskaplig bevisning används, främst när den tilltalade väljer att förhålla sig passiv under processen och möjligen även på ett mer generellt plan om neurovetenskaplig bevisning bedöms som osäker. Författaren förespråkar därför att Europadomstolens krav om att tystnaden inte får vara det huvudsakliga eller enda beviset för en fällande dom ska införas i svensk lagtext. Den förespråkade lagändringen innebär troligen att bevisvärderingen återges på ett mer utförligt och korrekt sätt i domskälen. Neurovetenskaplig bevisning bedöms slutligen inte vara tillförlitlig nog i dagsläget för att skapa en faktisk presumtion om att den tilltalade är skyldig, vilket föranleder att oskyldighetspresumtionen kvarstår som en rimlig rättslig presumtion att använda i straffprocessen. Oskyldighetspresumtionen bör dessutom vidhållas även om neurovetenskaplig bevisning i framtiden blir mer tillförlitlig eftersom presumtionen är viktig för den tilltalades rättsskydd i brottmål.The recent developments in neuroscience research have made it possible for a new field to emerge within law, neurolaw. Most of the research on neurolaw takes place in the United States and one intensively debated issue there is whether or not neuroscience-based lie detection should be allowed in criminal cases. There are currently two American private companies advertising the neuroscience-based lie detection tests as scientifically proven and highly reliable. This demonstrates that neuroscientific methods are able to produce evidence that can have a profound significance for the criminal procedure and that neuroscientific evidence may have the ability to create a factual presumption of the defendant being guilty. This thesis examines how neurolaw, which is about neuroscientific advances being implemented in the legal process, relates to the Swedish rules of criminal procedure, more specifically production and evaluation of evidence and the presumption of innocence. The final conclusion is that neuroscientific evidence can be presented in Swedish criminal courts and that neuroscientific evidence most likely will be evaluated to have no evidentiary value in the case. This conclusion is motivated by the fact that neuroscientific evidence lack reliability according to the research performed to date. It is furthermore apparent that neuroscientific evidence may be difficult for the court to evaluate because of its scientific and graphic nature, which may cause the court to be unduly influenced by the evidence or to misinterpret the evidence. Neuroscientific evidence can also be perceived as objective by nature and therefore as if subjective judgments are avoided when neuroscientific evidence is used. However this is not the case since both neuroscientific evidence and expert witnesses carries a subjective element to the evidence. The defendant’s right to silence can also be addressed in certain situations when neuroscientific evidence is presented in court, mostly when the defendant decides to remain silent during the proceedings and possibly also on a more general level since neuroscientific evidence can be deemed as uncertain. The author argues that Swedish law should be changed on this issue in order to better comply with the case law of the European Court of Human Rights, which repeatedly has ruled that a conviction cannot be solely or mainly based on the defendant’s silence. An amendment of the Swedish law will most likely cause the judges to explain the evaluation of the evidence more extensively and correctly in the judgment. Finally neuroscientific evidence is not presumed to be reliable enough to create a factual presumption of the defendant being guilty, which leaves the presumption of innocence as a reasonable legal presumption to use in criminal cases. The presumption of innocence ought to be persevered even if neuroscientific evidence in the future gains a greater reliability because the presumption is vital to the defendant’s legal protection in criminal cases