Högskolan i Skövde

Background: Newly graduated nurses, NGN, are offered a trainee program during their first year of work where they receive supervision and training. Previous research shows that the emphasis in nursing education is focused on knowledge and skills instead of the deeper understanding where nursing students should learn to reflect and have critical thinking.

Aim: Investigate newly graduated nurses' experiences of being new in the profession.

Method: A literature review based on 10 scientific articles with a qualitative design.

Findings: The analysis resulted in three themes: Feeling lack of knowledge, Newly graduated nurse's needs, Feelings of horror mixed with delight. The three themes yielded four subheadings: Need for reflection, Need for support and security, Joy and pride, Fear.

Conclusion: NGN experience challenges due to insufficient clinical knowledge as well as the difficulty in translating theoretical knowledge into practical nursing actions. Which gives rise to feelings of inadequacy, insecurity, worry, anxiety and stress. Need of support and reflection is important when these feelings arise. Support in forms of supervision and reflection that NGN receive in the trainee program can be a contributing factor that NGNsfeel they can handle their work situation and stay in the care profession.

The subject of digital animation witnessed the indispensable role of rigging in enabling movement and functionality, particularly within the context of game development. While animation principles (Thomas & Johnston, 1995) form the foundation of this discipline, rigging principles remain somewhat elusive, lacking the same fundamental status even to this day. As a highly technical subject, rigging can pose challenges to students who may not be aware of its intricate logic, yet still have to contend with it. This study presents an epistemic solution designed to elucidate the logic of rigging by emphasizing fundamental concepts over ready-made solutions. A full list of concepts was defined. To evaluate the effectiveness of this pedagogical approach, a workshop was held, focusing on experiential (Kolb, 2014), concept-based, teaching. It was compared with a control group whose workshop inherited the traditional pedagogical methodology. Afterwards, both groups were handed a convergent and a divergent test assignment (Guilford, 1968). Qualitative data was gathered through interviews, capturing student’s reflections and opinions on the respective workshops and test assignments. Results show a positive attitude towards both teaching methods. However, there was a particular alacrity among the students in the concept workshop, and they appreciated its pedagogical differences. Some students appeared to pick up on the epistemology and even expressed a realization of "why", and in doing so, stated the epistemic goal verbatim. Moreover, the traditional methodology entails less engagement in the convergent test assignment, further proving the potential for creative thinking (Runco, 2014) in the procedural test assignment. This demonstrated the potential benefit of this approach to education. This study is meant to start a discourse on effective pedagogical strategies in the context of rigging for digital animation, shedding light on the benefits of concept-based teaching. With more resources, it would have also focused on how the concepts affect game development directly.

Background: Euthanasia means that a person receives help from, for example, healthcare professionals to shorten their life. Euthanasia is divided into passive and active euthanasia. The study addresses the limitations that exist regarding legislation for active euthanasia in Sweden, as well as the nurse's role and the ethical perspective.

Aim: To describe nurses' experience of caring for patients who are in a terminal condition and asking for euthanasia.

Method: The method used in the study is a literature review based on qualitative research. Analysis of results was made of 11 scientific articles based on Friberg's five-step model.

Findings: Three themes emerged in the results: Satisfaction and dissatisfaction in care, Difficulties in care and Impact on one's own well-being. It emerged that nurses experienced both positive and negative emotions connected to the care during active euthanasia. The nurses experienced difficulties connected to conversations about the deathprocess and difficulties linked to the work environment. The emotional strain nurses experienced working with active euthanasia was largely linked to ethical and moral conflicts.

Conclusion: The nurses role is to keep the patient's autonomy the focus of care, an increased understanding of the subject can contribute to better care of terminally ill patients.

The health and well-being of the staff in elderly care are prominent issues as the number of elderly people who need support and care is expected to increase. Healthcare workers in Sweden are one of the largest groups of workers, and they have the highest number of sick days per employee. Social and organizational issues account for approximately 58% of sick leave due to work-related illnesses among staff in elderly care. Previous research shows that the quality of leadership is a valuable resource in a healthy organization and is considered to play a crucial role in promoting employees' psychological well-being and health. Aim. The aim was to investigate what health promoting leadership means for employees' mental health in municipal elderly care in Sweden. Method. A literature study was made including 10 scientific original articles were retrieved from the databases Medline and CINAHL the results of the articles were then analysed using a thematic analysis method. Results. The result of the analysis yielded two themes and four subthemes in response to the aim of the study. The health-promoting leader's way of being and the conditions that the leader creates to promote the employees' mental health. Conclusion. Health-promoting leadership in elderly care in Sweden is based on trust and the relationship with the employees and is important for the employees' mental health by contributing to increased well-being and job satisfaction.

Background: SME:s (small and medium-sized enterprises) play a crucial role in economic growth and employment. Despite their significance, these companies often face challenges when seeking financing from banks. The credit assessment process for SMEs is complex and requires careful evaluation of creditworthiness and repayment capacity. Banks need to consider the companies' financial position, industry-specific risks, character, and market trends to make informed decisions. Understanding these challenges and factors is essential for developing effective strategies and methods for lending to SMEs. Previous research shows that SMEs do not have as extensive financial reporting information as larger companies. Therefore, it is important to investigate and understand the specific challenges in the credit assessment process for SMEs so that appropriate measures can be taken to facilitate access to financing and support their growth.                                                       Purpose: The purpose of this thesis is to enhance understanding of the accounting information used in the credit evaluation process and the challenges that banks may encounter regarding SME accounting information when applying for credit. Additionally, the study will explore how banks can utilize alternative methods in the credit assessment process. By investigating these areas, the research aims to improve the relationship between SMEs and banks by identifying the most relevant accounting information for credit evaluation and reducing information asymmetries. The findings of the study can contribute to a fairer and more efficient credit assessment process, thereby facilitating access to financing for SMEs and fostering their growth.                                                                 Method: The study has been conducted using a qualitative method to gather empirical data and enhance understanding of the subject. Respondents were selected based on their expertise in corporate lending, particularly those holding positions such as credit managers. Four respondents were interviewed through semi-structured interviews.                              Conclusion: The results of the study show that the financial information reported in the annual financial statements, such as cash flow, key ratios, balance sheet, and income statement, are not the only significant factors for banks during the credit assessment process. Banks are more interested in other non-financial information, such as the company's business plan, character, marketing strategies, product differentiation, customer relationships, competitive situation, and management competence, among others. These non-financial information may not always be available in the annual financial statements, and therefore, banks need to collaborate with other stakeholders to reduce potential information asymmetries.

Introduction: Alcohol consumption has a significant impact on the health of the global population, with regular alcohol intake increasing the risk of both illness and injury. In 2017, expenditures related to alcohol consumption in Sweden amounted to 103 billion Swedish kronor. The workplace serves as a crucial arena for implementing health-promoting measures.

Objective: To identify potential preventive measures for employers regarding alcohol misuse among employees.

Method: A structured literature review with searches organized into searchblock. All articles were quality-reviewed and then analyzed using the systematic textcondensation method. The articles were coded and categorized based on the analysis.

Results: Nine articles were selected and included in the results. Three main categories emerge from the analysis: psychological factors, screening, and health behaviour. There was a subcategory: preventive measures following screening. Screening, combined with addressing negative psychological factors, reduced alcohol intake among participating employees. Psychological factors were foundational in employee alcohol consumption, with the key psychological factor being the ability to create a sense of psychological safety among employees. Health behaviours involved breaking habits and offering group discussions for employees, providing informationon health risks.

Conclusion: To work preventively, employers should combine multiplepreventive measures for optimal outcomes. Continuous communication of information on health risks related to alcohol misuse is essential. Screening should be conducted to identify employees with alcohol misuse at an early stage. Individually tailored preventive measures should be implemented for those with alcohol misuse. Employers should also consider psychological factors, which play a crucial role in preventive efforts.

Background: In ambulance healthcare in Sweden, as in other healthcare, the incidence of patients with melanin-rich skin is increasing. Legal requirements for individualized and equal care exist, at the same time deficiencies are demonstrated in teaching about melanin-rich skin for nursing students. In ambulance care, quick decisions are often made based on initial assessments, and knowledge of skin assessment is important to the nurse's working diagnosis because signs of acute illness can be quickly revealed by manifestations on the skin.

Aim: To investigate nurses' experiences of assessing patients with melanin-rich skin in ambulance care.

Method: A qualitative study with an inductive approach where semi-structured interviews were used as data collection method. The sample group consisted of ten nurses with professional experience from ambulance operations. The data has been analyzed through qualitative content analysis according to Graneheim and Lundman (2004).

Findings: Nurses experience uncertainty in assessing patients with melanin-rich skin due to educational gaps and visual challenges. This emphasizes the need for enhanced education to ensure equitable prehospital care.

Conclusion: Nursing education for nurses needs to incorporate more resources for the assessment of melanin-rich skin. Prioritizing diverse simulation cases and images is essential for equitable care.

The future is here with interconnected computers on four wheels - connected cars! Just like regular computers in networks, there is also a huge amount of cybersecurity challenges regarding vehicles. With the large amount of data transmitted between vehicles and other devices, a proper way of securing the connections is important. It is clear that the connected components and technologies in modern cars have a large amount of vulnerable points, and more research is needed for further studies. Several modern vehicle technologies such as electrical control units, over the air updates and lidar radars etc are discussed in this work. The most prominent way of securing the stored personal data and the constant flow of transmitted data is encryption, and with the use of blockchains. There are also suggestions on different types of new framework and standards to lock in an even keel for the cybersecurity environment. This work investigates the passive vulnerabilities existing in these connected vehicles systems.There will be a mapping of the most prominent and relevant surfaces vulnerable to for example cyber attacks. This will take the form of a literature study with thematic analysis. Scientific articles will be searched for in databases to find relevant data to code into different themes, answering the research question. The work aims to look at different sources describing ways of implementing cryptographic blockchains in order to achieve the level of security necessary. There will also be some proposals of future frameworks, and to put in standards to secure the future of vehicle cybersecurity. The purpose of this work is to gain a wide view of how the connected vehicles landscape looks like in the form of vulnerabilities, and how we could negate them in the future.

Introduction: Migraine, a neurological condition, affects around 15% of the population, leading to substantial repercussions, diminished quality of life, decreased work capacity and increased healthcare costs. Specialist referrals can ease symptoms, yet healthcare still lacks in providing sufficient care and options.

Objective: To explore the care and treatment experiences of adults with migraines.

Method: A cross-sectional, quantitative study collected data via a web survey on Facebook.

Results: Among 81 study respondents, 70,4% confirmed that migraines affected their daily lives extensively. Additionally, 5% felt that medical staff did not offer individualized treatment plans. Over half had not received information on potential migraine triggers, and about one-third felt their symptoms were misunderstood by healthcare providers. Those referred to neurologists often noted improved quality of life through their treatment.

Conclusion: The findings illustrate the significant daily impact of migraines and the necessity for patient-focused care and deficiencies in healthcare's ability to inform, treat, and support. The importance of enhanced education on migraine management for both patients and professionals is emphasized. Access to neurological expertise appears crucial for patient care experiences and quality of life, with those receiving specialist care reporting better symptom relief. This study deepens the understanding of migraine sufferers' care experiences, potentially guiding future health sector research and development.

Background: In March 2020, the WHO classified covid-19 as a pandemic. Hospitals worldwide were unprepared for a massive influx of seriously ill patients. Respiratory failure was a serious symptom that could cause patients to be admitted to the intensive care unit. Nurses' job was to provide good care, reduce suffering and meet the basic needs of patients despite prevailing circumstances.

Aim: To describe nurses' experiences of nursing during the covid-19 pandemic based on Henderson's nursing theory.

Method: The study is based on a qualitative method with deductive analysis. A literature study has been carried out where qualitative articles have been reviewed and a total of 14 qualitative scientific articles' results were compiled.

Findings: Presented based on three themes which are; lack of basic care, shortcomings in ethical responsibility and difficulties in creating good patient relationships. The themes are then presented in sub-themes which are; difficulties in helping the patient breathe, deficiencies in patient safety, visiting restrictions created ethical dilemmas and stronger relationship between nurse and patient. In these themes, difficulties based on Henderson's nursing theory have been identified. Critically ill patients and a high patient flow in hospitals caused difficulties in nursing for nurses.

Conclusion: Lack of resources, deficiencies in team cooperation, critically ill patients and a high patient flow were considered to threaten the quality of care. Nurses' experiences with the covid-19 pandemic indicate that healthcare needs more resources for future pandemics.

This study explores player experiences within Multiplayer Online Battle Arena (MOBA) games, focusing on the themes of competition, teamwork, and mastery. Through in-depth interviews, a qualitative analysis was made to shed light on the connection between game balance, communication tools, and player support systems. Mastery is highlighted as a central aspect, significantly enhancing player engagement, with an accentuated effect in team contexts. Emotional dynamics were found to be pivotal in player experiences, indicating the importance ofeffective communication and balanced game mechanics.

Recommendations include a broader approach in future research, combining qualitative and quantitative methods for a comprehensive understanding of player experiences. A diversified player demographic and consideration of evolving gaming trends are paramount. The findings underscore the necessity for game developers to integrate both technical and social dimensions in game design, facilitating the aspects of competition, teamwork, and mastery, which provide an enriched player experience. In essence, the research sheds light on the intricate interplay of skill development, emotional engagement, and team dynamics within the MOBA gaming sphere, providing direction for future game development and research.

Förmågan att kunna avgöra om en källa är autentisk och tillförlitlig blir allt viktigare. Möjligheten att använda AI-genererade texter ställer stora krav på kritiskt förhållningssätt och medför ökade risker för spridning av desinformation och misinformation. Falsk information kan skapa osäkerhet hos medborgarna och forskning visar att ju mer människor upplever kontrollförlust i vardagen, desto mer dras de till populistiska och autokratiska ledare.

Inom högskolevärlden diskuteras nu studenternas användande av AI-chatbotar, primärt om examinationsformer och risk för fusk. Perspektiv som rör kritiskt förhållningssätt och demokrati framförs sällan. Inte heller problematiseras effekterna av att studenter frestas att sluta skriva egna texter, vilket påverkar lärandet negativt och hotar deras förmåga att utöva sina demokratiska rättigheter och skyldigheter.

I högskolelagen, bibliotekslagen och den statliga värdegrunden finns stöd för att lärosäten och lärosätesbibliotek ska främja demokrati och ett kritiskt förhållningsätt. I denna presentation vill vi belysa riskerna med AI-chatbotar för demokratin och studenters lärande.

Introduction: Obesity and overweight have become a global epidemic. More people die from obesity than from underweight. Early prevention is important to prevent overweight and obesity because overweight at an early age increase the risk of overweight and obesity in adulthood. There are about 370.000 health apps for download, but little research has been done on the effectiveness of digital health services.

Aim: To investigate whether digital health service can support children up to 18 years of age to achieve a healthier lifestyle regarding eating habits and physical activity, and healthy weight.

Methods: A structured literature review where the articles were analysed thematically.

Results: After searches in CINAHL and PubMed, 21 scientific original articles were included. The articles described studies involving children up to 18 years from 16 different countries and with various digital health services. Four themes were identified: “Eating habits”, “Physical activities”, “BMI and BMI z-score”, and “Self-efficacy and engagement in children and parents”. The results showed both significant and non-significant changes regarding eating habits, physical activity, and BMI or BMI z-score. Some interventions had lasting effects, others did not. The families had an overall sense of satisfaction using digital health services to promote healthy lifestyle and weight development.

Conclusion: Lifestyle habits related to eating habits and physical activity can be changed with the help of digital health services. These changes can contribute to reduced prevalence of overweight and obesity. However, the changes in lifestyle were not always significant or lasting over time. More research is required.

Background: Type 2 diabetes mellitus is a chronic disease that causes significant health problems. It is characterized by a range of symptoms, including fatigue, thirst, and increased urine production. The risk of type 2 diabetes mellitus is linked to lifestyle factors such as poor diet, obesity and stress and can lead to serious complications such as cardiovascular disease, neuropathy, hypoglycemia, and retinopathy, which require regular care and healthy lifestyle habits to prevent.

Aim: The aim of this study is to describe patients' experiences of self-care in type 2 diabetes mellitus.

Method: The study was conducted as a literature-based study with a qualitative approach inspired guided by Friberg.

Findings: Through the analysis of selected articles, four themes have been identified: Difficulties in changing the diet, physical activity that promotes self-care, the influence of relatives, and the support and influence of healthcare professionals. These themes highlight patients’ experiences of self-care.

Conclusion: Self-care in patients with T2DM can be challenging, with initial feelings of shame and fear. It is necessary that care adapts to the patient's life situation and offers support and strategies for lifestyle changes. The support and motivation of relatives and care staff is important for promoting good self-care habits.

Background: Every year 3.9 million girls worldwide undergo female genital mutilation. Female genital mutilation involves the removal of parts of the external genitalia. The procedure is typically performed on girls aged 4 to 14 and it is a tradition in many African countries. Affected women suffer both physically and psychologically and often experience childbirth complications. When seeking healthcare in the Western world, they often encounter healthcare professionals with insufficient competence and knowledge to adequately address their needs.

Aim: The purpose is to highlight women's experiences after genital mutilation.

Method: A literature review with a qualitative approach selecting 10 articles that clarify women's experiences after female genital mutilation.

Findings: The literature review presents two themes and five subthemes. The theme 'Altered Body and Mind' includes the subthemes of physical consequences, psychological consequences, as well as the impact on relationships and loss of desire. The second theme is 'Powerlessness in Vulnerability,' with subthemes of being a victim and feelings of abandonment and helplessness.

Conclusion: Nurses should strive to acquire cultural competence and new knowledge to effectively care for women who have undergone female genital mutilation. This study aims to enrich knowledge and increase understanding of the complexity of this procedure.

The global pandemic, COVID-19 shattered everyday life as we know it and disrupted education globally. In this study, we explore an initiated digital transformation accelerated by the pandemic from school leaders’ perspectives in the context of Swedish high schools. The data consists of a questionnaire with 105 school leaders containing both fixed and open-ended response types. The results reveal significant differences in school leaders’ views on how the transition has worked, whether they and their staff have developed their digital competence, and, how it will affect the school onwards. Contributions include theorising about school leaders’ experiences of navigating an accelerated digital transformation prompted by the pandemic. We introduce four school leader profiles: (a) the enthusiast, (b) the affirmative (c) the skeptical, and (d) the hesitant. These profiles serve to encapsulate the nuanced perspectives of school leaders, thereby enriching our comprehension of their diverse requirements and priorities.

BACKGROUND: Although many surveys have been conducted on patients accessing their own health records in recent years, there is a limited amount of nationwide cross-country data available on patients' views and preferences. To address this gap, an international survey of patient users was conducted in the Nordic eHealth project, NORDeHEALTH. OBJECTIVE: We aimed to investigate the sociodemographic characteristics and experiences of patients who accessed their electronic health records (EHRs) through national patient portals in Norway, Sweden, Finland, and Estonia. METHODS: A cross-sectional web-based survey was distributed using the national online health portals. The target participants were patients who accessed the national patient portals at the start of 2022 and who were aged ≥15 years. The survey included a mixture of close-ended and free-text questions about participant sociodemographics, usability experience, experiences with health care and the EHR, reasons for reading health records online, experience with errors, omissions and offense, opinions about security and privacy, and the usefulness of portal functions. In this paper, we summarized the data on participant demographics, past experience with health care, and the patient portal through descriptive statistics. RESULTS: In total, 29,334 users completed the survey, of which 9503 (32.40%) were from Norway, 13,008 (44.35%) from Sweden, 4713 (16.07%) from Finland, and 2104 (7.17%) from Estonia. National samples were comparable according to reported gender, with about two-thirds identifying as women (19,904/29,302, 67.93%). Age distributions were similar across the countries, but Finland had older users while Estonia had younger users. The highest attained education and presence of health care education varied among the national samples. In all 4 countries, patients most commonly rated their health as "fair" (11,279/29,302, 38.48%). In Estonia, participants were more often inclined to rate their health positively, whereas Norway and Sweden had the highest proportion of negative health ratings. Across the whole sample, most patients received some care in the last 2 years (25,318/29,254, 86.55%). Mental health care was more common (6214/29,254, 21.24%) than oncological care (3664/29,254, 12.52%). Overall, most patients had accessed their health record "2 to 9 times" (11,546/29,306, 39.4%), with the most frequent users residing in Sweden, where about one-third of patients accessed it "more than 20 times" (4571/13,008, 35.14%). CONCLUSIONS: This is the first large-scale international survey to compare patient users' sociodemographics and experiences with accessing their EHRs. Although the countries are in close geographic proximity and demonstrate similar advancements in giving their residents online records access, patient users in this survey differed. We will continue to investigate patients' experiences and opinions about national patient-accessible EHRs through focused analyses of the national and combined data sets from the NORDeHEALTH 2022 Patient Survey. 

Background

Implementation of digital technology has been suggested as a potential solution to future healthcare challenges. Healthcare personnel’s attitudes are important in the acceptance and implementation of digital technologies.

Aim

The aims of this study were to (1) translate and validate two different questionnaires to Norwegian and Swedish respectively, and then (2) use these to examine nursing students’ attitudes towards digital technology in healthcare, as well as their attitudes towards older adults’ abilities to use digital technology.

Design

Cross-sectional.

Methods

A web-based questionnaire was distributed in first year nursing students in a Norwegian and a Swedish university college, respectively. The questionnaire consisted of the short form of the ‘Information Technology Attitude Scales for Health (ITASH)’ and the ‘Attitudes Towards Older Adults Using Digital technology (ATOAUT-11)’ questionnaire. The questionnaires were translated and validated in both countries. Frequencies, Student’s t-test, and one-way ANOVA were used to analyze the data.

Results

In total 236 students responded to the questionnaire in the period September 2022 to April 2023. Students mainly reported positive attitudes towards digital technology use in general. They most agreed with the items ‘Using digital technology devices makes my communication with other health professionals faster’, ‘The sort of information I can get from the digital technology devices helps me give better care to patient’, and ‘Digital technology skills are becoming more and more necessary for healthcare professionals’. However, they reported more negative attitudes towards older adults using digital technology. They most agreed with the items ‘One needs a lot of patience to explain to an older adult how to use digital technologies’, ‘It’s hard to explain to older adults how to use digital technology’, ‘Using digital technology is harder for most older adults’, and ‘Most older adults fear using digital technology because they fear of being scammed or cheated’.

Conclusion

The ITASH and the ATOAUT-11 is appropriate for use in a Norwegian and Swedish setting. Even if nursing students are positive to digital technology in healthcare in general, they are sceptical to older adults using digital technology. This may impact on their attitudes to using digital technology in the healthcare of older adults. These aspects need emphasis when revising nursing education curricula focusing on developing technological competencies in nursing, and gaining knowledge regarding older adults’ use of digital technology.

This thesis examines Cognitively Inspired Design (CID), which is the process of transferring cognitive science frameworks and theories to intelligent systems in an application context. The thesis studies the relation between cognitive science and the traditional approach to developing systems. There are numerous differences and challenges between those two fields, making the transformation from cognitive science to designing a novel cognitive system a challenging process. To examine this process, the Guest and Martin (2021) multi-layer model has been utilized. The model proposes a sequence of six layers in which a researcher follows from a defined cognitive concept or framework to an empirical experiment of a computational model. This multi-layered model is a path function in which each layer is a function that takes the input from the previous layer and passes the output to the following layer.

The thesis takes the application of self-driving cars as the context of study. Self-driving cars are considered one of the most important applications requiring a high level of intelligence and cognitive ability because they encounter real world scenarios and the risk of failure may cost lives. This thesis analyzes the transformation of CID in three main studies.

The first study theoretically analyzes the applicability and compares the different cognitive paradigms and current AI techniques for self-driving cars. The thesis argues for exploring the emergent paradigm as a less explored paradigm in cognitive systems compared to its main opponent paradigm; the cognitivist. The emergent paradigm is claimed to describe the interactive nature of the human cognition. The analysis highlights the opportunities that the field of self-driving cars benefits from when considering the characteristics of the emergent paradigm.

The second study considers the path function for a selected emergent paradigm theory. The study focuses on the aspect of how humans learn from hypothetical scenarios before encountering them in the real world, in particular, learning how to handle rare scenarios that are difficult to learn in the real world. The study addresses the mechanism for automatically generating these scenarios without being designed and created manually by a developer. The study considers curriculum learning as the candidate theory subject of study. The process of transferring this theory is studied using the path function multilayer model. The study conducts an experiment to address the relation between the importance of the theory in human learning and its equivalence in artificial cognitive systems.

The third study focuses on more debatable theories in the emergent paradigm, in particular enactive and embodiment theories. These theories have gained much attention in research because of the high promise they may deliver for advancing the field of artificial cognitive systems. The applicability of the transition of these theories into artificial cognitive systems is examined in relation to the application of self-driving cars, using the path function multi-layer model. The study considers the aspects that support and hinder such transformation.

The thesis concludes by discussing the current state of CID and the aspects the researchers and developers need to consider in this process before, during, and after the transformation. Overall, the thesis attempts to study cognitive theories mainly from an engineering perspective. In short, the thesis focuses on the transformation of CID, not the promise of delivering a novel cognitive system solution.

This paper explores the complex and time-critical work practices within operational train traffic in Sweden by reporting on an incident causing an infrastructure breakdown and large traffic disruptions. Based on a workplace study approach, we report on how the control room workers – train traffic controllers and information officers – grasp, make sense of, and handle the consequences of the incident as it unfolds in real-time. We portray how the workers develop and acquire a sense of place in relation to the incident’s severity which is essential for successfully handling the situation. By introducing the ‘sense of place’ concept originally derived from the field of natural resources to the domain of operational train traffic, we provide a deepened understanding of the challenges characterising remote control work from a safety-critical socio-technical systems perspective. Finally, reflections on the application of the ‘sense of place’ concept, safety aspects and directions for future research are provided.

Background: Shift handover is an important part of nurses’ responsibility. Nurses have a professional responsibility to provide safe and high-quality care which is promoted when the patient is a participant in their care. Bedside handover is the only model used during shift handover that includes the patient and has become a more common model.

Aim: To investigate nurses´ experiences of bedside handover.

Method: Qualitative interview study with an inductive approach. Eight semi-structured interviews were performed with nurses working in an inpatient ward.

Findings: The result were presented in three main categories; The patient in focus, The nurse´s professional responsibility and The impact of workload with associated seven subcategories. The nurse´s involvement of the patient during the bedside handover reporting promotes patient participation and was the most prominent aspect. Bedside handover was perceived as something positive but also brought some challenges by being time-consuming and compromising patient confidentiality.

Conclusion: Bedside handover promotes patient participation, but it does not happen automatically. It is required that the nurse has knowledge and skills in how to involve the patient in the handover to achieve patient participation. Bedside handover gives the nurse the opportunity to form their own opinion of the patient without being influenced by colleagues’ opinions. Challenges with bedside handover are that it is time-consuming and risks jeopardizing the patient´s confidentiality.

In industry, simulation software is used to simulate production, making it possible to predict events in production, calculate times and plan production, even in the early phases of the production development process. Software known as digital human modelling (DHM) tools can also be used to simulate humans working in production. When simulating digital human models, ergonomics evaluations can be carried out to assess whether workstation designs offer appropriate ergonomic conditions for the workers. However, simulations performed to predict and plan production are usually done separately from the human simulations performed to evaluate ergonomics. This can lead to suboptimal solutions in which a factory is optimized to improve either productivity or ergonomics. This thesis outlines the hypothesis that more optimal solutions for workstation design, layout and line balancing can be obtained in simulations by optimizing productivity and ergonomic factors simultaneously instead of considering them separately. Hence, the aim is to carry out research on the development of a simulation-based multi-objective optimization method for productivity and ergonomic factors and to realize the method as a software tool in order to test and communicate it. From an application and societal-impact perspective, the overall objective is to offer a new approach for designing production systems that focuses on both over-all system performance and the well-being of workers, reduces the effort of engineers and helps industry create more productive and sustainable workspaces.

The digital environment can pose health risks through exposure to unhealthy content. Yet, little is known about its relation to children’s cognitive functioning. This study investigates the association between digital media (DM) exposure and children’s cognitive functioning. This cross-sectional study is based on examinations of children aged 8–18 years (N = 8673) of the I.Family cohort (2013–2014). Exposure to television, computer, smartphone and internet was self-reported (hours/day). Media multitasking (MMT) was defined as simultaneous use of computers with other digital or non-screen-based activities. Standard instruments were used to assess cognitive inflexibility (score: 0–39), decision-making ability (− 100 to + 100) and impulsivity (12–48). Adjusted regression coefficients and 99.9%CIs were calculated by generalized linear mixed-effects models. In total, 3261 participants provided data for impulsivity, 3441 for cognitive inflexibility and 4046 for decision-making. Exposure to smartphones and media multitasking were positively associated with impulsivity (βsmartphone = 0.74; 99.9%CI = 0.42–1.07; βMMT = 0.73; 99.9%CI = 0.35–1.12) and cognitive inflexibility (βsmartphone = 0.32; 99.9%CI = -0.02–0.66; βMMT = 0.39; 99.9%CI = 0.01–0.77) while being inversely associated with decision-making ability. Extensive smartphone/internet exposure combined with low computer/medium TV exposure was associated with higher impulsivity and cognitive inflexibility scores, especially in girls. DM exposure is adversely associated with cognitive functioning in children and adolescents. Children require protection against the likely adverse impact of digital environment. 

BACKGROUND: Previous research reports that patients with mental health conditions experience benefits, for example, increased empowerment and validation, from reading their patient-accessible electronic health records (PAEHRs). In mental health care (MHC), PAEHRs remain controversial, as health care professionals are concerned that patients may feel worried or offended by the content of the notes. Moreover, existing research has focused on specific mental health diagnoses, excluding the larger PAEHR userbase with experience in MHC. OBJECTIVE: The objective of this study is to establish if and how the experiences of patients with and those without MHC differ in using their PAEHRs by (1) comparing patient characteristics and differences in using the national patient portal between the 2 groups and (2) establishing group differences in the prevalence of negative experiences, for example, rates of errors, omissions, and offenses between the 2 groups. METHODS: Our analysis was performed on data from an online patient survey distributed through the Swedish national patient portal as part of our international research project, NORDeHEALTH. The respondents were patient users of the national patient portal 1177, aged 15 years or older, and categorized either as those with MHC experience or with any other health care experience (nonmental health care [non-MHC]). Patient characteristics such as gender, age, education, employment, and health status were gathered. Portal use characteristics included frequency of access, encouragement to read the record, and instances of positive and negative experiences. Negative experiences were further explored through rates of error, omission, and offense. The data were summarized through descriptive statistics. Group differences were analyzed through Pearson chi-square. RESULTS: Of the total sample (N=12,334), MHC respondents (n=3131) experienced errors (1586/3131, 50.65%, and non-MHC 3311/9203, 35.98%), omissions (1089/3131, 34.78%, and non-MHC 2427/9203, 26.37%) and offenses (1183/3131, 37.78%, and non-MHC 1616/9203, 17.56%) in the electronic health record at a higher rate than non-MHC respondents (n=9203). Respondents reported that the identified error (MHC 795/3131, 50.13%, and non-MHC 1366/9203, 41.26%) and omission (MHC 622/3131, 57.12%, and non-MHC 1329/9203, 54.76%) were "very important," but most did nothing to correct them (MHC 792/3131, 41.29%, and non-MHC 1838/9203, 42.17%). Most of the respondents identified as women in both groups. CONCLUSIONS: About 1 in 2 MHC patients identified an error in the record, and about 1 in 3 identified an omission, both at a much higher rate than in the non-MHC group. Patients with MHC also felt offended by the content of the notes more commonly (1 in 3 vs 1 in 6). These findings validate some of the worries expressed by health care professionals about providing patients with MHC with PAEHRs and highlight challenges with the documentation quality in the records. 

White adipose tissue browning, defined by accelerated mitochondrial metabolism and biogenesis, is considered a promising mean to treat or prevent obesity-associated metabolic disturbances. We hypothesize that redox stress acutely leads to increased production of reactive oxygen species (ROS), which activate electrophile sensor nuclear factor erythroid 2-Related Factor 2 (NRF2) that over time results in an adaptive adipose tissue browning process. To test this, we have exploited adipocyte-specific NRF2 knockout mice and cultured adipocytes and analyzed time- and dose-dependent effect of NAC and lactate treatment on antioxidant expression and browning-like processes. We found that short-term antioxidant treatment with N-acetylcysteine (NAC) induced reductive stress as evident from increased intracellular NADH levels, increased ROS-production, reduced oxygen consumption rate (OCR), and increased NRF2 levels in white adipocytes. In contrast, and in line with our hypothesis, longer-term NAC treatment led to a NRF2-dependent browning response. Lactate treatment elicited similar effects as NAC, and mechanistically, these NRF2-dependent adipocyte browning responses in vitro were mediated by increased heme oxygenase-1 (HMOX1) activity. Moreover, this NRF2-HMOX1 axis was also important for β3-adrenergic receptor activation-induced adipose tissue browning in vivo. In conclusion, our findings show that administration of exogenous antioxidants can affect biological function not solely through ROS neutralization, but also through reductive stress. We also demonstrate that NRF2 is essential for white adipose tissue browning processes. 

Background: Many newly graduated nurses face a demanding reality with a challenging work environment where they are expected ta take on great responsibility and work independently based on laws and ethical principles. This leads to emotional challenges that can affect both well-being and health. Previous studies show that a professional introduction with collegial support, social community and space to be new gives newly graduated nurses the opportunity for a secure and positive start.

Aim: To investigate how newly graduated nurses experience their first time as a registered nurse.

Method: A qualitative interview study was conducted with twelve newly graduated nurses. Data was collected through semi-structured interviews. The material was compiled and interpreted using a qualitative content analysis.

Findings: The analysis resulted in three categories: A challenging transition, Organizational chaos and A reality shock.

Conclusion: Newly graduated nurses experience that the transition from being a supervised student to an independent nurse as challenging in multiple ways. It´s a shock for many to face a clinical reality with a higher pace and heavier workload than they have previously encountered. More responsibility and challenges during the education period can help students with mental preparation and a positive attitude, also support from colleagues promotes a good start into their professional career.

Throughout my education I have found that the psychological interventions in use are largely tailored to the masses, and some may be ill suited for those from certain subpopulations such as Autism Spectrum Disorder (ASD) or Asperger's syndrome (AS). I investigated whether there are statistically significant neurological differences between those with high functioning ASD or Asperger's and those without, with the goal of using those differences to propose what aspects might be used to create new psychological interventions more suited to neurodivergent individuals. After a thorough literature search, I found that the areas seeming to be the common denominators marking out those with ASD or Asperger's were the amygdala and orbito frontal cortex and hippocampus. My hypothesis that such neurological differences could be used to infer new psychological interventions for treating depression did not find support. The hope is that this review will nevertheless serve to inspire other researchers to create new interventions.

Background: A stoma operation is performed to relieving the intestine. Living with a stoma involves self-care for the person. Self-care means that the patient performs health care measures independently. The importance of sexual health is a balance between the individual's mental, social, emotional state and bodily well-being in relation to their sexuality. Living with a stoma can be a suffering for the individual. The concept of quality of life includes the individual's experience of happiness and satisfaction with life.

Aim: The purpose of the study was to describe experiences of sexual health in individuals living with a stoma.

Method: The study was conducted as a literature based study, with including twelve qualitative scientific articles.

Findings: Two themes were identified; a personal adjustment in life and fear of intimacy due to lack of information from healthcare. Under the theme personal changes in life was three subthemes identified.

Conclusion: The conclusion of the study is that the stoma is not just a bag on the stomach. People feel that the sexual relationship is negatively affected and therefore it’s of great importance that nurses are aware of this and dare to talk about the subject. Sexual health is a vulnerable topic to talk about.

Even though there is a plethora of research on the role of environmental turbulence in organizational performance in general, little attention has been paid to the effect of environmental turbulence on cyber security risk management and further - organizational resilience. Drawing on the resource-based view and contingency theory, this study investigates how technological and market turbulence influence organizational cyber security risk management (CSRM) and then organizational resilience. Using a data set from 150 European companies, the study findings show how the two types of turbulence have different effects on CSRM in the companies studied. Technological turbulence directly impacts the firms’ cyber security risk maturity while market turbulence has a direct positive affect on firms’ cyber security risk perception. The study also determines the interplay between risk perception and risk maturity and subsequent resilience.

Learning interest is a key determinant of children's motivation in mathematics. The main theme of this paper is to study the integration of stop-motion animation into children's daily mathematics learning, and to further develop the stop-motion animation format into a stop-motion game with interaction as a way to stimulate children's interest in mathematics in a non-traditional educational way. To test the viability and effectiveness of the theme, I designed an experiment with a sample of 30 children aged 5-6 years in kindergartens, and conducted follow-up questionnaires and interviews to collect feedback. The results showed that the integration of stop-motion animation into children's mathematical learning did have a positive effect on the irlearning of mathematics, increasing their interest and enthusiasm for learning. The use of interactive stop-motion games also provided positive guidance, but were not as effective as stop-motion animation, so further development of interactive stop-motiongames is needed.

Background: Hyperlipidemia is a medical condition that involves elevated levels of cholesterol and triglycerides in the blood. It is a complex interaction of cellular and molecular processes that governs the body's lipid metabolism. Factors such as lifestyle, diet and hereditary factors play adecisive role in its development. Adverse consequences of untreated hyperlipidemia include the risk of atherosclerosis, cardiovascular disease, pancreatitis, liver disease, vision problems, kidney failure, metabolic syndrome and cognitive impairment. Treatment and management of hyperlipidemia is necessary to minimize its impact on the individual's health. Nurses play an important role in monitoring and supporting patients with hyperlipidemia by offering advice on lifestyle changes, administering medications, and educating patients on the importance of adherence to treatment plans to prevent serious medical complications.

Aim: To investigate patients' experiences of being treated for hyperlipidaemia.

Method: A literature review in which five qualitative and five quantitative articles were analyzed.

Findings: The results are presented in three main themes: "Management of hyperlipidemia: diagnosis, communication and family care", "Emotional and physical health in hyperlipidemia treatment" and "Hyperlipidemia treatment: symptoms, financial challenges and compliance "which are divided into eight sub-themes.

Conclusion: Effective communication and early education are essential to support patients and minimize the risks of cardiovascular complications. Self-care with elements of the right diet, regular physical activity and managing stress is central to handle hyperlipidemia. Patient-centered care and individualized support from nurses are critical to improving patient health and reducing the risk of cardiovascular disease.

Background: Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system. Objectives: The aim of the study was to determine whether having a named GP is associated with hospital service use. Methods: The data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 (n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 (n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register). Results: A named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis. Conclusion: A named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized. 

Accurate prediction of cutting forces is critical in milling operations, with implications for cost reduction and improved manufacturing efficiency. While traditional mechanistic models provide high accuracy, their reliance on extensive milling data for force coefficient fitting poses challenges. The eXtreme Gradient Boosting algorithm offers a potential solution with reduced data requirements, yet the optimal utilization of eXtreme Gradient Boosting remains unexplored. This study investigates its effectiveness in predicting cutting forces during down-milling of Al2024. A novel framework is proposed optimizing its precision, efficiency, and user-friendliness. The model training incorporates the mechanistic force model in both time and frequency domains as new features. Through rigorous experimentation, various aspects of the eXtreme Gradient Boosting configuration are explored, including identifying the optimal number of periods for the training dataset, determining the best normalization and scaling technique, and assessing the hyperparameters’ impact on model performance in terms of accuracy and computational time. The results show the remarkable effectiveness of the eXtreme Gradient Boosting model with an average normalized root mean square error of 14.7%, surpassing the 21.9% obtained by the mechanistic force model. Additionally, the machine learning model could capture the runout effect. These findings enable optimized milling operations regarding cost, accuracy and computation time.

Sensitive and reliable protein biomarkers are needed to predict disease trajectory and personalize treatment strategies for multiple sclerosis (MS). Here, we use the highly sensitive proximity-extension assay combined with next-generation sequencing (Olink Explore) to quantify 1463 proteins in cerebrospinal fluid (CSF) and plasma from 143 people with early-stage MS and 43 healthy controls. With longitudinally followed discovery and replication cohorts, we identify CSF proteins that consistently predicted both short- and long-term disease progression. Lower levels of neurofilament light chain (NfL) in CSF is superior in predicting the absence of disease activity two years after sampling (replication AUC = 0.77) compared to all other tested proteins. Importantly, we also identify a combination of 11 CSF proteins (CXCL13, LTA, FCN2, ICAM3, LY9, SLAMF7, TYMP, CHI3L1, FYB1, TNFRSF1B and NfL) that predict the severity of disability worsening according to the normalized age-related MS severity score (replication AUC = 0.90). The identification of these proteins may help elucidate pathogenetic processes and might aid decisions on treatment strategies for persons with MS.

This study delves into the relationship between Dynamic Game Difficulty Balance and Game User Experience in the context of puzzle games. The aim of this study was to explore the impact of DGDB on user experience in puzzle games, focusing on player engagement, immersion, and the occurrence of a-ha moment. To this end, the researchers conducted a control group experiment and analyzed the results both quantitatively and qualitatively based on participants' objective data during the game and subjective responses in the post-game questionnaire. The findings suggest that DGDB has the potential to increase player engagement and satisfaction, but the impact is modest, as evidenced by higher completion rates and flow channels in puzzle games. We explored the impact of the DGDB system on a-ha moment and the results were mixed. However, it is clear that the relationship between DGDB and puzzles is a delicate one, with players' preferences and perceptions varying.