Linnaeus University

Background To minimize the risk of perioperative hypothermia, it is recommended that healthcare professionals be familiar with heat conservation measures and use passive and active warming methods, in line with international guidelines. However, there is a low level of adherence perioperatively to the use of heat conservation measures. To understand why, there is a need to capture the nurse anesthetists’ perspective. The aim is to describe nurse anesthetists’ perceptions of heat conservation measures in connection with surgery. Methods An inductive descriptive design with a phenomenographic approach was chosen. A total of 19 nurse anesthetists participated and were interviewed. Data were analyzed according to Larsson and Holmström’s phenomenographic seven-step model. Results Six ways of understanding the phenomenon heat conservation measures in connection with surgery were found: the preventive, the useable, the untenable, the caring, the adaptive, and the routine care approach. These approaches were related to each other in a flexible way, allowing for several to co-exist at the same time, depending on the situation. Conclusions Nurse anesthetists want to prevent the patients’ heat loss and maintain normothermia, regardless of the type of surgery. This willingness, motivation, and intention enable the use of heat conservation measures. However, there are perceptions that have an impact, such as doubts and uncertainty, access, time and financial constraints, preconditions, routines or habits, and lack of availability of education/training. These barriers will require support from an organizational level to promote lifelong education and guidelines. As well as offer education at the nurse anesthetists’ program.

Gangs are commonly presented in research as an attractive alternative for those who feel excluded and unrecognized in “ordinary” society. Gang life is volatile, however, and violence (open or suppressed) is more or less omnipresent. Exiting a gang seems to be motivated by both thoughts of a better life and disappointment in the gang's failure to meet hopes and expectations. Findings From an analysis of former gang members exit processes, this article investigates what about gang life was stressful and motivated participants dropout, how they coped with tensions, and elaborates how social work could use this tension productively to support people exiting gangs. The data consist primary of interviews with 20 former gang members and 42 professionals. Organizational theory was used in combination with theories on liminality and identity reformation to understand how tensions occurred in gang life, how they were managed, and what caused exit. Applications Social workers may help members exit from gangs by supporting and strengthening their motivations to leave, stimulating their self-reflection, and reminding them of their past transformative. Most important, gang members should be helped to recognize the positive urges that drew them towards gangs and refocus those wishes for community to general society.

This paper is devoted to clarification of the notion of entanglement through decoupling it from the tensor product structure and treating as a constraint posed by probabilistic dependence of quantum observable A and B. In our framework, it is meaningless to speak about entanglement without pointing to the fixed observables A and B, so this is AB-entanglement. Dependence of quantum observables is formalized as non-coincidence of conditional probabilities. Starting with this probabilistic definition, we achieve the Hilbert space characterization of the AB-entangled states as amplitude non-factorisable states. In the tensor product case, AB-entanglement implies standard entanglement, but not vise verse. AB-entanglement for dichotomous observables is equivalent to their correlation, i.e., ⟨AB⟩ψ≠⟨A⟩ψ⟨B⟩ψ.\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\langle AB\rangle _{\psi} \not = \langle A\rangle _{\psi} \langle B\rangle _{\psi} .$$\end{document} We describe the class of quantum states that are AuBu\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$A_{u} B_{u}$$\end{document}-entangled for a family of unitary operators (u). Finally, observables entanglement is compared with dependence of random variables in classical probability theory.

Background Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy. Aim To describe ambulance clinicians’ understanding of older patients’ self-determination when the patient’s decision-making ability is impaired. Research design A qualitative design with an inductive approach, guided by descriptive phenomenology. Participants In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews. Ethical considerations The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority. Findings The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination. Conclusion The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous.

Decades of interest in responsible leadership has drawn critical attention to how future leaders are formed by academic leadership education. It has forced teachers to increasingly contemplate what leadership ideas and pedagogical practices they bring to the classroom, and who they are in the light of the ideas and practices they adhere to. In this ‘Leading Questions’ we take an interest in how leadership educators’ identities are formed and exploited in everyday teaching. The questions and comments we present are part of an ongoing conversation on identity work triggered by the controversies we experienced when co-teaching a course titled Rethinking Leadership at a renowned international business school. Where most discussions of identity work in a business school context only highlight the distressing and unfavourable aspects of identity work, we take a different approach. We confess how we struggle with our own identities as leadership educators. We then argue this identity work comes with pedagogical potential, yet to be accounted for, especially relevant to future education of critical and responsible leaders. Finally, we confess that even if our years of conversation on our different teacher identities did not result in a distinct pedagogical model, it dramatically changed and charged our ability to intentionally make space for controversial identity work in the leadership classroom.

Through a dynamic polymerization and self-sorting process, a range of lowellane macrocycles have been efficiently generated in nitroaldol systems composed of aromatic dialdehydes and aliphatic or aromatic dinitroalkanes. All identified macrocycles show a composition of two repeating units, resulting in tetra-β-nitroalcohols of different structures. The effects of building block structure on the macrocyclization process have been demonstrated, and the influence from the solvent has been explored. In general, the formation of the lowellanes were amplified in response to phase-change effects, although solution-phase structures were in some cases favored.

Aims To describe assistant nurses' experiences of thirst and ethical challenges in relation to thirst in terminally ill patients in specialized palliative care (PC) units. Design A qualitative, reflexive thematic design with an inductive analysis was used. Methods Data were collected during November 2021–January 2023. Twelve qualitative interviews with assistant nurses working in five different specialized PC units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. The study was guided by the Standards for Reporting Qualitative Research (SRQR). Results Two main themes were found in this study. (1) ‘A world of practice for thirst relief’ where assistant nurses present a task‐oriented world where the knowledge of thirst is an experience‐based unspoken knowledge where mainly routines rule. (2) Ethical challenges presents different ethical problems that they meet in their practice, such as when patients express thirst towards the end of their life but are too severely ill to drink or when they watch lack of knowledge in the area among other health professionals. Conclusion Thirst in dying patients is a neglected area that assistant nurses work with, without communicating it. Their knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patient's record. There is a need for nurses to take the lead in changing nursing practice regarding thirst. Patient or Public Contribution No patient or public contribution. Impact In palliative care, previous studies have shown that dying patients might be thirsty. Assistant nurses recognize thirst in dying patients, but thirst is not discussed in the team. Nurses must consider the patient's fundamental care needs and address thirst, for example in the nursing process to ensure patients quality of life in the last days of life. Reporting Method The study was guided by the SRQR. What does this Article Contribute to the Wider Global Clinical Community? Thirst is a distressing symptom for all humans. However, when a patient is dying, he or she loses several functions and can no longer drink independently. The knowledge from this article contributes to our understanding of current practice and shows an area that requires immediate attention for the improvement of fundamental palliative care delivery.

Abstract Background Among those elements establishing decent quality of care from a patient perspective, opportunities to participate in accord with one’s individual needs and preferences are central. To date, little is known the extent of preference-based patient participation in kidney care, and what facilitates optimal conditions. This study investigated i) preference-based patient participation in kidney care over time, and ii) the effects of interventions designed to enhance person-centred patient participation. Methods A quasi-experimental study was conducted across nine kidney care sites in southeast Sweden. A cohort of 358 patients with stage IV chronic kidney disease (eGRF 15–19 ml/min) or V (eGRF

Posed 16 years ago in a much-cited editorial by gerontologist, Alan Walker, “Why involve older people in research?” is a question that has since inspired researchers in many countries and from diverse disciplines. In Sweden, researchers and older people have been collaborating in the 6-year UserAge research programme, focusing on user involvement in research on ageing and health, UserAge aims at contributing to an in-depth understanding of the challenges and benefits of user involvement in different phases of the research process. Approaching programme completion, the authors take the opportunity to dwell upon current reasons for and modes of user involvement in ageing research in light of the argument originally put forward by Alan Walker back in 2007.

Background: The healthcare systems in Nordic countries and worldwide are under press due to increase in the population of older people and shortage of nurses. Educating nurseswith a high level of competence, such as advanced practice nurses is of great importance to secure effective, safe and high-quality care. Aim: The aim of this study was to investigate self-reported competence among master’s students of advanced practice nursing in Denmark, Finland and Norway. Methods: A multicentre, cross-sectional study design was used and conducted at five universities in Denmark, Finland and Norway. The Nurse Professional Competence Scale Short-Form forming six competence areas was used with a maximum score 7 per item for analysis of single items and a transformed 1-100 scale for analysing the competence areas (higher score, higher self-reported competence). Descriptive and comparative statistics were used to analyse the data. Results: The highest mean score was found for the competence area ‘Value-based nursing care’. Students living with home-dwelling children (≤18 years) reported a significantly higher competence regarding ‘Nursing care’, while students ³33 years reported significantly higher competence regarding ‘Nursing care’ and ‘Value-based Nursing care’. No significant differences were found between the students working or not working alongside their studies, between students with or without further nursing-related education or between students having long or short experiences as nurses. Conclusion: The findings from this study might contribute to a further development of the curriculums in advanced practice nursing to ensure high-quality nursing and a sustainable health care in the future. Future high-quality master’s programmes might benefit from a systematically collaboration between Nordic higher education institutions. Higher age, having children at home and working while studying should not be considered factors of concern.

Background: Prostate cancer is a common form of cancer that is often treated with radical prostatectomy, which can leave patients with urinary incontinence and sexual dysfunction. Self-care (pelvic floor muscle exercises and physical activity) is recommended to reduce the side effects. As more and more men are living in the aftermath of treatment, effective rehabilitation support is warranted. Digital self-care support has the potential to improve patient outcomes, but it has rarely been evaluated longitudinally in randomized controlled trials. Therefore, we developed and evaluated the effects of digital self-care support (electronic Patient Activation in Treatment at Home [ePATH]) on prostate-specific symptoms. Objective: This study aimed to investigate the effects of web-based and mobile self-care support on urinary continence, sexual function, and self-care, compared with standard care, at 1, 3, 6, and 12 months after radical prostatectomy. Methods: A multicenter randomized controlled trial with 2 study arms was conducted, with the longitudinal effects of additional digital self-care support (ePATH) compared with those of standard care alone. ePATH was designed based on the self-determination theory to strengthen patients' activation in self-care through nurse-assisted individualized modules. Men planned for radical prostatectomy at 3 county hospitals in southern Sweden were included offline and randomly assigned to the intervention or control group. The effects of ePATH were evaluated for 1 year after surgery using self-assessed questionnaires. Linear mixed models and ordinal regression analyses were performed. Results: This study included 170 men (85 in each group) from January 2018 to December 2019. The participants in the intervention and control groups did not differ in their demographic characteristics. In the intervention group, 64% (53/83) of the participants used ePATH, but the use declined over time. The linear mixed model showed no substantial differences between the groups in urinary continence (β=-5.60; P=.09; 95% CI -12.15 to -0.96) or sexual function (β=-.12; P=.97; 95% CI -7.05 to -6.81). Participants in the intervention and control groups did not differ in physical activity (odds ratio 1.16, 95% CI 0.71-1.89; P=.57) or pelvic floor muscle exercises (odds ratio 1.51, 95% CI 0.86-2.66; P=.15). Conclusions: ePATH did not affect postoperative side effects or self-care but reflected how this support may work in typical clinical conditions. To complement standard rehabilitation, digital self-care support must be adapted to the context and individual preferences for use and effect. Trial registration: ISRCTN Registry ISRCTN18055968; https://www.isrctn.com/ISRCTN18055968. International registered report identifier (irrid): RR2-10.2196/11625.

Adults with ADHD experience a wide range of difficulties in daily life, and RNs and other healthcare professionals need to know how to support them. The aim was to conduct a systematic review of which selfcare strategies adults with ADHD use and need in order to manage daily life. A literature review based on the PRISMA model was performed, and seven articles with a qualitative design were found. Data were analyzed with thematic analysis. The analysis generated one major theme Enabling ways to manage the consequences of disability in daily life based on three subthemes; Establishing ways of acting to help yourself, Finding encouraging and helping relationships, and Using external aids for managing daily life. Professionals may benefit from knowing about these selfcare strategies when meeting people with ADHD.

Transferrin receptor 1 (TfR) delivers iron across cellular membranes by shuttling the ion carrier protein transferrin. This ability to deliver large protein ligands inside cells is taken advantage of by pathogens to infiltrate human cells. Notably, the receptor's outermost ectodomain, the apical domain, is used as a point of attachment for several viruses including hemorrhagic arenaviruses. To better understand interactions with the receptor it would be advantageous to probe sequence determinants in the apical domain with viral spike proteins. Here, we carried out affinity maturation of our computationally designed apical domain from human TfR to identify underlying driving forces that lead to better binding. The improved variants were confirmed by in vitro surface plasmon resonance measurements with dissociation constants obtained in the lower nanomolar range. It was found that the strong binding affinities for the optimized variants matched the strength of interactions with the native receptor. The structure of the best variant was determined experimentally indicating that the conformational change in the hairpin binding motif at the protein-protein interface plays a crucial role. The experimental methodology can be straightforwardly applied to other arenavirus or pathogens that use the apical domain. It can further be useful to probe host-virus compatibility or therapeutic strategies based on the transferrin receptor decoys.

The mechanical behavior of thermoplastics is strongly rate-dependent, and oftentimes it is difficult to find constitutive models that can accurately describe their behavior in the small to moderate strain regime. In this paper, a hyperelastic network model (modified neo-Hookean) and a set of experiments are presented. The testing consists of monotonic tensile loading as well as stress relaxation and zero stress creep. Two materials were tested, polyoxymethylene (POM) and recycled polypropylene (rPP), representing one more rigid and brittle and one softer and more ductile semi-crystalline polymer. The model contains two main novelties. The first novelty is that the stiffness is allowed to vary with the elastic deformation (in contrast to a standard neo-Hookean model). The second novelty is that the exponent governing viscous relaxation is allowed to vary with the viscous deformation. The basic features of the new model are illustrated, and the model was fitted to the experimental data. The model proved to be able to describe the experimental results well.