| 4241. |
- Nilsson, Madeleine, 1964
(author)
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The percieved threat of the risk of graft rejection among organ transplant recipients
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Transplantation is an established and successful treatment for critically ill patients. For many of the organ transplant recipients (OTR) it is the only option for survival. When OTRs are asked about what they fear the most, the most common answer is graft rejection. Graft rejection is a real threat against an OTR since it is the body’s natural way, through its immunological defence, to protect itself against foreign bodies or unknown substances. Aim: The primary aim of this thesis was to explore the risk of graft rejection from the perspective of OTRs by describing the characteristics of the threat experience. A secondary aim was to investigate the relationships between the perceived threat of the risk of graft rejection, by means of a domain specific questionnaire, and selected associated factors such as coping strategies and Health Related Quality of Life (HRQoL). Methods: The efforts to acquire scientific knowledge included seeking the unique in each individual case as well as group correlations. For this reason, the data collection methods were both inductive and deductive and included interviews and questionnaires. The study group consisted of 1) 16 adult OTR, 2) 8 adolescent OTR, 3) 185 adult OTR, 4)185 adult OTR. The instruments used to collect data were SF-36, General Coping Questionnaire (GCQ) and the Perceived Threat of the risk of Graft Rejection (PTGR) which was developed for the purpose in this thesis. Data analysis was performed mainly by descriptive and parametric statistical methods as well as by the use of phenomenography. Results: Adult OTRs perceived graft rejection in various ways involving five domains; abstract threat to life, concrete threat to health, trust in the body, striving to control the threat and one’s identity. There were also various ways of learning about graft rejection involving three domains; experience of graft rejection that was accompanied by symptoms and personal observations, experience of graft rejection in the absence of physical symptoms and personal observations and no experience of graft rejection. The adolescents’ perceptions were grouped into seven domains: tests and examinations, transplantation, medication, graft rejection as a condition, graft rejection and its consequences, friends and oneself as an organ transplant recipient. It was possible to develop an instrument for measuring the perceived threat of graft rejection and three homogenous and psychometrically sound factors were identified. These were labelled intrusive anxiety, graftrelated threat and lack of control. A majority (74 %) reported a low level of intrusive anxiety. The kidney transplant recipients reported more graft related threat than other OTRs. The differences between the transplanted organ groups in their use of coping strategies were small. Likewise, coping related very weakly with sex, age, time since transplantation and whether they had experienced graft rejections or not. The respondents tended in general to use more of ‘positive’ coping strategies (strategies related to positive well-being). Conclusion: OTRs perceive the risk of graft rejection in various ways, from nonthing to worry about to the threat of death. It was possible to measure the perceived threat of graft rejection among OTRs with an instrument comprising twelve items. Perceptions and coping seem to be independent of demographic and clinical variables such as type of organ transplanted, time since transplantation and experiences of graft rejection, age and sex.
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| 4242. |
- Nilsson, Martin, 1966
(author)
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The role of physical activity on bone density and bone geometry in men
- 2010
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Doctoral thesis (other academic/artistic)abstract
- THE ROLE OF PHYSICAL ACTIVITY ON BONE DENSITY AND BONE GEOMETRY IN MEN Introduction: Several studies indicate that peak bone mass, reached during the third decade in life, is an important determinant of osteoporosis later in life. Physical activity with dynamic loading of the bone is an important determinant of peak bone mass. Exercise especially before and during puberty is associated with increased bone density and cortical bone size in children and young adults. It has, however, not been established for how long this alteration will remain if the level of physical activity is decreased or ceased. Furthermore, the previously used technology in measuring bone mass has not been able to explain how physical activity influences bone microarchitecture that can affect bone strength and resistance to fracture in humans. Objective: The overall aim of this thesis was to gain a better understanding of the role of physical activity and inactivity on bone density, bone geometry, and trabecular microarchitecture in men. Methods: Four large and representative cohorts, three with young adult men and one with elderly men, were used in these population-based, cross-sectional studies. Data concerning physical activity was collected using standardized questionnaires. Bone parameters were assessed using dual-energy X-ray absorptiometry (DXA) for areal bone mineral density, peripheral quantitative computerized tomography (pQCT) for volumetric bone mineral density and bone geometry, and high resolution 3D pQCT for trabecular microarchitecture. Results: In a large cohort of young adult men (age 18, n=2,384), history of physical activity was the strongest predictor of calcaneal bone mineral density. Calcaneal bone mineral density was also higher in those who had ceased to be active compared to those who had always been inactive. In a cohort of young physically inactive men (age 19, n=367), previous sport activity was independently associated with cortical bone size of the tibia at the age of 19 years. Subjects, who ceased their sport activity for up to 6.5 years previously, still had larger cortical bone size of the tibia than always inactive subjects. In a large cohort of elderly men (n=498), we found that high frequency of competitive sports during the first three decades in life was independently associated with bone mineral density at several bone sites at the age of 75 years. In a large sample of young adult men (age 24, n=829), we found that the degree of mechanical loading due to type of present physical activity independently predicted trabecular volumetric bone density and trabecular number and that duration of previous physical activity independently predicted cortical cross-sectional area in the tibia. Conclusions: The findings in this thesis indicate that physical activity during growth plays an important role in the enhancement of peak bone mass and bone geometry even though physical activity is ceased, suggesting that physical activity during growth confers a lasting positive effect on bone and can contribute to the prevention of bone loss in men. We also demonstrated that the degree of mechanical loading due to type of present physical activity was predominantly associated with trabecular microstructure in weight-bearing bone.
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| 4243. |
- Nilsson, Morgan, 1964
(author)
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Vowel-Zero Alternations in West Slavic Prepositions: A Corpus Based Investigation of Polish, Slovak and Czech
- 2014
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis is to investigate the scope of the vowel―zero alternations in prepositions in the three major West Slavic languages, i.e. Polish, Slovak and Czech, and to formulate, within the Government Phonology framework, the general phonological principles responsible for the majority of these alternations. Many prepositions in the Slavic languages have two competing forms, such as the Czech v / ve in. It has long been a recognised problem that the conditions regulating the use of these two forms cannot easily be formulated, a difficulty which has led to complications in both prescriptive language recommendations intended for native speakers and in the teaching of these languages to foreign learners. The present investigation is based on extensive corpus data which have been studied primarily with quantitative methods, but also to some extent qualitatively. Data and previous research have also been derived from the literature on the subject. The contexts of the occurrences of the vocalised form of the preposi¬tions have then been defined as precisely as possible, and the phonological principles responsible for the phonologically driven vocalisations are discussed and formulated. A certain proportion of the alternations have also been found to occur on lexical, and not phonological grounds. The findings of this thesis make it possible to present both language learners and native speakers with new, more precise and detailed information concerning the actual usage of the vocalised forms of prepositions. The thesis also provides some interesting language-specific observations on vowel―zero alternations in relation to the comparative and typological research on the subject.
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| 4244. |
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| 4245. |
- Nilsson, Marco, 1971
(author)
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War and Unreason. Bounded Learning Theory and War Duration
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Why are some wars longer than others? Offense-defense theorists have assumed that wars are shorter and it is more difficult for states to create security when military technology favors the offense and attacking is easier than defending. This study argues that this assumption is wrong on both accounts. First, statistical hazards models show that various measures of the offense-defense balance are not associated with war duration in the state system between 1817 and 1992. Second, if wars are not shorter when offense is dominant, there should not be more rational incentives for decision-makers to start wars when offense has the advantage compared to when defending is relatively easier. The study develops the bounded learning theory to better understand the causes of war duration and tests it with four case studies. The theory argues that offense dominance is often so limited that it fails to guarantee that the enemy is swiftly run over, other things being equal. As a swift victory does not materialize with the help of offensive military technology and tactics, the process of finding a mutually acceptable negotiated solution to the war easily becomes long because of asymmetric information about expected offensive capacity and expansive ideology (asymmetric causal beliefs and offensive stakes). These variables make it unlikely that the combatants would quickly adjust their war aims so that they reflect their actual battlefield performance. As the combatants do not learn from the battlefield events, they cannot agree on their expected relative strength, which is necessary from a rational choice perspective for finding common ground for a peace treaty. Offense-defense theory specifies defense dominance as the prerequisite for more peaceful interstate relations. On the other hand, defense dominance is difficult to create as the realist self-help logic drives many states to continue developing offensive weapons technology. Furthermore, by assuming that wars are shorter during offense dominant eras, the offensedefense theory creates false incentives for aggression. It is common sense that the risk of war does not increase when defense is dominant. However, even when attacking is relatively easier than defending, incentives for aggression should not increase on average if wars are not particularly short. Thus the study is a contribution to defensive realism.
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| 4246. |
- Nilsson, Niklas, 1995
(author)
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Chronic Achilles tendon rupture - surgical reconstruction and post-operative outcomes
- 2023
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Doctoral thesis (other academic/artistic)abstract
- When the treatment of Achilles tendon ruptures is delayed by more than 4 weeks, the rupture is classified as chronic. This thesis aims to examine the postoperative outcome of chronic Achilles tendon ruptures treated surgically in terms of long-term functional outcomes, patient-reported outcome measurements, biomolecular changes, and economic cost. Additionally, a new surgical technique for treating chronic Achilles tendon ruptures will be described and evaluated. Study I: Fifty-nine patients that were surgically treated for a chronic Achilles tendon rupture with a gastrocnemius aponeurosis free flap were invited to participate in this study evaluating economic costs. The mean (SD) total cost for the treatment of a chronic Achilles tendon rupture was 6,494 € (6,508). This was 1,276 € more than the treatment of an acute Achilles tendon rupture. Study II: Twenty-two patients treated with a gastrocnemius aponeurosis free flap were evaluated one-year postoperatively. The median (range) ATRS was 67 (18-95) out of 100. The patients performed significantly worse on the injured than the healthy side in heel-rise repetitions and height. Calf circumference on the injured side was significantly smaller and the tendon was elongated compared with the healthy side. Study III: Twenty-two patients) treated surgically with endoscopically-assisted Achilles tendon reconstruction using a semitendinosus tendon autograft were included and evaluated at 12-months postoperatively. The patients reported a median (range) ATRS of 76 (45-99) out of 100. The median ATRA was significantly larger on the injured side and the tendon length significantly longer. Study IV: A systematic review of previous studies reporting postoperative outcomes of chronic Achilles tendon ruptures treated with a gastrocnemius aponeurosis flap or semitendinosus graft was performed. Out of the 818 studies identified, 36 studies justified the inclusion criteria. The mean (SD) ATRS was 83 (14) for patients treated with a gastrocnemius aponeurosis flap and 88 (6.9) for patients treated with a semitendinosus graft. Study V: Thirty-five patients that were surgically treated for acute (<4 weeks), short-term chronic (1-6 months) or long-term chronic Achilles tendon ruptures, each contributed tissue sample biopsies at the rupture site during surgical repair. RNA was extracted from the tissue samples using the TRIspin method and analyzed with RT-PCR. The mRNA levels for COL1A1 and COL3A1 were significantly higher in the short-term chronic rupture group compared with the acute group (p<0.05). MMP-1 and MMP-13 had both highest levels in the acute group (p<0.001) compared with the long-term chronic group. Inflammatory markers such as IL-1, IL-6, and TNF-alfa all had significantly higher mRNA levels in the acute group. To conclude, chronic Achilles tendon ruptures imply high, but reasonable costs, acceptable functional outcomes with multiple surgical techniques. The chronic Achilles tendon ruptures also show lower mRNA levels that could imply more degradation which indicates that the surgical treatment of Achilles tendon ruptures should not be delayed more than necessary.
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| 4247. |
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| 4248. |
- Nilsson, Per Anders, 1954
(author)
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A Field of Possibilities: Designing and Playing Digital Musical Instruments
- 2011
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Doctoral thesis (other academic/artistic)abstract
- This thesis focuses on a set of digital musical instruments I have designed and developed with ensemble improvisation in mind. The intention is not to create a universal improvisational instrument, but rather to create a set of instruments which each realize one musical idea. My research addresses the meaning and relations between activities in two stages, what I call “design time” and “play time”. In short, design time is conception, representation, and articulation of ideas and knowledge outside of chronological time, whereas play time takes place in real-time and concerns bodily activity, interaction, and embodied knowledge. In this work aesthetics play a crucial role, and here signify what is important for me. At design time my aesthetic preferences guide the design process, whereas in play time, a subjective aesthetic tenet is that musical improvisation has strong similarities to gaming and play. One hypothesis states that choices made during the design process at the development stages of a digital musical instrument significantly influence ensemble improvisation and musical results at play time. A digital instrument in this work constitutes a field of possibilities, which in play actualizes the aesthetic decisions of its designer, and in cases where the designer and player are one, during play there will be a double influence: directly through the player’s actions, and indirectly through the nature of the instrument.
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| 4249. |
- Nilsson, Pia, 1959
(author)
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Lateral epicondylalgia A new structured treatment program with an inter-disciplinary approach
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Conclusion: Interdisciplinary cooperation in the treatment of patients with acute lateral epicondylalgia benefits the patients by shortening the rehabilitation period and provides health care professionals the opportunity for an improved learning and exchanging experiences. There was a strong will to cooperate and the risks of side effects with corticosteroid injections and NSAID are well-known although they are the most common treatments. Treating the patient at the right level of care could minimize side effects. These basic conditions must be met in order to improve health care quality. Study IV: Aim: To evaluate whether patients with lateral epicondylalgia, two years after they were treated by a structured program, had less pain or function loss and if recurrent episodes and sick-leave days differed compared to a control group. Method: This study had a prospective design with a two year follow-up. The intervention group (n=103) were referred to a physiotherapist and an occupational therapist working together with a structured treatment program. The control group, chosen from the same diagnose code (n=194) were treated with various treatments. The outcome measures were pain, function, rates of recurrences and sick-leave using a questionnaire two years after their visit at the health care center. Result: More than half of the patients experienced some pain and function loss from their elbow. The intervention group had less sick-leave absence at the time for the first visit, less pain and function loss and fewer periods of recurrences and needed less additional therapy if a recurrence occurred. Conclusion: This disease is not always a self-limiting condition and needs treatment. A structured treatment and to teach the patients how to treat themselves if the symptoms re-occur, seems to be an effective way. The patient will not need additional treatment and do not need to be on the sick list. The main findings: With a structured program and by using interdisciplinary cooperation in the treatment of lateral epicondylalgia, the absence from work could decrease, the pain and the function loss was less for the patient, side-effects were minimized and the program could be an outlined and effective way for the health care professionals to treat the patient and to evaluate lateral epicondylalgia both clinical and in science.
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| 4250. |
- Nilsson, Rangnar, 1974
(author)
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God vetenskap. Hur forskares vetenskapsuppfattningar uttryckta i sakkunnigutlåtanden förändras i tre skilda discipliner.
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Rangnar Nilsson: Good science: How researchers’ conceptions of science expressed in peer review documents change in three different disciplines (God vetenskap: Hur forskares vetenskapsuppfattningar uttryckta i sakkunnigutlåtanden förändras i tre skilda discipliner). Ph.D. Dissertation in Swedish, with a summary in English. Department of Literature, History of Ideas and Religion, University of Gothenburg, 2009. ISBN: 978-91-7346-638-7. This dissertation examines the variety in perceptions of science and research in the academic communities of political science, literature studies and physics in Sweden 1950-1995 as expressed in expert evaluations of professorship candidates. The study relates commonalities as well as differences in these perceptions to internal conditions of the research field, and to the extramural settings and conditions of Swedish academia. Research is thus considered as a historically situated, socially entangled and contingent societal activity that produces knowledge in close concurrence with the surrounding society. The analysis of quality assessments for each discipline examines which of the following aspects of the works reviewed by expert panels are focused in their evaluation reports: problem, method, theory, object, results, writing, the totality of the work or the researcher him- or herself. Based on the panelists’ treatment of these aspects the thesis highlights the concomitant internal perceptions of science and research in each case. It is found that early on in expert evaluations, political science tends to be depicted as a research field largely focused on the research methods. The methods frequently define areas of research, and credibility is typically attained through proper use of reliable methods. Towards the end of the 1900s, political scientists took a new interest in theory, while the knowledge produced was described in less definitive or absolute words. Expert panels reviewing literature studies were traditionally more inclined to focus on the object of research or its material, whereas the methods used were rarely diagnosed. With time, however, one finds a theoretical turn, in as much as theory gained a new appreciation in this discipline as well, and it is, moreover, clearly considered as an active ingredient in knowledge production in the 1990s. As in political science, the descriptions of results - as depicted in evaluations - change from rather final pronouncements to ones that are more tentative. Such a trend may also be seen in the physicists’ evaluations. In that case evaluation reports largely home in on the results in general, but they also - when actual results are described - make explicit references to linkages with external actors or industry. The respective differences identified are analyzed as products of the history of each discipline, inherent requirements and differential relationships to the society outside of the academia.
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