| 1. |
- Blom Johansson, Monica, 1965-
(författare)
-
Aphasia and Communication in Everyday Life : Experiences of persons with aphasia, significant others, and speech-language pathologists
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to describe the experiences of persons with aphasia and their significant others of their conversations and use of communication strategies, examine current practice of family-oriented speech-language pathology (SLP) services, and test a family-oriented intervention in the early phase of rehabilitation.The persons with aphasia valued having conversations despite perceiving their aphasia as a serious social disability. They acknowledged the importance of the communication partners’ knowledge and understanding of aphasia and their use of supporting conversation strategies. Their own use of communication strategies varied considerably. The persons with aphasia longed to regain language ability and to be active participants in society.A majority of the significant others perceived their conversations with the person with aphasia as being less stimulating and enjoyable than conversations before stroke onset. Aphasia was considered a serious problem. The significant others took on increased communicative responsibility, where two thirds had changed their communicative behaviour to facilitate conversations. Type and severity of aphasia were especially related to the communicative experiences of the significant others and their motivation to be involved in SLP services.Thirty percent of the speech-language pathologists worked with people with aphasia and typically met with their families. They considered the involvement of significant others in SLP services as very important, especially in providing information about aphasia and communication partner training (CPT). However, involvement of significant others was restricted because of a time shortage and perceived limited skills and knowledge. In addition, there were national differences regarding aphasia rehabilitation services.The intervention consisted of three sessions directed to significant others (primarily emotional support and information) and three directed to the dyads (a person with aphasia and a significant other) (primarily CPT). All six participants (three dyads) felt that their knowledge and understanding of aphasia had increased and that their conversations had improved. These improvements were also evident to some extent with formal assessments.These results suggest the following: CPT should be an integral part of SLP services, national clinical guidelines are needed, and further education of speech-language pathologists and implementation of new knowledge into clinical practice requires consideration.
|
|
| 2. |
- Lau, Joey, 1979-
(författare)
-
Implantation-Site Dependent Differences in Engraftment and Function of Transplanted Pancreatic Islets
- 2008
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Transplanting pancreatic islets into the liver through the portal vein is currently the most common procedure in clinical islet transplantations for treating patients with brittle type 1 diabetes. However, most islet grafts fail within a 5-year period necessitating retransplantation. The vascular connections are disrupted at islet isolation and implanted islets depend on diffusion of oxygen and nutrients in the immediate posttransplantation period. Rapid and efficient revascularization is of utmost importance for the survival and long-term function of transplanted islets. In this thesis, the influence of the implantation microenvironment for islet engraftment and function was studied. Islets were transplanted into the liver, the renal subcapsular site or the pancreas. Islets implanted into the liver contained fewer glucagon-positive cells than islets implanted to the kidney and endogenous islets. Intraportally transplanted islets responded with insulin and glucagon release to secretagogues, but only when stimulated through the hepatic artery. Thus, the intrahepatic grafts were selectively revascularized from the hepatic artery. The vascular density in human islets transplanted into the liver of athymic mice was markedly lower when compared to human islets grafted to the kidney. Islets implanted into their physiological environment, the pancreas, were markedly better revascularized. Insulin content, glucose-stimulated insulin release, (pro)insulin biosynthesis and glucose oxidation rate were markedly decreased in transplanted islets retrieved from the liver, both when compared to endogenous and transplanted islets retrieved from the pancreas. Only minor changes in metabolic functions were observed in islets implanted into the pancreas when compared to endogenous islets. The present findings demonstrate that the microenvironment has a major impact on the engraftment of transplanted islets. Elucidating the beneficial factors that promote engraftment would improve the survival and long-term function of transplanted islets. Ultimately, islet transplantation may be provided to an increased number of patients with type 1 diabetes.
|
|
| 3. |
- Palm, Fredrik, 1973-
(författare)
-
Diabetes-induced Alterations in Renal Microcirculation and Metabolism
- 2004
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Diabetes-induced renal complications, i.e. diabetes nephropathy, are a major cause of morbidity and mortality. The exact mechanism mediating the negative influence of hyperglycaemia on renal function is unclear, although several hypotheses have been postulated. Glucose-induced excessive formation of reactive oxygen species (ROS) and increased glucose flux through the polyol pathway are two major mechanisms that have recently gained increasing support. In order to investigate the development of hyperglycaemia-induced renal alterations further, it is of great importance to use an animal model in agreement with the pathological development in diabetic patients.The aims of these investigations were to evaluate the streptozotocin (STZ)-diabetic Wistar Furth rat as a model for human diabetic nephropathy and to investigate involvement of ROS and the polyol pathway in development of diabetes-induced renal alterations.The used STZ-diabetic animal model displayed several similarities with the progression of human disease, including initial hyperfiltration and albuminuria. However, the observed proteinuria could be partly linked to the STZ treatment per se, making the use of this animal model less suitable for research concerning diabetes-induced urinary protein leakage.The diabetic state induced numerous alterations in renal function and metabolism, including increased oxygen consumption, decreased renal oxygen tension (pO2), and altered lactate/pyruvate ratio. These renal alterations were preventable by daily treatment with either a radical scavenger (α-tocopherol) or an aldose reductase inhibitor (AL-1576).In separate experiments the influence of nitric oxide (NO) on renal blood perfusion and pO2 was investigated. The diabetic animals displayed a larger increase in renal NO activity after injecting the NO substrate L-arginine compared to non-diabetic animals, suggesting substrate limitation of the nitric oxide synthase during chronic hyperglycaemia.In conclusion, the results from these investigations show that both ROS and the polyol pathway are involved in the development of diabetes-induced renal alterations in the STZ- diabetic Wistar Furth rat.
|
|
| 4. |
- Arvidsson, Eva
(författare)
-
Priority Setting and Rationing in Primary Health Care
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Studies on priority setting in primary health care are rare. Priority setting and rationing in primary health care is important because outcomes from primary health care have significant implications for health care costs and outcomes in the health system as a whole.Aims: The general aim of this thesis has been to study and analyse the prerequisites for priority setting in primary health care in Sweden. This was done by exploring strategies to handle scarce resources in Swedish routine primary health care (Paper I); analysing patients’ attitudes towards priority setting and rationing and patients’ satisfaction with the outcome of their contact with primary health care (Paper II); describing and analysing how general practitioners, nurses, and patients prioritised individual patients in routine primary health care, studying the association between three key priority setting criteria (severity of the health condition, patient benefit, and cost-effectiveness of the medical intervention) and the overall priority assigned by the general practitioners and nurses to individual patients (Paper III); and analysing how the staff, in their clinical practise, perceived the application of the three key priority setting criteria (Paper IV).Methods: Both qualitative (Paper I and IV) and quantitative (Paper II and III) methods were used. Paper I was an interview study with medical staff at 17 primary health care centres. The data for Paper II and Paper III were collected through questionnaires to patients and staff at four purposely selected health care centres during a 2-week period. Paper IV was a focus group study conducted with staff members who practiced priority setting in day-to-day care.Results: The process of coping with scarce resources was categorised as efforts aimed to avoid rationing, ad hoc rationing, or planned rationing. Patients had little understanding of the need for priority setting. Most of them did not experience any kind of rationing and most of those who did were satisfied with the outcome of their contact with primary health care. Patients, compared to medical staff, gave relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions when prioritising individual patients in day-today primary health care. When applying the three priority setting criteria in day-to-day primary health care, the criteria largely influenced the overall prioritisation of each patient. General practitioners were most influenced by the expected cost-effectiveness of the intervention and nurses were most influenced by the severity of the condition. Staff perceived the criteria as relevant, but not sufficient. Three additional aspects to consider in priority setting in primary health care were identified, namely viewpoint (medical or patient’s), timeframe (now or later) and evidence level (group or individual).Conclusion: There appears to be a need for, and the potential to, introduce more consistent priority setting in primary health care. The characteristics of primary health care, such as the vast array of health problems, the large number of patients with vague symptoms, early stages of diseases, and combinations of diseases, induce both special possibilities and challenges.
|
|
| 5. |
|
|
| 6. |
- Brodtkorb, Thor-Henrik, 1976-
(författare)
-
Cost-effectiveness analysis of health technologies when evidence is scarce
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Given the increasing pressures on health care budgets, economic evaluation is used in many countries to assist decision-making regarding the optimal use of competing health care technologies. Although the standard methods of estimating cost-effectiveness underpinning these decisions have gained widespread acceptance, concerns have been raised that many technologies would not be considered for funding, due to scarcity of evidence. However, as long as the amount and quality of evidence used for the analysis are properly characterized, scarce evidence per se should not be seen as a hindrance to perform cost-effectiveness analyses. Characterizing uncertainty appropriately, though, may pose a challenge even when there is a large body of evidence available, and even more so when evidence is scarce. The aims of this thesis are to apply a methodological framework of cost-effectiveness analysis and explore methods for characterising uncertainty when evidence is scarce. Three case studies associated with limited evidence provide economic evaluations on current decision problems, investigate the feasibility of using the framework, and explore methods for characterizing uncertainty when evidence is scarce.The results of the case studies showed that, given current information, providing transfemoral amputees with C-Leg and Airsonett Airshower to patients with perennial allergic asthma could be considered cost-effective whereas screening for hyperthrophic cardiomyopathy among young athletes is unlikely to be cost-effective. In the cases of C-Leg and Airsonett Airshower conducting further research is likely to be cost-effective. The case studies indicate that it is feasible to apply methods of cost-effectiveness in health care for technologies not commonly evaluated due to lack of evidence. The analysis showed that failing to account for individual experts’ might have a substantial effect on the interpretation of the results of cost-effectiveness analysis. Formal expert elicitation is a promising method of characterizing uncertainty when evidence is missing, and thus enable cost-effectiveness and value of further research to be appropriately estimated in such situations.In conclusion, this thesis shows that scarcity of evidence should not preclude the use of cost-effectiveness analysis. On the contrary, in such cases it is probably more important than ever to use a framework that enable us to define key parameters for a decision problem and identify available evidence in order to determine cost-effectiveness given current information and provide guidance on further data collection.
|
|
| 7. |
- Carlsson, Carl-Gustaf, 1946-
(författare)
-
Ungdomars möte med yrkesutbildning : en jämförelse mellan ungdomar i kommunal och företagsförlagd gymnasieutbildning
- 2001
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main purpose in this thesis was to study young persons and their encounter with vocational education and training as related to industrial work. Another was to compare the situation for these persons in two school organizations, a municipal upper secondary school and an industrial upper secondary school situated within a private company.The approach was to investigate the interplay in vocational training between the teacher's arrangement of the teaching and the student's view of this situation. The study was analysed using a theoretical model designed to focus on the interaction between student prerequisites and experiences and teacher and school influences.Data was collected from one class at a municipal upper secondary school and another class at an industrial upper secondary school that were followed for three years during their vocational education. The result has been analysed by interviews with teachers and students, student marks, student questionnaire and observa-tions of education.The students had started their industrial training with differing experien-ces. The common factor was an interest in technology. At the beginning of their education a marked difference was noted in the students' self-confi-dence, mainly between the groups in the two school organizations. The stu-dents in the company-based school showed considerably more self-confi-dence than those in the municipal school.The students can be divided into those who are theory-oriented and practice-oriented respectively. The former group had great confidence in theoretical explanations and seldom questioned these, carefully following instructions. The practice-oriented group used a more questioning and examining way of learning.The students at the municipal upper secondary school have difficulties in adjusting to educational situations, which they cannot see the use of, espe-cially those students who are practice-oriented. At the industrial upper secondary school, which has a more restricted educational process, the students adjust to the situations.
|
|
| 8. |
- Carlsson, Gunilla
(författare)
-
Det våldsamma mötets fenomenologi : - om hot och våld i psykiatrisk vård
- 2004
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present study focuses on the phenomenology of the violent encounter, and is to be understood as the study of the violent encounter as a phenomenon, i.e. as experienced. The overall aim is to elucidate, analyse and describe violent encounters within psychiatric care as experienced by carers and patients. Moreover, the study aims at promoting the development of a phenomenological research approach in caring science in general and elucidating tacit caring knowledge in particular.The thesis includes three empirical studies and one methodological study. The research is guided by a phenomenological and lifeworld theoretical approach. Research data consist of narratives and qualitative interviews, as well as reenactment interviews with carers and patients. Data are analysed for meaning. The analysis and synthesis of meaning are aimed at openness and meaning sensitivity through a reflective attitude characterised by the intent to bridle the process of understanding. The goal of the analysis is to describe the general structure of the phenomenon and its meaning constituents.The result shows that violence and threat do not evolve in “naked” caring, characterised by encounters where carers are able to touch their patients at the same time as being touched, speaking both literally and figuratively. It is through “naked” caring and caring touch that the carers are able to reach the patients and to give undisguised invitations to genuine presence. The possibilities of touch rely on the carers’ capacity to be authentic and to genuinely wish well. Violence is on the contrary nourished by touch without caring intention, or non-touch, i.e. caring where the reciprocity of touching and being touched is missing between patients and caregivers.In the discussion, the different meanings of the violent encounter are related to the philosophy of Merleau-Ponty and Lévinas. The philosophical dimensions of touch are investigated and it is discussed how the “naked” encounter can be understood from a phenomenological ethical standpoint. The discussion focuses on the caregivers’ vulnerability and the high demands they are subjected to. It is also argued that a foundation of caring science is needed in caring practice in order to make possible a development of a caring attitude that prevents violence.
|
|
| 9. |
- Carlsson, Inga-Lill, 1955-
(författare)
-
Towards System Supply : Development of Small and Medium-Sized Contract Manufacturers
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- One way for a small subcontractor to meet increasing global competition is to develop a system supplying ability, implying a transition in the supply chain toward a larger overall responsibility. As large corporations outsource parts of their manufacturing and services, many small and medium-sized enterprise (SME) suppliers are expected to deepen their capabilities and take on the role of system suppliers. The overall purpose of this thesis is to advance the understanding of how SME contract manufacturers can develop such capabilities, identifying demands and abilities in various steps of this process. The research approach is based on the resource-based view.This longitudinal case study of an SME supplier striving to become a system supplier covers the period from 2006 to 2014. The researcher’s role as business developer and member of the management made it possible to follow the company's development continuously and closely, providing access to relevant internal data complemented with internal and external semi structured interviews and focus discussions. The longitudinal aspect is evident in the overall description of the development of the focal supplier. More specific issues are covered in the separate studies, described in the appended articles.SME suppliers need basic capabilities of qualitative production performance as stepping-stones to develop more system supplier capabilities for added customer value. Development of stable production processes through lean implementation was by the focal supplier seen as a way to reach stable basic performance and to enable continuous development. The study further shows that knowledge integration with customers is an effective means to build system capability and indicates a stepwise and sequential process of developing specific supplier capabilities.The longitudinal case study deepens the knowledge of development of SME system suppliers and specifically point out three prerequisites that need to be in place for the supplier transition: (1) a capability of the supplier to manage internal processes of standardisation and continuous improvements for stable performance without disruptions, (2) a capability to collaborate in development projects with a limited number of customers, and (3) customer commitment to a long-term relationship. A customer demanding improvements is constantly driving its suppliers to better performance and proven supplier capabilities in turn promotes long-term customer commitment. The most essential component in supplier development is a competent and strategically oriented management, capable of identifying the specific system supplier offerings appropriate for the particular company in order to create customer value.This study contributes to better understanding of the conditions of medium-sized contract manufacturing SMEs, from a supplier perspective, and contributes to SCM research in illustrating how shifting responsibilities and subsequent activities in the supply chain may pave new competitive paths for SMEs. One issue here is the importance of knowledge integration for the development of supply chains. This has not often been discussed within SCM and thus provides a contribution to this theory.
|
|
| 10. |
- Carlsson, Jenny, 1984-
(författare)
-
On Crack Dynamics in Brittle Heterogeneous Materials
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Natural variation, sub-structural features, heterogeneity and porosity make fracture modelling of wood and many other heterogeneous and cellular materials challenging. In this thesis, fracture in such complicated materials is simulated using phase field methods for fracture. Phase field methods have shown promise in simulations of complex geometries as well as dynamics and require few additional parameters; only the material toughness and a length parameter, determining the width of a regularised crack, are needed.First, a dynamic phase field model is developed and validated against experiments performed on homogeneous brittle polymeric materials, wood fibre composites and polymeric materials with different hole patterns. Then, a high-resolution model of wood is developed and related to experiments, this time without considering fracture. Attention is finally focussed on high-resolution numerical analyses of fracture in wood and other cellular microstructures, considering both heterogeneity and relative density.The phase field model is found to reproduce crack paths, velocities and energy release rates well in homogeneous samples both with and without holes. In more complicated heterogeneous and porous materials, the model is also able to simulate crack paths, but the interpretation of the length scale is complicated by the inherent lengths of the micro-structural geometry. In sum, the thesis points to possibilities with the proposed method, as well as limitations in our current understanding of both quasistatic and dynamic fracture of heterogeneous and cellular materials. The findings of this thesis can contribute to an improved understanding of fracture in such materials.
|
|
