| 1. |
- Johansson, Anna, 1965-
(författare)
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Sleep-Wake-Activity and Health-Related Quality of Life in Patients with Coronary Artery Disease and evaluation of an individualized non-pharmacological programme to promote self-care in sleep
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sleep is a basic need, important to physical and psychological recovery. Insomnia implies sleep-related complaints, such as difficulty falling asleep, difficulty staying asleep, early awakening, or non-restorative sleep (NRS) in an individual who has adequate circumstances and opportunity to sleep. Insomnia is also related to impairment of daytime functions. The prevalence of reported sleep disturbances varies between 15% and 60% in patients with coronary artery disease (CAD) up to five years after intervention. Disturbed sleep may have a negative impact on self-care capacity and behaviours. Little attention has been given to evaluation of sleep promotion through individualized non-pharmacological interventions among CAD patients.The overall aim of this thesis was to describe the impact of sleep quality and disrupted sleep on health-related quality of life (HRQoL) in patients with stable CAD, in comparison to a population-based group. The objective was also to evaluate an individualized non-pharmacological programme to promote self-care in sleep.Four studies were conducted during seven years, starting in 2001. Patients from six hospitals in the south of Sweden were invited to participate. In addition, an age and gender matched population-based group was randomly selected during the same period as the patients and was used for comparison with the CAD patients in two of the studies. Data was collected through interviews, self-reported questionnaires, a study specific sleep diary and actigraphy registrations. A pretest-posttest control design was used to evaluate whether an individualized non-pharmacological intervention programme could promote self-care in sleep-activity in CAD patients.The results showed a high prevalence of insomniac CAD patients out of whom a large proportion were non-rested insomniacs. This showed that NRS is one of the core symptoms of insomnia. On the other hand there were weak or non-significant gender differences with increasing insomnia severity. Severe insomniac CAD patients displayed a two or threefold higher presleep arousal or anxiety score and were more limited in taking physical exercise than the general population. Generally low sleep efficiency (SE%) was revealed in the studies, particularly among severe non-rested insomniac CAD patients.Among CAD patients, the individualized non-pharmacological programme to promote self-care in sleep-activity indicated improvements in sleep and HRQoL.This thesis elucidates the importance of focusing on the individual’s perception of their sleep-activity and health in their local context and supporting self-care management. Furthermore, it is of importance that nurses set individual goals together with the patient in order to increase self-efficacy to promote HRQoL.
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| 2. |
- Kvernby, Sofia, 1987-
(författare)
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Myocardial Tissue Characterization Using Magnetic Resonance Imaging
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In cardiovascular disease, which is the most common cause of death in the world, early diagnosis is crucial for disease outcome. Diagnosis of cardiovascular disease can be challenging, though. Quantification of myocardial T1 and T2 relaxation times with MRI has demonstrated to be a promising method for characterizing myocardial tissue, but long measurement times have hampered clinical use. The overall aim of this doctoral thesis was to develop, validate and, in patient studies, evaluate a very fast three-dimensional method for simultaneous quantification of myocardial T1 and T2 relaxation times with whole coverage of the left ventricle.The 3D-QALAS method is presented in Paper I of this thesis. It is a method that simultaneous measures both T1 and T2 relaxation times in a three-dimensional volume of the heart. The method requires 15 heartbeats, to produce 13 short-axis slices of the left ventricle with voxelwise information of both T1 and T2 relaxation times. The 3D-QALAS method was validated in phantoms and in 10 healthy volunteers by comparing the method with reference methods and demonstrated good accuracy and robustness both in-vitro and in-vivo.In Paper II, the 3D-QALAS method was carefully validated in-vivo by investigating accuracy and precision in 10 healthy volunteers, while the clinical feasibility of the method was investigated in 23 patients with various cardiac pathologies. Repeated independent and dependent scans together with the intra-scan repeatability, demonstrated all a very good precision for the 3D-QALAS method in healthy volunteers.In Paper III and IV, the 3D-QALAS method was applied and evaluated in patient cohorts where the heart muscle alters over time. In Paper III, patients with severe aortic stenosis underwent MRI examinations with 3D-QALAS before, 3 months after and 12 months after aortic valve surgery. Changes in T1 and T2 were observed, which might be used as markers of myocardial changes with respect to edema and fibrosis, which may develop due to increased workload over a long period of time.In study IV, 3D-QALAS was used to investigate 10 breast cancer patients treated with radiation therapy prior to treatment, 2-3 weeks into treatment, and one and 6 months after completion of treatment, to investigate any changes in T1 and T2 and further if they can be correlated to unwanted irradiation of the heart during radiation therapy.
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| 3. |
- Agrasada, Grace V., 1956-
(författare)
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Postnatal Peer Counseling on Exclusive Breastfeeding of Low-birthweight Filipino Infants : Results of a Randomized Controlled Trial
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In a Manila hospital, 204 mothers were randomized into three groups: two intervention groups receiving home-based counseling visits, one of them (n=68) by counselors trained to use a locally developed, two-tiered program of breastfeeding counseling, and the other by counselors trained in general childcare (n=67), were compared with a control group of mothers (n=69) who did not receive any counseling. All infants were scheduled for seven visits to the hospital for follow-up. During hospital visits, maternal and infant body measurements were made and an independent interviewer asked the mothers individually to recall how the infant had been fed. One study physician, blind to participant groups, was consulted at all scheduled and unscheduled infant visits.At six months, 44% of the breastfeeding-counseled mothers, 7% of the childcare-counseled mothers and none of the mothers in the control group were exclusively breastfeeding. Twenty- four mothers breastfed exclusively during the first six months, of whom 22 received breastfeeding counseling and 2 had no breastfeeding counseling. Among 24 infants who were exclusively breastfed from birth to six months there were no episodes of diarrhea. All infants had gained in weight, length and head circumference. Mean maternal weight loss at six months was similar whether her breastfeeding was exclusive or partial.The reasons why mothers without breastfeeding counseling introduced non-breast milk feeding before six months reflected lack of knowledge and support. Breastfeeding support during the first six months focusing on how to prevent and solve breastfeeding problems, particularly during the first two weeks, will enable mothers to choose to breastfeed exclusively up to six months. This study has provided fundamental evidence of successful intervention by breastfeeding counseling to achieve six months of exclusive breastfeeding among term, low-birthweight infants. The locally developed training program in breastfeeding counseling, which successfully prepared volunteers to counsel mothers at home, could be incorporated into primary health care in the Philippines. Mothers who received breastfeeding counseling appreciated how this helped them to achieve their breastfeeding goals for the first six months. Improved breastfeeding practices as a result of breastfeeding counseling provided infants with protection from diarrhea and respiratory infections, contributing to their health and development.
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| 4. |
- Ahlsson, Fredrik, 1967-
(författare)
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Being Born Large for Gestational Age : Metabolic and Epidemiological Studies
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Obesity is a major health problem in the Western world. Mean birth weight has increased during the last 25 years. One explanation is that the proportion of large for gestational age (LGA) infants has increased. Such infants risk developing obesity, cardiovascular disease and diabetes later in life. Despite the risk of neonatal hypoglycemia, their postnatal metabolic adaptation has not been investigated. Our data, obtained with stable isotope labeled compounds, demonstrate that newborn LGA infants have increased lipolysis and decreased insulin sensitivity. After administration of glucagon, the plasma levels of glucose and the rate of glucose production increased. The simultaneous increase in insulin correlated with the decrease in lipolysis, indicating an antilipolytic effect of insulin in these infants.We also demonstrated an intergenerational effect of being born LGA, since women born LGA, were at higher risk of giving birth to LGA infants than women not born LGA. Further, the LGA infants formed three subgroups: born long only, born heavy only, and born both long and heavy. Infants born LGA of women with high birth weight or adult obesity were at higher risk of being LGA concerning weight alone, predisposing to overweight and obesity at childbearing age. In addition we found that pregnant women with gestational diabetes were at increased risk of giving birth to infants that were heavy alone. This could explain the risk of both perinatal complications and later metabolic disease in infants of this group of women.To identify determinants of fetal growth, 20 pregnant women with a wide range of fetal weights were investigated at 36 weeks of gestation. Maternal fat mass was strongly associated with insulin resistance. Insulin resistance was related to glucose production, which correlated positively with fetal size. The variation in resting energy expenditure, which was closely related to fetal weight, was largely explained by BMI, insulin resistance, and glucose production. Lipolysis was not rate limiting for fetal growth in this group of women. Consequently, high maternal glucose production due to a high fat mass may result in excessive fetal growth.
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| 5. |
- Andersson, Claes, 1978-
(författare)
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Fusing Domain Knowledge with Data : Applications in Bioinformatics
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Massively parallel measurement techniques can be used for generating hypotheses about the molecular underpinnings of a biological systems. This thesis investigates how domain knowledge can be fused to data from different sources in order to generate more sophisticated hypotheses and improved analyses. We find our applications in the related fields of cell cycle regulation and cancer chemotherapy. In our cell cycle studies we design a detector of periodic expression and use it to generate hypotheses about transcriptional regulation during the course of the cell cycle in synchronized yeast cultures as well as investigate if domain knowledge about gene function can explain whether a gene is periodically expressed or not. We then generate hypotheses that suggest how periodic expression that depends on how the cells were perturbed into synchrony are regulated. The hypotheses suggest where and which transcription factors bind upstreams of genes that are regulated by the cell cycle. In our cancer chemotherapy investigations we first study how a method for identifiyng co-regulated genes associated with chemoresponse to drugs in cell lines is affected by domain knowledge about the genetic relationships between the cell lines. We then turn our attention to problems that arise in microarray based predictive medicine, were there typically are few samples available for learning the predictor and study two different means of alleviating the inherent trade-off betweeen allocation of design and test samples. First we investigate whether independent tests on the design data can be used for improving estimates of a predictors performance without inflicting a bias in the estimate. Then, motivated by recent developments in microarray based predictive medicine, we propose an algorithm that can use unlabeled data for selecting features and consequently improve predictor performance without wasting valuable labeled data.
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| 6. |
- Bäckström, Pontus, 1983-
(författare)
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Exploring mechanisms of peer effects in education : Frame factor analyses of classroom instruction
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite a vast international literature, previous research into compositional effects and peer effects in education has remarked on the lack of consensus within the field. To date, peer effects in education and students’ different opportunities to learn in school have been studied separately. In this thesis, it is argued that these perspectives need to be synthesized.In the thesis, Frame Factor Theory is employed as a theory of peer effects in classroom instruction. According to the theory, one mechanism generating peer effects is the steering and limiting effect that class composition has on teachers’ instruction. It is argued that this perspective also needs to be synthesized with the Opportunity to Learn-perspective, to widen our understanding of why different students meet different instruction and thus are given different opportunities to learn. The theoretical perspectives and empirical models are evolved through three empirical studies included in the thesis. The theoretical development and the empirical results from each study is discussed in an integrative essay in the thesis.The results indicate that class composition affects the presence of limitations on instruction and content coverage in instruction, both of which is related to students’ opportunities to learn and individual students’ achievement. Implications for future research and educational policy is discussed.
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| 7. |
- Diderholm, Barbro, 1965-
(författare)
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Perinatal Energy Substrate Metabolism : Glucose Production and Lipolysis in Pregnant Women and Newborn Infants with Particular Reference to Intrauterine Growth Restriction (IUGR)
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Glucose is the most important fetal nutrient and the production of this substrate increases in the pregnant woman. In the last trimester the increased insulin resistance directs energy substrates to the fetus. Fetal growth is sometimes disturbed, often without an obvious explanation.After birth the newborn infant must produce its own glucose, primarily for the brain. Fatty acids from lipolysis are also important energy substrates. Hypoglycaemia can be a problem, occurring frequently in preterm infants and infants born small for gestational age (SGA). In addition, SGA infants are at risk of developing the metabolic syndrome in adulthood. Neonatal medication can influence energy metabolism. One such medication is theophylline, administered in preterm infants to prevent apnoea. We investigated energy substrate production in women with normal and IUGR pregnancies, in preterm neonates, before and after theophylline treatment and in newborn SGA infants, using stable isotope-labelled compounds and gas chromatography-mass spectrometry. We found that late pregnancy was associated with an almost twofold increase in the rate of lipolysis. This provides substrates for maternal energy metabolism, which may spare glucose for the fetus. Even though glucose production was comparable in the two groups of pregnant women, those with IUGR had a lower rate of lipolysis. A reduced supply of energy substrates could be one factor underlying IUGR. In spite of the insulin resistance of late pregnancy, insulin still had a regulatory role in energy substrate production in the women with normal pregnancies, but not in those with IUGR. Although infants born preterm and/or SGA have limited energy stores, we demonstrated that they are capable of both lipolysis and glucose production. Theophylline had no adverse effects on energy substrate production. Data on insulin and IGFBP-1 in the SGA infants indicate that in such infants insulin sensitivity is increased peripherally but reduced in the liver.
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| 8. |
- Dodig-Crnkovic, Gordana, 1955-
(författare)
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Investigations into Information Semantics and Ethics of Computing
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The recent development of the research field of Computing and Philosophy has triggered investigations into the theoretical foundations of computing and information.This thesis consists of two parts which are the result of studies in two areas of Philosophy of Computing (PC) and Philosophy of Information (PI) regarding the production of meaning (semantics) and the value system with applications (ethics).The first part develops a unified dual-aspect theory of information and computation, in which information is characterized as structure, and computation is the information dynamics. This enables naturalization of epistemology, based on interactive information representation and communication. In the study of systems modeling, meaning, truth and agency are discussed within the framework of the PI/PC unification.The second part of the thesis addresses the necessity of ethical judgment in rational agency illustrated by the problem of information privacy and surveillance in the networked society. The value grounds and socio-technological solutions for securing trustworthiness of computing are analyzed. Privacy issues clearly show the need for computing professionals to contribute to understanding of the technological mechanisms of Information and Communication Technology.The main original contribution of this thesis is the unified dual-aspect theory of computation/information. Semantics of information is seen as a part of the data-information-knowledge structuring, in which complex structures are self-organized by the computational processing of information. Within the unified model, complexity is a result of computational processes on informational structures. The thesis argues for the necessity of computing beyond the Turing-Church limit, motivated by natural computation, and wider by pancomputationalism and paninformationalism, seen as two complementary views of the same physical reality. Moreover, it follows that pancomputationalism does not depend on the assumption that the physical world on some basic level is digital. Contrary to many believes it is entirely compatible with dual (analogue/digital) quantum-mechanical computing.
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| 9. |
- Elmi Mohamed, Abdullahi, 1965-
(författare)
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Sharing Water in Africa : Comparative Analysis of the Limpopo and Orange-Senqu River Basins in SADC and the Juba and Shabelle River Basins in the Horn of Africa
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As water resources management becomes increasingly critical and many countries in the arid and semi-arid regions are increasingly forced to consider the possibilities of utilizing the water that is available in international rivers. Thus, the concerns relating to the use of international waters in shared rivers are becoming more important. The increasing competition over shared waters may have to lead either to more joint management and cooperation or to conflicts between basin countries.The purpose of the thesis work has been to analyze management of shared waters in international river basins with case studies from the Limpopo and the Orange River Basins in Southern African Development Community (SADC) region and the Juba and Shabelle River Basins in the Horn of Africa (HoA) region, focusing on river cooperation. The methodology employed was a comparative case study analysis through literature review, document analysis, interviews, focus groups and study visits.While similarities in climatic conditions and population growth stand out when comparing the basins in the two regions, the rivers differ primarily in terms of physical development of the water resources and institutional building for cross-border river cooperation. The Limpopo and Orange-Senqu river basins in the SADC region became reason for cooperation and catalyst of regional integration while the Juba and Shabelle river basins in the HoA has the potential to lead its riparian to conflict. The river basins in SADC established and operationalized functional system of river cooperation with both bilateral and multilateral basin-wide frameworks.The analysis concludes that management of water resources in internationally shared river basins is effectively affected by issues other than water. Sharing benefits from the shared waters in international rivers require basin-wide river cooperation. There are variety sets of factors that are of great importance for initiating, establishing and operationalizing river basin cooperation.
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| 10. |
- Frisk, Per, 1966-
(författare)
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Late Effects After Autologous Bone Marrow Transplantation in Childhood
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Fifty children with hematologic malignancies have been treated with autologous BMT in Uppsala. The aim was to describe late effects in this group with special reference to cataracts, reduced final height, and to hepatic, renal, and pulmonary late effects. Cataracts: All patients who received TBI in their conditioning developed posterior subcapsular cataract after BMT. A few patients with visual impairment affecting daily life needed cataract surgery, whereas the visual acuity was well preserved in most of the other patients.Final height: There was a decrease in final height relative both to height at BMT and to target height. This decrease was significant both in those who had received TBI only and in those who had been given cranial irradiation. Cranial irradiation, young age at BMT, and short duration of GH treatment were predictors of height loss. Hepatic function: Hepatic function was well preserved over a period of 10 years after BMT. TBI did not appear to be a risk factor for hepatic impairment. Renal function: Six months after BMT there was a decrease in renal function in patients who had received TBI. It then recovered, albeit incompletely, and stabilized. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for the development of chronic renal impairment in a number of patients. Nephrotoxic antibiotics may have contributed.Pulmonary function: Six months after BMT there was a decrease in pulmonary function in those who received TBI. It then recovered and stabilized at the pretransplant level. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for restrictive pulmonary disease in a number of patients whereas chemotherapy might also have been of importance for impaired gas exchange.
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