| 1. |
- Hellstrand Tang, Ulla, 1956, et al.
(författare)
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Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations : Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool
- 2024
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Ingår i: JMIR Human Factors. - : JMIR Publications. - 2292-9495. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations.OBJECTIVE: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up.METHODS: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges.RESULTS: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting.CONCLUSIONS: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.
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| 2. |
- Broman, Mikael, et al.
(författare)
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Recirculation during veno-venous extra-corporeal membrane oxygenation - a simulation study
- 2015
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Ingår i: International Journal of Artificial Organs. - : SAGE Publications. - 0391-3988 .- 1724-6040. ; 38:1, s. 23-30
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Veno-venous ECMO is indicated in reversible life-threatening respiratory failure without life-threatening circulatory failure. Recirculation of oxygenated blood in the ECMO circuit decreases efficiency of patient oxygen delivery but is difficult to measure. We seek to identify and quantify some of the factors responsible for recirculation in a simulation model and compare with clinical data. Methods: A closed-loop real-time simulation model of the cardiovascular system has been developed. ECMO is simulated with a fixed flow pump 0 to 5 l/min with various cannulation sites -1) right atrium to inferior vena cava, 2) inferior vena cava to right atrium, and 3) superior+ inferior vena cava to right atrium. Simulations are compared to data from a retrospective cohort of 11 consecutive adult veno-venous ECMO patients in our department. Results: Recirculation increases with increasing ECMO-flow, decreases with increasing cardiac output, and is highly dependent on choice of cannulation sites. A more peripheral drainage site decreases recirculation substantially. Conclusions: Simulations suggest that recirculation is a significant clinical problem in veno-venous ECMO in agreement with clinical data. Due to the difficulties in measuring recirculation and interpretation of the venous oxygen saturation in the ECMO drainage blood, flow settings and cannula positioning should rather be optimized with help of arterial oxygenation parameters. Simulation may be useful in quantification and understanding of recirculation in VV-ECMO.
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| 3. |
- Aagerup, Ulf, 1969-, et al.
(författare)
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The persuasive effects of emotional green packaging claims
- 2019
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Ingår i: British Food Journal. - Bingley : Emerald Group Publishing Limited. - 0007-070X .- 1758-4108. ; 121:12, s. 3233-3246
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Tidskriftsartikel (refereegranskat)abstract
- Purpose - The purpose of this paper is to investigate the effects of rational green packaging claims vs emotional green packaging claims on consumers' purchase propensity for organic coffee.Design/methodology/approach - Three within-subjects experiment were carried out (N=87, N=245, N=60). The experimental design encompasses packaging with rational green claims, emotional green claims, as well as a neutral (control) claim. Measured variables are introduced to assess participants' environmental commitment and information processing ability. A manipulated between-subjects variable is introduced to test how distraction interacts with preference for the claims.Findings - Overall, consumers prefer products with green claims over those with neutral (control) claims, and products with emotional green claims to those with rational green claims. The studies also reveal that this effect is moderated by participants' environmental commitment, information processing ability and by distraction. The findings were statistically significant (p<0.05).Research limitations/implications - As a lab experiment, the study provides limited generalizability and external validity. Practical implications - For most organic FMCG products, it is advisable to employ emotional packaging claims.Social implications - The presented findings provide marketers with tools to influence consumer behavior toward sustainable choices.Originality/value - The paper validates previous contributions on the effects of product claim types, and extends them by introducing comprehensive empirical data on all the Elaboration Likelihood Model's criteria for rational decision-making; motivation, opportunity and ability.
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| 4. |
- Maksuti, Elira, 1986-, et al.
(författare)
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Physical modeling of the heart with the atrioventricular plane as a piston unit
- 2013
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Cardiac models do not often take the atrioventricular (AV) interactioninto account, even though medicalimaging and clinical studies have shown that the heart pumps with minorouter volume changes throughout the cardiac cycle and with backand forthlongitudinal movements in the AVregion. We present a novel cardiac model based on physical modeling of the heart withthe AV-plane asa piston unit. Model simulationsgeneratedrealistic outputsforpressures and flows as well asAV-piston velocity, emphasizing the relevance of myocardial longitudinal movements in cardiac function
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| 5. |
- Rusaw, David, 1978-, et al.
(författare)
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Validation of the Inverted Pendulum Model in standing for transtibial prosthesis users
- 2016
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Ingår i: Clinical Biomechanics. - : Elsevier. - 0268-0033 .- 1879-1271. ; 31, s. 100-106
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Often in balance assessment variables associated with the center of pressure are used to draw conclusions about an individual's balance. Validity of these conclusions rests upon assumptions that movement of the center of pressure is inter-dependent on movement of the center of mass. This dependency is mechanical and is referred to as the Inverted Pendulum Model. The following study aimed to validate this model both kinematically and kinetically, in transtibial prosthesis users and a control group.METHODS: Prosthesis users (n=6) and matched control participants (n=6) stood quietly while force and motion data were collected under three conditions (eyes-open, eyes-closed, and weight-bearing feedback). Correlation coefficients were used to investigate the relationships between height and excursion of markers and center of masses in mediolateral/anteroposterior-directions, difference between center of pressure and center of mass and the center of mass acceleration in mediolateral/anteroposterior directions, magnitude of mediolateral/anteroposterior-component forces and center of mass acceleration, angular position of ankle and excursion in mediolateral/anteroposterior-directions, and integrated force signals.FINDINGS: Results indicate kinematic validity of similar magnitudes (mean (SD) marker-displacement) between prosthesis users and control group for mediolateral- (r=0.77 (0.17); 0.74 (0.19)) and anteroposterior-directions (r=0.88 (0.18); 0.88 (0.19)). Correlation between difference of center of pressure and center of mass and the center of mass acceleration was negligible on the prosthetic side (r = 0.08 (0.06)) vs. control group (r=-0.51(0.13)).INTERPRETATION: Results indicate kinematic validity of the Inverted Pendulum Model in transtibial prosthesis users but kinetic validity is questionable, particularly on the side with a prosthesis.
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| 6. |
- Salomonsson, Kent, et al.
(författare)
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Analysis of the Internal Mechanical Conditions in the Lower Limb Due to External Loads
- 2016
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Ingår i: World Academy of Science, Engineering and Technology, International Science Index, International Journal of Medical, Health, Biomedical, Bioengineering and Pharmaceutical Engineering. - London. ; , s. 288-293
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Konferensbidrag (refereegranskat)abstract
- Human soft tissue is loaded and deformed by any activity, an effect known as a stress-strain relationship, and is often described by a load and tissue elongation curve. Several advances have been made in the fields of biology and mechanics of soft human tissue. However, there is limited information available on in vivo tissue mechanical characteristics and behavior. Confident mechanical properties of human soft tissue cannot be extrapolated from e.g. animal testing. Thus, there is need for non invasive methods to analyze mechanical characteristics of soft human tissue. In the present study, the internal mechanical conditions of the lower limb, which is subject to an external load, is studied by use of the finite element method. A detailed finite element model of the lower limb is made possible by use of MRI scans. Skin, fat, bones, fascia and muscles are represented separately and the material properties for them are obtained from literature. Previous studies have been shown to address macroscopic deformation features, e.g. indentation depth, to a large extent. However, the detail in which the internal anatomical features have been modeled does not reveal the critical internal strains that may induce hypoxia and/or eventual tissue damage. The results of the present study reveals that lumped material models, i.e. averaging of the material properties for the different constituents, does not capture regions of critical strains in contrast to more detailed models.
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| 7. |
- Sant'Anna, Anita, 1983-, et al.
(författare)
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A wearable gait analysis system using inertial sensors Part I : Evaluation of measures of gait symmetry and normality against 3D kinematic data
- 2012
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Ingår i: BIOSIGNALS 2012 - Proceedings of the International Conference on Bio-Inspired Systems and Signal Processing. - [S. l.] : SciTePress. - 9789898425898 ; , s. 180-188
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Konferensbidrag (refereegranskat)abstract
- Gait analysis (GA) is an important tool in the assessment of several physical and cognitive conditions. The lack of simple and economically viable quantitative GA systems has hindered the routine clinical use of GA in many areas. As a result, patients may be receiving sub-optimal treatment. The present study introduces and evaluates measures of gait symmetry and gait normality calculated from inertial sensor data. These indices support the creation of mobile, cheap and easy to use quantitative GA systems. The proposed method was compared to measures of symmetry and normality derived from 3D kinematic data. Results show that the proposed method is well correlated to the kinematic analysis in both symmetry (r=0.84, p<0.0001) and normality (r=0.81, p<0.0001). In addition, the proposed indices can be used to classify normal from abnormal gait.
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| 8. |
- Sant'Anna, Anita, 1983-, et al.
(författare)
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A wearable gait analysis system using inertial sensors Part II: Evaluation in clinical setting.
- 2012
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Ingår i: Proceedings of the International Conference on Bio-inspired systems and signal processing, BIOSIGNALS 2012. - [S. l.] : SciTePress. - 9789898425898 ; , s. 5-14
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Konferensbidrag (refereegranskat)abstract
- The gold standard for gait analysis, in-lab 3D motion capture, is not routinely used for clinical assessment due to limitations in availability, cost and required training. Inexpensive alternatives to quantitative gait analysis are needed to increase the its adoption. Inertial sensors such as accelerometers and gyroscopes are promising tools for the development of wearable gait analysis (WGA) systems. The present study evaluates the use of a WGA system on hip-arthroplasty patients in a real clinical setting. The system provides information about gait symmetry and normality. Results show that the normality measurements are well correlated with various quantitative and qualitative measures of recovery and health status.
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| 9. |
- Ahlander, Britt-Marie, 1954-, et al.
(författare)
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An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion
- 2017
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Ingår i: Clinical Physiology and Functional Imaging. - : Blackwell Publishing. - 1475-0961 .- 1475-097X. ; 37:1, s. 52-61
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To assess myocardial perfusion, steady-state free precession cardiac magnetic resonance (SSFP, CMR) was compared with gradient-echo-echo-planar imaging (GRE-EPI) using myocardial perfusion scintigraphy (MPS) as reference.METHODS: Cardiac magnetic resonance perfusion was recorded in 30 patients with SSFP and in another 30 patients with GRE-EPI. Timing and extent of inflow delay to the myocardium was visually assessed. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Myocardial scar was visualized with a phase-sensitive inversion recovery sequence (PSIR). All scar positive segments were considered pathologic. In MPS, stress and rest images were used as in clinical reporting. The CMR contrast wash-in slope was calculated and compared with the stress score from the MPS examination. CMR scar, CMR perfusion and MPS were assessed separately by one expert for each method who was blinded to other aspects of the study.RESULTS: Visual assessment of CMR had a sensitivity for the detection of an abnormal MPS at 78% (SSFP) versus 91% (GRE-EPI) and a specificity of 58% (SSFP) versus 84% (GRE-EPI). Kappa statistics for SSFP and MPS was 0·29, for GRE-EPI and MPS 0·72. The ANOVA of CMR perfusion slopes for all segments versus MPS score (four levels based on MPS) had correlation r = 0·64 (SSFP) and r = 0·96 (GRE-EPI). SNR was for normal segments 35·63 ± 11·80 (SSFP) and 17·98 ± 8·31 (GRE-EPI), while CNR was 28·79 ± 10·43 (SSFP) and 13·06 ± 7·61 (GRE-EPI).CONCLUSION: GRE-EPI displayed higher agreement with the MPS results than SSFP despite significantly lower signal intensity, SNR and CNR.
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| 10. |
- Mårtensson, Mattias, et al.
(författare)
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Evaluation of tissue Doppler-based velocity and deformation imaging : a phantom study of ultrasound systems.
- 2011
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Ingår i: European Journal of Echocardiography. - : OXFORD UNIV PRESS. - 1525-2167 .- 1532-2114. ; 12:6, s. 467-476
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The objective of this study was to test the accuracy and diagnostic interchangeability of tissue Doppler-based displacement, velocity, strain, and strain rate measurements in commercially used ultrasound (US) systems. METHODS AND RESULTS: Using an in-house made phantom, four different US scanner models were evaluated. Two different scanners of the same model were tested, and one scanner acquisition was tested twice with two generations of the same workstation giving six test results in total. The scanners were in active clinical use and are subject to regular maintenance checks. There were three displacement and four velocity results that stood out from the rest and could be regarded as accurate and interchangeable. Among the deformation measurements, three acceptable strain results were found while there were no acceptable strain rate results. Furthermore, the study showed that measurements from scanners of the same model, same acquisition post-processed on different workstations and repeated measurements from the same scanner, can yield disparate results. CONCLUSION: Measurements that are accurate and of interchangeable use can be found for displacement and velocity measurements, but are less likely to be found for strain and strain rate measurements. It is strongly recommended that the ability of each individual US scanner to measure displacement, velocity, strain, and strain rate is evaluated before it is introduced into clinical practice, and it must always be evaluated together with the workstation the scanner is intended to be used in conjunction with.
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