| 1. |
- Falck-Ytter, Terje, et al.
(författare)
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Reduced Orienting to Audiovisual Synchrony in Infancy Predicts Autism Diagnosis at 3 Years of Age
- 2018
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Ingår i: Journal of Child Psychology and Psychiatry. - : Wiley. - 0021-9630 .- 1469-7610. ; 59:8, s. 872-880
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Tidskriftsartikel (refereegranskat)abstract
- Background: Effective multisensory processing develops in infancy and is thought to be important for the perception of unified and multimodal objects and events. Previous research suggests impaired multisensory processing in autism, but its role in the early development of the disorder is yet uncertain. Here, using a prospective longitudinal design, we tested whether reduced visual attention to audiovisual synchrony is an infant marker of later-emerging autism diagnosis.Methods: We studied 10-month-old siblings of children with autism using an eye tracking task previously used in studies of preschoolers. The task assessed the effect of manipulations of audiovisual synchrony on viewing patterns while the infants were observing point light displays of biological motion. We analyzed the gaze data recorded in infancy according to diagnostic status at 3 years of age (DSM-5).Results: Ten-month-old infants who later received an autism diagnosis did not orient to audiovisual synchrony expressed within biological motion. In contrast, both infants at low-risk and high-risk siblings without autism at follow-up had a strong preference for this type of information. No group differences were observed in terms of orienting to upright biological motion.Conclusions: This study suggests that reduced orienting to audiovisual synchrony within biological motion is an early sign of autism. The findings support the view that poor multisensory processing could be an important antecedent marker of this neurodevelopmental condition.
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| 2. |
- Konke, Linn Andersson, et al.
(författare)
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How Does Temperament in Toddlers at Elevated Likelihood for Autism Relate to Symptoms of Autism and ADHD at Three Years of Age?
- 2022
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Ingår i: Journal of autism and developmental disorders. - : Springer Science and Business Media LLC. - 0162-3257 .- 1573-3432. ; 52, s. 995-1006
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Tidskriftsartikel (refereegranskat)abstract
- The current study investigated longitudinal associations between parent-rated temperament, observed exuberance and accelerometer activity level at 18-months and symptoms of ASD and ADHD at 36-months in a sample of 54 children at elevated likelihood for ASD. For the specific parent-rated temperament scales, most observed significant associations appeared to be specific for either ASD or ADHD symptoms. Indeed, by controlling for overlapping symptoms a different pattern of associations emerged. These results illustrate how temperamental measures may signal risk for later ASD versus ADHD symptomatology in infants at elevated likelihood for ASD. In addition, they indicate the potential of adopting a broader view on neurodevelopmental disorders by investigating not only ASD traits, but also co-occurring disorders such as ADHD in samples of elevated likelihood for ASD.
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| 3. |
- Wadensten, Elisabeth, et al.
(författare)
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Diagnostic Yield From a Nationwide Implementation of Precision Medicine for all Children With Cancer.
- 2023
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Ingår i: JCO Precision Oncology (JCO PO). - : American Society of Clinical Oncology. - 2473-4284. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Several studies have indicated that broad genomic characterization of childhood cancer provides diagnostically and/or therapeutically relevant information in selected high-risk cases. However, the extent to which such characterization offers clinically actionable data in a prospective broadly inclusive setting remains largely unexplored.We implemented prospective whole-genome sequencing (WGS) of tumor and germline, complemented by whole-transcriptome sequencing (RNA-Seq) for all children diagnosed with a primary or relapsed solid malignancy in Sweden. Multidisciplinary molecular tumor boards were set up to integrate genomic data in the clinical decision process along with a medicolegal framework enabling secondary use of sequencing data for research purposes.During the study's first 14 months, 118 solid tumors from 117 patients were subjected to WGS, with complementary RNA-Seq for fusion gene detection in 52 tumors. There was no significant geographic bias in patient enrollment, and the included tumor types reflected the annual national incidence of pediatric solid tumor types. Of the 112 tumors with somatic mutations, 106 (95%) exhibited alterations with a clear clinical correlation. In 46 of 118 tumors (39%), sequencing only corroborated histopathological diagnoses, while in 59 cases (50%), it contributed to additional subclassification or detection of prognostic markers. Potential treatment targets were found in 31 patients (26%), most commonly ALK mutations/fusions (n = 4), RAS/RAF/MEK/ERK pathway mutations (n = 14), FGFR1 mutations/fusions (n = 5), IDH1 mutations (n = 2), and NTRK2 gene fusions (n = 2). In one patient, the tumor diagnosis was revised based on sequencing. Clinically relevant germline variants were detected in 8 of 94 patients (8.5%).Up-front, large-scale genomic characterization of pediatric solid malignancies provides diagnostically valuable data in the majority of patients also in a largely unselected cohort.
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| 4. |
- Mazzocato, Pamela, et al.
(författare)
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Kaizen practice in healthcare : a qualitative analysis of hospital employees' suggestions for improvement
- 2016
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare.METHODS: We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated.RESULTS: 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions.CONCLUSIONS: There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results.
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| 5. |
- Nyström, Elisabeth, 1975
(författare)
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Thermal Characterization and Modelling in Microsystem Packaging Applications
- 2005
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As the electronics circuits grow denser and the power consumption per area unit is increasing, new more efficient technologies for heat removal is necessary. Heat fluxes from the integrated circuit, IC, in the order of 100W/cm2 are not rare. Two possible approaches to improve the cooling of electronic packages are to improve the thermal conductivity of the packaging material and increase the heat removal from the package. In this thesis both approaches are explored. Anisotropic conductive adhesives are used for electrical interconnections but have a poor thermal conductivity. This can be improved by adding a third, electrically insulating but thermally conductive phase into the adhesive. The experimental work included producing thermally conductive composite from various micro- and nanosized fillers. Experimental effort was also put on developing the Transient Hot Wire Method for the measurement of the thermal conductivity. The thermal conductivity increased with increased amount of conductive filler and filler surface treatment. The experiments also indicated higher conductivity for alumina nanoscale particles than for microscale particles. Carbon nanotubes provided the highest conductivity at low filling levels. However, for carbon nanotubes, high filling levels were difficult to achieve due to high viscosity of the uncured composite. In order to explore whether the cooling effect of microchannels could be improved by fins mounted inside the channels, thermal and fluid dynamic modelling was carried out. The modelling based on experimental results was carried out in FEMLAB Multiphysics. The water was modelled as laminar with Navier-Stokes macroscopic models. Thermal modelling showed that the thermal resistance between hot active chip side and water could be reduce from 0.98 K/W to about 0.43 K/W when fins were used. Potential improvements of the fin layout were revealed. For example it could be seen that a small extent of the water stream was flowing close to the chip surface. Although the system was not optimized it showed great potential. System in a package, SiP is a new type of packaging concept for electronics but the thermal performance of the concept has not been studied significantly. The research has focused on the thermal performance of a system consisting of a chip mounted in a substrate cavity, with copper traces as interconnects embedded in epoxy. A parametric study on material properties, geometries and heat transfer coefficient was carried out with 3D Finite Element Modelling. The results variable was the chip temperature. It was shown that heat transfer coefficient had the largest influence for the joint temperature. The substrate conductivity also played an important role. The encapsulant conductivity was important only if the substrate had good conductivity. Seen from a thermal perspective, for the present system, the optimal copper thickness was found to be about 30micron.
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| 6. |
- Nyström, Pär, 1975-, et al.
(författare)
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Enhanced pupillary light reflex in infancy is associated with autism diagnosis in toddlerhood
- 2018
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Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Autism spectrum disorder (ASD) is a neurodevelopmental condition affecting around 1% of the population. We previously discovered that infant siblings of children with ASD had stronger pupillary light reflexes compared to low-risk infants, a result which contrasts sharply with the weak pupillary light reflex typically seen in both children and adults with ASD. Here, we show that on average the relative constriction of the pupillary light reflex is larger in 9–10-month-old high risk infant siblings who receive an ASD diagnosis at 36 months, compared both to those who do not and to low-risk controls. We also found that the magnitude of the pupillary light reflex in infancy is associated with symptom severity at follow-up. This study indicates an important role of sensory atypicalities in the etiology of ASD, and suggests that pupillometry, if further developed and refined, could facilitate risk assessment in infants.
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| 7. |
- Richter Sundberg, Linda, 1975-
(författare)
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Mind the Gap : exploring evidence-based policymaking for improved preventive and mental health services in the Swedish health system
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The challenges in the utilization of scientific findings in the fields of prevention and mental health are well documented. Scholars have found significant gaps between the knowledge available and the knowledge applied in healthcare. Studies have suggested that about half of the patients receive the recommended care for their medical condition. In order to address this gap, health systems at global, national, regional and local levels have made diverse efforts to facilitate the uptake of research for example through evidence-based health policy processes. In Sweden, government agencies and health policy actors such as the National Board of Health and Welfare support and control the health care system through evidence-based policies amongst other steering tools. The overall aim of this thesis is to explore evidence-based policy processes, and to further understand barriers to implementation of policies in the fields of preventive and mental health services.Methods: A multiple case study approach was used, and data were collected from several sources. Qualitative content analysis methodology was used. Case 1 comprises the development and early implementation of national guidelines for methods of preventing disease managed by the National Board of Health and Welfare during 2007–2014. Case 2 covers the effort to improve health care for the older population that was undertaken through an agreement between the Swedish government and the Swedish Association of Local Authorities and Regions during 2009–2014. Case 3 involves an effort to implement an adapted version of a systematic review from the Swedish agency for health technology assessment and assessment of social services on treatment of depression in primary health care. Data was collected between 2007 and 2010.In Paper 1, the policies from Case 1 and 2 were studied using a longitudinal, comparative case study approach. Data were collected through interviews, documents and observations. A conceptual model was developed based on prior frameworks. The model was used to organize and analyse the data. In Paper 2, the guideline development process (Case 1) was studied through interviews and the collection of documents. A prior framework on guideline quality was used in order to organize the data. Paper 3 investigated decision-making processes during guideline development using a longitudinal approach. Qualitative data were collected from questionnaires, documents and observations and analysed using conventional and summative content analysis. In Paper 4, the barriers to implementation were investigated through interviews and the collection ofdocuments. Data were analysed using qualitative content analysis with a conceptual model to structure the analysis.Results: The sources and procedures for policy formulation differed in Case 1 and 2, as did the approaches to promote the implementation of the policies. The policy processes were cyclical, and phases overlapped to a large degree. The policy actors intended to promote implementation, both during and after the policy formulation process.The thesis shows variation in how the key policy actors defined and used research evidence in the policy processes. In addition, other types of knowledge (e.g. politics, context, experience) served as alternative or multiple sources to inform the health policies. The composition of sources that informed the policies changed over time in Cases 1 and B. During the policy formulation and implementation process, efforts to integrate research evidence with clinical experiences and values were associated with tension and recurrent dilemmas. On the local level (i.e. primary health care centres), barriers to implementation were found related to the innovation and among health professionals, patients, in social networks as well as in the organizational, economic and political contexts.Conclusion: The concept of evidence holds a key position in terms of goals and means for knowledge based policymaking in the Swedish health system. Broad definitions of evidence – including research and non-research evidence - were requested and to various extents utilized by the policy actors in the studied cases. An explicit terminology and systematic, transparent methodology to define, identify, and assess also non-research evidence in policy processes would potentially strengthen the clarity and validity of these processes and also enhance policy implementation.Particular determinants to implementation, such as the interventions characteristic, are to a considerable degree established early in the policy process, during agenda setting and policy formulation. This early phase offers unique opportunities to assess and build capacity, initiate and facilitate implementation.Early analysis and considerations of target populations and contexts and other implementation determinants related to the specific policy scope (e.g. disease preventive guidelines) could enhance the forth-coming implementation of the policy.
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| 8. |
- Richter Sundberg, Linda, 1975-, et al.
(författare)
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Reaching beyond the review of research evidence : A qualitative study of decision-making during clinical guideline development
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: The judgment and decision-making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on four decision-criteria: research evidence; severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives is assigned the task of ranking condition–intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision-making process during the two-year development of national guidelines for methods of preventing disease.Methods: A qualitative longitudinal case study approach was used to investigate the decision-making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis.Results: The guideline development model was adapted ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs low adoptability of recommendation; insufficient evidence vs high urgency to act; and incoherence in vertical and horizontal judgments. Decision-criteria added by the group were ‘clinical knowledge and experience’, ‘potential guideline consequences’ and ‘needs of vulnerable groups’. Gender, professional status, and interpersonal skills were perceived to affect individuals’ relative influence on group discussions. Decision criteria changed over time in the group discussions.Conclusions: The study shows that guideline-development groups make compromises between rigour and pragmatism. The formal guideline-development model incorporated multiple aspects, but offered few details on how the different criteria should be merged. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from incorporating more guidance on if and how to integrate research evidence with other types of decision criteria, such as clinical experience and socioeconomic evidence.
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| 9. |
- Schröder, Björn O., et al.
(författare)
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Obesity-associated microbiota contributes to mucus layer defects in genetically obese mice
- 2020
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Ingår i: Journal of Biological Chemistry. - 0021-9258 .- 1083-351X. ; 295:46, s. 15712-15726
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Tidskriftsartikel (refereegranskat)abstract
- The intestinal mucus layer is a physical barrier separating the tremendous number of gut bacteria from the host epithelium. Defects in the mucus layer have been linked to metabolic diseases, but previous studies predominantly investigated mucus function during high-caloric/low-fiber dietary interventions, thus making it difficult to separate effects mediated directly through diet quality from potential obesity-dependent effects. As such, we decided to examine mucus function in mouse models with metabolic disease to distinguish these factors. Here we show that, in contrast to their lean littermates, genetically obese (ob/ob) mice have a defective inner colonic mucus layer that is characterized by increased penetrability and a reduced mucus growth rate. Exploiting the coprophagic behavior of mice, we next co-housed ob/ob and lean mice to investigate if the gut microbiota contributed to these phenotypes. Co-housing rescued the defect of the mucus growth rate, whereas mucus penetrability displayed an intermediate phenotype in both mouse groups. Of note, non-obese diabetic mice with high blood glucose levels displayed a healthy colonic mucus barrier, indicating that the mucus defect is obesity- rather than glucose-mediated. Thus, our data suggest that the gut microbiota community of obesity-prone mice may regulate obesity-associated defects in the colonic mucosal barrier, even in the presence of dietary fiber. © 2020 Schroeder et al.
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| 10. |
- Wang, Teng, 1983, et al.
(författare)
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Development and Characterization of Microcoolers using Carbon Nanotubes
- 2006
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Ingår i: Proceedings of the 1st IEEE CPMT Electronics Systemintegration Technology Conference (ESTC2006). - 1424405521 ; 2, s. 881-885
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Konferensbidrag (refereegranskat)abstract
- The continuously increasing integration and packaging density of microelectronic systems requires high-performance cooling technologies, among which the microchannel cooler is considered as a good approach. This work aims to develop a microchannel cooler with vertically aligned carbon nanotubes as the fins. Carbon nanotubes have unusually high thermal conductivity along with the possibility of small-scale formatting and wafer-level integration with chips, thus they provide a promising solution to implement microchannel coolers. By using photolithography, chemical vapor deposition, and adhesive bonding techniques, microcoolers containing carbon nanotube fins of different sizes and spacings are fabricated and then tested. They are also compared to a cooler with common silicon fins, as well as one with no fins. The experimental results reveal good heat removal capability of microcoolers using carbon nanotubes. The measurement result of the CNT cooler is about 10-15% better than the silicon cooler.
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