| 1. |
- Silins, Isabella, 1983-
(författare)
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Improved adrenocortical PET imaging
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Adrenal tumours can either be benign or malignant, hormone secreting or not, and they can be discovered through clinical examination of the patient or by pure chance. Increased knowledge in the area, plus the widespread use of imaging techniques, have resulted in a rising number of patients with adrenal tumours that subsequently need to be diagnosed. Improved imaging is needed for primary aldosteronism (PA) and adrenocortical carcinoma (ACC) but the positron emission tomography (PET) tracer currently in use, [11C]metomidate (MTO), has many important limitations. This thesis aims to improve adrenocortical PET imaging.Methods: Paper 1 investigated the pre-clinical properties of Para-Chloro-2-[18F]fluoroethyl-etomidate (CETO), by autoradiography, binding studies, ex vivo biodistribution on rats and in vivo imaging using mice and one non-human primate (NHP). Paper II investigated the clinical properties of [18F]CETO and included patients with various kinds of adrenocortical tumours, and healthy volunteers. Metabolic and kinetic analyses were performed and three out of five healthy volunteers also underwent [15O]water PET/CT to measure adrenal blood flow. Test-retest was performed on all healthy volunteers. Paper III assessed the in vivo and in-human radiation dosimetry of [18F]CETO. Ex vivo uptake data from rats and in vivo PET/CT from NHP and humans were used to calculate residence times. Paper IV evaluated the use of the block-sequential regularized expectation maximization (BSREM) reconstruction algorithm (Q.Clear, GE Healthcare, Milwaukee, USA) for [11C]MTO PET/CT in patients with PA.Results: Papers I and II demonstrated that [18F]CETO is highly specific to the adrenal cortex both in vitro and in vivo. The non-specific binding of [18F]CETO in the liver was significantly lower than that of [11C]MTO. [18F]CETO metabolizes rapidly and the single tissue irreversible (1T1k) kinetic model provided the best fit. [15O]water PET/CT results indicated that the adrenal [18F]CETO uptake was flow limited. Several retest values, including adrenal blood flow, were lower than the test values. Paper III found that the effective dose based on human data was 18.2 μSv/MBq and that the adrenal glands were the limiting organ regardless of species used. Paper IV showed that the BSREM reconstruction algorithm improves image quality, without compromising SUVmax quantification, and a β-value between 70 and 130 was found optimal.Conclusion: [18F]CETO PET/CT is a promising method for adrenocortical imaging and is safe for clinical imaging in terms of radiation dose. [18F]CETO PET/CT should be further investigated in patients with PA or ACC, preferably in conjunction with BSREM reconstruction.
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| 2. |
- Eriksson, Olof, 1978-
(författare)
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Imaging Islets of Langerhans by Positron Emission Tomography : Quantification of Beta-Cell Mass in the Native Pancreas and the Islet Graft
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Type 1 and 2 Diabetes Mellitus are a growing health problem throughout the world. There is an increasing need for methodologies, which are both reliable and non-invasive to measure the amount of insulin-producing tissue (Beta-cell mass, or BCM), as well as rapidly quantify changes in the BCM due to the onset of disease, beta-cell replacement therapy, or other treatments. Positron Emission Tomography (PET) is a non-invasive, quantitative functional imaging technique which can be used to study dynamical or static processes inside the body. In this thesis, we present a study protocol for in vivo imaging of the most common form of beta- cell replacement therapy; islet transplantation. Islets were labeled with the PET tracer, 2-deoxy-2[18F]fluoro-D-glucose ([18F]FDG), and administered intra-portally, while the recipient was monitored by PET/CT. The hepatic distribution of the islets was highly heterogeneous, and around 25% (human) or 50% (porcine) of the administered islets could not be found in the liver after completed transplantation, confirming previous reports of considerable cell injury during the procedure leading to low hepatic engraftment. Native BCM in the pancreas can potentially be quantified using a PET tracer with sufficiently high specificity, but the major obstacle is the relative low amounts of insulin producing tissue (only 1-2% of the pancreatic volume). Two tetrabenazine analogues, [18F]FE-(+)-DTBZ and [18F]FE-(+)-DTBZ-d4, are ligands to VMAT2, which is expressed in islet tissue. Both analogues were investigated and characterized as potential BCM imaging agents both in vitro and in vivo. Both tracers exhibited high preferential binding to islet tissue compared to exocrine pancreatic tissue. However, the specificity was not high enough to overcome the obscuring exocrine signal in vivo (7-10% of the signal originating from specific islet tracer uptake). This thesis demonstrates that it is possible to quantitatively assess islet transplantation by PET imaging. In vivo determination of native pancreatic BCM is, in theory, possible with both [18F]FE-(+)-DTBZ and [18F]FE-(+)-DTBZ-d4, but tracer analogues with higher islet specificity is needed for quantification of smaller BCM changes with physiological impact.
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| 3. |
- Lindström, Elin
(författare)
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Evaluation of Regularized Image Reconstruction for Clinical Positron Emission Tomography
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Positron emission tomography (PET) combined with computed tomography (CT) is a widely used noninvasive molecular imaging modality with a broad range of clinical applications in oncology, neurology, and cardiology. Producing imperative image quality and accurate quantification are important driving forces behind the technological advances within PET image reconstruction and system development. To ensure clinical quality and to understand how the modern state-of-the-art PET/CT systems and image reconstruction methods compare with older systems and reconstruction methods they need to be evaluated and assessed in a clinical setting. This thesis summarizes six studies assessing the effect of state-of-the-art image reconstruction methods and the introduction of digital PET on image quality and quantitative outcomes of clinical PET scans in oncology, neurology, and cardiology. The overall aim was to evaluate, optimize, and compare quantitative results of regularized image reconstruction with the current standard reconstruction method used in routine clinical practice, ordered subsets expectation maximization (OSEM).The optimal setting of regularized image reconstruction by block-sequential regularized expectation maximization (BSREM) was found to be tracer dependent, and a potential clinical benefit in terms of image quality measures of BSREM over OSEM was found when applied for whole-body 18F-FDG, 68Ga-DOTATOC, 18F-fluorde, 11C-acetate, and 68Ga-PSMA-11 PET imaging. Software-aided assessment of neurodegenerative disease evaluated with 18F-FDG and 18F-flutemetamol was affected by image reconstruction methods and should be used with caution when employing other image reconstruction methods than those used for acquisition of the normal database. In contrast, changes in reconstruction settings were shown to not implicate myocardial blood flow (MBF) based on 15O-water PET analyzed using automated software. This shows that diagnostic MBF cutoff values can be consistently used for 15O-water. Also, large variations in image noise with three different image reconstruction methods did not impact quantitative cerebral blood flow (CBF) in white and gray matter volumes of interest with 15O-water brain PET to any large extent.BSREM image reconstruction shows a great potential clinical benefit providing improved image quality measures with a subsequent possibility of shortening image acquisition durations and/or lowering amount of radioactivity needed for each examination.
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| 4. |
- Berglund, Karin, 1967-
(författare)
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Jakten på Entreprenörer : Om öppningar och låsningar i entreprenörskapsdiskursen
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Entrepreneurs are expected to play a crucial role in times of unemployment and economical regression. A “hunt for entrepreneurs” can thus be said to be occurring as they appear to be people who can save nations, societies, and companies in troublesome situations. The project Diversity in Entrepreneurship (DiE) aimed to introduce a broad view of entrepreneurship in a regional context. Three development areas are emphasized that are strategically important to transforming a traditional industrial community into an entrepreneurial region: paying attention to the spirit of enterprise among underrepresented groups; stimulating entrepreneurship among young people; and considering the importance of culture in stimulating a diverse and entrepreneurial society.An equality discourse is introduced through DiE that – emphasising social and mundane occurrences - stands in contrast to the historically rooted enterprise discourse that proffers companies as productive apparatus, where a few competent people – often men – have been, and still are, in charge. In the equality discourse, all people in the region make a difference, not merely a few. The encounter of the two discourses has resulted in confusion, and thus conflicts and collisions; but also in new possibilities.A new perspective of entrepreneurship and regional development is developed where conflicts are put forward as constructive. That the two discourses met on the same regional scene is therefore seen as positive as many people have been made aware of the social, political, and economic contradictions which restrain some groups in society from creating a (working) life. Hence, the contradictions have enabled the inhabitants to see themselves, and others, as entrepreneurs in regional development processes. Openings have thus emerged to view entrepreneurship from a broader perspective that includes people, to create practices through which a more diverse working life is becoming discernible.
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| 5. |
- Dahlman, Pär
(författare)
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CT Urography : Efforts to Reduce the Radiation Dose
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Computed tomography urography (CTU) is today the imaging method used to investigate patients with suspected urinary tract malignancy, replacing the old imaging method intravenous pyelography (IVP) about a decade ago. The downside of this shift was that the effective radiation dose to the examined patient was eight times higher for CTU compared to IVP. Based on four different studies, the present thesis focused on efforts to reduce the CTU radiation dose. In study I, the number of cysts and solid lesions in the separate scan phases was evaluated in 57 patients undergoing four-phase CTU 1997-98. The number of scans was reduced from four to three when the nephrographic scan was abolished following study I.Study II registered the diameter of renal cell carcinoma (RCC) and the presenting symptoms in the total number of patients (n=232) diagnosed with RCC between 1997 and 2003. The results from study II showed that the critical size for RCCs to cause macroscopic hematuria was ≥ 4 cm. Study III was a dose-escalation study aimed to decide the minimal possible tube load in the unenhanced and excretory phase scans if the low dose images are reviewed together with normal dose corticomedullary phase images. Study III showed that it is possible to reduce the mean effective dose in three phase CTU from 16.2 mSv to 9.4 mSv with a combined low and normal dose CTU protocol. Study IV investigated the changes in the CTU protocol between 1997 and 2008, and the development of the effective radiation dose. Study IV clarified how the CTU protocol has changed between 1997 and 2008 and as a result the mean effective radiation dose to patients undergoing CTU in 2008 is only 39% of the effective dose in 1997. In conclusion, the findings from the studies included in this thesis have contributed to a reduced radiation dose to patients undergoing CTU. The mean effective dose from CTU is at present only three times higher compared to that from the IVP.
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| 6. |
- Espmark, Kristina, 1975-
(författare)
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Utanför gränserna : En vetenskapshistorisk biografi om Astrid Cleve von Euler
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation is a scientific biography of Astrid Cleve von Euler. She was Sweden’s first female Ph.D. graduate in the natural sciences (1898) and pursued a scientific career in spite of formal and cultural limitations. Though she failed to secure a professional position as a scientist, she published numerous papers throughout her life. The dissertation studies her life in general and analyses her research in particular. How did her research change over time in relation to the rest of her life? How did established scientists receive her research? How did her status as a woman on the fringes of academia affect her research? Sociologist Thomas F. Gieryn’s concepts of boundary-work and credibility contests are important analytical tools in the interpretation of these questions, as Cleve’sresearch was regulated by various boundaries: between professionals and amateurs, between men and women and between different academic disciplines.The study is divided into seven chapters. The first chapter introduces the dissertation, its objective and theoretical framework. The remaining chapters follow Cleve’s life in a chronological and sometimes thematic order and the source material is continually analysed. Chapter two accounts for Cleve’s childhood and student years in Uppsala, ending with her Ph.D. graduation. Chapter tree focuses on her research as a chemist and her ten years of marriage to a fellow researcher, Hans von Euler-Chelpin, a marriage that was closely intertwined with their academic studies. The fourth chapter studies Cleve’s controversy with some of the leading quaternary geologists in Sweden at the time, regarding the level changes of the Scandinavian land mass following the latest Ice Age. The fifth chapter diverges slightly from Cleve’s research, and investigates her undertakings in popular science and her political standpoints. Chapter six analyses her archaeological studies as part of the scientific controversy she was involved in, but also as influenced by political and religious views. Finally, the seventh chapter begins with a closer look at Cleve’s diatom studies, already part of most of the study but thus far not focused on as such, and ends with the main conclusions of the entire dissertation project.The dissertation shows that while science was part of Cleve’s life from childhood to death, factors other than her personal desire to uncover scientific truths governed her research opportunities and the topics of her studies. While she was consistently highly regarded as a diatom expert and gained some success as a chemist, disciplines she was formally educated in, she was met with scepticism and eventually silence when she tried to make an impact in quaternary geology and archaeology, fields of research in which she had no formal training. This demonstrates a possibility to simultaneously be regarded as credible and non-credible as a scientist, as credibility is not necessarily attached to the individual, but to his or her formal expertise in a particular area.
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| 7. |
- Norlén, Olov
(författare)
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Small Intestinal Neuroendocrine Tumor : A Rare Malignancy with Favorable Outcome
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Small intestinal neuroendocrine tumor (SI-NET) is the most common small bowel tumor in Europe and USA, with an annual incidence of around 0.3-1.3/100000 persons. SI-NETs are the most common type of gastroenteropancreatic NETs (GEP-NETs), and they are known for their ability to produce hormones such as tachykinins and serotonin, as well as for their favorable long-term prognosis in comparison to gastrointestinal adenocarcinoma. The overall aim of the thesis was to investigate unknown or unclear aspects of SI-NET disease, in connection with prognosis, treatment and follow-up. Paper I confirmed several known negative prognostic factors and also showed, for the first time, that para-aortal lymph node metastases and peritoneal carcinomatosis were associated with worse survival by multivariable analyses. Locoregional surgery was associated with a low post-operative mortality, and a prolonged long-term survival by multivariable analysis. In Paper II we continued to investigate peritoneal carcinomatosis and found it be a risk factor not only for death, but also for emergency re-surgery. Furthermore, genetic analyses of samples from primary tumors in patients with and without peritoneal carcinomatosis showed a difference in the DNA between these two groups. In Paper III the outcome after liver surgery and/or radiofrequency ablation of liver metastases was investigated. To summarize, no difference in survival was seen in patients treated with surgery/radiofrequency ablation in comparison with matched controls. However, a superior radiological response of liver metasases and lower U-5-HIAA values were seen in patients subjected to liver surgery and/or radiofrequency ablation compared to matched controls. Paper IV compared ultrasonography, computed tomography and 11C-5HTP-PET in the follow-up after radiofrequency ablation of NET liver metastases. The study concluded that 11C-5HTP-PET depicted all residual tumors after RFA and that it, if used, should be combined with computed tomography for easier interpretation, as RFA areas are not clearly distinguishable with 11C-5HTP-PET alone. Paper V studied gallstone complications after somatostatin analog treatment in SI-NET patients, and concluded that there was a rather high risk to be subjected to a cholecystectomy due to biliary colic, cholecystitis, cholangitis or pancreatitis after primary surgery in somatostatin analog treated patients.
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| 8. |
- Söderman, Tomas
(författare)
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Radiological methods in rheumatoid arthritis and osteoarthritis
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The dissertation's theme is the critical role of radiology when evaluating two different groups of patients. Firstly, patients with rheumatoid arthritis (RA) of the cervical spine were studied to evaluate upper spine instability with dynamic computed tomography (CT). Secondly, after anterior cruciate ligament (ACL) reconstruction, patients with a long-term follow-up were studied to evaluate osteoarthritis (OA). In paper I, 21 consecutive patients with atlantoaxial subluxation due to RA planned for atlantoaxial fusion were included. Radiographs were obtained in neutral and flexed positions, CT and Magnetic Resonance Imaging (MRI) was performed with the neck in the neutral position and CT also in flexion. Radiographs and CT measurements of atlantoaxial subluxation correlated but were larger using radiographs than CT in flexion. The spinal cord compression was significantly worse at CT obtained in flexed position than MRI in the neutral position. In papers II and III, the cohort consisted of 60 patients, and in paper IV, 73 patients. Mean follow-up was 31 years after ACL reconstruction. MRI, radiographs, International Knee Documentation Committee (IKDC) clinical assessment, Knee injury Osteoarthritis Outcome Score (KOOS), Short Form-36 (SF-36), Tegner Activity Scale, and KT-1000 arthrometer were used in order to evaluate the patients. Thirty-three patients showed an intact ACL graft, and 40 a ruptured ACL graft. Forty-nine patients had tibiofemoral OA, and 28 patients had patellofemoral OA. Patients with ruptured ACL grafts had more OA in the medial tibiofemoral compartment than those with an intact ACL graft. Sport and Recreation Function and Quality of life scores were higher in patients with an intact ACL graft than those with a ruptured ACL graft. All subscales of KOOS were higher in the group without OA. KOOS Quality of life score was lower than for a control group of men. The IKDC overall clinical assessment was worse in patients with a ruptured ACL graft. This thesis suggests that radiographs remain the primary imaging method for evaluating atlantoaxial instability. However, CT in flexed position is useful in the preoperative imaging workup. Patients with a ruptured ACL graft presented with more OA of the medial tibiofemoral compartment than those with an intact graft. Patients with an intact ACL graft and those without OA reported higher sports activity and recreation and better knee-related Quality of life. Knee-related Quality of life in the study group was reduced compared to a reference group.
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| 9. |
- Jahn, Ulrika
(författare)
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Peptide Receptor Radionuclide Therapy in Neuroendocrine Neoplasms : Aspects of tumour characteristics, receptor recycling and peptide mass
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Neuroendocrine neoplasm (NEN) can arise in any part of the body, but most commonly in the lungs, bronchi, and the gastrointestinal tract including the pancreas. They combine neuroendocrine and tissue-of-origin-specific characteristics; explaining different symptoms depending on the organ of origin. NEN is divided into slow-growing neuroendocrine tumours (NETs) and the rarer aggressive neuroendocrine cancers (NECs). Some hormone producing NETs give rise to symptoms (functioning), generally detected earlier than the non-functioning NETs, which often are larger and metastatic at diagnosis. NETs commonly express an abundance of somatostatin receptors (SSTR). Synthetic copies of somatostatin (somatostatin analogues, SSA), supress hormonal symptoms such as diarrhoea and flush. The SSA-SSTR ligand-receptor complex interaction instantly internalises into the cells, separate, and the SSTR re-surface. Gallium-68 (68Ga)-labelled SSAs are used for PET/CT-camera visualisation of NETs, and SSA labelled with a therapeutic radionuclide, provide a means for internal radio-therapy, peptide receptor radionuclide therapy (PRRT).The aim of the thesis was to compare the tumour response to PRRT in small intestinal NET (SI-NET) and pancreatic NET (P-NET). Study I, II and IV are retrospective and include patients who underwent PRRT with 177Lu-DOTA-TATE at the Uppsala University Hospital. Study I, quantified and related the radiation dose in 25 SI-NETs to tumour shrinkage using two- and three-dimensional measurements, although no dose-response relationship was demonstrated. A relationship between tumour shrinkage and the total administered activity was however found. Study II compared the tumour response between SI-NETs from study I with P-NETs included in an earlier report, now re-evaluated by adding more tumour parameters, and with longer observation time. There radiation dose in P-NETs was the same as in SI-NETs. The radiation dose in P-NETs was highest at the first PRRT cycles, and then decreased significantly in consecutive cycles, which was not observed in SI-NETs.The prospective study III, mapped the recirculation time of SSTR in SI-NETs and normal organs. Twelve tumours were measured at repeated 68Ga-DOTA-SSA-PET examinations. Larger tumours (>4 cm) showed a faster SSTR turn-over rate than small tumours, demonstrating a turnover resembling that in the normal organs. These results open the possibility that pre-treatment could protect normal tissues during PRRT, and probably increase radioactivity tumour uptake and hence, the radiation dose.The retrospective study IV investigated the effects of various amounts of SSA delivered in the PRRT preparation, although the absorbed radiation dose to tumours and normal tissues, was unrelated to the amount of peptide and to the patient’s total tumour burden.
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| 10. |
- Selegård, Peter, 1972-
(författare)
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Tillväxtbilder, regionala intentioner samt entreprenörers orsaksförklaringar av tillväxt : en penroseisk syn på regional tillväxt
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Regional utveckling har fått större betydelse de senaste årtiondena. En mer liberal frihandelsstruktur antas ha bidragit till en ökad globalisering, vilket lett fram till en ökad konkurrensutsatthet. Nationers begränsade förmåga att snabbt fatta beslut har lett fram till att regionerna har fått ökat ansvar avseende sin egen utveckling och tillväxt. I Sverige visades sig ansvaret genom att regionförbund började bildas där ansvaret för regionala näringslivsfrågor hamnade. Under 2003 ombads Sveriges regioner att utveckla regionala tillväxtprogram (RTP) där man inom regionen skulle komma överens om vilka åtgärder och områden som var viktigast för att nå tillväxt i länet. I Södermanlands län ansvarade Länsstyrelsen för att utarbeta ett RTP i ett brett partnerskap med olika aktörer från akademi, politik samt näringsliv. Regionförbundet Sörmland, vilka bildades 2004, blev samordningsanvariga för genomförandet av programmet mellan åren 2004 tom 2007. Hösten 2004 inleddes ett forskningsprojekt vars syfte var att erhålla lärdomar om det regionala tillväxtprogrammet. Interaktiv kunskapsutveckling inom ramen för det regionala tillväxtprogrammen var ett projekt där både Södermanland samt Västmanlands län har varit delaktiga tillsammans med Mälardalens högskola. Två doktorander anställdes vilka skulle följa ett regionalt tillväxtprogram utifrån geografisk utgångspunkt. Föreliggande studie har haft Södermanlands läns RTP i fokus. Avhandlingens syfte erhölls efter intervjuer med tolv praktiker berörda av RTP i sitt eget arbete (här regionala samordningsansvariga, offentliga samt privata regionala näringslivsorganisationer, kommunalråd, kommunala näringslivstjänstemän). Samtidigt närvarade författaren på ett otal möten årligen vilka var knutna till RTP:s genomförandeprocess. I intervjumaterialet söktes kärnkategorier, vilka indikerade uppkomsten av liknande svarsbilder. Ett svar som bidrog till studiens intresse var svaret om hur olika aktörer såg på näringslivsmedverkan inom ramen för RTP:s genomförandeprocess. Generellt svarade de regionala offentliga näringslivsorganisationerna att det inte var självklart med en näringslivsmedverkan inom ramen för det partnerskap som skulle arbeta med regional tillväxt, medan kommunalråd samt kommunala näringslivtjänstemän tenderade att svara att det var en svaghet att inte låta näringslivet vara mer involverat i RTP. Svaren bidrog till att det fanns ett intresse att undersöka vilken typ av näringslivsmedverkan som fanns inom ramen för RTP. En genomgång av olika arenor med anknytning till RTP studerades och resultatet indikerade att det saknades praktiska näringslivkopplingar i RTP:s genomförandeprocess, i vart fall på partnerskapsnivå. Ett antagande växte sig starkare om det var möjligt att en inkongruens mellan ett regionalt tillväxtprograms innehåll samt ett lokalt näringslivs (entreprenörer från en solo-, mikro- samt småföretagskontext i Södermanlands län) upplevda tillväxtbilder samt orsaksförklaringar av tillväxt uppstått till följd av bristen av näringslivsmedverkan. En frågeställning formulerades. Hur en regional offentlig bild av tillväxt via ett RTP skiljer sig mot den bild av tillväxt som förmedlas av entreprenörer från en solo-, mikro- samt småföretagarkontext? Tillväxtbilder undersöktes, men även regionala intentioner ställt i relation till entreprenörernas orsaksförklaringar. Processen som följde efter frågeställningens tillkomst var intervjuer med elva entreprenörer från en solo-, mikro samt småföretagarkontext. Intervjuerna transkriberades och bearbetades ner till berättelser där kategorisering av nyckelmeningar ringades in. Tillväxt definierades huvudsakligen som ökning av omsättning samt vinst även fast inslag av företagets interna process även gick att åskådliggöra (t.ex. utvecklande arbetsuppgifter). Entreprenörers tillväxtdefinition kan betecknas vara situationsberoende där typ av verksamhet och situation kan förklara begreppet tillväxt. Resultatet av entreprenörernas orsaksförklaringar till sin historiska tillväxt indikerade interna (företagsförmåga eller personrelaterade förklaringar) samt externa (nätverk (stödjande omgivning) eller konjunktur) orsaksförklaringar. De interna orsaksförklaringarna tenderade dock att vara i majoritet. Edith Penrose (1959) teori om företagstillväxt (The Theory of the Growth of the Firm) med fokus på företags interna tillväxtprocess förenades med det induktivt framväxta resultatet från intervjuerna med entreprenörerna. I studien växte en teoretisk analysmodell fram (penroseisk analysmodell) vilken lyfte fram entreprenörskaps- samt managementförmågors betydelse för möjligheten att nå intern företagstillväxt. Den regionala bilden av tillväxt och intentioner utgick främst från RTP:s utkast och handlingsprogram (2003) samt revideringarna under programperioden (2004-2007). Textanalys av materialet resulterade i att tillväxt som begrepp inte entydigt definierades. Definition av regional tillväxt blev funnen i RTP:s målsättningar. Regionala intentioner för att nå regional tillväxt kan kategoriseras i dels interna regionala strategier (insatser riktade inåt regionen) dels i externa regionala strategier (insatser riktade från regionen). Huvuddelen av strategierna ansågs ha ett internt perspektiv med fokus på att utnyttja och utveckla regionens inneboende resurser. Teorier, vilka riktade sin uppmärksamhet mot regional utveckling samt tillväxt växte fram och skapade en regional analysmodell, vilken innehöll dels olika ekonomiska skolbildningar, dels skilda teorier om samverkan. Resultat En jämförelse mellan tillväxtbilder indikerar både likheter och skillnader. Ideologiskt finns en skiljelinje som delvis står i direkt kontrast till varandra. Exempel på detta är tillväxt via ökad arbetskraft i ett regionalt perspektiv, medan arbetskraftsökningar inte alltid ses som en del av det regionala näringslivets tillväxtdefinition. Likheter finns där RTP diskuterar förädlingsvärdet som ett mått på tillväxt och där näringlivet diskuterar vinst. Ett heterogent näringsliv indikerar även andra värden än ekonomiska och framställer personligt utvecklande samt kreativa uppdrag som tillväxt, bilder av tillväxt vilka saknas i RTP. Resultatet av entreprenörers orsaksförklaring av tillväxt och RTP:s intentioner indikerar likheter i synen på att nätverk och relationer, företagsförmåga samt konjunkturläget är av betydelse för tillväxten. En skillnad är att tillväxten orsakas eller hämmas av interna orsaksförklaringar och speciellt personrelaterade faktorer enligt entreprenörer. En annan skillnad är att regionala intentioner framhärdar att fler individer i arbete leder till regional tillväxt, vilket inte självklart orsakar tillväxt i en företagskontext. I relation till en penroseisk analysmodell har entreprenörerna brister i framförallt managementförmåga. Entreprenörskapsförmåga verkar lättare att uppnå för intervjuade entreprenörer. Den penroseiska analysmodellen indikerar att det är komplicerat att utläsa om regionala intentioner utifrån RTP kan svara mot en företagsteoretiskt tillväxt. En hög abstraktionsgrad i RTP bidrar till att RTP delvis kan ses som en resurs i jämförelse med en företagskontext utifrån penroseisk analys. Den finns ett behov av att beskriva intentionerna i ett RTP tydligare för att klargöra effekterna och innebörden för entreprenören av en intention. Ett resultat är också att intentioner, vilka RTP lyfter fram, vänder sig bort ifrån företagskontexten och riktar sig inåt dvs. mot de regionala näringslivsaktörerna. Däremot finns regionala intentioner vilka är relativt tydliga och med fokus på näringslivet, men som ur ett penroseiskt perspektiv mer fokuserar på resultatet av en tillväxtprocess snarare än på själva tillväxtprocessen inom ett företag. Den regionala analysmodellen indikerar överlappningar mellan olika ekonomiska teoribildningar (neoklassisk, neoösterrikisk, keyniansk) inom RTP. Det pekar på en region med mer pragmatisk inställning till ekonomisk teoribildning. Enligt Helliwell och Putnam (1995) kännetecknas en positiv regional utveckling av just en mer pragmatisk inställning av regionala beslutsfattare. Andra resultat från studien, vilka fokuserar på ökad näringslivsmedverkan i regionala tillväxtprocesser, indikerar att samverkan i partnerskap kan underlättas i lokala [kommunala] partnerskap. En diskussion fokuserar på att regionala näringslivsaktörer bör ha tillgång till entreprenörers berättelser för att ha möjlighet att göra gemensamma tolkningar och därmed undvika näringslivsorganisationers särintressen. Studien introducerar low-bottom-up-begreppet som ett tydligare tänk om ett målgruppsanpassat partnerskap, men också som ett tänk att närma sig entreprenörer via dess berättelser. Ett low-bottom-up-perspektiv kan se olika ut beroende på om partnerskapet söker radikala eller inkrementella lösningar.
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