| 1. |
- Svensson, Maria, 1980-
(författare)
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Assessing the ERG rearrangement for clinincal use in patients with prostrate cancer
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In Sweden, close to 10 000 men are annually diagnosed with prostate cancer (PCa) and approximately 2400 men die of their disease each year. Today there is no reliable marker that can separate patients who will have an aggressive type of disease that requires treatment, from patients who will have a more indolent clinical course and can be left untreated. This further leads to the current problem of over treatment of men with PCa. Hence, there is an urgent need for reliable prognostic markers that can be used at time of diagnosis. With the discovery of recurrent gene rearrangements in PCa, most commonly ERG rearrangements, hope came that this aberration could play a role in diagnosis and/or prognosis of the disease.The aim of this thesis was to investigate the clinical implication of ERG rearrangements in the management of PCa.The work in this thesis supports the findings from previous studies, suggesting that the ERG rearrangement is a sign of a more aggressive type of cancer. The major findings are that in multifocal PCa, the ERG rearranged cancer foci are more prone to metastatic dissemination compared to foci without the ERG rearrangement and that patients harboring the ERG rearrangement have a faster disease progression leading up to earlier start of hormonal treatment. Furthermore, the results add an additional level of complexity in a subset of PCa tumors that harbor multiple gene rearrangements on the cellular level. The result also show that the newly available ERG antibody is highly predictive of ERG rearrangement and is appropriate to use when faced with limitations in tissue amounts.The findings in this thesis indicate that the ERG rearrangement has a potential role in the clinical management of PCa but further studies arerequired.
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| 2. |
- Bennich, Maria, 1959-
(författare)
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Kompetens och kompetensutveckling i omsorgsarbete : Synen på kompetens och lärande – i spänningsfältet mellan samhälleliga förutsättningar och organisatoriska villkor
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Avhandlingen är en sammanläggningsavhandling med syfte att studera om synen på kompetens är relaterad till lärmiljön och strategier för kompetensutveckling. Parallellt med syftet har jag analyserat och diskuterat kompetensutveckling ur ett samhälleligt och interorganisatoriskt perspektiv. Fokus ligger här på styrprinciper, brukarinflytande och nationella utvecklingsprogram. Avhandlingen utgörs av en lokal studie som bygger på 22 intervjuer och 74 enkäter, en forskningsöversikt samt en studie som bygger på utvärderingar av det nationella utvecklingsprogrammet Kompetensstegen.Resultatet från den lokala studien – två vårdboenden och två hemtjänstverksamheter – visar att förutsättningarna för lärmiljön skiljer sig åt beroende på verksamhetstypen. Inom hemtjänstverksamheterna var stöd och engagemang från ledningen mer central för kompetensutveckling än inom vårdboendena. Samtidigt visar resultatet att i de verksamheter där det fanns en mer utvecklad lärmiljö och en integrerad strategi – dvs. en kombination av icke‐formella och formella läraktiviteter – för kompetensutveckling, var uppfattningarna om omsorgspersonalens kompetens mer utvecklade. Fokus låg här på att utveckla både kompetens och verksamhet. Det som förenade samtliga verksamheter var uppfattningen att personalen behöver en förmåga att utveckla relationer till brukaren.Analysen av Kompetensstegen – en stor nationell satsning – visar på en brist i samspel och jämlika relationer mellan arbetsplatserna och utbildningsanordnare. Denna brist hade implikationer för hur väl satsningen på kompetensutveckling lyckades. Inom de verksamheter där arbetsplats‐ och utbildningssystem samverkat, ledde detta samspel till att arbetsplatslärandet blev mer flexibelt, effektivt och användbart för deltagarna. Exemplet visar att kompetensfrågor behöver analyseras ur ett samhälleligt perspektiv.Den samhälleliga analysen visar att kompetensfrågor lätt kommer bort eftersom dessa inte är integrerade i styrprinciper som konkurrensutsättning, upphandlingsförfaranden och kundval. Kompetensutveckling inom äldreomsorgen är en komplex, svårbestämbar och krävande process som behöver synkroniseras på olika nivåer. De nationella satsningar, där formell utbildning dominerar, har sällan fått något genomslag i verksamheten. Perspektivet har oftast varit kortsiktigt och individinriktat. Tillfälliga resursförstärkningar och projektsatsningar leder inte heller till att frågan om kompetensutveckling prioriteras och att nödvändiga resurser avsätts lokalt. Nyckelord: omsorgspersonal, kompetens, kompetensutveckling, äldreomsorgen, interaktiv forskning, interorganisatorisk samverkan
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| 3. |
- Borgestig, Maria
(författare)
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The impact of gaze-based assistive technology on daily activities in children with severe physical impairments
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aim of the thesis was to investigate the impact of gaze-based assistive technology on daily activities in children with severe physical impairments and without speech. The objectives were to develop and pilot a gaze-based assistive technology intervention (GAT intervention) at home and in school for these children and to understand its impact on daily activities as experienced by their parents.Methods: Study I was a pilot study in which the basic components that were developed for the intervention were evaluated for students with physical impairments. The study aimed at improving the use of computers as assistive technology (AT) in school. Based on the findings in Study I, the GAT intervention was developed. The GAT intervention aimed at implementing gaze-based AT in daily activities. It consisted of two parts; having access to gaze-based AT and having access to services from a multi professional communication team during nine to ten months. Studies II-IV concerned gazebased AT for children with severe physical impairments without speech who participated in the GAT intervention. The participants were ten children (ages 1-15) (Studies II, III), and their parents (Study IV). Studies II and III had longitudinal designs and children were followed during 15-20 months with repeated measurements before, after and at follow-up. In Study II children’s repertoire of computer activities, extent of use, and goal attainment with gaze-based AT was evaluated, as well as parents’ satisfaction with the AT and with services. In Study III children’s eye gaze performance when using gaze-based AT was examined. In Study IV, parents were interviewed twice with the aim of exploring their experiences of children’s gaze-based AT use in daily life. In Study IV a hermeneutical approach was used.Results: The findings of Study I showed that the basic components of intervention improved the use of computers in school. Study II showed an increased repertoire of computer activities with the gazebased AT, maintained use in daily activities for all at follow up, and that all children attained goals for gaze-based AT use in daily activities. Parents were satisfied with the gaze-based AT, and with the services in the GAT intervention. In study III, nine children improved in eye gaze performance over time when using the gaze-based AT in daily activities. Study IV revealed that children’s gaze-based AT usage in daily activities made a difference to parents since the children demonstrated agency, and showed their personality and competencies by using gaze-based AT, and for the parents this opened up infinite possibilities for the child to do and learn things. Overall, children’s gaze-based AT usage provided parents with hope of a future in which their children could develop and have influence in life.Conclusions: This thesis shows that these children with severe physical impairments and without speech acquired sufficient gaze control skills to use gaze-based AT for daily activities in the home and at school. The gaze-based AT had a positive impact on performing activities, for example, play activities and communication- and interaction-related activities. For the parents, children’s gaze-based AT usage made a difference since it shaped a hope of a better future for their children, where they can develop and gain influence in their future life. Furthermore, the children continued to perform daily activities with gaze-based AT over time. This finding suggests that key persons were provided with sufficient knowledge and skills to support children in maintained use of gaze-based AT after withdrawal of the services provided in the GAT intervention.
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| 4. |
- Granholm, Linnea, 1986-
(författare)
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Stress, Drugs and Neuroscience : Neurobiological Effects of Social Stressors and Drug Exposure in Young and Adolescent Rats
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Experiences early in life or during adolescence modulate neuronal networks in the immature brain and consequently lay the foundation for future susceptibility or resilience towards psychiatric disorders. The objective in this thesis is to understand, in part, how the surrounding environment shapes the brain of a young individual. Three types of negative life events were studied, in an animal model, for their effects on the brain reward system (i.e., endogenous opioids and dopamine) and voluntary drug intake. These were: disruption of maternal care, disruption of interaction with peers, and exposure to drugs. Stress, in the form of maternal separation, altered expression of opioid genes in the dorsal striatum and amygdala, and the response to subsequent alcohol intake on these genes was dependent on early life conditions. Basal levels of endogenous opioids were also dependent on how the animals were housed in early adolescence. Short single housing (30 minutes) caused an acute stress response as evidenced by increased serum corticosterone and nociceptin/orphanin FQ in brain areas associated with stress. A prolonged single housing resulted in a marked decrease of Met-Enk-Arg6-Phe7 (i.e., a marker of enkephalins) in several brain areas. The endogenous opioids were also affected by repeated exposure of ethanol during adolescence; ethanol intoxication increased the accumbal levels of Met-Enk-Arg6-Phe7 and decreased those of β-endorphin. Residual effects of the adolescent ethanol exposure were found in Met-Enk-Arg6-Phe7 levels in the amygdala, ventral tegmental area, and substantia nigra. Furthermore, rats exposed to ethanol as adolescents had alterations in the dopamine dynamics in the dorsal striatum. Both endogenous opioids and dopamine are essential in mediating rewarding properties. Alterations of these systems, caused by environmental disturbances and alcohol exposure, presented herein could explain, in part, the increased susceptibility for alcohol- and substance use disorders later in life.
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| 5. |
- Sahli, David, 1976-
(författare)
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Early arterial disease of the lower extremities in diabetes : diagnostic evaluation and risk markers
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the present thesis was to assess the occurrence of early lower extremity arterial disease (LEAD) in patients with diabetes and to assess novel potential risk markers for development or worsening of LEAD in the same patients. In parallel different measures of impaired peripheral circulation were evaluated.The measurement of ankle-to- brachial blood pressure index (ABI) to screen for asymptomatic LEAD in diabetic subjects is unreliable since a large proportion of patients have stiff ankle arteries (mediasclerosis) and thus may display a too high ABI. We studied type 1-, type 2 diabetic and non-diabetic subjects without a previous history of LEAD and a composite variable of ankle – plus toe blood pressures and indices was compared to ABI alone in detecting LEAD. Significantly more subjects with reduced peripheral circulation were detected using the composite variable compared to ABI alone. This was particularly true in diabetic subjects, about 30% of whom had signs of impaired peripheral circulation. Thus, it was found that toe blood pressure measurements, alone or in combination with ankle blood pressure measurements, increase the sensitivity for finding early asymptomatic LEAD in diabetic subjects. No significant difference in reproducibility between measurements of absolute ankle- and toe blood pressure and indices was found, but a correlation between systemic (brachial) and toe blood pressure variations over time may suggest that indices are more correct in assessing peripheral arterial circulation.Furthermore, toe blood pressure measurements can be performed using either the great toe or dig II and a strong concordance is found between these measurements. In addition, since the pole-test, another non-invasive method to measure peripheral blood pressure which is less sensitive to the presence of mediasclerosis compared to ABI, correlated significantly with toe blood pressure measurements this method may be used as an alternative screening method in subjects with previously known LEAD.Age, hypertension and glycemic control are well known risk factors and, in addition, high tissue plasminogen activator (tPA) activity turned out to be a novel early marker for asymptomatic LEAD in diabetic subjects, particularly in patients with type 2 diabetes. Age and hyperglycemia are the most important risk factors for development and progression of subclinical lower extremity arterial disease in type 2 diabetic subjects. No independent associations between markers of inflammation, such as CRP, interleukin-6 and TNF-α and early asymptomatic LEAD were seen among non-diabetic or diabetic subjects.In conclusion, impaired arterial circulation in the lower extremities is common in diabetic subjects even in the absence of symptoms. Including toe blood pressure measurement when screening for asymptomatic LEAD in diabetic subjects improves the ability to detect reduced peripheral circulation and this method avoids falsely elevated blood pressures readings due to mediasclerosis in the ankle arteries. Moreover, an altered fibrinolytic activity should be further evaluated as an early marker of atherosclerosis and LEAD.
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| 6. |
- Svensson, Anna Maria
(författare)
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Rektors ledarskap : styrningssammanhang och stil
- 2010
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The role of the principal in Sweden has undergone significant changes over the past two decades. Task and responsibility has been decentralized from the national level to o the local school board affecting principals´ everyday life. At the same time a new inspection system for all schools has been introduced. These changes puts focus on how principals implement and report political decisions within established guidelines. For many principals it is a balancing act to achieve the national goals within a local context. All the above include for the principal important work with evaluations of quality in different processes in the school, especially those related to teacher performance and children’s grades and results. In the mid 1990’s a debate about the lack of evaluations and school improvement in Swedish schools started, and as a result the Government decided in 1997 that every school should write a quality assessments and that the school board should write a summery for the whole school district. Many schools had problems in the beginning with the working processes around quality assessments, and many schools view this national law only as a top-down control decision from the Government and were not able to see the school improvement part of the law. The aim of this study is to describe how principals take responsibility for the quality assessment regulation and to analyze how they act and lead their schools in relation to quality assessments. In this study, results are presented from survey data, done with 131 principals who attended the National Principal Training Program at Umeå University. A theoretical model which discusses four leadership styles is used as a theoretical background. This model has an organizational frame. After making an argument for the importance of each of these styles for understanding principals work with quality assessments, two strands are examined. First, leadership styles are described from a principal perspective and factor analysis is used to investigate if these styles can illustrate principals´ work with quality assessments. Second, important factors explaining different ways in which principals tackle the work with quality assessments is highlighted. These factors are affected by different laws and regulations and even some time local political decisions and policies which here is understood as structure and culture, and personal background, for example the principals´ age, sex, education and experience. Based on the empirical results, my theoretical conclusion is that the four leadership styles used are relevant for understanding how principals work with quality assessments. The study also shows that structure and culture are important factors when it comes to explaining how principals´ work with quality assessments. Personal background, however, are not shown as important in this study.
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| 7. |
- Svensson, Elin, 1985-, et al.
(författare)
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Evidence-Based Design of Fixed-Dose Combinations : Principles and Application to Pediatric Anti-Tuberculosis Therapy
- 2018
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Ingår i: Clinical Pharmacokinetics. - : Springer Science and Business Media LLC. - 0312-5963 .- 1179-1926. ; 57:5, s. 591-599
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: Fixed-dose combination formulations where several drugs are included in one tablet are important for the implementation of many long-term multidrug therapies. The selection of optimal dose ratios and tablet content of a fixed-dose combination and the design of individualized dosing regimens is a complex task, requiring multiple simultaneous considerations.METHODS: In this work, a methodology for the rational design of a fixed-dose combination was developed and applied to the case of a three-drug pediatric anti-tuberculosis formulation individualized on body weight. The optimization methodology synthesizes information about the intended use population, the pharmacokinetic properties of the drugs, therapeutic targets, and practical constraints. A utility function is included to penalize deviations from the targets; a sequential estimation procedure was developed for stable estimation of break-points for individualized dosing. The suggested optimized pediatric anti-tuberculosis fixed-dose combination was compared with the recently launched World Health Organization-endorsed formulation.RESULTS: The optimized fixed-dose combination included 15, 36, and 16% higher amounts of rifampicin, isoniazid, and pyrazinamide, respectively. The optimized fixed-dose combination is expected to result in overall less deviation from the therapeutic targets based on adult exposure and substantially fewer children with underexposure (below half the target).CONCLUSION: The development of this design tool can aid the implementation of evidence-based formulations, integrating available knowledge and practical considerations, to optimize drug exposures and thereby treatment outcomes.
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| 8. |
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| 9. |
- Svensson, Maria, 1978-
(författare)
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Marqueurs corrélatifs en français et en suédois : Étude sémantico-fonctionnelle de d’une part… d’autre part, d’un côté… de l’autre et de non seulement… mais en contraste
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis deals with the correlative markers d’une part… d’autre part, d’un côté… de l’autre and non seulement… mais in French and their Swedish counterparts dels… dels, å ena sidan… å andra sidan and inte bara… utan. These markers are composed of two separate parts generally occurring together, and announce a serial of at least two textual units to be considered together. The analyses of the use of these three French and three Swedish markers are based upon two corpora of non-academic humanities texts. The first, principal corpus, is composed only of original French and Swedish texts. The second, complementary corpus, is composed of source texts in the two languages and their translations in the other language. By the combination of these two corpora, this study is comparative as well as contrastive. Through application of the Geneva model of discourse analysis and the Rhetorical Structure Theory, a semantic and functional approach to correlative markers and their text-structural role is adopted. The study shows similarities as well as differences between the six markers, both within each language and between the languages. D’une part… d’autre part and dels… dels principally mark a conjunctive relation, whereas d’un côté… de l’autre and å ena sidan… å andra sidan more often are used in a contrastive relation, even though they all can be used for both kinds of relations. Non seulement… mais and inte bara… utan mark a conjunctive relation, but can also indicate that the second argument is stronger than the first one. By the use of these two markers, the language users also present the first one as given and the second one as new information. In general, the French correlative markers appear to have a more argumentative function, whereas the text-structural function is demonstrated to be the most important in Swedish.
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| 10. |
- Warne, Maria, 1957-, et al.
(författare)
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On Time : A Qualitative Study of Swedish Students’, Parents’ and Teachers’ Views on School Attendance, with a Focus on Tardiness
- 2020
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 17:4
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Tidskriftsartikel (refereegranskat)abstract
- Tardiness is a common problem in many schools. It can be understood as an individual risk for future problematic behavior leading to absenteeism, school dropout, exclusion and later health problems. Tardiness can also be examined in relation to a broader social-ecological perspective on health. The aim of this study was to analyze students’, school staff’s and parents’ views on students’ tardiness in two Swedish schools. A focus group interview design was used with 21 school personnel, 21 students in grade nine and two parents. The data were analyzed by using thematic content analysis. The results illustrated the main theme—It depends on . . . —regarding what will happen if a student arrives late to school lessons. This finding is further explained by the subthemes about teachers’ signals and reactions and the responses from teachers and students. The conclusion showed the importance of organizing the school day more predictably for the students. Late arrival is a sign of shortcomings in a school organization. It is necessary to develop guidelines related to how to handle students’ late arrival based on predictable viewpoints but even more so on how to promote students’ sense of belonging and their interest in and motivation for going to school.
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