| 1. |
- Andreasson, Thomas, et al.
(författare)
-
Evaluation of anamnestic criteria for the identification of patients with acute community onset viral gastroenteritis in the emergency department-A prospective observational study.
- 2014
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Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 46:8, s. 561-565
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Tidskriftsartikel (refereegranskat)abstract
- Background: To our knowledge no clinical criteria for the identification of community onset viral gastroenteritis in individual patients have been evaluated systematically with modern PCR-based diagnostic assays as gold standard. Objective: The aim of this study was to identify factors independently associated with the detection of virus by PCR in rectal swab samples from patients with acute community onset gastroenteritis. Methods: A prospective observational study was conducted from December 2010 through March 2011 at the emergency department (ED) of a large teaching hospital. All patients who reported vomiting and/or diarrhoea up to 48 h prior to their visit to the ED were asked to participate. A rectal swab sample was obtained from each patient. Symptoms, date of onset, and epidemiological data were recorded. Samples were analysed with a multiple real-time PCR targeting 6 viral agents (astrovirus, adenovirus, rotavirus, sapovirus, and norovirus GI and GII). Results: Two hundred and five patients fulfilled the inclusion criteria, of whom 66 agreed to participate; their median (IQR) age was 65 (38-84) y and 43 (65%) were females. Thirty-one (47%) were positive by PCR for at least 1 of the agents examined (26 norovirus, 2 sapovirus, 2 rotavirus, and 1 adenovirus). Diarrhoea and a short duration of symptoms (≤ 2 days) were independently associated with a positive rectal swab sample, with odds ratios of 7.5 (95% confidence interval (CI) 2.0-28) and 10.4 (95% CI 1.9-56), respectively (p < 0.01 for both). A multivariate model including these 2 variables had a sensitivity of 81% (25/31) and a specificity of 69% (24/35). Conclusions: Diarrhoea and a short duration of symptoms were the only anamnestic criteria independently associated with acute community onset viral gastroenteritis confirmed by PCR.
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| 2. |
- Carlsson, Per, 1951-, et al.
(författare)
-
National Model for Transparent Vertical Prioritisation in Swedish Health Care
- 2007
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The proposed national model described in this report has been developed by a working group comprised of staff from the National Board of Health and Welfare, the National Centre for Priority Setting in Health Care, and other organisations involved in vertical prioritisation – including the Östergötland County Council, Stockholm County Council, Västra Götaland, the Health Services Region of Southern Sweden, the Swedish Society of Medicine, the Swedish Society of Nursing, and the Swedish Association of Health Professionals. Throughout the process of designing the model, the Swedish Federation of Occupational Therapists and the Swedish Association of Registered Physiotherapists were regularly informed and given opportunities to review and comment on the proposal. Furthermore, the report was reviewed and discussed at a meeting with invited representatives from the other county councils, the Pharmaceutical Benefits Board, and several professional interest groups. Viewpoints were also obtained at a seminar arranged by PrioNet, a network of individuals interested in prioritisation.Potentially, the working model described in Chapter 4 could be used in any context where vertical prioritisation takes place, e.g. activities arranged by the state, county councils, municipalities, hospital departments, and professional groups.This report is designed to be a useful tool for those working on development projects in priority setting. We believe that the contents must be adapted, with the help of relevant examples and some simplifications; to fit the specific needs of different projects or groups. The text must also be adapted to a target group’s knowledge and previous experience in dealing with transparent priority setting. It must be the responsibility of each provider and other affected organisation to adapt the material to the given situation and project. The National Centre for Priority Setting in Health Care, the National Board of Health and Welfare, and others who have participated actively in this effort can be helpful to various target groups in adapting this report.When and how to engage in practically implementing vertical prioritisation are questions that need to be answered at the local level. Primarily, it is the duty of the local authorities/providers to take responsibility for implementation. Professional organisations also play an important role. Public agencies, universities, and knowledge centres should be sources of support for the local authorities/providers.The Riksdag’s resolution on prioritisation served as the foundation for developing the model.Where there are areas of uncertainty in how to translate these guidelines in practice, or where practical implementation might conflict with the principles, we have pointed this out.Our conclusions and proposals are the following:When facing a choice – regardless of whether it involves allocating new resources for different purposes, or to implement cutbacks – it can be advantageous to rank the possible choices in order of priority. In our model, only the relevant options can be ranked by priority. The consequences of this ranking are not obvious at the outset, but can serve as a basis either to allocate more resources or ration by some means.In vertical prioritisation, it is advantageous to organise the prioritization process starting from a general categorisation of health problems/disease groups. As a rule, these categories cover many organisational units/clinical departments, specialties, or professional groups, thus providing a more multidimensional view of the problem. Furthermore, this allows the process to start from a patient/population perspective, which appears to be more goal-oriented than an organisational/staff perspective.That which is ranked, i.e. one of the choices, we refer to as a prioritization object. We suggest that prioritisation objects consist of different combinations of health conditions and interventions.1 When deciding on the appropriate level of detail, the decision must be based on the context in which prioritisation is carried out. A starting point would be to focus on typical cases, large-volumes services, and controversial care.All forms of vertical prioritisation should be based on the ethical principles that the Riksdag decided should apply in prioritising health services. However, these ethical principles must be made known, clarified, and perhaps complemented before they can be applied to practical priority setting. Furthermore, we believe that the Riksdag’s four so-called priority groups should not be part of the model.The human dignity principle, i.e. that all people should have equal value and equal rights to care irrespective of their personal characteristics and function in society, is the undisputed cornerstone in priority setting. When personal characteristics such as age, gender, lifestyle, or function of a group are expressions of the presence of special needs, so that benefits of the interventions are different, these personal characteristics could be addressed in a priority at the group level. Further discussion is needed regarding the question of how external effects (i.e. the effects of an intervention on families and groups other than the individual directly affected by the intervention) should be valued in priority setting.The concept of need in health care includes both the severity level of the condition and the expected benefits of intervention. As a patient, one needs only those interventions that can be expected to yield benefits. Based on this definition of need, a person does not need an intervention that does not improve health and quality of life, i.e. an intervention with no benefit. In such cases, health services have a responsibility to refer people who seek care for some type of problem, to other appropriate services.The Riksdag’s guidelines regarding the cost-effectiveness principle (applied to individual patients) are too limited to provide guidance for vertical prioritisation at the group level. From the outset, the Government’s bill (Priority Setting in Health Care) highlighted the importance of differentiating a cost-effectiveness principle that applied to choices among various interventions for the individual patient (where the principle can be applied as the Commission of Inquiry proposed) and the aim of health services to achieve high cost-effectiveness in health care generally. Here we also refer to the Riksdag’s directive to the Pharmaceutical Benefits Board. In its decisions on subsidising (prioritising) a drug, the Board should determine, e.g. whether the drug is cost effective from a societal perspective, which requires comparing the patient benefits of the drug to its cost. In such decisions, the cost effectiveness should be considered along with the needs and solidarity principle and the human dignity principle.The proposed working model essentially concurs with the working model used by the National Board of Health and Welfare in developing national guidelines. In describing a national working model, it is not possible to include every aspect that might be considered. Hence, one must start from the model and decide which other relevant aspects should be included. For instance, the International Classification on Functioning, Disability, and Health (ICF) can be used as guidance to describe the severity of health conditions.Due to the wealth of variety in outcome measures for different activities, and the limited experience in working with explicit threshold values, we believe would be premature to recommend standardised categories, e.g. risk levels. However, it is important that those working with prioritization describe their reasoning. Primarily, the categories applied by the Swedish Council on Technology Assessment in Health Care (SBU) to grade the scientific evidence of an intervention’s effects should be used. Local prioritisation projects with limited resources at their disposal should describe (text) their appraisal of the scientific evidence and reference the scientific sources used. The strength of evidence should be expressed in numbers only when supporting a conclusion of a systematic review by SBU, or other literature reviews of good quality.Prioritisation projects having access to health economic evaluation should, until further notice, adhere to the approach used by the National Board of Health and Welfare and present cost-effectiveness on a scale from low to very high cost per life-year gained or cost per quality-adjusted life-year. Economic evidence should be presented according to the principles applied by the National Board of Health and Welfare. In local projects with limited resources, or problems in consistently acquiring information on cost effectiveness, we recommend that the authors at least discuss cost effectiveness in cases where the priority ranking would be decisively affected when costs are weighed in.A 10-level ranking list should be used. The ranking list should be complemented by a “don’t do” list for methods that should not be used at all, or not used routinely, and a research and development (R&D) list for methods where the evidence still insufficient to motivate their use in standard practice. In the absence of an objective quantitative/mathematical method, a qualitative method should be used in the appraisal. Here too, we believe that it is not yet possible to establish standard criteria to determine within which ranking level a prioritisation object should fall.Results should be presented as a ranking list. The parameters used as a basis for prioritisation should also be presented in a uniform manner in ranking lists that are shared with other parties. For pedagogic reasons, details concerning language and format need to be adapted to the respective target groups.Thresholds for what constitutes an acceptable coverage of need (care quality, volume, and percentage of the patient group with access to services) a
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| 3. |
- Carlsson, Per, 1951-, et al.
(författare)
-
Nationell modell för öppna vertikala prioriteringar inom svensk hälso- och sjukvård
- 2007
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- En arbetsgrupp med personer från Socialstyrelsen och PrioriteringsCentrum, andra organisationer som arbetat med vertikala prioriteringar såsom Landstinget i Östergötland, Stockholms läns landsting, Västra Götaland, Södra sjukvårdsregionen, Svenska Läkaresällskapet, Svensk sjuksköterskeförening och Vårdförbundet har tagit fram detta förslag. Förslaget har fortlöpande förankrats hos Förbundet Sveriges Arbetsterapeuter och Legitimerade Sjukgymnasters Riksförbund som kunnat lämna synpunkter på utformningen av odellen.Dessutom har rapporten varit föremål för granskning och diskussion vid ett möte med inbjudna representanter från övriga landsting, Läkemedelsförmånsnämnden och flera yrkesorganisationer. Synpunkter har också inkommit från ett seminarium som arrangerades av PrioNet, ett nätverk av personer med intresse för prioriteringar.Den arbetsmodell som beskrivs i kapitel 4 ska kunna användas i alla sammanhang där vertikala prioriteringar sker såsom aktiviteter som arrangeras av staten, landsting, kommuner, kliniker, professionella grupper eller motsvarande.Rapporten är skriven på ett sådant sätt att den ska kunna användas i första hand som ett stöd till dem som bedriver utvecklingsarbete rörande prioriteringar. Vi tror att innehållet måste anpassas till olika verksamheter eller personalgruppers specifika behov med hjälp av kompletterande exempel och vissa förenklingar. Texten måste givetvis också anpassas till de kunskaper och tidigare erfarenheter som den aktuella målgruppen har när det gäller arbete med öppna prioriteringar. Sådana situations- och verksamhetsanpassade versioner måste det åligga varje sjukvårdshuvudman och andra berörda organisationer att utarbeta. PrioriteringsCentrum, Socialstyrelsen och andra parter som deltagit aktivt i detta arbete kan givetvis vara behjälpliga i arbetet med att bearbeta denna rapport för olika målgrupper.Frågan om när och hur arbetet med vertikala prioriteringar ska bedrivas i praktiken kan också endast besvaras lokalt. Det är i första hand ett nsvar för huvudmännen att ta ansvar för implementeringen. Professionella organisationer har också en viktig roll. Myndigheter, universitet och kunskapscentra ska vara ett stöd till huvudmännen.Utgångspunkten i modellutvecklingen är Riksdagens beslut om prioriteringar. När det finns oklarheter om hur dessa riktlinjer ska omsättas i praktiken eller att praktiken kan förefalla i konflikt med principerna har vi påpekat detta.När man står inför ett val - oavsett om det handlar om att fördela nya resurser till olika ändamål eller att genomföra besparingar - kan det vara en fördel att kunna rangordna tänkbara valmöjligheter i enprioriteringsordning. I vår modell innebär prioritering enbart att de relevanta alternativen rangordnas. Konsekvenserna av denna rangordning är inte på förhand given utan kan ligga till grund såväl för tillskott av resurser som för ransonering av något slag.Vid en vertikal prioritering är det en fördel att organisera prioriteringsarbetet så att det utgår från en grov uppdelning i hälsoproblem/sjukdomsgrupper. En sådan uppdelning innebär i regel att flera organisationsenheter/kliniker, specialiteter eller yrkesgrupper berörs och man får en mer allsidig belysning av problemet. Dessutom utgår man från ett patient/befolkningsperspektiv vilket förefaller mer ändamålsenligt än ett organisatoriskt/personalperspektiv.Det som rangordnas och som någon väljer mellan benämner vi prioriteringsobjekt. Vi föreslår att prioriteringsobjektet utgörs av olika kombinationer av hälsotillstånd och åtgärder1. När det gäller att bestämma en lämplig detaljeringsgrad måste det avgöras utifrån sammanhanget prioriteringar ska göras i. En utgångspunkt är att fokusera på typfall, vård som representerar stor volym och kontroversiell vård.Alla former av vertikala prioriteringar ska baseras på de etiska principer som riksdagen beslutat ska gälla vid prioriteringar inom hälso- och sjukvården. De etiska principerna behöver dock göras kända, förtydligas och eventuellt kompletteras för att kunna omsättas i praktiska prioriteringar. Vidare anser vi att riksdagens fyra så kallade prioriteringsgrupper inte ska ingå i modellen.Människovärdesprincipen, som innebär att alla människor bör ha lika värde och samma rätt till vård oberoende av personliga egenskaper och funktioner i samhället, är den självklara utgångspunkten vid prioriteringar. När personliga egenskaper såsom ålder, kön, livsstil eller funktion hos en grupp är ett uttryck för att speciella behov föreligger så att nytta med insatserna blir olika ska de personliga egenskaperna kunna beaktas i en prioritering på gruppnivå. Frågan om hur externa effekter, d v s effekten av en insats för närstående och andra grupper än den individ som är direkt berörd av insatsen, ska värderas vid en prioritering behöver diskuteras ytterligare.Med behov av hälso- och sjukvård menas både tillståndets svårighetsgrad och den förväntade nyttan av en åtgärd. Som patient har man endast behov av sådana vårdåtgärder som man förväntas ha nytta av. Motsatt gäller att en människa enligt detta sätt att definiera behov inte behöver åtgärder som inte förbättrar hälsan och livskvaliteten, sådana som hon inte har nytta av. Här har givetvis hälso- och sjukvården ett ansvar att lotsa människor de kommer i kontakt med, och som far illa på något sätt, till andra lämpliga aktörer.Riksdagens riktlinjer, när det gäller kostnadseffektivitetsprincipen (tillämpad för enskilda patienter), är för begränsad för att vägleda vid vertikala prioriteringar som gäller prioritering på gruppnivå. Regeringen konstaterade redan i prioriteringspropositionen att det är angeläget att skilja på en kostnadseffektivitetsprincip som gäller val mellan olika åtgärder för den enskilde patienten (där principen kan tillämpas som utredningen föreslår) och på hälso- och sjukvårdens strävan efter en hög kostnadseffektivitet när det gäller vårdens verksamhet i allmänhet. Här stödjer vi oss på Riksdagens direktiv till Läkemedelsförmånsnämnden. Nämnden ska vid beslut om subvention (prioriteringar) av ett läkemedel bl a bedöma om det är kostnadseffektivt i ett samhälleligt perspektiv, vilket innebär att man ställer patientnyttan av läkemedlet mot kostnaden. I bedömningen ska kostnadseffektiviteten vägas samman med behovs- och solidaritetsprincipen och människovärdesprincipen.Den föreslagna arbetsmodellen överensstämmer i allt väsentligt med den arbetsmodell som används av Socialstyrelsens vid framtagning av nationella riktlinjer. Det är inte möjligt att rymma alla aspekter som kan vara aktuella att beakta vid beskrivning av en nationell arbetsmodell. Man måste därför utgå från modellen och fundera på vilka andra relevanta aspekter som dessutom bör vägas in. T ex kan den internationella klassifikationen för funktionsförmåga (ICF) användas som vägledning.På grund av den stora variationsrikedomen av effektmått i olika verksamheter och de begränsade erfarenheter som finns att arbeta med sådana explicita gränsvärden anser vi att det är för tidigt att rekommendera en enhetlig indelning i t ex risknivåer. Det är dock viktigt att de som arbetar med prioriteringar redovisar hur de har resonerat.SBU:s klassifikation för att gradera den vetenskapliga evidensen för en åtgärds effekt bör användas i första hand. Lokala prioriteringsprojekt med begränsade resurser till sitt förfogande föreslås redovisa bedömningen av det vetenskapliga underlaget med ord och referera till det kunskapsunderlag som använts. Evidensstyrkan bör endast uttryckas med siffror då man stöder en slutsats på en systematisk kunskapsöversikt från SBU eller en annan översikt av god kvalitet.Prioriteringsarbeten där hälsoekonomiska data finns tillgängliga bör tills vidare ansluta till Socialstyrelsens arbetssätt och ange kostnadseffektivitet i en skala från låg till mycket hög kostnad per vunnet levnadsår eller kostnad per kvalitetsjusterat levnadsår. Den hälsoekonomiska evidensen bör redovisas i enlighet med de principer som Socialstyrelsen tillämpar. I lokala projekt med små resurser eller svårigheter att konsekvent få fram uppgifter om kostnadseffektivitet rekommenderar vi att man åtminstone resonerar om kostnadseffektivitet i de fall prioriteringsordningen på ett avgörande sätt påverkas när kostnaderna vägs in.Tio nivåer bör användas för rangordning samt att rangordningslistan kompletteras med en ”icke-göra-lista” för metoder som inte bör utföras alls eller rutinmässigt samt en FoU-lista för metoder där det fortfarande saknas tillräcklig evidens för att kunna motivera ett införande i rutinsjukvården. Sammanvägningen sker företrädesvis med en kvalitativ metod i avsaknad av en invändningsfri kvantitativ/matematisk metod. Likaså tror vi att det för närvarade inte är möjligt att fastställa entydiga kriterier som avgör inom vilken rangordningsnivå ett prioriteringsobjekt ska hamna.Resultatet bör presenteras i form av en rangordningslista. De parametrar som ligger till grund för prioriteringen bör också på ett enhetligt sätt redovisas i sådana rangordningslistor som visas för andra. I detalj kan språket och utseendet av pedagogiska skäl behöva anpassas för respektive målgrupp.Gränser för vad som är acceptabel behovstäckning (vårdkvalitet, mängd liksom andel av de i patientgrupp som får tillgång till insatsen) är en regional och lokal fråga och ingår därför inte i den nationella modellen.
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| 4. |
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| 5. |
- Moberg, Christina, et al.
(författare)
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De unga gör helt rätt när de stämmer staten
- 2022
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Ingår i: Aftonbladet. - 1103-9000.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- 1 620 forskare och lärare i forskarvärlden: Vi ställer oss bakom Auroras klimatkrav
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| 6. |
- Wallin Bengtsson, Viveca, et al.
(författare)
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Alpha-1 antitrypsin deficiency and periodontitis : a pilot study
- 2011
-
Ingår i: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 35:1, s. 33-40
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Tidskriftsartikel (refereegranskat)abstract
- Målet med studien var att undersöka om parodontala parametrar och elastas i gingivalvätska (GCF) skilde sig hos individer med alfa-1-antrypsin-brist (AAT-brist) jämfört med individer med normal AAT-halt. I studien ingick 30 individer, varav 20 med allvarlig AAT-brist, fenotyp PiZZ. Tio individer med AAT- brist led av kronisk obstruktiv lungsjukdom (KOL) (grupp 1) och 10 var symptomfria (grupp 2). Tio individer med normal AAT-halt, fenotyp PiMM (grupp 3), utgjorde kontrollgrupp och rekryterades från en allmäntandvårdsklinik. Undersökningen bestod av insamling av GCF, gingivalindex (GI), plackindex (PlI), fickdjupsmätning (PPD) och röntgen. GCF samlades in med hjälp av pappers-strips (Periopaper®). AAT i plasma mättes med nefelometri och AAT i GCF mättes med ELISA. Elastasaktivitet och proteinmängd i GCF bestämdes med spektrofotometri. Medelvärden för GI, PlI, PPD och röntgenmätningar visade inga statistiskt signifikanta skillnader mellan grupperna. AAT i plasma och GCF visade mycket låga värden i grupp 1 och 2 utan några signifikanta skillnader mellan grupperna men en signifikant skillnad i jämförelse med grupp 3. Elastas i gingivalvätska visade inga skillnader mellan de tre grupperna. Sammanfattningsvis visade varken parodontala värden eller elastas i GCF några skillnader hos individer med AAT- brist, fenotyp PiZZ, jämfört med individer med normal AAT-halt, fenotyp PiMM, i detta material.
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| 7. |
- Al-Okshi, Ayman, et al.
(författare)
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Dose optimization for assessment of periodontal structures in cone beam CT examinations
- 2016
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Ingår i: Dento-Maxillo-Facial Radiology. - : British institute of radiology. - 0250-832X .- 1476-542X. ; 46:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate the relationship between dose and image quality for a dedicated dental CBCT scanner using different scanning protocols and to set up an optimal imaging protocol for assessment of periodontal structures. METHODS: Radiation dose and image quality measurements were made using 3D Accuitomo 170 (J. Morita, Kyoto, Japan) dental CBCT scanner. The SedentexCT IQ phantom was used to investigate the relationship between contrast-to-noise ratio (CNR) and dose-area product. Subjective image quality assessment was achieved using a small adult skull phantom for the same range of exposure settings. Five independent observers assessed the images for three anatomical landmarks using a three-point visual grade analysis. RESULTS: When correlating the CNR of each scanning protocol to the exposure parameters used to obtain it, CNR decreased as these parameters decreased, especially current-exposure time product. When correlating to subjective image quality, the CNR level remained acceptable when 5 mA and 17.5 s or greater was selected and 80 kV could be used without compromising the CNR. CONCLUSIONS: For a dedicated CBCT unit, changing the rotation angle from 360 degrees to 180 degrees degrades image quality. By altering tube potential and current for the 360 degrees rotation protocol, assessment of periodontal structures can be performed with a smaller dose without substantially affecting visualization.
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| 8. |
- Al-Okshi, Ayman, et al.
(författare)
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Effective dose of cone beam computed tomography (CBCT) of the facial skeleton : a systematic review
- 2015
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Ingår i: British Journal of Radiology. - : British Institute of Radiology. - 0007-1285 .- 1748-880X. ; 88:1045
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Forskningsöversikt (refereegranskat)abstract
- Objective: To estimate effective dose of cone beam CT (CBCT) of the facial skeleton with focus on measurement methods and scanning protocols. Methods: A systematic review, which adhered to the preferred reporting items for systematic reviews (PRISMA) Statement, of the literature up to April 2014 was conducted. Data sources included MEDLINE®, The Cochrane Library and Web of Science. A model was developed to underpin data extraction from 38 included studies. Results: Technical specifications of the CBCT units were insufficiently described. Heterogeneity in measurement methods and scanning protocols between studies made comparisons of effective doses of different CBCT units and scanning protocols difficult. Few studies related doses to image quality. Reported effective dose varied across studies, ranging between 9.7 and 197.0 mSv for field of views (FOVs) with height #5cm, between 3.9 and 674.0 mSv for FOVs of heights 5.1–10.0 cm and between 8.8 and 1073.0 mSv for FOVs .10 cm. There was an inconsistency regarding reported effective dose of studies of the same CBCT unit with the same FOV dimensions. Conclusion: The review reveals a need for studies on radiation dosages related to image quality. Reporting quality of future studies has to be improved to facilitate comparison of effective doses obtained from examinations with different CBCT units and scanning protocols. A model with minimum data set on important parameters based on this observation is proposed. Advances in knowledge: Data important when estimating effective dose were insufficiently reported in most studies. A model with minimum data based on this observation is proposed. Few studies related effective dose to image quality.
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| 9. |
- Al-Okshi, Ayman, et al.
(författare)
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Measurability and reliability of assessments of root length and marginal bone level in cone beam CT and intraoral radiography : a study of adolescents
- 2019
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Ingår i: Dento-Maxillo-Facial Radiology. - : British Institute of Radiology. - 0250-832X .- 1476-542X. ; 48:5, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate measurability and reliability of measurements of root length and marginal bone level in CBCT, periapical (PA) and bitewing (BW) radiographs. Methods: CBCT of both jaws, PA of maxillary incisors and posterior BW radiographs of 10 adolescents (mean age 13.4) were selected. The radiographs comprised part of the baseline examinations of a trial of orthodontic treatment. Six raters assessed measurability and measured root length and marginal bone level. Three raters repeated their assessments. Measurability was expressed as frequency of interpretable sites and reliability as intraclass correlation coefficient (ICC). Results: Measurability was 100 % in CBCT and 95 % in PA of maxillary incisors for root length measurements. For marginal bone level, measurability was 100 % in CBCT, 76 % in PA and 86 % in posterior BW. Mean ICC for interrater reliability for root length measurements in CBCT was 0.88 (range 0.27-0.96 among different teeth) and 0.69 in PA of maxillary incisors. For marginal bone level measurements, mean ICC was 0.4 in CBCT, 0.38 in PA of maxillary incisors and 0.4 in posterior BW. Intrarater reliability varied among methods, root length or marginal bone level and among raters, except for root length measurements in CBCT, which presented high reliability (above 0.8) for all raters. Conclusions: As measurability and reliability were high for root length measurements in CBCT, this may be the method of choice for scientific analyses in orthodontics. For clinical praxis, we recommend PA following the "as low as diagnostically acceptable" principle, as clinical decisions seem to be influenced only when severe root resorption occurs.
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| 10. |
- Al-Okshi, Ayman, et al.
(författare)
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Using GafChromic film to estimate the effective dose from dental cone beam CT and panoramic radiography
- 2013
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Ingår i: Dento-Maxillo-Facial Radiology. - : British Institute of Radiology. - 0250-832X .- 1476-542X. ; 42:7
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To demonstrate the feasibility of GafChromic(®) XR-QA2 (ISP Corp., Wayne, NJ) as a dosemeter when performing measurements of the effective dose from three cone beam CT (CBCT) units and to compare the doses from examinations of three common dental clinical situations. A second aim was to compare the radiation doses for three digital panoramic units with the doses for the CBCT units. METHODS: The CBCT units used were Veraviewepocs 3De(®) (J Morita MFG Corp., Kyoto, Japan), ProMax(®) 3D (Planmeca, Helsinki, Finland) and NewTom VGi(®) (Quantitative Radiology, Verona, Italy). GafChromic XR-QA2 films were placed between the selected layers of the head and neck of a tissue-equivalent human skull (RANDO(®) phantom; The Phantom Laboratory, Salem, NY). The exposure parameters were set using the automatic exposure control function of the units. Depending on the availability, medium and smaller field of view (FOV) scanning modes were used. The effective dose was estimated using the 2007 International Commission on Radiological Protection formalism. RESULTS: The lowest effective dose of a CBCT unit was observed for ProMax 3D, FOV 4 × 5 cm (10 μSv), the highest for NewTom VGi, FOV 8 × 8 cm-high resolution (129 μSv). The range of effective doses for digital panoramic machines measured was 8-14 μSv. CONCLUSIONS: This study demonstrates the feasibility of using radiochromic films for dental CBCT and panoramic dosimetry.
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| 11. |
- Ali, Neserin, et al.
(författare)
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Comprehensive proteome analysis of nasal lavage samples after controlled exposure to welding nanoparticles shows an induced acute phase and a nuclear receptor, LXR/RXR, activation that influence the status of the extracellular matrix
- 2018
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Ingår i: Clinical Proteomics. - : Springer Science and Business Media LLC. - 1542-6416 .- 1559-0275. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epidemiological studies have shown that many welders experience respiratory symptoms. During the welding process a large number of airborne nanosized particles are generated, which might be inhaled and deposited in the respiratory tract. Knowledge of the underlying mechanisms behind observed symptoms is still partly lacking, although inflammation is suggested to play a central role. The aim of this study was to investigate the effects of welding fume particle exposure on the proteome expression level in welders suffering from respiratory symptoms, and changes in protein mediators in nasal lavage samples were analyzed. Such mediators will be helpful to clarify the pathomechanisms behind welding fume particle-induced effects. Methods: In an exposure chamber, 11 welders with work-related symptoms in the lower airways during the last month were exposed to mild-steel welding fume particles (1 mg/m3) and to filtered air, respectively, in a double-blind manner. Nasal lavage samples were collected before, immediately after, and the day after exposure. The proteins in the nasal lavage were analyzed with two different mass spectrometry approaches, label-free discovery shotgun LC-MS/MS and a targeted selected reaction monitoring LC-MS/MS analyzing 130 proteins and four in vivo peptide degradation products. Results: The analysis revealed 30 significantly changed proteins that were associated with two main pathways; activation of acute phase response signaling and activation of LXR/RXR, which is a nuclear receptor family involved in lipid signaling. Connective tissue proteins and proteins controlling the degradation of such tissues, including two different matrix metalloprotease proteins, MMP8 and MMP9, were among the significantly changed enzymes and were identified as important key players in the pathways. Conclusion: Exposure to mild-steel welding fume particles causes measurable changes on the proteome level in nasal lavage matrix in exposed welders, although no clinical symptoms were manifested. The results suggested that the exposure causes an immediate effect on the proteome level involving acute phase proteins and mediators regulating lipid signaling. Proteases involved in maintaining the balance between the formation and degradation of extracellular matrix proteins are important key proteins in the induced effects.
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| 12. |
- Allen, P Danny, et al.
(författare)
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Detecting reduced bone mineral density from dental radiographs using statistical shape models
- 2007
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Ingår i: IEEE transactions on information technology in biomedicine. - : Institute of Electrical and Electronics Engineers (IEEE). - 1089-7771 .- 1558-0032. ; 11:6, s. 601-610
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Tidskriftsartikel (refereegranskat)abstract
- We describe a novel method of estimating reduced bone mineral density (BMD) from dental panoramic tomograms (DPTs), which show the entire mandible. Careful expert width measurement of the inferior mandibular cortex has been shown to be predictive of BMD in hip and spine osteopenia and osteoporosis. We have implemented a method of automatic measurement of the width by active shape model search, using as training data 132 DPTs of female subjects whose BMD has been established by dual-energy X-ray absorptiometry. We demonstrate that widths measured after fully automatic search are significantly correlated with BMD, and exhibit less variability than manual measurements made by different experts. The correlation is highest towards the lateral region of the mandible, in a position different from that previously employed for manual width measurement. An receiver-operator characterstic (ROC) analysis for identifying osteopenia (T < -1: BMD more than one standard deviation below that of young healthy females) gives an area under curve (AUC) value of 0.64. Using a minimal interaction to initiate active shape model (ASM) search, the measurement can be made at the optimum region of the mandible, resulting in an AUC value of 0.71. Using an independent test set, AUC for detection of osteoporosis (T < -2.5) is 0.81.
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| 13. |
- Andersen, Christina, et al.
(författare)
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Inhalation and dermal uptake of particle and gas phase phthalates - A human chamber exposure study
- 2018
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Ingår i: 15th Conference of the International Society of Indoor Air Quality and Climate, INDOOR AIR 2018. - 9781713826514
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Konferensbidrag (refereegranskat)abstract
- We have exposed sixteen test subjects to particle and gas phase phthalates in the controlled chamber exposure study. Deuterium labelled phthalates were used to generate particle D4-DEHP (di(2-ethylhexyl) phthalate) and gas phase D4-DEP (diethyl phthalate) for exposures scenarios allowed studying the dermal only and combined inhalational and dermal uptake. Metabolites were measured in urine samples before and after three hours of exposure. The inhalation was the dominant route of uptake for both DEHP and DEP in this study design and exposure settings. Larger uptake of DEP compared to DEHP both via inhalation and dermal uptake was observed. Dermal uptake of DEHP was not observed in this study. Inhalational urinary excretion factors of the metabolites were found to be 0.73 for DEHP and 0.53 for DEP. This study also highlights the importance of taking into consideration the deposited dose of inhaled particles in studies of uptake of particles.
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| 14. |
- Andersen, Christina, et al.
(författare)
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Inhalation and Dermal Uptake of Particle and Gas-phase Phthalates - A Human Exposure Study
- 2018
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Ingår i: Environmental Science & Technology. - : American Chemical Society (ACS). - 1520-5851 .- 0013-936X. ; 52:21, s. 12792-12800
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Tidskriftsartikel (refereegranskat)abstract
- Phthalates are ubiquitous in indoor environments, which raises concern about their endocrine disrupting properties. However, studies of human uptake from airborne exposure are limited. We studied the inhalation uptake and dermal uptake by air-to-skin transfer with clean clothing as a barrier of two deuterium-labelled airborne phthalates: particle-phase D4-DEHP (di-(2-ethylhexyl)phthalate) and gas-phase D4-DEP (diethyl phthalate). Sixteen participants, wearing trousers and long-sleeved shirts, were under controlled conditions exposed to airborne phthalates in four exposure scenarios: dermal uptake alone, and combined inhalation+dermal uptake of both phthalates. The results showed an average uptake of D4-DEHP by inhalation of 0.0014±0.00088 (µg kg-1 bw)/(µg m-3)/h. No dermal uptake of D4-DEHP was observed during the 3 hour exposure with clean clothing. The deposited dose of D4-DEHP accounted for 26% of the total inhaled D4-DEHP mass. For D4-DEP, the average uptake by inhalation+dermal was 0.0067±0.0045 and 0.00073±0.00051 (µg kg-1 bw)/(µg m-3)/h for dermal uptake. Urinary excretion factors of metabolites after inhalation were estimated to 0.69 for D4-DEHP and 0.50 for D4-DEP. Under the described settings, the main uptake of both phthalates was through inhalation. The results demonstrate the differences in uptake of gas and particles, and highlights the importance of considering the deposited dose in particle uptake studies.
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| 15. |
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| 16. |
- Bergkvist, Göran, et al.
(författare)
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Bone Density at Implant Sites and Its Relationship to Assessment of Bone Quality and Treatment Outcome
- 2010
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Ingår i: INTERNATIONAL JOURNAL OF ORAL and MAXILLOFACIAL IMPLANTS. - : Quintessence Publishing Co, Inc. - 0882-2786 .- 1942-4434. ; 25:2, s. 321-328
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate the relationship between bone mineral density (BMD) before implant placement, implant stability measures at implant placement, and marginal bone loss of immediately loaded implants after 1 year in situ. Materials and Methods: Consecutively recruited patients received Straumann SLActive implants loaded with fixed provisional prostheses within 24 hours. BMD was measured from computed tomographic images before implant placement. Alveolar bone quality was assessed during surgery. Implant stability-both rotational and as measured with resonance frequency analysis- and marginal bone height were assessed at implant placement and after 1 year. The Pearson correlation coefficient was used to calculate correlations, and significance was considered when P andlt; .05. Results: Twenty-one patients received 137 implants (87 in maxillae and 50 in mandibles). BMD was significantly correlated with bone quality classification in both arches (P andlt; .001). Mean BMD was also significantly correlated with stability values (P andlt; .001). Mean marginal bone loss at implant surfaces differed, but not significantly, at the 1-year follow-up, regardless of BMD values (P = .086) and measured stability (rotational stability P = .34, resonance frequency analysis P = .43) at implant placement. Conclusion: Within the limits of this study, it can be concluded that computed tomographic examination can be used as a preoperative method to assess jawbone density before implant placement, since density values correlate with prevailing methods of measuring implant stability. However, in the short time perspective of 1 year, there were no differences in survival rates or changes in marginal bone level between implants placed in bone tissue of different density.
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| 17. |
- Bergkvist, Goran, et al.
(författare)
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Immediate Loading of Implants in the Edentulous Maxilla : Use of an Interim Fixed Prosthesis Followed by a Permanent Fixed Prosthesis: A 32-Month Prospective Radiological and Clinical Study
- 2009
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Ingår i: Clinical Implant Dentistry and Related Research. - : Wiley. - 1523-0899 .- 1708-8208. ; 11:1, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to prospectively evaluate the survival rate of splinted and immediately loaded Straumann sandblasted, large-grit, acid-etched, solid-screw dental implants in the edentulous maxilla after 32 months of loading. Twenty-eight patients (mean age 63 years) with edentulous maxillae received 168 implants (six each) and an implant-supported fixed interim prosthesis within 24 hours after surgery. After a mean healing time of 15 weeks, the patients received permanent screw-retained prostheses. Clinical and radiological examinations were made at implant placement and after 8, 20, and 32 months of loading. All permanent prostheses were removed at the 32-month follow-up; implant stability was checked with a torque device, and the implant stability quotient was determined with resonance frequency analysis. Mean marginal bone loss from baseline to 8 months after loading was 1.6 mm (SD 1.16; p = .094), from 8 to 20 months 0.41 mm (SD 0.63; p = .094), and from 20 to 32 months 0.08 mm (SD 0.49; p = .039). The 32-month cumulative survival rate was 98.2%. The 32-month survival of solid-screw implants - immediately loaded within 24 hours after placement - was similar to survival rates reported for solid-screw implants with conventional loading. Immediate loading and splinting of implants in the edentulous maxilla is a viable treatment alternative.
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| 18. |
- Bergkvist, G, et al.
(författare)
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Immediate loading of implants with interim fixed prostheses in edentulous maxillas and mandibles. A 2 year prospective clinical and radiological follow-up
- 2009
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: An increasing number of studies show that one-stage surgery and immediate loading of implants, in both edentulous mandibles and maxillae, is a treatment alternative with success rates comparable with two stage-surgery and conventional loading. Furthermore, the development of new implant surfaces has shortened the healing time after implant placement. Such a new surface texture is the sand-blasted, large-grit and acid-etched, active surface (SLActive). Using implants with a shortened healing period is presumably advantageous when immediate loading implants. The aim of the study was to prospectively evaluate the survival rate of splinted and immediately loaded SLActive implants in edentulous mandibles and maxillae after 2 years of loading. Materials and methods Thirty-three patients (mean age 70 yr) with 23 edentulous maxillae and 14 edentulous mandibles received 6 implants each in maxillae and 5 in mandibles respectively, and an implant-supported fixed interim prosthesis within 24 hours after surgery. After a mean healing time of 15 weeks the patients received a permanent screw-retained implant supported fixed prosthesis. A total of 204 Straumann Standard Plus SLActive implants were placed. Bone quality and jaw shape were classified according to Lekholm and Zarb (1985). Implant stability was measured with Resonance Frequency Analysis at placement, after 2, 4 and 8 weeks and at the one year follow-up. Implant rotational stability was measured with a torque control device at placement and after one year. Radiological examinations and assessments were made at implant installation and after one and two years. Results Mean marginal bone level at baseline for implants placed in maxillae were measured at a point 1.74 (SD 0.94) apical of the reference point (the implant shoulder) and in mandibles 1.73 (SD 1.23). Change in mean marginal bone level from baseline to the 1-year follow-up was 1.18 mm (SD 0.98) in maxillae and 1.15 (SD 1.23) in mandibles. For almost 80% of the implant surfaces marginal bone loss was ≤ 1 mm. The cumulative implant survival rate was 100% after one and two years respectively. Conclusion Straumann Standard Plus SLActive implants immediately loaded within 24 hours, in combination with fixed cross-arch prostheses, had successful survival rate and is a viable treatment alternative.
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| 19. |
- Bergkvist, Göran, et al.
(författare)
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Immediately loaded implants supporting fixed prostheses in the edentulous maxilla : A preliminary clinical and radiologic report
- 2005
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Ingår i: International Journal of Oral & Maxillofacial Implants. - 0882-2786 .- 1942-4434. ; 20:3, s. 399-405
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the survival rate of immediately loaded ITI sand-blasted, large-grit, acid-etched (SLA) solid-screw dental implants in the edentulous maxilla after 8 months of loading. Materials and Methods: Twenty-eight patients (mean age 63 years) with edentulous maxillae each received 6 implants and 1 implant-supported fixed provisional prosthesis within 24 hours after surgery. After a mean healing time of 15 weeks, the patient received a definitive, screw-retained, implant-supported fixed prosthesis. A total of 168 implants were placed. Clinical parameters were registered after 1 month of loading with the implant-supported fixed prostheses as well as 8 months after implant place ment. Radiologic examinations and assessments were made at implant placement and after 8 months. Results: The mean marginal bone level at implant placement was 1.6 mm (range 0 to 5.1, SD 1.1) apical of the reference point (the implant shoulder). The mean marginal bone level at the 8-month follow-up was 3.2 mm (range 0.4 to 5.9, SD 1.1) apical of the reference point. Three implants failed during the healing period. Discussion: The improved results in the present study might be a result of the positive effect of splinting the implants immediately after placement Conclusion: ITI SLA solid-screw implants immediately loaded (ie, loaded within 24 hours of placement) and supporting fixed prostheses had successful survival rates after 8 months. The present results constitute a solid base line for future follow-up studies.
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| 20. |
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| 21. |
- Bergkvist, Göran, et al.
(författare)
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Implant-supported Fixed Prostheses in the Edentulous Maxilla. A 2-year Clinical and Radiological Follow-up of Treatment with Non-submerged ITI Implants
- 2004
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Ingår i: Clinical Oral Implants Research. - : Wiley. - 0905-7161 .- 1600-0501. ; 15:3, s. 351-359
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVES: To evaluate the survival rate of non-submerged solid-screw ITI dental implants with a rough (titanium plasma sprayed, TPS) surface in the edentulous maxilla after 1 and 2 years of loading. MATERIAL AND METHOD: Twentyfive patients (mean age 64 years) with edentulous upper jaws received five-seven implants and, after a mean healing time of 6.9 months, screw-retained implant-supported fixed prostheses. A total of 146 ITI solid screw TPS implants were inserted. The diameter of 56% of the implants was smaller (3.3 mm) than the standard (4.1 mm) and the diameter of the rest (44%) was standard. The bone quantity of the majority of the patients was low and the bone quality poor. Clinical parameters were registered at baseline and at two annual follow-ups. Radiological examinations and assessments were also made at these times. RESULTS: Mean marginal bone level at baseline was measured at a point 4.52 mm (range 1.45-7.70, SD 1.2) apical of the reference point. Mean bone loss from baseline to 1 year of loading was 0.24 mm (SD 0.9, P=0.002) and from 1 year to 2 years of loading 0.15 mm (SD 0.4, P<0.001). Five implants failed, four of which were early failures prior to loading. One implant failed shortly after bridge installation. The cumulative survival rate was 96.6% after 1 and 2 years. CONCLUSION: ITI TPS solid-screw implants in combination with fixed prostheses had successful survival rates and were found to be a viable treatment alternative in the edentulous maxilla.
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| 22. |
- Bornehag, Carl-Gustaf, 1957-, et al.
(författare)
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A Novel Approach to Chemical Mixture Risk Assessment—Linking Data from Population-Based Epidemiology and Experimental Animal Tests
- 2019
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Ingår i: Risk Analysis. - : John Wiley & Sons. - 0272-4332 .- 1539-6924. ; 39:10, s. 2259-2271
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Tidskriftsartikel (refereegranskat)abstract
- Humans are continuously exposed to chemicals with suspected or proven endocrine disrupting chemicals (EDCs). Risk management of EDCs presents a major unmet challenge because the available data for adverse health effects are generated by examining one compound at a time, whereas real-life exposures are to mixtures of chemicals. In this work, we integrate epidemiological and experimental evidence toward a whole mixture strategy for risk assessment. To illustrate, we conduct the following four steps in a case study: (1) identification of single EDCs (“bad actors”)—measured in prenatal blood/urine in the SELMA study—that are associated with a shorter anogenital distance (AGD) in baby boys; (2) definition and construction of a “typical” mixture consisting of the “bad actors” identified in Step 1; (3) experimentally testing this mixture in an in vivo animal model to estimate a dose–response relationship and determine a point of departure (i.e., reference dose [RfD]) associated with an adverse health outcome; and (4) use a statistical measure of “sufficient similarity” to compare the experimental RfD (from Step 3) to the exposure measured in the human population and generate a “similar mixture risk indicator” (SMRI). The objective of this exercise is to generate a proof of concept for the systematic integration of epidemiological and experimental evidence with mixture risk assessment strategies. Using a whole mixture approach, we could find a higher rate of pregnant women under risk (13%) when comparing with the data from more traditional models of additivity (3%), or a compound-by-compound strategy (1.6%).
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| 23. |
- Brown, J, et al.
(författare)
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Basic training requirements for the use of dental CBCT by dentists : a position paper prepared by the European Academy of DentoMaxilloFacial Radiology
- 2014
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Ingår i: Dento-Maxillo-Facial Radiology. - : British Institute of Radiology. - 0250-832X .- 1476-542X. ; 43:1
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Tidskriftsartikel (refereegranskat)abstract
- Cone beam CT (CBCT) is a relatively new imaging modality, which is now widely available to dentists for examining hard tissues in the dental and maxillofacial regions. CBCT gives a three-dimensional depiction of anatomy and pathology, which is similar to medical CT and uses doses generally higher than those used in conventional dental imaging. The European Academy of DentoMaxilloFacial Radiology recognizes that dentists receive training in two-dimensional dental imaging as undergraduates, but most of them have received little or no training in the application and interpretation of cross-sectional three-dimensional imaging. This document identifies the roles of dentists involved in the use of CBCT, examines the training requirements for the justification, acquisition and interpretation of CBCT imaging and makes recommendations for further training of dentists in Europe who intend to be involved in any aspect of CBCT imaging. Two levels of training are recognized. Level 1 is intended to train dentists who prescribe CBCT imaging, such that they may request appropriately and understand the resultant reported images. Level 2 is intended to train to a more advanced level and covers the understanding and skills needed to justify, carry out and interpret a CBCT examination. These recommendations are not intended to create specialists in CBCT imaging but to offer guidance on the training of all dentists to enable the safe use of CBCT in the dentoalveolar region.
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| 24. |
- Caporale, N., et al.
(författare)
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From cohorts to molecules: Adverse impacts of endocrine disrupting mixtures
- 2022
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 375:6582
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Tidskriftsartikel (refereegranskat)abstract
- Convergent evidence associates exposure to endocrine disrupting chemicals (EDCs) with major human diseases, even at regulation-compliant concentrations. This might be because humans are exposed to EDC mixtures, whereas chemical regulation is based on a risk assessment of individual compounds. Here, we developed a mixture-centered risk assessment strategy that integrates epidemiological and experimental evidence. We identified that exposure to an EDC mixture in early pregnancy is associated with language delay in offspring. At human-relevant concentrations, this mixture disrupted hormone-regulated and disease-relevant regulatory networks in human brain organoids and in the model organisms Xenopus leavis and Danio rerio, as well as behavioral responses. Reinterrogating epidemiological data, we found that up to 54% of the children had prenatal exposures above experimentally derived levels of concern, reaching, for the upper decile compared with the lowest decile of exposure, a 3.3 times higher risk of language delay. © 2022 American Association for the Advancement of Science. All rights reserved.
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| 25. |
- Casanovas, Inés
(författare)
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Online Education in Universities : Moving from Individual Adoption to Institutionalisation of an Information Technology Innovation
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis describes and analyses the move from individual adoption to institutionalisation of an information technology innovation: online education in universities. The study focuses on the processes that took place within two universities, one in Sweden and the other in Argentina, regarding online education adoption and the organisational changes developed.The aim is to contribute to the understanding of individual and organisational strategies for the institutionalisation of the innovation. To achieve this aim, three research questions were posed. The first focused on the way in which teachers influence the adoption processes. The next addressed the changes and interactions at the individual and institutional levels resulting from these processes. The third question deepened into the methodological practices that can harmonise stakeholders‟ objectives and the conflicting interests regarding online education initiatives. Innovation theory, complemented with organisational theories provided the foundation for the description and analysis of the information technology innovation and the adoption processes.The results of analysing and interpreting the collected data from the two universities in two different countries (Sweden and Argentina) showed that the adoption processes appeared to be evolutionary rather than revolutionary. The iterative nature of the appropriation and the constant “newness” of the information technology innovation may be plausible explanations for the phenomenon. Though the change has not yet become an integral part of the formal core of the institutions, it has been a great achievement considering the universities‟ structure, culture and resources.The contributions provide complementary and pluralistic insights into the research field of Information Systems, for both theory and practice, as well as into higher education managers‟ decision-making. Furthermore, the knowledge contribution of the thesis could be applied to implementation of information technology innovations in other organisations with similar characteristics as the studied higher education institutions. Such characteristics are, for example, to be complex and knowledge intensive.Interactions at macro and micro organisational levels could be modelled as the cyclic linkage between sensemaking outcomes and institutionalized structures. A higher level of theorization resulted in a meta-theory model to describe and explain the linkage itself within the perspective of adaptive structuration theory.Regarding practice, scholar-engaged research allowed conflicting interests to be reconciled by changing the existing practices through sensemaking and negotiation among stakeholders in an ongoing implementation. As an overall conclusion, online education is still far from being fully institutionalised. After four years of technological and contextual changes during the research development, a positive shift can be seen in teachers‟ attitude towards online education. They show more confidence in working with constantly improved virtual environments. Nevertheless, there are still key factors that need to be faced regarding online education adoption and institutionalisation. These factors are of a strategic nature and the way to handle them seems to be more political than technological or pedagogical.
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