| 1. |
- Allvin, Renée, 1956-, et al.
(författare)
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Confident but not theoretically grounded : experienced simulation educators’ perceptions of their own professional development
- 2017
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Ingår i: Advances in Medical Education and Practice. - Macclesfield : DOVE Medical Press Ltd.. - 1179-7258. ; :8, s. 99-108
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Tidskriftsartikel (refereegranskat)abstract
- Background: Medical simulation enables the design of learning activities for competency areas (eg, communication and leadership) identi ed as crucial for future health care professionals. Simulation educators and medical teachers follow different career paths, and their education backgrounds and teaching contexts may be very different in a simulation setting. Although they have a key role in facilitating learning, information on the continuing professional development (pedagogical development) of simulation educators is not available in the literature. Objectives: To explore changes in experienced simulation educators’ perceptions of their own teaching skills, practices, and understanding of teaching over time.Methods: A qualitative exploratory study. Fourteen experienced simulation educators partici- pated in individual open-ended interviews focusing on their development as simulation educators. Data were analyzed using an inductive thematic analysis. Results: Marked educator development was discerned over time, expressed mainly in an altered way of thinking and acting. Five themes were identi ed: shifting focus, from following to utilizing a structure, setting goals, application of technology, and alignment with profession. Being con dent in the role as an instructor seemed to constitute a foundation for the instructor’s pedagogical development.Conclusion: Experienced simulation educators’ pedagogical development was based on self- con dence in the educator role, and not on a deeper theoretical understanding of teaching and learning. This is the rst clue to gain increased understanding regarding educational level and possible education needs among simulation educators, and it might generate several lines of research for further studies.
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| 2. |
- Ekman, Agneta, et al.
(författare)
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Fusk hotar tilliten till blivande läkares professionalitet
- 2018
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; :115
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Det är med stor sorg vi noterat att några studenter valt att fuska sig till en plats på läkarutbildningarna. Vi förväntar oss nu att Universitets- och högskolerådet skärper säkerheten vid högskoleprovet för att förhindra att fusket fortsätter och att utredningen om vilka som fuskat sig in på utbildningarna drivs vidare.
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| 3. |
- Heurlin, Magnus, et al.
(författare)
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Synthesis of Doped InP Core-Shell Nanowires Evaluated Using Hall Effect Measurements.
- 2014
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Ingår i: Nano Letters. - : American Chemical Society (ACS). - 1530-6992 .- 1530-6984. ; 14:2, s. 749-753
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Tidskriftsartikel (refereegranskat)abstract
- InP core-shell nanowire pn-junctions doped with Zn and Sn have been investigated in terms of growth morphology and shell carrier concentration. The carrier concentrations were evaluated using spatially resolved Hall effect measurements and show improved homogeneity compared to previous investigations, attributed to the use of Sn as the n-type dopant. Anisotropies in the growth rate of different facets are found for different doping levels that in turn affects the migration of Sn and In on the nanowire surface. A route for increasing the In migration length to obtain a more homogeneous shell thickness is presented.
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| 4. |
- Jafari Jam, Reza, et al.
(författare)
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Template-assisted vapour-liquid-solid growth of InP nanowires on (001) InP and Si substrates
- 2020
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Ingår i: Nanoscale. - Cambridge : Royal Society of Chemistry. - 2040-3364 .- 2040-3372. ; 12:2, s. 888-894
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Tidskriftsartikel (refereegranskat)abstract
- We report on the synthesis of vertical InP nanowire arrays on (001) InP and Si substrates using template-assisted vapour-liquid-solid growth. A thick silicon oxide layer was first deposited on the substrates. The samples were then patterned by electron beam lithography and deep dry etching through the oxide layer down to the substrate surface. Gold seed particles were subsequently deposited in the holes of the pattern by the use of pulse electrodeposition. The subsequent growth of nanowires by the vapour-liquid-solid method was guided towards the [001] direction by the patterned oxide template, and displayed a high growth yield with respect to the array of holes in the template. In order to confirm the versatility and robustness of the process, we have also demonstrated guided growth of InP nanowire p-n junctions and InP/InAs/InP nanowire heterostructures on (001) InP substrates. Our results show a promising route to monolithically integrate III-V nanowire heterostructure devices with commercially viable (001) silicon platforms.
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| 5. |
- Lindelöw, Fredrik, et al.
(författare)
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Doping evaluation of InP nanowires for tandem junction solar cells
- 2016
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Ingår i: Nanotechnology. - : IOP Publishing. - 0957-4484 .- 1361-6528. ; 27:6
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Tidskriftsartikel (refereegranskat)abstract
- In order to push the development of nanowire-based solar cells further using optimized nanowire diameter and pitch, a doping evaluation of the nanowire geometry is necessary. We report on a doping evaluation of n-type InP nanowires with diameters optimized for light absorption, grown by the use of metal-organic vapor phase epitaxy in particle-assisted growth mode using tetraethyltin (TESn) as the dopant precursor. The charge carrier concentration was evaluated using four-probe resistivity measurements and spatially resolved Hall measurements. In order to reach the highest possible nanowire doping level, we set the TESn molar fraction at a high constant value throughout growth and varied the trimethylindium (TMIn) molar fraction for different runs. Analysis shows that the charge carrier concentration in nanowires grown with the highest TMIn molar fraction (not leading to kinking nanowires) results in a low carrier concentration of approximately 10(16) cm(-3). By decreasing the molar fraction of TMIn, effectively increasing the IV/III ratio, the carrier concentration increases up to a level of about 10(19) cm(-3), where it seems to saturate. Axial carrier concentration gradients along the nanowires are found, which can be correlated to a combination of changes in the nanowire growth rate, measured in situ by optical reflectometry, and polytypism of the nanowires observed in transmission electron microscopy.
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| 6. |
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| 7. |
- Lindgren, David, et al.
(författare)
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Study of carrier concentration in single InP nanowires by luminescence and Hall measurements
- 2015
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Ingår i: Nanotechnology. - : IOP Publishing. - 0957-4484 .- 1361-6528. ; 26:4
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Tidskriftsartikel (refereegranskat)abstract
- The free electron carrier concentrations in single InP core-shell nanowires are determined by micro-photoluminescence, cathodoluminescence (CL) and Hall effect measurements. The results from luminescence measurements were obtained by solving the Fermi-Dirac integral, as well as by analyzing the peak full width at half maximum (FWHM). Furthermore, the platform used for Hall effect measurements, combined with spot mode CL spectroscopy, is used to determine the carrier concentrations at specific positions along single nanowires. The results obtained via luminescence measurements provide an accurate and rapid feedback technique for the epitaxial development of doping incorporation in nanowires. The technique has been employed on several series of samples in which growth parameters, such as V/III-ratio, temperature and dopant flows, were investigated in an optimization procedure. The correlation between the Hall effect and luminescence measurements for extracting the carrier concentration of different samples were in excellent agreement.
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| 8. |
- Rodling Wahlström, Marie, et al.
(författare)
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Effects of prostacyclin on the early inflammatory response in patients with traumatic brain injury : a randomised clinical study
- 2014
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Ingår i: SpringerPlus. - : Springer. - 2193-1801. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE AND DESIGN: A prospective, randomised, double-blinded, clinical trial was performed at a level 1 trauma centre to determine if a prostacyclin analogue, epoprostenol (Flolan®), could attenuate systemic inflammatory response in patients with severe traumatic brain injury (TBI).SUBJECTS: 46 patients with severe TBI, randomised to epoprostenol (n = 23) or placebo (n = 23).TREATMENT: Epoprostenol, 0.5 ng · kg(-1) · min(-1), or placebo (saline) was given intravenously for 72 hours and then tapered off over the next 24 hours.METHODS: Interleukin-6 (IL-6), interleukin-8 (IL-8), soluble intracellular adhesion molecule-1 (sICAM-1), C-reactive protein (CRP), and asymmetric dimethylarginine (ADMA) levels were measured over five days. Measurements were made at 24 h intervals ≤24 h after TBI to 97-120 h after TBI.RESULTS: A significantly lower CRP level was detected in the epoprostenol group compared to the placebo group within 73-96 h (p = 0.04) and within 97-120 h (p = 0.008) after trauma. IL-6 within 73-96 h after TBI was significantly lower in the epoprostenol group compared to the placebo group (p = 0.04). ADMA was significantly increased within 49-72 h and remained elevated, but there was no effect of epoprostenol on ADMA levels. No significant differences between the epoprostenol and placebo groups were detected for IL-8 or sICAM-1.CONCLUSIONS: Administration of the prostacyclin analogue epoprostenol significantly decreased CRP and, to some extent, IL-6 levels in patients with severe TBI compared to placebo. These findings indicate an interesting option for treatment of TBI and warrants future larger studies.TRIAL REGISTRATION: ClinicalTrials.gov Identifier, NCT01363583.
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| 9. |
- Rodling Wahlström, Marie, 1960-, et al.
(författare)
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Subarachnoid haemorrhage induces a long-lasting increase of asymmetric dimethylarginine, ADMA, in serum
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background and Purpose: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase (NOS), inhibiting nitric oxide (NO) production and thus induces vasoconstriction and endothelial dysfunction. ADMA might therefore be involved in the cerebral vasospasm and cardiovascular complications observed after subarachnoid haemorrhage (SAH). The aim of this study was to evaluate whether ADMA was increased in subjects during the acute phase (first week) and non-acute phase (three months later) after SAH.Methods: Prospective clinical study of 20 subjects with SAH. ADMA in serum (ADMA/s) at admission was compared to sex and age matched controls. ADMA/s and ADMA in cerebrospinal fluid (ADMA/csf, from subjects with ventriculostomy) were determined by HPLC-based separation and detection.Results: There was no significant difference in ADMA/s the day after SAH (day 2) between SAH subjects and controls (0.22±0.10 vs. 0.25±0.12 µmol/L). ADMA/s increased by 68% during the first week after SAH (day 2; 0.22±0.10 vs. day 7; 0.37±0.34 µmol/L, p<0.05) and remained elevated at a three-month follow-up (0.36±0.10 µmol/L). ADMA/csf was significantly lower than ADMA/s throughout the study period.Conclusion; ADMA/s in SAH subjects increased significantly during the first week after SAH and remained elevated at a three-month follow-up. This might indicate that reduction of the available NO is involved in long-term effects after SAH.
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| 10. |
- Rodling Wahlström, Marie, et al.
(författare)
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Subarachnoid haemorrhage induces an inflammatory response followed by a delayed persisting increase in asymmetric dimethylarginine
- 2012
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Informa UK Limited. - 0036-5513 .- 1502-7686. ; 72:6, s. 484-489
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Tidskriftsartikel (refereegranskat)abstract
- Object: Subarachnoid haemorrhage (SAH) is associated with an inflammatory systemic response and cardiovascular complications. Asymmetric dimethyl arginine (ADMA), an endogenous inhibitor of nitric oxide synthase, mediates vasoconstriction and might contribute to cerebral vasoconstriction and cardiovascular complications after SAH. ADMA is also involved in inflammation and induces endothelial dysfunction.The aim of this study was to evaluate whether and how CRP (marker for systemic inflammation) and ADMA increased in patients during the acute phase (first week) after SAH. The ADMA level was also assessed in the patients in a non-acute phase (three months), and in healthy controls.Methods: Prospective study of 20 patients with aneurysmal SAH. ADMA and CRP were followed daily during the first week after SAH and a follow up sample for ADMA was obtained three months later. A single blood sample for ADMA was collected from age and sex matched healthy controls (n=40, 2 for each case).Results: CRP increased significantly from day 2; 16 (Confidence interval (CI) 10-23) mg/L to day 4; 84 (CI 47-120) mg/L, (p<0.01). ADMA increased significantly from day 2; 0.22 (CI 0.17-0.27) µmol/L, to day 7; 0.37 (CI 0.21-0.54) µmol/L, p<0.01. ADMA remained elevated at a three-month follow-up 0.36 (CI 0.31-0.42) µmol/L.ADMA in the first sample from the patients (day 1-3); 0.25 (CI 0.19-0.30) µmol/L, was not different from ADMA in matched healthy controls; 0.25 (CI 0.20-0.31), p>0.05.Conclusion: After SAH, CRP and ADMA in serum increased significantly during the first week and ADMA remained elevated three months later.
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| 11. |
- Tamás, Éva, 1968-, et al.
(författare)
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Simulation educators in clinical work : the manager's perspective
- 2020
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 34:2, s. 181-191
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Information is scarce on healthcare managers' understanding of simulation educators' impact on clinical work. Therefore, the aim of this study was to explore healthcare managers' perceptions of the significance of clinically active simulation educators for the organisation.DESIGN/METHODOLOGY/APPROACH: Healthcare managers were invited to be interviewed in a semi-structured manner. Inductive thematic analysis was used to identify and analyse patterns of notions describing the managers' perceptions of simulation educators' impact as co-workers on their healthcare organisations.FINDINGS: The identified relevant themes for the healthcare unit were: (1) value for the manager, (2) value for the community and (3) boundaries. Simulation educators were perceived to be valuable gatekeepers of evidence-based knowledge and partners in leadership for educational issues. Their most prominent value for the community was establishing a reflective climate, facilitating open communication and thereby improving the efficacy of teamwork. Local tradition, economy, logistics and staffing of the unit during simulation training were suggested to have possible negative impacts on simulation educators' work.PRACTICAL IMPLICATIONS: The findings might have implications for the implementation and support of simulation training programs.SOCIAL IMPLICATIONS: Healthcare managers appreciated both the personal value of simulation educators and the effect of their work for their own unit. Local values were prioritised versus global. Simulation training was valued as an educational tool for continual professional development, although during the interviews, the managers did not indicate the importance of employment of pedagogically competent and experienced staff.ORIGINALITY/VALUE: The study provided new insights about how simulation educators as team members affect clinical practice.
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| 12. |
- Zeng, Xulu, et al.
(författare)
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Electrical and optical evaluation of n-type doping in InxGa(1-x)P nanowires
- 2018
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Ingår i: Nanotechnology. - : IOP Publishing. - 0957-4484 .- 1361-6528. ; 29:25
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Tidskriftsartikel (refereegranskat)abstract
- To harvest the benefits of III-V nanowires in optoelectronic devices, the development of ternary materials with controlled doping is needed. In this work, we performed a systematic study of n-type dopant incorporation in dense InxGa(1-x)P nanowire arrays using tetraethyl tin (TESn) and hydrogen sulfide (H2S) as dopant precursors. The morphology, crystal structure and material composition of the nanowires were characterized by use of scanning electron microscopy, transmission electron microscopy and energy dispersive x-ray analysis. To investigate the electrical properties, the nanowires were broken off from the substrate and mechanically transferred to thermally oxidized silicon substrates, after which electron beam lithography and metal evaporation were used to define electrical contacts to selected nanowires. Electrical characterization, including four-probe resistivity and Hall effect, as well as back-gated field effect measurements, is combined with photoluminescence spectroscopy to achieve a comprehensive evaluation of the carrier concentration in the doped nanowires. We measure a carrier concentration of ∼1 ×1016 cm-3 in nominally intrinsic nanowires, and the maximum doping level achieved by use of TESn and H2S as dopant precursors using our parameters is measured to be ∼2 ×1018 cm-3, and ∼1 ×1019 cm-3, respectively (by Hall effect measurements). Hence, both TESn and H2S are suitable precursors for a wide range of n-doping levels in InxGa(1-x)P nanowires needed for optoelectronic devices, grown via the vapor-liquid-solid mode.
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| 13. |
- Ahlberg, Hans, et al.
(författare)
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Less use of rescue morphine when a combined PSP/IPP-block is used for postoperative analgesia in breast cancer surgery : A randomised controlled trial
- 2023
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Ingår i: European Journal of Anaesthesiology. - : Wolters Kluwer. - 0265-0215 .- 1365-2346. ; 40:9, s. 636-642
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Surgery for breast cancer is common, and intravenous opioids are often used to control postoperative pain. Recently, pectoralis-2 (PECS-2) block has emerged as a promising regional anaesthetic alternative. With nomenclature recently proposed, this block is termed combined PSP/IPP-block (pectoserratus plane block/interpectoral plane block).OBJECTIVE: We aimed to compare the need for postoperative rescue morphine between the intervention group that received a pre-operative combined PSP/IPP-block and a control group that received peri-operative long-acting opioids for postoperative analgesia.DESIGN: A randomised controlled study.SETTING: Operating theatres of two Swedish hospitals. The patients were recruited between May 2017 and October 2020.PATIENTS: Among the 199 women scheduled to undergo breast cancer surgery (sector resection or radical mastectomy) who were enrolled in the study, 185 were available for follow up.INTERVENTION: All patients received general anaesthesia. The intervention group received a combined PSP/IPP-block before surgery. The control group received intravenous morphine 30 min before emergence from anaesthesia.MAIN OUTCOME MEASURE: The primary endpoint was the cumulative need for intravenous rescue morphine to reach a predefined level of pain control (visual analogue scale score <40 mm) during the first 48 h after surgery.RESULTS: Data from 92 and 93 patients in the intervention and control groups, respectively, were analysed. The amount of rescue morphine administered in the 48 h after surgery was significantly lower in the intervention group than in the control group (median: 2.25 vs 3.0 mg, P = 0.021). The first measured pain score was lower in the intervention group than in the control group (35 vs. 40 mm, P = 0.035). There was no significant difference in the incidence of nausea between the groups (8.7 vs. 12.9%, P = 0.357).CONCLUSION: The use of a combined PSP/IPP-block block before breast cancer surgery reduces the need for postoperative rescue morphine, even when compared with the use of intra-operative morphine.TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03117894.
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| 14. |
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| 15. |
- Andersson, Jenny, et al.
(författare)
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Att skapa läkare i glesbygd
- 2018
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Ingår i: Allmänmedicin : tidskrift för Svensk förening för allmänmedicin. - Stockholm : Svensk förening för allmänmedicin (SFAM). - 0281-3513 .- 2001-8169. ; :3, s. 26-27
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 16. |
- Andersson, Jonas, et al.
(författare)
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Dysregulation of subcutaneous adipose tissue blood flow in overweight postmenopausal women
- 2010
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Ingår i: Menopause. - : Ovid Technologies (Wolters Kluwer Health). - 1072-3714 .- 1530-0374. ; 17:2, s. 365-371
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: A putative link between abdominal obesity and metabolic-vascular complications after menopause may be due to a decreased adipose tissue blood flow (ATBF). The present work aimed to analyze possible changes in ATBF with being overweight and menopausal and its putative link to endothelial dysfunction and autonomic nervous system balance.METHODS: Forty-three healthy women were classified into four groups according to weight and menopause status. The ATBF was measured by xenon washout while fasting and after oral glucose intake. The nitric oxide synthase inhibitor asymmetric dimethylarginine was used as a marker of endothelial function and heart rate variability-estimated autonomic nervous system activity.RESULTS: Fasting ATBF was decreased in both overweight groups (P = 0.044 and P = 0.048) versus normal-weight premenopausal women. Normal-weight and overweight postmenopausal women exhibited lower maximum ATBF compared with normal-weight premenopausal women (P = 0.015 and P = 0.001, respectively), and overweight postmenopausal women exhibited lower maximum ATBF compared with normal-weight postmenopausal women (P = 0.003). A negative correlation was found between fasting ATBF and asymmetric dimethylarginine (P = 0.015), whereas maximum ATBF was negatively associated with sympathetic-parasympathetic nervous system balance (ratio of the power of the low frequency to the power of the high frequency; P = 0.002).CONCLUSIONS: Loss of ATBF flexibility in overweight postmenopausal women may contribute to the metabolic dysfunction seen in this group of women.
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| 17. |
- Atterhem, Veronica, et al.
(författare)
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The incidence of hemodynamic and respiratory adverse events in morbidly obese presenting for Bariatric surgery
- 2018
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Ingår i: International Journal of Clinical Anesthesia and Research. - : Heighten Science. - 2640-2866. ; 2:1, s. 009-017
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Tidskriftsartikel (refereegranskat)abstract
- Context: Perioperative management of morbidly obese patients undergoing bariatric surgery is challenging. Lacking standardized perioperative protocols, complication rates may be high. This retrospective study aims to quantify the incidence of significant blood pressure decreases on induction of anesthesia and intraoperative hypoxemia, before implementation of a standardized protocol designed for bariatric surgery.Design: Retrospective, observational study.Setting: A 250-bed county hospital in northern Sweden.Subjects: 219 morbidly obese patients (body mass index > 35 kg/m2) who underwent bariatric surgery between 2003 and 2008.Main outcome measures: Incidence of systolic blood pressure (SAP) falls to less than 70% of the preoperative baseline during induction of anesthesia and incidence of perioperative hypoxemia.Results: The incidence of confirmed SAP falls to below 70% of baseline at induction of anesthesia was 56.2% (n = 123/219). This incidence rose with increasing age (p < 0.001) but not with body mass index (BMI). 3.7% (n = 8/219) of cases were marked as difficult intubations. A transient period of hypoxemia was observed in 6.8% (n = 15/219) and was more common with increasing BMI (p = 0.005). Fourteen different drug combinations were used in the study population. Of those administered an induction anesthetic drug, 72.6% (n = 159/193) were given an overdose when calculated by lean body weight, but this did not correlate significantly to SAP falls (p = 0.468).Conclusions: The incidence of a significant blood pressure fall upon induction of anesthesia was common. The incidence of airway and ventilation problems were low. Overdosing of anesthetics and excessive variation in applied anesthesia methods were found.
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| 18. |
- Bromfalk, Åsa, 1967-, et al.
(författare)
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Cardiorespiratory response to sedative premedication in preschool children : a randomized controlled trial comparing midazolam, clonidine, and dexmedetomidine
- 2023
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier. - 1089-9472 .- 1532-8473. ; 38:3, s. 454-460
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Sedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia.Design: A single-center randomized controlled trial.Methods: This is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2–6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg-1 (MID), oral clonidine 4 mcg/kg–1 (CLO), or intranasal dexmedetomidine 2 mcg/kg-1 (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period.Findings: The final cohort had 83 children (MID, n=27; CLO, n=26; DEX, n=30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P<0.001 and P=0.006, respectively). A negative correlation existed between the RSS and heart rate (HR) (r=-0.570, P<0.001). Before anesthesia induction, the respiratory rate was lowest in the DEX group (MID 21.5±1.7 min–1, CLO 20.6±2.6 min–1, DEX 20.2±1.7 min–1; P=0.042). The HR was lower in the CLO and DEX groups than in the MID group (MID, 102.8±10.0 min–1; CLO, 87.4±9.6 min–1; DEX, 87.6±7.9 min–1; P<0.001). The HR was lower immediately after induction (P=0.009) and intraoperatively (P=0.025) in the CLO and DEX groups than in the MID group.Conclusions: When used as premedication before propofol/remifentanil anesthesia, clonidine and dexmedetomidine provided deeper preoperative sedation compared to midazolam. From a clinical perspective, all three study drugs provided essentially stable cardiovascular and respiratory conditions during the entire perioperative period.
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| 19. |
- Bromfalk, Åsa, 1967-
(författare)
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Intervention for prevention : easing children’s preoperative anxiety
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Preoperative anxiety in children is associated with several adverse outcomes and consequences that can have a negative impact on the perioperative outcome and delay recovery. Anxiety can cause stress-induced cardiorespiratory instability, increased postoperative pain, nausea, emergence delirium, and long-term behavior changes. The ideal premedication for children is still debated. Only a few studies have examined the use of premedication in relation to total intravenous anesthesia (TIVA), and there is also a lack of studies exploring staff’s experiences of premedication. The aim of this thesis was to compare midazolam (a benzodiazepine), clonidine, and dexmedetomidine (a2-agonists) given as premedication to preschool children, regarding anxiety, cardiorespiratory response to sedation, time to postoperative recovery, posthospital negative behavior changes (NBCs), and staff’s experiences of the interventions.Methods: In a randomized clinical trial, 90 children aged 2–6 years, scheduled for TIVA and ear, nose, and throat surgery, were randomized to one of three groups, receiving midazolam 0.5 mg/kg, clonidine 4 mg/kg, or dexmedetomidine 2 mg/kg. The children were included at a 200-bed county hospital in northern Sweden and observed with validated tools from the day of surgery until two weeks postoperatively (Studies I–IV). To explore the clinical aspects, we conducted focus group interviews to elicit perioperative staff’s experiences of the studied interventions and analyzed the data with qualitative content analysis (Study V). Results: Midazolam reduced preoperative anxiety and provided perioperative cardiorespiratory stability. Clonidine and dexmedetomidine provided deeper sedation along with a minor decrease in heart rate. Some children, mainly from the clonidine group, awoke during the preoperative preparation, triggering anxiety, while the midazolam group remained conscious, calm, and cooperative. Postoperatively, the midazolam group emerged earlier from anesthesia compared to the two a2-agonist groups. However, the midazolam group had more episodes of postoperative anxiety, delirium, and pain compared to both groups receiving a2-agonists, and the overall recovery and discharge time from the post-anesthesia care unit was thus the same for all groups. The posthospital study showed at least one NBC in half of the children during the first two weeks after surgery. The staff’s experiences of premedication could be summarized in three themes: a matter of time, covering the efforts of building trust along with timing the administration and onset; don’t wake the sleeping bear, covering the challenge of maintaining sleep in the sleeping child in order to avoid a backlash if woken; and on responsive tiptoes, covering safety precautions and ethical perspectives on the interventions.Conclusion: The different premedications varied in their ability to reduce anxiety and to induce sleep, and this manifested itself throughout the perioperative process. Short-acting midazolam reduced preoperative anxiety but did not provide adequate sleep, and early postoperative emergence occasionally caused a rise in adverse symptom intensification. The long-lasting and sleep-inducing a2-agonists showed an unsatisfactory anxiolytic effect in comparison to midazolam. The sleep was superficial, and an awakening risked triggering anxiety. The staff strove to keep the sedated child asleep, and the recovery time was better and more peaceful when the children slept for a long time postoperatively. However, despite a calm perioperative process, one in two children presented with posthospital NBC. At the doses used in this study, all these premedications seem to be safe in cardiorespiratory terms, and the decision of which one to use should be tailored by individual and time.
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| 20. |
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| 21. |
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| 22. |
- Bromfalk, Åsa, 1967-, et al.
(författare)
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Postoperative recovery in preschool‐aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine
- 2023
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Ingår i: Pediatric Anaesthesia. - : John Wiley & Sons. - 1155-5645 .- 1460-9592. ; 33:11, s. 962-972
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPreoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol-remifentanil anesthesia have not been studied in preschool-aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2–6 years.MethodsIn this prespecified secondary analysis of a double-blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 μg/kg, or intranasal dexmedetomidine 2 μg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured.ResultsAfter excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups.ConclusionsNo statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2-agonists had a better recovery profile than short-acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.
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| 23. |
- Bromfalk, Åsa, 1967-, et al.
(författare)
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Preoperative anxiety in preschool children : A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine
- 2021
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Ingår i: Pediatric Anaesthesia. - : John Wiley & Sons. - 1155-5645 .- 1460-9592. ; 31:11, s. 1225-1233
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Anxiety in pediatric patients may challenge perioperative anesthesiology management and worsen postoperative outcomes. Sedative drugs aimed to reducing anxiety are available with different pharmacologic profiles, and there is no consensus on their effect or the best option for preschool children. In this study, we aimed to compare the effect of three different premedications on anxiety before anesthesia induction in preschool children aged 2-6 years scheduled for elective surgery. The secondary outcomes comprised distress during peripheral catheter (PVC) insertion, compliance at anesthesia induction, and level of sedation.Patients and methods: In this double-blinded randomized clinical trial, we enrolled 90 participants aged 2-6 years, who were scheduled for elective ear-, nose-and-throat surgery. The participants were randomly assigned to three groups: those who were administered 0.5 mg/kg oral midazolam, 4 µg/kg oral clonidine, or 2 µg/kg intranasal dexmedetomidine. Anxiety, distress during PVC insertion, compliance with mask during preoxygenation, and sedation were measured using the modified Yale Preoperative Anxiety Scale, Behavioral Distress Scale, Induction Compliance Checklist, and Ramsay Sedation Scale, respectively.Results: Six children who refused premedication were excluded, leaving 84 enrolled patients. At baseline, all groups had similar levels of preoperative anxiety and distress. During anesthesia preparation, anxiety was increased in the children who received clonidine and dexmedetomidine; however, it remained unaltered in the midazolam group. There were no differences in distress during PVC insertion or compliance at induction between the groups. The children in the clonidine and dexmedetomidine groups developed higher levels of sedation than those in the midazolam group.Conclusions: In preschool children, midazolam resulted in a more effective anxiolysis and less sedation compared to clonidine and dexmedetomidine.
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| 24. |
- Carson, Dean, et al.
(författare)
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Umeå University's proposed "Rural Stream" : An effective alternative to the longitudinal integrated clerkship model for small rural communities?
- 2020
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Ingår i: Education for Health. - : Wolters Kluwer. - 1357-6283 .- 1469-5804. ; 33:1, s. 3-7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Umeå University Faculty of Medicine (UUFM), Sweden, has a regionalized medical program in which students spend the final 2½ years of their undergraduate degree in district hospitals. In late 2018, UUFM started a "rural stream" pilot exposing students to smaller rural locations.Methods: The objectives are to deliver the benefits for medical education and rural workforce development that have been observed in longitudinal integrated clerkships (LICs) while maintaining consistency between learning experiences in the main campus, regional campuses, and rural locations. This article compares the UUFM rural stream with those typical of the LICs described in the medical education literature. Comparisons are made in terms of the four key criteria for LIC success, and additional characteristics including peer and interprofessional learning, "'continuity," and curriculum development.Results: The rural stream has elements of length, immersion, position in the degree program, and community engagement that are both similar to, and different from, LICs. Key challenges are to ensure that participating students create close relationships with host medical facilities and communities. The rural stream also has some potential advantages, particularly in relation to team learning.Discussion: Alternatives to the LIC rural stream model as typically described in the literature may be required to allow for immersive medical education to occur in smaller rural communities and to be suitable for medical schools with more traditional approaches to education.
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| 25. |
- Claesson, Jonas, et al.
(författare)
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Intestinal circulation, oxygenation and metabolism is not affected by oleic acid lung injury.
- 2005
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Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 25:6, s. 357-363
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Tidskriftsartikel (refereegranskat)abstract
- This study was performed to establish a platform for further studies on effects of ventilatory treatment modalities on the intestines during mechanical ventilation of acute lung injury (ALI). We tested the hypotheses that oleic acid (OA) infusion causes changes in intestinal circulation, oxygenation and metabolism, and that OA is distributed to tissues outside the lung. This was performed as an experimental, prospective and controlled study in an university animal research laboratory. Thirteen juvenile anaesthetized pigs were used in the main study, where seven were given an intravenous infusion of 0.1 ml kg(-1) OA and six served as control (surgery only). In a separate study, four animals were given an intravenous infusion of 0.1 ml kg(-1) (3)H-labelled OA. We measured systemic and mesenteric (portal venous blood flow, jejunal mucosal perfusion) haemodynamic parameters, mesenteric oxygenation (jejunal tissue oxygen tension) and systemic cytokines (tumour necrosis factor-alpha and interleukin-6). We calculated mesenteric lactate flux and mesenteric oxygen delivery, uptake and extraction ratio. In the animals given 3H-OA, we measured 3H-OA in different tissues (lungs, heart, liver, kidney, stomach, jejunum, colon and arterial blood). We found that OA given intravenously is distributed in small amounts to the intestines. This intestinal exposure to OA does not cause intestinal injury when evaluating mesenteric blood flow, metabolism or oxygenation. OA infusion induced a moderate increase in mean pulmonary arterial pressure and a decrease in PaO2/Fraction inspired O2 (P/F) ratio, giving evidence of severe lung injury. Consequently, the OA lung injury model is suitable for studies on intestinal effects of ventilatory treatment modalities during mechanical ventilation of ALI.
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| 26. |
- Edelbring, Samuel, et al.
(författare)
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Medicinpedagogisk forskning krävs för utveckling av läkarutbildningen
- 2023
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Ingår i: Lakartidningen. - 0023-7205. ; 120
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Tidskriftsartikel (refereegranskat)abstract
- To secure high-quality education for healthcare professionals, the teaching and learning processes-the "how" in education-should be informed by a research base. Although Swedish medical education research is growing, it lacks a national strategy. This study analysed and compared Swedish and Dutch production of medical education articles over ten years in nine core journals, including the number of editorial board members. During the period 2012-2021, Swedish authors produced 217 articles, whereas Dutch authors published 1,441. The journals had 466 board members, of which 31 (7%) were Dutch and four (<1%) Swedish. The results show that medical education in Swedish medical faculties requires improvement. To ensure high-quality education opportunities, we propose a national effort to strengthen the educational research base, using the Dutch effort as inspiration.
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| 27. |
- Edelbring, Samuel, et al.
(författare)
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Svensk medicinpedagogisk forskningsproduktion och förutsättningar för tillämpning för kvalitet och innovation
- 2023
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Konferensbidrag (refereegranskat)abstract
- Bakgrund: Beslut och metoder inom hälso- och sjukvården bygger på vetenskaplig grund vilket förutsätter en forskningsbas. Inom detta område är svensk vetenskaplig produktion och tillämpning relativt stark, däremot ser vi inte motsvarande styrka i kunskapsbasen för utbildningsuppdraget. I diskussionen om utbildningens forskningsförankring är det vanligtvis innehållet som avses eller kontakt med aktiva forskare, mer sällan hur utbildningen bör utformas för att stödja lärande eller förutsättningarna för lärarskicklighet.Det saknas inte forskning inom området, på den internationella arenan ser vi en växande högskolepedagogisk forskningsproduktion med medicin och hälsa som kontext, sk. medicinsk pedagogik. Däremot finns anledning att uppmärksamma från vilken kontext forskningen kommer och förutsättningarna att omsätta den till kvalitet och innovation i utbildningarna. Merparten av fältets forskningsproduktion kommer från USA, UK, Canada och Australien (Thomas, 2019). Den internationella prägeln på kunskapsbasen är inte alltid optimal för implementering i svenska förhållanden då resultaten och slutsatser är dragna från en kontext som i flera avseenden skiljer sig från vår. Förutom tillgång till forskning behövs möjligheter att ta del av den och omsätta till godo för utbildningen. Europeiska lärare anser inte att ny forskning når deras arbetsgrupper i någon hög utsträckning (Thomas et al., 2019). Medicinskt skolade lärare är ofta ovana vid den högskolepedagogiska forskningsgenren som evidensgrund (Kneebone, 2002). Nederländerna, som är mer befolkat än Sverige men har snarligt antal läkarutbildningar samt likartade förhållanden för högre utbildning, har satsat på en medicinpedagogisk utveckling som givit avtryck i fältet.Syftet med denna studie är att undersöka svensk forskningsproduktion inom det medicinpedagogiska området samt att föreslå en förstärkning av förutsättningar för denna produktion och dess tillämpning i utbildningar för medicin och hälsa.Metod: Författarna är pedagogiska aktörer vid tre medicinska fakulteter och har granskat svensk och nederländsk kunskapsproduktion för medicinsk pedagogik och aspekter av dess tillämpning. En bibliometrisk analys genomfördes av antal svenska och nederländska publikationer i 9 etablerade medicinpedagogiska tidskrifter för åren 1995-2021. Svenska affilieringar och finansieringskällor samt antal svenskar i tidskriftsredaktionerna analyserades också. Tidskrifterna var Medical education, Medical teacher, BMC medical education, Advances in health sciences education, Academic medicine, Perspectives on medical education, Anatomical sciences education, Teaching and learning in medicine samt International journal of medical education. Förutsättningar för forskning i medicinsk pedagogik identifierades genom sökningar på medicinska fakulteternas hemsidor samt på respektive lärosätes forskningsämnen/institutioner/forskargrupper. Resultat: Under tioårsperioden 2012–2021 publicerades 17 013 artiklar i dessa tidskrifter varav 1 441 från Nederländerna och 217 från Sverige. Nederländska publikationer ökade dramatiskt i det längre perspektivet för att plana ut till en hög produktion med 117–187 årliga publikationer under perioden, medan svenska publikationer ökade makligt till 16–33 årliga publikationer. Samtliga svenska medicinska fakulteter bidrog till produktionen, men andelen från KI dominerade. Tidskrifternas redaktioner bestod sammanlagt av 466 personer varav 31 (7%) nederländare och fyra svenskar (<1%). Organisatoriskt stöd till pedagogisk forskningsanknytning finns på alla medicinska fakulteter men i de flesta fall som en del av universitetets pedagogiska utveckling, inte anpassat till professionsutbildningar inom medicin och hälsa.Diskussion och slutsats: Forskningsbaserad kunskap bör vägleda utbildningarna, och eget forskningsengagemang i fältet skapar omdöme i utveckling och strategiska beslut. Hög forskningsproduktion är inte per se ett kvalitetsmått på utbildningarna, dock är det rimligt att anta att en satsning på produktion avspeglas i högre pedagogisk medvetenhet och säkrare beslutsunderlag i såväl fakultets- och kursledningar som hos lärare och handledare. En stark produktion och engagemang skapar delaktighet i det internationella forskarsamhället som vi både kan lära av och bidra i. Nederländerna har visat att även ett europeiskt land kan göra avtryck i fältet (Doja et al., 2014). Vi föreslår specifika svenska satsningar för en hållbar kvalitetssäkring och innovationskraft.
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| 28. |
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| 29. |
- Fahlgård Lahache, Anna, et al.
(författare)
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Organizational Identity Formation under Hybridity Inelasticity: The Case of a Digital Public Agency "Startup"
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Organizations increasingly hybridize as a response to external competing demands and expectations. In doing so, they develop more complex and contested hybrid identities. Identity elasticity – an organizations ability to adapt its identity boundaries – is a key aspect of shaping and sustaining such hybrid identities, yet less is known about this process when elasticity is restricted. To understand organizational identity formation under less elastic conditions, we followed a public agency for digital government from inception over 3.5 years. We traced identity unfolding in an organization where opposing organizing principles of Bureaucracy and Openness clashed and there was no opting-out from that hybridity. Our empirically grounded model show how hybrid identity is formed in cases of limited adaptability. This process is characterized by mission complexity, tensions, and externally imposed shifts in resource allocations. Our model provides direct implications for research on hybridity, organizational identity formation and identity (in)elasticity.
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| 30. |
- Fahlgård-Lahache, Anna, et al.
(författare)
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Organizational Identity Formation Under Hybridity Unawareness and Inelasticity
-
Ingår i: Academy of Management Annual Meeting Proceedings. - 2151-6561 .- 0065-0668. ; 2022:1
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Konferensbidrag (refereegranskat)abstract
- The formation of organizational identity for new types of government agencies are especially challenging due to their institutional context. Drawing on in-depth longitudinal data from the first 2.5 years of an agency for digital government, we induce an empirically grounded model of how organizational identity is formed when hybridity is pre-defined and inelastic due to strict institutional boundaries. In this process study, our findings run counter to prevailing models of organizational identity formation who proposes a convergent process of dual logics, that through the enactment of practice experimentation end up with a blended identity. Instead, we found an organization that was assigned hybridity from the start by mission duality, with no way to escape the tension it brought with it due to the inelasticity provided by the institutional context. Our findings showed a divergent process emerging from an initial unawareness of hybridity and ending with structural separation. Our theoretical model of organizational identity formation in unaware hybrids has a number of direct implications for ongoing research on elasticity in hybrid organizations and organizational identity formation.
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| 31. |
- Gottfridsson, Peter, et al.
(författare)
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Left atrial contraction strain and controlled preload alterations, a study in healthy individuals
- 2022
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Ingår i: Cardiovascular Ultrasound. - : BioMed Central. - 1476-7120. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In order to assess left atrial contractile function in disturbed circulatory conditions, it is necessary to have a clear understanding of how it behaves in a normal resting state with changes in loading conditions. However, currently the understanding of this relationship is incomplete. We hypothesize that in healthy individuals, left atrial contraction strain and its peak strain rate are increased or decreased by increasing or decreasing preload, respectively.METHODS: Controlled maneuvers used to change preload included continuous positive airway pressure by mask (CPAP 20 cmH2O) for preload decrease, and passive leg raise (15 degrees angle) for preload increase. Cardiac ultrasound 4-chamber views of the left atria and left ventricle were acquired at baseline and during maneuver. Acquired images were post processed and analyzed offline. Comparisons were made using paired t-test and means with 95% confidence interval.RESULTS: There were 38 participants, complete results were obtained from 23 in the CPAP maneuver and 27 in the passive leg raise maneuver. For the CPAP group, left atrial contraction strain was 11.6% (10.1 to 13.1) at baseline and 12.8% (11.0 to 14.6) during the maneuver (p = 0.16). Left atrial contraction peak strain rate was - 1.7 s- 1 (- 1.8 to - 1.5) at baseline and - 1.8 s- 1 (- 2.0 to - 1.6) during the maneuver (p = 0.29). For the passive leg raise-group, left atrial contraction strain was 10.1% (9.0 to 11.2) at baseline and 10.8% (9.4 to 12.3) during the maneuver (p = 0.28). Left atrial contraction peak strain rate was - 1.5 s- 1 (- 1.6 to - 1.4) at baseline and - 1.6 s- 1 (- 1.8 to - 1.5) during the maneuver (p = 0.29). Left atrial area, an indicator of preload, increased significantly during passive leg raise and decreased during CPAP.CONCLUSION: In healthy individuals, left atrial contraction strain and its peak strain rate seem to be preload-independent.TRIAL REGISTRATION: The study was 2018-02-19 registered at clinicaltrials.gov ( NCT03436030 ).
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| 32. |
- Gottfridsson, Peter, et al.
(författare)
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Left atrial contraction strain during a Valsalva manoeuvre : A study in healthy humans
- 2023
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Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 43:3, s. 165-169
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cardiac mechanics are influenced by loading conditions as well as sympathetic tone. Left atrial (LA) contractile function assessed by two-dimensional (2D) strain has been described in the setting of controlled preload alterations; however, studies show conflicting findings about change or direction of change. We hypothesized that the controlled preload reduction and the sympathetic nervous system activation that occurs during a standardized Valsalva manoeuvre would bring about a change in LA contraction strain.aMETHODS: Healthy young adults of both sexes were recruited. Transthoracic echocardiographic ultrasound images were collected before and during a Valsalva manoeuvre. Standard imaging windows for LA strain assessment were used and the images were copied and stored for later offline analysis. These were assessed for adequate atrial wall visualization in 2D strain assessment. Paired comparisons were carried out using Student's T test.RESULT: Thirty-eight participants were included and there were 22 complete studies with paired pre- and during Valsalva manoeuvre. LA contraction strain at baseline was 10.5 ± 2.8% (standard deviation) and during the Valsalva manoeuvre 10.6 ± 4.6%, p = 0.86.CONCLUSION: The Valsalva manoeuvre, a combination of preload reduction and sympathetic nervous system activation, seems not to be associated with a change in LA contraction strain in healthy young individuals. LA contraction strain should be interpreted in the context of both atrial loading conditions and prevailing autonomic nervous system activity.
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| 33. |
- Gummesson, Christina, et al.
(författare)
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Entrustable professional activities (EPAs) for undergraduate medical education : development and exploration of social validity
- 2023
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Ingår i: BMC Medical Education. - : BioMed Central (BMC). - 1472-6920. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders.Aim: The aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs.Method and material: In a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater’s perception of the present graduates’ required level of supervision when performing the activity. Free-text comments were also included and analyzed.Results: Ten Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as “important” by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported “independent”. The three themes of the free text comments were: ‘relevant target areas and content’; ‘definition of the activities’; and ‘clinical practice and learning’.Conclusion: Ten Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.
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| 34. |
- Göransson, Markus Balázs, Assistant Professor, 1984-, et al.
(författare)
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‘The phone means everything.’ : Mobile phones, livelihoods and social capital among Syrian refugees in informal tented settlements in Lebanon
- 2020
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Ingår i: Migration and Development. - : Informa UK Limited. - 2163-2324 .- 2163-2332. ; 9:3, s. 331-351
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Tidskriftsartikel (refereegranskat)abstract
- This study explores the role of mobile phones in livelihood creation among Syrian refugees in informal tented settlements in Akkar Governorate and the Bekaa Valley in Lebanon. Drawing on forty-five interviews with Syrian refugees and ten interviews with aid workers, the study highlights the importance of mobile phones in reviving, maintaining and leveraging social capital for the purpose of securing livelihoods in a context of precarity and restricted movement. We find that mobile phones offer important means for reviving social networks in exile, managing supportive relationships that have been established in Lebanon and liaising with employers. As such, they constitute important tools for coping with a context shaped by legal exclusion, restricted movement, police harassment, decentralised aid provision and a geographical dispersal of support networks, even as they remain a costly investment with uncertain returns.
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| 35. |
- Haggren, Tuomas, et al.
(författare)
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InP nanowire p-type doping via Zinc indiffusion
- 2016
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Ingår i: Journal of Crystal Growth. - : Elsevier BV. - 0022-0248. ; 451, s. 18-26
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Tidskriftsartikel (refereegranskat)abstract
- We report an alternative pathway for p-type InP nanowire (NW) doping by diffusion of Zn species from the gas phase. The diffusion of Zn was performed in a MOVPE reactor at 350–500 °C for 5–20 min with either H2 environment or additional phosphorus in the atmosphere. In addition, Zn3P2 shells were studied as protective caps during post-diffusion annealing. This post-diffusion annealing was performed to outdiffuse and activate Zn in interstitial locations. The characterization methods included photoluminescence and single NW conductivity and carrier concentration measurements. The acquired carrier concentrations were in the order of >1017 cm−3 for NWs without post-annealing, and up to 1018 cm−3 for NWs annealed with the Zn3P2 shells. The diffused Zn caused redshift to the photoluminescence signal, and the degree of redshift depended on the diffusion process.
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| 36. |
- Halliday, T. A., et al.
(författare)
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Post-operative nausea and vomiting in bariatric surgery patients : an observational study
- 2017
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Ingår i: Acta Anaesthesiologica Scandinavica. - Hoboken : Wiley-Blackwell. - 0001-5172 .- 1399-6576. ; 61:5, s. 471-479
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Tidskriftsartikel (refereegranskat)abstract
- Background: The risk of post-operative nausea and vomiting (PONV) in patients undergoing bariatric surgery is unclear. The aim of the study was to investigate the risk of PONV and the use and effectiveness of PONV prophylaxis.Methods: This prospective observational study included 74 patients undergoing bariatric surgery with total intravenous anaesthesia. Patients were given PONV prophylaxis based on published guidelines and a simplified PONV risk score. Perioperative data were collected and a questionnaire was used at 2, 4, 6, 24, 48 and 72 h after the operation to evaluate PONV. Data are presented as risk (%) with the 95% confidence interval.Results: Sixty five per cent (54-75) of the patients experienced PONV in the first 24 post-operative hours and the risk increased with the number of risk factors for PONV. PONV occurred in 78% (66-87) of women and 26% (12-49) of men during the first 24 h. In relation to the guidelines, one patient received suboptimal PONV prophylaxis, 23% received optimal prophylaxis and 76% supra-optimal prophylaxis. The risk of PONV was 82% (59-94) with optimal prophylaxis and 59% (46-71) with supra-optimal prophylaxis. Of all patients, 34% (24-45) experienced severe PONV in the first 24 h that limited their activity.Conclusions: The incidence of PONV in bariatric surgery patients was high despite a PONV prophylaxis regime following current guidelines. These results cast doubt as to the effectiveness of the usual PONV prophylaxis in this patient group and point to the need for further investigation of PONV prophylaxis and treatment in bariatric surgery patients.
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| 37. |
- Hultin, Hella, et al.
(författare)
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Cholecalciferol Injections Are Effective in Hypovitaminosis D After Duodenal Switch : a Randomized Controlled Study
- 2018
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 28:10, s. 3007-3011
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Tidskriftsartikel (refereegranskat)abstract
- Background: By treating obesity, one of the major epidemics of this past century, through bariatric surgery, we may cause complications due to malnourishment in a growing population. At present, vitamin D deficiency is of interest, especially in patients with inferior absorption of fat-soluble nutrients after biliopancreatic diversion with duodenal switch (BPD/DS).Methods: Twenty BPD/DS patients, approximately 4 years postoperatively, were randomized to either intramuscular supplementation of vitamin D with a single dose of 600,000 IU cholecalciferol, or a control group. Patients were instructed to limit their supplementation to 1400 IU of vitamin D and to avoid the influence of UV-B radiation; the study was conducted when sunlight is limited (December to May).Results: Despite oral supplementation, a pronounced deficiency in vitamin D was seen (injection 19.3; control 23.2 nmol/l) in both groups. The cholecalciferol injection resulted in elevated 25[OH]D levels at 1 month (65.4 nmol/l), which was maintained at 6 months (67.4 nmol/l). This resulted in normalization of intact parathyroid hormone (PTH) levels. No changes in vitamin D or PTH occurred in the control group.Conclusions: In BPD/DS patients, having hypovitaminosis D despite full oral supplementation, a single injection of 600,000 IU of cholecalciferol was effective in elevating vitamin D levels and normalizing levels of intact PTH. The treatment is simple and highly effective and thus recommended, especially in cases of reduced UV-B radiation.
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| 38. |
- Hultin, Hella, et al.
(författare)
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Left-Shifted Relation between Calcium and Parathyroid Hormone in Obesity
- 2010
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 95:8, s. 3973-3981
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Tidskriftsartikel (refereegranskat)abstract
- Background: A condition resembling secondary hyperparathyroidism (HPT), including raised levels of PTH and normal levels of serum calcium, has been reported in obesity. A plausible reason may be vitamin D deficiency, but conflicting data have been reported. Objective: Our objective was to investigate calcium homeostasis in obese individuals with emphasis on the function of the parathyroid glands. Design and Intervention: Morbidly obese patients (mean body mass index = 46.6 +/- 6) were examined for their status of calcium homeostasis. A subset was thoroughly investigated with calcium-citrate (CiCa) clamping. Patients: Of 108 morbidly obese patients, 11 underwent CiCa clamping as well as 21 healthy volunteers of normal weight and 15 with primary HPT (pHPT). Large patient cohorts of normal individuals and pHPT patients were also used as comparisons. Outcome Measures and Results: All obese individuals had normal serum calcium and creatinine levels. Mean levels of 25-OH-vitamin D-3 in serum were low, 53 nmol/liter (reference range 75-250 nmol/liter). Mean intact plasma PTH was 5.1 pmol/liter (reference range 1.1-6.9 pmol/liter). There was a significant positive correlation between PTH and duration of obesity. CiCa clamping in obese subjects revealed a remarkably high sensitivity for calcium and a left-shifted relation between plasma calcium and PTH (set point) compared with the normal population. CiCa clamping in pHPT patients demonstrated a right-shifted PTH-Ca curve. Conclusion: Although vitamin D levels in the obese individuals were low, few displayed overt signs of secondary HPT. The CiCa clamping implied a disturbance in the calcium homeostasis comparable to early renal insufficiency, with a left-shifted Ca-PTH curve and a lower set point compared with the normal population.
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| 39. |
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| 40. |
- Hultin, Lotta, et al.
(författare)
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Displacement, Marginalization and Identity: A Performative Perspective on Identity Re-construction amongst Refugees in Tented Settlements
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The notion of identity has acquired particular importance in studies of organizing within an increasingly fragmented, discontinuous and crisis-ridden world (Brown 2001: p. 113; Brown & Toyoki, 2013; Brown, 2015; Tomlinson & Egan, 2002; Ybema et al., 2009). Considering this bourgeoning field of research, it is striking that perhaps the most poignant micro-level manifestation of fragmentation, discontinuity and crisis today, namely the life and living of the many refugees forced to leave behind their families, friends, jobs, lives and, consequently, their sources of identification, remains understudied by organizational scholars (Binggeli et al., 2013). Through a qualitative study of the everyday life of Syrian refugees in tented settlements in Lebanon, this article aims to shed light on the practices (Feldman & Orlikowski 2011; Nicolini, 2012) through which the refugees, despite their marginalization and exclusion, are able to (re-)construct themselves as subjects, and thus as worthy of respect and dignity. Since the outbreak of the Syrian war, the UNHCR has registered over one million Syrian refugees in Lebanon, making the country the single largest recipient of refugees per capita in the world (World Bank, 2016). The vast majority of these refugees organize their lives outside of the purview of the Lebanese state. They are (if at all) granted only short-term residency permits, and on government orders, the UNHCR has since May 2015 suspended registration of new refugees. With little support forthcoming, they have to arrange their own accommodation, often consisting of makeshift tents erected on plots of land rented from rural landlords. They have access only to menial, temporary and low-paying jobs and in many cases depend on aid from humanitarian organizations. They carry traumas from war, terror and loss, face deep uncertainty, and harbor anxiety about their children’s upbringing and prospects under these precarious conditions. How do these refugees create a sense of meaning, self-worth and dignity? How does one live a life in which the “I” is not recognized by authorities and has no legitimate voice? A life in which means and resources to make claims to one’s rights and take actions that disrupt the field of power (Butler, 2009) are not available? This article aims to answer these questions by focusing on the everyday practices in the tented settlements through which agency and possibilities of becoming enacted as a legitimate subject are simultaneously restricted and enabled. More specifically, we draw on Judith Butler’s ideas on how performativity is linked with precarity through the question of “who can become produced as a recognizable subject, a subject who is living, whose life is worth sheltering and whose life, when lost, would be worthy of mourning” (Butler, 2009, xii). Based on forty-five interviews with Syrian refugees and their families on site in ten tented settlements, as well as observations in these settlements over a period of several weeks, our paper reports how the refugees, reduced to the basic functions of the reproduction of life—that is, finding food, creating shelter, getting clothes, having and rearing offspring, and so on—insist on their right to be an ‘I’ through the enactment of mundane everyday socio-material practices. We thus provide an account of how, in Butler’s terms, “the unspeakable population speak and makes its claims” (Butler, 2009, xiii). In our analysis, we highlight four different socio-material practices: the practice of caring and connecting, the practice of inviting/hospitality, the practice of play, humor and learning, and the practice of remembering and (re-)inventing the past. We show how, in all these practices the refugee becomes positioned (Butler, 1993) in relation to other humans, organizations, communities and institutions in ways that enables her to speak as an ‘I’ and to claim an individual identity beyond the passive, victimized collective identity of the refugee. Moreover, we show how the agency that makes these claims on identity does not belong to the human, the refugee, alone, but is rather enacted in socio-material practices. In these practices, smartphones, and specifically the smartphone apps WhatsApp, Facebook, and Google Translate, are important as they position the refugees in particular ways in relation to other refugees, their home in Syria, family and friends, local volunteers, aid organizations, the Lebanese state and its people, and the wider international political context. By assuming a performative practice perspective (Butler, 1993; Feldman & Orlikowski 2011; Nicolini, 2012) this study responds to recent critique of the tendency to center the human as the primary agent capable of making sense of complex organizational or institutional environments (Monteiro & Nicolini, 2015; Gawer and Phillips, 2013; Thornton, Ocasio, & Lounsbury, 2012), resisting change or oppression (Harding et al., 2017), and performing identity work (Bardon et al., 2012; Paring et al., 2017; Symon & Prichard, 2015; Hultin & Introna, 2017). The study thus contributes to the vibrant stream of organizational research that aims to move beyond an understanding of identity construction as a more or less rational human endeavor achieved through talk and narratives, and towards an understanding of the performative processes through which subjects become positioned to think and act the way they do (Butler, 1993). Specifically, studying the struggle of vulnerable groups living under precarious conditions through Butler’s conception of performativity enables us to move beyond a dualistic enactment of power and resistance, agency and structure, oppression and empowerment, and human and inhuman. Our account shows how refugees become positioned as legitimate and respectable not in spite of their precarious and vulnerable situation, but through it. In the enactment of the four practices outlined above, we show how vulnerability can be understood, not as a condition restricting identity formation practices, but as generative of new practices, repositioning subjects in relation to significant others, and reproductive of agency and alternative subject positions. We discuss what implications this understanding of vulnerability has for our view of responsibility and suggest that it is through our exposure and dependency that we not only become recognized as subjects, but can register the other as someone to whom we are responsible.
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| 41. |
- Hultin, Lotta, et al.
(författare)
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How practice makes sense in healthcare operations: Studying sensemaking as performative, material-discursive practice
- 2017
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Ingår i: Human Relations. - : SAGE Publications (UK and US) / Springer Verlag (Germany). - 1741-282X .- 0018-7267. ; 70:5, s. 566-593
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Tidskriftsartikel (refereegranskat)abstract
- This article aims to move sensemaking theory forward by exploring a post-humanist view of how sense is made in material-discursive practices. Answering recent calls for novel theoretical views on sensemaking, we adopt a relational ontology, assuming subject and object to be ontologically entangled, and viewing agency as a circulating flow through material-discursive practices. Employing this perspective, we study how sensemaking unfolds at the emergency ward of a Nordic university hospital. By working through the concepts of material-discursive practices, flow of agency and subject positions, we produce an account of sensemaking that decenters the human actor as the locus and source of sensemaking, and foregrounds the performativity of practices through which certain ways of acting become enacted as sensible. This allows us to propose an alternative to the traditional view of sensemaking as episodic, cognitive-discursive practices enacted within and between separate human actors. With this view, what makes sense is understood as a material-discursive practice and related subject positions, which owing to their specific positioning in the circulating flow of agency emerge as sensible. Consequently, every actor is not just making sense, but is also already being made sense of; positioning and being positioned in the flow of agency. © 2016, © The Author(s) 2016.
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| 42. |
- Hultin, Lotta, et al.
(författare)
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Precarity, Hospitality, and the Becoming of a Subject That Matters : A Study of Syrian Refugees in Lebanese Tented Settlements
- 2022
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Ingår i: Organization Studies. - : SAGE Publications. - 0170-8406 .- 1741-3044. ; 43:5, s. 669-697
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Tidskriftsartikel (refereegranskat)abstract
- How is it possible to gain a sense that you have a voice and that your life matters when you have lost everything and live your life as a ‘displaced person’ in extreme precarity? We explore this question by examining the mundane everyday organizing practices of Syrian refugees living in tented settlements in Lebanon. Contrasting traditional empirical settings within organization studies where an already placed and mattering subject can be assumed, our context provides an opportunity to reveal how relations of recognition and mattering become constituted, and how subjects in precarious settings become enacted as such. Specifically, drawing on theories on the relational enactment of self and other, we show how material-discursive boundary-making and invitational practices – organizing a home, cooking and eating, and organizing a digital ‘home’ – function to enact relational host/guest subject positions. We also disclose how these guest/host relationalities create the conditions of possibility for the enactment of a subject that matters, and for the despair enacted in everyday precarious life to transform into ‘undefeated despair’.
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| 43. |
- Hultin, Lotta, et al.
(författare)
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The decentered translation of management ideas: Attending to the conditioning flow of everyday work practices
- 2021
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Ingår i: Human Relations. - : SAGE Publications (UK and US) / Springer Verlag (Germany). - 1741-282X .- 0018-7267. ; 74:4, s. 587-620
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Tidskriftsartikel (refereegranskat)abstract
- Based on a study of Lean management practices at the Swedish Migration Board, we develop a novel theoretical understanding of the translation of management ideas. We show how translation, rather than being reduced to a network of human intentions and actions governing the transformation of organizational practices, can instead be understood as a historically contingent, situated flow of mundane everyday work practices through which social and material translators simultaneously become translated, conditioned to be and act in certain ways. We show how prior actor-centric accounts of translation of management ideas can be understood as performative consequences of a conceptual vocabulary inherited from Callon and Latour. Contrasting this, the non-actor-centric vocabulary of social anthropologist Tim Ingold allows us to background the intentional human actor and foreground the flow of mundane, situated practices. In adopting this vocabulary, we capture how the flow of practices conditions subjects and objects to become enacted as well as act, and develop an understanding of translation as occurring within, rather than distinct from, these practices. In essence, our novel view of translation emphasizes how management ideas are radically unstable, and subject to alteration through the flow of practices rather than as a result of deliberate implementation efforts.
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| 44. |
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| 45. |
- Hultin, Lotta, et al.
(författare)
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Visualizing institutional logics in sociomaterial practices
- 2014
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Ingår i: Information and Organization. - : Elsevier: 24 months. - 1471-7727. ; 24:3, s. 129-155
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Tidskriftsartikel (refereegranskat)abstract
- This paper aims to deepen our understanding of the mechanisms underlying the mutual constitution of competing institutional logics and sociomaterial entanglements by combining a sociomaterial lens with the institutional logics perspective. We present findings from an interpretive, longitudinal case study at the emergency general surgery ward of a Nordic university hospital. By focusing our analysis on how sociomaterial affordances emerge through the implementation, use and continued development of digital and physical visualization boards, we show how these artifacts constitute an integral part of the operational staff's sensemaking and enactment of a new institutional logic. We make two contributions. First, we show how the perceived affordances of a technology are created from the experience of using several different technologies and how the rejection of one technology can simultaneously constitute another. Second, we show how visualization artifacts, entangled in sociomaterial practices, can shape individual focus of attention and thus facilitate the integration of a new institutional logic in operational practice. © 2014 Elsevier Ltd.
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| 46. |
- Hultin, Lotta, et al.
(författare)
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Visualizing Institutional Logics in Sociomaterial Practices
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This paper aims to deepen our understanding of the mechanisms underlying the mutual constitution of competing institutional logics and sociomaterial entanglements by combining a sociomaterial lens with the institutional logics perspective. We present findings from an interpretive, longitudinal case study at the emergency general surgery ward of a Nordic university hospital. By focusing our analysis on how sociomaterial affordances emerge through the implementation, use and continued development of digital and physical visualization boards, we show how these artifacts constitute an integral part of the operational staff's sensemaking and enactment of a new institutional logic. We make two contributions. First, we show how the perceived affordances of a technology are created from the experience of using several different technologies and how the rejection of one technology can simultaneously constitute another. Second, we show how visualization artifacts, entangled in sociomaterial practices, can shape individual focus of attention and thus facilitate the integration of a new institutional logic in operational practice.
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| 47. |
- Hultin, Magnus, et al.
(författare)
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Chylomicron metabolism in rats : kinetic modeling indicates that the particles remain at endothelial sites for minutes
- 2013
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Ingår i: Journal of Lipid Research. - 0022-2275 .- 1539-7262. ; 54:10, s. 2595-2605
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Tidskriftsartikel (refereegranskat)abstract
- Chylomicrons labeled in vivo with (14)C-oleic acid (primarily in triglycerides, providing a tracer for lipolysis) and (3)H-retinol (primarily in ester form, providing a tracer for the core lipids) were injected into rats. Radioactivity in tissues was followed at a series of times up to 40 min and the data were analyzed by compartmental modeling. For heart-like tissues it was necessary to allow the chylomicrons to enter into a compartment where lipolysis is rapid and then transfer to a second compartment where lipolysis is slower. The particles remained in these compartments for minutes and when they returned to blood they had reduced affinity for binding in the tissue. In contrast, the data for liver could readily be fitted with a single compartment for native and lipolyzed chylomicrons in blood, and there was no need for a pathway back to blood. A composite model was built from the individual tissue models. This whole-body model could simultaneously fit all data for both fed and fasted rats and allowed estimation of fluxes and residence times in the four compartments; native and lipolyzed chylomicrons ("remnants") in blood, and particles in the tissue compartments where lipolysis is rapid and slow, respectively.
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| 48. |
- Hultin, Magnus, 1968-, et al.
(författare)
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Design of a program for complementary education of International Medical Graduates in Sweden : to include Swedish or not
- 2019
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Ingår i: AMEE 2019 : an International Association for Medical Education. - : AMEE. ; , s. 1390-1390
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Konferensbidrag (refereegranskat)abstract
- Background: International medical graduates (IMGs) can either select to take a proficiency test to become licensed to practice in Sweden or to take a 1-2-year complimentary medical education (CME) to qualify for internship. Both paths test the participant for proficiency according to the national Swedish standards for becoming a licensed physician and are given in Swedish. The national standards include medical knowledge, interprofessional skills, communication with patient, relatives and other personnel, and scientific scholarship. A prerequisite for the CME is a passing grade in a Swedish language level 3 course at an accredited adult education center. A recurring observation was that both those failing the proficiency test for IMGs and those taking previous CME was lacking in Swedish proficiency.Summary of Work: A programmatic approach was taken to implement systematic training in Swedish applied in medicine at this two-year CME that is mainly based on distance training using videoconference systems. During the first year the language training corresponds to 50% of the curriculum. Research questions: Did the students at the new CME perceive the education in Swedish as valuable and did the students pass the examinations? Design: Cross-sectional study based on the course evaluations and the results of the examinations from the first semester.Summary of Results: 28 students were admitted to the program and 22 remained with the course for the finals of the first semester. The majority had increased their proficiency in Swedish as measured in vocabulary and correct use of words, but the grammar had not improved. Half of the students failed the summative assessment and three of the students also failed the majority of the formative assessments. The participants scored the relevance and the value of the Swedish training as high.Discussion and Conclusions: The students appreciate the training in Swedish while also having difficulties to pass the tests. A more comprehensive study is warranted to study how to best deliver language training to IMGs.Take-home Messages: Medical education for IMGs needs to take language proficiency into account.
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| 49. |
- Hultin, Magnus, 1968-, et al.
(författare)
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En grundutbildning i förändring
- 2019
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Ingår i: Läkartidningen. - : Läkartidningen förlag AB. - 0023-7205 .- 1652-7518. ; 116
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 50. |
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