| 11. |
- Olofsson, Birgitta, 1963-
(författare)
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Old people with femoral neck fracture : delirium, malnutrition and surgical methods - an intervention program
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hip fracture is a global and a growing public health problem. More women than men sustain hip fractures, the incidence increases exponentially with age and mean age is above 80. About one third of hip-fracture patients suffer from dementia and are prone to develop acute confusional state (delirium). Delirium is one of the most common complications after hip-fracture surgery, and seriously impacts on morbidity and mortality. Malnutrition is also common in hip-fracture patients and is associated with postoperative complications, such as delayed healing of the wound, infections and decubitus ulcers. Arthroplasty is usually preferred procedure in displaced femoral neck fractures but is, however, controversial in patients with dementia due to the fear of dislocation of the prosthesis. The aims of this thesis are to identify risk factors for delirium and the impact of delirium on rehabilitation outcome, to evaluate whether a postoperative multi-factorial intervention program could reduce delirium, to investigate the effect of a nutritional intervention and to evaluate complications, functional outcome and mortality regarding two surgical methods, hemiarthroplasty (HAP) and internal fixation (IF), in old patients with femoral neck fracture. Thirty-eight out of 61 consecutive patients (62%) were delirious on admission to hospital or developed postoperative delirium. An increased risk of postoperative delirium was found among hip-fracture patients with dementia and/or depression. Delirious patients were hospitalized longer, were more dependent in their activities of daily living, had poorer psychological well-being and suffered more complications than non-delirious patients. A postoperative multi-factorial and multidisciplinary intervention program reduced the incidence, at 55% vs 75% (p=0.003), and number of days with delirium, 5 vs 10 days (p=0.009). Postoperative complications were also reduced; decubitus ulcers 9% vs 22% (p= 0.010), urinary tract infections 31% vs 51% (p=0.005), falls 12% vs 27% (p=0.007), and the mean hospitalization period was 10 days shorter in the intervention group (p=0.030). Malnutrition was common among all these patients (53 %) and associated with postoperative complications such as decubitus ulcers and delirium. However, the nutritional intervention had no effect on nutritional parameters at four months, nevertheless men had better nutritional outcomes than women. A higher proportion of patients with dementia operated on using HAP had regained their pre-fracture ability to walk independently at the one-year follow up compared with those operated on using IF. Six of 83 patients dislocated their HAP during hospitalization and during an episode of delirium, none had dementia. No difference in mortality between the surgical methods was seen. Dementia per se should not be a reason to disqualify patients from being treated with the most appropriate surgical method. It is clinically important to discriminate between dementia and delirium, since delirium can be prevented and treated even in patients with dementia. Old patients undergoing surgery have special needs that are not always catered for in ordinary orthopaedic or surgical wards. The special care for these patients should include: a combined nursing and medical care based on comprehensive geriatric assessments, systematic prevention, detection and treatment of postoperative complications such as delirium, hypoxemia, urinary tract infections, pain, malnutrition and an active rehabilitation. It is obvious that improved quality of care reduces patient suffering and seemingly the costs for society.
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| 12. |
- Sarstrand, Anna-Maria, 1976-
(författare)
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De första invandrarbyråerna : Om invandrares inkorporering på kommunal nivå åren 1965-1984
- 2007
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Immigration to Sweden increased during and after the Second World War. Initially the in-crease consisted of refugees, but after the war labour migration became the dominant form of migration to Sweden. The immigrants were expected to manage the adaptation to the Swedish society on their own, possibly with the help of voluntary organizations or the company they worked for. This situation began to change in the 1960s. The immigrants’ situation received public attention and different actions were taken to reduce the risk of marginalizing the immi-grants. Many of these actions started on a local level, in the municipalities, prior to the devel-opment of the first national immigrant policy in 1975. The first local public administrations for handling immigrant incorporation developed approximately ten years before. These or-ganizations, soon to be called Immigrant bureaus, were among the first public initiatives, on both state and local level, to actively take measures to incorporate the immigrants. The licen-tiate thesis is a comparative case study of five Swedish municipalities which started Immi-grant bureaus in the middle of the 1960s. The objective of the thesis is to study the creation and development of these organizations up until 1984. Thereby, the study gives an image of the creation and development of a specific local public administration for immigrant incorpo-ration. It describes and analyzes the common features of the bureaus as well as the unique character of each individual bureau. Accordingly, a theoretical perspective which stresses the early development in an organization’s history and accentuates the importance of specific contexts for understanding different organizational developments has been used. The result shows that the immigrant bureaus were initiated by different local actors, such as the public administration, labour unions and educational associations which meant that the purposes were somewhat divergent. Yet another consequence was not only variation in development between different bureaus, but also within each of them over time.
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| 13. |
- Tran, Phong, et al.
(författare)
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De novo dNTP production is essential for normal postnatal murine heart development
- 2019
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Ingår i: Journal of Biological Chemistry. - : American Society for Biochemistry and Molecular Biology. - 0021-9258 .- 1083-351X. ; 394:44, s. 15889-15897
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Tidskriftsartikel (refereegranskat)abstract
- The building blocks of DNA, dNTPs, can be produced de novo or can be salvaged from deoxyribonucleosides. However, to what extent the absence of de novo dNTP production can be compensated for by the salvage pathway is unknown. Here, we eliminated de novo dNTP synthesis in the mouse heart and skeletal muscle by inactivating ribonucleotide reductase (RNR), a key enzyme for the de novo production of dNTPs, at embryonic day 13. All other tissues had normal de novo dNTP synthesis and theoretically could supply heart and skeletal muscle with deoxyribonucleosides needed for dNTP production by salvage. We observed that the dNTP and NTP pools in wild-type postnatal hearts are unexpectedly asymmetric, with unusually high dGTP and GTP levels compared with those in whole mouse embryos or murine cell cultures. We found that RNR inactivation in heart led to strongly decreased dGTP and increased dCTP, dTTP, and dATP pools; aberrant DNA replication; defective expression of muscle-specific proteins; progressive heart abnormalities; disturbance of the cardiac conduction system; and lethality between the second and fourth weeks after birth. We conclude that dNTP salvage cannot substitute for de novo dNTP synthesis in the heart and that cardiomyocytes and myocytes initiate DNA replication despite an inadequate dNTP supply. We discuss the possible reasons for the observed asymmetry in dNTP and NTP pools in wildtype hearts.
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| 14. |
- Unneby, Anna, 1985-
(författare)
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Pain and pain management with femoral nerve block following hip fracture : effects and experiences: the perspective of older patients and staff
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Older people with hip fractures are often frail with several comorbidities and roughly half of them have dementia disorders. Pain is common among patients with hip fracture and pain management in these patients is a challenge. Opioids are known to relieve pain while at rest but are not as effective in movement. One alternative to opioids is a femoral nerve block (FNB). Previous studies have shown that FNBs can decrease pain and the need for opioids, but these studies excluded patients with dementia. Few studies have investigated whether FNBs decrease the incidence of complications in general, and delirium in particular. These studies were also based on different types of nerve blocks and methods. Few studies have described patients’ experiences of pain and pain management, and there are no studies on patients’ experiences of receiving or being treated with FNBs. In addition, there are no studies on staff´s experience of nursing care among patients with hip fractures who received an FNB. Objectives: The overall aim of this thesis is to investigate the effect of a preoperative FNB in patients with hip fracture in terms of pain and complications, and, further, to describe experiences of pain and pain management among patients with hip fracture who received FNBs as well as staff´s experiences of treating them. The first two papers (I and II) investigate the effect of an FNB compared to opioids, with a focus on pain and complications. To gain a deeper understanding, the final two papers (III and IV) describe experiences of pain and pain management in patients with hip fractures who received an FNB, and the staff's experiences of nursing care with patients with hip fractures who received an FNB. Methods: Papers I and II are based on a randomized controlled study which included patients aged 70 years or older with hip fractures, including those with cognitive impairment or dementia. Patients were randomized on arrival at the orthopaedic ward in terms of pain treatment to be administered; the options were FNB (with opioids if needed) or opioids alone. In paper I, 266 patients were included; the mean age was 84 years, 64% were women, and 45% had a dementia diagnosis. Paper II included 236 patients; the mean age was the same, 66% were women, and 46% had a dementia diagnosis. Pain assessment scales (self-rated VAS and VAS by proxy) was used preoperative to assess patients’ pain in rest. Nurses assessed the incidence of delirium using Nu-DESC, both pre- and postoperatively. In addition, a structural interview was performed with validated assessments 3 to 5 days after surgery by the author (AU). The assessments, nursing and medical records were subsequently evaluated by a specialist in geriatric medicine together with a trained research nurse in terms of complications, dementia, depression and delirium. Data collected in papers I and II were analysed using comparative and descriptive statistical analysis. In papers III and IV, semi-structured interviews were performed with patients (paper III) and with staff (nurses and assistant nurses, paper IV) based on interview guides with open-ended questions that offered opportunities for clarification and follow-up questions. In paper III, 23 patients with hip fractures aged 70 years or older who were treated with FNBs were interviewed, and in paper IV, staff working in the orthopaedic ward and emergency department with experience of caring for patients with hip fractures treated with FNBs were interviewed. The interviews were audio-recorded, transcribed and analysed using qualitative content analysis. Results: The results in paper I showed that patients who received an FNB assessed lower pain scores over a period of 12 hours. Patients required smaller amounts of opioids and the number of patients requiring opioids was reduced compared with the group that received opioids alone. Overall, in paper II was it a high incidence of complications, common complications in both groups were pre and postoperative delirium (44% and 73%), nutritional problems (71%), anaemia (66%), constipation (64%) and urinary tract infection (45%), but no statistical difference was found between groups of those complications. The results in paper II showed that 39% of the patients who received an FNB and 49% of those who received opioids developed delirium before surgery, with no statistical difference. In paper III, patients described how the pain before surgery was experienced from no pain, to the worst possible pain and everything in between. They described how they dealt with pain in their own way, but also how they felt dependent on the staff's willingness to relieve the pain. They described that the pain treatment could be lifesaving, but that it could also create the feeling of a near-death experience. Further, some patients experienced memory loss regarding the time before surgery, which made it difficult to remember the pain and pain treatment they received. Finally, in paper IV, the staff described that the FNB setting the agenda when caring for older patients with hip fracture in the preoperative phase. Nursing care required timing, with a need of staff orienting to time and customizing their communication. The outcome of the FNB affected nursing care, depending on if the FNB was successful or not successful. Further, staff faced ethical challenges regarding doing good and not harm and relieving pain and avoiding side-effects. Conclusion: This thesis shows that FNB is a feasible preoperative pain management for patients with a hip fracture, even among those with dementia. Evidence-based guidelines are necessary as a basis for assessing pain and providing pain management, but staff should add an individualized pain management approach. Staff should evaluate every patient and see each patient as a unique individual with different experiences of pain and pain management to successfully relieve pain among patients with a hip fracture.
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| 15. |
- Wall, Erika, 1978-
(författare)
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Riskförståelse : Teoretiska och empiriska perspektiv
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The thesis introduces the concept of ‘sense-making of risk’ (riskförståelse) for the purpose of the theoretical and empirical study of the individual’s sense-making of risk. Particular weight is attached to an examination of the term’s various components, its compass, and the relationship between sense-making of risk and behaviour. The premise is that risk is created and defined by the common conceptions that exist within the framework of a specific social context; the effect is to focus attention on the significance of social and cultural contexts. To provide a full picture of sense-making of risk, and risk behaviour, and to study these phenomena using a variety of methodological perspectives, the data was gathered from both polls and focus-group interviews. It is in the first article, based on a focus-group interview study, that the concept of sense-making of risk is introduced: the empirical results demonstrate that it can be used to chart how young people with similar risk perceptions differ in their understanding of a variety of risks. A theoretical model is proposed that establishes that there are two dimensions to the individual’s sense-making of risk. The second article considers young people’s risk behaviour in traffic milieus. The principal conclusion drawn in this study is that the individual’s sense-making of risk is insufficient to explain behaviour in relation to risk: the spatial context must also be taken into account. The third article focuses on the relationship between place attachment and sense-making of risk, and demonstrates that various aspects of place attachment have implications for the individual’s sense-making of risk. The fourth and final article offers a cluster analysis. The article’s most important result is its refinement of the theoretical concepts. Structure of meaning is singled out as the basis for the individual’s sense-making of risk. In its empirical application the concept was shown to be useful in studying the behavioural differences between various social groups, since grouping by structure of meaning furnishes an explanation for variations in risk and risk-reducing behaviour. The introductory and concluding chapters assemble the studies’ findings and offer a full account of the concept of sense-making of risk. The thesis’ most important conceptual contribution is to the question of how the individual arrives at a personal sense-making of risk. However, it will fall to future studies to establish the concept’s general applicability by considering its theoretical ramifications and empirical implementation. In this way, sense-making of risk can take its place in a specifically sociological conceptual apparatus that focuses on how the individual relates to risk.
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| 16. |
- Danielsson, Erna, Professor, 1954-, et al.
(författare)
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Risk Communication : A Comparative Study of Eight EU Countries
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- How do EU member states communicate risks to their citizens? In this study, we define risk communication as the information provided by different levels of government to citizens regarding possible future crises. The questions serving as departure points for this study are as follows: How is the administrative system for risk communication set up in the countries studied? How the different risk communication campaigns are (provided that they exist) embedded in the larger administrative context? How is risk communication strategy formulated in each country and what kind of threats are emphasized? In order to tackle these questions, we examine the risk communication strategy of eight countries: Sweden, Finland, Germany, England, France, Estonia, Greece and Cyprus. Our data consist of governmental web sites, publications, campaigns, as well as other modes of communication, such as videos posted on YouTube, with questions centering on institutional actors, methods of delivery, content, and effectiveness. We acknowledge that risk communication aims at supporting vulnerable populations and evening out imbalances, but at the same time we flesh out the power dimension of risk. In our analysis, we search for reproduction of norms and social inequality in risk communication practices. The results show that some patterns emerge regarding the way different EU countries convey information to the public, but they do not hold strictly to geography or administrative system. Digital media are the foremost vehicle of risk communication and the message generally conveyed is geared towards traditional, middle class households with the main language of the country as their first language. Volunteer organizations are present in all the countries in question, though not at the same degree. The conveyance of “self-protection” guidelines implicitly places the responsibility of protection to the individual. The results also show that in some countries, materiality has become more prevalent than the social dimension of risk in the message the public sector conveys, and that there is a move from focusing on risk to focusing on security.
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| 17. |
- Ekholm, Sara
(författare)
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Föräldraskap och klimatoro – betydelsen av omsorg
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the thesis is to study the relationships between parenthood, care and worry about the consequences of climate change and how these relate to climate behaviour. The thesis is based on the argument that care affect the degree of worry for the person to whom the care is directed and that the social context surrounding the individual has an influence on their experiences and worries about risks, in this case climate risks. In relation to climate change worry, it addresses differences in care practice between parents and people who are not parents, and between mothers and fathers. Time and practice with caring responsibilities may differ between these groups and may therefore also relate to levels of worry. Care practice can thus be one of several aspects that can be significant for climate change worry. Four studies have jointly addressed the overall purpose of the thesis and a ‘mixed methods’ approach has been used where quantitative and qualitative methods have been combined. The studies have thus complemented each other through four different sets of empirical material: three sets of quantitative survey data with random samples and one set of qualitative interview data. The empirical context of the survey studies includes a regional and a national survey in Sweden and a European survey. The qualitative material is based on interviews with respondents from several regions in Sweden that are vulnerable to climate change. The results of the thesis as a whole show a recurring pattern, in a Swedish context, regarding the relationship between parenthood and worry about the consequences of climate change. They show that parents in general are more worried about climate change than people who are not parents (Articles 1, 2 and 3). So, this pattern is reflected in the three independent surveys mentioned above, conducted at different times over a six-year period. The results also show that women are generally more worried than men are about the consequences of climate change. Fathers, on the other hand, are significantly more likely to experience climate change worry than men who are not fathers, a difference that is not evident between mothers and women who are not mothers (Articles 2 and 3). One of the studies (Article 3) examine whether the role of parenthood, as well as the role of mothers and fathers, differs between three care regimes (Orloff, 2002), in relation to climate change worry. Regimes here refer to normative and regulatory systems that are not reduced to individual institutions in society (Hood, Rothstein & Baldwin, 2001). It is only in the care regime prevailing in Sweden that parenthood reveals a significantly greater degree of climate change worry, both between parents and people who are not parents and between fathers and men who are not fathers. One possible explanation for this may be the nature of care regimes and how they relate to the individual, including the regulation of care time structures for both men and women through parental insurance. The fact that climate change worry increases for men who become fathers may be about the development of “caring masculinities” (Elliot, 2016) that relate to men’s emotional experiences such as worry, here through their spending time with their children. This seems to be particularly evident for men who become fathers in contexts where men are given more time for care practice, as shown in the Swedish context. Parents’ worry about the impact of climate change thus appears to be linked to care practice. A term for this kind of worry is referred to in the thesis as care-worry (Article 4) and includes a worry rooted in caring for and having a responsible attitude towards other people, both towards the specific child being cared for, and a concern for people in general and for future generations. This is supported by van Manen’s (2002) argument that worry is part of caring. People’s care-worry is also shaped by the specific context of discourses about caring, worry and risk (see Lupton, 2013; see also Giritli Nygren, Olofsson & Öhman, 2020). Based on parents’ experiences of climate change, the concept of care-worry has been empirically explored (Article 4) and reveals four ideal types that can illustrate parental care-worry in different ways. These are the worrying type, the trusting type, the calculating type and the security-seeking type. Differences between the ideal types are evident in the degree of worry, sense of uncertainty about the future and desire for control or security, with the common link of taking responsibility for the climate situation. Parents’ different types of climate behaviour can also be related to their type of care-worry. The worrying type talks about the climate situation with others, while the trusting type cares about sustainable consumption and is confident that global climate action will solve the climate situation. The calculating type focuses primarily on a climate-mitigating approach, such as reduced energy consumption, and the security-seeking type on a lifestyle adapted to the climate by means of such things as sustainable housing. Parents’ care-worry thus seems to relate to practical action with climate behaviour that takes personal responsibility for limiting the impact of climate change on future generations. The overall conclusions and contributions of the thesis are thus essentially that parenthood is significant for worry about climate change in the Swedish care regime, i.e. that parents have greater climate change worry than those who are not parents. It is also the case that in Sweden fathers’ climate change worry is greater than that of men who are not fathers, a difference that does not appear in women who become mothers. Caring for children can thus increase worry about the consequences of climate change, i.e. parents experience care-worry in relation to future climate risks that their children and other people may face. A further conclusion is that care-worry can also be a motivating aspect to act on climate change by limiting one’s climate impact for the sake of future generations.
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| 18. |
- Ghorbani, Morteza, et al.
(författare)
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Unravelling the Acoustic and Thermal Responses of Perfluorocarbon Liquid Droplets Stabilized with Cellulose Nanofibers
- 2019
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Ingår i: Langmuir. - : American Chemical Society. - 0743-7463 .- 1520-5827. ; 35:40, s. 13090-13099
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Tidskriftsartikel (refereegranskat)abstract
- The attractive colloidal and physicochemical properties of cellulose nanofibers (CNFs) at interfaces have recently been exploited in the facile production of a number of environmentally benign materials, e.g. foams, emulsions, and capsules. Herein, these unique properties are exploited in a new type of CNF-stabilized perfluoropentane droplets produced via a straightforward and simple mixing protocol. Droplets with a comparatively narrow size distribution (ca. 1-5 μm in diameter) were fabricated, and their potential in the acoustic droplet vaporization process was evaluated. For this, the particle-stabilized droplets were assessed in three independent experimental examinations, namely temperature, acoustic, and ultrasonic standing wave tests. During the acoustic droplet vaporization (ADV) process, droplets were converted to gas-filled microbubbles, offering enhanced visualization by ultrasound. The acoustic pressure threshold of about 0.62 MPa was identified for the cellulose-stabilized droplets. A phase transition temperature of about 22 °C was observed, at which a significant fraction of larger droplets (above ca. 3 μm in diameter) were converted into bubbles, whereas a large part of the population of smaller droplets were stable up to higher temperatures (temperatures up to 45 °C tested). Moreover, under ultrasound standing wave conditions, droplets were relocated to antinodes demonstrating the behavior associated with the negative contrast particles. The combined results make the CNF-stabilized droplets interesting in cell-droplet interaction experiments and ultrasound imaging.
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| 19. |
- Humbert, Marion, et al.
(författare)
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Functional SARS-CoV-2 cross-reactive CD4+ T cells established in early childhood decline with age
- 2023
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Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : National Academy of Sciences. - 0027-8424 .- 1091-6490. ; 120:12
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Tidskriftsartikel (refereegranskat)abstract
- Pre-existing SARS-CoV-2-reactive T cells have been identified in SARS-CoV-2-unexposed individuals, potentially modulating COVID-19 and vaccination outcomes. Here, we provide evidence that functional cross-reactive memory CD4+ T cell immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is established in early childhood, mirroring early seroconversion with seasonal human coronavirus OC43. Humoral and cellular immune responses against OC43 and SARS-CoV-2 were assessed in SARS-CoV-2-unexposed children (paired samples at age two and six) and adults (age 26 to 83). Pre-existing SARS-CoV-2-reactive CD4+ T cell responses targeting spike, nucleocapsid, and membrane were closely linked to the frequency of OC43-specific memory CD4+ T cells in childhood. The functional quality of the cross-reactive memory CD4+ T cell responses targeting SARS-CoV-2 spike, but not nucleocapsid, paralleled OC43-specific T cell responses. OC43-specific antibodies were prevalent already at age two. However, they did not increase further with age, contrasting with the antibody magnitudes against HKU1 (β-coronavirus), 229E and NL63 (α-coronaviruses), rhinovirus, Epstein–Barr virus (EBV), and influenza virus, which increased after age two. The quality of the memory CD4+ T cell responses peaked at age six and subsequently declined with age, with diminished expression of interferon (IFN)-γ, interleukin (IL)-2, tumor necrosis factor (TNF), and CD38 in late adulthood. Age-dependent qualitative differences in the pre-existing SARS-CoV-2-reactive T cell responses may reflect the ability of the host to control coronavirus infections and respond to vaccination. Copyright © 2023 the Author(s).
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| 20. |
- Kadefors, Anna, Professor, 1962-, et al.
(författare)
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Innovation processes and dissemination of research-based knowledge in Swedish rock engineering : Experiences in the trust geoinfra project
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Innovation in the project-based construction industry is generally perceived to be complex and poorly understood on a system level. This report describes and discusses the innovation system in Swedish underground construction based on a study of knowledge dissemination and implementation in relation to the large collaborative R&D program TRUST, Transparent Underground Structures.The study is primarily based on interviews performed with representatives of clients, contractors, consultants, researchers and funding bodies within the TRUST program. There are two main focus areas: the innovation system level and the TRUST project. The innovation system level describes drivers, organization and processes for engaging in R&D and implementing results within the Swedish Transport Administration (STA), contractor companies and consultancy firms, but also interviewee opinions about the innovation culture in Swedish rock engineering and construction more generally. The section covering the TRUST project describes the background, performance and experiences from the TRUST collaboration as well as innovation processes within some of the sub-projects.Underground construction is a part of the construction sector where comparatively much research is carried out and university-industry collaboration is lively. Still, our results confirm many of the observations made by previous researchers on innovation in construction in general: the small resources within companies devoted to research and innovation, the importance of champions at the project level and the difficulties to disseminate knowledge and implement company level initiatives. The contractor interviews illustrate how sensitive their innovation processes are to chance factors such as timing of new relevant business projects and the experiences and knowledge of the individuals that happen to be assigned to a specific project. In this respect, the client is more in control. However, the interviewed client representatives from STA express the same kind of difficulties in driving innovation more strategically on the organizational level and convince their project managers to open up for R&D tests and new knowledge in their business projects.Previous research has also shown that there are many drivers for firms to engage in R&D collaborations with public funding. R&D collaboration provides access to knowledge networks by enabling participation in reference groups and communities. Important such networks in Swedish underground construction were BeFo and SBUF. Another driver for R&D collaboration was to support M Sc and PhD education for future recruitment. Thus, the individuals themselves were often the most important research output. Implementation of results was not a primary motivation although a more strategic approach was emerging among both public organizations and private companies, who put more emphasis than they used to on application in practice of research results. One consultancy company was especially active in developing their R&D strategy to support a business model based on premium services. In general, however, knowledge development for underground construction was still mainly driven by individual specialists based on their contacts in business projects. Organizations had developed centrally defined R&D strategies, but these did not deal explicitly with technical disciplines but tended to focus on general goals such as sustainability, or on participation in high profile research collaborations.Most specialists within academia as well as industry were involved in several networks and perceived these to provide useful interaction platforms. Research funding was governed by BeFo and SBUF, and these peer networks thus strongly influenced research strategy on a national level. The number of PhDs in industry had increased over the last years, and important informal networks developed over time between these individuals and their former university departments. Such relationships formed the basis for gaining research funding, which is often dependent on industry co-funding.When establishing TRUST, the assumption was that a large coordinated R&D project would be better for communicating with industry and implementing results than several smaller projects. However, it turned out to be more or less the other way around. The existing system could handle innovation in construction projects, but not innovation on the organizational level. This became apparent when trying to find a joint test site. In smaller research projects, access to business projects is provided by individuals on the client or supplier side, often with an R&D background, who use their personal contacts to provide access to researcher to perform measurements in ongoing construction projects. This often requires that site work is going well and that measurements are found not to cause too much disturbance. Large programs for site measurements involving numerous actors, such as TRUST, call for planning and upfront commitment. The failure to arrange fieldwork in TRUST illustrate the difficulties to take the step from a bottom up, ad-hoc, individual based regime to an organizational strategy with national level anchoring and implications. Thus, the TRUST program appeared to be an ideal partner for the Swedish Transport Administration, but in practice the size of the project turned out to be a major disadvantage.In general, the internal innovation capabilities of companies and client authorities need to be developed in order for organizations to benefit from the collaborative research programs and act upon the knowledge developed. One aspect is that measures should be taken to more explicitly involve business project managers in both R&D and implementation. Innovation capability development is needed especially on the client side, since long term strategies in supplier organizations will not develop if the strategies of the dominant clients is not clear. However, assuming that the geo area in general is largely an open innovation environment, it also seems useful to explore if different actors could perform complementary activities in an industry innovation system. For example, specialist networks both within organizations and on the industry level may be more formally mobilized in external monitoring, strategy development and evaluation. In the future, top management, technically oriented specialists and researchers need to develop a joint understanding of how the innovation system works, including the regulatory and contractual environment.There is also a need to invest also in research that is relatively far from application. Thus, evaluation processes and output measurement systems should be adapted to how close to implementation the research project is and also assess the need to build capabilities on the receiver side.
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