| 1. |
- Agvall, Björn, 1963-
(författare)
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Heart failure in primary care with special emphasis on costs and benefits of a disease management programme
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim. Heart failure (HF) is a common condition associated with poor quality of life (QoL), high morbidity and mortality and is frequently occurring in primary health care (PHC). It involves a substantial economic burden on the health care expenditure. There are modern pharmacological treatments with evident impact on QoL, morbidity, mortality, and proved to be cost-effective. Despite this knowledge, the treatment of HF is considered somewhat insufficient. There are several HF management programmes (HFMP) showing beneficial effects but these studies is predominantly based in hospital care (HC).The first aim of this thesis was to describe patients with HF in the PHC regarding gender differences, diagnosis, treatment and health related costs (I, II).The second aim was to evaluate whether HFMP have beneficial effects in the PHC regarding cardiac function, quality of life, health care utilization and health care-related costs (III,IV).Methods. The initial study involved retrospective collection of data from 256 patients with symptomatic HF in PHC (I). The data collected were gender, age, diagnostics and ongoing treatment. The second study was an economic calculation performed on 115 patients (II). The economic data was retrospectively retrieved as the number of hospital days, visits to nurses and physicians in HC and PHC, prescribed cardiovascular drugs and performed investigation during retrospectively for one year. The third and fourth study was based on a randomized, prospective, open-label study which was subsequently performed (III,IV). The study enrolled 160 patients with systolic HF who were randomized to either an intervention or a control group. The patients in the intervention group retrieved follow-up of HF qualified nurses and physicians in the PHC, involving education about HF and furthermore, optimizing the treatment according to guidelines if possible. The patients in the control group had a followup performed by their regular general practitioner (GP) receiving customary management according to local routines but there was no contact with HF nurses. The primary endpoint of the study was a composite endpoint consisting of changes in survival, hospitalization, heart function and quality of life (QoL) and to compare differences in resource utilization and costs (III,IV).Results. In the first study, the prevalence was 2% and the average age was 78 years (I). The most frequent cause of HF was IHD followed o hypertension. The diagnosis in the study population was based on clinical criteria and only 31% had been subjected to echocardiography. The most common treatment was diuretics (84%) and angiotensin converting enzyme inhibitors (ACEI) were used in 56% of patients. In the following prospective study, the intervention group had significant improvements in composite endpoints. There were in the intervention group more patients with reduced levels of NTproBNP (p=0.012) and improved cardiac function (p=0.03). No significant changes were found in New York Heart Association (NYHA) functional class or QoL. The intervention involved less health care contacts (p=0.04), less emergency ward visits (p=0.002) and hospitalizations (p=0.03). The total cost for HC and PHC was EUR 4471 in the intervention group and EUR 6638 in the control group which implies a cost reduction of EUR 2167 (33%).Conclusions. HF is common in PHC with a prevalence of 2% the study population had an average age of 78 years. Only 31 % of the HF patients have performed an echocardiographic investigation. Treatment with ACEI occurred in 56 %. Differences were found between genders since women had performed significantly fewer echocardiographic investigations and, had less treatment with ACEI. When implementing HFMP in PHC, beneficial effects were found regarding cardiac function and health care-related costs in patients with systolic HF. These findings indicate that HFMP might be used even in PHC.
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| 2. |
- Andin, Josefine
(författare)
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Dealing with Digits : Arithmetic, Memory and Phonology in Deaf Signers
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Deafness has been associated with poor abilities to deal with digits in the context of arithmetic and memory, and language modality-specific differences in the phonological similarity of digits have been shown to influence short-term memory (STM). Therefore, the overall aim of the present thesis was to find out whether language modality-specific differences in phonological processing between sign and speech can explain why deaf signers perform at lower levels than hearing peers when dealing with digits. To explore this aim, the role of phonological processing in digit-based arithmetic and memory tasks was investigated, using both behavioural and neuroimaging methods, in adult deaf signers and hearing non-signers, carefully matched on age, sex, education and non-verbal intelligence. To make task demands as equal as possible for both groups, and to control for material effects, arithmetic, phonological processing, STM and working memory (WM) were all assessed using the same presentation and response mode for both groups. The results suggested that in digit-based STM, phonological similarity of manual numerals causes deaf signers to perform more poorly than hearing non-signers. However, for digit-based WM there was no difference between the groups, possibly due to differences in allocation of resources during WM. This indicates that similar WM for the two groups can be generalized from lexical items to digits. Further, we found that in the present work deaf signers performed better than expected and on a par with hearing peers on all arithmetic tasks, except for multiplication, possibly because the groups studied here were very carefully matched. However, the neural networks recruited for arithmetic and phonology differed between groups. During multiplication tasks, deaf signers showed an increased reliance on cortex of the right parietal lobe complemented by the left inferior frontal gyrus. In contrast, hearing non-signers relied on cortex of the left frontal and parietal lobes during multiplication. This suggests that while hearing non-signers recruit phonology-dependent arithmetic fact retrieval processes for multiplication, deaf signers recruit non-verbal magnitude manipulation processes. For phonology, the hearing non-signers engaged left lateralized frontal and parietal areas within the classical perisylvian language network. In deaf signers, however, phonological processing was limited to cortex of the left occipital lobe, suggesting that sign-based phonological processing does not necessarily activate the classical language network. In conclusion, the findings of the present thesis suggest that language modality-specific differences between sign and speech in different ways can explain why deaf signers perform at lower levels than hearing non-signers on tasks that include dealing with digits.
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| 3. |
- Andrén, A., et al.
(författare)
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Frost shattering and ice problems in rock tunnels from a maintenance perspective
- 2012
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Ingår i: ISRM International Symposium - EUROCK 2012.
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Konferensbidrag (refereegranskat)abstract
- Every winter a number of railway tunnels in Sweden are affected by problems with ice. When ice is allowed to form in the rock fracture network and interface between the rock and shotcrete, degradation of both materials occur which can cause fall-outs of rock debris and shotcrete. To reduce maintenance costs it is necessary to improve knowledge of frost penetration along tunnels and the effect of frost shattering on the load bearing structures. Temperature measurements in Swedish railway tunnels have shown that frost penetrates much deeper into tunnels than previously assumed. By field observations it has been confirmed that ice problems often occur throughout the entire tunnel, even for longer tunnels (>1.5 km). If the load bearing structures are subjected to alternating freezing and thawing the shotcrete can be exposed to frost shattering. In a similar manner as frost action in soil, water tends to migrate in rock and cause ice bodies to grow inside pores and cracks. Laboratory tests show that when a rock/shotcrete sample has access to water during the freezing process, degradation occurs that affects adhesion between the materials. Therefore the load bearing structures exposed to water leakage should be designed for freezing temperatures along the entire length of the tunnel.
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| 4. |
- Andrén, Anna, et al.
(författare)
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Temperaturflöden i järnvägstunnlar – Glödberget
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- During the winter ice is causing major problems in several of the Swedish Transport administrations railway tunnels. Freezing water is forming icicles and pillars that can fall down at track, and grow so large that they intrude on the clearance gauge. Lighting equipment and cables can be broken because of the ice load and tracks can become cowered with ice Periodic freezing can cause frost shattering and this process can cause fall-outs of rock and shotcrete. In order to maintain safety and prevent traffic disruption, many tunnels requiring extensive maintenance. In order to reduce maintenance of the tunnels, improved knowledge about frost penetration and the effects of ice pressure on the load-bearing capacity of the tunnel is required. 2002 the University of Gävle and KTH performed a model study to determine the temperature conditions in tunnels. To verify the model study field measurements are carried out in collaboration between the Transport Administration and Luleå University of Technology. This technical report describes the tests conducted so far in the Glödberget tunnel at Nyåker, 80 km south-west of Umeå. Measurements show that the developed models underestimate the frost penetration. Although the tunnel is 1680 meters long, the frost penetrates the entire length of the tunnel even if the temperature outside the tunnel is just a few degrees below zero. A contributing factor to why the field measurements and model do not conform can be that the model study is based on a completely uninsulated tunnel. In the Glödberget tunnel a large part of the walls and roof are covered the frost insulated drains. The function of the frost insulated drains is to prevent the cold tunnel air from reaching a leakage point and causing water to turn into ice. However, the insulation does not only prevent the cold air from reaching the rock, but also prevents the heat from the rock mass from entering the tunnel and warming up the cold tunnel air. Consequently, the frost penetrates further into the tunnel than it would do if the heat from the rock mass were allowed to warm up the outside air on its way into the tunnel. The amount of frost insulated drains and how much of the tunnel walls and roof that are covered are thereby affecting the length of the frost penetration. Temperature measurements has been carried out down into the ballast bed. To eliminate the risks with freezing drainage water, the drainage pipes are located at a depth of 2 m under the level of the rails. Measurements show that the temperature does not penetrate as far down as earlier feared and the depth of the pipes in the middle parts of the tunnel could be made shallower, with respect to risk of frost. Temperature measurements behind a frost insulated drain in the middle of the track tunnel, has shown that drains are able to smooth out the temperature changes that occur in the tunnel air. But when the temperature is negative for a longer period, the temperature behind the drain drops below 0ºC. Then the drainage ability is reduced due to icing and it can cause frost damage to the drain. Measurements of air temperature in the adjacent service tunnel shows how frost penetration is affected by air movement. The service tunnel is closed with gates at both ends. When the air in a tunnel is not exposed to movement, it is heated by geothermal heat and adopt the same temperature as the rock. Rock temperatures usually coincide with the average annual temperature applicable to the area where the tunnel is located. For the Glödberget tunnel there is a very good agreement between the average annual temperature for the area and the measurements performed in the service tunnel.
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| 5. |
- Arnesson, Annika, et al.
(författare)
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Forskningsverksamhet och försöksstallar inom nöt- och lammköttsproduktion i Wales, Irland, Skottland och Danmark : erfarenhetsutbyte - 2009
- 2010
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- SLU:s forskningsstation för nöt- och lammköttsproduktion är belägen på Götala gård utanför Skara. Här bedrivs utfodringsförsök till nöt och lamm baserat på vall och bete kompletterat med huvudsakligen inhemska kraftfodermedel, där syftet är att ta fram nöt- och lammkött av hög kvalitet. Djurens välfärd och lantbrukarens ekonomi står i centrum för vår forskning. Under 2010 kommer projektering utföras för nya försöksstallar för nöt och får. För att utbyta erfarenheter med forskare inom nöt- och lammproduktion och få idéer till smarta byggnadslösningar och utfodringsanläggningar i försöksstallar besökte vi under 2009 IBERS, Aberystwyth i Wales, Teagasc Grange Beef Research Centre på Irland och SAC Animal Breeding & Development Team i Skottland. I Danmark besökte vi Tjele gods, Forskningscenter Foulum och Kvaegbrugets Forsogscentrum (KFC). Forskningen i Wales, Irland och Skottland hade blivit mer inriktad mot mera tvärvetenskaplig forskning med klimat och miljö som viktiga faktorer. De nybyggda stallarna på IBERS och SAC var stora ljusa, luftiga fribärande hallar, där större delen av väggarna bestod av vindvävsgardiner. Man hade satsat på breda foderbord, flexibla boxstorlekar och fantastiska hanteringsanläggningar för sortering, vägning och behandling av djur. Det var imponerande att se deras foderhantering med många silor i olika storlekar och allt under tak. Fullfoder var vanligt och medförde en rationell utfodring. De datastyrda utfodringskrubborna, av både den holländska och brittiska modellen, krävde både tillsyn och skötsel för att fungera. Det blir också en stor mängd data att hantera vid användning av dem. På Tjele gods i Danmark hade man satsat på en enkel byggnad, med djurhantering i fokus. Mycket av arbetet gjordes maskinellt för att spara arbetskraft. Foderanläggningen på Foulum gav möjlighet till stor flexibilitet när det gäller att hantera många fodermedel och olika foderblandningar. Fodret utfodrades i de olika stallarna med hjälp av förarlösa robottruckar. Försöksstallet för mjölkkor var isolerat och inrett med liggbås och skrapade fodergångar. Här gavs möjlighet att genomföra försök med många behandlingar under exakt samma stallbetingelser. Stallet var utrustat med individuell utfodring av grovfoder. Kraftfoder fanns i automater där de kunde ha fyra olika foder samtidigt. Den dammsugare som användes för att tömma foderkrubborna ansågs helt nödvändig för en rationell foderhantering. All data från försöksstallarna registrerades automatiskt och samlades in till en gemensam databank, varifrån forskarna kunde hämta information. All datafiltrering sysselsatte fem datatekniker. Det som forskarna på Foulum skickade med oss som råd inför vår projektering, var att tänka på att ta till ordenligt när det gäller utrymmen, så att foder- och djurhantering blir rationell. KFC var en mycket välskött försöksgård som ägdes av näringen. Eftersom de höll på att slutföra en om- och tillbyggnation av ladugården var det extra intressant för oss att se och höra hur de tänkt vid projekteringen. De hade t.ex. gått ifrån gummimattor i mjölkkostallets fodergångar och satsat på betongspalt och gödselrobot, för att få torrare miljö och därmed bättre klövhälsa. Efter att ha prövat många olika sorter liggunderlag i liggbåsen hade man satsat på en 18 cm tjock madrass med små luftfyllda gummibollar, vilken höll formen bra. En självgående strövagn på räls för spån över liggbåsen, samt även en för halm i ungdjurs-avdelningen sparade mycket arbete. Även på KFC tillämpades individuell utfodring till alla mjölkkor och de hade 2-2,5 kor/ fodertråg. Utfodring gjordes fyra gånger per dag. I ungdjursstallet var det två fodertråg per tio djur och utfodringen gjordes två gånger per dag. Fodergrindar vid varje fodertråg var nödvändigt hos ungdjuren för att inte djuren skulle bli undanknuffade när de åt. Personalen påpekade att den individuella utfodringen kräver mycket datatekniskt arbete för att installation och funktion ska bli användarvänlig. Diskussionen med forskare och försökspersonal har varit oerhört värdefull och gett oss mycket att tänka på inför vår egen planering av nya försöksstallar. Det viktigaste att tänka på vid projektering, enligt våra kollegor både på Brittiska öarna och i Danmark, är flexibilitet, väl tilltagna ytor och en genomtänkt logistik. Det ger förutsättningar för stallar med god forsknings- och arbetsmiljö samt en god djurvälfärd
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| 6. |
- Bondarchuk, Alexander, et al.
(författare)
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Rock mass behavior under hydropower embankment dams : a two-dimensional numerical study
- 2012
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Ingår i: Rock Mechanics and Rock Engineering. - : Springer Science and Business Media LLC. - 0723-2632 .- 1434-453X. ; 45:5, s. 819-835
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Tidskriftsartikel (refereegranskat)abstract
- Sweden has more than 190 large hydropower dams, of which about 50 are pure embankment dams and over 100 are concrete/embankment dams. This paper presents results from conceptual analyses of the response of typical Swedish rock mass to the construction of a hydropower embankment dam and its first stages of operation. The aim is to identify locations and magnitudes of displacements that are occurring in the rock foundation and grout curtain after construction of the dam, the first filling of its water reservoir, and after one seasonal variation of the water table. Coupled hydro-mechanical analysis was conducted using the two-dimensional distinct element program UDEC. Series of the simulations have been performed and the results show that the first filling of the reservoir and variation of water table induce largest magnitudes of displacement, with the greatest values obtained from the two models with high differential horizontal stresses and smallest spacing of sub-vertical fractures. These results may help identifying the condition of the dam foundation and contribute to the development of proper maintenance measures, which guarantee the safety and functionality of the dam. Additionally, newly developed dams may use these results for the estimation of the possible response of the rock foundation to the construction
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| 7. |
- Bounyasone, Keophouthong, 1961-, et al.
(författare)
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Cultivating educational research in Lao PDR : For a better future?
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis looks at the introduction of educational action research as part of the national education reforms in Lao PDR. National policies on education emphasise concepts such as ‘education for all’ and ‘student-centred education’ taken from the globalised education reform agenda. Action research became a tool to implement the new pedagogy of student-centred education that was labelled ‘the five-pointed star’. The thesis contributes to the field of global policy studies. It combines global and contextual aspects in order to analyse how action research travelled from policy to practice. This process was part of a Lao national education reform that developed after the introduction of the new economic mechanism, when the previous socialist planned-economy system was replaced by a globalised market-oriented system. Data were collected from national policy documents, international donor documents, instructional material, and interviews with Lao educators involved with action research in different ways. Furthermore, we carried out action research as part of our own teaching duties in Lao PDR, which were subsequently documented and analysed. In this study of educational reform in Lao PDR we have found that an educational approach like action research that is introduced as part of a taken-for-granted global agenda of change, is reduced to a technical rationality and practices that resemble previous experiences. Our findings are explained from the theoretical perspectives of hidden policy ensembles and policy backlashes. Hidden policy ensembles reduce action research to a technical rationality due to their alien cultural and social connections that are not brought into the open at the reform arena. Policy backlashes become a way for practitioners to create meaning based on previous contextual practices, conceptions, and discourses as a consequence of the technical rationality created by the hidden policy ensembles and the use of the cascade model. The thesis concludes with an outline of a possible future educational development in the form of a critical and educative action research network in Lao PDR that is inspired by cross-cultural dialogue, a critical pedagogy of place, and our own action research experiences.
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| 8. |
- Cahlin, Birgitta Johansson, 1959, et al.
(författare)
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No effect of glucosamine sulfate on osteoarthritis in the temporomandibular joints-a randomized, controlled, short-term study.
- 2011
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Ingår i: Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. - : Elsevier BV. - 1528-395X .- 1079-2104. ; 112:6, s. 760-6
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the clinical effects of oral glucosamine sulfate, compared with placebo, on osteoarthritis in the temporomandibular joints (TMJs).
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| 9. |
- Carlsson, Anja M, et al.
(författare)
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Plasmodium falciparum population dynamics during the early phase of anti-malarial drug treatment in Tanzanian children with acute uncomplicated malaria
- 2011
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Ingår i: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875 .- 1475-2875. ; 10, s. 380-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:This study aimed to explore Plasmodium falciparum population dynamics during the early phase of anti-malarial drug treatment with artemisinin-based combination therapy in children with clinical malaria in a high transmission area in Africa.METHODS:A total of 50 children aged 1-10 years with acute uncomplicated P. falciparum malaria in Bagamoyo District, Tanzania, were enrolled. Participants were hospitalized and received supervised standard treatment with artemether-lumefantrine according to body weight in six doses over 3 days. Blood samples were collected 11 times, i.e. at time of diagnosis (-2 h) and 0, 2, 4, 8, 16, 24, 36, 48, 60 and 72 h after initiation of treatment. Parasite population dynamics were assessed using nested polymerase chain reaction (PCR)-genotyping of merozoite surface protein (msp) 1 and 2.RESULTS:PCR-analyses from nine sequential blood samples collected after initiation of treatment identified 20 and 21 additional genotypes in 15/50 (30%) and 14/50 (28%) children with msp1 and msp2, respectively, non-detectable in the pre-treatment samples (-2 and 0 h combined). Some 15/20 (75%) and 14/21 (67%) of these genotypes were identified within 24 h, whereas 17/20 (85%) and 19/21 (90%) within 48 h for msp1 and msp2, respectively. The genotype profile was diverse, and varied considerably over time both within and between patients, molecular markers and their respective families.CONCLUSION:PCR analyses from multiple blood samples collected during the early treatment phase revealed a complex picture of parasite sub-populations. This underlines the importance of interpreting PCR-outcomes with caution and suggests that the present use of PCR-adjustment from paired blood samples in anti-malarial drug trials may overestimate assessment of drug efficacy in high transmission areas in Africa.The study is registered at http://www.clinicaltrials.gov with identifier NCT00336375.
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| 10. |
- Cedströmer, Anna-Lena, 1974, et al.
(författare)
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Temporomandibular condylar alterations in juvenile idiopathic arthritis most common in longitudinally severe disease despite medical treatment
- 2014
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Ingår i: Pediatric Rheumatology. - : Springer Science and Business Media LLC. - 1546-0096. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Juvenile idiopathic arthritis (JIA) is an autoimmune, heterogeneous disease and the temporomandibular joint (TMJ) can be affected, with consequences for mandibular growth and function. The aim of this study was to evaluate the importance of longitudinal medical treatment and the burden of disease activity on the development of temporomandibular condylar alterations as judged on panoramic radiographs. Methods: The study was a retrospective evaluation of dental and medical records in consecutive JIA patients referred to three specialist dental clinics in Sweden during an eight-year period. Data on the total pharmacological treatment and disease activity were evaluated longitudinally from disease onset to the time of the panoramic examination, during a median observation period of 2.5 years. The radiographs were analysed in terms of structural and shape alterations in the condyles and judged dichotomously. Results: Panoramic examinations were analysed in 158 patients from 266 referrals diagnosed with JIA. Condylar alterations (shape or structural) were seen in 68 patients (43%). Patients with condylar alterations were more extensively treated over time compared with those without condylar alterations. Powerful disease activity and/or potent medication at any time during the course of the disease implied an increased risk of alterations. Conclusions: Patients with JIA who require more intensive medication over time run the greatest risk of condylar alterations. As yet, current medical programmes have not been specified for the TMJ and more knowledge in this area is needed.
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