| 1. |
- Becker, Per, et al.
(författare)
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‘Too many mice make no lining for their nest’ : Reasons and effects of parallel governmental structures for disaster risk reduction and climate change adaptation in Southern Africa
- 2021
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Ingår i: Jamba: Journal of Disaster Risk Studies. - : AOSIS. - 1996-1421 .- 2072-845X. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Many African countries face escalating challenges of increasing disaster risk and anticipated impacts of climate change. Although disaster risk reduction (DRR) and climate change adaptation (CCA) are tightly linked and comprising virtually identical practices in vulnerable countries in Southern Africa, research has identified parallel governance structures across the region. This study applied comparative case study research, based on 27 semi-structured interviews, to investigate the reasons for and effects of such parallel structures for DRR and CCA in Botswana, Mozambique, the Seychelles, Tanzania and Zambia. It revealed overwhelmingly negative effects in terms of unclear mandates and leadership, uncoordinated efforts, duplication of efforts, suboptimal use of resources and competition over resources and control. The study identified both external reasons for the parallel structures, in terms of global or international initiatives or incentives, and internal reasons, with regard to the history and quality of the governance structures. Although the identified negative effects are common to a range of complex nexuses, there is a clear distinction with the DRR–CCA nexus comprising virtually indistinguishable practices in Southern Africa. There is, as such, no practical reason for keeping them apart. The parallel structures for DRR and CCA are instead the result of pervasive institutionalisation across the region, driven by coercive, mimetic and normative pressures coming from both within and abroad. Although much point to the difficulties of changing the studied institutional arrangements, these parallel structures for DRR and CCA must be addressed if the populations in Southern Africa are to enjoy safety and sustainable development.
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| 2. |
- Evertsson, Maria, et al.
(författare)
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Design of a Pediatric Rectal Ultrasound Probe Intended for Ultra-High Frequency Ultrasound Diagnostics
- 2023
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Ingår i: Diagnostics. - 2075-4418. ; 13:10
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Tidskriftsartikel (refereegranskat)abstract
- It has been shown that ultra-high frequency (UHF) ultrasound applied to the external bowel wall can delineate the histo-anatomic layers in detail and distinguish normal bowel from aganglionosis. This would potentially reduce or lessen the need for biopsies that are currently mandatory for the diagnosis of Hirschsprung’s disease. However, to our knowledge, no suitable rectal probes for such a use are on the market. The aim was to define the specifications of an UHF transrectal ultrasound probe (50 MHz center frequency) suitable for use in infants. Probe requirements according to patient anatomy, clinicians’ requests, and biomedical engineering UHF prerequisites were collected within an expert group. Suitable probes on the market and in clinical use were reviewed. The requirements were transferred into the sketching of potential UHF ultrasound transrectal probes followed by their 3D prototype printing. Two prototypes were created and tested by five pediatric surgeons. The larger and straight 8 mm head and shaft probe was preferred as it facilitated stability, ease of anal insertion, and possible UHF technique including 128 piezoelectric elements in a linear array. We hereby present the procedure and considerations behind the development of a proposed new UHF transrectal pediatric probe. Such a device can open new possibilities for the diagnostics of pediatric anorectal conditions.
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| 3. |
- Graneli, Christina, et al.
(författare)
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Histopathological dimensions differ between aganglionic and ganglionic bowel wall in children with Hirschsprung’s disease
- 2022
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the validation of new imaging technology for children with Hirschsprung’s disease (HSCR), basic anatomical parameters of the bowel wall must be established specifically for this patient group. Aim: To explore differences in histoanatomical layers of bowel wall, comparing ganglionic and aganglionic bowel walls, and to examine if the bowel wall thickness is linked to patient weight. Methods: This was an observational study of bowel specimens from children weighing 0–10 kg, operated on consecutively during 2018–2020. Ganglionic and aganglionic bowel walls were measured in digitalized microscopy images from 10 sites per trans-sectional specimen and compared regarding the thickness of their histoanatomical layers. Results: Bowel walls were measured in 21 children. Full bowel wall thickness did not differ between aganglionic and ganglionic bowel (2.20 vs 2.04; p = 0.802) while weight at surgery correlated positively with both ganglionic and aganglionic bowel wall thickness (r = 0.688 and 0.849, respectively), and age at surgery with ganglionic bowel wall thickness (r = 0.517). In aganglionic segments, the muscularis externa layer was thicker compared to that in ganglionosis (0.45 vs 0.31 mm, p = 0.012) whereas the muscularis interna was thinner (0.45 vs 0.62 mm, p < 0.001). A diagnostic index was identified whereby a lower ratio of muscularis interna/externa thickness followed by a thinner muscularis interna differed between aganglionic and ganglionic bowel in all specimens. Conclusion: Thicknesses of the bowel wall’s muscle layers differ between aganglionic and ganglionic bowel walls in children with HSCR. These findings support a diagnostic index that could be validated for transfer to instant diagnostic imaging techniques.
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| 4. |
- Granéli, Christina, et al.
(författare)
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Ultra high frequency ultrasonography to distinguish ganglionic from aganglionic bowel wall in Hirschsprung disease : A first report
- 2021
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Ingår i: Journal of Pediatric Surgery. - : Elsevier BV. - 0022-3468. ; 56:12, s. 2281-2285
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Tidskriftsartikel (refereegranskat)abstract
- Background/Purpose: In Hirschsprung disease (HD) surgery, confirming ganglionic bowel is essential. A faster diagnostic method than the current frozen biopsy is desirable. This study investigated whether aganglionic and ganglionic intestinal wall can be distinguished from each other by ultra high frequency ultrasound (UHF ultrasound). Methods: In an HD center during 2019, intestinal walls of recto-sigmoid specimens from HD patients were examined ex vivo with a 70 MHz UHF ultrasound transducer. Data from four sites were described. Histopathologic analysis was compared to the ultrasonography outcome at each site. Each patient's specimen served as its own control. Results: 11 resected recto-sigmoid specimens (median 20 cm long [range 6.5–33]) with transition zones of 5 cm (2–11 cm) were taken from children aged 22 days (13–48) weighing 3668 g (3500–5508); 44 key sites were analyzed. There was full concordance for 42/44 (95%) key sites and 10 of 11 (91%) specimens. The specimen with discordance of two key sites contained a segment of aganglionosis (3 cm) and a transition zone (1 cm): the site discordance was limited to the transition zone ends. Conclusions: This first report on UHF ultrasound in recto-sigmoid HD shows promising results in identifying aganglionosis, transition zones and ganglionic bowel. Further in vivo studies are required.
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| 5. |
- Hagelsteen, Magnus
(författare)
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Capacity development in international aid : A contribution to theory and practice
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Although capacity development has been a key aspect of global aid policy for decades, success is limited. Capacity development is defined as a process, based on a partnership, to develop capacity to achieve a goal. The purpose of this thesis is to increase our understanding of why capacity development does not work as intended, and to inform the discussion on addressing the challenges. Two research questions were asked: 1) What are the principles and practices of capacity development? 2) Why is the current implementation of capacity development not leading to the desired results?Data were collected through qualitative semi-structured interviews with 115 participants from the international aid community. A framework of eight principles, four fundamental challenges and a typology of seven failures is presented. The results reveal significant gaps between theory and practice. The challenges stem from terminological and conceptual ambiguity, clashing principles, misguided accountability, risk aversion and the need for control. The aid system is built on short-term feedback, but capacity development requires long-term processes and commitment. Outdated worldviews, resistance to change, mindset lag, and power imbalances further complicate the situation.Based on the results, this thesis recommends an overhaul of the aid system, with power being redistributed along the aid chain. To develop sustainable capacities, three requisite types of capacity – technical, processual and contextual – are suggested. An equal partnership, flexible and adaptive roles, and mutual learning are crucial for capacity development to work. Effective capacity development requires donors and external partners to allow enough time, relinquish control, share risks, and embrace flexibility and adaptability over longer timeframes. Sustainability depends on the success of the principles, and the need for a mix of activities and methods.The principles need to be taken seriously so that the focus is not only on what the project should achieve, but also on how it is achieved. A change in mindset, attitude and role allocation is needed. By prioritising differently than today, there is a good chance of achieving the goal of sustainable capacity development.
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| 6. |
- Hagelsteen, Magnus, et al.
(författare)
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Caught between principles and politics : Challenges and opportunities for capacity development from governmental donors’ perspectives
- 2022
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Ingår i: International Journal of Disaster Risk Reduction. - : Elsevier BV. - 2212-4209. ; 70
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Tidskriftsartikel (refereegranskat)abstract
- Capacity development —an integral part of development cooperation in general and for disaster risk reduction (DRR) in particular—has had limited success so far. This article investigates capacity development challenges and opportunities from the viewpoint of the staff of progressive governmental donor agencies. Data were obtained from 26 semi-structured interviews with informants from seven donor agencies. The results show that donor staff are highly committed to the application of established principles for effective capacity development. However, despite capacity development being recognized as a cornerstone of development cooperation and crucial for DRR, it is described as a complex, broad or empty concept. The results reveal tensions between the principles for capacity development and current political priorities, power relations, and structural constraints of the aid system. Capacity development is undermined by the widespread aversion of donors and external partners to engage in the perceived risks associated with applying the principles in practice since they are accountable to other actors along the aid chain. Capacity development requires donors and external partners to let go of control and allow flexibility, adaptability and innovative approaches over longer time frames. This requires explicit risk-sharing agreements along the aid chain. Efforts are necessary at all levels of the system to realize the principles and conditions that enable effective capacity development for DRR.
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| 7. |
- Hagelsteen, Magnus, et al.
(författare)
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Troubling partnerships: Perspectives from the receiving end of capacity development
- 2021
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Ingår i: International Journal of Disaster Risk Reduction. - : Elsevier BV. - 2212-4209. ; 59
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to complement the overwhelming focus on external partners in existing studies of capacity development for disaster risk reduction (DRR) or climate change adaptation (CCA), by exploring the perspectives of internal partners on challenges and possible solutions. 27 qualitative semi-structured interviews with experts, program officers and managers in five countries in the Southern African Development Community region were conducted. Three requisite and interdependent types of capacities—technical, processual, and contextual—in order to develop sustainability are suggested from the result. A typology of seven failures for partners to avoid when designing and implementing capacity development projects for DRR or CCA in the future are presented. The more of these failures occur, the less effective and sustainable capacity development becomes. For capacity development to be sustainable, more credit to internal partners, explicit opportunities for mutual learning and adaptive roles of external partners spanning from expert to coach need to be considered.
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| 8. |
- Hawez, Tebin, et al.
(författare)
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Ultra-High Frequency Ultrasound Imaging of Bowel Wall in Hirschsprung’s Disease—Correlation and Agreement Analyses of Histoanatomy
- 2023
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Ingår i: Diagnostics. - 2075-4418. ; 13:8
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Tidskriftsartikel (refereegranskat)abstract
- Hirschsprung’s disease (HD) is characterized by aganglionosis in the bowel wall, requiring resection. Ultra-high frequency ultrasound (UHFUS) imaging of the bowel wall has been suggested to be an instantaneous method of deciding resection length. The aim of this study was to validate UHFUS imaging of the bowel wall in children with HD by exploring the correlation and systematic differences between UHFUS and histopathology. Resected fresh bowel specimens of children 0–1 years old, operated on for rectosigmoid aganglionosis at a national HD center 2018–2021, were examined ex vivo with UHFUS center frequency 50 MHz. Aganglionosis and ganglionosis were confirmed by histopathological staining and immunohistochemistry. Histoanatomical layers of bowel wall in histopathological and UHFUS images, respectively, were outlined using MATLAB programs. Both histopathological and UHFUS images were available for 19 aganglionic and 18 ganglionic specimens. The thickness of muscularis interna correlated positively between histopathology and UHFUS in both aganglionosis (R = 0.651, p = 0.003) and ganglionosis (R = 0.534, p = 0.023). The muscularis interna was systematically thicker in histopathology than in UHFUS images in both aganglionosis (0.499 vs. 0.309 mm; p < 0.001) and ganglionosis (0.644 versus 0.556 mm; p = 0.003). Significant correlations and systematic differences between histopathological and UHFUS images support the hypothesis that UHFUS reproduces the histoanatomy of the bowel wall in HD accurately.
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| 9. |
- Pedersen, Hanne, et al.
(författare)
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Visuospatial ability is associated to 2D laparoscopic simulator performance amongst surgical residents
- 2023
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Ingår i: Surgery Open Science. - : Elsevier BV. - 2589-8450. ; 11, s. 56-61
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Tidskriftsartikel (refereegranskat)abstract
- Background: The technical skills of a surgeon influence surgical outcome. Testing technical aptitude at point of recruitment of surgical residents is only conducted in a few countries. This study investigated the impact of visuospatial ability (VSA), background factors, and manual dexterity on performance in two different laparoscopic surgical simulators amongst applicants and 1st year surgical residents. Method: Applicants from general surgery, pediatric surgery, and urology were included from seven hospitals in Sweden between 2017 and 2021. Some 73 applicants were invited and 50 completed. Participants filled out a background form, and were tested for manual dexterity, and visuospatial ability. Two laparoscopic simulators were used, one 2D video box trainer and one 3D Virtual Reality Simulator. Results: A significant association was found between the visuospatial ability test and 2D video box laparoscopic performance (95 % CI: 1.028–1.2, p-value <0.01). For every point on the visuospatial test the odds of accomplishing the task increased by 11 %. No association was found between VSA and performance in a laparoscopic VR simulator using 3D vision. No other background factors were associated with performance in the two laparoscopic simulators. Conclusion: Visuospatial ability in applicants to surgical residency positions is associated to performance in a 2D video box trainer. Knowledge of a resident's visuospatial ability can be used to tailor individualized laparoscopic training programs, and in the future might function as a selection tool concerning laparoscopic ability. Key message: Visuospatial ability differs greatly amongst applicants for surgical residency and is associated to laparoscopic simulator performance. Testing applicants' visuospatial ability could possibly be used to tailor individualized laparoscopic training programs or in the future as a selection tool concerning laparoscopic ability.
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