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| 2. |
- Lekman, Jonatan, et al.
(author)
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The challenge of risk prevention in home healthcare - An interview study with nurses in municipal care
- 2023
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In: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 37:4, s. 1067-1078
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Journal article (peer-reviewed)abstract
- Background: Safety in home healthcare has garnered increased attention as more people are receiving care for complex conditions at home. The prerequisites for providing safe care at home differ from those in hospitals. Malnutrition, falls, pressure ulcers and inappropriate medication commonly follow poor risk assessments, causing unnecessary suffering and costs. Therefore, risk prevention in home healthcare needs to be prioritised and studied more closely. Aim: To describe nurses' experiences of performing risk prevention in municipal home healthcare. Methods: Qualitative inductive approach, using semi-structured interviews with 10 registered nurses in a municipality in southern Sweden. Data underwent qualitative content analysis. Findings: The analysis resulted in three main categories and one overarching theme describing nurses' experiences of risk prevention in home healthcare. Getting everyone onboard comprises the categories: Managing safety while respecting the patient's self-determination, which covers patient participation, the strategic importance of respecting different views of risks and information and the fact that healthcare workers are guests in the patient's home. Finding ways to make it work touches upon the relational aspect, including next-of-kin and promoting a common understanding to prevent risks. Being squeezed between resources and requirements refers to ethical dilemmas, teamwork, leadership and organisational prerequisites. Conclusion: Patient habits, living conditions and limited awareness of risks is a challenge in risk prevention in home healthcare, where patient participation plays a pivotal role. Risk prevention in home healthcare needs to be initiated at an early stage of disease and ageing and should be seen as a process where early health-promoting interventions can prevent the development and accumulation of risks over time. Long-term cross-organisational collaborations and patients' physical, mental and psychosocial conditions also need to be taken into account.
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| 3. |
- Lindén, Anja, et al.
(author)
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Protocolised reduction of non-resuscitation fluids versus usual care in patients with septic shock (REDUSE): a protocol for a multicentre feasibility trial
- 2023
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In: Bmj Open. - : BMJ. - 2044-6055. ; 13:2
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Journal article (peer-reviewed)abstract
- Introduction Administration of large volumes of fluids is associated with poor outcome in septic shock. Recent data suggest that non-resuscitation fluids are the major source of fluids in the intensive care unit (ICU) patients suffering from septic shock. The present trial is designed to test the hypothesis that a protocol targeting this source of fluids can reduce fluid administration compared with usual care.Methods and analysis The design will be a multicentre, randomised, feasibility trial. Adult patients admitted to ICUs with septic shock will be randomised within 12 hours of admission to receive non-resuscitation fluids either according to a restrictive protocol or to receive usual care. The healthcare providers involved in the care of participants will not be blinded. The participants, outcome assessors at the 6-month follow-up and statisticians will be blinded. Primary outcome will be litres of fluids administered within 3 days of randomisation. Secondary outcomes will be proportion of randomised participants with outcome data on all-cause mortality; days alive and free of mechanical ventilation within 90 days of inclusion; any acute kidney injury and ischaemic events in the ICU (cerebral, cardiac, intestinal or limb ischaemia); proportion of surviving randomised patients who were assessed by European Quality of Life 5-Dimensions 5-Level questionnaire and Montreal Cognitive Assessment; proportion of all eligible patients who were randomised and proportion of participants experiencing at least one protocol violation.Ethics and dissemination Ethics approval has been obtained in Sweden. Results of the primary and secondary outcomes will be submitted for publication in a peer-reviewed journal.
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| 4. |
- Lindén, Jonatan, et al.
(author)
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A Skiplist-based Concurrent Priority Queue with Minimal Memory Contention
- 2013
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In: OPODIS 2013: 17th International Conference On Principles Of DIstributed Systems. - Berlin : Springer Berlin/Heidelberg. ; , s. 206-220
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Conference paper (peer-reviewed)abstract
- Priority queues are fundamental to many multiprocessor applications. Several priority queue algorithms based on skiplists have been proposed, as skiplists allow concurrent accesses to different parts of the data structure in a simple way. However, for priority queues on multiprocessors, an inherent bottleneck is the operation that deletes the minimal element. We present a linearizable, lock-free, concurrent priority queue algorithm, based on skiplists, which minimizes the contention for shared memory that is caused by the DeleteMin operation. The main idea is to minimize the number of global updates to shared memory that are performed in one DeleteMin. In comparison with other skiplist-based priority queue algorithms, our algorithm achieves a 30 - 80% improvement.
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| 6. |
- Lindén, Jonatan, et al.
(author)
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A Skiplist-Based Concurrent Priority Queue with Minimal Memory Contention
- 2018
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Reports (other academic/artistic)abstract
- Priority queues are fundamental to many multiprocessor applications. Several priority queue algorithms based on skiplists have been proposed, as skiplists allow concurrent accesses to different parts of the data structure in a simple way. However, for priority queues on multiprocessors, an inherent bottleneck is the operation that deletes the minimal element. We present a linearizable, lock-free, concurrent priority queue algorithm, based on skiplists, which minimizes the contention for shared memory that is caused by the sc DeleteMin operation. The main idea is to minimize the number of global updates to shared memory that are performed in one sc DeleteMin. In comparison with other skiplist-based priority queue algorithms, our algorithm achieves a 30 - 80% improvement.
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| 7. |
- Lindén, Jonatan, et al.
(author)
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Exposing inter-process information for efficient parallel discrete event simulation of spatial stochastic systems
- 2017
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In: Proc. 5th ACM SIGSIM Conference on Principles of Advanced Discrete Simulation. - New York : ACM Press. - 9781450344890 ; , s. 53-64
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Conference paper (peer-reviewed)abstract
- We present a new efficient approach to the parallelization of discrete event simulators for multicore computers, which is based on exposing and disseminating essential information between processors. We aim specifically at simulation models with a spatial structure, where time intervals between successive events are highly variable and without lower bounds. In Parallel Discrete Event Simulation (PDES), the model is distributed onto parallel processes. A key challenge in PDES is that each process must continuously decide when to pause its local simulation in order to reduce the risk of expensive rollbacks caused by future "delayed"' incoming events from other processes. A process could make such decisions optimally if it would know the timestamps of future incoming events. Unfortunately, this information is often not available in PDES algorithms. We present an approach to designing efficient PDES algorithms, in which an existing natural parallelization of PDES is restructured in order to expose and disseminate more precise information about future incoming events to each LP. We have implemented our approach in a parallel simulator for spatially extended Markovian processes, intended for simulating, e.g., chemical reactions, biological and epidemiological processes. On 32 cores, our implementation exhibits speedup that significantly outweighs the overhead incurred by the refinement. We also show that our resulting simulator is superior in performance to existing simulators for comparable models, achieving for 32 cores an average speedup of 20 relative to an efficient sequential implementation.
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| 8. |
- Lindén, Jonatan, et al.
(author)
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Fine-grained local dynamic load balancing in PDES
- 2018
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In: Proc. 6th ACM SIGSIM Conference on Principles of Advanced Discrete Simulation. - New York : ACM Press. - 9781450350921 ; , s. 201-212
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Conference paper (peer-reviewed)
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| 9. |
- Linden, Johan, et al.
(author)
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Inflammatory activity and vitamin D levels in an MS population treated with rituximab
- 2019
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In: Multiple Sclerosis Journal, Experimental, Translational and Clinical. - : SAGE Publications. - 2055-2173. ; 5:1
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Journal article (peer-reviewed)abstract
- Background: Most multiple sclerosis patients on disease-modifying treatment at Umeå University Hospital are treated with rituximab and the prevalence of vitamin D supplementation has increased over time. Follow-up studies of these off-label treatments are needed.Objective: To study inflammatory activity and adverse effects in rituximab-treated multiple sclerosis patients, and associations with 25-hydroxy-vitamin D levels.Methods: Retrospectively collected data on repeated estimates of relapses, disability, side effects, magnetic resonance imaging, laboratory measures including 25-hydroxy-vitamin D levels and self-perceived health.Results: In 272 multiple sclerosis patients with a mean follow-up of 43 months, we identified seven possible relapses during active rituximab treatment. On magnetic resonance imaging examination, new T2 lesions were seen in 1.3% (10 out of 792 scans), and 0.25% (two out of 785 scans) showed contrast enhancement. Adjusted 25-hydroxy-vitamin D levels in samples drawn close to all magnetic resonance images with new T2 lesions were lower compared to the remainder (62 vs. 81 nmol/l; P = 0.030). Levels of 25-hydroxy-vitamin D were associated with self-perceived health (r = 0.18, P = 0.041, n = 130) and C-reactive protein (r = -0.13, P = 0.042) but not with the risk of side effects.Conclusion: The inflammatory activity in this rituximab-treated multiple sclerosis population that increasingly used vitamin D supplementation was extremely low. Higher 25-hydroxy-vitamin D levels were associated with beneficial outcomes.
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| 10. |
- Lindén, Jonatan
(author)
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Synchronization Techniques in Parallel Discrete Event Simulation
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Discrete event simulation is an important tool for evaluating system models in many fields of science and engineering. To improve the performance of large-scale discrete event simulations, several techniques to parallelize discrete event simulation have been developed.In parallel discrete event simulation, the work of a single discrete event simulation is distributed over multiple processing elements. A key challenge in parallel discrete event simulation is to ensure that causally dependent events are processed in the correct order, so that the same simulation trajectory is produced as in a sequential simulation. To preserve chronology between events processed in parallel, different synchronization protocols have been devised, each carrying a cost in performance.This thesis presents techniques for reducing synchronization costs in two approaches to parallel discrete event simulation, viz., optimistic space-parallel and share-everything parallel discrete event simulation.Firstly, we develop a concurrent priority queue, to be used as, e.g., a central event queue in the share-everything approach to parallel discrete event simulation. The priority queue is based on skiplists. It improves over previous queues by incurring fewer global synchronization operations, thereby inducing less contention and improving scalability.Secondly, we study how to improve the performance of optimistic parallel discrete event simulation by disseminating accurate estimates of timestamps of future events. We present techniques for obtaining the estimates in two different methods for simulation of spatial stochastic models. The estimates allow processing elements to determine when to pause simulation with high precision, thereby reducing the amount of performed useless work.Finally, we observe that in the applications that we have studied, the phenomena of interest are often non-homogeneous and migrate over time. Due to this, the work distribution tends to become unbalanced among the processing elements. A solution is to rebalance the work dynamically. We propose a fine-grained local dynamic load balancing algorithm for parallel discrete event simulation. The load balancing algorithm reduces the number of events arriving out-of-order, thereby reducing the amount of time spent on corrective actions.
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