| 1. |
- Magnusson, Eva Maria, 1947-
(author)
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Vad händer i själva verket? : Om styrning och handlingsutrymme i Skolverket under åren 1991–2014
- 2018
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Doctoral thesis (other academic/artistic)abstract
- This thesis deals with questions of governance, control and discretion in state agencies. It is grounded on a case study of the Swedish National Agency for Education (Skolverket), from its prelude in the late 1980s, to its start in 1991, through several governments, seven ministers and four direktor generals, up tp 2014.The empirical part of the thesis follows the periods of the four director generals. The study is based on a vast number of documents, supplemented with interviews. For the analysis, a model of governance and control was condensed from the literature. This model attempts to cover both the political governing of agencies and the internal organizational control of agencies. This model was furthermore developed into three ideal type control styles: Old public management/ Agency, New public management/ Actor, and New public governance/ Arena.Analysis showed that Skolverket started out as a new type of agency, resembling the ideal type of NPG/ Arena, but over time, with an increasing pressure from the political level, it gradually turned into a more “normal” state agency, at one period resembling the ideal type of NPM/ Actor but finally becoming more similar to the ideal type of OPM/ Agent, however with still strong internal traits of an Arena.Further analysis showed that the actual governance and control featured several crucial characteristics that proved to be of importance for the amount of discretion left for the directors and officials of the agency. These characteristics were the degree of 1) unified or plural value systems, 2) partial or comprehensive use of control “tools”, and 3) high or low degree of specificity. These three characteristics were combined into eight different types of roles, each with a specific type and level of discretion, from the most restricted (“Authoritarian”) to the most unrestricted (“Laissez-faire”) and six other roles in between. It is proposed that this scheme of roles form a novel way of analysing the level and distribution of discretion in agencies.
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| 2. |
- Sahlén, Klara
(author)
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Optimizing diagnostics and follow-up of patients with ureterolithiasis
- 2024
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Doctoral thesis (other academic/artistic)abstract
- Urolithiasis is increasing in incidence worldwide and subsequently so is the demand for customized imaging. Optimizing imaging strategies is needed to reduce radiation dose, time, and cost. This thesis investigated aspects of CT-diagnostics for patients with ureterolithiasis.In paper I the rate of urinary obstruction, the predictive value of secondary signs of obstruction, stone size and location, and renal cortical enhancement was assessed in 49 patients with a remaining stone at follow-up CT after a renal colic attack. A dynamic protocol was used to grade urinary obstruction and associated radiation doses evaluated. In paper II, renal parenchymal volumes were measured in CT-scans before, during and after an acute ureteral obstruction using 3D-segmentation in 20 patients. In paper III the interreader variability in stone size measurements in four different window settings was investigated in 124 patients with a proximal ureteral stone. In paper IV, patient reported symptoms was correlated to the degree of obstruction (defined with the dynamic protocol) in 81 patients with a remaining ureteral stone at follow-up.Obstruction was present in 28% (n=14). The absence of hydronephrosis and hydroureter had a negative predictive value (NPV) of 1.0. Stone characteristics were not associated with obstruction. Cortical enhancement was lower in obstructed kidneys. 1.8 mSv was saved using a dynamic scan compared to an excretory phase. Renal parenchymal volume decreased with 24% in the obstructed and 5% in the healthy kidney after obstruction. Interreader variability was ±1.6 mm (bone window), ±0.4 mm (soft tissue window), ±0.3 mm (half-value MEAN window) and ±0.2 mm (half-value MAX window). In total 47% (n=38) with a remaining stone were asymptomatic. Of these 11% (n=4) had a mild degree of obstruction. All patients with moderate or severe obstruction reported symptoms at follow-up.In conclusion, urinary obstruction was scarce in patients with a remaining ureteral stone at follow-up. Absence of hydronephrosis and hydroureter was a strong negative predictor of obstruction. A dynamic protocol saved radiation dose. Obstructed kidneys increased in parenchymal volume during obstruction and so did the contralateral kidney to a lesser extent. Interreader variability in stone size measurements is unsatisfying in the bone window and smallest in the half-value MAX window. Symptoms is an uncertain tool to rule out the presence of a remaining ureteral stone and obstruction at follow-up.The findings in this thesis contribute to the knowledge of CT-diagnostics in ureterolithiasis that may help sharpen the radiological work-up for patients with ureterolithiasis.
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| 3. |
- Landström, Eva, 1975-
(author)
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To Choose or not to Choose Functional Foods, that is the Question : Swedish Consumers’ and Health-care Professionals’ Attitudes to and Use of Functional Foods
- 2008
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis is to investigate attitudes to functional foods (here defined as foods with health claims) among Swedish consumers and health-care professionals. The aim is also to survey demographics and health interests associated with the consumption of functional foods among Swedish consumers. Finally, the aim is to investigate health-care professionals’ knowledge of and willingness to recommend functional foods to patients.Examples of functional foods used in the studies are probiotic fruit-drinks, probiotic milk-products, cholesterol-lowering spreads and fibre-rich bread with omega-3 fatty acids. Ten focus groups of consumers and three of health-care professionals were conducted. Two questionnaires were also used, one for consumers aged 17-75 years (n=2000) and one for health-care professionals (dieticians, n=100; registered nurses, n=200; physicians, n=200). Almost half of the consumers (48%) and exactly half (50%) of the health-care professionals responded.The consumers wondered whether the functional foods were normal foods or medicines. They considered functional foods unnecessary, unless you suffer from incurable diet-related problems. The consumers were worried that the foods could be used as a compensation for an unhealthy lifestyle. While the consumers in the focus groups were mainly sceptical towards functional foods, these foods are being consumed by those who perceive them as necessary, the health-conscious, the well-educated and people who have noticed effect of the foods.The registered nurses and physicians, in contrast to the dieticians, expressed doubts regarding the claimed effects of the functional foods. The dieticians rated higher knowledge and were more willing to recommend functional foods to patients than were the physicians and, to some extent, the registered nurses. The interviews with the health-care professionals revealed that the dieticians were more positive towards functional foods than the registered nurses and, primarily, the physicians. This was confirmed through the questionnaire. Those, who consumed functional foods, reported high knowledge, and perceived benefits of functional foods, were most likely to recommend these foods to patients.
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| 4. |
- Magnusson, Anders, 1957-
(author)
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Evaluation of surgically assisted rapid maxillary expansion and orthodontic treatment : Effects on dental, skeletal and nasal structures and rhinological findings
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Surgically Assisted Rapid Maxillary Expansion (SARME) is frequently used to treat skeletal maxillary transverse deficiency (MTD) in skeletally mature and non-growing individuals. Despite previous research in the field, questions remain with respect to the long-term stability of SARME and its effects on hard and soft tissue.The overall aim of the present doctoral work was to achieve a greater understanding of SARME, using modern image technology and a multidisciplinary approach, with special reference to effects on the hard and soft tissues and respiration. A more specific aim was to evaluate the long-term stability in a retrospective sample of patients treated with SARME and orthodontic treatment and to compare the results with a matched, untreated control group. The studies in this doctoral project are thus based on two different samples and study designs.The first sample, Study I (Paper I), is a retrospective, consecutive, long-term follow-up material of study models from 31 patients (17 males and 14 females) treated with SARME and orthodontic treatment between 1991 and 2000. The mean pre-treatment age was 25.9 years (SD 9.6) with a mean follow-up time of 6.4 years (SD 3.3). Direct measurements on study models were made with a digital sliding caliper at reference points on molars and canines. To evaluate treatment outcome and long-term stability, the results were compared with study models from an untreated control group, matched for age, gender and follow-up time.The second sample, Study II (Papers II-IV), is a prospective consecutive, longitudinal material of 40 patients scheduled to undergo SARME and orthodontic treatment between 2006 and 2009.In Paper II, one patient was excluded because of a planned adenoidectomy. The final sample comprised 39 patients (16 males and 23 females). The mean age at treatment start was 19.9 years (range 15.9 – 43.9). Acoustic rhinometry, rhinomanometry and a questionnaire were used to assess the degree of nasal obstruction at three time-points; pre-treatment, three months after expansion and after completed treatment (mean 18 months).In Papers III–IV, three patients declined to participate and two had to be excluded because their CT-records were incomplete. The final sample comprised 35 patients (14 males and 21 females). The mean age at treatment start was 19.7 years (range 16.1 – 43.9). Helical CT-images were taken pre-treatment and eighteen months’ post-expansion. 3D models were registered and superimposed at the anterior cranial base. The automated voxel-based image registration method allows precise, accurate measurements in all areas of the maxilla. In Papers II–IV, the treatment groups constituted their own control groups.The main findings in the retrospective, long-term follow-up study were that SARME and orthodontic treatment normalized the transverse discrepancy and was stable for a mean of 6 years post-treatment. Pterygoid detachment did not entirely eliminate the side effect of buccal tipping of the posterior molars. Relapse is time-related and is most pronounced during the first 3 years after treatment. Thus the retention period should be extended and should be considered for this period. The main rhinological findings in the prospective longitudinal study were that SARME had a shortterm, favourable effect on nasal respiration, but the effect did not persist in the long-term. However, subjects with pre-treatment nasal obstruction reported a lasting sensation of improved nasal function.SARME and orthodontic treatment had a significant but non-uniform skeletal treatment effect, with significantly greater expansion posteriorly than anteriorly. The expansion was parallel anteriorly but not posteriorly. The lateral tipping of the posterior segment was significant, despite careful surgical separation. No correlation was found between tipping and the patient's age. Furthermore, SARME and orthodontic treatment significantly affected all dimensions of the external features of the nose. The most obvious changes were at the most lateral alar-bases. The difference in lateral displacement profoundly influenced the perception of a more rounded nose. There were no predictive correlations between the changes. Patients with narrow and constrained nostrils can benefit from these changes with respect to the subjective experience of nasal obstruction. It is questionable whether an alar-cinch suture will prevent widening at the alar-base.The 3D superimposition applied in Study II is a reliable method, circumventing projection and measurement errors. In conclusion, SARME and orthodontic treatment normalize the transverse deficiency, with long-term stability. SARME has a favourable effect on the subjective perception of nasal respiration. SARME significantly affects dental, skeletal and nasal structures.
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| 5. |
- Magnusson, Mia-Maria
(author)
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Open drug scenes and the merging of policing practice and research : a pracademic approach
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Policing research has had an upswing as the evidence-based policing movement has grown stronger and entered police practises worldwide. Within the evidence-based policing (EBP) approach, practically and academically skilled individuals, pracademics, have attracted attention as facilitating the merging of policing practice and research.Using principles from EBP, and with a special focus on translating between policing practice, policy and research, this thesis aims to explore the characteristics of illicit drug markets with a place-based focus and to link this to the enhancement of EBP in Sweden. The theoretical base of the thesis is drawn from disorganization theory, routine activity theory and situational action theory, and these theories are combined with empirical studies from the research field of drug markets.Drug markets are defined as open drug scenes (ODSs) in this pracademic thesis, which includes two empirical studies of patterns that characterize ODSs, one randomized controlled trial (RCT) of a law enforcement tactic at an ODS, and one case study of the impact of the pracademic research approach. The findings show that there are almost 50 ODSs in Stockholm County, which are characterized by patterns of crime concentration, a gun violence overlap, and associations with perceptions of unsafety. Three types of ODSs were identified, providing a basis for the tailoring of future interventions based on area characteristics, ODS stability, levels of violence, and gang activity. Micro places associated with ODSs and gun violence were found to be characterized by harsh social conditions and high levels of crime. A predictive index was created to forecast micro places at which gun violence may occur, and the prediction was enhanced when ODSs were included as predictive locations. The RCT, which was completed at a well-known ODS in the inner city of Stockholm, showed a slight but non-significant effect of the police conducting motivational talks with offenders, which gave rise to questions regarding the method’s effectiveness. The case study of the RCT process found frustration in police departments to be a possible door-opener for research. Ease of implementation was associated with the research having credibility among police officers, which was achieved by including the needs of practice in research questions and through the role played by the pracademic researcher.This thesis argues for making use of pracademics to bridge the research-practice gap, a focus on ODSs, and the testing and tracking of methods such as hot spots policing, with an emphasis on properly implemented evidence-based methods and on the goals of enforcement strategies as a means of improving the effectiveness of drug-market policing.
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| 6. |
- Magnusson, Maria, 1960-
(author)
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Skylta med kunskap : en studie av hur barn urskiljer grafiska symboler i hem och förskola.
- 2013
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Doctoral thesis (other academic/artistic)abstract
- The topic of this study is to generate knowledge about children’s understandingof graphical symbols. These forms of knowledge are prevalent in contemporarysocieties, for example, in the form of letters, numbers, road signs, maps, andcomputer icons. More specifically, in this thesis is scrutinized in detail howchildren develop symbolic skills and how this can be supported througheducational activities. The theoretical basis of the study is variation theory(Marton & Tsui, 2004). This theory conceptualizes learning in terms ofdifferentiation and integration. Two empirical studies are reported. The first isabout two children, Olle and Lasse, who both are in the age span four to fiveyears. How these children handle graphical symbols in the form of producingsigns that they put up in their homes are followed over time. Hence, thechildren’s own make and use of symbols in their everyday life are studied. In thesecond empirical study, the findings from the first study and theoretical insightfrom variation theory are orchestrated in a preschool center with two teachersand twelve children, to see if these principles can be functional in supportingchildren’s development of symbolic understanding. Both studies are based onvideo data. The findings are that a particular pattern of variation entitled,‘contrast’ is functional in developing such insight, while another pattern ofvariation entitled, ‘induction’ is not. In addition, meta-communication is arguedto be important not only for the researcher to gain access to the child’sunderstanding but also to the child’s development as such. The theoreticaldistinction made by Vygotsky between ‘pseudo concepts’ and ‘concepts (proper)’is used to discuss the findings.
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| 7. |
- Yakymenko Alkaissi, Lina, 1988-
(author)
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Bacterial epithelial interaction in intestinal inflammation
- 2018
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Doctoral thesis (other academic/artistic)abstract
- The intestine is constantly exposed to bacteria, invading viruses and ingested food. The intestinal barrier serves as a gate preventing passage of harmful components, and at the same time maintaining absorption of nutrients and water. There are over 300 different bacteria species in the human gastrointestinal tract (GI) comprising over 10 times as many cells as the human body. These bacteria are both of commensal and pathogenic strains in which commensal bacteria and antimicrobial peptides have an important role of controlling the intestinal colonization. The intestinal flora is sampled by the membranous cells (M cells) that are present in the follicle associated epithelium (FAE). Antigens encounter immune cells found in Peyer’s patches located in the distal ileum with FAE overlaying them. Due to environmental factors, genetic predisposition, immune dysregulation or dysbiosis the balance can be shifted which, in turn, will lead to the defect in the barrier function, leading to the development of disorders such as Crohn’s disease (CD). CD is a chronic inflammation in the GI tract, often originating in the distal ileum in FAE and associated with an increased number of adherent invasive strains of bacteria. Specifically adherent invasive E.coli (AIEC) that have been isolated from the ileum and colon of CD patients.The aim of the present thesis was to study bacterial epithelial interaction during inflammation in in vivo, ex vivo and in vitro models.In the first project we found that that Faecalibacterium prausnitzii (FP), possess anti-inflammatory properties in the ileum of an in vivo DSS induced colitis mouse model.In the second project, we discovered that infliximab, known to have anti-inflammatory effects by binding soluble TNF and blocking TNF receptors, reduces bacterial transcytosis across colonic biopsies of CD patients and decreases transcytosis and internalization in cell monolayers in vitro. Moreover, we demonstrated that HM427 bacteria, isolated from colonic mucosa of CD patients, uses lipid raft formations to penetrate the barrier under the influence of TNF in an in vitro model.In project three, we demonstrated that LF82 bacteria, which is an adherent invasive strain of E.coli that has been isolated from the ileum of CD patients, exploits FAE of CD patients and non-IBD control patients to penetrate the barrier via the CEACAM6 receptor and long polar fimbriae. We further demonstrated that there is an increased expression of CEACM6 receptor in the FAE of CD patients, which leads to increased transcytosis of LF82 compared to non-IBD control group.In project four, our results suggested that human α-defensin 5 significantly decreases the passage of LF82 bacteria in an in vitro and ex vivo models. Moreover, we demonstrated that CD patients have a lower expression of human α-defensin 5 in the crypts compared to the non-IBD control patients.Taken together, our findings have given a novel insight into the etiology of CD and into the mechanisms involved in bacterial-epithelial interaction in CD.
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