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| 2. |
- Lindberg, Eva, et al.
(author)
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Clashes between understanding and doing – leaders’ understanding of management in intensive care during a period of reorganisation
- 2003
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In: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 16:7, s. 354-60
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Journal article (peer-reviewed)abstract
- Abstract: The objective was to elucidate hospital leaders’ understanding of the organisational structures and processes and their understanding of their leading role during an intensive period of reorganisation. From a qualitative exploratory study using semi-structured interviews and thematic analysis four themes were identified: understanding the function of leadership and management, understanding organisational structures and processes, their own role as leader, and the outside world. The results indicate that the organisation is characterised by disintegration and erratic structures. The leaders perceive that they lead a learning organisation but in practical care work the organisation functions more like an organisation streamlined for mass production. This discrepancy between their understanding and practical daily care work led to dissatisfaction and existential chaos among the leaders. Our findings show an example of “clashes with the individual attractor pattern”, an urgent, but not yet very clear problem in health-care organisations of today.
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| 3. |
- Malmström, Johan, et al.
(author)
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Transforming growth factor-beta 1 specifically induce proteins involved in the myofibroblast contractile apparatus
- 2004
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In: Molecular & Cellular Proteomics. - 1535-9484. ; 3:5, s. 466-477
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Journal article (peer-reviewed)abstract
- Transforming growth factor-beta(1) (TGF-beta(1)) induces alpha-smooth muscle actin (alpha-SMA) and collagen synthesis in fibroblast both in vivo and in vitro and plays a significant role in tissue repair and the development of fibrosis. During these processes the fibroblasts differentiate into activated fibroblasts (so called myofibroblasts), characterized by increased alpha-SMA expression. Because TGF-beta(1) is considered the main inducer of the myofibroblast phenotype and cytoskeletal changes accompany this differentiation, the main objective of this investigation was to study how TGF-beta(1) alters protein expression of cytoskeletal-associated proteins. Metabolic labeling of cell cultures by [(35)S]methionine, followed by protein separation on two-dimensional gel electrophoresis, displayed approximately 2500 proteins in the pI interval of 3-10. Treatment of TGF-beta(1) led to specific spot pattern changes that were identified by mass spectrometry and represent specific induction of several members of the contractile apparatus such as calgizzarin, cofilin, and profilin. These proteins have not previously been shown to be regulated by TGF-beta(1), and the functional role of these proteins is to participate in the depolymerization and stabilization of the microfilaments. These results show that TGF-beta(1) induces not only alpha-SMA but a whole set of actin-associated proteins that may contribute to the increased contractile properties of the myofibroblast. These proteins accompany the induced expression of alpha-SMA and may participate in the formation of stress fibers, cell contractility, and cell spreading characterizing the myofibroblasts phenotype.
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| 4. |
- Denison, Eva, et al.
(author)
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Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care
- 2004
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In: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0304-3959 .- 1872-6623. ; 111:3, s. 245-252
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Journal article (peer-reviewed)abstract
- This study examined the relations between disability, as measured by the Pain Disability Index (PDI) and self-efficacy, fear avoidance variables (kinesiophobia and catastrophizing), and pain intensity, using a prospective design. Two primary health care samples (n1=210; n2=161) of patients with subacute, chronic or recurring musculoskeletal pain completed sets of questionnaires at the beginning of a physiotherapy treatment period. Multiple hierarchial regression analyses showed that self-efficacy explained a considerably larger proportion of the variance in disability scores than the fear avoidance variables in the first sample. This finding was replicated in the second sample. Pain intensity explained a small, but significant proportion of the variance in disability scores in one sample only. Gender, age, and pain duration were not related to disability. These findings suggest that self-efficacy beliefs are more important determinants of disability than fear avoidance beliefs in primary health care patients with musculoskeletal pain. The findings also suggest that pain-related beliefs, such as self-efficacy and fear avoidance, in turn, are more important determinants of disability than pain intensity and pain duration in these patients.
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| 8. |
- Halfvarson, Jonas, 1970-, et al.
(author)
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Inflammatory bowel disease in a Swedish twin cohort : a long-term follow-up of concordance and clinical characteristics
- 2003
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In: Gastroenterology. - 0016-5085 .- 1528-0012. ; 124:7, s. 1767-1773
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Journal article (peer-reviewed)abstract
- Background & Aims:In 1988, we reported the first twin study in inflammatory bowel disease. The aim of the current study was to follow up these twins regarding new cases of inflammatory bowel disease and Crohn’s disease characteristics using the Vienna classification.Methods:The official Swedish population register and the cause of death register were used to search for the twins. All living patients were interviewed.Results:Three monozygotic twins earlier classified as healthy had been diagnosed with inflammatory bowel disease (ulcerative colitis, n = 2; Crohn’s disease, n = 1). Retrospectively, all 3 were symptomatic at the original survey. This changed the pair concordance in monozygotic twins from 6.3% to 18.8% in ulcerative colitis and from 44.4% to 50.0% in Crohn’s disease. A high degree of concordance regarding age at diagnosis, disease location at diagnosis and during the course, and disease behavior was found in concordant monozygotic twin pairs with Crohn’s disease. Seven of 9 pairs were identical in 3 or more of these disease characteristics compared with an expected number of 1.5 (P = 0.000076).Conclusions:This study confirms that the genetic influence is stronger in Crohn’s disease than in ulcerative colitis. A remarkable phenotype similarity within concordant pairs with Crohn’s disease was found using the Vienna classification.
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| 9. |
- Halfvarson, Jonas, 1970-, et al.
(author)
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Inflammatory bowel disease in a Swedish twin cohort : a long-term follow-up of concordance and clinical characteristics
- 2003
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In: Gastroenterology. - : Elsevier BV. - 0016-5085 .- 1528-0012. ; 124:7, s. 1767-1773
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Journal article (peer-reviewed)abstract
- BACKGROUND & AIMS: In 1988, we reported the first twin study in inflammatory bowel disease. The aim of the current study was to follow up these twins regarding new cases of inflammatory bowel disease and Crohn's disease characteristics using the Vienna classification.METHODS: The official Swedish population register and the cause of death register were used to search for the twins. All living patients were interviewed.RESULTS: Three monozygotic twins earlier classified as healthy had been diagnosed with inflammatory bowel disease (ulcerative colitis, n = 2; Crohn's disease, n = 1). Retrospectively, all 3 were symptomatic at the original survey. This changed the pair concordance in monozygotic twins from 6.3% to 18.8% in ulcerative colitis and from 44.4% to 50.0% in Crohn's disease. A high degree of concordance regarding age at diagnosis, disease location at diagnosis and during the course, and disease behavior was found in concordant monozygotic twin pairs with Crohn's disease. Seven of 9 pairs were identical in 3 or more of these disease characteristics compared with an expected number of 1.5 (P = 0.000076).CONCLUSIONS: This study confirms that the genetic influence is stronger in Crohn's disease than in ulcerative colitis. A remarkable phenotype similarity within concordant pairs with Crohn's disease was found using the Vienna classification.
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| 10. |
- Holmström, Inger, et al.
(author)
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Improving the diabetes-patient encounter by reflective tutoring for staff
- 2004
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In: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 53:3, s. 325-32
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Journal article (peer-reviewed)abstract
- There is relative consensus about the advantages of patient-centred consultations. However, they have not been easy to realise in clinical praxis. The aim of this study was to investigate whether an intervention focused on health care professionals' understanding of the diabetes-patient encounter could facilitate a patient-centred way to encounter these patients. Two GPs and two nurses participated in the year-long intervention. The intervention focused on the staff's understanding of the encounter. Staff video recorded four to five encounters each and reflected together with a supervisor on their understanding of the encounters and how they were conducted. The encounters were analysed with the Verona-MICS/Dr coding system and patients' comments were analysed separately. The content of the consultations and how they were conducted was also assessed. There was a significant change of two patient-centred items by the staff over time. Two staff seemed to change their educational model. Modern theories of competence development seem to be useful in clinical settings.
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| 11. |
- Håkansson, Anders, et al.
(author)
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Kurser i grundläggande forskningsmetodik till nytta för kliniker. Tolv års erfarenheter från Sydsverige
- 2002
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In: Läkartidningen. - 0023-7205. ; 99:10, s. 80-1083
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Journal article (other academic/artistic)abstract
- At the Department of Community Medicine at Lund University we have given courses in basic research methodology since 1989. The course has yielded 20 points of university credit, the equivalent of one full-time semester of studies, and it has been run part-time, covering one and a half years. Our aim has been to provide a large number of physicians with basic training in research methods, and to stimulate the engagement of new scientific students from the whole Southern Health Care Re-gion. During the first ten years, 138 general practitioners (20% of the GPs of the region) and 202 specialists completed our courses. Up till now, 19 GPs (14%) and 19 specialists (9%) have begun PhD studies. During the last two years, another 100 physicians from southern Sweden have attended our courses, as well as GPs from Zealand in Denmark. We have been developing our course in basic research methods during a twelve-year period, and it is now well established in our health care region. We feel that we have succeeded in reaching the two goals we had set up: to give a large number of physicians a fundamental knowledge of research meth-ods and to recruit and increase the number of PhD students. We believe that medical research and development must flourish also outside the traditional university settings.
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| 16. |
- Larsson, Jan, et al.
(author)
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Trainee anaesthetists understand their work in different ways : implications for specialist education
- 2004
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In: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 92:3, s. 381-387
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Journal article (peer-reviewed)abstract
- Background. Traditionally, programmes for specialist educationin anaesthesia and intensive care have been based on lists ofattributes such as skills and knowledge. However, modern researchin the science of teaching has shown that competence developmentis linked to changes in the way professionals understand theirwork. The aim of this study was to define the different waysin which trainee anaesthetists understand their work.Methods. Nineteen Swedish trainee anaesthetists were interviewed.The interviews sought the answers to three open-ended questions.(i) When do you feel you have been successful in your work?(ii) What is difficult or what hinders you in your work? (iii)What is the core of your anaesthesia work? Transcripts of theinterviews were analysed by a phenomenographic approach, a researchmethod aiming to determine the various ways a group of peopleunderstand a phenomenon.Results. Six ways of understanding their work were defined:giving anaesthesia according to a standard plan; taking responsibilityfor the patient’s vital functions; minimizing the patient’ssuffering and making them feel safe; giving service to specialistdoctors to facilitate their care of patients; organizing andleading the operating theatre and team; and developing one’sown competence, using the experience gained from every new patientfor learning.Conclusions. Trainee anaesthetists understand their work indifferent ways. The trainee’s understanding affects bothhis/her way of performing work tasks and how he/she developsnew competences. A major task for teachers of anaesthesia isto create learning situations whereby trainees can focus onnew aspects of their professional work and thus develop newways of understanding it.
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| 17. |
- Lindberg, Eva, et al.
(author)
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An animation tool for demonstrating the importance of edge filters in thermophotovoltaic applications
- 2002
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In: Renewable energy. - : Elsevier Science Ltd. - 0960-1481 .- 1879-0682. ; 28, s. 1305-1315
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Journal article (peer-reviewed)abstract
- In order to achieve high efficiency in a thermophotovoltaic (TPV) generator, it is important that a high fraction of emitted photons with energies below the TPV cell bandgap are reflected back to the emitter. This can be accomplished in several ways, and one suggestion is to place an edge filter between the emitter and the TPV cell array in an elliptical optic design. An animation tool, developed in the Excel® program, for determining the efficiency of an optical system is presented. The animation components are a black body emitter, an edge filter, and an array of TPV cells. The tool has been used to demonstrate the importance of an efficient filter and the usefulness of optics that makes the edge of the filter as sharp as possible.
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| 18. |
- Lindberg, Eva, et al.
(author)
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An animation tool for demonstrating the importance of edge filters in thermophotovoltaic applications
- 2003
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In: Renewable energy. - 0960-1481 .- 1879-0682. ; 28, s. 1305-1315
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Journal article (peer-reviewed)abstract
- In order to achieve high efficiency in a thermophotovoltaic (TPV) generator, it is important that a high fraction of emitted photons with energies below the TPV cell band gap are reflected back to the emitter. This can be accomplished in several ways, and one suggestion is to place an edge filter between the emitter and the TPV cell array in an elliptical optic design. An animation tool, developed in the Excel program, for determining the efficiency of an optical system is presented. The animation components are a black body emitter, an edge filter, and an array of TPV cells. The tool has been used to demonstrate the importance of an efficient filter and the usefulness of optics that makes the edge of the filter as sharp as possible. It is available at www.du.se/tpv.
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| 19. |
- Lindberg, Eva, et al.
(author)
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Animation tool and Q. E. measurements for estimating the optimum system efficiency of a TPV generator
- 2004
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In: Sixth Conference on Thermophotovoltaic Generation of Electricity. - Freiburg, Tyskland.
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Conference paper (other academic/artistic)abstract
- In order to achieve high efficiency in a thermophotovoltaic (TPV) generator, it is important that a high fraction of emitted photons with energies below the TPV cell band gap are reflected back to the emitter. This can be accomplished in several ways, and one possibility is to place an edge filter between the emitter and the TPV cell array in an elliptical optic design. By this arrangement the cooling demand on the TPV cells is reduced and the reflected radiation is reused in the emitter, the fuel demand is decreased. An animation tool, developed in the Excel program, for determining the optical availability in such a system has been presented previously. The animation components were a blackbody emitter, an adjustable edge filter, and an array of TPV cells. The tool was used to demonstrate the importance of an efficient filter and the usefulness of optics that makes the edge of the filter as sharp as possible. In such a system the TPV cells are the dominant cost. It is possible to tailor the selective filter in order to fit the bandgap of a certain TPV cell. For this purpose it is a great advantage to be able to measure the Quantum Efficiency Q.E. of the cell and how Q.E. changes at different temperatures. When this behaviour is known it is possible to tailor the selective edge filter in order to get higher efficiency. A simple measurement setup has been developed utilizing a lamp with IR reflector, a monochromator, a radiometer, and a heating system based on hot water. The animation tool has been further developed for estimating the optical efficiency, and more factors may be varied. The tool can now handle also the emittance of the emitter, absorption losses in mirrors and filter, as well as TPV cell characteristics such as adjustable Q.E., fill factor FF, and Uoc/(Eg/q).
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| 20. |
- Lindberg, Eva, 1957-
(author)
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Continuous Quality Development by Means of New Understanding : A four year study on an Intensive Care Unit during times of hard work and demanding organisational changes
- 2003
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Doctoral thesis (other academic/artistic)abstract
- The present thesis follows an intensive care unit during four year of hard work and demanding organisational changes (1998-2001). The changes were mainly initiated by diminishing resources and a legislative claim to pay regard to the quality aspect of health care service. The process of implementing a quality system was the main focus for the thesis. Triangulation was used aiming at explore the process from different views. Two interviews studies were conducted one with the staff and another with the leadership. Both interviews were analysed thematically combined with a phenomenographic technique (e.g. using the how, and what aspect). A longitudinal quasi experimental time-series study was also accomplished. The correlation between staff variables and workload were measured once a year. The result show a 20 % increase in workload per staff and year. The staff judged the organisational climate for innovativeness stable over the period. Sick leave increased, and more so, than the general trend in the society. In spite of this increase the prevalence of stress related symptoms was the same. Two different systems emerged, a complex adaptive system and a mechanical system. The two systems exist and functions intertwined. Because of the construction of the patient register it is possible to see that the situation around a patients being admitted ≥ 5 days functions according to the complex systems character while the situation around the acute patients functions according to a mechanical system. Sick leave correlated with number of patient admitted ≥ 5 days (P=,000). It seemed the problem found had its root in the unawareness of the existing of a complex system. The result has implications for a need of increased awareness about how to manage the situation when the ICU is functioning according to the complex adaptive system.
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| 21. |
- Lindberg, Eva, et al.
(author)
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Edge filters in thermophotovoltaic applications
- 2001
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In: 17th European Photovoltaic Solar Energy Conference. - München, Tyskland.
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Conference paper (peer-reviewed)abstract
- In order to achieve high efficiency in a TPV generator, it is important that a high fraction of emitted photons with energies below the TPV cell bandgap are reflected back to the emitter. This can be accomplished in several ways. We present the idea of an internally reflecting egg-shaped double cone with emitter at one end, an edge filter at the wide center, and the TPV array at the other end. This geometry has so far been studied by means of both ray tracing analysis and by means of measurements with a simulated emitter. A sharp switchover from transmission to reflection in a multiple layer dielectric filter can be achieved only if the angles of the incident rays are confined to a fairly narrow interval. The two methods both show thet the studied optics can lower the angular spread of rays incident onto the filter and that some 96% of the emitted rays (in the ideal case) reach their goal without passing the filter more than once.
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| 22. |
- Lindberg, Eva, et al.
(author)
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ESES, A European Master's Program In Solar Energy Engineering
- 2004
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In: Eurosun 2004. - Freiuburg, Germany.
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Conference paper (other academic/artistic)abstract
- The first group of students was admitted to the European Solar Engineering School, a master’s level two-semester program at Dalarna University in Sweden, in August 1999. Now that the fifth group is all but through their year, some conclusions from our experiences are possible to draw. The paper gives the background of ESES, some information about how the program is arranged, and also some of the ESES staff experiences.
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| 23. |
- Lindberg, Eva, et al.
(author)
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Fabergé optics and edge filter for a wood powder fuelled thermophotovoltaic system
- 2002
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In: Renewable energy. - : Elsevier. - 0960-1481 .- 1879-0682. ; 28, s. 373-384
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Journal article (peer-reviewed)abstract
- In order to achieve high efficiency in a TPV generator, it is important that a high fraction of emitted photons with energies below the TPV cell bandgap are reflected back to the emitter. This can be accomplished in several ways. We present the idea of an internally reflecting eggshaped double cone with the emitter at one end, an edge filter at the wide center, and the TPV array at the other end. This geometry has so far been studied by means of both ray tracing analysis and by means of measurements with a simulated emitter. A sharp switchover from transmission to reflection in a multiple layer dielectric filter can be achieved only if the angles of incident rays are confined to a fairly narrow angular interval. The two methods both show that the studied optics can lower the angular spread of rays incident onto the filter and that some 96% of the emitted rays (in the ideal case) reach their goal without passing the filter or being reflected by the filter more than once. The concept of the whole of the wood powder fuelled TPV system is also given.
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| 24. |
- Lindberg, Eva, et al.
(author)
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Managing complexity : acknowledge the attraction patterns by supporting sensemaking and allowing the quality system to serve as the panoptic system
- 2002
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In: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 15:5, s. 213-6
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Journal article (peer-reviewed)abstract
- This paper is of a theoretical type ending with a model describing the frame and function of a quality system. Quality in health care is largely dependent on the behaviour and action of the health care staff. Furthermore behaviour and action emanate from the individual and group sensemaking. When viewing the organisation as a complex adaptive system, the necessity of becoming aware of, and co-evolving with the process of sensemaking becomes very clear. It has potential to view the individual’s attraction patterns as the channel for creativity. The quality system can serve as the framework on which to enlighten this vital dimension. The concept of meaning status in the group is useful when it comes to managing a complex system through a quality system. When so, the core objective of the quality system is to support and enhance the awareness of all the disparate meanings (future-perspective), stimulate reflection upon them and transform them into a collective meaning status (presence) in order to make effective decisions and a successful adaptation to change.
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| 25. |
- Lindberg, Eva, et al.
(author)
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Non-imaging optics in a thermophotovoltaic generator
- 2002
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In: Fifth Conference on Thermophotovoltaic Generation of Electricity. - Rome, Italy.
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Conference paper (other academic/artistic)abstract
- In order to achieve high efficiency in a TPV Generator, it is important that a high fraction of emitted photons with energies below the TPV cell bandgap are reflected back to the emitter. this can be accomplished in several ways. We present the idea of an internally reflecting egg-shaped double cone with the emitter at one end, an edge filter at the wide center, and the TPV array at the other end. So far, we have studied this geometry by means of both ray tracing analysis in a computer program and by means of measurements with an emulated emitter. A sharp switchover from transmission to reflection in a multiple layer edge filter can ba achieved only if the angles of incident rays are confined to a fairly narrow angular interval. The two used methods both show that the studied optics can lower the angular spread of rays incident to the filter and that some 96% of the emitted rays (in the ideal case) reach their goal without passing the filter or being reflected by the filter more than once. A suggestion of a whole wood powder fuelled TPV system with this egg-shaped double cone and edge filter implemented is also given, as well as an animation tool for modelling the optical part of the system.
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