Publikationer från Umeå universitet
Not a member yet
55455 research outputs found
Sort by
Decrease of excessive daytime sleepiness after shunt treatment for normal pressure hydrocephalus
No full textSleepiness and apathy are often reported in patients with normal pressure hydrocephalus. However, research on outcomes after shunt surgery has mainly focused on the classical triad symptoms, that is, gait, cognition, and bladder dysfunction. This study aimed to describe the effects of shunt treatment on excessive daytime sleepiness and whether there was a relation to changes in ventricular volume. Pre- and postsurgical excessive daytime sleepiness was investigated using the Epworth sleepiness scale in a sample of 32 patients with normal pressure hydrocephalus who underwent shunt surgery. Data were gathered before surgery and at 1, 2, and 3 months after surgery and with different settings of the shunt. In the total sample, the Epworth sleepiness scale improved by a median of 1.5 points at 1 month after surgery, p = 0.026. The improvement was predominately found in the group (n = 6) with high presurgical daytime sleepiness (Epworth sleepiness scale >12) (median = 12 points, p = 0.035) compared with a median change of 0 points (p = 0.47) in the group with Epworth sleepiness scale ≤12 (n = 26). Between the postsurgical follow-ups, no further change in the Epworth sleepiness scale score was observed. The Epworth sleepiness scale score did not correlate with clinical tests nor with ventricular volume. Daytime sleepiness seems to be another domain of normal pressure hydrocephalus symptomatology in addition to the classical triad that is responsive to treatment, at least when pronounced. The Epworth sleepiness scale is a quick test to administer and could be a valuable addition to pre-surgical screening for treatable symptoms
Emotion, attention, and reason
No full textOur reasons for emotions such as sadness, anger, resentment, and guilt often remain long after we cease experiencing these emotions. This is puzzling. If the reasons for these emotions persist, why do the emotions not persist? Does this constitute a failure to properly respond to our reasons? In this paper we provide a solution to this puzzle. Our solution turns on the close connection between the rationality of emotion and the rationality of attention, together with the differing reasons to which attention and emotion are properly responsive
Understanding the complexity of barriers and facilitators to adherence to oral nutritional supplements among patients with malnutrition : a systematic mixed-studies review
No full textThe aim of this systematic mixed-studies review is to summarise barriers/facilitators to adherence to and/or consumption of oral nutritional supplements (ONS) among patients with disease-related malnutrition. In March 2022, the Cochrane CENTRAL, PUBMED, PsycINFO (Ovid) and CINAHL were searched for articles with various study designs, published since 2000. Articles were identified on the basis of 'population' (patients ≥18 years with malnutrition/at nutritional risk), 'intervention' (ONS with ≥2 macronutrients and micronutrients), 'comparison' (any comparator/no comparator) and 'outcome' (factors affecting adherence or consumption) criteria. A sequential exploratory synthesis was conducted: first, a thematic synthesis was performed identifying barriers/facilitators; and second, the randomised controlled trials (RCTs) were used to support these findings. The five WHO dimensions of adherence guided the analysis. Study inclusion, data extraction, analysis and risk-of-bias assessment (MMAT 2018) were carried out independently by two researchers. From 21 835 screened articles, 171 were included with 42% RCTs and 20% qualitative studies. The two major populations were patients with malignancies (34%) and older adults (35%). In total, fifty-nine barriers/facilitators were identified. Patients' health status, motivation, product tolerance and satisfaction as well as well-functioning healthcare routines and support were factors impacting ONS consumption. Few barriers/facilitators (n = 13) were investigated in RCTs. Two of those were serving a small ONS volume and integrating ONS into ward routines. Given the complexity of ONS adherence, non-adherence to ONS should be addressed using a holistic approach. More studies are needed to investigate the effect of different approaches to increase adherence to ONS
First-year university students’ mathematics capital and identities
No full textBased on a survey of 150 respondents and 16 timeline interviews with first-year university mathematics students in Sweden, we explore how the material resources and conditions available to them —mathematics capital— connect to their mathematical identities. We found that mathematics capital has bearing on how early in life students start to consider doing mathematics. We also found individually different trajectories among students with low mathematics capital into university mathematics. The study expands both existing theoretical and methodological ways of researching the material bearings of identity and opens up for new ways of understanding and exploring the conditions that may facilitate access to participation and success in university mathematics. It contributes to understanding on the social and cultural resources that students bring with them to start mathematics, thus complementing the insights that Simon Goodchild’s work had provided on the context of access to university mathematics.IMMPAC
Being open to a process of learning : the meaning of joint activities with patients as narrated by nursing staff in psychiatric inpatient care
No full textForming therapeutic relationships is considered important within psychiatric and mental health nursing. One way of achieving this is through social interaction when engaging in joint activities. However, introducing and using nursing interventions based on joint activities in psychiatric inpatient care has proven challenging. Since staff motivation is important, researching the meaning of engaging in joint activities from the nursing professional's point of view can provide information that is relevant in this area. This study aims to illuminate the meaning of participating in joint activities with patients as narrated by nursing professionals in psychiatric inpatient care. Narrative interviews with 14 nursing professionals with experience from psychiatric inpatient care were conducted. Data were analysed using phenomenological hermeneutics and reported following the consolidated criteria for reporting qualitative research (COREQ) guidelines. Results illuminate that engaging in joint activities means being open to a process of learning. Four themes contributed to this understanding: Struggling with uncertainty, discovering aspects of the other, unfolding paths to self-fulfilment and sharing personhood. Being open to a process of learning means being willing to face uncertainty when engaging in activities as well as being open to learning about oneself as well as the other. Through openness to this process of learning, a sharing of personhood can be achieved, where the nursing professional and the patient approach becoming two persons. Illuminating the meaning of joint activities from the nursing professionals' perspective may provide valuable insights related to introducing and using interventions focusing on joint activities
Utvärdering av potentiella riskmarkörer associerade med subklinisk ateroskleros
No full textBackground: Atherosclerotic cardiovascular disease (ASCVD) continues to be the predominant cause of mortality and morbidity worldwide. Atherosclerosis is driven mainly by modifiable traditional risk factors such as smoking, hypertension, dyslipidaemia, diabetes, and obesity. However, a significant portion of the population exhibits none of these traditional risk factors but might still suffer from a cardiovascular event. Additionally, current strategies for risk prediction demonstrate several limitations, particularlyamong younger individuals who are classified as low to intermediate risk for future ASCVD, where the risk is often underestimated. Potential approaches to more accurately identify individuals at elevated risk prior to their first ASCVD event encompass the identification of novel biomarkers and the utilisation of imaging techniques to visually assess early ASCVD. Several biomarkers, such as non-HDL and remnant cholesterol, have emerged as promising future risk markers due to their increasingly acknowledged role in the development of atherosclerosis.Other proposed risk markers are the ABO and RhD blood groups, which have previously been associated with increased susceptibility to ASCVD. However, the role of the RhD blood group in atherogenesis is more uncertain. Nonetheless, numerous aspects of the pathophysiological processes underlying atherosclerosis remain unclear, and by investigating associations between various risk markers and subclinical atherosclerosis, this might further deepen our understanding of early disease mechanisms, and possibly also contribute to the improvement of prevention strategies. Furthermore, the quality of laboratory data in studies concerning risk markers has infrequently been examined, and the true error frequency in laboratory information remains undetermined. Aim: The overall aim was to contribute to the development of personalised ASCVD prevention strategies by deepening our knowledge about risk markers linked to the early onset of cardiovascular disease. Specifically, the aim was to evaluate the associations between subclinical carotid atherosclerosis and a set of potential risk markers, including ABO and RhD blood groups, as well as the novel lipid biomarkers non-HDL and remnant cholesterol. Furthermore, the quality of laboratory information, with an emphasis on post-analytical errors, was examined. Methods: All participants were part of the VIPVIZA study, a pragmatic trial focusing on cardiovascular disease prevention, including 3532 participants. VIPVIZA measures traditional risk factors, such as plasma lipid levels, and includes ultrasound examinations of the carotid arteries to evaluate subclinical atherosclerosis. Subclinical atherosclerosis is defined as carotid plaques and increased carotid intima-media thickness (cIMT). Data on ABO and RhD blood groups were obtained by linking VIPVIZA to the SCANDAT database, a registry of blood group information from individuals who have undergone blood grouping, regardless of the indication. To ensure the accuracy of laboratory information, all lipid variables were validated, and the transcription errors were corrected. Results: The RhD antigen was associated with subclinical atherosclerosis in a cross-sectional study. This was represented by young RhD-negative individuals with CVD heredity having increased cIMT compared to RhD+ individuals. In the same study population, young male RhD– individuals also had higher levels of non-HDL, LDL, and remnant cholesterol. For the ABO blood groups, no association with subclinical atherosclerosis or dyslipidaemia was identified. Regarding lipids, increasing LDL and non-HDL cholesterol levels were associated with increased odds for carotid plaques and increased cIMT. However, no independent association was seen between remnant cholesterol and subclinical atherosclerosis when adjusting for the risk conferred by LDL cholesterol. Regarding the accuracy of laboratory information, the frequency of transcription errors in the lipid variables of the VIPVIZA database was 0.55% in 2019 and halved after an educational intervention to 0.25% in 2023. In 15% of the cases, the error had the potential of leading to an incorrect SCORE-2 risk category and, thus, an incorrect ASCVD risk assessment. Conclusions: The RhD antigen, LDL, and non-HDL cholesterol were all associated with subclinical atherosclerosis in these cross-sectional studies and may play a role in personalised ASCVD prevention in the future. The finding regarding RhD is novel and has not been previously reported. Thus, further research is required before clinical implementation is appropriate. The role of the ABO antigens and remnant cholesterol in atherosclerotic disease remains conflicting and needs further elucidation. In the future, it is likely that multiple risk markers will be combined with imaging diagnostics to more accurately predict an individual's risk of cardiovascular disease. Moreover, manual transcriptions of laboratory data should be minimised in both scientific studies and clinical practice to be able to achieve non-erroneous ASCVD risk assessments
Lrig3-deficient mice exhibit strain-specific alterations in liver fat accumulation, intestinal morphology, and middle ear inflammation
No full textThe transmembrane protein leucine-rich repeats and immunoglobulin-like domains 3 (LRIG3) regulates fat metabolism and bone morphogenetic protein (BMP) signaling. Lrig3-deficient mice exhibit impaired development of the snout and the inner ear lateral canal, neural defects, and cardiac hypertrophy in adulthood. However, no thorough and unbiased analysis of the physiological functions of Lrig3 has previously been performed. To address this knowledge gap, we performed histopathological examination of 42 tissues and organs from 1-year-old female C57BL/6JBomTac and 129S1-U mice with different Lrig3 genotypes. Among the scored pathologies, three were significantly associated with Lrig3 genotype: spontaneous macrovesicular hepatocellular degeneration (hepatocellular steatosis) was less prevalent in Lrig3-deficient C57BL/6JBomTac mice, whereas dilated or flaccid ileum and otitis media were more common in Lrig3-deficient 129S1-U mice. To further investigate hepatic steatosis phenotypes, 8-week-old C57BL/6JBomTac mice of both sexes and different Lrig3 genotypes were subjected to consuming a high-fat diet (HFD) for 8 weeks. The HFD regimen led to relatively few cases of hepatocellular steatosis, with no significant differences among the genotypes; however, female Lrig3-deficient mice presented reduced microvesicular hepatocellular degeneration compared with their wild-type littermates. This study revealed that Lrig3 regulates liver fat accumulation, intestinal morphology, and middle ear inflammation in a mouse strain-dependent manner
Mitral annular plane systolic excursion to left atrial volume ratio : a strainless relation with left ventricular filling pressures
No full textLeft atrial reservoir strain (LASr) offers diagnostic and prognostic value in patients with heart failure. However, LASr may be technically challenging and is not available to all clinical echocardiographers. Since LASr is a consequence of left atrial (LA) stretch during apical descent of the mitral annulus, we hypothesized that a ratio between mitral annular plane systolic excursion (MAPSE) and LA volume (LAV) may offer similar diagnostic value as LASr. We aimed to investigate the relationship between MAPSE/LAV and LASr and evaluate the diagnostic performance of MAPSE/LAV to identify patients with elevated LV filling pressure. MAPSE/LAV and LA strain measures were obtained in patients referred for echocardiography due to aortic stenosis, and in patients who had undergone clinically indicated right heart catheterization (RHC) with simultaneous echocardiography. In 93 patients with moderate aortic stenosis, MAPSE/LAV was moderately correlated with LASr (r = 0.57) but was lower in patients with elevated compared to normal LV filling pressure by echocardiography (0.11 vs. 0.16 mm/mL, p < 0.001). In 72 patients who had undergone RHC and simultaneous echocardiography, MAPSE/LAV and LASr correlated weakly with pulmonary artery wedge pressure (PAWP) (r=-0.44 and r = 0.37). MAPSE/LAV was lower in patients with elevated (> 15 mmHg) vs. normal PAWP (0.14 mm/mL vs. 0.27 mm/mL). Accuracy for detection of elevated PAWP was similar for MAPSE/LAV (area under the curve MAPSE/LAV: 0.75 [0.58-0.92] and LASr: 0.75 [0.57-0.90]). Despite a moderate correlation with LASr, MAPSE/LAV provided similar diagnostic value as LASr in predicting elevated LV filling pressures as determined by echocardiography and RHC
Social work in the shadows of disinformation : Social workers experience of the impact disinformation has on their work with children and youth
No full textDetta är en studie som utforskar socialsekreterares upplevelse av hur desinformation påverkar deras arbete med barn och unga. Dessa upplevelser har samlats in genom fyra semistrukturerade intervjuer och innehållet har därefter analyserats genom konventionell innehållsanalys. Det uppdagas att den desinformation som idag sprids på olika digitala plattformar är problematisk. Socialsekreterare möter dagligen familjer med en rädsla över att komma i kontakt med socialtjänsten. En rädsla för att socialtjänsten kommer kidnappa deras barn. De människor som verkligen behöver stöd eller hjälp riskerar att inte få den. Den uttalade information som sprids om socialtjänsten blir i slutändan problematisk för alla i samhället. Det som krävs är mer kunskap om socialtjänsten och deras arbete för att samhället ska ha möjlighet att ändra uppfattning
Tillförlitlig maskininlärning
No full textDenna avhandling studerar robusthet, integritet och reproducerbarhet i säker-hetskritisk maskininlärning, med särskild tonvikt på datorseende, avvikelse-detektering och undvikande attacker. Arbetet inleds med att analysera de praktiska kostnaderna och fördelarna med försvarsstrategier mot attacker, vilket visar att vanliga mått på robusthet är dåliga indikatorer på verklig prestanda i attacker (Artikel I). Genom storskaliga experiment visar arbetet vidare att exempel på attacker ofta kan genereras i linjär tid, vilket ger angripare en beräkningsfördel gentemot försvar-are (Artikel II). För att hantera detta presenterar avhandlingen ett nytt mått – Training Rate and Survival Heuristic (TRASH) – för att förutsäga modellfel under attack och underlätta tidigt avvisande av sårbara arkitekturer (Artikel III). Detta mått utvidgades sedan till verkliga kostnader, vilket visar att robusthet i attacker kan förbättras med hjälp av billig hårdvara med låg precision utan att offra noggrannheten (Artikel IV). Utöver robusthet behandlar avhandlingen integritet genom att utforma en lättviktig klientbaserad modell för spamdetektering som bevarar användardata och står emot flera klasser av attacker utan att kräva att beräkningar görs på serversidan (Artikel V). Som svar på behovet av reproducerbara och gransk-ningsbara experiment i säkerhetskritiska sammanhang presenterar avhandlingen även “deckard”, ett deklarativt programvaruramverk för distribuerade och robusta maskininlärningsexperiment (Artikel VI). Tillsammans erbjuder dessa bidrag empiriska tekniker för att utvärdera och förbättra modellers robusthet, föreslår en integritetsbevarande klassificeringsstrategi och levererar praktiska verktyg för reproducerbara experiment. Sammantaget främjar avhandlingen målet att bygga maskininlärningssystem som inte bara är korrekta, utan också robusta, reproducerbara och pålitliga.This thesis studies adversarial robustness, privacy, and reproducibility in safety critical machine learning systems, with particular emphasis on computer vision, anomaly detection, and evasion attacks through a series of papers. The work begins by analysing the practical costs and benefits of defence strategies against adversarial attacks, revealing that common robustness metrics are poor indicators of real-world adversarial performance (Paper I). Through large-scale experiments, it further demonstrates that adversarial examples can often be generated in linear time, granting attackers a computational advantage over defenders (Paper II). To address this, a novel metric—the Training Rate and Survival Heuristic (TRASH)—was developed to predict model failure under attack and facilitate early rejection of vulnerable architectures (Paper III). This metric was then extended to real-world cost, showing that adversarial robustness can be improved using low-cost, low-precision hardware without sacrificing accuracy (Paper IV). Beyond robustness, the thesis tackles privacy by designing a lightweight, client-side spam detection model that preserves user data and resists several classes of attacks without requiring server-side computation (Paper V). Recognizing the need for reproducible and auditable experiments in safety-critical contexts, the thesis also presents deckard, a declarative software frameworkfor distributed and robust machine learning experimentation (Paper VI). Together, these contributions offer empirical techniques for evaluating and improving model robustness, propose a privacy-preserving classification strategy, and deliver practical tooling for reproducible experimentation. Ultimately, this thesis advances the goal of building machine learning systems that are not only accurate, but also robust, reproducible, and trustworthy