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Signal-Averaged ECG in the Diagnostic Workup for Arrhythmogenic Cardiomyopathy: Insights From the Nordic ARVC Registry
No full textBackground The diagnostic role of signal-averaged ECG (SAECG) in arrhythmogenic right ventricular cardiomyopathy (ARVC) has lately been questioned. We assessed the value of SAECG-derived late ventricular potentials (LP) in ARVC diagnosis and its association with disease manifestations.Methods and Results Patients with definite ARVC diagnosis or genotype-positive family members who underwent SAECG were included in register-based observational study (n=357, mean age 41 years, 47% female, 43% probands). LP and terminal activation duration (TAD) were defined by Task Force Criteria 2010. We assessed the association of TAD and LP with structural RV abnormalities and ventricular tachycardia (VT), defined as sustained VT, appropriate implantable cardioverter-defibrillator shock, aborted cardiac arrest, or sudden cardiac death, at diagnosis. LP were documented in 210 patients (59%) and abnormal TAD in 66 patients (18%). Each of the SAECG parameters was significantly associated with definite ARVC diagnosis in receiver-operator characteristics curve analysis with area under the curve between 0.67 and 0.74. Exclusion of SAECG from diagnostic workup led to reclassification of 37 patients (16%) from definite to borderline ARVC (13 probands, 9 of whom had prevalent VT). Ninety patients (25%) had history of VT. LP, but not TAD, were associated with VT (adjusted odds ratio [ORadj], 2.42 [95%CI, 1.07-5.48]). LP had lower specificity (72% versus 97%) but higher sensitivity (71% versus 25%) for association with RV structural abnormalities than TAD.Conclusions In the Nordic ARVC cohort SAECG-derived LP are associated with VT and structural RV abnormalities and were critical for ascertainment of ARVC diagnosis in 16% of patients with narrow QRS complexes, including 8% of all probands.Funding Agencies|Swedish Heart Lung Foundation [20200674]; Swedish state under the agreement between the Swedish government and the county councils; ALF agreement; Skane University Hospital; Research Council of Norway [288438]; Independent Research Fund Denmark [0134-00363B]; Novo Nordisk Foundation, Denmark [NNF20OC0065799, NNF18OC0031258]; Finnish Foundation for Cardiovascular Research; Aarne Koskelo Foundation; Governmental Subsidy (EVO grants); Norwegian Research council [288438, 309762, 298736]</p
'Good communication and good team building, it's half of the work in managing a player': how team doctors perceive communication in the European professional men's football context
No full textCommunication influences players' performance and health and is influenced by the leadership style of coaches, internal team communication and the integration of the medical team in the professional men's football setting. However, the communication process between medical teams and other stakeholders in professional football has not been described in depth. Therefore, we explored the perspectives of team doctors regarding the communication process within the medical team and with other stakeholders in men's professional football. We conducted semistructured interviews with 10 team doctors from nine teams in six countries playing at the highest level of European professional football participating in the UEFA Elite Club Injury Study. Data were audio recorded, transcribed and analysed through reflexive thematic analysis. Three main themes described the communication process: (1) communication practices, (2) communication context and (3) communication foundation. The communication practices included involving specific stakeholders, using different communication channels and considering timing. The contextual factors in team structure, available resources and team standings require them to adapt their communication strategies. The foundation of effective communication relied on cultivating trust, acting respectfully, defining clear roles, following ethics and proactively developing relationships over time. In conclusion, the communication process is highly influenced by the context while team doctors constantly communicate with a diverse stakeholder group. This requires the team doctors to adapt to the different scenarios of professional football and dedicate time and effort to cultivating trustworthy relationships with stakeholders
Mechanical activated self-sustaining combustion synthesis of Mn3AlC magnetic powder from MnO2+Al+C mixture
No full textResearch on rare earth-free permanent magnets (REFPMs) as substitutes for rare earth permanent magnets (REPMs) has attracted extensive attention, primarily due to their affordability, reduced supply risk, and encouraging magnetic properties. In the present work, a rare earth-free magnetic powder consisting of Mn3AlC was prepared for the first time through a mechanical activation-aided self-propagating combustion process using a highly exothermic MnO2-Al-C mixture. This study aims to assess the possibility of producing Mn3AlC through low-cost raw materials with an energy-conserving process. The experimental procedure entailed changing the milling time and modifying the aluminum and carbon content to determine their impact on the synthesis reaction. X-ray diffraction (XRD) was used for analyzing the phase structure, while field emission scanning electron microscopy (FE-SEM) and energy dispersive X-ray spectroscopy (EDS) were utilized for identifying the microstructure and chemical composition, respectively. Magnetic properties were examined by vibrating-sample magnetometer (VSM). The examination revealed that a sudden and violent self-sustaining reaction took place after 5 h of mechanical activation, leading to the full conversion of the mixture to Mn3AlC and Al2O3. There were no intermediate phases before the reaction onset. The optimal stoichiometries of aluminum and carbon were 2 and 0.8, respectively.Validerad;2025;Nivå 2;2025-11-26 (u8);Full text license: CC BY</p
At the confluence of fiction and reality : Literary book-group discussions in a contact zone classroom of Swedish and Swedish as a Second Language
No full textThis article-based dissertation examines students’ constructions of social and linguistic participation and social belonging in a linguistically diverse upper secondary classroom in Sweden. The focus is on a group of second language learners and their meaning-making processes in literary book-group discussions in a combined practice of the two parallel school subjects Swedish (SWE) and Swedish as a Second Language (SSL). SWE and SSL are two distinct school subjects in their own right, with different subject curricula and required teacher qualifications. In this dissertation, combined practice entailed SWE and SSL students being taught in the same classroom by a teacher who was qualified to teach both subjects based on the two curricula. The four key participants in SSL had migrated to Sweden due to outbreaks of war in their home countries. The theoretical framework consists of contact zone theory, including safe houses as safe spaces, dialogism, and transactional theory. A common denominator in these underpinnings is the notions of negotiation processes and power structures. Methodologically and onto-epistemologically, this dissertation is anchored in linguistic ethnography, which presupposes that research participants are co-constructors of data and meaning, and that linguistic analyses of interactions in local contexts contribute to discussions about social change at large. Article I focuses on three different learning spaces that the students in SSL had to navigate as part of their second language learning: whole-class, separate SSL group, and literary book-group discussions. Based on the findings of Article I, where literary book-group discussions seemed prominent for negotiations of meaning, Article II concentrates on one student’s trajectory of participation in a series of book-group discussions, and Article III centers around a particular group of students in SSL and their reflections on grouping strategies, participation roles, and discussion topics. The findings from these three articles show that student mobility between different layers of contact zones and safe houses seemed to provide an incentive for social and linguistic participation and social belonging over time. The findings also show that the four key participants in SSL seemed to avail themselves of social and linguistic participation and social belonging through an agency of vulnerability in literary book-group discussions as both contact zones and safe houses. This dissertation contributes to further empirical and theoretical discussions about developments of contact zone classrooms in Sweden and beyond, including the problematization of what teaching and learning in contact zones entails for students and teachers in this age of forced migration
Visualization tool for detection of early health risks using IoT data
No full textDementia is a growing global health concern, particularly among the aging population. Traditional diagnostic methods for dementia rely heavily on clinical assessments, cognitive tests, and in-person observations, which can be resource-intensive, time-consuming, and often lead to late-stage diagnosis. The emergence of Internet of Things (IoT) technologies offers a promising solution by enabling continuous, real-time, and non-intrusive monitoring of elderly individuals in care facilities. This study explores the integration of IoT data with advanced visualization techniques to facilitate early detection and monitoring of dementia-related behaviours, thereby improving patient care and decision-making in elderly care environments. A prototype visualization dashboard was developed using Microsoft Power BI, leveraging IoT-based sensor data to track behavioural patterns, including sleep disruptions, activity transitions, and room occupancy trends. The system was designed to provide an intuitive, real-time interface for nursing staff and caregivers, offering interactive visual analytics, event playback functionalities, and anomaly detection features. Key features of the dashboard include: System monitoring: A real-time traffic light mechanism to indicate IoT sensor status and data integrity. Activity and dwell time analysis: Interactive visualizations that track movement patterns and detect deviations in patient behaviour. Sleep pattern insights: Line charts and heatmaps that highlight irregularities in sleep duration and continuity, which may indicate cognitive decline. Event mapping and playback: A dynamic process map and playback capability that reconstructs behavioural sequences for further analysis. To evaluate the effectiveness of the prototype, user testing was conducted with nursing staff in a simulated elderly care environment. The results demonstrated that the system improved caregivers' ability to monitor behavioural changes, detect anomalies, and make informed care decisions in a timely manner. The interactive and user-friendly design of the dashboard facilitated its adoption, ensuring that even non-technical users could interpret complex datasets efficiently. Furthermore, sleep pattern analytics proved particularly valuable in identifying early signs of dementia-related cognitive decline. Despite its promising outcomes, the study acknowledges certain limitations, including the reliance on passive infrared (PIR) motion sensors, which, while non-intrusive, do not capture qualitative aspects such as social interactions or facial expressions. Additionally, the sample size of end-users was limited, and future large-scale testing is required to assess its broader applicability in real-world care settings. Based on the findings, several avenues for future work are proposed, including: Integration with machine learning: Enhancing the system with AI-driven anomaly detection to provide predictive analytics for early dementia diagnosis. Expansion of IoT sensor networks: Incorporating additional wearable sensors (e.g., heart rate, temperature, gait tracking) to develop a more comprehensive health monitoring system. Decision Support System Development: Implementing automated recommendations based on behavioural patterns, allowing caregivers to intervene proactively. Scalability Testing: Conducting multi-resident deployment in elderly care facilities to assess long-term usability and clinical impact. In conclusion, this thesis work demonstrates the feasibility and potential of IoT-powered visualization tools in transforming dementia care. By bridging the gap between sensor-based monitoring and real-time decision-making, the developed dashboard paves the way for enhanced elderly care solutions. As the healthcare industry moves toward data-driven, AI-integrated solutions, IoT-based visualization tools like the one developed in this study hold great promise in improving patient outcomes, reducing healthcare costs, and optimizing caregiver workflows. Keywords: IoT in healthcare, dementia monitoring, visualization dashboard, elderly care, behaviour tracking, Power BI, real-time analytics, machine learning in dementia care, decision support system, IoT sensor data.Presentation was done online</p
Management of children and adolescents with autism spectrum disorder in dental care
No full textBakgrund: Autismspektrumtillstånd (AST) är en vanligt förekommande diagnos som kan orsakas av genetiska,icke genetiska och miljömässiga faktorer och kan variera från individ till individ. Bristande förmågor i blandannat kommunikation, ögonkontakt och sociala färdigheter hos barn och ungdomar med AST kan bidra tillstress, ångest och oro som uppstår i samband med tandvårdsbesök. Syfte: Att beskriva metoder för bemötande och omhändertagande bland barn och ungdomar medautismspektrumtillstånd i samband med tandvårdsbehandling.Metod: Studien var en litteraturöversikt. Litteratursökningen genomfördes i databaserna PubMed och Psycinfo.Artiklarna genomgick kvalitetsbedömning och därefter valdes totalt 12 artiklar i resultatet där dessa artiklaromfattade barn och ungdomar i åldersspannet 6–18 år. Artiklarna skulle vara publicerade mellan 2015–2025. Resultat: Resultatet visade att visuell pedagogik, sensoriskt anpassade miljöer och digitala hjälpmedel äreffektiva metoder vid omhändertagandet och bemötandet av barn och ungdomar med autismspektrumtillståndi samband med tandvårdsbesök. Slutsats: Litteraturöversikten undersöker metoder som kan tillämpas för att bemöta och omhänderta barn ochunga med AST inom tandvården. Genom tillämpning av metoder som visuella hjälpmedel, sensoriskanpassning och digitala hjälpmedel kan tandvårdspersonalen erbjuda en effektivare tandvård för barn ochungdomar med AST. Dessa metoder bidrar till att minska ångest och stress hos denna patientgrupp, samtunderlättar samarbetet mellan barnet och tandvårdspersonalen.
Yngre barns behov av trygghetoch möjligheter till anknytning i förskolan : En enkätstudie om förskollärares uppfattningar om yngre barns behov och tillgodoseende av trygghet i förskolan
No full textDet står skrivet i skollagen att barnet i förskolan ska ges en trygg omsorg, att barngruppernas storlek ska vara lämplig och miljön vara god (SFS 2010:800). Studiens syfte är att få en inblick i hur yngre barns behov av trygghet och anknytning tillgodoses i förskolan, utifrån förskollärares och barnskötares uppfattningar. Metoden som använts i datasamlingen är kvantitativ i form av enkät, som analyserats och diskuterats utifrån ett anknytningsteoretiskt perspektiv. Resultatet visar en hög andel pedagoger som upplever tillkortakommanden i förskolans miljö och struktur, i att leverera en barnomsorg där de yngre barnens behov utav trygghet tillgodoses i den mån den bör. Pedagogerna anser i hög grad att stora barngrupper och för låg personaltäthet är problemfaktorer som skapar utmaningar att ge de yngre barnen deras trygghetsbehov mötta. När pedagogerna anser att barngruppen är utav lämplig storlek, visar resultaten att mindre grupper om max 12 barn är det vanligaste. I denna svarsgrupp, återfinns också högre antal respondenter som anser att tillgodoseendet med trygghet för barnen är tillräckligt. När barn upplever trygghet, resulterar detta enligt anknytningsforskning, i att deras lärande och utveckling främjas. I enlighet med vad tidigare anknytningsforskningvisar, stöder resultatet i denna undersökning det faktum att mindre barngrupper i förskolan, är en förutsättning för att förskolan och pedagogerna ska kunna erbjuda trygghet åt de yngsta barnen
Primary aldosteronism: improving screening-based diagnostics and treatment
No full textPrimary aldosteronism (PA, non-physiologic adrenal overproduction of aldosterone) causes about 10% of arterial hypertension, and substantially elevates morbidity and cardiovascular mortality compared to primary hypertension (HT) alone. PA often lacks specific clinical traits, and remains mostly undiagnosed. Its diagnosis requires biochemical screening and confirmatory tests - which are quite difficult to perform and/or to interpret correctly. About a quarter of PA cases are lateralized (or unilateral, uPA) – and can be cured or significantly ameliorated by surgery, which gives the best long-term prognosis. Bilateral subtype (bPA) can be controlled by mineralocorticoid receptor antagonists. Even the current lateralizing procedures are technically demand-ing and invasive. The challenge of identifying PA and its subtypes to guide the treatment requires more straightforward and sensitive diagnostic methods. Our first paper describes the project of screening of 1181 unselected primary care hypertensive patients for PA. The 53 found cases of PA (corresponding to a prevalence of 4,5%) were further evaluated and treated (surgically or medically) according to the current guidelines. The pathophysiologic and clinical aspects of the recommended diagnostic and treatment principles, and the follow-up results after at least 6 months after treatment initiation were presented and analyzed. Our second and third papers present research of new peripheral blood markers that may support diagnostics of PA among hypertensive individuals, including differentiation between its lateralized and bilateral subtype. MicroRNAs (second paper) and proteomic profile (third paper) were analyzed in groups of well clinically studied patients with HT, bPA and uPA. MicroRNAs have been shown to regulate both aldosterone production and its effects in the target-tissues. Using machine learning (ML), we demonstrate the potential of both microRNAs (analyzed by NGS) and proteomics (analyzed by Olink® Explore 384 Cardiometabolic Panel based on proximity extension assay) to differentiate PA from HT, and uPA from bPA. Further validating studies are needed to evaluate the constructed ML-models and the clinical utility of both microRNA and proteomic analysis in hypertensive patients. The theoretic and practical experience of these studies confirms the necessity to actively screen hypertensive patients for PA and to further develop its diagnostic methods as specific treatment ameliorates the long-term prognosis.
On the origin of an insular hybrid butterfly species
No full textA new species can form through hybridization between species. Hybrid speciation in animals has been intensely debated, partly because hard evidence for the process has been difficult to obtain. Here, we report the discovery of a European hybrid butterfly lineage, a finding that can be considered surprising given the intense and long-term study of European butterflies. The lineage we describe is mainly inhabiting an island in the Baltic Sea and was previously designated as a subspecies (horkei) of one of the parental species (Aricia artaxerxes). By analyzing whole-genome resequencing data and developing a novel cluster analysis based on historical recombination events (Fisher junctions), we determine that horkei originated by hybridization between the nonsister species A. artaxerxes and A. agestis. This hybridization event occurred approximately 54,000 years ago, predating the last glaciation of the current distribution range. Horkei must therefore have persisted long enough to be able to colonize its current range, despite that this area lies between the current distributions of the parental species. The hybrid origin, the maintenance of genomic integrity across times of dramatic climate change, and the expression of a combination of parental traits suggest that horkei could be in the process of hybrid speciation
Cognitive Accessibility in eHealth – Introducing Participatory Research through Design
No full textThe digitalisation of healthcare often comes with promises of solving future expected increasing demands on healthcare and ensuring equitable health service distribution. However, this promise is not yet realised in Sweden’s present eHealth services. Meanwhile, Swedish public healthcare is moving towards person-centred care, where the person’s resources, experiences, and needs are considered. The primary motive of this thesis is to contribute to knowledge on how to design eHealth services that support cognitive accessibility for increased equity. The work in this thesis is based on the idea that accessibility is important, and that people affected by problems in eHealth should be part of the design of accessible eHealth services. The research started by looking into previous research on accessibility in eHealth services and then focused on Sweden’s local context. There are regulations on accessibility in eHealth services the European Union (EU). Therefore, we investigated how Swedish public healthcare complies with this regulation. The scope was then narrowed to cognitive accessibility, an area not sufficiently covered by the EU regulations and current guidelines. Together with people with lived experiences of cognitive impairments, we explored participatory design methods for cognitive accessibility and how to make an impact in real-life settings. We used two cases for the research: the personal eHealth services on the Swedish national healthcare website 1177.se; and a symptom checker and triage tool, called 1177 direkt, presented as a conversational agent. For the first case, we co-designed a prototype for enhanced cognitive accessibility and used it as a dialogue tool to make an impact on the development of the existing eHealth services. For the second case, we evaluated 1177 direkt and conducted co-design activities for suggestions on enhanced cognitive accessibility with a collaborative approach with representatives from the product owner. In this case, the product owners are both the company that develops and markets the product, and Inera, which procures the product so that public healthcare providers can select it from Inera’s range of services and products. This thesis ii concludes that eHealth services that are experienced as inaccessible will most likely remain inaccessible if we continue developing eHealth services as before. Considering the insights from people with lived experience of cognitive impairment in participatory approaches when designing eHealth services can contribute to eHealth services that support person-centred care.Digitalisering av hälso- och sjukvården lovar ofta att lösa framtida ökande krav och säkerställa rättvis fördelning av hälso- och sjukvårdstjänster. Dessa löften har ännu inte infriats i Sveriges nuvarande eHälsotjänster. Samtidigt rör sig den svenska offentliga hälso- och sjukvården mot personcentrerad vård, där individens resurser, erfarenheter och behov beaktas. Syftet med denna avhandling är att bidra till kunskapen om hur man utformar eHälsotjänster som stödjer kognitiv tillgänglighet för ökad jämlikhet. Avhandlingen bygger på idén att tillgänglighet är viktigt och att personer som påverkas av problem inom eHälsa bör vara en del av utformningen av dessa tjänster. Forskningen började med att granska tidigare forskning om tillgänglighet i eHälsotjänster och fokuserade sedan på den svenska kontexten. Det finns lagar om tillgänglighet i eHälsotjänster inom Europeiska unionen (EU). Vi undersökte hur den svenska offentliga hälso- och sjukvården följer EU:s lagar om webbtillgänglighet. Därefter fokuserade forskningen på kognitiv tillgänglighet, ett område som inte täcks tillräckligt av EU-lagar och de riktlinjer lagarna pekar på. Tillsammans med personer med levda erfarenheter av kognitiva funktionsnedsättningar utforskade vi deltagande designmetoder för att förbättra kognitiv tillgänglighet i eHälsotjänster samt hur man kan påverka de befintliga eHälsotjänsterna. Vi använde två fall: de personliga eHälsotjänsterna på den svenska nationella hälso- och sjukvårdswebbplatsen 1177.se samt ett symptombedömnings- och triageverktyg utformat som en samtalsagent, 1177 direkt. I det första fallet samskapade vi en prototyp för förbättrad kognitiv tillgänglighet som vi använde som ett dialogverktyg. För det andra fallet utvärderade vi 1177 direkt och genomförde samskapande aktiviteter för förbättringsförslag gällande kognitiv tillgänglighet. Studien gjordes med ett samarbetsinriktat tillvägagångssätt tillsammans med representanter från produktägarperspektivet. Produktägaren i detta fall är företaget som utvecklar och lanserar produkten på marknaden, och Inera som upphandlar produkten så att offentlig sjukvård kan välja produkten från Ineras utbud av tjänster och produkter. Slutsatsen är att om vi fortsätter utveckla eHälsotjänster som tidigare, kommer de troligen att fortsätta vara svåra att använda för många. Genom att involvera personer med levda erfarenheter av kognitiva funktionsnedsättningar i utformningen kan vi skapa eHälsotjänster som är lättare att använda och som bättre stödjer personcentrerad vård.QC 20250513</p