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Screening and surveillance practices for Multiple Endocrine Neoplasia type 1-related Neuroendocrine Tumours in European Neuroendocrine Tumor Society Centers of Excellence (ENETS CoE) : An ENETS MEN1 task force questionnaire study
No full textMultiple Endocrine Neoplasia type 1 (MEN1) Clinical Practice Guidelines (2012) are predominantly based on expert opinion due to limited available evidence at the time, leaving room for interpretation and variation in practices. Evidence on the natural course of MEN1-related neuroendocrine tumours (NET) and the value of screening programs has increased and new imaging techniques have emerged. The aim of this study is to provide insight in the current practices of screening and surveillance for MEN1-related NETs in ENETS Centers of Excellence (CoEs). A clinical practice questionnaire was distributed among all 65 ENETS CoEs. Response rate was 91% (59/65). In 14% of CoEs <10 patients, in 50% 10-49, in 31% 50-100 and in 3 centres (5%) >100 patients with MEN1 are seen. Practices with regard to screening and surveillance of NETs were markedly heterogeneous. Differences between countries were noted in the use of gut hormones for biochemical screening and the choice for imaging modality for screening/surveillance of pancreatic NETs (PanNETs). Magnetic resonance imaging (MRI) is the preferred modality for screening and surveillance of PanNETs, whereas this is computed tomography (CT) for thoracic NETs. Practices regarding screening for thoracic NETs were more homogeneous among larger volume CoEs, with longer screening intervals. The majority of CoEs tailored the surveillance of small pancreatic and lung NETs to observed growth rate. 68% of CoEs advise patients with clinical MEN1 with negative genetic testing to undergo periodic screening like mutation-positive patients. In conclusion, there is still marked heterogeneity in practice, although there are also common trends. Differences were sometimes associated with volume or country, but often no association was found. This underscores the need for clear and evidence-based practice recommendations
Improved heterogeneity handling in the collapsed cone dose engine for brachytherapy
No full textBackground: Model-based dose calculation algorithms (MBDCA), such as the Advanced Collapsed cone Engine (ACE) in Oncentra Brachy (R) can be used to overcome the limitations of the TG-43 formalism. ACE is a point kernel superposition algorithm that calculates the total dose separated into primary, first-scatter, and multiple-scatter dose. Albeit ACE yields accurate results under most circumstances, several studies have reported underestimations of the dose to cortical bone. These underestimations are likely caused by approximations in the handling of multiple-scatter dose for non-water media. Such would result in noticeable deviations where the multiple-scatter is a considerable fraction of the total dose, that is, at greater distances from the source. Purpose: To improve and test the accuracy of the multiple-scatter dose component in the ACE algorithm to remedy its inaccuracy for non-water geometries. Methods: A careful analysis of the transport and absorption of the multiple-scatter energy fluence revealed an inconsistency in the scaling of energy absorption ratios for non-water media of the multiple-scatter kernel. We implemented an updated algorithm version, ACEcorr, and tested it for three different geometries. All had a single 192Ir-source at the center of a cubic water phantom with a box-shaped heterogeneity of either cortical bone or air, positioned at different distances from the source. Dose distributions for the three cases were calculated with ACE and ACEcorr and compared to Monte Carlo simulations, using the percentage dose difference ratio as figure-of-merit. All dose calculation methods scored separately the dose deposited by primary, first-scattered, and multiple-scattered photons. Results: The accuracy of the updated algorithm ACEcorr was superior to ACE. In the cortical bone heterogeneity, the mean percentage dose difference ratio for the total dose improved from -11.7% to -2.2% (in the worst case) by our update. Less impact was seen in the air heterogeneity, where both ACE and ACEcorr deviated less than 2% from the Monte Carlo results. The algorithm update mainly concerns the multiple-scattered dose component, but an accompanying data processing update also had a small effect (<=0.5% difference) on the primary and first-scattered dose. The calculation times were not affected. Conclusions: The updates to ACE improved the accuracy of multiple-scatter dose calculation for non-water media, without increasing calculation times
Global Pariahs or Local Partners? : The United Nations’ Engagement with Non-State Armed Groups
No full textNon-state armed groups (NSAGs) are key actors in contemporary conflicts and play an increasingly significant role in international politics. While engaging non-coercively with NSAGs poses challenges for state-centric international organizations, actors operating in conflict contexts, protecting civilians, and enhancing international security must contend with their presence and influence. This dissertation examines how, why, and under what conditions the United Nations (UN) engages with NSAGs through four interrelated essays, analyzing both global-level dynamics within the UN Security Council and local-level interactions in peace operations. The essays are theoretically informed empirical studies that utilize unique observational, textual, survey, and interview data, analyzed through both qualitative and quantitative methods. Essay I develops a novel typology of UN-NSAG interactions in peace operations, categorizing them along two dimensions: thematic fields and the nature of interaction, ranging from confrontation to cooperation. It documents variations across two mission contexts, revealing that coordination and cooperation often occur across various thematic fields even amid conflict and political instability. Essay II examines high-level diplomatic engagement through the Security Council’s practice of naming and shaming NSAGs. The study finds that NSAGs are named almost as frequently as states. It proposes and tests two explanatory theories, concluding that naming and shaming serves both as a normative commitment and a strategic tool in global governance. Essay III explores local-level UN-NSAG engagement, arguing that the UN’s willingness to build relationships with civilians shapes these interactions. Focusing on Southern Lebanon, it demonstrates that non-coercive engagement is more likely when NSAGs govern, have local support, or when the UN fears backlash from populations closely tied to these groups. Essay IV investigates peacekeepers' perceptions of “local actors”, drawing on surveys and interviews with Swedish personnel in Mali. Findings suggest that NSAGs significantly influence peacekeepers' understanding of local actors and highlight the importance of including them, along with other local actors, in peacekeeping efforts. Collectively, this dissertation contributes to understanding how NSAGs influence both global governance and local conflict dynamics and how international organizations respond to conflicts through non-coercive means. It offers insights for research on international organizations, conflict management, and local orders in civil wars
Cohort profile : the Swedish Inception Cohort in inflammatory bowel disease (SIC-IBD)
No full textPurpose There is a need for diagnostic and prognostic biosignatures to improve long-term outcomes in inflammatory bowel disease (IBD). Here, we describe the establishment of the Swedish Inception Cohort in IBD (SIC-IBD) and demonstrate its potential for the identification of such signatures.Participants Patients aged >= 18 years with gastrointestinal symptoms who were referred to the gastroenterology unit due to suspected IBD at eight Swedish hospitals between November 2011 and March 2021 were eligible for inclusion.Findings to date In total, 367 patients with IBD (Crohn's disease, n=142; ulcerative colitis, n=201; IBD-unclassified, n=24) and 168 symptomatic controls were included. In addition, 59 healthy controls without gastrointestinal symptoms were recruited as a second control group. Biospecimens and clinical data were collected at inclusion and in patients with IBD also during follow-up to 10 years. Levels of faecal calprotectin and high-sensitivity C-reactive protein were higher in patients with IBD compared with symptomatic controls and healthy controls. Preliminary results highlight the potential of serum protein signatures and autoantibodies, as well as results from faecal markers, to differentiate between IBD and symptomatic controls in the cohort. During the first year of follow-up, 37% (53/142) of the patients with Crohn's disease, 24% (48/201) with ulcerative colitis and 4% (1/24) with IBD-U experienced an aggressive disease course.Future plans We have established an inception cohort enabling ongoing initiatives to collect and generate clinical data and multi-omics datasets. The cohort will allow analyses for translation into candidate biosignatures to support clinical decision-making in IBD. Additionally, the data will provide insights into mechanisms of disease pathogenesis
Askan är den bästa jorden : En studie av tre återuppbyggda kyrkor signerade arkitekt Rolf Bergh 1957–1965
No full textThis study of three burnt-down and then rebuilt Swedish church buildings follows how an architect takes on the task of recreating something dear, with both innumerable connotations to the surrounding population and many cultural-historical values. Rolf Bergh, the most trusted of post-war Swedish church architects - with an unbroken line of work between the late 1940s and 1992 – wrestles with questions of how the intrinsic values of a building are transferred from a lost one to a new one. This can, the study shows, be done in several ways: through choice of motif, choice of materials, through specific artifacts or through a larger narrative built on a close connection to the surrounding environment. The processes behind the reconstructions are well documented. All in all, this rich archival material shows a winding process that moves from a desire to rebuild a near-replica of the former church building to eventually ending up in the modernist solution that the architect Rolf Bergh advocated all the way. The architect is visible in the buildings, both in his highly personal aesthetic choices and in his role as an architect during a period where that role, sometimes omnipotent, had a great deal of influence on the result. In the latter part of the study, Rolf Bergh's theoretical base is tested, both in terms of his mentoring relationship with the leading name in Swedish restoration theory during the period - Erik Lundberg - and his deeper ties to architectural theorists with a liturgical focus such as Rudolf Schwarz. In this encounter, both the modernist and liturgical changes of the time are visible. In his surviving writings and interviews, Rolf Bergh shows a soft, sometimes romantically nostalgic side that broadens the picture of the encounter between modernism and tradition. This leads to an examination of how we potentially might see Bergh through the eyes of architectural theorists Juhani Pallasmaa and Peter Zumthor - working with key words such as “atmosphere” and “memory”. Finally, through the study's emphasis on the time perspective - based on Hanna Arendt's thoughts on how we’re constantly on the verge between the future and the past – we see Bergh's designs in a new light, where in fact several ongoing parallel processes crystallize in the creation of the new church building.
The UN Committee on the Rights of Persons with Disabilities Recommendations as Reliable Human Rights Indicators? : A critical examination of alternative reports on the implementation of article 29 of the Convention on the Rights of Persons with Disabilities in Sweden
No full textAtt övervaka implementeringen av internationella konventioner om mänskliga rättigheter genom indikatorer är komplext och utmanande för såväl nationella som internationella aktörer. Denna uppsats föreslår ett perspektivskifte: att betrakta FN traktatorgans etablerade övervakningsprocesser som ett potentiellt indikatorsystem. Uppsatsen har till syfte att granska om funktionsrättskommittéens rekommendationer till Sverige kan fungera som indikatorer för mänskliga rättigheter. Därför analyseras om civilsamhällesorganisationers och Sveriges nationella institut för mänskliga rättigheters alternativrapporter är tillförlitliga källor som ligger till grund för framtagandet av rekommendationerna. Studien visar att alternativrapporterna framstår som tillförlitliga källor samtidigt som de är otillräckliga. De tenderar att osynliggöra vissa personer med funktionsnedsättning, vilket skapar en form av utsatthet.Monitoring the implementation of international human rights conventions through indicators is complex and challenging for both national and international stakeholders. This thesis proposes a shift in perspective: to consider the established monitoring processes of the UN treaty bodies as potential indicator systems. The aim of this paper is to examine whether the concluding observations issued by the Committee on the Rights of Persons with Disabilities to Sweden can serve as human rights indicators. Thus, it analyzes whether the alternative reports of the civil society organizations and Sweden’s national human rights institution are reliable sources that are the basis for drafting the concluding observations. The findings suggest that while the alternative reports are generally reliable, they are also limited. Notably, they tend to overlook certain groups of persons with disabilities, thereby reinforcing forms of invisibility and vulnerability
Apparent Objects : Essays on the Identity and Existence of Manifest Entities
No full textThis dissertation investigates questions of ontology, i.e. questions about what exists, focusing primarily on the existence (and identity) of ordinary objects like tables, chairs, and mountains, but also, at times, objects, such as e.g., abstracta and persons. The overarching theme is whether and how the “manifest” objects we encounter in everyday experience fit into a world best described by fundamental physics and its sparse ontology of particles, waves and void. In paper one I critique "easy realism," the view that ordinary ontological claims can be trivially settled in favor of realism through empirical and linguistic inquiry alone (with no need for metaphysics). I argue that easy realism fails because it underestimate the extent to which ordinary language use is predicated on (defeasible) folk-metaphysical beliefs. Paper two targets a related view which I call “quasi-eliminativism.” This view says that ordinary object-talk can be true even if ordinary objects are not part of reality’s true ontology. I challenge some key metasemantical assumptions of this view, and argue that it fails given a typically sparse, eliminativist physics-ontology. In paper three I discuss grounding-based "easy ontology," according to which nonfundamental entities can be posited without adding theoretical cost provided they are metaphysically grounded in fundamental entities. I argue that this approach succeeds only if the fundamental base assumes full metaphysical responsibility for the grounded entities, and that this requires postulating metaphysical laws/principles which end up inflating the fundamental, cost-bearing domain instead. Paper four offers a more constructive contribution. Here I present a novel theory of the indeterminacy in cases of radical, gradual change (think ship of Theseus-type cases). I propose that the indeterminacy in such cases is genuinely de re, i.e., that it concerns the existence of the objects themselves (as opposed to the standard view that it concerns the application of concepts to objects). Finally, paper five, (really an appendix to paper four), offers a rebuttal to Gareth Evans’ influential argument against indeterminate identity. I show that this argument fails because it doesn't account for the effects of indeterminate identities on property distribution and certain issues to do with indeterminate self-referentiality.
Musikens kraft för språkinlärning : En kvalitativ intervjustudie om lärares inställning till musik som pedagogiskt verktyg i engelska som ett främmande språk i årskurs F-3
No full text Syftet med denna studie var att ta reda på spanska och svenska grundskollärares erfarenheter och inställningar inför att använda musik i undervisningen för engelska som främmande språk. Utöver detta undersöktes musikens betydelse för elevers språkinlärning och motivation samt vilka möjligheter och utmaningar lärare ser med användning av musik i språkundervisning. Studien belyser lärares inställning till användning av musik som pedagogiskt verktyg för att främja elevernas språkinlärning i engelska. Studien baserades på semistrukturerade intervjuer med grundskollärare från Sverige och Spanien med relevant erfarenhet och utbildning för studiens syfte. Intervjuerna hölls via digitala möten utefter en intervjuguide. Den insamlade empirin analyserades genom en tematisk analys utefter Språksinlärningsteori (Krashen, 1981), The Input Hypothesis (Krashen, 1982), The Affective Filter Hypothesis (Krashen, 1982) och Sociokulturellt perspektiv (Wallerstedt, et al,. 2014 & Rogoff, 1990). De teman som presenterades utgick från de huvudsakliga frågeställningarna och dess underrubriker från intervjuguiden. Resultatet visade att lärarna var positivt inställda till att använda musik som ett pedagogiskt verktyg för att främja språkinlärningen i engelska som ett främmande språk. De såg övervägande fördelar jämfört med utmaningar då det främjar ett engagerat klassrumsklimat som höjer elevers motivation. Utöver de sociala effekterna kan musiken bidra till förbättring av språkliga färdigheter. Den allra största utmaningen visade sig vara lärares kompetens att inkludera musik i språkundervisningen. Vi fann skillnader mellan intervjudeltagarna från respektive land, dock förekom det fler likheter än skillnader
Achieving energy efficiency in industrial manufacturing
No full textThis paper explores the use of digital technology stages and knowledge demand types for achieving energy efficiency. Digital technology stages are the steps toward developing an intelligent and networked factory: computerization, connectivity, visibility, transparency, predictive capacity, and adaptability. Knowledge demand types refer to the knowledge and skills needed to implement energy management through technical, process, and leadership knowledge. Empirical data were collected from a critical single case study at an industrial manufacturing company. The study made two significant contributions. Firstly, it identifies fourteen challenges and improvement potentials when working with energy monitoring, evaluation, and optimization, demonstrating the critical role of digital technology stages and knowledge demand types. Secondly, the study presents a conceptual framework indicating how companies could overcome pitfalls and enhance energy efficiency by combining digital technologies and knowledge demands. Future work will include technical implementations and its connection to knowledge management