Publikationer från Uppsala Universitet
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Experiences of non-conveyance : –A literature review
No full textBakgrund Efterfrågan på ambulanssjukvård ökar, fler patienter kvarstannar i hemmet efter bedömning, ett fenomen kallat non-conveyance. Ambulanssjuksköterskans roll har utvecklats och innefattar avancerade undersökningar och behandlingar, vilket ställer högre krav på komplexa bedömningar. Det förekommer en brist på forskning om ambulanssjuksköterskors och patienters upplevelser av att patienten kvarstannar på plats. För att utveckla enhetliga och evidensbaserade behandlingsriktlinjer krävs vidare forskning. Syfte Syftet med examensarbetet var att undersöka patienters och ambulanssjuksköterskors upplevelser kring att patienten kvarstannar på plats, oavsett om beslutet tas på initiativ av ambulanssjuksköterskan eller patienten själv, beskrivet utifrån ramverket Fundamentals of Care. Metod En kvalitativ litteraturöversikt med systematisk ansats och en deduktiv innehållsanalys utifrån Fundamentals of Care genomfördes. Totalt 17 artiklar inkluderades och kvalitetsgranskades. Resultat Resultatet belyser hur både patienter och ambulanssjuksköterskor upplever vårdrelationen, patientens fysiska och psykosociala behov samt hur vårdkontexten påverkar mötet när patienten kvarstannar på plats. Särskilt framträdande är vikten av aktivt lyssnande, empati, att ge tid, ta patienten på allvar samt att erbjuda tydlig och anpassad kommunikation för att möjliggöra delaktighet. Ambulanssjuksköterskor upplever att deras erfarenhet, kompetens och förmåga att skapa ett tillgängligt skyddsnät kring patienten är avgörande för en trygg vårdsituation. Slutsats Aktivt lyssnande, empati och tydlig kommunikation är avgörande när patienter kvarstannar på plats. Patientens delaktighet och anpassad information stärker tryggheten. Examensarbetet visar på ett behov av organisatoriska åtgärder för att skapa lättillgängliga säkerhetsnät, evidensbaserade riktlinjer och utbildningsinsatser för ambulanssjuksköterskor. I syfte att stödja en trygg och patientsäker vård när patienten kvarstannar på plats
Peace Talks in the Russia-Ukraine War : When, Who, and How?
No full textThis study explores the designs and dynamics of past, present, and potential mediation and negotiation efforts to stop the Russian invasion of Ukraine. Applying insights from mediation and negotiation literature, the article explores three questions relating to negotiating peace in Ukraine: who is best positioned to negotiate or mediate such a process (who should be presented at the table), when should such diplomatic efforts be launched, and how should the processes of peace talks be designed. The study examines the dynamics of the initial peace talks in the spring of 2022 as well as Ukraine's Peace Formula, which has been discussed by up to 92 countries, excluding Russia. The article discusses the unusual process of negotiating peace without the presence of one of the main parties (Russia) and the challenges and potential of negotiations in this form of international, asymmetric war
Leptophilic Z' bosons at the FCC-ee : Discovery opportunities
No full textWe examine the possibility to detect new SM-neutral vector bosons (Z') that couple exclusively to leptons in the electron-positron mode of the Future Circular Collider (FCC-ee). Focusing on the Z' production with a radiated photon search channel, we show that the FCC-ee can significantly extend the unprobed parameter space by increasing the exclusion in the coupling by one to two orders of magnitude in the kinematically allowed mass range (from 10 to 365 GeV), with the leading sensitivity being driven by the muon channel. In doing so, it outperforms other proposed lepton collider options such as CLIC and ILC in this range of masses. Further, we discuss the possibility of improving the sensitivity of the FCC-ee to this model through the modification of the dilepton invariant mass resolution and the photon energy resolution. The impact of systematic uncertainties on the expected sensitivities is also studied
Instruktörers lärandevägar : Kärnkraftsinstruktörers syn på den egna kompetensutvecklingen
No full textKompetensutveckling är viktigt för alla företag i tider av snabba förändringar, men kanske särskilt för dem inom kunskapsintensiva högteknologiska branscher. Anställda har fått ett ökat ansvar för sin egen kompetensutveckling och syftet med denna kvalitativa studie var att få en fördjupad förståelse för kärnkraftsinstruktörers syn på den egna kompetensutvecklingen med hjälp av teorin om lärande nätverk och begreppet lärandevägar. Enligt teorin om lärande nätverk är samverkan mellan alla aktörer (anställda, chefer och HRD-praktiker, t.ex. instruktörer och utbildare) i kompetensutvecklingsprocessen viktig. Instruktörerna kan enligt den definitionen ses som både anställda och HRD-praktiker. Sex kärnkraftsinstruktörer, två kvinnor och fyra män, anställda på ett utbildningsföretag tillhörande ett stort nationellt energiföretag intervjuades. De semistrukturerade intervjuerna var inspirerade av de fem lärandeelementen som kategoriserar framtagandet av lärandevägar: organisationens erbjudande, socialt sammanhang, ämne, aktivitet och motiv. Det insamlade materialet innehållsanalyserades för att besvara de tre forskningsfrågorna. Resultatet visade att förutsättningarna för kompetensutveckling var goda, det fanns ett välstrukturerat erbjudande av kompetensutvecklingsaktiviteter hos utbildningsföretaget och den sociala stöttningen från både chefer och kollegor var framträdande. Den trånga sektor som uttrycktes var bristen på tid. Det som var utmärkande för instruktörernas syn på kompetensutveckling var deras stora engagemang, motivation och breda syn på möjligheter till lärande i olika sociala sammanhang. De ville utvecklas både inom det tekniska, men främst inom det pedagogiska området. Den lärandeväg som kunde identifieras i grunden var en informations-driven lärandeväg, främst kopplad till organisationens kompetensutvecklingserbjudande. En självdriven lärandeväg kunde kopplas till instruktörernas initiativförmåga till att själva söka kunskap i olika kontexter. Denna var mer eller mindre framträdande bland instruktörerna. Vad gällde deras motivation till att lära nytt och göra ett bra jobb för kursdeltagarna framträdde en yrkesdriven lärandevägsstrategi som den strategi som bäst beskrev samtliga instruktörer.
Factorization of Quantum Time-Evolution into Holonomic and Dynamical Operators with Applications to Quantum Computation
No full textThe claimed solution [Phys. Rev. Lett. 131, 200202 (2023)] to the long-standing open problem concerning the factorization of quantum time-evolution into a holonomic and a dynamical part in the non-adiabatic non-abelian case is scrutinized. The background of the open problem, consisting of basic theory of quantum time-evolution and the previously established knowledge within the field of geometric phases and quantum holonomies, is thoroughly treated. It is found that the claimed solution to the open problem is technically correct, and details not presented in the cited paper are added. Notably, an interpretation of the main result is given. The usefulness of the results is explored by an attempt at constructing an analytical example of weak holonomic time-evolution
Predicting Shunt Surgery Outcomes in Idiopathic Normal pressure Hydrocephalus using Machine Learning
No full textIdiopathic Normal Pressure Hydrocephalus (iNPH) is a neurodegenerative disorder that targets people of older age groups. It is a result of abnormal cerebrospinal fluid (CSF) buildup. To combat that, iNPH can be treated with a shunt surgery. However, predicting the success of the surgery remains a challenge due to the variability in patient outcomes. This study explores the use of machine learning (ML) to predict post-surgical outcomes in iNPH patients by utilizing clinical data from the Swedish Hydrocephalus Quality Registry (SHQR). Several ML models were tested, including random forest, decision trees, logistic regression, support vector machines (SVM), k-nearest neighbors (KNN), and gradient boosting, with random forest chosen as the final model due to its ability to handle of missing data. The results indicate that while ML models provide promising predictions, challenges such as higher rates of missing data, variations in measurement methods across years, and limitations in the availability of further descriptive features for the input set affect model accuracy. The final model achieved an accuracy of 66% and a macro F1-score of 64%, demonstrating the potential of ML in predicting iNPH surgical outcomes but highlighting the need for further refinement
Two-step deep-learning identification of heel keypoints from video-recorded gait
No full textAccurate and fast extraction of step parameters from video recordings of gait allows for richer information to be obtained from clinical tests such as Timed Up and Go. Current deep-learning methods are promising, but lack in accuracy for many clinical use cases. Extracting step parameters will often depend on extracted landmarks (keypoints) on the feet. We hypothesize that such keypoints can be determined with an accuracy relevant for clinical practice from video recordings by combining an existing general-purpose pose estimation method (OpenPose) with custom convolutional neural networks (convnets) specifically trained to identify keypoints on the heel. The combined method finds keypoints on the posterior and lateral aspects of the heel of the foot in side-view and frontal-view images from which step length and step width can be determined for calibrated cameras. Six different candidate convnets were evaluated, combining three different standard architectures as networks for feature extraction (backbone), and with two different networks for predicting keypoints on the heel (head networks). Using transfer learning, the backbone networks were pre-trained on the ImageNet dataset, and the combined networks (backbone + head) were fine-tuned on data from 184 trials of older, unimpaired adults. The data was recorded at three different locations and consisted of 193 k side-view images and 110 k frontal-view images. We evaluated the six different models using the absolute distance on the floor between predicted keypoints and manually labelled keypoints. For the best-performing convnet, the median error was 0.55 cm and the 75% quartile was below 1.26 cm using data from the side-view camera. The predictions are overall accurate, but show some outliers. The results indicate potential for future clinical use by automating a key step in marker-less gait parameter extraction
Beyond the state : reimagining protection as constellations of care
No full textProtection is traditionally conceptualised in relation to the state. Not only does the state provide protection externally, i.e. vis-à-vis other states in an assumed anarchical system, but also internally through various instruments of care. Such protection however relies on the social contract and is thus inherently transactional. Protection, and associated care, then becomes something earned, something one is entitled to by virtue of certain, past, actions and behaviours, rather than something that is compassionately provided. How can we rethink protection away from the state? How to transform glimmers of hope of alternatives to the transactional model into sustained and sustainable change and care? We want to think through and offer alternative ways of care/ing: those more (inter-)personal, more community-focused, centred around intergenerational promises and responsibilities to ensure both a liveable present and future, ultimately disrupting imposed (state) boundaries that rely on and foster difference
Does Periodontitis Increase the Risk for Future Cardiovascular Events? Long-Term Follow-Up of the PAROKRANK Study
No full textBACKGROUND AND AIM: The study 'Periodontitis and Its Relation to Coronary Artery Disease' (PAROKRANK) reported an association between periodontitis (PD) and the first myocardial infarction (MI). This follow-up study aims to test the hypothesis that those with PD-compared to periodontally healthy individuals-are at increased risk for cardiovascular (CV) events and death. METHODS: A total of 1587 participants (age <75 years; females 19%) had a dental examination including panoramic radiographs between 2010 and 2014. PD was categorized as healthy (≥80% alveolar bone height), mild/moderate (79%-66%) or severe (<66%). A composite CV event (first of all-cause death, non-fatal MI or stroke and hospitalization following to heart failure) was investigated during a mean follow-up period of 9.9 years (range 0.2-12.5 years). Participants were divided into two groups: those with and without PD. The primary event rate, stratified by periodontal status at baseline, was calculated using the Kaplan-Meier method and Cox regression. RESULTS: The number of events was 187 in the 985 periodontally healthy participants (19%) and 174 in the 602 participants with PD (29%; p < 0.0001). Those with PD had a higher likelihood for a future event (hazard ratio [HR] = 1.26; 95% CI: 1.01-1.57; p = 0.038), following adjustment for age, smoking and diabetes. CONCLUSION: The PAROKRANK follow-up revealed that CV events were more common among participants with PD, which supports the assumption that there might be a direct relation between PD and CV disease
Exploring Heart Failure Through Bioinformatics : A Transcriptomic Analysis of Cardiac and Adipose Tissues
No full textHeart failure, characterised by either preserved (HFpEF) or reduced (HFrEF) left ventricular ejection fraction, involves complex and diverse pathophysiological mechanisms, making it a challenging field of research. Despite extensive studies, much remains to be learned about its underlying mechanisms and early diagnostic markers—particularly for HFpEF, as evidenced by the lack of effective treatment options. This thesis aims to explore the transcriptomic profiles of cardiac and adipose tissues in patients with different HF phenotypes, investigating differential gene expression, associated regulatory pathways, and correlation networks. Additionally, the work examines the expression of specific genes involved in iron metabolism under conditions of iron deficiency in myocardial and skeletal muscle tissues. Using high-throughput RNA sequencing, gene expression was analyzed in left and right ventricular biopsies from patients undergoing coronary artery bypass grafting, with or without diagnostic signs of HF. Gene expression and network analysis techniques were employed to identify distinct gene expression patterns and potential regulatory mechanisms in epicardial adipose tissue. The studies revealed significant differences in gene expression related to myocardial contraction, energy supply, remodeling, and fibrosis between HFpEF and normal physiology, as well as distinct profiles between HFpEF and HFrEF. Moreover, genes involved in heart muscle movement and energy production were less active in the left ventricle of HFpEF, particularly those facilitating contraction and relaxation of the heart muscle. This reduced activity potentially explains the stiffness and impaired relaxation characteristic of HFpEF. Additionally, genes influencing the heart's structural integrity, especially those involved in collagen production, showed changes that suggest alterations beyond simple stiffening in the heart’s structure. The analysis of adipose tissues identified unique gene expression clusters correlating with echocardiographic HF characteristics. These findings reveal the pathophysiological discrepancies and shared mechanisms across HF subtypes, offering a richer understanding of the disease's transcriptomic basis. By demonstrating the distinct transcriptomic signatures associated with HFpEF and HFrEF, this thesis builds on our understanding of heart failure's complex biology. Further research is needed to explore the therapeutic potential of the identified targets and to validate these findings in a larger, but also a more diverse patient cohort