Strain engineering of ScN thin films and its effect on optical, electrical, and thermoelectric properties

Scandium nitride (ScN) is a cubic NaCl-structured, degenerate, narrow-bandgap, n-type semiconductor that exhibits remarkable semiconducting, thermoelectric and plasmonic properties. However, its properties are sensitive to several types of defects, such as crystal defects, morphology, intentional or unintentional doping. For the purpose of reducing the deposition temperature of ScN, a series of films were deposited in the temperature range of 250–850 °C using a high-power impulse magnetron sputtering technique. While the stoichiometry and crystal structure remained unaffected in the sample series, the optical and electrical properties were affected when the temperature was decreased. Using in-depth XRD, optical and electrical characterizations, the effect of strain and dislocations on the semiconductor properties of ScN was evaluated. A reduction in the deposition temperature from 850 °C to 450 °C yielded a slow change in the electrical and optical properties, while a drastic change occurred for the films deposited below 450 °C. The main cause of the deterioration of the electrical transport properties (σ/10 000; n/100, and µ/100) was attributed to a high dislocation density (1011 cm−2) along with a rhombohedral distortion of the ScN cell (α: 90° → 88.6°), which was the main cause of the variation in the electrical transport. The presence of dislocations/crystal defects in the film generated defect states near the edges of the valence and conduction bands, softening the edges and impacting the electron density and mobility. The best thermoelectric properties of ScN were obtained when it was grown at 850 °C and were further modified and altered by strain engineering.Funding Agencies|Funding Agencies|Fundao para a Cincia e a Tecnologia [LA/P/0037/2020 (10.54499/LA/P/0037/2020), UID/50025/2025 (10.54499/UID/50025/2025)]; Vetenskapsrdet [2019-00191, 2021-03826]; Carl Tryggers Stiftelse fr Vetenskaplig Forskning [CTS14:310, CTS16:303, CTS20:272, CTS23:2746, CTS25:3972]; Agence Nationale de la Recherche [ANR-11-LABEX-0017-01, ANR-18-EURE-0010, ANR-21-EXES-0013]; Stiftelsen fr Strategisk Forskning [RIF14-0053]; Energimyndigheten [436061]; Knut och Alice Wallenbergs Stiftelse [KAW-2020.0196]</p

Olfaction and Memory Related Brain Connectivity : In Health and Parkinson’s Disease

Parkinson's Disease (PD) is among the most prevalent neurodegenerative diseases, primarily recognized for its motor symptoms. However, PD also encompasses debilitating non-motor symptoms (NMS), such as olfactory dysfunction and memory decline, both strongly associated with cognitive deficit. As the disease progresses, combined with long-term oral levodopa therapy, patients experience frequent and unpredictable motor fluctuations, marking the so called "complication phase". At this phase, device-aided Parkinson therapy (DAPT), which provides continuous dopaminergic stimulation, can effectively restore motor control. Despite its efficacy, some patients exhibit increased apathy and cognitive decline following DAPT, highlighting the need for new markers of cognitive decline in PD before DAPT selection. The objectives of this thesis are: (1) to explore dynamic functional connectivity (dFC) underlying olfaction and memory processes, with a particular emphasis on episodic odor memory, and (2) to map hippocampal dFC patterns during task-based and resting-state conditions and assess their implications for olfactory function and declarative memory in individuals with PD, awaiting evaluation for DAPT. By using independent component analysis and k-means clustering as main methodological approaches in this thesis, data analysis relied minimally on theoretical assumptions and was predominantly explorative and data-driven. Study I identified an overlapping neural network encompassing regions of the olfactory cortex engaged during passive smelling, odor encoding and odor recognition memory (ORM). A distinct ORM-related network involving the hippocampus exhibited delayed reactivity. Moreover, successful recognition of previously encoded odors was associated with neuronal suppression. Study II revealed that four hippocampal networks were sequentially activated during ORM. One network, incorporating regions of the dorsal attention network, showed shorter and less frequent activations, along with reduced asymmetric hippocampal activity (AHA), a pattern linked to impaired successful ORM in PD. Study III uncovered two resting-state hippocampal networks that distinguish individuals with PD from healthy controls. The first network, involving occipitoparietal regions and the cerebellum, exhibited shorter activations, whereas the second network, including regions of the central executive network, showed less frequent activations in PD. Individuals with PD who demonstrated reduced AHA within these networks, exhibited a general trend toward deficit in semantic odor memory and auditory-verbal memory. Taken together, ORM not only engages primary olfactory regions but also recruits higher-order cognitive areas such as the hippocampus. Individuals with PD exhibit shorter and less frequent activations of specific hippocampal networks, along with reduced AHA, both during episodic olfactory memory task and at rest. These hippocampal dFC patterns are associated with deficits in declarative odor memory and auditory-verbal memory, suggesting their potential as markers of cognitive decline in PD, particularly prior to the selection of DAPT. Nevertheless, longitudinal studies with larger, more diverse, and well-characterized cohorts are essential before these markers can be translated into clinical practice.Parkinsons sjukdom är en av de vanligaste neurodegenerativa sjukdomarna och är främst känd för sina motoriska symptom. Sjukdomen innefattar dock även inskränkande icke-motoriska symptom, som nedsatt luktsinne och minnesfunktion. Båda är nära relaterade till kognitiv svikt. I takt med sjukdomens progression och vid långtidsbehandling med oral levodopa, upplever patienter frekventa och oförutsägbara motoriska fluktuationer, vilket kännetecknar den så kallade "komplikationsfasen". Vid denna fas kan apparatassisterad behandling vid Parkinsons sjukdom, som ger kontinuerlig dopaminerg stimulering, effektivt återställa motorisk kontroll. Trots behandlingens effektivitet, uppvisar vissa patienter ökad apati och kognitiv försämring efter apparatassisterad behandling. Detta understryker behovet av nya markörer för kognitiv svikt vid Parkinsons sjukdom före valet av apparatassisterad behandling. Avhandlingens syften är: (1) att undersöka dynamisk funktionell konnektivitet (dFC) som ligger till grund för lukt- och minnesprocesser, med särskilt fokus på episodiskt luktminne och (2) att kartlägga hippocampala dFC-mönster under uppgiftsbaserade betingelser och vilotillstånd samt bedöma deras betydelse för luktfunktion och deklarativt minne hos individer med Parkinsons sjukdom inför utredning och val av apparatassisterad behandling. Användningen av oberoende komponentanalys och k-means klustring som centrala metodologiska angreppssätt innebar att dataanalysen i denna avhandling i begränsad grad baserades på teoretiska antaganden och i stället präglades av ett explorativt samt datadrivet förhållningssätt. Studie I identifierade ett överlappande neuralt nätverk som inkluderade områden i luktbarken vid passivt luktande, luktinlärning och luktigenkänning (ORM). Ett distinkt ORM-relaterat nätverk som inkluderade hippocampus uppvisade fördröjd reaktivitet. Utöver detta, framgångsrik luktigenkänning av tidigare inlärda dofter associerades med dämpad neuronal aktivitet. Studie II visade att fyra hippocampala nätverk aktiverades sekventiellt under ORM. Ett nätverk som inkluderade områden i det dorsala uppmärksamhetsnätverket uppvisade kortare och mindre frekventa aktiveringar samt reducerad asymmetrisk hippocampal aktivering (AHA), ett mönster kopplat till nedsatt ORM hos individer med Parkinsons sjukdom. Studie III identifierade två hippocampala vilonätverk som skilde individer med Parkinsons sjukdom från friska kontroller. Det första nätverket, omfattande områden i nackloben, hjässloben och lillhjärnan, uppvisade kortare aktiveringar, medan det andra nätverket, som inkluderade områden i det centrala exekutiva nätverket, uppvisade lägre aktiveringsfrekvens vid Parkinsons sjukdom. Individer med Parkinsons sjukdom som hade reducerad AHA inom dessa nätverk hade en generell tendens till nedsatt semantiskt luktminne och audioverbalt minne. Sammanfattningsvis engagerar ORM inte bara primära luktrelaterade områden utan även högre kognitiva områden som hippocampus. Individer med Parkinsons sjukdom uppvisar kortare och mindre frekventa aktiveringar i specifika hippocampala nätverk samt reducerad AHA, både under episodiska luktminnesuppgifter och i vila. De här hippocampala dFC-mönstren är associerade med nedsättningar i deklarativt luktminne och audioverbalt minne. Detta tyder på deras potential att fungera som markörer för kognitiv svikt vid Parkinsons sjukdom, särskilt före valet av apparatassisterad behandling. Longitudinella studier med större, mer heterogen och välkarakteriserade kohorter är dock nödvändiga innan dessa markörer är tillräckligt valida och reliabla för att implementeras kliniskt.Funding agencies: County Council of Östergötland, Lions Research Foundation against Endemic Diseases, Medical Research Council of Southeast Sweden (FORSS), The Swedish Parkinson Foundation, The Swedish Research Council</p

Mass Casualty Response in a Low-Resource Context : Challenges and Opportunities in Rwanda’s Mass Casualty Incident Response

Background In a mass casualty incident (MCI), sudden patient surges can overburden the health system and cause material and human resource limitations, as well as challenges in adapting systems and structures to the changed needs. This leads to an increased risk of avoidable patient morbidity and mortality. Low-resource countries bear the brunt of the global trauma and disaster burden, and, although not formally assessed, are more likely to be more frequently exposed to MCIs. The ability to adequately manage a sudden patient influx is called “surge capacity”, and can be measured using the 4S-Framework, which assesses the dimensions staff, stuff, systems, and space. However, current MCI research primarily originates from high-resource settings, with uncertain generalizability to low-resource settings. Objectives This thesis aimed to increase the understanding of MCI epidemiology in Rwanda, including at the incident level (event type, location, and timing) and at the patient level (injury patterns, patient outcomes, treatment provided) (studies I and IV). Secondly, this thesis aimed to assess the surge capacity to manage mass casualty incidents in Rwanda (studies II, III, and IV), and to develop a knowledge base for future surge capacity strengthening efforts. Materials and Methods This thesis employed multiple study designs and analysis methods. Study I was a pilot study for a new data collection method (the media review), based on a scoping review methodology using a database of news items. Study II was a qualitative study with semi-structured interviews with trauma care responders, which were analyzed using qualitative content analysis. Study III was a cross-sectional survey study of surge capacity perceptions with clinical department leaders at Rwanda’s leading trauma hospitals. Study IV was a retrospective study of routine prehospital data from emergency medical services (EMS). Studies I, III, and IV utilized descriptive statistics and parametric and non-parametric hypothesis tests for group comparisons. Study III additionally utilized analysis of one-way variance to assess intra-class correlation between respondents from the same hospital, and study IV utilized mixed-model analysis based on logistic and linear regression to evaluate the role of confounders in EMS MCI dispatch. Main results Studying MCIs and surge capacity in Rwanda is challenged by the lack of appropriate registers, the sudden onset of events, and resource limitations. In Rwanda, the media review demonstrated extensive reporting on the number of injured victims, on-site deaths, and the geographic location of the MCI, indicating that this method can be used as a complementary method to assess epidemiological patterns in MCIs in the absence of trauma registers. Rwanda has a high MCI exposure, with road-traffic accidents being the most frequent, but natural hazards appear to be on the rise. The majority of mass casualty incidents are small to moderately sized. MCIs are managed at all levels of the health system. Perceived surge capacity to manage low- to moderately sized mass casualty incidents is high in Rwanda. Trauma care responders attribute this to the wealth of real-life experience in MCI management and having a supportive team. The successful resolution of dilemmas during MCIs can lead to positive effects such as self-confidence, teambuilding, and personal or professional growth. Surge capacity is higher in tertiary “level 1” hospitals, located in urban areas. There are specific challenges in the Rwandan context, primarily resource and staff shortages, as well as limited EMS coverage in rural areas, that limit the generalizability of surge capacity paradigms from high-income countries. In formal assessment, surge capacity is limited in all 4S-domains metrics, including low levels of disaster plan uptake and limited awareness of existing plans. Formal surge capacity routines are also limited in the pre-hospital setting. Yet, Rwandan trauma care workers and emergency medical services utilize surge capacity strategies, including patient distribution to multiple facilities, on-site patient EMS treatment to reduce hospital referrals, and patient co-transportation. However, MCIs in rural areas are less likely to be managed by formal EMS. Viewed in the light of limited in-hospital surge capacity in rural areas, rural patients are likely at higher risk of poor outcomes in mass casualty incidents in Rwanda. Conclusions Despite limited formal disaster planning and routines, Rwanda appears to have developed a strong surge capacity to manage small- to moderately sized mass casualty incidents organically. However, there are limitations to surge capacity and areas for improvement in all 4S-domains, including staff, stuff, systems, and space, especially in rural areas. Trauma systems and emergency medical services need further development to ensure adequate surge capacity

Neighborhood social structure in Sweden: A latent transition analysis using registry data from 1991 to 2020

Background: Neighborhoods shape daily life through physical and social structures, such as socioeconomic conditions, population density, and resident turnover. Decades of research link neighborhood characteristics to health and behavioral outcomes. However, these factors are often studied independently, neglecting their interrelated nature. Methods: Using Swedish population registry data, we employed latent class analyses to identify neighborhood typologies across six timepoints spanning 1991-2020. Neighborhoods, defined by Demographic Statistical Areas, were characterized by socioeconomic conditions, ethnic heterogeneity, residential instability, and urbanicity. Latent transition analyses examined changes over time. Results: Four neighborhood types emerged in the early period (1991-2000): Rural Low-Diversity (45 %), Urban Professional (27 %), Urban Affluent (21 %), and Resource-Limited (7 %). From 2001 onwards, five types were identified, with the addition of Urban High-Diversity (9 %) and Rural Resource-Limited (3 %). Three types, Rural Low-Diversity, Urban Professional, and Urban Affluent, persisted across 30 years, representing 87-93 % of neighborhoods, with over 90 % of neighborhoods retaining their classification over time. Conclusions: This multidimensional framework offers a foundation for future research, urban planning, and policy development.Funding Agencies|Swedish Research Council (Vetenskapsradet) [2021-02105]; Swedish Research Council [2021-02105] Funding Source: Swedish Research Council</p

Propagation of Opinions on Signed Graphs : Stability and Collective Wisdom

This thesis investigates how collective opinions evolve in social networks, focusing on two crucial, real-world factors: individual stubbornness and antagonistic inter-actions. Classical models of opinion dynamics typically assume a cooperative environment, where all individuals collaborate to reach an agreement, causing opinions to naturally draw closer to each other. However, many real-world scenarios—from political debates to online discussions—are defined by stubbornness, where individuals resist changing their stance, and by rivalry or distrust, which can actively push opinions apart. We address these phenomena through the framework of signed networks, which explicitly encodes antagonistic relationships. Unlike models that rely on structural balance—a clean division into two opposing camps—we adopt a repelling interaction mechanism, treating negative ties as additive repulsive forces. This approach offers a more flexible and realistic representation of complex, unbalanced social structures. The first contribution is a thorough analysis of the signed Friedkin–Johnsen (SFJ) model, which combines stubborn attachment to initial opinions with antagonistic interactions. This combination fundamentally changes system behavior: while the classical FJ model is always stable, the SFJ model can diverge. Therefore, we establish sufficient stability conditions and show that even when the model is stable, antagonism allows opinions to escape the the convex hull of the initial opinions, meaning that agents can adopt positions more extreme than anyone held at the start. The thesis then examines repeated discussions through a concatenated SFJ model, reflecting scenarios such as a series of negotiations. Here, stability in an individual discussion does not imply stability for the repeated process. Two distinct behaviors emerge when the individual discussion rounds are stable: opinions may temporarily move apart before reconverging to consensus inside the convex hull, or they may drift farther apart with each round, leading to divergence. The first case corresponds to a transient amplification, which is a known consequence of non-normal matrices and is often referred to as reactivity. Given these possibilities, we provide sufficient stability conditions for the concatenated SFJ model. This analysis is extended to explore the dynamics in more complex scenarios, including time-varying interaction structures and bipartite (two-camp) networks. Next, we address multidimensional opinion dynamics models, where agents debate several interdependent topics (for example, climate policy is inherently linked to economic policy). We show that a set of topics that would be stable if discussed independently can become unstable and diverge when discussed together. The analysis of repeated (concatenated) multidimensional interactions reveal diverse outcomes, from full or partial or bipartite consensus to divergence. Finally, we shift the focus from opinion convergence to the quality of resulting collective judgement and study the wisdom of crowds problem, i.e., analyze the conditions under which a group’s aggregated opinion becomes more accurate due to collective interactions. The improvement of wisdom depends entirely on the allocation of the social power vector—the centrality measure that each individual has in the group. In classical cooperative systems, the social power vector is positive, which confines the concentration region (the set of allocations that improve wisdom) to a simplex. In contrast, signed networks allow for negative social powers, which expands the concentration region beyond the simplex, to a hyperplane. The analysis on signed networks also leads to a critical insight: agreement does not imply accuracy. The group can become confidently wrong—converging with high certainty to a false truth. We also analyze the case where the agents’ initial opinions are correlated, and characterize the new concentration regions and their properties under these conditions

Nocturnal gastro-oesophageal reflux and pulmonary abnormalities on chest CT in a general population: the Swedish CArdioPulmonary BioImage Study

Background Nocturnal gastro-oesophageal reflux (nGER) is common in people with respiratory diseases, but its association with pulmonary abnormalities is not known.Aim Investigate the association between nGER and pulmonary abnormalities on chest CT in an adult general population.Methods In total, 28 846 individuals from the general population aged 50-64 years completed questionnaires and underwent chest CT, in the Swedish CArdioPulmonary BioImage Study (www.scapis.org). Participants with nGER symptoms on &amp;gt;= 1 night per week were defined as having nGER. Chest CT was evaluated for bronchial wall thickening, bronchiectasis, reticular abnormalities, honeycombing, cysts and ground glass opacities. Ever-smoking, current asthma, inflammatory bowel disease and autoimmune disease were defined as risk factors for pulmonary abnormalities. Analyses were adjusted for sex, age, body mass index, education level and study centre.Results The prevalence of nGER was 9.4%. Among participants with risk factors for pulmonary abnormalities (n=4004), having nGER was positively associated with bronchial wall thickening (adjusted OR (aOR) (95% CI): 1.25 (1.07 to 1.48)) and reticular abnormalities (aOR (95% CI): 1.51 (1.04 to 2.17)), but negatively associated with cysts (aOR (95% CI): 0.68 (0.48 to 0.97)). Among participants without risk factors for CT abnormalities (n=2555), nGER did not relate with pulmonary abnormalities.Conclusions In a middle-aged general population, nGER was not associated with pulmonary abnormalities on chest CT. However, in the presence of other risk factors for pulmonary abnormalities, nGER was associated with bronchial wall thickening and reticular abnormalities. Persons with nGER and risk factors for pulmonary abnormalities should, therefore, be evaluated for respiratory disease and treated appropriately.Funding Agencies|Swedish Heart and Lung Foundation [20210558, 20230610]; Knut and Alice Wallenberg Foundation; Swedish Research Council, VINNOVA (Sweden's Innovation Agency); University of Gothenburg; Sahlgrenska University Hospital, Lund University; Skane University Hospital, Linkoeping University; University Hospital, Karolinska Institutet; Karolinska University Hospital; Uppsala University and University Hospital; Umea University and University Hospital</p

4D Flow MRI Velocity and Turbulence Mapping in Mild Valvular Heart Disease

Background: Valvular heart disease (VHD) commonly leads to the development of turbulent blood flow. Turbulent kinetic energy (TKE), measured with 4D flow MRI, may be a complement to current metrics for early identification of VHD. Purpose: To investigate TKE as a marker of VHD in relation to flow velocity and cardiovascular geometry. Study Type: Retrospective observational cross-sectional. Population: Twenty controls and 106 subjects with VHDs, including mitral regurgitation, aortic regurgitation, pulmonary regurgitation, tricuspid regurgitation, and aortic stenosis. Field Strength/Sequences: Four-dimensional flow MRI using a spoiled gradient-echo phase-contrast sequence with asymmetric 4-point motion encoding at 1.5 or 3 T. Assessment: Time-resolved segmentations of the left and right ventricles (LV, RV), atria (LA, RA), and aorta were performed. Total and maximum TKE, maximum and average velocity, and diameters were evaluated in each. Correlations between TKE, velocity, and diameter were assessed, along with group differences between VHD subjects and controls. Statistical Tests: Student's t-test, Wilcoxon rank-sum test, chi-squared test, Pearson's correlation, two-way analysis of covariance. A p value &amp;lt; 0.05 was considered significant. Results: Total and maximum TKE correlated significantly with maximum velocity (r = 0.45-0.76) and averaged velocity (r = 0.22-0.44) and less strongly with diameters for aorta, LV, LA, and RV (r = 0.18-0.37). Compared to controls, total and maximum aortic TKE were significantly higher in aortic stenosis (3.8 vs. 1.6 mJ; 291.7 vs. 133.7 J/m(3)). Maximum LV TKE was significantly elevated in aortic regurgitation (106.6 vs. 91.8 J/m(3)). Total TKE was significantly elevated in LA for mitral regurgitation (1.1 vs. 0.6 mJ), in RA for tricuspid regurgitation (1.6 vs. 0.7 mJ), and in RV for pulmonary regurgitation (1.7 vs. 1.0 mJ). Data Conclusion: TKE is elevated in mild VHD. When evaluated alongside velocity as a marker for VHD, TKE may be more discriminative. Consequently, it has potential to be a hemodynamic marker of early VHD conveying complementary information to velocity.Funding Agencies|Medical Faculty at Linkping University</p

Under Pressure : Microcirculatory Dynamics and Capillary Refill Assessment in Provocation and Hemodynamic Stress

Background: All patients seeking emergency care or admitted to hospital need to be assessed and often monitored over a period. Vital functions are assessed at the bedside with technical equipment and clinical judgement. A commonly performed test, the capillary refill test (CRtest), is supposed to assess circulatory function. The test is performed by pressing the examiners’ index finger onto the patient skin, often for 5 seconds, then rapidly remove the finger and watch the skin regain its original colour as it was before the blanching pressure was applied. The time it takes is called the capillary refill time (CRtime) and less than 2-3 seconds have been recommended as normal, and times longer than that as a sign of circulatory compromise. The CRtest, despite widely used, has been questioned due to its subjectivity, and uncertainty of the test’s external validity. Objectives: The purpose of the study in Paper I was to investigate the repeatability of the CRtest, In Paper II, inter- and intra-observer reliability of the test was investigated, In Paper III, the outcome of the test in a blood loss shock model was investigated. The relationship between the changes in microcirculation to the CRtime in a blood loss shock model was investigated in Paper IV. Methods: In Paper I, CRtests were performed on study subjects on the sternum, the forehead and the finger, in series of 2 and 5 minutes apart. Objectively quantified CRtime, (qCRtime), was obtained through polarized reflectance imaging and a software program. In Paper II, CRtests were performed on pediatric patients in an emergency department and video filmed, and qRCtimes were obtained. The video films were shown to health care staff in a pediatric clinic, and the staff was asked to assess CRtime with naked eye. In Paper III, healthy volunteers were subjected to lower body negative pressure, (LBNP), in a blood loss shock model and CRtests performed and qCRtimes obtained. In Paper IV, the qCRtimes from the healthy study subjects in the LBNP model were compared with simultaneous changes in perfusion, measured as speed resolved perfusion reflecting flow in different vessels, and tissue oxygenation was also measured. Results: In Paper I, there were no statistical differences in qCRtime in a series of CRtests, regardless of when in the series the test was performed. In Paper II, naked eye assessment of CRtimes in children showed poor reproducibility in pediatric nurses and pediatricians, as well as in comparison to qCRtimes. In Paper III, in a blood loss shock model, qCRtimes shortened statistically significantly. In Paper IV, the shortened qCRtimes in Paper III, correlated to a decrease in perfusion and in tissue oxygenation as well as reduced flow in the smallest vessels. Conclusion: The CRtest shows good repeatability, but the test, as it is commonly performed in clinical practice with naked eye assessment, could be questioned for its lack of reproducibility. The CRtest also shows shortening of qCRtime in a blood loss shock model, contradictory to previously believed. The shortening of qCRtime is associated with changes in perfusion. Objective methods for quantification of CRtime with biooptical imaging techniques, as in these studies with polarized reflectance imaging, is valuable in the study of the CRtest and changes in perfusion in provocations and hemodynamic stress

Results from a Swedish model-based analysis of the cost-effectiveness of AI-assisted digital mammography

ObjectiveTo evaluate the cost-effectiveness of AI-assisted digital mammography (AI-DM) compared to conventional biennial breast cancer digital mammography screening (cDM) with double reading of screening mammograms, and to investigate the change in cost-effectiveness based on four different sub-strategies of AI-DM.Materials and methodsA decision-analytic state-transition Markov model was used to analyse the decision of whether to use cDM or AI-DM in breast cancer screening. In this Markov model, one-year cycles were used, and the analysis was performed from a healthcare perspective with a lifetime horizon. In the model, we analysed 1000 hypothetical individuals attending mammography screenings assessed with AI-DM compared with 1000 hypothetical individuals assessed with cDM.ResultsThe total costs, including both screening-related costs and breast cancer-related costs, were &amp;lt;euro&amp;gt;3,468,967 and &amp;lt;euro&amp;gt;3,528,288 for AI-DM and cDM, respectively. AI-DM resulted in a cost saving of &amp;lt;euro&amp;gt;59,320 compared to cDM. Per 1000 individuals, AI-DM gained 10.8 quality-adjusted life years (QALYs) compared to cDM. Gained QALYs at a lower cost means that the AI-DM screening strategy was dominant compared to cDM. Break-even occurred at the second screening at age 42 years.ConclusionThis analysis showed that AI-assisted mammography for biennial breast cancer screening in a Swedish population of women aged 40-74 years is a cost-saving strategy compared to a conventional strategy using double human screen reading. Further clinical studies are needed, as scenario analyses showed that other strategies, more dependent on AI, are also cost-saving.Key PointsQuestionTo evaluate the cost-effectiveness of AI-DM in comparison to conventional biennial breast cDM screening.FindingsAI-DM is cost-effective, and the break-even point occurred at the second screening at age 42 years.Clinical relevanceThe implementation of AI is clearly cost-effective as it reduces the total cost for the healthcare system and simultaneously results in a gain in QALYs.Key PointsQuestionTo evaluate the cost-effectiveness of AI-DM in comparison to conventional biennial breast cDM screening.FindingsAI-DM is cost-effective, and the break-even point occurred at the second screening at age 42 years.Clinical relevanceThe implementation of AI is clearly cost-effective as it reduces the total cost for the healthcare system and simultaneously results in a gain in QALYs.Key PointsQuestionTo evaluate the cost-effectiveness of AI-DM in comparison to conventional biennial breast cDM screening.FindingsAI-DM is cost-effective, and the break-even point occurred at the second screening at age 42 years.Clinical relevanceThe implementation of AI is clearly cost-effective as it reduces the total cost for the healthcare system and simultaneously results in a gain in QALYs.Funding Agencies|Region Ostergotland and Linkoping University; Linkoping University</p

From analysis to findings: How do process mining analysts discover results?

Process mining involves analyzing event data from business process executions to uncover valuable insights. Although obtaining meaningful results is crucial for any process mining initiative, there is still little understanding of how process analysts derive these insights. In this paper, we fill this gap by characterizing findings of process mining analysis, the processes that lead to these findings, and the role of process mining expertise in guiding these processes. To this end, we leverage empirical data from a study with process mining analysts, including user interactions from process mining tools and inference steps from think-aloud protocols. Our empirical insights provide a comprehensive understanding of how analysts interact with process mining tools, highlighting approaches that lead to valuable findings. The results of our analysis lay the groundwork for the design of tools and visualizations that can support process analysts in their analysis and reasoning processes.Funding Agencies|Swiss National Science Foundation, Switzerland [2000 21_197032]</p