Use of mHealth Technology for Improving Exercise Adherence in Patients With Heart Failure: Systematic Review

Background: The known and established benefits of exercise in patients with heart failure (HF) are often hampered by low exercise adherence. Mobile health (mHealth) technology provides opportunities to overcome barriers to exercise adherence in this population. Objective: This systematic review builds on prior research to (1) describe study characteristics of mHealth interventions for exercise adherence in HF including details of sample demographics, sample sizes, exercise programs, and theoretical frameworks; (2) summarize types of mHealthtechnology used to improve exercise adherence in patients with HF; (3) highlight how the term "adherence" was defined and how it was measured across mHealth studies and adherence achieved; and (4) highlight the effect of age, sex, race, New York Heart Association (NYHA) functional classification, and HF etiology (systolic vs diastolic) on exercise adherence. Methods: We searched for papers in PubMed, MEDLINE, and CINAHL databases and included studies published between January 1, 2015, and June 30, 2022. The risk of bias was analyzed. Results: In total, 8 studies (4 randomized controlled trials and 4 quasi-experimental trials) met our inclusion and exclusion criteria. A moderateto high risk of bias was noted in thestudies. All studies included patients with HF in NYHA classification I-III, with sample sizes ranging from 12 to 81 and study durations lasting 4 to 26 weeks. Six studies had an equal distribution of male and female participants whose ages ranged between 53 and 73 years. Videoconferencing was used in 4 studies, while 4 studies used smartphone apps. Three studies using videoconferencing included an intervention that engaged participants in a group setting. A total of 1 study used a yoga program, 1 study used a walking program, 1 study combined jogging with walking, 1 study used a cycle ergometer, 2 studies combined walking with cycle ergometry, and 1 study used a stepper. Two studies incorporated resistance exercises in their program. Exercise programs varied, ranging between 3 and 5 days of exercise per week, with exercise sessions ranging from 30 to 60 minutes. The Borg rating of perceived exertion scale was mostly used to regulate exercise intensity, with 3 studies using heart rate monitoring using a Fitbit. Only 1 study implicitly mentions developing their intervention using a theoretical framework. Adherence was reported to the investigator-developed exercise programs. All studies were mostly feasibility or pilot studies, and the effect of age, sex, race, and NYHA classification on exercise adherence with the use of mHealth was not reported. Conclusions:The results show some preliminary evidence of the feasibility of using mHealth technology for building exercise adherence in patients with HF; however, theoretically sound and fully powered studies, including studies on minoritized communities, are lacking. In addition, the sustainability of adherence beyond the intervention period is unknown

Swedish speech and language pathologists reflect on how their clinical practises align to everyday language and communication skills of children with developmental language disorder

This study aims to extend current knowledge about the possibilities and challenges encountered by Swedish speech and language pathologists (SLPs) in targeting everyday language and communication in children with developmental language disorder (DLD). To explore this matter, unstructured focus groups were conducted where 15 SLPs, working with children with DLD, shared their views on the alignment between their clinical practices and children's everyday lives. Thematic analysis was used to analyse the data, which resulted in five themes: It's everyday life that matters; As an SLP, you're not a part of the child's everyday life; How do we merge the different worlds?; Resources at home vary, and The employer sets the framework for clinical practices. The SLPs stressed the importance of targeting everyday skills and needs, but they experienced themselves as being detached from the children's daily context. Collaboration with caregivers and (pre)school staff was emphasised; however, the resources and capacity of the caregivers and staff varied, and this was experienced as a challenge for providing the most appropriate care. Some children and their families were situated in a multifaceted context and needed more extensive care, and this group was described as increasing. However, the services that the SLPs were able to offer varied and were largely regulated by organisational constraints. Individualised services are crucial for ensuring a positive development for children with DLD and for empowering caregivers to be effective collaborative partners in intervention. Therefore, it is essential for SLPs to have the time and resources to ensure high-quality care.Funding Agencies|Majblommans Riksforbund; Stiftelsen Sunnerdahls Handikappfond</p

Health related quality of life (HRQOL) from the perspective of patients with chronic whiplash-associated disorders (WAD) in Sweden

BackgroundThe current study investigated Whiplash Associated Disorders (WAD) and health related quality of life (HRQOL) from the perspective of Swedish patients. Another aim was to assess medicine consumption and income loss due to WAD.MethodThe present study was a planned secondary analysis using baseline data from a prospective, multicentre randomized controlled trial. The study participants were WAD patients, victims of four-wheel motor vehicle collisions at least six months but not more than five years ago. Neck Disability Index and HRQOL were measured. HRQOL was measured by the EQ-5D instrument. Cross tabulations, Box Plots, and regression analyses were performed.Trial registration sectionThe study was registered before data collection started (ClinicalTrials.gov Protocol ID: NCT03022812, initial release 12/20/2016).ResultsThere were 137 WAD participants (78.8% women), and almost three-fourths (74.5%) were married. The majority (54.7%) of the WAD patients were in white-collar jobs, followed by blue-collar jobs (35%) and students /unemployed (10.2%). Both consumption of medicine for neck pain and income loss due to WAD have a negative relation with the Neck Disability Index (NDI). On average, EQ-VAS for WAD women is 58.21 (+/- 17.625), and for men, it is 61.11 (+/- 16.444). WAD patients with a university education have the highest EQ-VAS average of 60.42 (+/- 17.738).ConclusionsThe low HRQOL seen in WAD patients in this study should warrant the attention of the medical fraternity, researchers and policymakers.Funding Agencies|Mid Sweden University; Swedish Research Council; Ostergoetland; Soedermanland county councils; Linkoping University</p

When Two Becomes Three: Predicting Stable Ternary Boron-Based Compounds by Populating Unique Lattice Sites in Binary Prototype Structures

Boron-based materials are known for their excellent mechanical properties and structural versatility. However, the discovery of such novel materials is often hindered by challenging synthesis procedures, such as high temperature and pressure, which is why theoretical guidance can be used to identify candidates most promising for synthesis. In this study, new chemical phase spaces are explored utilizing the Materials Project database. 16 boron-based binary prototype structures are identified, each featuring two unique non-boron lattice sites. These sites are subsequently populated with elements from Groups 2 to 14 and expanded into 27 552 ternary compounds. Phase stability assessments identify 166 stable ternary compounds, 155 of which are mechanically stable. Analysis reveals a strong correlation between boron concentration and mechanical properties, with boron-rich compounds exhibiting higher Vickers hardness and improving shear and Young's moduli. Notably, multiple ternary compounds demonstrate significant mechanical property enhancements over their binary counterparts, with some showing Young's modulus improvements of up to 50%. These findings exemplify a pathway for designing novel boron-based materials with exceptional mechanical characteristics.Funding Agencies|Knut och Alice Wallenbergs Stiftelse [2022-06725]; Swedish Research Council [KAW 2020.0033]; Knut and Alice Wallenberg (KAW) Foundation for a Scholar Grant</p

Tensions and opportunities for cross-disciplinary collaboration in smart city work

Smart and sustainable cities entail inherent complexity, spanning various issue domains from resilience and sustainability to quality of life and social equity, bringing together multiple subjects and disciplines. This chapter elaborates on the meaning of cross-disciplinary research, which has become increasingly recognized as vital for tackling a growing number of contemporary societal issues. Nonetheless, work across disciplines remains challenging due to philosophical, conceptual, and skill differences but also collaboration. Therefore, understanding barriers to working across disciplines and issue domains is crucial. The study draws on a focus mapping literature review, addressing challenges of cross-disciplinarity, and on three interviews, respectively with two early-/mid-career scholars and the head of the University of Stavanger, and explores the research questions: What are the challenges entailed with cross-disciplinary research? How may these challenges be overcome with special regard to early-career researchers and to the smart city? The analysis identified common themes and obstacles encountered by novice researchers. The findings highlight challenges for early- and mid-career researchers in entering fields of various kinds of cross-disciplinary collaboration. The chapter advocates for the creation of more inclusive and supportive academic environments for early- and mid-career professionals and highlights ways of approaching this goal in the smart city

Personalized Analysis of Left Atrial Blood Flow through Computational Modeling

In this thesis, the atrial blood flow was modeled using computational fluid dynamics (CFD) to better understand atrial hemodynamics and blood stasis. Atrial hemodynamics and especially stasis are of interest since thrombi can form in the left atrium, travel with the blood stream to the brain, and cause strokes. To model atrial blood flow in a personalized manner, several modeling assumptions and choices need to be made, for example how to model the motion of the atrial wall. There are different approaches to estimate stasis; however, there is no standard method. While it is known that in patients with atrial fibrillation (AF), the stroke risk is increased, the exact mechanisms for this are not fully understood, especially in patients that are in sinus rhythm most of the time. One approach to reduce the stroke risk is to occlude the left atrial appendage (LAA). However, this has not been evaluated for patients in an early phase of AF. The aim of this thesis was to enhance our understanding of left atrial hemodynamics. For this, the blood flow in the left atrium was simulated using CFD based on time-resolved CT images, including the patient-specific geometry and wall motion. In this thesis, different stasis markers are investigated and a new method to quantify atrial hemodynamics was developed, splitting the atrial blood flow into 6 components. Additionally, virtual LAA occlusion was investigated to see how it impacts atrial hemodynamics during sinus rhythm. In this thesis, the atrial blood flow and stasis in 21 paroxysmal AF patients during sinus rhythm were compared to 8 controls. The wall motion tracked from time-resolved CT that was used in the CFD simulations showed similar flow rates as measurements from 4D flow MRI. All stasis markers investigated showed higher stasis in AF patients during sinus rhythm compared to the controls. Atrial flow component analysis revealed how blood travels through the left atrium. In the control group, the blood flow was dominated by components characterizing a direct path through the LA. In the patients with AF, however, an increased amount of blood stays in the LA for more than two heart beats and more blood flows back to the lungs. Virtual LAAO showed a reduction of stasis, for some individuals to similar levels as the control group. For others, stasis was reduced but still high, and stasis was located close to the occlusion device. This could indicate an increased risk for device-related thrombi. In conclusion, this thesis contributes to our understanding of the atrial blood flow. Using CT-based CFD simulations, we could show that stasis is increased in AF patients during sinus rhythm. In the future, adding patient-specific stasis assessment could improve decision-making to prescribe anticoagulants and thus reduce the incidence of cardioembolic strokes.Funding agencies: The Center for Medical Image Science and Visualization (CMIV) at Linköping University, the Swedish Research Council, the Swedish Heart and Lung Foundation, Sweden’s Innovation Agency Vinnova, County Council of Östergötland, Henry och Ella Ståhls Foundation, Konung Gustaf V:s och Drottning Victorias StiftelseThe computations were enabled by resources provided by the National Academic Infrastructure for Supercomputing in Sweden (NAISS), the Swedish National Infrastructure for Computing (SNIC), partially funded by the Swedish Research Council through grant agreement no. 2022-06725, and by the National Supercomputer Centre (NSC), funded by Linköping University.</p

” We Should be Able to do More” : - a Qualitative Study of Special Education Teachers’ reasoning on Digital Tools as Instruments of Inclusion

Syftet med denna studie är att undersöka specialpedagogers uppfattningar om digitala hjälpmedel som inkluderande verktyg i grundskolan. Genom att belysa hur dessa verktyg används och vilka faktorer som påverkar deras effektivitet, bidrar studien till en djupare förståelse för hur digitaliseringen kan stödja elever i behov av särskilt stöd. Studien analyserar specialpedagogernas beskrivningar utifrån Claes Nilholms teori om specialpedagogiska perspektiv för att identifiera hur olika synsätt påverkar användningen av digitala hjälpmedel i skolan. Studien bygger på en kvalitativ metod där semistrukturerade intervjuer genomförts med åtta specialpedagoger verksamma i grundskolan. Intervjuerna har analyserats genom tematisk analys. I resultatet framkommer fyra teman: Lärarens kunskap om digitala verktyg påverkar användandet; Lärarens roll påverkar användandet; Elevernas stödbehov påverkar användandet; Elever vill vara som sina klasskamrater. Resultaten visar att digitala hjälpmedel har stor potential att främja inkludering, men att deras effektivitet påverkas av flera faktorer. Lärarnas kunskap och inställning är avgörande för hur verktygen används, och en brist på kompetens kan begränsa deras inkluderingseffekt. Digitala hjälpmedel anses fungerar särskilt bra för elever med läs- och skrivsvårigheter men är ofta mindre effektiva för elever med koncentrationsproblem eller brister i exekutiva funktioner, där det istället behövs mer lärarstöd Samtidigt upplever många elever att de inte vill använda digitala hjälpmedel eftersom de inte vill avvika från sina klasskamrater, vilket kan leda till att de undviker verktyg som skulle kunna hjälpa dem.   Analysen visar att en inkluderande användning av digitala hjälpmedel ofta bygger på ett dilemmaperspektiv, där lärare arbetar aktivt för att kombinera individanpassning med gemensamma lösningar. Däremot tenderar en mer kompensatorisk syn på specialpedagogik att begränsa användningen genom att fokusera på individuella brister snarare än på en anpassad lärmiljö. Studien belyser därmed vikten av kompetensutveckling för lärare och behovet av vidare forskning kring skolmiljöns påverkan på digitala verktygs effektivitet.

Autonomous Email Categorization using Machine Learning Models in Thunderbird Client

Email categorization is a significant challenge in today's digital workplace, where sorting through messages may become complicated. This thesis addresses this problem by developing and evaluating the Thunderbird email client's autonomous email categorization system. Specifically, the study explores several machine learning models: Traditional algorithms (Logistic Regression, Support Vector Machines (SVM), Random Forest, XGBoost) and a Deep Learning model, Distil-BERT. The study also showcases the development of a custom Thunderbird extension that integrates fine-tuned machine learning models through a FastAPI backend service, providing empirical verification of the proposed approach. This implementation supports single and ensemble model predictions, offering flexibility in dealing with the trade-off between accuracy and computational resource usage. The findings of this research provide insights and lessons learned regarding the implementation, practical challenges, and future opportunities of automated email categorization, enriching the general understanding of using machine learning solutions for everyday productivity problems.

Parametric Digital Twins for Preserving Historic Buildings: A Case Study at Löfstad Castle in Östergötland, Sweden

This study showcases the digitalization of Löstad Castle in Sweden to contribute to preserving its heritage values. The castle and its collections are deteriorating due to an inappropriate indoor climate. To address this, thirteen cloud-connected sensor boxes, equipped with 84 sensors, were installed throughout the main building, from the basement to the attic, to continuously monitor various indoor environmental parameters. The collected extensive multi-parametric data form the basis for creating a parametric digital twin of the building. The digital twin and detailed data analytics offer a deeper understanding of indoor climate and guide the adoption of appropriate heating and ventilation strategies. The results revealed the need to address high humidity problems in the basement and on the ground floor, such as installing vapor barriers. Opportunities for adopting energy-efficient heating and ventilation strategies on the upper floors were also highlighted. The digitalization solution and findings are not only applicable to Löfstad Castle but also provide valuable guidance for the conservation of other historic buildings facing similar challenges.Funding Agencies|Swedish Innovation Agency (Vinnova); Swedish Energy Agency (Energimyndigheten)</p