Designing Activity-Based and Context-Sensitive Ambient Sound Environments in Open-Plan Offices

This paper addresses the problem of sound disturbance in open office environments. We have in a design-based research study explored how digital, real time generated sound can be added to a work environment and how these sound environments are perceived by respondents when performing work tasks. In this first explorative study we have chosen to focus on designing a digital sound system for activity-based offices, where the physical environment is already designed for particular activities. Our approach is to explore if adding appropriate acoustic designs to the ambient environment can enhance workplaces. Our results show that test subjects perceived that acoustic design could enhance the ambient environments if the acoustic design is pertinent with the environment as a whole

Sediment transport and coastal evolution at Thuan An Inlet, Vietnam

The Tam Giang-Cau Hai lagoon is located outside of Hue in central Vietnam. Southeast of Thuan An inlet, one of the two inlets of the lagoon, a groin was constructed in 2008 as a measure to reduce the sediment transport to prevent the inlet from closing. This groin has caused erosion of the eastern sand spit of the inlet and accretion of sediment on the coastline south east of the groin. The objectives of this study was to make a model of the sediment transport on the southeast side of the groin to be able to analyse how different measures to reduce the erosion of the inlet would affect the sediment transport past the groin. The field measurements and parts of the data collection took place in Vietnam during nine weeks in the beginning of 2013. The position of the coastline at Thuan An inlet was measured and the rest of the data, such as e.g. wave data, bathymetry data, previously measured coastlines and sediment transport was obtained from Institute of Mechanics in Hanoi. Other data used in this thesis was also obtained from The University of Agriculture and Forestry in Hue and from The Oceanographic Institute in Nha Trang. The study area has a tropical monsoon climate with two monsoon season per year – the southeast monsoon and the northwest monsoon. The micro tidal climate in the area is fully semi-diurnal and gives that the main sediment transport is wave induced. The modelling software GENESIS was used to model the sediment transport past the groin. The model was calibrated and validated using measured data and then the sediment transport on the southeast side of the groin was modelled during the years 2013 to 2017. First, the case where no measures were taken was modelled, to see what will happen if no changes of the groin were made. After that, three different measures to decrease the accretion of sediment on the southeast side of the groin (i.e. increase the sediment transport past the groin in order to reduce the erosion of the Thuan An inlet) were modelled and analyzed. These three measures were making the groin shorter, increasing the permeability of the groin and dredging sand from southeast side of the groin. The result of the model and the different measures to reduce erosion were discussed. The conclusion was that interventions to reduce the erosion are needed to protect the lagoon and the people living around it and making their livelihood from it. Many people work with e.g. fishery, aquaculture and agriculture and these occupations could be severely affected of the results of continuous erosion, such as changed water environment in the lagoon and flooding

Pulmonary disease in infancy, perinatal inflammatory risk factors and prophylaxis

Objective In the last decades the survival rate of preterm infants has increased substantially.1-3 Despite improved intensive neonatal care the incidence of chronic lung disease in infants born preterm has not changed.4-6 The overall aim of this thesis was to investigate pulmonary disease in infancy, perinatal inflammatory risk factors and prophylaxis, with specific emphasis on the development of bronchopulmonary dysplasia and the effect of antenatal corticosteroids. Methods This thesis was built on four observational population based studies. Studies I- III were cohort studies. Study IV was a case-control study. Studies I and II included infants born from 1976 through 1997 in Sweden and investigated the effect of antenatal corticosteroids exposure before gestational week 34. All infants in study I were born before gestational week 34, whereas infants in study II were born from gestational week 34 or later. Study III included infants born before gestational week 37, from 1988 through 2009 in Sweden and explored prenatal inflammatory risk factors for bronchopulmonary dysplasia. Study IV included infants born before gestational week 33, from 2005 through 2010 in Sweden, and investigated difference in risk factors associated with growth restriction and inflammation between infants with bronchopulmonary dysplasia and infants with respiratory distress syndrome only. Results Infants in studies I and II had reduced risk of respiratory distress syndrome after exposure of antenatal corticosteroids. In term infants an increased risk of low Apgar score, was noticed. Study III showed that preeclampsia was the strongest prenatal risk factor for bronchopulmonary dysplasia. A reduced risk of bronchopulmonary dysplasia associated with diabetes mellitus and gestational diabetes was also found. Study IV showed an increased risk of bronchopulmonary dysplasia associated with long duration of prelabor preterm rupture of membranes, small for gestational age, low Apgar score and resuscitation interventions in the delivery room. Conclusions Studies I and II confirmed the benefits of antenatal corticosteroids in preterm infants in a clinical setting and also in infants born late preterm. Except for an increased risk of low Apgar score in term infants, no increased risks of adverse effects were found. The findings from Study III, with preeclampsia as the strongest risk factor and a reduced risk associated with diabetic disorders, suggest that an impaired angiogenesis may contribute to development of bronchopulmonary dysplasia. The findings from Study IV indicate that infants who subsequently develop bronchopulmonary dysplasia were likely to have been exposed to factors causing lung injury and triggering inflammation already during fetal life

Effects of SERM (selective estrogen receptor modulator) treatment on growth and proliferation in the rat uterus

BACKGROUND: Selective estrogen receptor modulators (SERMs) have been developed in order to create means to control estrogenic effects on different tissues. A major drawback in treatment of estrogen receptor (ER) positive breast cancer with the antagonist tamoxifen (TAM) is its agonistic effect in the endometrium. Raloxifene (RAL) is the next generation of SERMs where the agonistic effect on the endometrium has been reduced. METHODS: The aim of the present study was to determine the effect of SERM treatment on the uterus, as assessed by proliferation markers and several factors involved in uterine growth. Ovariectomized (ovx) rats were treated with estradiol (E(2)), tamoxifen (TAM), RAL, ICI182780 (ICI) or vehicle (OVX-controls). We studied the effects on mRNA levels of the growth hormone (GH) receptor, insulin-like growth factor-I (IGF-I), ERα and ERβ. In addition, by immunohistochemistry the proliferation markers PCNA and Ki-67, as well as ERα and ERβ, were detected. RESULTS: The uterine weight of the rats treated with E(2 )or TAM was increased as compared to OVX-controls. The uterine GH-receptor mRNA level was highest in the E(2 )treated animals. In ICI treated rats no GH-receptor mRNA could be detected. The IGF-I mRNA level increased 16-fold in uteri of the TAM treated group and 9-fold in the E(2 )treated rats as compared to OVX-controls. The ERα mRNA level was increased in the E(2 )treated rats, while the ERβ mRNA level was increased after TAM treatment. The proliferation, as assessed by PCNA, was lowest in ICI treated animals. CONCLUSIONS: The uterine wet weight, the LE height and the GH-receptor mRNA levels showed similar patterns, indicating that GH is involved in the regulation of uterine weight. Tamoxifen, which has been related to increased incidence of endometrial carcinoma in women, dramatically increased IGF-I mRNA levels in rat uterus. Since proliferation was not higher in TAM and E(2 )treated rats than in OVX controls, this assay of simple, early proliferation does not give the full explanation of why TAM should enhance the risk of developing endometrial cancer

Adults with cystic fibrosis : mental health and patient experiences of the CF treatment

Background: Cystic fibrosis (CF) is an autosomal recessive inherited, life shortening multi organ disease most typically affecting the respiratory system and the gastrointestinal tract. In recent decades progresses in the management of CF has led to an increasing proportion of adults with CF. Sweden has a large proportion of adults living with CF, however there is no systematic evaluation conducted, and thus a lack of knowledge regarding their mental health. Aim: The overall aim with this thesis was to investigate the mental health among adults with CF, and to explore adult CF patients experiences of the CF treatment applied in Sweden. Methods and Results: Paper I, a cross-sectional study. Comparisons of Hospital Anxiety and Depression Scale (HADS) data from 129 Swedish adult CF patients, and from published studies in Belgian, British and German adult CF-patients with corresponding general population data showed no elevated risks for anxiety or depression among the adults with CF in a binary logistic analysis. ANOVA showed a slightly elevated level of anxiety in the Swedish CF-sample, but this effect was only seen among the women. Paper II, a crosssectional study in 68 adults. Structural Equational Modelling (SEM) showed that those with severer cftr mutation classes with increasing age and a parallel deterioration of somatic health get poorer psychological wellbeing. Exercise had a positive effect on psychological wellbeing, but only if it also had a positive effect on somatic health. Paper III, a longitudinal study in 68 adults. Latent Growth Modelling (LGM) showed that anxiety, especially when combined with some level of depression, was associated with a faster decline in lung function over time. Paper IV, a qualitative study. Semi-structured interviews were conducted with 12 ‘middle-aged’ (32-55 years) adults. Inductive content analysis resulted in three themes: ‘Prioritize and manage health – a life condition’, ‘Aspiration for and possibility to a ‘normal life’ and ‘The CF center as a partner in the life condition’. Conclusion: This thesis has contributed with an increased understanding of the mental health aspects of CF for adults. As a group, there is no elevated risk for impairment in mental health with regard to anxiety and depression in Swedish adults with CF. However, individuals with genetically more severe CF with age, and deteriorated health, get vulnerable for poor psychological wellbeing, and also those who are performing a high amount of physical exercise without maintaining their somatic health. Over time anxiety, when combined with some level of depression, seems to be associated with a faster decline in lung function. These mental health aspects can be deeper understood from the perspective that prioritization of health is (literally) a life condition for the adult with CF, and that the aspiration for and possibility for a ‘normal life’ can result in stressful conflicts, especially when health is deteriorating. In the coping with the life condition the CF center is seen a partner. Clinical implications should focus on the patients vulnerable for poorer mental health, and on including the patients’ perspective through person centered care (PCC) and a health psychological approach in the CF-care. Future research in the area of mental health in CF should broaden the perspective and focus also on the wellbeing aspects of mental health, and would benefit from having a more clearly defined health psychological framework thus including the study of behavioural patterns that underlie disease development and health

Procurement of Railway Infrastructure Projects – A European Benchmarking Study

This benchmarking study compares how railway investments are procured in five European countries: Sweden, Norway, Germany, the Netherlands, and the UK. In total, 19 procurement managers and project managers were interviewed. This study compares the national rail clients’ procurement strategies regarding: delivery system, reward system, contractor selection, and collaboration model. Historically, these clients have used in-house production. The first step towards a gradually increased usage of the market was to outsource the construction activities while keeping the design and development competence in-house. All five countries have mainly used Design-Bid-Build contracts in their initial outsourcing. However, the last few years there is a discernible trend in Sweden, Norway, the Netherlands and the UK towards allocating more design and development responsibilities to contractors (i.e. Design-Build contracts) and increasing the strategic focus on cooperation. The UK and the Netherlands are forerunners in this trend that can be viewed as a third step in the transition towards a market oriented railway sector. Norway and Sweden is in the middle of this transition, whereas Germany has not initiated this change. The transition towards a gradually increased usage of the market has two main dimensions; degree of cooperation and degree of contractor freedom, which differs among the countries. The UK and Sweden focus on increasing both these dimensions, while The Netherlands and Norway mostly focus on increasing the degree of contractor freedom. Germany still limits both dimensions by performing design and development in-house and letting contractors compete for construction work in Design-Bid-Build contracts. Due to historical and cultural reasons, Deutsche Bahn in Germany is very hesitant to engage in collaboration with external suppliers; focusing on competition is considered more appropriate and less controversial

Productivity in relation to organization of a surgical department : a retrospective observational study

Background Responsible and efficient resource utilization are important factors in healthcare. The aim of this study was to investigate how total case time differs between two differently organized surgical departments. Methods This is a retrospective observational study of a cohort of patients undergoing elective surgery for breast cancer or malignant melanoma in a university hospital setting in Sweden. All patients were operated on by the same set of surgeons but in two different surgical departments: a general surgery (GS) and a cardiothoracic (CT) surgery department. Patients were selected to the two departments from a waiting list in the order of referral for surgery. The effect of being operated on at the CT department compared to the GS department was estimated by linear regression. Results The final study cohort comprised 349 patients in the GS department and 177 patients in the CT department. Both groups were similar regarding surgical procedures, American Society of Anesthesiologists' score, body mass index, age, sex, and the skill level of the operating surgeon. These covariates were included in the linear regression model. The total case time, defined by the Procedural Time Glossary as room set-up start to room clean-up finish, was significantly shorter for the patients who underwent a surgical procedure at the CT department compared to the GS department, even after adjusting for the background characteristics of the patients and surgeon. After adjusting for the selected covariates, the average difference in total case time between the two departments was - 30.67 min (p = 0.001). Conclusions A significantly shorter total case time was measured for operations in the CT department. Plausible explanations may be more beneficial organizational factors, such as staffing ratio, skill mix in the operating room team, and working behavioral aspects regarding resource utilization.Peer reviewe

Combined life satisfaction of persons with stroke and their caregivers: associations with caregiver burden and the impact of stroke

<p>Abstract</p> <p>Background</p> <p>Little is known about the life satisfaction of the person with stroke combined with their caregiver, i.e. the dyad, despite the fact that life satisfaction is an important rehabilitation outcome. The aim of this study was to describe the dyads combined life satisfaction and to understand this in relationship to the perceived impact of stroke in everyday life and caregiver burden.</p> <p>Methods</p> <p>In this cross-sectional study, the life satisfaction of persons and their informal caregivers was measured in 81 dyads one year post stroke. Their global life satisfaction, measured with LiSat-11, was combined to a dyad score and the dyads were then categorized as satisfied, dissatisfied or discordant. The groups were compared and analyzed regarding levels of caregiver burden, measured with the Caregiver Burden scale, and the perceived impact of stroke in everyday life, measured with the Stroke Impact Scale (SIS).</p> <p>Results</p> <p>The satisfied dyads comprised 40%, dissatisfied 26% and those that were discordant 34%. The satisfied dyads reported a significantly lower impact of the stroke in everyday life compared with the dyads that were not satisfied. As expected, dyads that were not satisfied reported a significantly greater caregiver burden compared with the satisfied dyads. The discordant group was further broken down into a group of dissatisfied and satisfied caregivers. The caregivers that were not satisfied in the discordant group perceived a significantly greater level of caregiver burden compared with the satisfied group. Even caregivers who were satisfied with life but whose care recipients were not satisfied reported caregiver burden.</p> <p>Conclusions</p> <p>Measuring combined life satisfaction provides a unique focus and appears to be a feasible way of attaining the dyads' perspective. The findings suggest that those dyads with a discordant life satisfaction could be vulnerable because of the caregivers' reported caregiver burden. These findings support the importance of a dyadic perspective and add to the understanding of the reciprocal influences between the caregiver and recipient. This knowledge has clinical implications and contributes to the identification of possible vulnerable dyads in need of tailored support.</p