Människan; den medvetna biologiska maskinen.

I detta dokument ger jag mina teorier, idéer och förklaringar till hur jag tror att medvetandet fungerar, vad det är och varför vi har det. Enligt mig är alla levande varelser bara biologiska maskiner, skulpterade av evolutionen för att bli så anpassad som möjligt till den miljö som de befinner sig i. Allt fungerar på ett speciellt sätt, det går att förklaras och förstås, det finns ingen magi, och medvetandet är inget undantag, det finns där av en anledning

Making use of patient-reported outcome measures in health care : the case of EQ-5D in the Swedish national quality registries

Introduction: Patient-reported outcome measures (PROMs) have been widely used in clinical trials and research, for example to monitor the health of specific populations or to evaluate treatment effects. In the Swedish national quality registries (NQRs), structured individual-level data for specific patient populations are collected in routine health care settings. In addition to disease-related information, most NQRs include PROMs data. The most common PROM in the NQRs is EQ-5D, which is a generic instrument that can be used for measuring and valuing health across different patient populations and disease areas. The EQ-5D questionnaire includes questions addressing five dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and a visual analogue scale (EQ VAS). In addition, EQ-5D provides an indirect method for obtaining health state values and is therefore widely used for the purpose of economic evaluation in health care. There has been increasing interest in the use of PROMs in routine health care. Ideally, routinely collected PROMs data could be used to inform decisions to improve the quality of care and, ultimately, the health of the population. In addition to the potential benefits in patient-clinician encounters, aggregate-level PROMs data could for example be used for assessing the effectiveness of treatments, for detecting variations between health care providers or regions, or as input for decision-making. Real-world cases in which PROMs have been widely implemented in routine health care are needed to better understand the actual use of routinely collected PROMs data. Aim: The overall aim of the thesis was to increase knowledge on the use of PROMs collected in routine health care. Using the case of EQ-5D in the Swedish NQRs, this thesis addressed the overall aim by investigating current practices of routine collection and use of EQ-5D data, and by exploring measurement properties, thoughts behind patients’ responses, and applications of EQ-5D as an outcome measure. Methods: All four studies included in this thesis examined aspects of making use of EQ-5D data, but differed in their designs, samples, data, and analyses. Study I provided an overview of how EQ-5D data were collected in the Swedish NQRs, and how the collected EQ-5D data were made available and used. Information for each registry was obtained from webpages and through personal communication with representatives from the registries. In Study II, twenty patients with type 1 diabetes participated in qualitative individual interviews. Participants were asked to describe their thoughts out loud while reporting and valuing their own health, using EQ-5D-5L, EQ VAS, and time trade-off (TTO). The interviews were analyzed using qualitative thematic analysis. Study III and Study IV were based on data obtained from two NQRs: the Swedish Amputation and Prosthetics Registry and the Swedish National Quality Registry for ECT. In Study III, patients responded to either EQ-5D-3L or EQ-5D-5L six months after a major lower limb amputation (LLA). The assessment and comparison of the measurement properties for the two EQ-5D versions included analyses of feasibility, response patterns, informativity, and convergent and known-group validity. In Study IV, multiple linear regression analyses were used to examine the association between pulse width and health-related quality of life (HRQoL) after electroconvulsive therapy (ECT) in patients with unipolar or bipolar major depression. Findings: In Study I, the overview of current practices of the collection, presentation, and use of EQ-5D data in the NQRs showed that EQ-5D was administered across various populations and interventions, and often in combination with disease-specific measures. EQ-5D data were most frequently collected in registries targeting patients with conditions related to the musculoskeletal system. In Study III, the assessment of measurement properties indicated that there were advantages to using EQ-5D-5L over EQ-5D-3L in patients with a major LLA, mainly due to improved informativity and validity of the descriptive system. In Study II, thoughts expressed during the qualitative interviews revealed some variation in the aspects considered and the time perspectives and reference points used when assessing one’s own current health using the EQ-5D-5L, EQ VAS, and TTO. Some participants expressed a desire to discuss their responses with the health care provider. The overview showed several examples of ways in which routinely collected EQ-5D data were used, including assessment of interventions, health economic studies, benchmarking, in quality indicators, quality improvement, and in patient-clinician encounters. Still, 19 of the 41 NQRs reported that they were unaware whether the collected EQ-5D data were used for follow-up, quality improvement, or decision-making. In Study IV, which was an example of the use of EQ-5D data for assessing real-world outcomes associated with an intervention, the results showed no robust associations between pulse width and HRQoL after ECT. Nevertheless, relatively large mean improvements in HRQoL were observed for patients treated with ECT for unipolar or bipolar depression, regardless of the pulse width received. Conclusions: The findings from this thesis contribute to the understanding of the use of PROMs data routinely collected in the Swedish NQRs, of considerations in the choice of EQ-5D version in specific populations, of ways in which EQ-5D data can be used to assess specific interventions, and of the interpretations and thoughts behind patient’s responses when reporting and valuing their own health. The case of EQ-5D in the Swedish NQRs revealed several opportunities of making use of routinely collected PROMs data with the ultimate intention to improve health care and patient health. Still, there is potential to increase the use of EQ-5D data for follow-up, quality improvement, or decision-making. For future implementations of PROMs in routine health care, it may be useful to further explore how routinely collected PROMs data could be of most use to patients and other stakeholders, and to further explore prerequisites for making use of routinely collected PROMs data at different levels of the health care system

Authoritarian Foundations The Mechanisms of Support Behind Authoritarian Takeovers

In this study the author builds on previous materials and a statistical comparison between states with successful coup attempts and states without successful coups in an attempt to isolate a series of factors that may have an effect on the outcome of an attempted coup d'état. The isolated factors are then tested on the cases of Gambia, Ghana, Ecuador and Thailand. The five factors that resulted from this study and should be present in all countries with successful coups are: Low level of internationalisation and international interest, Economical instability and widespread poverty, often coupled with accusations of corruption, as well as a rurally or raw materials based production, Undereducated and largely illiterate population with a generally low status and ethnic clashes between themselves, Culturally and historically an authoritarian tradition, Incentives for the army or some other elite to attempt to seize power via a coup. The situation of support on the domestic arena and disinterest internationally is created by an interaction between all of the factors, and leads to a much higher success rate of the attempted coups

Catlysts for rural development : a studie of the Leader Nedre Dalälven 3 and the establishment of the new program community-led local development under the Leader approach 2014-2020

Denna uppsats bygger på en kvalitativ studie av Leader Nedre Dalälven 3. Det är en förening skapad för att jobba med lokalt ledd utveckling genom leadermetoden 2014-2020, även kallat Leader. Leader är en metod baserad på trepartnerskap, mellan offentlig, privat och ideell sektor, som genom olika projekt syftar till att skapa lokal utveckling. Det är en del av EU:s Landsbygdsprogram som löper i sjuårsperioder och strax innan uppsatsen skrevs lanserades en ny period vilket gjorde ämnet aktuellt att studera. Uppsatsen undersöker hur personer i Leader Nedre Dalälven 3 upplever sin roll inom Leader samt vilka som är de mest utmärkande förändringarna den nya programperioden och hur det påverkar dem jämfört med föregående programperiod. För att få svar på frågeställningarna genomfördes intervjuer och observationer med Leader Nedre Dalälven 3. Föreningen visade sig ha ett bra samarbetsklimat och för att synliggöra faktorerna bakom detta använder jag mig av begreppet social tillit. Informanteranas olika roller avspeglas i de förväntningar jag får ta del av gällande det kommande arbetet i Leader. Gemensamt för alla är att de tycker landsbygdsutveckling är viktigt och ser Leader som en metod för det. Genom sin roll vill de vara med att generera positiv utveckling för området. Ledaremetodens ursprungsutformning är baserat på governance, vilket är ett decentraliserat styrsätt utifrån ett underifrånperspektiv. Flera förändringar har skett gällande programmets utformning och tydligare riktlinjer med större kontroll pekar på en rationalisering av pro-grammet mot en mer byråkratisk struktur. Det påverkar Leader Nedre Dalälven 3:s sätt att arbeta och se på programmet som helhet.This thesis is based on a qualitative analysis of the Leader Nedre Dalälven 3. It is an associa-tion created to work with community-led local development under the Leader approach 2014-2020, also known as Leader. Leader is a method based on partnership, between public, private and voluntary sectors, which through various projects aim at creating local development. It is part of the EU's rural development program which runs in seven year periods and when the paper was written, a new period had just started, which made the current topic to date. The essay examines how people in Leader Nedre Dalälven 3 perceive their role in Leader, and which ones are the most significant changes in this period and how it affects them, compared with the previous period. To answer the questions interviews and observations with actors in Leader Nedre Dalälven 3 was made. What I found was good cooperation based on experience which has created social trust within the association. The informants roles are reflected in the expectations they have on the current work in Leader. Common to all is that they think rural development is important and they see Leader as a method for that, through their work they want to generate positive development for the area. Leaders origin design is based on governance, which is a decentralized control made for generating bottom-up approach. Several changes have taken place regarding the program design and clearer guidelines with more control points to a rationalization of the program towards a more bureaucratic structure. It affects the work in Leader Nedre Dalälven 3 and how they perceive the program as a whole

In the shadow of the scandal : a study about the horse in the food supply chain in Sweden

Denna uppsats bygger på en kvalitativ studie om häst i livsmedelskedjan i Sverige. Antalet hästar som gick till livsmedelsproduktion 2016 var 2668 vilket är det lägsta sedan mätningarnas start. Det motsvarar ungefär en femtedel av antalet avlivade hästar samma år. Samtidigt importeras hästkött för att mätta produktionen på charkuterivaror. Sällan har hästen studerats som livsmedelsproducerande trots att den uttryckt är det i lagar och förordningar. Initiativet till undersökningen kommer från LRF Häst som är en branschorganisation som jobbar för hästnäringen i Sverige. Syftet är att ta reda på orsakerna till det låga slaktantalet av hästar i Sverige. Genom att undersöka hur hästköttets livsmedelskedja fungerar samt tydliggöra dess olika påverkansfaktorer ämnar uppsatsen att ta reda på de hinder och möjligheter som föreligger. Undersökningen baseras på litteratur och intervjuer primärt med slakterier och sekundärt med hästhållare samt andra aktörer livsmedelsindustrin. Konsumenternas intentioner återges genom statistik eller media. Resultatet visade att hästens mångfacetterade roll i samhället påverkar hur många hästar som blir tillgängliga för slakt. Det tillsammans med etiska eller historiskt religiösa föreställningar påverkar hur hästköttet upplevs och hanteras. Med hjälp av leverantörsperspektiv och värdeperspektiv tydliggörs påverkansfaktorerna; önskemål om tillvägagångssätt vid slakt från hästhållare, hästpassanvändning, läkemedelsanvändning och fördomar gällande livsmedelssäkerhet. Livsmedelsskandalen 2013 pekas ut som en av de mest avgörande händelserna för dagens livsmedelskedja och marknad för hästkött i Sverige. Trots att svenska underleverantörer eller förädlare inte var inblandade satt händelsen spår vilket visar sig genom färre slakterier som slaktar häst och färre hästköttsprodukter. Det råder till viss del avståndstagande från hästkött vilket analyseras med hjälp av Mary Douglas teori om renhet och fara. Hästköttet kan ses som symbol för något negativt i samhället vilket ger uttryck för kulturell struktur och tradition. Samtidigt visar undersökningen att hästköttet lyfts som något positivt ur resurssynpunkt. Hästköttet kan tillskrivas miljömässiga, ekonomiska och sociala värden vilket gör hästen till en multiresurs. Utmaningen ligger inte i livsmedelskedjan utan i att förena förhållningssättet till hästen som bruksdjur och till hästen som livsmedel.This thesis is based on a qualitative analysis of horses in the supply chain in Sweden. The number of horses that went to food production 2016 was 2668, which is the lowest since the start of the measurement. This corresponds to one fifth of the number of horses that was euthanized in Sweden the same year. At the same time, horsemeat is imported to satisfy the production of horsemeat products. Rarely have the horses been studied as food producers even though it is stated in laws and regulations. The initiative for the investigation is from LRF Häst, an organization that works for the horse business and horse people in Sweden. The purpose is to find out the reasons for the low slaughter rate of horses in Sweden. By examining and understanding how the food chain of horse works, as well as clarifying its various factors of influence, the essay aims to find out about the obstacles and opportunities that exist. It is done through literature and interviews primarily with slaughterhouses and secondary with horse holders as well as other actors in the food industry. Consumer intentions are represented through statistics or the media. The result showed that the horse's multifaceted role in society affects how many horses become available for slaughter. Together with ethical or historical religious beliefs, it affects how the horse meat is perceived and managed. By using the supplier perspective and value perspective, the impact factors are clarified; requests for different approaches of slaughtering from horse holders, horse identity confirm, medical treatment and prejudice to food safety. The food scandal 2013 is identified as one crucial happening for today's food supply and market of horse meat in Sweden. Even though Swedish slaughterhouses or processors were not involved, the scandal leaved traces, which were shown by fewer slaughterhouses for horses and fewer horse meat products. Parts of the society is taking distance from horse meat, which is analysed using Mary Douglas’s theory of purity and danger. The horse meat can be seen as a symbol of something negative, which expresses cultural structure and tradition. At the same time, the survey shows that the horse meat is raised as something positive from a resource perspective. The horse meat can be attributed to environmental, economic and social values, which makes the horse a multi resource. The challenge is not in the food chain, but in linking the approach to the horse for hobby and sport and to the horse for food

Collection and use of EQ-5D for follow-up, decision-making, and quality improvement in health care - the case of the Swedish National Quality Registries

Background: The Swedish National Quality Registries (NQRs) contain individual-level health care data for specific patient populations, or patients receiving specific interventions. Approximately 90% of the 105 Swedish NQRs include any patient-reported outcome measure, with EQ-5D being the most common. As there has been no general overview of EQ-5D data within the NQRs, this study fills a knowledge gap by reporting how the data are collected, presented, and used at different levels of the Swedish health care system. Methods: All 46 NQRs with a license for the use of EQ-5D were included. Information was retrieved from the registries’ annual reports or from websites, using a template that was subsequently sent to eac

Refactoring GrPPI:Generic Refactoring for Generic Parallelism in C++

Funding: EU Horizon 2020 project, TeamPlay (https://www.teamplay-xh2020.eu), Grant Number 779882, UK EPSRC Discovery, grant number EP/P020631/1, and Madrid Regional Government, CABAHLA-CM (ConvergenciA Big dAta-Hpc: de Los sensores a las Aplicaciones) Grant Number S2018/TCS-4423.The Generic Reusable Parallel Pattern Interface (GrPPI) is a very useful abstraction over different parallel pattern libraries, allowing the programmer to write generic patterned parallel code that can easily be compiled to different backends such as FastFlow, OpenMP, Intel TBB and C++ threads. However, rewriting legacy code to use GrPPI still involves code transformations that can be highly non-trivial, especially for programmers who are not experts in parallelism. This paper describes software refactorings to semi-automatically introduce instances of GrPPI patterns into sequential C++ code, as well as safety checking static analysis mechanisms which verify that introducing patterns into the code does not introduce concurrency-related bugs such as race conditions. We demonstrate the refactorings and safety-checking mechanisms on four simple benchmark applications, showing that we are able to obtain, with little effort, GrPPI-based parallel versions that accomplish good speedups (comparable to those of manually-produced parallel versions) using different pattern backends.Publisher PDFPeer reviewe

Rehabilitation before and after autologous haematopoietic stem cell transplantation (AHSCT) for patients with multiple sclerosis (MS): Consensus guidelines and recommendations for best clinical practice on behalf of the autoimmune diseases working party, nurses group, and patient advocacy committee of the European Society for Blood and Marrow Transplantation (EBMT)

Autologous haematopoietic stem cell transplantation (AHSCT) is increasingly used to treat people with multiple sclerosis (MS). Supported by an evolving evidence base, AHSCT can suppress active inflammation in the central nervous system and induce long-term changes in immune cell populations, thereby stabilizing, and, in some cases, reversing disability in carefully selected MS patients. However, AHSCT is an intensive chemotherapy-based procedure associated with intrinsic risks, including profound cytopenia, infection, and organ toxicity, accompanied by an on-going degree of immuno-compromise and general deconditioning, which can be associated with a transient increase in functional impairment in the early stages after transplantation. Although international guidelines and recommendations have been published for clinical and technical aspects of AHSCT in MS, there has been no detailed appraisal of the rehabilitation needed following treatment nor any specific guidelines as to how this is best delivered by hospital and community-based therapists and wider multidisciplinary teams in order to maximize functional recovery and quality of life. These expert consensus guidelines aim to address this unmet need by summarizing the evidence-base for AHSCT in MS and providing recommendations for current rehabilitation practice along with identifying areas for future research and development

The mouse Na+-sulfate cotransporter gene Nas1. Cloning, tissue distribution, gene structure, chromosomal assignment, and transcriptional regulation by vitamin D

NaSi-1 is a Na+-sulfate cotransporter expressed on the apical membrane of the renal proximal tubule and plays an important role in sulfate reabsorption. To understand the molecular mechanisms that mediate the regulation of NaSi-1, we have isolated and characterized the mouse NaSi-1 cDNA (mNaSi-1), gene (Nas1), and promoter region and determined Nas1 chromosomal localization. The mNaSi-1 cDNA encodes a protein of 594 amino acids with 13 putative transmembrane segments, inducing high affinity Na+-dependent transport of sulfate in Xenopus oocytes. Three different mNaSi-1 transcripts derived from alternative polyadenylation and splicing were identified in kidney and intestine. The Nas1 gene is a single copy gene comprising 15 exons spread over 75 kilobase pairs that maps to mouse chromosome 6. Transcription initiation occurs from a single site, 29 base pairs downstream to a TATA box-like sequence. The promoter is AT-rich (61%), contains a number of well characterized cis-acting elements, and can drive basal transcriptional activity in opossum kidney cells but not in COS-1 or NIH3T3 cells. We demonstrated that 1,25-dihydroxyvitamin D3 stimulated the transcriptional activity of the Nas1 promoter in transiently transfected opossum kidney cells. This study represents the first characterization of the genomic organization of a Na+-sulfate cotransporter gene. It also provides the basis for a detailed analysis of Nas1 gene regulation and the tools required for assessing Nas1 role in sulfate homeostasis using targeted gene manipulation in mice

Sexuellt Handlingsutrymme – Ett Förhandlingsutrymme. Om studenters upplevda sexuella handlingsutrymme

Studien har en kvalitativ ansats och dess syfte är att studera studenters upplevda sexuella handlingsutrymme vid Växjö universitets Campus, med utgångspunkt i ett socialkonstruktionistiskt perspektiv. Kvalitativa intervjuer med sju studenter vid Växjö universitet, som är boende på universitets Campusområde ligger till grund för en förståelse av det sexuella handlingsutrymmet. Våra forskningsfrågor kretsar kring huruvida det finns ett sexuellt handlingsutrymme specifikt för Campus och vilka möjligheter respektive hinder som inryms. Med hjälp av socialkonstruktionistiskt orienterade teorier vill vi försöka nå en förståelse. Begrepp som normer, makt, maktstrukturer, heteronormativitet, genusordningen, det romantiska kärlekskomplexet, handlingsteori, den plastiska sexualiteten och demokratiseringen av privatlivet behandlas i uppsatsen. Ambitionen är att få människor att reflektera över maktstrukturer och den förgivet tagna diskursen. Vår förhoppning är att studien på längre sikt ska kunna vidga det sexuella handlingsutrymmet, vari fler individer inkluderas. Slutsatserna är att det finns ett specifikt upplevt sexuellt handlingsutrymme på Campus, som kan ses som en egen kultur. Hinder vi fann i detta utrymme var heteronormen samt genusordningen. Empirin kunde visa en pågående upplösning av det romantiska kärlekskomplexet och närvarandet av den plastiska sexualiteten