Psychological distress following oesophageal cancer treatment : is there a need for psychological support?

Oesophageal cancer is associated with a poor prognosis, an extensive treatment pathway and a difficult recovery process. Previous studies have shown that oesophageal cancer patients suffer from great physical impact of the disease and treatment from the early rehabilitation process up to ten years following curatively intended treatment. Thus, affecting all aspects of their life situation. In addition, major adjustments in food intake and eating habits are required, negatively affecting the patients’ wellbeing. Even though evidence regarding poor recovery and deterioration in Health related quality of life, have been established during the past years. The psychological distress experienced by oesophageal cancer patients has not yet been thoroughly investigated. Therefore, the overarching aim of this thesis was to describe the psychological distress experienced by patients undergoing curatively intended treatment for oesophageal cancer in an attempt to evaluate if psychological support is needed? Study I was a cross-sectional study using data from a prospective cohort study carried out at St Thomas’ Hospital in London, England. Using data from the data collection at St Thomas’ Hospital, Study II was longitudinal in design. Study III used data from a prospective cohort study based on Swedish data. Study IV was a qualitative interview study carried out in Sweden. Studies I-III used self-report questionnaires aiming to assess anxiety and depression (using the The Hospital Anxiety and Depression scale) and aspects of emotional functioning (i.e., four items; tension, worry, irritation and depressed mood) from the EORTC QLQ-C30. In Study I anxiety and depression were assessed pre-surgery, in Study II the same outcomes were measures at pre-surgery and then at six and 12 months post-surgery. In Study III aspects of emotional functioning were assessed at six months and five years following the operation. In Study IV in-depth interviews were completed at six months post-surgery. Logistic regression models were carried out in studies Study I and III, in order to assess the association between potential clinical and socio-demographic risk factors and anxiety and depression (Study I) or aspects of emotional functioning (Study III). In Study II mixed-effects models were used to evaluate the influence of clinical and socio-demographic variables on psychological distress (i.e., anxiety and depression). The interviews in Study IV were analysed using qualitative content analysis. A significant proportion of patients report anxiety and depression prior to surgery and then at six and 12 months following treatment (Studies I and II). Anxiety symptoms seem to remain stable from prior to surgery and up to 12 months post-surgery. However, depression symptoms seem to increase from pre-treatment to six months following surgery and then level off at 12 months after treatment (Study II). Younger age, female sex, limitations in activity status and dysphagia are some of the risk factors observed for psychological distress at the different time points (Studies I and II). Further, tension, worry, irritation and depressed mood are prevalent symptoms at six months and even after five years post-surgery Study III). Risk factors included for example low educational level. The patients’ narratives at 6 months following oesophageal cancer surgery described reflections of undergoing a crisis reaction (final theme, Study IV). In conclusion, oesophageal cancer patients report psychological distress during the treatment trajectory, partially influenced by factors related to previous known risk factors for psychological morbidity. Considering the findings of this thesis, the many patients suffering psychological distress throughout recovery and beyond, are likely in need of targeted psychological support to improve their overall well-being and adaptation to the consequences of this disease and treatment

What factors correlates with the use of game meat, wild fish, berries and mushroom in Swedish households

This study was made to see too what extent Swedes uses consumptive resources such as berries and mushrooms, game meat and meat from fish in their household on a yearly basis. I have also looked into the difference between rural and urban areas in Sweden. Further aim was to determine what factors that correlates with the participation in berry and mushroom picking and the use of game and fish meat within the household. The study was conducted in form of a mail survey that was sent to randomly chosen persons in every municipality in the six northern most counties in Sweden and in the county of Stockholm. In addition a sample was sent to randomly chosen persons on a national level. The results showed there is a difference in use between rural and urban areas in Sweden in all 4 investigated consumptive resources. Factors that correlated with berries and mushroom picking was age and access to a summer cottage. Factors significant correlated with use of game meat were sex, education and access to a summer cottage. Also for the consumption of fish access to summer cottage showed a significant correlation as well as education, sex and age. The differences between rural and urban areas is most likely due to the higher access of good conditions for berries and mushrooms in rural areas, the more available forestland and less competition due to the low amount of inhabitants. For the consumption of fish it is most likely due to better access to good fishing waters in rural areas. Another important factor that influences to what extent a household uses consumptive resources in their household is the social bond that thighs you to using this resource in a higher extent in rural areas than urban areas. You are more likely to know somebody that usually picks berries and mushroom, fish or hunt in their spare time in a rural area and therefore might learn and introduce you to that activity. Summer cottage showed a significant correlation to all of the consumptive resources and this is probably because you get closer to good habitats with high productivity of berries and mushrooms. This factor also provides better access to good fishing waters and good connections with the local people that might give you valuable fishing tips. Finally it might also provide you with hunting possibilities if you would like that. The positive and significant correlation with age for both picking berries and mushrooms and fishing indicates that older people are more likely to conduct these activities. The effect of sex on the use of fish and game meat both provided by someone within the household and not, shows that males are more likely to hunt and fish. Education is another factor that affects those consumptive resources and my result showed that lower levels of education have a positive correlation with hunting and fishing. My results also showed that males are more likely to hunt and fish and provide their households with meat. Income did not have any effect on the studied consumptive resources directly but it does affect if you have a summer cottage or not which in turn affects all of the consumptive resources that was studied.Rapport behandlar i vilken utsträckning Svenskar årligen utnyttjar konsumerbara resurser så som bär och svamp, viltkött och fisk i hushållet. Jag har också studerat skillnaden mellan städer och landsbygden i Sverige. Vidare har jag också försökt urskönja vilka faktorer som påverkar om man deltar i bär och svamp plockning och i användandet av vilt och fisk kött i hushållen. Studien utfördes i form av en brevundersökning som skickades ut till slumpvis utvalda personer i alla kommuner i de sex nordligaste länen i Sverige samt i Stockholmslän. Jag skickade också ut till slumpvis utvalda personer på en nationell nivå. Resultaten indikerar att det finns en viss skillnad i utnyttjandet av alla de förbrukningsbara resurserna mellan folk på landsbygden och folk i städerna. Faktorer som samvarierar med bär- och svampplockning är tillgång till sommarstuga och ålder. För utnyttjandet av viltkött så är det tillgång till sommarstuga, utbildning och kön som är de signifikanta faktorerna. Även för fisk så har tillgång till sommarstuga en signifikant roll tillsammans med utbildning, kön och ålder. Det är troligt att skillnaderna mellan landsbygden och städerna till stor del beror på den större andelen bra och tillgängliga habitat för bär och svamp på landsbygden, den större andelen tillgängliga skogsområden på landsbygden samt den mindre konkurrensen på grund av ett lägre invånarantal. För fisk är det troligtvis närheten till bra fiskevatten som påverkar i stor utsträckning. En annan avgörande faktor som påverkar i vilken utsträckning ett hushåll utnyttjat förbrukningsbara resurser är förmodligen det sociala bandet som knyter en till att använda förbrukningsbara resurser i högre utsträckning på landet än i städerna. På landsbygden är det en större chans att du känner någon som brukar plocka bär eller svamp, fiska eller jaga på fritiden och via det kan du bli introducerad och lära dig den aktiviteten. Tillgången till en sommarstuga visade en signifikant samvariation med alla förbrukningsbara resurser som jag har kollat på och det kan förmodligen ha något att göra med det faktum att en sommarstuga på landet ger dig en bättre tillgång till skogsområden med utmärkta habitat och hög produktion av bär och svamp. En sommarsuga på landet ger dig också närheten till fina fiskevatten och du kan få bra kontakt med det lokala folket som kan komma med tips om fina fiskevatten och de kan också leda till jaktmöjligheter i fall man skulle vilja det. Den positiva och signifikanta ålderskorrelationen för både bär- och svampplockning och fiske visar att det är mer troligt att äldre personer ägnar sig åt dessa aktiviteter. Effekten av kön på utnyttjandet av fisk och viltkött antingen från någon inom hushållet eller inte visar att män i större utsträckning jagar och bidrar med kött till hushållet. Utbildning är en annan faktor som påverkar dessa förbrukningsbara resurser och mina resultat visar att lägre utbildning hade en positiv korrelation till jakt och fiske. Inkomst å andra sidan hade ingen direkt påverkan alls på de resurser jag studerat men däremot så påverkar inkomst i vilken utsträckning man äger en sommarstuga vilket i sin tur på verkar alla mina studerade resurser

Adapted cognitive behavior therapy for obsessive compulsive disorder with co-occurring autism spectrum disorder: A clinical effectiveness study

Obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) commonly co-occur. Adapted CBT for OCD in adults with ASD has not previously been evaluated outside the United Kingdom. In this study, 19 adults with OCD and ASD were treated using an adapted CBT protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale-Brown Obsessive-Compulsive Scale (YBOCS). Participants were assessed up to 3 months after treatment. There were significant reductions on the YBOCS at post-treatment (d=1.5), and improvements were sustained at follow-up (d=1.2). Self-rated OCD symptoms and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from OCD. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted CBT for OCD in adults with co-occurring ASD is associated with reductions in obsessive-compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group

Är klassisk imperialism fortfarande relevant? : En komparativ fallstudie av Marocko-Västsahara och Kina-Tibet

Imperialism has for a long time been an important concept in international relations. The literature identifies many different types of imperialism. After the great de-colonization scientists stopped discussing “classic” imperialism, i.e. using physical strength in the form of conquest and occupation to subdue weaker states. Instead focus has for decades been on a new form of imperialism using economic measures to suppress weaker states; this is called neo-imperialism. Galtung, one of the leading scholars of imperialism, is among the scholars who have dismissed classic imperialism to be a thing of the past. This study asks whether classical imperialism can explain the situation in Morocco-Western Sahara and China-Tibet. Implementing the theories of classic imperialism and identifying several typical indicators of its existence clearly show the presence of classic imperialism in the case studies of China’s occupation of Tibet and the Moroccan occupation of Western Sahara. Thus, the results tell us that these theories are still of relevance in explaining the relationship between a stronger state and a weaker neighbouring state

Automatisk detektering av kretskorts position inom in-circuit testning

Detta arbete har försökt att skapa ett program som kan användas för att hitta position och vinklar av kretskort för ett automatiserat Bed-of-Nails test. Programmet har haft som krav att kunna räkna ut vilken position i en bricka kretskort ligger i, vilken vinkel kretskortet ligger i gentemot brickan samt hur många kretskort som finns i brickan. Metoden som har använts är en blandning av olika traditionella bildbehandlingsmetoder som filtrering, segmentering med hjälp av kantkartor, morfologi,watershed och Hough-transformation. Resultatet av detta arbete är ett program som har givit delvis lyckade resultat för bilder som har använt en extra ljuskälla. Resultatet har dock varit bristfälligt för bilder som endast använder indirekt ljus. Metoden som har tagits fram i detta arbete är inte en komplett lösning men kan utvecklas vidare för att ta fram ett program som kan användas inom automatiska Bed-of-Nails testsystem.This study has attempted to create a program that can be used to calculate the position and orientation of printed circuit boards to help automate Bed-of-Nails testing. The requirements of the program were to be able to calculate the position of PCBs on a plate, calculate the orientation of PCBs relative to the plate and to calculate the amount of PCBs on the plate. The method used to accomplish this was a mixture of traditional image processing methods like filtering, segmentation via edge maps, morphology, watershed and Hough-transformation. This study resulted in a program that works as expected for pictures that have an added source of light. The program is however inadequate for pictures that only contains ambient lighting. The method developed in this study lays a good foundation that can be developed further in order to use in a automatic Bed-of-Nails test system

Software Patents

The purpose of this chapter is to give an overview of the main issues in regard to software patenting in the 21st century. The focus is on the question of patentability of software, since this is the area which has caused the most problems for patent offices and courts. The main systems of concern are the European and U.S. patent systems. The chapter begins with a presentation of the concept of software in section 2, followed by section 3 with a presentation of IP and patents and the international legal context as well as the European and U.S. patent systems. In section 4 the debate regarding the patent system as a proper protection system for software is discussed. Section 5 outlines the international patent rules pertaining to software which are contained in the TRIPS agreement. Section 6 concentrates on the European approach to software and business methods’ patentability, while Section 7 explores the corresponding U.S. approach. Finally there are some brief final words in Section 8

The Research Exemption in Patent Law and its Application to hESC Research

T he scope of the experimental use exemption is one of the most important and hotly contested issues in patent law today, which aims to create incentivcs for cechnological progress and future innovation by rewarding inventors with (limiced) exd usive righrs. A contenrious issue is the risk of patents stifling further innovation, such as improvcments to patented inventions, and thus depriving sociecy of such benefits. This risk is managed by statutory !imitations on the exclusivc right for  the benefit of third parties to use the invention without the patent holder's consent. A main argument for !imitations is that uses of the invention as a source of further research and dcvelopment (R&D) should not be subject to the will of thc patent holder, as in those cases the interest of the public in the progress of science and technology should override the interests of the patentee. This theory is supporced by the so-called experimental use exemption, which exempts from patent infringements 'acts done for experimental purposes relating to the subject matter of the inventio

RPA, AI och IPA – Tekniska hjälpmedel vid verksamhetsstyrning enligt konceptet TQM och MBNQAmodellen.

RPA, AI och IPA blir allt mer populära verktyg inom företagande. Detta trots att det till stor del saknas teoretisk förankrad förståelse för vilka förmågor teknologierna besitter och hur de kan understödja företagsledning. Som ett svar på den bristande tillgängligheten av forskning kring ämnet, syftade denna studie till att på ett inkluderande och övergripande plan, samla teknologiernas förmågor och nytta. Varpå dessa kunde kopplas mot verksamhetsstyrning i form av konceptet TQM. Studien genomfördes som en kvalitativ enfallsstudie, där fallet utgjordes av ett internationellt teknikföretag som arbetar med applikationer kopplat till teknologierna. Den empiri som fallet erbjöd samlades in genom semistrukturerade intervjuer, där företagets personal utgjorde studiens respondenter. Empirin jämfördes sedan med och kompletterades av den tidigare spridda teoretiska forskningen kring RPA, AI och IPA:s nyttjande och nytta. Ur sammankopplingen skapades en modell vilken gav en bred bild av teknologiernas nytta i relation till TQM och MBNQA-modellen som nyttjades för att konkretisera TQM. Resultatet antydde att RPA, AI och IPA kan utgöra viktiga verktyg för att stödja verksamhetsstyrning enligt TQM, och bidrog med en bred teoretisk referensram för teknologiernas förmågor i relation till verksamhetsstyrning. Studien belyste även behovet av mer forskning kring teknologiernas snabbt föränderliga förmågor i relation till verksamhetsstyrning och TQM.RPA, AI, and IPA are becoming increasingly popular tools in the business sector. Despite their growing prevalence, there is a significant lack of theoretically grounded understanding of the capabilities these technologies possess and how they can support corporate management. In response to this research gap, the aim of this study was to comprehensively and inclusively gather the capabilities and benefits of these technologies. Subsequently, these factors were linked to business management through the concept of TQM. The study was conducted as a qualitative single-case study, with the case comprising an international technology company working with applications related to these technologies. The empirical data were collected through semi-structured interviews, with the company's personnel serving as the study's respondents. This empirical data were then compared with and supplemented by existing scattered theoretical research on the utilization and benefits of RPA, AI, and IPA. From this synthesis, a model was developed that provided a broad view of the technologies' benefits in relation to TQM and the MBNQA model, which was used to concretize TQM. The results suggested that RPA, AI, and IPA can serve as important tools to support business management according to TQM, and contributed a broad theoretical framework for the capabilities of these technologies in relation to business management. The study also highlighted the need for further research on the rapidly evolving capabilities of these technologies in relation to business management and TQM

It started with a kick-off : A qualitative case study about project participants experiences in a non-profit event project

Forskare hävdar att det behövs mer forskning om projektdeltagares upplevelser i ideella projekt och vad som krävs för att behålla dem i projektet. Forskning som gjorts har främst undersökt projektdeltagares motivation i megaevenemang, sportevenemang och studentengagemang i andra kulturer. Det blir därav viktigt att undersöka varför individer engagerar sig ideellt och varför de fullföljer till projektets slut när deltagandet i sig är belöningen. Studien har, utifrån en fallstudie med 11 kvalitativa intervjuer, undersökt projektdeltagares upplevelser från ett ideellt evenemangsprojekt. Det projektdeltagarna upplever som betydelsefullt för sin motivation att delta och stanna kvar i projektet är främst tillhörigheten till en grupp. Erhållandet av meriter på cv:t ses också som en anledning till att delta och en fördel efter projektets slut. Dock är samarbetet och känslan av en tillhörighet till gruppen det som väger tyngst för motivationen och att fullfölja projektet. När projektdeltagarna upplever samhörighet ökar också känslan av trygghet och stöttning i gruppen och det blir lättare att fråga om hjälp vid behov. Om en arbetsgrupp splittras försvinner sammanhållningen och med det tillkommer också en risk att projektdeltagare förlorar känslan över att ha en roll och ett tydligt ansvarsområde. Det är också viktigt att projektdeltagarna får uppleva sin förmåga och att de bidrar till projektet. Sammanfattningsvis väger alltså det sociala behovet tyngre än att få en merit på cv:t. Därav finns det anledning och tro att vid rekrytering bör man trycka på att man får göra något fantastiskt ihop med en liten grupp och inte bara lyfta att det är en bra merit.Researchers argue that more research is needed for project participants' experiences in nonprofit projects and key factors to keep them in the project. Former research has mainly examined project participants' motivation in mega events, sporting events and student engagement in other cultures. It is therefore important to examine why individuals engage in nonprofit projects and why they carry out until the end of the project when the participation itself is the reward. Based on a case study with 11 qualitative interviews, the study has examined project participants' experiences from a non-profit event project. The project participants experience that their motivation to participate and to go through with the project is mainly the feeling of belonging to a group. Qualifications for a resumé is also seen as a reason to participate and beneficial after the project is over. However, the collaboration and feeling of belonging to a group is important for motivation and to complete the project. The sense of security and support increases when the project participants experience belonging to a group, and it becomes easier to ask for help when needed. If a workgroup is divided, cohesion is lost and there is also a risk that project participants lose the feeling of having a role and a clear area of ​​responsibility. It is also important that the project participants experience their ability and their contribution to the project. In summary, the social need thus weigh heavier than getting qualifications for a resumé. There is therefore reason to believe that when recruiting, one should highlight the fact that you will be doing something great together in a small group and not just highlight that it is good for a resumé