LIVING WITH CHILDHOOD CANCER - Family Members’ Experiences and Needs

The overall aim of this thesis was to elucidate family members’ lived experiences and needs during a child’s cancer trajectory and to describe how the illness and its treatment influence both individuals within the family and the family as a whole. Seventeen families with a child under the age of 13 and newly diagnosed with cancer were followed during the child’s treatment trajectory by means of interviews and observations. Parents, patients and siblings seven years or older were interviewed at the time of diagnosis, during the treatment and after it was completed. Patients younger than seven were observed during their initial hospitalization. The interviews were analyzed with a hermeneutic phenomenological approach and the observations with content analysis. The results from the observations (Paper II) showed that the young children’s needs during their initial hospitalization were described as a need to have the parent close by, a need to play and feel joy, a need for participation in care and treatment, a need for a good relationship with the staff and a need for physical and emotional satisfaction. The results from the interviews showed that, at time of diagnosis (Paper I) the families’ lived experience was described as a broken life world and an immediate striving to survive. Their secure everyday life disappeared and was replaced by fear, chaos and loneliness. When striving to help the child and the family survive, family members endeavoured to feel hope and have a positive focus, to gain control and to feel close to other people. During treatment (Paper III) the families lived experience was described as focus on the ill child - an everyday struggle. Each day’s focus was on the child and the families experienced it as a tough period which they struggled to come through. Only when the sick child’s needs were satisfied, could the focus move to other parts of the family. Family members felt drained, locked up and isolated. Family life was experienced as disrupted and they struggled to retain normality and become experts. Perspectives on life changed; it was important to enjoy life and to be aware of sources of support. When treatment was completed (Paper IV) the families’ lived experience was described as returning to a changed ordinary life - incorporating a trying and contradictory experience. The families felt relieved that the child’s treatment was over but, at the same time they still experienced stresses and strains in life. Family members felt changed and especially the parents needed to focus on themselves in order to recover. The families wanted closeness but, from time to time, felt a loss of concern from others. The findings from this thesis can deepen the understanding of what it is like living with childhood cancer and of the needs of young children with cancer. By reflecting on the findings, paediatric oncology staff may become increasingly thoughtful and thereby better prepared to take care of family members of a child with cancer, including the sick children themselves

Biosensor assay for determination of haptoglobin in bovine milk

Despite more than 30 years of research into mastitis diagnostics, there are few alternatives to the somatic cell count (SCC) in practical use for identification of cows with subclinical mastitis. Mastitis is not only an animal welfare problem, but also affects the yield, composition and technological properties of milk. Hence, dairy cooperatives give farmers a premium quality payment to encourage low SCC although there is no clear scientific data defining the level of SCC in bulk tank milk that is associated with additional benefits in terms of milk quality. Recent research on alternative markers for inflammatory reactions in the lactating cow, e.g. in mastitis, includes investigations of the acute phase protein, haptoglobin (Hp). So far, the content of Hp in milk has mainly been studied in relation to mastitis diagnostics, with little attention given to its importance for milk composition and technological properties. At present, Hp in milk is measured using ELISA, but this technique is not suitable for routine large-scale analysis. In recent years, optical biosensor technology has been used for automated and rapid quantitative analysis of different components in milk, but so far not for analysis of acute phase proteins. The aim of the present study was to develop a rapid and sensitive biosensor method to determine Hp in milk. An affinity sensor assay based on the interaction between Hp and haemoglobin was developed using surface plasmon resonance (SPR) biosensor technology. The assay was used to analyse Hp in composite milk samples from cows without any clinical signs of mastitis and quarter milk samples with a weak to strong reaction in the California Mastitis Test (CMT). A commercial ELISA for determination of Hp in milk was used for comparison. The limit of detection (LOD) of the biosensor assay was determined as 1.1 mg/l. Within-assay and betweenday variations were determined both with bulk tank milk spiked with human Hp and with composite milk samples containing bovine Hp. Coefficients of variation varied between 3.6 and 8.6% at concentrations between 4.0 and 12 mg/l, respectively. Agreement between the results obtained by the biosensor assay and the ELISA was satisfactory ; however, the results obtained by the biosensor were generally lower than the results obtained by the ELISA. Possible explanations for this observation are discussed

Deep convolutional regression modelling for forest parameter retrieval

Accurate forest monitoring is crucial as forests are major global carbon sinks. Additionally, accurate prediction of forest parameters, such as forest biomass and stem volume (SV), has economic importance. Therefore, the development of regression models for forest parameter retrieval is essential. Existing forest parameter estimation methods use regression models that establish pixel-wise relationships between ground reference data and corresponding pixels in remote sensing (RS) images. However, these models often overlook spatial contextual relationships among neighbouring pixels, limiting the potential for improved forest monitoring. The emergence of deep convolutional neural networks (CNNs) provides opportunities for enhanced forest parameter retrieval through their convolutional filters that allow for contextual modelling. However, utilising deep CNNs for regression presents its challenges. One significant challenge is that the training of CNNs typically requires continuous data layers for both predictor and response variables. While RS data is continuous, the ground reference data is sparse and scattered across large areas due to the challenges and costs associated with in situ data collection. This thesis tackles challenges related to using CNNs for regression by introducing novel deep learning-based solutions across diverse forest types and parameters. To address the sparsity of available reference data, RS-derived prediction maps can be used as auxiliary data to train the CNN-based regression models. This is addressed through two different approaches. Although these prediction maps offer greater spatial coverage than the original ground reference data, they do not ensure spatially continuous prediction target data. This work proposes a novel methodology that enables CNN-based regression models to handle this diversity. Efficient CNN architectures for the regression task are developed by investigating relevant learning objectives, including a new frequency-aware one. To enable large-scale and cost-effective regression modelling of forests, this thesis suggests utilising C-band synthetic aperture radar SAR data as regressor input. Results demonstrate the substantial potential of C-band SAR-based convolutional regression models for forest parameter retrieval

Child Witness Policy: Law Interfacing with Social Science

The number of children testifying in court has posed serious practical and legal problems for the judicial system. One problem confronting the courts is how to protect children from experiencing the psychological trauma resulting from face-to-face confrontation with a defendant who may have physically harmed the child or threatened future harm to the child

Den skapande läsaren: Hermeneutik och tolkningskompetens

Recension av: Vikström, Björn: Den skapande läsaren, hermeneutik och tolkningskompetens. Lund: Studentlitteratur 2005

Like being covered in a wet and dark blanket – Parents' lived experiences of losing a child to cancer

Purpose The aim of this study was to illuminate parents' lived experiences of losing a child to cancer. Method Interviews and a narrative about parents' experiences of losing a child to cancer were gathered from six parents of children whom had participated in a longitudinal study across the child's illness trajectory. The analysis of the data was inspired by van Manen's hermeneutic phenomenological approach. Results One essential theme emerged: Like being covered in a wet and dark blanket, as well as six related themes: Feeling conflicting emotions, Preparing for the moment of death, Continuing parenting after death, Recollecting and sharing memories, Working through the sorrow and New perspectives in life. Conclusion There is a need for good palliative care. If not, there is a risk that the parent will perseverate and blame themselves for not being a good parent during the suffering child's last time in life. Meetings with the parents six months and two years after the child's death might facilitate healing through the grief process

Dental health care for children with Down syndrome:Parents’ description of their children's needs in dental health care settings

A visit to the dental clinic may be challenging for a child with Down syndrome due to medical and oral health problems as well as communication problems. The aim of the present study was to explore how parents of children with Down syndrome describe their child's needs in the dental health care setting. In a survey concerning parental experiences with dental health care in Sweden, free comments were analysed with content analysis and resulted in five categories: “Need for continuity of care in dental health care”; “Need for dental health care professionals to have knowledge and expertise in caring for children with Down syndrome and other disabilities”; “Need for dental health care professionals to use a caring approach with children with Down syndrome”; “Need for the child with Down syndrome to be prepared to participate in their dental health care visit” and “Need for the child with Down syndrome to be given the same rights as typically developing children”. To support children with Down syndrome in an optimal way, dental health care needs to be tailored to meet the child's unique needs. In addition, dental health care professionals need knowledge of and expertise in the care of children with Down syndrome

On the Potential of Sequential and Nonsequential Regression Models for Sentinel-1-Based Biomass Prediction in Tanzanian Miombo Forests

This study derives regression models for aboveground biomass (AGB) estimation in miombo woodlands of Tanzania that utilize the high availability and low cost of Sentinel-1 data. The limited forest canopy penetration of C-band SAR sensors along with the sparseness of available ground truth restricts their usefulness in traditional AGB regression models. Therefore, we propose to use AGB predictions based on airborne laser scanning (ALS) data as a surrogate response variable for SAR data. This dramatically increases the available training data and opens for flexible regression models that capture fine-scale AGB dynamics. This becomes a sequential modeling approach, where the first regression stage has linked in situ data to ALS data and produced the AGB prediction map; we perform the subsequent stage, where this map is related to Sentinel-1 data.We develop a traditional, parametric regression model and alternative nonparametric models for this stage. The latter uses a conditional generative adversarial network (cGAN) to translate Sentinel-1 images into ALS-based AGB prediction maps. The convolution filters in the neural networks make them contextual. We compare the sequential models to traditional, nonsequential regression models, all trained on limited AGB ground reference data. Results show that our newly proposed nonsequential Sentinel-1-based regression model performs better quantitatively than the sequential models, but achieves less sensitivity to fine-scale AGB dynamics. The contextual cGAN-based sequential models best reproduce the distribution of ALS-based AGB predictions. They also reach a lower RMSE against in situ AGB data than the parametric sequential model, indicating a potential for further development

Road traffic noise and hypertension: results from a cross-sectional public health survey in southern Sweden

BACKGROUND: Results from studies of road traffic noise and hypertension are heterogeneous with respect to effect size, effects among males and females and with respect to effects across age groups. Our objective was to further explore these associations. METHODS: The study used cross-sectional public health survey data from southern Sweden, including 24,238 adults (18 - 80 years old). We used a geographic information system (GIS) to assess the average road noise (LAeq 24 hr) at the current residential address. Effects on self-reported hypertension were estimated by logistic regression with adjustment for age, sex, BMI, alcohol intake, exercise, education, smoking and socioeconomic status. RESULTS: Modest exposure effects (OR approximately 1.1) were generally noted in intermediate exposure categories (45 -64 dB(A)), and with no obvious trend. The effect was more pronounced at > 64 dB(A) (OR 1.45, 95% CI 1.04 - 2.02). Age modified the relative effect (p = 0.018). An effect was seen among middle-aged (40 - 59 years old) at noise levels 60 - 64 dB(A) (OR = 1.27, 95% CI 1.02 - 1.58)) and at > 64 dB(A) (OR = 1.91, 95% CI 1.19 - 3.06)). An effect was also indicated among younger adults but not among elderly. No apparent effect modification by gender, country of origin, disturbed sleep or strained economy was noted. CONCLUSION: The study supports an association between road traffic noise at high average levels and self-reported hypertension in middle-aged. Future studies should use age group -specific relative effect models to account for differences in prevalence

Single photon emission and detection at the nanoscale utilizing semiconductor nanowires

We report recent progress toward on-chip single photon emission and detection in the near infrared utilizing semiconductor nanowires. Our single photon emitter is based on a single InAsP quantum dot embedded in a p-n junction defined along the growth axis of an InP nanowire. Under forward bias, light is emitted from the single quantum dot by electrical injection of electrons and holes. The optical quality of the quantum dot emission is shown to improve when surrounding the dot material by a small intrinsic section of InP. Finally, we report large multiplication factors in excess of 1000 from a single Si nanowire avalanche photodiode comprised of p-doped, intrinsic, and n-doped sections. The large multiplication factor obtained from a single Si nanowire opens up the possibility to detect a single photon at the nanoscale.Comment: 11 pages, 7 figure