SOMWeb: Supporting a Distributed Clinical Community of Practice Using Semantic Web Technologies

This thesis concerns supporting the collaboration and knowledge sharing of distributed clinicians of oral medicine, a sub-discipline of dentistry. The Swedish Oral Medicine Network (SOMNet) holds monthly telephone conferences where a group of clinicians discuss interesting and difficult cases, which distinguishes it from one-to-one teleconsultations. SOMNet can be seen as a distributed community of practice, that is, a group of people sharing a concern and who interact regularly to extend their individual and collective expertise. Related to this, several topics need further investigation: How can geographically distributed clinical collaboration be characterized? What is appropriate functionality for a Web-based system supporting such collaborations? What are the impacts of such systems on collaboration? Further, Semantic Web technologies, such as the Web Ontology Language (OWL), have been proposed as a means of enhancing knowledge sharing. What are benefits and limitations of using these technologies to encode domain knowledge in oral medicine and to support clinical collaboration, and what practical issues face developers? The developed system, SOMWeb, focuses on functionality for meetings and structured cases, and has been regularly used for three years. Interviews, observations, a questionnaire, system log analysis, and case analysis were used to study SOMNet's collaboration and identify system impacts. The documentation of the forms of collaboration in SOMNet can serve as a model for other groups of clinicians wishing to establish a distributed collaboration. SOMNet's meetings provide a necessary rhythm for the community and the cases give context to the clinicians' learning which point toward that the centrality of meetings and cases in a tool will benefit collaboration. Impacts on SOMNet's collaboration include enabling the participation of a wider range of clinics. Factors influencing this are the more accessible submission process as well as the increased tangibility of the collaboration. The thesis also provides recommendations for developers of systems supporting clinical collaboration and knowledge sharing. The use of OWL in examination descriptions has enabled reasoning over cases in the system to provide improved case browsing. At the same time, limitations were found in using OWL for examination templates. Based on the lessons learned in this development, the thesis provides recommendations for using Semantic Web technologies, which can be of value for other developers and to guide future research

Pan-Arctic Patterns in Black Carbon Sources and Fluvial Discharges Deduced From Radiocarbon and PAH Source Apportionment Markers In Estuarine Surface Sediments

A pan-arctic geospatial picture of black carbon (BC) characteristics was obtained from the seven largest arctic rivers by combining with molecular combustion markers (polycyclic aromatic hydrocarbons) and radiocarbon ((14)C) analysis. The results suggested that the contribution from modern biomass burning to BC ranged from low in the Yukon (8%) and Lena (5%) Rivers to high in the Yenisey River (88%). The Mackenzie River contributed almost half of the total arctic fluvial BC export of 202 kton a(-1) (kton = 10(9) g), with the five Russian-Arctic rivers contributing 10-36 kton a(-1) each. The (14)C-based source estimate of fluvially exported BC to the Arctic Ocean, weighted by the riverine BC fluxes, amount to about 20% from vegetation/biofuel burning and 80% from (14)C-extinct sources such as fossil fuel combustion and relict BC in uplifted source rocks. Combining these pan-arctic data with available estimates of BC export from other rivers gave a revised estimate of global riverine BC export flux of 26 x 10(3) kton a(-1). This is twice higher than a single previous estimate and confirms that river export of BC is a more important pathway of BC to the oceans than direct atmospheric deposition

Coordination in networks for improved mental health service

<!-- /* Font Definitions */ @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-format:other; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; mso-hyphenate:none; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-GB; mso-fareast-language:AR-SA;} @page Section1 {size:612.0pt 792.0pt; margin:70.85pt 70.85pt 70.85pt 70.85pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --><p class="MsoNormal"><strong><span style="font-size: 10pt; font-family: Times; color: black;" lang="EN-GB">Background</span></strong><span style="font-size: 10pt; font-family: Times; color: black;" lang="EN-GB">: Well-organised clinical cooperation between health and social services has been difficult to achieve in Sweden as in other countries.</span></p><p class="MsoNormal"><strong><span style="font-size: 10pt; font-family: Times; color: black;" lang="EN-GB">Purpose</span></strong><span style="font-size: 10pt; font-family: Times; color: black;" lang="EN-GB">: This paper presents an empirical study of a mental health coordination network in one area in Stockholm. The aim was to describe the development and nature of coordination within a mental health and social care consortium and to assess the impact on care processes and client outcomes.</span></p><p class="MsoNormal"><strong><span style="font-size: 10pt; font-family: Times; color: black;" lang="EN-GB">Method</span></strong><span style="font-size: 10pt; font-family: Times; color: black;" lang="EN-GB">: Data was gathered through interviews with coordina­tors from three rehabilitation units. The interviews focused on coordination activities aimed at supporting the clients’ needs and investigated how the coordinators acted according to the consortium's holistic approach. Data on The Camberwell Assess­ment of Need (CAN-S) showing clients’ satisfaction was used to assess on set of outcomes. </span></p><p class="MsoNormal"><strong><span style="font-size: 10pt; font-family: Times; color: black;" lang="EN-GB">Findings</span></strong><span style="font-size: 10pt; font-family: Times; color: black;" lang="EN-GB">: The findings revealed different coordination <span>activities and </span>factors both helping and hindering the network coordination activities. One factor helping was the history of local and personal informal cooperation and shared responsibilities evident. Unclear roles and routines hindered cooperation</span></p><p class="MsoNormal"><strong><span style="font-size: 10pt; font-family: Times; color: black;" lang="EN-GB">Practical</span></strong><span style="font-size: 10pt; font-family: Times; color: black;" lang="EN-GB"> <strong>value</strong>: The contribution is an empirical example and a model for organisations establishing structures for network coordination. One l<span>esson for current policy about integrated health care is to adapt and implement ”pair coordinators” where full structural integration is not possible.</span> </span><span style="font-size: 10pt; font-family: Times;" lang="EN-GB">Another lesson, based on the idea of patient quality by coordinated care, is specific to adapt the work of the local psychiatric addictive team – an independent special team in the psychiatric outpatient care serving psychotic clients with complex addictive problems. </span></p

Surface activity and film formation from the surface associated material of artificial surfactant preparations

AbstractSurfactant proteins B and C (SP-B and SP-C) are present in natural derived surfactant preparations used for treatment of respiratory distress syndrome. Herein the surface activity of an SP-C analogue (SP-C(LKS)), a hybrid peptide between SP-C and bacteriorhodopsin (SP-C/BR) and a model peptide (KL4) was studied with a captive bubble surfactometer (CBS). The peptides were mixed with either 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC)/phosphatidylglycerol (PG) (7:3, by weight) or DPPC/PG/palmitic acid (68:22:9, by weight) at a concentration of 1 mg/ml in HEPES buffer, pH 6.9 and a polypeptide/lipid weight ratio of 0.02–0.03. In some lipid/peptide preparations also 2% of SP-B was included. Adsorption, monitored as surface tension vs. time for 10 min after bubble formation did not show discernible differences for the whole set of preparations. Equilibrium surface tensions of approximately 25 mN/m were reached after 5–10 min for all preparations, although those with SP-C/BR appeared not to reach end point of adsorption within 10 min. Area compression needed to reach minimum surface tension of 0.5–2.0 mN/m was least for the KL4 preparation, about 13% in the first cycle. 3% SP-C(LKS) in DPPC:PG (7:3, by weight) reached minimum surface tension upon 27% compression in the first cycle. If DPPC:PG:PA (68:22:9, by weight) was used instead only 16% area compression was needed and 14% if also 2% SP-B was included. 3% SP-C(LKS) in DPPC:PG (7:3, by weight)+2% SP-B needed 34% compression to reach minimum surface tension. The replenishment of material from a surface associated surfactant reservoir was estimated with subphase depletion experiments. With the 2% KL4 preparation incorporation of excess material took place at a surface tension of 25–35 mN/m during stepwise bubble expansion and excess material equivalent to 4.3 monolayers was found. When 2% SP-B was added to 3% SP-C(LKS) in DPPC:PG (7:3, by weight) the number of excess monolayers increased from 1.5 to 3.6 and the incorporation took place at 30–40 mN/m. When SP-B was added to 3% SP-C(LKS) in DPPC:PG:PA (68:22:9, by weight) the number of excess monolayers increased from 0.5 to 3.4 and incorporation took place at 40–50 mN/m. With 2% SP-C/BR incorporation took place at 40–45 mN/m, frequent instability clicks were observed and excess material of approximately 1.1 monolayer was estimated

Paid Sick Leave as a Means to Reduce Sickness Presenteeism Among Physicians

Recurrent international data show that physicians often attend work while ill, termed sickness presenteeism. The current study investigated if sickness presenteeism scores among European physicians varied according to national paid sick leave legislation. We hypothesized that prevalence of presenteeism was higher in countries with lower levels of paid sick leave. We used repeated cross-sectional survey data, phase I (2004/2005, N = 1326) and phase II (2012/2013, N = 1403), among senior consultants at university hospitals in Sweden, Norway, and Italy. Analyses of variances assessed cross-country differences in presenteeism. To assess the impact of country on presenteeism, we used multiple regression analyses controlled for sex, age, family status, work hours, and work content. The results from phase I supported the initial hypothesis. At phase II, presenteeism scores had decreased among the Italian and Swedish sample. The results are discussed with regard to changes in legislation on workhours and medical liability in Italy and Sweden between phase I and II

Increasing cities\u27 capacity to manage noise and air quality using urban morphology

According to the World Health Organization, the top two in disease burden are air pollution and environmental noise. In cities, road traffic is the largest contributor to both noise and air pollution and the corresponding Swedish Environmental objectives are to date estimated to not be reached by 2020. Future reductions concerning both air quality and noise are considered insufficient whereby additional measures are needed.Air quality is linked to urban form such that compact cities were shown to result in increasing concentrations of air pollution. Further, urban form influences the meteorology due to changed surface roughness on the larger scale (urban scale), and even more in a local- and microscale at ground level in street canyons. This will affect wind patterns influencing the dispersion possibility of air pollutants. For investigating local effects of urban morphology on noise and air distribution simultaneously, the Spacematrix method has been shown to be useful, as described in Berghauser Pont and Haupt (2010). Building types can be composed of a combination of density variables enabling to quantify a type and manipulate each variable separately. The aim of this paper is to identify critical spatial parameters influencing noise and air pollution and translate them into measures of spatial form including size of the urban block, and distribution, positioning and height of the buildings within that block

Uncoupling Protein 3: Its Possible Biological Role and Mode of Regulation in Rodents and Humans

The recently discovered uncoupling protein 3 (UCP3) is highly homologous to the mitochondrialinner membrane protein UCP1, which generates heat by uncoupling the respiratory chainfrom oxidative phosphorylation. The thermogenic function of UCP1 protects against cold andregulates the energy balance in rodents. We review in vitro studies investigating the uncouplingactivity of UCP3 and in vivo studies, which address UCP3 gene expression in brown adiposetissue and skeletal muscle under various metabolic conditions. The data presented are, for themost, consistent with an uncoupling role for UCP3 in regulatory thermogenesis. We alsodiscuss mediators of UCP3 regulation and propose a potential role for intracellular fatty acidsin the mechanism of UCP3 modulation. Finally, we hypothesize a role for UCP3 in themetabolic adaptation of the mitochondria to the degradation of fatty acid

PP063—Changes in the utilisation of venlafaxine after the introduction of generics in Sweden: Implications for other countries

2013 e37 Significant but lesser changes in losartan utilization were seen in Austria and Belgium. There was no change in losartan utilization patterns in Scotland or Spain. Losartan typically generic at low prices, leading to appreciable increases in prescribing efficiency in NHS Bury, Sweden, Austria, and Belgium. There were some savings in Scotland with generic losartan. Conclusion: Multiple demand-side measures appreciably enhanced ARB prescribing efficiency. This mirrors previous findings that multiple measures are need to change prescribing habits. No significant increase in losartan utilization following generics where countries have not instigated specific measures suggests authorities cannot rely on a "spillover" effect between classes to change physician prescribing habits. This is the case even with multiple demand-side activities encouraging preferential prescribing of generics in related classes. This may be exacerbated on this occasion by a more complex message; for example, away from ACEIs first line versus ARBs to ACEIs + low cost ARBs first line. Disclosure of Interest: None declared

Novel Method for Controlled Wetting of Materials in the Environmental Scanning Electron Microscope

Environmental scanning electron microscopy has been extensively used for studying the wetting properties of different materials. For some types of investigation, however, the traditional ways of conducting in situ dynamic wetting experiments do not offer sufficient control over the wetting process. Here, we present a novel method for controlled wetting of materials in the environmental scanning electron microscope (ESEM). It offers improved control of the point of interaction between the water and the specimen and renders it more accessible for imaging. It also enables the study of water transport through a material by direct imaging. The method is based on the use of a piezo-driven nanomanipulator to bring a specimen in contact with a water reservoir in the ESEM chamber. The water reservoir is established by local condensation on a Peltier-cooled surface. A fixture was designed to make the experimental setup compatible with the standard Peltier cooling stage of the microscope. The developed technique was successfully applied to individual cellulose fibers, and the absorption and transport of water by individual cellulose fibers were imaged