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Background Providing secondary prevention through structured and comprehensive cardiac rehabilitation programmes to patients after a myocardial infarction (MI) reduces mortality and morbidity and improves health-related quality of life. Cardiac rehabilitation has the highest recommendation in current guidelines. While treatment target attainment rates at Swedish cardiac rehabilitation centres is among the highest in Europe, there are considerable differences in service delivery and variations in patient-level outcomes between centres. In this trial, we aim to study whether centre-level guideline adherence and patient-level outcomes across Swedish cardiac rehabilitation centres can be improved through a) regular audit and feedback of cardiac rehabilitation structure and processes through a national quality registry and b) supporting cardiac rehabilitation centres in implementing guidelines on secondary prevention. Furthermore, we aim to evaluate the implementation process and costs. Methods The study is an open-label cluster-randomized effectiveness-implementation hybrid trial including all 78 cardiac rehabilitation centres (attending to approximately 10 000 MI patients/year) that report to the SWEDEHEART registry. The centres will be randomized 1:1:1 to three clusters: 1) reporting cardiac rehabilitation structure and process variables to SWEDEHEART every six months (audit intervention) and being offered implementation support to implement guidelines on secondary prevention (implementation support intervention); 2) audit intervention only; or 3) no intervention offered. Baseline cardiac rehabilitation structure and process variables will be collected. The primary outcome is an adherence score measuring centre-level adherence to secondary prevention guidelines. Secondary outcomes include patient-level secondary prevention risk factor goal attainment at one-year after MI and major adverse coronary outcomes for up to five-years post-MI. Implementation outcomes include

Background: It is rather common for patients and informal caregivers affected by chronic conditions to experience aspects of disempowerment being in a paternalistic structure. Patient empowerment is often understood as a power to achieve control over the determinants of a person’s quality of life, as well as being authorized by healthcare professionals and steered from a healthcare perspective on self-management and care. Patient self-empowerment, on the other hand, describes patients’ and informal caregivers’ power to perform activities that are not mandated by health care and to take control over their own lives and self-management with increased self-efficacy and confidence. Self-empowered patients and informal caregivers are described in the literature by many different concepts and can be the key to future development of health care and diffusion of innovation solutions for themselves and their peers. Knowledge about self-empowering behaviors and motivation of patients and informal caregivers is scarce. Further, the perspective of healthcare professionals and their attitudes, experiences, and workplace support when working with self-empowered patients and informal caregivers has not been researched extensively. Aim: To further understand how patients and informal caregivers can take the lead in their own care and self-management, the overall aim of this thesis is to study the driving forces and self-empowering behaviors of patients and informal caregivers affected by chronic conditions, and how healthcare professionals and the healthcare systems meet these behaviors. Methods: This is a mixed methods thesis with four studies deriving from two projects. Qualitative data collection was done through semi-structured interviews (study I-III) and focus groups (study III), and quantitative data was collected through surveys (study II & IV). Patients and informal caregivers affected by chronic conditions and with self-empowering behaviors participated in study I (n=15)

Background: Patient empowerment is an important concept and a movement toward person-centered care of patients with chronic conditions. Nevertheless, to date, most research on empowered patients or informal caregivers has been conducted from a narrow clinical perspective. Such research has mainly focused on how health care professionals can empower patients to increase self-care or compliance with treatment. Research on empowered patient and informal caregiver needs and self-empowering activities is scarce. Objective: We aimed to explore empowering behaviors from a patient and informal caregiver perspective in the context of self-management and to understand how health care can support such behaviors better. Methods: We used an exploratory, qualitative study design. A total of 15 semistructured interviews and 6 focus group interviews were conducted with 48 patients and informal caregivers. We analyzed the interviews using thematic analysis and used a directed content analysis to analyze the focus group interviews. Results: A total of 14 patterns of empowering behaviors were identified that were characterized by several exploratory and influencing activities performed by the participants. The participants expressed a desire to be more active in their care than what is expected and supported by health care professionals. The participants also desired better support for activities imposed on them by health care professionals. Conclusions: To enable a transformation of the health care system to better support self-empowering behaviors, there is a need to develop self-management approaches from a patient and informal caregiver perspective.

Background: Current health care systems are rarely designed to meet the needs of people living with chronic conditions. However, some patients and informal caregivers are not waiting for the health care system to redesign itself. These individuals are sometimes referred to as e-patients. The first generation of e-patients used the internet for finding information and for communicating with peers. Compared with the first generation, the second generation of e-patients collects their own health data and appears to be more innovative. Objective: The aim of this study was to describe the second generation of e-patients through exploration of their active engagement in their self-care and health care. Methods: Semistructured interviews were conducted with 10 patients with chronic conditions and 5 informal caregivers. They were all recruited through a Web-based advertisement. Data were analyzed according to the framework analysis approach, using the 3 concepts of the self-determination theory-autonomy, relatedness, and competence-at the outset. Results: Study participants were actively engaged in influencing their self-care and the health care system to improve their own health, as well as the health of others. This occurred at different levels, such as using their own experience when giving presentations and lectures to health care professionals and medical students, working as professional peers in clinical settings, performing self-tracking, contributing with innovations, and being active on social media. When interaction with health care providers was perceived as being insufficient, the participants sought support through their peers, which showed strong relatedness. Competence increased through the use of technology and learning experiences with peers. Their autonomy was important but was sometimes described as involuntary and to give up was not an option for them. Conclusions: Like the first generation of e-patients, the participants frequently searched for Web-bas

Background: This study explores opinions and experiences of people with Parkinson's disease (PwP) in Sweden of using self-tracking. Parkinson's disease (PD) is a neurodegenerative condition entailing varied and changing symptoms and side effects that can be a challenge to manage optimally. Patients' self-tracking has demonstrated potential in other diseases, but we know little about PD self-tracking. The aim of this study was therefore to explore the opinions and experiences of PwP in Sweden of using self-tracking for PD. Method: A mixed methods approach was used, combining qualitative data from seven interviews with quantitative data from a survey to formulate a model for self-tracking in PD. In total 280 PwP responded to the survey, 64% (n = 180) of which had experience from self-tracking. Result: We propose a model for self-tracking in PD which share distinctive characteristics with the Plan-Do-Study-Act (PDSA) cycle for healthcare improvement. PwP think that tracking takes a lot of work and the right individual balance between burdens and benefits needs to be found. Some strategies have here been identified; to focus on positive aspects rather than negative, to find better solutions for their selfcare, and to increase the benefits through improved tools and increased use of self-tracking results in the dialogue with healthcare. Conclusion: The main identified benefits are that self-tracking gives PwP a deeper understanding of their own specific manifestations of PD and contributes to a more effective decision making regarding their own selfcare. The process of self-tracking also enables PwP to be more active in communicating with healthcare. Tracking takes a lot of work and there is a need to find the right balance between burdens and benefits.

Background More knowledge is needed regarding the perceptions of healthcare professionals when encountering empowered patients and informal caregivers in clinical settings. This study aimed to investigate healthcare professionals’ attitudes towards and experiences of working with empowered patients and informal caregivers, and perception of workplace support in these situations. Methods A multi-centre web survey was conducted using a non-probability sampling of both primary and specialized healthcare professionals across Sweden. A total of 279 healthcare professionals completed the survey. Data was analysed using descriptive statistics and Thematic analysis. Results Most respondents perceived empowered patients and informal caregivers as positive and had to some extent experience of learning new knowledge and skills from them. However, few respondents stated that these experiences were regularly followed-up at their workplace. Potentially negative consequences such as increased inequality and additional workload were, however, mentioned. Patients’ engagement in the development of clinical workplaces was seen as positive by the respondents, but few had own experience of such engagement and considered it difficult to be achieved . Conclusion Overall positive attitudes of healthcare professionals are a fundamental prerequisite to the transition of the healthcare system recognizing empowered patients and informal caregivers as partners.

Background: Patient empowerment is an important concept and a movement toward person-centered care of patients with chronic conditions. Nevertheless, to date, most research on empowered patients or informal caregivers has been conducted from a narrow clinical perspective. Such research has mainly focused on how health care professionals can empower patients to increase self-care or compliance with treatment. Research on empowered patient and informal caregiver needs and self-empowering activities is scarce. Objective: We aimed to explore empowering behaviors from a patient and informal caregiver perspective in the context of self-management and to understand how health care can support such behaviors better. Methods: We used an exploratory, qualitative study design. A total of 15 semistructured interviews and 6 focus group interviews were conducted with 48 patients and informal caregivers. We analyzed the interviews using thematic analysis and used a directed content analysis to analyze the focus group interviews. Results: A total of 14 patterns of empowering behaviors were identified that were characterized by several exploratory and influencing activities performed by the participants. The participants expressed a desire to be more active in their care than what is expected and supported by health care professionals. The participants also desired better support for activities imposed on them by health care professionals. Conclusions: To enable a transformation of the health care system to better support self-empowering behaviors, there is a need to develop self-management approaches from a patient and informal caregiver perspective.

Background: E-patients are described as patients and informal caregivers who are empowered, equipped, enabled and engaged, and use digital solutions for their self-care and in healthcare contexts. Self-care can be understood as health related activities and behaviors regarding life styles and environmental aspects. The self-determination theory can be used to understand aspects of motivation and to provide an understanding for the basic psychological needs of persons, and how their autonomy, competence and relatedness are supported. Understanding e-patients also includes understanding their use of different consumer health informatics applications. These are digital solutions where patients and informal caregivers as citizens are the end-users. In the beginning of this century, e-patients were described as persons using the Internet to find information about their condition or to prepare for clinical encounters, as well as engaging in online communities. They were called the first generation of e-patients. Today there is a broader use of and an increased access to better digital solutions. Therefore, the first generation of e-patients has evolved largely in tandem with the evolving environment. The overall aim for this thesis is to examine the experiences, actions and driving forces of the second generation of e-patients, and their applicability to a broader group of patients with chronic conditions and their informal caregivers. Methods: Three studies were performed. Study I consisted of a qualitative approach conducting semi-structured interviews with 15 e-patients. Deductive framework analysis was used, with the self-determination theory as an initial framework. Study II was a mixed method study with seven semi-structured interviews and a survey with 180 included respondents having Parkinson disease and self-tracking experience. Inductive conventional content analysis was applied for the interviews and statistical analysis for the survey. In study III the 15 semi

Background: This study explores opinions and experiences of people with Parkinson's disease (PwP) in Sweden of using self-tracking. Parkinson's disease (PD) is a neurodegenerative condition entailing varied and changing symptoms and side effects that can be a challenge to manage optimally. Patients' self-tracking has demonstrated potential in other diseases, but we know little about PD self-tracking. The aim of this study was therefore to explore the opinions and experiences of PwP in Sweden of using self-tracking for PD. Method: A mixed methods approach was used, combining qualitative data from seven interviews with quantitative data from a survey to formulate a model for self-tracking in PD. In total 280 PwP responded to the survey, 64% (n = 180) of which had experience from self-tracking. Result: We propose a model for self-tracking in PD which share distinctive characteristics with the Plan-Do-Study-Act (PDSA) cycle for healthcare improvement. PwP think that tracking takes a lot of work and the right individual balance between burdens and benefits needs to be found. Some strategies have here been identified; to focus on positive aspects rather than negative, to find better solutions for their selfcare, and to increase the benefits through improved tools and increased use of self-tracking results in the dialogue with healthcare. Conclusion: The main identified benefits are that self-tracking gives PwP a deeper understanding of their own specific manifestations of PD and contributes to a more effective decision making regarding their own selfcare. The process of self-tracking also enables PwP to be more active in communicating with healthcare. Tracking takes a lot of work and there is a need to find the right balance between burdens and benefits., Spetspatienter

BACKGROUND: Current health care systems are rarely designed to meet the needs of people living with chronic conditions. However, some patients and informal caregivers are not waiting for the health care system to redesign itself. These individuals are sometimes referred to as e-patients. The first generation of e-patients used the internet for finding information and for communicating with peers. Compared with the first generation, the second generation of e-patients collects their own health data and appears to be more innovative. OBJECTIVE: The aim of this study was to describe the second generation of e-patients through exploration of their active engagement in their self-care and health care. METHODS: Semistructured interviews were conducted with 10 patients with chronic conditions and 5 informal caregivers. They were all recruited through a Web-based advertisement. Data were analyzed according to the framework analysis approach, using the 3 concepts of the self-determination theory-autonomy, relatedness, and competence-at the outset. RESULTS: Study participants were actively engaged in influencing their self-care and the health care system to improve their own health, as well as the health of others. This occurred at different levels, such as using their own experience when giving presentations and lectures to health care professionals and medical students, working as professional peers in clinical settings, performing self-tracking, contributing with innovations, and being active on social media. When interaction with health care providers was perceived as being insufficient, the participants sought support through their peers, which showed strong relatedness. Competence increased through the use of technology and learning experiences with peers. Their autonomy was important but was sometimes described as involuntary and to give up was not an option for them. CONCLUSIONS: Like the first generation of e-patients, the participants frequently searched for Web-bas, Spetspatienter

In order to increase clinical trial participation, the reasons for participating need to be observed. Since there is rather inadequate information concerning how individuals such as patients, decides to participate in clinical trials semi-structured interviews have been done. Examining the use of EHR in clinical trials and co-creation of data, the result showed that it is important for the researches to have access to the patients' EHR and for the patients to contribute with their own ideas of research. Important aspects of further participation in clinical trials were that it should be fun and informative. The patients agreed on that the effort of participating could decrease with the use of electronically collection and self-reporting of data, e.g. through a patient portal.

Moranbah North Mine has employed the use of Remote Reading Tell Tale Systems (RRTT Systems) since 2012 for the purposes of ensuring accurate, continuous and real time roof movement monitoring for critical infrastructure roadways. Recently an integrated monitoring system was installed in the tailgate roadway of LW112 to monitor and record the continuous ground movement outbye of the retreating longwall face to better understand both the roof and floor movement. Vertical convergence of the tailgate roadway during longwall retreat is typically managed by installing both active support elements and standing support at Moranbah North Mine. The data has provided significant insights into the magnitude of both roof and floor movement outbye of the longwall which has enhanced the understanding of the required densities of standing support at various locations throughout the tailgate. The system has also demonstrated its potential to be used as a management tool, e.g. during extended face stoppages. Once installed, the monitoring system is entirely automated and the data is automatically collected and transferred to the surface via an optical fibre cable. The system and real-time communication are flexible and can be tailored to meet site specific monitoring needs. The system includes: an RRTT System, real time convergence monitoring probes and a real time data acquisition, communication and reporting system. The system enables Moranbah North to be able to measure total vertical roadway convergence and roof displacement continuously without having to access the tailgate at regular intervals. The combined data can be used to investigate: required standing support capacity and density; tailgate roadways ‘zones’ of increased vertical loading associated with intersections; the influence of strata and structural variation; and the optimum support strategy for ensuring roadway stability outbye of the longwall face. The analysis and results produced indicate that standing support d

This paper describes how the Swedish national Health Information Exchange platform can be used to facilitate clinical research in the future. Different e-services for different user groups are being developed using a user-centered design approach. The main user groups are study participants, clinical researchers and healthcare professionals. The different e-services are based on an in-depth analysis of the clinical research process, and the main identified needs relate to recruitment of study participants, access to clinical data from different sources as well as improved tools for patients' self-reporting. The national Swedish HIE platform has the potential to enable a seamless connection between patients/citizens as study participants, health care professionals and everyday clinical work and clinical researchers in both academia and industry.

We report here the 78,884,754 base pairs of finished human chromosome 16 sequence, representing over 99.9 percent of its euchromatin. Manual annotation revealed 880 protein coding genes confirmed by 1,637 aligned transcripts, 19 tRNA genes, 341 pseudogenes and 3 RNA pseudogenes. These genes include metallothionein, cadherin and iroquois gene families, as well as the disease genes for polycystic kidney disease and acute myelomonocytic leukemia. Several large-scale structural polymorphisms spanning hundreds of kilobasepairs were identified and result in gene content differences across humans. One of the unique features of chromosome 16 is its high level of segmental duplication, ranked among the highest of the human autosomes. While the segmental duplications are enriched in the relatively gene poor pericentromere of the p-arm, some are involved in recent gene duplication and conversion events which are likely to have had an impact on the evolution of primates and human disease susceptibility.

Chromosome 5 is one of the largest human chromosomes yet has one of the lowest gene densities. This is partially explained by numerous gene-poor regions that display a remarkable degree of noncoding and syntenic conservation with non-mammalian vertebrates, suggesting they are functionally constrained. In total, we compiled 177.7 million base pairs of highly accurate finished sequence containing 923 manually curated protein-encoding genes including the protocadherin and interleukin gene families and the first complete versions of each of the large chromosome 5 specific internal duplications. These duplications are very recent evolutionary events and play a likely mechanistic role, since deletions of these regions are the cause of debilitating disorders including spinal muscular atrophy (SMA).

Although the sonar amplitude of return is undoubtedly determined by the acoustic-sediment interaction at the seabed, the raw amplitude of return is of little practical use to geotechnical engineers. By focusing upon the relationships between the strength of the acoustic scattering and the roughness of the surficial seabed sediments, this research aims to derive a remote acoustic methodology that can be used to predict the geotechnical characteristics of the seabed sediment. The main field survey areas selected were Loch Earn, Scotland, and the Portsmouth coastal waters in the Solent, England, with the precise location of the field sites being determined by the distribution of differing sediment types. The sonar data was acquired by a 234kHz Interferometric Seabed Inspection Sonar system, which provided not only high precision and high resolution, but also extensive and very dense data coverage. These sonar datasets were then complemented by a sediment ground-truthing programme within the same area. Using trigonometry and the 'sonar equation' parameters, the complex post-processing of the bathymetric and acoustic data resulted in the generation of an acoustic roughness measurement. The sediment grain size analysis then followed standard techniques to derive values for the statistical roughness parameters of the sediment. The correlation between the acoustic and sediment roughness uncovered a good correlation between the mean grain size and also the finest modal value, with an increase in acoustic scattering strength reflecting an increase in the mean and finest modal grain sizes. The reversal of this correlation therefore enables a prediction of mean or finest modal grain size, thereby demonstrating an approach towards an 'unsupervised' acoustic sediment classification scheme. This study was carried out over a very narrow grain size range, from muds to fine sands, and therefore the addition of sonar datasets recorded over coarser sediments are required to complete th

Muncie Matinee Musicale's "Musician Youngins'" program.; Luella Wilson, president.; Mary Alice Cox, leader.; Held at Riverside Avenue Baptist Church., This archival material has been provided for educational purposes. Ball State University Libraries recognizes that some historic items may include offensive content. Our statement regarding objectionable content is available at: https://dmr.bsu.edu/digital/about

Clipping from Baltimore Sun, April 21, 1990. Item reports on concert by Leon Fleisher conducting the Peabody Symphony Orchestra with soloist Andre Watts.

Clipping from Baltimore Evening Sun, May 1, 1990. Item reviews concert by Leon Fleisher conducting the Peabody Symphony Orchestra with soloist Andre Watts.

This anthology marks key moments in the history of Canadian painting and sculpture. Works by the Group of Seven, the Automatistes, Painters Eleven and the Regina Five are discussed in relation to the cultural values of French / Victorian Canada and international modernism. Recent developments in feminist art, native art, video and performance are also presented. 6 bibl. ref.

Clipping from Baltimore Evening Sun, December 19, 1988. Item reviews concert by Leon Fleisher conducting musicians of the Baltimore Symphony Orchestra with Jaime Laredo and Sharon Robinson.