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Associations between various malignancies and work in the pulp and paper industry have been reported but mostly in analyses of mortality rather than incidence. We aimed to study cancer incidence by main mill pulping process, department and gender in a Swedish cohort of pulp and paper mill workers. The cohort (18,113 males and 2,292 females, enrolled from 1939 to 1999 with greater than 1 year of employment) was followed up for cancer incidence from 1958 to 2001. Information on the workers department and employment was obtained from the mills personnel files, and standardized incidence ratios (SIRs) were calculated using the Swedish population as reference. Overall cancer incidence, in total 2,488 cases, was not increased by work in any department. However, risks of pleural mesothelioma were increased among males employed in sulphate pulping (SIR, 8.38; 95 % CI, 3.37-17) and maintenance (SIR, 6.35; 95 % CI, 3.47-11), with no corresponding increase of lung cancer. Testicular cancer risks were increased among males employed in sulphate pulping (SIR, 4.14; 95 % CI, 1.99-7.61) and sulphite pulping (SIR, 2.59; 95 % CI, 0.95-5.64). Female paper production workers showed increased risk of skin tumours other than malignant melanoma (SIR, 2.92; 95 % CI, 1.18-6.02). Incidence of pleural mesothelioma was increased in the cohort, showing that asbestos exposure still has severe health consequences, and highlighting the exigency of strict asbestos regulations and elimination. Testicular cancer was increased among pulping department workers. Shift work and endocrine disruptors could be of interest in this context.

The objective of this study was to evaluate cancer mortality in pulp and paper industry workers exposed to chlorinated organic compounds. We assembled a multinational cohort of workers employed between 1920 and 1996 in 11 countries. Exposure to both volatile and nonvolatile organochlorine compounds was estimated at the department level using an exposure matrix. We conducted a standardized mortality ratio (SMR) analysis based on age and calendar-period-specific national mortality rates and a Poisson regression analysis. The study population consisted of 60,468 workers. Workers exposed to volatile organochlorines experienced a deficit of all-cause [SMR = 0.91, 95% confidence interval (CI), 0.89-0.93] and all-cancer (SMR = 0.93, 95% CI, 0.89-0.97) mortality, with no evidence of increased risks for any cancer of a priori interest. There was a weak, but statistically significant, trend of increasing risk of all-cancer mortality with increasing weighted cumulative exposure. A similar deficit in all-cause (SMR = 0.94, 95% CI, 0.91-0.96) and all-cancer (SMR = 0.94, 95% CI, 0.89-1.00) mortality was observed in those exposed to nonvolatile organochlorines. No excess risk was observed in cancers of a priori interest, although mortality from Hodgkin disease was elevated (SMR = 1.76, 95% CI, 1.02-2.82). In this study we found little evidence that exposure to organochlorines at the levels experienced in the pulp and paper industry is associated with an increased risk of cancer, apart from a weak but significant association between all-cancer mortality and weighted cumulative volatile organochlorine exposure.

To study cancer mortality among Swedish pulp and paper mill workers by main mill pulping process and department, and to present the Swedish part of an international exposure measurements database. A cohort of 18,163 male and 2,290 female workers at four sulfate and four sulfite mills, enrolled from 1939 to 1999, was followed up for mortality during 1952-2001. Standardized mortality ratios (SMRs) relative to the general Swedish population were calculated. There were 1,340 malignant cases out of 5,898 deaths. Total cancer mortality was not increased in either sulfate or sulfite mill workers, or by gender. Lung cancer mortality was increased among female workers (SMR 1.70, 95% CI 1.04-2.63), especially in paper production, but not among male workers (SMR 0.91, 95% CI 0.79-1.04). Exposure to wood dust and sulfur dioxide frequently exceeded occupational exposure limits. Female paper production workers had an increased mortality from lung cancer.

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Background: Malignant diseases but also cardiovascular and respiratory disorders and diabetes mellitus have been associated with work in pulp and paper production. The present cohort focuses on cardiovascular mortality in relation to various exposures in this industry. Methods: The cohort, followed-up for mortality, includes 7,107 workers, 6,350 men and 757 women, from three major old mills in the middle of Sweden. Results: Instead of a healthy-worker effect, a slightly increased risk for death in diseases of the circulatory system was found for male workers. Notably, work with sulfate digestion, steam and power generation and maintenance was associated with significantly increased risks. Cerebrovascular diseases showed non-significantly increased risks for maintenance and paper and paperboard production and manufacture. Conclusions: The differences in risk among various parts of the production are striking although it is hard to pinpoint any specific exposures. Dust and small particles along with sulfur compounds might be suspected. © 2007 Wiley-Liss, Inc.

Objectives The aim of this study was to determine mortality among pulp and paper mill workers according to the main mill pulping process, department, and gender, particular reference being given to diseases of the circulatory and respiratory systems. Methods The cohort of 18 163 men and 2291 women employed between 1939 and 1999 and with >1 year of employment was followed for mortality from 1952 to 2001 (acute myocardial infarction from 1969). Standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were estimated by comparing the observed number of deaths with the expected number for the entire Swedish population. Exposure was assessed from personnel files in the mills. Data from an exposure measurement database are also presented. Results There were 5898 deaths in the cohort. Total mortality had an SMR of 1.02 (95% CI 0.98-1.06) for the men in the sulfate mills and an SMR of 0.93 (95% CI 0.90-0.97) for the men in the sulfite mills. Mortality from acute myocardial infarction was increased among the men in both the sulfate and sulfite mills [SMR 1.22 (95% CI 1.12-1.32) and SMR 1.11 (95% CI 1.02-1.21), respectively] and by department in sulfate pulping (SMR 1.29, 95% CI 1.07-1.54), paper production (SMR 1.26, 95% CI 1.06-1.49), and maintenance (SMR 1.16, 95% CI 1.02-1.30). Mortality from cerebrovascular disease, diabetes mellitus, and nonmalignant respiratory diseases was not increased. Conclusions Death from acute myocardial infarction, but not cerebrovascular diseases, was increased in this cohort and was probably related to a combination of different occupational exposures (eg, dust, sulfur compounds, shift work, and noise).

We studied the mortality from lung and pleural cancers in a cohort of 62, 937 male workers employed for at least 1 year in the pulp and paper industry in 13 countries during 1945 to 1996. Mill departments were classified according to probability and level of exposure to asbestos on the basis of available dust measurements and mill-specific information on exposure circumstances. Thirty-six percent of workers were classified as ever exposed to asbestos. Standardized mortality ratios of lung cancer were 0.99 (95 % confidence interval [CI], 0.90 to 1.08) among unexposed and 1.00 (95 % CI, 0.90 to 1.11) among ever exposed workers. The number of pleural cancer deaths among unexposed workers was 10, that among exposed workers was 14, most of which occurred among maintenance workers. In internal analyses, a trend in mortality from either neoplasm was suggested for estimated cumulative exposure to asbestos, weighted for the individual probability of exposure within the department and for duration of exposure (relative risk for lung cancer for 0.78+ f/cc-years, as compared with = 0.01 f/cc-years: 1.44, 95 % CI, 0.85 to 2.45, corresponding relative risk for pleural cancer: 2.43, 95% CI, 0.43 to 13.63). Despite a possible nondifferential misclassification of exposure and outcome, this study suggests that the carcinogenic effect of asbestos can be detected among workers employed in industries such as the pulp and paper industry, in which it is not considered to be a major hazard.

Background: Ultrasound is widely accepted as a valuable diagnostic tool for detecting intra-abdominal and intrathoracic bleeding in trauma patients. Nevertheless, many doctors are reluctant to use it because they do not have sufficient training. This study aimed to define intraabdominal and intrathoracic fluid volumes that can be detected by sonography and their relation to fluid width in pigs to establish a clinically relevant animal model for teaching and training. Methods: Different volumes of normal saline were infused into the abdomen (50-2,000 mL) and chest (25-250 mL) in five anesthetized pigs. The maximum width of fluid as detected by ultrasound was recorded. The right upper quadrant, left upper quadrant, pelvis, and right paracolic section of the abdomen and right pleural cavity were studied. An experienced radiologist performed the studies. The effects on respiratory and cardiovascular functions were evaluated. Results: The sonographic findings in the pig were similar to those in humans. Up to 50 mL of intra-abdominal fluid and up to 25 mL of intrathoracic fluid could be detected by ultrasound. There was a significant correlation between the volume infused and the fluid width detected. The respiratory and cardiovascular monitoring of the animals showed that the infused intrathoracic volumes mimicked a survivable hemothorax. Conclusion: The pig may serve as an excellent clinically relevant model with which to teach surgeons detection of different volumes of intra-abdominal and intrathoracic fluids. The value of this model as an educational tool has yet to be tested.

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Purpose: This paper describes and analyzes the nature and development of liminality competence among mobile project workers. It draws on an interpretative approach documenting how mobile project workers develop their conceptions of work performed in liminal (in-between) positions. The overall aim is to extend the knowledge on how people in time-limited and ambiguous work positions develop competencies to address their specific work conditions. Design: This research relies on two in-depth narratives of mobile project workers drawn from a larger longitudinal study. The data include diaries and interviews. The study seeks to identify similarities and differences in the development of liminality competence over time. Findings: Three processes were identified as important in developing higher liminality competence: (1) understanding the value of in-betweenness, (2) understanding the role of the liminar as different and (3) translating liminal experience through reflexivity. The paper generally demonstrates the importance of context and critical events in progressing through these three processes. Practical implications: The paper demonstrates the need for employers to support individuals in passing through the three identified processes and to support thoughtful mobility across different project settings. Originality/value: In the dual ambition of offering insights based on interpretative research on competence and putting greater emphasis on people working in in-between positions, this study enhances the understanding of how individuals develop their conceptions of work in general and their conceptions of liminality at work in particular.

This book constitutes the refereed proceedings of the 18th Scandinavian Conference on Image Analysis, SCIA 2013, held in Espoo, Finland, in June 2013. The 67 revised full papers presented were carefully reviewed and selected from 132 submissions. The papers are organized in topical sections on feature extraction and segmentation, pattern recognition and machine learning, medical and biomedical image analysis, faces and gestures, object and scene recognition, matching, registration, and alignment, 3D vision, color and multispectral image analysis, motion analysis, systems and applications, human-centered computing, and video and multimedia analysis.

This book constitutes the refereed proceedings of the 18th Scandinavian Conference on Image Analysis, SCIA 2013, held in Espoo, Finland, in June 2013. The 67 revised full papers presented were carefully reviewed and selected from 132 submissions. The papers are organized in topical sections on feature extraction and segmentation, pattern recognition and machine learning, medical and biomedical image analysis, faces and gestures, object and scene recognition, matching, registration, and alignment, 3D vision, color and multispectral image analysis, motion analysis, systems and applications, human-centered computing, and video and multimedia analysis.

This book constitutes the refereed proceedings of the 18th Scandinavian Conference on Image Analysis, SCIA 2013, held in Espoo, Finland, in June 2013. The 67 revised full papers presented were carefully reviewed and selected from 132 submissions. The papers are organized in topical sections on feature extraction and segmentation, pattern recognition and machine learning, medical and biomedical image analysis, faces and gestures, object and scene recognition, matching, registration, and alignment, 3D vision, color and multispectral image analysis, motion analysis, systems and applications, human-centered computing, and video and multimedia analysis.

This book constitutes the refereed proceedings of the 18th Scandinavian Conference on Image Analysis, SCIA 2013, held in Espoo, Finland, in June 2013. The 67 revised full papers presented were carefully reviewed and selected from 132 submissions. The papers are organized in topical sections on feature extraction and segmentation, pattern recognition and machine learning, medical and biomedical image analysis, faces and gestures, object and scene recognition, matching, registration, and alignment, 3D vision, color and multispectral image analysis, motion analysis, systems and applications, human-centered computing, and video and multimedia analysis.

This book constitutes the refereed proceedings of the 18th Scandinavian Conference on Image Analysis, SCIA 2013, held in Espoo, Finland, in June 2013. The 67 revised full papers presented were carefully reviewed and selected from 132 submissions. The papers are organized in topical sections on feature extraction and segmentation, pattern recognition and machine learning, medical and biomedical image analysis, faces and gestures, object and scene recognition, matching, registration, and alignment, 3D vision, color and multispectral image analysis, motion analysis, systems and applications, human-centered computing, and video and multimedia analysis.

The aim of this study was to perform a literature review in order to present an overview of evaluations and interventions in occupational therapy for adults with intellectual disabilities. The search was conducted through the following data bases AMED, CINAHL, ERIC, OT Seeker, PsycINFO, PubMed and Scopus covering the period between 2000 (January) - 2010 (March). The search was limited to empirical studies in occupational therapy written in English and published in peer-reviewed journals. The search terms “developmental disability” “intellectual disability” learning disability” “mental retardation” “adults” and “occupational therapy”. The final sample that was examined was 22 papers. The result showed that eight of the papers focused on evaluation and three of these included assessments based on Model of Human Occupation (MOHO); Assessment of Communication and Interaction Skills, Assessment of Motor and Process Skills and Volitional Questionnaire. Interventions were described in 14 papers and these were categorized as focusing on function, occupation or environment. Nine of the 22 included papers were written by Swedish occupational therapists. In total six papers were related to MOHO. This shows that the model is a potential support in the implementation of evidence based occupational therapy practise for adults with intellectual disabilities.

This paper is about the role of working memory capacity in speech understanding under challenging listening conditions. The theoretical model that has driven most of the research reported in this paper is called the Ease-of-Language understanding model (Ronnberg, 2003; Ronnberg et al., 2008). The Ease-of-Language understanding model is part of a larger scientific endeavor called cognitive hearing science.

In this paper, the context for discussing socio-material arrangements for professional practice andresponsibilities is a student-led interprofessional training ward in health care. These realistic hospitaltraining wards have been implemented in response to the ongoing debate about the need of collaborationin order to increase quality and safety for patients in the health care system. In Linköping, medicalstudents, nursing students, physiotherapy and occupational therapy students work together in the trainingwards during a two week period, taking a joint responsibility for the total care of the patient, as well as forcontributing their own professional perspective.A survey evaluation shows an overall positive attitude and perception among the students regarding thepossibility to collaborate and how they have developed the understanding of their own professional roleas well as other professional roles – but medical students rate a number of factors significantly lower thanother students. A qualitative analysis of the open answers, focusing on socio-material aspects give adifferentiated picture of how the arrangements of the training ward produce i) produce enactments ofdifferent kinds of professional responsibilities ii) deal with the ‘unexpected’ -conflicting understandings inthe enactment of caring work iii) proximity opens for negotiations and boundary work. In the paper, wediscuss how the material arrangements create a clash between the ‘expected’ professionalresponsibilities and the ‘unexpected’ responsibilities of caring work and we problematize the implicationsfor professional learning within the framework of health care education.

In the field of health care there is an extremely strong tradition to both develop and practice new knowledge. This is by some emphasised as a requirement for an advanced health-care system. An often emphasised need is however to adopt new medical innovations, both technologies and methods, more systematically, since the use of technologies and methods are different depending on the care giver and geographical areas. Another argument is that in a tax-financed health-care system it is reasonable to monitor that methods are suitable and effective. It was in this setting the County Council of Östergötland in Sweden established a Health Technology Advisory Committee (HTAC). The top level managers’ intention was to support a controlled introduction and disinvestment of medical technologies. The aim was to develop an efficient way which would combine evidence-based knowledge with practice-based knowledge. Issues should be initiated by clinicians who, in their everyday practise, encountered knowledge gaps related to a medical technology. Few issues were however initiated to the HTAC which could be regarded as a setback. The aim of the paper is to study the different problem frames the various actors (clinicians and unit managers, experts, higher administrators and politicians) associate to “the problem” of introduction of new medical technologies. Is HTAC a solution of a non-problem? Are other solutions available? The paper explores issues related to problem-structuring, puzzling, powering, participation, evidence-based medicine and other factors as contextual-bound knowledge, social- and political aspects.

In accordance with the 20-20-20 targets set by the European Union in the climate and energy package (2009/28/EC), national policies aiming at increasing renewable electricity production have emerged among European countries. The tradable green certificate (TGC) is one of the policy instruments being used in e.g. Italy, the UK, Sweden and Norway, where the scheme was recently implemented. Previous literature has discussed the advantages and disadvantages of TGC systems, primarily from an economic efficiency point of view (del Rio, 2005; Fristrup, 2003; Lemming, 2003; Morthorst, 2000). However, very little has been said about their effect on investors’ decision to invest. In a recent working paper, we have demonstrated that investors in renewable electricity production are a heterogeneous group and argued that policy makers’ misconception of who actually invests in renewable electricity production may have important implications for the design of effective policies. In this paper, we focus on the triggers of different type of investors’ decisions to invest in renewable electricity production. Based on interviews with different types of investors in renewable electricity production, i.e. farmers, IPPs, diversified companies, project developers, sole traders, economic associations and public non-energy organizations, we show that for many types of investors, profit maximization is not the primary motive of the investment, and that financial incentives, such as TGC, have a limited effect on investment decisions. We therefore argue that different investor categories require different kind of incentives. Based on a multidimensional framework that includes entrepreneurship, innovation adoption and institutional aspects, we identify a number of investor-related variables, which should be considered by policy makers when designing future policies to promote investments in renewable electricity production. References: del Rio, P., 2005. A European-wide harmonised tradable gree, Nya investerare i förnybar elproduktion (NyEl)

To accelerate level-set based abdominal aorta segmentation on CTA data, we propose a periodic monotonic speed function, which allows segments of the contour to expand within one period and to shrink in the next period, i.e., coherent propagation. This strategy avoids the contour’s local wiggling behavior which often occurs during the propagating when certain points move faster than the neighbors, as the curvature force will move them backwards even though the whole neighborhood will eventually move forwards. Using coherent propagation, these faster points will, instead, stay in their places waiting for their neighbors to catch up. A period ends when all the expanding/shrinking segments can no longer expand/shrink, which means that they have reached the border of the vessel or stopped by the curvature force. Coherent propagation also allows us to implement a modified narrow band level set algorithm that prevents the endless computation in points that have reached the vessel border. As these points’ expanding/shrinking trend changes just after several iterations, the computation in the remaining iterations of one period can focus on the actually growing parts. Finally, a new convergence detection method is used to permanently stop updating the local level set function when the 0-level set is stationary in a voxel for several periods. The segmentation stops naturally when all points on the contour are stationary. In our preliminary experiments, significant speedup (about 10 times) was achieved on 3D data with almost no loss of segmentation accuracy., Original Publication: Chunliang Wang, Hans Frimmel and Örjan Smedby, Level-set based vessel segmentation accelerated with periodic monotonic speed function, 2011, SPIE medical imaging 2011 Lake Buena Vista, Florida, USA. http://dx.doi.org/10.1117/12.876704 Copyright 2011 Society of Photo-Optical Instrumentation Engineers. One print or electronic copy may be made for personal use only. Systematic reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited.

The primary aim of the present work was to analyze the effects of varying scatter-to-primary ratios on the appearance of simulated nodules in chest tomosynthesis section images. Monte Carlo simulations of the chest tomosynthesis system GE Definium 8000 VolumeRAD (GE Healthcare, Chalfont St. Giles, UK) were used to investigate the variation of scatter-to-primary ratios between different angular projections. The simulations were based on a voxel phantom created from CT images of an anthropomorphic chest phantom. An artificial nodule was inserted at 80 different positions in the simulated phantom images, using five different approaches for the scatter-to-primary ratios in the insertion process. One approach included individual determination of the scatter-to primary-ratio for each projection image and nodule location, while the other four approaches were using mean value, median value and zero degree projection value of the scatter-to-primary ratios at each nodule position as well as using a constant scatter-to-primary ratio of 0.5 for all nodule positions. The results indicate that the scatter-to-primary ratios vary up to a factor of 10 between the different angular tomosynthesis projections (±15°). However, the error in the resulting nodule contrast introduced by not taking all variations into account is in general smaller than 10 %., Original Publication: Angelica Svalkvist, Gustaf Ullman, Markus Håkansson, David Dance, Michael Sandborg, Gudrun Alm Carlsson and Magnus Båth, Investigation of the effect of varying scatter-to-primary ratios on nodule contrast in chest tomosynthesis, 2011, Proc SPIE 7961, 79615Y. http://dx.doi.org/10.1117/12.873173 Copyright 2011 Society of Photo-Optical Instrumentation Engineers. One print or electronic copy may be made for personal use only. Systematic reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited.

To accelerate level-set based abdominal aorta segmentation on CTA data, we propose a periodic monotonic speed function, which allows segments of the contour to expand within one period and to shrink in the next period, i.e., coherent propagation. This strategy avoids the contour’s local wiggling behavior which often occurs during the propagating when certain points move faster than the neighbors, as the curvature force will move them backwards even though the whole neighborhood will eventually move forwards. Using coherent propagation, these faster points will, instead, stay in their places waiting for their neighbors to catch up. A period ends when all the expanding/shrinking segments can no longer expand/shrink, which means that they have reached the border of the vessel or stopped by the curvature force. Coherent propagation also allows us to implement a modified narrow band level set algorithm that prevents the endless computation in points that have reached the vessel border. As these points’ expanding/shrinking trend changes just after several iterations, the computation in the remaining iterations of one period can focus on the actually growing parts. Finally, a new convergence detection method is used to permanently stop updating the local level set function when the 0-level set is stationary in a voxel for several periods. The segmentation stops naturally when all points on the contour are stationary. In our preliminary experiments, significant speedup (about 10 times) was achieved on 3D data with almost no loss of segmentation accuracy., Original Publication: Chunliang Wang, Hans Frimmel and Örjan Smedby, Level-set based vessel segmentation accelerated with periodic monotonic speed function, 2011, SPIE medical imaging 2011 Lake Buena Vista, Florida, USA. http://dx.doi.org/10.1117/12.876704 Copyright 2011 Society of Photo-Optical Instrumentation Engineers. One print or electronic copy may be made for personal use only. Systematic reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited.

The primary aim of the present work was to analyze the effects of varying scatter-to-primary ratios on the appearance of simulated nodules in chest tomosynthesis section images. Monte Carlo simulations of the chest tomosynthesis system GE Definium 8000 VolumeRAD (GE Healthcare, Chalfont St. Giles, UK) were used to investigate the variation of scatter-to-primary ratios between different angular projections. The simulations were based on a voxel phantom created from CT images of an anthropomorphic chest phantom. An artificial nodule was inserted at 80 different positions in the simulated phantom images, using five different approaches for the scatter-to-primary ratios in the insertion process. One approach included individual determination of the scatter-to primary-ratio for each projection image and nodule location, while the other four approaches were using mean value, median value and zero degree projection value of the scatter-to-primary ratios at each nodule position as well as using a constant scatter-to-primary ratio of 0.5 for all nodule positions. The results indicate that the scatter-to-primary ratios vary up to a factor of 10 between the different angular tomosynthesis projections (±15°). However, the error in the resulting nodule contrast introduced by not taking all variations into account is in general smaller than 10 %., Original Publication: Angelica Svalkvist, Gustaf Ullman, Markus Håkansson, David Dance, Michael Sandborg, Gudrun Alm Carlsson and Magnus Båth, Investigation of the effect of varying scatter-to-primary ratios on nodule contrast in chest tomosynthesis, 2011, Proc SPIE 7961, 79615Y. http://dx.doi.org/10.1117/12.873173 Copyright 2011 Society of Photo-Optical Instrumentation Engineers. One print or electronic copy may be made for personal use only. Systematic reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited.

To accelerate level-set based abdominal aorta segmentation on CTA data, we propose a periodic monotonic speed function, which allows segments of the contour to expand within one period and to shrink in the next period, i.e., coherent propagation. This strategy avoids the contour’s local wiggling behavior which often occurs during the propagating when certain points move faster than the neighbors, as the curvature force will move them backwards even though the whole neighborhood will eventually move forwards. Using coherent propagation, these faster points will, instead, stay in their places waiting for their neighbors to catch up. A period ends when all the expanding/shrinking segments can no longer expand/shrink, which means that they have reached the border of the vessel or stopped by the curvature force. Coherent propagation also allows us to implement a modified narrow band level set algorithm that prevents the endless computation in points that have reached the vessel border. As these points’ expanding/shrinking trend changes just after several iterations, the computation in the remaining iterations of one period can focus on the actually growing parts. Finally, a new convergence detection method is used to permanently stop updating the local level set function when the 0-level set is stationary in a voxel for several periods. The segmentation stops naturally when all points on the contour are stationary. In our preliminary experiments, significant speedup (about 10 times) was achieved on 3D data with almost no loss of segmentation accuracy., Original Publication: Chunliang Wang, Hans Frimmel and Örjan Smedby, Level-set based vessel segmentation accelerated with periodic monotonic speed function, 2011, SPIE medical imaging 2011 Lake Buena Vista, Florida, USA. http://dx.doi.org/10.1117/12.876704 Copyright 2011 Society of Photo-Optical Instrumentation Engineers. One print or electronic copy may be made for personal use only. Systematic reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited.

To accelerate level-set based abdominal aorta segmentation on CTA data, we propose a periodic monotonic speed function, which allows segments of the contour to expand within one period and to shrink in the next period, i.e., coherent propagation. This strategy avoids the contour’s local wiggling behavior which often occurs during the propagating when certain points move faster than the neighbors, as the curvature force will move them backwards even though the whole neighborhood will eventually move forwards. Using coherent propagation, these faster points will, instead, stay in their places waiting for their neighbors to catch up. A period ends when all the expanding/shrinking segments can no longer expand/shrink, which means that they have reached the border of the vessel or stopped by the curvature force. Coherent propagation also allows us to implement a modified narrow band level set algorithm that prevents the endless computation in points that have reached the vessel border. As these points’ expanding/shrinking trend changes just after several iterations, the computation in the remaining iterations of one period can focus on the actually growing parts. Finally, a new convergence detection method is used to permanently stop updating the local level set function when the 0-level set is stationary in a voxel for several periods. The segmentation stops naturally when all points on the contour are stationary. In our preliminary experiments, significant speedup (about 10 times) was achieved on 3D data with almost no loss of segmentation accuracy., Original Publication: Chunliang Wang, Hans Frimmel and Örjan Smedby, Level-set based vessel segmentation accelerated with periodic monotonic speed function, 2011, SPIE medical imaging 2011 Lake Buena Vista, Florida, USA. http://dx.doi.org/10.1117/12.876704 Copyright 2011 Society of Photo-Optical Instrumentation Engineers. One print or electronic copy may be made for personal use only. Systematic reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited.

To accelerate level-set based abdominal aorta segmentation on CTA data, we propose a periodic monotonic speed function, which allows segments of the contour to expand within one period and to shrink in the next period, i.e., coherent propagation. This strategy avoids the contour’s local wiggling behavior which often occurs during the propagating when certain points move faster than the neighbors, as the curvature force will move them backwards even though the whole neighborhood will eventually move forwards. Using coherent propagation, these faster points will, instead, stay in their places waiting for their neighbors to catch up. A period ends when all the expanding/shrinking segments can no longer expand/shrink, which means that they have reached the border of the vessel or stopped by the curvature force. Coherent propagation also allows us to implement a modified narrow band level set algorithm that prevents the endless computation in points that have reached the vessel border. As these points’ expanding/shrinking trend changes just after several iterations, the computation in the remaining iterations of one period can focus on the actually growing parts. Finally, a new convergence detection method is used to permanently stop updating the local level set function when the 0-level set is stationary in a voxel for several periods. The segmentation stops naturally when all points on the contour are stationary. In our preliminary experiments, significant speedup (about 10 times) was achieved on 3D data with almost no loss of segmentation accuracy., Original Publication: Chunliang Wang, Hans Frimmel and Örjan Smedby, Level-set based vessel segmentation accelerated with periodic monotonic speed function, 2011, SPIE medical imaging 2011 Lake Buena Vista, Florida, USA. http://dx.doi.org/10.1117/12.876704 Copyright 2011 Society of Photo-Optical Instrumentation Engineers. One print or electronic copy may be made for personal use only. Systematic reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited.

This paper describes the design and evaluation of a novel easy to use, tissue viability imaging system (TiVi). The system is based on the methods of diffuse reflectance spectroscopy and polarization spectroscopy. The technique has been developed as an alternative to current imaging technology in the area of microcirculation imaging, most notably optical coherence tomography (OCT) and laser Doppler perfusion imaging (LDPI). The system is based on standard digital camera technology, and is sensitive to red blood cells (RBCs) in the microcirculation. Lack of clinical acceptance of both OCT and LDPI fuels the need for an objective, simple, reproducible and portable imaging method that can provide accurate measurements related to stimulus vasoactivity in the microvasculature. The limitations of these technologies are discussed in this paper. Uses of the Tissue Viability system include skin care products, drug development, and assessment spatial and temporal aspects of vasodilation (erythema) and vasoconstriction (blanching).

Objective: Health economic evaluations provide decision makers with important information regarding the cost-effectiveness of technologies. However, such evaluations are still rare in most dental areas, and there is furthermore a need for methodological development in estimating costeffectiveness within dentistry. The purpose of this paper is to give an overview of methods used for estimating cost-effectiveness, and provide guidance for performing health economic evaluations within dentistry. Methods: Available health economics methods are discussed and analysed according to their usefulness when assessing cost-effectiveness in dentistry. Results: All types of health economic analyses may be suitable for evaluation in dentistry. It is most important that the outcome should be relevant to the decision problem. For this reason, various clinical outcomes are often used, such as DMFT or mm adjustment, number of infections, construction survival, etc. depending on what technology is assessed. It would be of value to also use quality-adjusted life-years (QALYs) as this is the most commonly used outcome measure in health economic evaluation, but this has rarely been done. Conclusion: There is a need for more health economic evaluations within dentistry to be able to use scarce resources efficiently. In this paper we discuss methods for how this can be done, with a focus on the use of outcome measures relevant for decision makers.

Objective: Health economic evaluations provide decision makers with important information regarding the cost-effectiveness of technologies. However, such evaluations are still rare in most dental areas, and there is furthermore a need for methodological development in estimating costeffectiveness within dentistry. The purpose of this paper is to give an overview of methods used for estimating cost-effectiveness, and provide guidance for performing health economic evaluations within dentistry. Methods: Available health economics methods are discussed and analysed according to their usefulness when assessing cost-effectiveness in dentistry. Results: All types of health economic analyses may be suitable for evaluation in dentistry. It is most important that the outcome should be relevant to the decision problem. For this reason, various clinical outcomes are often used, such as DMFT or mm adjustment, number of infections, construction survival, etc. depending on what technology is assessed. It would be of value to also use quality-adjusted life-years (QALYs) as this is the most commonly used outcome measure in health economic evaluation, but this has rarely been done. Conclusion: There is a need for more health economic evaluations within dentistry to be able to use scarce resources efficiently. In this paper we discuss methods for how this can be done, with a focus on the use of outcome measures relevant for decision makers.

Objective: Health economic evaluations provide decision makers with important information regarding the cost-effectiveness of technologies. However, such evaluations are still rare in most dental areas, and there is furthermore a need for methodological development in estimating costeffectiveness within dentistry. The purpose of this paper is to give an overview of methods used for estimating cost-effectiveness, and provide guidance for performing health economic evaluations within dentistry. Methods: Available health economics methods are discussed and analysed according to their usefulness when assessing cost-effectiveness in dentistry. Results: All types of health economic analyses may be suitable for evaluation in dentistry. It is most important that the outcome should be relevant to the decision problem. For this reason, various clinical outcomes are often used, such as DMFT or mm adjustment, number of infections, construction survival, etc. depending on what technology is assessed. It would be of value to also use quality-adjusted life-years (QALYs) as this is the most commonly used outcome measure in health economic evaluation, but this has rarely been done. Conclusion: There is a need for more health economic evaluations within dentistry to be able to use scarce resources efficiently. In this paper we discuss methods for how this can be done, with a focus on the use of outcome measures relevant for decision makers.

Objective: Health economic evaluations provide decision makers with important information regarding the cost-effectiveness of technologies. However, such evaluations are still rare in most dental areas, and there is furthermore a need for methodological development in estimating costeffectiveness within dentistry. The purpose of this paper is to give an overview of methods used for estimating cost-effectiveness, and provide guidance for performing health economic evaluations within dentistry. Methods: Available health economics methods are discussed and analysed according to their usefulness when assessing cost-effectiveness in dentistry. Results: All types of health economic analyses may be suitable for evaluation in dentistry. It is most important that the outcome should be relevant to the decision problem. For this reason, various clinical outcomes are often used, such as DMFT or mm adjustment, number of infections, construction survival, etc. depending on what technology is assessed. It would be of value to also use quality-adjusted life-years (QALYs) as this is the most commonly used outcome measure in health economic evaluation, but this has rarely been done. Conclusion: There is a need for more health economic evaluations within dentistry to be able to use scarce resources efficiently. In this paper we discuss methods for how this can be done, with a focus on the use of outcome measures relevant for decision makers.

Objective: Health economic evaluations provide decision makers with important information regarding the cost-effectiveness of technologies. However, such evaluations are still rare in most dental areas, and there is furthermore a need for methodological development in estimating costeffectiveness within dentistry. The purpose of this paper is to give an overview of methods used for estimating cost-effectiveness, and provide guidance for performing health economic evaluations within dentistry. Methods: Available health economics methods are discussed and analysed according to their usefulness when assessing cost-effectiveness in dentistry. Results: All types of health economic analyses may be suitable for evaluation in dentistry. It is most important that the outcome should be relevant to the decision problem. For this reason, various clinical outcomes are often used, such as DMFT or mm adjustment, number of infections, construction survival, etc. depending on what technology is assessed. It would be of value to also use quality-adjusted life-years (QALYs) as this is the most commonly used outcome measure in health economic evaluation, but this has rarely been done. Conclusion: There is a need for more health economic evaluations within dentistry to be able to use scarce resources efficiently. In this paper we discuss methods for how this can be done, with a focus on the use of outcome measures relevant for decision makers.

INTRODUCTION: Interdisciplinary differences regarding understanding the International Classification of Functioning, Disability and Health (ICF) concepts activity/participation may hinder its unifying purpose. In the ICF model, functioning (and disability) is described as a tripartite concept: 1) Body structures/functions, 2) Activities, and 3) Participation. Activities refer to an individual perspective on disability that does not tally with the basic structure of social models. OBJECTIVE: To review how activity and participation are actually used in studies of intellectual disability (ID). CONCLUSION: Based on 16 papers, four different usages of activity/participation were found. 1) Theoretical reference to tripartite ICF concept with attempts to use it. 2) Theoretical reference to tripartite ICF concept without actual use of activities. 3) "Atheoretical" approach with implicit focus on participation. 4) Theoretical reference to bipartite concept with corresponding use of terms. The highlighted studies have in common a focus on participation. However, the usage of the term "activity" differs both within and between studies. Such terminology will probably confuse interdisciplinary communication rather than facilitating it. Also, the use of an explicit underlying theory differs, from references to a tripartite to references to a bipartite concept of disability. This paper is focused on ID, but the discussed principles regarding the ICF and interdisciplinary disability theory are applicable to other diagnostic groups within rehabilitation practices.

The aim of this thesis is to contribute with knowledge concerning health-promoting conditions at work, and to investigate how individual, workplace and organisational conditions are interrelated. In the thesis, work-related flow, i.e. an experience of motivation, absorption and work enjoyment, is used as a holistic notion of occupational health. In Paper I, work-related flow is investigated in relation to decision latitude, social capital and an innovative learning climate at work. Paper II investigates whether the use of tools inspired by lean production, such as standardisation and value stream mapping, is positively associated with conditions for innovative learning in organisations. The aim of Paper III is to identify conditions for health and performance in organisation and at work; further, to investigate the association between work-related flow and performance. Paper IV reports on a longitudinal investigation of workrelated flow in relation to lean tool use and conditions at the workplace. The empirical material is based on data from 10 organisations, including 4442 employees. Papers I-III are cross-sectional, whereas Paper IV is longitudinal. Papers II-IV utilise multilevel analyses. The results show that decision latitude, social capital and an innovative learning climate are associated with an increase in work-related flow (Papers I, III & IV), and with performance (Paper III). Individuals’ decision latitude enables an increased benefit from the social capital and innovative learning climate at work (Paper I). The effect of tools inspired by lean production on work-related flow (Papers III & IV), and on conditions for innovative learning (Paper II) differs, depending on which tools are used, and on workplace conditions. These tools enable innovative learning mainly where decision latitude is low (Paper II), and it is primarily the lean tool value stream mapping which has the potential to create an arena for innovative learning (Paper II) and work

The immune-to-brain signaling is a critical survival factor when the body is confronted by pathogens, and in particular by microorganisms. During infections, the ability of the immune system to engage the central nervous system (CNS) in the management of the inflammatory response is just as important as its ability to mount a specific immune response against the pathogen, since the CNS can provide a systemic negative feed-back to the immune activation by release of stress hormones and also can prioritize the usage of the energy resources by the vital organs. Prostaglandin E2 (PGE2) and proinflammatory cytokines were among the first mediators to be identified to participate in the immuneto-brain signaling, a process that is clinically recognized by the development of manifestations of common illness such as fever, anorexia, decreased social interactions, lethargy, sleepiness, and hyperalgesia. In this thesis the contribution of PGE2 to the immune-to-brain signaling was further characterized at the blood-brain-barrier (BBB) and in the anterior preoptic area (POA) of the hypothalamus (i.e. the thermoregulatory region or, in sickness, the fever generating region). BBB is the major interface region between peripheral circulating cytokines and the neuronal parenchyma and a critical source of PGE2. Using chimeric mice lacking the inducible enzyme for PGE2 synthesis, microsomal PGE synthase-1 (mPGES-1), in either hematopoietic or non-hematopoietic cells, we demonstrate in paper I that brain endothelial cells are the critical source of PGE2 in BBB during peripheral inflammation. For the demonstration of the mPGES-1 expression in the BBB cells we developed in paper I a method for enzymatic dissociation of these cells, followed by fluorescence activated cell sorting (FACS). Using the same method, we show in paper II that the BBB response to immune stimuli is towards an increased production of PGE2 in endothelial cells and an increased sensitivity of these cells for pro-inflamm

The incidence of cutaneous malignant melanoma (CMM) is steadily increasing. Most of the patients have thin CMM with a good prognosis and a 5-year survival of about 90%. The prognosis is highly related to tumour thickness and clinical stage at diagnosis. Effective systemic treatment for patients with metastatic disease has only recently been available. This thesis aims to increase knowledge of trends in tumour thickness, prognostic factors, socioeconomic differences and medical costs in patients with CMM. The population-based Swedish melanoma register is the main source of data in all papers in the thesis. Papers I-III include patients from all of Sweden while paper IV is delimited to the County of Östergötland. Cox regression and logistic regression are the main multivariable methods used. Paper IV is focused on stage-specific costs of CMM by comparing direct healthcare costs to a general population. For men, there has been a shift over time towards thinner tumours at diagnosis accompanied by an improved survival. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men. Tumour ulceration, tumour thickness and Clark’s level of invasion all showed significant independent long-term prognostic information in T1 CMMs. By combining these factors, three distinct prognostic subgroups were identified. Lower level of education was associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. The direct healthcare costs for CMM patients were significantly higher than for the general population, independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs. Even though the survival among Swedish patients with CMM is among the highest in the world and still seems to improve, the results of this thesis emphasise the need of improved early detection strategies. This may be of particular concern in men, o

Every day and in all parts of the world, humans experience different grades of wounding and tissue loss of the skin, thus initiating one of the most complex biological processes. Acute and chronic wounds, as well as the additional problem of skin scarring, involve not only great suffering for the patient but also extensive health care costs for the society. Although the wound-healing process is a wellstudied field much knowledge must be gained to unlock the door to regenerative pathways in humans. Epidermis heals by complete regeneration, but dermal and full thickness injuries heal with fibrosis and scar formation. In Papers I and II, we studied whether dermal scarring could be turned into regeneration by using two different types of threedimensional dermal scaffolds. In Paper I, we studied a solid scaffold made of poly(urethane urea), initially in vitro then followed by in vivo studies. In Paper II, we intradermally injected a liquid three-dimensional scaffold consisting of porous gelatin spheres in human healthy volunteers. Both materials showed ingrowth of functional fibroblasts and blood vessels and appeared to stimulate regeneration while slowly degrading. This finding could be of significant clinical importance, for example in burn wound care or after cancer surgery. In Papers III and IV, we wanted to study the effects of amniotic fluid and hyaluronic acid on adult wound healing, because early fetal wounds re-epithelialize rapidly and naturally heal dermis by regeneration without the need of a dermal scaffold. Amniotic fluid, naturally rich in hyaluronic acid, induced an accelerated reepithelialization of adult human wounds in vitro, and hyaluronic acid seemed to be important for this effect. Stimulation with exogenous hyaluronic acid in vivo induced accelerated re-epithelialization and an altered protein expression in healthy human volunteers. The inflammatory phase of wound healing, as measured by tissue viability imaging, was not affected by hyaluronic acid

This thesis includes four papers based on three different prospective cohort studies on injury characteristics in men’s professional football. The same general methodology was used in all papers. Time-loss injuries and player individual exposure was registered for match and training separately. The general aim was to investigate potential internal and external risk factors for injury, with a focus on age, playing position, time in professional football, playing surface (artificial turf and natural grass), changes between surfaces and climate; and to evaluate the study methodology. Paper I was based on data collected between 2001 and 2010 from 26 top professional clubs in Europe; the UCL injury study. In total, 6140 injuries and 797 389 hours of exposure were registered. A decreased general injury rate was observed for newcomers compared with established players (hazard ratio (HR), 0.77; 95% CI 0.61-0.99). Using goalkeepers as a reference, all outfield playing positions had significantly higher age-adjusted injury rates. Using players aged ≤ 21 years as a reference, the overall adjusted injury rate increased with age, with a peak injury rate among players aged 29 to 30 years (HR, 1.44; 95% CI, 1.24-1.68). Paper II and Paper III are based on data collected during two consecutive seasons, 2010 and 2011, in the Swedish and Norwegian male first leagues. In total, 2186 injuries and 367 490 hours of football exposure were recorded. No statistically significant differences were found in acute injury rates on artificial turf (AT) compared with natural grass (NG) during match play (rate ratio, 0.98, 99% CI 0.79-1.22) or training (rate ratio 1.14, 99% CI 0.86-1.50) when analysing at the individual player level. However, when analysing at the club level, clubs with AT installed at their home arena had a significantly higher acute training injury rate (rate ratio 1.31, 99% CI 1.04-1.63) and overuse injury rate (rate ratio 1.38, 99% CI 1.14-1.65) compared to clubs with NG instal

The immune-to-brain signaling is a critical survival factor when the body is confronted by pathogens, and in particular by microorganisms. During infections, the ability of the immune system to engage the central nervous system (CNS) in the management of the inflammatory response is just as important as its ability to mount a specific immune response against the pathogen, since the CNS can provide a systemic negative feed-back to the immune activation by release of stress hormones and also can prioritize the usage of the energy resources by the vital organs. Prostaglandin E2 (PGE2) and proinflammatory cytokines were among the first mediators to be identified to participate in the immuneto-brain signaling, a process that is clinically recognized by the development of manifestations of common illness such as fever, anorexia, decreased social interactions, lethargy, sleepiness, and hyperalgesia. In this thesis the contribution of PGE2 to the immune-to-brain signaling was further characterized at the blood-brain-barrier (BBB) and in the anterior preoptic area (POA) of the hypothalamus (i.e. the thermoregulatory region or, in sickness, the fever generating region). BBB is the major interface region between peripheral circulating cytokines and the neuronal parenchyma and a critical source of PGE2. Using chimeric mice lacking the inducible enzyme for PGE2 synthesis, microsomal PGE synthase-1 (mPGES-1), in either hematopoietic or non-hematopoietic cells, we demonstrate in paper I that brain endothelial cells are the critical source of PGE2 in BBB during peripheral inflammation. For the demonstration of the mPGES-1 expression in the BBB cells we developed in paper I a method for enzymatic dissociation of these cells, followed by fluorescence activated cell sorting (FACS). Using the same method, we show in paper II that the BBB response to immune stimuli is towards an increased production of PGE2 in endothelial cells and an increased sensitivity of these cells for pro-inflamm

Improvements in health technology raise hopes for better patient outcomes and a more efficient delivery of health care. However, the processes of diffusion and implementation of new health technology have been shown to be complicated and to pose a number of challenges for the healthcare sector. Many at tempts have been made to influence and manage the introduction and diffusion of health technology. One prominent example is the Swedish nat ional guidelines that aim at influencing both clinical and political decision - making in the health sector. The overall aim of this thesis is to describe and analyze the factors influencing the diffusion and economic consequences of the introduction of a new technology with large variations in use, and to explore the process of implementation of nationally produced guidelines as an instrument for improv ing effectiveness and equity. The empirical focus is kept on the biological drugs (bDMARDs) for rheumatoid arthritis (RA), since they implied a substantial treatment change when they were first int roduced and they are relatively costly; and on the national guidelines for cardiac care, since they were the first nat ional guidelines, hence allowing a long-term perspect ive in the exploration of their implementat ion. Paper I presents a register study that uses data from national and regional registries on healt hcare use and work disability of patients with RA and shows that there was a 32 percent increase in the total fixed cost of RA during 1990-2010, mainly after the introduct ion of bDMARDs. Paper II shows that choosing to initiate treatment with bDMARDs varied substantially among 26 rheumatologists presented with hypothetical patient cases, and that there were also disparities between rheumatologists practicing in the same clinic. Paper III presents data from the Swedish Rheumatology Quality Register covering 4010 patients with RA, and shows that when using multivariate logistic regression to adjust for patient characterist ic

Angiogenesis is essential for physiological processes including embryonic development, tissue regeneration, and reproduction. Under various pathological conditions the same angiogenic process contribute to the onset, development, and progression of many human diseases including cancer, diabetic complications, ocular disease, chronic inflammation and cardiovascular disease. Vascular endothelial growth factor (VEGF) is a key angiogenic factor for physiological and pathological angiogenesis. In addition to its strong angiogenic activity, VEGF also potently induces vascular permeability, often causing tissue edema in various pathological tissues. VEGF transduces its vascular signal through two tyrosine kinase receptors-VEGFR1 and VEGFR2, the latter being a functional receptor that mediates both angiogenic and vascular permeability effects. To study physiological and pathological functions of VEGF, we developed novel zebrafish disease models that permit us to study hypoxia-induced retinopathy and cancer metastasis processes. We have also administered anti-VEGF and anti-VEGFR specific antibodies to healthy mice to study the homeostatic role of VEGF in the maintenance of vascular integrity and its functions in various tissues and organs. Finally, using a zebrafish model, we evaluated if VEGF expression is regulated by circadian clock genes. In paper I, we developed protocols that create hypoxia-induced retinopathy in adult zebrafish. Adult fli1:EGFP zebrafish were placed in hypoxic water for 3-10 days with retinal neovascularization being analyzed using confocal microscopy. This model provides a unique opportunity to kinetically study the development of retinopathy in adult animals using non-invasive protocols and to assess the therapeutic efficacy of orally administered anti-angiogenic drugs. In paper II, we developed a zebrafish metastasis model to dissect the complex events of hypoxia-induced tumor cell invasion and metastasis in association with angiogenesis at the sin, Blodkärlsnybildning, så kallad angiogenes, är viktigt för fysiologiska processer vid embryonal utveckling, vävnadsregenerering och reproduktion. Samma angiogena process kan också under olika sjukdomstillstånd bidra till uppkomst, utveckling och progress av många sjukdomar, såsom cancer, diabeteskomplikationer, ögonsjukdomar, kronisk inflammation samt hjärtkärlsjukdom. Vascular endothelial growth factor (VEGF) är mycket viktig för fysiologisk och patologisk angiogenes. Utöver sin starka angiogena effekt inducerar VEGF även ökad kärlpermeabilitet, som ofta orsakar ödem. VEGF utövar sin effekt på kärlen via två tyrosinkinasreceptorer: VEGFR1 och VEGFR2, där den senare är en funktionell receptor som förmedlar både angiogena signaler och har effekter på vaskulär permeabilitet. För att öka möjlgheterna att studera fysiologiska och patologiska funktioner av VEGF, har vi utvecklat sjukdomsmodeller i zebrafisk - hypoxi-inducerad retinopati och metastasering av cancer. Vi har också givit anti-VEGF och anti-VEGFR-specifika antikroppar till friska möss för att utvärdera VEGFs roll vid stabiliseringen av kärlfunktionen i olika vävnader och organ. Slutligen,utvärderade vi om expressionen av VEGF regleras av dygnsrytmen genom så kallade klock-gener. I papper I utvecklade vi en modell för hypoxiinducerad retinopati hos vuxna zebrafiskar. Vuxna fli1:EGFP zebrafiskar placeras i syrefattigt vatten i 3-10 dagar, varpå retinal nybildning av kärl analyserades. Denna modell ger en unik icke-invasiv möjlighet att studera kinetiskt utveckling av retinopati och den möjliggör bedömning av terapeutiska effekter av oralt givna anti-angiogena läkemedel. I papper II utvecklade vi en zebrafiskmodell för utvärdering av cancermetastasering, som möjliggör studier av detaljerade delprocesser vid hypoxi-inducerad tumörcellsinvasion och metastasering i samband med angiogenes på encellig nivå. I denna modell användes fluorescerande Dil-märkta humana- eller mustumörceller som implanterades vid den perivit

Background Sleep disorders are known to increase in prevalence during pregnancy, and associations between disturbed sleep during pregnancy and adverse outcomes for mother and child have been reported in a number of studies. However, most of these studies were retrospective and too small to satisfactorily demonstrate the association. Aims To prospectively investigate the development of snoring during pregnancy and assess if there is an association between snoring and sleepiness or adverse pregnancy outcomes. To study the development of restless legs syndrome during and after pregnancy, and whether it is associated with snoring or other pregnancy-related symptoms. To investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy, using screening instruments. To objectively evaluate sleep disordered breathing in pregnant women compared to non-pregnant controls and to evaluate differences in Epworth Sleepiness Scale scores between the two groups. Methods Questionnaires containing subjective rating of snoring, Epworth Sleepiness Scale and symptoms of restless legs were used in all studies. Information from the medical records of the pregnant women was also utilized. For objective evaluation of sleep disordered breathing, nocturnal respiratory recordings were used. In the research for the first three papers the same cohort of 500 pregnant women was followed on three occasions during pregnancy and also after delivery, and for the last paper, 100 other pregnant women were compared to 80 nonpregnant controls. Results and conclusions Both snoring and restless legs syndrome increase during pregnancy, but this had no convincing impact on obstetric outcome. Sleep recordings could not verify an increased prevalence of obstructive sleep apnea among pregnant women. Restless legs syndrome was associated with snoring and could persist after delivery. Women who had high scores on the Epworth Sleepiness Scale in the

The aim of this thesis is to contribute with knowledge concerning health-promoting conditions at work, and to investigate how individual, workplace and organisational conditions are interrelated. In the thesis, work-related flow, i.e. an experience of motivation, absorption and work enjoyment, is used as a holistic notion of occupational health. In Paper I, work-related flow is investigated in relation to decision latitude, social capital and an innovative learning climate at work. Paper II investigates whether the use of tools inspired by lean production, such as standardisation and value stream mapping, is positively associated with conditions for innovative learning in organisations. The aim of Paper III is to identify conditions for health and performance in organisation and at work; further, to investigate the association between work-related flow and performance. Paper IV reports on a longitudinal investigation of workrelated flow in relation to lean tool use and conditions at the workplace. The empirical material is based on data from 10 organisations, including 4442 employees. Papers I-III are cross-sectional, whereas Paper IV is longitudinal. Papers II-IV utilise multilevel analyses. The results show that decision latitude, social capital and an innovative learning climate are associated with an increase in work-related flow (Papers I, III & IV), and with performance (Paper III). Individuals’ decision latitude enables an increased benefit from the social capital and innovative learning climate at work (Paper I). The effect of tools inspired by lean production on work-related flow (Papers III & IV), and on conditions for innovative learning (Paper II) differs, depending on which tools are used, and on workplace conditions. These tools enable innovative learning mainly where decision latitude is low (Paper II), and it is primarily the lean tool value stream mapping which has the potential to create an arena for innovative learning (Paper II) and work

This thesis includes four papers based on three different prospective cohort studies on injury characteristics in men’s professional football. The same general methodology was used in all papers. Time-loss injuries and player individual exposure was registered for match and training separately. The general aim was to investigate potential internal and external risk factors for injury, with a focus on age, playing position, time in professional football, playing surface (artificial turf and natural grass), changes between surfaces and climate; and to evaluate the study methodology. Paper I was based on data collected between 2001 and 2010 from 26 top professional clubs in Europe; the UCL injury study. In total, 6140 injuries and 797 389 hours of exposure were registered. A decreased general injury rate was observed for newcomers compared with established players (hazard ratio (HR), 0.77; 95% CI 0.61-0.99). Using goalkeepers as a reference, all outfield playing positions had significantly higher age-adjusted injury rates. Using players aged ≤ 21 years as a reference, the overall adjusted injury rate increased with age, with a peak injury rate among players aged 29 to 30 years (HR, 1.44; 95% CI, 1.24-1.68). Paper II and Paper III are based on data collected during two consecutive seasons, 2010 and 2011, in the Swedish and Norwegian male first leagues. In total, 2186 injuries and 367 490 hours of football exposure were recorded. No statistically significant differences were found in acute injury rates on artificial turf (AT) compared with natural grass (NG) during match play (rate ratio, 0.98, 99% CI 0.79-1.22) or training (rate ratio 1.14, 99% CI 0.86-1.50) when analysing at the individual player level. However, when analysing at the club level, clubs with AT installed at their home arena had a significantly higher acute training injury rate (rate ratio 1.31, 99% CI 1.04-1.63) and overuse injury rate (rate ratio 1.38, 99% CI 1.14-1.65) compared to clubs with NG instal