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Clinical Laserthermia Systems AB (CLS) has developed a treatment protocol named immunostimulating interstitial laser thermotherapy (imILTCLS) which is intended to improve current treatment regimens for metastatic cancer diseases. It aims at a controlled local tumor ablation with a subsequent release of tumor specific antigens resulting in a systemic immune activation against the remaining cancer cells. The approach has its origins in the laser-induced interstitial thermotherapy procedure and is based on a proprietary and patented technique to optimize the immunological effect. CLS has gained know-how through long experience both in clinical and pre-clinical studies of the application, laser technology, thermometry, and expertise in regulatory affairs. However, CLS does not have the in-house expertise required for fiber development and production. Therefore the company has actively searched for industrial partners to collaborate with on the design and development of a fiber delivery system tailored to imILTCLS. The aim of this collaboration is to design an application-specific laser fiber that allows the treatment of a wider range of tumors with a single treatment and overcomes the limitations of currently available laser fibers, such as the limited achievable lesion sizes due the maximum power that can be used without carbonizing tissue. The present contribution gives a short overview about the current development steps within the network of developers, industry and users.

As the housing construction industry experiences a high pressure, many housing construction companies are increasing their production. HSB Bostad AB, being one of these companies, has high ambitions regarding remaining competitive and successful within the industry. It has shown that many of the errors made by the company, have been done before without being learnt from. As a step in the direction of never repeating mistakes and errors made, HSB Bostad AB has requested that a study is made regarding their need for knowledge sharing routines. This thesis has therefore investigated how knowledge sharing is applied at HSB Bostad AB as well as studied the theories of collective and reflective learning as a potential tool. The case study has been done by an abductive approach, winding a literature study with empirics from observations and interviews. The interviewees were chosen to reflect the employees of the company to a maximum range, with the characteristics of experience, gender, corporate position and divisional belonging. Through the interviews and observations, it was found that HSB Bostad AB is unconsciously working with activities and processes providing opportunities of knowledge sharing. One aspect was the lack of a common vision and understanding for the concept as well as the lack of opportunities for collective reflection. The conclusions made were that a joint, corporal vision and strategy of knowledge sharing could give HSB Bostad AB an advantage in the direction of remaining competitive and successful. Additionally, more specific and explicit recommendations of how to improve their current areas of knowledge sharing are given. Medan byggbranschen upplever en hög efterfrågan på bostäder ökar många byggbolag sina produktionsvolymer. HSB Bostad AB, som är ett av dessa bolag, har höga ambitioner att vara fortsatt konkurrenskraftiga och framgångsrika i branschen. Det har visat sig att många av felen som bolaget upplever återupprepas men utan att lärdomar dragits. Som ett steg i riktningen mot att aldrig upprepa misstag och fel som gjorts har HSB Bostad AB efterfrågat att en studie genomförs gällande deras behov av kunskapsspridningsrutiner. Denna studie har därför undersökt hur kunskapsspridning kan implementeras, både i allmänhet samt med ett fokus på HSB Bostad AB. Vidare har studien undersökt hur kollektiv och reflektivt lärande kan användas i kunskapsspridningssyfte. Denna fallstudie har gjorts med en abduktiv metod där en litteraturstudie varvats med observationer och intervjuer. Intervjurespondenterna valdes för att spegla medarbetarna på bolaget i så stor mån som möjligt med hänsyn till erfarenhet, kön, anställningsgrad samt avdelningstillhörighet. Efter genomförda intervjuer och observationer kunde det urskiljas att HSB Bostad AB arbetar omedvetet med kunskapsspridning genom både aktiviteter och processer. Det som förvånade mest av empirin var bristen på en gemensam vision och förståelse för begreppet kunskapsspridning samt bristen på möjligheter för kollektiv reflektion. Slutsatsen av studien innefattar att en gemensam bolagsmässig vision och strategi för kunskapsspridning kan ge HSB Bostad AB fördel på vägen mot att fortsatt vara konkurrenskraftiga och framgångsrika. Dessutom ges specifika och explicita rekommendationer för hur deras nuvarande områden för kunskapsspridning kan förbättras.

Five biochemical variables, S-Ca, U- Ca, S-P, U-P and S-ALP, all involved in calcium metabolism, have been investigated in 86 epileptics on long-term medication. We found hypocalciuria in half of the epileptics and increased S-ALP in one third. In contrast to earlier reports there was no hypocalcemia, whereas hypercalcemia was found in 7 epileptics. We have previously reported a high frequency of fractures in these epileptics. An increased fracture rate was found in the 13 epileptics with both hypocalciuria and increased S-ALP, indicating osteomalacia.

A 57-year-old male patient with metastasizing non-beta islet cell carcinoma of the pancreas is described. Both gastrin and VIP levels were elevated and the patient suffered from a syndrome of pancreatic cholera and hyperacidity. The tumour contained gastrin and VIP as demonstrated by immunofluorescence. The patient also had a history of familial renal stone formation and parathyroid nodular hyperplasia. Resection of pancreatic tumour in 1973 resulted in four years without symptoms. In 1977 definite signs of multiple hepatic metastases appeared. These signs disappeared after streptozotocin given in a dosage of 2 g three times at weekly intervals. The patient had remained well for 20 months after this treatment. The causative agents for the clinical syndrome in this case are discussed in view of circulating hormone levels.

A case of glucagonoma syndrome with necrolytic migratory erythema, glossitis, anemia, hyperglucagonemia and a malignant, pancreatic A-cell tumour in a 68-year-old male is described. Gel filtration of the highly elevated circulating glucagon immunoreactivity (2200 pg/ml) demonstrated 60% pancreatic glucagon and 30% “proglucagon”. Metabolic studies before operation demonstrated suppression of the total plasma glucagon concentration on oral glucose tolerance test, unchanged total plasma glucagon concentration during intravenous glucose tolerance test and insulin-induced hypoglycemia. Administration of arginine was followed by a rise in both the pancreatic glucagon and the “proglucagon”, whereas alanine increased only the pancreatic glucagon. The plasma somatostatin level was immeasurable preoperatively. Somatostatin infusion completely suppressed the release of the pancreatic glucagon but did not significantly affect the “proglucagon”. After removal of the tumour the skin lesions disappeared and the total plasma glucagon values fell to normal levels (120 pg/ml). Also, other abnormal laboratory findings returned to normal, including the preoperatively observed renal glucosuria.

Då en människa drabbas av en kris kan utomstående hjälp krävas för att hantera och bearbeta de existentiella frågor som uppkommer. Ett allvarligt hot mot kvinnors hälsa är våld i nära relationer. Föreliggande studie har undersökt jourkvinnors stödsamtal med våldsutsatta kvinnor på kvinnojourer. Syftet var att undersöka vilken typ av existentiella frågor som personalen möter i stödsamtalen, samt att studera om och i så fall på vilket sätt utrymmet för dessa frågor i stödsamtal bidrar till ett ökat välmående för kvinnor utsatta för mäns våld. Semistrukturerade intervjuer genomfördes med sex jourkvinnor runt om i landet. Hermeneutisk analys med existentialistisk förankring vägledde fram till slutledning. Studiens resultat visar att några av de vanligaste existentiella frågor som uppkommer i stödsamtalen är frågor relaterade till kvinnans identitet samt hennes upplevelse av skuld i koppling till olika val hon gjort. Betydelsen av utrymme för existentiella frågor har relevans för våldsutsatta kvinnor i stödsamtalen.

Systematic evaluation of child and adolescent psychiatric outpatient treatment is important but time-consuming. The aim of this paper was to study whether Interactive Voice Response (IVR) is a more effective method than a questionnaire sent by post when following up outpatient treatment in child and adolescent psychiatry. Eighty patients were recruited from a child and adolescent psychiatric outpatient unit in Sweden. One parent of each of the patients was randomized to complete the BCFPI follow-up form, using either IVR (n = 40) or postal survey (n = 40) one month after discharge. The response rate for complete answers was 65% in the IVR group and 38% in the postal survey group (p = 0.014). There was less need for reminders in the IVR group (p = 0.000). IVR is a promising and cost-effective method for evaluating evidence-based treatment in child and adolescent psychiatric care.

I uppsatsen undersöks hur debatten om ECT konstrueras av de två sociala aktörerna Socialstyrelsen samt Kommittén för Mänskliga Rättigheter, KMR. Det analyserade materialet består av aktörernas publicerade texter på Internet. Kritisk diskursanalys med Norman Faircloughs tredimensionella modell har utgjort studiens ansats. Frågeställningarna har varit; vilka diskurser kan identifieras samt hur kommer dessa till uttryck i ord av de skilda sociala aktörerna involverade i debatten? Hur ser relationerna mellan identifierade diskurser ut? Vilka funktioner fyller de identifierade diskurserna? Analysens mest framträdande resultat påvisar en tydlig medikaliseringsdiskurs samt en antipsykiatrisk diskurs i det empiriska materialet. De sociala aktörerna företräder en förespråkande diskurs respektive en motståndsdiskurs och debatten innebär en hegemonisk kamp omkring behandlingsmetoden ECT och dess legitimitet. Diskussionen mellan parterna förs till stor del genom deras inställning till behandlingen vilken här analyseras diskursivt. The paper examines how the debate on ECT is constructed by the two social actors Socialstyrelsen (the Swedish social board) and KMR (the Swedish branch of the American association Citizens Commission on Human Rights, CCHR). Analysis material consists of texts published on the Internet by these social actors. The method of analysis used in the essay has been critical discourse analysis, focusing on the three-dimensional model developed by Norman Fairclough. The research questions have been: which discourses can be identified and how are these reflected in the words of the two different social actors involved in the debate? What are the relationships between identified discourses? What features does the identified discourses fill? The most prominent results in the analysis show a clear medicalization discourse and an anti-psychiatry discourse in the empirical material. The social actors represent an advocacy and a resistance discourse, and the debate involves a hegemonic struggle on the treatment method ECT and its legitimacy. The discussions between the parties are to a large extent made out by their approach to treatment which is here analyzed discursively.

Objective: This paper describes a new flow phantom, designed to simulate slow, small volume flow, such as that found in the capillary beds. Existing flow phantoms imitate flow in blood vessels with a narrow flow area and the flow velocities are normally not extendible down to capillary blood flow velocities. Recent progress in ultrasonic blood perfusion measurements has resulted in devices that operate at blood flow velocities of the order 0.1−5 m/s and flow that is spatially and directionally distributed over the sample volume. Method: The phantom uses a ball of spatially random-oriented thin plastic tubes to carry scatterers through the sample volume. To avoid stationary echoes, and thereby ensure that the ultrasound reflections emanate mainly from the circulating blood mimicking particle suspension inside the tubing, the surrounding liquid has been acoustically matched to the tubing material. Results: The phantom has been tested on a novel blood perfusion measurement equipment and shown to set up a reasonably reproducible approximation of blood perfusion in tissue. Conclusion: It is believed that the design of the phantom is satisfactory for mimicking blood perfusion.

The incidence of recurrence and of hypothyroidism was determined in all new patients treated for thyrotoxicosis during the period 1970-1974 in an unselected, well-defined urban population. A total of 309 patients were followed up for a median time period of 108 (1-192) months. There was a cumulative incidence of 51% recurrence in patients who were treated with antithyroid drugs for Graves' thyrotoxicosis, whereas after surgery or radioiodine treatment there were few recurrences, but 32% and 78% cumulative incidences of hypothyroidism. There were no recurrences after surgery or radioiodine treatment in patients with toxic multinodular goitre or solitary toxic adenoma, but 29% and 40% cumulative incidences of hypothyroidism following radioiodine treatment. Late hypothyroidism occurred after surgery for Graves' thyrotoxicosis, and in all groups treated with radioiodine. Thus it is advisable that all patients with Graves' thyrotoxicosis, regardless of treatment, and all patients with toxic multinodular goitre or solitary toxic adenoma treated with radioiodine, should be followed up for many years, and probably for life.

A novel method for noninvasive measurement of viscosity is proposed. The method is based on acoustic streaming, which can be induced by ultrasound in a liquid enclosed in a container. Measurements of the streaming velocity, obtained with wetted transducers at 10.4 MHz, show that it is inversely proportional to the viscosity of the liquid. Since the ultrasound Doppler technique can be used to measure flow velocities of enclosed liquids containing scatterers, the described method would appear to be well suited for the assessment of the viscosity or changes in the viscosity of such liquids enclosed in sealed containers. This opens up new possibilities in quality control of sterile packaged products such as milk and blood. Accuracy of the method in the reported experiments is found to be within ±6%.

A measurement system for evaluating ultrasound fields is presented. The system utilizes a PVDF hydrophone and a mechanical scanning device. For continuous wave (CW) ultrasound, a high sensitivity is achieved by using a narrow band technique. The high sensitivity is demonstrated in a recording of the beam profile from an air transducer. Recordings from fetal Doppler equipment shows that, due to interference between the multiple transmitters, a high spatial resolution is needed in the field measurements in order to obtain correct values for peak intensities.

The need to develop clinical methods for the noninvasive monitoring of regional blood perfusion, i.e., the blood flow through the very fine capillaries in body tissue, has long been felt. Hitherto existing methods exhibit limitations, such as insufficient measurement depth and poor time- or space-resolution, which restrict the measurements that can be performed. Dymling (1982) introduced a new CW Doppler ultrasound method for noninvasive blood perfusion measurement which might be one possible solution to this problem. Preliminary experiments indicated a correlation between blood flow and measured perfusion value. Unexpectedly large variations in the recorded perfusion values lead to further investigation of the method, both in vitro using a specially designed flow phantom and in vivo. This study indicates that at least some of the large variations recorded are the result of measurement errors caused by movement artifacts or ultrasonic signal interferences. Methods to diminish the effects of these artifacts are discussed.

Syftet med studien är att undersöka hur muslimska föräldrar upplever mötet med den svenska förskolan. Vilka problem uppstår enligt föräldrarna och hur tycker de att de blir bemötta av förskolepersonalen. Jag valde att använda mig av intervjuer som metod. Jag intervjuade sammanlagt fyra muslimska föräldrar. Resultatet visar att föräldrarna bland annat tycker att det är problematiskt att få barnen att följa de religiösa föreskrifter som föräldrarna vill då de är i förskolan. En del av föräldrarna tyckte även att språket och de många frågor som förskolepersonalen ställde kring deras religion utgjorde en svårighet i mötet med den svenska förskolan. Oron att förlora sina barn totalt till den svenska kulturen och att barnen ofta hamnade i kläm mellan den egna och den svenska kulturen fanns också där bland föräldrarna.

Validerat; 20101217 (root)

A method for noninvasive measurement of viscosity, based on acoustic streaming, is described. The induced streaming velocity, which is measured by an ultrasonic Doppler technique, is used as a measure of the viscosity of the liquid. Experiments were performed on a glycerin/water mixture with a transmitted sound frequency of 10.4 MHz. The viscosity was varied from 40 mPa-s to 330 mPa-s by changing the temperature of the experimental liquid. Transmitted sound intensity was varied up to 640 mW/cm/sup 2/, yielding streaming velocities up to 14 mm/s. The streaming velocity is reported to be proportional to the sound intensity and inversely proportional to the viscosity of the liquid. Experiments on milk turning sour are also reported. Since ultrasound propagates through most materials for enclosing liquids, the method is suited for the assessment of the viscosity of liquids in sealed containers. >

Due to its sensitivity to measurement artifacts, the ultrasonic Doppler technique has not yet become a clinically useful tool for blood perfusion measurements. One of these measurement artifacts is caused by ultrasonic wave interference in combination with the small changes of structures inside the ultrasonic field. These changes are a result of variations in blood pressure, small movements in muscles, and involuntary movements of the transducer. The changes alter the ultrasonic interference pattern, causing fluctuations in the measured perfusion value. In this paper a new multifrequency technique for blood perfusion measurement is presented. The technique is based on a multifrequency setup, with four ultrasonic frequencies simultaneously transmitted with the same transducer. It is shown that by averaging the measured values obtained from each frequency, the sensitivity to ultrasonic wave interference can be lessened. Measurement results from both in vitro and in vivo experiments are presented.

A new ultrasonic method for fluid property measurements is described. The method uses ultrasound to generate acoustic streaming in a fluid. The resulting flow velocity will vary due to several viscous parameters of the fluid. If there are acoustic scatterers in the fluid, it will be possible to monitor the resulting flow velocity with an ultrasound Doppler device. The same acoustic energy is then utilized both to generate the acoustic streaming in the medium and to measure the resulting flow. The method seems to be very well suited for monitoring biological processes. Of special interest, for measurements on contaminated blood or on fluids in a fermentation process, is the method's ability to investigate liquids in a completely closed vessel.

A diagnostic tool for noninvasive evaluation of microcirculatory blood flow using continuous-wave CW Doppler ultrasound is presented. In this study, the properties of this method are investigated both theoretically and experimentally. The method utilizes a nondirectional CW Doppler flowmeter. Blood perfusion in tissue is shown to be proportional to the integral ∫ fS(f)df where S(f) is the Doppler power spectrum and f is the Doppler frequency. The instrumentation needed to implement the method is described. Using an experimental flow model it is demonstrated that the above integral is proportional to the product between the number of scatterers in the sample volume of the Doppler probe and the mean speed of these scatterers. This is true even for low flow velocities (down to 1 mm/s). The results from in-vivo measurements on tissues in the finger, and the calf demonstrate that the method can monitor changes in the blood perfusion. It also shows the present limitations of the method due to movement artefacts.

A total of 138 male body builders who regularly attended a gym participated anonymously in a study of the use of anabolic-androgenic steroids in relation to side-effects, blood pressure, body mass index (BMI; kg m−2), training frequency, social background, occupation, knowledge and attitudes to steroid use. Fifty-three of the 138 body builders had used anabolic-androgenic steroids for a median duration of 2 years. Steroid use was linked to a higher BMI and more frequent training. Seventy-five per cent (n = 18) of those attending body building for competition, and 24% (n = 11) of those attending to improve their sense of well-being, used anabolic-androgenic steroids. Of all body builders, 94% considered anabolic-androgenic steroids to be dangerous. Of the users, 81% experienced side-effects, but 74% still intended to continue steroid medication.