User perspectives on the Swedish Maternal Health Care Register

Background: Established in 1999, the Swedish Maternal Health Care Register (MHCR) collects data on pregnancy, birth, and the postpartum period for most pregnant women in Sweden. Antenatal care (ANC) midwives manually enter data into the Web-application that is designed for MHCR. The aim of this study was to investigate midwives? experiences, opinions and use of the MHCR. Method: A national, cross-sectional, questionnaire survey, addressing all Swedish midwives working in ANC, was conducted January to March 2012. The questionnaire included demographic data, preformed statements with six response options ranging from zero to five (0 = totally disagree and 5 = totally agree), and opportunities to add information or further clarification in the form of free text comments. Parametric and non-parametric methods and logistic regression analyses were applied, and content analysis was used for free text comments. Results: The estimated response rate was 53.1%. Most participants were positive towards the Web-application and the included variables in the MHCR. Midwives exclusively engaged in patient-related work tasks perceived the register as burdensome (70.3%) and 44.2% questioned the benefit of the register. The corresponding figures for midwives also engaged in administrative supervision were 37.8% and 18.5%, respectively. Direct electronic transfer of data from the medical records to the MHCR was emphasised as significant future improvement. In addition, the midwives suggested that new variables of interest should be included in the MHCR ? e.g., infertility, outcomes of previous pregnancy and birth, and complications of the index pregnancy. Conclusions: In general, the MHCR was valued positively, although perceived as burdensome. Direct electronic transfer of data from the medical records to the MHCR is a prioritized issue to facilitate the working situation for midwives. Finally, the data suggest that the MHCR is an underused source for operational planning and quality assessment in local ANC centres.

Effekter av icke-farmakologiska metoder vid beteendemässiga och psykiska symtom hos personer som lever med Alzheimers sjukdom : En litteraturöversikt

Bakgrund: Alzheimers sjukdom (AD) är den vanligaste formen av demenssjukdomar och antalet människor som insjuknar i AD förväntas öka kraftigt med tiden. Dessutom kännetecknas personer med AD ofta av beteendemässiga och psykiska symtom (BPSD) som kan innefatta agitation, depression, vanföreställningar, oro, ångest, hallucinationer, sömnrubbningar, rastlöshet och apati. Dessa symtom kan orsaka lidande hos patienten och är svåra att hantera för både vårdgivaren och anhöriga, samt försvårar omvårdnadsarbetet. Syftet var att beskriva icke-farmakologiska metoder och effekter av dessa metoder vid omvårdnad av personer med Alzheimers sjukdom som har beteendemässiga och psykiska symtom. Metod: En litteraturöversikt bestående av 16 utvalda kvantitativa forskningsartiklar har genomförts. Artiklarna publicerades mellan år 2006-2016. Resultat. De studerade icke-farmakologiska metoderna var musikterapi, vissa typer av massage, reminiscence-terapi, vårdhundterapi och ljusterapi. Resultaten visade att icke-farmakologiska metoder kan ha en varierande effekt på BPSD. Litteraturöversikten visade att musikintervention var mest effektiv för att minska agitationsbeteende. Individualiserad musik i samband med speciella minnen minskade stress, fobier hos personer med svår demens. Intervention av handmassage, aromaterapi, taktil massage och terapeutisk beröring minskade aggression och agitationsbeteende. Vissa studier visade dock att fotmassageintervention och vårdhundterapi kunde öka verbal aggressivitet hos personer med demens, medan en annan studie visade att djurassisterade aktiviteter kunde minska nedstämdhet medan glädje och generell uppmärksamhet ökade. Effekten av ljusbehandling var förbättrad sömn, minskad depression, agitation och ätstörningar. Slutsats. Icke-farmakologiska metoder kan minska beteendemässiga och psykiska symtom hos personer med Alzheimers sjukdom, dock med varierande effekt. De varierande resultaten kan tolkas som att icke-farmakologiska metoder bör individanpassas och att det behövs vidare forskning inom området.

Machine vision for the automatic classification of images acquired from Non-destructive tests

This project is based on Artificial Intelligence (A.I) and Digital Image processing (I.P) for automatic condition monitoring of sleepers in the railway track. Rail inspection is a very important task in railway maintenance for traffic safety issues and in preventing dangerous situations. Monitoring railway track infrastructure is an important aspect in which the periodical inspection of rail rolling plane is required.Up to the present days the inspection of the railroad is operated manually by trained personnel. A human operator walks along the railway track searching for sleeper anomalies. This monitoring way is not more acceptable for its slowness and subjectivity. Hence, it is desired to automate such intuitive human skills for the development of more robust and reliable testing methods. Images of wooden sleepers have been used as data for my project. The aim of this project is to present a vision based technique for inspecting railway sleepers (wooden planks under the railway track) by automatic interpretation of Non Destructive Test (NDT) data using A.I. techniques in determining the results of inspection.

Novel Statistical Methods in Quantitative Genetics : Modeling Genetic Variance for Quantitative Trait Loci Mapping and Genomic Evaluation

This thesis develops and evaluates statistical methods for different types of genetic analyses, including quantitative trait loci (QTL) analysis, genome-wide association study (GWAS), and genomic evaluation. The main contribution of the thesis is to provide novel insights in modeling genetic variance, especially via random effects models. In variance component QTL analysis, a full likelihood model accounting for uncertainty in the identity-by-descent (IBD) matrix was developed. It was found to be able to correctly adjust the bias in genetic variance component estimation and gain power in QTL mapping in terms of precision.  Double hierarchical generalized linear models, and a non-iterative simplified version, were implemented and applied to fit data of an entire genome. These whole genome models were shown to have good performance in both QTL mapping and genomic prediction. A re-analysis of a publicly available GWAS data set identified significant loci in Arabidopsis that control phenotypic variance instead of mean, which validated the idea of variance-controlling genes.  The works in the thesis are accompanied by R packages available online, including a general statistical tool for fitting random effects models (hglm), an efficient generalized ridge regression for high-dimensional data (bigRR), a double-layer mixed model for genomic data analysis (iQTL), a stochastic IBD matrix calculator (MCIBD), a computational interface for QTL mapping (qtl.outbred), and a GWAS analysis tool for mapping variance-controlling loci (vGWAS).

Non-challenging education and teacher control as factors for marginalization of students in diverse settings

This article discusses teachers’ attitudes towards immigrant students in poor settings and the effect these attitudes have on organization of education on classroom level. It draws on results from two ethnographic studies where some primary school classes in Sweden were followed with participant observation and interviews as main research methods. The article focuses on classroom activities and teachers’ attitudes towards immigrant students and students with low socio-economic status. In the article is argued for the importance of presenting students in poor settings with demanding tasks and challenging education. In these cases, intellectually undemanding tasks in combination with little room for students’ own initiatives resulted in low enthusiasm among students regarding schoolwork and accordingly low learning, while classroom work that demanded active involvement by students in combination with high level of students’ influence on what took place in classrooms resulted in high level of students’ engagement and high outcome.

Acceptability of home-assessment post medical abortion and medical abortion in a low-resource setting in Rajasthan, India : Secondary outcome analysis of a non-inferiority randomized controlled trial

Background: Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective: To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Design: Secondary outcome of a randomised, controlled, non-inferiority trial. Setting Outpatient primary health care clinics in rural and urban Rajasthan, India. Population: Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85mg/l and were below 18 years. Methods: Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1: 1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Main outcome measures: Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. Results: 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as compared with 188 (70%) of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001). Conclusion: Home-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women's preference should be offered to foster women's reproductive autonomy.

Self-assessment of the outcome of early medical abortion versus clinic follow-up in India : a randomised, controlled, non-inferiority trial

Background: The need for multiple clinical visits remains a barrier to women accessing safe legal medical abortion services. Alternatives to routine clinic follow-up visits have not been assessed in rural low-resource settings. We compared the effectiveness of standard clinic follow-up versus home assessment of outcome of medical abortion in a low-resource setting. Methods: This randomised, controlled, non-inferiority trial was done in six health centres (three rural, three urban) in Rajasthan, India. Women seeking early medical abortion up to 9 weeks of gestation were randomly assigned (1:1) to either routine clinic follow-up or self-assessment at home. Randomisation was done with a computer-generated randomisation sequence, with a block size of six. The study was not blinded. Women in the home-assessment group were advised to use a pictorial instruction sheet and take a low-sensitivity urine pregnancy test at home, 10-14 days after intake of mifepristone, and were contacted by a home visit or telephone call to record the outcome of the abortion. The primary (non-inferiority) outcome was complete abortion without continuing pregnancy or need for surgical evacuation or additional mifepristone and misoprostol. The non-inferiority margin for the risk difference was 5%. All participants with a reported primary outcome and who followed the clinical protocol were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT01827995. Findings: Between April 23, 2013, and May 15, 2014, 731 women were recruited and assigned to clinic follow-up (n=366) or home assessment (n=365), of whom 700 were analysed for the main outcomes (n=336 and n=364, respectively). Complete abortion without continuing pregnancy, surgical intervention, or additional mifepristone and misoprostol was reported in 313 (93%) of 336 women in the clinic follow-up group and 347 (95%) of 364 women in the home-assessment group (difference -2.2%, 95% CI -5.9 to 1.6). One case of haemorrhage occurred in each group (rate of adverse events 0.3% in each group); no other adverse events were noted. Interpretation Home assessment of medical abortion outcome with a low-sensitivity urine pregnancy test is non-inferior to clinic follow-up, and could be introduced instead of a clinic follow-up visit in a low-resource setting.

Recent developments in statistical methods for detecting genetic loci affecting phenotypic variability

A number of recent works have introduced statistical methods for detecting genetic loci that affect phenotypic variability, which we refer to as variability-controlling quantitative trait loci (vQTL). These are genetic variants whose allelic state predicts how much phenotype values will vary about their expected means. Such loci are of great potential interest in both human and non-human genetic studies, one reason being that a detected vQTL could represent a previously undetected interaction with other genes or environmental factors. The simultaneous publication of these new methods in different journals has in many cases precluded opportunity for comparison. We survey some of these methods, the respective trade-offs they imply, and the connections between them. The methods fall into three main groups: classical non-parametric, fully parametric, and semi-parametric two-stage approximations. Choosing between alternatives involves balancing the need for robustness, flexibility, and speed. For each method, we identify important assumptions and limitations, including those of practical importance, such as their scope for including covariates and random effects. We show in simulations that both parametric methods and their semi-parametric approximations can give elevated false positive rates when they ignore mean-variance relationships intrinsic to the data generation process. We conclude that choice of method depends on the trait distribution, the need to include non-genetic covariates, and the population size and structure, coupled with a critical evaluation of how these fit with the assumptions of the statistical model.