A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol

Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment. Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment. Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family. Trial registration: Current controlled trials: ISRCTN22444034

The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants : study protocol for a randomized controlled trial

Background: Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers' sense of trust in their own capacity and thereby facilitate breastfeeding. Methods/design: A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge. Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff. Discussion: This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed. Trial registration: NCT01806480

Automatic and objective assessment of alternating tapping performance in Parkinson’s disease

This paper presents the development and evaluation of a method for enabling quantitative and automatic scoring of alternating tapping performance of patients with Parkinson’s disease (PD). Ten healthy elderly subjects and 95 patients in different clinical stages of PD have utilized a touch-pad handheld computer to perform alternate tapping tests in their home environments. First, a neurologist used a web-based system to visually assess impairments in four tapping dimensions (‘speed’, ‘accuracy’, ‘fatigue’ and ‘arrhythmia’) and a global tapping severity (GTS). Second, tapping signals were processed with time series analysis and statistical methods to derive 24 quantitative parameters. Third, principal component analysis was used to reduce the dimensions of these parameters and to obtain scores for the four dimensions. Finally, a logistic regression classifier was trained using a 10-fold stratified cross-validation to map the reduced parameters to the corresponding visually assessed GTS scores. Results showed that the computed scores correlated well to visually assessed scores and were significantly different across Unified Parkinson’s Disease Rating Scale scores of upper limb motor performance. In addition, they had good internal consistency, had good ability to discriminate between healthy elderly and patients in different disease stages, had good sensitivity to treatment interventions and could reflect the natural disease progression over time. In conclusion, the automatic method can be useful to objectively assess the tapping performance of PD patients and can be included in telemedicine tools for remote monitoring of tapping.

A Computer Vision Framework For Finger-Tapping Evaluation In Parkinson's Disease

Objective: To define and evaluate a Computer-Vision (CV) method for scoring Paced Finger-Tapping (PFT) in Parkinson's disease (PD) using quantitative motion analysis of index-fingers and to compare the obtained scores to the UPDRS (Unified Parkinson's Disease Rating Scale) finger-taps (FT). Background: The naked-eye evaluation of PFT in clinical practice results in coarse resolution to determine PD status. Besides, sensor mechanisms for PFT evaluation may cause patients discomfort. In order to avoid cost and effort of applying wearable sensors, a CV system for non-invasive PFT evaluation is introduced. Methods: A database of 221 PFT videos from 6 PD patients was processed. The subjects were instructed to position their hands above their shoulders besides the face and tap the index-finger against the thumb consistently with speed. They were facing towards a pivoted camera during recording. The videos were rated by two clinicians between symptom levels 0-to-3 using UPDRS-FT. The CV method incorporates a motion analyzer and a face detector. The method detects the face of testee in each video-frame. The frame is split into two images from face-rectangle center. Two regions of interest are located in each image to detect index-finger motion of left and right hands respectively. The tracking of opening and closing phases of dominant hand index-finger produces a tapping time-series. This time-series is normalized by the face height. The normalization calibrates the amplitude in tapping signal which is affected by the varying distance between camera and subject (farther the camera, lesser the amplitude). A total of 15 features were classified using K-nearest neighbor (KNN) classifier to characterize the symptoms levels in UPDRS-FT. The target ratings provided by the raters were averaged. Results: A 10-fold cross validation in KNN classified 221 videos between 3 symptom levels with 75% accuracy. An area under the receiver operating characteristic curves of 82.6% supports feasibility of the obtained features to replicate clinical assessments. Conclusions: The system is able to track index-finger motion to estimate tapping symptoms in PD. It has certain advantages compared to other technologies (e.g. magnetic sensors, accelerometers etc.) for PFT evaluation to improve and automate the ratings

MAPfastR : quantitative trait loci mapping in outbred line crosses

MAPfastR is a software package developed to analyze QTL data from inbred and outbred line-crosses. The package includes a number of modules for fast and accurate QTL analyses. It has been developed in the R language for fast and comprehensive analyses of large datasets. MAPfastR is freely available at: http://www.computationalgenetics.se/?page_id=7.

Svenska för invandrarskap? : Språk, kategorisering och identitet inom utbildningsformen Svenska för invandrare

The overall purpose of this thesis and the four independent studies it builds upon is to examine how categorizations and identity positions are constructed and negotiated in the educational program Swedish for immigrants (SFI) both historically and among participants in the program at the beginning of the 21th century. The analytical focus is on the discourses that frame the development of the SFI program with a specific interest in categorizations and identity in relation to gender, language and national belonging. The empirical material includes historical texts (curricula, commission reports, public inquiries, political propositions, laws) from 1965 to 2010, as well as approximately 95 hours of audio and video recorded data and ethnographic field notes from five SFI classrooms. The results are presented primarily in the four articles but partly also in the thesis itself. Our analysis in the first study, that takes a sociohistorical perspective as a point of departure, indicates shifts in discourses with regards to the categories and aims of the educational program, thus, making certain identity positions more accessible than others at specific times. Using the approach of nexus analysis, the theoretical framework employed in the second study approaches language policies n terms of a dialectical elationship between policy and the learning that takes lace in the language focused classroom. Feminist and postcolonial frameworks re employed ore pecifically in the third and fourth studies. The historical nalysis presented in article three shows how the categories of “immigrant” and Swedes” ave been produced and negotiated in discourses on gender and gender quality in the SFI program since the early 1970s. The fourth study highlights he omplex relationship between gender equality and integration policies, as well as he perception of gender equality as a central part of Swedishness”, negotiated in he everyday conversations in the SFI classroom. Overall, the results illuminate he circulation of discourses both cross ime and between policy and classrooms. oreover, it contributes to a critical discussion about the intersection of language, ender and national elonging in the negotiation of boundaries between insiders and outsiders in Swedish society.

"Ja, denna stig är stigarnas stig" : Taoistiska influenser i Vilhelm Ekelunds verk

In this article I show how Taoist philosophy has influenced the Swedish poet, essayist and aphorist Vilhelm Ekelund. I note that the author mentions the Taoist philosophers Lao Tzu and Chuang Tzu and discusses their ideas on a couple of occasions in his later works (Atticism – Humanism, 1943; Plus salis–, 1945). Examples of such explicit influence can also be found in Ekelund’s private notebooks, posthumously published in two volumes: Hemkomst och flykt (1972) and Ur en scholaris’ verkstad (1974). I argue that Taoist philosophy implicitly influenced the Swedish author as early as the second part of the 1910’s – when he started to emphasize such principles as moderation, composure, dispassion and non-desire in his writing. I also discuss other important ideals which Ekelund shared with the Taoist philosophers, such as poverty, humility, simplicity and dishonour. Finally, I see a parallel in the anti-intellectual aspects of Taoist thinking and Ekelund’s use of the term misologi (misology), a word which often has positive connotations in his works. In Ekelund’s prose, as well as in the famous Taoist text Tao Te Ching, excessive intellectualism is frequently criticized.

Vilhelm Ekelund och den fransk-italienska kultursfären : Några nedslag i de tidiga prosaverken - från Antikt ideal (1909) till Attiskt i fågelperspektiv (1919)

Vilhelm Ekelund och den fransk-italienska kultursfären: Några nedslag i de tidiga prosaverken – från Antikt ideal (1909) till Attiskt i fågelperspektiv (1919). (Vilhelm Ekelund and the French and Italian cultural heritage: A study of his early prose – from Antikt ideal (1909) to Attiskt i fågelperspektiv (1919)). The Swedish poet, essayist and aphorist Vilhelm Ekelund was not only influenced by German literature and philosophy, he also wrote extensive literary criticism on the subject of Romance language authors. This article discusses Ekelund’s relationship to some of the most influential French and Italian writers – as it can be seen in his work during the period 1909-1919. This relationship was ambiguous: he paid homage to French authors such as Montaigne, Montesquieu, Stendhal and Comte – as well as to the Italian poet and philosopher Leopardi – but he also severely criticized such distinguished writers as Baudelaire, Rousseau and Maupassant. One conclusion of this article is that the authors praised by Ekelund all venerate the Greek and Roman cultural heritage, whereas the despised novelists and poets were, in his opinion, either too “modern” or too “feminine” – both highly pejorative adjectives in the author’s terminology. It is also noted that Ekelund’s most ferocious attacks date from the first part of the decade, before he entered a more harmonic period with the works Metron (1918) and Attiskt i fågelperspektiv (1919).

Relative durations of post-vocalic consonants in readaloud Spanish by native Swedish L2-learners

Prosody is said to be a persistent feature in foreign accents, particularly in the speech of adult learners. Native Swedish speakers have been reported to lengthen vowels in Spanish as well as post-vocalic consonants in English and German, more than native speakers of the respective languages. The aim of the present study is to examine whether native Swedish learners of Spanish produce increased postvocalic consonant durations in a reading aloud exercise. The text contains certain words that could be expected to trigger complementary consonant lengthening in native Swedish speakers. The result shows that there is no general tendency for native Swedes to lengthen post-vocalic consonants more than native speakers of Spanish in the present speech material. There are examples of longer consonant durations in the speech of the native,Swedish subjects, but it could be a coincidence. A conclusion is that the text used in the study, and probably Spanish as a language, contains few words that are ideal for triggering lengthening of post-vocalic consonants in native Swedish speakers.

The priority of temporal aspects in L2-Swedish prosody : Studies in perception and production

Foreign accent can be everything from hardly detectable to rendering the second language speech unintelligible. It is assumed that certain aspects of a specific target language contribute more to making the foreign accented speech intelligible and listener friendly, than others. The present thesis examines a teaching strategy for Swedish pronunciation in second language education. The teaching strategy “Basic prosody” or BP, gives priority to temporal aspects of Swedish prosody, which means the temporal phonological contrasts word stress and quantity, as well as the durational realizations of these contrasts. BP does not prescribe any specific tonal realizations. This standpoint is based on the great regional variety in realization and distribution of Swedish word accents. The teaching strategy consists virtually of three directives: · Stress the proper word in the sentence. · Stress proper syllables in stressed words and make them longer. · Lengthen the proper segment – vowel or subsequent consonant – in the stressed syllable. These directives reflect the view that all phonological length is stress-induced, and that vowel length and consonant length are equally important as learning goals. BP is examined in the light of existing findings in the field of second language pronunciation and with respect to the phonetic correlates of Swedish stress and quantity. Five studies examine the relation between segment durations and the categorization made by native Swedish listeners. The results indicate that the postvocalic consonant duration contributes to quantity categorization as well as giving the proper duration to stressed syllables. Furthermore, native Swedish speakers are shown to apply the complementary /V: C/ - /VC:/ pattern also when speaking English and German, by lengthening postvocalic consonants. The correctness of the priority is not directly addressed but important aspects of BP are supported by earlier findings as well as the results from the present studies.

Determinants and effects of central bank independence reforms

This thesis consists of four empirically oriented papers on central bank independence (CBI) reforms.    Paper [1] is an investigation of why politicians around the world have chosen to give up power to independent central banks, thereby reducing their ability to control the economy. A new data-set, including the possible occurrence of CBI-reforms in 132 countries during 1980-2005, was collected. Politicians in non-OECD countries were more likely to delegate power to independent central banks if their country had been characterized by high variability in inflation and if they faced a high probability of being replaced. No such effects were found for OECD countries.    Paper [2], using a difference-in-difference approach, studies whether CBI reform matters for inflation performance. The analysis is based on a dataset including the possible occurrence of CBI-reforms in 132 countries during the period of 1980-2005. CBI reform is found to have contributed to bringing down inflation in high-inflation countries, but it seems unrelated to inflation performance in low-inflation countries.    Paper [3] investigates whether CBI-reforms are important in reducing inflation and maintaining price stability, using a random-effects random-coefficients model to account for heterogeneity in the effects of CBI-reforms on inflation. CBI-reforms are found to have reduced inflation on average by 3.31 percent, but the effect is only present when countries with historically high inflation rates are included in the sample. Countries with more modest inflation rates have achieved low inflation without institutional reforms that grant central banks more independence, thus undermining the time-inconsistency theory case for CBI. There is furthermore no evidence that CBI-reforms have contributed to lower inflation variability    Paper [4] studies the relationship between CBI and a suggested trade-off between price variability and output variability using data on CBI-levels, and data the on implementation dates of CBI-reforms. The results question the existence of such a trade-off, but indicate that there may still be potential gains in stabilization policy from CBI-reforms.

Vocational English in policy and practice

The aim of this licentiate thesis is to examine how, and in what ways, vocational English is a part of English language teaching in the Building and Construc­tion Programme in Sweden, and what the influences are for such pedagogy. The main research question is how policy documents relate to the views of teachers and their educational practice regarding vocational English. The study consists of two parts: a textual policy analysis of the three latest upper secondary school reforms in Sweden (Lgy 70, Lpf 94, and Gy 2011), and semi-structured interviews with practicing English teachers in the Building and Construction Programme. The interviews are categorised by using Spradley’s (1979) semantic relationships and taxonomies. Balls’ (Ball, 1993) and Ozga’s (1990; 2000) concept of policy enactment is used in the analysis as well as Bernstein’s (1990; 2000) theoretical framework of classification, framing, and horizontal and vertical discourse. The results show that five of the six teachers in the interviews work with vocational English in some way. The study also shows that there is a distinct gap between policy and practice. Several of the teachers have the notion that they are supposed to work with vocational English and that it must be written down in policy somewhere. The greatest influence on the teaching for these teachers are their students, either indirectly or directly. Further, the study shows that different frame factors such as time poverty hinders the teachers from reading policy texts and cooperating with the vocational teachers in the Building and Construction Programme.

Kvinnors och mäns återhämtning från psykisk ohälsa

The overall aim with this thesis is to describe and analyze women’s and men’s recovery processes. More specifically, the aim is to determine what women and men with experience of mental illness describe as contributing to the personal recovery process. The point of departure for the studies was 30 in-depth interviews conducted with 15 men and 15 women. The selection of interview subjects was limited to individuals who had been treated in 24-hour psychiatric care and diagnosed as having schizophrenia, psychosis, a personality disorder, or a bipolar disorder.   Four studies have been carried.  Study 1 was a baseline article that examined what people in recovery from mental illness outline as facilitating factors to their recovery. The results that emerged from that study indicated areas for further analysis to condense the understanding of the recovery process. In study 2 the similarities and the differences in recovery described by women and men were examined. In Study 3 women’s and men’s meaning-making with reference to severe mental illness facilitate the recovery process were studied. The forth study explored how peer-support contribute to women’s and men’s recovery from mental illness.   The results emphasize recovery from mental illness as a social process in which relationships play a key role in creating new identities beside the mental illness. For a majority of the participants meeting peers facilitated the recovery process. The participants described how peer support meant an end to isolation and became an arena for identification, connection, and being important to others. Throughout these recovery processes the impact of gender has been emphasized. The results from this thesis provide new insight into gender as an important factor in understanding the recovery processes. The results from the four studies emphasize the mental patient, the psychiatric interventions and the individual recovery strategies as being influenced by gender constructions.