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  • Public defence: 2019-04-26 09:00 Örebro universitet, Campus USÖ, hörsal C3, Örebro
    Jerlström, Tomas
    Örebro University, School of Medical Sciences.
    Clinical aspects of cystectomy and urinary diversion2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to explore different aspects of treatment of advanced urinary bladder cancer with radical cystectomy, pelvic lymph node dissection, and urinary diversion. Surgery that carry a high risk of complications as well as mortality. Aside from complications and risk of recurrance, patients have to cope with lifelong postoperative changes of body function, including sexual function, and body image, all affecting quality of life (QoL). The thesis comprises four papers. In the first paper, we compared functional outcome and QoL following two types of ileal orthotopic neobladder substitution. The results suggest that the S-shaped substitute entails better functional results than the U-shaped substitute, with better continence, especially at night. There was no difference in QoL. The second paper reports results from the first year of registration in the nation-wide Swedish Cystectomy Register. Analysis of risk factors for complications showed that high age and prolonged operation are associated with increased risk of short-term complications. The third paper investigated whether preoperative chemotherapy in patients with muscle-invasive bladder cancer (MIBC) affects the risk of shortterm complications after radical cystectomy, using data from the Cystectomy Register covering 1340 patients of whom 39 percent received preoperativevchemotherapy. We found no such increase in risk. In the fourth paper, we analysed the results of a validation study of the Cystectomy Register. The validation showed 17 percent more low grade complications, three percent more high grade complications, and five percent more readmissions, within 90 days of surgery. Hence, a third-party validation may improve the validity of the register

    List of papers
    1. Functional outcome of orthotopic bladder substitution: a comparison between the S-shaped and U-shaped neobladder
    Open this publication in new window or tab >>Functional outcome of orthotopic bladder substitution: a comparison between the S-shaped and U-shaped neobladder
    2010 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 44, no 4, p. 197-203Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To compare the functional outcome of two types of orthotopic bladder substitution, the S-shaped and the U-shaped neobladder, with respect to leakage, functional capacity and quality of life.

    MATERIAL AND METHODS: Between 1999 and 2007, 45 male patients with urinary bladder cancer were treated with cystectomy and orthotopic bladder substitution; 23 with the S-shaped bladder ad modum Schreiter and 22 with the U-shaped bladder ad modum Studer. Patients were followed up by a urologist and a specialized nurse (urotherapist) at 1, 3 and 6 months. At each visit the patient completed a voiding chart, a weighted pad test and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Differences between the groups in functional outcome and quality of life variables were analysed by Student's t test using SPSS software.

    RESULTS: Mean maximum bladder capacity increased over time. At 6 months, the S-bladder had a larger capacity than the U-bladder (525 ml vs 423 ml). Patients with an S-bladder had less urine leakage at all follow-ups, although this was statistically significant only at 6 months regarding day-time incontinence and at all visits regarding night-time incontinence. The mean urine leakage at 6 months was 7 g (day) and 30 g (night) in the S-bladder group and 50 g (day) and 250 g (night) in the U-bladder group. However, quality of life did not differ between the groups.

    CONCLUSION: The S-bladder had better bladder capacity and less leakage than the U-bladder, but these differences did not translate into differences in quality of life. The results should be confirmed in larger prospective studies.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2010
    Keywords
    Functional outcome, neobladder, orthotopic bladder substitution, quality of life, urinary leakage
    National Category
    Urology and Nephrology Nursing
    Research subject
    Medicine; Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-35176 (URN)10.3109/00365591003727577 (DOI)000282143600001 ()20367221 (PubMedID)2-s2.0-77955538348 (Scopus ID)
    Available from: 2014-05-27 Created: 2014-05-27 Last updated: 2019-04-09Bibliographically approved
    2. Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database
    Open this publication in new window or tab >>Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database
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    2014 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 48, no 4, p. 334-340Article in journal (Refereed) Published
    Abstract [en]

    Objective: Cystectomy combined with pelvic lymph-node dissection and urinary diversion entails high morbidity and mortality. Improvements are needed, and a first step is to collect information on the current situation. In 2011, this group took the initiative to start a population-based database in Sweden (population 9.5 million in 2011) with prospective registration of patients and complications until 90 days after cystectomy. This article reports findings from the first year of registration.

    Material and methods: Participation was voluntary, and data were reported by local urologists or research nurses. Perioperative parameters and early complications classified according to the modified Clavien system were registered, and selected variables of possible importance for complications were analysed by univariate and multivariate logistic regression.

    Results: During 2011, 285 (65%) of 435 cystectomies performed in Sweden were registered in the database, the majority reported by the seven academic centres. Median blood loss was 1000 ml, operating time 318 min, and length of hospital stay 15 days. Any complications were registered for 103 patients (36%). Clavien grades 1-2 and 3-5 were noted in 19% and 15%, respectively. Thirty-seven patients (13%) were reoperated on at least once. In logistic regression analysis elevated risk of complications was significantly associated with operating time exceeding 318 min in both univariate and multivariate analysis, and with age 76-89 years only in multivariate analysis.

    Conclusions: It was feasible to start a national population-based registry of radical cystectomies for bladder cancer. The evaluation of the first year shows an increased risk of complications in patients with longer operating time and higher age. The results agree with some previously published series but should be interpreted with caution considering the relatively low coverage, which is expected to be higher in the future.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2014
    Keywords
    Bladder carcinoma, complications, radical cystectomy
    National Category
    Urology and Nephrology
    Identifiers
    urn:nbn:se:oru:diva-56495 (URN)10.3109/21681805.2014.909883 (DOI)000340072700001 ()24844275 (PubMedID)2-s2.0-84904320467 (Scopus ID)
    Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2019-04-01Bibliographically approved
    3. No increased risk of short-term complications after radical cystectomy for muscle invasive bladder cancer among patients treated with preoperative chemotherapy: a nationwide register-based study
    Open this publication in new window or tab >>No increased risk of short-term complications after radical cystectomy for muscle invasive bladder cancer among patients treated with preoperative chemotherapy: a nationwide register-based study
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-73417 (URN)
    Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2019-04-01Bibliographically approved
    4. Who should record surgical complications? Results from a third-party assessment of complications after radical cystectomy
    Open this publication in new window or tab >>Who should record surgical complications? Results from a third-party assessment of complications after radical cystectomy
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-73418 (URN)
    Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2019-04-01Bibliographically approved
  • Public defence: 2019-04-29 13:15 Örebro universitet, Teknikhuset, Hörsal T, Örebro
    Persson, Andreas
    Örebro University, School of Science and Technology.
    Studies in Semantic Modeling of Real-World Objects using Perceptual Anchoring2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Autonomous agents, situated in real-world scenarios, need to maintain consonance between the perceived world (through sensory capabilities) and their internal representation of the world in the form of symbolic knowledge. An approach for modeling such representations of objects is through the concept of perceptual anchoring, which, by definition, handles the problem of creating and maintaining, in time and space, the correspondence between symbols and sensor data that refer to the same physical object in the external world.

    The work presented in this thesis leverages notations found within perceptual anchoring to address the problem of real-world semantic world modeling, emphasizing, in particular, sensor-driven bottom-up acquisition of perceptual data. The proposed method for handling the attribute values that constitute the perceptual signature of an object is to first integrate and explore available resources of information, such as a Convolutional Neural Network (CNN) to classify objects on the perceptual level. In addition, a novel anchoring matching function is proposed. This function introduces both the theoretical procedure for comparing attribute values, as well as establishes the use of a learned model that approximates the anchoring matching problem. To verify the proposed method, an evaluation using human judgment to collect annotated ground truth data of real-world objects is further presented. The collected data is subsequently used to train and validate different classification algorithms, in order to learn how to correctly anchor objects, and thereby learn to invoke correct anchoring functionality.

    There are, however, situations that are difficult to handle purely from the perspective of perceptual anchoring, e.g., situations where an object is moved during occlusion. In the absence of perceptual observations, it is necessary to couple the anchoring procedure with probabilistic object tracking to speculate about occluded objects, and hence, maintain a consistent world model. Motivated by the limitation in the original anchoring definition, which prohibited the modeling of the history of an object, an extension to the anchoring definition is also presented. This extension permits the historical trace of an anchored object to be maintained and used for the purpose of learning additional properties of an object, e.g., learning of the action applied to an object.

    List of papers
    1. A Database-Centric Architecture for Efficient Matching of Object Instances in Context of Perceptual Anchoring
    Open this publication in new window or tab >>A Database-Centric Architecture for Efficient Matching of Object Instances in Context of Perceptual Anchoring
    (English)Manuscript (preprint) (Other academic)
    National Category
    Information Systems
    Identifiers
    urn:nbn:se:oru:diva-73526 (URN)
    Available from: 2019-04-05 Created: 2019-04-05 Last updated: 2019-04-05Bibliographically approved
    2. Semantic Relational Object Tracking
    Open this publication in new window or tab >>Semantic Relational Object Tracking
    (English)Manuscript (preprint) (Other academic)
    National Category
    Computer Vision and Robotics (Autonomous Systems)
    Identifiers
    urn:nbn:se:oru:diva-73529 (URN)
    Available from: 2019-04-05 Created: 2019-04-05 Last updated: 2019-04-05Bibliographically approved
    3. Learning Actions to Improve the Perceptual Anchoring of Object
    Open this publication in new window or tab >>Learning Actions to Improve the Perceptual Anchoring of Object
    2017 (English)In: Frontiers in Robotics and AI, E-ISSN 2296-9144, Vol. 3, no 76Article in journal (Refereed) Published
    Abstract [en]

    In this paper, we examine how to ground symbols referring to objects in perceptual data from a robot system by examining object entities and their changes over time. In particular, we approach the challenge by 1) tracking and maintaining object entities over time; and 2) utilizing an artificial neural network to learn the coupling between words referring to actions and movement patterns of tracked object entities. For this purpose, we propose a framework which relies on the notations presented in perceptual anchoring. We further present a practical extension of the notation such that our framework can track and maintain the history of detected object entities. Our approach is evaluated using everyday objects typically found in a home environment. Our object classification module has the possibility to detect and classify over several hundred object categories. We demonstrate how the framework creates and maintains, both in space and time, representations of objects such as 'spoon' and 'coffee mug'. These representations are later used for training of different sequential learning algorithms in order to learn movement actions such as 'pour' and 'stir'. We finally exemplify how learned movements actions, combined with common-sense knowledge, further can be used to improve the anchoring process per se.

    Place, publisher, year, edition, pages
    Lausanne: Frontiers Media S.A., 2017
    Keywords
    Perceptual anchoring, symbol grounding, action learning, sequential learning algorithms, common-sense knowledge, object classification, object tracking
    National Category
    Computer Sciences Computer Vision and Robotics (Autonomous Systems)
    Research subject
    Computer Science
    Identifiers
    urn:nbn:se:oru:diva-54025 (URN)10.3389/frobt.2016.00076 (DOI)000392981800001 ()
    Projects
    Chist-Era ReGround project
    Funder
    Swedish Research Council, 2016-05321
    Note

    Funding Agency:

    Chist-Era ReGround project

    Available from: 2016-12-18 Created: 2016-12-18 Last updated: 2019-04-09Bibliographically approved
    4. Fast Matching of Binary Descriptors for Large-scale Applications in Robot Vision
    Open this publication in new window or tab >>Fast Matching of Binary Descriptors for Large-scale Applications in Robot Vision
    2016 (English)In: International Journal of Advanced Robotic Systems, ISSN 1729-8806, E-ISSN 1729-8814, Vol. 13, article id 58Article in journal (Refereed) Published
    Abstract [en]

    The introduction of computationally efficient binary feature descriptors has raised new opportunities for real-world robot vision applications. However, brute force feature matching of binary descriptors is only practical for smaller datasets. In the literature, there has therefore been an increasing interest in representing and matching binary descriptors more efficiently. In this article, we follow this trend and present a method for efficiently and dynamically quantizing binary descriptors through a summarized frequency count into compact representations (called fsum) for improved feature matching of binary pointfeatures. With the motivation that real-world robot applications must adapt to a changing environment, we further present an overview of the field of algorithms, which concerns the efficient matching of binary descriptors and which are able to incorporate changes over time, such as clustered search trees and bag-of-features improved by vocabulary adaptation. The focus for this article is on evaluation, particularly large scale evaluation, compared to alternatives that exist within the field. Throughout this evaluation it is shown that the fsum approach is both efficient in terms of computational cost and memory requirements, while retaining adequate retrieval accuracy. It is further shown that the presented algorithm is equally suited to binary descriptors of arbitrary type and that the algorithm is therefore a valid option for several types of vision applications.

    Place, publisher, year, edition, pages
    Rijeka, Croatia: InTech, 2016
    Keywords
    Binary Descriptors, Efficient Feature Matching, Real-world Robotic Vision Applications
    National Category
    Robotics
    Identifiers
    urn:nbn:se:oru:diva-49931 (URN)10.5772/62162 (DOI)000372839300002 ()
    Funder
    Swedish Research Council, 2011-6104
    Available from: 2016-04-26 Created: 2016-04-26 Last updated: 2019-04-05Bibliographically approved
    5. Fluent human–robot dialogues about grounded objects in home environments
    Open this publication in new window or tab >>Fluent human–robot dialogues about grounded objects in home environments
    2014 (English)In: Cognitive Computation, ISSN 1866-9956, E-ISSN 1866-9964, Vol. 6, no 4, p. 914-927Article in journal (Refereed) Published
    Abstract [en]

    To provide a spoken interaction between robots and human users, an internal representation of the robots sensory information must be available at a semantic level and accessible to a dialogue system in order to be used in a human-like and intuitive manner. In this paper, we integrate the fields of perceptual anchoring (which creates and maintains the symbol-percept correspondence of objects) in robotics with multimodal dialogues in order to achieve a fluent interaction between humans and robots when talking about objects. These everyday objects are located in a so-called symbiotic system where humans, robots, and sensors are co-operating in a home environment. To orchestrate the dialogue system, the IrisTK dialogue platform is used. The IrisTK system is based on modelling the interaction of events, between different modules, e.g. speech recognizer, face tracker, etc. This system is running on a mobile robot device, which is part of a distributed sensor network. A perceptual anchoring framework, recognizes objects placed in the home and maintains a consistent identity of the objects consisting of their symbolic and perceptual data. Particular effort is placed on creating flexible dialogues where requests to objects can be made in a variety of ways. Experimental validation consists of evaluating the system when many objects are possible candidates for satisfying these requests.

    Place, publisher, year, edition, pages
    Springer, 2014
    Keywords
    Human–robot interaction, Perceptual anchoring, Symbol grounding, Spoken dialogue systems, Social robotics
    National Category
    Robotics
    Research subject
    Computer Science; Information technology
    Identifiers
    urn:nbn:se:oru:diva-39388 (URN)10.1007/s12559-014-9291-y (DOI)000345994900022 ()
    Funder
    Swedish Research Council, 2011-6104
    Available from: 2014-12-06 Created: 2014-12-06 Last updated: 2019-04-05Bibliographically approved
  • Public defence: 2019-05-03 13:00 Örebro universitet, Campus USÖ, hörsal C2, Örebro
    Jonsson, Marcus
    Örebro University, School of Medical Sciences.
    Physiotherapy and physical activity in patients undergoing cardiac or lung cancer surgery2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Cardiovascular diseases are the leading cause of death worldwide. Cardiac surgery is performed to improve prognosis, relieve symptoms and increase functional capacity in patients with cardiac disease. Postoperative pulmonary complications are common after cardiac surgery and a reduced lung function can persist a long time after surgery. A positive association between level of physical activity and lung function has been proposed in both healthy individuals and people with different disabilities. It is not clear if there is an association between level of physical activity and recovery of lung function after cardiac surgery. Lung cancer is one of the most frequently diagnosed forms of cancer worldwide, and a leading cause of cancer deaths. Surgical resection is the primary approach for curative treatment. Despite the fact that physical activity has many positive effects on health, patients undergoing lung cancer surgery often report a low level of physical activity. Measuring physical activity is not easy, self-reported physical activity remains the most clinically applicable type of measurement, and a simple and valid questionnaire for screening patients would be valuable. Patients undergoing lung cancer surgery are often routinely treated by physiotherapists, but this kind of treatment has not been thoroughly investigated. The purpose of this thesis was to investigate the effect of physiotherapy and physical activity in patients undergoing cardiac or lung cancer surgery. This thesis include one cohort study of physical activity and recovery of lung function in patients undergoing cardiac surgery, one validation study of two self-reported physical activity instruments in patients undergoing lung cancer surgery, and two randomized controlled trials investigating the effect of physiotherapy for patients undergoing lung cancer surgery. In study I, patients who remained active or increased their level of physical activity had better recovery of lung function, compared to patients who remained sedentary or reported a lower level of physical activity postoperatively. In study II, two self-reported physical activity instruments were validated against accelerometer data in patients three and twelve months after lung cancer surgery. Both instruments were found able to identify patients not meeting recommendations on physical activity. In study III, patients treated by physiotherapists were significantly more active during the first three days after lung cancer surgery, compared to an untreated control group. In study IV, no between-group differences three months after surgery were found between patients receiving in-hospital physiotherapy compared to an untreated control group. However, the patients in the treatment group reported an increase of physical activity three months after surgery compared to preoperatively, while the patients in the control group did not.

    List of papers
    1. Self-reported physical activity and lung function two months after cardiac surgery: a prospective cohort study
    Open this publication in new window or tab >>Self-reported physical activity and lung function two months after cardiac surgery: a prospective cohort study
    2014 (English)In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 9, article id 59Article in journal (Refereed) Published
    Abstract [en]

    Background: Physical activity has well-established positive health-related effects. Sedentary behaviour has been associated with postoperative complications and mortality after cardiac surgery. Patients undergoing cardiac surgery often suffer from impaired lung function postoperatively. The association between physical activity and lung function in cardiac surgery patients has not previously been reported.

    Methods: Patients undergoing cardiac surgery were followed up two months postoperatively. Physical activity was assessed on a four-category scale (sedentary, moderate activity, moderate regular exercise, and regular activity and exercise), modified from the Swedish National Institute of Public Health's national survey. Formal lung function testing was performed preoperatively and two months postoperatively.

    Results: The sample included 283 patients (82% male). Two months after surgery, the level of physical activity had increased (p < 0.001) in the whole sample. Patients who remained active or increased their level of physical activity had significantly better recovery of lung function than patients who remained sedentary or had decreased their level of activity postoperatively in terms of vital capacity (94 +/- 11% of preoperative value vs. 91 (+/-) 9%; p = 0.03), inspiratory capacity (94 +/- 14% vs. 88 +/- 19%; p = 0.008), and total lung capacity (96 +/- 11% vs. 90 +/- 11%; p = 0.01).

    Conclusions: An increased level of physical activity, compared to preoperative level, was reported as early as two months after surgery. Our data shows that there could be a significant association between physical activity and recovery of lung function after cardiac surgery. The relationship between objectively measured physical activity and postoperative pulmonary recovery needs to be further examined to verify these results.

    Place, publisher, year, edition, pages
    London: BioMed Central, 2014
    Keywords
    Cardiac surgery, Lung function, Physical activity
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:oru:diva-35213 (URN)10.1186/1749-8090-9-59 (DOI)000335462200001 ()24678691 (PubMedID)2-s2.0-84901980219 (Scopus ID)
    Funder
    Swedish Heart Lung FoundationSwedish Research Council
    Note

    Funding Agencies:

    Research Committee of Orebro County Council

    Swedish Heart and Lung Patients National Association

    Uppsala University

    Uppsala-Orebro Regional Research Council, Sweden

    Available from: 2014-06-03 Created: 2014-06-02 Last updated: 2019-04-10Bibliographically approved
    2. Validation of two self-reported physical activity instruments for patients who have undergone lung cancer surgery
    Open this publication in new window or tab >>Validation of two self-reported physical activity instruments for patients who have undergone lung cancer surgery
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-73595 (URN)
    Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-10Bibliographically approved
    3. In-hospital physiotherapy improves physical activity level after lung cancer surgery: a randomized controlled trial
    Open this publication in new window or tab >>In-hospital physiotherapy improves physical activity level after lung cancer surgery: a randomized controlled trial
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    2018 (English)In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465Article in journal (Refereed) Epub ahead of print
    Abstract [en]

    OBJECTIVES: Patients undergoing lung cancer surgery are routinely offered physiotherapy. Despite its routine use, effects on postoperative physical recovery have yet not been demonstrated. The aim of this study was to investigate whether physiotherapy could improve postoperative in-hospital physical activity level and physical capacity.

    DESIGN: Single-blind randomized controlled trial.

    SETTING: Thoracic surgery department at a University Hospital.

    PARTICIPANTS: Patients undergoing elective thoracic surgery (n=94) for confirmed or suspected lung cancer were assessed during hospital stay.

    INTERVENTION: Daily physiotherapy, consisting of mobilization, ambulation, shoulder exercises and breathing exercises. The control group received no physiotherapy treatment.

    OUTCOMES: In-hospital physical activity assessed with the Actigraph GT3X+ accelerometer, six-minute walk test, spirometry and dyspnea scores.

    RESULTS: The treatment group reached significantly more accelerometer counts (2010 (1508) vs 1629 (1146), mean difference 495 [95% CI 44 to 1109]), and steps per hour (49 (47) vs 37 (34), mean difference 14 [95% CI 3 to 30]), compared to the control group, during the first three postoperative days. No significant differences in six-minute walk test (percent of preoperative 71% vs 79%, P=0.13), spirometry (FEV1 percent of preoperative 69% vs 69%, P=0.83) or dyspnoea (M-MRC 2 vs 2, P=0.74) between the groups were found.

    CONCLUSIONS: Patients receiving in-hospital physiotherapy showed increased level of physical activity during the first days after lung cancer surgery, compared to an untreated control group. However, no effects on the six-minute walk test or spirometric values were found. The clinical importance of an increased physical activity level during the early postoperative period needs to be further evaluated.

    CLINICAL TRIAL REGISTRATION NUMBER: NCT01961700.

    Place, publisher, year, edition, pages
    Elsevier, 2018
    Keywords
    Lung cancer, Physical activity, Physical therapy, Randomized clinical trial
    National Category
    Surgery Cancer and Oncology
    Identifiers
    urn:nbn:se:oru:diva-73624 (URN)10.1016/j.physio.2018.11.001 (DOI)30871894 (PubMedID)
    Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-10Bibliographically approved
    4. In-hospital physiotherapy and physical recovery three months after lung cancer surgery: a randomized controlled trial
    Open this publication in new window or tab >>In-hospital physiotherapy and physical recovery three months after lung cancer surgery: a randomized controlled trial
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Cancer and Oncology Surgery
    Identifiers
    urn:nbn:se:oru:diva-73625 (URN)
    Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-10Bibliographically approved
  • Public defence: 2019-05-10 10:15 Örebro universitet, Forumhuset, Biografen, Örebro
    Axelsson, Tobias
    Örebro University, School of Humanities, Education and Social Sciences.
    När män möts som pappor: Fadrandets politik och praktik i det jämställda och pappavänliga Sverige2019Doctoral thesis, monograph (Other academic)
    Abstract [en]

    This thesis analyses how fathering is done and how fathers are constructed through the separate organising of men as fathers in meeting places for fathers on parental leave in Sweden. The study is located within the Swedish gender regime, characterised by its dual-earner/dual-carer model, progressive parenthood and daddy politics, and universally-oriented parenting support, making it a relatively gender-equal and father-friendly society.

    Theoretically and methodologically, the thesis draws on a feminist perspective. It uses ‘doing gender’ theory, and is informed by critical realism. The material is based on 25 observations at two fathering spaces, seven semi-structured interviews with fathers, and six policy documents on parenting support. Qualitative content analysis is used to analyse the material.

    The findings show: first, meeting places for fathers on parental leave can be understood as fathering spaces. Second, these fathering spaces are child-oriented settings and constitute somewhat of an exception within gender-neutral gender regimes. Third, fathering spaces function as transitional sites in which fathers manage different aspects of responsibility and relations to their own selves, to children, to mothers, and to other fathers. Fourth, three approaches to separate organising of men as fathers are identified: a) anti-separate; b) pro-separate; and c) gender paradoxical. The identified arguments for separate organising can be located along two parallel continua: one that stretches from individual to collective argumentation, and another that stretches from general to gender-specific argumentation.

    The thesis contributes to research on childcare and masculinities, and fathers’ experiences of parental leave, and to knowledge about separate organising of men as fathers. It also contributes to research and policy debates on daddy politics and parenting support by critically discussing fathering in terms of autonomy, dependence, and masculinity politics.

  • Public defence: 2019-05-10 12:30 Örebro universitet, Campus USÖ, hörsal C1, Örebro
    Ugge, Henrik
    Örebro University, School of Medical Sciences.
    Inflammation and prostate carcinogenesis: influence of immune characteristics and early-adulthood exposure to inflammatory conditions on prostate cancer risk2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Chronic inflammation has been implicated in the development of several types of cancer, and evidence from observational and animal studies suggests that it may play a role also in prostate carcinogenesis. Recent observations have brought Cutibacterium acnes (C. acnes) forward as a possible causative agent in pro-oncogenic prostatic inflammation. However, evidence also suggest that underlying immune characteristics contribute to prostate cancer risk. The overall aim of this thesis was to explore potential mechanisms underlying the proposed link between inflammation and prostate cancer, by evaluating associations between inflammatory conditions during early adulthood, circulating inflammation markers, and prostate cancer. Due to the suggested role of C. acnes in both diseases, we aimed to investigate whether acne vulgaris is a determinant of prostate cancer. Using prospectively collected data from Swedish national registers, we observed that presence of acne during early adulthood conferred an increased risk of prostate cancer later in life. Similarly, we found that appendicitis before late adolescence – a proposed marker of individual immune characteristics – to be positively associated with subsequent prostate cancer. We further evaluated whether prostatic C. acnes infection is linked with elevated systemic levels of IL6 and CXCL8, two inflammation markers previously associated with prostate cancer. No association was observed, however, potentially explained by the subclinical low-grade infection typically caused by C. acnes. Finally, we evaluated 52 circulating inflammation markers as determinants for prostate cancer in a population-based case-control study. In this hypothesis-generating study, we identified CX3CL1, CCL21, PDGF-BB, CCL11 and IL10 as candidate markers for evaluation in prospective studies. If confirmed, these markers may hint at targetable molecular pathways involved in prostate carcinogenesis.

    List of papers
    1. Acne in late adolescence and risk of prostate cancer
    Open this publication in new window or tab >>Acne in late adolescence and risk of prostate cancer
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    2018 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, p. 1580-1585Article in journal (Refereed) Published
    Abstract [en]

    Accumulating evidence suggest that Propionibacterium acnes may play a role in prostate carcinogenesis, but data are so far limited and inconclusive. The aim of this population-based cohort study was therefore to test whether presence of acne vulgaris during late adolescence is associated with an increased risk of prostate cancer later in life. We identified a large cohort of young men born in Sweden between 1952 and 1956, who underwent mandatory assessment for military conscription around the age of 18 (n= 243,187). Test information along with health data including medical diagnoses at time of conscription was available through the Swedish Military Conscription Register and the National Patient Register. The cohort was followed through linkages to the Swedish Cancer Register to identify the occurrence of prostate cancer until December 31st 2009. We used Cox regression to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between acne in adolescence and prostate cancer risk. A total of 1,633 men were diagnosed with prostate cancer during a median follow-up of 36.7 years. A diagnosis of acne was associated with a statistically significant increased risk for prostate cancer (adjusted HR: 1.43 95%; CI: 1.06-1.92), particularly for advanced stage disease (HR: 2.37 95%; CI 1.19-4.73). A diagnosis of acne classified as severe conferred a 6-fold increased risk of prostate cancer (HR: 5.70 95% CI 1.42-22.85). Data from this large prospective population-based cohort add new evidence supporting a role of P acnes infection in prostate cancer.

    Place, publisher, year, edition, pages
    Hoboken, NJ, USA: John Wiley & Sons, 2018
    Keywords
    Propionibacterium acnes; prostate cancer; acne vulgaris; inflammation; acne vulgaris
    National Category
    Cancer and Oncology
    Identifiers
    urn:nbn:se:oru:diva-63302 (URN)10.1002/ijc.31192 (DOI)000425184800009 ()29205339 (PubMedID)2-s2.0-85037982996 (Scopus ID)
    Note

    Funding Agency:

    UK Economic and Social Research Council (ESRC)  RES-596-28-0001  ES/JO19119/1

    Available from: 2017-12-11 Created: 2017-12-11 Last updated: 2019-04-09Bibliographically approved
    2. The influence of prostatic Cutibacterium acnes infection on serum levels of IL6 and CXCL8 in prostate cancer patients
    Open this publication in new window or tab >>The influence of prostatic Cutibacterium acnes infection on serum levels of IL6 and CXCL8 in prostate cancer patients
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    2018 (English)In: Infectious Agents and Cancer, ISSN 1750-9378, E-ISSN 1750-9378, Vol. 13, article id 34Article in journal (Refereed) Published
    Abstract [en]

    Background: Chronic prostatic inflammation, caused by Cutibacterium acnes (C. acnes), has been proposed to influence the risk of prostate cancer development. In vitro studies have demonstrated the capacity of C. acnes to induce secretion of Interleukin 6 (IL6) and C-X-C motif chemokine ligand 8 (CXCL8) by prostate epithelial cells. Both these inflammatory mediators have been implicated in prostate cancer pathophysiology. In this cohort study, we aimed to investigate the influence of prostatic C. acnes on serum levels of IL6 and CXCL8.

    Methods: We recruited 99 prostate cancer patients who underwent radical prostatectomy at orebro University Hospital. The cultivation of pre-operatively obtained prostate biopsies identified C. acnes in 60 of the 99 patients. Levels of IL6 and CXCL8 in pre-operative serum samples were analyzed using ELISA, and concentrations were compared between prostate cancer patients with and without prostatic C. acnes infection using standard statistical methods.

    Results: No statistical differences were observed in serum levels of IL6 and CXCL8 between subjects with and without prostatic C. acnes infection.

    Conclusions: Our results indicate that prostatic C. acnes infection may give rise to low-grade inflammation with little effect on systemic levels of IL6 and CXCL8.

    Place, publisher, year, edition, pages
    BioMed Central, 2018
    Keywords
    Prostate cancer, Inflammation, Cutibacterium acnes, IL6, CXCL8, Cytokines
    National Category
    Cancer and Oncology Immunology in the medical area
    Identifiers
    urn:nbn:se:oru:diva-70366 (URN)10.1186/s13027-018-0204-7 (DOI)000450287500001 ()30473726 (PubMedID)2-s2.0-85056906445 (Scopus ID)
    Note

    Funding Agency:

    Foundation Lions Cancerforskningsfond vid Akademiska sjukhuset i Uppsala 

    Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2019-04-08Bibliographically approved
    3. Appendicitis before age 20 years is associated with an increased risk of later prostate cancer
    Open this publication in new window or tab >>Appendicitis before age 20 years is associated with an increased risk of later prostate cancer
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    2018 (English)In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 27, no 6, p. 660-664Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Appendicitis before age 20 years has been observed to influence the risk of several inflammatory conditions, possibly through underlying immunological mechanisms. Inflammation has further been suggested to be involved in prostate cancer development. We therefore hypothesized that immunological characteristics signaled by appendicitis before late adolescence might influence the risk of later prostate cancer, and aimed to evaluate this association in a population-based study.

    METHODS: We identified a large cohort of Swedish men who underwent assessment for military conscription around the age of 18 years (n= 242,573). Medical diagnoses at time of conscription were available through the Swedish Military Conscription Register. The Swedish Cancer Register was used to identify diagnoses of prostate cancer. Multivariable adjusted Cox regression analyses were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between appendicitis and prostate cancer.

    RESULTS: During a median of 36.7 years of follow-up, 1,684 diagnoses of prostate cancer occurred. We found a statistically significant association between appendicitis and overall prostate cancer (adjusted HR: 1.70; 95% CI: 1.08-2.67). The risk was notably increased for advanced (HR: 4.42; 95% CI: 1.74-11.22) and lethal (HR: 8.95; 95% CI: 2.98-26.91) prostate cancer.

    CONCLUSION: These results suggest that a diagnosis of appendicitis before adulthood potentially signals underlying immune characteristics and a pattern of inflammatory response relevant to prostate cancer risk.

    IMPACT: The study lends support to the proposed role of inflammation in prostate carcinogenesis, and adds another area of investigation potentially relevant to prostate cancer development.

    Place, publisher, year, edition, pages
    American Association for Cancer Research, 2018
    National Category
    Cancer and Oncology
    Identifiers
    urn:nbn:se:oru:diva-66449 (URN)10.1158/1055-9965.EPI-17-1204 (DOI)000433945800006 ()29588305 (PubMedID)2-s2.0-85047896683 (Scopus ID)
    Note

    Funding Agency:

    UK Economic and Social Research Council (ESRC)  RES-596-28-0001  ES/JO19119/1

    Available from: 2018-04-13 Created: 2018-04-13 Last updated: 2019-04-09Bibliographically approved
    4. Circulating inflammation markers and prostate cancer
    Open this publication in new window or tab >>Circulating inflammation markers and prostate cancer
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-73573 (URN)
    Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-04-08Bibliographically approved
  • Public defence: 2019-05-24 09:00 Föreläsningssalen Falu Lasarett, Falun
    Göras, Camilla
    Örebro University, School of Health Sciences.
    Open the door to complexity: Safety climate and work processes in the operating room2019Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2019-05-24 13:00 Örebro universitet, Prismahuset, Hörsal P1, Örebro
    Rapado, Irene
    Örebro University, School of Humanities, Education and Social Sciences.
    Performing and Re/Defining Democracy in Post-Austerity Spain: Political Communication and Discursive Practices of the Podemos Party-Movement2019Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2019-05-29 13:00 Örebro universitet, Campus USÖ, hörsal C3, Örebro
    Kardeby, Caroline
    Örebro University, School of Medical Sciences.
    Studies of platelet signalling and endothelial cell responses using unique synthetic drugs2019Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2019-06-05 10:00 Örebro universitet, Campus USÖ, hörsal C2, Örebro
    Ahl, Rebecka
    Örebro University, School of Medical Sciences.
    The Association Between Beta-Blockade and Clinical Outcomes in the Context of Surgical and Traumatic Stress2019Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2019-06-10 13:00 Örebro universitet, Hörsalen, Musikhögskolan, Örebro
    Bakunzibake, Pierre
    Örebro University, Örebro University School of Business.
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  • Public defence: 2019-06-12 13:15 Örebro universitet, Hörsalen, Musikhögskolan, Örebro
    Mutimukwe, Chantal
    Örebro University, Örebro University School of Business.
    Information privacy protection in e-government in Rwanda2019Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2019-06-12 13:15 Örebro universitet, Teknikhuset, Hörsal T, Örebro
    Jansson, Anton
    Örebro University, School of Science and Technology.
    More Than a Shadow: Computed Tomography Method Development and Applications Concerning Complex Material Systems2019Doctoral thesis, comprehensive summary (Other academic)