University of Gävle

Background Health information technology has developed into a cornerstone of modern healthcare. It has changed workflows and enhanced communication, efficiency, and patient safety. However, technological development has progressed faster than research on its potential effects on care quality and the healthcare work environment. Using the Job Demand-Resources theory, this study investigated the associations between "frustration with technology" and three outcomes: stress, emotional exhaustion, and staff satisfaction with care, holding job resources and the demand workload constant. Method A cross-sectional correlational study was conducted between January and April 2022. Healthcare staff from different professions (e.g., physicians, registered nurses, physiotherapists, licensed practical nurses) and workplaces (n = 417, response rate 31%) answered a survey regarding job demands and resources in the workplace, frustration with technology, stress, emotional exhaustion, and satisfaction with care. Data were analyzed with Spearman’s rank correlation coefficient, the Mann–Whitney U test, and the Kruskal–Wallis test, and multiple variables, one for each outcome, were tested with Generalized Estimated Equations models in SPSS. Results The bivariate correlation analyses confirmed statistically significant associations between all the independent variables and the outcomes, except for the independent variable high workload. A high workload was associated with stress and emotional exhaustion but not with staff satisfaction with care. In the three GEE models, one for each outcome, higher stress was statistically significantly associated with more frustration with technology and lower scores for the variables participation in decision-making, sense of community at work, and higher workload. Higher emotional exhaustion was associated with more frustration with technology, higher workload, a lower teamwork climate, and lower growth opportunities. Lower staff satisfaction with care was associated with lower scores for the variable participation in decision-making. Conclusions Taking other variables into account, technology frustration matters in staff ratings of stress and emotional exhaustion, but not with the satisfaction of given care. Future studies should aim to further investigate what causes technology frustration and how to mitigate it.

Digitalisation has changed communications dramatically over the last 20 years. This has entailed that preschool documentation of children and their activities, previously communicated with enrolled families, have become part of a mass distribution of social images. Thereby photographs, which initially aimed to involve the families in their children's education, are made visible to larger groups in society. This article examines digitally circulated photographs from three preschools in Sweden and, using critical image analyses, relates them to visibility, transparency and participation. The results show that digitally circulated photographs mediate a normative image of a universal preschool child, where the extended visibility of the preschool does not seem to make children's different interests, characteristics and standpoints visible. In fact, the children themselves are, in order to protect them, almost made invisible in the photographs. The discussion of this article concerns the ethics of a mass distribution of images where children are portrayed as a uniform group, and raises the fact that children become dependent on adults to interact with the photographs. Aims of marketing seem to become superior to aims of involvement, and preschools are able to tailor their communications to reach certain audiences. Thereby digital communication seems to contribute to increasing rather than decreasing inequalities among children.

Determining moisture content (MC) in wood chips finds its application in many industries including energy production. In this letter, we aim to develop an automated method for determining MC in woodchips using ultra-wideband (UWB) radio signals and machine learning algorithms. Firstly, to acquire UWB signals through wood chips on conveyor belts in industrial plants, we use measurement devices with a radio transmitter and receiver, and a laser sensor to determine the thickness of the wood chips. UWB and laser data corresponding to 1923 samples from four power plants is acquired. Secondly, we extract the amplitude and delay-based features, and these are finally, fed to three different machine learning algorithms namely; linear regression, artificial neural network (ANN), and ensemble trees to determine the MC. The proposed method achieves best results when the ANN is used. More specifically, our method achieves a mean absolute error (MAE) of 2.75% when the features from both UWB and laser sensors are used for determining MC. MAE of 3.95% is achieved when features only from UWB data (without the laser) are used for determining MC. Our results for industrial data suggest that the proposed method is effective for determining MC in industrial applications.

Background: Cancer care professionals need to be aware of kinesiophobia, fear of motion, in patients undergoing cancer therapy. The new instrument the Tampa-Scale Kinesiophobia Symptoms (TSK-Symptoms) aims to measure fear and avoidance of motion in relation to multiple symptoms (eg, nausea, fatigue, anxiety, pain). It is modified from the TSK, which relates solely to pain. Aim: To test the feasibility of the TSK-Symptoms, to quantify kinesiophobia in patients with cancer, to study whether kinesiophobia was associated with symptoms or physical activity, and through interviews to gain a deeper understanding of patient experiences. Methods: In this preparatory longitudinal study, patients (n = 55, mean age 68 years; 51% men; 38% had prostate cancer, 23% breast cancer) undergoing radiotherapy provided questionnaire data on kinesiophobia using the new instrument TSK-Symptoms, symptoms and physical activity twice (at baseline, T1, and 1 week later, T2). Eight patients were interviewed. Results: At T1 and T2, 4 of 54 (7%) and 8 of 55 patients (14%) reported kinesiophobia (P = .009). From T1 to T2, occurrence of nausea increased. Of the 16 nauseated patients at T2, 6 (38%) reported kinesiophobia compared to 2 (5%) of the 39 nausea-free patients (P = .005). Patients who reported kinesiophobia practiced less physical activity (median 0 days at moderate intensity at T1 (P < .001), median 2 days at moderate intensity at T2, P = .006) compared to patients free from kinesiophobia (median 4 and 5 days). Three qualitative content analysis categories described patient experiences: (1) “Struggling to stay physically active in an extraordinary situation associated with burdensome symptoms,” (2) “Feeling damaged and at the same time grateful,” and (3) “Needing support due to fear of motion and of worsened condition.” Conclusions: This preparatory study showed that the new instrument the TSK-Symptoms was feasible for use in patients undergoing cancer therapy to quantify kinesiophobia, which was present in approximately 1 in 10 patients. Kinesiophobia was more common in patients with nausea, and patients reporting kinesiophobia practiced less physical activity. Patients highlighted a need for support. The psychometric properties of the TSK-Symptoms, completed on several languages, need to be evaluated. Cancer care professionals may quantify kinesiophobia using the TSK-Symptoms instrument and give kinesiophobic patients support.

Since the 1970s the Swedish government has been promoting social work based on research into methods which work in practice for practitioners and patients. In 2015, the Swedish Agency for Health Technology Assessment (SBU), a government agency instigated in 1987, was commissioned to expand its remit, to review empirical research on social work interventions and to disseminate the results to stakeholders. SBU was then renamed The Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU). This article describes the fusion of health technology assessment (HTA) and Social Intervention Assessment (SIA), including advantages and challenges.

Background Leadership and access to structural empowerment are known to influence the work life experiences of staff and quality of care. Knowledge about relationships between specific factors of structural empowerment, leadership and management, staff well-being and quality of care at both an individual and unit level is scarce. Aim To study the relationship between staff-rated access to empowering structures, leadership and management performance, well-being, and quality of care in hospital settings measured at the individual level and aggregated at the unit level. Methods A cross-sectional correlative design was applied. Questionnaire data from 331 randomized hospital nursing staff working at 38 units in 25 hospitals in Sweden were analyzed using bivariate correlations and general estimation equation (GEE) models. Results Results from the bivariate analysis of relationships confirmed earlier research. In the GEE models, some unexpected results were found and differences between the individual and unit levels. Adding management and leadership as independent factors in the second model showed few relationships of significance to the outcome variables. Conclusion Results confirm the importance of staff access to empowering structures in relation to well-being and quality of care. Differences and similarities were shown when studying these relationships at both the individual and unit level. The findings feature implications for hospital management to promote staff access to empowering structures. The findings provide information on how these structures relate to the individual and the unit; information that could be useful when planning or implementing strategies with the aim to promote staff well-being and care quality. The non-significant results for leadership and management in relation to staff outcomes in the GEE-models, raise questions for further research where a shift from individual to organizational focused performances within the field of leadership is implied.

Airborne mobile mapping systems are crucial in various geodetic applications. A key aspect of these systems is the accurate estimation of exterior orientation parameters (EOPs), which is achieved through the integration of global navigation satellite systems (GNSSs) and inertial measurement unit (IMU) technologies. One critical component in this integration is the lever arm (LA), the vector that connects the GNSS antenna and the IMU center. The uncertainty (standard deviation) in LA measurements can introduce errors in the EOP estimation, thereby affecting the overall system performance. However, how much the EOP estimation is affected by LA measurement uncertainty is examined in this study based on calibration data (test flight) using the TerrainMapper 2 system collected by Lantmäteriet in Sweden. The findings reveal that LA uncertainties have minimal influence on attitude and negligible impacts on position in terms of standard deviation (SD) if the LA is measured with an accuracy of better than 2–3 cm. Additionally, the research explores the combined effects of virtual reference station-rover baseline length and dilution of precision on positioning accuracy and their correlation with LA uncertainty, providing further insights into the complexities of EOP estimation. By advancing GNSS/IMU integration techniques, this study contributes to the enhancement of geodetic technologies customized for airborne mobile mapping applications.

Geopolymer concrete (GPC) has been developed using supplementary cementitious materials to reduce the carbon footprint associated with conventional concrete production. This study aimed to explore the production and simultaneous modeling of the properties of GPC using fly ash (FA) as the primary binder and ordinary Portland cement (OPC) as a partial replacement. Mechanical tests revealed that replacing FA with up to 30% OPC resulted in a 28-day compressive strength (CS) of 33.52 MPa and a flexural strength (FS) of 15.21 MPa. X-ray diffraction (XRD) analysis indicated the formation of nepheline and albite, which are associated with sodium aluminosilicate hydrate gel, a primary strength giving product in GPC. Additionally, gene expression programming (GEP), an artificial intelligence technique, was employed to predict the mechanical properties utilizing the experimental data. The prediction models demonstrated high accuracy, with a correlation coefficient greater than 0.90. The study’s results provide valuable insights into the performance of OPC-blended FA-based GPC and propose easy-to-use empirical formulations for standard mix design and proportioning of alternative blended GPC, promoting the application of sustainable concrete.

Increased use of cogeneration in district heating (DH) systems is important in the pursuit towards a low-carbon society, particularly in light of the ongoing electrification across multiple sectors. Apart from reducing CO2 emissions, cogeneration also contributes to additional income for the DH system owner. Nonetheless, it is important to be aware that the economic and environmental performance of DH systems are directly connected to the energy use within DH networks. This research investigates sector interactions associated with the introduction of a biomass combined heat and power (CHP) and residential energy renovation according to (life cycle cost) LCC optimum and Swedish energy targets, with a focus on CO2 emissions and the system cost of the energy utility company. The study object consists of a DH system in Visby, Sweden, and 920 historic residential building undergoing energy renovation. The results show a profitability of 905–915 MSEK for the DH system with the integration of a CHP. Global CO2 emissions decrease by 32.6–33.1 ktonnes/year, 9.0–9.2 ktonnes/year, and 19.9–20.1 ktonnes/year, for marginal coal-condensing power (limited biofuel), natural gas combined cycle power (limited biofuel), and European average production, respectively. In addition, sensitivity analyses confirm the benefits of cogeneration related to both economics and CO2 emissions based on changes in key parameters of the DH system.

Background The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) multimodal lifestyle intervention yielded cognitive and other health benefits in older adults at risk of cognitive decline. The two-year multinational randomized controlled LETHE trial evaluates the feasibility of a digitally supported, adapted FINGER intervention among at-risk older adults. Technology is used to complement in-person activities, streamline the intervention delivery, personalize recommendations, and collect digital biomarkers. Methods Trial includes older adults (60–77 years) with digital readiness/experience with smart devices and increased dementia risk but without substantial cognitive impairment. Participants are enrolled at four sites (Austria, Finland, Italy, Sweden). At baseline, participants were randomized 1:1 ratio to 1) intervention i.e., structured multimodal lifestyle program (including diet, exercise, cognitive training, vascular/metabolic risk management, social stimulation, sleep/stress management) where in-person activities led by professionals are supported with an Android mobile phone application developed by the consortium (the LETHE App); or 2) control i.e., self-guided program (regular health advice; simplified App with no personalized/interactive content). All participants wear smartwatches to gather passive data (e.g., physical activity, sleep). Primary outcomes are retention, adherence, and change in validated dementia risk scores. Secondary outcomes include changes in lifestyle, cognition, stress, sleep, health-related quality of life, and health literacy. Additional outcomes (exploratory) include e.g. participant experiences and dementia-related biomarkers (Alzheimer’s disease blood markers, neuroimaging). A sub-study explores the feasibility of novel interactive technology (audio glasses, social robot). Results Recruitment began in September 2022, and the last participant was randomized in June 2023. In total, 156 individuals were randomized (mean age 69 years, 65% women; balanced recruitment across the four sites). Vascular and lifestyle risk factors were common (e.g., 65% with hypertension, 69% with hypercholesterolemia, 39% physically inactive), indicating successful recruitment of a population with risk reduction potential. Trial will be completed by summer 2025. Retention until the first post-baseline visit at 6 months is high (n = 2 discontinued, retention 98.7%). Conclusion LETHE provides crucial information about the feasibility of technology and a digitally supported FINGER lifestyle program to promote brain health. Digital tools specifically designed for older adults could offer potential for large-scale, cost-effective prevention programs. Trial registration ClinicalTrials.gov (NCT05565170).

The need to decarbonise and reduce pollutant emissions from maritime transport is facilitating the studies of ground effect vehicles. Technical development in recent decade concerning unmanned flights in drones has supported this development. These vehicles could have much higher speed than sea vessels and they are estimated to be less costly compared to air transport. Unmanned operations without passengers enable wider range of transport connections (even in difficult conditions). In this research we analyse prototype vehicle called Airship and its possible use in different routes of intra Canary Islands’ transport. We suggest the most lucrative routes and cargo groups. Initial cost and revenue considerations are made over the life-cycle of Airship. As a result, we can point that there are three main factors determine the success of the transport operations. They are: the number of journeys per day, business days operating per year and freight price.

Objective: Since placebo and nocebo-responses during acupuncture therapy are rarely studied in clinical contexts, the objective was to investigate placebo and nocebo-responses in a clinical context through comparing positive and negative side-effects between genuine and sham acupuncture, and to identify factors modifying placebo and nocebo-responses. Methods: Patients reported positive side-effects (non-intended positive effects) or negative side-effects (non-intended negative effects) of genuine (penetrating; n = 109) or sham (telescopic non-penetrating; n = 106) acupuncture during 5 weeks of chemoradiation for cancer. Results: The genuine and the sham acupuncture group reported rather similar frequencies of positive (P-values .223-.800) or negative (P-values .072-1.0) side-effects: relaxation 59%/57% of the patients, improved mood 46%/38%, improved sleep 38%/38%, pain-reduction 36%/28%, tiredness 42%/42%, feeling cold 37%/31%, sweating 23%/21%, and dizziness 20%/12%. Positive side-effects occurred in 79% of patients who highly believed acupuncture to be effective, compared to in 0% of patients who did not believe. Other factors associated with placebo-response were female sex (P = .042), anxious mood (P = .007), depressed mood (P = .018), and blinding-success (P = .033). Factors associated with nocebo response were female sex (P = .049), younger age (P = .010), and needle-induced pain (P = .014). Sham-treated patients experiencing positive side-effects experienced better quality of life at the end of the treatment period (mean, m 64 on a scale 0-100 millimetres, Standard Deviation, SD, ±26.1 mm) than those who did not (m 48 ± 25.5 mm), P = .048 (adjusted for other characteristics). Conclusions: Clinically significant levels of placebo and nocebo effects commonly occurred during acupuncture therapy in integrative cancer care and this paper identified factors modifying these responses. This implicates that acupuncture-delivering therapists striving to maximize placebo-responses and minimize nocebo-responses may considering strengthen the patient’s treatment expectations, and offer a pleasant, pain-free, acupuncture treatment.

Gender differences in pain reporting and prevalence have been demonstrated. As gender of examiner also affects reporting of pain on palpation, the aim of this study was to evaluate the effects of examiner gender on palpation performance using three different palpation methods. Examiners of both genders were instructed on the correct technique for each palpation method by either a female or male instructor. The target was to achieve a pressure of 100 kPa, corresponding to the 1 kg of force for muscle palpation described in the diagnostic criteria for temporomandibular disorders (DC/TMD). All examiners performed traditional palpation with the index finger, palpation with a palpometer, and a novel bimanual palpation with visual feedback, in a randomized order. The examiner's gender, and its interaction with the gender of the instructor did not significantly affect magnitude, accuracy, or precision of the pressure applied. The method of palpation was the only factor that significantly impacted all metrics. The palpometer achieved the lowest palpation magnitude (mean pressure applied = 113.7 kPa, 95% CI: 109.8–117.6), the highest accuracy (absolute difference = 15.7 kPa, 95% CI: 12.3–19.1), and the highest precision (mean coefficient of variation = 6.8, 95% CI: 6.0–7.6), followed by bimanual palpation and traditional palpation. The results suggest that gender differences in pain reporting in patients are not likely to be a result of the technical aspects associated with the gender of the examiner. Instead, these differences may be attributed to other factors, such as sociocultural influences.

Natural language is known to play a crucial and specific role for children’s learning in school mathematics. Not only does it carry special vocabulary, but subtle differences between natural languages may lead to surprising challenges, for instance, for learners who are not taught mathematics in their mother tongue. In this paper, the anthropological theory of didactic (ATD) is used as a main framework, and we analyse some praxeological anomalies from the teaching of fractions at Japanese schools abroad, while learners attend, at the same time, a regular school in some other language (in this case, the local language, Swedish). Our findings indicate that these praxeological anomalies arise not only from linguistic disparities related to specialised vocabulary and syntax for elementary mathematics but also from institutional and curricular differences. This study gives new insights on these language challenges related to mathematics as taught at expatriate schools, particularly in the case of Japanese.

Background The number of older adults with complex healthcare needs is growing alongside limited resources available in health services. To meet this challenge, it is urgent that healthcare staff are motivated and able to continuously translate new knowledge and working methods into daily practice. To facilitate such implementation, supportive measures responding to the healthcare personnel’s needs seem essential. The present study aims to translate, contextualize and test a Swedish version of the Implementation Process Assessment Tool (IPAT) for measuring the facilitation needs among staff implementing a new working process in municipal elderly care. Methods A mixed-method design was used. First, the existing instrument was translated into Swedish. Thereafter, twelve staff members with different professions working in healthcare and at the municipal elderly care were interviewed using Think-aloud interviews to contextualize and test the face validity of the translated instrument. Lastly, the adjusted instrument (Swe-IPAT) was psychometrically evaluated through a cross-sectional survey among 305 staff members working in municipal elderly care. Results The psychometric evaluation of the Swe-IPAT revealed satisfying properties. Three factors, largely in line with the original IPAT, are suggested. Internal consistency assessed using Cronbach’s alpha was 0.93 for the factor individual phases for behavioral change and perception of the intervention, 0.84 for the factor individual activities, and 0.95 for the factor collective readiness and support. Conclusions The 27-item Swe-IPAT, translated into Swedish and contextualized, demonstrated satisfactory psychometric properties when tested in an elderly care context. The instrument is suggested to be useful in providing feedback to managers in tailoring support and assessing implementation efforts among healthcare staff in elderly care. However, more research is needed to evaluate its properties throughout the entire implementation process and to test the usability of Swe-IPAT in other settings.

Aim This study re‐evaluated the classification accuracy of language screening. This is because the new Swedish child health programme moved this screening from 3 to 2.5 years of age. Another aim was to investigate the stability of diagnoses between these two time points. Methods Children were recruited consecutively during 2016–2017 from three Child Health Services in Gävle, Sweden. Forty‐eight monolingual children (31 boys) and 93 bilingual children (38 boys) underwent language screening and a clinical examination by a speech and language pathologist at 2.5 years of age. They were re‐examined after 6 months (at 36–38 months) for clinical diagnosis. Results Of the 48 monolingual children, 45 retained their status at both 2.5 and 3 years of age, while three no longer met the criteria for development language disorder. Among the 93 bilingual children, 87 retained their 2.5‐year status at age 3, two no longer met the criteria, and four new cases were diagnosed. These differences were not statistically significant. All changes in screening parameters between 2.5 and 3 years were within the 95% Confidence Interval, indicating stable classification. Conclusion Screening accuracy and language status were robust between 2.5 and 3 years, providing no support for a wait‐and‐see approach.

In this paper, we suggest the following generalisation of Mikhalkin’s simple Harnack curves: a generalised simple Harnack curve is a parametrised real algebraic curve in $({\mathbb {C}}^{*})^{2}$ with totally real logarithmic Gauss map. First, we investigate which of the many properties of simple Harnack curves survive this generalisation. Then, we construct new examples using tropical geometry. Eventually, since generalised Harnack curves can develop arbitrary singularities, in contrast with the original definition, we pay a special attention to the simplest new instance of generalised Harnack curves, namely curves with a single hyperbolic node. In particular, we determine the topological classification of such curves for any given degree.