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  • Public defence: 2020-02-28 09:00 N440, Naturvetarhuset, Umeå
    Gaitonde, Rakhal
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Divergences, dissonances and disconnects: implementation of community-based accountability in India’s national rural health mission2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Accountability of health systems to the individuals and communities they serve is increasingly recognized as a key aspect in efforts at health system strengthening. This has led to a greater focus on efforts to evolve systems that enable communities to hold health systems accountable. In parallel with this change, the governance of public systems has been transformed under the influence of the neo-liberal paradigm of governance. India introduced the flagship National Rural Health Mission (presently termed the National Health Mission) in 2005, to bring about an architectural correction of the health system. One of the five key components of the mission was ‘Communitization’. This component aimed to increase the ownership of the health systems by the communities they serve. As part of this a programme called Community Action for Health (CAH) was piloted in nine states and then rolled out nationally. The implementation diverged from the originally envisaged process in different states.

    This PhD research aims to understand the institutional level influences that impact on the implementation of community-based accountability and governance mechanisms and the potential of integrating such processes in the public health system in India. I used qualitative methods to map out the divergences in implementation and sought to understand the reasons for these. Next, I conducted a case study of the southern state of Tamil Nadu, in which I focused on the processes within the apex administrative level of the state.

    In addition to mapping two dimensions along which the policy seemed to diverge, I also documented three distinct perspectives on accountability among the key actors involved in implementing CAH. Overall there were three constructs that emerged from the research: ‘Divergences’, ‘Dissonances’ and ‘Disconnects’. Divergences refer to the way in which policies and programmes shift from the original conceptualization. Dissonances points to the presence of multiple perspectives on the same concept in the same organizational setting. Disconnects represents the lack of spaces within the organization that enable processes of collective sensemaking. The emergent understanding from the research is that the divergences in policy implementation may in fact reflect a deeper level of conflict at the level of belief and perspectives in different layers of the administration. In the absence of spaces and processes to facilitate collective sense-making, it is likely that policies, even when introduced with significant commitment from policymakers at the higher administrative layers, are likely to require systematic effort to sustain.

  • Public defence: 2020-02-28 10:00 Hörsal N360, Umeå
    Lindahl, Jonas
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    In search of future excellence: bibliometric indicators, gender differences, and predicting research performance in the early career2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The governance of higher education institutions and science have endured significant changes during the last decades, emphasizing competitiveness, performance, and excellence. Embedded in this development is an increased use of bibliometric indicators as decision support tools in contexts of e.g., employment, appointment, and funding. These changes have gradually extended to the early career phase and the doctoral education.

    The aim of this thesis is to make a contribution to an ongoing discussion about the predictability of research performance and the reasonability of using bibliometric indicators in the early career, with a focus on gender differences. The thesis revolves around three overarching research questions focusing the early career and the doctoral education: (1) the degree to which research performance, as operationalized with bibliometric indicators, is predictable; (2) the degree to which gender differences in early career performance can be explained by research performance during the doctoral education; and (3) to what degree factors such as collaboration and supervisor behaviour, might affect gender differences in research performance.

    The main results suggests that research performance in the early career, as operationalized by bibliometric indicators, is predictable. Individuals who publish larger volumes, publish more in high prestige journals, and more excellent research early in their career, are more likely to attain excellence later on. The results also indicates that gender differences in performance can be observed as early asduring doctor education and that these differences partly explain the observed performance differences between males and females in the early career.

    Finally, the results suggests that gender differences in performance during doctoral education can largely be explained by the doctoral student’s collaborative networks and supervisor behaviour. It is concluded that while research performance, as operationalized by bibliometric indicators, duringthe early career is predictable, there are gender differences in performance that have to be taken into consideration. If they are not, the use of these types of performance indicators in science policy and management might increase the gender gap in science.

  • Public defence: 2020-02-28 13:00 Aulan, Sundsvalls sjukhus, Sundsvall
    Wennstig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Long-term side effects of radiotherapy in breast cancer: studies in ischemic heart disease and lung cancer2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Breast cancer (BC) is the most common cancer in women worldwide. Due to early detection and advances in adjuvant therapies, most women diagnosed with early BC will be cured of their disease, and issues of survivorship are of great importance. Adjuvant radiotherapy (RT) in BC is well established and significantly reduces local recurrences and BC mortality. Still, it usually involves some accidental irradiation to the heart and lungs, which may lead to long-term side effects, mainly ischemic heart disease (IHD) and lung cancer (LC). The overall aim with this thesis was to study IHD and radiation-induced LC in women receiving RT for BC from the early 1990s until recently.

    In paper I and paper II a cohort of women (n=182) receiving computed tomography (CT)-based RT (3DCRT) for BC during 1992 to 2012, who subsequently were referred to a coronary angiography and treated for coronary stenosis, was studied. Paper I was a reproducibility study with the aim to examine the inter-observer variation in delineation of the coronary arteries (CAs) in CT scans used for 3DCRT planning. All patients treated at one of the participating RT departments (n=32), were selected from the larger cohort, and the CAs were delineated in the patients’ CT-scans by three oncologists independently, with a validated CT-based heart atlas as guideline. Spatial difference between the different delineations, and variance in radiation dose was calculated. The median distance between the centers of the arteries was 2-8 mm for the right coronary artery (RCA), and 1-4 mm for the left main coronary artery (LMCA) and the left anterior descending artery (LAD). The intraclass correlation coefficient (ICC) was derived to quantify the variance in estimated doses. The ICC for mean doses varied from 0.76 to 0.98 for LMCA-LAD, and from 0.73 to 0.92 for RCA, indicating that variation in radiation doses was mainly due to interpatient variation. In conclusion, the study showed high consistency in contouring the CAs in the patients’ planning CTs, in particular the LMCA-LAD. In paper II, the aim was to examine the relationship between radiation dose to the CAs and subsequent coronary stenosis that required a coronary intervention at this location. The CAs were delineated and divided into segments in the 182 patients’ planning-CTs and doses were recalculated based on the dose distribution of the original RT plans. The location of the CA stenosis was identified from the Swedish Coronary Angiography and Angioplasty Register (SCAAR). Mean doses to the heart and the LAD were substantially higher in women receiving left-sided RT compared to right-sided RT. Segment-wise analyses were performed to assess the risk of developing a coronary stenosis that required an intervention at a certain radiation dose. Segments receiving radiation doses < 1 Gray (Gy) were used as reference. The main finding was a five-fold increase in risk of a clinically relevant coronary stenosis in the mid LAD at mean doses over 20 Gy, compared to doses of 0-1 Gy (odds ratio 5.23; 95 % CI (confidence interval) 2.01-13.6). There were iv too few events to calculate increase in risk per Gy. Still, the result of this study supports that the radiation dose to the LAD should be considered at RT planning and kept as low as possible.

    In paper III and IV, the BcBaSe cohort was used to examine risk of IHD, and radiation-induced LC after adjuvant RT for BC. The BCBaSe consists of 68089 women diagnosed with BC during 1992 to 2012, and 340352 age-matched women without BC diagnosis. In paper III, Cox regression analyses were performed to estimate risk of IHD, by comparing women with BC to women without BC diagnosis, and by comparing left-sided BC to right-sided BC. Kaplan-Meier analysis was performed to assess cumulative incidence of IHD. Women with BC had a lower risk of IHD compared to women without BC diagnosis at follow-up (hazard ratio (HR) 0.91; 95 % CI 0.88-0.95). Women irradiated for left-sided BC had a higher risk of IHD compared to women irradiated for right-sided BC (HR 1.18; 95 % CI 1.06-1.31). The HRs increased with more extensive lymph node involvement and with addition of systemic therapy. The cumulative IHD incidence was increased in women receiving left-sided RT compared to rightsided RT, starting from the first years after RT and sustained with longer followup. In paper IV, Kaplan-Meier analyses were performed to assess cumulative incidence of LC and LC-specific survival. Cox regression analyses were performed to estimate risk of LC after adjuvant RT for BC, comparing women with BC to women without BC diagnosis. Women with BC receiving RT had a higher cumulative incidence of LC compared both to women with BC not receiving RT and women without BC. This became apparent 5 years after RT and increased with longer follow-up. Women with BC receiving RT had a higher risk of LC compared to women without BC diagnosis (HR 2.35; 95 % CI 1.54-3.59). LCspecific survival was significantly higher in women with a prior BC compared to women without a prior BC diagnosis. In paper III and paper IV information on individual dosimetry data was not available. Most women likely received 3DCRT given with tangential fields and were treated before breathing adaption techniques were implemented in Sweden. The results of these studies emphasize the importance of further development and implementing of RT techniques and regimens that lower the cardiac and lung doses.

    In conclusion, we found that radiation doses to the LAD remained high in women receiving 3DCRT for BC between 1992 and 2012, and were associated with an increased risk of clinically relevant CA stenosis. Delineating the LAD was feasible and the results of these studies support that the LAD radiation dose should be considered in RT treatment planning. The register-based studies confirmed that the risk of IHD was significantly increased in women receiving left-sided RT and that the risk of LC after BC RT was significantly increased in this large cohort of women with BC.

  • Public defence: 2020-02-28 13:15 S213, Samhällsvetarhuset, Umeå
    Mancheva, Irina
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Forest water governance: challenges in cross-sectoral and multi-level collaboration2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Forests and water are highly interconnected with forestry practices negatively affecting forest water. In the last five decades, the Swedish state has enacted multiple policy changes and allocated significant resources towards the implementation of soft policy instruments to alleviate the effects on forest water. The European Union Water Framework Directive has further raised the legal requirements for water protection, including within the forest sector. However, these efforts have largely failed thus far. Forests and water are governed by two separate sectors, each with its own polycentric governance system and policy goals that are often conflicting. The governance mode of these systems is determined by a unique combination of policy instruments and a varying degree of centralisation depending on state involvement. Since governing forest water requires collaboration between the forest and water sector governance systems, it entails interplay between the two systems on different ecological scales. The aim of this thesis is to explore and explain the challenges related to the governance of a resource that requires cross-sectoral multi-level governance and to examine the role of the state in those interactions. The thesis includes a mix of quantitative (survey and aerial photographs) and qualitative (interviews, analysis of documents and meeting observations) research methods for investigating forest water governance across national, regional and local levels. Empirically, it involves four case studies analysing units embedded in the larger case – namely cross-sectoral governance of forest water.

    The results show that within the current structure of Swedish forest water governance there is minimal cross-sectoral collaboration, with an exception being at the national level. Regional and local implementation of the outputs produced at national level relies mainly on the forest sector, with little to no coordination with water sector institutions at the regional district or river basin levels. Moreover, power asymmetries between the two sectors are transposed to the collaborative process which affects participants’ capacity to influence the governance of forest water. Since the studied cases show that most of the financial resources for forest water protection are provided top-down, the role of the state in initiating and maintaining collaboration is crucial. The thesis confirms previous research findings that water governance requires a more centralised polycentric governance system. Combining polycentric governance (including at the river basin scale) with centralised state-coordination is a potential solution to problems that require cross-sectoral and multi-level governance interplay. Further inquiry into cross-sectoral governance of natural resources could develop a better understanding of how coordination in polycentric governance systems at different ecological scales could be structured to mitigate policy goal conflicts across sectors and institutional levels, thus fostering more effective governance.

  • Public defence: 2020-02-28 14:12 Lilla Hörsalen, KBC, Umeå
    Guo, Junwen
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Consequences of consumer-resource stoichiometric imbalance in planktonic food webs2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Resource imbalance between consumers and their resources can come from inadequate resource quantity or quality. The ecological stoichiometry theory focuses on understanding the consequences of imbalance in elemental composition.  In this thesis, I have used both resource quality (e.g., inorganic vs organic forms of nutrients) and resource quantity (e.g., terrestrial and freshwater nutrient loading to natural coastal systems) to address the consequences of consumer-resource imbalance in planktonic food webs. First, I provided a framework that summarizes how the stoichiometric imbalance is transferred from one biological level to another. The framework highlights the importance of the distribution of elements among different chemical forms and the distribution of elements among connected ecosystems. The framework then served as a guideline for the empirical work of my thesis.  Second, I studied the response of bacterial community mineralization to the relative availability of different forms of nitrogen (inorganic vs. organic form) in a batch culture experiment. The study shows that different forms of nitrogen can significantly influence the growth of bacteria. More importantly, my results show that it is crucial to measure the actual bacterial carbon to nitrogen consumption ratio, rather than use classical theoretical models, to be able to make an accurate prediction of bacterial ammonium regeneration. Third, I tested the effect of different forms of nitrogen on microplankton food web dynamics in a microcosm experiment. I found that differences between nitrogen forms have a strong impact on food web dynamics that is channeled by the bacteria-phytoplankton interaction at the base of the food web. The whole microplankton food web benefits from organic forms of nitrogen as a result of increased mutualistic interactions between bacteria and phytoplankton. Hence, the form of nitrogen is an important factor to be considered in microplanktonic food web dynamics, at least on the short-term. In the final part of this thesis, I explored resource quality and quantity effects on the stoichiometric response of a natural coastal ecosystem in a field study. I expected that the relative availability of inorganic or organic forms of carbon, nitrogen and phosphorus in our sampling bays may affect organismal elemental composition both temporally and spatially. The results indicate that the stoichiometry among seston size fractions and zooplankton varied more through time than in space. However, zooplankton stoichiometry was relatively stable among species within specific months. Overall, the concentration of dissolved organic carbon and dissolved organic nitrogen in the water column were the major explanatory variables for the seston stoichiometry. In summary, this thesis uses multiple systems to elucidate how the form and input of nutrients shape the plankton food web dynamics and its stoichiometric responses.

  • Public defence: 2020-03-11 13:00 Carl Kempe salen (KB.E3.03), Umeå
    Sullivan, Alexis R.
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Umeå University, Faculty of Science and Technology, Umeå Plant Science Centre (UPSC).
    A forest dark: an evolutionary history of Norway spruce2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Embedded within the relationships among species is a dense forest of gene trees, each with a potentially unique and discordant history. Such widespread genealogical heterogeneity is expected, but embracing this hierarchy of discordance while reconstructing the histories of populations and species remains a major challenge.

    In this thesis, I studied the history of the genes and genomes contained within Norway spruce (Picea abies: Pinaceae), a forest tree distributed throughout boreal and montane Europe. I sequenced plastid genomes from all the commonly-recognized Picea species and developed a novel strategy to assemble the bacterial-sized mitochondrial genome of Norway spruce. Using multispecies coalescent network models, I reconstructed the relationships among populations of Norway spruce and the parapatric Siberian spruce (P. obovata) and distinguished between drift and hybridization as sources of phylogenetic discord.

    Norway spruce holds heterogenous histories at multiple levels of organization. Although organelle genomes are expected to be clonal and uniparentally inherited, the chloroplast genome held by Norway spruce originated after sexual recombination between two divergent lineages. In the mitochondrial genome, recombination creates a diverse population of genome arrangements subjected to drift and selection within individuals and populations. Genetic diversity among populations is shaped in nearly equal measure by divergence and hybridization. Norway spruce is discordance distilled.