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  • Public defence: 2018-10-19 09:00 Lilla hörsalen KBE301, Umeå
    Ghorbani, Ramin
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Real-time breath gas analysis of carbon monoxide: laser-based detection and pulmonary gas exchange modeling2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Breath gas analysis is a promising approach for non-invasive medical diagnostics and physiological monitoring. Real-time, breath-cycle resolved biomarker detection facilitates data interpretation and has the potential to improve the diagnostic value of breath tests as exhalation profiles carry spatiotemporal information about biomarker origin and gas exchange in the respiratory tract. This thesis presents and scrutinizes a novel methodology for the analysis of real-time breath data, where single-exhalation profiles are simulated using a pulmonary gas exchange model and least-squares fitted to measured expirograms to extract airway and alveolar contributions and diffusing capacities. The methodology is demonstrated on exhaled breath carbon monoxide (eCO), a candidate biomarker for oxidative stress and respiratory diseases. The thesis mainly covers (1) the construction of a compact optical sensor based on tunable diode laser absorption spectroscopy (TDLAS) in the mid-infrared region (4.7 μm) for selective and precise real-time detection of CO in breath and ambient air (detection limit 9 ± 5 ppb at 0.1 s), (2) the design of an advanced online breath sampling system, (3) the implementation of a trumpet model with axial diffusion (TMAD) to simulate the CO gas exchange, and (4) the application of extended eCO analysis in clinical studies to establish the healthy non-smoker baseline of the eCO parameters and to study the response to CO and wood smoke exposure. It is shown that the TMAD adequately describes the gas exchange during systemic CO elimination for different breathing patterns, and that there is no difference between eCO parameters from mouth- and nose exhalations. Expirogram shape and eCO parameters exhibit a dependence on the exhalation flow rate, but for a given breathing maneuverer, the parameters lie in a narrow range. Airway CO is close to and correlates with ambient air CO, indicating negligible airway production in the healthy population. The alveolar diffusing capacity is independent of endogenous CO, even after exposure to elevated exogenous CO, and could be used to assess lung diffusion abnormalities. Compared to CO exposure, no clear additional effect of exposure to wood smoke particles on eCO is observed. The discrimination between endogenous and exogenous CO sources remains a challenge.

  • Public defence: 2018-10-22 13:00 N300, Naturvetarhuset, Umeå, Sweden
    Brembilla, Christian
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Efficiency factors for space heating system in buildings2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The thesis focuses on the efficiency of the space heating system. In particular, the efficiency factors measure the efficiency of thermal zone. The efficiency factors measures how the energy is used in a space heating. Efficiency factors relatively close to one mean that the energy is used "efficiently'', by contrast, efficiency factors close to the zero mean that the majority of the energy is lost to the outdoor environment. This method for the appraisal of space heating performance reads as if it is apparently simple and intuitive. In reality, the efficiency factor method has several pitfalls.

    The thesis provides tools, insights and remarks on how to apply the efficiency factor method to space heating systems equipped with hydronic panel radiator and floor heating respectively. Models of the latter heaters together with the multilayer wall were developed and validated to understand the reliability of their predictions. The hypothesis is that the heat stored in the building thermal mass and heaters plays a role in defining the building thermal performance and as a result in the appraisal of the efficiency factors. The validation is based on the sensitivity bands of the models' predictions. The heaters were tested in in a thermostatic booth simulator. Benefits and drawbacks of each model were highlighted to increase awareness of their use in the engineering fields. The results showed how the models accounting for the heat stored performed the charging phase. In addition, results of how the multilayer wall delayed and damped down the heat wave coming from the outdoor environment were presented with the appraisal of the decrement factor and time delay of the indoor temperature. The results of the efficiency factors analysis reveal how the weather affects the efficiency of each locality situated in cold climates. Lastly how different control strategies impact on the efficiency factors of space heating and its distribution system. To conclude, this study highlights the paradoxes around the efficiency factor method. The thesis proposes how such factors have to be interpreted by researchers and scientists tackling the lack of information around this topic.

  • Public defence: 2018-10-26 09:00 Hörsal D, Unod T9, Umeå
    Pujilestari, Cahya Utamie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Abdominal obesity among older population in Indonesia: socioeconomic and gender inequality, pattern and impacts on disability and death2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Population ageing has contributed to the rise of chronic non-communicable diseases (NCDs). Concurrently, obesity prevalence is increasing in all age groups and has become a serious public health problem. Obesity is the main risk factors of the major chronic NCDs such as type 2 diabetes and has been linked to disability and mortality. Studies of socioeconomic inequalities in obesity among older people in Indonesia are scarce. Understanding socioeconomic inequalities are essential to develop appropriate health programme to improve the population health. This thesis describes the pattern of socioeconomic and gender inequality in abdominal obesity and analyses its impact on disability and all-cause mortality among older people in Indonesia.

    Methods: This thesis is based on four studies conducted in Purworejo Health and Demographic Surveillance System (HDSS) site in Purworejo district, Central Java, Indonesia. This thesis uses both quantitative and qualitative methods. The qualitative study (sub-study 1) was based on 12 Focus Group Discussions (FGDs) with 68 participants from different age groups, sex, and living area. Content analysis was used to describe the community perceptions on diabetes and its risk factors. The quantitative studies (sub-study 2 to 4) utilized longitudinal panel data from the 1st (n = 11,753 individuals) and 2nd wave (n = 14,235 individuals) of the WHO-INDEPTH Study on global AGEing and adult health (SAGE) conducted among all individuals aged 50 years and older in 2007 and 2010. Sub-study 2 used concentration index and decomposition analysis to analyse the pattern of socioeconomic and gender inequality in abdominal obesity. Sub-study 3 used linear regression to examine the association between abdominal obesity and disability. Sub-study 4 used Cox regression analysis with restricted cubic splines to examine the impact of abdominal obesity on all-cause mortality.

    Results: The FGDs reveals that the community holds unrealistic optimism in perceiving diabetes its risk factors. The community stated that chronic NCD such as diabetes is caused by modern lifestyles and mostly attacks those who are considered as the wealthy (sub-study 1). Socioeconomic inequality in abdominal obesity exists in Purworejo HDSS. Abdominal obesity was more prevalent among the affluent men and women, with a lesser inequality gaps between rich and poor among women. The main contributing factors to inequalities in abdominal obesity were occupation, wealth index, and education (sub-study 2). In three-year period, the mean waist circumference decreased significantly among the poor. An increase in waist circumference was significantly associated with disability, and the poor people were more disabled compared to the rich (sub-study 3). A U-shaped association was observed between waist circumference and all-cause mortality, particularly among women. This indicated an increased risk of mortality in the lower and upper end of the waist circumference distribution. The poor with low waist circumference had a higher risk of mortality than the rich (sub-study 4).

    Conclusion: Abdominal obesity was disproportionately more prevalent among older Indonesian women. Though the wealthy people have higher burden of abdominal obesity, the poor people experiences more disability and higher risk of death. Misperception on chronic NCDs and its risk factors exist among the Indonesian population. Abdominal obesity prevention strategies are needed to prevent chronic NCDs, disabilities, and mortality among Indonesian older population. The prevention strategies should be culturally sensitive and address all socioeconomic levels. Special attention should be given to disadvantaged women as the most vulnerable group.

  • Public defence: 2018-10-26 10:00 N430, Umeå
    Holmgren, Per
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Entrained flow studies on biomass fuel powder conversion and ash formation2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Reducing the global dependence on fossil fuels is of paramount importance in tackling the environmental challenges we face, not only tomorrow, but already today. Biomass offers a renewable supply of CO2-neutral raw material that can be converted into many different forms of fuels and valuable chemicals, making it a prime candidate for the technologies of tomorrow. However, the heterogeneous nature and distinctly different elemental composition of biomass compared to traditional fossil sources present new challenges to be solved. When it comes to thermochemical technologies, key issues concern fuel conversion efficiency, ash formation, ash/fuel interactions and ash/reactor material interactions.

    The objective of the present thesis was to provide new knowledge and insights into thermochemical fuel conversion, in particular its application in entrained flow technologies. A laboratory-scale reactor was constructed, evaluated and was used to study several aspects of high-temperature entrained flow biomass fuel conversion. Pulverized fuel particles from different biomass sources were used, and their physical and chemical interactions with the surrounding atmosphere, the concurrent ash element release, ash formation, and phase interactions were also studied in detail. In addition to the entrained flow reactor designed and constructed for this purpose, the main method for data collection was in situ optical studies of converting particles, either while entrained in the flow or when impacting upon surfaces. Elemental composition analysis of collected samples and gas analysis were also performed, allowing for a deeper understanding of ash element fractionation and interactions and thus explaining the observed properties of the resulting deposits or slag.

    The degree of conversion of fuels with very low ash content, such as stem wood, was well described and modeled by a novel method using optical data, offering a non-intrusive and non-destructive alternative to traditional techniques. Coupling computational fluid dynamics with optical data allowed for improved experimental data interpretation and provided improved accuracy for fuel particle residence time estimations, which is an important parameter when studying fast chemical reactions such as those taking place in reactors for entrained flow conditions. The results from studies on ash formation gave new insights into the feasibility of using dry-mixed K-rich additives for improving slag properties during gasification of Ca-rich and Si-rich fuels. Interpretations of the experimental results were supported by thermodynamic equilibrium calculations, and the conclusions highlight both possibilities and challenges in gasification with high fuel flexibility while at the same time producing a flowing slag. Applications and future implications are discussed, and new topics of interest are presented.

  • Public defence: 2018-11-02 09:00 Bergasalen, Umeå
    Semasaka Sengoma, Jean Paul
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. University of Rwanda.
    Pregnancy and delivery-related complications in Rwanda: prevalence, associated risk factors, health economic impact, and maternal experiences2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Every year more than 1.5 million women suffer from pregnancy and delivery-related complications (PDCs) during pregnancy and childbirth worldwide, and these women are a vulnerable population for lifelong consequences, somatically, psychologically and financially. Following the establishment of Millennium Development Goal no 5, which targeted a reduction of 75% of the maternal mortality ratio from 1990 to 2015, many efforts were made to reduce maternal mortality worldwide. In low-income countries saving a pregnant woman’s life requires a focused medical intervention so that near-miss cases of death are considered as obstetric success and thus postpartum follow-up may be neglected. In Rwanda, maternal mortality is estimated to 210 per 100,000 live births and main obstetric complications are hypertensive disorders during pregnancy, obstructive/prolonged labour, post-partum haemorrhage (PPH) and sepsis/infections. However, the specific prevalence of PDCs as well as their consequences to the woman and her family is currently relatively unknown.

    Aims: The overall aim of this thesis was to determine the prevalence of PDCs and their associated risk factors and to investigate delivered women’s experiences of PDCs, the consequences of these complications on postpartum health and family situation, and to estimate the societal economic costs of pregnancy, delivery and postpartum-related problems.

    Subjects and methods: A population-based cross-sectional study including 921 women who gave birth within the past 13 months prior to time of data collection (Paper I) and a health facility-based study including 817 women that were at discharge time (Paper II) were conducted in the Northern Province of Rwanda and Kigali City. Fifteen women who experienced PDCs were interviewed through individual in-depth qualitative interviews (Paper III). A micro costing approach to collect health facility data and household costs including opportunity cost, transport and food cost was conducted to estimate the societal economic cost of PDCs (Paper I-V). Descriptive statistics, Chi-Square, bi- and multivariable logistic regression, Cox regression, and health economic analysis were applied for quantitative data analyses (Papers I, II and IV). Qualitative manifest and latent content analysis was used for qualitative data analyses (Paper III).

    Results: Prevalence of anaemia, hypertension, diabetes mellitus during pregnancy, and severe bleeding during pregnancy and labour were estimated to 15.0%, 4.9%, 2.4%, and 3.7%, respectively (Paper I). In total, 56.4% of the participants were transferred and the majority were transferred from health centres to district hospitals, with caesarean section (CS) as the main reason for transfer. Almost three-quarters of the women started labour spontaneously; 5% had induced labour and 28.4% of all pregnant women were delivered by CS (Paper II). Pre-eclampsia/eclampsia, PPH, and caesarean section (CS) due to prolonged labour/dystocia represented 1%, 2.7% and 5.4% of all participants, respectively (Paper II). Risk factors for CS due to prolonged labour or dystocia were poverty, nulliparity, and residence far from health facility (Paper II). The prevalence of poor-self rated health (poor-SRH) for participants who gave birth within the past 14 months prior to time of data collection was 32.2% at one day postpartum, 7.8% at one month, and 11.7% at time of the interview (Paper I). Most participants who had experienced PDCs reported that they were previously unaware of the complications they had developed, and they claimed that at discharge they should have been better informed about the potential consequences of these complications (Paper III). Most participants blamed the health care system as the cause of their problems due to the provision of inadequate care. Participants elaborated different strategies for coping with persistent health problems (Paper III). PDCs negatively affected participants’ economic situation due to increased health care expenses and lowered income because of impaired working capacity (Paper III). The estimated total societal cost of a normal uncomplicated vaginal delivery was 107 United States dollars (USD). The incremental cost of a vaginal delivery followed by PPH was 55 USD. The incremental cost of prolonged, dystocic or obstructed labour resulting in a CS was 146 USD. The incremental cost of pre-eclampsia with vaginal delivery and pre-eclampsia with CS were 289 and 339 USD, respectively. The major cost categories of the estimated costs for each mode of delivery were staff, the hospitalisation rooms, and household expenditures (Paper IV).

    Conclusions: A high prevalence of poor self-rated health status was reported in the early postpartum period. Identified factors associated with poor-SRH were severe bleeding, hypertension, infection, and anaemia during pregnancy and postpartum haemorrhage. The estimated prevalences of specific pregnancy and delivery-related complications were relatively low, probably in part due to underestimation. Rwandan women experiencing PDCs are facing many challenges and problems during pregnancy, delivery and postpartum period. The costs of PDCs were calculated to be very high in comparison to the net median monthly wage in Rwanda. In addition, the Rwandan health system presents weaknesses in relation to the prevention of PDCs. Above all, there is an insufficient postpartum health care provision and community support to women experiencing PDCs. The results from this thesis call for interventions, to improve the postpartum health care services and call for the community sensitisation for the increased support to women who face difficult living circumstances because they have experienced severe pregnancy and delivery-related complications.

  • Public defence: 2018-11-07 13:00 Aula Anatomica (Bio.A.206), Umeå
    Östman, Marcus
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Antimicrobials in sewage treatment plants: occurrence, fate and resistance2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The World Health Organization (WHO) has identified antibiotic resistance as a major threat to human health. The environment has been suggested to play an important role in the emergence of antibiotic resistant bacteria. The external environment can act as a source of resistance genes that could potentially be transferred into human pathogens. It is also an important route for the dissemination of antibiotic resistance genes and bacteria. Sewage treatment plants (STPs) are among the most important routes by which antibiotics and antibiotic resistance genes enter the environment. It has been suggested that STPs are hotspots for the development of antibiotic resistance because they contain relatively high concentrations of antibiotics as well as both human and environmental bacteria. Further complicating matters, there is evidence that other substances with antimicrobial properties, such as biocides and metals, can cause antibiotic resistance due to co- and cross-resistance.

    This thesis contributes new knowledge on the concentrations, mass flows, and removal efficiencies of antimicrobials in STPs and their connections to the emergence of antibiotic resistance. Paper I presents data on the levels of 40 different antimicrobials in the incoming wastewater, treated effluent, and digested sludge of eleven different STPs. Although not previously detected in STPs, chlorhexidine is shown to be ubiquitous in such plants. In Paper II, mass flows and removal efficiencies are calculated for eleven antimicrobials over various treatment steps in three STPs, showing that polar antimicrobials were inefficiently removed from the wastewater. In Paper III, the minimum selective concentration (MSC) for the antibiotic tetracycline was determined in a complex bacterial aquatic biofilm using both phenotypic and genotypic endpoints. It was found that 10 µg/L selected for phenotypic resistance, and 1 µg/L selected for certain resistance genes. Paper VI used metagenomics to determine whether there is selection for antibiotic-resistant bacteria in STPs and whether the extent of this selection can be correlated to the concentrations of antimicrobial compounds. No clear evidence for selection was identified. Paper V evaluates advanced wastewater treatment techniques for removing antimicrobial compounds using ozonation and granular activated carbon (GAC). The identity of the GAC material was found to strongly affect removal efficiency, and GAC was more efficient than ozonation for most compounds at the tested concentrations.

  • Public defence: 2018-11-09 09:00 N440, Naturvetarhuset, Umeå
    Vikström, Kevin
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Importance of bacterial maintenance respiration and baseline respiration for development of coastal hypoxia2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Reduced oxygen concentrations and increasing hypoxic zones havebecome more common in the sea due to climate change andeutrophication. The main cause of oxygen loss in oxygenatedenvironments is respiration. Respiration rates can be estimated usingoptode methodologies which utilize dynamic luminescence quenching toestimate the oxygen concentration declines in dark incubations. Apublished optode methodology was improved by using optodes withtitanium housing instead of plastic housing plausibly trapping oxygen.Drift was highly reduced by the titanium casings leading to a higherprecision and lower detection limit of 0.97 mmol O2 m-3 d-1. 28% ofmeasurements were shown to have non-linear oxygen concentrationdeclines. The rate of oxygen change was derived with a 2nd degreepolynomial at 1 hour from the incubation start. The majority of non-lineardeclines were concave and due to carbon substrate limitation. Analyzingnon-linear trends linearly, a common practice, leads to anunderestimation of respiration by up to 64%.

    Bacterial maintenance respiration (Rm) was studied using anecophysiological model unverified in natural environments. The modelwas applicable at high productivities but a quadratic model wasdemonstrated to give a better fit. Rm was found to represent a significantpart in the sub-arctic estuary contributing to 58% of the annual specificbacterial respiration. Therefore, Rm may be more important in nature thanpreviously recognized. The ecophysiological model is driven solely by thebacterial specific growth rate (μ) where the relative influence of Rm iselevated as μ decreases. As a consequence, I hypothesize that a reductionin nutrients may not decrease the oxygen consumption but rather shiftbacterial growth based respiration to Rm as μ approaches zero.Baseline respiration (Rbl), defined as ecosystem respiration disconnectedfrom contemporary primary produced carbon, was also studied. Rbl wasshown to be largely supplied by allochthonous carbon in a coastalecosystem and had a contribution of 50% to the annual planktoncommunity respiration in the sub-arctic estuary studied. I claim that Rbland Rm are crucial to include for understanding and managingdevelopment of aquatic hypoxia in an effective and economic manner.

  • Public defence: 2018-11-09 09:00 Aulan, Vårdvetarhuset, Umeå
    Lundell, Sara
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    COPD in primary care: exploring conditions for implementation of evidence-based interventions and eHealth2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Chronic obstructive pulmonary disease (COPD) is a major public health problem. Symptoms and comorbidities associated with COPD affect the whole body. Clinical guidelines for COPD recommend pulmonary rehabilitation (PR) including exercise training and education promoting self-management strategies. Despite the positive effects on health status, few people with COPD have access to PR. Electronic health (eHealth) has been seen as promising for increased access to evidence-based interventions. To increase the likelihood of a successful implementation, it is important to identity enablers and barriers that might affect implementation outcomes. The aim of this thesis is to explore the experiences, interactions and contexts of the management of COPD in primary care, as well as the design, experienced relevance, effect and expected usefulness of eHealth solutions.

    The thesis is based on four papers that have used qualitative, quantitative and mixed methods. Qualitative interviews (papers I, II, IV) and focus group discussions (paper IV) were analysed using qualitative content analysis (papers I, IV) and grounded theory (paper II). Quantitative data, collected using questionnaires (paper I) and in a systematic review (paper III) was analysed with descriptive statistics (paper I) and meta-analysis (paper III). The qualitative and quantitative findings in paper I and II were merged in a mixed methods design. Participants in the studies included healthcare professionals (papers I, IV), people with COPD (papers II, III, IV), their relatives (paper IV), senior managers representing primary care centres (paper I), and external researchers (paper IV).

    The findings in this thesis gave insight in the complex interactions within COPD management between the healthcare organisation (e.g. resources and priority), healthcare professionals (e.g. attitudes, collaboration and competence) and people with COPD (e.g. emotions, attitudes and coping). The healthcare organisation is fragmented with few resources and COPD care takes low priority. The healthcare professionals are Building COPD care on shaky ground (paper I), where the shaky ground is a presentation of the non-compliant organisation and other challenging circumstances. Driven, responsible and ambitious healthcare professionals wish to provide empowering COPD interventions through interprofessional collaboration, but are inhibited by their limited knowledge of and experience with COPD. People with COPD are (Re)acting in an ambiguous interaction with primary care providers (paper II), have limited knowledge and struggle with stigma, while they try to accept and manage their disease. The attitudes and support of healthcare professionals’ are essential for necessary interaction and self-management strategies. For people with COPD, this can take different paths: either enhancing confidence with empowering support or coping with disempowering stigma and threat.

    eHealth solutions such as telehealth, have been used to provide interventions to people with COPD through phone calls, websites or mobile phones, in combination with exercise training and/or education. They show a significant effect on physical activity level, but not on physical capacity and dyspnoea (paper III). Healthcare professionals, people with COPD and their relatives, and external researchers report that, to be useful and relevant in clinical practice, an eHealth tool should be reinforcing existing support structures (paper IV). Furthermore, it needs to fit in the current routines and contexts and create a sense of commitment in its users. According to the participants, information about selfmanagement strategies, such as how-to videos are valuable, and need to help them identify themselves with the people in the videos. The participants regard eHealth as providing knowledge and support for self-management.

    In conclusion, there is a need for implementation of clinical guidelines for COPD in primary care in order to improve both the management of COPD, as well as the interaction between healthcare professionals and people with COPD. Several actions are needed to facilitate this implementation. The priority and status of COPD management in primary care need to be raised. In addition, more resources (e.g. healthcare professionals) for COPD interventions is required to enhance the conditions for interprofessional collaboration and patient participation. Furthermore, it is important to include physiotherapists in COPD management, considering the focus on exercise training and physical activity. Healthcare professionals in primary care need further training and more time to educate and empower people who have COPD. The use of eHealth may lead to improvements in patient outcomes, although more research on web-based interventions is required. User involvement in the development process of an eHealth tool increases its usefulness and relevance in clinical practice and everyday life. The findings from this thesis may guide implementation processes in primary care, as well as the development of eHealth tools for people with COPD or other long-term conditions.

  • Public defence: 2018-11-09 09:00 Hörsal D Unod T9, Umeå
    Maquibar Landa, Amaia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of the Basque Country UPV/EHU.
    An insight into institutional responses to intimate partner violence against women in Spain2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Intimate Partner Violence (IPV) has been widely acknowledged as a major public health issue and a human rights concern. The international burden of this type of violence have lead countries to develop institutional responses to address the consequences for women as well as to reduce its prevalence. With this aim, the Spanish government enacted in 2004 one of the most comprehensive laws in the world. Among all sectors, the role of health care professionals in the identification, management and prevention of IPV becomes essential. Thus, this thesis analyses institutional responses to intimate partner violence against women in Spain, focusing on the public health-care sector.

    Methods

    This thesis is based on three qualitative papers and one mixed methods paper. Data collection was conducted through in-depth interviews in the two first papers, documentary review and in-depth interviews in the third paper and focus groups in the fourth paper. In the first paper I used thematic analysis to explore the perceptions of professionals working in different sectors regarding institutional responses to IPV with special attention to prevention campaigns aimed at young people. In the second paper we used grounded theory to develop a conceptual model representing the diverse responses generated when attempting to integrate a response to IPV into a biomedical health system. The third paper mapped and explored the training in IPV that nursing students receive at the undergraduate level in Spain through the revision of public documents and individual in-depth interviews. The fourth paper explored nursing students’ perceptions of, and attitudes towards, IPV after having received specific training in the topic.

    Main findings

    One of the main findings in Paper I was that the sustainability of programmes to address IPV was always jeopardized by politicians and colleagues that did not considered that IPV should be prioritized. Concerning prevention campaigns, participants in that study perceived that they sent messages that did not fit young people’s needs and thus were ineffective. Besides, they stressed that institutional responses failed to focus on on men to discourage violence. The main finding of Paper II was the coexistence of a range of responses in the health sector that included avoidance, voluntariness, medicalization and comprehensiveness. Attitudes and beliefs of health-care professionals about IPV were strongly related with the development of this variety of responses. In relation with training (Paper III), the majority of nursing training programmes in the country have incorporated IPV training in their curricula. However, there was a great variability between universities in the topics included in the training. Which topics were included in the training programme was influenced by lecturers’ perceptions of IPV. Nursing students who have received training on IPV (Paper IV) showed an increased acknowledgement of IPV as a health issue and consequently considered that early identification of IPV and referral were part of their nursing role. However, readiness to act was limited by persistence of myths around IPV as believing false accusations of IPV being widespread.

    Conclusions

    Policies enacted with the aim of reducing IPV and its consequences in Spain have been essential for initiating institutional responses to IPV, specifically in the health sector. However, responses have been weakly institutionalized so far, favouring front line workers or ‘street level bureaucrats’ exercise of discretion. This leads to inequalities between and within regions in the country in the implementation of the policies. The most relevant element influencing the use of discretion in the case of IPV responses was the understanding of the relationships between gender inequities and IPV. The predominant gender regime of the institutions responsible for policy implementation influenced political and economic support for the development of responses to IPV.

  • Public defence: 2018-11-09 10:00 S 213, Samhällsvetarhuset, Umeå
    Palmadottir, Valgerdur
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Perplexities of the personal and the political: how women's liberation became women's human rights2018Doctoral thesis, monograph (Other academic)
    Abstract [en]

    In this dissertation, I analyze understandings and employment of the idea that ‘the personal is political’ and how it appears in feminist politico-theoretical thought and activism in the period from the late 1960s until the middle of 1990s. My focus is primarily on the uses of personal stories in activism at the intersections of politics and legal discourse. The period in question is characterized by an evolving global feminist movement that gradually turned towards the framework of human rights. I explore two events that took place on either side of the human rights turn. These events are two international People’s Tribunals and their respective theoretical and historical contexts. The two tribunals were outspoken feminist initiatives, one held in Brussels in 1976 and the other in Vienna in 1993. They were organized by different actors at different historical moments who nevertheless identified themselves as being participants in a common international or global women’s movement. Their common denominator was both the choice of the form of a people’s tribunal and their aim of transcending national borders. Yet, their frameworks and language differ significantly.

    The first tribunal, Crimes against Women, held in Brussels in 1976, was planned as a radical feminist grassroots event, an upfront and critical response in opposition to the United Nations Conference on Women held in Mexico in 1975. In Brussels, feminist consciousness raising was fused with the method of a people’s tribunal to contribute to the creation of a transnational feminist political subject. Testimonies included personal stories of oppression and sexual violence, and they were meant to educate and motivate the women themselves in their struggle. There were no judges involved in the ‘trial’ procedures because the organizers and participants claimed that women had had enough of being judged by a patriarchal society. The event was for women only and no media were allowed to attend. Inspired by the tribunal in Brussels, the Vienna Tribunal on Women’s Human Rights, however, was planned in relation to the UN’s Conference on Human Rights in 1993, with the conceptual framework “Women’s Rights are Human Rights.” Testimonies were now directed outwardly, and strategically-selected judges commented and promised to offer support for the campaign to include gender-based violence in the human rights framework.

    My analytical focus is on three interrelated and overarching threads. Firstly, I identify ideas about politics found in the tribunal texts and the theoretical contexts that I place them in. Secondly, I trace the genealogy of violence against women as an international political issue. This converges with the history of transnational feminist activism, the rise of the human rights discourse and the search for common denominators. Thirdly, I look at the affective dimensions of the personal story as a political mobilizer. I argue that they change significantly according to historical, institutional and theoretical (ideological) context.

    Although the strategy of using personal testimonies might at first sight seem to be the greatest similarity that links the two events, the ‘method’ underwent some significant changes. I argue that the focus in Brussels was on creating a ‘counter-public’, to cultivate the participant’s own political emotions, notably righteous anger and to forge transnational feminist consciousness and solidarity, whereas, in Vienna, the framework had a more strategic character, as the individual stories were aimed at personalizing the political and motivating the empathy or compassion of an audience. 

     

  • Public defence: 2018-11-09 13:00 Hörsal N360, Naturvetarhuet, Umeå
    Carlborg, Markus
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Refractory corrosion in biomass gasification2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    To stop the net emission of CO2 to the atmosphere, we need to reduce our dependency of fossil fuels. Although a switch to a bio-based feedstock hardly can replace the total amount of fossils used today, utilization of biomass does still have a role in a future in combination with other techniques. Valuable chemicals today derived from fossils can also be produced from biomass with similar or new technology. One such technique is the entrained flow gasification where biomass is converted into synthesis gas. This gas can then be used as a building stone to produce a wide range of chemicals.

    Slagging and corrosion problems are challenges presented by the ash forming elements in biomass during thermochemical energy conversion. The high temperature in the entrained flow process together with ash forming elements is creating a harsh environment for construction materials in the reactor. Severe corrosion and high wear rates of the lining material is a hurdle that has to be overcome to make the process more efficient.

    The objective of this work is to investigate the nature of the destructive interaction between ash forming elements and refractory materials to provide new knowledge necessary for optimal refractory choice in entrained flow gasification of woody biomass. This has been done by studying materials exposed to slags in both controlled laboratory environments and pilot scale trials. Morphology, elemental composition and distribution of refractories and slag were investigated with scanning electron microscopy and energy dispersive X-ray spectroscopy. Crystalline phases were investigated with X-ray diffraction, and thermodynamic equilibrium calculations were done in efforts to explain and make predictions of the interaction between slag and refractory.

    Observations of slag infiltration and formation of new phases in porous materials indicate severe deterioration. The presence of Si in the materials is limiting intrusion by increasing the viscosity of infiltrated slag. This is however only a temporary delay of severe wear considering the large amount of slag that is expected to pass the refractory surface. Zircon (or zirconium) (element or mineral?) based material show promising properties when modeled with thermodynamic equilibrium, but disassembling of sintered material and dissociation of individual grains was seen after exposure to a Si- and Ca-rich slag. Fused cast materials have a minimal slag contact where the only interaction is on the immediate hot face. Dissolution was however observed when exposed to a silicate-based slag, as was the formation of NaAlO2 after contact with black liquor.

  • Public defence: 2018-11-09 13:15 Lecture Hall C, Social Sciences building, Umeå University, Umeå
    Rosales, Virginia
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Business Administration.
    The interplay of roles and routines: Situating, patterning, and performances in the emergency department2018Doctoral thesis, monograph (Other academic)
    Abstract [en]

    This thesis took its point of departure in the lack of research regarding the intricate and important relationship between roles and routines. With roles and routines providing individuals with enough discretion to accomplish work while ensuring consistency, the overall research question posed was: how do roles and routines interplay to enable flexible performances? This question was operationalized through three sub questions: (1) why are roles and routines flexible, (2) how do roles and routines interplay, and (3) what contextual aspects influence which patterns come into play? The purpose was to increase the understanding of the interplay of roles and routines in organizations.

    The theoretical basis was built up in three steps. First, the foundations of roles and routines were explored separately, laying the basis for further conceptualizations. Second, overlaps of role and routine studies were explored, highlighting their contributions to current understandings. Third, through a joint discussion of the fields, commonalities between the two areas were put forth. Central to this were the ontological foundations in performances, and re-enacting the duality of structure and agency. The theoretical work resulted in a conceptual framework, which integrated roles and routines and served as the basis for unpacking and furthering an understanding of their interplay.

    In order to fulfil the purpose, and in line with the view on roles and routines as patterns of action, an organizational ethnography of an emergency department at a Swedish university hospital was conducted. Due to its characteristics, this setting represented a unique opportunity to study the interplay. Primarily based on observations, a total of 25 field visits (136,5 hours), 19 interviews, and hundreds of documents, served as the empirical material, which was analysed through iterative rounds of coding. Narratives, visual mapping, and narrative networks, were analytical strategies used in progressively moving from an understanding of the context to the identification of role and routine patterns.

    Furthering the developed conceptual framework, the findings showed how roles and routines interplay in, and through, performances. Depending on individual, interpersonal, and environmental aspects, scripted and unscripted patterns are situated in performances, which trigger role and routine patterning. Summarized in an integrated framework, which highlights the key findings, this thesis showed how the interplay of roles and routines provides organizations with stability and flexibility. This has implications not only for role and routine theories, but also organization theory in general. Implications, regarding the organizing of work at emergency departments, and other organizations, as well as for educators, the society and governments were also outlined.