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Coming theses from other universities

  • Inviting Community into the Development of Globally Sustainable Food Systems Author: Liesel Carlsson Link: Publication date: 2019-11-28 10:31

    Food systems and human diets contribute to unsustainable socioecological conditions, which in turn negatively affect human health. These driver-impact relationships span multiple scales, prompting international governance bodies, nations, and communities alike to grapple with solutions for a better food future. Collaborative action across scales and sectors is necessary; however, how communities can align contributions with efforts at broader scales is unclear.

    The aim of this research is to develop theoretical and procedural supports for community engagement in globally sustainable food systems (SFS), and to provide concrete results relevant to one case community.

    The community of nutrition and dietetics professionals was chosen as the case community given its history of engagement with SFS, its integration throughout food system sectors, and because dietary shifts have significant potential to contribute to SFS. Furthermore, the researcher’s position as a member of this community supported the case study work.

    The research uses transdisciplinary methods guided by the Framework for Strategic Sustainable Development (FSSD) and Community Development theory. The FSSD provides a concrete definition of sustainability and includes methodological supports for co-creation of sustainability transitions. Community Development theory supports participatory approaches and welcomes different knowledge cultures in such co-creation. The Delphi Inquiry method was used to facilitate data collection and community engagement. For measurement-specific elements of the research, causal loop diagrams (CLD) informed by the Cultural Adaptation Template (CAT) theory were used, and Critical Dietetics was used as a framework for dietetics-specific analysis.

    High level insights include that: (i) participatory and multidimensional approaches are important to facilitate community engagement in SFS development; (ii) objective parametres for defining sustainability are critical to guide concerted action and can provide an innovation space that invites creative and diverse solutions within; (iii) systems thinking and related tools help simplify the complexity of food systems without disregarding broader context, and support assessment in the absence of all data. Specifically in relation to the case community explored, insights include that, (i) integrating an SFS lens into existing roles and activities is important, because dietitians already work across sectors and scales, making them well positioned to contribute in diverse ways; (ii) a shared language based on transdisciplinary understandings of SFS is required; (iii) engaging in activities that facilitate SFS knowledge development within the profession, prior to integrating it into roles and activities, is an important first step; (iv) collaborative and reflexive approaches to continued knowledge development and practice are important, such that in the end sustainability becomes integrated into a cultural way of thinking about food.  

    Based on these insights, this dissertation outlines a procedure for collaborative community work for globally SFS. The procedure is adaptable to various community settings. The dissertation also provides specific guidance for how dietitians could utilise their strategic positions throughout food systems to contribute to SFS development.

  • On Surgical Treatment of Aortic Pathology Author: Jacob Budtz-Lilly Link: Publication date: 2019-11-26 07:07

    The use of endovascular aneurysm repair (EVAR) in the treatment of abdominal aortic aneurysms has advanced from a premature characterization as a “failed experiment” in early 2000 to the predominant modern method of treatment. Technology has accommodated initial shortcomings, but it has also led to expansions in the treatment of ruptured aneurysms and complex aortic pathologies. The overall aim of this thesis is to characterize the contemporary utilization of endovascular repair in the international setting and to evaluate its expanding use in complex aortic disease treatment.

    Paper I is an analysis of outcomes after intact aneurysm treatment from registries of 12 countries. From 2005 to 2013, and with 83,253 patients included, it was shown that the use of EVAR has increased while, the perioperative mortality has decreased. This was counterbalanced by a worsening mortality for those patients treated with open aortic repair.

    Paper II is an analysis of ruptured aneurysms from the above-mentioned international registries. EVAR is also increasing for these patients, although open repair is still the predominant treatment strategy in most centres. Perioperative mortality was superior for EVAR patients, despite increased age and comorbidities. An association between patient-volume and perioperative mortality could be shown for open repair, but the same could not be demonstrated for EVAR.

    Paper III is an evaluation of the adaptation of a total endovascular approach for the treatment of complex abdominal aortic aneurysms from a single centre. The technical success and midterm mortality, as well as post-operative complications, including spinal ischemia, were similar to those reported from large and multi-centre analyses. Previous studies reveal disparate results for centres performing open complex aortic repair. The results here suggest that a total endovascular approach is feasible for dedicated centres contemplating this strategy.  

    Paper IV is an analysis of multiple pre-, peri-, and post-operative variables documented from complex aneurysm procedures. A relationship between increased complexity and variables such as anaesthesia duration, bleeding, hospital stay, and radiation exposure was found. As patients and their comorbidities increase, a decision to embark on a complex procedure should be made with due diligence to these relationships.

    Paper V is a technical analysis of patients following acute treatment for Type A aortic dissections. Many patients are unfit for open aortic arch repair. Based on current availability of endovascular aortic stentgrafts, it was shown that the majority of patients can be treated endovascularly, while anticipated device improvements should further increase the proportion of eligibility. 

  • Mechanisms in Tendon Healing : Pain, Biomarkers and the Role of Mast Cells Author: Abdul Alim Link: Publication date: 2019-11-22 10:09

    Tendon injuries and tendinopathy are common disorders, but the underlying mechanisms are not well understood. The overall aim of this thesis was to better understand the mechanisms underlying tendon healing, pain, and inflammation.

    The aim of the first study was to assess biomarkers of tendon healing, including procollagen type I (PINP) and type III (PIIINP) in relation to patient outcome in 65 patients with Achilles tendon rupture (ATR). At two weeks post-ATR, PINP and PIIINP-levels were quantified using microdialysis followed by ELISA. At one-year post-ATR patient outcome was assessed using the validated Achilles tendon Total Rupture Score. We found that higher ratio of PINP and PIIINP to total protein were significantly associated with less pain but more fatigue in the affected limb.

    In the second study, we applied Intermittent Pneumatic Compression (IPC) therapy for two weeks to stimulate tendon healing. The patients received either adjuvant IPC treatment or treatment-as-usual in a plaster cast without IPC. We observed that IPC therapy significantly increased PINP levels in the injured tendon, suggesting enhanced healing response.

    In our third study, we investigated healing response and the role of mast cells (MCs) in-vivo using an ATR rat model. Three weeks postoperatively, we demonstrated an increased number of MCs and a higher proportion of degranulated MCs in the injured tendon compared to the control. We further established that MCs in the injured tendon were positive for the glutamate receptor NMDAR1.

    In our final study, we assessed the effect of glutamate stimulation on in-vitro-derived mouse bone marrow MCs. Mast cell degranulation was quantified through β-hexosaminidase release, immunofluorescence was used to quantify NMDARs at the protein level, and RT-qPCR/microarray was used to study the expression of NMDARs and associated genes. Glutamate induced a robust upregulation of glutamate receptors of both ionotropic and metabotropic type, both at the mRNA and at protein level. NMDAR1 co-localized with glutamate in the membrane of MCs, thereby confirming an interaction between glutamate and its receptor. Glutamate also induced expression of pro-inflammatory compounds such as IL-6 and CCL2 and transcription factors such as Egr2, Egr3 and FosB. Moreover, the NMDA-channel blocker MK-801 completely abrogated the response of MCs to glutamate, supporting a functional glutamate–glutamate receptor axis in MCs.

    Together, findings presented in this dissertation reveal possible mechanisms of tendon healing in relation to pain and function, and establish a novel principle for how immune cells can communicate with nerve cells after ATR.