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Coming dissertations at Uppsala university

  • SOMETHING GOOD BUT NOTHING TO BE PROUD OF : Inheritance and Succession Practices, and Sociopolitical Stakes in Times of Decentralization in Marracuene, Mozambique Author: Fernando Matai Manjate Link: Publication date: 2022-04-13 11:10

    This ethnographic study focuses on inheritance and succession practices and sociopolitical stakes in present-day Marracuene in southern Mozambique. It explores how in contexts of rapid economic, social, cultural and political change, individuals, social actors and institutions deal with inheritance and succession rights, both when the property holders and incumbents are still alive and after they have passed away. Besides exploring legal processes, this study approaches inheritance and succession as social, cultural, economic and political processes.

    The study is based on twelve months of fieldwork, and, to a lesser extent, archival research. It focuses on inheritance and succession through five entry points. First, the study looks at how people deal with inheritance and succession rights pertaining to their own life situation. Second, it explores cultural understandings, as well as different strategies and arguments mobilized to secure and safeguard inheritance and succession rights. Third, the study investigates how individuals anticipate what is going to happen with inheritance and succession after their passing. Fourth, it explores how in global, national and local arenas rights and interests of traditionally weak social actors, such as widows and orphans, are defended and protected from disinheritance and dispossession. Fifth, the study analyses the extent to which local inheritance and succession practices relate to, and are influenced by, ongoing sociopolitical transformations, such as decentralization and urbanization, in Marracuene.

    Ethnographically, the study describes and analyzes actual inheritance and succession practices and strategies of individuals, kin groups and various sociopolitical institutions. The study furthermore describes and analyzes local politics, notably in relation to decentralization processes, so as to analyze the practical implications of the fact that chieftaincy and other community-based positions are nowadays defined as “community authorities,” according to the Mozambican state law.  

    The findings show that there are general principles of inheritance and succession: a man is supposed to transfer inheritance to his wife and children and to be succeeded by his eldest child. However, such principles are often overruled, which can lead to disinheritance and dispossession of widows and orphans. The actual inheritance and succession practices result from a combination of factors. They include the economic and cultural values of the properties and positions in question (and the ways through which they were acquired), the power and authority of the actors, the power relations between different social actors involved in each case, the normative orders referred to and their interpretation and practical implementation, and the institutions involved in the process of decision-making. Overall, people have different understandings of inheritance and succession that furthermore more influence practices. In a local context of legal pluralism, individuals and groups tend to combine different normative orders and practices to claim and secure their rights, or to protect themselves whenever their rights are questioned. Through detailed ethnographic descriptions, the study demonstrates that inheritance and succession are complex processes and depend on economic, social, cultural and political factors at play in specific circumstances. 

  • Preventing pressure ulcers : – risk assessment and patient participation Author: Lisa Hultin Link: Publication date: 2022-04-13 10:51

    Background: Pressure ulcers are considered as an adverse event. Identifying patients at risk is the first step in pressure ulcer prevention. The patient should receive relevant information about their risk status and be encouraged to participate in their own preventive care. PURPOSE T is a new pressure ulcer risk assessment instrument, and the CBPM system shows the patient’s pressure points visually in real time. Aim: This thesis aimed to evaluate the psychometric values, usability and feasibility of PURPOSE T and to investigate the possibility of improving patient participation through the CBPM system. Method: The study setting was a university hospital and three nursing homes. Nurses (n=28) risk assessed patients (n=235) with PURPOSE T in an observational, descriptive and comparative study (I). Focus group interviews were then conducted with the nurses (II). A mixed-method study evaluated the feasibility of PURPOSE T with patient record review (n=60), individual patient interviews (n=15) and focus group interviews with nurses (n=15) and assistant nurses (n=8) (III). A descriptive study with patients (n=31) evaluated if the CBPM system increased patient participation (IV). Results: Study I demonstrated good inter-rater and test-retest reliability of PURPOSE T. Study II showed that PURPOSE T had good clinical usability. It was an efficient risk assessment instrument performed at bedside; the nurses gained a deeper understanding and awareness of risk factors. Study III showed that PURPOSE T has good clinical feasibility. More patients were identified at risk for pressure ulcers and were prescribed more preventive interventions in comparison with patients assessed with the Modified Norton Scale. These results were mirrored in the focus group interviews with the nurses´ and assistant nurses’ experiences. Risk assessment took the same amount of time despite being more comprehensive; the instrument encouraged more preventive actions, and nurses were more involved at bedside. However, almost all the patients expressed not receiving any information about pressure ulcers. Study IV showed that the CBPM system increased the patients’ knowledge, and as they became aware of increased pressure, they started to take preventative action in their own care. Thus, patient participation increased. Conclusion: The evaluation of PURPOSE T in Sweden demonstrates good results and could be considered as replacing the Modified Norton Scale at a national level. Providing information to the patient needs to be a priority, and new information and communication technologies, such as the CBPM system, need to be taken advantage of, to benefit the patients.

  • The role of the lymph node stroma in cancer and aging Author: Tove Bekkhus Link: Publication date: 2022-04-13 09:59

    The function of the lymph node (LN) stroma is crucial for the induction of an adaptive immune response. The stroma includes lymphatic vessels, high endothelial venules (HEVs) and mesenchymal cells (MCs). In this thesis, I have been investigating the role of the LN stroma in cancer and aging. In Paper I, we demonstrate that LNs draining invasive breast cancer present remodeling of the HEVs and dysregulation of the perivascular MCs. Dilation of HEVs is correlating with inhibition of normal lymphocyte recruitment due to perivascular changes in the expression of molecular cues necessary for chemotaxis. As a follow up of Paper I, we created an automatic method for image analysis of HEVs by using artificial intelligence and deep learning. In paper II, we validate the HEV-finder that we suggest is a good automatic image analysis tool to study HEV remodeling in different subtypes of cancer and to perform survival studies in larger patient cohorts. In paper III, we present a mapping of the lymphatic endothelial cells (LECs) of the mouse and human LNs by using single-cell RNA sequencing and present a new LEC subset called PTX3-LECs. We demonstrate that both in mouse and human LNs there are four LEC subsets, forming the subcapsular and medullary sinuses where immune cells enter and exit the LN, respectively. Our mapping is a great tool for further investigation of different subsets and their specific genes in translational studies of homeostasis or disease. In paper IV, we are focusing on LN lipomatosis, which is an age-related phenomenon where the normal LN parenchyma is replaced by adipose tissue. Our data support that LN lipomatosis is developing in the medulla of the LN due to transdifferentiation of medullary MCs into adipocytes. We found that it is causing remodeling of the HEVs and loss of medullary lymphatic vessels, affecting both the entry and exit of lymphocytes. Based on our findings, we suggest that LN lipomatosis is a contributing factor in immunodeficiency in elderly. In paper V, we created a new transplantable breast cancer model in mouse to study the effect of LN metastasis by inducing the expression of the chemokine receptor CCR7 in the mammary carcinoma cell line EO771. The new model will allow us to study the effect of LN metastasis on the anti-tumor immunity and response to therapy. In summary, my thesis shed light on the importance of a functioning LN stroma in both cancer and aging and provides new tools for image analysis, translational studies of the LN stroma and models for LN metastasis.