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Coming dissertations at Uppsala university

  • Invasive treatment of coronary artery disease : Aspects on antithrombotic and percutaneous treatment options Author: Per Grimfjärd Link: Publication date: 2020-03-05 13:48

    The outcome after percutaneous coronary intervention (PCI) has improved considerably thanks to more effective antithrombotic treatment strategies and improved coronary stents. Stent thrombosis (ST) is a rare complication to PCI associated with considerable mortality and morbidity.

    The general aim of this thesis was to add real-world evidence for antithrombotic and technical strategies in invasive treatment of coronary artery disease. Five observational studies were performed on a large, unselected, real-world population undergoing PCI. All studies were based on data from the national registry SWEDEHEART.

    In 31,258 patients undergoing PCI for ST-elevation myocardial infarction (STEMI), the rate of definite early ST was low (0.84%, n=265) but ST was associated with very high mortality (21%, n=51) at one year.

    Among 20,600 patients with STEMI, we compared the outcomes for those treated with heparin and those treated with bivalirudin during PCI. Rates of ST were low and similar with heparin and bivalirudin but all-cause mortality at 30 days and one year was significantly higher with heparin. We found no differences in rates of major bleeding, re-infarction and stroke.

    A novel bioresorbable scaffold (Absorb), used in patients undergoing PCI for all indications, was associated with a four- to eightfold higher adjusted rate of definite ST over two years, compared with conventional modern drug-eluting stents (DES). One in four ST events occurred later than one year after PCI. Rates of in-stent restenosis were comparable with Absorb and DES. Suboptimal implantation technique and non-adherence to antiplatelet therapy guidelines was common among patients with bioresorbable scaffold thrombosis.

    The novel parenteral and potent platelet inhibitor cangrelor was used nearly exclusively in STEMI (n=899), in early presenters with high-risk, often with cardiac arrest (18%) but was associated with low ST rates and no major bleeding events.

    In an unselected population of 65,000 patients undergoing PCI for all indications, the Xience permanent polymer everolimus eluting stent (n=36,600) appears to be safe and effective with low event rates of ST and in-stent restenosis. Compared with a control group of other modern DES (n=167,000) including a high proportion of thinner struts and absorbable polymers, Xience exhibits similar results in all important endpoints.

    All studies of this thesis provided important real-world evidence on antithrombotic and technical treatment strategies in invasive management of coronary artery disease.

  • The Outsider in Our Midst : A Study of Language and Norms Concerning the “Outsider” in Persian Period Yehud Author: Karin Tillberg Link: Publication date: 2020-03-05 12:02

    The topic for the present study concerns how values and norms are conveyed through language. I explore two texts set in the Persian period—Isaiah 56:1–8 and Nehemiah 13:1–3, 23–31—and how these texts discuss those literary figures described as not belonging to the community. The investigation is conducted through a method inspired by Pierre Bourdieu’s work in social anthropology. Bourdieu’s notions are turned into heuristic tools for literary analysis. By systematically examining the literary figures that appear in the texts—how they can be interpreted as agents, possessing different forms of capital, which situate them in various fields—the analysis consists of studying the power dynamic between the “in-group” and those on the outside. Thus, the implicit values and tacit knowledge of the agents are highlighted, which in turn means that an understanding is gained as to what affects the language used by the agents. This doxa affects the agents and their position in the fields. I interpret Deuteronomic theology—particularly in the form of Deuteronomy 23:2–9— and imperial ideology as doxic, as notions common to everyone.

    At the end of the investigation, the results of the analysis are discussed by critically engaging with the theoretical notion of hospitality. This discussion is included in order to situate the agents in the fields as host and guest, to examine the power dynamic further.

    One of the primary aims of the present study is to challenge the position among scholars that these texts contradict each other, where the former is viewed as inclusivist and the latter considered exclusivist. I arrive at a different conclusion, that Isaiah 56 and Nehemiah 13 could be read in dialogue with one another. Nehemiah 13 can be seen as an embodiment of Isaiah 56 through the character of Nehemiah as an image of utmost loyalty, similar to the sārîs and the ben-nēkār, which both emerge as tropes conveying loyalty.

  • Social Interaction Involving Non-speaking Children with Severe Cerebral Palsy and Intellectual Disability : The role of communication partners and speech-generating devices Author: Helena Tegler Link: Publication date: 2020-03-05 08:23

    The overall aim of this thesis was to investigate the use of speech-generating device (SGD)-mediated interaction with children with anarthria, severe physical impairments and intellectual disabilities due to cerebral palsy with a focus on partner strategies and social practices.

    Studies I and II were cross-sectional studies that used questionnaires, which were analyzed using descriptive statistics and directed content analysis. In Study I, speech and language pathologists’ (SLPs) practices and perceptions of communication partner training in SGD-mediated interaction were examined. In Study II, communication partners’ (i.e., caregivers’, teachers’, and assistants’) practices and perceptions of communication partner training in SGD-mediated interaction were examined.

    Studies III and IV were qualitative observational studies that used video recordings, which were analyzed with ethnomethodological conversation analysis. Study III investigated how multiparty classroom interaction was organized when one of the students used an eye-gaze accessed SGD. Study IV explored the social actions that mobilized SGD-mediated responses when the child was a beginner user of the eye-gaze accessed SGD.

    The findings suggest the following: all participants (i.e., SLPs, caregivers, teachers, and assistants) considered that SGD-mediated interaction was beneficial for the children. SLPs were important providers but they provided few training sessions and used mostly verbal instructions. Communication partners could benefit from more support from SLPs and SLPs should consider using additional instructional approaches such as feedback and role-play when coaching communication partners in SGD-mediated interaction. Children could interact with their eye-gaze accessed SGDs in multiparty classroom interactions provided that the turn-taking in Initiation-Response-Evaluation (IRE) sequences was applied and that the teacher or the assistant provided contingent on-screen gaze and deictic scaffolding actions. Communication partners to children who were beginner users of an eye-gaze accessed SGD may need to produce repeated turn transition relevance places and use contingent on-screen gaze and deictic practices to scaffold an SGD-mediated response.

    This thesis brings new knowledge to the field of SGD-mediated interaction. Partner strategies that can enhance children’s linguistic skills were seldom used in multiparty classroom interaction, but other social practices were used, which facilitated social inclusion and participation.