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Coming dissertations at Uppsala university

  • The evaluation process of nutrition interventions for patients at risk of malnutrition : From a person-centred perspective Author: Lina Al-Adili Link: Publication date: 2023-02-10 13:06

    This thesis is aimed at exploring the process of evaluating nutrition interventions for patients at risk of malnutrition from a person-centred perspective. 

    An explorative cross-sectional study was conducted based on data from the International Nutrition Care Process and Terminology Implementation Survey (INIS). Associations between the reported documentation of goals and outcomes and the reported implementation of the nutrition care process and its terminology, demographic factors, and factors associated with the workplace were explored. Responses were received from 347 Scandinavian dietitians. Strong associations were found between the implementation of nutrition monitoring and evaluation terminology and the documentation of goals and outcomes. Standardisation may support the documentation of goals and outcomes, and improve nutrition monitoring and evaluation. 

    Focus group interviews were held with Swedish dietitians working in hospital and primary healthcare settings. The dietitians’ reflections on the process of nutrition monitoring and evaluation (Paper II) and the goal-setting process (Paper III) with patients at risk of malnutrition in nutrition intervention were explored. A lack of routine and structure in the process of evaluation and a lack of shared decision-making (SDM) in goal-setting was found. Dietitians described qualitative subjective outcomes as being most important to patients but that these are only implied in the nutrition intervention. They highlighted discrepancies between their clinically oriented goals and the patients’ own goals. The clarification of patients’ perspectives in the evaluation process is necessary to promote person-centredness, improve communication, and support the evidence-informed practice of nutrition intervention.

    An interview study with patients at risk of malnutrition was conducted. Patients’ experiences, perspectives and needs concerning goals in nutrition intervention were explored. Patients rarely reflected on goals in nutrition interventions, instead they described striving towards increased strength and energy. Goal-setting is part of the dietitian’s structured way of working, while the patient’s life-world is complex and unstructured. Elucidating patients’ goals may counteract the discrepancies between the dietitians’ clinically oriented goals and patients’ perspectives.

    In summary, this thesis highlights the need for tools and strategies for the improvement of the evaluation process in nutrition intervention. The person-centred practice of the evaluation process is described in this thesis as key to improving this process. This can be achieved through exploring what matters to patients in terms of perspectives, goals, and priorities, creating partnerships through involving patients in goal-setting and communicating feedback, and documenting and evaluating outcomes that are meaningful to patients.  

  • Factors influencing transferrin receptor-mediated brain delivery : Evaluating preclinical antibody-based proteins for PET imaging in Alzheimer’s disease Author: Rebecca Faresjö Melander Link: Publication date: 2023-02-10 11:17

    Antibody-based proteins targeting amyloid-beta (Aβ) could be used as radioligands in positron emission tomography (PET) to study Alzheimer’s disease (AD) pathology in the living brain. The prospective advantages of antibody-based PET are to detect pathology earlier, with higher sensitivity, and to evaluate treatment effects of emerging immunotherapies against Aβ. However, antibodies and other proteins are too large to cross the blood-brain barrier (BBB). This can be circumvented by fusing antibodies with transferrin-receptor (TfR) binders that penetrate the BBB via receptor-mediated transcytosis. 

    In this thesis, I evaluated different bispecific antibody-based proteins that bind both TfR and Aβ. The overall aim was to determine which factors are important for TfR-mediated brain delivery of these proteins and their use as PET radioligands. 

    In paper I, we studied a large, high TfR-avidity antibody compared with a smaller antibody fragment fusion with lower TfR avidity. The small antibody had fast elimination from blood and was cleared from the brain earlier than the large antibody, thus providing better signal-to-noise ratio for brainPET. In paper II, antibody-like proteins (affibodies), even smaller than the previously studied antibody, had enhanced TfR-mediated brain delivery but had an imbalance in binding to TfR and Aβ. This resulted in poor pathology-related retention of 125I-radiolabeled affibodies. In paper III, we observed that aged mice had poorer brain delivery of the bispecific antibody, mAb3D6-scFv8D3, compared with young mice. Age was also related to increased blood cell binding of the bispecific antibody, and a lower dose resulted in higher relative delivery to the brain parenchyma. In paper IV, we evaluated single domain llama-based antibodies, VHHs, which bound both mouse and human TfR, and were characterized by rapid elimination from blood and brain. The VHHs were fused to an Aβ binding antibody fragment, scFv3D6, which enabled increased brain retention of the 125I-radiobeled antibodies in an AD mouse model, and, thus, provided high contrast to healthy controls.

    In conclusion, antibody format, size, mouse age, dose, and TfR binding were important factors influencing brain delivery and retention. 

  • Planeringsforskningens genombrott : Försvarets forskningsanstalt och det globala kalla krigets planeringsexperter Author: Eric Bergelin Link: Publication date: 2023-02-10 09:56

    This dissertation highlights the impact of Swedish defense research in Cold War Sweden, with an emphasis on the impact of planning experts from the Swedish Defense Research Establishment (Försvarets forskningsanstalt, FOA). FOA was established as a research institute for applied military science in 1945. In pursuit of the aim to highlight the impact of this institution, the dissertation explains two related phenomena. First, it explains why FOA started to use and develop new planning technologies. Second, it explains the impact of planning research from the defense sector on a larger community in Cold War Sweden. 

    Methods and theories from STS-scholarship guide the research process in this dissertation. The study is inspired by the tendency in STS-scholarship to “follow the actors”. Using previously classified sources and correspondence between researchers at FOA and their American counterparts, primarily from RAND Corporation in California, this study traces the circulation of planning technologies within a transnational network of experts. Concepts, well known in STS-scholarship, such as boundary-work, co-production and transnational circulation of knowledge helps to interpret the influence of FOA. 

    The influence of planning experts from FOA can be described as a knowledge breakthrough for planning technologies that circulated in the defense community for a long time. This dissertation shows that two factors can explain FOA's contribution to this knowledge breakthrough. First, FOA's position in the Swedish administration provided a forum to develop close relationships between researchers and military personnel. Since FOA was not guided by a research council, the agency had the opportunity to introduce, translate and develop intellectual technologies from abroad. The second factor that explains FOA's contribution was the agency's close contacts with RAND Corporation in the United States. These results demonstrate a need to reinterpret certain aspects of Swedish historiography. Above all, this applies to how previous scholarship has described Swedish defense research, the national research policy and the changes that took place in Swedish public administration at the end of the 1960s. In short, these activities were the result of co-production between planning experts from FOA and the military.